Hospital Administrators :: Why Partner with CEP America

CEP America (CEP) is the national leader in developing programs in emergency department quality, service, and operations excellence. Our goal is to be the emergency department (ED) physician group of choice by accurately predicting the healthcare environment and partnering with our client hospitals to provide the leadership and management expertise necessary to meet the challenges that face emergency medicine.

Our hospital administrators expect the best and CEP delivers with its combination of physician leadership and proven programs. Have you ever felt that you had to choose between the local attention you receive from a solo group and the programs and resources you receive from a larger physician group? CEP's medical practice model provides a solution that has withstood the test of time. The CEP Partnership strives to secure satisfying, long-term work opportunities for our high quality physician Partners by enabling physicians to enjoy the best attributes of both a small and large emergency department group.

Our physician Partners are active on many levels in the communities they serve and hold positions in the American College of Emergency Physicians (ACEP), Hospital Boards, County EMS and Medical Societies, as well as serving as Chief of Staff at numerous sites. Board Certification is a requirement to become a Full Partner; and these emergency room professionals are also expert speakers on a variety of topics in this field - CEP America's Speakers Bureau. Also, check out a copy of CEP America’s Annual Report to Hospital Administrators.

Physician Leadership
Operations Excellence
Service Excellence
Quality Excellence

PHYSICIAN LEADERSHIP

CEP Medical Director

The right medical director, the right physicians, and strong working relations with the nurses are the keys to a successful emergency department team. Because of our democratic partnership structure and physician support services, CEP's track record of attracting and retaining highly productive, clinically competent, board certified physicians who are effective leaders is second to none. However, qualifications are only part of the picture. CEP works hard to find the right fit between each physician and the ED where they have a clinical practice. Established physician evaluation procedures allow CEP to identify areas where there is potential for concern and intervene for early and prompt resolution.

We believe that the Medical Director is key to a successful relationship between CEP and a client hospital. Medical Directors are chosen by mutual agreement between CEP and hospital administration. CEP expects each medical director to have superior administrative, clinical and technical skills; a professional demeanor; and local site and community commitment. Furthermore, CEP evaluates the continuous demonstration of effective and timely communications with the entire hospital team.

CEP also offers an ED Medical Director Academy program to provide future and present directors with the skills and resources necessary to manage physicians and become an effective team leader within the ED.

CEP Regional Director

In addition to the site leadership of the Medical Director, CEP has a Regional Director who oversees several hospital contracts in an area. CEP Regional Directors provide administrative support and serve as the liason between hospital administration, emergency departments, and CEP. They are responsible for bringing the full resources of CEP to the local ED sites within the region. Regional Directors also work clinical ED shifts. Our Regional Directors provide valuable support to Medical Directors in all physician management situations, and regularly schedule meetings with hospital administration to ensure that client expectations are verified and met. As a direct result of this improved communication structure, hospital administrators have alternate pathways in which to share their thoughts and are protected from having to directly intervene in the correction of local phsyician problems.

Physician Education

CEP is accredited by the Institute for Medical Quality, a branch of the CMA and a CME granting organization. The following CME programs are currently offered to our Partners:

North and South Regional Meetings – the objective of this course is to provide our emergency physicians with up-to-date knowledge regarding emergency medicine.
On-line Pediatric Journal Review
Sepsis Performance Improvement Initiative
CEP LLSA Journal Club
Onsite Two-Day Ultrasound Course

In addition to the CME Programs, CEP also has available the following training programs:

EMTALA Certification & Training Program
Service Excellence Training Program

Check Six Patient Safety Training Program

All CEP emergency physicians are encouraged to belong to one or more recognized professional societies; and many physicians choose to obtain their CMEs through the educational offerings of these societies, which also keeps them involved in local and state economic and political issues as they affect emergency medicine. As noted above, CEP received CME granting privileges by the Institute for Medical Quality, a branch of the CMA. To support our efforts in this area, we have developed a CME/Clinical Quality Committee to provide input regarding CEP CME objectives and clinical quality initiatives. This committee serves as the review body for clinical education materials provided to the Partnership. Two regional CME courses for Partners are provided for all interested physicians each year at the Partnership’s expense. Additionally, CEP has developed an ultrasound course which provides 40 hours of training to physicians in this important diagnostic modality.

OPERATIONS EXCELLENCE

Patient Flow

Optimizing patient flow and decreasing time to provider is a key CEP initiative. Re-engineering the emergency department requires buy-in of the physicians, nurses, and hospital administrators. We have supported this process by facilitating the networking of our physicians and nurse managers across all CEP emergency departments to showcase to our new ED sites how concrete and reproducible improvement in patient flow can be achieved through our Rapid Medical Evaluation Program^© (RME). RME is not a one size fits all program. Customization by patient volume, as well as by physical plant limitations, and available personnel is essential. A strong relationship between the ED nursing and physician leadership is also necessary to make RME work. Additionally, MedAmerica’s (our physician-owned practice management partner) Practice Management Consultants provide another level of management expertise by conducting detailed operations assessments and on-going site visits across CEP client sites.

In December of 2006, the average time to provider for CEP emergency departments reached an all-time low of 35 minutes. Our five greatest improvements in TTP (Time to Provider) in 2006 had an average decrease of 35%.

At CEP, we also understand that improving front-end ED flow is not enough. The Institute of Medicine (IOM) and The Joint Commission (TJC, formerly JCAHO) recently recognized that hospital inpatient capacity problems are the primary reason for ED overcrowding. Many CEP physician leaders have already started working with their hospitals and medical staffs to address inpatient length-of-stay, hospital capacity management, and movement of patients from the ED to inpatient wards. In March 2007, CEP convened a group of our key physician leaders and managers to discuss how we can best support our hospitals to decrease inpatient LOS, and decrease the transfer time between the ED and inpatient unit. Our goal is to use our patient flow management expertise and our experience leading multi-disciplinary hospital improvement to help our hospital partners address patient flow throughout the hospital.

Data for Performance Improvement

CEP’s proprietary data warehouse system MARS (MedAmerica Analysis and Reporting System) provides CEP Management with easy access to data that is used as a management tool to monitor and improve performance. Through MARS, CEP can compare any element for which data has been collected, including physician profiling, clinical costs and outcomes, capabilities to aid in improving quality and delivery of care. With appropriate data sources, MARS can make detailed analysis reports tailored to the needs of physicians, nurses, and administrators on innumerable aspects and measurable metrics of the practice. These range from patient satisfaction, length of stay by patient or per individual physician, to an analysis of length of stay by discharge status, day of the week, and diagnosis to CAT Scans by diagnosis by physician. MARS has also been used by the state of California for early detection and monitoring of the annual flu season.

CEP America also links all emergency departments and physician Partners to extensive management resources through our proprietary intranet and website. For instance, one tool that provides value to both hospital administrators and the ED medical director is our ED Calculator. This tool is used to show the relationship between improvements in ED operational metrics and hospital revenue. By entering your hospital's data, this tool can approximate annual savings. (The ED Calculator can also be seen courtesy of CEP America at the Studer Group® website.) We also share best practices developed throughout our national network of over 60 emergency departments.

Support for Patient Throughput

CEP has developed other programs and services to support the management of targeted patient populations within the emergency department, to maximize patient flow and address specialized patient, medical staff and client hospital needs. Through our practice support partner, MedAmerica, we can offer Hospitalist and On Call Panel solutions to further enhance patient throughput as well as consultations for any aspect of ED operations.

SERVICE EXCELLENCE

Like our hospital clients, CEP regards the emergency department as the front door to the hospital. All of our medical directors understand the importance of a positive patient experience and are leaders in ensuring a caring environment for our patients. Attention to service excellence is part of our core strategy and CEP-staffed emergency departments regularly score near the very top of their peer group in patient satisfaction.

Our Director of Operations and Service Excellence, Dr. Jay Kaplan, also a consultant to the Studer Group and Press-Ganey, spearheads our comprehensive patient satisfaction program. This program includes formal service excellence training for all ED personnel, a physician driven ED patient callback program, and a proprietary patient satisfaction survey. This comprehensive approach also includes the development of patient satisfaction work groups, service recovery and complaint management.

Patient Satisfaction Surveys

Our survey, which has been sent to over 1.4 million patients, is highly statistically significant, is provided at no additional cost to our hospitals, and unlike many commercially available surveys, is both physician and issue specific. Thus it not only measures, but more importantly, helps focus ED customer service efforts.

Teamwork

CEP emphasizes a team approach and identification of opportunities to improve the outcome of the patient encounter for all stakeholders, including patients and families, medical staff, nursing, EMS, administration, the community and healthcare system. Teamwork is key to improving patient satisfaction, reducing medical errors, increasing productivity, and expediting admissions.

Our group is committed to fostering an atmosphere of mutual respect and teamwork amongst all of the ED team members. Creating a strong, team environment in our emergency departments improves job satisfaction for all team members, enhances patient care, and improves the operations and efficiency of the department. To that end, CEP has a formal Physician-Nurse Relationship Program. Additionally, nurses and ED Staff are surveyed on a regular basis to obtain their input and feedback on how we can continue to enhance this relationship.

CEP also has a collaborative training program, Check Six, designed to improve patient safety as well as staff and provider satisfaction through a team approach to performance improvement and error reduction. This is a proprietary program modeled after the MedTeams program.

QUALITY EXCELLENCE

Because of our Partnership’s structure CEP has, since our inception, been uniquely successful at attracting the highest caliber emergency physicians. At CEP, we understand that providing high quality, cost-efficient emergency care is much more than hiring the best emergency physicians. Thus, we provide our physicians with the education and system support necessary to make measurable quality improvements. For example, CEP started providing biannual updates to all of our sites on the CMS (Centers for Medicare & Medicaid Services) performance indicators as soon as this program was adopted by the federal government. In addition, we began participation in the physician specific CMS PI Program equivalent, the CMS Physician Quality Reporting Initiative (PQRI, formerly PVRP) in January 2007, months before the official program rollout date.

CEP provides and requires Partnership-wide education and compliance with EMTALA, HIPAA, and TJC regulations. Thus, when TJC developed its new medication reconciliation standards, CEP medical directors were already prepared to provide expert assistance to our hospitals on best practice compliance with this regulation, making implementation a seamless “business as usual” event for our emergency departments.

CEP is the first Institute of Medical Quality (IMQ), CME granting institution to link performance improvement to physician CME. We offer all of our Partners the ability to obtain CME for improving performance on sepsis, congestive heart failure, and the CMS indicators. Why did we choose these clinical issues? Because congestive heart failure is the number one cause of lost hospital revenue and because goal directed sepsis therapy has been shown to substantially decrease inpatient ICU days and mortality. Our goal is to ensure that our quality programs not only provide our physicians with cutting edge knowledge, but compliment the needs of our client hospitals.

Improving patient safety and risk reduction are key CEP quality initiatives. CEP is the first large physician group in the U.S. to directly access risk records to develop specific risk reduction programs at the individual physician and site level. In addition, one of our Partners, Dr. Marc Taub, developed the Check Six program. This program teaches healthcare providers the communication techniques similar to those used by top jet fighter pilots. It is available to all of our sites to improve communication among all members of the ED team to decrease medical error and reduce both hospital and physician risk.

Superior Regulatory and Liability Experience

CEP contract sites benefit from our expertise in billing, TJC, coding and compliance, and HIPAA. CEP has an active compliance program that complies with the Federal Sentencing Guidelines and the Model Compliance Plans recommended by the OIG. Annual compliance training is required for all CEP providers. CEP has the ability to perform coding and billing compliance audits to monitor our contract sites' adherence to current coding and reimbursement principles contained in applicable federal and state healthcare program statutes and regulations through our billing subsidiary, MedAmerica Billing Services, Inc. (MBSI). CEP can assist client hospitals in ensuring ED compliance with HIPAA regulations.

With over 60 emergency departments across the nation, CEP maintains current knowledge of important TJC issues that pertain to the ED. CEP has developed a proprietary handbook to assist our Medical Directors and ED Nurse Managers with their preparations.

As the founders of the physician-owned MedAmerica Mutual Risk Retention Group, CEP has access to the unique risk management and loss control services this insurer provides. Actuarial studies indicate that CEP’s claims experience is 20-30% better than the average claims experience for emergency department groups throughout the U.S.