"The Ronan Report" provides insight about the activities at the Western Maryland Health System in Cumberland, Maryland, and about the changes taking place in healthcare today from a CEO's perspective.

Thursday, May 31, 2012

Wireless Technology at WMHS

Congratulations to Bill Byers, CIO, and his IT staff at WMHS on the attached video that was produced by Enterasys promoting our wireless technology.   The video shows how we are 100% wireless in our mobility to care for patients.  We also have the capability to have physicians and advanced practice professionals bring their own portable devices such as smartphones and iPads into the hospital and to be operated at the patient's bedside, on a patient unit or in their offices rapidly and securely.  Wireless technology  has  greatly enhanced our workflow in care delivery as well as patient safety at WMHS

Wednesday, May 30, 2012

That Delicate Balance of Choosing Wisely

In April, a number of physician groups launched the Choosing Wisely campaign focusing on 45 tests and procedures that are overused during annual physicals.  In fact, one of the overused tests is the PSA to test otherwise healthy men over 50 for prostate cancer. 

At our last President's Clinical Quality Council, the issue was debated between a few of our primary care doc members and a urologist member of the Council.  The primary care docs have embraced Choosing Wisely while the Urologist suggested that the change be used with caution.  The delicate balance comes in with the necessity of the Choosing Wisely campaign versus the diagnosis of prostate cancer in healthy men. 

The issue hit close to home recently when an extended family member of mine went for an annual physical, had a PSA and it was determined that he had prostate cancer.  He had his prostate removed yesterday and all went well.  The cancer was caught in time as a result of the PSA test. 

The Choosing Wisely campaign is truly necessary to reduce the overuse of procedures and tests, but it has to be balanced with the patient in mind.

Tuesday, May 29, 2012

The Jazz Corner

Last night, I had the pleasure of another visit to the Jazz Corner on Hilton Head Island.  Great food and drink with wonderfully amazing music.  Last night was more Motown with Reggie Deaz than jazz, but wow, what a night.  Not being musical by any means, I am fascinated that these musicians can play for hours without referencing a sheet of music.  The sounds from the guitars, the drums, the piano and the voice--truly unbelievable.  To have such a gift and to share it night after night is special.  Playing to packed house in a club ranked among the top 100 jazz clubs in the world while making everyone feel great; it doesn't get any better. 

Friday, May 25, 2012

Memorial Day

Last year at this time, there was an ad in the local newspaper for a Chevrolet dealer in Pennsylvania, stating that Memorial Day was all about picnics and retail sales without a mention of the real meaning of Memorial Day.  Unbelievable, to say the least.  As we approach Memorial Day, lest we never forget the men and women who sacrificed their lives over the years for our freedom.  Have a safe and reflective Memorial Day.

Thursday, May 24, 2012

No More Mister Nice Guy

More and more, we are encountering patients who are delaying treatment or simply want to remain in the hospital because they still have "days of eligibility." Well, those days have to be over.  We can no longer afford to cover denied days at WMHS.  Effective immediately, patients will be very politely informed that they will be personally responsible for any charges incurred if they or family members delay treatment or refuse to leave if denied days result.  These costs in the past have been underwritten by hospitals, not any more.

Wednesday, May 23, 2012

A Continued Bleak Economic Outlook

Yesterday, our investment advisors were at WMHS with their semi-annual report on the health system's investments.  Each gave a perspective on the market outlook for the remainder of this year and the next several years.  The most surprising comment was that we shouldn't see any improvement until 2015 to 2018.  According to their outlook, the current and future risks are many: a great deal of political uncertainty both in the US and abroad; a projected $500 billion in new taxes looming this coming January 1 which will impact disposable income; an economic slowdown in China; ongoing debt issues where the US government is addressing the debt issue by creating more debt (huh?).  There is some good news with a few positives: US corporations are getting stronger; inflation continues to be low; aside from oil, energy costs are low; and the housing supply is improving but the housing market is still trying to bottom out.  Using a health care analogy to describe our economy, one investment advisor said that it's like a patient who is no longer critical but remains in a weakened state, vulnerable to relapse.  I wish the news was better, but at least we have the necessary information to plan accordingly.

Tuesday, May 22, 2012

Oh, To Be "Wealthy"

A friend of mine had a great line after last week's vote by the Maryland General Assembly to raise taxes.  He said, "On Tuesday, I went to bed middle class and when I woke up on Wednesday, I was wealthy." Not only did the House and the Senate raise taxes on everyone making over $100K as a single filer and for any joint filers making over $150K, but they also shifted 25% of the pension costs for teachers to the counties.   County governments across the state will in turn be forced to raise taxes locally.  So, not only will we soon pay close to 9% for state income taxes, but the counties will increase their taxes to cover the pension shift.   Wait a minute, aren't we the same taxpayers?  So why is the State telling us about the money that they saved us by reducing the state's pension costs?   Come January 2013, if the previously approved tax cuts aren't continued, the triple whammy will hit with an increase in the Federal income tax rate.  What all of this tells me is that we are in store for a much deeper recession as our disposable income becomes significantly reduced.

Monday, May 21, 2012

Our Greatest Challenge

Health Leaders magazine did a survey throughout the health care industry recently.  When focusing on clinical quality improvement, one of the components of Health Care Reform's Triple Aim along with reducing the cost of care and focusing on population health, 30% of hospital and health system CEO's responded that care coordination along the continuum of care is their greatest challenge.  Interestingly enough, 25% of all groups surveyed also responded that care coordination was their number one challenge with improving the patient experience as a close second with 21%.  CEOs also had the patient experience as second at 17%.

At WMHS, we are pulling out all stops to better coordinate the care of the patient.  We have reorganized our Care Management department to better address overall care coordination of our inpatients.  We have strengthened patient education and discharge planning.  We have a care team lead by our Chief Medical Officer rounding on patients with a length of stay greater than 5 days to ensure that all that can be done for the patient is being done while they are an inpatient.  We are working to enhance the communication process between our Hospitalists and physicians and other caregivers.  We also have nurses rounding on patients with physicians and shift report taking place at the patient's bedside.  At WMHS, we continue to make progress in all of these areas and I was pleasantly surprised to see that care coordination has become such an industry priority.

Friday, May 18, 2012

Graduating from College

Being a board member of Allegany College of Maryland, I have the distinction of being the part of tomorrow's graduation ceremonies.  It is a wonderful accomplishment for the graduates as well as their professors and instructors.

I have been holding onto an article that I received a few weeks ago from my daughter.  The article was written by Charles Wheelan and was published in the Wall Street Journal on April 30th; it is entitled, "10 Things Your Commencement Speaker Won't Tell You."  Some of the 10 that are worth sharing are as follows:
2) Some of your worst days are ahead of you - you will face periods of self-doubt and failure, but work through them.
3) As you attempt to change the world, don't make things worse - do the right thing; you don't have to cure cancer but don't spread it either. 
6) Read obituaries - these are short biographies that demonstrate that successful people rarely lead linear lives. 
7) Your parents don't want what's best for you - they want what's good for you.  As parents we want what is safe and comfortable; sometimes you have to take risks. 
9) It's all borrowed time - don't take anything for granted; live life to the fullest. 
10) Don't try to be great - the less you think about being great the more likely it is to happen and being solid isn't bad.

Congratulations to all of the graduates tomorrow.  God speed.

Thursday, May 17, 2012

The Double Edged Sword

Yesterday, I read an article in Compliance Today magazine entitled, "The role of compliance in the quest to improve (the) patient experience."   The gist of the article is that hospitals need to be careful with the inducements that we provide in forgiveness of financial obligations beyond financial hardship or purchasing items or services on behalf of the patient.  This is a new area of concern that our compliance officer is addressing as our doctors and nurses work to get patients well enough to be discharged from the acute care and into the most appropriate care setting.  In some cases, we provide items and services for the patient to facilitate the transition into the alternate care setting.  As the article states, "while striving to improve (the) patient experience, we must recognize the legal limitations....."  Sound advice in this era of false claims, anti-kickback violations and over payment for services.  The article is worth the read in this ever changing complex field of health care.

Wednesday, May 16, 2012

Top Ten Priorities for Hospitals

Health Leaders magazine just released the 2012 CEO Survey results as to the priorities for hospitals and health systems around the country for the next three years.  The list is as follows:
1) Payment Reform
2) Patient Satisfaction
3) Cost Reduction
4) Quality and Safety
5) Physician Hospital Alignment
6) Clinical Information Technology
7) Leadership and Organizational Development
8) Regulatory Issues (Stark Laws, HIPAA, Anti-trust, etc.)
9) Revenue Cycle
10) Capital Dollars

How does the list of priorities stack up against the WMHS?  Our list would be very similar, but there would be a few minor changes.

1) Quality and Safety (the safe delivery of care to the patient has to be our first priority)
2) Payment Reform (success working under a new payment methodology is critical)
3) Patient Satisfaction (again, patient centered is key to our continued success)
4) Cost Reduction (we have to reduce cost, improve quality and focus on the health of our population--with better quality you get reduced cost)
5) Revenue Cycle (no margin, no mission)
6) Leadership and OD (critical thinking skills have to be instilled in all of our leaders and especially our bedside clinicians and staff)
7) Clinical Information Technology (not as much a priority because it is well in hand by our CIO and his team)
8) Physician Hospital Alignment (the 12 physician members of the President's Clinical Quality Council are helping greatly in this area)
9)Regulatory Issues (our compliance officer ensures that we are always compliant with laws & regulations)
10) Capital Dollars (a great deal of emphasis on fundraising, planning and best use of limited dollars)
The order may change over the next three years but these are our key issues today and going forward.

Physician Award Winners

Last Friday evening, we celebrated and honored the members of our medical staff at WMHS.  The Gala is held each May to acknowledge and thank our physicians, dentists and advanced practice professionals.  We also select a physician of the year, a lifetime achievement awardee and a mane ictum (quick impact) awardee all from the medical staff.  We had 33 different physicians nominated for the three awards.  The decision was extremely difficult.   The winners were:

Mane Ictum Award: Dr. Aman Dalal, Infectious Disease
Physician of the Year: Dr. Bill Lamm, Hospital Medicine
Lifetime Achievement Award: Dr. Jim Raver, Hospital Medicine and Chief Medical Officer (Retired)

Congratulations and thank you for your dedication to our patients and staff.

Monday, May 14, 2012

A "Shocking" Incident

On Saturday morning I was at the gym and CNN was on one of the televisions.  I don't normally watch CNN and now with good reason.  CNN was reporting on the story regarding Mitt Romney as a 17-year- old allegedly being party to holding down a fellow high school  student with long hair who was reportedly effeminate and cutting his hair.  Now for the best part, the reporter actually called it a shocking incident.  Give me a break.  Wrong, yes.  Bully-like, certainly, boys being boys back in 1965, you bet.  I was 17 in the early seventies and doing stupid things was par for the course on any given day.  The bias of today's media is unbelievable on both the left and the right.  What happened to reporters giving us the news in a direct forthright manner and saving the bias for the general public?  For a CNN reporter to call the Romney incident shocking is absurd.  The horrific shooting at Columbine High School in Colorado by a couple of 17-year-olds was shocking; the alleged Mitt Romney incident was stupid.  Even the family of the now deceased victim whose hair was cut is appalled that the incident is being used for political purposes.  It is now become very clear that this Presidential Campaign is going to be quite a ride.

Friday, May 11, 2012

No More Picking the Feds This Week

It's time to comment on the upcoming special legislative session scheduled next week to deal with a single issue: to raise taxes on Marylanders.  There are reasons on both sides of the aisle not to allow the doomsday budget to take effect this fiscal year.   However, my blog is about the absurdity of our elected leaders, all from the same party (Democrats), not finalizing the budget, which includes raising taxes, during the regular session.  Instead, many of these senators and delegates, who will be running for re-election in 2 years, will have to vote to raise taxes in a spotlighted special session.  This is a great time for any prospective challenger to begin preparing his or her campaign.  Maryland, according to Governor O'Malley, has some of the lowest taxes in the country.  Really?  By raising the state income taxes to almost 9% that will place Maryland in the top 10 of states with the highest state and local income taxes.  I guess the good news is that we don't live in France.  Their newly elected President wants to raise taxes up to 75%.  Get ready for the brain drain from France.

Thursday, May 10, 2012

The Efficiency of Government

Every day I pass by an electric typewriter that sits outside my office.  I finally stopped and asked why do we continue to have a typewriter in our work area.  The response was that we could probably move it to the Mailroom, but we use it with some frequency. What? Huh? Really?  A typewriter used frequently in 2012.  What work product generated by this health system could possibly require the use of a typewriter?  Are you ready for this?  THE GOVERNMENT.  There are a number of forms that we have to complete and send to the Federal Government that can only be typed.  Need I say more?  There are Federal Government requirements that exist for health care related to meaningful use and an industry wide conversion to electronic "everything" by this same government that continues to require forms be typewritten.  The good news is that the instances requiring typewritten forms continue to decline, but they are not yet eliminated.  Also, the typewriter has now found its new home in the Mailroom.  Next stop, a museum.

Wednesday, May 9, 2012

You've Come a Long Way Since Florence Nightingale

Happy Nurses Week to all the nurses throughout WMHS who serve our patients with exceptional care and compassion each and every day.  At WMHS, we are blessed to have a wonderful nursing staff led by an exceptional individual, Nancy Adams, who epitomizes what is to be a caring, competent, experienced professional every hour of every day. 

The role of the nurse continues to change year after year as we change how we deliver health care in this era of reform.  The patients are changing as well.  The very great majority continues to be grateful for the care and compassion that they receive as a patient--on an acute care unit, in an outpatient setting, in the Operating Room, in a physician's office, at home through Home Care, in our Emergency Department, by the Care Management team, though Nursing Leadership and the list goes on. 

Our nurses have to endure so much more from an increasing number of patients—those come to the ED intoxicated or in a drug-induced state, ones who are threatening or violent, or simply those who are ungrateful no matter what you do for them.  Fortunately, that last group of challenging individuals is a small percentage of the patients and families that our staff faces. 

We are blessed to have so many wonderful employees at WMHS who complement such a caring and skilled component of our workforce.   Please join me this week in honoring and celebrating all of our nurses at WMHS for the extremely challenging job that they do each day with always with the utmost care and compassion.

Tuesday, May 8, 2012

Hospital Rates in Maryland

Last week, the Health Services Cost Review Commission met to approve new rates for hospitals beginning in July.  Maryland has a unique rate-setting system that gives hospitals a waiver from the standard Medicare payment system as long as our hospital costs grow more slowly than the rest of the country.  Maryland’s rate-setting system is in jeopardy due to assessments used to fund Medicaid over the last several years--assessments that were approved by the Maryland General Assembly and the Governor.   Maryland Hospitals are close to losing the waiver, which represents approximately $18 million in additional revenue for WMHS annually.  Preserving the waiver is critical.  As a result, hospitals agreed to a 1% reduction in rates, which equates to a $3 million reduction to the WMHS budget effective July 1, 2012 (Fiscal Year 2013).  We will receive a modest increase in outpatient rates for FY 2013. 

The Maryland waiver benefits everyone--payers, consumers, businesses and hospitals.  Yet, hospitals have continued to shoulder the burden of trying to save the waiver.  Insurers mark up the cost of health care ten times higher in every other state but Maryland, so the benefit of the waiver is a plus for everyone.  There needs to be greater sharing of this burden going forward. 

The financial health of Maryland hospitals, including the Western Maryland Health System, is in serious jeopardy.    The Maryland waiver needs to be modernized to reflect current realities in health care to strengthen the focus on incentives for physicians to control total costs, advance the total patient revenue (TPR) payment methodology, apply population health based delivery systems for the urban and suburban hospitals in Maryland, and look at such creative initiatives as primary care medical homes. 

A lot has to be done and hospitals continue to ask the General Assembly to allow us to assist in a better approach to Medicaid sustainability going forward rather than apply assessments to hospitals year after year.  We need a plan of approach in Maryland but, unfortunately, we aren't yet there.

Monday, May 7, 2012

You’ve Got to Love the Bureaucracy of our Government

Today, I received a response to a letter that I sent to Senator Mikulski on March 1st regarding a grant application that Western Maryland Health System submitted on behalf of seven hospitals across Maryland.  The application was submitted to the $1 Billion Health Care Innovation Challenge for a transitional care program to support the transition of inpatients to the home to ensure that they are supported and well managed in the home and, ultimately, kept out of the hospital for needless readmissions. 

Initially, our application was not accepted due to a technical issue.  Upon submission of the application, it was discovered that our existing registration number had expired.  We immediately updated the registration and resubmitted the application.  We thought that all was well but were later informed that we missed the filing deadline because of the expired registration number.  We then appealed and were told that the Health and Human Services was not accepting appeals.  We then contacted Medicare directly and were told again that they were not reviewing any appeals.   Letters were then written and signed by the CEOs of the seven hospitals across Maryland to our Senators, Congressional Representatives, Governor O'Malley and Maryland’s Department of Health and Mental Hygiene Secretary Sharfstein.

After two months and no word other than an auto response from Medicare, we finally receive word on our application.  On April 30, Senator Mikulski received a response from the Director of the Center for Medicare confirming that our application was rejected for that same technicality, since we did not meet the standard requirements specified on pages 17 - 23 of the Funding Opportunity Announcement (FOA).
Let's not consider these applications based on their merit, their creativity or their ability to be applied across an entire state, let's use the hard and fast criteria on pages 17 - 23 of the FOA.  Gimme a break!  I just love when bureaucrats indiscriminately apply rules for their convenience and not for the benefit of the people they serve.  In our instance, the Center for Medicare and & Medicaid Innovation followed their criteria.  I wonder if they did so for everyone who may have failed to follow the criteria on pages 17 -23 of the FOA?   More to follow.

Friday, May 4, 2012

Hell May Be Freezing Over

If  you haven't figured out by now, my political leanings are right of center, but not far right.  I thought that President Obama deserved a chance to bring change about in our country after he was elected.  I still respect the office of the President, but I am disappointed at his performance and accomplishments to date.  The President is an exceptional campaigner but, in my opinion, not a leader.  A leader would be working nonstop to figure out ways to work with a Republican House of Representatives to address the gridlock on key issues facing our country, but he hasn't.  I am not letting Speaker Boehner off the hook either, but the President ran his campaign on his ability to reach consensus and to change the direction of the country.  Again, in my opinion, that hasn't happened. 

The subject of today's blog is actually the Washington Post.  I read the Post daily for a perspective that for the most part is different from mine.  I learn a lot though my daily read of the Post, but find the editorials the most difficult to find common ground with, at least until recently.  There was a recent editorial that the Washington Post needed to begin to look at the President with a more critical eye.  My reaction was, yeah right, when hell freezes over, which would have been the same if Fox News said that they were going to take a more critical look at President Bush when he was in office.  To my amazement, there was an editorial in the Post the other day that was critical of the President.  The editorial was about President Obama as Campaigner in Chief written by Dana Milbank.  The editorial is linked for your review.  So, I stand corrected and appreciate Mr. Milbank's perspective on the issue, especially since the issue is an important one for our country.

Thursday, May 3, 2012

What Not to Do

Often, I blog about leadership and service excellence topics.  For today's blog, the CEO of Spirit Airlines made blogging very easy.  This blog contains an article regarding absolutely no regard for his customers and an approach to leadership that is an excellent example of what not to do, especially in a service industry.  This CEO's self-described focus as a leader is very simple: expand his airline while making money.  The survival of this CEO and Spirit Airlines into the future will be dependent on a whole lot more than his singular vision for success.  This is a wonderful case study for any leader in any industry. 

Spirit Airlines Soars Above Field in Flier Complaints.

Wednesday, May 2, 2012

Checklist Health Care

My sister's boyfriend had a hernia repair on Monday at a hospital in another state.   When they opened him up, they found a mass the size of a lemon and everyone thought the worst.  Even the surgeon thought that the mass was cancerous by eyeing it and cutting into it to obtain a biopsy.  Fortunately, the biopsy came back negative today.  Great news! 

My sister then proceeds to tell me that although relieved that he doesn't have cancer, he has a fever of 102.3 degrees, a severe headache and is vomiting.  She said they don't know why.  She then proceeded to tell me that he was going to be discharged tomorrow.  I told her my thoughts on what was going on, but said don't let them discharge him in that condition.  She appreciated my input and would make sure that they address his current state before discharge. 

The reason for blogging about this situation is that all too often in health care we follow a checklist and once a task is complete, we check it off the list.  We need to treat the patient in his or her entirety.  I heard a great line today that is very appropriate in this instance, we need to make sure that we don't confuse activity with achievement; a great lesson for all of us.

Tuesday, May 1, 2012

Extraordinary Bosses

Last week, I wrote about a great article in Inc. magazine, "8 Core Beliefs of Extraordinary Bosses."  Some of the tidbits worth noting in the article were as follows:

* Average bosses see business as conflict and build "armies" for the fight; extraordinary bosses create teams that attempt to more easily adapt to the market.

*Average bosses view their company as a machine with rigid structures and rules; extraordinary bosses see their employees as a collection of individual hopes and dreams all connected to a higher purpose or goal.

*Average bosses want employees to do exactly as they are told; extraordinary bosses set direction and ask employees to commit themselves to getting the job done.

*Average bosses view their employees as children; unlike extraordinary bosses who view their employees as peers.

*Extraordinary bosses motivate through vision not fear.

*Extraordinary bosses embrace change while average bosses see change as complicated and threatening.

*Extraordinary bosses use technology for creativity purposes while average bosses see it as a way to increase control and dependence.

*Extraordinary bosses see work as something that should be inherently enjoyable while average bosses see it as a necessary evil.

These are great tidbits for a leader to work into his or her repertoire.