Merry Christmas & Happy New Year

I will be taking a blogging hiatus after today until January 2nd.  For my last blog of the year, I wanted to extend a blessed holiday season to everyone.  To all the employees, medical staff members and board directors--thank you for what you do for our health system throughout the year.  Safe travels during the holiday season to all. I am looking forward to a healthy and happy 2013.

WMHS Holiday Meal

Yesterday was our Holiday Meal at the Health System.  What a great day!  Management serves the meal to employees and visitors.  For the first time in a while, all the servers were asked to decorate aprons with a holiday design.  Included in today's blog is a photo of my apron and a photo of the executive staff donning their aprons.  The aprons looked great; lots of creative designs.  When I arrived at Joann Fabrics on Saturday to buy the materials for the apron, I announced that I was clearly out of my element.  My apron took me all day on Sunday to make and when I was done I then napped for three hours.  I also learned from previous apron design attempts when I glued my apron to carpet in the family room.  Every aspect of the day was great and I now have great ideas for future apron designs.

Bye, Tom

Today is the last day that I will work with Tom Dowdell, Senior Vice President and Chief Operating Officer for WMHS as he begins his new life of retirement on December 29th.  Tom and I began our careers in Cumberland six weeks apart, Tom around Halloween in 1989 and I started in mid-December 1989.  We never imagined that we would work together for 23 years; most marriages don't last that long.  We became friends instantly with the same Black Irish sense of humor.  We laughed together, cried together, but most importantly respected the hell out of each other.  We served as each other's confidents;  we mentored each other and on some occasions even tormented each other. 

The legacy that Tom has left for us is amazing from the consolidation of the two hospitals to form the Western Maryland Health System to building a new hospital and over two decades of unbelievable accomplishments before, after and in between.  I am not sure what December 31st, the next day that we would have worked together after today will be like, but I have wonderful stories and fabulous memories that will last a lifetime.  God speed, Tom.

An Unauthorized Biography of Congress

I saw a headline on another blog this a.m. stating that the infamous biographer, Kitty Kelly, is thinking about writing an unauthorized biography on Congress.  The idea really struck me as being a good one.  I find it amazing that the approval rating for Congress is at record lows, and yet, individual Congressional representatives are idolized.  Their individualized ratings are extremely high; but as an elected body, they are abysmal.  Kitty Kelly calls it a secret society.  Really?  I think it is pretty obvious as to what they are all about: getting re-elected.  Of recent, I am involved with a state initiative that requires federal involvement.  Every elected official who is involved doesn't care about the particulars of the outcome just the outcome and how can they use it to their benefit for re-election and self-promotion.  Maybe, if Kitty doesn't write the unauthorized biography, I will.

Making Sense of the Newtown Tragedy

There isn't any way to make sense of what happened Friday morning in Newtown, CT.  It was an absolutely horrific tragedy for which there is no logical explanation.  To be perfectly honest, I have minimized watching, listening or reading about what happened.  The national electronic media has become an absolute disgrace when such horrific incidents occur.  They are all looking for that edge in being the first to report an exclusive aspect of any story.  In doing so, they ignore fact checking; they just run with what they have been told and don't care if they are inaccurate.  The bottom line is that they were successful in grabbing our attention. 

As for the gun control issue, quite frankly, the only scary thing about banning assault weapons is where will the ban stop?  No average Joe needs to have an arsenal of assault weapons, even one for that matter.  But, once a ban starts, where will it stop?  Pamela and I own guns for our safety in this day and age and every time an incident like Friday occurs, the appropriateness of our reasoning becomes stronger.  Going forward, I will make every effort to maintain that right. 

In my opinion, the biggest issue from Friday is how our country is dealing with the mental health issue.  Funding continues to be cut and in many cases eliminated at every level of government.  We have some extremely ill individuals in this country who are freely walking among us every day.  It is no longer politically correct to institutionalize those who are in need the services of mental health professionals.  Some of these folks need a great deal of help, but we leave it up to them in their compromised state to decide for themselves if help is necessary. 

I was encouraged by the Lt. Governor from Alaska, who attended Sandy Hook Elementary School as a child growing up in Newtown, CT.  Lt. Governor Mead Treadwell spoke of what has been done in Alaska due to the crisis of mental health issues and suicide in that state. He said that what we need first and foremost is a more robust mental health system in the US.  Because of Alaska's double the national average suicide rate, they have set aside funding to address their issues in Alaska.  They are doing a great deal with research and new methods for treating mental illness in his state. 

I hope that when President Obama said that we will stem gun violence in our schools through meaningful action that it will be an across-the-board solution and not one focused exclusively on banning guns.  By the way, I applaud President Obama for going to Connecticut last evening to begin the much-needed healing in that community.

Smarter Health Care Regulations

In yesterday's Wall Street Journal, there was an op-ed piece from Rich Umbdenstock, President of the American Hospital Association.  Rich's message on behalf of hospitals from across the country is to the Federal Government.   That message is that we don't need any more regulations, we need smarter regulations. 

Currently, there are over 122,000 federal regulations which hospitals are responsible for each day. Many of these regulations are unnecessary, outdated, duplicative and counterproductive.  What first and foremost comes to mind are the four separate federal programs that conduct redundant reviews of hospital payments to uncover improper billing.  One is Recovery Audit Contracting (RAC), and it has become the most frustrating since the RAC auditor determines that care should have been handled differently and payment is now withheld even though everyone who delivered the care agrees that the care was appropriate.  Hospitals are forced to appeal the decision and we have been right 75% of the time and winning our appeals.  Now, there are so many appeals that the process has slowed to a crawl and our money is being withheld prospectively for a much greater period of time.  These appeals cost hospitals a great deal of time, money and other resources and yet our concerns are ignored.  

Hospitals strive to put patients first and make careful use of decreasing resources, but regulators make that more difficult each day.  In order to successfully implement the triple aim of health care reform (better quality, healthier patients and lowering the cost of care), regulators must review all federal regulations to ensure that they allow hospitals to be successful going forward.  Those 122,000 federal regulations equate to a process out of control when you add state regulations, Health Services Cost Review Commission regulations for Maryland hospitals, the IRS requirements, OSHA, MIOSH and the list goes on.

Missing the Mark on Accountability

Recently, I read a great article that I ended up sharing with the entire management team today.  The article was from the Harvard Business Review and was entitled, "One Out of Every Two Managers Is Terrible at Accountability."

Some of the more salient points of the article included: the single most shirked responsibility of executives is holding people accountable; leaders routinely step back from the heat; managers are obsessed with managing their popularity; they try to avoid tough conversations; controversy and conflict in the workplace have been replaced with efforts not to offend; the younger workforce expect praise and recognition, but are not open to critical feedback or talking about employee weaknesses, only celebrating their strengths.  Clearly, there is a delicate balance to making sure that there is an appropriate amount of recognition and celebration, but we have to do a better job as leaders in ensuring that expectations are met.  We no longer have the luxury of allowing employees to get it right most or part of the time.  We have to expect it all of the time; and if it doesn't happen, then we work to figure out how to achieve those pre-established expectations going forward.  Accountability as a leadership behavior we be our Leadership Development focus for 2013.  I'll let you know how we do in the coming months.

Setting the Record Straight on Tearing Down Hospitals

In yesterday's local newspaper, there was a letter to the editor taking the County Government and the Board of Education to task for tearing down the former Sacred Heart Hospital.  The feeling is that the building is a perfectly good building and should be used for economic development purposes or a Veteran's Hospital.  It is important for the letter writer to know that there had been numerous conversations with the Federal Government on the reuse of both Memorial Hospital and then Sacred Heart as potential sites for VA hospitals.  The answer had been an emphatic "NO" from the VA Administration; even Senator Mikulski was told, "NO."  The VA is building new hospitals for veterans, fewer than before the economic downturn, but not re-deploying ones that have been previously used as hospitals.  These former hospitals require tens--if not hundreds--of million dollars to renovate and bring up to code; and it is important to note that WMHS built a new hospital for a very good reason. 

Which brings me to the use of the hospital for economic development purposes.  Prior to trading Sacred Heart Hospital for land adjacent to our Willowbrook campus, we engaged a developer to assess the campus for uses beyond a hospital.  After a lengthy tour and subsequent assessment of the entire campus, we were informed that the only use would be for another hospital and that would require tens--if not hundreds--of million of dollars in renovation costs.  It would be far less expensive to tear down the buildings and build whatever one may desire on that land than to attempt to retrofit the existing buildings for other purposes.   So, the bottom line is that it may seem like a good idea to those who don't have all of the facts, but what the Board of Education and the County are embarking on is the right way to go.

Right to Work Legislation

Today, the Michigan legislature will vote on making that state the 24th to adopt right to work legislation.  Labor unions from across the country will converge on Michigan to challenge the law's passage.  What is interesting is that Michigan has an unemployment rate that is 9.1%, the sixth highest in the nation.  Over the last ten years, eight of the ten states that have the greatest personal income growth have right-to-work laws in place.  Such laws allow states to attract new employers and jobs.  The unions and even the President say that this is all about politics; actually, it's about freedom to choose.  If I want to join a union, I'll join a union, but I shouldn't be required to be a union member as is the case in 26 other states, including Maryland.  What I find interesting is that the President and Congressional representatives from Michigan who are opposed to the new legislation can find the time to weigh in on this issue, with even the President visiting Michigan yesterday.  Why not stay in DC and solve the Fiscal Cliff crisis facing our entire nation?

Where Have Our Leaders Gone?

Where have our leaders gone is a question many Americans have been asking since the 2010 interim elections.  We are at twenty-one days and counting until the Fiscal Cliff occurs.   If our leaders fail to act, the US will almost immediately go into a recession just as the 49 out of 50 states are seeing themselves surviving the last recession (except for Connecticut).  The top 8 states that are leading the US in economic growth are all energy producing states in the areas of oil and natural gas.  Texas, Alaska and North Dakota lead the pack.  Where does Maryland stand?  We are what's called an Administrative and Government Sector State. With hundreds of thousands of jobs for Marylanders compliments of the Federal Government, we are very dependent on the success of the Federal Government.  That is not good news with the impending Fiscal Cliff.  With the expiration of the Bush-era tax cuts and $1.2 trillion in automatic spending cuts, that will translate to job loss in the federal government and in sectors like defense and health care.  All three of these areas will significantly impact Maryland.  It is hoped that President Obama will bring his leadership to Capitol Hill and reach across the aisle to get to matter resolved before 12/31.  Then again, we have been hoping for constructive collaboration from our leadership for the last two years, but to no avail.

Meaningful Use

Just what is Meaningful Use?  It gives health care providers financial incentives to improve patient care, reduce costs and to create an infrastructure to integrate health records.  Under the American Recovery and Reinvestment Act, aka TARP or stimulus funds, hospitals and other providers could request reimbursement under Meaningful Use, provided we could substantiate how our money was spent and that we achieved the expected results.  Once the request was developed and the results verified through an audit process, it was submitted to the Federal Government.  This week, we received $3.3 million from the government based on what we have spent  at WMHS on information technology advances that fell under Meaningful Use criteria.  Quite honestly, I never thought that we would see the money.  After all, the US is in an economic crisis, the Fiscal Cliff is ahead and sequestration is looming.  I thought that any remaining TARP funds or Stimulus monies would be the first to go, but that wasn't the case, thankfully.  We have a request pending for another $1.4 million from the State also for Meaningful Use and, hopefully, that will come in the very near future.  Our investment in information technology has been considerable over the last few years and it will continue well into the future.  Such technology will be required going forward in order to get paid by the payors, as well as to extract data to improve the delivery of  patient care.  Both are extremely beneficial to our business and getting some of those monies that we invested back is great.

Maintaining Strong Economic Ties to Our Community

As I have blogged previously, WMHS is the region's largest employer with 2300 employees.  Our employees receive over $143 million in salaries and benefits and have an economic impact on the community of over $234 million.  For every job at WMHS, another 2 jobs are supported in the local economy equating to another 4,500 jobs in our region.  The overall economic impact of WMHS on the region exceeds over $300M with local purchases for goods and services exceeding $20 million.  During FY 2012, over $16 million was spent on financial assistance for patients who could not afford their care, which was a 28% increase over the previous fiscal year.  Another $26 million supported programs and services that benefit the community.  These programs fell into the following categories:  community health services, health professions education, mission driven services, financial contributions to non- profit organizations and community building activities.  Wow, that's a lot to be extremely proud of!

FY 2012 Accomplishments

Each year, we publish a list of accomplishments at WMHS that occurred the preceding fiscal year.  Although FY '12 was a challenging year financially, we did redesign how we deliver care consistent with the goals of health care reform as well as to better position ourselves going forward.  During the year, we worked to improve the delivery of care component of health care reform's triple aim through programs to reduce readmissions, improve outcomes and enhance quality.  We also collaborated with our medical staff, improved our patient safety results and established new processes in the ED to better facilitate care.  The second component of the triple aim is to reduce the cost of providing care.  We added resources for delivering the right care in the right place and numerous cost saving initiatives were started generating a savings of $6.5 million for FY '13.  The third component of the triple aim is to create healthier patients and we did so through new programs focused on improving community health, promoting nutrition, increasing our outreach efforts into the region and serving as a role model for wellness with our own employees.  Fiscal year 2012 was certainly a year to remember in that we had our financial challenges but we also dramatically changed how we do business.  We created a model that will serve us well into the future.

The CDC has Spoken

The Centers for Disease Control announced yesterday that the flu season has already started with confirmed cases being reported in the South.  This is the earliest start to the flu season in almost a decade.  The last time the flu season started early it claimed the lives of over 48,000 Americans, and it just so happens that this same deadly strain of flu is what is being reported as this year's strain.  On average, though, half as many Americans die from the flu each year. The good news is that the current flu shot seems to be an excellent match with this unique virus strain. 

At WMHS, this the first time that we are requiring flu shots of all of our employees and medical staff.  Declinations can be given for health and religious reasons.  As of today, over 86% of our employees and 85% of our physicians and advanced practice professionals have received their flu shots.  The most vulnerable population for contracting the flu is the elderly; with our new approach to treating patients in the most appropriate location while reducing admissions and readmissions to the hospital, the majority of patients who are now hospitalized are both elderly and severely compromised with a host of chronic conditions.  I can't think of a better reason for our staff to get the flu shot.  Requiring flu shots of our staff is consistent with 41 of 46 hospitals in Maryland; it's consistent with our mission (Superior Care for All We Serve) and core values of Innovation, Compassion, Respect, and Excellence.  Most importantly, we owe it to our community, our patients, our families and each other.

Let's Talk Meetings at WMHS

Last week, we held our Let's Talk meetings for employees throughout the health system.  Our focus was twofold--sharing a video that highlights our Trauma Program at WMHS to show the importance that we have in our community and making sure that our staff is aware of our industry's financial challenges as health care reform continues to evolve.  It is important to note that the Triple Aim of Health Reform (Better Care, Healthier Patients and Communities and Lower Total Cost of Care) are all positive aspects of where health care is headed.  Unlike the 60 Minutes segment last evening on one for- profit health care provider, Health Management Associates, that is accused of driving increased revenue through "do or die" admission targets.   

WMHS is successfully reducing admissions and readmissions.  We have also implemented measures to reduce hospital-acquired conditions such as infections, pressure ulcers and ventilator-assisted pneumonia while increasing patient satisfaction.  It is true that better care equates to better outcomes resulting in increased revenue through Maryland's pay-for-performance initiative.  We went from losing $1.2 million in revenue last year because our quality scores trailed other hospitals in Maryland to a turnaround of $1.5 million gain this year.  We continue to shift our services by providing the right care in the right place as evidenced by our new Wound Center, our Anticoagulation Clinic, our Diabetic Medical Home, our CareLink Program, our Congestive Heart Failure Clinic and case managing our most chronic patients.  At WMHS, we continue to strive to fulfill our mission of Superior Care for All We Serve through evidence based care, patient centered care, a continued focus on keeping our patients healthy and out of the hospital, collaborating with our physicians and advanced practice professionals, being innovative in all that we do and having a continued awareness of our cost of doing business.  Believe or not, running a health system with annual revenues of over $325 million isn't as easy as some make it out to be, especially in this era of reform.

Let's Talk Meetings at WMHS

Last week, we held our Let's Talk meetings for employees throughout the health system.  Our focus was twofold--sharing a video that highlights our Trauma Program at WMHS and showing the importance that we have in our community, along with making sure that our staff is aware of our industry's financial challenges as health care reform continues to evolve.  It is important to note that the Triple Aim of Health Reform: Better Care, Healthier Patients and Communities and Lower Total Cost of Care are all positive aspects of where health care is headed.  Unlike the 60 Minutes segment last evening on one for- profit health care provider, Health Management Associates, that is accused of driving increased revenue through "do or die" admission targets.   

WMHS is successfully reducing admissions and readmissions.  We have also implemented measures to reduce hospital-acquired conditions such as infections, pressure ulcers and ventilator-assisted pneumonia while increasing patient satisfaction.  It is true that better care equates to better outcomes resulting in increased revenue through Maryland's pay-for-performance initiative.  We went from losing $1.2 million in revenue last year because our quality scores trailed other hospitals in Maryland to a turnaround of $1.5 million gain this year.  We continue to shift our services by providing the right care in the right place as evidenced by our new Wound Center, our Anticoagulation Clinic, our Diabetic Medical Home, our CareLink Program, our Congestive Heart Failure Clinic and case managing our most chronic patients.  At WMHS, we continue to strive to fulfill our mission of Superior Care for All We Serve through evidence based care, patient centered care, a continued focus on keeping our patients healthy and out of the hospital, collaborating with our physicians and advanced practice professionals, being innovative in all that we do and having a continued awareness of our cost of doing business.  Believe or not, running a health system with annual revenues of over $325 million isn't as easy as some make it out to be, especially in this era of reform.