"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.

Tuesday, December 30, 2014

2014: A Year In Review

Fiscal Year 2014 is a year that WMHS can look back on with great pride.  Throughout the year, we continued to provide value-based care with that care being provided in the most appropriate location whether it was in the acute care setting, in a clinic, a physician's office or in the home.  We also continued to align our care delivery model with the Triple Aim of Health Care Reform: improving quality, making our community healthier and reducing the cost of care.  Many in the health care field continue to be skeptical of value-based care, but it is working.  

We are most fortunate that Maryland got it right by introducing a new payment methodology, Total Patient Revenue, four years ago in ten Maryland hospitals and Global Budget Revenue earlier this year for the remaining Maryland hospitals.  As a result, FY'14 was our second consecutive year for exceeding our net revenue over expense, which has enabled WMHS to re-invest those savings into programs and services that support our new care delivery model as well as to enhance our role as the safety net for the region.  This year was the first that we were able to provide funding to local agencies like County United Way, Salvation Army, Western Maryland Food Bank, Associated Charities, Allegany Health Right and HRDC that assist us in meeting the social needs of those patients whom we serve.  It is our intent to enhance the needs of our community through better transportation services for those getting to and from the hospital, assistance with housing, assistance with drug availability and cost, better dental care, healthier foods, bringing health care to the communities that we serve and better navigating the wide array of needs on behalf of our most vulnerable patients.

During FY'14 we have also achieved a great deal of notoriety in the success of our care delivery model.  We have presented to groups across the country; hospitals have visited WMHS to learn about our success; we have been written about in national publications, newspapers and journals; Maryland's Governor and the Secretary of Health visited WMHS in August lauding our accomplishments in care delivery and improvements in community health; and in December we were one of ten hospitals recognized by the American Hospital Association with its Living the Vision Award.  

Along with our partners, Meritus Health and Frederick Memorial Health System, we also formed the Trivergent Health Alliance this year.  The focus of the Alliance is improved clinical quality, better population health and the formation of a Management Services Organization where we consolidated Information Systems, Pharmacy, Human Resources, Revenue Cycle, Laboratory Services and Supply Chain.

Fiscal Year 2015 is not expected to be any different as we continue in the same direction through our ongoing focus in bringing improvement to our care delivery model, remaining as one of the top ten best hospitals in Maryland in improving the patient experience, reducing hospital acquired conditions, increasing the use of core measures and being there for all of our patients, especially those who are the most vulnerable with multiple chronic illnesses.  Some of the initiatives to watch for in FY'15 would be introducing community gardens into areas of our region where healthier eating is a necessity; bringing primary and speciality care to underserved areas of our region through a mobile health unit; new state- of-the-art technology in Cancer Care, Women's Health and Diagnostic Radiology to better diagnose, treat and care for those who we serve; as well as continue to recruit for both primary and specialty care physicians bringing the latest knowledge and expertise to our health system and community.

It may seem like a tall order, but with the dedicated and committed employees of WMHS and Trivergent along with our medical staff, we continue to be very well positioned.

Have a safe and happy New Year!

Tuesday, December 23, 2014

Top 11 CEO Bloggers

Last week, I received my regular newsletter from Fierce Healthcare, which writes each day on a variety of issues in health care.  The second article below the headline was "The Top 11 Health Care CEO Bloggers to Follow.”  Since I am a regular blogger, I thought, “Let's see who they are; maybe I can learn something from them.” Much to my surprise, I was one of the top 11 (how they came up with 11 rather than 10 sure beats me).  

Fierce Healthcare included some examples of my past blogs and based on the quality of the information shared by me, I made the list.  There are a lot of health care CEO bloggers out there and I am both humbled and honored to have been included.  

Blogging is becoming more challenging each day.  I used to blog on an almost daily basis, but that has become much more challenging of late.  I am now averaging two per week.  I would routinely write my blog when I arrived in the office at around 7 AM.  My day is now being consumed with so much other stuff that it is becoming more and more difficult to find the time.  Oh well, after the honor bestowed upon me by Fierce Healthcare, I had better find the time to blog with greater frequency.


Friday, December 19, 2014

Living the Vision

On Wednesday of this week, the ten Total Patient Revenue hospitals in Maryland were recognized by the American Hospital Association with their Living the Vision Award.  The award is given to hospitals for their work in improving the health of its communities through actions that go beyond traditional hospital care.  

We were honored to both be recognized for our accomplishments in value-based care delivery at WMHS and our work in creating the collaborative of the ten hospitals from across Maryland several years ago.  Truly an honor for the ten hospitals to be recognized as trailblazers for health care in both Maryland and across the country.

AHA President and CEO Rich Umbdenstock presented the award to WMHS
 and the other hospitals in the Maryland Total Patient Revenue Collaborative

Monday, December 15, 2014

Obamacare Blamed for Killing Hospitals

A friend shared an article with the above title written by Paul Bremmer in WND based on a book that is being written by Lee Hieb, MD, entitled “Surviving the Medical Meltdown: Your Guide to Living Through the Disaster of Obamacare.”  Looking for my perspective, the friend suggested that I write a blog about the article. 

The article notes the number of hospitals closing around the country, 18 acute care hospitals in 2013 and over 20 in 2014.  There could be a lot of reasons for a hospital closing: the size, the payor mix, the location, recruitment and retention challenges, the burden of regulation and even being closed by the regulators.  Not every hospital is well run and, sooner or later, that can catch up with a board or administration. It isn’t easy to run a hospital today and it is projected to get even harder based on payment reductions, an increase in regulation, and a shift from private insurance to Medicare or Medicaid.  

As noted earlier, hospitals across the US are faced with challenges of recruitment and retention of clinical staff.  There are shortages of physicians in rural communities as well as urban areas.  Recently, I had a conversation with a colleague who is a CEO at a large urban teaching hospital who, to my surprise, continues to have difficulty in recruiting neurosurgeons.  At WMHS, we struggle with recruiting primary care practitioners.  Under our new care delivery model of value-based care, we have an ever growing need for primary care and we are competing with hospitals across the US for urgent care physicians, hospitalists, primary care clinic physicians and office practice physicians.  Advanced practice professionals have been a Godsend, but we also need to maintain a balance between physicians and nurse practitioners-

The article states that as hospitals see a decrease in private insurance and a shift to government payment, as has been the case at WMHS, more hospitals will be closing because hospitals can’t keep up with reduced payment rates and ongoing denials of payment after the care has been provided.  In Maryland, we are fortunate to have either Total Patient Revenue and Global Budget Revenue.  Both payment methodologies are based on value-based care delivery and not volume-based care, as the great majority of hospitals across the country have.  Because of our rate regulation system and the Medicare Waiver, our payment model is based on the Affordable Care Act (Obamacare) and the Triple Aim of Health Care Reform: less cost, better care and improved community health.  The rest of the country is trying to figure out how to meet the requirements of the Triple Aim but under a fee-for-service payment methodology.  There are rewards and penalties for those hospitals just like in Maryland, but our model is purer: everything is aligned under value-based care except for physician payment and that should change in the short term.

In closing, I don’t think that it is as cut and dry to say that hospitals are closing because of Obamacare, but there is a great deal more that our government can do to prevent hospitals from closing.  Suggestions would include: aligning payment with value-based care delivery models; getting a better understanding of how care is actually delivered in hospitals and not relying on a set of standards by judging care delivery after the fact; reducing the burden of over-regulation; introducing tort reform measures; expanding the designated physician shortage areas across the country by location and specialty and by providing assistance to those hospitals that are struggling to ensure that they don’t close their doors in communities where the loss of a hospital would be devastating to a city or town.

Friday, December 12, 2014

Legislative Breakfast

This morning, I had the opportunity to attend the Chamber of Commerce's legislative breakfast.  I haven't been to one of these breakfasts in quite some time because previously it was the same thing year after year.  The delegation would talk about the challenges each year of western Maryland being slighted by the rest of the state because we are a more Republican dominated part of the state in a Democratic controlled state.  Well, as expected this year was different.  

Joining Senator Edwards, all of our delegates are now Republican with the defeat of Kevin Kelly and they are all heading to Annapolis to work with a Republican governor.  Although, both the House and Senate are controlled by the Dems, there is a feeling that both parties will be working together for the betterment of Maryland.  

According to our delegation, their focus will be in the following areas: 1) economic development with a real plan to provide tax-free incentives for 10 years to new businesses looking to locate specifically in western Maryland; 2) encouraging a more business friendly approach to our regulatory environment in Maryland, which is desperately needed; 3) pursuing new business interests in areas such as cybersecurity and biotechnology, as has been the case is Frederick with the addition of Astra Zeneca and 600 new jobs, and restore the highway user funds to the individual counties.  All in all, it was time well spent and I think that we will be better represented in Annapolis through this mix of new delegates.

Thursday, December 11, 2014

Silver Anniversary

Today, I celebrate my Silver Anniversary in Cumberland, first at Memorial Hospital and then, at the Western Maryland Health System.  I never imagined twenty-five years ago that I would still be in Cumberland celebrating such a milestone.  

When I first arrived in Cumberland, my plan was to get experience in the C Suite at a community hospital after spending almost fifteen years at two large urban teaching hospitals working at various levels in those organizations. Obviously, Cumberland was a wonderful professional opportunity at the time and it continues to be the case today.  

A little known fact is that just prior to my Thursday interview at Memorial, Pamela and I loaded up the kids in the car and drove from Pittsburgh to Cumberland on the previous Saturday.  Pamela was driving and we arrived in Cumberland through the Narrows on Mechanic Street.  It wasn't the best first impression of the area.  I said to Pamela, "Let's get out of here, I am canceling the interview." It was Pamela who said, "No, we need to drive around and see all of the area, not just one street."  We then drove to Memorial and I walked around the hospital.  I found the people to be the nicest that I had ever met and that continues today.  

We certainly had a blip in our community love fest when we first brought the two hospitals together to form the System; that is when I was getting the "get out of town" messages.  However, to have survived that tumultuous period was short of a miracle, but it happened and I am a better person because of it.  Today, we have a beautiful new hospital delivering care in a very new and different way, well ahead of the rest of the country.  All is good!

WMHS System Management acknowledged my Silver Anniversary with beautiful flowers. 

Friday, December 5, 2014

The Ongoing Disrespect of Left Handers

Today, I read about a Harvard University Economics professor who recently disclosed the results of his recent study in the Journal of Economic Perspectives.  He found that left-handed individuals from the US and the United Kingdom as making less money than right- handed individuals, both male and female; they are less talented; they perform more manual labor jobs; they do worse on cognitive skills tests; they have more emotional and behavioral problems; more learning disabilities and they complete less schooling.  

The last time that I looked, four of the last seven US presidents were left handed, along with Babe Ruth, Larry Bird, Arnold Palmer, John McEnroe, Jimmy Conners, Ivan Lendl, Fred Astaire, WC Fields, Cary Grant, Paul McCartney, Bill Gates, John McCain, Alexander the Great, Napoleon, Julius Caesar, Joan of Arc, Charlemagne, many kings and queens of England and France, Jimi Hendrix, Phil Collins, Benjamin Franklin, Sir Isaac Newton, Marie Curie, Michelangelo, Leonardo da Vinci,  Mark Twain, HG Wells, Henry Ford, Buzz Aldrin and me.  What a bunch of bunk! 

One in eight is left handed.  In addition to the above list, I know some pretty great people who are left handed, including my mother.  In my early years of Catholic School, one of the nuns tried to change me from writing left handed to writing right handed.  I came home and told my mother about the switch.  That was the end of that!  The next day, my mother was in my classroom and when the nun told her that left handers were known to be possessed by the devil, that's when the fun started.  Needless to say, I am still left handed and that nun didn't like me very much for the rest of the year but feared the wrath of my mother so, it all worked out.  

Wednesday, December 3, 2014

Governor-Elect Hogan

Last evening, I had the opportunity to attend a Maryland Hospital Association event in honor of Maryland's newly elected governor, Larry Hogan.  I found the Governor-elect to be exceedingly personable, very easy to talk with, engaging and overall pleasant to be around.  A really nice guy!  He made every person with whom he talked feel like they were the only person in the room and that they had his undivided attention.  

His remarks were genuine in that he said that it is not his intention to try to change Maryland from a blue state to a red state.  He wants to work in a bi-partisan way with the House and Senate in Maryland and that process has already begun.  He has met with both Senate President Miller and House Speaker Busch and felt that those meetings went very well.  (However, Senate President Miller was quoted yesterday saying that there will not be a reduction in state taxes no matter what the Governor-elect says.  Why anyone wants to get into politics is beyond me.)  

The Governor-elect was impressed with the economic impact statistics that Carmela Coyle, MHA President, shared related to Maryland hospitals, i.e. hundreds of thousands of jobs and billions of dollars in economic impact each year.  He has pledged to work with hospitals on our legislative priorities this year which are 1) to eliminate the hospital tax which started several years ago as $19 million to pay for Medicaid changes and has since mushroomed to over $400 million; 2) tort reform and 3) address to growing needs for Behavioral Health programs and funding throughout Maryland.  

Governor-elect Hogan said that he has a significant challenge ahead of him with a $1 billion deficit on a $40 billion state budget, but he expects his cabinet and advisers, who will be the best and brightest and both Democrat and Republican, to guide him through this challenging budget process.

During the time that I spent with the Governor-elect, we talked about western Maryland and the support that he has from my part of the state.  We also talked about WMHS.  After my description of building a new hospital five years ago and how we have since changed health care delivery over the last four years, he asked to visit and such a visit would be welcomed.  All in all, it was an evening very well spent.

Tuesday, November 25, 2014

So Much To Be Thankful For

As we approach Thanksgiving, it is an excellent time to reflect on what we have to be thankful for this year.  For me, there are so many things including:

  • My son-in-law Terrell, beating cancer this year and successfully recovering from a knee and partial femur replacement which was required due to the cancer.
  • My wife Pamela, who came into my life almost 40 years ago and whom I love more each day.
  • My daughters, Jessica and Lauren.  Jessica was faced with a plethora of challenges this year and successfully overcame every one of them.  Both daughters are wonderfully successful, both personally and professionally, as well as being two really nice people.
  • My executive team members, who are an exceptional group of people, extremely hardworking and do amazing things each day.
  • My Board of Directors, who are strongly committed to the success of WMHS and  personally supportive of me each day.
  • The WMHS employees and the many physicians who serve our patients each day.  These people are focused daily on the success of our mission.....Superior Care For All We Serve.
  • I am grateful for my extended family, my friends and my new colleagues through the Trivergent Health Alliance.

As 2014 comes to a close next month, I will be anxious for the year to be over, based on the personal challenges that my family faced, but excited for 2015.  A new year where we can continue to do amazing things, but with everyone around me healthy. 

Happy Thanksgiving!  Please have a safe and happy holiday.

Friday, November 21, 2014

Five Years

This week, we celebrate the five-year anniversary of the opening of the new hospital.  It is truly remarkable as to how fast those five years have gone and how great the facility has held up.  The amount of attention that was paid to the planning, the design, the construction, the move and the opening was simply amazing.  That hard work has paid off many times over.  Aside from issues with the elevators early on, we have been free of incidents related to the construction and subsequent installation of many new systems and technology throughout the hospital campus.  

We were so fortunate to have such a committed and dedicated staff five years ago; many who are still with us today.  These people perform exceptionally in their jobs and allow us to remain ahead of many hospitals with our technological and care delivery advances.  

Over the last five years, we have been recognized by the NY Times, the American Hospital Association, the Maryland Hospital Association, the Governor of Maryland, the Maryland's Health Secretary, just to name a few.  In December, WMHS and the nine other TPR hospitals will receive the American Hospital Association's Living the Vision Award.  

Since the opening to the new hospital, we have been doing some amazing things in changing how we deliver care and ensuring that the health system continues to be viable in an ever-changing health care environment.

Wednesday, November 19, 2014

Legislative Priorities for Health Care

Yesterday was a day well spent in Hagerstown.  Joe Ross, my counterpart at Meritus, hosted a forum for elected officials from across western Maryland, from Garrett County to Carroll County.  There was great attendance from delegates, senators, county commissioners and the aides to Senators Cardin and Mikulski as well as Congressman Delaney.  

The CEOs from the five counties presented on a variety of related topics and Carmela Coyle, President of the Maryland Hospital Association, gave the keynote presentation.  The four CEOs from Allegany, Washington, Frederick and Carroll Counties presented on today's successes and challenges related to health care reform, transitioning to value-based care delivery in our hospitals, and newly formed partnerships for healthier communities.  We also heard from the Garrett CEO, who gave a presentation on his many successes since arriving in January 2014 at Garrett Memorial, one of the state's smallest and most isolated hospitals.  Lynn Rushing, the CEO at Brook Lane, gave a wonderful presentation on behavioral health issues and challenges and Dr. Ted Howe, the Medical Director for the Williamsport Retirement Village, gave an enlightening presentation on new partnerships for improved resident outcomes.  

It was a great opportunity to provide our elected officials with information about how health care is changing and remind them that we need their support as we continue to evolve under the new Medicare Waiver for Maryland.  Again, time well spent.

Monday, November 17, 2014

Medical Malpractice

I was in Charleston, SC, last week for a meeting and, coincidently, my son-in-law's inpatient stay for his last chemotherapy treatment.  As a side, he was successfully discharged on Saturday morning and will hopefully never have to return to the "Cancer Floor" at MUSC.

On Friday evening after visiting Terrell in the hospital, Pamela and I needed to have dinner.  Terrell and Jessica suggested Fig, supposedly "THE" restaurant in Charleston and Charleston has many fabulous places to eat.  They suggested that we see if we could get two seats at the bar since there is a long lead time to get a reservation for a table.  So, we did and we were successful.  Shortly after we arrived, a gentleman arrived by himself and sat next to me at the bar.  He seemed like a nice guy and we started talking about food and travel and exchanged some recommendations of our favorite restaurants in Charleston and other cities.  

As our conversation continued, I asked what he did for a living and he said that he was an attorney.  A short time later, I asked what type of law did he practice?  He responded that he was a medical malpractice attorney. I jokingly yelled to the bartender, "Check please!" He then asked what I did; I told him and we laughed.  It was a fascinating conversation as he told me that medical liability is by far the most interesting and challenging law to practice and that it also pays very well (don't I know it).  

I was able to tell him about our approach at WMHS after we learn that harm to a patient has occurred.  I explained that we inform the patient of our error; apologize; meet with the family; provide the necessary support to all who are involved, including the caregivers; maintain open communications; waive all related fees and, when appropriate, offer financial support.  Our approach is to get out in front of the harm that we caused as soon as we verify that it has occurred and assess the situation to ensure that it doesn't recur. During our subsequent conversation, my new friend gave me the impression that, thankfully for him, most hospitals and physicians don't take that same approach.  

It was an interesting evening to say the least, from the build-your-own Manhattan menu, to the food that was so different and unique, to the best bartender by whom I have ever been served, to my new friend.  An interesting as well as enjoyable evening, especially when I can talk about the very progressive approaches that we are taking at WMHS.

Wednesday, November 12, 2014

The Last One

As many of you are aware, my son-in-law Terrell has been battling cancer, specifically high- grade osteosarcoma since February.  It just so happens that, truly by coincidence, I am in Charleston, SC, this week with Pamela for a meeting.  Charleston is where Jessica and Terrell live and where Terrell is receiving his treatment.  

We were able to arrive a day early, so yesterday Pamela and I had the privilege to take Terrell to the Medical College of South Carolina to be admitted for his LAST round of chemotherapy.  He will be hospitalized from Tuesday into the weekend, provided all goes well.  

Going into this last round of chemotherapy, he has had well over 60 inpatient treatments with various chemotherapy drugs and each hospital stay lasting anywhere from 4 to 13 days.  In addition, he had his right knee replaced, along with part of his femur, in June.  In addition to his hospital admissions, he has endured physical therapy several times each week since June, doctor visits and numerous procedures and tests since his diagnosis.  He has literally spent over a third of this year hospitalized.  

Through this ordeal, both Terrell and Jessica have truly become my heroes.  What they have endured since February and how they have handled it has been amazing.  Their faith, their resiliency, their endurance, and their ability to cope under such challenging circumstances have been remarkable. Their lives have been filled with ups and downs throughout the year, but normalcy returns next week.  

I want to thank everyone for their thoughts, their prayers and their concern.  People have been amazing, from the friend who organized meals almost every night since Terrell's diagnosis to the Greek Orthodox neighbor who provided anointing oil and holy water prior to each hospitalization, to the neighbors who watched Sammy (their dog), to their friends and relatives who have traveled from all over the country to visit throughout their ordeal.  The kindness and generosity have been overwhelming.  To think that both Jessica and Terrell have lived in Charleston, SC, for less than four years and to have such an outpouring of love, concern and friendship.  Both Jessica and Terrell, along with Pamela and I, have been truly blessed to have such wonderful people in our lives.  Please accept a most heartfelt thank you!

Friday, November 7, 2014

The Analysis and Implications of Maryland's Election Results

Yesterday, Nancy Adams, COO and CNE at WMHS, and I participated in a statewide conference call sponsored by the Maryland Hospital Association on the election results from Tuesday and what they mean for Maryland hospitals. Some of the background from the experts on the call was as follows: 

The outcome of the gubernatorial race was unexpected and based on the anti-tax trends against President Obama and Governor O'Malley, as well as an anti-incumbency trend.  Registered democrats in Maryland hold a two to one advantage over Republicans and Lt. Gov. Brown outspent Gov. Elect Hogan by a 4 to 1 margin ($19 million to $5 million), making the results that much more stunning.  

There were 1.6 million votes cast in total, which were less than what was cast in 2002 when Gov. Erhlich won (1.7 million votes).  Lt. Gov Brown lost by 75,000 votes to Gov. Elect Hogan.  There has been a steady decline in voter turnout, yet there has been an increase in registered voters in Maryland over the years.  Lt. Gov Brown won in Prince Georges, Montgomery and Charles Counties and Baltimore City but by a significantly lower margin than Governor O'Malley did four years ago.  Even Howard County, the home county of Ken Ulman, Lt. Gov Brown's running mate who was also the County Executive, was won by Gov. Elect Hogan by more than 5000 votes.  According to the experts, the 2012 redistricting based on the 2010 census that was done by the O'Malley Administration to strengthen Democratic districts didn't work to Lt. Gov Brown's advantage.

In the Maryland General Assembly, there are 57 new House members (seven new Republicans for a total of 50 Republicans out of 141) and 11 new Senators (two of which are Republicans for a total of 14 out of 47).

There will also be an overhaul of cabinet secretaries.  We are likely to see previous appointees from the Erhlich Administration since Gov. Elect Hogan served as Gov. Erhlich's appointment's secretary.  

For Maryland hospitals the message will not change based the election results.  We will continue to focus on preserving the Medicare waiver; reduce and eventually eliminate the Medicaid Assessment (tax) on hospitals; pursue medical liability (tort) reform and get State support for an increase in Behavioral Health services statewide.  MHA encouraged hospitals to build relationships with the newly elected House and Senate members in our districts and to appropriately educate them on issues facing WMHS as well as hospitals throughout Maryland.

Tuesday, November 4, 2014

Flu Shot News

Good news related to the flu shot in Maryland.  I learned yesterday that because of the Ebola scare, influenza vaccinations are up 30% so far this year.  Now it could be that the Ebola scare is reminding folks to get their shot, but I am also hearing from people who have opted out of getting the flu shot in previous years that they are getting it this year.  That's a good thing, but unfortunately it has taken the Ebola scare to get people motivated.  Isn't it enough that tens of thousands die every year from the flu?

I will be traveling for the next week and a half so I will be blogging intermittently.  Be well!

Friday, October 31, 2014

The Flu

I couldn't resist writing at least one blog during the influenza season on the flu.  I find it almost amusing as to the fear that is being expressed over Ebola by those outside of health care.  Yet, many of these same people who live in fear of contracting Ebola are still opposed to getting a flu shot.  On average 36,000 people die each year from the flu and hospitals are inundated with hundreds of thousands of  patients with the flu or flu-like symptoms usually from December through February each year.  

Getting the flu is far more easier and dangerous than Ebola, at least at this point in time.  Many say, "no" to a flu shot, but when asked if they would get vaccinated for Ebola, they say, "of course."  Americans are funny people.  According to a New Yorker article on "Ebola vs Flu," we underestimate the risk associated with common perils such as the flu, but overestimate the risk of novel or remote perils such as Ebola.  Similarly, we worry about flying and subsequently dying in a plane crash yet, by driving our cars everyday, our chances of dying are almost equal to dying from the flu.  There are around 30,000 car accident deaths per year in the US.  

So, if you haven't yet gotten your flu shot, get one.  You owe it to yourself, your family, your co-workers and if applicable, your patients.  Also, your chances of becoming a statistic will be significantly reduced.

Tuesday, October 28, 2014

The New Scarlet Letter, "E"

I just read an article on Texas Health Presbyterian's (THP) drop in revenue since since October 1, 2014.  Their revenue was down 26% or $8 million dollars for the first 20 days of the month.  As you will recall, THP is the hospital where Thomas Duncan, the first patient diagnosed with Ebola in the US, first presented himself in the THP ED and subsequently died on October 8th.  Two nurses who cared for Mr. Duncan then tested positive for the Ebola virus.  They have since been released from the hospital.  

The THP ED visits are down 53% and their average daily census fell by 91 patients over the same period.  One of the OBs at THP reported that since October 1, 15 of his patients chose to deliver their babies at other hospitals and not deliver at THP.  If the lingering fears continue and patients continue to seek care elsewhere, this hospital may not be able to recover from such losses.  What a tragedy if that happens.

Monday, October 27, 2014

Do You Know What Could Be Done With $4 Billion?

Over the weekend, I read an article in the Washington Post as to the cost of the 2014 mid- term elections.  The total price tag is projected at $4 Billion.   That's right, "B" as in Billions.  Fortunately, when I watch television, it mainly consists of programming that I have recorded so I don't have to watch paid political advertisements.  But, when I do catch one on live TV, it's never about what the candidate will do if elected; it is an announcer talking about the horrible things that the candidate's opponent stands for.  In these commercials, the announcer is even gifted in using their best voice of doom when describing the opponent, but then the same announcer turns cheery once the candidate and his or her family appear on the screen. 

Early on in the election cycle, the candidates may focus on what they plan to do or what they have accomplished.  Quickly thereafter, the candidates and incumbents alike end up in the gutter trashing each other with out and out lies.  If we are lucky, we may get a half truth on occasion.  The entire process sickens me.  

Talk about campaign finance reform, I have some suggestions.  Instead of spending ridiculous amounts of money on campaign advertising, severely limit such spending especially if the ads are negative in nature. With the amount of legitimate hunger and homelessness in today's world, the need for greater interest in the pursuit of studies in science technology, engineering and math among our youth and the need to cure devastating diseases, wouldn't the $4 Billion be much better spend elsewhere than on paid political announcements?  Of course, it would, but as long as those seeking and holding office benefit from such advertisements, change will never happen.  

Friday, October 24, 2014

Treating and Caring For Ebola Patients in Maryland

Below is a message from Carmela Coyle, President of the Maryland Hospital Association, regarding the latest on the care of patients in Maryland who may have been exposed to the Ebola virus.  On behalf of the Western Maryland Health System, I want to offer my most sincere thanks to Governor O'Malley and Secretary Sharfstein on rapidly establishing a treatment strategy.  Patients will be initially evaluated and cared for in whichever hospital that they present until they can be transferred to one of three designated hospitals in Maryland / DC.  The first preference of treatment will be a one of four federal facilities, but if they are not available, Johns Hopkins, University of Maryland and Med Star Washington Hospital Center are the newly designated centers.  

Hospitals across the State continue to prepare, train, educate and drill should a patient with symptoms for Ebola present at an Emergency Department, but the designated center concept is a good one.  With these three hospitals, a greater focus can occur with equipment allocation, training and CDC support rather than trying to provide the preceding to 40 other acute care hospitals throughout Maryland.  Leadership acted quickly and correctly.

MHA Update, Friday, October 24, 2014

Thursday, October 23, 2014

Refinancing Our Bonds

In 2006, we financed the new hospital through a bond offering with HUD's FHA 242 Hospital Financing Program.  We went to the traditional rating agencies and couldn't get an investment grade rating at the time due to the amount of debt that we would be incurring.  HUD was more than happy to assist, and the process went much better than we had expected.  

The only issue was the continuing oversight of WMHS required by HUD's bond covenants.  They required WMHS to submit a number of transactions for approval, i.e. anytime we changed our bylaws, made a major change (like joining the Trivergent Health Alliance), etc.  Earlier this year, we began to pursue the refinancing of our bonds, although the HUD relationship was far less onerous than anticipated.  

We contacted Standard and Poor's and they agreed to assess WMHS for an investment grade rating.  Kim Repac and I presented to the rating analysts from Standard and Poor's in September, and we were approved for a BBB stable rating, which is investment gradeOnce the approval was received, a lot of work began between the WMHS team, our attorneys and our consultants.  Kim and I flew to Boston last week and presented to financial and investment analysts.  Then, the next day we did a webinar for analysts from all over the country.  Lots of questions regarding our perspective on health care, our value- based care delivery model and how it differs from volume-based care, and even some questions on Ebola.  

When we first presented  the concept of refinancingto our board, we were told by our consultants that we could expect a 4% savings, depending where the interest rates were at the time.  We set a target of 10%, which would have been around a $25 million net present value (NPV) savings.  By the time we went out to the market this past Tuesday, interest rates were very favorable and the result was a NPV of $47.1 million dollars or a 19.94% savings of refunding the bonds.  Through this refinancing, we will save WMHS $47 million over the next 20 years and reduced the average life of the bonds by two years and reduced our new hospital debt by $94 million from $333 million to $236 million.  All in a day's work!

Tuesday, October 21, 2014

That Was An Interesting First

I am currently attending a governance education meeting out of town with five board members.  At one of the breakout sessions on Sunday (The Total Cost of Health Care), the speaker was talking about value based care delivery being on the horizon for all US hospitals.  At the beginning of his presentation, he actually asked the attendees if they would be converting to value based care delivery at some point in the future or not.  I was surprised to see a number of hands that went up when asked if they were not.  (Are they in for a rude awakening?)

During his presentation, the speaker provided a few examples of some health systems around the country that are dabbling in value based care.  None of the examples were remotely close to what we are doing in Maryland.

After the session, I went up and introduced myself and explained what was going on in Maryland with value based care delivery.  I also relayed the experiences at WMHS over the last four years.  He was very impressed and asked if he could come and visit me in western Maryland. I said, "certainly".

This same speaker was then presenting the next morning to several hundred attendees at the General Session.  In the middle of his presentation, he asked where the attendees from Maryland were in the audience.  I, along with the five board members stood up.  He then started asking me questions about our care delivery model which led to me providing a detailed overview of Total Patient Revenue and value based care delivery to the audience.

The round of applause at the end of my overview was very nice.  There were a number of attendees who reached out after the presentation asking me for more information.  It was also interesting to be in different locations around the hotel yesterday afternoon hearing attendees talking about our model of care delivery at WMHS; some admiring the initiative that we took four years ago and others expressing a great deal of skepticism as to whether it would work in their hospital.  Interesting.

Friday, October 17, 2014

Have You Ever Lost Your iPad?

Earlier this week when I was in San Diego for a speaking engagement, I unknowingly left my iPad in the large hotel ballroom.  I had settled into my front row seat to hear our keynote speaker, Magic Johnson.  We then received word that he was going to be late because LA was socked in with fog so instead he would be our lunch speaker.  I then left the ballroom without my iPad and didn't realize until a few hours later that I didn't have it.  

After getting over that initial sick feeling that it was lost forever, I went to the Find My iPad app on my iPhone and began the tracking process.  The location came up immediately as being across from the hotel at Starbucks.  I remotely sounded the alarm on the iPad and made sure that it was also locked.  The iPad was then on the move further away from the hotel.  I sounded the alarm again.  I sent a message to the iPad with my cellphone number and another alarm.  Lo and behold as I started my trek to the lobby from the 35th floor, the tracking showed that the iPad was returning to the hotel.  I kept sending alarms.  

By the time I got to the Lobby, the tracking was showing that the iPad was back in the hotel.  I went to the front desk and asked about the iPad.  They didn't have it, but called Security to inquire about it.  The iPad wasn't in Lost and Found, but they would let me know if it was turned in.  I kept sending alarms the entire time, not sure if the alarm sounds and shuts off or keeps sounding.  

I then thought that I should go to the conference registration booth upstairs to see if they had it.  I sent another alarm just in case so I would hear it en route.  As I approached the registration booth, I could hear my iPad alarm sounding.  As soon as I walked up to the booth, they asked if it was my iPad and I said yes.  They said "thank God, the sounding of the alarm was driving them crazy."  I suggested that the next time they are in a similar situation, that they open it up and see the telephone number on the screen that they could have called.  They said that they hadn't thought of that.  We laughed and I was thrilled to have my iPad back.  

I never found out who had it out for coffee and a short walk outside the hotel, but quite frankly, I didn't care.  I had it back. The Find My iPad / iPhone app is a great addition and I would suggest that you familiarize yourself with it just in case.

Thursday, October 16, 2014

WMHS Is Ready—Just In Case

WMHS, like all hospitals and health systems across the country, is following the evolving situation surrounding the emergence of Ebola in the U.S.  As part of our continuous emergency preparedness planning, our team had already developed a response plan for a possible case of Ebola coming to our health system.  That plan was based on the  guidelines established by the CDC at that time, and the team was getting everything in place for an appropriate response.  

Since the first Ebola patient was identified in Texas, our team has accelerated its efforts to have us ready.  Our team is constantly monitoring the CDC’s advisories and is in close contact with state and other federal health agencies.  It is meeting regularly to update our plan as new information becomes available, making sure our plan is consistent with the latest guidelines.  

Our staff is accustomed to following strict infection control and prevention procedures and we have the necessary personal protection equipment (PPE) available.  The readiness team quickly developed additional training for physicians and staff to practice the proper way to put on their PPE and safely remove it.  We also are using the “buddy system” where a co-worker monitors the process to ensure the right procedures are followed.  Over 100 employees have already gone through the training over the past several days.  

WMHS is committed to maintaining the highest standards and most current protocols to minimize the risk of anyone contracting an infectious disease like Ebola.  I want to recognize the many members of our readiness team for their hard work to get us prepared for this and similar situations.  It is an exemplary group of professionals who are dedicated ensuring the health and safety of our patients and our caregivers.  

Wednesday, October 15, 2014

SHSMD San Diego

This past weekend I had the opportunity to participate in the annual conference for the American Hospital Association's Society for Health Strategy and Market Development.  I was invited to serve on a Thought Leader's Panel for senior executives with three other individuals.  I was thrilled to serve with Dr. Henry DePhillipe, the CMO of Teladoc, and Lynn Miller, the EVP for Clinical Services at Geisinger.  The three of us had a great time, along with two senior executives from Kaufman Hall.  They are all exceedingly bright people; what an honor for me.  

We each had the opportunity to present background on ourselves as well was what we were doing to keep viable as a health care provider in an ever changing environment.  Of course, I presented on our journey from volume-based care delivery to value-based care.  As has been the case for the last year, the information was very well received.  We then were asked a question by our moderator about our perspective on the changes in health care, which gave me the opportunity to talk about the many initiatives that we are engaged in related to our new care delivery model at WMHS.  Again, very well received with lots of great feedback.  

The floor was then opened for questions.  During our pre-session lunch, our moderator expressed concern that I would get the bulk of the questions based on the uniqueness and success of our journey into value-based care.  However, he did a nice job of making sure that we all had the opportunity to participate.  There were several "crystal ball" questions based on what we know now and what can then be expected in the future.  The attendees had a lot of great questions and also offered some wonderful perspectives related to our various topics.  

In fact, after the session, the moderator asked if I was publishing our journey into Value- Based Care Delivery.  I said not at this time as there are too many things going on.  He said that I would be doing a disservice to the health care industry if I chose not to write a book.  Of course, I took that as a compliment and have started to think about the idea.  Anyway, it was time very well spent, and to be able to do it in San Diego with most of my expenses paid was certainly a bonus.

Tuesday, October 14, 2014

Blinded By the Light

The other day, I heard a national radio interview with a nurse who was leaving for West Africa to care for Ebola-infected patients.  She said that she was called by God to be there.  She said that she told her family that she had to go so please support her in her decision. She never asked for their permission, only their support.  

I certainly don't know her personal circumstances, but if I was faced with the same situation and my wife, a nurse, said that she was called by God, I would have trouble supporting such a calling, at least under the current circumstances in West Africa. I guess that I know too much.  I have read numerous accounts and have seen footage of what is happening in West Africa in the care and treatment of these patients. The conditions in which these people are being cared for are primitive at best.  They lay on rugs on dirt floors in large huts with scores of other infected patients around them.  There is an extreme shortage of gowns, gloves, masks, face shields, water, hand sanitizer and the list goes on.  

This nurse is going there for all of the right reasons but could be failing to grasp to gravity of the situation, well at least until she arrives.  God speed to all who find themselves in a similar situation.

Monday, October 13, 2014

Thrown Under The Bus

That sound you just heard was the newly diagnosed Texas Health Resources nurse who now has a confirmed case of Ebola, as well as the entire Texas Health Resources organization, being thrown under the bus by the Director of the Centers for Disease Control.  While he was at it, he either intentionally or unintentionally took the opportunity to throw the other 4999 US hospitals under the bus, as well.  

He told the world that the second contraction of Ebola in the U.S. was because of a breach in protocol, i. e. poor technique by a health care worker who is a nurse and a trained professional. Now the CDC is going to work with hospitals to teach us how to properly gown and glove.  

There were a whole lot of other ways the CDC could have handled this reported exposure, but they chose the "the bus route."  You gotta love politics.  The Director's self-proclaimed "tell it like he sees it" approach fails to mention that he is following the Administration's policies at whatever cost.  I can understand not wanting to create panic across the U.S., but maybe understand the situation a little better before declaring that hospitals don't know what they are doing, which seemed to be order of the day yesterday for ABC, CBS, NBC and CNN. 

Also, who better to deal with such matters as isolation, quarantine, worker and patient protection than hospitals, etc.?  This same government now has 4000 troops and Public Health Service members in or en route to west Africa to work directly with Ebola patients and their current caregivers.  Do you really think that the military and the US Public Health Service have thoroughly trained these individuals to follow their "well established" protocols; they haven't.  

One would think if you are with the Public Health Service that you would have the knowledge and background to deal with such situations.  They  are very well trained in many aspects of health care and medicine, but not the care and treatment of Ebola patients.  Everyone is getting a crash course.  These Public Health officers are coming out of federal prisons, off Indian Reservations and out of federal government offices such as CMS, FDA and CDC.  The same with the military; a crash course for the great majority, but yet hospitals that deal with similar exposure and subsequent isolation situations daily, maybe not as deadly as Ebola, are being criticized by the CDC for failing to follow protocols.  

How about stopping the travel out of west Africa, reserving judgment on the work of trained professionals, giving all US hospitals what they need to best care for and treat Ebola patients, designating some hospitals as super centers across the U.S. for the extended care of such patients and establishing the necessary regulations for the safe handling, transportation and disposal of Ebola waste rather than on a case by case basis.  You have had months, if not years, to have been working on this and so far very little has been done.  

Thursday, October 9, 2014

A Step By Step Guide To How Hospitals Discourage Doctors, Really?

I read a blog last week from a midwest physician who posted on KevinMD's blog page.  I am a regular subscriber to KevinMD and it has proven to be a great blog especially for physicians.  

This particular blog was about a radiologist who was waiting to see someone in administration and he finds a document that was left by a vendor / consultant.  The document was entitled, "How to Discourage a Doctor".  According to the radiologist, the document provides hospitals with tactics and proven strategies on how to better control physicians in their hospital.  He describes the contents which suggests that hospitals introduce barriers to the physician's care, increase their responsibility while decreasing their authority, no longer allow them to meaningfully influence health care decisions, promote a sense of insecurity among the medical staff, convince them that their professional judgement is no longer reliable, make health care incomprehensible through information technology, show physicians that they are no longer important in the care delivery model, transform all independent physicians to employees, insist upon the use of broad practice guidelines and subject physicians to escalating productivity expectations.  

What the blog did for me was to give me a good laugh.  When I first read the blog, I thought that it was a joke.  So, my reaction is as follows: first of all, the garbage that comes across my desk or finds it's way into my email box throughout the day from vendors/consultants is immeasurable.  Everyone's got an angle which would certainly be the case for the consultant who left this particular document.  If there are health care executives following these suggested tactics and strategies, they won't be around for long.  

Based on changes in health care today and going forward, hospitals have to find ways to better integrate physicians into the ever changing care delivery model.  If anything, the physician's role is more critical as we work to put the patient in the center of everything that we do.  Are their changes impacting hospitals and physicians, most certainly.  Are these changes at the expense of the physician, absolutely not.  We are constantly looking for ways to get the physician more involved with what we are trying to accomplish.  There are regulations and requirements that are being heaped upon hospitals (and soon to be heaped upon physicians), but we can only be successful if physicians and advanced practice professionals are part of the team.  

For example, with new IT systems, we are only as good as the extent of our medical staff's involvement in bringing such systems up.  Are we using protocols, we are and when a physician arrives who had been trained in using such protocols, you can't get them to deviate from them; they have a place in the new care delivery model.  Are we pushing physicians to be employees, nope.  We will work with them if they are interested, but employment is not for every physician.  We seek common ground for physicians who are looking for a different practice model.  Are we escalating performance expectations, we are for our employed physicians, but at the same time incentivizing them accordingly.

I certainly hope that the many physicians who read this radiologist's blog don't believe what this particular consultant was promoting, but if they do, they need to sit down with a member of the C-Suite with whom they are most comfortable and discuss the contents of the document.

Tuesday, October 7, 2014

Finally, A Study That Says Pot Is NOT Harmless

Professor Wayne Hall, a drug advisor to the World Health Organization, recently completed the results of a 20-year study on the effects of marijuana usage.  Some of his findings are as follows: 

  • The drug is not safe. 
  • One in 6 teenagers who use it regularly will become dependent on it.
  • Usage doubles the risk of psychosis, such as schizophrenia.
  • One in 10 adults who use it regularly will become dependent on it and it will lead to use of harder drugs.
  • Smoking while pregnant will reduce at minimum the baby's weight and impact its ability to thrive.
  • After smoking it and then driving, the risk of an accident is doubled.
  • It is harder to stop using than heroin.
  • Long-term use increases the risk of heart disease, cancer and respiratory disorders.
And his main finding is again the impact on teenagers; those who use it regularly can have mental disorders and addiction issues. The lone bright spot of the study was that it is less dangerous than heroin or cocaine in the risk of sudden death since you cannot take a lethal dose of marijuana.

Now, if you listen to Hollywood, liberal politicians and even our President, marijuana is not harmful, it should be decriminalized, legalized and ultimately, TAXED.  I agree with the decriminalization aspects.  It is ridiculous to have one state treat possession of a small amount as the equivalent of a parking ticket and another state  treat the amount as a felony.  Our President, who is a self proclaimed past user of marijuana, views it as a bad habit, liking it to smoking cigarettes, and says that it is no more dangerous than alcohol.  That may be true, but we all know that there are dangers associated with the use of alcohol, especially in excess, but to date we keep hearing that marijuana use is harmless, at least until now.  As a side and "to offer comfort," the actor, Jack Nicholson, said back in 2011 that he is a regular, but responsible user of marijuana......I rest my case.

Friday, October 3, 2014

My Concerns Regarding Ebola Continue to Grow

As the Centers For Disease Control continue to attempt to reassure the American public that there is nothing to worry about now that we have our first confirmed case of Ebola in the US, quite honestly, I feel that there is a great deal to be concerned about.  One can certainly start with the waste that is being created in the care and treatment of the patient in Dallas and the two patients who preceded him in Atlanta.

It appears that no one has told the Department of Transportation that they need to act "quick and in a hurry" on changing their regulations on the safe handling, transportation and disposal of products used in the care and treatment of these patients.  Right now, hospitals are pretty much on their own as no company that deals in hospital waste is permitted to handle Ebola waste at this time.  The hospital in Atlanta was forced to have their staff go to Home Depot stores throughout the city and buy all of their 30 gallon drums to store the waste.   Hospitals and public health agencies have been under the gun to gear up for Ebola while the DOT has done what appears to be little in addressing handling, transportation and disposal of Ebola waste.  

Then there is the demand associated with hospitals across the US in acquiring key items such as gloves, masks, linens, special supplies and equipment to be prepared for patients exposed to the Ebola virus.  With 13,500 active US visas from Liberia alone; all 5000 of US hospitals have to be prepared.  Since travel is not restricted from Liberia or west Africa, anyone of these people could walk through our doors at anytime.

It has already been determined that the Dallas patient from Liberia lied on his health application in order to travel to the US.  How many more are out there who will do whatever it takes to get to the US for treatment after an exposure? The gearing up will create immediate shortages not to mention the cost of acquisition for which we are pretty much on our own.  

Then there's the concern that no one wants to talk about which is using infected patients or their waste products are weapons for terrorism.  My opinion is that hospitals, public health agencies and even government need more time to prepare for this epidemic and the residual impact that this will have on our country.  Day to day, there is a lot that goes on with government that concerns me; this issue scares the hell out of me!

Thursday, October 2, 2014

A Series of Teachable Moments

In recent days, we have learned of the first confirmed case of Ebola in the US.  A Liberian man flew from Liberia in West Africa to Brussels, Belgium, then to Dulles Airport in Virginia and onto Dallas, Texas.  He came to this country to visit his girlfriend, who is also the mother of one of his children; she has four other children, as well.  

Shortly after his arrival, he fell ill and went to the ED at Texas Health Presbyterian in Dallas to be seen.  The appropriate CDC protocols for Ebola were followed as a part of his triage as it relates to questions being asked regarding his travel.  However, the RN failed to communicate that he recently came from Liberia or the provider in the ED failed to pick up on this critical piece of information.  The patient was never admitted and subsequently discharged with antibiotics.  

Two days later, he returned to the same ED, this time via ambulance, and eventually tested positive for Ebola.  In that two-day period, he was exposed to many members of his girlfriend's family, including her five children who went to school after being exposed to the patient.  The authorities are still trying to determine the extent of the exposure including other family members, members of the community, the EMTs and unsuspecting health care providers.

Now for the teachable moments, first the communication in the ED.  I can't imagine how the intake RN and other providers feel at this point in time after not sharing or picking up on a critical piece of information regarding this patient.  The second teachable moment is with the US government allowing unrestricted travel to and from a hot zone like Liberia and other hot zones for Ebola in west Africa.  Third would be the US airlines that have not ceased travel into and out of these hot zones.  I am not sure what their reasoning is, but they have the potential of putting a lot of people in harm's way by not following the lead of other international carriers who have suspended such flights.  The reason that the US government has given for not restricting travel is the criticality of commerce to and from that region.  Really?  

I would feel a whole lot better if public health had more experience in managing Ebola exposures and preparation for ongoing exposures, which they will acquire over time but more time is needed.  With unrestricted travel to the US, there will be a burden that will eventually impact public health and health care in caring for and protecting the general public from exposure. There needs to be greater protection of Americans on the part of those who can do something about keeping us safe going forward.  There are  quite a few lessons that can be learned from this exposure; hopefully, common sense will prevail and changes are imminent.

Wednesday, October 1, 2014

You've Made My Day

This morning while I was on rounds throughout the hospital, I stopped to talk with one of the nurse managers.  She told me that one of her staff nurses included in the comments section of her performance evaluation that she wanted to sit down and have a cup of coffee with the CEO.  The nurse asked the nurse manager if she could arrange that.  The nurse manager said that she would try.  

Well, it just so happened that this particular staff nurse was working today.  I had the opportunity to meet and briefly chat with Kiea Barnes.  She said that she had heard so much about me and wanted the opportunity to meet me and to sit down and have a cup of coffee.  I asked her if a cup of tea would work and she said of course.  It was a very pleasant conversation, ending with her saying that meeting me made her day.  I told Kiea that she certainly made my day as it was very kind of her to want to sit down with me just to talk.   And talk we will; arrangements are  already underway for our chat.  

I was told many years ago by my predecessor that when it comes to how people view a CEO, they see you sitting on top of a flag pole.  One group looks at you and admires what it took for you to get up there.  The second group says that you are crazy for being up there and the third group tries to shake the pole to get you to fall off.  Kiea is certainly in the first group and it is very much appreciated.  I am so fortunate to have such a wonderful group of employees like Kiea who support what we are trying to do each day to advance care delivery in our community.

Tuesday, September 30, 2014

Sympathy for the Recovery Audit Contract (RAC) Process, Really?

I read an editorial this AM from the editor of Fierce Health Finance and I think that it's a first........someone sympathetic to the RAC process.  I have written a number of blogs on this topic in the past as to the absurdity of the RAC process.  Centers for Medicare and Medicaid (CMS) created this process to rid health care of waste and inefficiency.  For the most part, I have no problem with the concept since both exist and need to be eliminated.  It was the way in which CMS went about putting the program in place.  

Their contractors deny virtually every appeal at the first two appeal levels, where the CMS contractor gets paid a percentage for every identified RAC claim.  At the third level where the appeal involves an administrative law judge who is outside of the RAC contractors' purview, the game changes.  At the ALJ level, WMHS has won virtually every appeal.

Unfortunately, CMS and their contractors got greedy and as a result, hospitals and health systems are now challenging every denial at the administrative law judge appeal level.  Previously, many hospitals budgeted a percentage for the RAC process as a cost of doing business, but not any more.  As a result, it would take decades to hear every appeal at this level.  

Since CMS put a flawed process in place, they are now offering hospitals 68 cents on the dollar to settle short stay claims and scrambling to figure out a solution to their backlog of the rest of their cases.  Of course, hospitals are taking advantage of the settlement offer.  
At WMHS, we have had over $10 million dollars tied up in all RAC appeals; and through the settlement just for short stay disputes, we should receive over $3 million.  

Now the editor of Fierce Health Finance is equating hospitals to the five year old who hasn't gotten his way.  Really?  I took the opportunity to read previous editorials from this same guy and he is obviously no friend of hospitals.  It's time to cancel my subscription to Fierce Health publications; if you can't be balanced in your editorials, I have no use for your tainted opinions.

Thursday, September 25, 2014

Summit on Population Health

Yesterday, I had the privilege to serve on a panel of "experts" on population health at the Mid-Atlantic Summit on Population Health.  The focus was "Value Based Payments in Population Health: Accelerating Concept into Reality."  Two of my favorites presenters preceded the panel discussion, Anirban Basu, the Chief Economist for the Sage Policy Group, and Dr. David Nash, Dean of the Thomas Jefferson School of Population Health.  I have heard both speakers a number of times; in fact, Anirban served as our keynote speaker at our board summer planning meeting last year.  He is extremely knowledgable and quite entertaining as a presenter.  David Nash is also an excellent presenter and is one of the nation's leading experts on population health.  He is a frequent speaker at the Governance Institute meetings and his message now resonates very well with what we are doing at WMHS.  

What I found yesterday was not necessarily that deer-in-the-headlights look from the audience, but still a look of skepticism regarding accelerating concept into reality by what we have done over the last four years with value-based care delivery at WMHS.  We are living it, but it is really hard for those who have been part of the fee-for-service or volume- based care delivery model for their entire career to understand  just how value-based care really works.  I tried to assure the group, including a number of folks from outside of Maryland, that it does work and that I would never go back to fee for service.  Unfortunately, it doesn't really sink in until they visit with us.  Once they see first hand the success that we have achieved in reducing admissions, re-admissions, and use rates; improving quality-based reimbursement and patient satisfaction scores and ultimately providing better care to those patients who are our high utilizers with multiple co-morbidites, they become believers.  

As I have blogged previously, we have had a multitude of visitors to WMHS to experience our journey on value-based care delivery; I guess the rest will have to experience it for themselves.

Wednesday, September 24, 2014

It's Hard to Believe

Recently, WMHS was notified that our application for a Department of Health & Human Services grant on Mobilization for Health: National Prevention Partnership Awards Program was approved.  This grant submission took a great deal of time to assemble and to ensure that it was thorough in meeting the scoring criteria requirements.  The grant request was for $1.3 million; and as I noted previously, it was approved.  Time to pop the champagne corks........$1.3 million and it was approved.  

Unfortunately, the celebration stops before it begins.  The letter from HHS says, "Your application was approved, but UNFUNDED because there are no remaining funds available."  I am not joking; that's what the letter from an acting Assistant Secretary for Health says.  Why bother seeking grants or approving grants when you have NO MONEY?  I can't stop shaking my head in disbelief over this one, but then again, it's government and, based on some of their actions over the years, I should be less and less surprised.

Tuesday, September 23, 2014

Don Alexander

Yesterday, I blogged about my trip to Germany and how good it was to be home. Unfortunately, when I arrived back in the US, I was immediately informed of the death of Don Alexander, President of Allegany College for nearly 30 years until his retirement six years ago.  But, more importantly, at least from my perspective, Don was a Memorial Hospital and then a WMHS board member for well over 17 years.  He served as the WMHS Board Chair for three years just a few years ago.  Don served our organizations so very well and he will be missed immensely.  

Even in Don's retirement, we would stay in touch.  Don would send a politically charged email, a joke or a message that immediately complimented me and my team when he read something favorable about WMHS.  Even during some of our most challenging times early in the WMHS history, Don was always upbeat and positive.  He was a gentle giant in so many ways; not so much his stature, but in every other way.  

In the decades of knowing Don, I never heard an unkind word spoken about him.  He touched so many lives in so many ways.  I looked to Don as both a friend and a mentor.  Fortunately, I am left with some wonderful memories and stories from Don but sad to have lost someone so special far too early in one's life.  Don's wonderful sense of humor and his kind heart are now in a better place and free of suffering from the ravages of cancer.