"The Ronan Report" provides insight about the activities at the Western Maryland Health System in Cumberland, Maryland, and about the changes taking place in healthcare today from a CEO's perspective.

Monday, April 14, 2014

A Successor Has Been Named

At the end of last week, Kathleen Sebelius, Secretary of Health and Human Services, resigned.  Her tenure was marred with the disastrous start up of HealthCare.gov and everyone knew that she wasn't going to survive the mid-term elections in November.  The "fall gal" in this case will be Secretary Sebelius, but again, that's politics.  

However, the rub for me is related to her successor, Sylvia Mathews Burwell.  Ms Mathews Burwell is a "proven manager" from the Office of Management and Budget according to the Administration, but she has zero experience in health care, medicine, social services or public health.  Isn't that pretty much what the Secretary of HHS oversees--those four areas?  We now have an individual who is a policy expert and she will be running one of the largest components of our Federal Government.  No one is DC seems to mind that she is an experienced bureaucrat with no related experience to HHS.  Her primary responsibility will be to get the Affordable Care Act up and running.  

Members of Congress are hoping for answers from Ms. Mathews Burwell on the future of health care in America.  Really?  I expect Ms. Mathews Burwell will be well prepared to address issues related to the public policy aspects of health care.  But, focusing on the complexities of this business while improving the health status of our communities, providing senior care or focusing on health care for families, especially children, just to name a few, may take a back seat while she gets the failed aspects of the ACA up and running.  ( I am on the record supporting the value-based care delivery aspects of health care reform, which are an integral part of the ACA.)  

Somehow this reminds me of the newly appointed Ambassador to Argentina, who admitted that he had never stepped foot in that country during his nominating hearing in February.  Call me crazy or old school, but related experience, knowledge and background need to be taken into consideration when such appointments are being made.  I hope that Ms. Mathews Burwell excels at her job, but I will have to wait and see.

Friday, April 11, 2014

Some Things That I Think That I Think At The End Of A Week

First, Happy 18th Anniversary, a day late.  The Western Maryland Health System was formed on April 10th 1996.  Wow, how time flies when you are having this much fun.  At least, it became a lot more fun several years after the formation of the System.  Those first three years were a nightmare, but on the positive side it was a character building experience for me personally.

While blogging about anniversaries, it was three years ago today that I started the Ronan Report.  I think that it's time to write a book; I certainly have enough material.

Congratulations to Dr. Jerry Goldstein, our new Chief Medical Officer.  Dr. Goldstein was appointed to the position this week and has done a great job as interim CMO over the last three and a half months.

We had a great meeting of the President's Clinical Quality Council this week.  A wonderful presentation on patient satisfaction as it relates to our physicians by Karen Johnson and some of the best practices around the state that could even make our scores higher by Cindy Bridges.  Rounding out the presentation was Karen Howsare on our Perfect Circle of Care.  Lots of great discussion, ideas and suggestions thanks to Drs. Allaway, Haas, Dusenbery, Lamm, Khanna, Zaman, Goldstein, Wolff, Chappell and Watkins.

At that meeting, it was also interesting to hear their reaction to the release of how much Medicare has paid to physicians.  Overall, the reaction was one of surprise, but more importantly, this will now bring a lot of scrutiny on what physicians are paid.  Investigative reporters across the country have been salivating to get their hands on this information.  By the way, the leader of the physician Medicare billing hit parade was a South Florida ophthalmologist who was paid $21 million by Medicare in 2012.  Oh,my!

What was surprising at the release of what physicians have been paid by Medicare is that payment information was never before shared in the 50 years of Medicare's existence.  Also, I have it on very good authority that at the time the Affordable Care Act was being created the American Medical Association, the drug companies, AARP, the American Hospital Association and the Catholic Health Association, just to name a few were told that "if you aren't at the table, that you will be on the menu" meaning if you don't support the ACA, life could be difficult for those you advocate for.  No surprise there; that's politics.  After all, I watch House of Cards, I know how these things work.

In closing and to add some amusement to my day, I am sitting at my desk finishing my blog and out my window is a woman sitting on the wall in front of the hospital smoking a cigarette with her feet comfortably positioned on our "No Smoking" signs.


Enjoy your weekend!

Thursday, April 10, 2014

Trivergent Health Alliance

The Alliance of health systems, Western Maryland, Meritus and Frederick, has finally arrived at a name for our new Alliance........Trivergent Health Alliance.

Congratulations to our own Clay Jones, who came up with the name.  In a previous blog, I asked for suggestions and got many,  Most, unfortunately, had already been trademarked.  Trivergent was available so we trademarked it and also secured a variety of domain names, i.e .org, .com.

The Alliance continues to make progress in that we are close to finalizing operating and service agreements; obtaining a tax ID number; signing contracts for new technology and consultative assistance; developing systems for tracking savings and allocating cost; issuing RFPs for banking and insurance; finalizing locations for services across the Alliance and developing a new logo for Trivergent Health Alliance.  There continues to be a lot of work ahead of us, but a great deal has been accomplished to date.  The individual work groups in Human Resources, Supply Chain, Pharmacy, Laboratory, Revenue Cycle and Information Technology have done an amazing job in creating an individual business plan for each area.  We are looking at over a $20 million annual dollar saving by year three across the Alliance.  This is a saving that we would not have been able to achieve as three independent health systems.

Wednesday, April 9, 2014

Hospitals Safer Than Homes for Births

There was an article in yesterday's NY Times with the above title.  The bottom line of the article is that the Centers for Disease Control looked at 14 million births, including 130,000 deliveries that occurred outside of the hospital.  Home deliveries had four times the risk for death than deliveries in the hospital.  Personally, I can't fathom choosing to have your baby in your bedroom at home.  If Pamela and I opted for a home delivery with our first child, she would have died.  Complications began toward the end of Pamela's labor and it was only through the quick actions by her obstetrician that our daughter lived.  

We continue to make it so expectant mothers are as comfortable as possible in our Labor and Delivery Center; yes, it's still a hospital, but because it is, your chances of a successful delivery just increased appreciably.

Monday, April 7, 2014

What Not to Wear.........in Hospitals

This blog isn't about what Clinton and Stacey of the show "What Not To Wear" would suggest as to business attire vs. business casual while at work in the hospital.  It's about the recommendations from the Society for Healthcare Epidemiology of America (SHEA).  I read an article this AM as to SHEA's focus, which is the spread of infection by health care workers, clinicians, advanced practice professionals, RNs and physicians and pretty much anyone who comes in contact with the patient through their clothes, jewelry, shoes and accessories.  

SHEA's recommendations would include:
  • Bare Below the Elbows: wearing short sleeves, no wristbands, no wristwatches, no rings and no jewelry of any kind.  No long sleeves in the clinical setting to minimize the transfer of bacteria.
  • White Lab Coats: Although the lab coat denotes professionalism and is a patient satisfier, if you don't have several and have them laundered frequently, they can also be a source of bacteria.  Clinicians are also encouraged to place them on a hook before they enter the patient's room and not wear them around the patient.
  • Neckties:  They too denote professionalism and can be worn but need to be secured by a tie tack or tie bar or preferably tucked in the shirt between buttons to keep them from being in contact with the patient.
  • Shoes:  They should be clean, closed toe, low heel and non skid.  Soiled shoes should not be worn in patient care areas at anytime.
  • Stethoscopes:  They should be cleaned and disinfected between patients as they are a great source of bacteria if not cared for properly.
  • Accessories:  ID badges, ASCOM phones and smart phones can be brought into the patient care area but must be disinfected with great frequency.  
I thought that this article was interesting and worth sharing; I hope that it helps.

Monday, March 31, 2014

A Humbling Account of WWII

Over the weekend, my aunt shared with my cousin who in turn shared with me an account of WWII that was recently declassified which had a direct impact of my existence.  You see, my father, along with his twin brother, was in the Pacific on the USS Fall River, a heavy class cruiser.  He would speak very little of the war.  I knew that he manned the guns on the ship and that his ship never saw any real action.  At least that's what he told me whenever I asked.  

When the war broke out, he left high school and enlisted in the Navy.  He actually came back after the war and graduated from high school.  What I learned this weekend was that if Truman hadn't authorized the use of the atomic bomb on Japan, an elaborate all out attack on Japan had been planned.  The Army, the Army Air Force, the Navy and the Marines would attack Japan in two separate but coordinated invasions.  The casualties were estimated to be over 250,000 Americans and close to a million when you included the Japanese.  

It was later learned that Japan, in addition to planes, ships and submarines, had planned to use thousands of suicide bombers, suicide divers and suicide swimmers to attack ships in waves throughout the Pacific.  But because of Japan's unconditional surrender after the bombings of Hiroshima and Nagasaki, the invasions and attacks weren't necessary.  

We talk of the dropping of the atomic bomb as ending the war in the Pacific theater sooner, but we don't think of the lives that were spared as a result.  I know that many question to use the atomic bomb to this day, but I wonder if knowing that millions upon millions of us Baby Boomers, as well as Generation Xers and Millennials wouldn't be here today, would change some minds?  

Friday, March 28, 2014

Armed Law Enforcement in the ED

Beginning this weekend, there will be an armed law enforcement presence in the ED.  When I moved here 25 years ago, the hospital that I left was just beginning to have armed security in their ED.  A gang presence begin to evolve in the neighborhoods around the hospital and there was an attempted murder in the ED that was gang-related which prompted the change.  I thought at the time that it was nice to get out of that environment. 

Well, here we are 25 years later and we will now have armed deputy sheriffs in our ED.  Times have changed to the point where we need to protect our staff and our patients, especially during weekends.  EDs across the country are experiencing such challenges in protecting their staff as assaults on ED staff continue to rise.  The issues in our ED are primarily drug and alcohol related but nonetheless can still put our staff in a vulnerable position.  

We identified the prime coverage hours and we will have law enforcement on duty along with our security officers.  I am grateful to Sheriff Craig Robertson for his willingness to assist and his coordination of such a effort in a relatively short period of time.  I also appreciate the work of Jo Wilson, VP Operations, and Glenn Emerick, Director of Safety and Security, in making this happen.