MHP Section October UPDATE Part of October 20 2004 Presentation to Execom IM Dept

1. MHP Section October UPDATEPart of October 20 2004 Presentation to Execom IM Dept Nazario Macalintal Jr., MD MHP SECTION Department of Internal Medicine

2. MUST RECONCILE ITS DIRECTION COLLECTIVELY WITH • HOSPITAL and IM DEPARTMENT’s MISSION AND VISION • PCP EXPECTATIONS • RESIDENTS REQUIRED TRAINING EXPOSURE

3. The Role of theMHP Section

4. MHP Section MISSION Statement To become an effective arm of the MMC in its commitment to provide adequate medical careto the indigent constituents of the community 2

5. MHP Section Goal 1 To actively participate in the MMC MHP Service by providing adequate medical care within the prescribed working budgetary allocationprovided by the institution, with the view in mind of achieving the vision-mission statements of the institution and the department.

6. MHP Section Goal 2 To maintain the delivery of quality services and ensure the competent medical residency program via continuous cooperation from all Medical Consultants of all subspecialties

7. MHP Section Goal 3 To utilize the MHP in helping Consultants comply with the General Requirements of Section 3.5 No. 10, to wit “assist in any Medical Staff-approved teaching activities for medical students, interns, residents, fellows, nurses, Medical Staff members, and others as required by the Department of which they are a member”.

8. MHP Section Goal 4 To help MMC reduce the cost of healthcare delivery while maintaining an effective, practical management of medical cases

9. CRITICAL AREA II.CONSULTANTS’ ROTATION

10. MUST TIE UP PLANS OF ACTIONS COLLECTIVELY WITH • HOSPITAL EXPECTATIONS • IM DEPT REQUIREMENTS • PCP EXPECTATIONS • RESIDENTS REQUIRED TRAINING EXPOSURE • JCI AND ISO REQUIREMENTS - NOT AN ISSUE. • THEY CAN BE DECKED AS LONG AS THEY ARE MEMBERS OF THE MEDICAL STAFF ASSOCIATION / MILA UY SEPT 4 2004

11. Recall MHP SECTION Goals… • To utilize the MHP service in complying with the General Requirements of Section 3.5 No. 10, to wit “assist in any Medical Staff-approved teaching activities for medical students, interns, residents, fellows, nurses, Medical Staff members, and others as required by the Department of which they are a member”.

12. Original assumption that is no longer valid • “PREVIOUS DECKING STRATEGY WORKED” • Px GETS REFFERED TO MD NEXT-ON-DECK AND SO ON. • NEXT ON LINE COMPLAINED.. And REFUSED, AND DID THE SAME….

13. Option 1 - • ROTATE ALL INTERNISTS in the MHP Decking • Problem 1:DO THEY HAVE OPTION TO REFUSE? • HOSPITAL DIRECTIVE ON ALL CONSULTANTS - • General Requirements of Section 3.5 No. 10, ...“assist in any Medical Staff-approved teaching activities for medical students, interns, residents, fellows, nurses,, Medical Staff members, and others as required by the Department of which they are a member”. • Implemented : October 1st, 2004 per ADL Memo Sept 28, 2004

14. Option 1a • ROTATE ALL INTERNISTS in the MHP DECKING • Problem 2 on Option 2 PCP EXPECTATION? - “How much of teaching staff is PCP Fellow? • Solution: Create TANDEM NON-PCP/PCP for PCPAccreditation Committee viewing purposes only but allow non-FPCP to participate in the care of pxs • Example: DE LA CRUZ (n-PCP) / Litonjua PCP - means dela Cruz renders the care, “together” with ADL • Example: de la Cruz (n-PCP) / LITONJUA PCP - means LItonjua renders the care, “together” with dela Cruz • Benefit 1: BOTH PCP and non-PCP Consultants are able to participate in the MHP service, allowing them to comply with the hospital’s Section 3.5 directive; • Benefit 2: The IM Department is able to comply with the PCP requirements, without the non-PCP being left behind

15. Option 2 - • DECKING PROBLEM Solution : GET A BACK UP • MAKE THE SECTION BOSS THE BACK UP - • The one on deck will think twice before calling his/her back up. • Should back up be called, the Section Boss just decides whom to refer and ORDERS the transfer of service or referral, not necessarily to the one next on deck. • THE ONE CALLED WILL BE HESISTANT TO REFUSE BEC IT’S HIS/HER SECTION BOSS WHO CALLED

16. OTHER ISSUES • NEED TO DECK ALL SPECIALTY REFERRALS TO THOSE ON CALL FOR THE SAID SPECIALTY BY PRACTICE • CANNOT DECK ADMISSIONS BY SPEC OF CASES SINCE • ~1/3 OF CASES IS CARDIO. • ~ 1/3 IS PULMONARY • Cannot use On-Call for Private Patients - almost ALL CARDIOLOGISTS! (Why?) • BY PRACTICE, REFERRAL TO SPEC IS BY THE DATE THE NEED FOR REFERRAL IS REQUIRED , NOT ON THE DATE CASE WAS ADMITTED

17. CRITICAL AREA 2: CONSULTANT DECKING - PLANS OF ACTION • Create Stop-Gap measure for the next quarter DONE • Secured Consultants’ Updated Directory - talked to Mila Uy • Announced the new Decking System before year end • But some not aware of their scheduled decking

18. CRITICAL AREA 2: CONSULTANT DECKING - PLANS OF ACTION • Summary of Results - if things go as proposed • Total decking / consultant : only 3-5 / YEAR for each of the 180 consultants • MMC General Requirement for consultants to train residents /fellows is ADDRESSED

19. Oct-Dec 2004 Schedule of Decking for MHP Admissions • Memo released for this last quarter • INITIAL Observations: • Objections from Consultants was NIL • PROJECTION:Only a handful from the WHOLE IM STAFF will refuse being decked for MHP 3-5x a year…

20. EVERYONE TOGETHER MORE ACHIEVES

21. ISSUE 4…:Consultants not receiving communication letter on decking

22. ISSUE 5…: ER Consultants under the Dept of Medicine - for decking??

23. HSP Issues as of per Ces Landicho NOV 2007 • JCI does not allow tandem decking • Referral only to Active / Assoc Active • Total IM = 183 • Active / Assoc Active = 133 • Excluding MDs 60/?> ,(#34) no decking option • Only 101 willing to be decked • Therefore 365decking days/101MDs = IMs will be decked 3.6x a year ONLY • Non-PCP = 50 • What role can they have ?