"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.