Status of Clinical Affiliation with UPMC

In an effort to keep everyone informed as to the progress that we are making in our discussions and negotiations with UPMC on our clinical affiliation, let me offer the following:

The discussions for a clinical affiliation with UPMC are progressing well.  The next step is finalizing the letter of intent, which summarizes the contractual agreement between WMHS and UPMC.  We anticipate that this letter should be signed in the next few weeks. Once the letter of intent is signed, we will negotiate the definitive agreement, which specifies the details for the clinical affiliation between WMHS and UPMC.

The following areas have been identified as part of the first phase of the clinical affiliation:  vascular surgery, thoracic surgery, cardiac surgery, neurosurgery, medical oncology, and behavioral health. We have established clinical services work groups for these areas, and we are in the process of identifying dates for a series of site visits by UPMC’s clinical leadership in theses areas.

Kim Repac, WMHS CFO, is in Pittsburgh today giving a presentation to UPMC leadership and staff on the Maryland Rate Regulation System.  Since our affiliation is their first in Maryland, they would like to have a better understanding of our rate system and our current payment model.

UPMC leadership will be presenting at the WMHS board meeting in April as to their plans for our affiliation and also will provide an update on other affiliation activity currently underway within their system.

Last Friday, I had the opportunity to meet and spend some time with six hospital CEOs from throughout Pennsylvania whose hospitals all have a clinical affiliation with UPMC in some form.  To a person, they were exceedingly complimentary of UPMC and how they are delivering what they say that they will provide in each of their relationships.

All in all, the process continues to proceed very well.  I am very much encouraged by our continued interaction and their commitment to WMHS.  

DEA Presentation on Heroin and Opioids

All that I can say is WOW!  This afternoon at WMHS, we had a continuing medical education session with well over two hundred attendees, most of whom were clinicians.  The presentation was made by Charles “Buck” Hedrick, who works in Intelligence for the U. S. Drug Enforcement Administration and is based in Baltimore.  Buck provided a wealth of information and answered many great questions that followed from the audience.  

Virtually everyone who is involved with the Opioid / Heroin Crisis facing our community was in attendance.  There were law enforcement officers, psychiatrists, trauma surgeons, primary care physicians, hospitalists, nurse practitioners, dentists, ED staff, nurses, crisis counselors and Allegany Health Department staff in attendance.  

Some of the information that he shared included: 

• the USA has 5% of the world’s population, but we use 80% of the opioids and 99% of oxycodone
• there are 24 health departments and over 500 law enforcement agencies in Maryland so teamwork is key as has been the case in Allegany County
• Baltimore is almost exclusively western Maryland’s source for heroin
• the introduction of Fentanyl has set this epidemic apart from the others that began once soldiers started to return from Viet Nam
• Fentanyl is used to enhance poorly produced heroin and it is a killer
• there are over 100,000 clandestine labs in China producing drugs like bath salts and fentanyl
• the DEA has three offices in China
• one kilo of heroin can be bought for around $50K at the Mexican border but it can be cut 3 to 4 times with items like milk sugar and children’s laxative
• you can buy one kilo of fentanyl online for about $3500
• the world’s heroin comes from Southeast and Southwest Asia, South America and Mexico where the poppy crop grows the best
• the DEA has a drug monitoring program where they buy heroin in Baltimore for the sole purpose of testing it to determine where in the world it is coming from

The most interesting piece of information was that 95% of the heroin coming into the US comes from Mexico via three routes: Interstate 5 to San Diego, Route 85 to El Paso and Interstate 35 to Laredo, Texas. (This should be reason enough to better control our southern border.)

Throughout his presentation, Buck repeatedly emphasized teamwork, the sharing of best practices, the need for medical school training of new physicians on prescribing, the success with using peer recovery specialists who can relate very well to those who are addicted, the benefit of mandatory prescription drug monitoring in Maryland, and law enforcement involving the DEA once leads are obtained.  

When an overdose occurs, it is first a medical emergency and then a crime scene. Sharing information and leads among law enforcement with the DEA can be most helpful in addressing the criminal side of this issue.  I, along with the rest of the audience, could have listened to Buck all day.  Like Jimmy Pyles and Sheriff Robertson, who lead many of local efforts on this subject, Buck was a wealth of information and brought a very global perspective to this crisis.

Preserving Value-Based Care

As you may know, I am a contributor to FierceHealthcare's Hospital Impact online publication, which is a peer-to-peer forum for hospital executives, physicians, and other hospital leaders that addresses clinical and operational issues.  A current topic of discussion is the uncertainty about the fate of the Affordable Care Act.  

Below is my latest post that explains why preserving the value-based care components of the Affordable Care Act is so important to the patients we serve.  

FierceHealthcare

Selecting UPMC as an Affiliate Partner

As the WMHS Administration was finalizing our strategic plan, which will take the health system into 2020, it was determined that WMHS would need an academic medical partner to ensure that we could maintain and enhance the clinical programs and services we provide to our patients.  

After a careful review, the WMHS Board of Directors voted to send a Request for Proposal (RFP) to: UPMC (University of Pittsburgh Medical Center);  West Virginia University Health System (WVUHS); and University of Maryland Medical System (UMMS).  UMMS, although initially expressing an interest, chose not to submit a response to the RFP as they were already heavily engaged with the transition of Prince Georges Hospital into their system.  Both UPMC and WVUHS submitted responses to the RFP.  

The WMHS Board of Directors established criteria to determine which organization best fit with our health system.  The criteria included such items as: clinical breadth and depth, commitment to the community, organizational culture, physician alignment, population health initiatives, and clinical innovation.  After a thorough review of the responses to the RFP, responses to written questions posed by WMHS, visits to WMHS by both UPMC and WVUHS, site visits by WMHS representatives to both institutions, and meetings with the WMHS Medical Staff, the WMHS Board of Directors determined that UPMC had the breadth and depth of clinical services necessary to strengthen and broaden clinical programs here at WMHS.  

Throughout this process, we have maintained that our goal for a clinical affiliation is to maintain and expand the services that we provide to our patients locally.  Our intention is that our patients will continue to receive almost all of their care here, and would have to travel of out of town only for those highly specialized services that need to occur at a tertiary care center.  

We are very excited about this potential clinical affiliation and it is just that, a clinical affiliation.  I have already heard rumors that WMHS has been sold to UPMC, but that is not the case.  We will be working much more closely in a variety of areas, but WMHS will continue to be an independent health system that is part of the Trivergent Health Alliance.

Our Region's Opioid / Heroin Crisis

Yesterday, I read about the Chamber of Commerce breakfast with the Western Maryland Legislative Delegation. I was unable to attend since I was on vacation.  During the breakfast meeting, one of the delegates commented on the opioid crisis when asked what the state was doing about it.  During his response, he said, "too many people are becoming addicted because physicians are prescribing too many opioid-based medications" and that this is a relatively new issue.  

After reading the comment, I realized that not everyone really knows about what all we are doing to address this problem and that has to change. In response, over prescribing isn't a new issue; in fact, much has been done to reduce the amount of opioids being prescribed, especially here at WMHS.  

The over prescribing evolved when health care regulators imposed what is known as the fifth vital sign in 2001, which was to control pain. As opioid addiction began to increase, hospitals and physicians began to move away from such requirements and worked to address pain in other ways.  Controls both self-imposed and those imposed by medical staff leadership at WMHS have been put in place in the Emergency Department, Surgery, our Pain Clinic, and in all of the WMHS clinics and practices.  Are there over prescribers out there; of course there are, but the more egregious offenders, who are very few in number, are known to law enforcement and are being closely monitored.  Dr. Jerry Goldstein, WMHS Chief Medical Officer, is having a list compiled through the Maryland state registry that monitors opioid prescribing, as well as through other sources, of those independent physicians and dentists who are considered to be prescribing beyond newly established standards.  Once that list is completed, Dr. Goldstein will meet with each practitioner individually.

Recognizing that this crisis was only going to get worse, the Western Maryland Health System convened its first community-wide meeting to address the opioid / heroin epidemic in our area in August.  Representatives from law enforcement, the State's Attorney's office, the Health Department, the Finan Center, the EMS community and WMHS met for nearly two hours to learn from each other as to the challenges that we each face and to plan the next steps needed to address the many issues.  

It is interesting to note that during that meeting, one representative commented that because there are so many controls on the prescribing of opioids by doctors and the hospital, those who were addicted to painkillers have become our newest heroin addicts.  

The meeting was an open and frank discussion.  It was so well received that a second meeting was held in December and with representatives from the dental community, the Allegany County Board of Education, the Greater Cumberland Committee (TGCC) and local pharmacists being invited to join the group.  A third meeting has been scheduled for February.  

During the December meeting, we talked about many topics, including:

• the amount of crime being committed in our community that is drug related 
• the inadequacies of the State Crime lab for drug testing and how that ties the hands of law enforcement when arrests need to be made 
• the idea of having crisis counselors ride along with EMS and the police
• the number of active Health Department and community programs that are available to wean those addicted off of opioids
• the drug court concept for drug offenders
• the availability of Narcan to law enforcement and EMS and how lives have been saved through its availability
• the new drugs that we are seeing in the ED that may be a danger to anyone who comes in contact with them from police to EMS to ED providers
• the amount of education that is going on throughout the community by Sheriff Robertson and others on the use and abuse of opioids
• the business community's involvement in the issue through an upcoming Greater Cumberland Committee meeting to address the issue throughout the tri-state region.

There has been a great deal of interest as well as action that continues to occur throughout our region on this subject.  After reading yesterday's Chamber breakfast comment, an invitation to the Western Maryland Legislative Delegation to attend our February meeting is in order.  As our progress evolves, there will be more to follow.

Experiencing Amazing Generosity

Once again, it's been a while since my last blog, but I have been exceedingly busy in both my personal and professional lives.  I have taken some time off earlier than usual to spent it with family for Christmas so I have found a few minutes to blog.

As for the generosity, last Friday, my daughter Lauren, who does market intelligence for the Pulte Group (home builders), turned over a newly built and furnished home in Summerville, SC, to a Gold Star family.  Lauren coordinated the entire project so we promised to be there for the release ceremony.  What an amazing gift to this family of a Navy Seal who was killed in action.  In addition to fully furnishing the home, they raised enough money for the taxes, insurance and utilities for at least three years.  A Charleston bar owner even donated a new tricked out golf cart for the surviving mother and daughter to travel around the neighborhood.  The Coastal Carolina Pulte Group pretty much does a home a year for a veteran wounded in combat, but this was a first for a Gold Star family.  There were dozens of subcontractors who donated their time and materials.  Big screen TVs and audio equipment were donated for virtually every room; Lauren had landscapers who were fighting over who was going to landscape around the home.  People are truly amazing and it was a very special day for me.

As many of you are aware, my son-in-law Terrell's cancer is back in both his leg and his lungs; second time this year and third time since February of 2014 in his leg, but the first time in the lungs.  He started chemotherapy in October and will be heading to MD Anderson in Houston the day after Christmas for a five-day visit.  Because of his chemotherapy, my son-in-law will be severely immunocompromised so routine air travel wasn't the best option.  Last month, I reached out to friends and colleagues seeking a private jet / airplane to take them to Houston with the full intention to cover all of the expenses.  Not only did I have an offer within five minutes of the Facebook ask, but the entire trip has been donated by this friend. I continue to be amazed at the kindness of people.

This takes me to the Western Maryland Health System, where generosity abounds.  On the Saturday before Thanksgiving, the Health System, along several partners provided a complete Thanksgiving meal to over 2500 people who most likely wouldn't have had much to eat let alone a traditional Thanksgiving dinner.  They were invited to the Regional Medical Center for dinner with transportation being provided if needed.  If you were a shut-in and unable to come to us, we came to you.  Meals were also delivered to homes throughout the communities we serve.  It was an amazing event coordinated by our own Jo Wilson, who is by far one of the kindest, most caring people that I have ever met, and she was joined by a wonderful group of volunteers who were mostly WMHS employees and their families.

  

Which brings me to Christmas.  As I was preparing to head out for Christmas, I watched dozens of departments and patient units throughout the hospital prepare their many gifts for the Christmas families that they sponsored this year.  I saw bikes, games, clothing, toys, coats, blankets and gift cards being wrapped in spare offices and conference rooms.  Carts of gifts were being transported to waiting cars for delivery to homes, churches, the YMCA, nursing homes and the rescue mission so those less fortunate could experience Christmas like the rest of us.  I am honored to work with such wonderful people each day.

As I noted above, the year 2016 was a busy one and, for the most part, one that I would like to forget.  In addition, to Terrell's cancer returning, my mother-in-law was diagnosed with Stage 4 ovarian cancer in February, my own mother passed away in June and both of our six-year-old cocker spaniels died with a few months of each other; but there were bright spots as well.  The love, kindness and generosity of the people mentioned above as well as those who have been there to support me and my family throughout this year with so many personal challenges.  Undoubtedly, the brightest spot of all has been the birth of my first grandchild, Matthew Ronan Jackson.  (Photos below.)  What Jessica and Terrell went through to have Matthew and then to bring into this world this sweet, little child who is always smiling and laughing (at least when I am around). God knew that we needed something good this year and he certainly delivered.  

Now for 2017, I am hopeful, as is Terrell, that God is ready to deliver again.  Have a Blessed Christmas and a very Happy New Year.

Improving the Community’s Perception of WMHS

On Monday, I blogged about feedback that we received from our leadership related to improving the community’s perception of WMHS.  Lots of ideas were offered and I thought that it would be beneficial for everyone to know what we will be focusing on over the next few months related to perception.

Executing on Fundamentals

• First and foremost, find out the drivers for the misperceptions
• Educate and engage our employees to a much greater extent on the many positives occurring at WMHS
• Hardwire the patient experience process organization wide
• Explain why there may be long waits in the ED and the steps that are being taken to address
• Ensure accountability of our staff that they are putting the patient at the center of everything that they do
• Better manage patient and family expectations
• Encourage patients to make complaints when problems occur – we can’t fix it if we don’t know about it
• Do a better job of scripting staff when they hear negative comments about WMHS
• Make sure that the staff know where complaints should be directed
• Use Voice of the Patient findings from our patient satisfaction results to identify patient issues and follow up when possible
• Patients need to understand how health care is changing and what to expect when you come to the hospital
• Explain our triage process in the ED as to why some patients may be seen more rapidly than others
• Need to engage physicians more so they have a better and more accurate perception of WMHS; especially those who no longer have a hospital practice
• Establish a Patient / Family Council at WMHS

Prove Our Credibility

• Tell our story to a greater extent; a little shameless self-promotion could be a good thing
• More thoroughly explain the Hospital Medicine program and the credentials of these very well trained hospitalists
• Make sure that the public knows that their primary care physician has chosen not to come to the hospital and that he or she has been replaced by a hospitalist
• Encourage staff to intervene as quickly as possible to address problems and issues so they can be resolved as quickly as possible.
• Send the latest annual report (Transforming Healthcare) to homes throughout the region
• Provide that same annual report to every patient upon admission
• Contact every patient post discharge to thank them for choosing WMHS
• Provide blameless apologies while patients and families are still at the hospital

Demonstrate Value

• Promote the positives, i.e. the WMHS Heart Institute, the Da Vinci Robot, the Wound Center, the Schwab Family Cancer Center, etc.
• Increase engagement of patients and families
• Ensure the community that it’s not only academic medical centers that have the latest technology.  We have state of the art technology for all programs and services offered at WMHS.
• Provide ongoing education to staff on the latest happenings at WMHS that would benefit both them and their patients
• Promote our quality measures that are already on our website to the community
• Ensure that our Marketing Dept is well aware of the latest technology, equipment and techniques being used and applied at WMHS

Again, it was a day very well spent with many wonderful ideas being offered.  I have attached an electronic copy of our annual report, Transforming Healthcare, to this blog so you can see for yourself what we have been up to at WMHS over the last year.  Lots of great things are happening every day at WMHS; we just need to tell someone.

WMHS FY2016 Accomplishments