One of the Benefits of Clinical Innovation

Clinical innovation such as the one described in this report is just one of the many reasons why our evolving relationship with UPMC is so beneficial to our health system and to our community.  They are bringing cutting edge, evidence based medicine to our health system as we diligently work to serve patients throughout the tri-state region.

https://pittsburgh.cbslocal.com/2018/11/14/upmc-childrens-hospital-pittsburgh-diabetes-cure-research/

SWOT Analysis

I was extremely pleased to learn that 84 health system departments and patient units participated in our most recent ask of participating in a SWOT (that's the strengths, weaknesses, opportunities and threats facing our health system). As we strive to live up to our mission, being dedicated to providing patient-centered care and improving the health and well-being of the people in the communities we serve, information that can be provided through a SWOT analysis can be invaluable.

Such information also allows us to be better prepared to achieve our organizational vision of being the best place to deliver quality care, the best place to work, the best place to transform care, the best place to reduce the total cost of care and the best place to refer patients.

There was a great deal of consistency with the strengths that were identified, which were as follows (just to name a few):

• The many clinical services that we provide
• Our approach to population health
• Being a good place to work
• Our state-of-the-art facility
• The people with whom we work 

Our weaknesses were less in number, thank goodness, but included:

• The services that we currently don't have that we are pursuing through our clinical affiliation with UPMC
• A variety of issues surrounding the ED 
• Various communication issues

The opportunities included:

• The evolving relationship with UPMC
• Our work in population health
• Enhancing the community's perception of us

As for the threats, the leaders were:

• Growing competition
• Increasing violence in the community and its potential for carryover into the hospital
• Cyber attack concerns
• Over regulation

All in all, the list was very well thought out and will go a long way in assisting us in our strategic planning efforts for the next several years.

Thank you to the many staff who participated in this very important process.

One of the Greatest Transformations for Hospitals: Value-Based Care

BR:  Since 1980, the healthcare environment has been reshaping itself. Today, there are 1400 less hospitals and yet a 40 percent increase in population. In 2010, Western Maryland Health System (WMHS) could see this change and implemented a value-based care model within our system. We transitioned our workforce to shift the delivery of care away from volume-based care to value-based by moving care across the care continuum and to provide care in the most appropriate location. Value-based care is considered to be the future of healthcare with a focus on helping patients improve their health and well-being through a shift on health emphasis and resources. This care model engages healthcare providers to reduce admissions and readmissions; strengthen patient engagement; reduce variation in quality; work collaboratively with community partners; reduce utilization of the emergency department (ED) as well as observation and ancillary services while saving millions of dollars. This approach measures health outcomes against the cost of delivering those outcomes.

BR:  While implementing the value-based model at WMHS, we found that a critical component of keeping patients healthy and out of the hospital that still needed to be addressed were the social determinants of health. After a careful analysis, issues affecting the patient’s health outcome were the result of poverty, food insecurity, heart disease, chronic obstructive pulmonary disease, diabetes, access to care and substance abuse. We started to look at the whole person more carefully and the needs surrounding them.  From job opportunities to primary care “hot spot” clinics to community gardens, patients now have resources to address not only their physical health but the social triggers that may affect their health outcomes.

By building a culture of health and collaborating to address the social determinants of health, we have dramatically reduced the cost of care over the last eight years by tens of millions of dollars, improved the health status of our community in a number of areas, improved our regional health rankings in key focus areas, and truly made a difference in the lives of many of our patients and residents throughout the region.

BR: WMHS has established many safety net partnerships throughout the region with pharmacies, the local health department, social service agencies, the business community, the food bank, the Boards of Education, Chambers of Commerce, City and County governments, and our colleges and universities. By collaborating with community partners, we are working to build a culture of health and provide comprehensive care to our community and the surrounding region. Through this culture of health, WMHS has seen a decline of 27 percent in admissions, 25 percent in readmissions and 15 percent in emergency room visits through these initiatives. One such initiative is Bridges to Opportunity, this is a program that provides community leadership to bring people out of poverty. We have also implemented a focus on food insecurity throughout the community that is delivered through education around healthy eating, school exercise programs and participating in several feeding programs for children and the community at large. Through our community partners, we have gone even further by establishing seven community gardens and an orchard to ensure fresh fruits and vegetables are available in the surrounding food desert locations. To deliver accessible comprehensive care to the community, WMHS is providing primary care clinics or “hot spot” clinics in homeless shelters, churches, senior centers and even, municipal buildings. There are many health concerns facing our community, but by creating many community partnerships, we are very well positioned to address those concerns now and into the future. When delivering the value-based care model and the initiatives surrounding population health, it is necessary to respond to the needs of the community.

How is WMHS Meeting the Many Challenges in Healthcare?

The healthcare field is certainly changing and if Western Maryland Health System isn’t keeping up with the changes, we could end up like one of the 89 hospitals that closed in 2017 with the majority being in rural areas. It has become apparent that because of our remoteness and economic development challenges, it is more difficult to bring physicians, primarily specialists and sub-specialists to our area. As a result, we have signed a clinical affiliation agreement with University of Pittsburgh Medical Center. They will assist us with such clinical needs as Vascular Surgery, Thoracic Surgery and coverage for Dr. Mark Nelson and the Cardiac Services program, as well as Oncology and Behavioral Health. We will continue to explore other ways in which UPMC can assist with the many challenges we face every day. Fortunately, we do have a lot still going for us. We benefit greatly from the Maryland Waiver which brings an additional $2.6 billion to the state provided we continue to meet a series of benchmarks related to improved quality, reduced utilization and cost savings. We transitioned healthcare delivery in Maryland eight years ago from a system based on volume to one that is value based. That transition brought us a great deal of advantage as it allowed us to demonstrate our commitment of placing the patient first in the care delivery system. We’ve been able to achieve remarkable partnerships across the care continuum to ensure patients receive the care they need where they need it. These partnerships have helped reduce the gaps in care and have better addressed the needs of the most vulnerable. We are much further ahead of other hospitals, in other states, with our care delivery model and our efforts in reducing the cost of care. We now care for patients in the most appropriate location including throughout the community and within the home.

As we attempt to work through the many changes, challenges and disruptions facing our industry, our goal at WMHS is to not only sustain healthcare services in western Maryland, but to enhance those services. Building upon the newly created relationship with UPMC could take us to long term viability through cutting edge technology, innovative programs and services as well as access to the many other clinical programs offered by one of the largest health systems in the United States. Most importantly, UPMC wants to offer those services in our community to the extent possible and not have the patient travel to Pittsburgh or Altoona unless it is absolutely necessary. This relationship with UPMC is an excellent next step for WMHS as we not only attempt to improve our viability but, with all of the difficulties that we face, our long-term survivability.

THE PEDIATRIC UNIT AT WMHS IS NOT CLOSING

If there was ever a time to re-engage my blog, now is it.

Since early June, I have been reading and hearing so much misinformation regarding the WMHS Pediatric Unit.  We are NOT abandoning children by closing our Pediatrics Unit.  The term “closing” is a regulatory term that we have to use even if we are transitioning our unit from virtually a single Pediatric inpatient bed on an adult patient unit to a five bed Pediatric Observation Unit adjacent to the Emergency Department.  Unfortunately, last Saturday’s newspaper headline stated that the unit was closing.  If you just read the headline and not the article, I can see how one would think that the Pediatric unit was actually closing, but again, that is not the case.

Beginning in early August 2018, any child requiring an overnight stay will be cared for in a dedicated, secure unit that is being newly constructed next to the ED.  The child can remain in the unit up to 48 hours; after that, clinical decisions will be made as to transfer or discharge to home.  This unit will be staffed by Pediatric Advanced Life Support trained nurses along with Emergency Department physicians and physician assistants.  Pediatricians will continue to attend to children in the unit, as well.  Because we have so few pediatric patients (for the first nine months of the fiscal year, we have admitted 44 children who have stayed an average of 1.93 days), our Pediatric staff nurses cannot maintain their expertise, nor can we recruit dedicated Pediatric nurses because we admit so few children.  The ED staff are very well trained in caring for and treating both adults and children.  In fact, last year we treated close to 9,500 Pediatric patients in the Emergency Department with 86 being admitted to WMHS and about 300 being transferred to a Pediatric Specialty hospital due to their chronic or critical condition.  As a parent and a grandparent, I can’t imagine why a parent or guardian wouldn’t want their very ill child treated in a specialty facility where the specialists treat thousands of children each year. 

Some have said just bring the specialists to Cumberland and we do, but caring for children on an outpatient basis usually for chronic or follow up care in Pediatric Cardiology and Neurology.  With a two hour travel distance and so few patients, it is unrealistic to think that specialists would come to Cumberland to perform surgery on one child.  There are physician shortages in virtually every specialty for both adults and children and areas such as ours have the greatest challenges in recruiting.  WMHS like so many other community hospitals have had to resort to alternatives in the care and treatment of children.  We are using more digital technology, telemedicine, and partnerships to address the needs of children and through our affiliation with UPMC, these advancements will continue to grow.  In Maryland, 33 out of the 47 hospitals, have Pediatric Units.  Eighteen of those hospitals have a length of stay for Pediatrics of less than a day and there are nine Maryland hospitals similar to WMHS with a length of stay of less than two days.  Over the last 30 years, Pediatric beds in Maryland have decreased by more than half from 882 to 385.  More and more children are being cared for in the most appropriate location, a specialty hospital, when they have a critical or chronic condition.

I certainly recognize the hardship for families who have to travel out of the area if their child is very ill.  Our staff at WMHS will work with the specialty hospital as well as throughout our community to assist with this hardship to the extent possible.  Although such transfers have been occurring for the last several years, we will become more engaged in the process and assist these families in navigating the challenges that they face when such circumstances arise.

I hope that the information contained within this blog helps to clarify the circumstances surrounding Pediatrics at WMHS.

Insurers and ED Visits

I can’t tell you how many people sent me the article last week regarding Blue Cross and Blue Shield of Georgia stopping coverage for ED visits that they deem unnecessary.  I am not sure as to all of the fuss since insurers serving their members in western Maryland have been denying payment for what they deem unnecessary care for the last several years.  If BC /BS of Georgia is like our local insurers, they will do little to nothing to educate their members on when and when not to use the ED, but hold the hospital accountable for the care that it rendered to their member.  

When a patient presents in the ED, we are required by law to provide care.  We have been working to educate patients on when to use their physician versus urgent care versus the ED.  We have had some success over the last few years, but we still have to fight denials on a continual basis.  We have increased visits to urgent care while reducing the number of ED visits; but again, that responsibility has fallen to the hospital.  We can’t be providing expensive emergency level care knowing that we won’t be paid.  

I certainly do not begrudge insurers seeking to reduce their costs, but their solutions need to be well thought out and applied as such.  Simply removing the proverbial monkey from their back and placing on the back of the hospital isn’t a viable solution.

Reducing Healthcare Spending While Preserving Jobs

As you may know, I am a contributor to FierceHealthcare's Hospital Impact, an online publication that is a peer-to-peer forum for hospital executives, physicians, and other hospital leaders that addresses clinical and operational issues.  

Below is my latest post about the challenges involved with addressing healthcare spending while preserving jobs in the community.


FierceHealthcare