"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 29, 2013

Master Facility Plan

Before everyone thinks that we are crazy at WMHS, I figured that I had better explain why we are engaging in a Master Facility Planning process.  Next month, our "new" hospital will be four years old; it is in great condition and continues to serve us well.  However, much has changed since we planned and subsequently built the new regional medical center.  

In 2010, WMHS accepted an offer from the Health Services Cost Review Commission to move from a volume-based care delivery model to a value-based model along with nine other hospitals.  With that model, the goal was to care for patients consistently with the changes being made under health care reform and treating them in the most appropriate setting.  As a result, we have fared well under this new delivery model, but our average daily census has declined to around 150 patients per day.  We built 275 beds in 2009 and have subsequently created all private rooms.  Because of how health care has changed and will continue to change, we will need to re-purpose some of the campus, including the Willowbrook Office Complex, the Administrative Center / Diagnostic Center and the newly acquired Imaging Center and its associated property, which is about 10 acres.  Through such changes, we will be able to look at health care opportunities that are new and exciting for our community and the patients who we serve.

As an FYI, I will be traveling for the next week and my blogs may not be appearing daily.

Monday, October 28, 2013

NSA "Opens" Up

I read an interview with the John DeLong, Director of Compliance for NSA, the other day.  He was asked the question point blank if the NSA is spying on Americans.  His answer was "we are not watching, we are being watched."  Huh?  He said that all three branches of government play a role in watching the NSA and that the NSA acts on the permission from the US government authorities.  The NSA doesn't listen to average Americans and they don't do what they are unauthorized to do.  So, there you have it.  The NSA is acting on behalf of the three branches of the Federal Government in their gathering of information; they are not acting alone.  I feel so much better having Mr. DeLong's perspective.........NOT.

Friday, October 25, 2013

The Urge To Merge

At the Governance Institute meeting earlier this week, there was a session on Networking & Partnering presented by Marian Jennings, who facilitated our first WMHS Board Retreat back in 1996.  She provided a perspective on the new wave of mergers, affiliations and alliances.  For this calendar year to date, there have been 93 hospitals or health systems in some form of affiliation.  We are on a record pace this year to exceed the most affiliations of some sort since the 90's, when they last occurred at a record pace.  Last year, there were 105 such affiliations, the most in this decade.  

Anyway, the question was raised during the breakout session as to whether or not hospitals needed to affiliate in this era of the Affordable Care Act (ACA).  Her response was that you don't have to affiliate if you possess most or all of the following characteristics:
  •       Strong financial performance
  •    Sole community provider
  •    Well-aligned primary care physician base
  •    Ability to manage population health
  •     Sufficient population base to support a population health management infrastructure
  •   Consistently named one of the top 100 hospitals
  •   Top performer in clinical outcomes
  •    Possess a strong positive brand
  •    Well-distributed outpatient centers throughout the service area.  

After hearing that list, I guess it is safe to say that most will be affiliating in some form.  There are very few hospitals or health systems that possess a few, let alone the majority or all of characteristics provided by Marian.  I think that the approach taken by WMHS, Frederick and Meritus to form an alliance that will focus on a few key areas is the best way to go.  To validate our approach, I keep reading about hospitals and health systems in GA, NJ and PA pursuing similar alliances as a way to remain viable under ACA.

Thursday, October 24, 2013

Relationship Building

At yesterday's Governance Institute meeting, a presenter actually made the statement that "60% of every CEO's time should be spent on relationship building throughout the organization."  When I heard the statement, I thought, “Get a real job beyond consulting and see just how realistic that statement is.”  I love it when, in this a case, a psychologist who has never worked a day in his life as a CEO in a hospital--let alone in a hospital, period--throws out such a ridiculous statement, especially in a room filled with board members.  If I spent 60% of my time out and about building relationships, I wouldn't be a CEO for long.  

After that presentation as I was walking down the hall on my way to another meeting, I overheard a group of guys talking about the 60% statement.  One CEO said to the other, "Did I hear him right? Was that 60 minutes a day?"  The other one said he thought so.  I stopped and said, "No, it's worse, it's 60% of your day."  For a 12-hour day, that would be 7.2 hours spent on building relationships.  We all laughed and the other CEOs said that they thought an hour a day would be tough to achieve.  

Now, don't misunderstand, relationship building is important in what I do, along with every other CEO does, but so is the plethora of other responsibilities that we have to accomplish each day.  Crazy

Wednesday, October 23, 2013

School Lunches

Departing from my usual blogging topics, I read an article in today's Wall Street Journal on the nouveau chic approach to school lunches.  I would be an abysmal failure in preparing school lunches under today's new requirements.  I prepared my younger daughter's lunches every day that she was in middle and high school. (My older daughter will never let me forget that I never made her lunches.)  My lunches usually consisted of a sandwich of meat and cheese or peanut butter and jelly, a juice box, fruit, a vegetable like carrot sticks, a snack item (cookies, chips) and sometimes, even a candy bar.  

Today, I would get a grade of F since no nuts, no candy, no snacks, no plastic sandwich bags, no disposable bottles and zero trash are allowed at many schools across the country.  There are some schools that permit candy, but the lunch monitors will move the students to another area of the lunchroom to consume those "politically incorrect" chocolate kisses, M&Ms and gummy bears.  Some school districts have compost piles for leftovers under their no waste policy.  Wow!  In the article, some parents prepare their child's lunches as they are preparing dinner.  The preparation process is that time consuming.  You have to wash, rinse and dry all of the reusable lunch containers and then prepare the tuna sushi rolls, cantaloupe bits, pureed fruit, hummus and 100% whole wheat crackers, organic carrot sticks and a hard boiled egg.  School lunches shouldn't be that complicated, but now they are.  

The entire school lunch issue is an area where I am torn.  The nanny-state approach is troublesome, but the health and wellness of our children is critical.  Some of these regulations seem and are extreme, but the obesity of our kids and nut allergies can be killers over the long term and the short term.  Today's schools have a difficult task ahead of them to protect the kids and the environment while balancing the wishes of the parents.

Tuesday, October 22, 2013

The Feds Be As Forgiving To Us?

In this morning's NY Times, there is an editorial on the Federal Government's Health website and its chaotic debut.  Actually, there are articles in every major newspaper this AM based on the President's news conference yesterday.  But, it was the Times editorial that got me to thinking: If this had happened to hospitals across the US, would the feds be as forgiving?  My answer is "heck no"!  There would be immediate fines and penalties associated with the delays.  Our industry would be under an immediate and prolonged attack until the problem was fixed.  They would demand answers; there would be no evasiveness, no deflecting of blame or finger pointing outside of the health care industry.  The bottom line is that it's nice to be king; in this case, the Feds.