Survivor and an inspiration



It’s Breast Cancer Awareness Month and there’s been a recurring theme on the blog this month – I’ve been able to share the stories of people who dealt with breast cancer with dignity and determination.  I first shared this story three years ago and to this day Courtney is an inspiration for me.  Courtney is one of the kindest, most positive people I have the honor and pleasure of associating with.  Here’s the blog I posted three years ago this month.

This is the link to a You Tube video. The video is 2 minutes and 14 seconds long. The last 20 seconds are the best and if you watch you’ll get to see one of my hero’s and one of the most inspirational people I know.

God Bless You Courtney, you amaze me every day and your strength, faith and courage are an inspiration to us all!

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Chrissy’s Story 2016: Breast Cancer Awareness Month


October is Breast Health Awareness Month and that means it’s time to once again share “Chrissy’s Story”.

Chrissy Wilson shares her story of being diagnosed with breast cancer at age 28, her story is awesome and I could have never done it justice. Without further ado, in her own words, here’s Chrissy’s story:

It all started with me touching myself! Here’s the story…One evening while in the shower I decided to do a self breast exam. I’m not sure why, I’ve done self exams in the past but I wasn’t good about doing them regularly, I’d probably read about them in a magazine earlier in the day. When I crossed my right breast I had shooting pain and I could feel 3 knots. I felt the left side and it seemed fine. I’d never felt knots in my breast before but as I said I wasn’t good at doing the exam on a regular basis so I asked my husband, Jeremy, to feel them. If anyone knows how my breasts feel, it should be him! After feeling the knots himself he suggested that I see my family doctor who referred me for a mammogram. At this point cancer was the farthest thing from my mind for a number of reasons. 1) It could never happen to me 2) I’m too young and there’s no family history 3) I had read, probably in the same magazine that recommend the self breast exam, that breast cancer isn’t painful.

I was anxious about my first mammogram, afterall, I was only 28 years old at the time and I had no reason to have a mammogram before. I was worried that it would be painful, truth is it didn’t hurt a bit, maybe that was because I didn’t have much to hurt, who knows. That same day, after my mammogram, it was recommended that I have an ultrasound but again, no big deal because I was told my breasts were dense since I was young. I soon started to worry a little. I was sitting in a hallway with a gown on watching other women leave after their mammograms and I started to wonder “why aren’t they having an ultrasound, they look young, aren’t all young breasts dense”.

I sat and waited in that hall so long that Jeremy, who was in the waiting room asked the receptionist if I’d left the building. If I knew what was ahead of me, trust me, I would have left that building! After my ultrasound I was told I would need a biopsy. I asked them if they thought it was cancer and that moment, for some reason, I knew the answer even though they said they were 99% sure it wasn’t.

On November 15, 2006 I was diagnosed with breast cancer, stage II Invasive duct carcinoma to be exact. I was given two options, a lumpectomy or mastectomy. I chose the mastectomy; in fact, I chose to have a bilateral mastectomy even though the cancer was only on one side. I felt that they came as a pair so they should go as a pair!

On December 12, 2006 I had both breasts and 7 lymph nodes under the armpit removed. One lymph node was involved and my cancer was found to be estrogen and progesterone receptor positive which means the cancer grows from these hormones. After the surgery I began chemotherapy and had to do eight rounds, Cyclophoshamide with Doxorubicin the first 4 treatments followed by Taxol last 4. I lost my hair and my breasts, but I never lost HOPE.

Over an 11 month time span I had 3 major surgeries; mastectomy, breast reconstruction, and hysterectomy and with the hysterectomy I had my gall bladder removed because at this point my feeling was “If I don’t need it, take it out”. I also had two procedures to place and remove a port used for blood draws and chemo administration.

At the time I was diagnosed, my sons were 9 and 5 years old. These two children saw more in a year than most see in a life time. I never once tried to keep anything from them. I believe what they saw and experienced has made them stronger and helped them become who they are today. People tell me how strong I am, but really it’s my family who’s strong. They’re the ones that got me through this. I could have never done it on my own.

I deal everyday with what breast cancer has taken from me. I’m going through menopause due to my hysterectomy and the anti cancer drug, Aromasin, I now take. I have Osteopenia (bone loss) which is a side effect of the Aromasin and I have to take Boniva for the bone loss. As a result of the removal of my lymph nodes I struggle with Lymphedema which causes swelling and pain in my right arm and hand. I have man-made breasts, minus the nipples. That’s right, no nipples, a mastectomy really does take it ALL. Breast cancer took a lot from me, but it DID NOT TAKE MY LIFE AND IT DIDN”T TAKE MY HOPE!!!

This was my journey and I’ve decided to take the bad and turn it into a positive. I tell my story because someone reading this may someday hear “You have Cancer”. Just like you I thought “it will never happen to me”.

My hope is my story will encourage you to do your self breast exams and get regular mammograms, it could save your life. – Now go touch yourself!!!

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Bundled payments bring both risk and opportunity


Here’s how bundled payments work.  CMS sets a target price for a medical or surgical episode.  It pays providers on a fee for service basis through the course of care but after a certain amount of time the total cost of care is reconciled with the target amount.  Hospitals get to pocket the difference or pay back the amount it cost to provide care for the patient above the target.  Hospitals are “on the hook” for the cost of services provided within their facility and the cost of care when the patient leaves their four walls for a designated amount of time.  This model requires hospitals to carefully control cost for services they provide and identify low cost providers to meet the patients needs once the patient leaves their facility.

Around a year ago CMS launched a bundled payment initiative for hospitals and ambulatory surgical centers that perform hip and knee replacements in certain areas of the country.  The bundled payment program was launched as a demonstration and certain geographic areas were included.  The bundled payment program pays the hospital on a fee for service basis for the surgery and any other services provided to the patient that relate to the joint replacement.  Any additional services the patient needs for 90 days following the surgery are also tracked.  Most patients who have an elective joint replacement will need either a skilled nursing stay or home health and many will then progress to outpatient rehab.  Once 90 days passes the hospital where the surgery was performed gets to pocket some money or pay back the difference.  You can see how hospitals have real incentive to reduce cost and identify low cost, high quality, post acute services.

CMS has now proposed bundled payments for three new episodes including heart attack, coronary artery bypass and hip fracture.  The three diagnosis I just mentioned really raise the stakes and the difficulty in controlling cost.  Elective joint replacements are just that, elective.   Surgeons and hospitals can be selective about who they provide services to.  If a patient is high risk or has other underlying health concerns a decision can be made to not provide the service.  Heart attacks and hip fractures are different.  No one plans to have a heart attack or fracture a hip.  Patients who have these diagnosis are generally high risk and they tend to have complications because of comorbidities.

Bundled payments provide a lot of incentive for hospitals to reduce cost.  It’s easier to reduce cost when the patient population is hand picked.  The newly proposed expansion to bundled payments increases the complexity in controlling cost exponentially.



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Being better, doing better, helps our patients get better

Quality Billboard

Our Mission is to provide exceptional health and wellness services with friendliness and compassion and we devote most of our time and resources to helping people get better.  When we help people get better we’re not only helping the sick become well but we help the healthy learn how to get healthier.

This next week we have an opportunity to help our organization get better.  Beginning Monday, September 12, GVMH will host a site visit for a team of examiners from the Excellence in Missouri Foundation as a result of our most recent Missouri Quality Award application.

GVMH submitted its first Missouri Quality Award application in 1999 and we’ve continued to participate for the past 17 years.  Although the process involves the word “Award” the value is in the feedback we receive from our application and the value of the feedback is increased by a site visit.

The application we submit is 50 pages and is a response to the criteria for performance excellence based on the Malcolm Baldrige National Quality Award Criteria.  The feedback we receive as a result of the application and site visit will provide us actionable feedback to help us grow and improve as an organization.

While on-site, examiners will look at our approach, deployment, learning and integration for processes we use in the areas of leadership, strategic planning, customer focus, knowledge management, workforce focus, process improvement and results of our activities relative to our five pillars – people, service, quality, finance and growth.

Examiners will be meeting with hospital personnel to better understand the information we submitted in the application and examiners will be traveling throughout the organization in hopes of talking with as many staff as possible to validate that we do what we say we do.

We help people get better everyday, our participation in the Missouri Quality Award process provides us feedback to get better as an organization.  The better we are as an organization the better we can help those we serve.

I’m excited for the site visit and I hope you are as well.  If you have an opportunity to visit with one of the examiners tell your story with pride because at GVMH we have a lot to be proud of!

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The insurance marketplace; buyers and sellers needed


The Affordable Care Act better known as Obamacare, has a lot of moving parts.   One of the main aspects of Obamacare, insurance marketplaces, have hit a rough spot.  The law’s online marketplaces — where people were supposed to be able to easily shop for health insurance — have been suffering from double digit premium increases and defections by big name insurers.

Three years in, many of the established, and known, insurers say they are seeing losses from selling individual plans. Many of the nonprofit Blue Cross plans and other known insurers are having trouble. Insurance co-ops created by the law have mostly gone out of business and one of the biggest insurance providers, United Health has exited most states where it once offered individual plans.  In addition, Aetna has pulled out from 11 states.   The defections are adding up and it appears there is something of a herd mentality taking place and no one insurer wants to be the last one participating.

When the marketplaces were established the thought was competition amongst insurers hoping to sign people up for their plans would help to keep premiums low.  In addition to controlling cost, the marketplaces should also help to improve service.  In theory that’s what competition does, decrease cost and improve service but now fewer options exist and it’s estimated that 17% of people eligible for the market will have no choice of carrier next year.

Health insurance is a business and insurance companies want to stay in business which means they can’t operate at a loss.  One way to bring insurance providers back to the table is to increase the number of enrollees but they have to be the right types of enrollees.  Premiums will continue to grow if heavy users of health care continue to shop on the marketplace and cost control goes out the window.  Young, healthy people are the key to reducing costs in the marketplace.  Healthy people consume fewer health care resources so they help to offset the cost of insurance for everyone covered by a plan.  To date there are only half as many people as projected participating in the health insurance marketplace so enrollment has never grown to a critical mass.

There’s been talk about the government creating, and selling, an insurance product to compete with private insurers.  As you can imagine, this approach is controversial and probably won’t receive enough bipartisan support to work.  Tax incentives could be increased to help cover the cost of insurance for those who are shopping on the marketplace.  While incentives may encourage more participation, it doesn’t seem like incentives will reduce cost.  It’s kind of like moving money from one pocket to the other.

There’s no easy solution and there’s a lot of uncertainty in how to improve the market place.  One thing is certain, a marketplace only exists when both a buyer and a seller are present.  To date the health insurance marketplace doesn’t have enough buyers and there are fewer and fewer sellers.

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Aim for Excellence


Patients deserve and expect safe, high-quality, evidence-based care from their health care providers. This requires hospitals to have a continuous focus on improvement to ensure the quality and safety of the care delivery processes and the use of evidence-based practice.

In 2013 GVMH made the decision to eliminate Catheter Associated Urinary Tract Infections (CAUTI) in our organization.  To accomplish our goal we began a comprehensive, interdisciplinary quality and safety improvement project to reduce catheter-associated urinary tract infection (CAUTI) by 25% through implementation of evidence-based policies, processes, and protocols.

There were many reasons this project was given priority focus at our organization.  CAUTI was the most common healthcare-associated infections occurring within our patient population and considered to be reasonably preventable when appropriate, evidence-based strategies are in place, this project was deemed as one that could significantly improve patient outcomes and experience, as well as reduce the costs associated with care and treatment of patients who develop a CAUTI.

Research estimates that costs associated with CAUTI range from $911 to treat a symptomatic CAUTI (with a 1 day length of stay increase) up to $3,824 to treat a blood stream infection associated with an indwelling urinary catheter (with an average of 3 days length of stay increase).

Through hard work and diligence by nursing staff and providers, GVMH has gone more that 1,000 days without a CAUTI and we are being recognized as a leader in the state for our efforts.

On November 3, GVMH will be presented with the prestigious Aim for Excellence Award at the Missouri Hospital Association Annual Convention.  The award recognizes up to six hospitals across the state who have been successful at improving the patient experience, improving patient health and decreasing cost.  GVMH has been identified as a role model organization in reducing CAUTI’s.  More importantly, GVMH is being recognized for our efforts in the primary role of all health care providers – “first do no harm”.  Adopting processes to help our patients avoid preventable infections is more than just good care, it’s about saving lives and providing the best care.

GVMH is your hospital and that’s why we Aim for Excellence.


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CMS Star Rating


In late July the Centers for Medicare & Medicaid Services (CMS) released Overall Hospital Quality Star Ratings for all hospitals in the United States.  The Star Rating is designed to help individuals, their family members, and caregivers compare hospitals in an easily understandable way. Over the past decade, CMS has published information about the quality of care across the five different health care settings that most families encounter.  The new Star Data incorporates more measures and allows consumers to compare hospitals side by side which increases transparency.

The new Star Rating methodology takes 64 existing quality measures already reported on the Hospital Compare website and summarizes them into a unified rating of one to five stars. The rating includes quality measures for routine care that the average individual receives, such as care received when being treated for heart attacks and pneumonia, to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections.

The rating system has come under scrutiny because some hospitals contend that socioeconomic data does not factor in.  Patient’s who do not have ready access to healthcare services either because they do not have health coverage, or services are not available in their community, are at a disadvantage.  Health outcomes are impacted by a patient’s ability to access care.  The more access a patient has to care the more likely they are to receive timely treatment.

Only 2% of hospitals received a 5 Star Rating and roughly 20% received a 4 Star Rating.  GVMH received a 4 Star Rating and compares very favorably to hospitals in this region and across the country.  GVMH was above, or at, the national average for all measures.

GVMH’s 4 Star Rating fits with our Mission: To provide exceptional health and wellness services with friendliness and compassion.

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