A Series of Teachable Moments

In recent days, we have learned of the first confirmed case of Ebola in the US.  A Liberian man flew from Liberia in West Africa to Brussels, Belgium, then to Dulles Airport in Virginia and onto Dallas, Texas.  He came to this country to visit his girlfriend, who is also the mother of one of his children; she has four other children, as well.  

Shortly after his arrival, he fell ill and went to the ED at Texas Health Presbyterian in Dallas to be seen.  The appropriate CDC protocols for Ebola were followed as a part of his triage as it relates to questions being asked regarding his travel.  However, the RN failed to communicate that he recently came from Liberia or the provider in the ED failed to pick up on this critical piece of information.  The patient was never admitted and subsequently discharged with antibiotics.  

Two days later, he returned to the same ED, this time via ambulance, and eventually tested positive for Ebola.  In that two-day period, he was exposed to many members of his girlfriend's family, including her five children who went to school after being exposed to the patient.  The authorities are still trying to determine the extent of the exposure including other family members, members of the community, the EMTs and unsuspecting health care providers.


Now for the teachable moments, first the communication in the ED.  I can't imagine how the intake RN and other providers feel at this point in time after not sharing or picking up on a critical piece of information regarding this patient.  The second teachable moment is with the US government allowing unrestricted travel to and from a hot zone like Liberia and other hot zones for Ebola in west Africa.  Third would be the US airlines that have not ceased travel into and out of these hot zones.  I am not sure what their reasoning is, but they have the potential of putting a lot of people in harm's way by not following the lead of other international carriers who have suspended such flights.  The reason that the US government has given for not restricting travel is the criticality of commerce to and from that region.  Really?  

I would feel a whole lot better if public health had more experience in managing Ebola exposures and preparation for ongoing exposures, which they will acquire over time but more time is needed.  With unrestricted travel to the US, there will be a burden that will eventually impact public health and health care in caring for and protecting the general public from exposure. There needs to be greater protection of Americans on the part of those who can do something about keeping us safe going forward.  There are  quite a few lessons that can be learned from this exposure; hopefully, common sense will prevail and changes are imminent.

You've Made My Day

This morning while I was on rounds throughout the hospital, I stopped to talk with one of the nurse managers.  She told me that one of her staff nurses included in the comments section of her performance evaluation that she wanted to sit down and have a cup of coffee with the CEO.  The nurse asked the nurse manager if she could arrange that.  The nurse manager said that she would try.  

Well, it just so happened that this particular staff nurse was working today.  I had the opportunity to meet and briefly chat with Kiea Barnes.  She said that she had heard so much about me and wanted the opportunity to meet me and to sit down and have a cup of coffee.  I asked her if a cup of tea would work and she said of course.  It was a very pleasant conversation, ending with her saying that meeting me made her day.  I told Kiea that she certainly made my day as it was very kind of her to want to sit down with me just to talk.   And talk we will; arrangements are  already underway for our chat.  

I was told many years ago by my predecessor that when it comes to how people view a CEO, they see you sitting on top of a flag pole.  One group looks at you and admires what it took for you to get up there.  The second group says that you are crazy for being up there and the third group tries to shake the pole to get you to fall off.  Kiea is certainly in the first group and it is very much appreciated.  I am so fortunate to have such a wonderful group of employees like Kiea who support what we are trying to do each day to advance care delivery in our community.

Sympathy for the Recovery Audit Contract (RAC) Process, Really?

I read an editorial this AM from the editor of Fierce Health Finance and I think that it's a first........someone sympathetic to the RAC process.  I have written a number of blogs on this topic in the past as to the absurdity of the RAC process.  Centers for Medicare and Medicaid (CMS) created this process to rid health care of waste and inefficiency.  For the most part, I have no problem with the concept since both exist and need to be eliminated.  It was the way in which CMS went about putting the program in place.  

Their contractors deny virtually every appeal at the first two appeal levels, where the CMS contractor gets paid a percentage for every identified RAC claim.  At the third level where the appeal involves an administrative law judge who is outside of the RAC contractors' purview, the game changes.  At the ALJ level, WMHS has won virtually every appeal.

Unfortunately, CMS and their contractors got greedy and as a result, hospitals and health systems are now challenging every denial at the administrative law judge appeal level.  Previously, many hospitals budgeted a percentage for the RAC process as a cost of doing business, but not any more.  As a result, it would take decades to hear every appeal at this level.  

Since CMS put a flawed process in place, they are now offering hospitals 68 cents on the dollar to settle short stay claims and scrambling to figure out a solution to their backlog of the rest of their cases.  Of course, hospitals are taking advantage of the settlement offer.  
At WMHS, we have had over $10 million dollars tied up in all RAC appeals; and through the settlement just for short stay disputes, we should receive over $3 million.  

Now the editor of Fierce Health Finance is equating hospitals to the five year old who hasn't gotten his way.  Really?  I took the opportunity to read previous editorials from this same guy and he is obviously no friend of hospitals.  It's time to cancel my subscription to Fierce Health publications; if you can't be balanced in your editorials, I have no use for your tainted opinions.

Summit on Population Health

Yesterday, I had the privilege to serve on a panel of "experts" on population health at the Mid-Atlantic Summit on Population Health.  The focus was "Value Based Payments in Population Health: Accelerating Concept into Reality."  Two of my favorites presenters preceded the panel discussion, Anirban Basu, the Chief Economist for the Sage Policy Group, and Dr. David Nash, Dean of the Thomas Jefferson School of Population Health.  I have heard both speakers a number of times; in fact, Anirban served as our keynote speaker at our board summer planning meeting last year.  He is extremely knowledgable and quite entertaining as a presenter.  David Nash is also an excellent presenter and is one of the nation's leading experts on population health.  He is a frequent speaker at the Governance Institute meetings and his message now resonates very well with what we are doing at WMHS.  


What I found yesterday was not necessarily that deer-in-the-headlights look from the audience, but still a look of skepticism regarding accelerating concept into reality by what we have done over the last four years with value-based care delivery at WMHS.  We are living it, but it is really hard for those who have been part of the fee-for-service or volume- based care delivery model for their entire career to understand  just how value-based care really works.  I tried to assure the group, including a number of folks from outside of Maryland, that it does work and that I would never go back to fee for service.  Unfortunately, it doesn't really sink in until they visit with us.  Once they see first hand the success that we have achieved in reducing admissions, re-admissions, and use rates; improving quality-based reimbursement and patient satisfaction scores and ultimately providing better care to those patients who are our high utilizers with multiple co-morbidites, they become believers.  

As I have blogged previously, we have had a multitude of visitors to WMHS to experience our journey on value-based care delivery; I guess the rest will have to experience it for themselves.

It's Hard to Believe

Recently, WMHS was notified that our application for a Department of Health & Human Services grant on Mobilization for Health: National Prevention Partnership Awards Program was approved.  This grant submission took a great deal of time to assemble and to ensure that it was thorough in meeting the scoring criteria requirements.  The grant request was for $1.3 million; and as I noted previously, it was approved.  Time to pop the champagne corks........$1.3 million and it was approved.  

Unfortunately, the celebration stops before it begins.  The letter from HHS says, "Your application was approved, but UNFUNDED because there are no remaining funds available."  I am not joking; that's what the letter from an acting Assistant Secretary for Health says.  Why bother seeking grants or approving grants when you have NO MONEY?  I can't stop shaking my head in disbelief over this one, but then again, it's government and, based on some of their actions over the years, I should be less and less surprised.

Don Alexander

Yesterday, I blogged about my trip to Germany and how good it was to be home. Unfortunately, when I arrived back in the US, I was immediately informed of the death of Don Alexander, President of Allegany College for nearly 30 years until his retirement six years ago.  But, more importantly, at least from my perspective, Don was a Memorial Hospital and then a WMHS board member for well over 17 years.  He served as the WMHS Board Chair for three years just a few years ago.  Don served our organizations so very well and he will be missed immensely.  

Even in Don's retirement, we would stay in touch.  Don would send a politically charged email, a joke or a message that immediately complimented me and my team when he read something favorable about WMHS.  Even during some of our most challenging times early in the WMHS history, Don was always upbeat and positive.  He was a gentle giant in so many ways; not so much his stature, but in every other way.  

In the decades of knowing Don, I never heard an unkind word spoken about him.  He touched so many lives in so many ways.  I looked to Don as both a friend and a mentor.  Fortunately, I am left with some wonderful memories and stories from Don but sad to have lost someone so special far too early in one's life.  Don's wonderful sense of humor and his kind heart are now in a better place and free of suffering from the ravages of cancer. 

Nice to be Back

For the last ten days or so, I had the opportunity to celebrate my 38th wedding anniversary in Germany with Pamela.  How fitting to celebrate along the Romantic Road in southern Germany and then into Austria?  Pamela and I had a wonderful time visiting small towns, villages, castles, palaces and churches.  I was able to take some magnificent photos of King Ludwig's Neuschwanstein castle, which served as the model for Disney's Magic Kingdom castle; Zugsptiz, the highest mountain in the German Alps; and Eagle's Nest in Berchtesgaden, which was Hitler's retreat in Bavaria.  At the same time, it's nice to be home and back to work; so little time, but so much to do.