Holding Back the Tears

Last week, I had the opportunity to surprise my 88-year-old mother in Lubbock, Texas, with a long overdue visit.   I had a meeting in Arizona earlier in that week so Pamela and I decided to delay our return home and stop in Texas.  

Traveling to Lubbock is no easy feat, but we made it happen.  It had been two and one-half years since I last saw my mother, which was actually the last time that she traveled out of Lubbock.  We attended a family wedding and she traveled with my younger sister, who swore that it was the last time that they would travel together.  My octogenarian mother has lost her filter; pretty much what she thinks she says, which can get quite interesting on a good day.  Two and a half years is far too much time, but my schedule and the challenges in traveling to Lubbock make it very difficult to visit.  

I do talk with my mother at least once a week, which seems more than sufficient until I see it in print in front of me.  (Yikes, note to self, call your mother more frequently.)  My mother has always been very tough from as far back as I can remember.  She is a very nice person until you cross her or make her do something that she doesn’t want to do.  Not many people get thrown out of the hospital, but last year she did.  She was difficult, somewhat abusive, non-compliant and a real challenge to the point that her doctors said,  "There isn’t much that we can do for you if you aren’t going to listen."  My sister asked her, “What if you were in Barry’s hospital?”  Her response, “Well, I sure as hell wouldn’t act like this!”

Quite frankly, I didn’t know what to expect with the visit nor did Pamela.  Pamela is now the heavy when my mother has a medical emergency and doesn’t want to go to the hospital.  So Pamela gets to assess her via the telephone, photographs or Skype and has to threaten my mother that if she isn’t compliant, she will have to go the hospital.  So far, we’ve been lucky with this approach, but it won’t last forever.  Pamela thought that she might not be welcomed as a result.  To make a long story short, we arrived and rang the bell.  She was surprised to see me and shocked to see Pamela.  

All in all, she was absolutely thrilled that we came for a visit.  It was time very well spent for everyone, even with six inches of snow (the most that Lubbock has seen in a very long time).  We were able to run some errands for her, take her dog to the vet and have the dog groomed.  We assessed the house and were able to have some much needed upgrades to her kitchen done.  We took her to dinner and she was absolutely delightful throughout the visit.  

Although we are already planning our next visit for later this year, saying good-bye was very difficult.  Seeing this frail, elderly woman who still lives by herself in a neighborhood that has changed for the worst over the last 36 years was more emotional for me than I expected.  What was more of a duty visit became a much cherished time that we were able to spend with my mother.  As I was pulling out of her driveway and seeing her standing there waving goodbye, I was holding back tears and saying to myself that she deserves better from her only son.  See you soon, Mom.

Two Excellent Presenters

On the last day of the Premier Governance Conference there were two exceptional speakers, David Gergen, who previously worked as former President Clinton's Chief of Staff and is currently the editor in chief of US News and World Report as well as the co-director of Harvard's Center for Public Leadership; and Leon Panetta, most recently the Secretary of Defense, the former Director of the CIA, former Director of the Office of Management and Budget and a Congressman.  All I can say is WOW!  These gentlemen were wonderful at providing the Washington perspective as well as what is happening in the world today.  They both barely touched on health care, but that was OK; it's not really their forte.  

They were there to talk to us about the gridlock in DC, the Black Swans (Gergen) or the Flash Points (Panetta) that the US continues to face (i.e. 9/11, ISIS, cyberterrorism, Putin and the Ukraine, etc.), the upcoming Supreme Court challenge on the Affordable Care Act, and the 2016 Presidential Election.  Both called Vladmir Putin an extremist thug. 

Gergen talked about VUCA (Volatility, Uncertainty, Chaos and Ambiguity) that is being taught at West Point in relationship to our world today.  Both felt that if Hillary Clinton or Jeb Bush were elected, the US would be far better off than we are today. (Surprisingly, since both are either Dems or worked for a Dem.) 

Gergen felt that the Supreme Court would take a contextual reading of the Affordable Care Act and uphold it.  Gergen also commented that he knows Sylvia Matthews Burwell, the HHS Secretary, very well and she is extremely intelligent.  He said she has a plan B if the court reverses the incentive dollars being paid to the 8 million people in the health care exchanges.  Gergen said that the most significant issue that could derail Hillary's campaign for President is her husband.  He reached back to his North Carolina roots to describe Bill's infidelity and said that, "he is a hard dog to keep on the porch."  He also talked about the extremes in both the Democratic and Republican parties; and as long as the "wing nuts" are there, gridlock will continue.  

Leon Panetta was an extremely passionate speaker about his service in government and our country.  His message and delivery as to his love of our country gave me chills.  Both he and David Gergen are so very much impressed with our children's generation and that our country will be so much better under their commitment, dedication and leadership of this country.  Panetta spoke of the American Renaissance of the 21st century being in the hands of that same generation which will be great for our world.  

The conference was well worth the time and it didn't hurt that it was in the 60's and 70's in Scottsdale, Arizona.  Unfortunately, I had to leave Arizona and go to Texas, where it was in the teens with six inches of snow.  And guess what--in Lubbock, Texas, they don't have plows.  What a mess.  More on that next week.

Advanced Health Collaborative

The other day it was announced that WMHS, through the Trivergent Health Alliance, became a member of the Advanced Health Collaborative consisting of four other Maryland health systems, LifeBridge in Baltimore, Adventist in suburban DC, Mercy also in Baltimore and Peninsula Regional in Salisbury.  

WMHS was the founding member of the Total Patient Revenue Collaborative almost four years ago and will remain actively engaged with that Collaborative.  However, it was felt that being a member of this new learning collaborative, Advanced Health, would be especially beneficial to our Trivergent alliance partner Frederick Memorial since its membership is primarily Global Budget Revenue hospitals.  Both WMHS and Meritus are TPR hospitals, but we felt that we too could benefit from the work of this new collaborative.  

Hospitals in Maryland continue to face many challenges as we continue the transition to value-based care delivery; and although WMHS has been at the forefront of this new care delivery model for over four years, there is always more that we can learn and benefit from.

Texas Health Resources

I am attending a Premier Governance meeting in Scottsdale, Arizona, this week.  (70 and sunny, sorry!)  So far, it's an excellent meeting.  Yesterday, I attended a breakout session with the CEO and COO of Texas Health Resources on Leadership in Crisis Management.  

If you remember, this was the Dallas hospital that received Mr. Duncan, the first patient exposed to Ebola while in west Africa who traveled to the US.  Mr. Duncan subsequently died at that hospital, but the story told by these gentlemen was most interesting.  They told of repeated incorrect information being reported by the media; even after they corrected them, the media continued to report the misinformation for sensationalization purposes. 

The CEO said that they followed the CDC guidelines for Ebola exposed patients and found that they were woefully inadequate to the point that they dramatically improved upon the standards as they cared for Mr. Duncan.  The nurses at Texas Health Resources were furious at the American Nurses Association when they repeatedly reported misinformation about what was happening in the care of Mr. Duncan simply to promote their position on issues and to embarrass the hospital.  In turn, the nurses held a rally in support of the hospital. When they learned that 60 Minutes was in Dallas to do a story on the death of Mr. Duncan, the nurses volunteered to tell their story.  If you remember that  60 Minutes segment, the nurses were wonderful in telling it like it happened and dispelling what the ANA was spewing.  The nurses were so effective that Texas Health Resources used them to restore the public's trust in their system because of the misinformation that had been shared nationally.  These gentlemen provided a wealth of knowledge related to managing in a crisis, but their story related to Mr. Duncan was fascinating.

Maryland Community Health Resources Commission (MCHRC)

I have the honor of serving on the above commission.  Last week, the Commission met and we had the opportunity to hear from a variety of providers about their respective grant proposal submissions.  It is amazing as to how creative these providers, consisting of primary clinics, hospitals, health departments, FQHCs, mental health clinics and the list goes on, have become.  

With Maryland now requiring all hospitals and health systems to provide care delivery under a value-based care delivery model, a lot of partnerships have evolved and that's the way it should be.  Providers need to partner with each other and I can now assure you that it's happening in Maryland.  The Commission is awarding millions in grant dollars in areas such as care coordination, dental care, primary care and behavioral health partnerships, infant mortality and diversity in the provision of care.  We voted at the end of the meeting as to who would be awarded the grants and these grantees should be thrilled with our decisions.  

However, it will also be necessary in the near future to use the savings that hospitals and managed care organizations are benefiting from as their utilization begins to decrease and savings begin to occur.  We have been benefiting from our savings by re-investing them in the organization as well as sharing it with agencies in our communities that assist with the social needs of our patients.  We are precluded from applying for grant funding under the MCHRC because I am a commissioner; but I find it rewarding to see these partnerships evolve to better address the care of their patients, and the many ideas are great for potential consideration at WMHS.

Questioning Protocols

Last week, the System Management group met to discuss a variety of issues facing WMHS over the next five years.  For that meeting, the group had been asked by me to read the book, Questioning Protocols, by Randi Redmond Oster.  Randi is a mother of a teenage son with Crohn's Disease.  The book describes how the mother and son navigated the health care system while dealing with such a challenging illness.  

The book discussion on Friday was exceptional.  Part of the group loved the book and the other part of the group didn't like the book or the author.  At the end of the day, everyone agreed as to the overall value of the book as we attempt to do our jobs better, especially as it relates to keeping the patient and his family in the center of all that we do.  

Some of the common threads throughout the book were as follows: the importance of advocacy on behalf of the family for their loved one and that we need to understand and embrace such advocacy; the importance of communication and that we, as health care providers, can fail at that from time to time; that we need to involve the family in the plan of care to a much greater extent; and lastly, that we need to meet the needs and expectations of the family as well as the patient.  

Through the discussion, we now have a host of initiatives under each of the above threads that we will be putting into place as we deliver value-based, patient-centered care.

You Gotta Love These States and Their Taxes

Last night, Pamela and I ate at a very small, unassuming restaurant in Bedford, PA.  If you are a foodie, then again even if you aren't a foodie, you have to go 10/09 Kitchen on Pitt Street. Wow, the food was amazing.  

The owners just got their liquor license and the bar just opened last night. Pamela and I challenged them with a French Martini (her) and a Maker's Mark Manhattan (me); both were great. Previously, they served only beer and wine, but you could bring your own bottle of wine and pay a corkage fee of $15, which is very reasonable.  Restaurants, especially in Cumberland, should consider a corkage fee.  You can buy some great wines for $23 a bottle, but not Pinot Noir. I don't mean to sound snooty, but that's a fact! 

Anyway, at 10/09 Kitchen you can bring your own bottle of wine; but after a recent visit by the Pennsylvania Liquor Control Board, the restaurant now has to ask for proof that the wine was purchased in the Commonwealth of Pennsylvania.  You have to show your receipt to verify that you paid the PA liquor tax.  Without that verification by the restaurant, they could lose that newly attained, much coveted liquor license. And here I thought it was only the People's Republic of Maryland that had cornered the market on taxes and fees!  Rain tax, need I say more?

Again, you have to try 10/09 Kitchen as it will be well worth the trip. Reservations are required since the restaurant holds only 48 people.  Enjoy!