A True Statesman

Last evening I had the privilege to hear former Senator George Mitchell, who was a federal judge, Senate Majority Leader, mediator of the 800-year conflict in Northern Ireland and, most recently, special envoy for the Israeli Palestinian conflict.  Wow, what a true leader and statesman.  He spoke of his time as the Senate Majority Leader and his excellent working relationship with Presidents and Republicans, especially Bob Dole, who was the Senate Minority Leader.  He calls Bob Dole a great friend to this day.  His mentor in the Senate was former Majority Leader Howard Baker, a Republican from Tennessee. This is what is needed in Washington today.  He made decisions based on what was best for the country and compromise was the order of the day.  He wasn't focused on polarization of the parties with a focus on winning or maintaining control of the Senate, the House and the Presidency.  Senator Reid, Speaker Boehner and President Obama could take a page out of Senator Mitchell's book on leadership and statesmanship.

We're Almost #1

The State of Maryland is 9th from the bottom in tax friendliness out of the 50 states.  Yet, knowing this statistic, the State, through the Governor and the General Assembly, is proposing and discussing additional taxes to include a sales tax increase, a tax on personal services, an increase to the state income tax, an increase in the gasoline tax, a personal exemption elimination, a reduction in the mortgage deduction and a tax Internet downloads such as music, books, videos, etc.   Wow!  How do you get them to understand that they can reduce spending by eliminating patronage positions such as the assistant to the assistant of whatever for the State of Maryland, relaxing business regulation and virtually balancing the budget by taxing SAFE drilling for natural gas in Maryland?

The Challenges That We Face

The transformation in health care delivery through Federal reform and payment reform in Maryland is not without its challenges.  Our care delivery model is changing from the traditional model whereby everything revolves around acute care.  We are now heavily focused on the entire continuum of care.  From physician offices, to clinics, to rehab, to home care to nursing homes......all are a growing part of that continuum.  We are here if needed for inpatient care or a visit to our ED.  However, we need to get providers, patients and our community to realize that the traditional model cannot be sustained.  We all need to come to grips with caring for the patient in the most appropriate setting which could be in the home, in a heart failure clinic or remaining at the nursing home for care rather than being transferred to the hospital.  This new approach is the right emphasis, but it is not without its challenges.  There is a lot to be learned by a lot of people, ergo the challenge.

Why is your staff so good?

Recently, I had a board member ask why is your staff so good?  I asked, "so good at what?"  He replied, "at everything."   As a recent patient, he was blown away with the care and compassion demonstrated by everyone.  Quite honestly, many of the staff didn't know who he was since he has moved out of the community since retirement, but continues to serve as a board member.  The clinical experience was exceptional as was the approach to service excellence. I told him that what he experienced is our expectation of how every patient should be treated and cared for.  We strive for service excellence in every interaction with patients, their families and each other.  I went on to tell him that it starts with our core values and our service excellence standards in which every employee must embrace.  New employees are told at Orientation that if you can't adhere to our service excellence standards, not to waste their time or ours by beginning to work here.  If current employees can't support our service excellence standards that are reviewed annually during sessions where every employee must attend and agree in writing to adhere to each standard, then we will work with them on their transition from WMHS.  Our approach and commitment to service excellence are taken very seriously.  Is everyone fully engaged?  No, but if they are not, they will eventually reveal themselves.  Then if they can't get onboard, separation is in their future.

Snow Ball 2012

Last Saturday was the health system's 56th Snow Ball.  It was a great event and it reflected the hard work and dedication of our Auxiliary.  The country club was decorated beautifully, the food was wonderful and the music was great.  There were over 330 in attendance and all appeared to be having an enjoyable time.  What really struck me was the number of younger people in attendance.  It was wonderful.  I am pleased to say that this was our 21st and 22nd Snow Balls, respectively, Pamela missed two and I missed one.  It is also pretty obvious that we are now the more senior attendees.  It is comforting to see the next generation coming along to keep this wonderful evening that raises a great deal of money for the health system.  It has become the signature event for our health system and community. 

Paula Deen's Diabetes

Have you heard that Paula Deen, a Celebrity Chef and the Queen of Low Country cooking, announced last week that she has had Type 2 Diabetes for the last three years.  For those of you who are unfamiliar with Paula Deen, her style of cooking promotes high fat, high calorie meals.  There has been a great deal of criticism of her diagnosis and her continuing to promote unhealthy foods.  Quite frankly, Paula Deen's diagnosis is her business and she has chosen to disclose it and that's great.  As Americans, we put far too much emphasis on celebrities and what they think or do.  I will give you that athletes can influence the actions of kids, but I am not going to have George Clooney influence my politics or eat unhealthy foods every day because that's Paula Deen's cooking style.  If you like low country foods, fine, eat them, but do so in moderation. Since when is it a celebrity chef's responsibility to alert us to unhealthy foods.  We need to grow up and take some responsibility for our actions. 

Hospital Medicine

Here we go again!  Once again, we are hearing in the community that the Western Maryland Health System is forcing patient to go to our doctors (hospitalists) and not allowing their doctors to have privileges in the hospital.  Obviously, nothing can be further from the truth.  The majority of primary care docs who previously had both an inpatient and office practice have chosen to focus on an office practice exclusively.  I only wish that THEY would better inform THEIR patients of their decision to give up THEIR inpatient privileges.  We wrote letters on their behalf to hand to their patients; some handed them out, others didn't and some posted them on the waiting room wall along with a thousand other announcements.  It is left to us to educate the public and we will, but it would sure be nice to have a little help.

Losing Confidence in Obamacare

I read yesterday in USA Today that physicians are losing confidence in the President's health care reform plan.  Acceptance by the American people has recently declined to now only one-third supporting it.  Is the plan perfect? Nope.  But there are aspects of the reform plan that make sense. Putting the patient first, focusing on wellness and the health of the population served by hospitals and other providers, caring for the patient in the most appropriate setting by not requiring an inpatient admission for virtually  everyone who comes through the door, and reducing the cost of health care that has become unsustainable are aspects of the plan that make sense.  There are a host of deficiencies that need to be addressed, such as aligning incentives between hospitals and physicians, tort reform, less regulation,  more incentives for physicians to deliver quality health care rather than continuing to cuts fees and reimbursement and the list goes on.  Quite honestly, the President is onto something.  If we could only get the partisan politics out of designing and delivering a workable reform plan, everyone, patients, providers, physicians, payors and even politicians would benefit.

Drug Seekers

The health system is being inundated with drug-seeking patients who are addicted and claiming lots of toothaches and back pain.  Our ED staff do excellent work in this area as this class of patient can be persistent, abusive, desperate, menacing and threatening.  Unfortunately, it spills over to the clinics, practices, the Pain Center and even administration.  In this day and age, it is pretty difficult to get pain meds in any of these settings unless there is serious confirmation of an illness requiring pain meds.  Our number of repeat visitors to the ED continues to grow.  So far, we have been fortunate at WMHS; whenever such situations arise, our Security officers respond and the City Police are called.   Our situation has been less dangerous than in the local pharmacies, where they have been held up, some repeatedly.  As a community, we need to work together to address this growing problem. 

On a related, but lighter note, recently a local pharmacy was burglarized and on the surveillance video, you can see the burglar going right for what he thought were the Fentanyl patches.  Unfortunately for him, he got away with a whole lot of Estrogen patches.  Then again, maybe he knows a number of women who are in need of hormonal therapy.

Transitioning to a "Get It Done" Organization

The days of taking that kinder, gentler approach to just about everything at WMHS are now over.  We are transitioning the organization to be all about the patient; it's no longer about "me."   Whether "me" is the physician, the nurse, the manager, the CEO, the director, the technician and the list goes on.  We are here to provide the most appropriate care in the most appropriate setting.  We are transitioning to an organization that is moving quickly to change how we deliver care.  Previously, we accommodated just about everyone.  If we are going to be successful in the age of health care reform, we have to provide patient-centered care; we have to focus on the health of the population that we serve and we have to lower the total cost of health care.   As an example, in the "let's accommodate everyone era,” we amassed a total of nine different type of latex exam gloves, not surgical gloves, exam gloves that were available at WMHS.  We just reduced the number to ONE, saving at minimum tens of thousands of dollars in better pricing, less man hours from ordering to delivering and reduced inventory costs.   I will provide a list of examples of such changes in the coming weeks as there will be many.

Walk in Their Boots

I just heard a story from my Naval Officer daughter regarding a Marine Officer and fellow US Naval Academy grad, with whom she is acquainted.  This Marine Officer did tours in both Iraq and Afghanistan.  He said that after what we did in Iraq, they have a wonderful opportunity to be a great country.  Afghanistan, not so much.  During his last tour, he was responsible for training Afghan men to fight in their military.  He recently learned that one of the Afghan men, whom he trained to fight, killed the Marine Officer's replacement as well as other Afghan members of the training group.  He is sick over it and feels somewhat responsible.  That's a tough thing to live with day after day.  It also explains the recently reported actions of our Marines who were videotaped urinating on the corpses of Taliban fighters.  Am I condoning their actions, no, but I have a much better understanding of why such acts occur.  What these men and women are experiencing is horrific so, until you have walked in their boots, if you will, don't call for their heads.  That advice goes for the Commander-in Chief-and Secretary Clinton, as well.

Counting Calories

I was thinking of the topic for today's blog and it came to me after hearing two separate news stories this AM and reading an early morning blog on MedPage Today all on the same issue --Counting Calories.  Now this isn't the same approach of counting calories that I saw a few years ago in a "Born Loser" cartoon.  The Born Loser's wife is watching him eat this very large meal and says, "I thought that you were counting calories?"  He responds by saying, "I am and this is 5,280 so far today." 

Actually, with all of the information and mis-information out there about the most effective diet or dieting techniques, the caloric content is the most effective to determine the amount of fat gain.  Simply put, if you eat more calories than you burn, you gain fat.  So the good news is that you can eat what you want you; the bad news is that you just need to do so in moderation.  My trainer always says that table push aways are the most effective exercise.  Translated, that means know when to stop eating. Throw in some exercise each day and you got yourself a lifestyle change that will start to show a change pretty quickly.

Binge Drinking

I saw a factoid the other day revealing that 38 million Americans binge drink at least 4 times a month.  Wow!  I thought it would be high, but 38 million.  Binge drinking is defined as a man drinking at least 5 drinks in 2 hours or a women drinking 4 drinks during the same period with both exceeding a blood alcohol level of 0.08%.  That's a lot of college students.  Actually, according to the Centers for Disease Control, 70% of binge drinkers are over the age of 25.  Now for the even scarier part; the health risks associated with binge drinking include: unintentional injuries, intentional injuries, alcohol poisoning, sexually transmitted diseases, unintended pregnancy, liver disease, high blood pressure, stroke, heart disease, sexual dysfunction and neurological damage, just to name a few.  Makes you want to swear off alcohol consumption altogether or, at a minimum, to drink in moderation.  Sobering to say the least.

Plan Maryland

I recently read that Maryland Gov. Martin O'Malley signed the Plan Maryland executive order targeting urban sprawl and virtually any rural development.  This executive order will achieve this administration's goal of keeping western Maryland green, pristine and poor as hell.  If this order was in place when we were working to find a site for the new hospital on Willowbrook Road, the new Western Maryland Regional Medical Center would not be here today.  We would have been forced to use one of the existing campuses, costing millions of dollars more and keeping the Memorial / Sacred Heart issue in the forefront for many more years to come.  By building the new hospital on "greenfield" site, we almost immediately eradicated the anti-affiliation issues that plagued this community for over a decade.  The Governor has virtually stripped away any local planning and zoning authority and did so without any involvement from the General Assembly.  Democracy?

Setting the Record Straight on Senator Cardin

A number of weeks ago, I wrote a blog about Senator Cardin's fundraising efforts and how strange it was since he is extremely well positioned for re-election to the US Senate and didn't have any opposition.  I blogged too soon.  Now I know what the Senator knew.  He is being challenged in the April primary by a very popular African American minister / state senator from Prince Georges County.  I still think that Senator Cardin doesn't have much to worry about especially since the Maryland Democratic Party has already broken its own rules by openly endorsing Senator Cardin during a primary, which is a no-no.  Gotta love politics and government--where the rules are in place for everyone but them.

Sudden Infant Death Syndrome (SIDS)

The very good news is that SIDS cases in the US have declined by 50 % since 1990.  Public health officials are now trying to figure out why.  A new database has been created to capture data and monitor trends.  What has truly helped has been a great deal of education of parents, especially new parents, on how to put an infant to sleep (on their backs not stomachs), place the baby on a firm surface, keep soft objects and loose bedding out of the crib and very importantly, avoid co-sleeping.  

There is another category of Sudden Unexplained Infant Death (SUID) when an infant dies due to unexplained circumstances.  Areas routinely considered are poisoning, metabolic disorders, neglect and ultimately, homicide.  However, another area to consider is smoking while pregnant and second-hand smoke while pregnant and after delivery.  There is a direct correlation between smoking and SUID and more needs to be done in educating new moms and families in this area.  In Allegany County, like our surrounding counties in WV, we have a very high rate of pregnant women who smoke during pregnancy.  Our Community Health Coalition will be addressing this issue with our local OBs and our peri-natal staff.  Drawing a direct correlation between SUID and smoking may help in saving even more lives.  Saving the lives of infants at the expense of an unhealthy lifestyle makes us two for two.

She's Coming Home

On Friday, we received word that Lauren's ship is on its way home.  Thank God.  The holidays were a bit disconcerting with what was going on in the area of the Strait of Hormuz, learning that her ship was in the thick of it and being concerned about my daughter's safety.  I know, I know, that's what she is trained to do, but it is still difficult as a parent. I think of the loved ones all over our country with family members serving and with so many in harm's way.  The sacrifice especially around the holidays is especially challenging.  I spent Christmas with my mother-in-law, who related a story about her brother who was an officer in the Army Engineering Corps during WWII.  What was so amazing about the story was that he was away from his parents and sisters for over 4 years and his family never heard from him in those 4 years.  He left and when the war was over he came home.  He said that he was too busy to write as he was building air fields and bridges all over the world.  It is hard to imagine, but it is true.  Thank goodness for today's technology so we can at least get an occasional phone call and email.

HPV, Cancer & Oral Sex

Today's blog is a bit out of the ordinary since it deals with oral sex.  I read an article that pretty much shocked me (click here to read article).  Twenty million Americans have the Human Papilloma Virus and with the HPV increase there is also an increase in throat and tonsil cancers mainly due to the proliferation of oral sex among teenagers and young adults.  It is time for parents to take control of this issue and have that difficult conversation with your son or daughter.  Oral sex is sex and it is not safe sex; sorry, Bill Clinton.  It is also time to get them vaccinated; sorry, Michelle Bachman.  We are talking about cancer here and your kid; this is serious and preventable.  Education on the matter is critical as is getting your child vaccinated.

Living Life to the Fullest

I am going to share one of my wife's resolutions for 2012, living life to the fullest.  I don't know if she actually realizes that it's a resolution but on January 1st she told me that she had a wonderful time at the New Year's Eve party.  She danced all night, laughed, smiled, talked and drank champagne.  She told me that you don't know how many more years that you can enjoy life so she was starting to do so in 2012.  Good for her.  I thought that the reason she had such a great time on New Year's Eve was because we hadn't gone out in many years and that I was always asleep by 10:30 PM.  Pamela and I already have a great life.  I can't wait to see what living life to the fullest really means in 2012; I sure hope that it includes me.

Resolutions

So, what comes with a new year?  Resolutions.  How did you do with your resolutions from last year?  I had six and I achieved five of the six.  Continuing with that healthy lifestyle is always the tricky one.  I started out so well and continued throughout the year, but that last quarter was a challenge.  Too much great food and not enough exercise.  Post Christmas, the health lifestyle resumed and, hopefully, can become the way of life that I planned for last year.  My other resolution for 2012 is to be an all-round better person:  a better Christian, a better husband, a better father, a better CEO, a better service excellence champion, a better co-worker, a better friend, a better son and a better brother.   Time will tell.

Happy New Year

Happy 2012, everyone.  So, what will be different this new year?  Two major changes at WMHS are the addition of a new Director of Quality Initiatives, Carol Everhart, who will head up our transition to our new payment methodology, Total Patient Revenue, and all that it entails.  Also, around March our new Chief Medical Officer, George Garrow, will begin his tenure at WMHS.  These two individuals will be key as we move forward with the changes that are necessary to be successful in health care.  The concept of value over volume is real and already happening at WMHS.  Two key components are breaking down the barriers to change and ensuring that our staff are on board and committed to the significant changes that are expected.  Carol will be key with breaking down the barriers and George will be key in getting the medical staff on board with the changes in how we do business. 

I hope that you have a safe, healthy and prosperous new year.