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Currents Recently it was announced that the UMA Ambulatory Care staff will be transferred to the Medical Center (Hospital Authority) payroll in July. This change is mandated by the new federal Outpatient Pospective Payment System regulations that require “provider-based” clinic employees to be employees of the hospital. We would be unable to bill for technical or diagnostic services and we could not recover the overhead costs of the clinics if we failed to meet the requirements of the new regulations.     Approximately 475 Ambulatory Care employees will be affected. These employees’ employment with UMA in recent years has been made possible through a contract arrangement with the Medical Center (Hospital Authority).  No Ambulatory Care employees will be separated from employment as result of this change.     The UMA leadership will continue to provide oversight for the operation of the clinics. Other components of UMA, including the physicians’ practice plan, community-based clinics and corporate office will not be affected.     In arriving at a determination that this change was required, we sought verification from the Centers for Medicare and Medicaid Services (CMS) that the transfer had to be done to comply with the new regulations. Now that the determination has been made, it is our goal to make the best of it. We will use this organizational change as an opportunity to enhance our communication, improve our efforts to fulfill JCAHO standards and to strengthen our training and human resources practices.     We are committed to making this change happen as smoothly as possible.  Everyone’s cooperation with the announcement and planning process is greatly appreciated.     Thank you very much. W. Stuart Smith Vice President for Clinical Operations and Executive Director, MUSC Medical Center   Center preparing for expected cuts in funding Due to anticipated budget cutbacks at state and federal levels, the Medical University of South Carolina is expecting to feel the impact in the upcoming fiscal year—Medicaid reimbursements to MUSC could amount to reductions of $15 - $32 million.   Addressing the management team at the March 5 communications meeting, Stuart Smith, vice president for clinical operations and executive director for the MUSC Medical Center, and Lisa Montgomery, chief financial officer, said the Medical Center is actively exploring ways to reduce the impact on South Carolina hospitals as much possible. The legislature is expected to act on the budget in May or June.   “We must prepare for the worst case scenario and hope for the best,” Montgomery said. “It is too early in the process to predict what the final outcome will be.”  In the meantime, the Medical Center is taking several measures to try to manage the expected reduction in funding, including freezing the operating budget at the FY’02 level with some provision for inflation and cost of living increases. All new programs or purchases will have to be evaluated on a case-by-case basis.   “We are committed to trying to stay competitive with salaries so we can recruit and retain good people,” Montgomery said. Hospital officials also said that one of the ways they likely will have to offset the loss in state and federal funding is by raising rates.   Cuts in Medicaid funding at the state level also impact federal dollars since the federal government matches state dollars three to one. The budget under consideration by the House could ultimately result in a $400 - $500 million reduction in Medicaid funds to South Carolina.    Smith said reductions in funding will impact rural South Carolina hospitals, and will severely impact children’s health services and medical centers such as MUSC that serve a proportionately greater number of Medicaid patients.   Updates on the financial picture will be given regularly, Smith said. Policy Management announces new policy on standing orders The new standing orders policy C-60 was written to legitimize common practices already in place at the Medical Center, according to Rosemary Ellis, director of quality, who presented the policy wording and new form to the management team.   The policy reads: “Standing orders are those orders developed for the use of certain patient populations that present with particular needs or symptoms in the absence of a physician examination and assessment.”    Standing orders can only be used if the following criteria are met: 1. Clear delineation of conditions/circumstances for which action/treatment should be initiated and clearly identify the discipline responsible for initiating; 2. Controlled substances are not permitted; 3. A Department/Service will request in writing that the identified discipline institute standing orders for their patients.  All requests for standing orders will be submitted to the medical director Copies of these requests must be kept on the unit; 4. Standing orders (which must be approved at the time of development and on a yearly basis thereafter) must be approved by:unit medical director, nursing clinical director pharmacy and therapeutics committee (if medications are listed); and medical director; 5. Will be developed on preprinted orders; 6. The treating physician must sign the order within 24 hours of being initiated or the order will be discontinued. Policy changes detailed In addition to the new policy regarding standing orders, Ellis presented three policy changes: Organ/tissue donation policy C-17 was revised to reflect current practice. For more information contact Jeanine Gage. Conscious sedation policy C-44 was revised to include appropriately licensed and credentialed respiratory therapists among disciplines to administer conscious sedation. For more information, contact Peggy Simmons. Patient care unit refrigerators policy C-60 was revised to address refrigerators used solely for staff food. Contact Jodell Johnson.  To view the complete policy language, refer to the MUHA Intranet.  MEDUCARE expands ground transport services The MUSC MEDUCARE Medical Transport Service recently expanded its ground transport services for wheelchair patients, according to Robert Winn, MEDUCARE ground supervisor.   The service has refurbished a vehicle and purchased more wheelchairs to facilitate the transport of wheelchair patients from building to building on campus, as well as to transport them to their home or other health care facilities.   MEDUCARE is available for referred patients who need immediate medical intervention as a result of severe, life-threatening or potentially disabling conditions. It is available 24 hours a day, seven days a week to provide rapid and quality care in transporting critically ill or injured patients.   Three teams are available: the Adult Critical Care Flight Team, the Pediatric/Neonatal Critical Care Flight Team and the Ground Transport Teams. Ground transportation provides for critical care, advanced life support, basic life support and wheelchair transport. MEDUCARE transports patients in the tri-state area from the hospital, Winn said.   For more information call MEDUCARE at 792-3311 in the Charleston area or 1-800-423-1330 nationwide. MEDUCARE also can be reached through the toll-free MEDULINE number 792-2200 in the Charleston area, or 1-800-922-5250. This line is available 24 hours a day, seven days a week.      Volunteer Services announce popular events Susanne Banks, manager of MUSC Volunteer Services, announced the roster of upcoming events sponsored by volunteer services, including this week’s Family and Friends Night at the North Charleston Lowgators.   The Lowgators game is on Friday, March 15, with tip-off at 7:30 p.m. Regularly priced tickets are $15 - $18 and are available on Family and Friends Night for $5.  The Volunteer Services arts and crafts sale will be held May 1 - 2, from 7:30 a.m. - 4:30 p.m., at the portico of the Administration Building.   The annual leather sale will be held Aug. 21-22 in the Administration Building, room 100.    For more information on these events, call 792-7038. Introduction of new employee Colleen Corish, R.N., clinical director of Oncology and Medical/Surgical Services, announced the appointment of Yvonne McPherson, R.N., to the position of nurse manager for 8 West. McPherson has been a nurse for 22 years and has worked on 8 West for the past three years.