HEARTBEATSeptember 4, 2015 3rd Quarter Edition ISSUE 72

Transition from ICD-9 to ICD-10 The transition from ICD-9 to ICD-10 is necessary because the current coding system is unable to take health care into the future. ICD-10 will advance health care in many ways, with benefits accruing across five major categories: quality measurements, public health, research, organizational monitoring, and performance and reimbursement. “Transitioning to ICD-10 is a major disruption that providers and payers may prefer to avoid. But it is an upgrade long overdue, and the benefits are far-reaching,” says Jean Harrell, Director of Health Information Management. With regards to quality measurements, ICD-10-CM and -PCS offer greater detail and increased ability to accommodate new technologies and procedures. The codes have the potential to provide better data for evaluating and improving the quality of patient care. Complete, accurate, and up-to-date procedure codes will improve data on the outcomes, efficacy, and costs of new medical technology, and ensure fair reimbursement policies for the use of this technology. Expanded detail will help payers and providers more easily identify patients in need of disease management, and more effectively tailor disease management programs. Public health relies on the receipt of ICD data from healthcare providers to conduct a variety of activities. The United States is the only industrialized nation not using an ICD-10–based classification system for morbidity purposes. This makes it difficult to share disease data internationally at a time when such sharing is critical for public health. The United States’ ability to track and respond to global threats in real time is thus limited. The United States belongs to the World Health Organization, which requires member states to notify the organization of all events that constitute a public health emergency of international concern and to respond to requests for verification of information regarding such events. The vision is that every country

should be able to detect, rapidly verify, and respond appropriately to epidemic-prone and emerging disease threats to minimize their impact on the health and economy of the world’s population. It is anticipated that ICD-10-CM will open new opportunities in injury research and trauma services evaluation. It will provide much-needed improvements in accurately classifying the nature of injuries and correlating them with cause, treatment, and outcome. The upgrade to ICD-10 offers providers and payers better data in support of their efforts to improve performance, create efficiencies, and contain costs. Better data also enhances health policy decision making. The improved logic and standardized definitions of ICD-10-PCS, the more accurate clinical terms in ICD-10-CM, and the more specific code descriptions in both systems give reason to believe that coding error rates will eventually drop below their current level under ICD-9-CM. The detailed nature of ICD-10-CM will lead to higher quality data, resulting in higher quality information for measuring healthcare quality, safety, and efficiency. ICD-10-CM allows for wider expansion and provides space to accommodate many additional codes for new medicine and technology developed in the future.

Begins this

October!

Latest InnovationImplantable Cardiac Monitors Tremendous Benefit to Patients and Their Cardiologists

Over the years, there have been many different types of cardiac monitors. These cardiac monitors—basically loop recorders that records each and every heartbeat, and stores it— have been extremely useful in the diagnosis of patients who are having unexplained, infrequent fainting, syncope/near syncope, fluttering, and palpitations. Among the first cardiac monitors was the 24-hour holter monitor, later followed by a 30 day monitor; in both of these cases, accurate monitoring was dependent upon the proper placement of the leads, and the patient then keeping the leads in place for the duration of the monitoring period. The next innovation was implantable cardiac monitors. The first of these was a device roughly the size of a cigarette lighter that was implanted through an incision underneath the skin on the chest wall. This device could be left in place for one year, with the patient regularly coming in to the cardiologist’s office for evaluation. The latest innovation is the “Reveal LINQ” implantable cardiac monitoring system. The Reveal LINQ is remarkably small—about the size of a wooden matchstick—making it the smallest heart monitor currently on the market. It can detect and record abnormal heart rhythms for up to 3 years, and is safe for use in MRI’s (in a specified environment and with specified conditions of use). The LINQ cardiac monitor is implanted through a simple outpatient procedure that takes about 15 seconds. The LINQ comes on the end of a needle, which is injected under the skin by way of a small incision. The patient receives a topical anesthetic at the incision site, but there’s no surgery involved, and no stitches; the small incision site is sealed with Dermabond. Once implanted, the LINQ is extremely discreet; it is not visible in most patients. Patients should experience no discomfort while the LINQ is implanted, and can go about their normal lives—showering, swimming, etc.—without the need to worry about dislocating the leads used by older cardiac monitors. The LINQ device can be easily removed if necessary.

Once the LINQ is implanted, it connects wirelessly to a station in the patient’s home, which is then connected either through a cell phone service or landline phone to a remote monitoring center. This remote monitoring center routinely and regularly informs the cardiologist as to the patient’s condition. According to Dr. Jose Piriz, cardiologist with the Heart & Vascular Institute at Clinch Valley Health, “the nice thing about the LINQ is that it is connected wirelessly, so I constantly have access to what’s going on with the patient. If there’s anything unusual on the report, we can follow up immediately” Dr. Piriz has already implanted LINQ’s in

several of his patients. “For one of these patients, the heart actually stopped for four to six seconds. I immediately got a call from the monitoring company, and we got the patient in and installed a pacemaker. We found this problem thanks to the LINQ. The patient had been having episodes of passing out or almost passing out for a long time, with no expla-nation. With the older 24 hour monitors, catching such a problem could be a matter of being lucky… If the patient was wearing the leads properly and everything was perfect and it happened to happen while the patient was being moni-tored, you could get lucky and catch it. Now with the LINQ, it’s always on, always connected wirelessly, and is basically intensive cardiac monitoring.” For more information about the LINQ cardiac monitoring device, please contact the Heart & Vascular Institute at Clinch Valley Health at (276) 596-6060.

Jamal Sahyouni, M.D. recently earned his certification as a diabetologist,

following an intensive training program through the Mayo Clinic. Dr. Sahyouni will be providing

comprehensive evaluation and management of diabetes as part of his practice at the Advanced Wound

Center at Clinch Valley Health. Diabetes can often exacerbate wounds and complicate

healing; diabetes decreases blood flow, so injuries are slower to heal than in people who do not have the disease. Further, many people with diabetes also have neuropathy —reduced sensation

in their hands or feet— which means they don’t necessarily notice an injury right away. Failure to diagnose and treat diabetic wounds can result in amputation. With the close

relationship between diabetes and wound care, Dr. Sahyouni’s new certification in diabetology

will be of tremendous benefit to patients at the Advanced Wound Center.

Jamal Sahyouni, M.D.New Certification

When an athlete goes down on the playing field, the athletic trainer is the first responder to prevent or treat an injury; yet only 42 percent of high schools have access to athletic trainers today. With the proliferation of school sports, and increasing student athletic participation, the importance of proper on-site health care has never been greater. Last year, Scott Rinehardt, DPT began working with the local high school football team because he recognized a need for sports medicine and athletic training care in high school athletics. He developed a partnership with the Athletic Training Department at Emory & Henry College. With the help of Emory & Henry’s Head Athletic Trainer Melissa Davis, Scott and Melissa were able to stand on the sidelines and care for the needs of the football

team throughout the entire season. “There are so many things an athletic trainer does," said Dr. Rinehardt. Among other responsibilities, they handle preseason conditioning programs and strength and flexibility training throughout the season, help students rehabilitate after injury, manage concussion care, ensure proper equipment fitting, help prevent heat-related illnesses and take care of small injuries before they become big problems. Last year alone, Scott and Melissa cared for sprains, cramps, dislocations, fractures, concussions, dehydration and torn muscles. Together they were able to facilitate treatment of injuries and monitor the recovery, so that the athlete did not return to play prematurely. "Football is such a great thing, and it has such an important place in our hearts in Richlands," Rinehardt said. "One of the keys is to make sure the game is played safely."Davis and Rinehardt are not motivated by wins and losses. Their main motivation is how they can ensure the kids enjoy their season injury free.

Physical Therapist on the Football Field

New Advances In Imaging

Clinch Valley Health is proud to announce that its new Magnetic Resonance Imaging (MRI) machine is operational. This new state-of-the-art MRI delivers both remarkable image quality, high productivity, and faster scanning. The MRI features a wider, shorter bore which, coupled with the well-lit, calming suite in which it is housed, will help to ensure patient comfort and satisfaction, especially for patients with claustrophobia. MRI diagnostic scanning uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. In many cases, MRI gives more detailed information about structures in the body than can be

seen with an X-ray, ultrasound, or computed tomography (CT) scan. Doctors may order MRI scans to help diagnose multiple sclerosis, brain tumors, torn ligaments,

tendonitis, cancer – including breast and prostate, and strokes, for example. Peter Mulkey, Chief Executive Officer at Clinch Valley Health stated,

“Our new MRI Suite will allow us to better meet community needs and enhance our ability to provide quality care close to home. The Suite

provides a calming patient environment with leading edge technology and we are very excited to offer that here at Clinch

Valley Medical Center.” The Clinch Valley Medical Center MRI Suite is open

9:00am to 5:00pm, Monday through Friday. Patients with a prescription for MRI from their personal physician

may schedule an MRI outpatient appointment by calling (276) 596-6000.

FALL CME CONFERENCESATURDAY, OCTOBER 3, 20158:30 a.m. to 5:00 p.m.Southwest Virginia Community College Buchanan Hall Room 130

REGISTRATION AND ACCREDITATIONContact Sally T. Presnell for registration form and for more information. (276) 596- 6482 or Sally.Presnell@lpnt.net

Danville Regional Medical Center designates this educational activity for a maximum of 1.0 AMA PRA Category 8 Credits.

• Status of Health Care in Virginia • Health Risks of Long Distance Running and Marathons• Demographics and Mechanism of Farm Machinery Injuries • Posttraumatic Stress Disorder in the Primary Care Setting • Pain Management of Trauma Patients - After Discharge • A New Surgical Specialty: Acute Care Surgery • Concussions, Traumatic Brain Injuries, and Carbon Monoxide Brain Injury• Antibiotics and Antimicrobial Stewardship in the Treatment of Sepsis and Septic Shock

TOPICS

Telemedicine Now at Clinch Valley Health Traditionally, health care has been provided in the physician’s office, hospital, or outpatient clinic. Patient care has been based primarily on face-to-face contact, with the exchange of information via conversation. However, technology is changing how and where care is delivered. Many patients now expect to interact with their providers online, and barriers that once prevented some patients from receiving care can be removed using telecommunication tools. Telemedicine is the delivery of health care through electronic communication such as audio/video teleconferencing. With health care reform emphasizing efficient, cost-effective, value based care, the use of telemedicine is spreading rapidly. It’s now being integrated into health caresystems, hospitals, long-term facilities, home health care, private physician offices, as well as consumers’ homes and workplaces. VALIS is a telemedicine company being utilized by Clinch Valley Health. Their mission is to increase patient access to specialty care services in rural and community settings through effective adoption of telemedicine services. VALIS is assisting Clinch Valley Health in developing a vision and strategy in-line with our overall goals. With their help, we are planning and implementing an integrated comprehensive telemedicine program that will support the objectives of the clinical operational and administrative teams at Clinch Valley Health. In particular, what this means for Clinch Valley Health is that Pulmonologist, Sami Jawad, M.D. will now be covered when he is absent. Patients will still be able to consult with a Pulmonologist via a teleintensivist.

RATE OF RESPONSE TO QUERIES Clinch Valley Health’s Health Information Management Department, through its Clinical Documentation Improvement (CDI) program, has been extremely successful in improving documentation and enhancing and improving physician profiles. Physicians have been responsive to queries, leading to improvements in appropriate documentation, which enhances quality. Jean Harrell, Health Information Management Department Director, has been very pleased with the success of the CDI program. Jean wants to particularly point out the awesome job completed by: Debbie Newberry and Rhonda Anderson, who have been excellent at dialoguing with physicians about this program; Dr. Farrell as CVMC Chief Medical Officer; and of course the amazing CVMC medical staff members, who are willing partners in the program to improve documentation. Since our new program started in April, CVMC medical staff members have a 95.5% rate of response to queries issued.

NEW PACEMAKER TECHNOLOGY ALLOWS PATIENTS TO SAFELY UNDERGO MAGNETIC RESONANCE IMAGING (MRI) TESTING

The use of implantable cardiac devices, such as pacemakers, is increasing dramatically in the United States. An estimated 75% of patients with an implanted cardiac device will need magnetic resonance imaging (MRI) at some point during their lifetime. In the past, MRI was not advised for patients with implantable cardiac devices due to concerns that the MRI’s powerful magnetic field might cause damage to the device or cause the device to malfunction. Now, new technology has made it possible for patients with pacemakers to undergo MRI testing. The new pacemakers and wires, approved for use by the Food and Drug Administration, are constructed of special metal alloys that allow for MRI imaging. According to Dr. Jose Piriz, a specialist in Cardiology at Clinch Valley Health, “It’s a crucial step forward in pacemaker technology, because that was always the limitation that we had with pacemakers. If you had a pacemaker, you couldn’t do an MRI. So, they’ve developed these pacemakers now with special alloy materials that are actually MRI compatible. Now a person can get a pacemaker and if it’s MRI compatible, with compatible wires, the patient isn’t limited in their ability to get an MRI. As we get older, things tend to wear out, and the MRI is a great technology for detecting a lot of different body abnormalities, and you hate to close the door on all these patients, who just because they have a pacemaker they can’t have an MRI. This new type of pacemaker makes it a lot easier for more patients to get the benefit of MRI technology.” Dr. Piriz is a part of the Clinch Valley Heart and Vascular Institute, which has integrated Clinch Valley Health’s specialists to provide an extraordinary level of expertise and experience to patients and physicians alike. Dr. Piriz specializes in Non-Invasive/Nuclear Cardiology for the diagnosis and treatment of heart and vascular illness. Dr. Piriz has been instrumental in amplifying cardiology services at Clinch Valley Health, such as the Nuclear Cardiology Lab, Echocardiology Lab, and the Coumadin clinic. Clinch Valley Health’s mission is to set and live the standard for delivering exceptional health care and improving the quality of life for our community. Clinch Valley Health is a place where patients choose to come for health care, physicians want to practice and employees want to work. For more information, please visit www.clinchvalleyhealth.com or call 276-596-6000.

“It’s a crucial step forward in pacemaker technology”

CLINCH VALLEY HEALTHMEDICAL STAFF DEPARTMENTS AND HOSPITAL COMMITTEE

MEETING DATES 2015

Mark Your Calendar!Important Upcoming Meetings