"The Ronan Report" provides insight about the activities at the Western Maryland Health System in Cumberland, Maryland, and about the changes taking place in healthcare today from a CEO's perspective.

Friday, May 31, 2013

Six Words

Recently, I attended a meeting with a group of executives and we were asked in advance to introduce ourselves using only six words.  Six word stories have become very popular of late.  Actually, the concept dates back to Hemingway, who said that his six-word story ("For sale: baby shoes, never worn") was his best work.  Talk about being brief.  It was fun trying to nail those most descriptive six words.  There were suggestions for me from family such as: Used to be skinny, not anymore; Witty and charming, wife just laughs and Be someone family can always respect.  From a business perspective, Surprise your wife, not your board; Values focused, every decision, every time; Work like you own the company and The respect was earned never demanded.  So what did I end up with sharing as my introduction.......Mentor to many, tormentor to some.  I tried to interject humor into the introduction and it worked.  The Six Word Introduction was a fun way to get to know people very quickly and it served as a great ice breaker for a group who didn't know each other but will be working together for some time to come.

Thursday, May 30, 2013

Striving for Perfection

Let me start off by saying no one is perfect, but that is the expectation in health care.  Quite honestly, when a loved one is ill, the expectation is valid.  My goal as CEO is to ensure that we strive for perfection.  I want us to minimize any medical errors and, when one occurs, to learn from it.  The root- cause analysis is commonplace when medical errors occur due to a system or process failure.  In addition to making every effort to learn from any error, we also self-disclose when an error happens.  We strive for a just culture or blame-free environment unless the act is due to negligence; then, we work with the individual through as constructive a process as possible. 

The goal is to demonstrate a safe environment of care for our patients every hour of every day.  This is achieved by having a process where caregivers must feel comfortable in discussing patient care with physicians; and if they aren't, we want them to speak up.  Nurses are our advocates for the patient and if the nurse feels that a patient's needs aren't being met, they must elevate their concern and never feel reluctant to do so.  Leadership's responsibility is then to ensure that everyone who is involved in the care of that patient understands our commitment of that patient.  That is the least that we can do for patients when they are in such a most vulnerable state.

Wednesday, May 29, 2013

Lessons from the Joint Commission

As I blogged yesterday, the Joint Commission conducted their three-year accreditation survey last week.  It was a very good experience.  This was my thirteenth survey during my career and it is amazing as to how things have changed over thirty eight years.  My first survey was very different from last week's survey.  That survey focused on the negative; the Joint Commission has standards and you had better be in compliance.  Then, if you weren't, you had to hear about it from the Joint Commission surveyors as well as at a department directors meeting in front of everyone else.  None of it was fun. 

Rolling forward to last week, the survey was very consultative as has been the case with the last several.  We were concerned that the "thoroughness" of one of the surveyors would be a problem, but in the end the lead surveyor took control and the survey was both helpful and at the same time a validation of the hard work that goes on at WMHS to ensure quality care of our patients.  There were a few issues that we will need to bring in line, but overall, we did well.  A lot of people worked very hard in preparation for this survey that was three years in making. 

What I did find interesting is that the surveyors know pretty much on day two of the five day survey as to what the outcome will be.  Obviously, a lot goes into how they are treated as well as the reaction to and acceptance of what the surveyors have to say.  In our case, all went well, but I can see that not being the case all of the time. 

For me, it was another good lesson.  Many years ago, I was involved in a survey where the CEO actually stopped the survey and called the Joint Commission regarding the perceived unfairness of a nurse surveyor. She backed off once the lead surveyor took control of the situation after receiving a call from the home office in Chicago.  That was very interesting as well as so very risky. 

All in all, at WMHS we are done hopefully for another three years although the work for that next survey already has begun.

Tuesday, May 28, 2013

The Days of the Do Nothing Board Are Over (Really?)

The other day, one of the WMHS board members shared an article with me with the same title as above, except for the really part.  The article was fascinating because it seemed like it was written for a time a few decades ago.  In addition to the WMHS Board, I have interacted with board members from other Maryland hospitals through the Maryland Hospital Association's Executive Committee and board leadership from the other two hospitals in our proposed alliance.  I also interact with CEOs from across the US on a frequent basis and I don't know of any "do nothing" boards. 

In fact, last week at WMHS, we had our three-year Joint Commission accreditation survey.  After the Leadership Session, which by the way was focused exclusively on the board's level of knowledge, commitment and involvement with Quality, Patient Safety, Communications, Health Care Reform and Population Health, the surveyors commented that having such an engaged board as I have at WMHS can be challenging for a CEO.  I told them that I wouldn't have it any other way.  Every hospital that I have been a part of over my 38 years in health care has had a very engaged board, just lucky I guess. There may be some hospitals that haven't had the luxury of such a board and how unfortunate for them. 

The "do nothing" board may seem advantageous for a CEO, but it isn't.  Actually, if they are not engaged, they are not aware of what is going on and that can be a job killer for a CEO.  As soon as something out of the ordinary happens, the so called "do nothing" board becomes involved and could easily over react.  Governance has changed dramatically in the last 10 years especially with the passing of the Sarbanes Oxley law.   Although it isn't a requirement for health system boards, many like WMHS have modeled themselves against it and that is a good thing for health care.

Monday, May 27, 2013

Memorial Day

Oh, the memories of being a child on Memorial Day. I loved this holiday. The annual parade down the main street of our town with the fire engines, the marching bands, the marchers from many different organizations, the bagpipers, the service men, the drill teams, the vintage cars, the politicians and the list goes on. I got to march in the parade once as a Cub Scout next to my father, who was the Scout Leader, pretty special.

Then there were the barbecues and family gatherings; the start of season for watermelon, hot dogs, hamburgers, ice cold root beer and ice cream. It wasn't until I went to the local cemetery with my father to visit my grandfather's grave and there they were...........American flags everywhere. As far as my eyes could see, the stars and stripes of red, white and blue lining the streets of the cemetery and neatly placed on gravesides. I asked my father, "Why all of the flags?" He responded that they were placed on the graves by the members of American Legion and the VFW to commemorate Memorial Day. And here, I thought that it was parade to start summer.

He told me that Memorial Day was created first to commemorate those who died in the Civil War. It was then expanded to remember those who died while serving the military and fighting for our freedom. Very cool and an amazing sight that I will never forget. Now some fifty years later, I am a part of the Rotary Club and proud that we are the service organization that places flags on the gravesides and lining the roads of the cemeteries. We were asked to assume the responsibility a few years ago due to the declining number of veterans and the Club was happy to do it.

Friday, May 24, 2013

Don Alexander

Yesterday, our last board meeting of the fiscal year was held and it ended an era.  Dr. Donald Alexander attended his last WMHS board meeting after serving on the health system's board since its inception.  Although we have term limits of three, three year terms, Don's term was extended after Ascension Health left the community.  For continuity purposes, Don and two other board member's terms were extended since Ascension leaving left us with almost half of the board needing to be replaced.  Don served as chair for three years and doing so even after he retired to Williamsburg, VA. 

Don has been exceptional in his board service to the health system and both predecessor hospitals, Memorial and Sacred Heart.  Don first served as an advisory board member for Sacred Heart and his service began in 1980.  He then joined the Memorial Board of Trustees and served as Chair of that board.

I will miss Don greatly.  He is a visionary, an excellent listener, mission and values focused, knowledgeable, supportive, and complimentary and has a wonderful sense of humor.  I have been blessed to have had Don's mentorship and guidance for these so many years.  He will leave a legacy at this health system that will be matched by very few.  God speed, Don.

Thursday, May 23, 2013

Couch to 5K

This week, WMHS began promoting "Run For the Health of It", a 12 week program to prepare anyone associated with WMHS for the Great Allegany Run, a 5K Race on October 5th.  The program is open to physicians, employees, volunteers and board members and it's free.  Each participant can also bring a friend.  The program walks you through how to properly prepare for a run, running nutrition and terminology.  The 12-week program culminates with the 5K race in October.  I am looking forward to participating, provided my body cooperates.

Wednesday, May 22, 2013

Patrick Lencioni

Recently, I was in Chicago for a series of meetings and had the opportunity to hear Patrick Lencioni, who is one of my favorite authors, speak.  Pat has most recently written, The Advantage.  I have read all of his books from The Five Temptations of a CEO to The Five Dysfunctions of a Team.  His books deal with leadership and management.  They are always well written, very readable and, if appropriately applied, can have a profound effect on an organization. 
His focus for the presentation was The Advantage and from it organizational health and its four components.  The four components included: Build a Cohesive Leadership Team; Create Clarity; Over Communicate Clarity and Reinforce Clarity.  Organizational health starts with the leadership team asking six questions: why do we exist; how do we behave; what do we do; how will we succeed; what is most important right now and who must do what.

All of the above can be found in an organization's mission, its vision statement, its core values, the strategic plan and things like service excellence standards.  But, we have to provide a level of clarity for our employees around these questions as we embark on achieving organizational health.  Pat admits that most of what he writes is common sense, but it is amazing as to how many of us don't apply the four components or do we ask the six questions.  If we did, each would have a profound impact on our people and the organization. 

In these challenging economic times, especially in health care, we should be focusing on reducing confusion in our organizations, over communicating, reducing turnover, increasing morale and encouraging greater productivity; all of which can be achieved by focusing on  the health of one's organization.

Tuesday, May 21, 2013

A New and Exciting Opportunity for Western Maryland

Yesterday, I had the opportunity to meet with representatives from Frostburg State University, Allegany College of Maryland, Allegany County Board of Education and a few others to discuss the potential opportunity to bring a Physician’s Assistant (PA) program to Western Maryland.  Currently, there are only three programs in Maryland and none in Western Maryland.  The group heard a presentation by James Cawley, who is a professor at George Washington University, one of the country's leading PA schools. 

Although it would take almost two years to develop such a program, it has great potential for our region.  Physician's Assistants, along with other advanced practice professionals such as Nurse Practitioners, are in high demand as the number of physicians continues to decline nationwide.  The mean salary in the US for a PA is $102,000 annually and the 6500 students graduating from PA schools are always in high demand, especially those who graduate with a focus in primary care.  There are currently over 90K PAs nationwide and 65% are now female.  Forty seven percent of PAs are hospital based and 33% are in primary care. 

The outcome of the meeting was to pursue the opportunity through a feasibility study led by Frostburg State University.  Such a program could certainly be a win, win, win for the students in the region, the college and university as well as for the providers.

Monday, May 20, 2013

Do As I Say Not As I Do

I don't mean to kick our federal government while they are down (and boy are they down), but a week or so ago, I received a reference form from the US Office of Personnel.  I was required to fill out the reference form and return it ASAP.  Now for the ridiculous part.  In order to complete the form, I needed to use a No. 2 pencil and not place any stray marks on the sheet. 

I sat there and thought about all the times that I had to complete forms with that infamous No. 2 pencil, those pesky State tests in the first, third and fifth grades, personality tests in high school Sociology classes, IQ tests for middle school grade level placement, civil service exams and the list goes on. Unfortunately, those were all taken by me in the 60's and 70's.  This is 2013 and the federal government is still requiring a No. 2 pencil to complete a form.  This is the same government that is mandating that health care providers spend millions of dollars per provider to create state of the art health information systems. 

I don't have a problem with advancing information technology in health care.  I do, however, have a problem with the federal government mandating such a requirement when they asking me to provide a reference on a potential government employee with a Ticonderoga No. 2 pencil in hand. 

As I blogged last year, this is the same federal government that still requires certain forms to be typed written only.  Last year, I asked our clerical staff why we still had a Selectric typewriter available for use and the answer was government forms.  If it wasn't so ridiculous, it would be funny.

Friday, May 17, 2013

Driving Physicians Away

I had an interesting visit yesterday from a WMHS Advisory Board member.  At WMHS, we encourage our Advisory Board members to seek us out to offer their perspective on the health system, especially about how we are being viewed in the community.  His concern was that we are driving physicians out of the Health System and, subsequently, the community.  He gave some examples of physicians who have left or recently announced that they are leaving.  I was able to explain the reasons why each left the organization and their stated reasons were not related to the health system, except for one.  We tried to keep that physician in the community, but we were unsuccessful.  So, in that case one could say that physician felt that he was being driven out.  Also, in each case, we have been able to successfully recruit replacements for each of the departing physicians. 

The board member then asked questions regarding what we are "now" requiring physicians to do in order to admit patients, perform surgeries, order tests, etc.,  implying that our requirements are extremely onerous and unnecessary.  I explained that hospitals are held accountable for compliance with over 122,000 federal regulations.  In addition, each payor has its own set of requirements to which we must comply in order to get paid.  And on top of that, there are state laws and regulations for which we are responsible.  This is why Peter Drucker, the management guru, says that health care is the most difficult industry to manage. 

The board member also said that the new payment methodology, Total Patient Revenue, is not being embraced by the physicians.  That gave me the opportunity to explain that TPR will be the only way in which all hospitals across the US, as well as physicians, will be paid in the next few years.  WMHS was able to participate in a demonstration project and get the opportunity to learn how to apply a value- based payment methodology over the more costly volume-based methodology. 

Thursday, May 16, 2013

Pay for Performance

Last evening, we had an excellent meeting with the President's Clinical Quality Council.  The single agenda item was creating a pay for performance methodology for physicians who partner with WMHS to improve the care of patients enrolled in our Congestive Heart Failure (CHF) Clinic, our Center for Diabetes Management and our soon-to-be on line Chronic Obstructive Pulmonary Disease (COPD) Clinic.
In fiscal year 2012, WMHS treated 2,207 patients with a primary and secondary diagnosis of CHF for a total cost of $28.8 million.  Of those 2,207 patients, 300 had three or more inpatient stays accounting for nearly 30% of that almost $29 million.  For that same period, we treated 11,400 with either a primary or secondary diagnosis for Diabetes with nearly $50 million in costs.  Four hundred of those patients had three or more inpatient stays, accounting for more than 30% of the cost.  Lastly, we treated 3,603 patients with COPD; costing us $33 million in cost during FY'12.  Three hundred of those patients had three or more inpatient stays and accounted for 37% of the cost. 

Of these three groups of patients, 1036 have been identified as frequent users (great than 3 hospitalizations in a year).  From that group, 578 patients have at least two and some with three of these conditions.  Our goal is to better manage these patients jointly between the Health System's care coordination initiatives and the participating primary care physicians.  We are anticipating saving millions of dollars and the pay-for-performance (P4P) program  will allow us to share some of that savings with the physicians since in many cases their incentives for payment and ours are misaligned.  Primary care physicians are still paid on a volume basis, while WMHS is paid on a value basis. 
Focusing on patients with chronic conditions such as Diabetes, CHF and COPD has it challenges, but the reward for the patient, the physician and the health system could be monumental. The Council decided to move forward with the P4P program as quickly as possible since there is so much at stake.

Wednesday, May 15, 2013

A Day of Celebration

Today was one of those days when you stand in awe of the people who surround you. This is the day that we hosted a reception to recognize 315 WMHS employees who are celebrating milestone anniversaries with us this year.  What is truly remarkable is that 17 of these individuals were honored for 40 years of service.  They represented every aspect of the organization--some are long-time nurses; others work in diagnostic areas.  Members of this distinguished group provide valuable support services.  And others are part of the teams in the non-traditional areas that are helping us meet the challenge of healthcare change. 

It takes a special kind of person to pursue a career in healthcare--and these individuals are truly to be admired for their commitment to helping others.

Congratulations to all those who were recognized today and the entire team at WMHS as we celebrate National Hospital Week and National Nursing Home Week.

Tuesday, May 14, 2013

What a Difference a Year Makes

Last year at this time, we were struggling financially for a variety of reasons.  Changing the way in which we were doing business (shifting from volume to value), a bad debt / charity care formula that was penalizing WMHS, and increased revenues and savings projections that never materialized were some of the contributing factors to our losses, just to name a few.  Experiencing losses that resulted in a year-end operating loss of $6.5 million was humbling for many of us, but we vowed not to repeat it this fiscal year. 

As a result of better budgeting, negotiating a better bad debt / charity care formula, savings of over $8 million through eliminating over 100 positions and supply costs reductions, WMHS is in a position this year, through March, that has resulted in a dramatic financial turnaround.  Recognizing that we are facing considerable challenges going forward through modernization of the Maryland waiver, continuing to change how we do business, declining revenues from every payor with increasing the recipients of care, increased regulations, the ever increasing bad debt and charity care requirements, recruitment challenges for attracting new physicians and employed staff, increasing requirements for information technology and the list goes on, WMHS has to be good stewards of the results of our YTD financial benefit.  It is also important to appreciate how we got to where we are today, financially.  So, on Thursday of this week, we will be awarding a bonus to our hourly staff, exempt staff, supervisors, managers and directors to say thank you for your efforts in this turnaround.  We have asked a lot of our employees this fiscal year; by awarding a bonus, it is one way to say thank you and to recognize each employee during National Hospital Week and National Nursing Home Week.  Thank you all for job so very well done!

Monday, May 13, 2013

Just What Is Culture

We hear about the culture of an organization and, quite honestly, I am not sure that most of us understand what it truly is.  It's actually how we do things. It's how we behave, how we think, how we feel, how we act and what we believe.  It's our values, our attitudes and our practices.  It's the driver of an organization's success.  It's the collective capacity of its people to create value according to Lou Gerstner, the former CEO of IBM. 

Strategy must be aligned with culture.  As we embarked on changing how we do business at WMHS-- moving from a volume-based approach to patient care to one of value based--we had to change the culture of the organization.  It was challenging and it took over two years and we are still working on it.  When an organization makes a change as we did under Total Patient Revenue, we had to improve performance and that can only be achieved through culture (how we act) and strategy (what we act upon).  Most importantly, we did it.  We aren't fully there, but we have made great progress and that is a tribute to both our employed staff and our medical staff.  Happy Hospital Week to all of our employees.

Friday, May 10, 2013

Wellness Ambassadors

Earlier this week, I had the pleasure of serving as host to five area high school students who served as Wellness Ambassadors for WMHS this past year.  A Wellness Ambassador is a high school student who is passionate about health and wellness and created an initiative to advance that passion.  The program required that each student facilitate at least one wellness initiative during the school year.  The initiatives were well done as each involved the community as well as the individual schools.   We are so fortunate to have the best and the brightest serving as the wellness ambassadors.  Congratulations to Joni Miller, Rebecca Smith, Urvashi Dayalan, Marisa Steiner and Nathan Bussard on a job extremely well done. 

To reward each wellness ambassador, WMHS gave each a $500 scholarship to reward them for their wonderful initiatives.  It is my intention to expand the Wellness Ambassador program in an effort to continue to address our wellness and population health initiatives at WMHS.  We are now off to a great start thanks to the students and Carey Moffat and Nancy Forlifer of Community Wellness at WMHS.

Thursday, May 9, 2013

I Couldn't Have Said Better Myself

In today's Baltimore Sun there is an article, "Hospital Rates Vary Significantly, Medicare Data Show."  I thought to myself that CMS keeps releasing this data and it doesn't tell an accurate story. CMS says that they are trying to elevate the conversation as to why there is no much variation in the cost of care.  The actual Secretary of Health and Human Services is quoted as saying the rates vary in ways that can't really be explained.  The rates vary because of teaching / non teaching, wage rates, cost of living, severity of the patients, rural / urban; these are rates that in Maryland's case are set by the  Health Services Cost Review Commission.  In other states, they use formulas established by CMS.   This morning, I then received the attached blog from Paul Levy, who responds to the Secretary so eloquently.  In the Sun article, CMS also says that they are looking at the Maryland system which prevents hospitals from raising their rates artificially. Good idea and while you are at it, listen to the Maryland hospitals as we try to modernize the waiver.  The devil is in the details and, so far, there are few specifics in the current application.

Useless noise from CMS

What on earth did CMS have in mind when it released the FY2011 chargemasters for America's hospitals?  Well, according to one report:

The public release of the data is part of an effort by Medicare to increase transparency in the health system. 

“Historically, the mission of our agency has been to pay claims,” said Deputy Medicare Administrator Jonathan Blum. “We’ll continue to pay claims, but our mission has also shifted to be a trusted source in the marketplace for information. We want to provide more clarity and transparency on charge data.”

CMS explains:

Hospitals determine what they will charge for items and services provided to patients and these charges are the amount the hospital bills for an item or service.

This is a case where the release of bad data is worse than having no data at all.

A hospital's chargemaster is an archaic fiction, a way previously used to allocate the joint and common costs of the hospital to particular services.  It does not serve as the basis for how much a hospital is paid by Medicare.  It does not serve as the basis for how much a hospital is paid by Medicaid.  It does not serve as the basis for how much a hospital is paid by private insurers.

Further because of federal and state prohibitions against balance billing of patients (i.e., the difference between the amount paid by an insurer and the amount of the charge), it also provides no basis to consumers that means anything at all.

But it sure creates a stir to be able to say: "For joint replacements, which are the most common hospital procedure for Medicare patients, prices ranged from a low of $5,304 in Ada, Okla., to $223,373 in Monterey, Calif. The average charge across the 427,207 Medicare patients’ joint replacements was $52,063."

For the record, Medicare pays hospitals based on a formula that takes into account the difference in overall wages and prices in different parts of the country.  There are also adjustments for rural hospitals.  There are also adjustments for academic centers to pay for residency training. The chargemaster employed by a hospital is not a consideration in the establishment of these federally determined rates.

Likewise, Medicaid rates are based on a state-determined formula.

Likewise, private insurance companies often base their hospital and physician rates off the Medicare formula, or have their own approach (often not even related to the hospital's actual costs).  Very, very few have rates based on "a percentage of charges."

I don't know what CMS really hoped to accomplish in the way of transparency by publishing out-of-date, irrelevant data.  But such behavior is consistent with CMS publishing out-of-date, irrelevant clinical outcome data.

Transparency, CMS style.
CMS says that the recent release of information is "part of the Obama administration’s work to make our health care system more affordable and accountable."  Oh, wait, this is the same president who had a photo-op with a robotic surgery company that has made its fortune by marketing high cost clinical equipment that lacks clinical evidence to support its relative efficacy.  This is the same president who compared hospital readmissions to going to an auto mechanic and having to bring your car back for re-repair, who doesn't seem to understand the unintended consequences of poorly design federal payment penalty strategies.

Meanwhile, CMS fails to take action to solve the well established and recognized problems in its own rate structure that encourage the medical arms race.  Even Mr. Obama's former adviser wonders why the agency won't or can't solve that kind of problem.

When Brent James advises doctors "Don't wait for Washington," he knows of what he speaks.  Improvement in the health care system will not come from confused and politically conflicted federal officials.  The challenge is whether it will come from the health care professions, or whether we will start heading down an inexorably declining slope towards higher costs, poorer quality, and (quiet) rationing of services.

Wednesday, May 8, 2013

Internet Sales Tax

Today could be a first for me.  I actually support the legislation giving states the ability to tax  retail internet sales that was passed by the Senate on Monday.  What has been happening nationwide is the amount of retail sales via the Internet vs. in-store sales has grown exponentially.  As a result, tax revenues in states across the US are eroding rapidly.  I know that is hard to fathom in Maryland where even the rainfall is now taxed, but the retail sales tax is critical in the running of state government.  Quite honestly, it pays the bills.  It funds education, portions of health care, public safety, public health, wages, etc. 
If the state doesn't have the funds a lot of people are left to suffer.  I know, what about the waste?  Sorry to say, but waste is inherent is government and in politics.  The goal is to minimize it to the extent possible, but it will always be there.  As long as there are special interests and patronage, there will be waste.   As for the ability to tax Internet sales, it will be interesting to see what the House of Representatives does with the legislation.  A number of Republican senators voted in favor of the tax, but it will be a lot tougher sell in the House.  Stay tuned.

Tuesday, May 7, 2013

Putting America Before Politics

I read a great article last week from Hospitals & Health Networks Daily by their managing editor, Bill Santamour.  The article is entitled, "Can Our Legislators Put America Before Politics?”  The article is based on the outcome from the most recent AHA Annual Membership Meeting which was that Congress and the White House need to finally end the stalemate that is crippling our government. 

Apparently, the most direct speaker on the issue was Bob Woodward of Watergate fame.  He said that the political gridlock is tragic for our country.  Republican speakers said to tell Congress that the gridlock must stop as did the Democratic speakers.  They talked about Sequestration and called it stupid as to how our government is "working." (Thank God, I thought that they thought that was good policy and strong leadership.)  The best line of the day was from Bob Woodward, who suggested that Jimmy Carter was successful in reaching detente with Egypt and Israel back 1978.  When people asked how it could happen; the answer was if you had to spend 14 days locked up with Jimmy Carter, you'll sign anything.  Woodward then suggested that our present day Congressional leaders and White House staff be locked up with Joe Biden for two weeks.  That could be the solution to political gridlock in all of Washington.  By God, something has to change so I say, make it happen.

Monday, May 6, 2013

Nurses Week

"Save one life, you're a hero; save 100 lives, you're a nurse."

I can't think of a better motto for a more deserving group of individuals, nurses that is.  Although there are so many changes occurring in the field of nursing with advances in technology, innovation, regulation, quality and safety, what hasn't changed is the complexity of the patients who are hospitalized today.  Every effort is being made in many hospitals and health systems across the US, including WMHS, to keep patients healthy enough so they don't need to be admitted.   As a result, today's hospitalized patients are the sickest that they have ever been, presenting challenges daily for our nurses.  The response continues to be one of compassion and dedication.  The bedside nurse is truly a special person and is joined by those nurses who work throughout the continuum of care.  These nurses include Home Care, Performance Improvement, Patient Safety, Infection Control, Care Coordination, Surgery, Labor and Delivery, Education, Cardiac Services, Imaging and the list goes on. 

In so many ways, the nurse has come so far from the days of Florence Nightingale; but in so many other ways, the care, the compassion and the tireless work of the bedside nurse has not changed in over last 150 years.  Happy Nurses Week!

Friday, May 3, 2013


When I first got my iPad several years ago, one of the first apps that I downloaded was iTriage.  It was highly recommended by Apps Magazine.  Yesterday, I had the opportunity to meet and listen to a presentation by Jonathan White, VP of Business Development for iTriage.  If you haven't used the app, I would suggest that you download it; it's free. 

The app provides information on doctors, hospitals, urgent centers.  You can enter symptoms for a particular condition and it will provide you with common causes and how the condition should be treated.  It will also tell you where to get medical help.....whether you need to go to an ED, Urgent Care or a physician's office.    Videos describing treatment of the condition are available for viewing.  You can even watch a surgical procedure should that be the recommended treatment.  I, then, had the opportunity to see where iTriage was headed next.  A patient will be able to see test results on iTriage and communicate directly with his / her physician.  In addition, reminders will be provided to take meds, check your BP, your weight, etc.   You can check out, iTriage on their website, www.iTriageHealth.com, for yourself.

This technology is very cool and has been designed to keep patients as healthy as possible as well as out of the hospital.  When it was created by two ED physicians in Denver, CO, I don't think they realized what a benefit it would be to hospitals as we work to implement changes to better care for and treat our patients.

Thursday, May 2, 2013

Maryland Hospitals Will Absorb Sequestration Cuts

Yesterday, the Health Services Cost Review Commission met and voted five to one on having the Sequestration cuts absorbed by hospitals in Maryland.  No sharing with insurers, no absorbing into rates.  Today, I am at a meeting with other Maryland CEOs and CFOs and everyone is trying to figure out how to absorb the millions of dollars in cuts without impacting people.  You would think that it would be relatively easy with, according to insurers, 30% of spending in health care being waste.  Well, it isn't that easy. 

It has taken WMHS almost three years to get where we are today with changing how we do business.  We have done so by addressing unnecessary tests, dealing with redundancy in processes, reducing potentially preventable conditions, performing operating cost improvements, addressing readmissions, case managing the frequent utilizers of our services and the list goes on.  And, we aren't done.  There is a lot more that we can do, but it takes time.  The impact on rates is virtually an overnight change for most Maryland hospitals.  Hospitals need a glide path for change; payors and regulators don't see the need primarily because they have no understanding of how the health care system works nor do they grasp the extent of regulation on hospitals.  Unfortunately, most have never worked in health care. 

Anyway, WMHS is fortunate since we took advantage of a new payment methodology three years ago through a demonstration project.   We have used a glide path during that time so we are better positioned today to absorb the $1 million cut for only one quarter for WMHS.  We can't absorb much more going forward so, I hope that the HSCRC will address the Sequestration cuts for FY 2014 at their next meeting in June as they have promised.

Wednesday, May 1, 2013

Health Care in Five Years

Two weeks ago, I asked the leadership of WMHS to answer a question, "From your perspective, will the health care environment in the next five years be: Very Difficult; Difficult; The Same; Easy; Very Easy?  My intention was to gauge the leadership as to our alignment for the future.  So far, the aggregate response is Difficult.  The explanations that accompanied each response were wonderful.  This is a group of leaders who truly get it.  They understand the challenges, but at the same time are up for each challenge. 

Information Technology has been labeled as Very Difficult and appropriately so, but they are following a strategic plan that will get us to where we need to be over the next five years.  Leaders in other areas wrote about the importance of planning, teamwork, a focus on quality, continuing to be fluid and dynamic as an organization, the importance of adaptability, continuing to educate the community on changes in health care, being creative and ingenuous, continuing our focus on our approach to perfect care and learning how to "fly blind" with the uncertainty of the federal government's Affordable Care Act and Waiver Modernization in Maryland.

I am thrilled that I asked the question and I am honored to be associated with such a stellar group of leaders.