"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.

Friday, August 8, 2014

Are Women Really Smarter Than Men?

The other day, Michelle Obama said at the US-Africa Leader's Summit in Washington DC that women are smarter than men and that they must use their intelligence to effect change.  Interesting point to say the least.  

I am surrounded by women every day.  A mother and two sisters, wife and two daughters and 82% of the employees at WMHS are women.  So, what say me?  Heck yeah, they're smarter.  Actually, the perspective that women bring to most any situation is invaluable.  According to Internet sources, their brains develop faster, they are better at the arts, and they are better at communications, interpersonal skills, relationships and lateral thinking.  They also have a better episodic memory.  

There have been two recent studies, one in Canada and one in England, that show men are just slightly more intelligent than women.  However, a July 2014 article in the Huffington Post has humans being smarter than ever and that women are rapidly catching up to men in areas where they had been superior for years, such as math and science.  Scientists have said that improvements in women's intelligence has a direct correlation to improvements in societal development, such as living conditions, more so than men. 

Nonetheless, it's all pretty fascinating, but my money is still on the women; they are truly an amazing gender; far more fascinating than men.

Thursday, August 7, 2014

What a Week

So, the reason that I haven't been blogging this week is because I have been too, too busy. For Monday, Tuesday and Wednesday there just weren't enough hours in the day.

On Monday, representatives from Johns Hopkins Health System/Bayview Campus came to WMHS to learn about value-based care delivery.  Our team spent around three hours taking them through our journey over the last four years.  The visit ended with a tour of our Center for Clinical Resources.  They were around the eighth hospital or health system to
visit WMHS to learn about our successes, as well as our challenges, under Total Patient Revenue.  There are two more visits scheduled this month. It is so rewarding to be able to tell our story and to repeatedly re-live this pretty amazing journey.

A few weeks ago, we were asked to serve as the site for the Governor and Secretary of Health to present their Governing for Results Tour.   The Governor is making visits around the state providing an overview of his administration's innovative policy efforts.  Quite honestly, I was under the impression that WMHS was serving as a backdrop for the Governor to present his white paper, "A Prescription for Innovation: Maryland's Data Driven Approach to Containing Costs and Advancing Health.”  To my surprise, and to the surprise of everyone else at WMHS, his visit yesterday was more about us than anything else.  

Governor O'Malley touted our success in advancing the Triple Aim of Health Care Reform (Better Quality, Less Cost and a Healthier Community).  He said that we had become a model for the state, as well as the rest of the country, on health care innovation. Secretary Sharfstein said that we are at the cutting edge of health care in our nation.  Wow!  The visit was scheduled to be an hour and it lasted almost two.  We met for almost an hour then he toured the Center for Clinical Resources.  The visit culminated with a press conference.  

It was a tiring three days in that Tuesday was spent preparing for the visit as well as dealing with all of the other issues and challenges of the day. It is truly great to have this health system and our exceedingly creative staff recognized for their amazing work over the last four years.



Friday, August 1, 2014

Oversees Adoption

I learned this AM that one of our employees previously accompanied a team of doctors and nurses to the Philippines on a mission trip.  While there, she encountered a toddler in an orphanage whose arm was badly burned and had to have it amputated.

To make a long story short, she is now in the process of adopting this young girl.  What I find most distasteful is that it is costing her $37,000 to adopt this little girl and it will have taken three years before it's all said and done.  It will be three years that this little girl has to continue to be housed in an orphanage rather than with a loving family and only after everyone "gets a taste" as they used to say on the Soprano's.

The lawyers, various governments, government officials, Catholic Charities, the orphanage and God knows who else get to divvy up the $37,000.  Certainly, a tribute to the employee and her family, but there has to be a cheaper, more expeditious way.

Wednesday, July 30, 2014

Nobody's Perfect, But............

The other day, I received a series of announcements from the American Hospital Association on their selected Quality and Patient Safety winners for 2014.  I am sure that these awards are well deserved for the work at each of these hospitals and health systems.  What I found interesting is that in two of the hospitals that received awards, I visited one not that long ago and, in fact, blogged about what I saw as to the serious lack of cleanliness et al, at least in one particular patient care tower and that I recently heard a story about the other hospital.  

The story is that there is a particular cancer drug that should be infused over a longer period of time like three and half hours.  Strangely enough, I have two friends suffering from the same cancer; one is receiving his treatments at WMHS and the other out-of-town.  The two friends of mine are also friends of each other and, of course, talk with great frequency about their cancers, their care and their treatments.  The out-of-town friend mentioned to the in-town friend as to the difficulty that he is having with one particular drug.  He said that after the drug is infused that it gives him severe headaches which last for quite a while.  Since they are taking the same drug, the in-town friend probed further and realized that he receives the drug over the three and half hour time frame while the out-of-town friend gets the drug infused in one hour.  

When the in-town friend had to be somewhere else on a particular treatment day, he asked to have the drug infused at a quicker rate and was told absolutely not. That if he couldn't stay the three and a half hours that the appointment could be rescheduled.  The reason that our folks gave him was that if you infuse the drug too rapidly, you will get severe headaches for a prolonged period of time.  After learning this revelation, the in-town friend shared the information with the out-of-town friend, who, you guessed it, now gets his drug infused over a three and a half period of time. 

Unfortunately, it took this exchange to realize what was happening to the out-of-town friend.  It was either a matter of convenience for the staff at the out-of-town hospital or sheer incompetence.  I guess my point is that nobody is perfect in that we are doing so much in our hospitals and health systems to deliver safe, quality patient care, but there will always be some challenge somewhere else within those same hospitals.  Now, I am not letting that out-of-town hospital off the hook. What they were doing was egregious and it sickens me.  I have encouraged my out-of-town friend to pursue the issue to the highest level of that hospital.  No patient should be subjected to what he has been subjected to in his care and treatment.  Health care is certainly both an interesting as well as challenging business.

Tuesday, July 29, 2014

The Rest of the Story on the New Missouri Law

One of my blog followers pointed out from yesterday's blog that even though Missouri appears to be progressive with their new law creating an assistant physician, they could have easily addressed their primary care shortage situation in the rural parts of their state by relaxing the restrictions that exist for nurse practitioners.  Point very well taken.  

In Maryland, we have certainly benefited from the ability to use nurse practitioners in a variety of settings, including primary care, due to the practice autonomy that they are afforded in this state.  That is certainly not the case in Missouri, where nurse practitioners are highly restricted in what they can and cannot do in the care of their patients.  How unfortunate.

Monday, July 28, 2014

A New Missouri Law

This morning, I read Paul Levy's blog, Not Running a Hospital, and found it most interesting.  His blog is as follows:

Here's a fascinating story in Governing about Missouri's approach to alleviating a physician shortage in rural areas.  (Thanks to the folks at Commonwealth Magazine for the tip in one of their daily newsletters.)  The lede:

A new Missouri law allows recent medical school graduates to practice primary care in underserved areas without completing a residency in a teaching hospital.

The Missouri State Medical Association, the law’s chief backer, is calling it an unprecedented effort to help deal with doctor shortages in rural and other underserved areas, but opponents raise questions about whether circumventing the traditional path to the exam room will do more harm than good. 

The article goes on to explain:

Missouri’s law, signed by Gov. Jay Nixon earlier this month, carves out a new classification called “assistant physician.” The law allows medical school graduates who have completed their licensing exams but haven't finished a residency to practice immediately in underserved areas. These graduates have to join a primary care practice of a “collaborating physician” who agrees to accept responsibility for an assistant physician. An assistant physician, who can legally be called a doctor, has to practice continually with his or her collaborating physician for one month before being able to serve independently. 

My buddy Rosemary Gibson, a board member at the Accreditation Council for Graduate Medical Education, doesn't like the idea.  She is:

warning other states not to follow Missouri's lead because rural residents are sicker, older and poorer, on average, than the country as a whole. She said the Missouri law goes well beyond the scope-of-practice laws that have popped up in state legislatures. 

“On the surface, it looks like a quick fix, but I think it really behooves [policymakers] to do their homework, to understand what it means to have a graduate of a medical school be called doctor, to have prescriptive authority for powerful drugs like narcotics, to accurately dose and treat people,” she said. “Primary care is not simple. If you have a lot of older people living in rural areas, they have a lot of co-morbidities [such as diabetes combined with heart disease].”

I've run the story by other experts in medical education.  Another buddy, Dave Mayer, said:

I don't like the new law either. But it made me think and ask myself the following question: What is worse...Putting a new medical school graduate on an acute care hospital floor July 1st and asking them to take care of many hospitalized patients into the evening with little in-house supervision or asking a new medical school graduate on July 1st to take care of a few non-acute, non-hospitalized patients in a clinic where there is another fully trained/completed residency MD on site during the time they are working? Both have serious flaws but the second non-acute scenario sounds less scary to me. 
  
Of course, it can be a false choice to compare one scenario to the other, but the point is well made.  What's your take?



What I found so interesting is the a dramatic departure from "this has always been the way that it's been done.”  I find the new Missouri law extremely progressive and an effective response to a growing crisis in rural America.  At the same time, I can certainly see the threat that this law brings to traditional academic medicine.  (Just to clarify, under the Missouri law, an assistant physician is recognized as a medical doctor and that is different from a Physician's Assistant.)  

In the blog, Rose Mary Gibson of the Hastings Center recognizes the vulnerability of the underserved due to their poor health status and the importance of well trained physicians caring for such patients.  However, the model that we have adopted in our region to care for the patients in our region is the use of Advanced Practice Professionals in addition to primary care physicians.  In a perfect world, we would love to have the most highly trained providers on staff and we are fortunate to have many who are just that.....extremely well trained.  Quite honestly, our Advanced Practice Professionals have done a great job with our most vulnerable patients; and our nurse practitioners in the Center for Clinical Resources are a perfect example.

As our physicians are well aware, it has become very difficult to recruit for primary care physicians due to the shortage nationwide and that trend will continue.  At WMHS, we have not had a Maryland-trained physician come directly from their residency or fellowship in quite sometime. We have had many discussions, but to no avail.  

In Paul's blog, Dr. Dave Mayer's perspective is interesting in that he doesn't see a difference between going out and caring for patients in underserved areas under the direction of a MD or DO versus entering a residency and caring for patients in the hospital under the auspices of a physician preceptor.  If those in academic medicine feel threatened by the Missouri law, they should recognize the crisis that exists and is only worsening by doing so much more in developing new physicians to embrace a rural environment for their practice setting post training.  Why not make it a requirement for a percentage of those admitted to medical school that they practice in a rural setting for at least three years after completion of their residency?

Thursday, July 24, 2014

The Buy Local Challenge

I was asked last week to provide a blog to Fierce Healthcare on the Buy Local Challenge in which many members of the Maryland Hospitals for a Healthy Environment's are participating.  It was scheduled to run in their publication today.  My blog was as follows:

The Western Maryland Health System is a member of the Maryland Hospitals for a Healthy Environment (MD H2E) and has been since the inception of the organization in 2005.  MD H2E advances a culture of environmental health and sustainability in Maryland's health care community.  WMHS is one of twenty eight Maryland hospitals / health systems participating in MD H2E's latest initiative, Buy Local Challenge.  Simply put, we have agreed to support farms by serving / eating local during Buy Local Week, which is this week, July 19-27.  We have pledged through our Food and Nutrition Service at WMHS to serve at least one local food item each day during Buy Local Week.  Our staff understands the importance of providing the freshest produce whenever possible to our patients and employees while supporting our local farmers.  Such support expands our regional food system as well as our local economy.  

And it doesn't stop there.  At WMHS, we support our local farmers though a weekly on-site Farmers' Market throughout the summer and our Dietitians work cooperatively with our staff and visitors with menu ideas and recipes while promoting the Farmers' Market.  They also have an Exhibition Cooking Day around the items that are available at the Farmers' Market for that day.  I am so very much encouraged by the active participation of our staff in every aspect of the Buy Local Challenge.  They are engaged participants in the various activities as well as regular purchasers of the produce. We clearly recognize that by providing healthier food choices for our patients, visitors and staff that we are fulfilling our mission of "superior care for all we serve."