"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.

Friday, July 31, 2015

Just When Did The Lights Go Out

Last week, Kevin Turley, VP of Operations at WMHS, was going through photographs from when the new hospital was getting ready to open.  At that time, Kevin came to the hospital in the evening and took some wonderful photographs.  As he was going through the photos last week, he noticed that the Schwab Family Cancer Center sign was lit.  He thought to himself, that sign can be lit?  Realizing that the sign hasn't been lit in years, he reached out to Facilities and asked why the Cancer Center sign is no longer lit.  He was told that the sign can't be lit since it has no lights.  He showed our Facilities guy the  photograph.  He was shocked.  To make a long story short, the sign is now lit at night.  The
solution to getting the sign re-lit............simply flipping the switch.  Someone had turned it off a number of years ago and never turned it back on.  Shame on those of us who work those long hours arriving when it's dark and leaving when it's dark.  We should have made note of it long ago.  Well, anyway, the sign is now lit proudly and a mechanism for keeping track of lighting around the campus has been created.  Nicely done, Kevin.

Tuesday, July 28, 2015

Tour of a Lifetime

Yesterday afternoon, I participated in our Foundation's Tour of a Lifetime event.  We had a special tour for our Foundation Board members after their regular meeting.  This series of Tours is at our Cancer Center.  Julie Hardy, Director of Medical Oncology, and Deana Ouellette, Chief Technologist for Radiation Oncology, conducted the tours in both of their areas.  

The tours were amazingly enlightening for all attendees, including me.  I continue to marvel at what the staff in both of these areas do for our patients, day after day.  There are jobs and then there are callings; this is truly a calling for those who work in our Cancer Center.  The staff is kind, compassionate, pleasant, knowledgable and highly experienced.  
We had the opportunity to see our newest addition to our Cancer Center, our Varian True Beam linear accelerator.  The True Beam, with a price tag of just under $3M, uses pinpoint accuracy to radiate tumors anywhere in the body.  

I had the opportunity to explain to the group during the tour that shortly after moving to a Total Patient Revenue payment methodology in FY 2011, we heard from some staff, physicians and even folks in the community that operating under such a payment methodology would be the end of any new technology and that our intention would be to save money by not effectively treating patients any longer.  In fact, I saw a headline the other day in the NY Post that said just that--the new "dangerous" direction for health care.  Wrong!!  In addition to the article/thought being insulting, nothing could be further from the truth.  The True Beam linear accelerator was a great opportunity to demonstrate for the organization and the community that by reducing unnecessary admissions, ED visits, and ancillary utilization, we could re-invest that savings in new programs and new technology to better treat those in need.  

Now with that said, the efficacy of any treatment needs to be demonstrated to be effective; otherwise, no one will support the treatment financially.  There was a time when if the technology or a drug was available, for the most part, it was provided; few questions were asked.  That is no longer the case.  The payers have said that there needs to be demonstrated viability in the treatment in order for them to pay for it, even though it may be listed as a covered service.  If it doesn't substantially prolong life or have a demonstrated life-saving benefit, you can almost be certain that the treatment will be denied.  With close to $3 trillion in health care spending in the US each year, an "anything goes" model for care delivery couldn't be sustained.  

Anyway, back to our Cancer Center and the Tour of a Lifetime, it was time very well spent and gave me the idea that we need to do more with opening up the health system to the public so they can see what we have accomplished since bringing this still state-of-the-art facility to little old Cumberland.

Monday, July 27, 2015

US News and World Report Hospital Ratings

The US News and World Report ratings are out and whenever that happens, the questions begin as to just how important are they to hospitals.  If you are on the list, they are VERY important; if you aren't, their value can be immediately brought into question.  

The clear benefit is the ability to market your health system and its ranking.  With that said, it is important to mention that the hospitals listed are some of the best hospitals in the United States, so from that perspective US News and World Report gets it right.  However, when you look closely at the criteria and data that are used, yikes, there are a great deal of inaccuracies.  Take the Western Maryland Health System; we are ranked 11th overall in Maryland and number one in western Maryland.  But there are a few problems such as, no geographic definition of western Maryland,  a significant lag in the data that is used and at least for WMHS, the data is out and out wrong.  They have us much larger than we actually are from a bed size perspective; we have many more physicians listed than we actually have in our individual clinical areas;and  they don't rate some of our highly rated clinical areas by HealthGrades nearly as high and vice versa.  

The bottomline is don't use the ratings as the only factor in determining how good a hospital / health system may be.  There are numerous sources to check before deciding on which to use, but the US News and World Report rating are a very good place to start.

Wednesday, July 22, 2015

"Strategic" Divestitures

I was reading the most recent issue of Modern Healthcare and I got a "blast from the past," if you will.  There was an article that Ascension Health, with whom WMHS was a part of until 2008, is divesting itself from the Carondelet Health Network in Tucson, AZ.  They have formed a joint venture with Dignity Health and Tenet, a for-profit health care system to own that system, with Tenet operating it.  I didn't have to read any further to know that Carondelet was not doing well financially since according to the article that has become the strategy of Ascension.  

"They are shedding unprofitable operations and beefing up operations in more profitable markets, which was the case when we part of Ascension," according to Melanie Evans, who wrote the article.  Once WMHS announced back in 2005 that we were going to consolidate the WMHS hospitals into one new hospital, we were told that Ascension Health couldn't be part of a single hospital in Cumberland. 

Back then, Ascension had targeted all except one of their less-than-profitable hospitals / health systems for transition out of their system.  (The one less-than-profitable hospital that they were keeping was Providence in DC.  I am sure that the divestiture of that hospital would not have played well among their many constituencies.) They identified six hospitals across the country that they were going to divest themselves from and we were one of the six.  Our situation was a little different.  Although we weren't a cash cow, we were holding our own financially, but we no longer fit in their model since they only controlled half of WMHS and at the time they were looking for complete control.  Then with the announcement to build a new hospital, that seemed to seal our fate.  Actually, it was a most beneficial transition away from Ascension since our respective missions had changed as we became more formidable as a health care system and they seemed to have transitioned away from their Daughters of Charity heritage.  That particular divestiture was a win / win for both of us, but it was an interesting strategy for a faith-based, mission- focused organization back in 2008, and it still is today.

Wednesday, July 15, 2015

The Path to Lower Readmissions

Both Nancy Adams, Chief Operating Officer and Chief Nurse Executive at WMHS, and I were interviewed for a story on readmissions for the current issue of Trustee Magazine.  The article, "The Path to Lower Readmissions Lies in Patient Support," was written by John Morrisey and is attached.

Tuesday, July 14, 2015

One of the Nation's Most Wired Hospitals

The Western Maryland Health System has been named as one of the nation's Most Wired Hospitals for 2015 by the American Hospital Association. (See the link below to download the article.) Forty percent of US hospitals submitted to be nominated and out of 2213 hospitals, we were selected.  In addition to WMHS being selected, other Maryland hospitals and health systems included Frederick Memorial Health System, our Trivergent Alliance partner; Anne Arundel Medical Center; Peninsula Regional Health System; Calvert Memorial Hospital and the MedStar Health System.  A total of 338 hospitals and health systems were selected as AHA's Most Wired Hospitals in 2015. Selections were made on four criteria, including: infrastructure; business and administrative management; clinical quality/safety and clinical integration between ambulatory/physician/patient/community.  Additional requirements were added this year related to Meaningful Use Stage 2.

The use of data and information has grown dramatically over the last four years at WMHS.  Previously, there would be a significant lag time with data availability sometimes as much as six months to a year, putting the usefulness of the data in question.  Under value-based care delivery, data analysis is absolutely critical so real-time decision making is key.  Because of a commitment over the last few years to acquire real-time information systems, WMHS is much better positioned today than ever before in obtaining data and using it to ensure that patient care is being delivered effectively and efficiently.  Such data also allows us to make better decisions related to our patients who have been determined to be the sickest of the sick.  Previously, our data was focused on the inpatient stay, which continues to be important.  However, we are now appropriately positioned to obtain data in the ambulatory setting and blend it with our other data sources.  

Our connectivity has never been as robust as it is today and that is attributable to a lot of people beginning with Bill Byers, our Chief Technology Officer, David Quirk, Trivergent's CIO, a remarkable team of IT staff at WMHS and at Trivergent, along with many clinicians who have provided their expertise to ensure that the usefulness of the data is meeting the needs of our patients and our staff.  Congratulations to all at WMHS and Trivergent!


Monday, July 13, 2015

Our Newest Employees

This morning, as is the case the second Monday of each month, I had the opportunity to welcome our newest employees to WMHS.  We had a large group this AM with about 50 in attendance.  I usually open with a welcome, a congratulations for being selected as an employee of WMHS and a thanks for selecting us since many have the opportunity to choose where they want to work.  I then ask them to introduce themselves and tell the group a little about themselves and where they are going to work at WMHS.  I also ask them to tell me how they are going to apply our Mission Statement, "superior care for all we serve," in their daily work at WMHS.  

Well, this morning I couldn't have started off with a better person than James, our new director of Health Information Management.  He was excellent in his response to each question and set the tone for the rest of the group.  What usually takes about 20 minutes took almost 50 minutes today.  I learned so much about these folks, more so than at any past orientation.  I was introduced to a number of individuals who changed careers and who are now in health care and loving it.  There were a  number of employees who worked at WMHS previously and are returning (they are my favorites).  I met a lot of new graduates from Allegany College of Maryland (ACM) in mostly nursing, but also in occupational therapy and coding.  

There were great answers to the mission application questions from new EVS employees, patient transportation escorts, food service workers, geriatric nursing assistants and lab techs.  Explaining how their job is going to fulfill our mission can be more challenging and their answers were excellent.  

My favorite answer of this morning's session came from Michele, a newly hired nurse, who said that she decided to come to work for WMHS after reviewing our website.   In her review, she learned of our care delivery model being based on value and she said that care model made the most sense to her so this was the place where she wanted to work.  Since there were so many newly graduated nurses from ACM, I asked what they were being taught about valued-based care delivery.  Their response was that they learned about value-based care delivery during their clinical time at WMHS.  They said that all of their nurse preceptors and pretty much anyone with whom they come in contact when at WMHS was well versed in our very different care delivery model.  Music to my ears!  It was an hour that was very well spent and I loved every minute of it.