Hospitals are in for a Very Rough Road Ahead

As I have blogged previously, health care cannot be sustained financially primarily due to the impact of the Medicare and Medicaid programs.  Earlier this week, I watched a videoconference on "Anticipating Lower Reimbursements."  A panel of experts was predicting that if hospitals are not taking seriously the calls to get cost out of their hospitals and health systems, their boards will be looking for new CEOs.  Several years ago at WMHS, we had an expense reduction strategy and attacked all of the "low hanging fruit."  We got out a great deal of excess spending; but by comparison, that was the easy stuff.  Now, the task is much harder. 

We know that we have to reduce our spending by at least 10% to 15% over the next five years as there will no longer be rate increases only reductions in our rates.  In the videoconference, some were predicting 25% over the same period; that equates to $75 million for WMHS.  In order to get our projected 2% per year starting with this fiscal year (July 1 to June 30), organizational transformation has begun and will continue over the next four fiscal years.  

Our annualized target for FY '13 is $6 M to $8M.  We are focused on a host of initiatives including changing how we work; creating labor savings through benchmarks with other hospitals and health systems; reducing senior management by two positions; eliminating many vacant positions; filling remaining vacant positions with displaced employees; continually seeking cost saving initiatives from leadership, staff and consultants; improving collections through a renewed commitment to revenue cycle management,  renegotiating supply and service  contracts; reducing the overall cost of care; improving the quality of care, addressing unexplained / unsubstantiated clinical variation; continuing to reduce medical errors and reducing readmissions.  (Just to name a few of the many initiatives underway at WMHS.)  We have a lot of work ahead of us, but getting everyone on board from employees to physicians to board members to the community will help us survive the deceleration of Medicare and Medicaid spending a lot faster.

Reducing Readmissions at WMHS

It's working!  Our readmission rate for July was 8.51%; a dramatic improvement over the same month last year which was around 20%.  Why is it so important, you ask?  Any patient who is readmitted with a similar diagnosis within 30 days of a previous admission results in no payment for any subsequent admission within that 30-day period.  Such admissions are deemed avoidable and unnecessary.  We are making excellent progress as a result of exceptional teamwork, led by Dr. George Garrow, our Chief Medical Officer and Carol Everhart, our Director of Care Coordination.  These two individuals and their team have been chipping away at readmissions and reached single digits around April of this year.  They continue to focus on preventing avoidable readmissions through a variety of approaches including:  a more effective patient education program prior to discharge, a more thorough longitudinal discharge plan, follow up with the discharged patient at home through CareLink, a nursing home RN transitionist visiting patients in the hospital before they are returned to the nursing home and once at the nursing home, many more referrals to Home Care, high-risk patients being provided with the discharge medications before they leave the hospital, more immediate follow up primary care physician / nurse practitioner appointments once the patient is discharged, reconciliation of patient medications upon admission and upon discharge.  Just to name a few.  What does this mean in dollars and cents?  Our readmission rate for July annualized would save WMHS around $1.4M this fiscal year.  An absolutely awesome outcome for WMHS.  Great job everyone!

New WMHS Website

When you get a chance, visit the new WMHS website at www.wmhs.com.  It is much crisper, cleaner and easier to navigate than our old website.   A lot of staff were involved in its creation and I am so appreciative of all of their hard work in making it happen.  The new site also has a secure employee access to the portal so we can communication directly with employees on specific information related to issues important to them.  They can also receive their pay information through the employee portal.  In the near future, we will also be rolling out a patient portal for patients to store their personal health information, receive test results and access their records.  Lastly, the new website will also contain real-time quality and performance data on WMHS and how we compare with other hospitals.  The data will be more current than what is currently out there on the internet and allow for our patients and community to see just how well or not so well we are doing in a number of quality related areas.

We Are Strange People

I have been receiving the New York Times each day for the last week from my newspaper delivery person.  I don't know if it's an extra newspaper or a promotion, but it isn't a newspaper that I usually read.  I have read it each day to get a perspective that I don't usually get.  I currently read the Washington Post every day for a more liberal perspective on current issues since I lean more to the right of center; however, the New York Times is considered the heart of liberalism in the print media.  I found it interesting that their articles and editorials clearly demonstrate that they are champions for the poor, the downtrodden, those who have been disenfranchised by America.  At the same time, the NY Times repeatedly attacks the rich, the powerful and corporate America.  What I also noticed in each issue is the extravagance of their advertisements.   When you open to the second page of the front section of the newspaper each day, you see their first advertisement of prominence.   It is always for a $3000 handbag or a pair of shoes for $1295.  There are ads for Tiffany's, Saks Fifth Avenue, Neiman Marcus and Burberry throughout each issue.  The very people who they attack in their articles and editorials are the same people who they are hoping will support their advertisers.  Ridiculously strange, if you ask me.

Unfair Advantage

Okay, one more blog on the Olympics.  Yesterday, I read an article about Oscar Pistorius, the South African sprinter who will be the first amputee to compete in the Olympics.  Oscar, aka the Blade Runner, has been a double amputee since he was 11 months old and uses carbon fiber prosthetic legs. Oscar will be competing in a 400 meter runner.  There are some, including Michael Johnson who is a 43 second 400 meter runner and world record holder, that say Oscar has an unfair advantage.  I wonder if Michael Johnson has seen Oscar's bloody stumps after a race. If Oscar has such an advantage, why aren't blade runners flooding the Olympics?  I applaud the Olympic Committee for reversing their decision to allow Oscar to compete in what they previously termed "able bodied track.”

Nobody Asked Me, But........

Regarding this week's badminton "scandal" at the Olympics, it is really hard to blame the coaches of the Chinese, Indonesian and South Korean teams for their actions based on the competition format.  Providing an advantage to lose really needs to be re-examined going forward by the Olympics Committee.  I realize that it's despicable to reach the Olympics and not make every effort to win, but the focus is on winning a medal and there is a lot at stake for the Olympians to be successful.  I am not sure that winning a gold medal in badminton is that big of a deal, but one never knows what goes on in some of these countries.  It has been interesting reading the varying opinions on the "scandal”; I just hope that those in charge get it right.  Badminton players and coaches need to be careful; they could find themselves as an eliminated sport like baseball and softball.  Oh, that's right - those are sports that the Americans dominated over the years and that's why they were eliminated.  Badminton is a more global sport, as boring as it may be.

Doctor Shortages

In a recent NY Times article," Doctor Shortage Likely to Worsen With Health Law," there were a number of areas throughout the country listed with shortages of physicians.  The impact on the shortage by the Affordable Care Act is the number of newly eligible individuals nationwide for insurance coverage.  These communities are talking about shortages in every specialty, sub-specialty and primary care today and that problem is only going to worsen.  Right now, patients are being transferred to other hospitals for care, waiting excessively to be seen in Emergency Departments, overusing EDs and even foregoing care.  Rural areas, as well as urban areas, throughout the country are especially hard hit.  In Maryland, rural areas are significantly impacted, with urban areas faring much better than most due to Johns Hopkins and the University of Maryland in Baltimore and many hospitals in Washington DC supporting PG County.  At WMHS, we have been able to hold our own in attracting new physicians (the new Hospital has helped greatly) with the exception of Gastroenterology.  We have call coverage issues due to having only three GI docs in Allegany County and only one of the three who is employed by WMHS.  We continue to recruit; in fact, we have offered $10,000 to anyone who brings us a GI doc who joins our staff and remains in the community for at least one year.  When we recruited our last GI doc to Cumberland, there were 500 openings or opportunities for every one Gastroenterologist coming out of training.  We continue to recruit and will do so until we are successful.  In the meantime, we, along with the rest of the country, are re-engineering how we deliver care as to its efficiency and appropriateness.  We want to make sure that individuals are being cared for in the most appropriate setting, reducing the burden on the ED and acute care.  Also, as a state, Maryland leads the country in its treatment of Nurse Practitioners.  They can now practice on their own without the supervision of a physician and that has helped greatly in Primary Care. In this day and age, as well as with what is on the horizon, every little bit helps.