Labor Day Weekend

Labor Day weekend is fast approaching, which reflects the end of summer.  Have a wonderful weekend and please be safe, especially if you are heading to the DC area.  I just read that DC has the worst drivers in the nation.  I don't know, have those who deemed DC as the city with the worst drivers ever been to NYC?  After a trip to NYC some years ago, my daughters said that they had 12 near death experiences before we even got to the Lincoln Tunnel on our way home.  Again, have a great weekend and you will hear from me after Labor Day.

If It Were Only That Easy

In Friday's USA Today, there was an editorial about hospital acquired infections based on an interview with the former head of the CDC's Infection Division.  William Jarvis makes it out to be that hospitals are sitting idly by, infecting everyone who comes through the door.  There is no doubt that hospitals can be dangerous places, especially for infections.  But to say that we are failing to address these issues is ridiculous.  Never before in the history of health care and medicine have hospitals done more to address infections.  The widespread use of antibiotics, which allows the good bacteria that keeps C-Diff under control, is being addressed in every hospital, every day.  In addition, WMHS and hospitals across the country have stepped up hand washing and facility cleaning tenfold to stop the spread of infection.  Have we eliminated infection, no, but we have stepped up infection control like never before. 

The editorial states that this is the most important issue facing hospitals today and that it should be virtually our only focus.  Well the good news is that it is a primary focus, along with a hundred other "most important" issues facing today's hospitals.  We are faced with preventing ALL potential complications, eliminating medical errors, keeping our patients safe, reducing readmissions, increasing patient satisfaction, covering specialty call in our EDs, keeping our hospitals functioning effectively 24/7 as competing 9 to 5 centers "skim the cream,” continuing to recruit and retain specialists and sub-specialists, maintaining our financial viability in a financially challenging environment and the list goes on and on.  As I heard on a TV program last night, "it is obvious that you have never worked in a hospital."  That is the obvious statement for Dr. Jarvis and USA Today's editor.

Nike LeBron and the Urban League

This is going to be one of those blogs that might be a bit controversial, but what the heck.  I read last week that the National Urban League is taking on Nike for coming out with the $315 LeBron Nike X Plus basketball shoe.  Yes, $315 is quite a bit over the top for a pair of sneakers; however, with all of the issues facing the black community, this is what the Urban League chooses to focus on............sneakers?  At a time when the black community nationwide is suffering from unemployment, the highest among any group at almost 15%; children being born into a single parent family is nearing 80%; the dropout rate among black youth is the highest among any group; there are more black males in our prison system that any other group; black on black murder is the highest than it's ever been and the National Urban League is focused on Nike and a pair of sneakers.  Where is the outrage on the devastating social issues facing the black community?  Where is the outrage toward LeBron James, whose name is adorning the $315 sneakers?   It seems there is quite a disconnect between the National Urban League and the black community and the black community deserves better.

WMHS Family and Friends Auction

While planning the 16^th annual WMHS Golf Classic, which includes a pre-event dinner featuring silent and live auctions, the question was raised as to how we could include more of our employees in the fun and festivities.  The result:  A WMHS Family and Friends Auction featuring both a silent auction and a Chinese basket auction.  The Foundation asked health system departments to consider creating themed baskets/boxes/buckets, etc., and over two dozen absolutely amazing “treasure chests” have been created and filled to the brim for bidding.  The teamwork, fun, generosity, and imagination have been absolutely incredible.   We expected modest offerings…perhaps ten baskets….but no!  Twenty-six themed baskets, many containing over $200 worth of items, from “Family Fun Night” to “Chocolate Lovers” to “Wellness” and “Picnic Time.” Each basket is unique and attractive.  The auction will take place September 5 and 6 in our auditorium.   Many thanks to our employees, who have once again shown their generosity and team spirit.

What A Turnaround

I have previously blogged about Maryland Hospitals being incentivized or penalized based on quality.   Last year was the first year that hospitals fell under such a program.  Nationally, hospitals will be a part of a similar program beginning in October 2012.

The impact on WMHS for FY 2012 based on 2011 performance was a $1.2M decrease in our rates. Based on a zero sum game formula, some hospitals were winners (not us) and some were losers, as was the case with WMHS.  All Maryland hospitals pay into a fund and by performing better than expected on potentially preventable conditions (Medicare calls them hospital acquired conditions) such as hospital acquired infections, falls with injury and pressure ulcers, hospitals are awarded monies.  Also factored in are patient satisfaction scores (HCAHPS) and core measure results.  We were penalized $782K based on our quality-based reimbursement scores and over $400K for our potentially preventable conditions.  Yesterday, we received this year's results based on last year's performance.   After a lot of hard work and attention to detail, WMHS rates will be increased by over $200K; a turnaround of over $1.4M between last year and this year.  We cannot rest on our laurels, as all hospitals in Maryland are striving to do better.  Our goal is to exceed last year's performance by continually improving our core measure performance and our patient satisfaction scores and eliminating our potentially preventable conditions.  Great job to our change agents at WMHS!

Medicare as the Focus of the Presidential Campaign

Mitt Romney's selection of Paul Ryan as VP candidate virtually catapulted Medicare to the center of the stage for the Presidential race.  The issue of what to do with Medicare has already been that "third rail" issue with no one wanting to upset the senior citizens who are active voters in every election.  There will continue to be lots of scare tactics on both sides during the campaign, making it tough for individuals to sort out as to what is accurate and what isn't. 

As I have continued to blog, Medicare is unsustainable financially so there are no quick and painless fixes to the problem.  Spending has to be controlled so moving away from volume based system to a value-based system will be key.  We have to have incentives aligned between providers.  Right now at WMHS, we are paid under a value-based model focused on better quality at a reduced cost while many of our physicians are still paid under a volume based model.  Malpractice reform needs to be a part of the fix as it is detailed in the Romney / Ryan plan, but not in the Obama plan.  The President continues to leave the issue up to the states and, for Maryland providers, as long as we have a trial lawyer as senate president, there will never be any change in Maryland's tort reform laws.  The Obama plan rewards hospitals for quality, a system that all Maryland hospitals are under and it is making WMHS better at what we do and more efficient in the care that we are providing to our patients. Quite honestly, I see the attention that Medicare is receiving during this election cycle as being very positive for our seniors, for providers and for our future.

Taking Your Meds

Last week there was an article in Fierce Healthcare entitled, "Med adherence could save $8.3 billion in healthcare costs."  The article was sent to me by a physician friend who is a passionate advocate of getting patients to take responsibility for their health and wellbeing.  When you read the article, it is amazing to learn that by diabetic patients simply taking their prescribed medications they would save the $8.3 billion in healthcare costs.  The tough part is getting folks to take their meds.  It was reported this AM on the news that 1 in 3 patients do not take their maintenance medications, in general.  I have been "blessed" with the gout and take medication to prevent an attack every day.  If I don't take my meds faithfully, within a few days I will have an attack.  In that short period of time, the uric acid builds up in my joints, crystalizes and the pain begins until I take another med to stop the attack and the associated pain.    I can't imagine suffering though that pain by not taking my daily dose of Allopurinol.  I recognize that affordability is a major issue for those who don't take their meds on a regular basis.   However, providers, payors, government, pharmacies and drug companies are trying to make drugs affordable, even giving them away to high risk patients who can't afford them in order to keep them out of the hospital.  The non-compliant patient is a whole other story and technology will become a major player related to patient adherence in the near future.  The FDA is already working with implantable microchips that confirm when medications have been ingested.  I am not a big fan of the "nanny state" but government and other payors have a lot at stake to ensure adherence among patients.

Changes in Health Status

A few weeks ago, our Director of Community Health and Wellness, Nancy Forlifer, made a presentation to our board as to the progress that our community has made related to improvements in a number of health status related areas.  Between 2011 and 2012, Allegany County has made improvements in high school graduation rates, less children in single-parent households, less adults smoking, motor vehicle crash deaths, sexually transmitted diseases, preventable hospital days and a reduction in the teen birth rate.  We are still one of the three worst locations in Maryland for Behavioral Health related visits to the Emergency Department.   Those joining Allegany County are Baltimore City and Dorchester County on the eastern shore of Maryland. 

It is important to note that our priorities for Allegany County continue to be tobacco cessation (especially with pregnant women), obesity, behavioral health, access to care, substance abuse, heart disease, health literacy, prenatal care, dental care, cancer care, flu shots and screening for Diabetes.  One fact that Nancy shared that got everyone's attention was in Allegany County, if 5% more people attended some college and 5% more people had an income higher than twice the poverty level, we could save 24 lives, prevent 372 cases of Diabetes and eliminate $2.7 million in Diabetes costs every year.  Socioeconomic factors and health status are amazingly linked.  If socioeconomic status in a region improves so does their health status.

Giving Sage Advice

The other day my wife said to me that I am now of the age where I need to be providing more advice and guidance to others.  She said as someone of your age and with your experience, you need to go beyond your daughters and reach out to those who would benefit the most from what you have gleaned over these many years.  It just so happened that yesterday I received a call from a friend and business associate.  We dealt with the business issue and he then said, "I've had it with my (relatively new)boss, he's crazy and wants to control everything and everyone".  He went on to tell me that he has made the decision to leave his position, but felt that he would have to resign before he could look for another opportunity (preferably consulting) as it just wouldn't be right.  I suggested that he not resign, but consider networking with the various consultants with whom he has worked over the last thirty years.  I told him that he has a lot to offer and since he does not want to retire, he should call them up and let them know that he is looking to make a change and gauge their interest.  I know that many of them would jump at the opportunity to hire this guy.  In addition, he has given so much to his current employer over the last three decades and making contact while still serving your current employer is perfectly acceptable.  I have always felt that it far better to begin seeking a new opportunity while currently employed as long as you don't take unfair advantage of your current employer.  He was most appreciative of the advice and boost in self-esteem; he actually seemed energized as we ended the call.  So, once again, Pamela was right; it really felt good being able to help someone who was in need of my "sage" advice.

What a Day at WMHS

Yesterday was quite a day at WMHS beyond the usual activities of caring for patients, procedures, tests, counseling and everything else that happens here on a daily basis.   It was also Farmer's Market Day at WMHS, which has been well received by our staff and the community.  In addition, we had an opportunity to kickoff Project Fit with participants from the Allegany County Board of Education, Flintstone Elementary School, Bishop Walsh School, New Creek School in Mineral County, WV and WMHS.  Project Fit involves enhancing opportunities to increase the physical activities of our youth.  The Health System is sponsoring these three sites with the hope that the concept will be successful and these three schools will serve as a model for the rest of Allegany County and Mineral County Schools.

Simultaneous to the Project Fit kickoff, Dr. George Garrow, Chief Medical Officer for WMHS, was hosting about a 150 people at a forum on Bath Salts.  The panel that he assembled was excellent and the program was extremely informative, as well as, very well received by all attendees.  Physicians, nurses, other staff, Health Department. employees, community counselors, prison officials and others were in attendance.  Between comments from yesterday's audience and very positive postings on Facebook, the demand for additional sessions on this topic is great.  WMHS will hold another forum next month.  After the lunchtime forum, there was then a special training session for law enforcement on Bath Salts.  Law enforcement officers from Cumberland, the Sheriff's Office, the State Police and other jurisdictions were in attendance.  That session was also well received.   

Because of the seriousness of the Bath Salts issue, WMHS will remain in the forefront of increased community awareness, community education, education of professionals and certainly caring for patients who fall victim to a bath salts overdose.  Our ultimate goal is to have our youth as well as our adult population focus on more health and wellness related activities such as Project Fit so there is no longer an interest in or a market for head shops selling Bath Salts.

Pit Bulls Residing in Maryland

If you are a pit bull owner who rents a home or apartment in Maryland, you may be forced to choose between your dog or your residence, at least until the next legislative session in 2013.  The Maryland Court of Appeals ruled that pit bulls and any related type of dog are considered a dangerous breed of dog and any owner whose dog bites a person is liable for those injuries.  The Court also ruled that any landlord who rents to a pit bull owner is liable.  During the special legislative session, the Senate voted to apply the law to all breeds of dogs and to not hold the landlord liable.  The House Judiciary Committee said no way.  They felt that they needed more time to study the issue and that such a law would drive up insurance rates for all dog owners.  It really makes you wonder as I blogged last week as to why the Senate took up this particular issue as part of the special legislative session.  Although I don't agree that we needed a special session to approve table gaming as well as additional gambling locations, that is a big enough issue to warrant a special session.  Dog bite legislation?  One would surmise that someone in a Senate leadership position has got to be a landlord of some significance.

Lifelong Homes

This morning I read an interview with Henry Cisneros, HUD Secretary under President Clinton.  In the interview, he was talking about his mother and baby boomers.  His 87-year-old mother lives in the same house that she and her husband bought when they were first married and it's across the street from her now deceased parent's home.

He notes the importance of making changes in her house in order to make it easier for her to function.   Such changes included as a ramp rather than stairs leading to the home, an elevated toilet, a walk-in shower, lower sinks, window guards, alarms and outdoor lighting.  He says that we should all be considering such changes for our elderly parents.  In addition, he said that 10,000 baby boomers turn 65 each day and that more needs to be done to support aging Americans.  Communities are being developed for the soon-to-be elderly with shopping centers in walking distance, supportive people around them, age related home improvements, along with adjacent parks, recreation and transit.  We need to remake our older communities with the aged in mind, but affordability has to be a major consideration.  Secretary Cisneros closes with people who live independently are much less of a burden on society and he's right.

Bath Salts (Part II)

There was a great article in yesterday's Cumberland Times News about the bath salts epidemic facing our community.  A link to the article is attached.  This week the Western Maryland Health System is sponsoring a community wide presentation on the bath salts issue.  The program is open to physicians, nurses, social workers, school nurses, principals and corrections staff.  Dr. George Garrow, Chief Medical Officer for WMHS, will present along with our Trauma Nurse Coordinator, Chuck Barrick; Dr. Christine Lee,  a WMHS staff Psychiatrist; Rebecca Myers, Program Director for the Health Department's Outpatient Addictions; and Capt. James Pyles, Maryland State Police.  There will be a case presentation, a review of the growing incidents as a result of bath salts and the impact on the ED, review of clinical issues related to bath salts and Q&A for attendees.  Following the community wide presentation is a similar presentation for 30 members of area law enforcement.  A training session will be held with some of the same panel expertise that participated in the community wide meeting.  This epidemic is spreading with overdoses related to bath salts being seen in our ED each day.  In addition, the head shops that sell the bath salts are opening throughout the region with increased frequency.

http://times-news.com/latest_news/x1555259886/Bath-salts-A-very-bad-problem

Gambling in Maryland

This week the Maryland General Assembly was called back for its second special session since the regular session ended in mid-April.  The first special session was to raise taxes.  This session is to approve a  video lottery facility (slots) in Prince Georges County at National Harbor (much to the dismay of those slots facilities already struggling) and to allow existing slots facilities to have table gaming.  They will also consider legislation establishing strict regulations on dog owners for injury caused by dangerous dogs, such as pit bulls.  Really?  With all of the pressing issues facing our State, they are going to deal with dog owner liability and gambling.    As far as I am concerned they are 0 for 2 in good reasons in calling special legislative sessions.  Remember, this is the same State that sold the 250 acre Rocky Gap Resort for $6.8 million and wrote off $41 million with a promise by the new owners to build a 300-room hotel and a 50,000 sq. ft. casino through an investment of another $52 million.   The new owners have since said that they couldn't get financing for the hotel and casino additions.  What a deal for the new owners.  Sometimes, I truly wonder why the State does the things that it does.  I am sure that some think the same of some of the decisions made at WMHS; the difference is the WMHS decisions all are made with sound reasoning and judgment, well, at least to me.

Hospitals are in for a Very Rough Road Ahead

As I have blogged previously, health care cannot be sustained financially primarily due to the impact of the Medicare and Medicaid programs.  Earlier this week, I watched a videoconference on "Anticipating Lower Reimbursements."  A panel of experts was predicting that if hospitals are not taking seriously the calls to get cost out of their hospitals and health systems, their boards will be looking for new CEOs.  Several years ago at WMHS, we had an expense reduction strategy and attacked all of the "low hanging fruit."  We got out a great deal of excess spending; but by comparison, that was the easy stuff.  Now, the task is much harder. 

We know that we have to reduce our spending by at least 10% to 15% over the next five years as there will no longer be rate increases only reductions in our rates.  In the videoconference, some were predicting 25% over the same period; that equates to $75 million for WMHS.  In order to get our projected 2% per year starting with this fiscal year (July 1 to June 30), organizational transformation has begun and will continue over the next four fiscal years.  

Our annualized target for FY '13 is $6 M to $8M.  We are focused on a host of initiatives including changing how we work; creating labor savings through benchmarks with other hospitals and health systems; reducing senior management by two positions; eliminating many vacant positions; filling remaining vacant positions with displaced employees; continually seeking cost saving initiatives from leadership, staff and consultants; improving collections through a renewed commitment to revenue cycle management,  renegotiating supply and service  contracts; reducing the overall cost of care; improving the quality of care, addressing unexplained / unsubstantiated clinical variation; continuing to reduce medical errors and reducing readmissions.  (Just to name a few of the many initiatives underway at WMHS.)  We have a lot of work ahead of us, but getting everyone on board from employees to physicians to board members to the community will help us survive the deceleration of Medicare and Medicaid spending a lot faster.

Reducing Readmissions at WMHS

It's working!  Our readmission rate for July was 8.51%; a dramatic improvement over the same month last year which was around 20%.  Why is it so important, you ask?  Any patient who is readmitted with a similar diagnosis within 30 days of a previous admission results in no payment for any subsequent admission within that 30-day period.  Such admissions are deemed avoidable and unnecessary.  We are making excellent progress as a result of exceptional teamwork, led by Dr. George Garrow, our Chief Medical Officer and Carol Everhart, our Director of Care Coordination.  These two individuals and their team have been chipping away at readmissions and reached single digits around April of this year.  They continue to focus on preventing avoidable readmissions through a variety of approaches including:  a more effective patient education program prior to discharge, a more thorough longitudinal discharge plan, follow up with the discharged patient at home through CareLink, a nursing home RN transitionist visiting patients in the hospital before they are returned to the nursing home and once at the nursing home, many more referrals to Home Care, high-risk patients being provided with the discharge medications before they leave the hospital, more immediate follow up primary care physician / nurse practitioner appointments once the patient is discharged, reconciliation of patient medications upon admission and upon discharge.  Just to name a few.  What does this mean in dollars and cents?  Our readmission rate for July annualized would save WMHS around $1.4M this fiscal year.  An absolutely awesome outcome for WMHS.  Great job everyone!

New WMHS Website

When you get a chance, visit the new WMHS website at www.wmhs.com.  It is much crisper, cleaner and easier to navigate than our old website.   A lot of staff were involved in its creation and I am so appreciative of all of their hard work in making it happen.  The new site also has a secure employee access to the portal so we can communication directly with employees on specific information related to issues important to them.  They can also receive their pay information through the employee portal.  In the near future, we will also be rolling out a patient portal for patients to store their personal health information, receive test results and access their records.  Lastly, the new website will also contain real-time quality and performance data on WMHS and how we compare with other hospitals.  The data will be more current than what is currently out there on the internet and allow for our patients and community to see just how well or not so well we are doing in a number of quality related areas.

We Are Strange People

I have been receiving the New York Times each day for the last week from my newspaper delivery person.  I don't know if it's an extra newspaper or a promotion, but it isn't a newspaper that I usually read.  I have read it each day to get a perspective that I don't usually get.  I currently read the Washington Post every day for a more liberal perspective on current issues since I lean more to the right of center; however, the New York Times is considered the heart of liberalism in the print media.  I found it interesting that their articles and editorials clearly demonstrate that they are champions for the poor, the downtrodden, those who have been disenfranchised by America.  At the same time, the NY Times repeatedly attacks the rich, the powerful and corporate America.  What I also noticed in each issue is the extravagance of their advertisements.   When you open to the second page of the front section of the newspaper each day, you see their first advertisement of prominence.   It is always for a $3000 handbag or a pair of shoes for $1295.  There are ads for Tiffany's, Saks Fifth Avenue, Neiman Marcus and Burberry throughout each issue.  The very people who they attack in their articles and editorials are the same people who they are hoping will support their advertisers.  Ridiculously strange, if you ask me.

Unfair Advantage

Okay, one more blog on the Olympics.  Yesterday, I read an article about Oscar Pistorius, the South African sprinter who will be the first amputee to compete in the Olympics.  Oscar, aka the Blade Runner, has been a double amputee since he was 11 months old and uses carbon fiber prosthetic legs. Oscar will be competing in a 400 meter runner.  There are some, including Michael Johnson who is a 43 second 400 meter runner and world record holder, that say Oscar has an unfair advantage.  I wonder if Michael Johnson has seen Oscar's bloody stumps after a race. If Oscar has such an advantage, why aren't blade runners flooding the Olympics?  I applaud the Olympic Committee for reversing their decision to allow Oscar to compete in what they previously termed "able bodied track.”

Nobody Asked Me, But........

Regarding this week's badminton "scandal" at the Olympics, it is really hard to blame the coaches of the Chinese, Indonesian and South Korean teams for their actions based on the competition format.  Providing an advantage to lose really needs to be re-examined going forward by the Olympics Committee.  I realize that it's despicable to reach the Olympics and not make every effort to win, but the focus is on winning a medal and there is a lot at stake for the Olympians to be successful.  I am not sure that winning a gold medal in badminton is that big of a deal, but one never knows what goes on in some of these countries.  It has been interesting reading the varying opinions on the "scandal”; I just hope that those in charge get it right.  Badminton players and coaches need to be careful; they could find themselves as an eliminated sport like baseball and softball.  Oh, that's right - those are sports that the Americans dominated over the years and that's why they were eliminated.  Badminton is a more global sport, as boring as it may be.

Doctor Shortages

In a recent NY Times article," Doctor Shortage Likely to Worsen With Health Law," there were a number of areas throughout the country listed with shortages of physicians.  The impact on the shortage by the Affordable Care Act is the number of newly eligible individuals nationwide for insurance coverage.  These communities are talking about shortages in every specialty, sub-specialty and primary care today and that problem is only going to worsen.  Right now, patients are being transferred to other hospitals for care, waiting excessively to be seen in Emergency Departments, overusing EDs and even foregoing care.  Rural areas, as well as urban areas, throughout the country are especially hard hit.  In Maryland, rural areas are significantly impacted, with urban areas faring much better than most due to Johns Hopkins and the University of Maryland in Baltimore and many hospitals in Washington DC supporting PG County.  At WMHS, we have been able to hold our own in attracting new physicians (the new Hospital has helped greatly) with the exception of Gastroenterology.  We have call coverage issues due to having only three GI docs in Allegany County and only one of the three who is employed by WMHS.  We continue to recruit; in fact, we have offered $10,000 to anyone who brings us a GI doc who joins our staff and remains in the community for at least one year.  When we recruited our last GI doc to Cumberland, there were 500 openings or opportunities for every one Gastroenterologist coming out of training.  We continue to recruit and will do so until we are successful.  In the meantime, we, along with the rest of the country, are re-engineering how we deliver care as to its efficiency and appropriateness.  We want to make sure that individuals are being cared for in the most appropriate setting, reducing the burden on the ED and acute care.  Also, as a state, Maryland leads the country in its treatment of Nurse Practitioners.  They can now practice on their own without the supervision of a physician and that has helped greatly in Primary Care. In this day and age, as well as with what is on the horizon, every little bit helps.