You've Come a Long Way Since Florence Nightingale

Happy Nurses Week to all the nurses throughout WMHS who serve our patients with exceptional care and compassion each and every day.  At WMHS, we are blessed to have a wonderful nursing staff led by an exceptional individual, Nancy Adams, who epitomizes what is to be a caring, competent, experienced professional every hour of every day. 

The role of the nurse continues to change year after year as we change how we deliver health care in this era of reform.  The patients are changing as well.  The very great majority continues to be grateful for the care and compassion that they receive as a patient--on an acute care unit, in an outpatient setting, in the Operating Room, in a physician's office, at home through Home Care, in our Emergency Department, by the Care Management team, though Nursing Leadership and the list goes on. 

Our nurses have to endure so much more from an increasing number of patients—those come to the ED intoxicated or in a drug-induced state, ones who are threatening or violent, or simply those who are ungrateful no matter what you do for them.  Fortunately, that last group of challenging individuals is a small percentage of the patients and families that our staff faces. 

We are blessed to have so many wonderful employees at WMHS who complement such a caring and skilled component of our workforce.   Please join me this week in honoring and celebrating all of our nurses at WMHS for the extremely challenging job that they do each day with always with the utmost care and compassion.

Hospital Rates in Maryland

Last week, the Health Services Cost Review Commission met to approve new rates for hospitals beginning in July.  Maryland has a unique rate-setting system that gives hospitals a waiver from the standard Medicare payment system as long as our hospital costs grow more slowly than the rest of the country.  Maryland’s rate-setting system is in jeopardy due to assessments used to fund Medicaid over the last several years--assessments that were approved by the Maryland General Assembly and the Governor.   Maryland Hospitals are close to losing the waiver, which represents approximately $18 million in additional revenue for WMHS annually.  Preserving the waiver is critical.  As a result, hospitals agreed to a 1% reduction in rates, which equates to a $3 million reduction to the WMHS budget effective July 1, 2012 (Fiscal Year 2013).  We will receive a modest increase in outpatient rates for FY 2013. 

The Maryland waiver benefits everyone--payers, consumers, businesses and hospitals.  Yet, hospitals have continued to shoulder the burden of trying to save the waiver.  Insurers mark up the cost of health care ten times higher in every other state but Maryland, so the benefit of the waiver is a plus for everyone.  There needs to be greater sharing of this burden going forward. 

The financial health of Maryland hospitals, including the Western Maryland Health System, is in serious jeopardy.    The Maryland waiver needs to be modernized to reflect current realities in health care to strengthen the focus on incentives for physicians to control total costs, advance the total patient revenue (TPR) payment methodology, apply population health based delivery systems for the urban and suburban hospitals in Maryland, and look at such creative initiatives as primary care medical homes. 

A lot has to be done and hospitals continue to ask the General Assembly to allow us to assist in a better approach to Medicaid sustainability going forward rather than apply assessments to hospitals year after year.  We need a plan of approach in Maryland but, unfortunately, we aren't yet there.

You’ve Got to Love the Bureaucracy of our Government

Today, I received a response to a letter that I sent to Senator Mikulski on March 1st regarding a grant application that Western Maryland Health System submitted on behalf of seven hospitals across Maryland.  The application was submitted to the $1 Billion Health Care Innovation Challenge for a transitional care program to support the transition of inpatients to the home to ensure that they are supported and well managed in the home and, ultimately, kept out of the hospital for needless readmissions. 

Initially, our application was not accepted due to a technical issue.  Upon submission of the application, it was discovered that our existing registration number had expired.  We immediately updated the registration and resubmitted the application.  We thought that all was well but were later informed that we missed the filing deadline because of the expired registration number.  We then appealed and were told that the Health and Human Services was not accepting appeals.  We then contacted Medicare directly and were told again that they were not reviewing any appeals.   Letters were then written and signed by the CEOs of the seven hospitals across Maryland to our Senators, Congressional Representatives, Governor O'Malley and Maryland’s Department of Health and Mental Hygiene Secretary Sharfstein.

After two months and no word other than an auto response from Medicare, we finally receive word on our application.  On April 30, Senator Mikulski received a response from the Director of the Center for Medicare confirming that our application was rejected for that same technicality, since we did not meet the standard requirements specified on pages 17 - 23 of the Funding Opportunity Announcement (FOA).

Let's not consider these applications based on their merit, their creativity or their ability to be applied across an entire state, let's use the hard and fast criteria on pages 17 - 23 of the FOA.  Gimme a break!  I just love when bureaucrats indiscriminately apply rules for their convenience and not for the benefit of the people they serve.  In our instance, the Center for Medicare and & Medicaid Innovation followed their criteria.  I wonder if they did so for everyone who may have failed to follow the criteria on pages 17 -23 of the FOA?   More to follow.

Hell May Be Freezing Over

If  you haven't figured out by now, my political leanings are right of center, but not far right.  I thought that President Obama deserved a chance to bring change about in our country after he was elected.  I still respect the office of the President, but I am disappointed at his performance and accomplishments to date.  The President is an exceptional campaigner but, in my opinion, not a leader.  A leader would be working nonstop to figure out ways to work with a Republican House of Representatives to address the gridlock on key issues facing our country, but he hasn't.  I am not letting Speaker Boehner off the hook either, but the President ran his campaign on his ability to reach consensus and to change the direction of the country.  Again, in my opinion, that hasn't happened. 

The subject of today's blog is actually the Washington Post.  I read the Post daily for a perspective that for the most part is different from mine.  I learn a lot though my daily read of the Post, but find the editorials the most difficult to find common ground with, at least until recently.  There was a recent editorial that the Washington Post needed to begin to look at the President with a more critical eye.  My reaction was, yeah right, when hell freezes over, which would have been the same if Fox News said that they were going to take a more critical look at President Bush when he was in office.  To my amazement, there was an editorial in the Post the other day that was critical of the President.  The editorial was about President Obama as Campaigner in Chief written by Dana Milbank.  The editorial is linked for your review.  So, I stand corrected and appreciate Mr. Milbank's perspective on the issue, especially since the issue is an important one for our country.

http://www.washingtonpost.com/opinions/president-obama-campaigner-in-chief/2012/04/30/gIQATAfbsT_story.html

What Not to Do

Often, I blog about leadership and service excellence topics.  For today's blog, the CEO of Spirit Airlines made blogging very easy.  This blog contains an article regarding absolutely no regard for his customers and an approach to leadership that is an excellent example of what not to do, especially in a service industry.  This CEO's self-described focus as a leader is very simple: expand his airline while making money.  The survival of this CEO and Spirit Airlines into the future will be dependent on a whole lot more than his singular vision for success.  This is a wonderful case study for any leader in any industry. 

Spirit Airlines Soars Above Field in Flier Complaints.

Checklist Health Care

My sister's boyfriend had a hernia repair on Monday at a hospital in another state.   When they opened him up, they found a mass the size of a lemon and everyone thought the worst.  Even the surgeon thought that the mass was cancerous by eyeing it and cutting into it to obtain a biopsy.  Fortunately, the biopsy came back negative today.  Great news! 

My sister then proceeds to tell me that although relieved that he doesn't have cancer, he has a fever of 102.3 degrees, a severe headache and is vomiting.  She said they don't know why.  She then proceeded to tell me that he was going to be discharged tomorrow.  I told her my thoughts on what was going on, but said don't let them discharge him in that condition.  She appreciated my input and would make sure that they address his current state before discharge. 

The reason for blogging about this situation is that all too often in health care we follow a checklist and once a task is complete, we check it off the list.  We need to treat the patient in his or her entirety.  I heard a great line today that is very appropriate in this instance, we need to make sure that we don't confuse activity with achievement; a great lesson for all of us.

Extraordinary Bosses

Last week, I wrote about a great article in Inc. magazine, "8 Core Beliefs of Extraordinary Bosses."  Some of the tidbits worth noting in the article were as follows:

* Average bosses see business as conflict and build "armies" for the fight; extraordinary bosses create teams that attempt to more easily adapt to the market.

*Average bosses view their company as a machine with rigid structures and rules; extraordinary bosses see their employees as a collection of individual hopes and dreams all connected to a higher purpose or goal.

*Average bosses want employees to do exactly as they are told; extraordinary bosses set direction and ask employees to commit themselves to getting the job done.

*Average bosses view their employees as children; unlike extraordinary bosses who view their employees as peers.

*Extraordinary bosses motivate through vision not fear.

*Extraordinary bosses embrace change while average bosses see change as complicated and threatening.

*Extraordinary bosses use technology for creativity purposes while average bosses see it as a way to increase control and dependence.

*Extraordinary bosses see work as something that should be inherently enjoyable while average bosses see it as a necessary evil.

These are great tidbits for a leader to work into his or her repertoire.