Bringing That Personal Touch To Health Care

My, are times changing.  It wasn't that long ago that the great majority of care was delivered in the acute care setting.  Now, and as I have written on my blog for the last year, care can be delivered in so many different settings.  Today, I am blogging about a concept that the Western Maryland Health System and six other hospitals in Maryland are pursuing, Transitional Care.  The focus would be to target high-risk patients, primarily those patients with pneumonia, heart disease, diabetes, COPD and other chronic conditions.  Nurses function as caregivers, coaches and navigators.  They meet with patients before they are discharged from the hospital and then after discharge in the patient's home.  These Transitional Care Nurses make sure that the patient is set with their medications prior to discharge, appointments are set for follow up once the patient is discharged, transportation to doctor's appointments is available and that the patient is appropriately caring for himself to avoid readmission.  Most of the seven hospitals noted above are performing some form of transitional care, but by collaborating on such a venture, we could bring best practices to the program, benefit from the economies of scale through less duplication and potentially serve as a model for Maryland.  At WMHS, we have already demonstrated that case managing patients and bringing that personal touch to their care can not only reduce needless admissions, readmissions and expensive testing, but it can also reduce the cost of care and improve the quality of the care that is being delivered.

Health Care Reform, What it is and What it isn't

Yesterday, the oral arguments before the Supreme Court on the Patient Protection and Affordable Care Act (aka, Obamacare) ended.  We won't know until June of the outcome of those arguments and their decision.  However, it is important to sort out what is reform.  Actually, it is the legislation now being tested before the Court, but it is also reform in how the delivery of care is provided.  Hospitals such as Western Maryland Health System are involved with changing how we do business.  You will continue to hear value over volume, most appropriate care in the most appropriate setting, reduced readmissions, less utilization of services, more clinic visits, more care provided in the home, etc.  We have designed our three-year strategic plan around health care reform, but not the reform contained within the legislation.  We are converting our health care delivery model to one of reduced cost, better quality and less volume from a model focused almost exclusively on the provision of acute care services and higher utilization of procedures and testing.  Obamacare may not survive in its entirety, but there is no going back to the traditional approach to the delivery of care.

So Much For The Do Not Call List

Usually when I am home and the phone rings, I screen the call to see who is calling.  If it's identified as out of area, a toll-free number, a private caller, the Republican National Committee or any political candidate, I don't answer the call.  This past weekend was different; for the fun of it, I answered every call. 

I can tell you that the International Firefighters Association doesn't like to be challenged; they can be nasty.  I guess I would be nasty too, in a defensive kind of way, if I were a charity collecting money for firefighters and they were getting less than 30% of what is being collected.  I told the RNC that they wouldn't get a dime until they support candidates who will do a better job in Washington DC (less gridlock) and start putting pressure on Rick Santorum to get out of the campaign.  Lots of calls, lots of challenges by me of the callers; actually it was kinda of fun. 

However, I am curious.  What ever happened to the Do Not Call List? I signed up several years ago and it's like it doesn't exist.  When you challenge the caller by telling them that you are on the list not to call, they tell you that you have had a past relationship with the organization or better yet, given them money in the past.  I think not.

Act of Valor

This past weekend, I saw Act of Valor for the second time.  Pamela wanted to see the movie since I saw it alone while she was in Virginia Beach moving our Naval Officer daughter into her new apartment.  I told Pamela that it was great, but not really her kind of movie......romantic comedy, it isn't.  Anyway, after seeing the movie, she loved it and I was wrong AGAIN.  What she found so unbelievable was the ease in which someone would throw themselves on a grenade in order to save the lives of their men.  Now we both recognize it was a movie, but again, anyone in uniform in this movie wasn't a Hollywood actor, they were a serviceman or woman so it is part of Navy Seal training.  Pamela mentioned this observation to our daughter who said that she has received training on how to fall on a grenade.  The things that our children try to keep from us.  It is truly amazing what the Navy Seals, along with all servicemen and women, do for us day in and day out.  When you see a movie like this one, it is hard to comprehend the dedication, the selflessness and the sacrifice of our military and their families.

But It's Free

Over the weekend, I received a call from Potomac Edison regarding receiving my "free" home energy conservation kit.  I said that I have energy efficient light bulbs, power strips and water conservation devices for my showers, so I don't need the kit.  She said "but it's free."  I said nothing is for free, what's the catch? She said the state of Maryland has mandated that Potomac Edison offer these kits to their customers.  I said how generous of Potomac Edison; so you are covering the cost of this "kit" at no cost to the customer?  She responded, "No, it's already in your rates."  I said, "So I am already paying for it, whether I take it or not? “ She said, "Yes."  What a deal.  Thank you, Maryland state government.  You always know what's best for me.

Geography Does Matter

First off, I forgot about yesterday's blog until I was walking out the door after a long day that started at about 3:30 AM.  Lots of meetings, including a Finance Committee meeting and a Board meeting.  So, my apologies. 

In this week's issue of Modern Healthcare, there is an article "For better or worse - Where you live affects the type of healthcare you're going to get."  The article describes the first-ever scorecard on local health system performance done by the Commonwealth Fund. It tracked 43 indicators covering 4 dimensions of care: access, prevention and treatment, cost and avoidable reuse and, lastly, health outcomes.  There are strong geographic patterns of performance with the Northeast and Upper Midwest being in the top quartile and the Deep South being the lowest performing region in all categories.  Allegany County, Maryland, received a top quartile score overall with access and prevention \ treatment scoring in the top quartile, cost and readmissions scoring in the third quartile (obviously there is room for improvement) and health outcomes scoring in the second quartile.  In both the areas of cost \ readmission as well as health outcomes, there are numerous initiatives underway at WMHS to bring almost immediate improvement to these areas.  The results were a pleasant surprise and it shows that all of our efforts in changing how we do business are finally paying off.

Another One Bites the Dust

As a health system, we go to great lengths to protect the privacy of our patients.  We are constantly reminding our employees of preserving and protecting patient information.  You routinely hear of famous people's patient information being breached and sold to tabloids.  At WMHS, we continually run audits to determine if such breaches occur.  Not that George Clooney has ever been hospitalized at WMHS (and I couldn't tell you if he was), but we do get local VIPs and we will audit their electronic records to ensure that access has been limited to those involved with that patient's care.  Our number of breaches has been reduced dramatically over the years as all System employees know that if you breach confidentiality of a patient you will be terminated.  I make that perfectly clear at New Employee Orientation and then every opportunity thereafter of our policy and how seriously it is taken.  Of late, any such breaches have been the result of employees who have friends, acquaintances or family members as patients and they access their records.  It doesn't matter if you are checking grandma's lab results just to make sure that she is OK.  If you do and you don't have the need to know that information in the course of your position at WMHS, you are fired.   As I noted earlier, the numbers of breaches are very few each year; however, I am striving for none.