"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, June 28, 2013

What the Business World Thinks of Health Care

I was in a meeting yesterday and one of my colleagues said that he was asked in a recent survey by the American Hospital Association as to what keeps him up at night.  He said that he gave the standard answers such as: surviving health care reform, transitioning from volume to value, aligning physician incentives, medical malpractice and population health.  He told the AHA that he would also like to know what the business community thinks about health care.  He said that is one group whose input we need as we plan for the future. 

A few hours later, I received a report from AHA that was published by the US Chamber of Commerce entitled, "Health Care Solutions from America's Business Community: The Path Forward for US Health Reform.”  How timely?  Ask and you shall receive.   So, after reading the report I sent it to him and he was grateful. 

In reading the report, it contains an interesting perspective.  On the positive side, according to the report, health care has tremendous medical innovation, cutting-edge technology and drugs, and world-leading medical institutions.  On the negative side, there is tremendous variation in quality, cost and access to care as well as the growing burden of preventable chronic diseases.  In addition, reforms are needed for better health for Americans. 

In their report, they also gave us solutions which included: better communication between and among providers, defining quality in simple and clear terms, removing barriers to information on quality and cost, encouraging consumers to use this information to make health care decisions, protecting the ability to buy affordable care and applying lessons from the private sector on employee-sponsored programs to Medicare and Medicaid. 

Actually, the report contained good advice and it is nice to see that WMHS has been successfully addressing for the last two years the various issues, along with implementing population health initiatives and pursuing ways to better address chronic diseases in our patients.  Through the President's Clinical Quality Council, we are also seeing some success with communications between providers, simplifying the information that we share, and transparency in quality and cost information. Issues such as protecting affordable care, along with applying lessons learned from the private sector, rest with our policymakers in Washington DC and Annapolis, MD.  All in all, the information was useful and a good benchmark for WMHS to measure itself against.

Thursday, June 20, 2013

Health Secretary Sharfstein

Dr. Joshua Sharfstein, Secretary of the Maryland Department of Health and Mental Hygiene, visited WMHS this morning, giving us an opportunity to provide a brief tour of our hospital.  But more importantly, it gave us the opportunity to talk about the new initiatives that we have applied in western Maryland to improve the delivery of care and, at the same time, reduce the cost of care. 

We had a very productive visit with the Secretary, who is an obvious fan of Total Patient Revenue, our payment methodology for the last three years.  Dr. Sharfstein was pleased to learn how we are now better managing the care of our high utilizers of our services and patients with multiple co-morbidities.  It is obvious that we are making a difference in better managing the overall health of our population, and it was a great opportunity to share some the ways that we are accomplishing the effort with the Secretary.

I will be taking some time off from blogging; I will be back next week at this time.

Wednesday, June 19, 2013

The AARP Weighs in on Hospital Mergers

In the June issue of the AARP Bulletin, there is an article on hospital mergers, "Hospital Mergers May Be Good for Business, But Patients Don't Always Benefit.”  Numerous people have advised me over the last two weeks that the article is in the AARP Bulletin and that it may be of interest to me due to our proposed alliance with Meritus Health System in Hagerstown and Frederick Health System in Frederick. 

Actually, it is an accurately written article. It describes the trend to consolidate due to tremendous financial pressures on hospitals to cut our costs. Hospitals are partnering with others in health care (many who were previously competitors) and such alliances are enhancing patient care. Patient admissions are declining rapidly as hospitals such as ours try to care for patients in the most appropriate setting, and such alliances or partnerships are allowing hospitals to better coordinate patient care under a more bundled payment approach, which takes away the argument that alliances increase the cost of care. 

The policy makers, as well as the regulators, are constantly looking for ways to get savings from hospitals as we adjust how we do business today.  At WMHS, we have been very fortunate to have agreed to be a TPR hospital three years ago whereby we are paid under a value-based payment methodology and not a fee-for-service methodology, which is based on volume.  I appreciate the AARP publishing such a piece as it clearly supports our initiative of "Meeting the Challenge of Health Care Change" at WMHS.

Tuesday, June 18, 2013

Wind Power is No Longer the Panacea

I had the opportunity to drive to and from Somerset, PA, yesterday afternoon and evening to attend an Allegany College of Maryland board meeting on the Somerset Campus.  Once I got into Pennsylvania, my drive consisted of seeing wind turbines in every direction for miles and miles.   Every time that I now go to PA, there seem to be more and more of them. 

At one point, I thought that wind power was a great way to pursue alternate sources of energy; and since our region had been labeled "the Saudi Arabia of wind," it made sense.  Now, not so much.  What has happened is that there is now comparison to what power plants using nuclear energy, coal or gas can generate versus wind.  Wind pales by comparison.  It was recently reported by former Sen. Phil Graham that wind power has been subsidized over the last ten years to the tune of $24 billion by the federal government.  The Audubon Society estimates that wind turbines kill over one million birds per year.  Then, there is the little known fact that if there are high winds in the area of the turbines, they must be shut down due to potential damage to the blades.  Seriously? 

In addition to the preceding, I also have a problem with the aesthetics.  Since virtually every mountaintop is now lined with these turbines, you can no longer get a decent photo of the beautiful vistas in our area.  And, if you think it's bad now, wait until the energy subsidies run out and there is no money to dismantle the wind turbines.  Having rusted, semi-bladeless turbines populating the mountain tops will really be an eyesore.  

Monday, June 17, 2013

A Decline in Primary Care Physicians Being Produced

News flash: a study has recently been released by the George Washington University's School of Public Health and the findings are that medical schools across the US are producing less primary care physicians, which ultimately hits rural areas especially hard.  Really?  Welcome to our world and, in the case of most rural hospitals and health systems, the challenges don't stop at primary care. 

GI docs are at a premium nationwide, with hundreds of openings and few physicians to fill them. We are located in a rural area but have to compete on a national level to attract and retain physicians.  From time to time, I get a letter from a patient or a patient's family member telling me that I need to recruit a gastroenterologist to the community due to our sporadic coverage during the week.  They are right; we do need to recruit a GI doc, preferably two, but it is very difficult.  This time last year, we had three GI docs in the community: one was terminated for cause; one is near retirement and will help out when he can; the third offers little help since he has moved his outpatient practice out of the hospital and does very little inpatient work.  We are once again offering anyone who identifies and assists us in successfully delivering a viable GI doc, $10,000.  Desperate times require desperate measures. 

Back to primary care, one thing that Maryland has done extremely well and leads the nation in their progressiveness is that Nurse Practitioners can work independently of a physician.  This has greatly helped in primary care recruitment and coverage.  Our own Nancy Adams, SVP and COO/CNE, who also serves as the President of the Maryland Board of Nursing, has had a leadership role in making this happen. So, the shortage of primary care docs is no surprise to us; it has been a challenge for years.  You just have to figure out how to work through this issue with creative approaches and a little help from our friends.

Friday, June 14, 2013

Happy Father's Day / The Living Years

I wasn't there that morning
When my father passed away
I didn't get to tell him
All the things I had to say

I think I caught his spirit
Later that same year
I'm sure I heard his echo
In my baby's new born tears
I just wish I could have told him in the living years

Mike and The Mechanics - The Living Years

My eyes still well up with tears when I hear "The Living Years."  This song came out shortly after my father passed away.  It's been over twenty-five years since I last said Happy Father's Day to my father.  My dad died in 1989 at the age of 62, far too early for anyone.  To this day, I think about my father often, but especially every Sunday afternoon.  He would always call me at 4 o'clock on Sunday no matter where he was or what he was doing.  We would catch up on what was happening in our lives with work and family. 

His death wasn't totally unexpected, but it happened much sooner than anyone thought.  I got the call that he was declining rapidly on a Saturday.  We quickly packed and started to leave for Texas when I noticed the child-proof container of Tylenol with the lid off and on the floor.  Some capsules were still in the container, but we had no idea how many were in there to start.  Asked both girls if they took any, Jessica (age 7), "no;" Lauren (age 3), "no."  Pamela grabbed the Poison Control number just in case and out the door we went. 

About three hours into the trip, Lauren began throwing up, but she looked fine otherwise.  We quickly called the Poison Control Center and they said to get her to the nearest hospital.  Got there and blood work was drawn.  The ED doctor said since she appears fine; go on your way, just call us in the morning and we'll give you the results.  About two in the morning, we were exhausted and so much for driving straight through to Texas.  We stopped at a hotel and decided to call the hospital just to see if they had the results.  Got the ED doc on the phone, who said, "thank God you called; her levels are off the chart for acetaminophen poisoning.  Get her to the nearest hospital as fast as you can.” 

Long story short, Lauren ended up in ICU.  I called my mother to let her know what happened and to check on my father.  She said that he was just given Last Rites and continued, but if it means him dying to save Lauren, then so be it.  Lauren responded almost immediately to the Mucomyst treatment and we were allowed to leave, provided we gave her the treatments and had blood work done upon arrival in Texas. 

Got to Texas, checked into the hotel and called to see how my father was doing.  He died that morning and as my mother says "so Lauren could live."  To this day, I see a lot of my father in Lauren.  That same wonderful sense of humor, a closeness to family, a great smile and that love of country. 

So that's the challenge every time I hear "The Living Years."  I wish I could have been there to tell him all the things that I had to say, but I continue to catch his spirit in Lauren and for a very good reason.  After twenty five years, Happy Father's Day, Dad!

Thursday, June 13, 2013

The Trouble with Social Media

I have been blogging for over two years as well as using Facebook, Twitter and LinkedIn for some time now.  I enjoy each of them very much.  However, I have found a major downside.......the unwanted solicitations from every consultant who has ever logged onto a computer or driven by a hospital.  I am inundated with invitations to meet; webinars to attend; services to buy; equipment to lease and the list goes on. 

My favorite that I get almost daily is the underling who is connecting with me on behalf of their boss since the boss will be in my area visiting other clients on a particular day and time.  So, when can we meet?  But, only specific dates and times are provided.  Be serious!  First of all, can't you even make believe that you are making the contact directly with me?  You are soooooo busy that you are reaching out to do business with me via your office staff.  Quite honestly, the days of having your secretary make your calls for you or sending your emails are over.  It's demeaning to me as well as your employee. 

Then there is "IN THE AREA VISITING OTHER CLIENTS," really?  We are two hours to the nearest major city with very few hospitals in between.  Then I get, he or she can meet between 1 PM and 3PM on this specific date or 10 AM and noon on another date.  Wait a minute, you want to do business with me and you provide a window to meet that is convenient for you, really? 

So, what is the solution?  Well for me, I only friend people on Facebook whom I know.  The same with Twitter.  With LinkedIn, I do not connect with anyone who has the potential to extract money from me or the health system by selling me their product or service.  As for my blog, all of my information is out there.  The best I could do would be to have IT tighten that spam filter just a little tighter.  What I would like to do is for every person who contacts me on behalf of their bosses with the extremely high opinion of themselves who will be in the area on a specific day and time, make the appointment and then not be available.  They may figure out a better way to make contact for a potential meeting if that were to happen to them enough times.  Fortunately or unfortunately, I am too nice and too respectful to do such a thing, but I am there are times that I am so tempted.  Actually, by the end of the day I have a very sore finger deleting the many unsolicited emails that I get as a result of my love for social media.

Wednesday, June 12, 2013

We Can't Help Ourselves

What do the following have in common: Health Care, the Catholic Church, Education and Government?
The answer is that we hold onto low performing staff members far too long.

Yesterday in my blog, I mentioned Quint Studer (author consultant and former hospital CEO) whose company has done work at WMHS in the past.  Quint is an expert on service excellence and leadership with a focus on health care, although he is now consulting outside of health care as well.  Quint spent a considerable amount of time on the issue of low performers and how we don't have the luxury in allowing the low performers to continue in our organizations.   We never really had a place for them; however, we tolerated them over the years.  Based on the demands on hospitals and the increasing complexity of our industry according to Quint, we can barely tolerate middle performers.  

He said that when he was at the Baldridge Award presentation ceremony receiving his award along with a barbecue restaurant in Texas, the owner of the barbecue restaurant was asked what does he do with an employee who doesn't wash his hands.  He answered in his Texas drawl, "I fire them."   Quint's point was look at what we tolerate in health care with our low performers.  

A couple of years ago at WMHS, we asked our department directors to provide what they think is the percentage of low performers at WMHS.  The result of that exercise was 13% or around 300 employees.  We then used that opportunity to identify who they were in the individual departments and to focus our attention on them.  Preferably, work to develop them to at least be middle performers and eventually high performers.  We saw a lot of success with some employees stepping up their performance, others leaving the organization because of too much attention on their individual performance and others being dealt with because of their low performance and other service excellence shortcomings. 

We haven't solved the problem of low performers in its entirety, but we have made great progress.  Maybe in the short term, we can be in better company (no intended disrespect to the Catholic Church and Education; Government is a whole other story) by completely turning the corner in dealing with low performers at WMHS.

Happy Birthday!

As a side, a very happy birthday to my wife, Pamela and former President George H. W. Bush.  We had the opportunity to meet President Bush a number of years ago (see the attached photo).  He was both gracious and charming.  He had a great deal in common with Pamela, who is also gracious and charming.  I have always liked President Bush, but Pamela remains the love of my life.  I hope that both have a wonderful day and a great year!

Tuesday, June 11, 2013

Perception Isn't Necessarily Reality

Today, I am attending the Maryland Hospital Association's Annual Meeting in Baltimore.  It is always an informative meeting and a great opportunity for networking and board education.  WMHS has eleven attendees between board and executives; may seem like a lot, but it is a great opportunity for all of us to learn and to hear a consistent message related to health care in Maryland. 

One of today's speakers was Quint Studer, who is an author, consultant and former hospital CEO.  Quint's message was stressing the urgency for leadership in today's very complicated health care environment.  It was a very informative presentation.  In the Q&A session, he was asked which one was the highest performer out of the hundreds of hospitals with whom he has worked in his consultative role and why.  He gave his answer.  He named the health system, which will remain unidentified for what will become obvious. 

Quint said that what sets this health system apart is that their CEO has the stated desire for high performance (actually most of us do), they communicate with purpose, their metrics are transparent (they are posted throughout the hospital), they use objective and weighted performance evaluations and their leaders are required to have fifty hours of leadership training.  Impressive!  At WMHS, we are always looking for successful health systems to benchmark ourselves against.  So, I Googled them and what I found was not very complimentary.  Most of the comments about this health system from the perspective of their patients were not very favorable and their overall rating was in the fair-to-poor range.  Wow!  Here is a high profile consultant who is well known throughout health care, is extremely knowledgeable and has a wealth of experience and who perceives that his named highest performing hospital is functioning at the top of their game and yet reality is very different.  As I have blogged in the past, health care is an extremely difficult and challenging industry.  A point that is well demonstrated in the preceding example.

Monday, June 10, 2013

Another Crisis in the Federal Government

In 2003, the federal government passed the Medicare Modernization Act, creating a program that detects and corrects improper payments by Medicare.  In 2005, they began using Recovery Audit Contractors to perform the work of identifying improper Medicare payments. 

The RAC program has become an absolute disaster for hospitals.  Currently, WMHS has $4 million tied up with RAC auditors, who are incentivized by the feds to ferret out improper payments.  We take billing Medicare (and all other payors) very seriously and have chosen to be aggressive in challenging the RAC.  Every claim has been denied on appeal through a virtual "rubber stamp" approach.  Each case takes about ten months to process, again resulting in a denial. 

The third appeal level is with an Administrative Law Judge, who is the first individual not incentivized as to the outcome of their decision.  We have been very successful winning every appeal at the ALJ level.  Because of our success and the success of others, that process has been slowed to a crawl.  We are now getting letters indicating that because of a backlog of cases they cannot render opinions at the ALJ level. 

An interim step has also been added that any time we appeal at the ALJ level, we first have to notify the patient as to our appeal, which sends a panic through every patient notified.  We are spending excessive amounts of time and money on these appeals because there is a great deal at stake. 

The American Hospital Association has taken a very active role in trying to bring improvement to the RAC process and now there are bills in Congress to rectify this broken process.  WMHS is actively involved with AHA since we have so much at stake.  Four million dollars tied up for one health system in a heavily flawed program in this economy is a "very big deal" and it needs to be solved immediately.

Friday, June 7, 2013


I just received my annual survey from the American College of Healthcare Executives on Futurescan.  This survey requests the input from executives as to the future delivery of health care from 2014 to 2019.  This year's survey focuses on population health, physician integration, provider affiliations, reimbursement, IT, patient care and efficiency. 

As I answered the questions, I had a pretty good feeling as to our level of readiness in each area.  In population health, we have already established partnerships with community partners; we are ensuring stronger coordination of care among those same partners and long before 2019, we will be a controlling entity for a complete continuum of care.  Within the next two years, our physicians will be heavily involved in patient centered medical homes; and by next year, we will be actively engaged in a pay-for-performance initiative with our physicians to better align financial incentives.  Within the year, we should be further along with our potential alliance between the three western Maryland health systems, as well as clinical data integration system wide.  Lastly, we continue to be focused on being a highly reliable organization; continually expecting the unexpected, but being resilient enough in working to contain the unexpected. 

Being in a state of readiness for the many changes occurring in healthcare is a very good position to be in going forward.

Thursday, June 6, 2013

CEOs Against Cancer

Recently, I joined a group of 23 other CEOs in Maryland who have come together through the American Cancer Society to prevent cancer and save lives.  Today, we had a series of presentations and meetings at WMHS to raise awareness about how to stay well, get well, find cures and fight back against cancer. 

We are already doing a great deal through our employee wellness programs, our screenings, being a smoke free campus, availability of and access to cancer studies, healthy eating and offering comprehensive exercise programs, as well as our advocacy programs related to healthier lifestyles for our employees and their families. 

I have pledged WMHS support in this fight against cancer due to its prevalence in our region.  When you hear statistics like one in every two men and one in every three women will face cancer in their lifetime, it becomes staggering.  Cancer truly affects everyone in some way and it has a direct impact on our workforce.  It is my intention to ensure that we pull out all stops to help our staff stay well by fostering a culture of health and wellness at WMHS.  Where better a place to start but here?

Wednesday, June 5, 2013

There They Go Again

Today, the Health Services Cost Review Commission (HSCRC) voted to allow hospitals to raise our rates by a mere 1.65% for the period of July 1, 2013 to December 31, 2013, which is less than inflation.  Maryland hospitals asked for a 2.11% increase with a temporary .32% to offset the Sequester cuts which impacted hospitals in April of this year.  Previously, the HSCRC didn't act on any relief for hospitals on the Sequester cuts, but asked that we be patient and that they would address the Sequester impact at their June 6th meeting.  LOL! 

This inaction by the Commission will have a detrimental effect on most hospitals in Maryland and will only worsen an already bad situation.  Hospitals will be forced to cut jobs and curtail services beyond what they already have done as a result of the Sequester cuts.  At WMHS, because of the action that we took earlier this fiscal year, we should be able to absorb the less than inflation increase, but not much more.  The health insurers have asked for as high as almost a 17% increase in their rates while fighting the 2.43% increase for hospitals.  It will be interesting to see what they are granted.  Stay tuned.

Tuesday, June 4, 2013

Congratulations Lauren!

I am stepping away from my usual blog today to congratulate my daughter Lauren, who, as she puts it, "is no longer a child officer in the Navy." Yesterday, Lauren received her silver Lieutenant bars (see attached photo zooming in on her Lt. bars).  Four years ago, she graduated from the United States Naval Academy as an Ensign assigned to Surface Warfare. (Attached is a photo of her graduation from the Naval Academy that was taken by the White House photographer and posted on the White House website).  Two years later, she was promoted to Lt. junior grade; she served two tours to the Middle East (attached is her hugging her mother after her return from the second deployment) and I got to join her on her ship for eight days as it returned from her first deployment.  She is now assigned to Fort Meade in Maryland.   So, twenty six years old, and already lived in San Diego, CA and Chesapeake Beach, VA as well as being around the world (first deployment from the Pacific and the second from the Atlantic).  Congratulations, Lauren, I know that it has been a very challenging eight years, but thank you for all that you have sacrificed over those eight years.  

Monday, June 3, 2013

Making Strides

I have blogged in the past about the many ways that we are trying to improve the health and well being of our patients.  So far, we seem to be on the right track and are seeing improved outcomes, including reduced admissions, for those who are receiving  appropriate follow-up care and support from these newly implemented services.

Our Outpatient Coagulation Clinic opened late last fall and has already outgrown its current location.  In order to accommodate the growing number of patients, it just moved to a larger, off-site location.  It's actually sharing space with one of our Primary Care Centers, all of which are experiencing increased volumes. 

The Center for Diabetes Management continues to see more and more patients.  An outgrowth of that service will be a new diabetes support group, which meets for the first time tomorrow night.  It will be facilitated by two certified diabetes educators and a registered dietitian.  Participants will be able to learn from the expertise of the entire diabetes team and will benefit from the interaction of others who share their concerns. 

All of these activities are examples of how we are meeting the challenge of healthcare change by improving the health of the patients we serve.  What is most rewarding is the benefit that our patients derive from these new services.