Perception Isn't Necessarily Reality

Today, I am attending the Maryland Hospital Association's Annual Meeting in Baltimore.  It is always an informative meeting and a great opportunity for networking and board education.  WMHS has eleven attendees between board and executives; may seem like a lot, but it is a great opportunity for all of us to learn and to hear a consistent message related to health care in Maryland. 

One of today's speakers was Quint Studer, who is an author, consultant and former hospital CEO.  Quint's message was stressing the urgency for leadership in today's very complicated health care environment.  It was a very informative presentation.  In the Q&A session, he was asked which one was the highest performer out of the hundreds of hospitals with whom he has worked in his consultative role and why.  He gave his answer.  He named the health system, which will remain unidentified for what will become obvious. 

Quint said that what sets this health system apart is that their CEO has the stated desire for high performance (actually most of us do), they communicate with purpose, their metrics are transparent (they are posted throughout the hospital), they use objective and weighted performance evaluations and their leaders are required to have fifty hours of leadership training.  Impressive!  At WMHS, we are always looking for successful health systems to benchmark ourselves against.  So, I Googled them and what I found was not very complimentary.  Most of the comments about this health system from the perspective of their patients were not very favorable and their overall rating was in the fair-to-poor range.  Wow!  Here is a high profile consultant who is well known throughout health care, is extremely knowledgeable and has a wealth of experience and who perceives that his named highest performing hospital is functioning at the top of their game and yet reality is very different.  As I have blogged in the past, health care is an extremely difficult and challenging industry.  A point that is well demonstrated in the preceding example.

Another Crisis in the Federal Government

In 2003, the federal government passed the Medicare Modernization Act, creating a program that detects and corrects improper payments by Medicare.  In 2005, they began using Recovery Audit Contractors to perform the work of identifying improper Medicare payments. 

The RAC program has become an absolute disaster for hospitals.  Currently, WMHS has $4 million tied up with RAC auditors, who are incentivized by the feds to ferret out improper payments.  We take billing Medicare (and all other payors) very seriously and have chosen to be aggressive in challenging the RAC.  Every claim has been denied on appeal through a virtual "rubber stamp" approach.  Each case takes about ten months to process, again resulting in a denial. 

The third appeal level is with an Administrative Law Judge, who is the first individual not incentivized as to the outcome of their decision.  We have been very successful winning every appeal at the ALJ level.  Because of our success and the success of others, that process has been slowed to a crawl.  We are now getting letters indicating that because of a backlog of cases they cannot render opinions at the ALJ level. 

An interim step has also been added that any time we appeal at the ALJ level, we first have to notify the patient as to our appeal, which sends a panic through every patient notified.  We are spending excessive amounts of time and money on these appeals because there is a great deal at stake. 

The American Hospital Association has taken a very active role in trying to bring improvement to the RAC process and now there are bills in Congress to rectify this broken process.  WMHS is actively involved with AHA since we have so much at stake.  Four million dollars tied up for one health system in a heavily flawed program in this economy is a "very big deal" and it needs to be solved immediately.

Futurescan

I just received my annual survey from the American College of Healthcare Executives on Futurescan.  This survey requests the input from executives as to the future delivery of health care from 2014 to 2019.  This year's survey focuses on population health, physician integration, provider affiliations, reimbursement, IT, patient care and efficiency. 

As I answered the questions, I had a pretty good feeling as to our level of readiness in each area.  In population health, we have already established partnerships with community partners; we are ensuring stronger coordination of care among those same partners and long before 2019, we will be a controlling entity for a complete continuum of care.  Within the next two years, our physicians will be heavily involved in patient centered medical homes; and by next year, we will be actively engaged in a pay-for-performance initiative with our physicians to better align financial incentives.  Within the year, we should be further along with our potential alliance between the three western Maryland health systems, as well as clinical data integration system wide.  Lastly, we continue to be focused on being a highly reliable organization; continually expecting the unexpected, but being resilient enough in working to contain the unexpected. 

Being in a state of readiness for the many changes occurring in healthcare is a very good position to be in going forward.

CEOs Against Cancer

Recently, I joined a group of 23 other CEOs in Maryland who have come together through the American Cancer Society to prevent cancer and save lives.  Today, we had a series of presentations and meetings at WMHS to raise awareness about how to stay well, get well, find cures and fight back against cancer. 

We are already doing a great deal through our employee wellness programs, our screenings, being a smoke free campus, availability of and access to cancer studies, healthy eating and offering comprehensive exercise programs, as well as our advocacy programs related to healthier lifestyles for our employees and their families. 

I have pledged WMHS support in this fight against cancer due to its prevalence in our region.  When you hear statistics like one in every two men and one in every three women will face cancer in their lifetime, it becomes staggering.  Cancer truly affects everyone in some way and it has a direct impact on our workforce.  It is my intention to ensure that we pull out all stops to help our staff stay well by fostering a culture of health and wellness at WMHS.  Where better a place to start but here?

There They Go Again

Today, the Health Services Cost Review Commission (HSCRC) voted to allow hospitals to raise our rates by a mere 1.65% for the period of July 1, 2013 to December 31, 2013, which is less than inflation.  Maryland hospitals asked for a 2.11% increase with a temporary .32% to offset the Sequester cuts which impacted hospitals in April of this year.  Previously, the HSCRC didn't act on any relief for hospitals on the Sequester cuts, but asked that we be patient and that they would address the Sequester impact at their June 6th meeting.  LOL! 

This inaction by the Commission will have a detrimental effect on most hospitals in Maryland and will only worsen an already bad situation.  Hospitals will be forced to cut jobs and curtail services beyond what they already have done as a result of the Sequester cuts.  At WMHS, because of the action that we took earlier this fiscal year, we should be able to absorb the less than inflation increase, but not much more.  The health insurers have asked for as high as almost a 17% increase in their rates while fighting the 2.43% increase for hospitals.  It will be interesting to see what they are granted.  Stay tuned.

Congratulations Lauren!

I am stepping away from my usual blog today to congratulate my daughter Lauren, who, as she puts it, "is no longer a child officer in the Navy." Yesterday, Lauren received her silver Lieutenant bars (see attached photo zooming in on her Lt. bars).  Four years ago, she graduated from the United States Naval Academy as an Ensign assigned to Surface Warfare. (Attached is a photo of her graduation from the Naval Academy that was taken by the White House photographer and posted on the White House website).  Two years later, she was promoted to Lt. junior grade; she served two tours to the Middle East (attached is her hugging her mother after her return from the second deployment) and I got to join her on her ship for eight days as it returned from her first deployment.  She is now assigned to Fort Meade in Maryland.   So, twenty six years old, and already lived in San Diego, CA and Chesapeake Beach, VA as well as being around the world (first deployment from the Pacific and the second from the Atlantic).  Congratulations, Lauren, I know that it has been a very challenging eight years, but thank you for all that you have sacrificed over those eight years.  

Making Strides

I have blogged in the past about the many ways that we are trying to improve the health and well being of our patients.  So far, we seem to be on the right track and are seeing improved outcomes, including reduced admissions, for those who are receiving  appropriate follow-up care and support from these newly implemented services.

Our Outpatient Coagulation Clinic opened late last fall and has already outgrown its current location.  In order to accommodate the growing number of patients, it just moved to a larger, off-site location.  It's actually sharing space with one of our Primary Care Centers, all of which are experiencing increased volumes. 

The Center for Diabetes Management continues to see more and more patients.  An outgrowth of that service will be a new diabetes support group, which meets for the first time tomorrow night.  It will be facilitated by two certified diabetes educators and a registered dietitian.  Participants will be able to learn from the expertise of the entire diabetes team and will benefit from the interaction of others who share their concerns. 

All of these activities are examples of how we are meeting the challenge of healthcare change by improving the health of the patients we serve.  What is most rewarding is the benefit that our patients derive from these new services.