Celebrating 40 Years

As I see it

Get Better

Thomas Zguris

The ultimate goal of all physicians is to help patients "Get Better!", and as a result, NES Health has adopted this poignant phrase as our new tagline. From here forward, you'll be seeing a lot more about how NES helps our clients "Get Better!"

Better metrics, better patient satisfaction, better financial performance, better leadership and better recruitment: we call these the "five pains" because without fail, when we are invited to discuss our services with a prospective client, these for the most part are the areas of primary concern. Understanding these pains and developing solutions has helped us be successful, and it has helped our clients find relief from these pains, or in other words, "Get Better!"

More and more, we're finding that patient satisfaction is a key concern for hospitals, and that achieving their goals is elusive. The focus on patient satisfaction will shift to a focus on patient experience over the next few years as EDCAHPS emerges on the scene and links compensation to the results of the Patient Experience Surveys.

CMS clearly draws a distinction between the two, and experience trumps satisfaction in their view. That said; a patient could be satisfied with their care but not their experience overall. This is analogous to flying on an airplane. The flying public is almost always satisfied with the flight because they overwhelming tend to land safely, but there are few flyers who actually enjoyed the experience.

Introducing Our New Chief Experience Officer, Chris Pepin

What is NES Health doing about this, and how will it benefit our clients? I am proud to announce that we have appointed Chris Pepin, RN, our current National

Director of Clinical Services, as our new Chief Experience Officer. NES Health is the first company in the industry to staff such a role. Chris will take complete ownership of the patient experience throughout our client base and will use proven techniques and tools to monitor and improve the experience-not only for the patients, but for families, providers, medical and nursing staffs, and hospital administration. Creating a better experience is contagious. Once there is a paradigm shift in culture and practice, the results can be dramatic. Periodically, Chris will share case studies that show where we have been able to achieve success in improving the experience.

Some years ago, I had a hospital administrator tell me that he wanted the ED physicians to act like the Walmart greeter. Frankly, I was a bit disturbed by that suggestion. Although his comment was offensive, I understand what he was seeking. He wanted his patients to have a good experience. Recently, I visited one of our client hospitals and spent some time looking over metrics with the Site Medical Director and CEO. Their metrics were very good, but patient satisfaction was lagging a bit because of one doctor who tended to get 4 out of 5 more often than 5 out of 5 on surveys. Although the former score sounds pretty good, it's actually considered failing because the only acceptable score is a 5. Hard to imagine, but true.

This physician will be coached until she is consistently getting 5s. Yes, it's difficult to explain to a physician that they are failing when they get a 4 out of 5. However, it's an important message we all need to understand if we are to succeed. The bottom line? NES Health is committed to delivering results for our clients, and a "good" or "acceptable" outcome is not sufficient. Instead, excellence is always our end goal.

Just Ask
Chris Pepin Patient experience is a very individual thing; however, we tend to take broad and sometimes complicated approaches to improving the patient experience when the problems are actually quite simple. I usually already know what I want when I go into a restaurant, grocery store, or any other business. I want to be treated with kindness and respect while also dealing with someone who is more informed than I am about their service or product.

It's no mystery, then, that our patients want the same thing. If you don't practice rounding in your organization, you should try asking patients those simple things: Are staff members being respectful and kind? Are they communicating effectively to you and your family? If you are already aware of a problem in these areas, round anyway, because the conversations and insights you can gain are priceless.

My children are young, so I recently watched the movie "Big Hero 6" with them. If you haven't seen it, one of the main characters, Baymax, is a robot that is designed to help people. Before a person is free of his service, they must state that they are satisfied with the care he provided.
The entire time I watched the show, I thought it was a perfect model for a reality to come at some distant point in the future, but also a goal for us to strive towards now. Many of you use the motto "every patient, every time." I absolutely love this sentiment, because it individualizes our approach. The difficulty, though, is how do we keep this real and fresh? Our motto at NES is Get Better!, at everything we do. While we want it to address every patient every time, we know there will still be shortcomings. But if we continuously learn and improve, we will always Get Better!

On a final note, I was at a Studer conference in May and had the opportunity to talk to a Chief Experience Officer after she gave a presentation. I asked her what area people often went wrong with when developing a patient experience program. Her answer resonated with me, as I had made the mistakes myself when I was the director of a patient experience program. She said, "Be sure you balance hospitality with metrics and outcomes. Too often, people focus on the need to improve the hospitality aspect without setting clear goals and measuring." This woman also told me to "deliver education to department leaders to avoid getting bogged down with re-training at the individual level."

My ideal approach would be to never let a patient leave the hospital if they aren't totally satisfied. Maybe customer satisfaction robots will be a reality one day, like in the movie. But for now, I challenge us all to simply ask what will improve a visit for our patients, and truly try to act upon the response with the individual and at the system level. The results just may surprise us.
NES Expands
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NES In Ethiopia NES In Ethiopia NES In Ethiopia

Welcome ICD-10
Jennifer Moore As ICD-9 turns thirty- six, the healthcare community welcomes, with great trepidation, its successor ICD -10. The International Classification of Diseases' (ICD) was conceived in 1900 for epidemiological purposes and the ability to statistically track diseases within a universal system. The transition is necessary because ICD-9 fails to capture current medical practice and is outdated with advances in medical treatments over the past several decades. In the United States, the ICD system was later adopted for the purpose of billing and coding, and that's where rubber is about to meet the road in October 2015.

ICD-10 will expand our current set of diagnostic codes from 13,000 to over 68,000, and completely revamp the current set of DRG "groupers". It will also covert from a 3-5 numerical code to a 7 character alpha- numeric code. All of which has kept an army of programmers busy for the past several years. ICD-10's ultimate value is a more robust system more logically arranged to re-

flect anatomy, etiology and severity. The tradeoff is that every physician will be required to document with far greater specificity.

NES' Documentation Committee has been working in close collaboration with our billing company, Probill, for the past year to pave the way for a smooth transition. Step one was identifying the top diagnosis codes currently utilized by our ED providers. Next, we developed training materials around the new requirements of ICD -10 for those specific diagnosis codes. Those materials were presented in April to every site medical director during mandatory training sessions conducted by Probill' s VP of Revenue Cycle Management and Dr. Steve Wexler, RMD, Chairperson of NES' Documentation Committee.

Preparedness is critical at every level of our organization from our RMD's, SMD's, providers to our coders and reimbursement specialists at Probill. It will take the efforts of everyone working as a team to minimize the impact on reimbursement while maintaining our current level of patient throughput, documentation accuracy, and overall billing production. All while methodically, patiently and thoughtfully exceeding the expectations of every patient. Welcome ICD-10!

Keri Gardner
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Patient Experience
At NES Health, customer service is very important to us. Our representatives are in direct contact with patients each day, providing vital assistance with the Physician bill as well as patients' concerns with their Emergency Department (ED) experience. That's why we invest in our teams by providing monthly webinars in an effort to constantly improve skills and techniques.

Traci Lopez One of the most common services we provide is educating patients on what our bills represent, and discussing options to resolve the balance due. It's true that a consent and financial form were signed by the patient at the start of their visit, which explained that some services are billed separately from the Hospital. But let's face it: this is an emergency. The patient's attention is focused on getting better-not reading the fine print.
A few months ago, I received a request to improve our statements. We discovered an essential paragraph was missing. This paragraph further explained that our bill represents services performed by the physician, nurse practitioner, and others and is separate from the Hospital bill. Adding this language to our statement has given patients more insight into what the bill represents. Another common service is walking through the insurance carrier maze and identifying why a carrier did not pay a claim. Our team responds to denied claims in a few ways: by simply updating billing information and resubmitting a claim, by participating in a three-way call to further explain the professional services being billed, and by writing appeals on behalf of the patient.

The healthcare landscape is becoming increasingly challenging, and we find that patients are frustrated because of a basic lack of information. Once our representatives are given the opportunity to explain and provide practical solutions, patients feel more empowered. This not only makes patients more cooperative in resolving their bill; it also improves their perception of their overall experience with the Hospital and NES clinicians. At the end of the day, that's what we're all striving for.

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Helmet Safety Initiative

At NES Health, we believe in serving the communities we partner with. Our service never stops in the emergency department-it simply starts there. The front doors we represent are a part of communities, just like the members that make up NES.

Helmet Safety Initiative

Earlier in 2015, NES launched a new initiative focused on providing community service to patients, employees, and members of communities all over the country. Our most recent effort focused on the prevention of head injuries and trauma in school-aged children in grades 3-5. We know this is a group that is still quite impressionable, and one in which we can make a major difference. The need to educate is dire, especially when you look at these startling statistics from 2010:

- 800 bicyclists were killed
- 515,000 bicyclists required ED care from a bike-related injury
- Roughly 200,000 injured were children or adolescents
- Of this 200,000, nearly 26,000 sustained a traumatic brain injury

The efforts of NES and our Chief Experience Officer Chris Pepin culminated in a series of helmet safety presentations at schools across the country, from New York to Alaska. We were able to get in front of nearly 500 children and donate our time as well as bike helmets and information on preventing trauma.

This has been a very worthwhile and rewarding initiative for NES. According to Dr. Mark Raine from Ketchikan, Alaska, "It was great to know that we put something in place that
will truly impact the lives of children and help prevent serious injury."

About the Program

The head injury prevention program was designed to be interactive, engaging children, while educating through hands-on experience. We started by exploring the anatomy of the head and brain while discussing types of injuries, either closed or open. We then talked about how to prevent these injuries and what to expect in the emergency department should the child or a family member be injured.

The entire lecture provided comparisons of the head represented by an egg, and helmets represented by plastic cups. The conclusion was the most memorable for the children, requiring them to create a helmet out of the cup and tissues. The grand finale involved putting the egg inside the cup and throwing it in the air to see if the egg was protected by the cup. This truly hit home the importance of helmets and the dangers of not wearing a properly fitted or poorly padded helmet.

The presentation ended with helmet fitting demonstrations and a helmet giveaway. Principals at all of the elementary schools said they observe children riding bikes every day without wearing helmets, and expressed how pleased they were to have NES Health and site medical directors from the communities join together for such an important cause.


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David Moattar
The work of change in an organization never ends. While it's true that no single action can be the cureall remedy, this can't become an excuse to do nothing. A great leader is someone who, as Gandhi says, does something-but that something must be true to his own deepest and most important principles.

So how do you lead? How do you know what "the right thing" to do is? The natural leader knows that the work begins with a brutally honest self-examination. She starts off by looking within herself: What can I do within this organization that will be the seed for change? How can I change my own behavior or speech in a way that is both honest and inspiring to others?

I believe anyone can be a leader, as long as he is selfaware. If we are not afraid to look within, or perhaps are afraid but look anyway, we can help others to do the same. And that, after all, is the essence of leadership: leading by example-by acting honestly, by speaking truthfully, by being receptive to others and eager to
hear their input. The good leader does not necessarily need to have many brilliant or innovative ideas. It is imperative, however, that she be open to the ideas of others, and be able to sift through much chaff to come up with the grain of wheat.

Another important trait among leaders seems to be having enough sense of self-worth to take responsibility for their reactions. A leader who is afraid of criticism will not inspire those around him to speak openly, without fear of an angry backlash. When employees feel comfortable enough to interrupt their boss, make jokes, contradict, and give new ideas, a miracle happens. They think it was the boss who had the brilliant new insight!

It would behoove all of us to pay heed to Gandhi's sage words. We must take action. Whatever we do will be insignificant in the grand scheme of things, but making that small ripple is what ultimately triggers tidal waves of change.

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The NYU Lutheran Comprehensive Stroke Center, led by Salman Azhar, M.D., is aggressively identifying, targeting and providing stroke treatment and stroke rehabilitation services. Our three-pronged approach includes rapid assessment, immediate intervention and comprehensive rehabilitation. Because of its advances in stroke care and recovery, the New York State Department of Health has named NYU Lutheran a designated primary Stroke Center. The Joint Commission has designated NYU Lutheran as a Primary Stroke Center. The certification demonstrates that the Stroke Center meets the Joint Commission's rigorous standards and performance measurements in caring for stroke patients.

The NYU Lutheran Comprehensive Stroke Center offers:
  • Launch Pad - rapid evaluation and treatment by the ED and stroke team
  • FAST CT scans or MRI
  • Advanced Stroke Neurology Team
  • Interventional neuroradiology
  • Cerebrovascular neurosurgery
  • Telestroke collaboration with other hospitals
  • 6 designated neuro-intensive care unit beds
  • 4 monitored stroke beds
  • A staff of specialized nurses
  • Joint commission accredited Stroke Rehabilitation program
  • The latest technology advancements and expertise in stroke and cerebrovascular care
  • Removal of clots right from the brain through the groin
  • Management of complex aneurysms and blood vessel abnormalities
  • Treatment of blockage of carotid arteries
  • Emergency management of bleeding strokes
  • Opportunities to participate in stroke research
What to expect when you come to the NYU Lutheran Comprehensive Stroke Center

NYU Lutheran has a team of doctors and clinicians with expertise in stroke in the emergency department available 24 hours a day 7 days a week. Upon arrival patients are immediately assessed by our team have a rapid CT scan done. Additional tests such as CT angiogram and MRI are tests that may be used to look at the brain and the blood vessels and assist your physician in determining the best treatment options. Normally within 45 minutes of arrival in the emergency room patients will begin treatment.

Betty Looze adds over 20 years of recruiting and management experience to NES.

Betty Looze Betty Looze joined the Staffing Services division of NES Health on November 17, 2014 as a National Physician Recruiter for the Eastern Region. Betty brings over 20 years of hands-on medical staffing experience to our organization. Prior to joining NES, she served as Director of Staffing Operations for Hospitalists Consultants, a division of ECI Healthcare Partners. Betty has a proven track record of success in physician recruiting and management in the context of emergency medicine and hospital medicine services.

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