"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, June 29, 2018

How is WMHS Meeting the Many Challenges in Healthcare?

The healthcare field is certainly changing and if Western Maryland Health System isn’t keeping up with the changes, we could end up like one of the 89 hospitals that closed in 2017 with the majority being in rural areas. It has become apparent that because of our remoteness and economic development challenges, it is more difficult to bring physicians, primarily specialists and sub-specialists to our area. As a result, we have signed a clinical affiliation agreement with University of Pittsburgh Medical Center. They will assist us with such clinical needs as Vascular Surgery, Thoracic Surgery and coverage for Dr. Mark Nelson and the Cardiac Services program, as well as Oncology and Behavioral Health. We will continue to explore other ways in which UPMC can assist with the many challenges we face every day. Fortunately, we do have a lot still going for us. We benefit greatly from the Maryland Waiver which brings an additional $2.6 billion to the state provided we continue to meet a series of benchmarks related to improved quality, reduced utilization and cost savings. We transitioned healthcare delivery in Maryland eight years ago from a system based on volume to one that is value based. That transition brought us a great deal of advantage as it allowed us to demonstrate our commitment of placing the patient first in the care delivery system. We’ve been able to achieve remarkable partnerships across the care continuum to ensure patients receive the care they need where they need it. These partnerships have helped reduce the gaps in care and have better addressed the needs of the most vulnerable. We are much further ahead of other hospitals, in other states, with our care delivery model and our efforts in reducing the cost of care. We now care for patients in the most appropriate location including throughout the community and within the home.

As we attempt to work through the many changes, challenges and disruptions facing our industry, our goal at WMHS is to not only sustain healthcare services in western Maryland, but to enhance those services. Building upon the newly created relationship with UPMC could take us to long term viability through cutting edge technology, innovative programs and services as well as access to the many other clinical programs offered by one of the largest health systems in the United States. Most importantly, UPMC wants to offer those services in our community to the extent possible and not have the patient travel to Pittsburgh or Altoona unless it is absolutely necessary. This relationship with UPMC is an excellent next step for WMHS as we not only attempt to improve our viability but, with all of the difficulties that we face, our long-term survivability.

Thursday, June 21, 2018


If there was ever a time to re-engage my blog, now is it.

Since early June, I have been reading and hearing so much misinformation regarding the WMHS Pediatric Unit.  We are NOT abandoning children by closing our Pediatrics Unit.  The term “closing” is a regulatory term that we have to use even if we are transitioning our unit from virtually a single Pediatric inpatient bed on an adult patient unit to a five bed Pediatric Observation Unit adjacent to the Emergency Department.  Unfortunately, last Saturday’s newspaper headline stated that the unit was closing.  If you just read the headline and not the article, I can see how one would think that the Pediatric unit was actually closing, but again, that is not the case.

Beginning in early August 2018, any child requiring an overnight stay will be cared for in a dedicated, secure unit that is being newly constructed next to the ED.  The child can remain in the unit up to 48 hours; after that, clinical decisions will be made as to transfer or discharge to home.  This unit will be staffed by Pediatric Advanced Life Support trained nurses along with Emergency Department physicians and physician assistants.  Pediatricians will continue to attend to children in the unit, as well.  Because we have so few pediatric patients (for the first nine months of the fiscal year, we have admitted 44 children who have stayed an average of 1.93 days), our Pediatric staff nurses cannot maintain their expertise, nor can we recruit dedicated Pediatric nurses because we admit so few children.  The ED staff are very well trained in caring for and treating both adults and children.  In fact, last year we treated close to 9,500 Pediatric patients in the Emergency Department with 86 being admitted to WMHS and about 300 being transferred to a Pediatric Specialty hospital due to their chronic or critical condition.  As a parent and a grandparent, I can’t imagine why a parent or guardian wouldn’t want their very ill child treated in a specialty facility where the specialists treat thousands of children each year. 

Some have said just bring the specialists to Cumberland and we do, but caring for children on an outpatient basis usually for chronic or follow up care in Pediatric Cardiology and Neurology.  With a two hour travel distance and so few patients, it is unrealistic to think that specialists would come to Cumberland to perform surgery on one child.  There are physician shortages in virtually every specialty for both adults and children and areas such as ours have the greatest challenges in recruiting.  WMHS like so many other community hospitals have had to resort to alternatives in the care and treatment of children.  We are using more digital technology, telemedicine, and partnerships to address the needs of children and through our affiliation with UPMC, these advancements will continue to grow.  In Maryland, 33 out of the 47 hospitals, have Pediatric Units.  Eighteen of those hospitals have a length of stay for Pediatrics of less than a day and there are nine Maryland hospitals similar to WMHS with a length of stay of less than two days.  Over the last 30 years, Pediatric beds in Maryland have decreased by more than half from 882 to 385.  More and more children are being cared for in the most appropriate location, a specialty hospital, when they have a critical or chronic condition.

I certainly recognize the hardship for families who have to travel out of the area if their child is very ill.  Our staff at WMHS will work with the specialty hospital as well as throughout our community to assist with this hardship to the extent possible.  Although such transfers have been occurring for the last several years, we will become more engaged in the process and assist these families in navigating the challenges that they face when such circumstances arise.

I hope that the information contained within this blog helps to clarify the circumstances surrounding Pediatrics at WMHS.