The South Shore Physician Hospital Organization (SSPHO) was formed in 1994 by physicians and the South Shore Hospital. The mission of the SSPHO is to preserve and protect the value and quality of health care for the people who live and work in Southeastern Massachusetts.
Save The Date
Please mark your calendars for the upcoming SSPHO Annual Meeting
When: Thursday, November 6. 7AM - 1:30PM
Where: Old South Union Church, 25 Columbian Street, S. Weymouth, MA
Agenda and registration forms are available on the Physician Quick Reference page.
Debra A. Cooper, RN, MSN, MBA/HCM, CIC, CPHRM
Annemarie Provencher, RN, HCN, CPHRM
When least expected, "something" happens in the world that puts healthcare facilities in a quandary. In the past decade, many of these events involved an infection control issue with which organizations had not previously dealt or even heard about.The severe acute respiratory syndrome (SARS) pandemic that started in China in late 2002 and the 2009 H1N1 influenza pandemic are examples of infection control issues that healthcare organizations in the United States were not initially prepared to handle; they may have had no understanding of what impact the outbreak may have on the organization. On September 30, 2014, the Centers for Disease Control confirmed that a traveler from West Africa who presented to a hospital in Dallas, Texas, had Ebola.1 Once again, healthcare organizations need to implement strategies to prepare for an infection control threat.
Previously known as Ebola hemorrhagic fever, diseases associated with strains of the Ebola virus species were first identified in African countries. "Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo."2 Although intermittent Ebola outbreaks have occurred in Africa since Ebola was first discovered, the first cases of what is now considered the largest Ebola outbreak ever recorded was identified in West Africa in March 2014.3 By early August 2014, the outbreak was declared a "Public Health Emergency of International Concern" by the Director-General from the World Health Organization (WHO).4 While the death rate for Ebola virus disease (EVD) averages about 50 percent, "Case fatality rates have varied from 25 % to 90 % in past outbreaks."5 The fatality rate of the Ebola outbreak in West Africa had been estimated to be as high as 70.8 percent "among persons with known clinical outcome of infection."6
The Director General of the World Health Organization (WHO) was right on target with the identification of this newest public health emergency. Although not contagious until an ill person has symptoms of EVD, the virus is highly virulent in humans once symptoms are present. "Transmission [of EVD] is through direct contact of bodily fluids of an infected person or exposure to objects like needles that have been contaminated with infected secretions."7 The Dallas patient did not present with any symptoms until four days after returning from West Africa; he died on October 8, 2014.8 With respect to the situation in Dallas, "CDC and public health officials in Texas are taking precautions to identify people who had close personal contact with the patient and health care professionals have been reminded to use meticulous infection control at all times."9
How Can Hospitals Prepare for EVD?
Healthcare organizations can prepare for the possibility that a patient may present to their facility with symptoms that are suggestive of EVD. A first step healthcare organizations can take to identify patients who may have, or are at risk of having, EVD is to modify existing triage questions. Early recognition of patients infected with the Ebola virus is critical. Triage questions should include the following:
1. Have you recently traveled to West Africa within the past three weeks?
2. Have you resided in or traveled to any geographic location where the transmission of Ebola virus disease is active?
3. Have you had contact with the blood or other body fluids of a patient who has or is suspected of having Ebola virus disease?
Have you had direct contact with bats, rodents or primates from any geographic
location that has reported Ebola virus diseases?
If an answer to any of the above questions is "YES," the following additional question should be asked:
Do you have any of the following symptoms:
a. A fever of greater than 101.5 degrees Fahrenheit/38.6 degrees Celsius
b. Joint or muscle aches
f. Stomach/abdominal pain
g. Lack of appetite
h. Severe headache
i. Unexplained bleeding or bruising
If an at-risk patient has any symptoms that are suggestive of EVD, the patient should be isolated. Precautions to follow when caring for these patients include standard, droplet and contact precautions. Adhering to effective infection prevention and control procedures is paramount to protect staff members and other people who may have contact with infected patients.
All staff members caring for or treating a patient with EVD should be provided with education about the illness, transmission of the illness, and isolation procedures. Education should also be provided to staff members who may come in contact with EVD patients, including housekeeping and laboratory staff members. Education is a key risk mitigator for disease transmission. Providing such education should also decrease anxiety and fear that staff members may have when learning that a patient with EVD has been admitted to the facility. Appropriate precautions, including the appropriate use and disposal of personal protective equipment (PPE), should be key components of the education that staff members receive.
Resources are available to help healthcare organizations prepare for the possibility that a patient who is at risk of having Ebola may arrive on their doorstep. The Centers for Disease Control (CDC) recently released their Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Virus Disease in U.S. Hospitals. It may be viewed on the CDC website at: http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html
What Do Physician Practices Need to Know About EVD?
With the first travel-associated Ebola case being diagnosed in the United States, the possibility exists that a patient who has Ebola symptoms or a patient who came in contact with a person suspected of having Ebola could present at a physician office practice. Early recognition is critical to controlling the spread of EVD. Physician office practices must have screening protocols in place. Providers should be aware of the CDC Ebola framework: Prepare to Detect, Prepare to Protect and Prepare to Respond.10
Prepare to Detect - Screen high-risk patients:
· Does the patient have a fever ≥ 101.5°F?
· Does the patient have compatible EVD symptoms such as headache, weakness, muscle pain, vomiting, diarrhea, abdominal pain or hemorrhage?
Has the patient traveled to an Ebola-affected area in the 21 days
onset?11 A list of countries can be accessed at the following link:
Prepare to Protect - What to do if you suspect EVD:
· Move patient to an exam room and close the door.
· Implement standard, contact and droplet precautions.
· Immediately notify local and state health authorities.12
Prepare to Respond: What are some risk management processes physician office practices may want to have in place before a potential case of Ebola presents?
· Review signs and symptoms of Ebola with clinical staff members.
· Identify strategies for limiting exposure of well patients to patients suspected of having EVD.
· Train clinical staff members on proper use and correct disposal of PPE. Refer to www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf for instructions.
· Assign responsibility for an inventory supply of PPE, including gloves, fluid resistant or impermeable gowns, eye protection and face masks.
· Prepare an Ebola response guide for staff members; address handling phone calls and inquiries regarding potential cases.
· Provide patients with accurate public health information, such as the CDC poster Facts about Ebola in the U.S., which is available at www.cdc.gov/vhf/ebola/pdf/infographic.pdf.
· Assign responsibility for keeping up with CDC updates.
· Determine staff member responsibilities should a potential Ebola patient present to the office practice.
· Have a plan for environmental cleaning and medical waste disposal if treating a suspected or confirmed Ebola patient. See the Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus at http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html.
· Be aware of the follow-up and/or reporting measures necessary after caring for a suspected or confirmed Ebola patient.
· Develop strategies to address staff member concerns.
· Review routine infection control measures with staff members, such as hand hygiene, disinfecting surfaces, and properly cleaning and discarding instruments, needles and syringes.
Prepare to Detect - Prepare to Protect - Prepare to Respond
For more information, see the CDC’s Health Care Provider Preparedness Checklist for Ebola Virus Disease at http://www.cdc.gov/vhf/ebola/pdf/healthcare-provider-checklist-for-ebola.pdf.
1. Centers for Disease Control and Prevention (CDC), "First Imported Case of Ebola Diagnosed in the United States," Page last updated October 10, 2014, http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/united-states-imported-case.html, 10/10/2014.
Centers for Disease Control and Prevention (CDC), "About Ebola Virus Disease,"
Page last updated
October 3, 2014, http://www.cdc.gov/vhf/ebola/about.html, 10/10/2014.
World Health Organization (WHO), "Ebola Virus Disease,” Updated September
6. Who Ebola Response Team, "Ebola Virus in West Africa – The First 9 Months of the Epidemic and Forward Projections," The New England Journal of Medicine, September 23, 2014, http://www.nejm.org/doi/full/10.1056/NEJMoa1411100?query=featured_home&, 10/10/2014.
7. Centers for Disease Control and Prevention (CDC), "CDC Telebriefing on Ebola Outbreak in West Africa," Press Briefing Transcript, July 28, 2014, http://www.cdc.gov/media/releases/2014/t0728-ebola.html, 10/10/2014.
8. Centers for Disease Control and Prevention (CDC), "First Imported Case of Ebola Diagnosed in the United States."
10. Centers for Disease Control and Prevention (CDC), "Health Care Provider Preparedness Checklist for Ebola Virus Disease," n.d., http://www.cdc.gov/vhf/ebola/pdf/healthcare-provider-checklist-for-ebola.pdf, 10/10/2014.
Centers for Disease Control and Prevention (CDC), Checklist for Patients
Being Evaluated for Ebola Virus Disease (EVD) in the United States, n.d.,
Policyholder Alerts are a publication of Coverys’ Risk Management Department. This information is intended to provide general guidelines for risk management. It is not intended and should not be construed as legal or medical advice.
South Shore PHO Selected As A Particpating Organization In The CMS Bundled Payment Program
July 1, 2014
South Shore PHO announced today that it was recently accepted as a participating organization in the Center for Medicare and Medicaid Services (CMS) pilot program the Bundled Payments for Care Improvement (BPCI) Initiative as designed by the CMS Innovation Center. Under the BPCI initiative, organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare.
Traditionally, Medicare makes separate payments to providers for each of the individual services they furnish to beneficiaries for a single illness or course of treatment. This approach can result in fragmented care with minimal coordination across providers and health care settings. Payment rewards the quantity of services offered by providers rather than the quality of care furnished. Research has shown that bundled payments can align incentives for providers – hospitals, post-acute care providers, physicians, and other practitioners– allowing them to work closely together across all specialties and settings.
The Bundled Payments initiative is comprised of four broadly defined models of care, which link payments for multiple services beneficiaries receive during an episode of care. SSPHO elected to participate in two of the 4 Models; both Models 2 and 3 involve a retrospective bundled payment arrangement where actual expenditures are reconciled against a target price for an episode of care. In Model 2, the episode of care will include the inpatient stay in the acute care hospital and all related services during the episode. The episode will end either 30, 60, or 90 days after hospital discharge. In Model 3, the episode of care will be triggered by an acute care hospital stay and will begin at initiation of post-acute care services with a participating skilled nursing facility, inpatient rehabilitation facility, long-term care hospital or home health agency. The post-acute care services included in the episode must begin within 30 days of discharge from the inpatient stay and will end either a minimum of 30, 60, or 90 days after the initiation of the episode. Under either Model 2 or 3, participants can select up to 48 different clinical condition bundles.
By January 2015 SSPHO will select which of the 48 bundles in either Model to work on and enter into an agreement with CMS around those bundles. Over the course of the three-year initiative, CMS will work with participating organizations to assess whether the models being tested result in improved patient care and lower costs to Medicare.
About the CMS Innovation Center:
The Bundled Payments for Care Improvement initiative was developed by the Center for Medicare and Medicaid Innovation (Innovation Center). The Innovation Center was created by the Affordable Care Act to test innovative payment and service delivery models that have the potential to reduce Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) expenditures while preserving or enhancing the quality of care for beneficiaries. Further information on the CMS BPCI can be found at the CMS website:
South Shore PHO Continues Participation In The BCBSMA Alternative Quality Contract (AQC)
December 20, 2013
South Shore PHO announced today that they recently renewed the agreement with Blue Cross Blue Shield of Massachusetts – HMO Blue to continue to participate in the Alternative Quality Contract (AQC). The BCBSMA AQC is an innovative contracting arrangement that addresses both cost and quality, helping to create a health care system in which financial and clinical goals are aligned. A key component is to change the way insurers reimburse doctors and hospitals for their services. BCBSMA has developed and implemented a model: the Alternative Quality Contract (AQC). The AQC contract model combines a per-patient global budget with significant performance incentives based on quality measures. The AQC places the focus on what matters most to all of health care’s stakeholders— quality, value, and patient outcomes. SSPHO has historically performed in the upper levels of the program on most metrics.
The AQC design is an innovative global payment model that uses a budget based methodology, which combines a fixed per-patient payment (adjusted annually for health status and inflation) with substantial performance incentive payments (tied to the latest nationally accepted measures of quality, effectiveness, and patient experience). The goal of this restructured model is to enable the delivery system to give the patient the best result from the most appropriate treatment (e.g. based on the best medical evidence), by the right kind of provider (e.g. specialist, family doctor, nurse), at the right time (when intervention is most appropriate), and in the most appropriate setting (e.g. hospital, physician office, independent laboratory, home).
December 18, 2013
Presentations from the Annual Meeting, held December 12, are now online. Click on the image below to view them.
The SSPHO Welcomes Its New Associate Medical Director, Stephen Johnson MD.
November 4, 2013
The SSPHO is pleased to welcome Dr Stephen Johnson as its new Associate Medical Director. Dr. Johnson is with the South Shore NeuroSpine Group, LLC on Main Street in Weymouth. He has been a member of the POSS Quality-Performance Committee. His primary role as Associate Medical Director will be to strategize how to best engage our specialist physicians in SSPHO goals and to lead the Quality-Performance Committee.
The SSPHO would also like to thank David Demick MD, for his help during the time that he spent as Interim Medical Director. He was instrumental in helping us move our agenda forward while we redesigned the Medical Director role and were involved in recruitment.
Matt Whalen Named Vice President of Managed Care/SSPHO Executive Director
February 5, 2013
Matt Whalen has been named vice president of managed care/South Shore Physician Hospital Organization (SSPHO) Executive Director. He is responsible for planning and directing SSPHO operations, contracts and programs designed to achieve Triple Aim goals of: better health for populations, better care for individuals and lower cost per capita.
Matt comes to us from Lower Merrimac Valley Physician Hospital Organization/Whittier Independent Practice Association/Wellport, where he was executive director. Previously, he was director of contracting and network at EVERCARE in Auburndale, MA. He was also contracts manager at SSPHO for seven years.
Matt earned a bachelor’s degree from Northeastern University. He is a member of Healthcare Financial Management Association (HFMA), Medical Group Management Association (MGMA), The IPA (Independent/Integrated Physician Association) Association of America (TIPAAA) and American College of Healthcare Executives (ACHE). Matt may be reached at (781) 624-8820. His offices is located at 1221 Main Street in Weymouth.