August 6, 1998

I want to take this opportunity to commend everyone involved in the opening of Rutledge Tower and in the moving process. The move to Rutledge Tower has been going smoothly, and I thank everyone for their efforts. I also was pleased to hear that we received the last of our licenses for services that will be in the tower. This has been a fantastic undertaking, and I hope all of you can take the time to enjoy this success.

W. Stuart Smith, Interim Vice President for Clinical Operations Interim CEO, MUSC Medical Center

Announcements

• Sue Pletcher has been named the new director of Patient Access Services. Her responsibilities will include the areas of registration, bed management, financial counseling and utilization review.
• Royce Sampson, M.S., R.N., C.S., has been named associate director for Geriatric Psychiatry and Alzheimer’s Research and Clinical Programs in the Institute of Psychiatry. She will provide administrative assistance to Jacobo Mintzer, M.D., in the operation of all geriatric psychiatry research, training and clinical activities. She also assumes the responsibilities of manager of the gero-psychiatry inpatient unit, partial hospitalization program and outpatient services.

Compliance Update

• Federal investigations into whether health care organizations are in compliance with policies regulating nearly every area of the business are hitting hospitals and insurers nationwide. At the Aug. 4 communications meeting, Lisa Montgomery, administrator for Financial Services, shared information with the management team on recent settlements.
• Grady Memorial Hospital in Atlanta: $4.3 million, pharmacy billing issues.
• University of Texas Health Science Center in San Antonio: $17.2 million, poor documentation of teaching physicians’ presence.
• North Louisiana Rehabilitation Hospital: $4.4 million, meeting admissions criteria.
• Blue Cross Blue Shield of Illinois, $144 million, alleged claims processing misconduct. (Five employees were indicted.)
• Several of the Mayo clinics are under investigation: all physician billing records between 1992-97 are being reviewed.
• Here at MUSC, many compliance initiatives are under way. Reece Smith, compliance program manager, discussed three of them.
• Radiology medical necessity training. Physicians are required to give specific information, including a patient’s history, signs and symptoms, when ordering radiology tests. This information must be completed on a radiology request form and must be confirmed by documentation in the patient’s chart. To help all the staff members responsible for making sure this documentation is complete and correct, the compliance area is holding inservice training. Layton McCurdy, M.D., dean of the College of Medicine and vice president for medical affairs, also reminded the medical staff of their responsibilities in a June 11 memorandum to department chairmen, attending physicians and residents.
• Compliance audit. The Medical Center has enlisted the help of Medical Management Plus to make sure it is in compliance with regulations affecting all aspects of the revenue cycle. The revenue cycle begins at the time of service and continues through the time a bill enters the financial system and is sent to a carrier for payment. A May audit conducted by the company resulted in the formation of a task force.
• The Revenue Cycle Task Force, made of representatives from all areas touched by the revenue cycle, is meeting every other week to address any potential problem areas.

Unauthorized Purchases: Buyer Beware

• Ed Antoniak, director of Procurement, discussed the problem of unauthorized purchases and what those include. Because we are a state organization, purchases are highly regulated by the state procurement code. An unauthorized purchase is any purchase that is made by an employee who is not authorized to make it, or when procurement regulations are not followed. Examples of problem areas where the procurement code is sometimes overlooked include:
• Doing business with other state agencies. Example: the contract we have with the School for the Deaf and Blind.
• Disposal of state property. Example: trading old equipment for new without receiving the authority to do so.
• Jeopardizing federal funding if we don’t properly purchase products in compliance with federal rules and regulations.
• Use of direct vouchers, or DVs. These can only be used for purchases under $1,500. For amounts over that, a competitive bid must be obtained, and a DV can’t be used.
• Improper use of requisition numbers. Giving a vendor a requisition number rather than obtaining the purchase order number from Procurement is improper.
• Antoniak mentioned that there are certain purchases and funds that are exempt from these requirements.
• Antoniak said that violations of the procurement code could cost MUSC its certification with the state and subject all purchases to delay. He said MUSC has many emergency purchases and reminded managers that those purchases are reserved for times when there is an immediate threat to safety, public health or welfare.
• Effective Aug. 1, any department responsible for an unauthorized purchase will be charged an administrative fee of $100.
• Procurement will charge departments $100 for each unauthorized purchase incident.
• Joe Logan, manager of Quality Assurance, announced that Procurement will soon test the new credit card purchasing program. A server connecting MUSC to NationsBank was installed last week to handle the process. Training on the system will be held Aug. 13 and 14.

Information Technology Update

• Dave Northrup, director for Healthcare Information Services in the Center for Computing and Information Technology, updated the management team on several information technology projects.

ClinLAN95 status:

• The installation of ClinLAN95 is progressing. More than four hundred workstations at Rutledge Tower now have ClinLAN95. Included in the installation project are plans to make the eventual transition to WindowsNT easier. (Windows98 is currently under evaluation.)
• In the current MS Windows 3.11 system, all software, e-mail and documents for a workstation are provided in one ClinLAN server. If that server is down, users attached to it can’t use any of the programs or get to personal information, such as e-mail or WordPerfect documents. With ClinLAN95, separate servers will serve e-mail, data (from the i: drive) and software applications such as WordPerfect and PowerPoint. If one server is down, the user can still access programs from another server.
• Some software also will be loaded onto hard drives for greater flexibility. The downside to that, however, is that if a person uses more than one workstation in an area, it may take time for the system to download some software.
• The time line for campuswide roll-out of ClinLAN95 is being developed. Training will be offered in advance of upgrades and is recommended.

GroupWise passwords:

• Including a password to access e-mail is currently optional, but Northrup said his department is considering making it mandatory. There have been incidents recently when unprotected GroupWise accounts were compromised. Confidential E-mails were accessed and E-mail messages were sent by one person posing as another. Users can set their GroupWise password to be the same as their ClinLAN password for ease of use.

Backups of e-mail and files:

• For GroupWise, Mr. Northrup said the area is considering using a system that would automatically delete e-mails that are older than six months from in and out boxes, and from “trash” after three months. Users would still be able to save e-mail messages indefinitely in folders.
• CCIT currently backs up e-mail messages and data files daily, keeping them for 30 days, and also takes monthly “snap shots,” which are kept for many months. CCIT is considering limiting the amount of time backup tapes are kept.
• Northrup said backup tapes will continue to be made daily. However, tapes of e-mails will be deleted after 30 days. Tapes of data files from server i: drive also will be deleted after a specified time, probably 30 days or longer. Individual users will be able to keep data files indefinitely and these will continue to be backed up. They also can keep e-mails indefinitely in folders. However, if a user deletes a file, CCIT will not be able to retrieve it after it is deleted from the taped backup system.
• Northrup also said CCIT recommends that no more than 50 megabytes of storage per person be kept on the i: drive so as not to put undue stress on the storage capacity of the system. Exceptions can be handled, however.

Help Desk improvements:

• Calls to the CCIT Help Desk at 792-9700 are now automatically logged, reducing the chance of messages “falling through the cracks.”
• Northrup said service from the Help Desk continues to improve and encouraged everyone to use the service.