Episodios
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On this episode, Dr. Tomas Villanueva and a leading clinical documentation expert finish their discussion on the need to correctly document everything involving spial surgery. Spinal surgery represents a complex challenge for documentation specialists and clinicians alike, and this episode will clear up what is needed to be successful in coding and documenting these procedures.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Clinical Operations and QualityVizient
Guest:Rachel Mack, MSN, RN, CCDS, CDIP, CCS, CRCConsulting Director, Clinical Documentation ImprovementVizient
Show Notes:
[00:31] Query opportunities and low-hanging fruit
[01:53] Blood loss and the whole clinical picture in querying
[02:50] Using that “magic word” can make a difference – coding to an MCC
[03:43] Other query opportunities
[10:36] When the documentation is wrong
[12:44] Reconciliation and feedback needed
Links | Resources:
To contact Modern Practice: [email protected]
Rachel Mack’s email: [email protected]
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On this episode, Dr. Tomas Villanueva continues his discussion with a leading clinical documentation expert on the need to correctly document everything involving spial surgery. Spinal surgery represents a complex challenge for documentation specialists and clinicians alike.
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Senior Principal, Clinical Operations and Quality
Vizient
Guest:
Rachel Mack, MSN, RN, CCDS, CDIP, CCS, CRC
Consulting Director, Clinical Documentation Improvement
Vizient
Show Notes:
[00:41] Rise in spinal surgeries
[01:23] Coding challenges and parameters
[01:53] Predicaments for coding and CDI specialists
[07:22] Common DRGs for spinal surgeries – the need to use the “magic words”
Links | Resources:
To contact Modern Practice: [email protected]
Rachel Mack’s email: [email protected]
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Spinal surgery represents a complex challenge for clinical documentation. Difficult to code and representing query situations that can be demanding, this is the area of focus for this episode of Modern Practice. Joining Dr. Tomas Villanueva is a leading expert returning to the podcast to talk about the challenges of spinal surgery documentation.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Clinical Operations and QualityVizient
Guest:Rachel Mack, MSN, RN, CCDS, CDIP, CCS, CRCConsulting Director, Clinical Documentation ImprovementVizient
Show Notes:
[01:26] Around 1.62 million procedures per year
[02:22] Procedures on the increase (2.4 times the level of 15 years ago)
[03:54] The most common spinal diagnoses
[05:15] Often not caught by primary care
[06:20 Less common reasons for spinal surgery
[07:09] Reasons for planned surgeries—often a last resort
[08:45] Risks for avoiding surgery
Links | Resources:
To contact Modern Practice: [email protected]
Rachel Mack’s email: [email protected]
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Years of medical school, residency and fellowships have proven to do little in teaching physicians how to care for themselves. Physician burnout is at an all-time high. On this episode, a physician who is a leading expert on physician stress discusses how to improve mental fitness in those who’ve given their lives to the care of others.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guest:Cecilia Cruz, MD, MPH, CPCC, ACCFounder and Chief Executive OfficerMarpe, LLCBoard-certified emergency medicine physicianFormer co-chair of QualityDivision of Emergency MedicineNorthShore University HealthSystem
Show Notes:
[00:34] Physician suicide
[02:44] Need connection
[04:03] What organizations need to do
[06:20] A learned skill and resource
[06:37] Mental fitness
[08:20] The Marpe approach
Links | Resources:
To contact Modern Practice: [email protected]
Dr. Cruz’s email: [email protected]
Dr Cruz’s Linkedin page: Cecilia Cruz - Founder and CEO - MARPE, LLC | LinkedIn
MARPE, LLC website: https://www.marpejourney.com/
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This episode of our award-winning podcast continues the discussion on why mental fitness is so crucial for physicians and other clinicians today and yet is a concept that physicians still tend to avoid or downplay. Physician training and medical school have not helped. Join us for this gritty discussion.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guest:Cecilia Cruz, MD, MPH, CPCC, ACCFounder and Chief Executive OfficerMarpe, LLCBoard-certified emergency medicine physicianFormer co-chair of QualityDivision of Emergency MedicineNorthShore University HealthSystem
Show Notes:
[01:00] The in-box, EMR documentation and authorizations have only gotten worse
[01:40] If we don’t change, it’s all going to fall apart
[03:23] Examples from medical school and training—a lack of respect
[06:45] The EMR and the need for a 27-hour day
[08:05] Deficit of 40,000 primary care physicians by 2030 (AAMC)
[08:30] Emerging mental health issues and workplace violence
Links | Resources:
To contact Modern Practice: [email protected]
Dr. Cruz’s email: [email protected]
Dr Cruz’s Linkedin page: Cecilia Cruz - Founder and CEO - MARPE, LLC | LinkedIn
MARPE, LLC website: https://www.marpejourney.com/
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Though physicians spend years in medical school, residency and fellowships to learn how to care for patients, they spend little time learning how to care for themselves. Physician burnout, leading to physician turnover, is skyrocketing. On this episode, a physician who is a leading expert on physician stress, having gone through that stress herself, discusses how to improve mental fitness in those who’ve given their lives to the care of others.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Clinical Operations and QualityVizient
Guest:Cecilia Cruz, MD, MPH, CPCC, ACCFounder and Chief Executive OfficerMarpe, LLCBoard-certified emergency medicine physicianFormer co-chair of QualityDivision of Emergency MedicineNorthShore University HealthSystem
Show Notes:
[01:10] Physician heal thyself? Not happening!
[02:35] Weakness means not being the best
[03:31] An ingrained culture of perfectionism
[04:20] The burnout crisis
[06:40] Physician types affected the most
[07:30] Bigger burden on specialists
[09:13] Overcoming – awareness is only 20% of progress
Links | Resources:
To contact Modern Practice: [email protected]
Dr. Cruz’s email: [email protected]
Dr Cruz’s Linkedin page: Cecilia Cruz - Founder and CEO - MARPE, LLC | LinkedIn
MARPE, LLC website: https://www.marpejourney.com/
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On this episode of our award-winning podcast, Dr. Tomas Villanueva concludes his discussion on how organizations can approach quality metrics today – what metrics to choose and how to apply them.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Performance Improvement ConsultingVizient
Guest:Rick May, MDSenior Principal, Consulting SolutionsVizient
Show Notes:
[00:38] The burden of reporting
[02:09] Surgical quality and outcomes – technical vs. medical
[03:41] A focus on the systems
[05:00] Systems changes and results
[05:42] Engaging the physicians
Links | Resources:
To contact Modern Practice: [email protected]
Dr. May’s email: [email protected]
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On this episode of our award-winning podcast, Dr. Tomas Villanueva continues his discussion on how organizations can approach quality metrics today – what metrics to choose and how to apply them.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Performance Improvement ConsultingVizient
Guest:Rick May, MDSenior Principal, Consulting SolutionsVizient
Show Notes:
[00:54] Importance clinical documentation
[02:40] Is it possible to eliminate all CLABSIs (or other infections)?
[04:40] Length of stay as quality metric
[05:10] Surgical complications and length of stay
[05:55] Length of stay and complication rates
[06:40] The most heavily weighted metric
Links | Resources:
To contact Modern Practice: [email protected]
Dr. May’s email: [email protected]
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Concerning quality measures in healthcare organizations, a common complaint is, “I've got so many people looking over my shoulder, pulling our data in, ranking me, rating me, everything else, and there is no way I can keep track of literally the hundreds of metrics for which we’re accountable.”
On this episode of our award-winning podcast, Dr. Tomas Villanueva welcomes back a leading quality expert to discuss how organizations can approach quality metrics today – what metrics to choose and how to apply them.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Performance Improvement ConsultingVizient
Guest:Rick May, MDSenior Principal, Consulting SolutionsVizient
Show Notes:
[01:49] Why measuring quality is crucial
[02:17] If you do quality well, financial success follows
[02:57] Quality attracts staff
[03:46] Has quality improved overall in healthcare?
[04:42] Choosing the right metrics – 500 metrics exist overall
[05:58] Mishmash in timing of measures – complex and “all over the map”
[08:03] Realistic rate of improvement (hint: it’s not 10%!)
[08:53] Impact of under-capturing documentation
Links | Resources:
To contact Modern Practice: [email protected]
Dr. May’s email: [email protected]
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This episode of the award-winning podcast examines the importance of risk adjustment. Dr. Tomas Villanueva leads the discussion on the impact of this crucial aspect of documentation that can affect hospital outcomes.
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Senior Principal, Clinical Operations and Quality
Vizient
Guest:
Erica Braun, MS, RN, CCDS
Senior Consulting Director, Clinical Documentation Improvement
Vizient
Show Notes:
[01:29] Defining risk adjustment – maintaining an apples to apples comparison
[02:41] Capturing comorbid conditions to the highest level of specificity
[04:08] Capturing the low-hanging fruit
[05:47] Case mix index issues
[07:44] Severity of illness and risk of mortality
[08:52] Addressing query fatigue
Resources:
To contact Modern Practice: [email protected]
Erica Braun’s email: [email protected]
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Screening for colorectal cancer (CRC) has seen a lot of innovations, but there is still the conventional gold standard. On this episode of our award-winning podcast, Dr. Tomas Villanueva welcomes Dr. Aziz Aadam to discuss the need for early colorectal cancer (CRC) detection, and the options available to patients.
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Senior Principal, Clinical Operations and Quality
Vizient
Guest:
Abdul Aziz Aadam, MD
Interventional Gastroenterologist
Director, Interventional Endoscopy
Medical Director, International Patient Services
Northwestern Medicine
Show Notes:
[01:05] CRC screening options
[02:40] Colonoscopy advantages and disadvantages
[03:35] Virtual colonoscopies
[04:14] Artificial intelligence enhancement
[04:54] Improvements in the future
[07:10] No tests are foolproof
[07:50] Need to improve access
Resources:
To contact Modern Practice: [email protected]
Dr. Aadam’s email: [email protected]
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In this episode of the award-winning podcast Dr. Tomas Villanueva welcomes Dr. Aziz Aadam to discuss the need for early colorectal cancer (CRC) detection, which drastically increases the rate of survival, and how improvements in CRC screening are giving patients better options.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Clinical Operations and QualityVizient
Guest:Abdul Aziz Aadam, MDInterventional GastroenterologistDirector, Interventional EndoscopyMedical Director, International Patient ServicesNorthwestern Medicine
Show Notes:
[01:11] Endoscopic submucosal dissection
[02:10] Prevalence of colorectal cancer
[02:38] Risk factors
[05:10] Reason for the need of early detection
[06:35] Challenges for screening
[07:56] Rise in younger patients
[09:11] Screening of the elderly
[09:54] Increasing screening rates
[11:09] Additional screening options
Links | Resources:
To contact Modern Practice: [email protected]
Dr. Aadam’s email: [email protected]
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On this episode, we continue our discussion on preventing surgical smoke in the OR.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Performance Improvement ConsultingVizient
Guest:Rachel Medina, BSBASenior Category Manager, Surgical ServicesVizient
Show Notes:
[00:29] Regulation and legislation around surgical smoke
[03:04] Best practices
[04:09] Sustaining efforts on smoke prevention
[05:01] Technological advances in prevention
[06:15] Financial costs and learning curve – outweighed by benefits
Links | Resources:
To contact Modern Practice: [email protected]
Rachel Medina’s email: [email protected]
“As important as the air you breathe” (Vizient Tech Watch, p 38): Tech Watch Medical Device - Volume 2, 2022
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The daily smoke produced in an operating room is the equivalent of 27-30 cigarettes, and the OR staff breathes this in five days a week. When tools in the OR cut and cauterize human tissue, they generate a plume of smoke containing toxic chemicals, carcinogens, malignant cells and viruses. Surgical smoke can cause a host of conditions, anything from headaches and sore throat to lung disease and lung cancer. On this episode, a Vizient expert discusses the ramifications of surgical smoke and how to begin preventing it.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Performance Improvement ConsultingVizient
Guest:Rachel Medina, BSBASenior Category Manager, Surgical ServicesVizient
Show Notes:
[01:27] Surgical smoke: a byproduct of surgical procedures
[01:51] Health issues from surgical smoke
[02:15] Not considered seriously over the decades
[02:47] Lung disease in physicians and OR staff
[03:34] Financial implications
[04:47] Growing awareness and the role of AORN
[06:33] Toxic materials and the effects of smoke plumes in the OR
[08:30] Vizient platform developing on surgical smoke
Links | Resources:
To contact Modern Practice: [email protected]
Rachel Medina’s email: [email protected]
“As important as the air you breathe” (Vizient Tech Watch, p 38): Tech Watch Medical Device - Volume 2, 2022
Subscribe Today!Apple PodcastsAmazon PodcastsAndroidSpotifyRSS Feed
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On this episode of our award-winning podcast, we finish our feature on an organization that has made huge strides in reducing Patient Safety Indicators (PSIs) throughout health system. We will discuss the phenomenal results of the initiative so far and what is planned for the near future at Sanford Health.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guests:Rachel Leyk, RN, CMSRN, CPHQImprovement AdvisorQuality and Safety – FargoSanford Health
Devendranath (Dev) Mannuru, MD, CHCOMInternal Medicine HospitalistCDI and Quality Physician AdvisorSanford Hospital – Fargo
Khaled Zreik, MDDirector, Critical CareAcute Care SurgeonSanford Health
Show Notes:
[00:39] Use of data in managing PSI reduction
[03:14] Results of a successful program
[04:05] Lessons learned
[08:15] Expanding and standardizing throughout the enterprise
Links | Resources:
To contact Modern Practice: [email protected]
Rachel Leyk’s email: [email protected]
Dr. Mannuru’s email: [email protected]
Dr. Zreik’s email: [email protected]
PSI ACS Poster: PSI ACS Poster
2023 Quality and Safety Conference presentation: 2023 QSC presentation
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On this episode of Modern Practice, we continue highlighting an organization that has made huge strides in reducing Patient Safety Indicators (PSIs) throughout health system.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guests:Rachel Leyk, RN, CMSRN, CPHQImprovement AdvisorQuality and Safety – FargoSanford Health
Devendranath (Dev) Mannuru, MD, CHCOMInternal Medicine HospitalistCDI and Quality Physician AdvisorSanford Hospital – Fargo
Khaled Zreik, MDDirector, Critical CareAcute Care SurgeonSanford Health
Show Notes:
[01:06] Managing PSI notifications to staff – keeping it non-punitive
[03:46 Escalation process versus peer review – addressing practice variation
[05:12] Keys to achieving collaboration
Links | Resources:
To contact Modern Practice: [email protected]
Rachel Leyk’s email: [email protected]
Dr. Mannuru’s email: [email protected]
Dr. Zreik’s email: [email protected]
PSI ACS Poster: PSI ACS Poster
2023 Quality and Safety Conference presentation: 2023 QSC presentation
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This episode of our award-winning podcast continues the success story of how Sanford Health has reduced PSIs through a concerted, multifaceted effort throughout the organization. Tomas interviews members of the clinical team that guided the way.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Clinical Operations and QualityVizient
Guests:Rachel Leyk, RN, CMSRN, CPHQImprovement AdvisorQuality and Safety – FargoSanford Health
Devendranath (Dev) Mannuru, MD, CHCOMInternal Medicine HospitalistCDI and Quality Physician AdvisorSanford Hospital – Fargo
Khaled Zreik, MDDirector, Critical CareAcute Care SurgeonSanford Health
Show Notes:
[00:34] Surgeon’s perspective
[02:04 Role of nurse reviewer
[03:18] Necessities for success
[04:05] Importance of executive leadership; need to be non-punitive (the “gold nugget”)
[06:37] Reliable software and establishing the stop bill process
[08:15] Involving HIM, coding and the CDI team
[10:36] Engaging the clinical staff
Links | Resources:
To contact Modern Practice: [email protected]
Rachel Leyk’s email: [email protected]
Dr. Mannuru’s email: [email protected]
Dr. Zreik’s email: [email protected]
PSI ACS Poster: PSI ACS Poster
2023 Quality and Safety Conference presentation: 2023 QSC presentation
Subscribe Today!Apple PodcastsAmazon PodcastsAndroidSpotifyRSS Feed
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Developed by the Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators, or PSIs, represent measurements of adverse events that enable healthcare organizations to gauge how they compare to others regarding patient safety. In addition, CMS looks at PSIs in scoring and penalizing organizations. In this series, Tomas talks with members of a clinical team that has seen great results in reducing PSIs throughout the organization.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior Principal, Clinical Operations and QualityVizient
Guests:Rachel Leyk, RN, CMSRN, CPHQImprovement AdvisorQuality and Safety – FargoSanford Health
Devendranath (Dev) Mannuru, MD, CHCOMInternal Medicine HospitalistCDI and Quality Physician AdvisorSanford Hospital – Fargo
Khaled Zreik, MDDirector, Critical CareAcute Care SurgeonSanford Health
Show Notes:
[02:00] Patient Safety Indicators (PSIs) defined
[02:46] PSI-90 and individual PSIs
[03:43] Hospital Acquired Conditions Reduction Program (HACRP)
[05:06] Documentation and the “dotted line” to quality
[05:44] Benchmarking with the Vizient Clinical Data Base
[06:23] Focused objectives for the PSI reduction program
[07:34] Steps in building the program structure
[09:35] Addressing gaps in education – once clinicians know what to do, they don’t fail
Links | Resources:
To contact Modern Practice: [email protected]
Rachel Leyk’s email: [email protected]
Dr. Mannuru’s email: [email protected]
Dr. Zreik’s email: [email protected]
PSI ACS Poster: PSI ACS Poster
2023 Quality and Safety Conference presentation: 2023 QSC presentation
Subscribe Today!Apple PodcastsAmazon PodcastsAndroidSpotifyRSS Feed
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On this episode of our award-winning podcast, a leading expert in electrophysiology concludes our discussion on pulsed field ablation as the newest approach to treating atrial fibrillation.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guest:Thomas Munger, MDChair, Heart Rhythm DivisionAssociate Professor of MedicineMayo Clinic
Show Notes:
[00:48] New energy source
[01:40] Current electroporation is more controlled
[06:30] Anticoagulation and pulse field ablation
[08:42] Be sure to work with colleagues when wanted to adopt PF ablation
[09:05] Exciting development in electrophysiology
Links | Resources:
To contact Modern Practice: [email protected]
Dr. Munger’s email: [email protected]
More information (Vizient): Additional pulsed field ablation resources
Information on improving an electrophysiology program (Vizient):
Optimizing your EP program
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On this episode of our award-winning podcast, a leading expert in electrophysiology explains the pathophysiology of atrial fibrillation and how therapies for it have evolved over the years, with pulsed field ablation emerging as the newest approach.
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMSenior PrincipalClinical Operations and QualityVizient
Guest:Thomas Munger, MDChair, Heart Rhythm DivisionAssociate Professor of MedicineMayo Clinic
Show Notes:
[00:50] Atrial fibrillation: pathophysiology and risk factors
[03:20] Treating rhythm and treating rate
[07:01] Efficacy of ablation and other treatments
[09:40] Pulse field ablation
Links | Resources:
To contact Modern Practice: [email protected]
Dr. Munger’s email: [email protected]
More information (Vizient): Additional pulsed field ablation resources
Information on improving an electrophysiology program (Vizient):
Optimizing your EP program
Subscribe Today!Apple PodcastsAmazon PodcastsAndroidSpotifyRSS Feed
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