Value Report 2015-2016 Reporting on 2015 Results Women s Florida Exceptional Women s for Every Patient, Every Time www.womensfl.com
Letter from the Chairman It is with great pleasure that I introduce the Women s Florida (WCF) 2015 2016 Value Report. WCF is a recognized national leader in women s health. For example, our organization is the only women s healthcare group in the US to have achieved 100% Safety Certification in Outpatient Practice Excellence (SCOPE) by the American Congress Obstetrics and Gynecology. Furthermore, we make up the majority the SCOPE certified care centers in the nation. WCF is truly committed to transforming women s healthcare in the communities we serve. As an organization, we continue to lead this effort both locally and at the national level. Our fourth annual value report demonstrates our evolution towards outstanding clinical quality, excellent patient experience and compassionate care every single woman we serve. As a physician, I have had the privilege to take care women in my community for the past 28 years. I take this role very seriously and strive to provide the most current and best quality care for all my patients. In my leadership role at WCF, I am fortunate to work alongside some the most amazingly dedicated healthcare providers. On a daily basis, I deal with physicians, nurse midwives, nurse practitioners, medical assistants, administrative, clerical and support staff that are truly committed to providing the absolute best possible care and patient experience to the women in the communities we serve. It is great to see how each our providers treat their patients as they would their own families. Being a health care provider is not easy. We are experiencing significant changes in the way that medicine is practiced. We have to deal with ever increasing regulations from the government, as well as, increased requirements from the health plans and hospital systems. Despite the added requirements, I am very proud all our healthcare providers for meeting all these demands! As an organization, we have decided through a strategic planning process to redefine our Mission, Vision and Value statements. We are truly committed to improving the lives women every single day. To this end, we have made substantial financial and time commitments to assure that we continuously improve both the quality care and the overall patient experience. We foster a culture learning throughout all WCF. We have gone above and beyond industry standards and have attained certifications such as SCOPE and from the American Institute Ultrasound in Medicine (AIUM). The Women s Florida Laboratory was recently recertified by the American College Pathology (CAP). Our entire medical assistant staff has gone through a certification process and 100% our medical assistants are now certified. We have engaged the firm Press Ganey to help us reach our goal attaining CGCAHPS scores 95% across the enterprise. We are committed to expanding our services in order to provide comprehensive care for generations women across their life continuum. Our goal is to do this while maintaining an exceptional patient centered experience; fostering a culture that inspires excellence and empathy in every employee WCF is an essential aspect this process. We regard our stated values:, Compassion, Empathy, Respect, Excellence and Accountability as our guiding principles. We insist on this from all WCF employees, no exceptions. We have transformed WCF into a high quality, high performing organization. Furthermore, by embracing technology and innovation, I see a future that provides our patient with greater access, affordability and transparency. As part this process, WCF is committed to initiating and participating in population health, patient experience and additional quality initiatives. WCF pledges to provide the best possible patient centered healthcare to the grandmothers, mothers, daughters and sisters in our communities. As a physician, I am excited in what the future will bring to our patients. I am privileged to be able to serve their medical needs and I am honored to work with extremely committed individuals that have one thing in mind, exceptional women s care for every patient, every time. Ignacio Armas, MD Chairman, Board Directors Women s Florida 2 Value Report 2015-2016
Letter from the CEO Women s Florida is recognized as a leading provider women s health services in Central and West Florida. Some say it has to do with the fact that we have over 200 providers ranging from genetic and nutritional counseling to general OB/Gyn services to subspecialty care such as urogynecology, breast surgery, MFM services and gynecological oncology. Others believe that it has to do with our incredible quality results as we outline in this year s report and our continual improvement in our quality outcomes. I believe that the reason we are recognized as a leader in healthcare services is because our relationships with our patients. Our processes for surveying patients, analyzing results and our relentless pursuit to engender patient loyalty is what sets us apart and the patient experience is our strategic driver for WCF. We also recognize that to achieve our mission and vision, we cannot do this alone. We are partnering with other high quality physician practices in the Tampa area to address quality and cost and are working with hospital partners in Central Florida to address the same issues. The seamless integration care within our organization is not enough to address the total needs our patients. We will relentlessly pursue all good options to ensure that every WCF patient receives excellent care every time and in every place, even if not in the direct control our organization. That commitment requires us to do business and provide care in new and innovative ways. WCF will be at the forefront creating those processes and programs to meet our goals. As for our clinical quality, we continue to see improved outcomes in our C-Section rates as well as exceeding standards in almost every category perinatal care, health and wellness as well as efficiencies, access and patient satisfaction. We have delineated our success in this report and indicate where we have met national benchmarks. More importantly, we have set goals for ourselves that far exceed those the national benchmarks. In some circumstances, we have met those measures, and in others, we know we can be even better. Our success is based upon the process creating, vetting and implementing our clinical guidelines, for which we now have hundreds them. We have committees physicians, nurses and other staff to review new and updated protocols. Once created, we share these proposed protocols with all our providers for input. We take all that feedback and create our new guidelines and then integrate those guidelines into our templates in our electronic health record. This gives us the ability to track compliance with those guidelines and look at the reasons why we deviate from those guidelines. I would like to thank all our physicians, certified nurse mid-wives, nurse practitioners, nurses, medical assistants and our clerical and management staff for taking the time and effort to understand our mission, vision and goals, for providing input on how to make ourselves successful, and for providing exceptional women s care for every patient, every time. Andrew Mintz Chief Executive Officer Women s Florida 3
In 2015, the Women s Florida Board spent significant effort addressing the strategic future the organization. During this process, the group revisited its Mission, Vision and Values, updating them with significant input from providers and staff. It is our pleasure to share our new Mission, Vision and Values. Mission Statement Women s Florida is committed to improving the lives women every single day. Women s Florida will: Expand services to provide comprehensive care for generations women across their life continuum. Deliver an exceptional patient centered experience utilizing innovation and engaging her in our team based model care. Foster a culture that inspires excellence in every employee. Vision 4 Value Report 2015-2016 Values QUALITY: Providing the highest quality care through evidence based guidelines and best safety practices. COMPASSION: Treating our patients like mothers, sisters and daughters. EMPATHY: Being attentive to our patients thoughts and feelings. RESPECT: Acting respectfully towards every person, every day. EXCELLENCE: Pursuing excellence through continuous learning. ACCOUNTABILITY: Assuming responsibility for our actions and behaviors.
Table Contents Mission, Vision and Values...4 The Evolution Clinical....6 Transforming Women s Healthcare...7 Population Health Initiatives...9 Redefining the Well-Woman Exam...10 Performance Standards....12 The Right Test for the Right Patient at the Right Time...17 Affordability...18 Safety in Medical Assistant Certification Program...20 Certification & Accreditation...22 Service Coordination....24 Sub-Specialization...25 A Soldier s New Baby From the Eyes a Certified Nurse Midwife...27 Technology and Innovation...28 Community Impact....29 Resources....30 Appendixes...31 Acknowledgments...35 Women s Florida 5
T he Evolution Clinical For nearly two decades, Women s Florida (WCF) has been a driving force behind innovative and high quality women s care in West and Central Florida. The Improvement and Patient Safety Initiative continues to serve as our foundation for quality and is a vehicle for our physicians and staff to improve the care we provide. Driven by our mission to improve the lives women in the communities we serve, we are able to deliver value and transform the care model into one that focuses on integration and accountability. Our goal is to provide superior quality patient-centered care, which is safe and affordable. We strive to maintain an ever learning environment which is data driven and focused on outcomes. Safety in Service 6 Value Report 2015-2016
Transforming Women s Healthcare Today, we serve over 350,000 women. Our vision is to expand care for generations women through clinical excellence and a patient-driven model care. The emphasis is on: Supporting our physicians in delivering cost effective care Offering preventive services Using defined protocols to ensure safety and privacy Using evidence-based guidelines in a coordinated team-based environment In the last year, our Physician Committee (PQC) developed and updated several clinical practice guidelines for common women s health conditions including: Screening for cervical cancer and HPV Nutrition protocols and body mass index (BMI) screening Depression screening Management gestational diabetes Management chronic hypertension in pregnancy Prediction and prevention preterm birth Management anemia in pregnancy Donald Wilson, MD Chief Medical Officer David Minton, MD Chair, Physician Committee Board Member Patient education and industry standard screening tools were deployed throughout WCF to better engage patients in their care. We have committed significant time and resources to help transform our practices and improve care, access and coordination, through population health initiatives, redefining the well woman visit and continued efforts in improving our quality care outcomes. Our Mission Women s Florida is committed to improving the lives women every single day. Women s Florida 7
Safety in Service 8 Value Report 2015-2016
Safety in Service Population Health Initiatives Mental Health Screening During a woman s reproductive years, the risk for developing depression increases dramatically to twice that men. Untreated depression can have serious effects for women and their families (ACOG, 2015). At WCF, the standard care is for all non-ob patients to be screened for clinical depression at least annually using an age appropriate standardized depression screening tool. Obstetrical patients are screened for depression at least once during the perinatal period and at the postpartum period. Our providers and staff are trained to recognize early signs depression and through our care coordination program, we create follow up plans and coordinate care for further behavioral health treatment. Through partnership with several local organizations, we ensure there is continuity care for patients suffering from depression. Weight Management & Nutrition We teach our patients that good health starts with good nutrition. We encourage our patients to make smart choices that can help them reach or maintain a healthy body weight. Our nutritional counseling program is available to all patients. The program, directed by a licensed dietitian and certified diabetic educator, focuses on disease prevention, patient education and counseling. Patients with body mass index (BMI) outside normal parameters are referred for appropriate follow up and management. Intimate Partner Violence Screening Despite domestic or intimate partner violence remaining prevalent in today s society, the reporting rate remains very low. Most abuse victims are female. We partner with local organizations such as The Spring Tampa Bay, Community Action Stops Abuse (CASA) in St. Petersburg and Harbor House Central Florida in Orlando to teach our staff to recognize signs intimate partner violence. We screen all women at least annually. For women who are pregnant, screening takes place at various times over the course the pregnancy. Women s Florida 9
Redefining the Well-Woman Visit Safety in Service The annual well woman visit is a fundamental component WCF s health assessment because it: Promotes prevention Helps identify risk factors for disease Identifies medical problems Supports the physician-patient relationship Components the updated Well-Woman Visit: P Continuity care over the life span P Cervical cancer screening P Breast cancer screening P Cardiovascular health P Obesity P Smoking cessation P Depression screening P Access to primary care P Reproductive health management P Contraceptive management P Family planning and clinical outcome indicators P Patient education with anticipatory guidance P Perimenopause symptoms P Sexual health as a component wellbeing P Delaying onset chronic conditions P Genetic testing with appropriate counseling Source: Well-Woman Taskforce Participants. American Congress Obstetrics and Gynecology. 2015 Our Vision Expand services to provide comprehensive care for generations women across their life continuum. 10 Value Report 2015-2016
The Patient Protection and Affordable Act 2010 includes strong well-woman healthcare provisions as a means optimizing preventive healthcare, increase access and contain cost. In response, there is a national movement towards consistency in medical care and as part this movement our specialty is redefining what constitutes a well woman visit (ACOG, 2015). At WCF, the focus is redesigning the well woman visit to include evidence-based care that is age specific and aims to improve outcomes across a woman s life. Our goal is to develop customized health assessment plans that include screening, evaluation and counseling, and immunizations that are based on the patient s specific age and risk factors. By incorporating global health issues such as cardiovascular health, mental health, immunizations, nutrition and lifestyle assessment (alcohol and tobacco use) into the well-woman exam, we are able to transform the system from one that reacts to disease to one that proactively fosters optimal health and well-being. Adolescent Reproductive Age Over 64 Mature Women s Florida 11
Safety in Service Performance Standards Our Improvement and Patient Safety Initiative includes clinical performance metrics set by industry standards, including the National Forum and the American Congress Obstetrics and Gynecology. The program also includes cost and patient experience metrics that are most important to patients, their employers and our health plan partners. The purpose the program is to assist WCF in developing a strategy for achieving quality improvement goals. The program continues to expand with new metrics introduced annually. WCF initiatives have expanded beyond management specific women s health conditions towards management the total health women. There are currently many measures in the program in the following categories: Perinatal, Health and Wellness, Efficiency, Access and the Patient Experience. Our metrics are tested to assess validity the data, and they help support strategies developed to provide clinical operational support to providers. Women s Florida continues to exceed best practices as defined by National Center for Health Statistics, the Joint Commission, the Leapfrog Group, the American Congress Obstetrics and Gynecology, Healthy People 2020 and March Dimes. Perinatal Health & Prevention Improvement & Patient Safety Patient Program Metrics Experience Efficiency Access 12 Value Report 2015-2016
2015 Performance Below is a summary our performance for quality metrics based on internally set targets. As an organization dedicated to continuous improvement, we set targets based on peer-reviewed literature and standards set by national health care quality organizations. In addition, we are also providing a comparison to the national average for each quality metric when that data is publicly available. Clinical Perinatal WCF Target WCF Compared to National Average Primary Cesarean Deliveries 2 2 Non-Medically Indicated Elective Deliveries (NMI) 2 2 Exclusive breasfeeding 2 2 Episiotomy 2 2 Antenatal Steroids 2 2 Appropriate Prophylatic Antibiotic for Cesarean Deliveries 2 N/A Appropriate DVT Prophylaxis for Cesarean Deliveries 2 N/A Health and Wellness WCF Target WCF Compared to National Average BMI Screening and Follow Up 2 2 Unhealthy Alcohol Use Screening 2 2 Tobacco Use Screening and Cessation Intervention 2 2 Screening for Clinical Depression and Follow Up 2 2 Documentation Current Medications in the Medical Record 2 2 Efficiency WCF Target WCF Compared to National Average Prescribing Generic Medications 2 2 Office surgery 2 N/A Access WCF Target WCF Compared to National Average Median time for a new appointment 2 N/A Patient Experience WCF Target WCF Compared to National Average Overall Patient Satisfaction 2 2 Likelihood Recommending Practice 2 2 Key Actual Performance exceeded target 2 Actual Performance below target within 5 percent 2 Performance below target by greater than 5 percent 2 National average data is not currently available N/A Women s Florida 13
2015 Performance There are many metrics in our program. The following graphs represent only a subset our results. Safety in Service the Centers for Disease Control and Prevention (CDC). Primary Cesarean Section Reduction Initiative (PCSRI) The rate cesarean section (C/S) deliveries in the United States as a whole rose by 50 percent between 1998 and 2008 (California Collaborative, 2011). This upward trend was observed among women all demographics, with a rate 32.12 percent in 2014, as reported by The primary C/S rate has become a major driver in the total C/S rate. Recently published data concluded that the rise in primary C/S accounted for 50% the overall increase in the C/S delivery rate (Source: Barber). Our group, in keeping with the increasing national attention on primary C/S deliveries, is committed to become the leader in primary C/S rate reduction by decreasing variation in care while providing a safe labor and delivery experience for our patients. WCF Primary C-Section Rate by Year 33.0% 31.0% 29.0% 27.0% 25.0% 23.0% 21.0% 31.4% 30.1% 27.3% 24.0% Our overall primary cesarean rate continues to trend downward reaching 22.2% in December 2015. Our goal is 21.3% (ACOG Study). 22.2% 19.0% 17.0% 15.0% 2011 2012 2013 2014 2015 Rate Target 14 Value Report 2015-2016
2015 Performance Reduction Non-Medically Indicated Early Term Deliveries The American Congress Obstetrics and Gynecology and the American Academy Pediatrics support a standard requiring 39 completed weeks gestation prior to an elective delivery. WCF tracks the rate early deliveries as a group metric with the goal remaining below the national average for early elective deliveries without a medical indication. Non-Medically Indicated (Elective) Deliveries Our current rate is 1.27%. We meet our target and perform better than the national average at 4.3% (Joint Commission) 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% WCF National Average Administration Antenatal Steroids Preterm birth continues to be the lead cause infant mortality. Antenatal steroids are medications given to pregnant women expecting preterm delivery, and they have been shown to reduce neonatal death, respiratory distress syndrome and intraventricular hemorrhage (ACOG, 2012). Antenatal Steroids 100.00% 95.00% 90.00% 85.00% 80.00% 75.00% 2014 2015 WCF Target National Average Our goal is to administer antenatal steroids to 100% patients that meet the criteria. Our current rate is 96.4%, and we perform better than the national average 89.7% (Joint Commission) Women s Florida 15
Safety in Service 2015 Performance Episiotomy Rate Episiotomy, a surgical incision made into the perineum to widen the vaginal opening for delivery, has decreased in recent years, but it is still a commonly preformed procedure. ACOG encourages physicians to use clinical judgment to decide whether or not episiotomy is necessary. The episiotomy rate is a perinatal core measure as identified by The Joint Commission (2009). Episiotomy 18.00% 16.00% 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% WCF Target National Average Our goal is for episiotomies to be performed in less than 5% patients. Our current rate is 11%, but we perform better than the national average 16.2% (National Perinatal Information Center) Generic Prescribing One cost efficiency metric at WCF is to produce cost savings by maximizing the use clinically appropriate genetics when possible. Generic Prescribing We achieved a generic prescribing rate 78% in 2015. This compares favorably to the generic dispensing rate reported by major insurance carriers for our peer group. Percentage 80% 70% 60% 50% 40% 30% 47% 49% 59% 61% 70% 68% 72% 76% 78% 2007 2008 2009 2010 2011 2012 2013 2014 2015 Year 16 Value Report 2015-2016
T he Right Test for the Right Patient at the Right Time The WCF Laboratory was created with the goal real-time collaboration between our gynecological pathologists and the patient s provider resulting in better outcomes for patients. We achieve improved decision making by incorporating the patient s clinical history with laboratory testing. The result is a care coordination model yielding a more clinically meaningful diagnosis. Through our laboratory, we have also achieved clinical and operational efficiency in the form : Reduced variation through development evidence based ordering guidelines Elimination unnecessary and expensive testing Standardized reporting Improved communication More accurate results Quicker turnaround times Laboratory Value Cases The following Value Cases demonstrate how our laboratory helps avoid adverse events and points to the most appropriate treatment protocol. A 59 year-old female presented with post-menopausal bleeding. She had an endometrial biopsy that was read by the Women s Florida Lab as small superficial fragments closely compacted atypical glands with a comment that the biopsy was suspicious for cancer but the volume tissue was not sufficient for a definitive diagnosis. A recommendation to provide additional tissue for evaluation was made. A dilation & curettage was performed at a local hospital where a benign diagnosis endometrial polyp, negative for atypia was made. Upon review these slides at the WCF Lab, it was determined that this subsequent specimen represented endometrial cancer. Because the significant discordance in the diagnosis, the case was sent to the preeminent expert in endometrial/uterine cancer who agreed with the WCF Lab diagnosis cancer. The patient was then fered hysterectomy for cancer treatment as opposed to routine follow-up if the original diagnosis had not been re-reviewed. A 31 year-old female presented with an abnormal pap (LGSIL) and a positive HPV test. She underwent colposcopy and was diagnosed by the WCF Lab with HGSIL or high-grade dysplasia. A LEEP excision was performed at a local hospital where a diagnosis benign cervix with no significant pathologic changes was made. The slides upon review at the WCF Lab revealed HGSIL and it was present at one the surgical margins. This patient was then referred to a GYN oncologist to have a cold knife cone in the hospital to excise the remainder the disease. The result that definitive excision was also HGSIL and it was not present on the final surgical margins. Without the rereview those slides by the WCF Lab, the patient would still have had residual HGSIL in her cervix which is the direct precursor to cervical cancer. A 62 year-old female presented with an 8 cm ovarian mass. The patient underwent removal her uterus, cervix, both ovaries and fallopian tubes at a local hospital. The diagnosis made was atypical proliferative mucinous tumor/borderline mucinous tumor bordering on mucinous adenocarcinoma. This nondefinitive diagnosis left the GYN oncologist with a question what to recommend for this patient s treatment. Patients with atypical proliferative mucinous tumor/borderline mucinous tumor without evidence spread beyond the ovary (this patient s tumor had not spread) are generally not recommended to have chemotherapy but for mucinous adenocarcinoma, chemotherapy is standard care. The slides were reviewed by the WCF Lab and it was determined that this represented a mucinous adenocarcinoma. Thus the patient received the necessary treatment in order to prevent recurrence and/or metastasis. Women s Florida 17
Safety in Service Affordability For many years, both physicians and patients have had a more is better attitude toward healthcare. According to a survey published by Dartmouth College (Dartmouth, 2008), a significant number physicians say their own patients get too much medical care, which can be hazardous and results in unnecessary costs to the patient and the system. As medical treatments and testing continues to grow and become more complex, WCF continues to be committed to a value approach that focuses on affordability. Our goal is to practice medicine that is supported by evidence, free from harm, not duplicative other tests or procedures already received and that is truly necessary. Our Physician Committee and our Medical Affairs Team is dedicated to reviewing new technologies and procedures to ensure we are employing those that are best for our patients at the lowest possible price. The emphasis is in ordering the right test or procedure at the right time for the right patient in an effort to cut down on both over and under-utilization. We have many cost efficiency strategies in place including: Reduction in unnecessary testing Standardization through adoption clinical evidence-based guidelines Order sets Generic prescribing Office based surgery program Referral program Billing, coding and compliance program With the development our sub-specialty practice, we have recently developed a model that focuses on enhanced care coordination that is efficient and valuable. The best patient outcomes at the lowest possible price 18 Value Report 2015-2016
Safety Service Women s Florida 19
Safety in Medical Assistant Certification Program Service Medical Assistants are integral members the healthcare team. They assist with patient care management and the day-to-day functioning our fices under the direct supervision our physicians. In 2015, we made certification a requirement for all our medical assistants. WCF believes that priciency in care leads to better patient care. By certifying all medical assistants, we are able to: Enhance patient safety Decrease the likelihood medical errors Optimize employee performance Assure our patients that our pressionals meet standards practice Demonstrate our staff s commitment to their pression and to lifelong learning Provide our staff with a sense pride and pressional accomplishment This program serves as an example our commitment to patient safety. Other safety programs in place at our group include: Physician Committee Staff Committee Standard Safety Protocols Patient Safety Reporting System Safety Review Meetings Annual Patient Safety Inspections SCOPE Certification Clinical Competency Assessment The physician team responsible for development, review and management new and existing clinical and safety guidelines. The clinical and administrative staff team responsible for feedback on and implementation clinical and safety guidelines. These are in place with the goal standardizing care and ensuring appropriate tests are ordered in compliance with national guidelines. Through this program, employees report safety concerns, adverse events and near misses. These meetings are mandatory and focus on internal review events identified through the Patient Safety Reporting System. This program focuses on compliance with requirements imposed by the Florida Department Health, HIPAA and OSHA standards. A voluntary and comprehensive safety review certification program through the American Congress Obstetrics and Gynecology (ACOG). An internally developed and mandatory competency assessment education program that focuses on clinical skills. It includes a detailed review WCFs safety and quality guidelines. 20 Value Report 2015-2016
I have been a medical assistant at Women s Florida, Lakeland OB- GYN for 19 years. When I learned the opportunity to become certified, I jumped at the chance. Becoming a certified medical assistant was a great accomplishment for me personally, and the confidence I gained enhanced my ability as a patient safety leader in our fice. Women s Florida has done so much over the years to promote patient safety, including this MA certification process, SCOPE certification, and standardization our policies and procedures. When our patients come to our fice, they can be confident that a quality, qualified medical staff is there to provide them with excellent care. I feel so blessed to be a part the WCF family. Kay Donaway, CCMA Women s Florida cares about keeping their employees long term and making sure they are well educated and up to date on the latest medicine has to fer to patients. I am proud to be part an organization that goes this far to keep patients safe. Rebecca Wray, CCMA Women s Florida strives for exceptional women s care, and by doing so, it goes the extra mile to make sure our patients are safe. Through this safety-focused initiative, our group encourages and supports all providers and staff in their efforts to make patient safety a continuous priority. Having the opportunity to become certified was truly a blessing. It gave me the opportunity to enhance my knowledge in order to effectively help and teach others and the encouragement to continue my education. Lashay Burden, CCMA Women s Florida 21
Service Safety in Certification and Accreditation Safety Certification in Outpatient Practice Excellence In 2011, our group was selected by the American Congress Obstetrics and Gynecology to participate in a pilot program for their Safety Certification in Outpatient Practice Excellence (SCOPE) Program. Since then, SCOPE has become ACOG s ficial patient safety certification. The program includes the following domains: Clinical management Documentation and reporting Medication management Equipment management Office based surgery safety SCOPE is a voluntary comprehensive patient safety review program and we are proud to report that our goal 100% certification eligible locations was achieved in early 2016. American Institute Ultrasound Medicine The American Institute Ultrasound Medicine (AIUM) accreditation program is in place to ensure safe, effective and affordable use ultrasound. Initially received in 2010, our group continues to maintain this accreditation for all sites performing ultrasound to ensure our patients are receiving the highest level care. The program provides access to the most up to date clinical evidence-based guidelines for ultrasound medicine and high-quality pressional education opportunities that focus on the importance and value ultrasound. College American Pathologists The Women s Florida Laboratory is accredited by the College American Pathologists (CAP). CAP is the leading organization for this specialty serving patients, pathologists and the public by fostering and advocating excellence in the practice pathology and laboratory medicine. The accreditation is voluntary and it demonstrates our ongoing commitment to quality in all aspects care. CAP accreditation focuses on patient safety goals, quality control, personnel, operations, instrument and equipment and priciency testing. During our most recent CAP Survey the inspector noted The Women s Florida Laboratory is an excellent institution using the latest technology to diagnose and guide treatment. I give my highest commendation as to the quality this laboratory. 22 Value Report 2015-2016
Service Safety in Women s Florida 23
Service Safety in Coordination The goal our care coordination program is to establish key links between providers who work collaboratively with patients to accomplish shared goals across settings. When care coordination is successful, providers receive timely information and our care coordination staff tracks the status all referrals and transitions. Our group remains committed to enhancing coordination between providers across the continuum care to achieve improved clinical outcomes. To this end, we continue to optimize our electronic health record by making collection information less difficult, by ensuring providers have quick access at the point care and by helping facilitate coordination with the medical neighborhood. Coordination Model Ancillary Pharmacy Financial and Social Resources Community Resources Patient Provider Coordinator Hospital Specialty Counseling Primary Education The Team: Patient Providers (multiple settings) coordinators Principles: Engaged patients and family members Shared vision Accountability Collaboration Requirements: Enhanced communication Connectivity Transparency Shared decision making Adoption evidence-based practice guidelines Programs to monitor and control quality Programs to monitor and control utilization 24 Value Report 2015-2016
Sub-Specialization Our vision for growth is centered on quality. To that effect, our focus is on a comprehensive approach to women s care including obstetrical, gynecological, surgical and specialty care. As we strive to provide comprehensive care to our patients, we are proud our continued strategic growth into sub-specialty care that is complementary to our core services and allows for real time coordination care. This coordinated care is efficient, valuable and helps us provide our patients with unparalleled quality. We fer the following services provided by sub-specialty board certified physicians: Maternal Fetal Medicine Breast Surgery Gynecological Oncology Focusing on high-risk pregnant women with chronic health conditions or unexpected conditions developed during pregnancy. Providing evaluation, treatment and care coordination for breast cancer, breast lumps and breast pain. Treating cervical, ovarian, uterine, vaginal, fallopian tube, primary peritoneal and vulvar cancers. Female Pelvic and Reconstructive Surgery Dedicated to the diagnosis and treatment urinary incontinence and pelvic floor disorders. Gynecological and Breast Pathology Genetic Counseling Nutrition Therapy and Counseling Focused on tests relevant to our specialty to arrive at a more clinically meaningful diagnosis and treatment plan. Providing patients an understanding chromosomal and genetic disorders allowing them to make decisions about genetic testing and treatment options. Developing individualized plans that help address specific conditions, outcomes and lifestyle choices. This fice is amazing and I can t imagine being treated for my cancer anywhere else! Women s Florida is the absolute best! Within a week, something that s been going on for five years was found and a solution decided. ~ Patient Testimonial Women s Florida 25
Service Safety in Danielle is more than my provider. She is my friend. She went above and beyond because she is invested in my happiness. ~Talita Waring Talita Waring, Patient & Danielle Cizek, ARNP, CNM, Women s Florida Defining the Patient Experience In recent years, perceptions performance and quality healthcare organizations have begun to move beyond examining the delivery clinical care, but now include the patient s perspective regarding their experience. Patients are predominantly choosing their provider based on their perception quality and their relationship with their provider. Delivering patient-driven care is more than exceptional clinical care; it is about making sure our patient s physical, clinical and emotional needs are met. Our strategic driver is the patient experience, and our goal is to transform healthcare through empathy and effective communication. How we measure the Patient Experience Over the years, we have employed several survey instruments and processes that were designed to measure patient satisfaction. In 2015, we implemented the Press Ganey survey, a tool that allows WCF to compare the patient s perception against other physicians locally, regionally and nationally. Our goal is to increase transparency around the patient experience and create continuous sustainable improvement. By doing this, we achieve our vision giving patients an exceptional patient-centered experience utilizing innovation and engaging her in our team based model care. 26 Value Report 2015-2016
A Soldier s New Baby From the Eyes a Certified Nurse Midwife Talita Waring is a personal trainer who I started caring for when she became pregnant with her second child. Talita knew her husband, Private Justin Waring, would be in military training during the delivery. Talita knew she could get through the delivery alone, but she was concerned about her husband missing the birth his first child, Gunner. I believe family is the most important thing, and I am passionate about taking care expecting mothers. I made them a promise that day that I would do everything I could so that he could be in some way present during the delivery. I stayed true to that promise. On September 28, 2015, I was on my way to the hospital to deliver Gunner when I contacted the Red Cross about locating Private Waring. They said they would attempt to contact him, but only after the baby was born. I was not one to stop at the easiest option. My plan was to get him on the phone so he could see his baby, not just hear him. To that end, I spoke to the base operator, the sergeant in charge communications and finally to the commander in charge Private Waring s unit who said they would try to get Private Waring on the phone, but made no firm commitment. When Talita was close to delivering, I called the base and left a message. A few minutes later, Private Waring was on the phone with Talita who was in tears. They hung up and Talita was to call him as soon as the baby was born. She instead attempted to FaceTime and was successful. He answered the phone in joyful tears, and he told his wife how beautiful she was and how proud he was her. At the end the conversation you could hear the Unit in the background giving their signature Uh Rah. The concern and love in his eyes that day really set me on a path determination to make sure he at least could be on the phone with her during the delivery. This was one those deliveries that remind me why I do what I do. One little act on my part was life changing for this new family. ~ Danielle Cizek, ARNP, CNM Photos by: Will Staples Photography Danielle Welter Photography Women s Florida 27
Technology & Innovation Data Analytics WCF was founded in 1998 with the underlying goal improving quality and outcomes in women s health. In order to support this goal, we implemented a first generation electronic health record (EHR) in 2007, and eclinicalworks (ecw), our current EHR in 2011. ecw is a fully integrated EHR with advanced functionality and interconnectivity that helps facilitate patient care and outcome measurement. Because this platform, we successfully participate in Meaningful Use and the Physician Reporting System (PQRS) programs established by the Centers for Medicare and Medicaid Services (CMS). The ultimate goal is to develop the ability to transform healthcare through a systematic framework. We have invested in analytic resources that support improvements in quality care at lower costs and with enhanced clinician and patient satisfaction. Our data analytics program focuses on evidenced based medicine, decision support, perinatal and gynecological outcomes, wellness and prevention. Telemedicine Platform The goal telemedicine is to create an exchange between a provider and a patient via electronic communications with the purpose improving a patient s health status. The model includes a growing variety applications and services using two-way video, email, smart phones, wireless tools and other forms technology. WCF developed a Telemedicine program because its many benefits including: Delivery care Faster access, particularly in urgent and remote circumstances More efficient, convenient and cost effective delivery care Informed decision making Through the telemedicine platform, our Genetic Counselor is able to provide genetics expertise to prenatal patients ten resulting in elimination unnecessary laboratory testing. In 2016, our platform will be expanded to fer nutrition consults and perinatology consults for management high risk pregnancies. 2007 First Generation EHR 2010 Improvement & Patient Safety Initiative 2011 ecw Implementation 2013-Present Data Analytics 28 Value Report 2015-2016
Community Impact Women s Florida Foundation After a long history community giving, in 2013, the physicians associated with Women s Florida identified an opportunity to have a more active and formalized philanthropic presence that will help make the health women in our community a priority. Today, the Women s Florida Foundation is dedicated to supporting women s health and wellbeing. The focus is promoting health in West and Central Florida through volunteerism, funding and partnership. The American Cancer Society is honored to partner with Women s Florida. Through their dedication to the cause, Women s Florida, makes it possible for the American Cancer Society to continue its fight against breast cancer and to celebrate more birthdays with the brave women and men who are winning their battle. Jenna Digiannantonio Senior Community Manager Making Strides against Breast Cancer Florida Division American Cancer Society, Inc. The Board Directors and I value the partnership Women s Florida and Celma Mastry Ovarian Cancer Foundation tremendously. Your support enables us to fulfill our mission sponsoring research that will assist in the development early detection and prevention ovarian cancer, provides an avenue to educate women in the community about symptoms and most importantly, we are able to financially assist patients in treatment. It has been a pleasure having many your physicians as volunteers and participants at our various functions and I know they have used some influence in getting others to volunteer and participate. Thank you for your years support! Claudette Carlan Executive Director Celma Mastry Ovarian Cancer Foundation Women s Florida 29
Resources American Congress Obstetrics and Gynecology. Screening for Perinatal Depression. Committee Opinion, Number 630 (2015). Dartmouth Atlas Healthcare. Improving and Curbing Health Spending: Opportunities for the Congress and the Obama Administration. http://www.dartmouthatlas.org/ (2008). Redefining the well woman visit American Congress Obstetrics and Gynecology. Well-Woman Visit. Committee Opinion, Number 534 (2014). Institute Medicine. Clinical preventive services for women: closing the gaps. Washington, DC: The National Academies Press; 2011. American Congress Obstetrics and Gynecology. Well-Woman Task Force: Components the Well-Woman Visit. Green Journal. Volume 126, Number 4, October 2015. 2015 Performance Barber,E.L., Lundsberg, L.S., Belanger,K., Pettker, C.M., Funai, E.F., Illuzzi, J.L. (2011). Indications contributing to the increasing cesarean delivery rate. Obstetrics and Gynecology 118:29-38 Main, E, Morton C, Hopkins, D, Giuliani G, Melsop K, and Gould, J. Cesarean Deliveries, Outcomes, and Opportunities for Change in California: Toward a Public Agenda for Maternity Safety and. December 2011. Available at https://www.cmqcc.org/resources/2079. Hamilton, Brady E., Ph.D, Martin, Joyce Al, M.P.H., Osterman, Michelle J.K., M.H.S., Curtin, Sally C., M.A. and Mathews, T.J.,M.S., Division Vital Statistics. Centers for Disease Control. Available at www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_12.pdf American Congress Obstetrics and Gynecologist. Management Preterm Labor. Practice Bulletin. Number 127. (June, 2012) American Congress Obstetrics and Gynecologist. Episiotomy. Practice Bulletin. Number 71. (2015). The Joint Commission. Perinatal. Available at www.jointcommission.org/perinatal_care/ Boyle, A.B., Reddy, U.M., Landy H.J., Huang, C.C., Driggers, R.W. & Laughon, S.K. (2013). Primary Cesarean Section in the United States. Obstetrics and Gynecology 122 (1):33-40 Clark, S., Miller, D., Belfort, M., Dildy, G., Frye, D., & Meyers, J. (2009). Neonatal and maternal outcomes associated with elective delivery. [Electronic Version]. Am J Obstet Gynecol. 200:156.e1-156.e4. American Congress Obstetrics and Gynecologist. Elective Deliveries before 39 Weeks. (June, 2013) http://www.acog.org/patients/faqs/elective-delivery-before-39-weeks#too The Leapfrog Group. Early Elective Deliveries. FactSheet. Available at www.theleapgrop.org (January, 2011). American Congress Obstetrics and Gynecologist. Non-Medically Indicated Early-Term Deliveries. Committee Opinion, Number 561. (June, 2013) Perinatal. The Joint Commission. (2014). Available at http://www.jointcommission.org/perinatal_care/ Service and Patient Experience Press Ganey. http://www.pressganey.com/ 30 Value Report 2015-2016
Appendixes Statistics Healthcare Providers 2015 2014 2013 2012 2011 Physicians OB/GYN 143 139 133 132 126 GYN Oncology 3 2 2 2 - OB/GYN & Urogynecology 3 3 2 - - GYN Pathology 2 2 1 - - Breast Surgery 2 1 - - - Certified Nurse Midwives 29 23 18 16 19 Advanced Registered Nurse Practitioners 24 29 28 27 24 Certified Genetic Counselor 1 1 - - - Registered Dietitian/Certified Diabetic Educator 1 - - - - Total 208 200 184 177 169 Certification 2015 2014 2013 2012 2011 SCOPE Certified Locations 19 10 2 1 - Obstetrical Services 2015 2014 2013 2012 2011 Total Deliveries 13,424 13,032 13,272 13,861 12,701 Obstetrical Visits 179,750 167,052 166,953 176,167 160,945 Biophysical Priles 6,577 5,393 4,895 4,291 3,414 Fetal Non-Stress Tests 16,880 14,424 13,584 15,473 14,729 Nuchal Translucency Ultrasound 9,356 8,837 8,918 8,700 8,254 Circumcisions 3,253 3,331 3,526 3,689 3,551 Genetic Counseling Sessions 506 70 - - - Nutrition Counseling Sessions - - - - - Preventive Services 2015 2014 2013 2012 2011 Well Woman Visits 156,441 151,534 151,169 150,486 145,836 Digital Mammography Screening - - - - - 2D 10,235 18,523 17,635 15,998 9,055 3D 11,588 519 - - - Bone Density Studies 3,272 3,204 2,973 3,359 3,205 Immunizations 19,703 20,534 21,293 28,000 26,473 Gynecological Services 2015 2014 2013 2012 2011 Office Problem Visits 137,134 128,204 130,764 121,167 102,792 Hysterectomies - - - - - Abdominal 441 448 338 382 411 Vaginal 151 147 164 206 259 Laparoscopic 1,508 1,321 1,437 1,284 1,068 Hysteroscopies 1,128 1,301 1,687 1,527 1,634 Office-based Surgical Procedures 1,937 1,595 1,722 1,747 1,772 Other Hospital & ASC Surgical Procedures 5,872 5,746 5,329 5,150 5,039 Intrauterine Device Insertions 6,240 5,282 4,746 4,650 4,681 Injections (Treatment) 11,357 10,3208 9,357 8,387 7,234 Other 2015 2014 2013 2012 2011 In-Office Blood Draws 78,820 71,598 64,736 64,769 59,040 WCF Laboratory Tests 2015 2014 2013 2012 2011 Biopsies 23,163 15,556 1,013 - - Chlamydia/Gonorrhea 54,574 14,955 - - - Group B 10,826 3,162 - - - Trichomonas (Trich) 4,429 1,717 - - - Vaginitis 13,610 3,028 - - - HPV 26,461 - - - - Women s Florida 31
Leadership Positions We believe that the most effective way to transform healthcare is through physician leadership. Our providers volunteer their time and serve as OB/GYN Chairs, Vice-Chairs and committee members at the many the hospitals and community programs we affiliate with. These roles allow unique opportunities to align with our partners on our patient quality and safety programs. 2015-2016 Physician Name Organization Role James LaPolla, MD Bayfront Medical Center Co-Director, Robotics Committee Megan Indermaur, MD Kimberly Biss, MD Molly Long, MD Bayfront Medical Center Women s Florida, LLC Bayfront Medical Center Women s Florida, LLC Bayfront Medical Center Women s Florida, LLC Co-Director, Robotics Committee Member, Nominating Committee Board Trustees Vice-Chief Staff Member, Nominating Committee OB/GYN Chair Member, Nominating Committee Raphael Guichard, MD Bayfront Medical Center OB/GYN Vice-Chair Greg Den Haese, PhD, MD Brandon Regional Hospital Chairman the Board Ignacio Armas, MD Brandon Regional Hospital St. Joseph s Hospital - South Women s Florida, LLC James Baron, MD Brandon Regional Hospital OB/GYN Chair Member, Committee Chief, OB/GYN Member, Executive Committee Member, Perinatal Safety Committee Member, Committee Chairman, Board Directors Member, Physician Committee Member, EHR Committee Karin Stanton, DO Brandon Regional Hospital Medical Excellence Peer Review Committee Steven Granger, MD Brandon Regional Hospital OB/GYN Vice-Chair Gregory Wilkerson, MD Florida Hospital - Tampa Bay OB/GYN Secretary Amy Solomon, MD Judeo Christian Clinic, Tampa Board Member Jeffrey L. Puretz, MD Lakeland Volunteers in Medicine Options for Women, PHC Women s Florida, LLC Ester Lincourt, MD March Dimes, Orlando Spokesperson Josh Goldman, MD Mease Dunedin & Mease Countryside Women s Florida, LLC Physician Business Services, LLC Volunteer Medical Director Member, Nominating Committee Chairman, Bay GYN Minimally Invasive Surgery Committee Director, Minimally Invasive Surgery & Urogynecology Member, Bay Women s Steering Committee Member, Credentials Committee Member, Nominating Committee Chairman, Board Directors 32 Value Report 2015-2016