The Day After the Announcement

At this point after yesterday's announcement regarding the potential alliance between WMHS, Meritus and Frederick, the reaction seems to be somewhat subdued.  The political types say that they are supportive, and the local media did a nice job in reporting the story in each community.  The staff at WMHS seem to be surprised with the choice of partners, but at the same time are intrigued.  The medical staff reaction seems positive, but there is always concern in the "what about me category," which we will continue to address.  The business community seems very supportive of the alliance.  We will see how this all plays out, but it is very exciting as we work to position our health system for the future. 

I will be traveling next week and attending a number of meetings out of town.  My blogging may be sporadic during the week.  Have a great weekend.

Exploring A Potential Alliance

Today, the Western Maryland Health System Board gave their approval to the formation of an exploratory group consisting of representatives of WMHS, Frederick Regional Health System in Frederick, Maryland and Meritus Health in Hagerstown, MD to examine ways in which the three health systems could possibly work together.  Health care is changing quickly and dramatically.  Each health system feels that a potential alliance may be the best way to meet the many challenges and still preserve viable health care in each community.  Below is a press release that was issued today.  I will continue to blog from time to time on the progress that is made over the next six to nine months.

Three Maryland Hospitals Announce Strategic Discussions for Potential Alliance

Three independent Maryland health systems announced today the signing of a memorandum of understanding to enter into strategic discussions of collaboration and affiliation.  Chief executive officers of Frederick Regional Health System, Meritus Health and Western Maryland Health System and their respective boards of directors have agreed to study and discuss opportunities that will allow each organization to enjoy continued success in meeting the challenges of the current and future health care environment.  

Barry P. Ronan, President and CEO of Western Maryland Health System, explains, “We are three not-for-profit organizations that are deeply -rooted in our communities.  We share a common set of values, with rich traditions of service and support, and we are exploring ways to work together to continue to best serve the health needs of our communities.”

The proposed alliance would provide a sound business structure for developing new services and improving infrastructures. Joseph P. Ross, President and CEO of Meritus Health, states, “We are beginning discussions that will focus on our shared vision of clinical collaboration, physician services, support services and shared resources to enable us to deal successfully with today’s health care challenges.  Some of the issues our organizations must manage include health reform, the next fiscal cliff and financial pressures on both a national and state level, and the intensified health needs of an aging population.”

Thomas A. Kleinhanzl, President and CEO of Frederick Regional Health System, adds, “The forces shaping health care are challenging for independent community hospitals and many are creating alliances for continued stability.  Our collective goal is to explore options in order to maintain high quality and cost-effective health services for our communities.” 

The group will undertake a feasibility study with the Berkeley Research Group (BRG) that will explore the merits of affiliation and collaboration of the three health systems.  It is expected to take several months to receive a final recommendation.

                                                                                               

Frederick Regional Health System operates health care facilities and services in Frederick County, Maryland, including Frederick Memorial Hospital.  Meritus Health operates health care facilities and services in Washington County, Maryland, including Meritus Medical Center.  Western Maryland Health System operates health care facilities and services in Allegany County, Maryland, including Western Maryland Regional Medical Center.

Now, For What To Watch On TV

Yesterday, I blogged about excessive violence from Hollywood and its influence, along with a host of other contributors, to our extremely violent society.  If you would like to watch the complete antithesis of violence on TV and be thoroughly entertained by exceptional acting, amazing costumes and beautiful scenery, then watch Downton Abbey, a Masterpiece Theater contribution from England on PBS.   The series is in Season 3 here in the US, but I am told it is Season 5 in England.  Rent or buy Seasons 1 and 2and the first three episodes of Season 3.  Start at the beginning with episode one of Season 1; it will help immensely.  I have been thoroughly entertained so far with the aristocracy upstairs and the extremely enjoyable story lines, personalities and antics of the servants downstairs.  Downton Abbey is on PBS every Sunday at 9 PM.  The previous week's episode then is shown on Sunday at 8 PM.  Season 1 is a little slow in starting but it picks up pretty quickly.  Enjoy!

Absurd Violence

OK, so last night I needed to do something other than work so I turned on the TV.  I happened to watch two shows back to back on Fox that were the most violent shows that I have ever seen.  The first was "Bones" and it was about a serial killer who tortured and then skinned his victim alive.  Not one of my favorite shows, and now I know why.  The second show was a new show "The Following" with Kevin Bacon.  I really didn't know what the show was about only that it was starring Kevin Bacon and I like him as an actor.  Now that show is one that I won't watch going forward--there will be no "following" by me.  It's about a mass murderer who has established a cult and they will pretty much kill people in the most violent, vicious ways possible week after week. 

The problem that I have is why does Hollywood get a pass on extreme violence?  Even the commercials during both shows were for upcoming movies that feature explosions, the firing of lots of automatic weapons, killings on top of killings.  But yet, Hollywood is boycotting the movie "Zero Dark Thirty" because terrorists were water-boarded in an effort to capture Osama bin Laden.  Give me a break!!! We are pretty much focusing on gun control to address today's violence; talk about missing the boat. 

What about mental illness and that so little is being done to address it? Funding is cut year after year and the rights of those who are severely challenged mentally seemed to be relaxed repeatedly.  Then there are video games; where is the policing in that industry?  In an effort to really address the violence in this country, we need a much more comprehensive approach and deal with all of the above, not just gun control.  We are so good at dealing with a fraction of a problem and then patting ourselves on the back while telling everyone what a great job that we did.

Meeting the Challenge of Health Care Change Part 2

On Friday, I blogged about how we are going to share information as to the changes in health care by using the Meeting the Challenge of Health Care Change mantra.  In Sunday's local newspaper there was an editorial that fits into our meeting the challenge initiative.  The editorial was entitled, "More doctors are losing their independence" by Nat Hentoff.  I wanted to make sure that our community knows that the environment is different in Cumberland.  Nat paints all hospitals with a very broad brush in his editorial; it's not very flattering nor is it accurate.  In Cumberland, physicians have chosen to either to remain independent or join the health system.  If a physician chooses to be employed by WMHS, we will work with him or her to accommodate their desire to work for us.  We do not, however, buy practices as Nat writes in his editorial piece.  In addition, many local independent physicians have chosen to give up their hospital practice and dedicate themselves to an office practice exclusively.  We have worked with them to achieve their goals.  As a result, we have been forced to expand our hospitalist program in order to care for their patients when they are hospitalized. 

In addition, Nat pretty much takes on the industry related to the economic changes that are occurring. As I have blogged in the past, the cost of health care is unsustainable.  Throughout his editorial, Nat is placing all that is changing in health care squarely on the shoulders of hospitals.  Changes in health care, especially the cost, are being driven from a variety of sources, primarily federal and state government, a host of other regulators / influencers, payers and also from within hospitals.  We are making many changes in how we do business in an effort to comply with the changes being driven to get cost of the US health care system.  We are now being paid differently.  The model is no longer based on volume of services provided; it is now based on the value of the care provided.  We will continue to treat patients in the most appropriate setting whether that is in the hospital or in an alternate location such as a clinic, diagnostic center, a physician's office or at home.  Mr. Hentoff's closing paragraph of his editorial piece finally gets to the source of the issue, however misplaced his thinking may be, by applying his First Amendment rights at the polls to protest the end of physician independence.

Meeting the Challenge of Healthcare Change

Like other hospitals and health systems across the country, we are changing how we deliver care to meet the goals of healthcare reform.  We have implemented many new programs and services and we are starting to see the results—we are providing better care, keeping our patients healthier, and lowering the cost of providing care. 

Today, we had a kick-off event to give employees an opportunity to share what they are doing to meet the challenge in their areas with our Community and Marketing team.  This information will be incorporated into the materials we will be sharing with our community.  We’ll be featuring our employees, physicians, volunteers and board members in our advertisements and on our website. 

We are proud of our accomplishments so far, and we want our patients and the community to know that we are changing to meet the goals of healthcare reform and to serve them for years to come.

Another Medical School for Maryland

The University of Maryland - Baltimore, Salisbury State University, the University of Maryland - Eastern Shore are coming together with Peninsula Regional Medical Center to form a third medical school in Maryland.  It's about time because hospitals and health systems across Maryland, primarily in the more rural areas, struggle daily with physician recruitment with little help from the existing medical schools in Maryland.  Residents coming out of training in Maryland either remain in the central Maryland region or move out of state.  The last resident from a Maryland program whom we were able to recruit to WMHS was over a dozen years ago; we have far greater success with WVU. 

This initiative to build another medical school in Maryland was explored with the leadership at the University of Maryland - Baltimore and WMHS this past summer; however, the Eastern Shore initiative was already in the planning stages.  Personally, I think this is great news.  It's not only another source to recruit physicians from, but the concept has great potential.  Dr. Perman, the President of UMB,started a similar initiative in rural Kentucky when he was dean of the University of Kentucky's medical school and he is attempting to model that concept in Maryland. 

Lance Armstrong, Hero to Zero

Now that's a pretty harsh title, but so well deserved.  Lance Armstrong was an icon to millions, especially the cancer community.  He gave so many people hope as they battled cancer.  He convinced us all that he would be crazy to put anything in his body after what he had been through in fighting cancer.  And, we believed him.  Why wouldn't we.  He was so convincing when he took on his accusers.  He brutalized them.  He mocked them.  Now we come to find out that he was doping all along.  He cheated and now he is sorry; in my opinion, not for cheating, but getting caught.  What is now complicating his life is that he is being sued by sponsors and the federal government for tens of millions of dollars that he fraudulently took from them during his years of winning the Tour de France.  He should have realized that through his sponsorship by the US Postal Service that he would eventually be sued under the false claims statutes; clearly nothing to mess around with. There are so many wonderful lessons here for all of us.  I just hope that we all can benefit from these many lessons by applying them to our own professional and personal lives in the "what not to do" category.

The Last One is No More

Yesterday, I read an article in The Gazette regarding the sale of Maryland's last for-profit hospital to MedStar Health System.  There never were many for-profit hospitals in Maryland.  When I arrived in Maryland 23 years ago to begin my health care career here, there were only two for-profit hospitals and one of them closed many years ago.  That left only Southern Maryland Hospital Center.  The hospital was founded 35 years ago by Dr. Chiaramonte and most recently run by his son, Michael.  I have known Michael for a number of years and he has done an admirable job of continuing to run his for-profit hospital in a rate-regulated state.  A formidable challenge to say the least.  In the article, Michael is quoted on the sale saying, "as a result of ongoing federal reforms, hospitals are being required to take more risks and act almost like insurance companies.  Obamacare is helpful in seeing that more people are insured but less helpful in seeing standalone hospitals remain solvent." 

Southern Maryland is the seventh hospital in Maryland that has been acquired by MedStar and tenth overall.  The other three are in Washington DC.  Even the Secretary of Health for Maryland thinks that the trend to affiliate, merge or be acquired is a good one.  Secretary Sharfstein is quoted in the article, saying "It's a good trend even if it just involves information sharing.  Integration can bring a lot of value to patients because it makes it easier to get their data from one system to another.”

Throughout Maryland the activity continues to grow related to affiliations.  You can almost count on two hands the number of independent hospitals and health systems that remain.  At this point in time, WMHS is still a standalone health system.

Not That Rumor Again

Since last weekend, I have been dealing with the rumor that WMHS has been once again sold to Johns Hopkins Health System.  It was pretty pervasive around the community, including the media and politicians who were getting their information from "very reliable sources."  During the week, I talked with my counterpart at Meritus Health in Hagerstown.  He told me that he deals with that same rumor repeatedly in his community.

During the last year, I have blogged and written about a meeting that I had with a senior VP from Hopkins shortly after we moved into the new hospital.  He and I had been colleagues for a number of years in Maryland and he asked to visit the new hospital.   During that visit, I told him of the rumors that I had been dealing with over the years concerning Hopkins acquiring WMHS.  He told me that Hopkins will pursue other hospitals provided that hospital or health system provides a competitive advantage and / or brings a critical mass of new patients to their system.  He said that he didn't mean to be disrespectful, but WMHS provides neither for Hopkins.  Maybe it's a desire of those "reliable sources" to have Hopkins in the community.  I, for one, recognize the reputation of a Johns Hopkins Health System, but such an outcome would not be in this health system's or our community's best interest.  By forming the Western Maryland Health System and building the new hospital, our goal has been to preserve low cost, viable health care in our community.  So far, we have been successful.  Our goal is to figure out a way to ensure that same low cost viable health care can continue with the dramatic changes that continue to occur in health care nationwide and in Maryland.

Making Primary Care More Convenient

You often hear people say that they never get sick so they don’t need a primary care provider or PCP.  Actually, establishing a relationship with a PCP is important for maintaining good health.  Another excuse is that they can’t get to a provider’s office because of their work schedule.  At WMHS, we recently added early evening hours at our Primary Care Center at South Cumberland Marketplace so patients can schedule appointments after work.  We want to make access to primary care more convenient and encourage people to establish an on-going relationship with a PCP.  It’s all part of our efforts to make our community healthier, which is one of the Triple Aims of health care reform.

D2B

Congratulations to our entire Door-to-Balloon team at WMHS for being selected as the Maryland Patient Safety Center's Minogue Award winner for Patient Safety Innovation for 2013.  Our group was selected out of submissions from hospitals and health systems across Maryland.  It is wonderful when hard work and dedication are recognized by an independent panel of experts who know patient safety and innovation.  The award won't be presented until early April but the recognition is so well deserved.  Great job, everyone!

Now I Understand

This morning on the radio, I heard a commentary from Dr. Dean Edell that really helped me understand my elderly mother.  His commentary was regarding the elderly and their inability to recognize unscrupulous individuals.  There was actually a study done using unsavory types of individuals and normal, clean-cut individuals and showing them to a group of elderly folks as well as younger and middle-aged people.  The results were amazing in that the group of elderly people couldn't see the difference between either group of individuals.  They saw nothing wrong with the unsavory types in their appearance compared to the normal, clean-cut looking group. 

That information was so helpful for me.  You see, my mother who lives alone, answers the door to anyone who comes calling, has invited strangers in and has had items stolen from her; fortunately, that's all that has happened.  I thought that she was just lonely and I tried to tell her that she couldn't just open the door to anyone.  Each time she tells me that it was a bad idea on her part and she won't do it again.  Now I know that as an elderly person, she may not be able to recognize the difference between those who may want to do her harm and those with legitimate intentions.   I am not quite sure how to use the information that I learned today, but it clearly puts it in a different perspective.  Now have they done a study on why the elderly (my mother) give money to anyone who calls on the phone and asks?

Health Care Spending

I saw a report from the Department of Health and Human Services this a.m. that health care spending is slowing.  Even though Medicare spending is up and the nation's health care cost is $2.7 trillion annually, Medicaid spending is down along with hospital spending.  That is three years in a row that spending in both Medicaid and hospitals is down.  The country saw a 3.9% increase, but it is the lowest in some time.  Health care spending pacing economic growth is a good thing.  When health care spending outpaces our economy therein lies the problem, making recovery very difficult.  Spending increases were seen in drug and physician costs along with private health insurance.  More people are now covered by insurance and that rate is expected to grow.  Premium increases are also expected to be high this year in anticipation of the continued Affordable Care Act rollout.  The news is good; however, we have to continue to focus on getting cost out of the system and not simply cutting payments to hospitals and doctors.  Align incentives for providers, reimburse for quality, enact tort reform on a national basis and work with the health care industry as we attempt to address the sickest 5 % of our patients who account for nearly 50% of the cost.

Are Leaders Born or Made?

Over the weekend, I read a book, "How To Be Exceptional--Drive Leadership Success By Magnifying Your Strengths" by Zenger, Folkman, Sherwin and Steel.  Overall, very good read on leadership.  A question was posed in the book as to whether leaders are born or made.  Believe it or not, there are arguments on both sides. 

For the most part, I have always been from the "made, not born" camp, but agree that much of one's leadership ability is hardwired by your mid-twenties.  I think back to when I was in middle or high school, and I can't think of anyone who at the time was a born leader.  They may have excelled at a sport or held office, but their leadership came from being good at that sport or not shy about getting up to speak in front of people. 

Leadership truly evolves over time, as it did for me.  I was a shy kid who was an average athlete and an above-average (but not by much) student.  When I got to college, I joined a fraternity and went on to become President of the fraternity as well as President of the Greek Council (the Council oversaw all of the fraternities and sororities on campus).  I then became part of the Dean of Student's inner circle and was called on whenever something needed to be addressed with the student population.  Although I was off to a great start, the hardwiring of my leadership abilities was actually set in my twenties.  My college leadership experience originated more from popularity, but evolved to true leadership ability later.  By the time I was 20, I was managing a small restaurant, which started to hone my leadership skills.  I then became the youngest director of the second largest department at a large teaching hospital by the age of 25, which sealed the deal. 

Now to be perfectly honest, you can't completely discount genetics.  My grandfather was a human resources executive with a large corporation, and he was significantly engaged in leadership through community service, including serving as a city councilman.  My father's twin brother went on to become an executive with Gulf Oil and he, too, was significantly engaged in community service and he served in various leadership positions.  So, genetics can play a part with your genes, potentially predisposing you to leadership skills, but your environment and your life stream seem to be what really count.  Clearly, leadership development is an area that is critical today and going forward.  It needs to be a focus of every organization.

The Flu

Hospitals across Maryland, including the Western Maryland Regional Medical Center, are filling up with patients with the flu.  It is hitting the US earlier than usual.  Early indications are that the shot that we all received is consistent with the current strain of flu; very good news.  WMHS took an extraordinary step this year by requiring all employees and members of our medical staff to be vaccinated against the flu.  (We also offered the vaccine at no charge to the immediate family members of our employees, as well.)  We advised our employees in 2011 that they would be required to get the flu shot in 2012 and the overwhelming majority complied.  Some were excused for very valid medical reasons and a few have requested a religious exemption.  We are currently evaluating those who requested an exemption for religious reasons and until that matter is sorted out, they have continued to work.  A handful of employees resigned as they refused to get the flu shot.  Some got the flu shot but claimed to do so under duress.  There was no duress; it's simple: we are in the business to protect our patients at an extremely vulnerable time in their lives.  If you can't embrace that concept, you will have a hard time working in health care going forward. 

Hospitals across the country have the highest overall employee participation this year with 83.4%.  The great majority of Maryland hospitals now require their employees and members of the medical staff to get the flu shot.  As an industry, health care is at a 63% compliance rate and the general US population is 42% in receiving the flu shot.  Nursing home compliance is at 49% and physician office settings are at around 65%.  At WMHS, including our nursing home and physician practices, we have around 98% of our employees and physicians who received the shot.  A heartfelt thank you to our employees and medical staff members as our patients will be the true beneficiaries of such an outstanding rate of compliance.

The Next Fiscal Crisis x 2

In 2008, we had the housing bubble and the banking crisis both contributing heavily to our last recession.  On the horizon, there are two new crises, student loans and government pensions. 

The amount of student loans that are owed to the government has now exceeded $1 trillion; that leaves me speechless.  If we had every individual who had borrowed money attend college and graduate, then we would be the envy of every industrialized nation.  Unfortunately, that isn't the case.  The majority have borrowed the money, attended college, but never graduated.  Many never made it past their first semester and have no means to pay the borrowed money back.  These individuals have defaulted on their student loans; truly, a crisis. 

As for government pensions, the most recent estimate for unfunded pension liabilities for state and local governments exceeds $3.4 trillion dollars.  On top of that, state and local government retirees have been promised health care in their retirement at an amount that exceeds $1.2 trillion dollars.  Again, both are promised, but not funded at this point.  I just read that in the state of California, it takes over 75% of their tax revenues just to pay for the salaries and benefits of state workers.  Where is the funding going to come from to pay and support these retirees? 

Ah wait, is that another hand I feel in my pocket?  Bottom line is that both are unbelievable and they say health care is screwed up.

Averting the Fiscal Cliff

Happy New Year!  I had a wonderful time off over Christmas having the opportunity to visit with family.  It is great to be back; actually, I got back to work on Monday and worked yesterday as well. A lot was accomplished in catching up without back-to-back meetings each day. 

Now for averting the fiscal cliff.  Both the Senate and the House averted the cliff by passing legislation that increases taxes but does not address spending.  The spending piece will come in two months when they have to address sequestration.  Rest assured, hospitals will be in their sights and our revenues will be cut. 

Quite honestly, there is waste in health care as is the case in every industry:  defense, banking, manufacturing, government, education and the list goes on.  I know of many hospitals across the country and in Maryland that are getting cost out of the system, but there are still some hospitals that still don't get it.  They have no desire to bend the cost curve.  There are hospitals that want us to send them patients for additional procedures, testing and admissions as we try to keep patients healthy and out of the hospital.  We are trying to do the right thing by focusing on improving the care of the patient while bending the cost curve (reducing health care costs).  These hospitals see this as an opportunity to game the system.  At WMHS, we will refer patients in need of care elsewhere, but only do so if it's in the best interest of the patient, not enhancing the profitability of a tertiary care facility.  Given the opportunity, all hospitals will do the right thing, but give us that opportunity.  Don't blindly cut revenues across the board.  Set the expectations of hospitals under a given time frame and we'll get there.  At the same time, do something to address misaligned incentives between hospitals and physicians, legislate tort reform and relax the 122,000 federal regulations that hospitals must adhere to.  

Have a wonderful 2013!