Maryland Senate President in Favor of Legalizing Marijuana

I made a prediction the other day that within four years Maryland would legalize marijuana.......boy, was I wrong with my end date.  It appears that approval is on the fast track with the Senate President, a tobacco farmer and trial lawyer, being in favor of legalization and probably more importantly, taxation.  Public opinion has the majority in favor of legalization; at least that's what the media is deducing from the polls.  I sure as heck don't know many people who are in favor of legalization, but I guess they are out there.  

What amazes me is that the state is committed to improving the health status of its residents and yet they are going to approve the use of marijuana, a drug that is known to be addictive, harmful, cancer causing through prolonged use, and a gateway to the introduction of other extremely harmful drugs such as cocaine, heroin and other hard drugs.  All in the name of tax dollars.  One of the candidates for Maryland Governor wants to legalize marijuana to fund full-day kindergarten education across Maryland.  Somehow, isn't like legalizing prostitution to fund research on sexually transmitted diseases.

The effects of marijuana on one's mental status are well known.  According to WedMD, the psychological effects are a distorted sense of time; paranoia; "magical" thinking; memory loss; slowed reaction time; anxiety and depression with impairment and the residual effects from the drug lasting hours, days or even weeks.  This doesn't even take into consideration the physiological effects that marijuana has on one's body.  

In my almost 60 years, which was old when my father was 60, but not today, more and more, I am feeling like a dinosaur as these "progressive" ideas take center stage and get traction for all the wrong reasons.

Unbelievable!

Today, we received a letter from the Chief Administrative Law Judge (ALJ) with the Office of Medicare Appeals and Hearings.  The letter was to inform hospitals that an administrative law judge's decision on a Medicare claims denial appeal could now take up to three years to adjudicate.  Up until this point, the law required a decision within 90 days.

The reason for the delay: there is backlog of appeals from the Recovery Audit Contracting (RAC) Process.  So, instead of stopping or reducing the number of audits, they have increased the audits and, as a result, simply do not pay hospitals for the care that they have already rendered.  We currently have hundreds of cases in the RAC appeal process, tying up millions of dollars and now we find out that the delays will only get worse and never get better.  

The national backlog of appeals has grown to almost one half million and it continues to rise.  Previously, hospitals across the US simply budgeted for the RAC process and didn't appeal to the ALJ level.  Then, CMS stepped up the number of audits to the point where hospitals could no longer allow the audits to continue without appeal.  What is of great interest is that we have won every appeal at the ALJ level except one and even that one should have been ruled in our favor.  This is a broken process that everyone in Washington continues to ignore.

It's More Than A Change in Payment Methodologies

I am preparing to present at the end of the month to a couple of external groups regarding our success under the "new" payment methodology, Total Patient Revenue.  As a reminder, WMHS along with nine other Maryland hospitals changed how we were paid for care delivery back in FY 2011, ultimately impacting how we actually deliver care.  

What I have gleaned from this change in shifting care delivery from one of volume to one of value has been remarkable.  In three years, we went from providing care for the convenience of pretty much everyone except for the patient to the gold standard, which puts the patient and their family in the center of everything that we do.  In addition, we, along with our employed staff and physicians, now have a much better understanding of what it takes to deliver the best possible care.  

Mandated by the State, initiatives like Quality Based Reimbursement, which either rewards or penalizes hospitals in Maryland for the care that they provide, have given us the opportunity to bring improvement to our Core Measures, Patient Satisfaction, Re-admission Rate and our Potentially Preventable Conditions.  We have greatly improved the overall coordination of the patient's care through these many initiatives.  

There is now a partnership between our patients and our staff from which everyone has benefited.  Our staff has embraced their empowerment as well as the very critical core value of innovation.  Everyone is looking at ways to bring improvement to the care delivery process while the patient is in the hospital as well as post discharge and we have found it.  What started as a way to reduce the cost of care has become so much more for our patients and our staff.

What a Difference a Year Makes

This morning, I received an email message from a relative of a patient complimenting WMHS on a dramatic turnaround in the care delivered between January of last year and this year.  I wasn't thrilled to hear of the outcome from last January's admission to WMHS.  The description of the patient's stay was clearly far from our best always, but today's email was a great affirmation of all that we have done over the last year in putting the patient in the center of everything that we do in the delivery of care.  The family member described the turnaround as amazing.  Every aspect of the care and interaction with the family has been exceptional.  She said that she had heard that we had made many positive changes over the last year and now she had the opportunity to experience them first hand.  Congrats to so many people who have embraced the Perfect Circle of Care approach at WMHS.

What Keeps Leaders Up at Night? It May Not Be What You Think

Yesterday, I read a book summary for the relatively new business book, "What Keeps Leaders Up at Night," by Nicole Lipkin.  I thought that the book would be consistent with the phrase that I often hear primarily from consultants, "As CEO, what are the things that keep you up at night?"  The book was very different from the phrase.  The book focuses on basically how to be a better boss.  Not that being a better boss isn't something that we all need to focus on as leaders; however, I was expecting something very different of this particular read.

The beginning of the book focuses on why do we sometimes act like bad bosses.  It says that we could be too busy, too proud or too afraid.  It then asks why our advice as leaders isn't heeded all of the time; why aren't people buying into our messages?  The book also deals with why do we lose our cool in difficult situations; how can we better deal with stress; why can ambition sabotage success; why do people resist change and lastly, what causes a star to fade?  In recommending this book, I would suggest a cafeteria approach.  Pick and chose what may be of importance or significance to you in your attempt to recognize and resolve any troubling management issues.  

Quite honestly, there are a lot of things that keep me up at night, actually from about 4 AM on, but at this point none is related to management issues.  My demons are ensuring a safe environment for our patients, providing the best care possible to every patient who walks through our doors, remaining financially healthy in today's health care environment, being positioned to keep viable health care in this community going forward, keeping physicians engaged in the changes facing us, complying with the 122,000 federal regulations not to mention the Joint Commission and the State of Maryland, and the list goes on.  

The bottom line is that there is enough to keep all of us up at night and whatever tool may be available to assist us in dealing with these issues we should use it.  That's why I was excited to review this book, but it missed the mark for me.  Maybe it's time to write a book on how to better deal with the myriad of issues that plague all of us.

A Year in Review at WMHS

Over the Christmas holiday and that's what it was, "the Christmas Holiday" not the “Happy Holiday,” I had the opportunity to reflect on my many blogs throughout 2013.  Although it's tough to come up with a blog topic everyday, I really do enjoy it.

To recap, some of my more memorable blogs during the year included:  health care spending down for three consecutive years and the process necessary for continuing to get cost out of the system; our Door-to-Balloon team winning the Maryland Patient Safety Center's award for patient safety innovation; our many accomplishments under Meeting the Challenge of Health Care Change; the formation of Alliance Health between WMHS, Frederick Regional Health System in Frederick and Meritus Health in Hagerstown; the impact of Sequestration on hospitals, especially WMHS; a personal call from Senator Paul Sarbanes in reaction to some recent blogs (which turned out fine); the impact of social media in health care; efforts to legalize marijuana in Maryland; just how wrong Consumer Reports Hospital Compare data really is; the 86% increase in the gasoline tax in Maryland; my platform for success as shared with the business students at Frostburg State University; the “how to” of becoming a CEO; the senselessness of the bombing at the Boston Marathon; the importance of mentorship; some of the many books that I read during the year: Lean In; Patients Come Second; Linchpin; A Culture of High Performance; The Advantage; How to be Exceptional - Drive Leadership Success; the criticality of organ donation; Total Patient Revenue and disruptive innovation; the dual role of hospitals in communities across the US - economic engines and deliverers of patient care; recognition of WMHS physicians; the value of iTriage for consumers; recognition of our nurses; our high school wellness ambassadors; recognition of WMHS employees for their service awards; the roll out of our pay for performance for our docs; blogs on Governance; recognition of outgoing board member Don Alexander; lessons from the Joint Commission after their five-day survey;  joining CEOs against cancer; the absurdity of the Recovery Audit Contracting on the part of the feds; a Tribute to my father; a tribute to my daughter when she was promoted to Navy Lieutenant; the problems with wind power; critical thinking skills and common sense; many blogs on leadership; over-regulation of the health care industry (122,000 federal regulations......really); the opening of the Center for Clinical Resources; the failure of the Health.gov website and last, but not least how unforgiving the Feds would be toward any other organization's failure of a similar magnitude and the government's shut down.

Let me know if there are any of the blogs mentioned above that you may have missed and would like to see.  

Anyway, have a safe and happy New Year's Eve.  Here's hoping that 2014 will be as memorable as 2013.