"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, March 27, 2015

I Knew You When........

I had a  nice surprise the other day.  I received the attached links to an interview from my good friend, Lou Shapiro, who is the President and CEO for the Hospital for Special Surgery (HSS) in NYC.  Lou was interviewed by Maria Bartiromo of Fox Business on changes in health care and how HSS is handling such changes.  They also discussed health care innovations, Obamacare, mergers and acquisitions and the technology evolution. 

I told Lou that I was disappointed that he didn't do a shoutout to his good friend in western Maryland.  He quickly responded with that he was a little nervous being on live TV and simply forgot.  The interview was very well done and the success that Lou has experienced is so well deserved.  He is a bright, tireless professional who has brought HSS to the position as the number one ranked orthopedic hospital / program in the United States.  Lou and his wife, Mary Lee, would pretty much give the proverbial shirts off of their backs to anyone in need.  They are a delightful couple who truly get the responsibility that comes with Lou's position and their status in New York City.   Congratulations!


Monday, March 23, 2015

We Need More Information

When I arrived home from work the other evening, there was a letter in the mail from the IRS; that's never good news.  In this case, that adage held true.  The letter starts with, "We need more information before we can process your 2014 federal tax return and issue your refund."  The immediate problem was that I hadn't yet filed my 2014 tax return.  

So, I contact the IRS via their website to verify my personal information as they requested.  Of course, when you call, all of their lines are busy so you have to hold until they come on the line to tell you "because of a high volume of calls, you will need to try back later." So after entering all of my personal information and answering a series of personal questions on their website, the IRS request for information culminates with asking if I have filed my 2014 federal tax return. HELL NO!!!! would be my answer but only a simple YES or NO were the options.  

They then explain that a tax return has been fraudulently filed using my identity.  I was then informed that I will not be permitted to complete the 2014 tax return electronically and that a hard copy will have to be sent to a special IRS office in Texas.  That's it, have a nice day!  I am beside myself at this point.  I am like what the hell do I do next?   

So, I proceed to inform my accountant of the news; and I then thought, wait a minute, I pay $127 a year to have my identity protected by Lifelock.  Someone now has access to my SSN and other information; I had better call Lifelock.  So far, the only benefit that I have received from Lifelock has been their alerts every time a registered sex offender moves into the 21502 zip code.  Even that has been useless for the most part.  If a sex offender moves onto my street, that's worth an alert.  But, if identity theft hasn't been an issue before, that's good news and I guess that they have been doing their job. 

So, I call Lifelock and ask to speak to a representative.  I am connected to a Lifelock rep who asks me to verify my identity with more personal questions that I successfully answer.  Then she asks, "How can I help you?"  I explain the situation and she says, "Thanks for letting us know."   I say, "That's it?"  She asks what else would I like for her to do?  I say, "I don't know but you are the ones whom I pay to protect my identity and so far you are not doing a very good job."  She offers to have someone from Lifelock work with the IRS on my behalf. I say," No, that's my accountant's job."  So, she says, "Well let us know when you file your tax return and give us the date of the fraudulent tax return filing and we will note that in your file."  That's what $127 gets you, just about nothing.  

When I went online to see what else I should be doing to protect my identity, there's an ad from Lifelock to sign up with them to be protected from fraudulent tax returns being filed using your identity.  Really?  

I also learned that so far this year over 15,000 fraudulent tax returns have been filed, costing taxpayers over $19 million.  I would love to hear from you as to whether you have had a similar experience with the fraudulent filing of a 2014 tax return.  This is a whole new issue for me, especially for someone who is vigilant in protecting one's identity and the solution seems to be to file your tax return as soon as humanly possible.

Thursday, March 19, 2015

Consolidate or Die

So the message for U.S. hospitals from some at the American College of Healthcare Executives Annual Congress is consolidate or die.  That certainly doesn't leave a lot to the imagination.  

The message is dire, but seems to be on point based on what we have learned through the experience in creating Trivergent.  There are so many more opportunities available to us through Trivergent, and we haven't really scratched the surface.  The cost savings and cost avoidance alone is projected at $40 million by the end of year 3 and that is a conservative estimate.  Individually, each health system would not have been able to achieve that kind of savings since each of us has not only gathered the low-hanging fruit on the expense side, but we pretty much have picked the tree clean.  Then there is the willingness of major healthcare institutions wanting to be Trivergent's academic partner since the day of our initial announcement, although no decisions have been made, which in itself is rewarding.  Prior to Trivergent being formed by the respective CEOs and boards, we were limited in so many ways because of our size and geography.  Since July, that has all changed.


The message in Chicago is that, for the most part, hospitals understand what needs to be done through the expectations being expressed by Health and Human Services and CMS.  Unfortunately, the FTC and Justice Department seem still to be using the playbook from the 90's.  They are blocking affiliations, mergers and acquisitions from an anti-trust perspective.  One government agency is saying "more is better," but yet another is saying "not so fast."  They all need to get on the same page and it shouldn't be asking too much for the President and Congress to legislate and authorize relaxation of such scrutiny.  Then again, they need to get on the same page with this as well as so many other areas of government.  Hopefully, someone is listening in DC.

Tuesday, March 17, 2015

Happy St. Patrick's Day from Chicago

What better place to spend your St. Patrick's Day birthday but in Chicago.  And yes, the river is Green!  I am here for the American College of Healthcare Executives Annual Congress.  As a Fellow, I need ongoing continuing education in order to maintain my board certification.  

So far, many aspects of the Congress haven't been as fulfilling, with a great deal of presentations and conversations related to the "upcoming" shift to value-based care.  At WMHS, we are looking for the next wave beyond value-based care since we have been doing it for the last four plus years.  When I tell colleagues what we have been doing in Cumberland for the last four years related to care delivery, they are amazed.  And well they should be.  What our staff have accomplished in just four short years is amazing.  The level of care that is now being provided to our patients with multiple co-morbidities, such as diabetes, COPD, congestive heart failure and hypertension, is truly making a difference in the health and wellbeing of so many people.  

As we move into that next wave of value-based care, we are looking at much more care being provided in the home setting and through tele-health.  We are looking to issue iPads / tablets to those patients who frequently have issues but may not require a trip to the ED or a hospital admission.  Quite honestly, a tablet is a lot less expensive than an ED visit, provided we do a good job teaching and training patients and their family members on the use of the tablet.  I asked our ED physician group, MEP, to consider their role in such a venture as we would need a call center for these patients to contact.  Having the ability to Skype or use FaceTime to assess a patient in real time in their home can be of great advantage for everyone concerned.  

These are really exciting times for health care and medicine, but I still marvel at those who choose not to embrace the change.

Friday, March 6, 2015

Holding Back the Tears

Last week, I had the opportunity to surprise my 88-year-old mother in Lubbock, Texas, with a long overdue visit.   I had a meeting in Arizona earlier in that week so Pamela and I decided to delay our return home and stop in Texas.  
Traveling to Lubbock is no easy feat, but we made it happen.  It had been two and one-half years since I last saw my mother, which was actually the last time that she traveled out of Lubbock.  We attended a family wedding and she traveled with my younger sister, who swore that it was the last time that they would travel together.  My octogenarian mother has lost her filter; pretty much what she thinks she says, which can get quite interesting on a good day.  Two and a half years is far too much time, but my schedule and the challenges in traveling to Lubbock make it very difficult to visit.  
I do talk with my mother at least once a week, which seems more than sufficient until I see it in print in front of me.  (Yikes, note to self, call your mother more frequently.)  My mother has always been very tough from as far back as I can remember.  She is a very nice person until you cross her or make her do something that she doesn’t want to do.  Not many people get thrown out of the hospital, but last year she did.  She was difficult, somewhat abusive, non-compliant and a real challenge to the point that her doctors said,  "There isn’t much that we can do for you if you aren’t going to listen."  My sister asked her, “What if you were in Barry’s hospital?”  Her response, “Well, I sure as hell wouldn’t act like this!”

Quite frankly, I didn’t know what to expect with the visit nor did Pamela.  Pamela is now the heavy when my mother has a medical emergency and doesn’t want to go to the hospital.  So Pamela gets to assess her via the telephone, photographs or Skype and has to threaten my mother that if she isn’t compliant, she will have to go the hospital.  So far, we’ve been lucky with this approach, but it won’t last forever.  Pamela thought that she might not be welcomed as a result.  To make a long story short, we arrived and rang the bell.  She was surprised to see me and shocked to see Pamela.  
All in all, she was absolutely thrilled that we came for a visit.  It was time very well spent for everyone, even with six inches of snow (the most that Lubbock has seen in a very long time).  We were able to run some errands for her, take her dog to the vet and have the dog groomed.  We assessed the house and were able to have some much needed upgrades to her kitchen done.  We took her to dinner and she was absolutely delightful throughout the visit.  
Although we are already planning our next visit for later this year, saying good-bye was very difficult.  Seeing this frail, elderly woman who still lives by herself in a neighborhood that has changed for the worst over the last 36 years was more emotional for me than I expected.  What was more of a duty visit became a much cherished time that we were able to spend with my mother.  As I was pulling out of her driveway and seeing her standing there waving goodbye, I was holding back tears and saying to myself that she deserves better from her only son.  See you soon, Mom.

Friday, February 27, 2015

Two Excellent Presenters

On the last day of the Premier Governance Conference there were two exceptional speakers, David Gergen, who previously worked as former President Clinton's Chief of Staff and is currently the editor in chief of US News and World Report as well as the co-director of Harvard's Center for Public Leadership; and Leon Panetta, most recently the Secretary of Defense, the former Director of the CIA, former Director of the Office of Management and Budget and a Congressman.  All I can say is WOW!  These gentlemen were wonderful at providing the Washington perspective as well as what is happening in the world today.  They both barely touched on health care, but that was OK; it's not really their forte.  

They were there to talk to us about the gridlock in DC, the Black Swans (Gergen) or the Flash Points (Panetta) that the US continues to face (i.e. 9/11, ISIS, cyberterrorism, Putin and the Ukraine, etc.), the upcoming Supreme Court challenge on the Affordable Care Act, and the 2016 Presidential Election.  Both called Vladmir Putin an extremist thug. 

Gergen talked about VUCA (Volatility, Uncertainty, Chaos and Ambiguity) that is being taught at West Point in relationship to our world today.  Both felt that if Hillary Clinton or Jeb Bush were elected, the US would be far better off than we are today. (Surprisingly, since both are either Dems or worked for a Dem.) 

Gergen felt that the Supreme Court would take a contextual reading of the Affordable Care Act and uphold it.  Gergen also commented that he knows Sylvia Matthews Burwell, the HHS Secretary, very well and she is extremely intelligent.  He said she has a plan B if the court reverses the incentive dollars being paid to the 8 million people in the health care exchanges.  Gergen said that the most significant issue that could derail Hillary's campaign for President is her husband.  He reached back to his North Carolina roots to describe Bill's infidelity and said that, "he is a hard dog to keep on the porch."  He also talked about the extremes in both the Democratic and Republican parties; and as long as the "wing nuts" are there, gridlock will continue.  

Leon Panetta was an extremely passionate speaker about his service in government and our country.  His message and delivery as to his love of our country gave me chills.  Both he and David Gergen are so very much impressed with our children's generation and that our country will be so much better under their commitment, dedication and leadership of this country.  Panetta spoke of the American Renaissance of the 21st century being in the hands of that same generation which will be great for our world.  

The conference was well worth the time and it didn't hurt that it was in the 60's and 70's in Scottsdale, Arizona.  Unfortunately, I had to leave Arizona and go to Texas, where it was in the teens with six inches of snow.  And guess what--in Lubbock, Texas, they don't have plows.  What a mess.  More on that next week.

Thursday, February 26, 2015

Advanced Health Collaborative

The other day it was announced that WMHS, through the Trivergent Health Alliance, became a member of the Advanced Health Collaborative consisting of four other Maryland health systems, LifeBridge in Baltimore, Adventist in suburban DC, Mercy also in Baltimore and Peninsula Regional in Salisbury.  

WMHS was the founding member of the Total Patient Revenue Collaborative almost four years ago and will remain actively engaged with that Collaborative.  However, it was felt that being a member of this new learning collaborative, Advanced Health, would be especially beneficial to our Trivergent alliance partner Frederick Memorial since its membership is primarily Global Budget Revenue hospitals.  Both WMHS and Meritus are TPR hospitals, but we felt that we too could benefit from the work of this new collaborative.  

Hospitals in Maryland continue to face many challenges as we continue the transition to value-based care delivery; and although WMHS has been at the forefront of this new care delivery model for over four years, there is always more that we can learn and benefit from.