"The Ronan Report" provides insight about the activities at the Western Maryland Health System in Cumberland, Maryland, and about the changes taking place in healthcare today from a CEO's perspective.

Tuesday, October 21, 2014

That Was An Interesting First

I am currently attending a governance education meeting out of town with five board members.  At one of the breakout sessions on Sunday (The Total Cost of Health Care), the speaker was talking about value based care delivery being on the horizon for all US hospitals.  At the beginning of his presentation, he actually asked the attendees if they would be converting to value based care delivery at some point in the future or not.  I was surprised to see a number of hands that went up when asked if they were not.  (Are they in for a rude awakening?)

During his presentation, the speaker provided a few examples of some health systems around the country that are dabbling in value based care.  None of the examples were remotely close to what we are doing in Maryland.

After the session, I went up and introduced myself and explained what was going on in Maryland with value based care delivery.  I also relayed the experiences at WMHS over the last four years.  He was very impressed and asked if he could come and visit me in western Maryland. I said, "certainly".

This same speaker was then presenting the next morning to several hundred attendees at the General Session.  In the middle of his presentation, he asked where the attendees from Maryland were in the audience.  I, along with the five board members stood up.  He then started asking me questions about our care delivery model which led to me providing a detailed overview of Total Patient Revenue and value based care delivery to the audience.

The round of applause at the end of my overview was very nice.  There were a number of attendees who reached out after the presentation asking me for more information.  It was also interesting to be in different locations around the hotel yesterday afternoon hearing attendees talking about our model of care delivery at WMHS; some admiring the initiative that we took four years ago and others expressing a great deal of skepticism as to whether it would work in their hospital.  Interesting.

Friday, October 17, 2014

Have You Ever Lost Your iPad?

Earlier this week when I was in San Diego for a speaking engagement, I unknowingly left my iPad in the large hotel ballroom.  I had settled into my front row seat to hear our keynote speaker, Magic Johnson.  We then received word that he was going to be late because LA was socked in with fog so instead he would be our lunch speaker.  I then left the ballroom without my iPad and didn't realize until a few hours later that I didn't have it.  

After getting over that initial sick feeling that it was lost forever, I went to the Find My iPad app on my iPhone and began the tracking process.  The location came up immediately as being across from the hotel at Starbucks.  I remotely sounded the alarm on the iPad and made sure that it was also locked.  The iPad was then on the move further away from the hotel.  I sounded the alarm again.  I sent a message to the iPad with my cellphone number and another alarm.  Lo and behold as I started my trek to the lobby from the 35th floor, the tracking showed that the iPad was returning to the hotel.  I kept sending alarms.  

By the time I got to the Lobby, the tracking was showing that the iPad was back in the hotel.  I went to the front desk and asked about the iPad.  They didn't have it, but called Security to inquire about it.  The iPad wasn't in Lost and Found, but they would let me know if it was turned in.  I kept sending alarms the entire time, not sure if the alarm sounds and shuts off or keeps sounding.  

I then thought that I should go to the conference registration booth upstairs to see if they had it.  I sent another alarm just in case so I would hear it en route.  As I approached the registration booth, I could hear my iPad alarm sounding.  As soon as I walked up to the booth, they asked if it was my iPad and I said yes.  They said "thank God, the sounding of the alarm was driving them crazy."  I suggested that the next time they are in a similar situation, that they open it up and see the telephone number on the screen that they could have called.  They said that they hadn't thought of that.  We laughed and I was thrilled to have my iPad back.  

I never found out who had it out for coffee and a short walk outside the hotel, but quite frankly, I didn't care.  I had it back. The Find My iPad / iPhone app is a great addition and I would suggest that you familiarize yourself with it just in case.

Thursday, October 16, 2014

WMHS Is Ready—Just In Case

WMHS, like all hospitals and health systems across the country, is following the evolving situation surrounding the emergence of Ebola in the U.S.  As part of our continuous emergency preparedness planning, our team had already developed a response plan for a possible case of Ebola coming to our health system.  That plan was based on the  guidelines established by the CDC at that time, and the team was getting everything in place for an appropriate response.  

Since the first Ebola patient was identified in Texas, our team has accelerated its efforts to have us ready.  Our team is constantly monitoring the CDC’s advisories and is in close contact with state and other federal health agencies.  It is meeting regularly to update our plan as new information becomes available, making sure our plan is consistent with the latest guidelines.  

Our staff is accustomed to following strict infection control and prevention procedures and we have the necessary personal protection equipment (PPE) available.  The readiness team quickly developed additional training for physicians and staff to practice the proper way to put on their PPE and safely remove it.  We also are using the “buddy system” where a co-worker monitors the process to ensure the right procedures are followed.  Over 100 employees have already gone through the training over the past several days.  

WMHS is committed to maintaining the highest standards and most current protocols to minimize the risk of anyone contracting an infectious disease like Ebola.  I want to recognize the many members of our readiness team for their hard work to get us prepared for this and similar situations.  It is an exemplary group of professionals who are dedicated ensuring the health and safety of our patients and our caregivers.  

Wednesday, October 15, 2014

SHSMD San Diego

This past weekend I had the opportunity to participate in the annual conference for the American Hospital Association's Society for Health Strategy and Market Development.  I was invited to serve on a Thought Leader's Panel for senior executives with three other individuals.  I was thrilled to serve with Dr. Henry DePhillipe, the CMO of Teladoc, and Lynn Miller, the EVP for Clinical Services at Geisinger.  The three of us had a great time, along with two senior executives from Kaufman Hall.  They are all exceedingly bright people; what an honor for me.  

We each had the opportunity to present background on ourselves as well was what we were doing to keep viable as a health care provider in an ever changing environment.  Of course, I presented on our journey from volume-based care delivery to value-based care.  As has been the case for the last year, the information was very well received.  We then were asked a question by our moderator about our perspective on the changes in health care, which gave me the opportunity to talk about the many initiatives that we are engaged in related to our new care delivery model at WMHS.  Again, very well received with lots of great feedback.  

The floor was then opened for questions.  During our pre-session lunch, our moderator expressed concern that I would get the bulk of the questions based on the uniqueness and success of our journey into value-based care.  However, he did a nice job of making sure that we all had the opportunity to participate.  There were several "crystal ball" questions based on what we know now and what can then be expected in the future.  The attendees had a lot of great questions and also offered some wonderful perspectives related to our various topics.  

In fact, after the session, the moderator asked if I was publishing our journey into Value- Based Care Delivery.  I said not at this time as there are too many things going on.  He said that I would be doing a disservice to the health care industry if I chose not to write a book.  Of course, I took that as a compliment and have started to think about the idea.  Anyway, it was time very well spent, and to be able to do it in San Diego with most of my expenses paid was certainly a bonus.

Tuesday, October 14, 2014

Blinded By the Light

The other day, I heard a national radio interview with a nurse who was leaving for West Africa to care for Ebola-infected patients.  She said that she was called by God to be there.  She said that she told her family that she had to go so please support her in her decision. She never asked for their permission, only their support.  

I certainly don't know her personal circumstances, but if I was faced with the same situation and my wife, a nurse, said that she was called by God, I would have trouble supporting such a calling, at least under the current circumstances in West Africa. I guess that I know too much.  I have read numerous accounts and have seen footage of what is happening in West Africa in the care and treatment of these patients. The conditions in which these people are being cared for are primitive at best.  They lay on rugs on dirt floors in large huts with scores of other infected patients around them.  There is an extreme shortage of gowns, gloves, masks, face shields, water, hand sanitizer and the list goes on.  

This nurse is going there for all of the right reasons but could be failing to grasp to gravity of the situation, well at least until she arrives.  God speed to all who find themselves in a similar situation.

Monday, October 13, 2014

Thrown Under The Bus

That sound you just heard was the newly diagnosed Texas Health Resources nurse who now has a confirmed case of Ebola, as well as the entire Texas Health Resources organization, being thrown under the bus by the Director of the Centers for Disease Control.  While he was at it, he either intentionally or unintentionally took the opportunity to throw the other 4999 US hospitals under the bus, as well.  

He told the world that the second contraction of Ebola in the U.S. was because of a breach in protocol, i. e. poor technique by a health care worker who is a nurse and a trained professional. Now the CDC is going to work with hospitals to teach us how to properly gown and glove.  

There were a whole lot of other ways the CDC could have handled this reported exposure, but they chose the "the bus route."  You gotta love politics.  The Director's self-proclaimed "tell it like he sees it" approach fails to mention that he is following the Administration's policies at whatever cost.  I can understand not wanting to create panic across the U.S., but maybe understand the situation a little better before declaring that hospitals don't know what they are doing, which seemed to be order of the day yesterday for ABC, CBS, NBC and CNN. 

Also, who better to deal with such matters as isolation, quarantine, worker and patient protection than hospitals, etc.?  This same government now has 4000 troops and Public Health Service members in or en route to west Africa to work directly with Ebola patients and their current caregivers.  Do you really think that the military and the US Public Health Service have thoroughly trained these individuals to follow their "well established" protocols; they haven't.  

One would think if you are with the Public Health Service that you would have the knowledge and background to deal with such situations.  They  are very well trained in many aspects of health care and medicine, but not the care and treatment of Ebola patients.  Everyone is getting a crash course.  These Public Health officers are coming out of federal prisons, off Indian Reservations and out of federal government offices such as CMS, FDA and CDC.  The same with the military; a crash course for the great majority, but yet hospitals that deal with similar exposure and subsequent isolation situations daily, maybe not as deadly as Ebola, are being criticized by the CDC for failing to follow protocols.  

How about stopping the travel out of west Africa, reserving judgment on the work of trained professionals, giving all US hospitals what they need to best care for and treat Ebola patients, designating some hospitals as super centers across the U.S. for the extended care of such patients and establishing the necessary regulations for the safe handling, transportation and disposal of Ebola waste rather than on a case by case basis.  You have had months, if not years, to have been working on this and so far very little has been done.  

Thursday, October 9, 2014

A Step By Step Guide To How Hospitals Discourage Doctors, Really?

I read a blog last week from a midwest physician who posted on KevinMD's blog page.  I am a regular subscriber to KevinMD and it has proven to be a great blog especially for physicians.  

This particular blog was about a radiologist who was waiting to see someone in administration and he finds a document that was left by a vendor / consultant.  The document was entitled, "How to Discourage a Doctor".  According to the radiologist, the document provides hospitals with tactics and proven strategies on how to better control physicians in their hospital.  He describes the contents which suggests that hospitals introduce barriers to the physician's care, increase their responsibility while decreasing their authority, no longer allow them to meaningfully influence health care decisions, promote a sense of insecurity among the medical staff, convince them that their professional judgement is no longer reliable, make health care incomprehensible through information technology, show physicians that they are no longer important in the care delivery model, transform all independent physicians to employees, insist upon the use of broad practice guidelines and subject physicians to escalating productivity expectations.  

What the blog did for me was to give me a good laugh.  When I first read the blog, I thought that it was a joke.  So, my reaction is as follows: first of all, the garbage that comes across my desk or finds it's way into my email box throughout the day from vendors/consultants is immeasurable.  Everyone's got an angle which would certainly be the case for the consultant who left this particular document.  If there are health care executives following these suggested tactics and strategies, they won't be around for long.  

Based on changes in health care today and going forward, hospitals have to find ways to better integrate physicians into the ever changing care delivery model.  If anything, the physician's role is more critical as we work to put the patient in the center of everything that we do.  Are their changes impacting hospitals and physicians, most certainly.  Are these changes at the expense of the physician, absolutely not.  We are constantly looking for ways to get the physician more involved with what we are trying to accomplish.  There are regulations and requirements that are being heaped upon hospitals (and soon to be heaped upon physicians), but we can only be successful if physicians and advanced practice professionals are part of the team.  

For example, with new IT systems, we are only as good as the extent of our medical staff's involvement in bringing such systems up.  Are we using protocols, we are and when a physician arrives who had been trained in using such protocols, you can't get them to deviate from them; they have a place in the new care delivery model.  Are we pushing physicians to be employees, nope.  We will work with them if they are interested, but employment is not for every physician.  We seek common ground for physicians who are looking for a different practice model.  Are we escalating performance expectations, we are for our employed physicians, but at the same time incentivizing them accordingly.


I certainly hope that the many physicians who read this radiologist's blog don't believe what this particular consultant was promoting, but if they do, they need to sit down with a member of the C-Suite with whom they are most comfortable and discuss the contents of the document.