Yesterday, I was honored to speak at the American Hospital Association's State Issues Forum Meeting. It was a meeting of State, Regional and Metropolitan Hospital Association Executives in Washington, DC. I was invited to speak on the Possibilities and Limitations of Provider Payment Reform, specifically the Western Maryland Health System's journey related to value-based care delivery. In addition to describing our journey, I was able to address questions related to work force, the challenges that we faced, the lessons learned, why we chose to pursue value based care delivery when no one else was, how the concept was financed, how the model is sustainable and how did we meet the needs of the behavioral health patients who also have general acute care needs.
The presentation was well received with a number of follow up requests to speak at the individual state association meetings. All is all, a very rewarding day.
Friday, January 16, 2015
Tuesday, January 13, 2015
Weighing in on Emerging Health Care Trends for 2015
Fierce Healthcare, a national health care newsletter, contacted me last week for a piece that they were doing related to emerging health care trends for this year. I was honored to be included and attached is the finished product.
Monday, January 12, 2015
America's Bitter Pill
Last night as the 60 Minutes segment on health care started, my iPhone lit up with messages about getting my thoughts on the content. That was easy; first, Steven Brill has little credibility with the misinformation and inaccuracies that appeared in his Time article about two years ago. Lucky for us, he is now shilling his new book with a similar title as the article, America's Bitter Pill.
He needed to quickly hurry up and get the book released because, in the short term, it will be more useless than it is now. Health care is changing as demonstrated by what health systems such as ours have been doing for the last four years. Our focus has been on value-based care delivery, not generating as many tests, procedures, surgeries, admissions and ED visits as possible. Volume-based care paid on a fee-for-service basis is quickly being replaced with incentivizing hospitals for keeping people healthy and out of the hospital. America will start to see a sea change in the short term related to care delivery. Everyone recognizes that spending almost $3 trillion on health care in the US annually is unsustainable, so new approaches like Maryland's Total Patient Revenue and Global Budget Revenue will be popping up all over the country.
As for 60 Minutes, I received information last week from the American Hospital Association on last night's segment. AHA was asked to make someone available to be interviewed for the segment. AHA in turn asked for a copy of the book since they took great exception to his Time article again due to misinformation and inaccuracies. 60 Minutes refused. AHA said in order to respond to charges made by Mr. Brill, having an idea of what was in the book critical of hospitals would have been helpful. As a result, they declined.
Using the Institute for Health Care Improvement's Triple Aim of Health Care reform (better care; healthier communities and reducing the cost of care), as well as the related components of the Affordable Care Act, hospitals across the country are focused on building healthier communities. Mr. Brill in his book glosses over what hospitals do each day in the care of our patients as did 60 Minutes. They love to focus on the negatives that are quickly being addressed and eliminated as Jeffrey Romoff, the CEO of UPMC, stated during the segment.
Mr. Romoff agreed to be interviewed for the segment since he, UPMC and his salary have been targets of Mr. Brill's since the Time article came out in 2013. I thought that Mr. Romoff held his own during the segment and, quite honestly, he is the CEO of the largest non-government employer in Pennsylvania with 62,000 employees and almost $12 billion in revenues. Mr. Brill likes to equate not-for-profit health care with your typical not-for-profit organization and that is not a fair comparison. Health care is big business and, in UPMC's case, it's very big business. Quite frankly, they do it well. They are ranked 12th as one of America's top health systems.
Hospitals continue to be an easy target for the likes of Mr. Brill and 60 Minutes; however, they had better get their licks in quickly because changes are a comin'. Stay tuned.
He needed to quickly hurry up and get the book released because, in the short term, it will be more useless than it is now. Health care is changing as demonstrated by what health systems such as ours have been doing for the last four years. Our focus has been on value-based care delivery, not generating as many tests, procedures, surgeries, admissions and ED visits as possible. Volume-based care paid on a fee-for-service basis is quickly being replaced with incentivizing hospitals for keeping people healthy and out of the hospital. America will start to see a sea change in the short term related to care delivery. Everyone recognizes that spending almost $3 trillion on health care in the US annually is unsustainable, so new approaches like Maryland's Total Patient Revenue and Global Budget Revenue will be popping up all over the country.
As for 60 Minutes, I received information last week from the American Hospital Association on last night's segment. AHA was asked to make someone available to be interviewed for the segment. AHA in turn asked for a copy of the book since they took great exception to his Time article again due to misinformation and inaccuracies. 60 Minutes refused. AHA said in order to respond to charges made by Mr. Brill, having an idea of what was in the book critical of hospitals would have been helpful. As a result, they declined.
Using the Institute for Health Care Improvement's Triple Aim of Health Care reform (better care; healthier communities and reducing the cost of care), as well as the related components of the Affordable Care Act, hospitals across the country are focused on building healthier communities. Mr. Brill in his book glosses over what hospitals do each day in the care of our patients as did 60 Minutes. They love to focus on the negatives that are quickly being addressed and eliminated as Jeffrey Romoff, the CEO of UPMC, stated during the segment.
Mr. Romoff agreed to be interviewed for the segment since he, UPMC and his salary have been targets of Mr. Brill's since the Time article came out in 2013. I thought that Mr. Romoff held his own during the segment and, quite honestly, he is the CEO of the largest non-government employer in Pennsylvania with 62,000 employees and almost $12 billion in revenues. Mr. Brill likes to equate not-for-profit health care with your typical not-for-profit organization and that is not a fair comparison. Health care is big business and, in UPMC's case, it's very big business. Quite frankly, they do it well. They are ranked 12th as one of America's top health systems.
Hospitals continue to be an easy target for the likes of Mr. Brill and 60 Minutes; however, they had better get their licks in quickly because changes are a comin'. Stay tuned.
Thursday, January 8, 2015
It's Taken This Many Days to Get Over the Loss
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Wednesday, January 7, 2015
89 New Accountable Care Organizations
I was reading Sean Cavanaugh's blog the other day. Sean was formerly with Maryland's Health Services Cost Review Commission and now is the Deputy Administrator and Director for the Center for Medicare. His blog was announcing the 89 new Accountable Care Organizations (ACOs) that joined the Medicare Shared Savings Program. The new ACOs in the CMS program now bring the total to 405, serving close to 8 million Medicare beneficiaries.
We are one of the new ACOs, the Western Maryland Physician Network LLC. Together with physicians and other providers, we are focusing on providing higher quality, coordinated care for patients in the Medicare program. We have almost 6000 Medicare beneficiaries that our ACO is serving and we hope to deliver better care consistent with our new care delivery model that is based on providing value, reducing the cost of care and ensuring that our community is healthier as a result. All of which are consistent with the Triple Aim of Healthcare Reform.
This partnership with our physicians and advanced practice professionals is great progress as we are continually exploring new and better ways to deliver care to our community.
We are one of the new ACOs, the Western Maryland Physician Network LLC. Together with physicians and other providers, we are focusing on providing higher quality, coordinated care for patients in the Medicare program. We have almost 6000 Medicare beneficiaries that our ACO is serving and we hope to deliver better care consistent with our new care delivery model that is based on providing value, reducing the cost of care and ensuring that our community is healthier as a result. All of which are consistent with the Triple Aim of Healthcare Reform.
This partnership with our physicians and advanced practice professionals is great progress as we are continually exploring new and better ways to deliver care to our community.
Monday, January 5, 2015
Hospital Patients are Watching and Listening
Over the holidays, I had the opportunity to spend a lot of time with my daughter Jessica and her husband Terrell, who is a very recent cancer survivor. Anyone who has read my blogs since last February knows of the challenges that these two individuals have gone through. I have blogged that they became my heroes after what they have endured. My hero worshipping continues.
Over breakfast one day last week, we were talking about Terrell returning to his job today on a full-time basis. I asked if he was ready for all of the challenges that he would face on his first day back to work at Pulte Homes. (By the way, a wonderful company to work for in how they treated Terrell during his nine-month battle with cancer last year). He said that he was, but that he would be approaching his job very differently this time around.
After spending well over 100 days hospitalized receiving chemotherapy and having his knee and partial femur replaced as a result of the cancer, he made a very valuable observation during his many hospitalizations. He realized that he had an expectation to be cared for in the most effective and efficient way possible. His caregivers recognized that and they managed his expectations, but they also did everything possible to meet his needs, requests and demands as a patient.
He learned that same thinking can be translated to his position as a project manager for a new housing development in Charleston, SC. His new homeowners have an expectation to have a "perfect" home built for them. Previously, he felt that these new homeowners were being overly demanding and unrealistic. He has since realized that no one was managing their expectations and that they have every right to expect a perfect home. Starting today, the new approach to his job will be to deliver the best possible new home to each new homeowner and, if something isn't right, to make every effort to ensure that it is right.
Pamela said that my face lit up, as I could immediately identify with Terrell's new approach to customer service. Many years ago when I was Director of Materials Management in a large teaching hospital, I needed an attitude adjustment. I felt that nursing was taking advantage of my employees with their demands and that they were not carrying out their duties and responsibilities as it related to interactions with my departments. Then, my office was temporarily re-located to a patient unit while construction of my new office occurred. It turned out to be a few of the best months of my professional life. I quickly realized that there were unbelievable demands that were being placed on nursing by patients, family members, physicians and their leadership; many of which were unrealistic with no recognition of that fact. The staff nurses were being pulled in every direction and orders were written with the expectation that they were filled immediately. The entire experience was a learning revelation for me and just as quickly for my staff. I immediately changed our approach in working with nursing. I took members of my leadership team on rounds and walked them through why our role was changing. I showed them why we were there to now serve nursing as they cared for our patients. My staff got it pretty quickly and I become beloved by nursing.
As Terrell returns to work today, he will be asking if he can lead an inservice for his division's employees on what it takes to be truly customer service focused. Awesome and because of what he experienced as a patient in seeing how important service engagement can really be, his company and homeowners will be very well served as a result.
Over breakfast one day last week, we were talking about Terrell returning to his job today on a full-time basis. I asked if he was ready for all of the challenges that he would face on his first day back to work at Pulte Homes. (By the way, a wonderful company to work for in how they treated Terrell during his nine-month battle with cancer last year). He said that he was, but that he would be approaching his job very differently this time around.
After spending well over 100 days hospitalized receiving chemotherapy and having his knee and partial femur replaced as a result of the cancer, he made a very valuable observation during his many hospitalizations. He realized that he had an expectation to be cared for in the most effective and efficient way possible. His caregivers recognized that and they managed his expectations, but they also did everything possible to meet his needs, requests and demands as a patient.
He learned that same thinking can be translated to his position as a project manager for a new housing development in Charleston, SC. His new homeowners have an expectation to have a "perfect" home built for them. Previously, he felt that these new homeowners were being overly demanding and unrealistic. He has since realized that no one was managing their expectations and that they have every right to expect a perfect home. Starting today, the new approach to his job will be to deliver the best possible new home to each new homeowner and, if something isn't right, to make every effort to ensure that it is right.
Pamela said that my face lit up, as I could immediately identify with Terrell's new approach to customer service. Many years ago when I was Director of Materials Management in a large teaching hospital, I needed an attitude adjustment. I felt that nursing was taking advantage of my employees with their demands and that they were not carrying out their duties and responsibilities as it related to interactions with my departments. Then, my office was temporarily re-located to a patient unit while construction of my new office occurred. It turned out to be a few of the best months of my professional life. I quickly realized that there were unbelievable demands that were being placed on nursing by patients, family members, physicians and their leadership; many of which were unrealistic with no recognition of that fact. The staff nurses were being pulled in every direction and orders were written with the expectation that they were filled immediately. The entire experience was a learning revelation for me and just as quickly for my staff. I immediately changed our approach in working with nursing. I took members of my leadership team on rounds and walked them through why our role was changing. I showed them why we were there to now serve nursing as they cared for our patients. My staff got it pretty quickly and I become beloved by nursing.
As Terrell returns to work today, he will be asking if he can lead an inservice for his division's employees on what it takes to be truly customer service focused. Awesome and because of what he experienced as a patient in seeing how important service engagement can really be, his company and homeowners will be very well served as a result.
Tuesday, December 30, 2014
2014: A Year In Review
Fiscal Year 2014 is a year that WMHS can look back on with great pride. Throughout the year, we continued to provide value-based care with that care being provided in the most appropriate location whether it was in the acute care setting, in a clinic, a physician's office or in the home. We also continued to align our care delivery model with the Triple Aim of Health Care Reform: improving quality, making our community healthier and reducing the cost of care. Many in the health care field continue to be skeptical of value-based care, but it is working.
We are most fortunate that Maryland got it right by introducing a new payment methodology, Total Patient Revenue, four years ago in ten Maryland hospitals and Global Budget Revenue earlier this year for the remaining Maryland hospitals. As a result, FY'14 was our second consecutive year for exceeding our net revenue over expense, which has enabled WMHS to re-invest those savings into programs and services that support our new care delivery model as well as to enhance our role as the safety net for the region. This year was the first that we were able to provide funding to local agencies like County United Way, Salvation Army, Western Maryland Food Bank, Associated Charities, Allegany Health Right and HRDC that assist us in meeting the social needs of those patients whom we serve. It is our intent to enhance the needs of our community through better transportation services for those getting to and from the hospital, assistance with housing, assistance with drug availability and cost, better dental care, healthier foods, bringing health care to the communities that we serve and better navigating the wide array of needs on behalf of our most vulnerable patients.
During FY'14 we have also achieved a great deal of notoriety in the success of our care delivery model. We have presented to groups across the country; hospitals have visited WMHS to learn about our success; we have been written about in national publications, newspapers and journals; Maryland's Governor and the Secretary of Health visited WMHS in August lauding our accomplishments in care delivery and improvements in community health; and in December we were one of ten hospitals recognized by the American Hospital Association with its Living the Vision Award.
Along with our partners, Meritus Health and Frederick Memorial Health System, we also formed the Trivergent Health Alliance this year. The focus of the Alliance is improved clinical quality, better population health and the formation of a Management Services Organization where we consolidated Information Systems, Pharmacy, Human Resources, Revenue Cycle, Laboratory Services and Supply Chain.
Fiscal Year 2015 is not expected to be any different as we continue in the same direction through our ongoing focus in bringing improvement to our care delivery model, remaining as one of the top ten best hospitals in Maryland in improving the patient experience, reducing hospital acquired conditions, increasing the use of core measures and being there for all of our patients, especially those who are the most vulnerable with multiple chronic illnesses. Some of the initiatives to watch for in FY'15 would be introducing community gardens into areas of our region where healthier eating is a necessity; bringing primary and speciality care to underserved areas of our region through a mobile health unit; new state- of-the-art technology in Cancer Care, Women's Health and Diagnostic Radiology to better diagnose, treat and care for those who we serve; as well as continue to recruit for both primary and specialty care physicians bringing the latest knowledge and expertise to our health system and community.
It may seem like a tall order, but with the dedicated and committed employees of WMHS and Trivergent along with our medical staff, we continue to be very well positioned.
Have a safe and happy New Year!
We are most fortunate that Maryland got it right by introducing a new payment methodology, Total Patient Revenue, four years ago in ten Maryland hospitals and Global Budget Revenue earlier this year for the remaining Maryland hospitals. As a result, FY'14 was our second consecutive year for exceeding our net revenue over expense, which has enabled WMHS to re-invest those savings into programs and services that support our new care delivery model as well as to enhance our role as the safety net for the region. This year was the first that we were able to provide funding to local agencies like County United Way, Salvation Army, Western Maryland Food Bank, Associated Charities, Allegany Health Right and HRDC that assist us in meeting the social needs of those patients whom we serve. It is our intent to enhance the needs of our community through better transportation services for those getting to and from the hospital, assistance with housing, assistance with drug availability and cost, better dental care, healthier foods, bringing health care to the communities that we serve and better navigating the wide array of needs on behalf of our most vulnerable patients.
During FY'14 we have also achieved a great deal of notoriety in the success of our care delivery model. We have presented to groups across the country; hospitals have visited WMHS to learn about our success; we have been written about in national publications, newspapers and journals; Maryland's Governor and the Secretary of Health visited WMHS in August lauding our accomplishments in care delivery and improvements in community health; and in December we were one of ten hospitals recognized by the American Hospital Association with its Living the Vision Award.
Along with our partners, Meritus Health and Frederick Memorial Health System, we also formed the Trivergent Health Alliance this year. The focus of the Alliance is improved clinical quality, better population health and the formation of a Management Services Organization where we consolidated Information Systems, Pharmacy, Human Resources, Revenue Cycle, Laboratory Services and Supply Chain.
Fiscal Year 2015 is not expected to be any different as we continue in the same direction through our ongoing focus in bringing improvement to our care delivery model, remaining as one of the top ten best hospitals in Maryland in improving the patient experience, reducing hospital acquired conditions, increasing the use of core measures and being there for all of our patients, especially those who are the most vulnerable with multiple chronic illnesses. Some of the initiatives to watch for in FY'15 would be introducing community gardens into areas of our region where healthier eating is a necessity; bringing primary and speciality care to underserved areas of our region through a mobile health unit; new state- of-the-art technology in Cancer Care, Women's Health and Diagnostic Radiology to better diagnose, treat and care for those who we serve; as well as continue to recruit for both primary and specialty care physicians bringing the latest knowledge and expertise to our health system and community.
It may seem like a tall order, but with the dedicated and committed employees of WMHS and Trivergent along with our medical staff, we continue to be very well positioned.
Have a safe and happy New Year!
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