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Community Newsletter A message from Steve

Recently, I had a chance to see firsthand the impact of St. Charles’ Community Benefit program, which gives thousands of dollars in grant funding to community organizations throughout Central Oregon each year.

On a recent Tuesday morning, I had the honor of presenting a $30,000 grant to the La Pine Senior Activity Center to help the facility pay for a much-needed kitchen remodel and new commercial ovens.

This work is vital in La Pine, where the center provides nutritious meals to 60 to 90 community members every week. In a town of a few thousand folks, that is a significant number of people who depend on the center for food.

While I was there, I met a staff member named Barbara, who calls herself “the baker.” She has been putting the new ovens to good use, making treats for patrons of the center.

“There are really no words,” she said. “I love it so much!”

That day, I was reminded of what an important role senior centers play in our communities. By providing a place for seniors to gather, they help to reduce social isolation and give people a place where they belong and can make connections with others.

As you may already know, St. Charles’ Community Benefit program recently announced its grant priority for the next three years: reducing loneliness and increasing belonging in Central Oregon. We’re calling this effort Celebrate, Together; Celebrando Juntos, and the goal is to direct thousands of dollars in grant funding to organizations that are creating opportunities for communities to connect in person.

We’re doing that because we know that isolation, loneliness and depression affect more than just the individual experiencing them. They are root causes of a variety of health problems and societal issues, and we believe that by bringing people together and helping them connect with others, we can make a positive impact on their health and the health of our community.

That’s why we’re here. It’s one reason St. Charles has a Community Benefit program. And it’s why seniors in La Pine will be able to come together and enjoy Barbara’s baked treats for the foreseeable future.

The health system is now accepting grant applications, and community-based groups, nonprofit organizations, education systems and tribal entities that serve youth, older adults and/or vulnerable populations are encouraged to apply. Applications are due Sept. 30. To learn more about the grant requirements and application process, visit our webpage.

Thanks, as always, for reading.
Steve

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Community Benefit

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Press Release

St. Charles is pleased to welcome Dr. Jeremy Kenison as a new Family Medicine physician at the Sisters Family Care Clinic.

Born and raised in New Hampshire, Kenison attended Rocky Vista University College of Osteopathic Medicine in Colorado and then went on to serve for 10 years as an active duty physician in the U.S. Navy, most recently in Washington. Now a civilian, he is excited to be serving the Sisters community and to start building relationships with patients of all ages.

“I’m looking forward to engaging with my patients, from newborns to retirees, and building that physician-patient bond while providing them with a broad spectrum of care,” Kenison said. “I want to understand who they are and their concerns, and what they need from me so I can better advise and help them understand their health and their health journey.”

Dr. Kenison is a Doctor of Osteopathic Medicine, which typically take a more holistic, whole-person approach to health care and emphasize improving wellness through education and prevention. Kenison believes in providing his patients with an informed and clear understanding of medicine, and empowering them to understand and take charge of their well-being.

Osteopathic forms of treatment and diagnosis can also involve manual medicine, called osteopathic manipulative therapy (OMT), of which Kenison is a big proponent.

“OMT is often focused on musculoskeletal and chronic pain issues, but it can also help out in other areas like your lymphatic and pulmonary systems. There’s a lot of opportunity for where hands-on manipulation can augment what the body is naturally doing to heal, with very minimal side effects.”

Hiring a new provider is one of the ways that St. Charles is demonstrating its commitment to serving the Sisters community. The health system also reopened the Sisters lab this summer, eliminating the need to commute to Bend or Redmond for lab services, a move that has already garnered gratitude from patients and caregivers.

Kenison is looking forward to being a part of that long-term commitment and becoming a health resource patients can look to in times of need.

“Sisters is a smaller practice but that’s exactly what I’m excited for and what I came from in Washington. Growing the clinic and finding how we can be of service and how we can best support that community is something I’m definitely excited for.”

When not working, he and his family are looking forward to exploring Central Oregon and spending as much time outdoors as possible.

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St. Charles Family Care

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Grand Rounds

Grand Rounds - September 22, 2023
"Dermatology for the Primary Care Physician"

Speaker: Cindy Wassef, MD. Residency Program Director, Rutgers Center for Dermatology; Assistant Professor, Department of Pathology & Laboratory Medicine Rutgers, Robert Wood Johnson Medical School.

Objectives

Accurately describe and document skin problems using proper terminology.
Diagnose common skin conditions, including benign skin growths and skin cancers.
Treat dermatologic conditions, including utilization of recently approved medications.

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)^TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

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Grand Rounds

Grand Rounds - September 15, 2023
"Artificial Intelligence in Medicine"

Speaker: Geoffrey Tso, MD. Clinical Assistant Professor, Stanford University School of Medicine.

Objectives

Discuss how artificial intelligence is changing the landscape of medical science.
Examine the benefits and risks of established artificial intelligence applications in clinical practice on physicians, healthcare institutions, medical education, and bioethics.
Assess the challenges and future directions of artificial intelligence in medicine.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

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Press Release

This is a joint press release from Mosaic Community Health, St. Charles Health System and Deschutes County:

Sisters, Oregon, Sept. 13, 2023 – The Sisters School-Based Health Center, located adjacent to Sisters High School, will soon expand its operations from two days a week to four days a week, thanks to a partnership between Mosaic Community Health, St. Charles Health System and Deschutes County. On Oct. 18, Mosaic will assume operations of the health center, which is currently operated by St. Charles Health System, in a building owned by Deschutes County.

“We are thrilled to be able to provide additional access to pediatric patients in Sisters by offering expanded hours for the health center,” said Tamarra Harris, pediatrics manager for Mosaic. “In addition to a pediatric-trained medical provider, we also plan to have a full-time behavioral health consultant on site. We want to thank our community partners, St. Charles and Deschutes County, for supporting this transition, which will benefit our community.”

Under Mosaic, which operates six additional SBHCs throughout Central Oregon, the health center will provide a pediatric-trained medical provider, a full-time behavioral health consultant, a community health worker, plus clinical pharmacy, Oregon Health Plan enrollment and nutritionist support. Deschutes County Behavioral Health staff will also be located on site.

“We believe this transition will benefit the Sisters community and shows the exceptional partnership the medical community has in Central Oregon,” said Emily Salmon, vice president for whole person care and community health at St. Charles. “Ultimately, our goal is to provide the best access possible to medical care in our community and, in this case, that means transitioning the clinic to Mosaic, which has access to federal funding to expand services.”

Since 2015, the Sisters SBHC, located at 535 N. Reed St. in Sisters, has been providing convenient access to quality healthcare for local pediatric patients—one of the primary goals of SBHCs, according to the Oregon Health Authority. Other goals for SBHCs include:

Providing patient-centered care for all students, regardless of insurance status
Reducing costs related to unnecessary hospital stays and use of emergency rooms
Improving education outcomes—because healthy kids learn better
Saving parents time by reducing hours of missed work to transport children to appointments

Utilizing unique public-private partnerships, SBHCs have been operating in the state of Oregon since 1986. There are currently 85 certified SBHCs across Oregon. Mosaic and their school district and county health partners currently operate six of those in Central Oregon, including at Bend High, Mountain View High, Madras High, Redmond High, Lynch Elementary and Crook Kids in Prineville. La Pine Community Health Center operates one SBHC in La Pine.

“School-Based Health Centers provide a great service within Deschutes County, helping eliminate barriers for our youngest residents to receive health care. Together, Mosaic and St. Charles are helping to create a healthier Central Oregon and we applaud our continued partnerships,” said Holly Harris, Deschutes County behavioral health director.

In addition to medical and behavioral health care, providers at Mosaic SBHCs emphasize prevention, early intervention, risk reduction and the development of healthy habits with their young patients. Mosaic SBHCs are open to anyone from birth through age 18; patients do not need to be a student at the school where the SBHC is located.

“We appreciate St. Charles, Deschutes County Health Services and all of our local partners for working together with us to improve the health of everyone in Central Oregon,” said Elaine Knobbs-Seasholtz, Mosaic director of strategy and development.

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SBHC

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Grand Rounds

Grand Rounds - September 8, 2023
"Psychosis and Comorbid Substance Use Disorder: Dual Diagnosis"

Speaker: Joseph M. Pierre, MD. Health Sciences Clinical Professor, Department of Psychiatry and Behavioral Sciences, UCSF School of Medicine.

Objectives

Identify rates of comorbidity between psychotic disorders like schizophrenia and substance use disorders.
Identify illicit drugs that can cause psychosis.
Describe evidence-based components of dual diagnosis treatment programs.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

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Enduring Materials

Enduring Materials - Sept 6, 2023
"Gender Affirming Care: Treatment, Care, and Services"

Speaker: Kerry Gillette, PA. Mosaic Community Health.

Objectives

Differentiate gender-affirming care and trans-inclusive healthcare across a wide spectrum of provider types, including primary, Behavioral, pharmacy and dental providers.
Illustrate the many diverse pathways of gender-affirming care for trans and non-binary patients/clients.
Recognize and manage personal and potential implicit bias to help reduce healthcare inequities.
Report Oregon specific data and trends of suicide within LGTBQ+ population.
Utilize WPATH criteria tool to help identify gender dysphoria.
Select treatment options that supports patients care plan such as common HRT, risk/side effects, labs, monitoring, and follow-up care.
Address special considerations for the Pediatric population.
Provide additional resources, references in and around Central Oregon.
Address provider-specific concerns about gender-affirming and trans-inclusive care.

Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of St. Charles Health System and Mosaic Medical. St. Charles Health System is accredited by the ACCME to provide continuing medical education for physicians. St. Charles Health System designates this live virtual activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

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Grand Rounds

Grand Rounds - September 1, 2023
"Mobility is Medicine"

Speakers: Kelly Plunkett, MSN, RN, CCRN, Timothy Preston, DO, Theresa Kramer, Lisa Rodriguez. St. Charles Health System

Objectives

Describe the theories behind MIM.
Practice the paradigm shift; every patient moves unless there is a clinical reason for bedrest.
Employ mobility approach in interdisciplinary teams to improve patient outcomes .

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

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Community Newsletter A message from Steve

At St. Charles, one of my responsibilities as president and CEO is to keep our community informed about health care services, access to care and other topics that could impact local residents. That’s why we recently shared the news that St. Charles is reevaluating its participation in all Medicare Advantage plans, which are operated by private insurance companies and are different from traditional Medicare, which is funded and operated by the federal government.

To hopefully alleviate some of the concerns that have been raised, I’d like to share a few facts about why we are evaluating our participation in Medicare Advantage plans and where we are in our negotiations.

Please know that all of us at St. Charles are listening and we understand your concerns about possibly having to change plans or incurring increased costs. We take these concerns seriously and are certainly weighing potential impacts on community members in our decision-making. But we have also seen and felt for years the impact of not publicly acknowledging these problems, and the burden often lands on the shoulders of our sickest patients and our caregivers.

Every day, I hear stories of Medicare Advantage patients who have trouble getting the care they need. Recently, a patient in the St. Charles Cancer Center was diagnosed with prostate cancer. As a routine next step, the treating physician ordered a PET scan to see if the cancer had spread. It was denied by the patient’s Medicare Advantage plan. The patient had to wait and wonder if the cancer was spreading while three different physicians ordered the test and all three times it was denied, even though it is nationally accepted best practice care for this type of case. Eventually, the scan was approved.

As a physician, I have firsthand knowledge of how delays in care can impact a patient both emotionally and physically. I started out in my career when managed care plans were just coming into existence. I’m struck now by how dramatically the administrative burden has piled up on the backs of my colleagues, our caregivers and our patients since those early days.

It is increasingly clear that Medicare Advantage plans do a pretty good job of providing coverage for outpatient visits and procedures, and some plan members rave about their experience. For patients sick enough to need hospitalization or high levels of specialty care, however, the plans too often fall short. Patients on Medicare Advantage plans frequently end up staying in the hospital longer than traditional Medicare patients. In many cases, these patients also wait longer for approval of necessary care and experience a high rate of denials for care that has already happened.

From my perspective, it’s important for people to understand that we do not believe the current system under Medicare Advantage is working effectively for the interests of all patients.

We, like many other health care organizations across the nation, are asking insurance providers to do better through ongoing contract negotiations. Here is where we stand today:

St. Charles Health System is currently in contract negotiations with four Medicare Advantage plans.
Contract negotiations between health care providers and insurance companies are routine.
We are asking for proposals that address our concerns about delays in patient care, denials for treatments that have already been provided and administrative burdens on our care teams.
Since our recent announcement, we are pleased to share that some insurers have responded with their intention to continue negotiating. We believe some are willing to work with us to find creative solutions to these complex problems.
Regardless of where we land in negotiations, we anticipate St. Charles will continue participating in some Medicare Advantage plans in Central Oregon in 2024.
We want people to be aware that these negotiations are taking place so they have plenty of time to research options and consult with insurance experts before the annual open enrollment period for Medicare beings on Oct. 15.

If you have continued concerns, your insurance provider is the best source of information about the plans they will continue to provide to Central Oregonians into the future. We are also committed to providing updates once negotiations are complete.

Sincerely,
Steve

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Medicare Advantage

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Community Newsletter

In the hospital, most of a patient's time is spent in bed. And during that time, muscle function can quickly ebb away. That's why movement and mobility are vital to recovery, whether a patient is resting during an extended treatment or recovering from surgery.

But mobility must be maintained in a way that is safe for patients and their providers. That's why St. Charles launched its Mobility is Medicine initiative last year.

"Mobility is part of medicine that you receive in the hospital," said Kelly Plunkett, a nurse manager in St. Charles' Intermediate Care Unit. "That's just as important as the pills and the treatment that you're getting here."

Inspired by a Johns Hopkins Medicine conference about mobility in hospitals, Plunkett and the health system’s injury prevention coordinator, Theresa Kramer, started infusing St. Charles with best practices for safe mobility in the spring of 2022. These practices center around preventing falls, decreasing pressure injuries in patients, and teaching providers how to aid patients' mobility without injuring themselves. (For example, if a nurse lifts a patient without the proper equipment, they can hurt their back.)

Made possible by several generous grants from the St. Charles Foundation, Plunkett and Kramer have secured numerous equipment upgrades that make movement safer and easier, such as bed slings.

“A lot of people think of a hospital stay as bedrest,” Kramer said, “but if you come to stay at St. Charles, you will be asked to move in a way that is safe for you.”

Across the organization, more than 600 nurses have been trained in safe mobility practices so far. In addition to training, the program also introduced a new bedside mobility assessment tool nurses can use to determine patients' mobility needs and the best ways to meet them.

Movement is a vital part of preventing secondary debilities that arise from patients spending more than 97% of their hospital time in bed, Kramer said.

"One of the themes we have been training is, 'Has my patient had their mobility medicine at least three times today?'" she said. "We’re trying to consciously put it in everybody's brain that there is an actual prescription for mobility so they get that it's just as important as a medication."

In the best-case scenario, mobility as medicine might be a patient getting up to walk three times in a day. But that isn't always possible, particularly if a person has suffered an extreme injury or trauma to the spine. In that case, providers may need to manually move patients' limbs to maintain muscles and promote blood flow.

While the training phase of the initiative recently wrapped up, it was just the beginning of the work, Plunkett said. In the coming months, the team will have enough preliminary data to track how effectively the program reduces patient and caregiver harm. Anecdotally, it seems to be making a dent in nurse injuries – a promising trend, given that health care workers are five times more likely to get hurt on the job than other professions.

"If we can get somebody assessed at the beginning and get them mobilized to their full potential every single day, that'll help get them out of the hospital sooner," Kramer said. "It's just so important."

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Mobility is Medicine

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