The Challenge of Preventing Readmissions

The readmission rate at WMHS has dropped over 20% from about five years ago to around 10% today.  Reducing readmissions is critical since we are not paid for those re-admissions within 30 days if the readmission is related to the same co-morbidities or disease classifications.  A recent article in the Wall Street Journal calls into question as to just how much control hospitals have in controlling readmissions.  The article states that it is a worthy goal, but can jeopardize the health of the patient and the bottom line of the hospital.  I am not concerned about the bottom line since WMHS is paid on a value basis, but we are always on guard to ensure that if the patient requires readmission that they are re-admitted.  We don't withhold care because of a penalty; we try to learn from the reasons as to why the patient had to be re-admitted.  There are many reasons for readmissions and some can't be prevented, but hospitals can play a role in preventing them.  One factor was discharging patients too soon.  We perform a chart review on every readmitted patient as well as interview the patient and / or family members to ascertain why the readmission occurred.  We have found that there is less that we can do for the non-compliant patient as well as the poor and the elderly with little to no family support.  The social factors contribute greatly to readmissions and as a safety net provider, in this case, we carry a greater burden due to the lower socioeconomic status of our population.  Our philosophy has been that we need to control the readmissions that we can and work with the non-compliant, the poor and the elderly in other ways to hopefully prevent readmissions in the future.

Additional Tidbits from Anirban Basu

Yesterday, I blogged about our board meeting last Friday and the value that Anirban Basu brought to our board.  In yesterday's blog, I focused on his presentation related to the proposed alliance; in today's blog, I will provide some of the additional information that he covered.  His tidbits worth sharing are as follows:

The US economic recovery is in it's fifth year but still very weak at 2.1%

Health Care spending is at it's lowest in 50 years; the average annual growth has slowed to 3.5% over the past five years and 1.5% is attributable to inflation

The contributing factors to the slowing of health care spending are use rates are down, quality reimbursement has been instituted along with evidence based medicine protocols.  The recession also played a part

The increase in the national debt for 2012 was $1.7 trillion and for 2013 it's "only" $640 billion

Since April 2013, we have added just under 200K jobs; in a year the US has added 2.3 million jobs predominantly in the business sector but many are temporary or part time jobs.  Other leading sectors include: Hospitality, Travel, Transportation and Health Care.

By 2020, the US will be the largest producer of oil.  Currently, we are third with Saudi Arabia being first and Russia second.

The states with the greatest job growth are all oil producing states: Idaho, Texas, North Dakota, Utah, Montana and Nevada.  The economies of Arizona and Florida are racing back to normal with new housing and tourism.  Maryland is 14th  due to the high number of government jobs added, but of late our unemployment rate has increased to 7% (national rate is 7.6%)

The US is unique in that health care delivery is very comprehensive.  Cardiac surgery being delivered in western Maryland would not occur for example, in England.  Hospitals that are located outside of large cities in other industrialized countries provide primary care for the most part.  Individuals have to travel to large cities for comprehensive health care services.

Health care expenditures at 18% of the Gross Domestic Production is still high for an industrialized country but not as high as some may think for a civilized compassionate society like the US

As I blogged yesterday, Anirban is fascinating with his wealth, scope and depth of knowledge.

A Brave New World

Last Friday, the WMHS board met for their annual strategic planning meeting.  We were honored to have Anirban Basu as our guest presenter. Anirban is the CEO of the Sage Policy Group in Baltimore; he is an attorney as well as an economist.  He specializes in economics of economic development, health care and government.  The primary purpose of inviting him to present at the meeting was to gain valuable insight on where health care is going and to assist the board in deciding as to whether or not the proposed alliance with Meritus Health and Frederick Health System is in the best interest of WMHS and the region that we serve. 

According to Anirban, the Accountable Care Act has created a land of giants resulting in a diminishing role for smaller to medium sized hospitals and health systems.  He said that bigger is better in delivering care at a lower cost and with greater efficiency.  He said that the Accountable Care Organization of which we would pursue with this proposed alliance requires a larger network formation.  There is far too much risk to be taken and smaller organizations can't handle that amount of risk nor the cost of forming an ACO. 

In 2010, there were 72 hospital consolidations; that number grew to 92 in 2011 and 94 in 2012.  The number is expected to grow to well over 100 in 2013 and the trend is expected to continue.  In Maryland, WMHS is one of 15 independent health systems left out of 46.  That number continues to shrink with University of Maryland Medical System, Johns Hopkins and MedStar in discussions with some of the 15 independents as well as those hospitals in DC.  Anirban discussed the cost pressures on hospitals that are coming from every direction.  These pressures include technology, physician recruitment, retention and employment, depreciation, rate regulatory challenges, Medicare, Medicaid, declining revenues and growing competition just to name a few. 

In this Brave New World, there are a lot of changes occurring now as well as on the horizon.  We have to be ready to not only continue to exist in this community but to thrive; it is clearly in the best interest of our patients, this health system and the community.

I Want to Thank Those Charity Care People

Last week, a member of System Management was approached by an acquaintance, who with tears in her eyes, said that she wanted to thank those people who provide the Charity Care Fund at WMHS.   She said that her daughter was seriously ill and in the hospital.  She has no health insurance and no money to pay for her care.  The family was told that it was OK; Charity Care will take care of it.  So, in turn, the mother wanted to send a letter to the people who fund Charity Care.  The WMHS employee said that the health system funds Charity Care for those patients who can't pay.

Some of that care is covered in the hospital rates that have been established through Maryland’s unique reimbursement system, but that continues to fall short year after year.  There are a host of steps that we walk people through to obtain financial assistance.  But when it's all said and done, the health system takes a loss for the care that was provided to those who couldn't afford to pay.  And that amount has grown dramatically over the last several years.  Last year, the total amount for our Community Benefit was just under $40 million, with almost $16 million being provided in the form of charity or uncompensated care. 

We are fortunate to have some funds that will cover minimal needs for our indigent patients, but nowhere near the magnitude to cover the cost of the care for a serious illness.  The woman was shocked that WMHS covers those costs and said "I am sure that most people have no idea that the health system covers those costs."  I guess this is another opportunity for WMHS to do some "shameless" self-promotion.

CMS to Link Physician Pay to Quality

Finally, CMS is beginning to align incentives between providers.  Right now, WMHS is paid on a value-based care delivery system, while many of our physicians continue to be paid based on volume.  As of 2015, physician pay for those physicians working in large groups (100 or more) will have a portion of their pay at risk.  They will get bonuses or be penalized.  It looks like our physicians who are in mostly small practices (less than 9) will have to wait until 2017. 

The program will be similar to the Quality Based Reimbursement program in Maryland based on a zero- sum game.  There will be winners and losers since there is no new money for the bonuses.  Through our President's Clinical Quality Council, we have been working with our physicians to get them to understand how the QBR program works and impacts us.  The intention has been to better prepare them for what's on the horizon with CMS's Pay For Performance (P4P) plan.  Under the CMS P4P plan, quality measures for physicians will be based on basic medical approaches, and initially physicians will get to pick the measures by which they want to be judged.   I realize that many physicians are not excited about the new pay plan, but it is a start in getting all providers aligned with each other.  Stay tuned.

President's Clinical Quality Council Enters Its Third Year

The President's Clinical Quality Council was formed in 2011 and has been meeting monthly since its inception.  To take you back, the Council was formed to create a vehicle for closer alignment with our physicians.

The members of the C-Suite recommended medical staff members who were leaders of the medical staff (either official or unofficial) and were considered early adopters or change agents.  I selected the first six from that list and then we asked the six newly appointed members to provide six names of physicians whom they would like to see join them on the Council and who met the criteria for selection.  Through that process, we created the Council of 12 and it has been very successful.  Over the last two years, we have used them primarily as a sounding board on initiatives such as improving communications, getting a better handle on our high utilizers, improving physician documentation, reducing our preventable conditions, eliminating denials, reducing readmissions and, of late, developing a pay for performance (P4P)  initiative. 

As we enter our third year, in addition to focusing on P4P, we will be asking this group to work with us on clinical integration within WMHS as well as with the proposed alliance between WMHS, Frederick Health System and Meritus Health in Hagerstown.  Should the boards of the three health systems decide that this alliance is in the best interest of their respective communities, clinical integration will be a critical component of the alliance going forward.  The expertise and input from the Council will be essential.

An Education That Could Have Just Saved My Life

As I blogged yesterday, last week I had the opportunity to spend some time at the Center for Diabetes Management.  Much of my time was spent with Jennifer, one of the Health System's Dietitians and a Nutritionist for Healthier Eating. 

Talk about time very well spent, WOW!  I learned that my daily intake of Carbohydrates could actually kill me.  As an example, I go to the gym on Saturday mornings and workout for about an hour and a half.  I then come home for what I thought was a hardy, but healthy breakfast.  I would have a smoothie with a half of banana, a handful of raspberries, blackberries, blue berries, strawberries, OJ and yogurt.  I would then have a bowl of cereal with the other half of the banana.  I would round out my "healthy" breakfast with a whole grain muffin with peanut butter.  Total servings of carbs for that one meal was about 13.  The maximum about for me should have been 4.  That's right, four servings of 15 grams of carbohydrates per meal, and I was eating three times that amount.  Sure there are healthy items that I was eating, but far too many carbs.  Carbs turn to glucose, which is an energy source for your body and is something that your body needs.  My body needs to have the same amount of carbohydrates at about the same time every day. 

So being in a pre-Diabetic state as I blogged about yesterday, my pancreas may not be functioning properly forcing my blood glucose levels to get too high.  As a result, I need to control my blood glucose levels through my food intake and balance my carbs accordingly.  The hope is that I caught all of this in time.  Since last Thursday's educational session, I have changed how I eat, dramatically reducing my carb intake.   Another example of a high number of carbs that I found amazing is a baked potato.  A large baked potato with nothing on it is four servings of carbs for one meal, which would be the max for me.  Add to that all of the dressings for that baked potato, a vegetable, a roll or two, a cocktail before and / or during dinner and the carbs keep adding up.  

I told Jennifer that I was blown away with the information that she shared with me.  I thought that I had a good understanding of healthy eating, but actually, I didn't have a clue.  I would strongly suggest that everyone gain a much better understanding of carbohydrates and what they can do for you as well as what they can do to you.

Pre-Diabetic, Say It Ain't So!

Last week, I took the opportunity to visit our Center for Diabetes Management at WMHS.  The reason was to sort out what may be going on with me from a health perspective.  I have been in a pre-Diabetic state for the last year (gotta love those genetics) and was hoping that I could beat it.  Although still having my blood glucose level reflecting a pre-Diabetic level, my numbers were going the wrong way.  So, I thought that it was time to get a better understanding of what I was doing or better yet, not doing.

I met with Tammy, the Nurse Practitioner, and she did a great job of explaining where I was in this pre-Diabetic state and what I needed to do to bring improvement to my health status, hoping to put it all in remission.  The majority of the time was spent learning about healthy eating with Jennifer, the Dietician.  I will devote tomorrow's blog to that topic.  Next, was exercise and I have that covered in that I am now do a variation of cross fit training three times per week that seems to be working.  Lastly, was medication, which is what I was resisting when suggested by my physician back in March.  Tammy suggested that I begin taking Metformin to protect my pancreas and Lisinopril to protect my kidneys. I reluctantly agreed; again hoping to put all of this in remission. 

The bottom line is that I want to be healthy.  I can only achieve that goal by paying closer attention to what is going on with my body and using the wonderful resources that we have available in our community, such as the Center for Diabetes Management.

TheTruth is Somewhere in the Middle

Of late, there has been a great deal of back and forth between the White House and the House of Representatives on Obamacare.  Once the employer mandate delay was announced, the feeding frenzy began.  Personally, I think that the employer mandate, as well as the individual mandate, should both be delayed and reworked.   However, saying that the health care law is a train wreck isn't true. 

The triple aim of health care reform is working and it is working very well at WMHS.  We have improved the quality of care as demonstrated by our quality-based reimbursement scores, the reduction in potentially preventable conditions, and improvements in our patient satisfaction scores as well as our Core Measure results.  We have reduced the cost of care in so many areas, but where we are seeing a significant impact is with our congestive heart failure patients and our COPD patients.  We have brought down the cost of care and have been able to shift many patients from the inpatient arena to the less expensive outpatient setting.  We have also made headway in population health through our partnership with the Allegany County Health Department by improving the health status of our community.  Although the improvement is minimal in a number of areas, we have reversed the negative trend that has been occurring over many years. 

So, the care delivery aspect is working and if we can be successful, so can others.

A Word (Actually, a Couple of Words) to the Wise

Each week, I eat at the same local restaurant mostly for lunch and it usually involves a meeting.  I have noticed more frequently during lunch time, individuals coming in requesting an application for a job.  What I have found most interesting is that if you look like a bum, they are suddenly out of applications.  However, if you are dressed half way decently and your appearance is even somewhat presentable, they have an ample supply of applications. 

In today's economy, jobs are tight and it is interesting that there are job seekers who enter this particular restaurant usually in a tee shirt, jeans or shorts (each garment soiled and / or torn), unkempt in their appearance and looking like a shower is more the exception than the rule.   They are then surprised that the owner or manager isn't thrilled to bring them on board. 

Last week, I was leaving the restaurant when a young man came in to ask for an application.  He fell into the category of "we are out of applications right now."  He left the restaurant behind me and his mother was waiting in the parking lot in a mini-van.  As he got into the mini-van, he told his mother that they were out of applications.  Her response should have been son, why don't you go home, shower and put on some decent clothes then return and ask when they might have an application available.  Instead, she said with the expletives deleted for this blog that it was the restaurant's loss and that he deserved to work in a better place anyway.  So much for her teachable moment. 

Let me take the opportunity to use this as a teachable moment.  Whenever, you are going into any place of business to ask for anything remotely related to a job, look presentable; it's not that difficult.  No one was ever turned away from a job because they were overdressed or too clean.

The CEO of the Future - Adapt or Die

Since health care is changing dramatically right now, hospital and health system CEOs had better be adapting or they will cease to be effective which equates to dying.   We have to take advantage of the changes that are happening now as well as those on the horizon.  Today's change is rapid, it's volatile and it's uncertain.  So, in order to thrive going forward according to Chief Executive magazine, we have to be able to detect external change no matter how complex or uncertain; we have to be prepared to change course even if it means moving away from key people and core competencies; we will have to move fast; we have to turn experts into leaders and not the other way around and we have to get our boards to accept fluctuations in our financials without losing confidence in our direction.  Each of the preceding new capabilities are tall orders for CEOs, but necessary ones.  At WMHS, we have been involved in dramatic and dynamic change for the last several years with no relief in sight.  But, at the same time it is exciting as we adapt to the changes that are upon us as well as those that aren't fully envisioned, yet necessary in order to be successful.

Making Yourself Indispensable

The summer reading for WMHS leadership is about to arrive.  The book, "Linchpin - Are You Indispensable?" by Seth Godin is a great read and an extremely well timed reading for present day circumstances.  It is in everyone's best interest to make themselves indispensable or that linchpin in the organization.  The linchpins keep the wheels in place and prevent them from falling off the axles.  In our world, they are the innovators, the early adopters, the movers and the shakers.  They get the promotions, the best jobs and the most freedom in their jobs.  

At every New Employee Orientation, as I review our Core Values, I stress that Core Value of Innovation.  I tell the new employees that they are the ones doing the work and we need to hear from them as they have ideas or new ways of getting the work done.  They have so much to offer and they need to tell us about it.  I want them to apply their creativity in such a way that we all get to benefit from their expertise. 

As is the case with our leaders, the knowledge and expertise is amazing among our team leaders, supervisors, managers and directors.  And, they have the track record to prove it.  In addition to doing their routine work first, they performed double duty in assisting with the planning and operationalizing of the new hospital.  They helped us consolidate two campuses into one new one.  Then about a year later, began the transition to Total Patient Revenue, a value-based care delivery model, again in addition to doing their routine work.  We have changed how we do business and they continue to master their expertise in ensuring that we remain focused on the triple aim of health care reform: better care, healthier communities and reduced cost of care.  So, if you haven't read "Linchpin," do so, as it will provide great insight into how, as leaders, we should be meeting the challenge of health care change.

Common Sense Prevails

This week the Maryland Court of Special Appeals overturned a multimillion dollar judgment against Johns Hopkins Hospital and returned the case to the lower court for retrial.  The case was from February 2011 and it alleged that an infant was born with hypoxic ischemic encephalopathy because the baby was deprived of oxygen as the mother waited for a Cesarean section at Hopkins.  The plaintiffs were awarded $55 million, but it was later reduced to $28.3 because of the state cap on damages. 

Now for the rest of the story.  Originally, this birth was being attended to by a nurse midwife in the home of the parents.  The midwife performed outdated procedures in her attempt to deliver the infant naturally, which eventually led to the injuries.  The mother was brought to Johns Hopkins for the eventual delivery of the infant.  During the trial, Hopkins was prevented from presenting expert testimony or showing evidence that the midwife was negligent.  The plaintiff's lawyers were allowed tell the jury how the midwife's treatment was appropriate, but Hopkins was not allowed to say how it was negligent.  As a result, the case was sent back for retrial.  The outcome for the child and the family was horrific; however, the negligence rests with the midwife whose license has since been suspended because of this delivery and her handling of four other home deliveries over a three year period. 

All too often, egregious acts take place outside of hospitals and we are left to make it right and, if we don't, we end up getting sued. When this verdict first came out, everyone was stunned as to the amount and the circumstances in which it was rendered.  The original verdict has also had a dramatic impact on obstetrical deliveries in Baltimore city.  Obstetricians began to move their practices out of Baltimore city and into the suburbs because of this and other jury verdicts.  Doctors and hospitals have said that in recent years, jury verdicts in Baltimore have consistently favored the plaintiffs.   In many of these cases, the jury rules in favor of the plaintiffs only because they feel that someone has to be responsible for the care of the child and it falls to doctors and hospitals with their deep pockets. 

Thank God, the case was appealed and common sense on the part of the Court of Special Appeals prevailed, but I don't know if it's enough to reverse the flight of OBs back to Baltimore city.

That's Your Physician's Decision, Not Ours

Last evening, I was heading to a meeting in the hospital and said hello to a woman who was waiting to go into another meeting.  She first stared at me, not saying anything, and she then looked me up and down and said "You're Ronan, the CEO, right?”  I responded that I was and she continued in a somewhat agitated tone to ask "Why is it that you won't allow my doctor to practice in this hospital?"  I informed her that the reason her physician doesn't practice at the Western Maryland Health System has nothing to do with not being allowed; it is because her physician has chosen to have an office practice exclusively and not follow his patients into the hospital.  She looked at me incredulously and said, "Well, why didn't he tell me that?" 

As physicians make the choice to no longer follow their patients in the hospital, we are left with no alternative but to hire hospitalists who follow their patients when they are hospitalized.  I also told the woman that WMHS also encouraged these physicians to send letters to their patients informing them of their decision to have an office practice exclusively.  In some cases, we even drafted the letter for them; some sent the letters, others didn't.  Based on what has happened to physician payment over the last five or so years, I can certainly understand why many have resorted to an office practice exclusively, but it would be helpful to all concerned if they would have told their patients why they were making that decision. 

The woman then told me that she used to work at both Memorial and Sacred Heart and she could tell me lots of stories about physicians so nothing would surprise her.  I wished her a good evening and continued onto my meeting.  Actually, I was glad that I had the opportunity to clarify the situation for this woman.  There has been a lot of criticism of the health system in the past over this issue; all of which is unfounded.

Would You Like a Little Whine with That Cheese?

Yesterday, I read an article in the Pittsburgh Post-Gazette, "Drugmakers Accuse Hospitals of Profiting from Federal Discounts."  Yes, drug companies complaining about someone else making a profit, sometimes an enormous profit (and they are clearly experts in enormous profits). 

The 340B Program is designed to help poor patients receive cheaper medications and it works.  Believe it or not, it took WMHS several years to eventually qualify, which we did just this year.  So, there is a great deal of oversight with the program and not just any entity is allowed to enter.  The steps that we are making to ensure that low income patients, along with the uninsured and underinsured, receive their medications are unbelievable.  We have allowed for much greater access to prescription drugs and it can only help reduce the cost of care in the long run.  In addition to helping with changes to the care delivery model to one of value based, the 340B Program is an integral part of our Charity Care efforts at WMHS. 

With the many ways that government has reduced payments to hospitals over the recent years, this program continues to help and is one that truly assists those in need.  In closing, before you start feeling sorry for the drug industry, the 340B Program is about 2% of the $320 billion drug market in the US.

Critical Thinking

During yesterday's new employee orientation, as is with every orientation, I go around the room and ask all new employees to introduce themselves and to tell me how they are going to apply our mission statement while at work.   In responding, one of our new nurses said that she would fulfill the mission of WMHS (Superior Care for All We Serve) by making sure that she thinks through the care of her patients to ensure that she has done all that she possibly could for each patient.  Wow!  What a great response and one that gets to an issue that we continue to deal with in the care and treatment of patients. 

We need to make sure that we ask ourselves the vital questions as we render care, gather information and interpret it effectively, think open-mindedly when alternatives arise, and effectively communicate as we try different solutions and approaches in the care of the patient.   We need to reach beyond our individual silos as we care for our patients.  Having a checklist is fine, but if we are able to check off every item on the list and the patient still has issues then we need to apply what our new nurse said, "ensure that she has done all that she possibly could for her patient."

We are talking about our patients, who while they are in the hospital, are at their most vulnerable point.  They are counting on us to step out of our comfort zone and do everything that we can to get them better and transition them to an alternate setting whether it is home, ,a nursing home or, another level of care.  A gold star for that new nurse; most importantly, she gets it, but she also gave me the opportunity to stress such a critical issue with our newest employees as well as to blog about it today.

So, How's It Going?

Someone asked me the other day, "How’s it going?" The question was related to my health care life, not my personal life.  With so many hospitals and health systems struggling, especially those in Maryland with about an average operating margin of 0.83%, just how is WMHS doing?  The answer was actually, we are doing much better than most in Maryland and comparably sized and structured health systems outside of Maryland. 

First, let me start with the construction of a new hospital from 2006 to 2009.  If we would not have acted in 2004 to begin the process of planning, designing and building a new hospital, we would be in dire straits at this point in time with no relief on the horizon.  One of the two hospitals would have been closed by now.  We built a new hospital with 275 beds; we now have an average daily census of 170 patients due to the more recent changes in health care.  At one time, both Memorial and Sacred Heart Hospitals combined for a total of 464 beds.  The vision that the Board and executive leadership in this organization had was remarkable.  We knew that a new hospital had to be built rather than investing well over a hundred million dollars in two rapidly aging campuses.  We certainly had our critics and our detractors, but we persevered.  I can't imagine in today's environment how we would be faring with little to no ability to borrow money, the cost associated with maintaining an infrastructure that was built starting in 1929 and trying to position ourselves for potential alliances in order to remain viable--not to mention implementing the triple aim of health care reform (better care, reduced cost and addressing population health). 

Secondly, roll the clock forward to 2010 and accepting the Maryland Rate Commission's offer to implement a new payment methodology called Total Patient Revenue (TPR).  Through TPR, we dramatically changed how we do business, shifting from a volume-based model to a value-based model, but ultimately preparing this health system for a transformation that the health care industry has never seen before.  We are now one of a very limited number of hospitals and health systems across the country extremely well positioned for the complete reform of our industry.   We just ended FY 2013, financially and operationally strong. We have thoroughly educated our staff and physicians on the changes in how we do business and now we are educating our community through Meeting the Challenge of Health Care Change.

As I have blogged before, this is a tough business, but a rewarding one in so many ways.  So, how's it going.........just fine, but because of the unbelievably strong and talented people associated with WMHS.

Taking Advantage of the Synergies of our Location

Yesterday, the administrative teams from WMHS and Allegany College of Maryland met to discuss the ways in which both organizations could benefit from being located across the street from each other.  Actually, that was one of the reasons why we located the new hospital on Willowbrook Road, to take advantage of the synergies of WMHS, ACM and Allegany County Health Dept. being adjacent to each other. 

WMHS has always had a very good working relationship with the Health Dept. since we jointly sponsor or work together on a host of  programs and have done so for many years.  Aside from the didactical programs in the Allied Health arena, my serving on the college board and  Dr. Bambara, ACM's President, serving on the WMHS Advisory Board, we weren't capturing all of the potential synergies between our organizations.  Well, yesterday that all changed in that we had a great meeting. 

After providing a perspective from the Community College and Health Care fields, we then began exchanging ideas as to how we could better work together.  We came up with a host of potentials including: guidance on strategic planning from WMHS; establishing linkages between IT, Facilities and Support Operations; assistance from the college as we expand our Leadership Institute; greater access for students with behind the scenes tours, practicums, internships, work study programs and project work at WMHS; use of media services at ACM; better preparation of the soft skills and critical thinking for graduating students as they seek jobs at WMHS; student focus groups with WMHS leaders as to the quality of their WMHS experience; assistance with Employee  Wellness support at ACM and the list goes on. 

A great deal was accomplished at this meeting and we agreed to at least meet annually.  At the VP level, they will begin having joint meetings with their dept. directors to establish relationships going forward.  It took some time due to leadership turnover at ACM, but we finally got to take advantage of those well intended synergies.

Walking the Talk

Like it or not, Bob Chrencik, the President and CEO of the University of Maryland Medical System is walking the talk.  He repeatedly warned the Health Services Cost Review Commission, legislators, the Governor and the media that if the 2% impact of the Sequester was not addressed by the HSCRC that UMMS would be forced to layoff staff directly impacting programs and services.   Left with no choice, UMMS is laying off over 350 employees; impacting staff and operations in Baltimore and on the eastern shore.  

In her recent update to the Maryland Hospital Association, Carmela Coyle, President and CEO, reported that the Governor is going to bat for two cruise lines at the Port of Baltimore because of the EPA's new cleaner fuel mandate.  The Governor is lobbying the EPA to obtain a waiver to save 220 jobs and the $90 million that the cruise lines pump into the economy.  Yet, hospitals across the state, in addition to UMMS, are having to reassess staff and programs in order to address the ongoing cuts. 

According to Carmela, hospitals account for almost 100,000 jobs in Maryland and contribute about $26 billion into Maryland's economy.  The financial condition of hospitals across Maryland has worsened to a level that I haven't experienced in my 23 years in Maryland health care.  Is change necessary to reduce the cost of health care in Maryland and across the country, most certainly.  Is there a better way to do that rather than simply cutting funds, one would think so.  The model used by the HSCRC to assist WMHS with our transition to a new payment methodology (TPR) was to provide us with upfront dollars to assist with a transition to a new model of health care delivery. 

Last year was a challenging year for us, but we were able to survive those challenges.  We ended up directly impacting around 28 employees while eliminating over 100 positions.  The upfront TPR monies helped to ease the impact on other positions at WMHS.  The transition has allowed us to better care for our patients in the most appropriate setting rather than everyone being admitted to the hospital.  Our intention over the next three years is to share the savings generated with those who pay for health care in Maryland and within our communities.  That's a model that works and similar models should be explored further in an effort to save hospital jobs going forward.