Medical/Dental Professionals

Message from the Chief Medical Officers

January Update

Quality: Wrapping Up a Successful 2019, Planning for 2020
As we begin 2020, thank you for your commitment to providing high quality, safe care, leading to better patient outcomes. cmoBelow are some of the many quality milestones Kaleida Health achieved in 2019:

  • To date, 89% of our quality metrics improved from last year or are at/above national mean
  • Achieved DNV GL survey accreditation, with zero repeat non conformities; and ISO 9001:2015 re-certification
  • Achieved DNV GL Comprehensive Stroke Center Certification
  • U.S. News & World Report ranked Kaleida Health 16th for Best Hospitals in New York State, and 1st in Western New York; Identified as Top Performer in Neurology and Neurovascular Surgery
  • John R. Oishei Children’s Hospital named Top Children’s Hospital by Leapfrog for the 2nd consecutive year
  • Laboratories received College of American Pathologist (CAP) Accreditation
  • John R. Oishei Children’s Hospital achieved Baby Friendly Designation
  • John R. Oishei Children’s Hospital designated as Neuromuscular Disorders Specialty Care Center site by NYSDOH Wadsworth Center’s Newborn Screening Program
  • Buffalo General Medical Center/Gates Vascular Institute received Blue Distinction for Cardiac Care designation
  • Visiting Nursing Association of WNY ranked in the top five percent nationally; HomeCare Elite Top 500
  • HighPointe ranked 1 out of 15,200 nursing homes across U.S. by CMS value-based ranking
  • DeGraff Rehabilitation and Skilled Nursing Facility ranked by U.S. News & World Report as one of the Top Short Stay Skilled Nursing Facilities
  • Get With the Guidelines (GWTG) awards: BGMC/GVI receive Mission: Lifeline Silver achievement; BGMC Stroke Honor Roll elite Plus Gold Plus award
  • Kaleida Health Merit-Based Incentive Program (MIPS) achieved maximum quality score

2020 QIPS (Quality Improvement and Patient Safety) Plan
In 2020, Kaleida Health will remain focused on key quality drivers related to safety, outcomes and engagement. Our quality dashboard will track our progress on hospital acquired infections (HAIs), patient safety indicators (PSI), mortalities, readmissions, patient experience (HCAHPS), and population health/CPC+/MIPS. Our System Quality Design Teams will continue complete multidisciplinary reviews of quality issues to maintain a culture of safety. We will also be adding Operational Design Teams to complement the clinical work of our Quality Design Teams. All Design Teams will continue to focus on proactive risk-based thinking and mitigation to resolve issues.

We also restructured and streamlined our Quality Management System (QMS) reporting process so that quality remains a priority and there are clear communication channels rolling up from front line staff to managers and all the way up through site and system-level clinical and administrative leadership. This structure will also enable us to better close the loop on action plans.

In addition, teams will be developing service line quality plans to establish protocols, standardization and efficiencies, and ensure quality throughout the continuum of care.

Staying Strong Despite Financial Challenges
At the end of 2019, we made some significant changes across the system, including right-sizing programs, eliminating duplicative services, expense reductions and more. While difficult, these changes were necessary for Kaleida Health to continue delivering great care for our community despite reimbursement challenges, market dynamics and continued cuts by the State and Federal government.

Consider the following financial challenges that we are facing:

  • Kaleida Health has been negatively impacted by nearly $30 million in State and Federal reimbursement cuts for 2019-2020.
  • These government related cuts are expected to grow significantly in 2020: ◦New York State is expected to further cut hospitals, skilled nursing facilities and health organizations in the coming weeks, after announcing that they are facing a $6.1 billion deficit. Cuts will come in a number of reimbursement areas that impact us.
    • On the Federal side, the Centers for Medicare & Medicaid Services (CMS) continues to cut hospitals that serve a high Medicaid and uninsured population, resulting in a $12 million reduction to the organization.
    • The Visiting Nursing Association is facing a multi-million cut to its reimbursement from New York State for its managed long-term care program.
  • Rate impacts (labor increases, increased pension expense, health insurance, workers compensation, medical malpractice increases, etc.) will total more than $40 million in year-over-year increases to Kaleida Health in 2020.
  • Market dynamics that are beyond our control that we continue to manage. This includes supplies (pharmaceutical costs) and other expenses continuing to outpace reimbursement and revenue.
  • Changes in the delivery system overall: There continues to be a very rapid pace of inpatient visits moving to outpatient setting. In addition, there is a sharp growth of observation cases in the inpatient setting, resulting in lower reimbursement.
  • Denials from both commercial and public payers. About one in every 10 submitted claims are being denied based on various circumstances. This is a multi-million dollar issue that we are addressing.

There is no question that our industry is under tremendous stress, that our Federal and State government’s budget woes are problematic for us, and that change is not going to come easy. But the Western New York community deserves and is counting on a strong and vibrant Kaleida Health so we must persevere.

Thank you for continuing to provide that great patient experience, no matter the issues or challenges that we face each and every day. Our community is better served because of you.

Influenza and RSV
According to the New York State Department of Health, t
he 2019-20 influenza season started earlier than it has in the past three seasons. Influenza activity has not yet peaked, there have been steep increases in cases in the last few weeks, and it is expected to continue to increase in the upcoming weeks. Surveillance data indicates that influenza A(H1) and influenza B(Victoria) virus are co-circulating with the predominate virus type varying by region. Influenza A(H1) is the predominate virus in the New York City, Metropolitan/Hudson Valley and Capital District regions, while influenza B(Victoria) is the predominate virus in Central and Western regions. As of January 3, 2020, there have been 22,763 laboratory-confirmed influenza cases and 3,592 hospitalizations reported this season, with 61% of all laboratory-confirmed cases occurring in persons aged 5–49 years and 79% of hospitalizations in persons aged 18 and older. There has been one influenza-associated pediatric death this season in New York State. 

According to the CDC, antiviral medications are an important adjunct to flu vaccine in the control of influenza. Almost all (>99%) of the influenza viruses tested this season are susceptible to the four FDA-approved influenza antiviral medications recommended for use in the U.S. this season.

Oishei Children’s Hospital is also seeing many young patients (<2yo) with RSV (respiratory syncytial virus) needing IV fluid rehydration and varying levels of oxygen and respiratory support. The hospital is experiencing high patient volumes in both the Emergency Department and Pediatric ICU (PICU) with patient floors over capacity.

OCH STATS:

    • # Patients admitted with RSV:
      • 2017 = 66 (11/1/17 – 12/31/17)
      • 2018 = 78 (11/1/18 – 12/31/18)
      • 2019 = 208 (11/1/19 - 12/29/19)
    • # Patients admitted to PICU with RSV:
      • 2017 = 11 (11/1/17 – 12/31/17)
      • 2018 = 23 (11/1/18 – 12/31/18)
      • 2019 = 61  (11/1/19 - 12/29/19)
    • Since 11/1/19, OCH has had 237 respiratory admissions: 88% are RSV, 7% are Flu (16 as of 12/29)
    • Overall RSV started earlier this season and has been more severe
  • The entire country including our neighbors are also experiencing high volumes in their Pediatric Emergency Departments and PICUs due to RSV

As we continue to care for patients throughout this cold and flu season, please remember to wash your hands frequently, avoid touching your face and eyes, stay home and away from large crowds and people who are sick, clean high touch surfaces frequently, cover your cough, and sneeze into your elbow not your hand.

David Hughes, MD, MPH
Chief Medical Officer
Kaleida Health

Kenneth Snyder, MD, PhD
Chief Physician Quality Officer
Kaleida Health

Michael Mineo, MD
Chief Medical Officer
Millard Fillmore Suburban Hospital and DeGraff Memorial Hospital

David Pierce, MD, FACEP
Chief Medical Officer
Buffalo General Medical Center/Gates Vascular Institute

Stephen Turkovich, MD
Chief Medical Officer
Oishei Children’s Hospital