You're Fired…

Commonly uttered by Donald Trump on his show "The Apprentice,” WMHS was on the receiving end of the "you're fired" message from Rocky Gap Resort and Casino.  After having the WMHS Foundation's Golf Tournament there for the last nine years, we recently got the boot.   

We were scheduled to have a meeting with their general manager to discuss some issues from last year's tournament as well as this year's tournament; but when we called to reschedule the meeting because one of our attendees couldn't make the meeting, we were told that the meeting wouldn't be necessary.  We were then informed that our golf tournament would no longer be held at Rocky Gap.  They were releasing the hold date for our tournament in an effort to get other perspective business.  I guess that the rooms that we reserved and the thousands of dollars paid to them for the event weren't enough.  In addition, the business that we brought them over their many lean years in the form of rooms reserved, meetings held, meals eaten and rounds of golf played.  So much for the casino's new owners, Lakes Entertainment, partnering with and endearing itself to the community and, in particular, this community's largest economic driver.  

Oh well, it’s onto pursuing an alternate location for our golf tournament in September.  In addition to the Cumberland Country Club, which does a fabulous job with the event, we are in discussions with Bedford Springs Resort.  Quite honestly, Omni has done a wonderful job at Bedford Springs and it’s less than 30 minutes to the resort from WMHS.  We have far too many golfers for both a morning and an afternoon round, so, it’s onto another site.  Karen Johnson, WMHS Foundation's Executive Director, and her staff will do their same wonderful job in delivering another very successful golf tournament even without Rocky Gap.

CEO Exodus

I read this AM that the health care industry has experienced its highest rate of CEO turnover in 30 years.  Yikes!  Twenty percent of all hospital CEOs were replaced in 2013 according to the American College of Healthcare Executives. Apparently, the reasons are related to mergers, acquisitions and alliances as well as changes in how care is currently or is going to be delivered.  

Many CEOs, such as myself, had evolved in a fee-for-service environment, where volume was the driver of health care services and revenues.  They now see the new approach to care being delivered based on value as too much of a challenge.  Not me.  I have embraced the change and feel that care is being delivered better than ever at WMHS.  I have heard from a number of colleagues that the adjustment will be too difficult and they are leaving the C-Suite.  Some have said that they will go into consulting.  I not sure as to their areas of expertise in that every aspect of health care is changing from Finance to Governance to Operations to Patient Engagement to Service Delivery to Patient Care.  

If you fail to embrace the new direction of health care delivery, you will fast become that proverbial "dinosaur" and that's sad.  Never has an industry changed as dramatically as health care is changing today and into the future.  I wish them luck in their transition.

Not-So-Safe Driving

This morning, I was driving to work and behind me was a guy driving an SUV larger than mine. While he was driving, he was reading and drinking coffee.  The coffee and the document that he was reading were in each hand. along with the steering wheel.   Even at 30 miles and hour, he was traveling around 30 feet per second.  So, you can imagine my concern every time traffic slowed or we had to stop.  Even if he was looking at his paper for only two to three seconds, he was traveling 70 to 100 feet without looking at the road.  Thank God that he wasn't tailgating, too!

Last week, I was on I-95 returning from South Carolina.  As I am driving about 75 miles per hour (the speed limit is 70 in North Carolina on I-95, but you are pretty safe unless you exceed 80), I notice in my rearview mirror that there are two speed bikes in the left lane.  They are coming up at a very high rate of speed.  I estimated that they were going well over 100 MPH.  As they passed me, I was able to see that they had on, in addition to helmets (its the law in NC), chest protection safety vests. Really?  At over 100 MPH, if you become separated from your motorcycle, you are DEAD.  There is no product on the market that is going to protect you from massive trauma to your entire body.  

During the same trip on I-95, I have never seen so many vehicles pulled over and being searched for drugs.  There were multiple vehicles pulled over and being aggressively searched in each state that I traveled through.  I had the opportunity to talk with Capt. Jim Pyles of the Maryland State Police on Thursday.  Capt. Pyles told me that in addition to drugs, they could also be searching for untaxed cigarettes and, even worse, human trafficking.  Both are up dramatically and there is a crackdown on all interstates.  State and local police have become very aggressive in combating each of these areas of criminal activity.  A dramatic increase in human trafficking, wow!

Mixed Messages

On Wednesday of this week, the US Court of Appeals issued a decision backing the Federal Trade Commission and ordered an Ohio-based health system, ProMedica, to dissolve its 2010 acquisition of St. Luke's Hospital in Maumee, Ohio.  The FTC challenge was based on the acquisition reducing competition and allowing ProMedica to raise prices.  They have six months to unwind the transaction from four years ago and any purchase of St. Luke's has to be approved by the FTC.  I can't imagine unwinding an acquisition of this magnitude after four years.  


Now for the mixed message.  Under the Affordable Care Act, competition is no longer front and center as it once was in health care.  We are moving away from volume-based care delivery to value based.  Our goal is to keep patients out of the hospital where and when necessary and to care for them in the most appropriate location. It is our intention to bend the cost curve by getting unnecessary cost out of the system.  In addition, because of the new risk associated with the ACA, hospitals have been told that they can only make it if they have revenues anywhere from greater than $1 billion dollars to $5 billion dollars. (It depends on which consultant you listen to on the subject, but so far the advice is proving to be solid.)  There is also the blurring of the lines between insurers becoming providers and providers becoming insurers.  Our industry is changing dramatically; however, the FTC has stated publicly that they don't care what Health and Human Services or the Centers for Medicare and Medicaid (CMS) do under ACA, they will continue to focus on health care competition as one of their top priorities.  Maybe, the time is now for the FTC Chair and the newly appointed Secretary for HHS to have a discussion on the matter.

State Certified Counselors

I am pleased that our Finance and Business Office leadership had the foresight to successfully enroll four of our staff members in a state program to become certified as Maryland State Certified Application Counselors.  What that means is that four of our Business Office staff are now certified counselors who can enroll our patients in the Maryland health insurance exchange.  They can also assist with Medicaid enrollment.  There was a lot of work involved in studying for and passing the two-hour exam, but they did it. 

Through this certification, we have added another dimension to ensure that patients are appropriately covered for the care that they receive as well as for us being paid for the care that is delivered.  Great job on everyone's part.

An End of An Era

This morning, I drove by the former Memorial Hospital to see the status of the demolition.  I have attached a few photographs of the current status of the buildings that are being demolished.  The medical office building is already completely demolished while the North wing is currently under demolition.  The Main Hospital appears to have been gutted for salvage and appears to be next for demolition.  The South Tower is undergoing a salvage operation at this point in time and then should  be demolished after the main hospital.  

I was surprised that after working on that campus for 20 years, I wasn't at all impacted by the demolition process.  Possibly, if the demolition process started right after we vacated the building, as was recommended to the City then, I would have been truly moved by the process.  When I look at that campus today and envision what could be placed on that site, I feel good about the next chapter that is awaiting Cumberland and the former Memorial Hospital.

Creating a Culture of Quality

There is an interesting article in the April 2014 of Harvard Business
Review on Creating a Culture of Quality.  The article covers the four
essentials of quality which are leadership emphasis; message credibility;
peer involvement and employee ownership.

Leadership Emphasis - Managers are told that quality is a leadership
priority; they walk the talk on quality and when they evaluate employees,
they emphasize quality.

Message Credibility - Messages are delivered by respected sources in the
organization.  They are consistent and easy to understand.  The messages
have to appeal to them personally.

Peer Involvement - Most employees have a strong network of peers for
guidance; they routinely raise quality as a topic for team discussion and
peers hold each other accountable.

Employee Ownership - Workers clearly understand how quality fits with the
job; workers are empowered to make quality decisions and are comfortable
raising concerns about quality.

After reviewing the above and applying it WMHS, I need to re-examine our
emphasis on quality.  These four essentials exist, but not to the extent
that they are emphasized in the article.  I need to ensure that our
leadership is emphasizing quality with their employees and creating a

true culture of quality.

Redefining the Hospital

The attached article is from the latest issue of Hospitals and Health Networks magazine. Our value based care delivery model continues to get a great deal of national attention.  It wouldn't be possible without a lot of dedicated people at WMHS who really do understand the importance of such a care delivery model.

http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Magazine/2014/Apr/cover-story-redefining-hospital&utm_source=daily&utm_medium=email&utm_campaign=%20HHN

An Appalling Story

This AM, I read a story about a woman from Macon, Georgia, who WAS a radiological technician.  She was just sentenced to 6 months in jail, 10 years probation, a $12,500 fine and not allowed to work in health care for 10 years.  Her crime, she was too busy to read mammograms of over 1289 patients so she simply entered them as negative.  Of the 1289 patients, 10 had breast cancer and two have since died.  The District Attorney said the plea deal was fair.  Really?  Because she had personal problems and got behind in her work, she directly contributed to the deaths of two people.  The DA said that she was also very cooperative; one can surmise that the hospital where she worked is being sued.  

After I shared the article with my team, I was immediately assured that we have many systems of checks and balances in Radiology, Lab and the rest of our clinical areas.  It is always good to check, just in case.  A few years ago something similar happened at WMHS involving a Billing Office employee who was also suffering from a host of personal problems and decided not to do her job.  In fact, she created a ruse to demonstrate that she was performing as she was supposed to be performing.  Once her deception was uncovered, she was immediately fired and and it took a great deal of time to recover hundreds of thousands of dollars in billings that were never submitted, which we did.  We immediately audited her areas of responsibilities and put a number of safeguards in place to ensure that a similar practice could not recur.  In our case, it involved money and it served as a great learning experience.  Thank God, that our learning experience didn't involve the loss of life.

A Successor Has Been Named

At the end of last week, Kathleen Sebelius, Secretary of Health and Human Services, resigned.  Her tenure was marred with the disastrous start up of HealthCare.gov and everyone knew that she wasn't going to survive the mid-term elections in November.  The "fall gal" in this case will be Secretary Sebelius, but again, that's politics.  

However, the rub for me is related to her successor, Sylvia Mathews Burwell.  Ms Mathews Burwell is a "proven manager" from the Office of Management and Budget according to the Administration, but she has zero experience in health care, medicine, social services or public health.  Isn't that pretty much what the Secretary of HHS oversees--those four areas?  We now have an individual who is a policy expert and she will be running one of the largest components of our Federal Government.  No one is DC seems to mind that she is an experienced bureaucrat with no related experience to HHS.  Her primary responsibility will be to get the Affordable Care Act up and running.  

Members of Congress are hoping for answers from Ms. Mathews Burwell on the future of health care in America.  Really?  I expect Ms. Mathews Burwell will be well prepared to address issues related to the public policy aspects of health care.  But, focusing on the complexities of this business while improving the health status of our communities, providing senior care or focusing on health care for families, especially children, just to name a few, may take a back seat while she gets the failed aspects of the ACA up and running.  ( I am on the record supporting the value-based care delivery aspects of health care reform, which are an integral part of the ACA.)  

Somehow this reminds me of the newly appointed Ambassador to Argentina, who admitted that he had never stepped foot in that country during his nominating hearing in February.  Call me crazy or old school, but related experience, knowledge and background need to be taken into consideration when such appointments are being made.  I hope that Ms. Mathews Burwell excels at her job, but I will have to wait and see.

Some Things That I Think That I Think At The End Of A Week

First, Happy 18th Anniversary, a day late.  The Western Maryland Health System was formed on April 10th 1996.  Wow, how time flies when you are having this much fun.  At least, it became a lot more fun several years after the formation of the System.  Those first three years were a nightmare, but on the positive side it was a character building experience for me personally.

While blogging about anniversaries, it was three years ago today that I started the Ronan Report.  I think that it's time to write a book; I certainly have enough material.

Congratulations to Dr. Jerry Goldstein, our new Chief Medical Officer.  Dr. Goldstein was appointed to the position this week and has done a great job as interim CMO over the last three and a half months.

We had a great meeting of the President's Clinical Quality Council this week.  A wonderful presentation on patient satisfaction as it relates to our physicians by Karen Johnson and some of the best practices around the state that could even make our scores higher by Cindy Bridges.  Rounding out the presentation was Karen Howsare on our Perfect Circle of Care.  Lots of great discussion, ideas and suggestions thanks to Drs. Allaway, Haas, Dusenbery, Lamm, Khanna, Zaman, Goldstein, Wolff, Chappell and Watkins.

At that meeting, it was also interesting to hear their reaction to the release of how much Medicare has paid to physicians.  Overall, the reaction was one of surprise, but more importantly, this will now bring a lot of scrutiny on what physicians are paid.  Investigative reporters across the country have been salivating to get their hands on this information.  By the way, the leader of the physician Medicare billing hit parade was a South Florida ophthalmologist who was paid $21 million by Medicare in 2012.  Oh,my!

What was surprising at the release of what physicians have been paid by Medicare is that payment information was never before shared in the 50 years of Medicare's existence.  Also, I have it on very good authority that at the time the Affordable Care Act was being created the American Medical Association, the drug companies, AARP, the American Hospital Association and the Catholic Health Association, just to name a few were told that "if you aren't at the table, that you will be on the menu" meaning if you don't support the ACA, life could be difficult for those you advocate for.  No surprise there; that's politics.  After all, I watch House of Cards, I know how these things work.

In closing and to add some amusement to my day, I am sitting at my desk finishing my blog and out my window is a woman sitting on the wall in front of the hospital smoking a cigarette with her feet comfortably positioned on our "No Smoking" signs.

Enjoy your weekend!

Trivergent Health Alliance

The Alliance of health systems, Western Maryland, Meritus and Frederick, has finally arrived at a name for our new Alliance........Trivergent Health Alliance.

Congratulations to our own Clay Jones, who came up with the name.  In a previous blog, I asked for suggestions and got many,  Most, unfortunately, had already been trademarked.  Trivergent was available so we trademarked it and also secured a variety of domain names, i.e .org, .com.

The Alliance continues to make progress in that we are close to finalizing operating and service agreements; obtaining a tax ID number; signing contracts for new technology and consultative assistance; developing systems for tracking savings and allocating cost; issuing RFPs for banking and insurance; finalizing locations for services across the Alliance and developing a new logo for Trivergent Health Alliance.  There continues to be a lot of work ahead of us, but a great deal has been accomplished to date.  The individual work groups in Human Resources, Supply Chain, Pharmacy, Laboratory, Revenue Cycle and Information Technology have done an amazing job in creating an individual business plan for each area.  We are looking at over a $20 million annual dollar saving by year three across the Alliance.  This is a saving that we would not have been able to achieve as three independent health systems.

Hospitals Safer Than Homes for Births

There was an article in yesterday's NY Times with the above title.  The bottom line of the article is that the Centers for Disease Control looked at 14 million births, including 130,000 deliveries that occurred outside of the hospital.  Home deliveries had four times the risk for death than deliveries in the hospital.  Personally, I can't fathom choosing to have your baby in your bedroom at home.  If Pamela and I opted for a home delivery with our first child, she would have died.  Complications began toward the end of Pamela's labor and it was only through the quick actions by her obstetrician that our daughter lived.  

We continue to make it so expectant mothers are as comfortable as possible in our Labor and Delivery Center; yes, it's still a hospital, but because it is, your chances of a successful delivery just increased appreciably.

What Not to Wear.........in Hospitals

This blog isn't about what Clinton and Stacey of the show "What Not To Wear" would suggest as to business attire vs. business casual while at work in the hospital.  It's about the recommendations from the Society for Healthcare Epidemiology of America (SHEA).  I read an article this AM as to SHEA's focus, which is the spread of infection by health care workers, clinicians, advanced practice professionals, RNs and physicians and pretty much anyone who comes in contact with the patient through their clothes, jewelry, shoes and accessories.  

SHEA's recommendations would include:

• Bare Below the Elbows: wearing short sleeves, no wristbands, no wristwatches, no rings and no jewelry of any kind.  No long sleeves in the clinical setting to minimize the transfer of bacteria.
• White Lab Coats: Although the lab coat denotes professionalism and is a patient satisfier, if you don't have several and have them laundered frequently, they can also be a source of bacteria.  Clinicians are also encouraged to place them on a hook before they enter the patient's room and not wear them around the patient.
• Neckties:  They too denote professionalism and can be worn but need to be secured by a tie tack or tie bar or preferably tucked in the shirt between buttons to keep them from being in contact with the patient.
• Shoes:  They should be clean, closed toe, low heel and non skid.  Soiled shoes should not be worn in patient care areas at anytime.
• Stethoscopes:  They should be cleaned and disinfected between patients as they are a great source of bacteria if not cared for properly.
• Accessories:  ID badges, ASCOM phones and smart phones can be brought into the patient care area but must be disinfected with great frequency.  

I thought that this article was interesting and worth sharing; I hope that it helps.