A Pretty Fascinating Week Comes to a Close

As I prepare to leave Florida after what has turned out to be a pretty fascinating week, I want to reflect on some of the highlights.  First the venue: South Beach on Miami Beach is very nice.  Then the weather: for at least three days it was beautiful.....sunny and 80 degrees.  Rain and "cooler" temps for the rest of the week.  By the way, those cooler temps were 70 to 75 degrees.  This was a nice escape from the frigid temps up north.  Then, the opportunity to tell the story of the Western Maryland Health System by presenting to the American Hospital Association's Board of Trustees at their retreat.  That presentation went extremely well and appeared to have been very well received by those in attendance.  

I then presented twice to board members, physicians and C-Suite members from across the country at the Premier Governance Education Meeting.  All presentations were on the same subject - our successful transition from volume based care delivery to value based care delivery.  For the Premier sessions, Kim Repac, CFO; Nancy Adams, COO/CNE; and Rolf Haarstad, a WMHS Board Member, join me for the Q&A.  Their  presence was invaluable in that there were a lot of questions that Kim Repac in particular could answer without hesitation.  

There are so many nuances with our Total Patient Revenue payment methodology as well as the new Medicare Waiver in Maryland and our rate system.  Nancy provided a great perspective on the clinical intricacies of value based care delivery and Rolf gave more of a perspective from his professional role as an architect. (What do you do with all of that inpatient space that needs to be repurposed?)  We were very fortunate to have six board members in attendance for the Premier Conference and they attended at least one of my sessions.  It was great for them to hear from others as to how we are trendsetters in the health care industry through our new care delivery model and how we have been successful in implementing it in western Maryland.  

At the end of the second presentation, Derek Feely, who presented two years ago at the same conference came up to me to congratulate me and WMHS on our stunning achievements in value based care delivery.  Derek was previously the Kathleen Sebelius of Scotland.  He was their Health Minister.  He is now with IHI (the Institute for Healthcare Improvement) and asked for my contact information so they could contact me.  Derek said that we have made some remarkable achievements and our story needs to be told to every US hospital as they wrestle with their transition from volume to value.  All in all it was a very good week. 

Bob Woodward of Woodward and Bernstein Fame

One of the presenters at yesterday's Premier meeting was Bob Woodward of the Washington Post.  He had quite a few great stories about Washington DC and with whom he has interacted with there.  Hillary Rodham Clinton is certainly not a favorite of Bob's.  He said that her motto is fake it until you make it and she has a lot of experience faking it.  He wasn't a fan of Harry Reid, Barack Obama or George W. Bush.  Woodward said that Harry Reid is pretty much an empty suit; President Obama makes no human connection with anyone and former President Bush wasn't the sharpest tool.  Asked who he admired the most as a great leader and his answer came as quite a surprise.  His answer was Gerald Ford.  Remember that former President Ford pardoned Richard Nixon and at the time everyone thought that it was corruption at its finest.  Twenty five years later, Bob Woodward sat down with Gerald Ford and asked the question as to why the pardon was granted.  He said that a deal was requested by Nixon's chief of staff.  Ford declined the deal but pardoned Nixon anyway,  The reason for the pardon was it was what the county needed. Ford risked being re-elected as President and of course he lost the election to Carter.  It took great courage for Ford to pardon Nixon and twenty five years later was awarded the Kennedy Profiles in Courage award for his action twenty five years earlier.  Everyone thought that a deal had been cut and here that was never the case.  It was done to protect a nation.

Premier's Governance Education Conference

What a great time to be in Miami Beach and missing all of that "wonderful" weather back home.  I was invited in November to present at the Premier Governance Education Conference.  This conference has board, C - Suite and physician attendees.  My topic was "Capitalizing on Change: Improving Value and Community Health. The presentation focused on how we re-engineered our organization to deliver care under value based care delivery model.  I was able to provide information on the innovative strategies and individual successes that we have put in place over the last three year as well as the results that we have acheived.  There were two concurrent sessions where I presented and joining me on stage were Kim Repac, CFO, Nancy Adams, COO/ CNE and Rolf Haarstad, Board Member for the Q&A session after each presentation.  Both presentations were very well received by those in attendance with many compliments being offered. I greatly appreciate the assistance of Kim, Nancy and Rolf.  There were lots of great questions and it gave recognition to especially Kim and Nancy and their leadership in driving all aspects of Total Patient Revenue throughout WMHS for the last several years.  It was a wonderful opportunity to showcase WMHS to health care leaders across the country.

Meetings in Miami

Yesterday, the presentation to the American Hospital Association Board of Trustees went very well.  They were very welcoming and most appreciative of the presentation.  They said after the presentation that there was hope in being able to Redefine the H, the theme for their conference.  The ten TPR hospitals have really figured out how to deliver a much better care delivery model and to be successful at it.  Lots of great questions.

Then last evening, the keynote speaker for our Premier Governance Meeting was Hillary Clinton.  This was her third presentation for the day and if the NY Times is accurate, yesterday was quite a payday at $200K per speech.  I found her to be engaging, extremely knowledgeable on issues other than health care.  She read prepared remarks from the teleprompter related to our work in health care and you could tell that someone else wrote her remarks.  

However, once she moved to politics and her roles as Senator and Secretary of State, she was very much on her game.  She said her greatest moment as Secretary of State was the capture and death of Osama Bin Laden and her worst was the death of Ambassador Stevens and three others in Benghazi.  Good answers under any circumstances, especially if you are running for President.  She did not use our venue to announce her intent.  

Other great moments had a more human interest spin, i.e. freeing the Chinese dissident from the US Embassy in China where he sought asylum.  In her opinion, the best world leader to work with is Angela Merkel, the German Chancellor, and the worst is Vladimir Putin, the Russian President.  At least Hillary has her dislike for Putin in common with George W. Bush.  We heard W speak two years ago at this same conference  and say that he very much disliked Putin for the same reasons--that he is an intimidating bully who is trying to make Russia great once again but is failing miserably.  The greatest threats against the US over the next five years per Hillary are terrorism (I guess we didn't defeat it after all), weapons of mass destruction (and we are negotiating with Iran to keep their enriched uranium?) and China picking fights of already claimed territories, islands, atolls, etc. mostly with Japan.  

All in all, it was a most interesting evening; and like her or not, she is very much Presidential material.

State of the State

In last Thursday's State of the State address by Governor O'Malley, the ten TPR hospitals in Maryland were mentioned.  The except of that part of his speech is as follows:

"...with the leadership of Lieutenant Governor Brown and Secretary Sharfstein, and I must add the support of our Congressional delegation, earlier this month we embarked on a new and better way to improve wellness and reduce overall health care costs.  Let me talk about this for a second.  The old payment system for health care encouraged the volume of services instead of the wellness of our people.  The more sickness, the more pay.  It was a system that made it look as if even our hospitals needed hospitals.  But not any more.  This new approach will change our payment system to reward hospitals for actually keeping people well.  It has been described by health care experts as without any question, the boldest proposal in the United States in the last half century.  Ten of our forty six hospitals in Maryland have already adopted this new approach partnering with nursing homes, public health agencies, primary care doctors, wellness professionals and others to keep their communities well.  It works.  It achieves results.  It's a better way.  And it will improve wellness."

This week, I am in Miami.  I have been invited to present the concept of Total Patient Revenue and how well it has worked at WMHS to first the American Hospital Association at their board retreat and then at the Premier Governance meeting.  Leslie Simmons, the President of Carroll Hospital Center, will join me at the AHA presentation.  Kim Repac, CFO at WMHS, Nancy Adams, COO / CNE at WMHS, and Rolf Haarstad, a WMHS board member, will join me on stage for the Premier presentation, which will be presented twice.

We did a great thing four years ago when we chose to change our approach to health care delivery.  Now others want to learn from us as we blazed a very new and challenging trail in health care.

Thank You, Patrick Kennedy

Below is a story that appeared in Politico based on Patrick Kennedy's appearance on MSNBC last night.  The article very nicely complements my blog from yesterday on the dangers of marijuana.

Patrick Kennedy to President Obama: Pot has changed - Tal Kopan - POLITICO.com

http://www.politico.com/story/2014/01/patrick-kennedy-president-obama-marijuana-102412.html

My New Favorite Topic

In today's Cumberland Times News, there is an article on what is fast becoming my favorite topic, the decriminalization of marijuana in Maryland.  Senator Jamie Raskin, D - Montgomery County, is sponsoring the Marijuana Control Act of 2014 along with Delegate Curtis Andersen, D - Baltimore.  Last week, Governor O'Malley said that he is opposed to legalizing marijuana in Maryland, citing that it remains a gateway to harmful activity.  Delegate Anderson countered with "studies now show that marijuana is no longer dangerous" and that "it's not the addictive drug that we have been led to believe that it is.”  Sen. Raskin said that marijuana is a gateway drug in a whole different respect.  He said that a marijuana arrest could prevent young people from getting jobs or getting into school.  

Advocates say a lot of things in order to get their message out, and obviously Del. Anderson believes whatever they say.  I, on the other hand, will stick with research in the health field that marijuana is addictive and can be a gateway drug as well as my personal experience.  When I arrived at college at the beginning of my freshman year, alcohol was the preferred "high of choice."  By October, it was smoking marijuana (which is as far as I got and all that it did was make me throw up).  By December, it was hash being smoked by my fellow students.  After Christmas break, Quaaludes were the high of choice; and by the end of the school year, cocaine was being introduced.  It was interesting, those students who were really into the Quaaludes and eventually cocaine never returned for the next school year.  Also by the second year, no one could afford drugs, especially when you could get a six-pack of Valley Forge beer for $1.10.  

I don't think that behaviors have changed that much and isn't the THC component of marijuana much stronger than it was 30 years ago?

I continue to have a great deal of trouble with legalizing marijuana, taxing it and supporting education programs, school construction, all day kindergarten and ALCOHOL treatment programs.  What's next in order to keep our youth out of jail-- that we will find what is an acceptable amount of cocaine or crystal meth and legalize it too?  

Then there is President Obama, who said recently that he supports limited legalization of marijuana because it could help reduce the number of African American and Latino men who are jailed for drug offenses.  There are a whole lot of other initiatives that could be pursued instead of legalizing marijuana to keep these men out of jail.  I wonder if anyone would consider legalization of the other drugs that may result in a higher number of arrests for Asians, whites or American Indians?  That's how ridiculous these arguments really are.

Maryland's New Medicare Waiver Agreement

Last Thursday, there was an announcement in Baltimore by the Governor about the new Medicare agreement for hospitals in Maryland to focus on population health.  Hospitals will do this by preventing illness and keeping communities healthier while reducing costs and providing higher quality.  Hospitals in Maryland will now work to care for patients in the most appropriate setting whether it's in a physician's office, a skilled nursing facility or an urgent care center.  Sound familiar?  This is value-based care delivery; something that WMHS and nine other Maryland hospitals have been doing for the last three plus years. 

It's nice to have been an early adopter in this demonstration project.   Based on our experience, we are now going to be assisting the Maryland Hospital Association and the other hospitals in Maryland by working with them on value-based care delivery, reducing the cost of care and working to improve the health status of our communities.  In the first year of our demonstration project, the ten hospitals formed a Collaborative to learn from each other, share experiences, create a single set of metrics and to have a single voice for the Collaborative in Maryland.  Some of the results and outcomes have been remarkable in what the ten hospitals of the Collaborative have achieved.  These are exciting times at WMHS and across the Collaborative as a result.

Minimum Wage in Health Care

There is an editorial in yesterday's Modern Healthcare magazine, "Raising the Minimum Wage will Help Improve Healthcare Productivity.”  This is an area where I agree that the $7.25 minimum wage rate is unacceptable.  Quite frankly, a fast food worker making minimum wage is appropriate since it is a job that was designed to cater to high school and college kids; it was never meant to be a career.  In healthcare, the work is far more demanding than "do you want fries with that burger."

As Merrill Goozner, the editor of Modern Healthcare, writes, "wages in these (health care) occupations are extremely low and are expected to remain so."  Having an average wage for such employees as Goozner writes of $9.50 is ridiculously low.  At WMHS, our starting wage rate for an entry-level service employee is $9.55 per hour, remember that's starting wage rate not the average.  We made a commitment to a socially just wage when we were part of Ascension Health and have remained committed to it.  

Goozner continues, "one thing that when healthcare employers are faced with a rising wage tab, they look for ways to improve productivity to offset their increased labor costs."  He's right.  At WMHS, we performed a labor and supply analysis during FY '12 generating an annual savings of over $8 million.  That savings positioned us to give a bonus last May to all of our employees and to provide $2.5 million in wage increases this fiscal year.

A socially just wage rate is long overdue in hospitals especially as these lowered skilled jobs become the fast growing occupations in health care.

Robert Gates / Duty

I am yet to really sit down and read former Secretary of Defense Robert Gates’ new book "Duty," but I have been reading excepts over the last several days.  I am not enamored with his insider criticism of a seated President, but then again I am old school.  However, I still have a great deal of respect for Secretary Gates as this time last year I had the opportunity to hear him speak and I was thoroughly impressed.

He is a man of character and conviction; he served two US Presidents as Secretary of Defense, one very right of center (Bush 2) and one very left of center (Obama) and did so extremely well.  Robert Gates is very well respected and was committed to the men and women serving in our armed forces.  His love and admiration for them came through repeatedly throughout his speech.  

What I have found surprising in his book is his extreme criticism of Congress.  He labels them as incompetent, uncivil, petty, sanctimonious, hypocritical and dysfunctional.  He says "they routinely subordinate the national interest to their own." Now, none of this is a surprise, except maybe to the members of Congress.  Even their staff recognizes their dysfunction.  I was at a presentation last week when a senior Congressional aide said, "after all, we talking about Congress, so our expectations have to be very low." 

So, if everybody sees it, why isn't anything being done about it?  When Robert Gates says that Congress is pretty much a national disgrace, it's a great start, but more needs to be done.  My solution, we need a term-limits initiative to start immediately.  Many members of Congress get far too comfortable with a prolonged stint and forget why they were elected in the first place.  I will take you back to my first meeting with Congressman Bartlett when he was running on a term-limit platform back in 1992.  He was elected and began serving in 1993.  He left Congress last year after 20 years.  I rest my case.....far too comfortable.