They Really Need to Study a Decline in Lottery Sales

In yesterday's Baltimore Business Journal, there was a headline that got my attention, "Maryland Lottery taps research firm to study sales decline."  I sure hope that they aren't going to spend a lot of money on this study because I can help them out in one word, GAMBLING, or another word, CASINOS, or another word, SLOTS.  Really, they have to study the Lottery sales decline?  Lottery sales are down 2.2% from $1.795 billion to $1.756 billion and mostly in Keno and Racetrack games.  Any idea as to what these two Lottery games are most similar to in casinos..............you guessed it, slots.  

For the same period, gambling in Maryland is up 27% over last year and at almost $830 million dollars in revenues.  Two more casinos are expected to come online, one in Baltimore across from M&T Bank Stadium and another in PG County.  I sure hope that the Maryland Lottery Commission figures that into their study.  Overall, after taking into consideration the $39 million loss from the Lottery, the $830 million for FY '13 in revenues from gambling and $3.2 billion in new taxes; the State should be very well positioned from a revenue perspective.

Push America’s Journey of Hope

Last evening, I attended a picnic hosted by the Cumberland Rotary Club.  The picnic serves two purposes:  first, the annual picnic for Rotarians and their spouses; and second, we host 35 young men from all over the country who are cycling across the US.  The young men have raised a minimum of $5500 each, which goes to Push America’s Journey of Hope.  The Journey of Hope benefits the disabled across the U.S.  In fact, they cycle around 75 to 80 miles a day and then stop and spend time working with the disabled in the many communities where they spend the night.  They started in San Francisco in June and are about to arrive in DC; the entire trip is around 65 days.  These young men, all of whom are in the late teens or early twenties, are attending some of the best colleges and universities.   They are pursuing studies in an array of areas, many with double majors.  They are charming, articulate, friendly, respectful and appreciative.  It was a wonderful way to spend the evening, hearing from each of them as to their background and how they raised their minimum of $5500 (actually, the average for group was $8000 per cyclist).  These are our leaders of tomorrow; and after spending a few hours with them, we will be in very good hands in the not too distant future.

An Opportunity to Teach

Yesterday, I had the opportunity to share the WMHS success story on health care reform with young people who are participating in Mercer’s National Intern Program.  Mercer is a national Human Resources firm that WMHS uses to perform an independent analysis of our executive compensation program. 

I was invited to speak to the group six weeks ago as an expert on health care reform (how flattering), but I didn’t quite grasp the magnitude of the invitation.  The engagement was done via conference call.  On the call were their executive leader and groups of Mercer interns from all over the country.  I had the opportunity to tell the story of our transition from a volume-based health care delivery system to one of value.  Their interest was related to a health care industry work project with which they were tasked. Their focus was the impact of health care reform on the various stakeholders, the employees, the physicians, the patients and the community.  As I told the story and briefed them on the impact on the individual stakeholders, they asked great questions.  At the end of the presentation, the interns said that they were thrilled to learn that there are very positive aspects of reform and that key stakeholders, such as employees and physicians, seem to be embracing it.

I love it when I get the opportunity to share what we are doing at WMHS related to our transformation to a value based care delivery system and it is especially rewarding to have such an engaged audience.

Energy Consumption in the US

Last week, I wrote about some of the wonderful tidbits from Anirban Basu’s presentation to the Board.  One of them was that by 2020, the US would be the leading producer of oil in the world.  Currently, we are third behind Saudi Arabia and Russia. 

Today, I saw the attached chart that depicted energy consumption in the U.S. from 1980 to the present and projected to 2035.   What is interesting is that consumption of fossil fuels (oil, coal and natural gas) will fall only six percent by 2035, while renewable energy (wood, waste, solar, geothermal, wind, nuclear and hydroelectric) will grow only slightly.  Renewable energy will provide less than 11% of the total energy demand for the U.S. by 2035.  Currently, fossil fuel consumption is about 83%.  Some of you may remember in 1977 when the U.S. Energy Department was formed under the premise to find alternate sources of energy?  In 1950, our renewable energy consumption was only slightly lower than it is today at around 10%; yet, how much has been invested in the development of renewable energy sources since 1977?  Billions and billions of dollars have been invested in finding new sources of renewable energy through direct allocations, tax incentives, grants, awards, loan guarantees and subsidies.  For 2012, the Department of Energy received $2 billion to identify new sources of renewable energy, focusing on geothermal, solar, hydroelectric and biofuels.  So, the waste of tax dollars continues on failed strategies to bolster the sources and use of renewable energy.  Like it or not, hydrocarbon energy is still a major part of our future and will continue to power our economy for years to come. 

Consumer Reports and Their Hospital Ratings for Surgery

In the September issue of Consumer Reports (CR), there is an article on Safer Surgery which lists the surgery ratings for 2,463 hospitals across the county.  So, how’d WMHS do?  Was the traditional CR circle, solid red (Good), solid white (Average) or solid black (Worse).  WMHS was solid white or average in our rating.  I guess if it were red, we would be celebrating such recognition like nine Maryland hospitals.  If it were solid black or even half black, we would be vehemently challenging the rating.  But, in our case, like nineteen other Maryland hospitals, we were average.  So, because we were average, I should put the rating in perspective. 

Consumer Reports, using Medicare claims data for 2009 through 2011, grouped the common surgical procedures into 27 different categories.  The ratings were based on two outcomes: death at the hospital after surgery and a longer length of stay in the hospital than expected.  So, what does it all mean to the consumer?

Some of the shortcomings of their ratings would include:

CR used only Medicare data.  There are a lot more patients having surgery; so, they are reporting only a portion of the data.

They say that the data is risk-adjusted; but such methodology is usually flawed.

The complexity of the patient isn’t taken into consideration in this data.

Smaller hospitals have a very limited sample size, resulting in less reliable data for them.

Socioeconomic factors aren’t taken into consideration, which routinely reflect the health of the population.

Today, there is a great deal of transparency in reporting quality and patient safety data, including WMHS, which shows our current quality data on our website.  There are so many measures that hospitals are adhering to today and they are readily available on the internet.  These measures go far beyond surgery performed on Medicare patients.  However, the CR’s article and data are very good starting points. Hospitals and health systems are fast becoming more and more transparent in our performance improvement data reporting and the sole beneficiary of such reporting is the patient.   That’s a very good thing.

There's That Brave New World of Health Care Again

An issue brief from KPMG came across my desk this week entitled, "Convergence is Coming: A Brave New World for US Health Care."  The Brave New World theme is how I opened this week's blogs as I blogged about last Friday's presentation by Anirban Basu to the WMHS Board.  The KPMG  issue brief describes the transformation of health care delivery in the US.  It describes the challenges such as less revenues, disruptive new market entrants, aggressive competition and rapidly shifting regulation.  The issue brief then gets into what health care executives need to do in dealing with these challenges.  We need to align ourselves with new partners, work more closely with the payers, focus on patient centricity, seek new delivery models, pursue collaborative operating models that are best suited for your organization and become much more engaged with data analytics. No real new news there, as we are deeply imbedded in each of these areas.   But, it's helpful to have confirmation of what you are doing in the transformation of health care delivery by the experts at KPMG's Healthcare and Life Sciences Institute.

Returning to Old Fashioned Health Care, Well Kinda

When you take a step back and look at all that we are doing to address population and community health, it is amazing as to how much we are returning to the past.  I remember as a child, my pediatrician coming to the house to provide care to me when I was sick.  We haven't gone that far, but we are getting closer.  We are now sending a lot more people into the home either in person or through technology as we transition patients from the hospital.  Our goal is to keep them as healthy as possible so they do not have to return.  We are focused on being there if patients need us, but also having alternatives available to visits to the ED or an inpatient stay.  We have a series of clinics and medical homes, new primary care practices as well as individuals reaching out to patients  post discharge to make sure that they are keeping their appointments, weighing themselves, checking their blood pressure, their glucose levels, making sure that they have their medications and the list goes on.  Soon, we will have technology that will support these same patients in their homes with the preceding information being transmitted electronically.  In the near future, we may also have nurse practitioners and possibly, physicians going into the home to improve the health status of our most vulnerable patients.  There are lots of examples in other communities of practitioners going into the home beyond Home Care to better serve those in need.  We continue to monitor these practices for their application in Western Maryland.