Reducing Medicaid Hospital Stays to 10 Days

Wow, what a headline in USA Today the other day.  Hawaii is limiting Medicaid inpatient admissions to 10 days and Arizona is going to 25 days. Do you think that it is going to prevent Medicaid recipients from not going to the hospital after they have used their 10 or 25 days? Nope.  The burden once again falls to the hospital.  Hospitals can't and won't refuse treatment or discharge patients on the 11th or 26th day; they will absorb the cost.  The question is how long can these hospitals incur such losses.  As states attempt to balance their budgets, they need to seek more creative solutions to this challenge. 

Cape Air

Yesterday, I wrote about my recent trip to Vermont.  I didn't pay much attention to the travel plans only that I didn't want to drive several hours from a large airport.  Great news, there are flights from Boston to Rutland.  We flew JetBlue to Boston.  I thought that the flight was continuing on JetBlue.  Nope, Cape Air.  We flew to Rutland and back on a 9-seat commercial plane.  The trip in was spectacular.  The trip back was a little disconcerting in that we flew from Rutland to Boston in a cloud.  Thank God for a great pilot and technology.  The trip went off without a hitch from start to finish.

New Payment Models in Vermont

I, along with Kim Repac, WMHS CFO, just returned late last night, actually early this morning, from Rutland, Vermont.  The Vermont Hospital Association, the State of Vermont and Blue Cross of Vermont held a conference for hospitals across Vermont as they seek new approaches to creating sustainable payment models in Vermont.  We were there to present our transition to a form of global budget under total patient revenue (TPR).  We learned a lot from the host of speakers throughout the day.  Our presentation brought the day of presentations at the 30,000 foot level to ground level as we were the only health system presenting on our successes as well as our challenges under the new payment methodology for the last year.  Met some great people in an area that very closely resembles Western Maryland.  Time well spent.

Improving Your Health System in 10 Minutes

Really?  This article title caught my attention yesterday in Becker's Hospital  Review.  Actually, a handful of speakers on a service excellence panel were given 10 minutes to tell the audience how to improve their health systems.  OK, that's better.  Improvements of the magnitude that hospitals need can be measured in months to years.  Some of the service excellence strategies that we have engaged in with our employees at WMHS have taken six months before we have seen any appreciable improvement and, fortunately for us, that improvement continues.  It can be done, but there is no magic bullet; although to be honest, when I saw the title, I was hoping for a breakthrough in service excellence that maybe we had missed previously.  Just goes to show you that it's never easy.

Well Positioned

I just read an article on the four priority strategies for health systems for the future.  The significance is that at this week's WMHS Board Meeting, I will present my assessment of Future Scan 2012 - 2016.  The presentation includes my perspective on what trends we will see in health care over the next 4 to 5 years.  The four priorities fit very well with the presentation since they are four areas that we are heavily engaged in currently.  The four areas are as follows:  aligning hospitals, physicians and other providers along the care continuum; utilizing evidence based practices to improve quality and patient safety; improving efficiency; and developing integrated information systems. 

WMHS leadership, including the physicians on our Clinical Quality Council, is heavily engaged in delivering care in the most appropriate setting and not necessarily the acute care setting. The Council and our staff are also focused on enhancements to quality and safety as demonstrated through our dramatic improvement in core measure results. We have engaged our process engineers with our middle and senior management to reduce redundancy and better standardize our processes. Lastly, we are deploying electronic medical records software, electronic order entry, e-Prescribing and e-Clinical Works in physician practices.  It is nice to have reaffirmation from time to time that we are on the right track.

Heart Healthy

The cost of caring for congestive heart failure patients has dropped dramatically as hospitals and providers seek alternatives for care of CHF patients.  The days of ER visits and the subsequent admission are much less these days.  Insurers, physicians and hospitals are  continually seeking ways to treat such patients in the most appropriate care setting starting in the home.   At WMHS, we have experienced similar successes and we are building upon that success as we make every effort to use the acute care setting as only one option for our patients.  We are finally applying the complete continuum of care that we have available for our patients.

Legalization of Marijuana

Can you believe that 50% of Americans support the legalization of marijuana?  I can't, but a recent Gallup survey says "yes."  Not surprising is that 62% of 18 to 29 year olds favor legalization.  What is surprising is that 31% of adults over 65 favor legalization.  What probably is happening is that these folks think that it's the same pot that they smoked as teens and young adults.  Also, today's parents seem to be afraid to tell their kids that they can't smoke pot because they did it when they were kids.   Today's pot is  more addictive and it reported to be ten times stronger than it was in the 70's and 80's.  It is also linked to disorders in the brain.  Parents need to try talking about the previous factors and tell their kids "NO" and, while they are at it, they can fill in grandma and grandpa on the dangers.

The Igloo

First it was the Civic Arena, then it was Mellon Arena, but it was always known as the Igloo, where the Pittsburgh Penguins played hockey.  At least it was until last season when Consol Energy Center was built across the street from the Igloo.  Recently, I was flying out of Pittsburgh and picked up the Pittsburgh Post-Gazette.  There was an article on the court challenge to preserve the Igloo.  A group known as Preservation Pittsburgh filed an injunction to stop the planned razing of the arena.  The suit said that redevelopment of the 28-acre site would be an economic boon for the area.  Let me try to understand this plan.  You are going to ask for federal dollars to prop up a 50-year-old building that was severely dated, in major disrepair and loaded with asbestos.  They wanted to preserve a landmark at the expense of 1200 housing units, 600,000 sq. ft. of office space and 200,000 sq. ft. of commercial space that would truly be economic development in a severely depressed area of Pittsburgh.  Preservation Pittsburgh actually called the City Officials lacking innovation and integrity.  Preservationists do have a place, but they need to know when to fold.  They have no concept of the cost involved with preserving aging landmarks and holding onto the past.  The city leaders in this case got it right.  What a shot in the arm for such an economically depressed area as the Hill District in Pittsburgh.

Interviewing for a Job

This is a true story, sad, but true.  We recently had two positions for which the Foundation Executive Director was hiring. There were over 60 applicants for these positions,  with the overwhelming majority being  young women.  Yesterday I picked on 18 to 24 year old men; today it's the ladies, although this blog could easily apply to the guys.  The jobs were posted on the WMHS website so the great majority of candidates were local.  However, the issue isn't a local one; it has become a societal one.

First order of business was to do an Internet search on each candidate.  Thank you, Facebook, as it has become a wonderful screening tool.  Some of the stuff posted on Facebook was unbelievable and access was easy. Sixty applicants quickly became twenty. 

Next, the screening interview.   The new attire for the interview has become a sweater and slacks, crop pants, big earrings and I mean big earrings (maybe to distract one from actually listening to some of the answers to some of the interview questions).  What happened to pant suits, dresses, even a skirt?  In some cases, you gave the benefit of the doubt on attire for the first interview, but now it's the second interview.........this is serious.  What to wear, what to wear.  I think I'll wear that same sweater and slacks or those crop pants.  This is the time to really set yourself apart, you made the cut.  It's down to three candidates and you get to work for the employer of choice for the region.  Wow, what these young women (and men) don't understand about making a favorable impression and truly setting yourself apart. 

Prepare for the interview.  Know the potential employer and understand the expectations of the job.  Do a mock interview with someone........be prepared.  The basic knowledge of preparing for an interview used to be obtained in the home, but that no longer seems to be the case.  It's not there, but somebody needs to take up the cause:  high schools, colleges, extended family, media, the Chamber of Commerce..........somebody, please and don't even get me started on the follow up thank note!

18 to 34 Year Old "Men"

I recently read a frightening statistic that more men between the age of 18 and 34 play more video games than 12 to 17 year olds.  I think that they call this the Peter Pan Syndrome, where these "men" never grow up.  OK, guys, don't you think that it's time to man up?  You should be going to college, working, at some point getting married and supporting a family. Isn't the number of single family households where the mother is raising the family staggering?

I am aware of family after family where the son has come back home to live so, Mom and Dad can help "Johnny" get back on his feet.  Actually, Johnny was never able to stand on his two feet since Mom and Dad were enablers from the start.    These men need to take control of their lives, but first Mom and Dad need to give them a swift kick in the rear end.  These men need to turn off the TV, put down the game controller, wake up before noon, start to network with responsible adults as Mom and Dad may not qualify, go to college (community college is a great opportunity), get to work (yes, you may have to start in an entry level position so, you can demonstrate that you have what it takes), but most importantly, begin to take some responsibility. 

Healthy Aging

Death is inevitable; however, we need to do a better job of helping our seniors, in some cases, soon to be all of us, age better.  They need to approach life based on a healthier lifestyle and we need to help them get there.  Wellness initiatives focused on the elderly will go a long way in minimizing the obsession with many of our seniors who wear their various illnesses as badges of honor.  Wouldn't you rather talk about how great you feel and the activities that you are participating rather than being bogged down with talk of your latest aliment.  I want to be like my mother-in-law, who at 85 years young, is an accomplished artist who still paints, golfs twice a week, has been preparing  meals for Meals on Wheels for the last 19 years, teaches an art class each week and remains very active in her church.   At WMHS, we reach out to our seniors with healthy aging initiatives through our Senior Suppers each month.  Maybe it's time to reach a little further and to help this generation that has earned our respect to age better.

The Impaired Nurse

Last week, Pat Noble, Executive Director of the Maryland Board of Nursing, spoke to our Nursing Leadership Group on Substance Disorders and the Impaired Nurse.  Pat shared story after story, all were true, but without specifics.   It is amazing as to the lengths that the impaired or addicted nurse will go to hide their addiction, but still satisfy it.  We learned of addicted nurses who have lost everything, their spouses, their children, their homes, their cars, but taking away their license to be a nurse was the final straw that lead to their rehabilitation.  We were also reminded that a nurses' license depends on him or her reporting any threat to a patient being committed by another nurse.  Addiction or impairment certainly qualifies.  It is in everyone's best interest for such reporting to occur, but most importantly for the patient whose care we are entrusted with as well as the addicted nurse.  At WMHS and at the Maryland Board of Nursing, both go to great lengths to support the rehabilitation of the impaired nurse.    Pat's approach to the Impaired Nurse is to be commended.  She is truly there to protect the patient, but also to save not only a nurse's career, but his or her life.  The presentation was enlightening and made me think how fortunate Maryland nurses are to have Pat at the helm.

Connecting with Your Community

In health care, we routinely inundate the public with indecipherable information.  We are notorious for acronyms, we use health-speak known to us, but no one else, the public doesn't understand their bills, they don't understand that physicians are independent and don't necessarily work for hospitals (although that trend is changing) and that hospitals need to better engage employers in our effort to drive value.  We need to do a better job of reaching out to the community and to those footing the bill for health care spending.  They need to know that payment reform has taken hold and change is upon us.  We need to educate them on value replacing volume,  that care doesn't necessarily need to be provided on an inpatient unit over a four-day period of time, what wellness initiatives exist for their employees and the criticality of quality in all that we do.

Health Fair 2012

WMHS is already starting to plan our next health fair for the Spring 2012.  This will be a health fair on "steroids."  We will model our event after the dental community's Mission of Mercy that I blogged about yesterday.   WMHS physicians, RNs, advanced practice professionals, technicians, pharmacists, therapists and the list goes on will provide care to anyone needing care in our region.  We will also use the event to educate the community on wellness initiatives and living a healthier lifestyle.  I'll keep you posted on our progress.

Mission of Mercy

Congratulations to the dental community in our region on receiving a $20K grant for their Mission of Mercy event.  This event is where dentists, hygienists, technicians and a variety of other health professionals provide free dental care, including extractions, for two days.  The event will occur later this month and it is the second annual.  Last year, individuals came from as far away as the Midwestern US to be seen.  It was a wonderful event last year, and hopefully year's event will be another overwhelming success.

Live Longer

Great advice from www.bluezones.com on how people from all over the world approach life:

1. Move Naturally - Walk, get physical activity naturally. 

2. Purpose Now- Know why you wake up in the morning, have purpose.

3. Downshift - Find time to de-stress.  Enjoy happy hour, rest, nap (not at work).

4. 80% Rule for Eating - Stop eating when you are 80% full.  Eat a big breakfast, eat with others, remove distractions and be mindful of what you eat.

5. Plant Slant - Limit meat to twice weekly.  Eat green, as well as nuts and beans.

6. Drink Alcohol - Enjoy 2 glasses of wine.  Drinkers out live non-drinkers.

7. Connect to a Faith Based Community - Engage with a church, synagogue, or other faith based entity.

8. Loved Ones First - Thrive with positive committed relationships.

9. Right Tribe - Choose healthy and supportive friends.

Numbers 1, 2, 3, 6, 7, 8 and 9 are no brainers for me.  4 and 5 will require some work.

Infant Mortality

In USA Today this week, there was an editorial on infant mortality and how the US ranks internationally.  Whatever the number, it is always too high.  We need to pull out all stops in keeping pregnant moms healthy, expanding pre natal care and giving guidance to new moms once they leave the hospital, as has been the case in Maryland. 

Now, I have to take issue with comparing the US to other countries.  Infant mortality statistics aren't reported consistently from state to state in the US, so how can we accurately report such statistics between countries.  And, for the US to rank below Cuba, I find that mind boggling.  A few years ago, a relative visited Cuba as part of a special education visit to discuss challenges, successes, etc., related to educating developmentally disabled children.  There were none.  Their idea of the developmentally disabled were children who were blind, deaf or couldn't speak.  The truly disabled don't survive.  (I will leave it to you to think about how that happens.)  So, we are going to compare our infant mortality statistics to Cuba, give me a break.  Also, countries that are now providing "clean surfaces" to deliver children rank better than the US, come on.  Does the US need to improve, most definitely, but don't rank us against countries that consistently undercount, manipulate or out and out lie and then chastise us for it.    Also, the counter point editorial in the same newspaper gives a great perspective on the inaccuracies and inconsistencies in the data.

Mobile Hospital

At WMHS over the last 24 hours, we have been using our mobile hospital for mass flu vaccinations of our staff.  The purpose was three fold: getting as many employees vaccinated at one time; to test the mass inoculation process and to put our mobile hospital to the test in the event of a catastrophic event.  As you can see from the photos, it is pretty big at 72 feet in length and 23 feet in width.  It can accommodate 16 patients at a time; it closely resembles a MASH hospital.    However, it actually assembles in minutes.  You roll it out, hook up the air pump and you're done.  It has hookups for HVAC, lighting and electric.  It also has a self-contained generator.  We have used the mobile hospital before to test the assembly, but have never used it for medical purposes, at least until now.  In the first 10 hours of operation, we vaccinated over 600 employees.  Great outcome, so far.

God Speed, Lauren

This afternoon my Naval officer daughter, Lauren, begins a scary, but necessary trip three quarters of the way around the world and across three continents.  She will leave Norfolk, VA, for Detroit, MI.  She will have a brief layover in Detroit and will then fly to Amsterdam, The Netherlands.  After a few hours in Amsterdam, Lauren will then fly to Nairobi, Kenya, and will arrive there on Wednesday night.  Her final LAND destination is Djibouti, Africa, where she will arrive at 1 AM on Thursday.  From Djibouti, she will be flown by helicopter to her ship somewhere east of Africa.  Her final destination is unknown to Mom and Dad and pretty much everyone else.  In fact, her whereabouts for the next 4 months will be unknown to us.  As a colleague said yesterday, when I was in the Army and we were deployed, we were part of a large group traveling abroad, never alone.  I can't imagine the stress around such a trip.  I was going to write that when I was 24, my toughest decision was what I was going to have for dinner or was I going out to party that night.   But then I remembered in reality, I had a pretty stressful job as Assistant Director of Materials Management for a large tertiary care hospital with a multi-million dollar budget and responsibility for a hundred or so employees. I was also finishing my degree by going to school at night.  However, that time in my life was still nowhere near as challenging as to what Lauren has to look forward to.  God speed, "little" Lauren, you are loved and will be sorely missed.

Inconsistencies in All Aspects of Life

This weekend, I attended the Navy / Air Force football game.  Air Force dominated the game until the final minute when Navy tied the game with 19 seconds remaining.  The game went into overtime and Navy had the first possession in OT.  They scored a touchdown, but immediately following the play, the Navy quarterback was called for an unsportsmanlike conduct penalty for "getting in the face of the Air Force player" as actually stated by the referee.  According to the Navy player, the  Air Force defender was blocking his way back to the sideline and he told him to" move" in explicit terms.  Unfortunately, a chip shot extra point became a 35 yard attempt against the wind and Navy missed the extra point and went onto lose the game in OT. 

There was another incident later in the afternoon when the momentum of a Clemson defender takes him into the end zone of the home crowd after he successfully defends a sure touchdown pass against a Virginia Tech receiver and he high fives a student in the crowd.  He was penalized for an unsportsmanlike conduct penalty and Virginia Tech went on to score a touchdown after the ball is put on the 1 yard line. The inconsistency comes in when later that evening while watching the Alabama / Florida game, there are hits after the plays were over, hits out of bounds and, at one point, three Alabama defenders standing over a Florida receiver who missed a pass taunting him; in each case, no penalty.  A hard lesson for these players but useful in that such inconsistencies continue in life.  

Take health care; we have to deal with CMS, intermediaries and regulators who take inconsistent interpretations to a new level day after day.  Organizations like CMS, the NCAA and the NFL need to really examine their rules and regulations and do a better job of training those left to interpret them.