Financial Condition of Maryland Hospitals

In preparation for how the Health Services Cost Review Commission is going to handle Sequestration cuts for Maryland hospitals, the Maryland Hospital Association asked for a report about hospital financial conditions to be done.  The results are telling.  The aggregate operating margin for Maryland hospitals is 0.8%, meaning hospitals are barely breaking even in the care that is provided.  Forty-two percent of Maryland hospitals have negative operating margins, resulting from four years of hospital rate increases (2010 - 1.49%; 2011 - 1.41%; 2012 - 1.56% and 2013 - .30%) which were below the inflation rates that exceeded 2% each year.  Hopefully, the HSCRC will take into consideration the seriously declining financial condition of Maryland hospitals at their meeting tomorrow as they are deliberating Sequestration cuts, as well as at their meeting in June about rate increases for FY 2014.

Physician Recognition & Awards

On Friday evening, WMHS celebrated the medical staff and our advanced practice professionals at a wonderful event.  The evening culminated with the awards presentation for Physician of the Year, Lifetime Achievement and Mane Ictum or quick impact.  Dr. Chris Haas, medical director for Cardiology, received the Mane Ictum award.  That award is presented to one of our newer physicians who has made a dramatic impact on the organization in a very short period of time.  There were excellent nominees and Dr. Haas was a great choice.  Next, was the Lifetime Achievement Award and it was presented to Dr. Narayan Saheta, staff Cardiologist, who has served his patients and this health system for 37 years.  He, too, was among some wonderful nominees for this well-deserved award.  Lastly, was the presentation for Physician of the Year.  Many wonderful physicians were nominated by staff with a very speechless Dr. Murtaza Amir, a staff Neurologist, being selected.  Again, so very well deserved. 

The evening is a great time with wonderful food and great conversation.  Dr. George Garrow served as Master of Ceremonies, and he would have made any professionally trained MC jealous.  It always turns out to be a late night for me, but it is well worth it.  Spending quality time with a room filled with special people doing very special work is time very well spent.

That Critical Dual Role for Hospitals in Maryland

So, in addition to caring for sick (the obvious role for hospitals), we are also economic engines across the State and in our communities.  We are one of the largest private sector employers in the State by employing around 100,000 employees.  There is then the ripple effect for every one hospital job, an additional two jobs are created outside of the hospital.  We generate a Statewide economic impact of $26 billion; at WMHS, our economic impact on the region is $300 million.  As an industry, we have to be very careful through spending cuts, zero rate increases, inflation and changes in how we do business, that the financial condition of hospitals in Maryland is at one of the lowest points in our history. 

WMHS is doing somewhat better than most Maryland hospitals this year, but that wasn't the case last year.  We had a very challenging year last fiscal year.  While insurers are asking for and in many cases receiving double digit increases, many Maryland hospitals are at a barely break even point.  To date, we have been able to sustain the cuts and the well below inflation rate increases through focusing on the greatest portions of our operating budgets which is "staff and stuff."  We have eliminated vacant positions, renegotiated supply costs and sought new sources of revenue, but you can go only so far. 

The current and continued weakening of hospital finances will likely lead to program and service cutbacks and an increase in layoff activity Statewide.  At WMHS, we are pulling out all stops to ensure that we are managing our financial situation through careful planning as was the case this time last year as we planned for the current year's budget.  Hopefully, the rate setting commission will get the message and allow hospitals to continue to act as the State's economic buoy during these challenging financial times.

Free Phones, Now Free Internet

Yesterday, I heard on the Stuart Varney radio show that the Lifeline Program put in place by the federal government in 1984 to provide landlines for the rural poor will be expanded to include the Internet and possibly the 11 million "undocumented workers" who are now seeking a path to citizenship.  The program has grown to include cell phones - actually 300,000 of them at a cost to the taxpayer of $2.2 billion.  Not that long ago, the cost of the Lifeline program was $143 million per year until cell phones were added in 2008.   According to Mr. Varney, the program is riddled with fraud and now the government wants to add broadband access.  I can't fathom why anyone has to have internet access for emergency purposes.   The "good news" is that there will be limits as there are with cell phone minutes which are limited to 250 minutes per month.  The only problem is that of those 300,000 cell phones, many are duplicate phones owned by one person; one would assume that's where the fraud comes in.  In a time of sequestration, I can't understand how we are furloughing air traffic controllers and potentially putting our air traveling public in jeopardy, but continuing to provide cell phones and now internet access to the "poor".  Both commonsense and leadership seem to be limited these days in certain sectors of our government.

Impact on Sequestration at WMHS

On May 1, the Health Services Cost Review Commission, the group that sets rates for Maryland hospitals, will decide how to handle the Federal Sequestration cuts for Maryland hospitals.  The HSCRC staff recommended that hospitals absorb the 2% cuts and actually the cuts became effective April 1st.  Hospitals have received nominal increases in rates for several years while insurers have enjoyed in some cases double digit increases.  The hospital industry has asked that the 2% be put in rates as has been the case in the past with previous sequestration cuts. The impact of the 2% cut on WMHS for the last quarter of the fiscal year will be $1 million.  The impact on all Maryland hospitals annually will be over $108 million.  This will directly result in the loss of health care jobs and services across Maryland.  At WMHS, if we were to follow the federal government's approach to sequestration, we would immediately and dramatically reduce the hours of patient care, cut back on our trauma and heart programs, reduce cancer services and layoff essential personnel.  Fortunately, we took a proactive approach with our spending in preparation for things like sequestration and the Affordable Care Act last year while preparing this year's budget.  We eliminated over 100 positions and reduced supply costs by several million dollars; in total we reduced spending by almost $8 million.  So, we should not have to impact the organization, our employees or our patients with this cut.  As an aside, we would make every effort not to directly impact employees (although that is becoming more and more challenging) and essential services if we did have to cut expenses in order to absorb sequestration, unlike our Federal Government.  They make cuts based on how much media attention that they can garner and how much blame can be heaped upon whatever political party is in control of the House or Senate.  I will let you know how the decision comes out next week.

Making Money From Surgical Errors (Really?)

Last week, there was an article in the Journal of the American Medical Association based on a study that hospitals are benefiting by earning money due to surgical complications.  The article and its subsequent editorial by a renowned health care economist were also carried by the New York Times. Well, for the record, not in Maryland and not at WMHS.  In Maryland, now in place for several years, we have been penalized for potentially preventable complications or PPCs, certainly not rewarded.  We apply such reporting to all payors.  In addition, as a TPR hospital, such an approach would be contrary to our two- year-old new payment methodology.  Apparently, government payors through Medicare and Medicaid are extremely conscientious while private payors aren't as restrictive.  The bottom line is that I can't believe that in 2013 with all of the scrutiny of the health care industry that benefitting from surgical or medical errors is occurring.  It's time for everyone to wake up and reverse this perverse payment system.

Mastering Disruptive Innovation

It is nice to know that we have arrived as a health care industry leader at WMHS.  The other day, I received a solicitation for a seminar, "Disruptive Innovation: Creating the Healthcare Systems of the Future." The purpose of the seminar is to get the health care industry to change how they do business, but at an accelerated pace.  We have been well aware at WMHS that organizations can't succeed in a fee-for-service environment going forward and they must ensure that value-based care becomes their immediate focus.

Forward thinking organizations such as WMHS have already disrupted the status quo in a very dramatic way.  Actually, we did it two and a half years ago when we became a part of the Maryland Total Patient Revenue demonstration project.  It took a great deal of work to get everyone on board with such a dramatic change.  We have changed the way that we care for our patients with a focus on the triple aim of healthcare reform: reducing cost; enhancing quality and improving the health of our patients as well as the population in general.  We have educated our employees, our board members and our medical staff.  We are now in the process of educating our community as part of our campaign, "Meeting the Challenge of Health Care Change."   It is very cool to go to meetings and talk about what we have done at WMHS related to disrupting the status quo through innovative processes and new technologies.

Organ Donation

Today is the other day for the wearing of the green.  Usually, it's St. Patrick's Day, but today is Be Seen In Green Day to celebrate National Donate Life Month.  Today, we celebrate the lives of thousands of people who now have a second chance at life through the selfless decision to save lives.  As you can see from the attached photo, I am wearing my Donate Life Maryland green tie that was so generously sent to be by the Living Legacy Foundation.  If you are not registered as an organ donor, today's the day.  At WMHS, we now fly a flag in front of the Regional Medical Center each time that an organ is successfully harvested to represent that lives have been saved.  One donor can save or enhance the lives of up to 50 people.  Saving lives is our business so, I thought that it would be appropriate to wear the green tie so people would ask about the tie and boy, have they.  The more attention that I can bring to the issue, the more lives that may be saved.  If you are interested in learning more about organ donation or registering as an organ donor visit: www.donatelifemaryland.org.   Have a great weekend.

Patients Come Second

I just started reading a new book that was sent to me at no charge, which actually happens with some frequency and I like it.  The book is entitled "Patients Come Second" by Paul Spiegelman and Britt Berrett.  The book is about leading change by changing the way one leads.  The title is controversial especially in this day and age with patients being at the center as well as the focus of everything that we do.  The controversy is detailed and explained in the beginning of the book.  The authors reveal that there is a very direct correlation between patient satisfaction and employee engagement.  It describes how closely linked both are and that description is pretty accurate.  Happy employees make for happy doctors resulting in happy patients.  One area of significance early in the book is the importance of our mission, our vision and our core values.  All too often organizations have a mission (why we are here); a vision (where we aspire to go) and values (the rules we live by), but they don't stress them enough as keys to success.  Recently, I asked our executive team to re-introduce our mission, our vision and our core values organization wide.  I want our mission, our vision and our values to be personalized for each employee so they can better understand their role in putting the patient first.  As I proceed with this book, I will share any other pertinent aspects, but so far, so good.

Mentorship

On Monday, I blogged about the book, "Lean In" by Sheryl Sandberg.  In the book was a section on the importance of mentorship, especially for women.  I have been a both the mentee as well as the mentor.  I recognize the challenges associated with a male / female mentorship relationship, but I have made it work.

One of my early mentors was a woman who was an excellent boss and a true mentor.  We both competed for the same promotion to VP and she got the job and I was left to report to her.  She immediately changed my responsibilities by adding clinical and ancillary departments to my already strong base of support areas.  She then assigned me the responsibility of project manager for Stereotactic Radiosurgery using the Gamma Knife, which was the first to be used clinically in the US.  As a result, I worked hard but became a rock star in the organization.  The Gamma Knife was new, clinically cool and from Sweden.  I gleaned a great deal of international exposure and experience.  She did more for my professional development than anyone ever had.  I came to like and respect her immediately and, ultimately, she became a very good friend. 

I have also had the privilege of serving as a mentor over the years to a lot of both young and mature executive talent by broadening their knowledge, assigning stretch assignments, assigning special projects, exposing them to challenging situations,  introducing them to key individuals and rotating them through different positions in an effort to glean addition experience. There isn't any reason males should shy away from serving as mentors to females or vice versa.  Serving as a mentor should be a priority for every executive during their professional career as it can be exceedingly rewarding for both.

Senseless Violence

I was prepared to write today's blog about Mentorship as a follow up to yesterday's blog, "Lean In." However, after yesterday's bombing at the Boston Marathon, I had to weigh in.  First and foremost, what a horrific outcome to what is supposed to be a wonderful day of fun, pride and accomplishment.  My heart goes out to those who were injured and to the families of those who were killed.  I was in the car for almost ten hours yesterday so I began hearing about the bombing almost as soon as it happened.  I then had the opportunity to hear and read about the goings on for several hours.  I would like to comment on two facets from yesterday. 

First and of lesser importance, what I did find amazing is the media and their rush to get out a story before everyone else as well as their rush to judgment.  MSNBC had it as an act of domestic terrorism by a right wing anti-government group.  Fox had it as an act of international terrorism.  CNN's spin was in retaliation for high taxes with the act being committed on tax day, April 15th.  Why can't they simply report the facts and save the speculation for their internal prep meetings so they are better prepared to report on who did what after more is known?  Their speculative reporting breeds contempt for either the right or the left when they have no facts to support their stories. 

The second aspect and a much more important one was the emergency medical response in Boston.  It was amazing watching individuals running to assist those who were injured, not knowing if additional bombs would explode as thousands were running away from the scene.  Then to have over 140 patients, many who were critically injured with some requiring leg amputations, arriving in a limited number of hospitals.  That would be taxing to any health care system, but they made it happen.  They got it done; they work miracles as hospitals across the US do almost every day when there are car accidents with mass casualties, bus crashes, train derailments, industrial accidents, mass shootings, weather disasters and the list goes on.  Over my thirty seven years in health care, I have had the opportunity (?) to participate in about a dozen disasters, fortunately, none to the magnitude of yesterday, but at least one explosion that resulted in a loss of lives and numerous injuries.  It is amazing to see how the medical field responds at every level........from those in the field to the nurses to the physicians to the housekeepers to the technicians. We are blessed as a nation to have dedicated and committed health care professionals who truly care about their patients, their communities and their fellow man.  What an amazing job on the part of Boston's health care community yesterday and  it will be continuing for weeks, if not months, to come.

Lean In

Over the weekend, I read an excellent book by Sheryl Sandberg, COO of Facebook.  Her book, "Lean In," is fast becoming a best seller and is a wonderful read for any woman and actually, most men.  Normally, a book like this wouldn't be my first choice, but after reading an interview with the author, I was intrigued by what I had read.  I, in turn, bought two copies of the book, one for each of my daughter's and I took the opportunity to read a copy. 

Sheryl offers solutions to women looking to pursue leadership positions or enhance their leadership abilities. This book would be especially valuable for any young woman having any doubt about what she is or can contribute.  Sheryl writes about how she suffered from the "imposter syndrome" with even being the best in her class from high school through Harvard, working for the World Bank, the US Treasury Department, Google and now Facebook.  She was fearful that someone would find out that she really isn't all that.  She was overwhelmed with self-doubt as many of us can be in varying times in our lives. 

"Lean In" is filled with excellent advice for all of us, from mentorship to the struggles of working mothers.  I chose to read "Lean In" so I can be of greater assistance to my two daughters and the many women with whom I work as they look to enhance their leadership abilities.   I would hope that by coupling my mentorship background and knowledge with the insights provided in Sheryl's very well written book, it will benefit the many women by whom I am so fortunately surrounded.

Patient Safety At WMHS

Last evening, a team of physicians and staff attended the Maryland Patient Safety Center's Award Ceremony hosted by Rudy Giuliani.   WMHS was invited because we were the guests of honor.  You see, we won the Maryland Patient Safety Center's Award for Patient Safety.  The award is presented each year to the hospital or health system that has the most innovative patient safety solution in the state.  We won for "Door 2 Balloon: A Rural Community's Story of Shifting Cath Lab Activation for Acute MI to EMS First Responders".  What that means in English is that we now allow for emergency medical responders to activate our cardiac catheterization lab from the field when they suspect that a patient is having a heart attack. The goal is to deliver cardiac intervention within 90 minutes of the patient's arrival to the hospital.  Field activation has reduced D2B to an average of 55 minutes with a low of 40 minutes.  What I find amazing is that 50% of our heart attack patients still arrive by private vehicle and that average is 73 minutes.  Having a heart attack is a situation whereby every minute counts so that 18 minutes could be the difference between life and death.  We now have a campaign to educate those in our region to call 911 rather than driving to the ED.  Another interesting aspect of this life saving initiative was the number of potential false activations from the field.  For the last three years, the average has been about 14% of the time activation wasn't necessary, but 86% of the time the EMS responders were correct.  An excellent outcome and a credit to our region's emergency medical responders.  Receiving  this award is great recognition of the very hard work of dedicated physicians and staff at WMHS.  Congratulations on a job very well done!

   I will be away next week so my blogs will resume the week of April 15th.

Heart Surgery in Aisle 2

The retail industry is getting bolder as they reach further and further into the health care market.   According to Kaiser Health News, Walgreens is now moving beyond the typical flu shots and sore throats and venturing into primary care.  They will be treating patients with chronic conditions such as asthma, diabetes and elevated cholesterol levels.  Other retail stores, like Wal-Mart, Target and CVS, assist customers with managing their chronic illnesses, but only after they have been diagnosed elsewhere. 

The American Academy of Family Physicians isn't happy with Walgreens’ plan as it is too difficult to manage the care of patients who are receiving care in a variety of settings and in locations where specialty services aren't readily available.  Quite frankly, two and a half years ago, I would have been taking the same position as the AAFP.  However, when $140 million of my costs are from treating 1972 patients who are high utilizers of services due to their multiple co-morbidities such as diabetes, COPD and congestive heart failure, I am thrilled that there is additional help out there.  Having Walgreens treating patients with chronic conditions in a retail setting is just one more tool that can be used in keeping patients healthy enough to remain out of the hospital.  As long as Walgreens is providing safe, accessible care and know their limitations, I applaud their initiative.

Taking the Pulse of Health Care CEOs

I read an article today in H&HN Daily based on a CEO Forum that was conducted  by Huron Healthcare.  The consensus was that something has to change and the fee for service model isn't going to last.  What was surprising is that there are still some CEOs who believe that the transformation which is occurring now will at some point pass and "the cash register will once again start ringing" based on increases volumes.  Really?  The US now spends almost $3 trillion on health care annually, and I thought everyone knew that was unsustainable.  Wow, there still are dinosaurs sitting in the C-Suites across the country.  Fortunately, the majority of CEOs are projecting optimism and working tirelessly and inspiring their staff on the positive aspects of health care reform.  From my perspective, the optimism is real and we are living it today.  There are aspects of the Affordable Care Act and health care reform that are working for our patients and staff.  Every day, we are working to build upon our successes to date.  Those CEOs who are waiting for reform to pass are in for a long wait; and, if their thinking doesn't change, their boards will make them extinct.

Family Feud Doctor Style

Yesterday, we celebrated Doctor's Day at WMHS.  The day culminated with our first ever game of Family Feud.  The game was based on the popular game show and was emceed by our own tuxedo attired, Dr. George Garrow, Chief Medical Officer.  We had the surgeons (Scalpels) vs. Medicine (Scopes).  They were asked to match the answers from questions asked of 100 WMHS nurses.  The event was very well attended and was a lot of fun.  I was laughing from start to finish.  It was also a great opportunity to see our physicians in a very different light and they exceeded our expectations.  They are already talking about the next match to include the doctors verses Administration (Suits) or doctors verses nurses.  Photos of the two teams are included.  My thanks are extended to both teams, Dr. Garrow, Cindy Bridges and the many volunteers who assisted in putting the event together.

April Fools' Day

For some reason, I have never embraced April Fools’ Day.   I am not really into practical jokes; although I am reminded by my wife that I have “that Black Irish sense of humor,” which is not necessarily a good thing.  As a kid, I remember my mother coming into my bedroom to wake me up and asking if I thought that we would have school that day since it snowed all night.  After she saw how excited I was, she would then say “April Fool” while she pulled up the shade to reveal what would be a beautiful sunny Spring morning.  I think that I fell for that every year as I was always hoping for no school under any circumstances. 

Rolling the clock forward to today, I read an article on making sure that as leaders we keep April Fools’ Day pranksters from crossing the line.  Someone had to write an article on April Fools’ guidelines for leaders, really?  OK, now that I piqued your curiosity, here are the guidelines for us leaders from ManageBetterBiz:

Choose the right victim – don’t select new employees or a boss without a sense of humor.

Keep a lighthearted tone – never humiliate a colleague.

Be open about your role – if you are the prankster, own up to it; if you can’t own up to it, don’t do it.

Think safety first – don’t damage anything or hurt anyone.

Avoid sexual humor – this is a no-brainer; too much at risk.

So, there you have it; an actual article on how to encourage your employees to be effective pranksters on April Fools’ Day.  Enjoy your day.