"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.

Friday, July 31, 2015

Just When Did The Lights Go Out

Last week, Kevin Turley, VP of Operations at WMHS, was going through photographs from when the new hospital was getting ready to open.  At that time, Kevin came to the hospital in the evening and took some wonderful photographs.  As he was going through the photos last week, he noticed that the Schwab Family Cancer Center sign was lit.  He thought to himself, that sign can be lit?  Realizing that the sign hasn't been lit in years, he reached out to Facilities and asked why the Cancer Center sign is no longer lit.  He was told that the sign can't be lit since it has no lights.  He showed our Facilities guy the  photograph.  He was shocked.  To make a long story short, the sign is now lit at night.  The
solution to getting the sign re-lit............simply flipping the switch.  Someone had turned it off a number of years ago and never turned it back on.  Shame on those of us who work those long hours arriving when it's dark and leaving when it's dark.  We should have made note of it long ago.  Well, anyway, the sign is now lit proudly and a mechanism for keeping track of lighting around the campus has been created.  Nicely done, Kevin.

Tuesday, July 28, 2015

Tour of a Lifetime

Yesterday afternoon, I participated in our Foundation's Tour of a Lifetime event.  We had a special tour for our Foundation Board members after their regular meeting.  This series of Tours is at our Cancer Center.  Julie Hardy, Director of Medical Oncology, and Deana Ouellette, Chief Technologist for Radiation Oncology, conducted the tours in both of their areas.  

The tours were amazingly enlightening for all attendees, including me.  I continue to marvel at what the staff in both of these areas do for our patients, day after day.  There are jobs and then there are callings; this is truly a calling for those who work in our Cancer Center.  The staff is kind, compassionate, pleasant, knowledgable and highly experienced.  
We had the opportunity to see our newest addition to our Cancer Center, our Varian True Beam linear accelerator.  The True Beam, with a price tag of just under $3M, uses pinpoint accuracy to radiate tumors anywhere in the body.  

I had the opportunity to explain to the group during the tour that shortly after moving to a Total Patient Revenue payment methodology in FY 2011, we heard from some staff, physicians and even folks in the community that operating under such a payment methodology would be the end of any new technology and that our intention would be to save money by not effectively treating patients any longer.  In fact, I saw a headline the other day in the NY Post that said just that--the new "dangerous" direction for health care.  Wrong!!  In addition to the article/thought being insulting, nothing could be further from the truth.  The True Beam linear accelerator was a great opportunity to demonstrate for the organization and the community that by reducing unnecessary admissions, ED visits, and ancillary utilization, we could re-invest that savings in new programs and new technology to better treat those in need.  

Now with that said, the efficacy of any treatment needs to be demonstrated to be effective; otherwise, no one will support the treatment financially.  There was a time when if the technology or a drug was available, for the most part, it was provided; few questions were asked.  That is no longer the case.  The payers have said that there needs to be demonstrated viability in the treatment in order for them to pay for it, even though it may be listed as a covered service.  If it doesn't substantially prolong life or have a demonstrated life-saving benefit, you can almost be certain that the treatment will be denied.  With close to $3 trillion in health care spending in the US each year, an "anything goes" model for care delivery couldn't be sustained.  

Anyway, back to our Cancer Center and the Tour of a Lifetime, it was time very well spent and gave me the idea that we need to do more with opening up the health system to the public so they can see what we have accomplished since bringing this still state-of-the-art facility to little old Cumberland.

Monday, July 27, 2015

US News and World Report Hospital Ratings

The US News and World Report ratings are out and whenever that happens, the questions begin as to just how important are they to hospitals.  If you are on the list, they are VERY important; if you aren't, their value can be immediately brought into question.  

The clear benefit is the ability to market your health system and its ranking.  With that said, it is important to mention that the hospitals listed are some of the best hospitals in the United States, so from that perspective US News and World Report gets it right.  However, when you look closely at the criteria and data that are used, yikes, there are a great deal of inaccuracies.  Take the Western Maryland Health System; we are ranked 11th overall in Maryland and number one in western Maryland.  But there are a few problems such as, no geographic definition of western Maryland,  a significant lag in the data that is used and at least for WMHS, the data is out and out wrong.  They have us much larger than we actually are from a bed size perspective; we have many more physicians listed than we actually have in our individual clinical areas;and  they don't rate some of our highly rated clinical areas by HealthGrades nearly as high and vice versa.  

The bottomline is don't use the ratings as the only factor in determining how good a hospital / health system may be.  There are numerous sources to check before deciding on which to use, but the US News and World Report rating are a very good place to start.

Wednesday, July 22, 2015

"Strategic" Divestitures

I was reading the most recent issue of Modern Healthcare and I got a "blast from the past," if you will.  There was an article that Ascension Health, with whom WMHS was a part of until 2008, is divesting itself from the Carondelet Health Network in Tucson, AZ.  They have formed a joint venture with Dignity Health and Tenet, a for-profit health care system to own that system, with Tenet operating it.  I didn't have to read any further to know that Carondelet was not doing well financially since according to the article that has become the strategy of Ascension.  

"They are shedding unprofitable operations and beefing up operations in more profitable markets, which was the case when we part of Ascension," according to Melanie Evans, who wrote the article.  Once WMHS announced back in 2005 that we were going to consolidate the WMHS hospitals into one new hospital, we were told that Ascension Health couldn't be part of a single hospital in Cumberland. 

Back then, Ascension had targeted all except one of their less-than-profitable hospitals / health systems for transition out of their system.  (The one less-than-profitable hospital that they were keeping was Providence in DC.  I am sure that the divestiture of that hospital would not have played well among their many constituencies.) They identified six hospitals across the country that they were going to divest themselves from and we were one of the six.  Our situation was a little different.  Although we weren't a cash cow, we were holding our own financially, but we no longer fit in their model since they only controlled half of WMHS and at the time they were looking for complete control.  Then with the announcement to build a new hospital, that seemed to seal our fate.  Actually, it was a most beneficial transition away from Ascension since our respective missions had changed as we became more formidable as a health care system and they seemed to have transitioned away from their Daughters of Charity heritage.  That particular divestiture was a win / win for both of us, but it was an interesting strategy for a faith-based, mission- focused organization back in 2008, and it still is today.

Wednesday, July 15, 2015

The Path to Lower Readmissions

Both Nancy Adams, Chief Operating Officer and Chief Nurse Executive at WMHS, and I were interviewed for a story on readmissions for the current issue of Trustee Magazine.  The article, "The Path to Lower Readmissions Lies in Patient Support," was written by John Morrisey and is attached.

Tuesday, July 14, 2015

One of the Nation's Most Wired Hospitals

The Western Maryland Health System has been named as one of the nation's Most Wired Hospitals for 2015 by the American Hospital Association. (See the link below to download the article.) Forty percent of US hospitals submitted to be nominated and out of 2213 hospitals, we were selected.  In addition to WMHS being selected, other Maryland hospitals and health systems included Frederick Memorial Health System, our Trivergent Alliance partner; Anne Arundel Medical Center; Peninsula Regional Health System; Calvert Memorial Hospital and the MedStar Health System.  A total of 338 hospitals and health systems were selected as AHA's Most Wired Hospitals in 2015. Selections were made on four criteria, including: infrastructure; business and administrative management; clinical quality/safety and clinical integration between ambulatory/physician/patient/community.  Additional requirements were added this year related to Meaningful Use Stage 2.

The use of data and information has grown dramatically over the last four years at WMHS.  Previously, there would be a significant lag time with data availability sometimes as much as six months to a year, putting the usefulness of the data in question.  Under value-based care delivery, data analysis is absolutely critical so real-time decision making is key.  Because of a commitment over the last few years to acquire real-time information systems, WMHS is much better positioned today than ever before in obtaining data and using it to ensure that patient care is being delivered effectively and efficiently.  Such data also allows us to make better decisions related to our patients who have been determined to be the sickest of the sick.  Previously, our data was focused on the inpatient stay, which continues to be important.  However, we are now appropriately positioned to obtain data in the ambulatory setting and blend it with our other data sources.  

Our connectivity has never been as robust as it is today and that is attributable to a lot of people beginning with Bill Byers, our Chief Technology Officer, David Quirk, Trivergent's CIO, a remarkable team of IT staff at WMHS and at Trivergent, along with many clinicians who have provided their expertise to ensure that the usefulness of the data is meeting the needs of our patients and our staff.  Congratulations to all at WMHS and Trivergent!


Monday, July 13, 2015

Our Newest Employees

This morning, as is the case the second Monday of each month, I had the opportunity to welcome our newest employees to WMHS.  We had a large group this AM with about 50 in attendance.  I usually open with a welcome, a congratulations for being selected as an employee of WMHS and a thanks for selecting us since many have the opportunity to choose where they want to work.  I then ask them to introduce themselves and tell the group a little about themselves and where they are going to work at WMHS.  I also ask them to tell me how they are going to apply our Mission Statement, "superior care for all we serve," in their daily work at WMHS.  

Well, this morning I couldn't have started off with a better person than James, our new director of Health Information Management.  He was excellent in his response to each question and set the tone for the rest of the group.  What usually takes about 20 minutes took almost 50 minutes today.  I learned so much about these folks, more so than at any past orientation.  I was introduced to a number of individuals who changed careers and who are now in health care and loving it.  There were a  number of employees who worked at WMHS previously and are returning (they are my favorites).  I met a lot of new graduates from Allegany College of Maryland (ACM) in mostly nursing, but also in occupational therapy and coding.  

There were great answers to the mission application questions from new EVS employees, patient transportation escorts, food service workers, geriatric nursing assistants and lab techs.  Explaining how their job is going to fulfill our mission can be more challenging and their answers were excellent.  

My favorite answer of this morning's session came from Michele, a newly hired nurse, who said that she decided to come to work for WMHS after reviewing our website.   In her review, she learned of our care delivery model being based on value and she said that care model made the most sense to her so this was the place where she wanted to work.  Since there were so many newly graduated nurses from ACM, I asked what they were being taught about valued-based care delivery.  Their response was that they learned about value-based care delivery during their clinical time at WMHS.  They said that all of their nurse preceptors and pretty much anyone with whom they come in contact when at WMHS was well versed in our very different care delivery model.  Music to my ears!  It was an hour that was very well spent and I loved every minute of it.

Saturday, July 11, 2015

A Father’s Paranoia

Everyone is well aware of the shooting death of Kate Steinle in San Francisco on July 1.  If you aren’t, she was walking with her father on Pier 14 and was shot by a Mexican national who in the US illegally.  He had been deported back to Mexico on five separate occasions only to return each time.  He was arrested most recently and then released instead of being turned over to federal authorities by San Francisco authorities.  He had seven previous felony convictions but remained free to roam the streets of San Francisco, a self -described sanctuary city that in itself has become something well beyond what it was originally intended. 

Then earlier this week, I read about three murders in Baltimore the other evening adjacent to the University of Maryland Baltimore Campus where my daughter Lauren,\ is attending school in the evenings as she is completing her MBA. 

My heart is still breaking for Kate’s father.  I can’t fathom strolling leisurely with your daughter only to have her shot and die in your arms.  Then, to see the politicians and law enforcement officials blaming each other for Kate’s death.  Well, there is plenty of blame to go around, starting with not securing our southern border.  To have this felon be deported five previous times only to return each time is absurd.  Then to release him after yet another felony arrest without notifying federal authorities as should have been the case is inexcusable.  Some are clamoring about one more gun death; however, in this case, the weapon was stolen from a federal law enforcement officer’s car trunk; it’s not like it was purchased Lenny’s Guns and Ammo.  As for the Baltimore murders, the victims were shot, but there isn’t any word on the gun that was used. 

My point to all of this: As as a father of two daughters, I am appalled by senselessness of these crimes and how close they have hit home.  I can’t wait for Lauren to be finished with her program in late August and I pray to God each night that she has class in Baltimore that she is safe.  I am also thrilled that she has decided not to relocate to Baltimore.  What has happen to what had been a wonderful city is a disgrace.  I previously would go to Baltimore and never think about my or my family’s safety until this past spring.  Now, I avoid a visit to downtown and the surrounding areas at all cost. 

As for Kate Steinle, there needs to be a series of laws enacted to ensure that what has happened to Kate and her family NEVER happens to another family.  I have written my Senators and Congressman stating that much needs to be done to best serve the memory of Kate Steinle.  I hope that you will join me in writing about securing our southern border to keep felons from entering / re-entering our country, passing Kate’s law (an automatic 5-year sentence if a felon is deported but returns to the US), using the concept of what a sanctuary city is supposed to be and not what it’s become and tightening up the release process between law enforcement agencies and the courts as it relates to illegal immigrant felons to ensure that any release is well vetted and warranted.

Friday, July 10, 2015

Addressing the Needs of the Behavioral Health Patients Can Make a Difference

I couldn’t agree more with the observations described in Paul Levy’s blog (see below) for today.  We have seen this exact situation in Maryland.  Until Behavioral Health (BH) patients were included in our readmission numbers, they were not getting the attention that our sickest of the sick on the acute care side were getting.  

Since that change, there are a number of initiatives that have been put in place to better address their needs at WMHS.  We created dedicated care coordinators and clinical coordinators in Behavioral Health; we are working in partnership with other providers to care for BH patients in settings other than as inpatients; better linking Psych services with inpatient care since close to 50% of our acute care patients also have a BH diagnosis; linking BH services with Primary Care to serve these patients more quickly and more thoroughly and most recently, evolving to using DNA testing to determine the efficacy of psychotropic drugs, just to name a few.  

This population is especially vulnerable and can be challenging, but recognizing that you can certainly make a difference in their care while reducing unnecessary admissions, readmissions and ED visits can be extremely rewarding for all concerned.

Posted: 09 Jul 2015 05:31 AM PDT

Norbert Goldfield is one of the more sophisticated and deep thinkers on the topic of integrating financial incentives with patient care improvement.  He and Richard Fuller recently addressed the issue of the segmentation of different kinds of patients under such programs.  Here's a teaser:

"It is evident that mental health issues drive increased utilization and, particularly within Medicaid programs, increase the likelihood of readmission. Poorly constructed penalties, apparent in many earlier health management efforts, look at the frequency of readmission at an institution, typically a hospital, and conclude that the hospital patient population as a whole has high rates and therefore the hospital performance merits a penalty. The result is a push to exclude and dilute the impact of patient populations that generate this loss, while the providers that treat them are seen as “loss centers.” The resulting mindset is a pervasive fear in which complex, high-needs patients that require more resources will uniformly experience higher rates of adverse outcomes, leading to them being identified as a problem.

"Exclusion from incentive programs may remove patient populations from the radar of cost-cutting administrators but will also ensure that attempts to improve their care will not be a top priority.

"But, with better crafted policies this need not be the case – in fact the reverse is true."

Wednesday, July 1, 2015

Another Year of Value-Based Care Delivery

On Monday, I had the opportunity to serve as a panelist on the topic of Value-Based Care Delivery for the Society for Healthcare Strategy and Market Development.  This was a continuance from my role with its  Thought Leader panel in October of 2014.  Joining me were Lynn Miller, EVP at Geisinger, and Henry DePhillips MD, CMO for Teledoc.  Two very bright people also doing some amazing things for those whom they serve.  

Actually, it was a good idea on the part of SHSMD to check in with the panelists to hear what continues to develop in our respective worlds related to evolving, growing and thriving is this era of health care change.  I had the opportunity to talk about the continued change and innovation occurring at WMHS.  How we continue to learn to do new things and continue to stay ahead of the industry since we crafted change well ahead of others under Maryland's Total Patient Revenue demonstration project.  How we continue to harness efficiencies and share new ideas.  How we continue to disrupt pretty much everything that we do related to care delivery in a positive and constructive way.  How we continue to educate our staff, physicians, advanced practice professionals, our patients and our community on value-based care delivery since the entire concept is counterintuitive to fee-for-service payment based on volume of care delivered.  

Lastly, how we deal with the new entrants into our market whether they are partners, competitors or "frenemies."  In this instance, so far, most have become partners in our delivery of health care.  The competitors are those who seek to decrease our market share by shifting care to their acute care centers.  They aren't doing anything to reduce or bend the cost curve, only bolstering revenues under what is fast becoming an outdated strategy and payment methodology.  The frenemies are Walmart (its new approach to primary and chronic care), CVS (Minute Clinics), and Med Express (urgent care), but for us they are partners since they are / will be caring for patients in the most appropriate location.  Our goal is to assure that patients are cared for in the best setting.  These alternatives to the Emergency Department and admitting patients unnecessarily are what is necessary to reduce the cost of health care while ensuring that care is delivered to those in need.  

It is so very rewarding to not only watch but to be a part of such an amazing transformation of an entire industry.