Leadership Conference

On Friday, the WMHS leadership (supervisors, managers, directors and VPs) met for several hours on how to be best prepared for the changes in health care and its impact on our Health System.  The morning began with a great presentation by Evan Offstein, a professor at Frostburg State University.  Evan presented on "Making Time Count."  He focused on the quality and speed of decision making, how leaders spent their time, how to make better decisions and the errors that we make when making decisions.  The presentation was timely and well received.  It was a great lead in for my presentation on the Triple Aim of Reform: Improved Quality, Cost Reduction Through an Enhancement of Value and Improving Our Community's Health.  I was able to cover all of our results since going under a new payment methodology, Total Patient Revenue.  We have accomplished a great deal, but have a lot to do going forward.  Our organizational focus first and foremost has to be reducing readmissions.  I was also able to cover the lessons learned under TPR.  We were able to ascertain that TPR was the right choice for WMHS, but there is a lot of work yet to do.  We have a great leadership to accomplish our goals and we will get it done.

EEOC "Guidelines" on Arrest and Conviction Records

In an attempt to tie the hands of employers just a little bit tighter, the EEOC has issued guidelines related to hiring decisions on individuals with arrest and conviction records.  The new guidelines state that employers must show that when using a criminal record to exclude a candidate for a job, the exclusion is related  and consistent with business necessity or the exclusion is unlawful under the Civil Rights Act.  The new guidelines don't stop there.  The guidelines also state that an arrest is not sufficient to deny employment.  The employer must make the decision to employ based on  the conduct underlying the arrest.  In other words, the conduct leading to the arrest needs to be used in determining if the candidate is unfit for the job.  The EEOC also prohibits using a policy  excluding everyone with criminal record to deny employment.   Recently, Progressive Maryland, a far left organization based in Montgomery County, Maryland, had been attempting to re-write Maryland law to include what the EEOC has done with their most recent "clarification."    In an effort to protect our patients and their families as well as our employees, we will continue to thoroughly screen candidates for positions at WMHS; it is just that the EEOC made our job more difficult as we work to protect our most vulnerable individuals.

Extraordinary Bosses

Yesterday, I read a great article in Inc. magazine, "8 Core Beliefs of Extraordinary Bosses" by Geoffrey James.  Geoffrey writes that the best managers have a very different understanding of team dynamics, the workplace and the company.  What are the 8 core beliefs, you ask?

·         First, business is an ecosystem not a battlefield.

·         Secondly, a company is a community not a machine. 

·         Third, management is service not control.

·         Fourth, my employees are my peers, not my children. 

·         Fifth, motivation comes from vision not fear. 

·         Sixth, change equals growth, not pain. 

·         Seventh, technology offers power not automation.

·         Lastly, work should be fun, not mere toil.

Wow, what an article.  It is amazing as to how timely this article is, especially at WMHS.  We have so much going on as we change the delivery of health care in our community, and this article needs to be mandatory reading for all of our leaders.  The particulars of the individual core beliefs are worth expanding upon, especially how they relate to WMHS and I will do so in subsequent blogs.

Delaware, Really?

Last night, I heard that Presidential candidate, Newt Gingrich, was going to remain in the race for the GOP nomination for President if he won Delaware.  Are you kidding me?  He only won two previous states going into yesterday's Northeast primaries and, in addition to Delaware, there were primaries in New York, Rhode Island, Connecticut and Pennsylvania.  Newt, who I liked more when he was focusing on being positive as a Presidential candidate and who is, in my opinion, the smartest guy running for President, campaigned extensively in Delaware.  Why Delaware is somewhat of a mystery to me.  Maybe when your campaign is $4.3 million in debt, you could tell your supporters that you have momentum by winning another state.  But, Delaware?  Believe me, I love Delaware.  I have wonderful memories of Delaware, having gone to college there for two years.  After losing Delaware, I think that Newt needs to realize that the party is over and the proverbial fat lady is singing.  It is time to get out of the race, endorse Mitt Romney, beg him to help offset your extensive campaign debts and hope for a position in a Romney White House should that happen.

You're Killing Us

As the State of Maryland has wrestled with its budget issues for the last several years, WMHS has suffered immensely.  Not only are we hit with payment reductions for the hospital-related services that we provide year after year, but we are also impacted by the elimination of funding for community health  and social needs programs.  We have become one of the lone resources for behavioral health patients.  By the State reducing and, in some cases eliminating, funding for drug and mental health programs offered by our local health department, these services are no longer available or have been significantly diminished and the responsibility for care falls to us.  A large percentage of our ED patients now have a behavioral health diagnosis since the maintenance programs which previously existed no longer exist and these patients are at their worst by the time they get to us.   The Health Department continues to do what they can with their limited resources.  We provide outpatient services, but they are at capacity and there is little to no funding to grow such programs. I am not sure how this situation will be resolved, but until then we will continue to serve this vulnerable population without the help from the State.

A Major Scientific Breakthrough

I read this morning that scientists have a major breakthrough in identifying the cause of brain freeze.  Ever since I was a little kid I, have been plagued by brain freeze while eating ice cream or drinking an exceedingly cold drink.  I am sure that most of us get brain freeze, but some worse than others.  I think that I am in the "worse" category.  I have to stay away from really cold drinks like frozen strawberry daiquiris; you can feel my pain (pun intended). 

What is really remarkable is the link between brain freeze and migraine headaches.  For centuries, a mystery as to cause of migraines, but now a better understanding due to brain freeze research.  According to scientists, the pain associated with brain freeze results from an increased blood flow to the brain increasing the size of the anterior cerebral artery, which is a large blood vessel located in the middle of your head behind the eyes.  When the blood vessel constricts, the pain immediately goes away.  The answer for migraines may be in the drugs that are available to stop the blood vessels from opening up.  Not having migraines is a blessing because I know how debilitating they can be for those who suffer with them.  All in all, great news for migraine sufferers.  Brain freeze sufferers, not so much.

Weight Loss "Secrets" That Work

Driving to work this morning, I heard an interview on the radio with a guy who wrote a book on the best diets and worst diets.  He spent three years trying different diets and exercise programs.   He was 5'11" and I guess still is, but he weighed 178 pounds.  Over the three years, he eventually lost 20 pounds and is now about 156 lbs.   He described himself as skinny fat; his description of himself was that he looked like a snake that ate a rat.  What a vivid description.  Anyway, what didn't work and was the worst diet was a calorie elimination diet where you don't eat anything.  He went to a party with other such dieters and had a single blueberry as an hors d'oeuvre.  What did work was chewing your food to a greater extent, wearing a pedometer every day and recording what you eat throughout each day.  He said those "secrets" really did work.  My latest approach to a healthier lifestyle is significantly reducing sugar and processed foods in my diet.  I will keep you posted.

Focusing on What is Important to You

Recently, I wrote about a productivity suggestion from a social media start-up CEO who focuses on three things each day and nothing more.  I was critical of her approach in that it wasn't realistic, especially for a CEO.  I was reminded of that recommendation this morning when I read an article in the May issue of "Success" magazine about highlighting the top three things that matter most today. 

The article, "Take Control of Your Day," was written by Mel Robbins.  Mel tells us not to check our smartphones or iPads as soon as we wake up.  She suggests that we first do a "brain dump" by listing all of your projects, to-do items, reminders, thoughts from the night onto a single piece of paper. (This is where I might be in trouble as I may need a legal size pad of paper, there's a lot swirling thru this mind throughout the night.)  She then suggests that you highlight what three things on the list are most important to you for that day.   Next, she suggests that you open your calendar and find a 30-minute block of time in your day to focus on your top three things.  She writes, "Find the time and schedule it."

The bottom line is that you find time for yourself and what is important to you versus what others want you to do.  You set the tone for the day rather than it being set for you.  I think that it may be worth a try.  After all, according to Mel, 80% of smartphone users sleep with their cellphones.  Really?  Unless you are someone who has abandoned a landline telephone and use your smartphone as your sole means of telephonic communication, give your smartphone a rest.

Community Benefit

The other day one of our physician competitors was on one of the local radio stations doing his weekly infomercial and taking WMHS to task on our community benefit numbers.  In FY 2011, we provided community benefit in the amount of $34 million.  Community Benefit is mandated by law for hospitals and regulated by the Health Services Cost Review Commission (HSCRC) for Maryland.  In FY 2010, hospitals in Maryland provided Community Benefit in excess of $1 billion. 

Community Benefit consists of activities performed by hospitals that address community needs, improve population health and enhance disease prevention.  It covers a variety of areas from the amount of Charity Care that a hospital provides to the amount of mission-driven services.  These are the highest dollar areas for WMHS and probably the areas that our physician friend takes issue with.  Our Charity Care was almost $12.5 million.  This category consists of the amount of free care that we provide to patients throughout the year for all services, inpatient and outpatient. 

Our mission-driven services, which amounted to almost $17.5 million, include those services that are needed in our community and WMHS provides but loses money on each service.  They include our urgent care clinics, our hospice program, our hospitalist service, our obstetrical practice, our behavioral health practice and outpatient dialysis program.  Additionally, we provide community health services through support groups, health screenings, health fairs and educational sessions.  We also provide support for health professions education through Allegany College of Maryland and financial contributions to organizations that have a mission which is consistent with WMHS. 

Our Community Benefit reporting closely follows the requirements and guidelines of the HSCRC and exists to support the health care needs of our most vulnerable populations.  We are extremely proud of our Community Benefit activities at WMHS.

Doomsday Budget? Not For Long

At the end of last week's legislative session in Maryland, the House and the Senate leadership couldn't agree on a gambling issue and, as a result, failed to pass new funding sources to support the State's budget.  Instead, there is a doomsday budget lacking $512 million in new taxes and pension funding shifts to counties that will take effect in the event that there is not a special session called before July 1.

My perspective is that there will be a special session called as there is far too much at stake. 

Not only is the political future of the Senate President and Speaker of the House of Delegates hanging in the balance, but those areas impacted the greatest by the doomsday budget are the counties where the largest number of voters live.  I attended a college board meeting yesterday and I received a listing of funding hits that each community college in Maryland would take and the highest dollar amounts are in Baltimore City, Baltimore County, Prince Georges County and Montgomery County.  

The leadership including, the Governor, will not allow the doomsday budget to occur.  All of these leaders are part of the Democratic Party and their political futures, including the lame duck Governor and the party's future are in serious jeopardy if this budget is implemented without $512 million in revenue enhancements.

Power As A Test of Character

Over the weekend, I read a quote "just because you are driving the bus doesn't mean you have the right to run people over."  The quote reminded me of last week's blog about the two leaders who abused their power, Bobby Petrino and Ken Melani.  It was Lincoln who said, "To test a man's character, give him power."  As leaders, we have a responsibility to teach, mentor, inspire, encourage, be visionary and be trustworthy.  That trust is so critical for any leader in getting people to both support and follow that leader's vision.

The Maryland TPR Collaborative

I have previously written about the Maryland demonstration project called Total Patient Revenue or TPR.  The 10 hospitals across Maryland, including WMHS, are paid on a fixed basis regardless of volume or case mix.  These hospitals are focused on increased efficiency, reducing cost, reducing avoidable admissions and readmissions in order to achieve financial savings.  If the preceding factors aren't well managed, then the hospital bears the risk and the cost.  The 10 hospitals have been making progress on increasing value over volume, keeping patients healthier and treating patients in the most appropriate setting, not necessarily in the hospital.  The Collaborative is also making great progress in the overall delivery of care and reducing cost of care.  These 10 hospitals are doing a wonderful job of learning from each other as they share best practices, improve the patient experience in their respective communities and bend the cost curve.  What these 10 hospitals are doing should be modeled across the country in an effort to better address the components of reform.

Live by the Sword, Die By the Sword

As I noted last week, I am on vacation so I am a little more in tuned with current events as they are happening. Yesterday, I watched Ozzie Guillen, the new Manager of the newly reinvented Miami Marlins, be suspended for five days after only playing five regular season games. What Ozzie did for those of you who are not on vacation and have no time for anything but work, he said in an interview with Time magazine that he loved Fidel Castro. Really, you said that in Miami where it is more Cuban than American. Cuban Americans HATE Fidel and Ozzie loves and respects him. Ozzie has said lots of stupid things over the years as a player and most recently, as the Manager of the Chicago White Sox. Previously, he said that he likes and respects fellow countryman, Hugo Chavez, Supreme Dictator, actually President of Venezuela. Ozzie apologized for what he said yesterday not because he said it, but that Cuban Americans called for Ozzie to be fired and if he wasn't fired they are going to boycott all of the Marlins games until he is fired. This will never go away for Ozzie or the Marlins. They wanted an over the top Latino Manager to lead their team in Latin American dominated market so they could put more fans in the seats. Five games into the season, they are already going to have worse attendance this year then they did previously.

We All Make Mistakes, But........

My mother used to say, "You made your bed, now you have to lie in it."  I guess that is what Bobby Petrino's wife and Ken Melani's wife are saying to their respective husbands, most likely soon to be ex- husbands.  You see both of these men thought because of their extremely important positions that they were above everyone and everything else.  First, they needed to act their ages.  Both are fifty-something, Bobby is 51 and Ken is 58 and were having extra marital affairs with twenty-something women. 

Bobby Petrino was, up until yesterday, the Head Football Coach at Arkansas.  He was in a motorcycle accident and forgot to tell everyone that his mistress was riding on the back when the accident happened.  So he lied to his wife and four children, his boss and everyone else.  It was then reported that his mistress was also his employee and he gave her a $20K gift (can we presume from the University's coffers?). 

As for Ken, he was the CEO at Highmark Blue Cross in PA--a physician and brilliant leader who pulled off some amazing things at Highmark.  Unfortunately, he hired this young woman last October and three weeks later began an affair that was the worst kept secret at Highmark.  His wife found out and he left his wife.  He then moved in with his mistress after Ken's wife called the mistress's husband to let him know of the affair.  Then the relationship began to crumble.  Ken hired a private investigator to check on the "love of his life;" she found out and went ballistic.  She went to her husband's house to commiserate and lo and behold, Ken shows up and lets himself in.  He is told to leave more than once by the husband and refuses.  They get into a fight and subsequently Ken is charged with assault and trespassing.  Ken is overheard by the police on the scene saying that if the police didn't show up when they did, he would have killed both of them. 

Now, Ken and Bobby are surprised that they were fired.  Really?  They gave the Highmark Board and the AD at Arkansas no choice.  Hey boys, you are held to a much higher standard whether you know it or like it.  As leaders, you are expected to be above all of this.  People count on you every day to lead, guide and mentor them.  When you fall, you fall hard.  It is a unfortunate that the careers of these men may never recover from these very shameful acts, but hopefully others will learn from their big time missteps.

Two Milestones Celebrated on One Day

I asked my wife if she had any plans for the celebration of today's milestones and, of course, she looked at me like I was crazy.  She asked what milestones? First, there is the 16-year anniversary of the formation of the Western Maryland Health System and secondly, the one year anniversary of my blog. 

As for the blog, it was inspired by Paul Levy's blog, Not Running a Hospital, which I thoroughly enjoy reading every day.   Overall, I like blogging about the health system, people, politics, leadership, aspects of my job and even my personal life.  There are days that it is difficult to come up with a topic to blog about, but that lasts only a few minutes.  I am never at a loss for words once that I settle on the topic.  I hope that you continue to find the blog interesting. 

As for the anniversary of WMHS, what an amazing 16 years.  The early years were significantly challenging; however, what we were able to accomplish has been nothing short of amazing.  Three hospitals in Allegany County into one system; an open heart surgery program that is one of the best in the State of Maryland; the region's largest employer and an employer of choice; an exceptional trauma center; a dedicated board; a great team of physicians; an amazing workforce; an exceptional management team; a new state-of-the-art hospital and the list goes on.  I hope that our region realizes how blessed they are to have the Western Maryland Health System.

Getting the Message Out

I have attached to my blog a link to the WMHS YouTube channel, where you can find our most recent TV commercials that are running locally in an effort to get our patients and staff to understand how health care is changing.  There are similar radio commercials running on the local airwaves, as well.  Our Marketing team is also tying print ads to the health care is changing theme and what it means to them.  We will then include a QR code in the print ad showing you can view the commercial on a smartphone by scanning the code.  Technology is amazing as is our team with their creativity and what they do for our health system. 

www.youtube.com/wmhscumberland

Unnecessary Medical Procedures

The other day, I read an article about the various medical groups releasing a list of tests and procedures that patients don't need yet are routinely performed by physicians.  The article is very timely as we have been identifying such practices at WMHS and asking our physicians why such a test or procedure is necessary.  If your respective physician board says that a certain procedure isn't necessary, then why are you doing it?  As our Chief Medical Officer says, "I have been trained as a medical oncologist, so teach me doctor as to why you need to practice differently in your area of specialty.”  The article said that ordering such tests is wasteful due to the cost and can be dangerous for the patient.  Such practices are also fraudulent.  For example, if you order a specific test on every patient before you take them to surgery whether they need it or not and bill Medicare, you are committing a crime.  That is frowned upon by the payors, especially Medicare, and will get both the physician and the hospital in trouble.  Most physicians get it by understanding the importance of not putting their patient, the hospital and themselves at risk.  We will continue to work on the others. 

I am officially on vacation so my blogs for next week may be sporadic during the week.  However, there are two milestones next week that I will blog about for certain.

Have a blessed Easter and Passover!

When is Enough Enough?

This past weekend, we had four intoxicated individuals show up in our ED.  Three were accompanying their friend who had a head injury.  All four were drunk, including the patient.  All of them were disorderly, threatening, angry and rude. I find it incredulous each day  as to what our staff is subjected to as they try to care for and treat a growingly ungrateful public.  Drunks are not new to the ED, but those who are abusive and threatening seem to be on the rise.  Our Security officers were assisted by City police officers in dealing with this situation that resulted in two of the four being arrested.  We have no choice in that we cannot turn patients away from the ED, especially one with a head injury.  However, it is important to note that we will have you arrested if you conduct yourself in a manner that is threatening to an already vulnerable staff.  I would be remiss if I didn't thank our Staff and the City Police.  We are so fortunate to have a very responsive City Police Dept and a very dedicated staff.

A Different Kind of Sacrifice for Lent

Many of my Catholic friends have given something up for Lent as they do during the Lenten Season year after year.  Being a former Catholic, the concept is not foreign to me; however, now being a Lutheran, my pastor takes a slightly different approach.  You can still sacrifice desserts, candy, cake, cookies, cigarettes or alcohol; however, you can also do something for someone or a group that you may not usually do.  So, I didn't give anything up this Lenten Season, but I have donated to Water Missions International.  In this day and age, it is hard to imagine that over 800 million people throughout the world do not have clean safe drinking water.  The number of children who die each day is staggering because of diseases associated with unsafe drinking water.  So if you haven't given up anything for Lent and you would like to make a difference, do something nice for someone or some group.  If you would like more information on Water Missions International go to www.watermissions.org.

Hot Topics Sessions for Our Docs

Yesterday at WMHS, we provided a physician and advanced practice professional education event called Hot Topics.  We chose eight different areas for physician / APP education.  Topics included the latest in Information Technology at WMHS, our expanded Observation Unit, our new Infusion Center, Performance Improvement Initiatives, Quality Initiatives, Use of Restraints, Advanced Directives and Care Management changes.  We offered three different opportunities throughout the day and into the evening for medical staff members to spent 30 minutes at the event and receive CME credits.  Why is such an event (that will happen at least quarterly) so important?   One of our physician members of the President's Clinical Quality Council said it best, "with all of the change that is here and coming in health care, the information that physicians need to know is like taking a drink from a fire hose."  We have used a similar approach to educate our physicians, but on  much smaller scale.   Usually in the medical staff lounge from time to time,  we will do a demonstration on a new IT program that will make their professional lives easier.  We simply expanded the approach with 8 topics consisting of a 5 minute target message at each booth.  Thanks to all who attended and organized the event.

We Are From The Government and We Are Here To Help

Over the weekend, I read that the IRS is moving forward with hiring 4500 IRS employees to enforce the new health care law.  For the "nominal" cost of $303 million dollars, the IRS will get 4000 agents for health reform enforcement.  The law requires all legal citizens of the US to have health insurance.  If you don't, you will be fined and it will be paid at tax time.  If you are a business with over 50 employees, you will have to demonstrate that you provide affordable coverage to your employees; if not, that's right, you'll be fined too.  This law is so complex that the IRS is saying that it could take years for them to understand the specifics in their entirety.  Reassuring, isn't it?  It reminds me of the State of Maryland a few years ago with its laws related to lead poisoned children.  Detecting, treating and caring for the kids became too costly so they decided to step up enforcement of fines and penalties.  They virtually ignored evolving sources of lead poisoning, such as schools, because it would cost too much to address.  And they criticize health care for how we run our hospitals and health systems.