WHA’s Physician Leaders Council (PLC) for the first time convened using the Microsoft Teams video platform in an “all virtual” meeting June 24.
The physician leaders who comprise the PLC shared the current status of the COVID-19 pandemic in their respective communities and their challenges. A number of PLC members noted a recent uptick in confirmed cases and percent positive results but also relayed that many of the new cases were among younger people who experienced a relatively mild clinical course. Despite an increase in the number of confirmed cases and the percent positive of those tested, hospitalization numbers for COVID-19 patients were flat or still in decline in many PLC member home communities. The current status of community testing and who will fill the void when the Wisconsin National Guard departs after August 7 is a concern.
WHA General Counsel Matthew Stanford led a discussion of regulatory flexibility with respect to hospital licensing, Medicare waivers, liability changes and telehealth related to the COVID pandemic and what an emerging post-COVID agenda looks like in each of these regulatory areas. Stanford and WHA Chief Medical Officer Mark Kaufman, M.D. updated the PLC on the activities of DHS’ State Disaster Medical Advisory Committee regarding allocation of scarce resources including ventilators, Remdesivir and potentially a COVID vaccine if and when it becomes available.
WHA Senior Vice President of Public Policy Joanne Alig led a discussion on the upcoming state budget and the potential financial implications for Wisconsin hospitals and health systems. May economic projections appeared better than April’s, but unemployment was still in double-digits at 12%. State revenue projections were down significantly in April, and although May projections appeared better than April’s, more precise revenue projections will not be available until after July 15 – the deadline for 2020 tax filings. Economic changes impact enrollment in health care coverage, with enrollment in the state’s Medicaid program increasing nearly 72,000 from March to May 2020. It is projected that the state will see reductions in commercial coverage and an increase in the uninsured rate as well, although precise data is not yet available.
Alig also updated the Council on a new white paper from Benefit Services Group, Analytics (BSGA) which cautions against using incomplete data to rank physicians, as is attempted in a study released last December. The original study from GNS Healthcare was funded by the Business Health Care Group (BHCG) and the Greater Milwaukee Business Foundation on Health. BSGA found several shortcomings in the study which make it unlikely to improve health care delivery. (Read more in last week’s The Valued Voice
PLC members reviewed a revised set of 2020 WHA goals related to physician leadership, education and wellness. Because of the COVID pandemic, both the Physician Leader Development Conference and the Rural Health Conference were cancelled in 2020. WHA Vice President of Education and Marketing Leigh Ann Larson reviewed WHA’s On-demand Learning Center
. The Learning Center provides 24/7 access to educational resources such as documents, videos and recorded webinars, and video links. PLC members affirmed WHA’s decision to increase on-demand learning resources while also looking forward to connecting with physician leader colleagues in person at the 2021 Physician Leadership Development Conference in Kohler, pending the status of the COVID-19 pandemic. Larson also informed the group that an Education survey will be sent to them, as well as their colleagues, at the end of July. This survey will have questions related to virtual learning topics and future in-person events.
In an effort to decrease the use of post-operative opioids in children undergoing appendectomies, Children’s Wisconsin’s Department of Pediatric Surgery began a quality initiative improvement project in 2017.
For many children, perioperative care after an appendectomy may be their first exposure to opioids. This quality improvement project was implemented to assess current practice of prescribing pain medications after an appendectomy to decrease unnecessary opioid use via simple, targeted steps. A Plan-Do-Study-Act (PDSA) methodology was used to determine the best interventions to improve opioid use after appendectomies. These interventions included the use of ice packs in the post-anesthesia care unit, documenting pain scores within 30 minutes of return to the hospital bed postoperatively, and using a standard order set for care with scheduled non-opioids like Tylenol and Ibuprofen.
After the completion of the PDSA cycles, there was a 93 percent decrease in intravenous use of opioids and a 54 percent decrease in the use of oral opioids while in the health care system. Overall, the total number of prescribed doses of opioids decreased from a median of 17 doses to 11 doses. A period of sustainment and monitoring occurred over an 18-month period. Outcomes were notable for compliance of greater than 99 percent use of the standard order set, 96 percent reduction in intravenous opioid use, and greater than 67 percent reduction in oral opioids. At discharge, the total number of opioid prescriptions decreased by greater than 58 percent with only 54 percent of the prescriptions being filled at a pharmacy. The total number of opioid doses was reduced by greater than 79 percent.
Given the success of the quality initiative, Pediatric Surgery has expanded the goals to use scheduled Tylenol and Ibuprofen for at least 48 hours, use opioids only in the immediate post-operative period and prescribe only three to five doses of opioids if a prescription is needed at discharge. Another 2020 goal is to leverage the electronic medical record for prescriptions that may need to be provided after discharge, using electronic prescribing to eliminate the “just in case” prescriptions that were being provided at discharge.