Governance Trends for 2014

I read a great article this AM about what the board governance trends are for health systems in 2014 by Michael Peregrine of McDermott, Will & Emery.  Michael's trends and how each are being addressed at WMHS are as follows:

• Standard of Care - the board's role is ever increasing in this area to ensure that it is aware of its duties and that they are being executed appropriately.  A great deal of emphasis was placed on this trend through our recent board assessment results during our last board retreat.
• Level of Engagement - As complexity increases and challenges grow, boards will be asked to step up their engagement on the board.  Our board has recognized this challenge since the planning for the new hospital started and it has continued for the last three plus years under TPR.
• Strategic Planning - Special attention will be expected based on all of the challenges facing health care.  Our board approved the WMHS three-year strategic plan in late March 2014.  Development of the plan occurred under the auspices of the board's Planning Committee.
• Board Composition - Needed competencies to meet the challenges will be the focus of boards this year and into the future.  Such competencies have been a continual focus of our board's Governance Committee.
• Compliance Oversight - The Tuomey whistleblower decision, the vagaries of the Stark Law, RACs, and anti-fraud enforcement will combine to bring increased compliance oversight.  Compliance with these areas occurs through the board's Audit and Compliance Committee.
• Risk Reporting - Boards expect to be informed when substantial risk to the organization occurs.  A key responsibility of executive management at WMHS.
• Governance Structure - Emphasis will be on board size, composition, reporting relationships, and committee structure and composition, along with reporting relationships. An ongoing focus of the board Governance Committee.
• Heightened Involvement - Any issues critical to the success of the organization, such as risk, reputation, quality, care delivery and financial performance need to be shared with the board.  Executive management needs to manage each but the board needs to be "in the know."  The board is routinely kept informed when a critical issue occurs at WMHS.
• Conflict Awareness - The board needs to be sensitive to all types of potential conflicts of interest on the part of the board beyond the traditional financial relationships.  The board very throughly assesses such conflicts and they are addressed by the Executive Committee of the board.
• The Role of General Counsel - This role has evolved to guardian of the organization's legal and reputational profiles as well as a partner to management as hospitals pursue new and different business lines.  General counsel has been engaged in these areas for sometime at WMHS and has been effective at each.

In closing, having such a list of trends is very helpful and it serves as a great source of verification of just how well our board is performing its fiduciary duties at WMHS.

Did She Really Say That?

During Tuesday's House Committee on Ways and Means Subcommittee on Health, a regional inspector for the Department of Health and Human Services blamed hospitals for the backlog in processing Recovery Audit Contractor (RAC) audit appeals.  She said that we are filing too many appeals.  Really?  

How dare we challenge a severely flawed process that is creating a crushing burden on hospitals across the US.  From the American Hospital Association, over two thirds of the medical records reviewed by RACs contain no errors.  They also reported that when claim denials are appealed at the Administrative Law Judge (ALJ) level, hospitals prevail over 72 percent of the time.  

At WMHS, each time that we appeal at the RAC level, we lose almost 100% of the time because there is a financial incentive at stake for the RAC.  When we appeal at the ALJ level (the next level of appeal) where there is no financial incentive to keep hospital monies, we win almost 100% of the time.  Unfortunately, at the ALJ level, the backlog at this point is so great that it would take many years to hear the current cases under appeal. 


Earlier this month, I again wrote to Senator Mikulski, following up on a letter from a year ago that went unanswered.  I advised her that what was previously over $10 million being tied up in the RAC process for WMHS alone has now grown to $14 million in less than a year.  I asked Senator Mikulski to support legislation that would allow hospitals to retain monies until all appeals have been concluded and to ensure that the necessary resources are provided for timely ALJ reviews within the 90-day statutory time frame.  My letter is attached.  

Some action is occurring in Congress with bills being created to make RACs more accountable, but CMS is fighting the changes.  They say that they respond to hospital complaints and that the process is flawed, but then we get responses like the one above that hospitals are the problem when they appeal RAC audits that are part of a severely flawed process.  CMS says that they need the RAC process to collect these monies and support Medicare programs.  What they are failing to realize is that, previously, many hospitals simply budgeted for the RAC process, but when the process grew and millions and millions of dollars were being impacted, hospitals began to challenge the RAC audits.  A la the backlog.  All that we are asking is to improve the process and apply the correct standards going forward.

Being Surrounded by Tough Women...........How Fortunate for Me

I realized this weekend the extent to which I am surrounded by tough women, both personally and professionally.  I had the opportunity to interact with all of the women in my personal life this weekend and I can only marvel at what they are made of.  From my mother and mother-in-law, both who are full of life at 87 and soon to be 88.  Both sharp as can be mentally and my mother-in-law can tire me out by just watching her.  Both have buried husbands and have gone about their lives remarkably well.  

Then there is my wife, who is my world and to this day is a remarkable mother, always there for her daughters in whatever they need.  When they are having a tough day, she usually gets the call and talks them through whatever challenge they may be facing.  She exercises wonderful judgement and has great common sense, a trait that seems to be lacking in many today.  On top of that, she's a nurse and what she has learned and experienced benefits her mother, mother-in-law, husband, daughters, dogs, a son-in-law and the list goes on.  

As for the daughters, two remarkable women in their own right.  Jessica, who works for Boeing and is their manager of Global Corporate Citizenship along with being Master's prepared from Georgetown University, is dealing with her husband's bout with cancer.  She works all day, dinner meetings in the evenings and then onto speaking engagements after that.  Balancing her professional life with a very challenging personal life at this point in time...........there are many days that I marvel as to how she keeps it together.  

Lauren, the USNA graduate and Navy Lt., is assigned to Fort Meade responsible for Internet security for the White House and Defense Department, along with pursuing her MBA in her "spare time."  Need I say more?   

Then there are the women with whom I work, wow!  What they do day in and day out to keep this health system operating and financially sound.  Their interactions with physicians and staff along with providing care delivery in a way that is so cutting edge, it is done by very few in the industry.  They are amazing; sensitive when they need to be, but tough beyond tough when situations call for it.  These women are afraid of very little as they face challenges every day.  But, most importantly, they don't care how they are judged by others because they are tough, seasoned women who are overflowing with both a great self- esteem and very strong self-confidence.  

I am truly blessed to have all of these absolutely wonderful women in my life.

Heroin Trade

Yesterday, I received a Twitter message from Josh Sharfstein, MD, the Secretary of the Department of Health and Mental Hygiene in Maryland, about heroin trade in the US and in particular in NYC, which serves as an east coast distribution center. He referenced an article in the New York Times stating that the drug trade is at its highest level in 20 years.  

In Maryland, the numbers are rivaling the rest of the east coast cities and states.  The heroin is coming out of Mexico in record amounts; and as a result, it's really cheap.  This information was verified by Major Jim Pyles of the Maryland State Police just a few weeks ago when he and I were talking about what's new in our respective jobs.  Jimmy said that he has never seen it this bad in Maryland, especially western Maryland.  

I then reached out to the folks at WMHS and learned that we are seeing a significant increase in both lethal and non-lethal heroin overdoses.  Rob Flint, MD, our Chairman of Emergency Medicine, at WMHS said it's bad, but it was really bad a few months ago when seeing Fentanyl-laced heroin overdoses that actually killed a number of folks in the Pittsburgh area.  

Even with the increase in heroin trafficking, that hasn't slowed the overuse and abuse of prescription drugs and the subsequent overdoses and resultant deaths from these drugs either.  If law enforcement can get a handle on drug trafficking in our area, it would be interesting to see the reductions in related crime such as robberies, thefts, fraud and even gun violence, along with the reductions in overdoses and drug related deaths.

Going the Way of the Steel Industry

I attended an educational session yesterday and the title was "Healthcare Inflection.”  The basis for the session was the extensive disruption that is occurring and will continue in what has been a legacy industry (health care) that has been rarely impacted by such disruption.  The presenter made a statement that if hospitals don't change, they will fast become what had become of the steel industry a few decades ago.  Simply put, that industry couldn't compete with China on price for steel.  

Hospitals will be impacted by not only price competition, but also brands coming from retail entities (i.e. CVS, Walgreens, Target, etc.) and the access, convenience, technology, quality and level of satisfaction by these same retail entities.  Large chain pharmacies have expanded into health care's territory of primary care with the intention of disrupting the longstanding relationship between patients and their doctors and hospitals.  This disruption has also impacted the cash flow.  For the most part, hospitals don't know what their prices are in so many areas, but Walgreen's does.  Registration at Walgreen's for their retail clinics or primary care is same day and is done through kiosks.  When you arrive, you enter your information and you are assigned an appointment for that day.  

Retail is counting on the ability to keep prices low and that they will then have a consumer for life.  Of course, brand, technology, convenience, access, quality and satisfaction are important, but price is key.  As an industry, hospitals have a lot of work ahead of them.  

Thank God Someone Had Some Sense

I read in the Chicago Tribune this AM that a breastfeeding mom was thrown out of the National Restaurant Show over the weekend for bringing her 10-day-old baby to the conference.  She was there to promote her family's wine business and why was she thrown out--not because she was breastfeeding, but because no children under the age of 16 are permitted at the show.  I assume due to insurance and safety purposes.  

However, I am glad that someone had the sense to throw her out--not because the child was under 16, but to protect the infant.  A 10-day-old infant should not be exposed to thousands of people under any circumstances.  For the first two months after birth, any infant should be protected because their immune system is still weak and the child is at risk for serious infection, even death.  I remember my wife when she was an fetal and infant mortality nurse describing fetal deaths as a result of newborns being infected with viruses innocently passed through airborne droplets.  I guess this mom must have missed that particular prenatal class.

Trivergent Health Alliance Leadership

I missed two days of blogging last week due to so many meetings and trips to Frederick and Hagerstown that were Alliance related.  Last week, we started interviews at the Corporate Director level for the MSO and finished our second round of interviews for the CEO of the Alliance MSO.  The candidates for each of the positions did an excellent job.  Each was so well prepared for the sets of interviews with the CEOs and the CFOs.  We will finish the interviews next week and make recommendations to the MSO CEO, who will make the final selection.  As for the Alliance MSO CEO, we hope to have a selection by the end of this month.  The CEOs will have a conference call with our Executive Recruiter tomorrow afternoon and will hopefully reach a decision shortly thereafter.  

The Alliance is proceeding nicely in that the operating agreements have been finalized and approved by both the Alliance Board and the Frederick Regional Health System Board of Directors.  The Boards for both Meritus and WMHS meet with this week and the agreements should be approved by the close of business on Thursday. This week there will also be meetings with the various managers and supervisors of departments that will be part of the MSO in order to brief them primarily on the HR aspects of the Alliance MSO. 

All is all we continue to make great progress and continue on track for a July 1 start to the MSO.

Employee Service Awards

Another great event at WMHS this afternoon, our Service Awards Reception.  The attendance was great as depicted by the auditorium being full and everyone seeming to be having a wonderful time.  

It is amazing to see so many 40-year awardees (13) and to have five 45-year awardees. WOW!  This year, I celebrate 25 years and my years of service pale by comparison.  

Many thanks to the Human Resources and Dietary staff, who did such a wonderful job in planning the event.  Congratulations to the hundreds of employees who joined our 40 and 45 year awardees in celebrating their 5, 10, 15, 20, 25, 30 and 35 years of service.

Pinnacle Awards

Last night, WMHS held its Pinnacle Award Dinner to honor and celebrate our Values in Action Award winners over the past year and to select our Pinnacle Awardee.  All twelve of these individuals are exemplary employees who inspire all of us.  The Committee had a most challenging task in selecting one Pinnacle Award winner out of this particular group of twelve, but they were able to make their selection.  I had the honor of presenting the award to Jennifer Perrin, a Certified Diabetes Educator in the Center of Clinical Resources.  

I previously blogged about Jennifer from my first-hand visit to the Center.  Her accomplishments have been amazing as she is meeting the challenge of health care change in so many ways.  Jennifer has patients who are now living healthier, more satisfying lives thanks to her knowledge and expertise.  She has saved countless lives and has given so many a much improved quality of life.  We have seen amazing results from our Center for Clinical Resources; a direct outcome of the many wonderful people fulfilling the mission of WMHS each day and as so well demonstrated by Jennifer.  Congratulations, Jennifer..........so very well deserved.

How to Judge One's Character

A friend shared a recent Rick Reilly article.  Rick was a long time Sports Illustrated writer who a few years ago went over to the dark side, ESPN.  He now writes for ESPN and continues to do a great job.  Last week's article was written with the pending NFL Draft coming up.  Rick's article was "How to Judge One's Character.” He wrote that this time of the year you hear from NFL general managers, "is he a character guy?”  He writes that GMs do so much to determine if a potential draftee has character and yet all that they need to do is to find out how generously they tip. I have attached the article and it is worth the read.  

I agree with Rick Reilly that this is a great way to judge one's character.  I also judge one's character on how they treat the wait staff in a restaurant.  If they are rude, abrupt, ungrateful or demanding, that says a lot about them and I have not hired individuals, not engaged consultants and even ended friendships as a result of how they treat a server, a host / hostess or a bartender.  I live by the motto, treat people as you would like to be treated; and so far, that has worked for me.

http://m.espn.go.com/nfl/story?storyId=10896190&src=desktop&wjb

Transforming Care Delivery Through High-Risk Clinics

I am attending a meeting in Nashville, TN, and yesterday we had a presentation on transforming health care delivery through high-risk clinics.  Their tag line is "the right care at the right time in the right location."  If you remember, WMHS has been touting "the most appropriate care in the most most appropriate location.”  

A significant aspect of our care transformation has been the Center for Clinical Resources, our high-risk clinic equivalent.  It was reassuring to get affirmation on how well our clinic is doing in comparison with a group that has been doing this for a while.  This company is new to Maryland, but is not new to this care delivery model.  They were touting their client satisfaction, their reduction in admissions and re-admissions, reduction in ED visits, reduction of inpatient costs and their optimal care delivery through this model.  These are all areas that WMHS has been equally successful in achieving.  

As a reminder, our Center for Clinical Resources assists patients with COPD, congestive heart failure, diabetes, anticoagulation medications, medication therapy management, nutrition counseling, navigation and outreach for social needs, and prevention and wellness education.  Our CCR team is doing some remarkable work with these patients and truly making a difference in the lives of these individuals.

Recognition Of Our Nurses

I am truly blessed to have so many nurses in both my personal as well as professional life.  This week is Nurses' Week and whatever the recognition, it is never enough.  These women and men have dedicated their lives to the holistic care of their patients.  They are creative, persistent, active, dynamic, proficient, imaginative, dedicated and caring.   They demonstrate care as the essence of what they do for their patients.  They advocate for every patient, every time.  They balance both the art as well as the science of nursing almost to perfection.  These individuals are truly special and I thank God that there are such dedicated professionals demonstrating that essence of care each day at WMHS.

Business Unfriendly

This morning as I was listening to the radio, I heard Allegany County Commissioner Creade Brodie talk about his meeting last week with the State Highway Administration (SHA).  He spoke of projects that are a well behind schedule and mired in over-regulation by SHA.  

As I listened, I was reminded of the challenges that WMHS had as we were building the new hospital on Willowbrook Road.  SHA was an obstacle pretty much every step of the way.   I finally said enough is enough and told them that we would not be paying for roundabouts at the I-68 interchange nor would we be paying to have sidewalks installed from I-68 to the new hospital along Willowbrook Road for the less than ten people walking on average each day.  WMHS was expected to pay millions of dollars, beyond what we had to pay as it was, to accomplish SHA's master plan for road improvements in western Maryland.  They were told that if they persisted, I would go public with how they were single handedly trying to ensure that a new hospital would never be built in Cumberland.  Finally, reasonableness prevailed and they backed off of their demand for roundabouts at the I-68 interchange and sidewalks along Willowbrook Road.  WMHS was still required to pay for the road improvements related to the new hospital and sidewalks to Allegany College, but the craziness finally stopped. 

Recently, I was at a meeting with Lt. Gov. Anthony Brown and I had the opportunity to talk about the over-regulation in Maryland, specifically SHA.  He was empathetic and said that he would tackle that issue if elected as he was well aware of the challenges that exist to create new business in Maryland.  Maybe, help is on the way.

Emotional Competence

This morning, I was getting a briefing on the recent successes within our Leadership Institute at WMHS.  The focus was on how we are doing with training our evolving leaders.  The leadership group in training is nearing completion of a nine-month program; and, as a result, executive leadership has been introduced to some very talented people in our organization—our succession of leaders.  So, the program has proven to be a success and will be built upon going forward.  

As was discussed this morning, one of those areas to be built upon will be emotional competence.  It is no longer simply how smart you are or what you know; it's also about how you handle yourself and how you are viewed by others. We go to great lengths in selecting and on-boarding staff to ensure that they are the right fit for WMHS.  Through our more recently established processes, we do very well in choosing the right people.  Not only do they need to have the right training and education, but they need to be able to embrace our mission, our values and our service excellence standards.  It is one's ability to demonstrate these prime qualities that will keep someone employed at WMHS.  In simple terms, it is more than the hard skills, those few initials after your name i.e. RN, MD, RD, Pharm D, etc.  You have to possess the soft skills as well: the knowledge, the job skills and the experience.  These soft skills equate to that emotional competence on the part of the individual employee.  

The upcoming message to our evolving leaders through the Leadership Institute will be that possessing a strong emotional competence along with the necessary hard skills is the difference between an outstanding leader and a mediocre one.  Going forward embrace the importance of emotional competence.

Private Conversations Are Now A Thing Of The Past

First and foremost, I am not condoning the vile, racist comments made by LA Clippers owner, Donald Sterling.  In my opinion, what he said warranted his banishment from the NBA.  I think that it was Oprah Winfrey who said it best when she said "he has a slave owner mentality" and he does.  He has made hundreds of millions of dollars in a sports business where the commodity is professional basketball players, of which close to 90% of the players are African American.  It is hard to imagine being a racist and owning a professional basketball franchise.  

With all of that said, what is also alarming and will now become a trend is the the recording of what are thought to be private conversations.  Certainly, there are laws that cover such acts; however, the revenge or shock value will win out in each instance.  We are heading for a slippery slope as the smartphone is pressed into service beyond its videotaping capabilities, those instant messages and unexpected photographs.  Simply placing what appears to be an idle smartphone on a table and recording private conversations which are meant to be just that, private, will become a trend in an instant.  Maybe it's time to start having guests to your home check their smartphones at the door.