Grand Rounds - Jan. 28, 2022
"Screening for Cervical Cancer and Management of Abnormal Results"

Speaker: Michael Policar, MD MPH, Professor Emeritus of Ob, Gyn, and Repro Sciences UCSF School of Medicine.

Objectives

1. Integrate either the USPSTF or American Cancer Society cervical cancer screening intervals into clinical practice.
2. Describe the risk-based paradigm for managing abnormal cervical cancer screening test results.
3. Demonstrate use of the ASCCP app to apply the new guidelines to patient care.

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].

Effective for dates-of-service beginning Jan. 1, 2022

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible. 

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. 

“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.”  This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit. 

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service. 

You’re protected from balance billing for: 

Emergency Services 

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.  

Certain services at an in-network hospital or ambulatory surgical center 

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. 

If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections. 

You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network. 

Under Oregon’s balance billing law, health providers cannot balance bill a patient for health services provided at an in-network health care facility.  Balance billing occurs when an out-of-network health care provider you did not choose, such as an emergency room physician, anesthesiologist or radiologist, bills you for more than the allowed in-network charges when you are at an in-network facility. Please contact the Oregon Division of Financial Regulation for more information (888-877-4894).

When balance billing isn’t allowed, you also have these protections: 

• You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly. 
• Generally, your health plan must: 
  • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”). 
  • Cover emergency services by out-of-network providers. 
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits. 
  • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you’ve been wrongly billed, contact the Department of Health & Human Services  at (800-985-3059), or contact the Center for Medicare & Medicaid Services (www.cms.gov/nosurprises/consumers) for more information about your rights under federal law.  Visit the Oregon Department of Consumer and Business Services to file a complaint (dfr.oregon.gov/help/complaints-licenses/Pages/file-complaint.aspx).

Your Rights

You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost

Under the law (effective Jan. 1, 2022), health care providers need to give patients who don't have insurance or who are not using insurance, an estimate of the bill for medical items and services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.

Make sure your health care provider gives you a Good Faith Estimate, in writing, at least one business day before your medical service or item.

You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-888-703-8401 or 541-706-7750, option 1.

Service Estimates

Patients are encouraged to use our self-serve estimates tool for certain common procedures. You can access the tool by clicking the button below.

Financial Estimates

Jenny O'Brien, JD, MS, CHC

Jenny O'Brien is an experienced attorney and compliance professional who has held leadership roles in government, nonprofit and for-profit organizations, including chief compliance officer of UnitedHealthcare, the nation’s largest health insurance company. She served as chief compliance and ethics officer for a large nonprofit integrated health care system and on the board of directors for Bon Secours Mercy Health System, a large integrated health care organization. Jenny received her bachelor's degree from the University of St. Thomas, her master's from Dartmouth College and her juris doctorate from Mitchell Hamline College of Law.

"Thank you to the St. Charles caregivers for working so tirelessly to serve the needs of the community during this unprecedented time,” she said. “It is a privilege to be asked to join the St. Charles Board of Directors and contribute to the organization's great work and ongoing commitment to its mission, vision and values."

Grand Rounds - Jan. 21, 2022
"Behavioral Addictions: Gambling, Internet, Sex & Shopping"

Speaker: Timothy Fong, MD, Professor of Psychiatry, UCLA Gambling Studies Program.

Objectives

1. Identify behavioral addictions, including gambling, problematic internet use, problematic sexual behaviors, and compulsive buying disorder.
2. Recognize clinical clues for diagnosis, and ways to differentiate from use that is not problematic.
3. Identify treatment of behavioral addictions and complications resulting from these.

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].

Starting this week, St. Charles Health System is offering three new outpatient treatments for people with COVID-19, but supplies are “severely limited,” said Dr. Jacoby Allen, one of the physicians working to operationalize the treatments.

“Studies are showing that these medications do have some benefit. They seem to be effective in preventing severe disease and hospitalization for those at high risk,” Allen said Monday. “It’s availability that’s the big issue. We are going to try to deploy them as equitably and appropriately and quickly as possible, but we’re not going to have enough on hand to treat our current surge.”

The three treatments are:

• Paxlovid, an oral antiviral treatment
• Sotrovimab, a monoclonal antibody infusion
• Molnupiravir, an oral antiviral treatment

Per National Institutes of Health recommendation, health care organizations should prioritize use of the three medications, starting with Paxlovid, followed by Sotrovimab and Molnupiravir, Allen said. That recommendation – along with the limited supply of each treatment – prompted Allen and a team of his colleagues to spend significant time devising an algorithm to determine who should be prioritized to receive a treatment and which one they should receive.

The treatment algorithm – called the COVID-19 Therapy Screen and Prioritization Policy – factors in a patient’s risk factors and how their current medications would interact with the treatment, as well as their access to other potential resources for treatment. St. Charles’ service area is approximately the size of South Carolina, which means ease of delivery is a factor that must be considered, Allen said.

The ultimate goal is to target the best therapy to the person with the highest risk, he said.

“Since the end of December, when we started receiving notification that we would have some of these, we’ve spent a lot of late nights developing this treatment algorithm,” Allen said. “So now that they’re here, we do have a clear process that we’re deploying this week that will guide patients through our system.”

That process allows for self-referrals as well as physician referrals and includes, for some people, a consultation with a provider to discuss medical history and current medications. A consultation is not a guarantee of treatment, Allen said.

High-priority patients include people age 65 and older, pregnant women and people who are severely immunocompromised or who have at least one high-risk comorbidity, such as obesity, chronic kidney disease, cardiovascular disease or a pulmonary disease.

“Our Incident Command team, our administrators and our clinical folks have put a lot of thought into this policy and trying to make it equitable to all the communities we serve,” Allen said. “It hasn’t been an easy conversation, but all along, we have been committed to following the science, and that means we’re really trying to objectively identify who needs the treatment first, and which one is right for them.”

Learn more about St. Charles’ new COVID-19 treatments on our website.

It was almost exactly two years ago that a team of St. Charles caregivers began planning and preparing our response to the arrival of COVID-19 in Central Oregon.

Two years later, our hospitals are experiencing what will be the most dramatic surge of COVID-positive patients of the pandemic so far, thanks to the Omicron variant.

Our caregivers know a lot more about the disease and how to treat it than they did two years ago. They also have more tools to protect themselves from COVID-19 than they did back then, including vaccination.

Still, they need your help. This surge will fill our facilities beyond capacity, and we need you to do everything you can to stay out of our Emergency Departments and our hospitals over the next few months, unless you are having a true medical emergency or you really need to be there.

One way you can avoid the ED is by avoiding those pesky wintertime slips, trips and falls that happen when the ground gets icy or snowy. As we all saw early this month, one big storm can make getting around town very treacherous.

At St. Charles, we remind our caregivers throughout the winter of nine simple tips to help keep them upright when it’s slippery outside. Here they are:

1. Walk like a penguin: Take short, flat steps to maintain balance.
2. Wear appropriate footwear for the weather.
3. Give yourself more time to get places.
4. Exit your car with both feet on the ground.
5. Don’t carry too much. Hands free and arms out for balance.
6. Resist shortcuts. Use paths that have been cleared.
7. Ditch distractions (like your phone) and focus on walking.
8. Consider using traction cleats on your shoes.
9. Remove snow and ice from your shoes when you enter a building.

Those nine tips don’t only apply to St. Charles caregivers, of course. They apply to everyone, and that includes you.

So this winter, support our health system and our incredible caregivers by staying upright and avoiding slips, trips and falls – not to mention a trip to the hospital. You’ll be glad you did, and so will we!

Sincerely,
Joe

For most people, New Year’s Eve is a time for celebration and remembrance, for noisemakers and midnight kisses, for swaying together and singing “Auld Lang Syne.”

The caregivers on the Cash Management crew in St. Charles’ Single Billing Office, however, are not “most people.”

Cash Management is a team of 12 caregivers who are responsible for, among other things, taking payments made to the health system – from insurance companies, outpatient clinics, gift shops, cafeterias and so on – and posting those payments to the appropriate accounts.

“All monies that come into St. Charles, we are the hub for that,” said Terri McCreary, the team’s supervisor. “We work with Finance to get that money in the system and posted to a patient account or to the general ledger – wherever it needs to go.”

Thanks to the general cadence of accounting work, the end of each month is a rush for the team as it works to get as many payments posted as possible. That rush is heightened on Dec. 31, when reducing the health system’s accounts receivable by end-of-year is a top priority, McCreary said.

“I watch the numbers closely throughout the day,” she said. “We want to see how low we can go with what is unposted.”

The job all but precludes partying on one of the world’s biggest party nights. In fact, McCreary brings up the possibility of working New Year’s Eve when she interviews prospective hires.

“I tell them, ‘You might have to work till midnight on New Year’s.’ That’s always a possibility,” she said. “And with the people on the team, we start talking about it Dec. 1: ‘Don’t forget you’re working!’”

The caregivers on McCreary’s team not only remember, they embrace the assignment.

“My family always watches (football) on New Year’s Eve, so I was prepping everybody that this year’s going to be a little different for me,” said Amber Buhmann, one of the newest members of the team. “But I was also really excited. (That day), we were all sending each other messages and getting each other pumped up about getting through the day. It made it fun.”

People who work in the field of finance get used to working hard at the end of months and quarter, said payment posting Specialist Lead Stephanie Sapp, but year-end is “super exciting” as the Cash Management team works hard to post every payment it possibly can.

“We want to make Terri proud,” said Christy Vermillion, echoing a sentiment voiced by several of her colleagues. “We have a goal and we want to make that goal. It’s important to us.”

It’s important to the health system, too, said Jan Haverly, who has worked for St. Charles for 25 years.

“We’re not at the bedside, but it’s kind of our job to keep the doors open by making sure the money is where it belongs,” she said. “If we’re not putting the money where it belongs and where the auditors are going to say, ‘Yes, that’s right,’ then that’s a problem for the whole system. We keep the doors open so our people can take care of the community.”

Grand Rounds - Jan. 14, 2022
"Alzheimer’s Disease"

Speaker: Erik D. Roberson, MD, PhD, Rebecca Gale Endowed Professor of Neurology; Director, Alzheimer's Disease Research Center; Director, Center for Neurodegeneration and Experimental Therapeutics.

Objectives

1. To understand current concepts for the cause of Alzheimer’s disease.
2. To understand current and future strategies for the diagnosis of Alzheimer’s disease.
3. To understand current and future treatment approaches for Alzheimer’s disease.

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].

Save the date: St. Charles Foundation hosts virtual Saints Gala Feb. 5

BEND, Ore. — St. Charles Foundation’s annual Saints Gala is going virtual this year, and the community is invited to participate. Bidding starts on Wednesday, Feb. 2, and the free livestream event is Saturday, Feb 5. Raffle tickets are now available for purchase.

The 2022 western-themed gala will benefit the St. Charles PEDAL clinic (Programs of Evaluation, Development and Learning). The clinic provides comprehensive evaluations for children and youth with special health care needs and developmental disorders including autism spectrum, Down syndrome, ADHD, feeding issues, epilepsy and cardiac disorders. The only clinic of its kind east of the Cascades, PEDAL serves families from all over Central and Eastern Oregon, helping them navigate diagnosis and treatment for children with complicated medical conditions.

Funds raised from the Saints Gala are critical for the expansion of the PEDAL program and its ability to serve Central Oregon. Proceeds will help underwrite the cost to expand the program, which includes the addition of two full-time developmental pediatricians and specialized equipment.

Raffle tickets are $100 each and the drawing will be held during the livestream on Feb. 5. The winner can choose from three preselected trips and will have two years to complete travel. Vacation packages include:

1. Chauffeured wine tasting tour and lunch, including a three-night weekday stay for two at The Setting Inn in Willamette Valley.
2. Bloomingdale’s San Francisco shopping spree and stay, which includes a two-night stay for two at The Fairmont San Francisco. Includes a $1,000 shopping spree with a personal shopper, beauty consultation and champagne.
3. Churchill Downs VIP experience, including a private jockey club suite for two, a race named in your honor, winner’s circle trophy presentation with photo, and three-night stay with airfare for two.

For full event details, visit www.SaintsGala.org.

About St. Charles Foundation

As the philanthropic arm of St. Charles Health System, the Foundation works to support and improve health care in Central and Eastern Oregon. Private donations raised by the Foundation allow St. Charles to build new medical facilities, purchase state-of-the-art medical equipment, keep pace with the latest technological advances and deliver exceptional patient care in a healing environment. The Foundation does more than just raise money for bricks and mortar. The organization also raises money to support many programs that benefit low-income and uninsured patients.

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