Changes to the Hospital Payment System

For almost the last year, we have been dealing with a process for modernizing the payment system in Maryland.  The application for a new agreement was filed with the federal government this week.  The attached article provides a summary perspective of the issue and is an interesting read.  What I derive from the article as well as the many discussions over the last year is that the capitated payment system that WMHS, along with nine other Maryland Hospitals, is under certainly  has the potential to be the payment model for the state, going forward.  Have a wonderful Easter weekend.

http://www.bizjournals.com/baltimore/news/2013/03/28/maryland-proposes-dramatic-change-to.html

How Do I Become a CEO?

As I blogged yesterday, I had the opportunity to speak to around 50 students at Frostburg State University's School of Business last evening.  It was actually the Finance Club and I served on a panel with two other executives.  Before the event, I stopped and had dinner with my wife and daughter. As I spoke of what my evening entailed, my daughter Lauren decided to join me for the event. 

After each executive gave a perspective on their background and "secrets to success," we were met with lots of great questions from highly engaged and interested students.  One student asked when did I know that I wanted to be a CEO because he wants to be a CEO.  He asked what does he need to do in order to achieve that professional goal.  My answer was that I didn't set out to be a CEO; it sort of just happened 18 years ago when I was first appointed CEO of Memorial Hospital and I am glad that it did.  To this day with all of the challenges that I face every day, I love what I do. 

I told him that in addition to mastering my platform for success, which I covered last evening and blogged about yesterday, that he should focus on aligning his vision and outlook with that of the organization.  He should never underestimate how change affects an organization's employees and always work to drive variability out of the organization's leadership.  He needs to be well organized and an effective communicator, including having strong listening skills.  Depending on the organization, being a servant leader isn't a bad thing either.  I encouraged him to stay in touch and offered to help with his career goal. 

I don't have the opportunity to interact with younger people with great frequency so I really enjoyed last evening. I am already looking forward to a return invitation.

Platform for Success

I have been asked by a student business and finance group at Frostburg State University to speak this evening about myself (which is always challenging), my educational background, and my career progression.  I have also been asked to focus on the factors that have led to my success and what I look for in perspective employee.  So here goes; the following is the Ronan Platform for Success:

1) Make Yourself Indispensable in Your Job

2) Surround Yourself with the Best Talent Available

3) Dress to the Next Level in the Organization

4) Treat People Like You Would Like to be Treated

5) Work Like You Mean It

6) Give Back to Your Community

7) Learn From Your Failures

8) Be a Visionary or At Least Creative

9) Network, Network, Network

10) Thank, Recognize and Reward People

11) Be a Mentor

12) Laugh, Have Fun and Enjoy What You Do

Remember, I have been in health care for 38 years so, some of these may not apply for everyone, but they have benefitted me over the years.

For example, I still wear a suit and tie each day.  Dressing down for me is a sport coat and tie.  I think that the CEO of any organization should dress the part and that is an expectation of me by many in my organization.  I realize that business casual is the more appropriate business attire today; that's fine for many in the organization, just not me.

I am looking forward to tonight's program, especially listening to the two other CEOs on the panel and interacting with the students and faculty.

An 86% Gas Tax Increase in Maryland

I rarely disagree with the Maryland Chamber of Commerce; not only am I a member, but I am also a board member.  When it comes to the recent approval of the gas tax increase by the General Assembly, the Chamber was touting its role in the approval to increase the gas tax.  They even sent a listing of who in the General Assembly voted against the approval.  Thank you, Chamber, now it will be easier to designate my political contributions to those on the list.  I am not a proponent in what amounts to an 86% increase in the gasoline tax over the next three years.  The increase will go from 23.7 cents to 43.7 cents per gallon by July 2016.  This will place Maryland with the 5th highest gas tax in the country and we wonder why we can't compete against Virginia, whose gas tax remains at 10.5 cents per gallon.  In these challenging economic times to raise the gas tax will mostly penalize low income households who, for the most part, drive older, less efficient cars. 

I am also still mad at the raids on the Transportation Trust Fund that occurred by the past two administrations to balance the budget.  The current administration took $1.3 billion out of the fund, but now that fund is protected.  Really?  Going forward, the raiding of the fund will take a 60% majority vote of two key committees whose membership is controlled by the Committee Chairs.  Those members are easily replaceable until they get the votes.  In addition, the majority of the transportation monies are used for mass transit, which is non-existent in western Maryland; we benefit very little from the transportation fund and that has been the case for decades.

So, even though the majority of Marylanders (in excess of 70%) don't support a gas tax increase, the political forces in Maryland disagree.  This will add another $800 million to the $2.3 billion in new taxes per year that Marylanders pay as a result of to the Maryland political types.  I recognize how challenging it is run anything of any magnitude today, but there has to be a better way rather than taxing our way through this economic crisis.

Impact on Economic Development Among Other Areas

Last week, I was invited to speak to the Allegany County Chamber of Commerce's Economic Development Committee.  My topic "Meeting the Challenge of Health Care Change" covered three areas: the health system's economic impact on the region; how health care is changing at WMHS and some background on the potential alliance between WMHS, Frederick Regional Health System and Meritus Health.  The meeting was well attended and the response was extremely positive.  Lots of questions and the group received a great perspective on health care and how dramatically it is changing under the Affordable Care Act. 

Tomorrow, Dr. Rob Flint, Chairman of Emergency Medicine, and Jamie Karstetter, the Director of Nursing who responsible for the ED as well as a number of other areas, will be presenting to the Cumberland Rotary Club on how we are meeting the challenge of health care change in the Emergency Department.  We will also be taking the success that we have had with the Door-to-Balloon project out on road so our community is aware of our success in this area, as well.   We jokingly refer to taking our message out to the public as shameless self-promotion, but quite honestly, there are many wonderful things happening at WMHS that we have to share with our patients and the community.

Allegany County: Still One of Maryland's Unhealthiest Counties? Wait, Not So Fast.

This week there were national and local media stories that Allegany County is still an unhealthy place to live; next to the worst in Maryland, with Baltimore City being the worst.  So just how bad are things?  Well, first and foremost, the most recent study was one released by the Robert Wood Johnson Foundation and the University of Wisconsin.  These rankings are broad measures designed to educate communities as to how long and how well they live.  The rankings extend well beyond medical care and are supposed to be a call to action according to the surveyors.  At WMHS, we do take the community's health status very seriously and continue to focus on a number of health status measures that we can affect.

WMHS, working in conjunction with the Allegany County Health Department, has a set of measures on community health status that we monitor and update frequently.  The status was updated in January 2013, and we have shown improvement in tobacco use during pregnancy, access to care, infant mortality, access to primary care, cancer mortality and behavioral health.  Areas continuing to need improvement are dental care, health literacy, drug-induced deaths, ED visits for hypertension and diabetes (at least they are seeking care) and heart disease deaths. 

To address the hypertension, diabetes and heart disease issues, WMHS has created a Diabetic Medical Home and a Congestive Heart Failure Clinic within the last year.  We have also stepped up our education and screenings through our Stroke Center to better address the hypertension issues in our community.  Improving health literacy is a major initiative of both WMHS and the Health Department.  The local Dental Society is working to bring improvement to dental care, especially in adults over 21. 

Areas not directly related to health care showing improvement include: increased physical activity in schools, prescription disposal, alcohol awareness and opportunities for social support.

It is apparent that poverty is a major driver of poor health status, but it is our goal to not let that stop us from bringing improvement to every health status indicator for the people of Allegany and Mineral Counties.

Consumer Reports' Hospital Compare Data

 This morning, I was alerted by one of the Health System's board members that the Consumer Reports' Hospital Compare Data was in the news a.m.  The bottom line is that the information being shared by Consumer Reports is unfavorable for the majority of hospitals in the U.S. and Maryland in particular.  So, of course, I logged on and went to Maryland data with a focus on WMHS.  What garbage and they have the nerve to go public with "Trust Our Expert Ratings."  For WMHS, there isn't any Net Safety Score, there wasn't any Bloodstream Infection Score, Avoiding Readmissions Score was next to worst and for the Drug Information Score we received the worst rating.  Finally, we were rated highly for Electronic Records.  Where they got their information from is beyond me because for the most part, it's flat out wrong. 

First of all, none of the Maryland hospitals received a patient safety score; I would assume because we are a rate-regulated state operating under a Medicare waiver so that our information doesn't match up with the rest of the nation.  Secondly, seventeen of the Maryland Hospitals didn't receive a Bloodstream Infection score including WMHS and yet, I just got our scores last week showing a positive result in compared to other Maryland Hospitals.  As for Avoiding Re-admissions, we have taken those readmissions for which we are penalized and reduced them by over 10% to an average of about 8.5% (that's a great result).  For Drug Information, that information is from the HCAHPS survey data and our YTD result is 72.5%.  This means that almost 73% of those responding answered "Always" when asked if they were told about their new medicine.   That is a pretty good result when compared to other hospitals, especially in Maryland.  What is interesting is that every Maryland Hospital scored either worse or next-to-worse in both the Re-admission and Drug Information categories.  It appears that the Electronic Records rating is accurate as we have dedicated a great deal of resources to information technology at WMHS over the last several years.

I really have to question Consumer Reports’ expert ratings in this case.  They are virtually the same ratings as they were in the July 2012 report and I would certainly question the period of time that the ratings reflect.  I find it interesting that the Consumer Reports’ doctor in charge of hospital ratings is making the talk show rounds taking hospitals to task with ratings that are inaccurate or inconclusive for at least Maryland hospitals.

Legalizing the Use of Marijuana in Maryland

So I thought that I heard it all when Senator Zirkin, who is sponsoring a decriminalization bill (from criminal to civil), said that he is not trying to get teens to smoke pot; he just wants to unclog the judicial system with marijuana possession cases.   Then Delegate Anderson, in sponsoring his bill to LEGALIZE marijuana possession and use, says, "Marijuana is not addictive at all unlike other drugs and alcohol." Well, Delegate Anderson, it's time for a reality check.

Marijuana has proven to inflict a long lasting, negative impact on your brain and the younger you are the worse it is.  Marijuana can result in functional brain deficits affecting communication skills and learning capabilities and shortening one's attention span.  It also affects the lungs and can lead to use of stronger drugs.  Studies have shown that the younger that you start to smoke marijuana, the more dependent that you become on other drugs.   Today's marijuana is not the marijuana that was smoked in the 70's; THC, the main ingredient, is far more potent today than the pot from the 60's and 70's.  And, don't even get me started on the effects of marijuana on the fetus when women smoke it while pregnant.  In fact, researchers aren't even sure what the overall or long-term effects are on children whose mothers smoked marijuana while pregnant. 

If you can't tell from today's blog, I am adamantly opposed to decriminalization and certainly legalization.  I would support a bill legalizing medical marijuana with strict conditions as I think that there are enough people who would benefit from such a law.  Hopefully, some sense will prevail in Annapolis during this legislative session and the bills sponsored by Senator Zirkin and Delegate Anderson are defeated.

Aesthetics of Hospitals

I saw an article the other day, "How Much Should Be Spent Beautifying Hospitals.” The article talks about the limited resources available for hospital design and construction, but yet hospitals continue to pour money into ensuring a hotel or spa-like venue.  Such amenities in hospitals are not usually found outside of the U.S. unless they are privately developed.  Recently, we had a team of Chinese students visit our hospital and they were amazed at what they saw.  Since we opened three plus years ago, we have had a number of international visitors and to a person they said that our hospital was nicer than most of the hotels in their countries. 

When we designed our hospital a lot of thought went into the attention to detail.  First and foremost, we wanted it to be welcoming as a healing environment without being ostentatious.  Our architects and interior designers went to great lengths to capture the essence of our region with the lighting, the earth tone colors throughout the facility, the spaciousness of the interiors and the quality of local art.  Our design also focused on state-of-the-art safety and infection control measures, along with ease of access and egress.  To this day, the exterior as well as the interior remain safe, beautiful and very well maintained.  Most importantly, they enhance the healing environment.

Another aspect of providing a healing environment occurred a little over a week ago while I was in the hospital doing rounds.  I stopped to listen to our volunteer Dion play the donated baby grand piano.  I was watching and listening from the second floor area that overlooks the lobby.  I was amazed at the number of people who walked by smiling--patients, visitors and employees, it didn't matter.  Some stopped to listen; some kept on walking, but to a person, everyone was smiling as they listened. 

Giving folks that calming, feel good environment certainly is an objective that we set out to accomplish when the hospital was being planned.  The environment that we created hopefully allows patients to transcend their illness for a period of time.  What we have done through design and amenities, along with other U.S. hospitals, should be looked at as an added bonus toward the healing process.

South Carolina Gets It Right

I learned over the weekend that Governor Nikki Haley of South Carolina has issued an Executive Order to all Cabinet agencies, boards and commissions to review all current and proposed statutes, regulations and policies that are overly burdensome to the state's economy.  Wow, talk about a Governor who gets it.  Governor Haley is soliciting input on the matter from the public, businesses, professional associations, government employees and others throughout the State.  What a refreshing change it would be to have a governor issue such an order and challenge everyone to get rid of overly burdensome laws. 

In Maryland, it seems that we can't help but to drive business away year after year through excessive regulation and taxes.  It is especially troublesome when we border one of the most business friendly states in the US (Virginia) and that Maryland is one of the most poorly rated states in which to do business.  Maryland seemed to be making some headway in the business friendly rankings, but to make matters worse we are now considering increasing the minimum wage and making sick days mandatory for every employer to provide to its employees.  Neither is that onerous to large businesses in Maryland, but a killer to small business.  I applaud Gov. Haley for undertaking such a visionary initiative in making South Carolina less regulatory burdensome and more business friendly.

Andrew Weil, MD

Last evening, I had the rare opportunity to hear Dr. Andrew Weil speak.  He was the guest of Frederick Memorial Hospital, as was I, and he spoke at the Weinberg Center in downtown Frederick.  For those of you who don't know Dr. Weil is, he is on the leading experts on Integrative Medicine.  When I lost 40 pounds a number of years ago, it was Dr. Weil's approach to a healthier life style that I followed.  I am back at it trying head off a pre-diabetic condition by once again following Dr. Weil's food pyramid which includes red wine (thank God), dark chocolate sparingly, tea (my drink of choice), healthy fats  (I have since acquired a taste for Salmon),  water (my other drink of choice), multi-grain pasta, fruits, vegetables, whole grains, good protein and dietary supplements.  I am still not a fan of soy products, beans and legumes, but who knows now that I like good Salmon.  I have lost 13 pounds in about 6 weeks and brought my blood glucose level down with an A1C now in the normal range. 

I will keep you posted on my progress, but I really enjoyed the opportunity to hear Dr. Weil. I am even practicing his breathing technique that is supposed to be a cure all so we'll see.

The Good, The Bad and The Ugly of Social Media in Health Care

One of the educational programs that I attended when I was in Chicago this week was on Social Media.  This is a topic that intrigues me based on how fast it is growing, and anytime that I can attend such a session, I try to because the information changes so quickly.  I learned that the use of Social Media among older adults is growing rapidly, especially those over 65.  The reason is attributable to seniors being able to Skype directly with grandkids, see photos of them almost daily and the same with videos and messaging.  Up until now, the traditional health care Social Media early adopters have been the young, family caregivers, minorities, Medicaid beneficiaries and patients with complex needs.  I also learned that 82% of American health care consumers feel that hospitals with a strong social media presence also feel that the clinical functions of those hospitals are on the cutting edge.  Also, 80% of health care consumers look online for health information, which is up dramatically from previous years.  Another interesting point was that customer relationship management in hospitals is aided greatly through Social Media as we have found at WMHS.  We have seen a growth in texting, emailing, Twitter, Facebook and the use of You Tube.  We will also begin a more intense look at Yelp, Google +, Wikipedia and Foursquare going forward.  All good stuff; little to no bad and ugly.

The Real Accountable Care

I have been at the American College of Healthcare Executives Annual Congress for the last several days.  What I have found truly amazing by interacting with colleagues and attending the many educational sessions is that the Western Maryland Health System is so far ahead of hospitals across the US in our approach to accountable care.  By accountable care, I don't mean the creation of an Accountable Care Organization, aka ACO; that will come in time.  What I mean is our approach to finding better ways to care for our patients while reimbursement is being ratcheted down and expectations for better outcomes have been elevated. Our approach to accountable care can be found in our initiatives to reduce readmissions, more comprehensive care plans and discharge plans, case managing our high utilizers, the establishment of clinics and medical homes, the creation of primary care practices in the community and a much more comprehensive approach to the care of the patient through initiatives such as Perfect Care and better care coordination.  We should be teaching this stuff.  Great job, everyone!

Sequestration is Being Done The Right Way in Certain Government Depts.

Over the last two weeks, I have complained on a few occasions about the Federal Government's approach to Sequestration.  I am happy to say that there are some in the Government who are approaching their cuts appropriately.  I am in Chicago for the American College of Healthcare Executives Annual Congress.  I try to get here every two to three years for ongoing board recertification purposes as a Fellow in the American College of Healthcare Executives.  Anyway, for this year's Congress, the great majority of attendees from the Department of Defense and Veterans Affairs are not here.  They were not permitted to attend due to the cost associated with their attendance and the unavailability of funds.  The Congress is usually attended by thousands from both Defense and the VA.  There are a few in attendance; however, they are not in uniform this year (of which they usually proudly don their respective uniform whether it's Army, Navy, Air Force or Marines).  I don't know how the chosen few were selected to attend, but again, only a few are here.  In fact, during one of the educational sessions that I attended, an Army officer in attendance revealed that the Army alone is getting ready to release over 80,000 soldiers from their ranks with an expectation of 200,000 over the next few years.  We continue to hear of the cuts that have been put in place to alarm the country; however, some Government agencies are approaching their cuts just as those in business have done when faced with the need to reduce expenses.

Cumberland - Our Town

On Friday evening, WMHS served as the preview location for Maryland Public Television's Cumberland - Our Town.  The public debut was over the weekend on MPT as well as the WV Public Television station.  WMHS was one of a number of sponsors of the documentary with the intention of using it for recruitment and marketing purposes.  Overall, it was well done.  A little long at 68 minutes; some obvious editing is needed.  My goal is to have it reduced to about 20 minutes for our purposes. 

For the most part, Bill Macy was the narrator and he did an exceptional job.  As a Hollywood actor who also hails from Cumberland and who made his acting debut at Allegany High School, he was most generous with his time as well as his very kind remarks.  My understanding is that his time was at no charge to MPT or the sponsors and he filmed his part at the public television station in Los Angeles.  As for the documentary, it captured the essence of Cumberland as to its history, although that part could have been longer and sooner in the documentary; the friendliness of the people throughout the region and the beauty of the area.  There were some true stars in the documentary in addition to Bill Macy, they were Andy Vick, Al Feldstein, Dave Williams, Gino Giaritas and of course, our own Kathy Rogers, Dr. George Garrow and our new hospital.  All in all, it was well done and gives you a very good feeling while you watch it.

Telecommuting: Good or Bad?

In February, Marissa Mayer, the relatively new CEO for Yahoo, issued a change in company policy that there would be no more telecommuting.(If my mother is still reading my blog, that means working from home.)  First of all, I am not a big fan of working from home.  I understand that there are many professions that do it and do it well.  We have a few at WMHS and it seems to work.  You need to have the appropriate oversight and metrics in place to ensure that the work is being accomplished thoroughly and in a timely manner.  In Ms. Mayer's case, it is certainly her prerogative as the CEO to make such a change.  She wants to turnaround a somewhat distressed company and is taking the necessary steps to do so.  Through the boldness of her action, everyone, both in and out of the Web-based industry, is talking about Yahoo.  Also, her board gave her a $1 million bonus last week, so they must be pleased with the actions that she has taken to date.  She joined Yahoo in July 2012, so she obviously had time to study the telecommuting component of her company and found that those employees were not being as productive as they could have been if they were coming to the office each day.  I applaud her for her actions.  The workplace culture at Yahoo was in need of some obvious re-alignment and she took the necessary steps to jumpstart that process.  Could she have handled the matter better?  Probably.  But, these are desperate times requiring desperate measures, especially for Web-based companies.

A Somewhat Surprising, But Welcomed Call

The other day I was sitting at my desk and my cellphone rang.  I looked at the caller ID and it said "Paul Sabarnes."  I answered the phone and it was US Senator Ben Cardin.  He said that his staff was following my daily blog and he felt that he needed to call me directly related to some recent topics.  He said that he certainly valued my opinion and if there was any time that I wanted to talk with him that he would arrange it. 

Some of my recent blogs have been about the Affordable Care Act, sequestration and ethics in government.   In some cases, they were less than flattering for our Federal Government.  I told Senator Cardin that I greatly appreciated that he reached out to me.  I said, for example, that there are aspects of the Affordable Care Act that fit very well with our Total Patient Revenue initiative at WMHS, but there are also some challenges.  He said that my input was important and he would like to hear more from me.  I assume directly and not through my blog, although I have always been complimentary of Senator Cardin.  His politics occasionally will differ from mine, but I think that he represents Maryland, and especially western Maryland, extremely well.  He is one of those guys who is rated very favorably by his constituents (deservedly so), while Congress as a whole is poorly rated.  The Senator said that his door was always open to me in Washington and on a future trip to western Maryland, he would love to sit down and talk with me.  Again, a welcomed call.  Thank you, Senator.

Is It Time to Go?

In this month's issue of the Harvard Business Review, I read an article on the tenure of CEOs.  The article, "Long CEO Tenure Can Hurt Performance," reported that the optimal CEO tenure length is 4.8 years according to a University of Texas professor and two of his doctoral students.  They studied 356 US companies from 2000 to 2010 and examined human resource aspects vs. magnitude and volatility of stock returns.  They wrote that CEOs early in their tenure focus on what's happening inside as well as outside the organization.  As time goes by, they turn their focus internally and focus more intently on employee relations and issues related to operations vs. the marketplace. 

I am in my 14th year as CEO of WMHS (who would have thought that) and although the focus of the article was not health care, there are aspects of the article that can't be ignored by me or any other CEO.  First of all, this is why you have a Chief Operating Officer who can focus on internal operations; they are looked at as the great motivators.  The CEO has to be a motivator but also be the marketplace strategist and the visionary.  I like to think that such strategies and visions brought us our affiliation sixteen years ago, our independence from Ascension Health in 2008, a new state- of-the-art hospital in 2009, a new payment methodology in 2010 that is the future of health care and in 2013 potentially a new alliance between three health systems looking to preserve low-cost, quality health care in their respective communities. 

According to the article, Boards need to provide the necessary oversight to ensure that the CEO is still focused on the internal but also external strategies.  Since I serve at the pleasure of the Board and I have been doing so for over three times the optimal length of CEO tenure, I hope that it is safe to assume that my approach to the position of CEO remains on target.  If it turns out that isn't the case, I'll hear about it.

A Unique Female: She Wasn't Unlike So Many Others

Over the weekend, I read about a 28-year-old woman who paid $275 to participate in the NFL Combine as a kicker.  The expectation by participating in the Combine is that you are the best at what you do and that you are in the best shape of your life.  The NFL is serious business and Lauren Silberman made a mockery of it.   During her five minutes of fame with the media, she was more interested in promoting herself and her business interests.  Ms. Silberman was a club-level soccer player in college who trained with a former college kicker in preparation for her tryout.  Unfortunately, she kicked twice at the NFL Combine, barely reaching midfield from the 35-yard line on her first kick and never reaching it on her second kick.  She injured herself and had to see a trainer after her second kick.  Her actual quote was, "Hopefully the scouts will notice my technique.  It's not always length." You can't be serious???? 

I feel sorry for this woman.  In an effort of self-promotion, she embarrassed herself and made it difficult for women going forward who really feel that they can compete at a professional level.   The complete antithesis of Ms. Silberman is the women whom I get to interact with every day.  From my wife (RN now involved with charitable interests in the region) and daughters (Jessica who heads Boeing's Community Foundation in South Carolina and Lauren who is a Naval Officer), to the female executives with whom I work, the directors, the managers, the nurses, the business leaders, the therapists, the accountants, the physicians,  the assistants and the list goes on.  These are phenomenal individuals who are the best at what they do every day.  Truly special people who can compete with anyone at any level at any time.  Take that, Ms. Silberman.

Projected Impact of Sequester Cuts on WMHS

Leading up to the March 1st Sequester cuts and over this past weekend, there were numerous articles as to the potential impact of the cuts on hospitals and health care systems across the nation and in Maryland.  Health care provider cuts, which equate to $10 billion, are anticipated for April 1st. 

Last year at WMHS, we anticipated that cuts would occur and took steps through a Quality Cost Initiative to reduce the cost of care along with improving quality and making our patients / community healthier.  We took steps to reassess every aspect of the care that we provide and looked to see how we could deliver better care more efficiently.  In addition to a labor savings, we also looked at our supply costs focusing on total joint hip and knee implants, cardiac implantables, drug costs, better blood product utilization, better ways to reprocess equipment, an improved approach to waste management as well as other initiatives.   By looking at both labor expenses and supply expenses through this Quality Cost Initiative, we were able to save almost $8 million.  As a result, I feel that we are better positioned to address any impact on Medicare and Medicaid funding brought on by Sequestration cuts. 

It is important to note that we are not completely out of the woods.  We took steps to address the 2% impact of the cuts for this year's operating budget; however, changes to the Maryland Waiver are still an unknown and we are currently negotiating our next three-year agreement as the Collaborative of ten TPR (Total Patient Revenue) hospitals.  In addition, if Congress reaches an agreement on entitlement cuts, health care could fare far worse that a $10 billion cut.  I, along with members of the executive team, will continue to monitor this issue and attempt keep everyone informed in a timely manner.

Any Idea as to What This Device is Used For?

Do you know what this device is? 

It is used to secure high efficiency light bulbs in their light sockets.  We were experiencing a high loss rate of the now mandatory light bulbs in our common areas throughout the hospital.  The cost to replace the stolen light bulbs was fast becoming a concern.  Those babies aren't cheap and it is safe to assume that is the reason that they were disappearing.  Our team came up with a great solution at least until the perpetrators start taking our lamps in their entirety.  Have a good weekend.