The Ruling

Well, I didn't see that coming.  Both Chief Justice Roberts siding with the liberal side of the Supreme Court and upholding the individual mandate by it's treatment as a tax were unexpected.  First, it was kind of refreshing to see the Chief Justice take political ideology out of the decision and rule on the reform law based on it's constitutionality.  As for the ruling as a whole at least from the hospital side, we can now continue on our path toward reform with more certainty.  My prediction was that there was going to be little impact in Maryland if the law was overturned being in a State with a Democratic governor who has embraced the Affordable Care Act from the onset.  As the Governor said in his press conference, it's full steam ahead.  After yesterday's ruling, I was asked to serve as part of a webinar panel for the Huffington Post.  They needed a hospital CEO who had a dissenting opinion of the Supreme Court ruling.  I don't know if I fully fit the bill since there are aspects of the ACA that I am not crazy about starting with its treatment of the individual mandate as a tax, that is quite a reach for me, especially since it was clearly stated by the Obama administration and Congress that it wasn't a tax but, argued before the Supreme Court that it was tax.  You can't have it both ways.  I like the idea of more people being covered with access to health care coverage, but I don't like that we are now destined for a single payer system for health care.  I also don't think that the Act goes far enough in a number of areas especially with medical malpractice.  As an industry, we still practice defensive medicine and over utilize ancillary testing as well as physician consultants in the care of a hospitalized patient.  On the positive side, I have seen firsthand what can be done when hospitals and providers focus on value based care which translates to improved quality, reduced cost and a healthier community.  Congressman Roscoe Bartlett said at the groundbreaking for our new medical center in 2006, that the US needs to become truly a "health" care system and not continue as a sick care system.  He said that we are focusing on treating the illness, but not enough was being done to prevent the illness.  He was right and at the Western Maryland Health System our focus has become just that: we are there if you are sick, but our goal is to get you better and keep you out of the hospital.  And it is working.  We are seeing dramatic difference by more efficiently and more effectively caring for patients while they are in the hospital, but making sure that once they are discharged they have appropriate follow up care, that they are able to see their physician within a week of discharge, if need be, that high risk patients have their medications upon discharge, that patients and families are educated on the patient's illness while in the hospital and that there is a clear plan to keep them as healthy as can be to avoid readmission.  All in all, the Affordable Care Act and the Supreme Court's affirmation of the law have removed barriers for full implementation of the reform law and allow for the continued transition to value based care as a nation.  As I have blogged before, US health care is financially unsustainable in its current form.  We now have a clearer path for better, more cost effective care, covering more people when they are sick and focusing on their overall health and wellness in an effort to prevent hospitalization going forward.  I find it amazing that I was not a fan of the Affordable Care Act in its entirety in 2010, but as I have worked under the value based care delivery model for the last year and a half, there are aspects of the reform law that make sense and should be built upon.  We need to take the politics out of health care and focus on improving what has already been started.  However, some additional areas of focus would be tort reform, ensuring that health care remains affordable for businesses and individuals, aligning incentives of providers since many physicians are still reimbursed on a volume of service basis, more is done to support and grow the practice of medicine across the US, especially in rural areas, less onerous regulation and immediate attention to what has become the absurdity of the CMS RAC audit process, just to name a few.

I will be on vacation next week and not blogging.  Please have a safe and happy 4th of July.

Today's the Day, but First.

The Supreme Court is to announce their ruling today on the Affordable Care Act at around 10 AM.  I routinely write my blog first thing in the morning based on reflections from about 4 AM on.  So, once again, I will write about another "burning" issue and blog about the decision tomorrow.

I think that I have written before that I am a Yankee fan.  I have been one since I was a young child when I would watch the Yankees with my grandmother sitting in her rocking chair with her rosary beads in her hands praying for her boys, Maris and Mantle throughout the game.  This week most would say that it is a great time to be a Yankee fan as they are 5 games ahead in first place heading into the All -Star break in a week or so.  Actually, I am embarrassed to be a Yankee fan at least for this week and it's about integrity or a lack there of.  On Tuesday, leftfielder Dewayne Wise didn't make a catch in the outfield as he fell into the stands, but the umpire called it a catch and the inning was over.  All of the follow up articles and press coverage was about the umpire not making the correct call and that Dewayne did what any player would have done.  Really?  I'll take you back to my father in law's memorial service when his best friend and high school football teammate got up and told the story of my father in law and the extent of his integrity.  During a football game, he caught a pass and ran it down the sidelines for a touchdown.  Everyone was cheering on the field and in the stands except my father in law who walked back along the sidelines and pointed to the referee where he stepped out of bounds as he was running down the field.  Needless to say, everyone was angry with my father in law that he came clean.  His friend told him that he was crazy to have told the referee since no one would have known.  My father in law said that he knew and that was enough for him.  Ask yourself, would you rather be known as the guy with his integrity  well in check or the one who sheepishly ran off the field after not catching a foul ball and then getting to see yourself all over national TV in what should be an extremely embarrassing moment?  Some might chalk it up to a different era or winning is everything.  From perspective, about one's personal integrity and it's a core value of this health system for a very good reason.

Drug Shortages - Who is to Blame?

OK, I know that I said that I would blog all week about tomorrow's Supreme Court decision, but so is everybody else.  Blogs, newspapers, radio and TV, the story is everywhere.  Can't wait for tomorrow so we can all get on with our lives.  Outside of the hospital, I have never had so many people ask me about an issue as they have with the upcoming Supreme Court's decision.  So, today I am taking a break from the Affordable Care Act and blogging about a recent poll on the drug shortage issue. 

Recently, a Congressional Committee stated that the FDA is responsible for the shortages because of their over-regulation and not allowing new drugs to the market fast enough.  The results are as follows: Drug Companies - 42.2%; FDA - 11.3%; Both - 42.7% and Neither - 3.8%.  I am in the both category.  I think that the FDA shares in the blame but to a much lesser degree than Big Pharma.  Of course, Congress is going to blame the FDA in an attempt to embarrass the Obama administration.  Congress is not going to bite the hand that feeds them, the drug companies!  We need to stop pointing fingers and work on viable solutions to the drug shortage issue, especially when it is avoidable, as is the case here.

If ACA is Overturned

Needless to say, no matter what happens, a firestorm will result from either side of the aisle--Democrat or Republican--if the Affordable Care Act is overturned.   Everyone from politicians to insurers to providers are preparing for the "what happens if" scenario.  For Congress and the President, it is back to the drawing board.  For others, like insurers and providers, many of the provisions created under the Affordable Care Act will continue.  Hospitals and physicians will continue to work with insurers, policymakers, regulators and each other to do what's right for patients and to build upon many of those reforms already in place. 

A focus on the inability to financially sustain the cost of health care will continue with greater emphasis on the value of the care over the volume of tests, procedures and admissions.  Providers and regulators will continue to focus on quality and patient safety initiatives as well as linking quality with payment reform.  The triple aim of health care reform (better quality, reduced cost and enhanced population health) will also continue to be the focus of all of those groups previously mentioned in today's blog.  States would also individually enact stand-alone legislation on some of aspects of the Act.  Fortunately, Maryland will continue to make changes and build upon those components of reform already in place. 

So far, I am shocked that the Supreme Court's ruling hasn't been leaked to the media, especially in DC where un-named sources run rampant.  Actually, that gives me a good feeling about the integrity of the Court.

The Waiting Continues

This is the week for the Supreme Court's ruling on the Patient Protection and Affordable Care Act (aka Obamacare).  Everyone is weighing in on what the ruling will be.  So I figured why not weigh in, as well.  Actually, I have about as much to offer in the area of expertise as everyone else so why not.  My guess --because it is simply that, a guess--is that the individual mandate will be struck down, but other aspects of the law will be upheld. The Court will focus on the constitutionality of the law as they did with Arizona's Immigration Reform, which they ruled on today.   What such a ruling means, however, is that it presents a number of challenges for Marylanders.  It puts pressure on Medicaid with increased enrollment; access to care may be threatened; those with pre-existing conditions may be denied coverage; varied premiums for healthier employees would be put in jeopardy and the increase in uninsured will increase the amount of uncompensated care. 

I read about an interesting poll today whereby the majority of Americans like the provisions in the Act but don't like how it was enacted by Congress and the President.  Tomorrow, I will blog about what it would mean for Marylanders if the entire Act is overturned. In fact, I will blog all week about the Affordable Care Act leading up to the Supreme Court's announcement of their ruling on Thursday.

Traveling

Last night, I was in Pittsburgh at the Petersen Event Center on the campus of the University of Pittsburgh (by the way, my alma mater is celebrating its 225th anniversary this year) for the James Taylor concert.  Wow, what a show.  His first for his summer tour.  At age 64, he still has it; actually he may be at his best.  Wow!  Also, my first for a concert.......floor seats, about 12 rows from the stage. 

I will be leaving Pittsburgh this AM and heading to my New Jersey roots, actually to the Jersey Shore for a wedding and pretty much a family reunion.  The Ronan Report may be on hiatus until Monday so, enjoy the weekend. 

Congratulations!

The Western Maryland Area Health Education Center sponsors health professional caucuses that meet regularly to give their members a way to network, discuss issues, and plan continuing education courses and other events.  Many of the caucuses recognize one member each year for their outstanding contributions to their field.  Three members of the WMHS family were so honored recently:

Kim Bittner, Nurse Practitioner of the Year

Jennifer Hoover, Registered Dietitian of the Year

Mary Lou Perkins, Social Worker of the Year

Congratulations to Kim, Jennifer, and Mary Lou; all are most deserving recipients of these awards.  Recognition is always nice but means even more when it comes from your peers. 

The Eradication of Polio

Over the weekend, I read an article in the Washington Post on the near eradication of polio throughout the world.  This news has special significance for me as a member of Rotary International.  I have been a Rotarian since 1994 and our local club has been actively involved with the eradication effort since the effort started in 1988.   I was thrilled to read the article.  Of course, there still is the need for funding to kept the effort going.

Yesterday, I read an article on the CNN website that threatens this very eradication effort.  With Pakistan, Afghanistan and Nigeria being the three countries left to target, the Taliban has informed the US government that if the drone attacks don't stop in their country then they will not allow polio vaccines to continue on Pakistani children.  For men of religion and law to use their children as pawns is inexplicable.  Then again, they are responsible for the massacre of hundreds of thousands of their own people while in power for the years prior to September 11, 2001. I hope that the threats are just that--a threat--and that the Taliban is powerless it carry out.

Father's Day

I really don't want to sound judgmental, but yesterday's front page article in the Cumberland Times News on Father's Day was based on an interview with Martin Sheen.  Advice on being a father from Martin Sheen, really?  Advice on acting, great, but Martin Sheen as a role model for Father's Day, you couldn't aim even a little higher?  Oh wait a minute, he and other son Emilio Estevez have written a father / son memoir entitled, "Along the Way" which would assume now classifies them as experts; weren't they estranged for many years?  It wasn't that long ago that Martin Sheen was on the cover of the Sunday Parade magazine for Father's Day under the same mantra: "I may not have been the best father due to my career and never being there or my years of alcoholism, but it doesn't matter who you are, you are never going to get the ideal relationship.  Whatever your kids choose to do is not a reflection of you."

Although they seem to be less and less, including Martin Sheen, there are other Father's Day role models to choose from starting with President Obama.  Like him or not, he is a devoted father to his daughters.  In this day and age, devoted fathers seem to be less and less the rule and more and more the exception.  All the more that we should be promoting great Dads and wonderful role models on Father's Day rather poor or even marginal ones.  Happy belated Father's Day to the many devoted, wonderful fathers out there.

Congratulations Dr. Flint

Rob Flint, MD, our Chairman of Emergency Medicine, has been named Physician of the Year by his group MEP.  Rob is a great guy and a wonderful physician.  Rob is so well deserving of this year's award.  Congratulations on the award and heartfelt thanks for all that you do for WMHS, our patients and our staff.

Insulted or Flattered

Over the past month, I have had several individuals request meetings to discuss "getting on" at the Health System.  These individuals are executives in industries that are unrelated to health care but want to transition into administration at WMHS.  I always meet individuals looking for career guidance and advice and, in this case, gave them sound career advice.  But, after these meetings, my first reaction was really; you sell XYZ product and you have a bachelor's degree in some unrelated field, but you think that you can just move right into the executive offices.  Renowned leadership and management expert and author Peter Drucker says that "health care is the most difficult, chaotic and complex industry to manage in today".  I assure you that Drucker’s quote is true. 

Drucker also said that the four most difficult jobs in America are President of the US, a university president, a hospital CEO and a pastor.  I am not sure that I agree with the hospital CEO part, especially as I look around at the phenomenal job that our staff at WMHS does every day in dealing with unbelievable challenges, many of which involve life and death decisions.  Tough job as a CEO, sure, but one of the four toughest, I don't think so.  Anyway, as I was smarting over the thought that these people feel that they can easily make such a transition into health care, my wife says, "Did you ever think that maybe you make what you do look so easy that others think that they can make such a transition?" Actually, I didn't but much prefer her way of thinking and I should be flattered.  Thanks, Pamela.

The Health Care Hour

Yesterday was a first for me, moderating a 1 hour radio program.  As I blogged yesterday, I participated in Rotary Radio Days at WCBC.  I had no idea what to expect, but it was a lot of fun, especially when one has great people to work with as part of the program.  The panelists consisted of Dr. George Garrow, CMO at WMHS, Jane Jenkins from WMHS Home Care, Carol Everhart, Director of Care Coordination and Quality Initiatives at WMHS and John McMullen, President of Comfort Keepers.  An outline was prepared on the topics that we should cover, the Triple Aim of Health Care Reform: Better Quality, Reduced Cost and Healthier Communities; Quality and Patient Safety and the role of Comfort Keepers as a partner in the health care continuum.  We pretty much blew through those items in the first 20 minutes.  We then had to figure out what were we going to cover for the next 40 minutes.........not a problem.  With the great group of panelists, we ended up with more material than we had time for.   All in all, it was an enjoyable 60 minutes and one that I would repeat in the future.  Again, thanks to WCBC for their assistance as well as their generosity to the Rotary Club.

Rotary Radio Days

Today is Rotary Radio Days, which is a major fundraiser for the local Rotary Club of which I am a member.  A local radio station, WCBC, virtually turns over its station to the Rotary Club for the day.  Rotarians sell advertising and do commercials on the radio station; in turn the Rotary Club uses the monies raised to benefit local charities.  The Rotary Club is also responsible for programming from the afternoon into the early evening on WCBC.  I have the honor of moderating a panel discussion on Health Care for an hour this afternoon.  I am very excited and have been told by numerous people today that I will be wonderful since I have a face for radio. Hey, wait a minute!  Anyway, it should be fun and helps a number of great causes.  Thank you, Dave Aydelotte, owner of WCBC, for you continued generosity and support of Rotary.

Healthiest Companies in America

Congratulations to the employees of the Western Maryland Health System for being named one of Interactive Health Solutions’ Healthiest Companies.  According to IHS, out of 1400 employers with whom they work, they identified 70 honorees, and WMHS is one of those 70.  We have created a culture of wellness among our employees by actively engaging employees in proactive health and wellness initiatives.  We have far exceeded the key indicators and previously established benchmarks by IHS.  WMHS has also been able to reduce our overall employee health care costs.  Great job on the part of the Human Resources staff as well as the staff of Wellness and Employee Health.

Yesterday's Message to Staff at WMHS

At yesterday's Department Director meeting there were a series of presentations related to our current fiscal situation and our FY 2013 operating budget.  Regarding our current state of the System, we are making great progress in improving the quality of care and improving the health of our population.  A great deal of work will continue in both areas, but our early results are most promising.  The area where we have fallen short is in the area of generating a cost saving through the improvement in quality and delivery of care.  It takes a great deal of effort to virtually change the way you do business in any industry, but patient care is especially challenging as we have found out first hand.  Would I change the direction of the organization away from a model based on the value of the care rather than the volume of the services provided, absolutely not!  In fact, I am staking my career on the direction of health care continuing to reduce readmissions, greater focus on quality and safety, reducing utilization, caring for the patient in the most appropriate setting and the list goes on. 

As I have blogged before, health care spending at its current level is unsustainable.  It is my opinion that it doesn't matter what happens with the upcoming Supreme Court decision, even if the Affordable Care Act is overturned, the delivery of health care will continue to change in the direction which WMHS has embraced and that is consistent with our strategic plan.

The Pinnacle Award Winner

Congratulations to Denise Marsh, Charge Nurse on 7 North, on her selection as the WMHS Pinnacle Award winner for 2012.  Denise was selected among a field of 12 "stars" at the Western Maryland Health System. As I told the group yesterday, I was both honored and humbled to be in their presence at the awards ceremony.  These are special people and Denise will very well represent the group throughout the year.  She is an outstanding nurse, an effective leader, always upbeat and positive, a mentor to others and has an excellent rapport with patients and families.  Denise has been described by her colleagues as epitomizing service excellence and exemplifying our Core Values.   Way to go, Denise the award is so very well deserved! 

The Pinnacle Award

Today is a very special day at WMHS as we recognize one of our twelve previous Values in Action award winners (employee of month winners for those of you outside the System) with the Pinnacle Award.  This award is presented to the one employee who stands atop the group through their embracing of our Core Values, their contributions to the organization and their community, as well as, being highly respected by their WMHS colleagues.  What a difficult choice out of the twelve exceptional individuals who demonstrate professionalism and exemplify a dedication to service excellence each day.  These individuals are exceptional; they are the "cream of the crop," if you will, and truly stand out among an already unbelievably dedicated staff at WMHS.  Congratulations to each of the nominees as you are all extremely special in all that you do for our patients, our organization and each other.

The nominees for the 2012 Pinnacle Award are below.

Ruth Romesburg, RN         

Bob MacMillan                     

Jim Brant                                 

Amy Campbell                      

Denise Marsh, RN

Debbie Dayton

Carol Strawderman

Shirley Young

Joshua Payne

Alda Westfall, RN

Chris Seibert

Glenda Billy, RN                

Employee Service Awards

Last week, we celebrated the employee service award milestones for employees with 5, 10, 15, 20, 25, 30, 35, 40 and 45 years.  That's right, we had 2 employees with over 45 years of service.  Amazing and it says a lot for our organization.  We had over 250 employees with 5 to 20 years of service, 34 employees with 25 years, 23 with 30 years of service and 17 employees with over 35 years of service.  There were 13 employees with over 40 years of service, which is also amazing.  The longevity of our staff is unmatched in any other hospital or health system in which I have worked.  This group of awardees has combined years of experience exceeding 5,300 years.  Wow, we are truly blessed with the knowledge, background and experience of our very committed and dedicated staff.

Nanny Bloomberg?

Mayor Bloomberg of NYC has recently been renamed “Nanny Bloomberg” after beginning the prohibition of large sugary drinks being sold in his city.  Quite honestly, my intention in this blog was to criticize the Mayor for his action and ask, "Doesn’t he have more important things to deal with then to tell us what we can and cannot consume?"  I then remembered about a year ago walking through the health system's atrium dining area and seeing an extremely obese forty-something woman who was a double amputee and nearly blind sitting in a wheelchair pulled up to a table eating the biggest sweet roll  that I have ever seen.   My reaction was if people are not going to help themselves then we are going to have to do our part.  We have since adjusted our menu with much healthier choices and have significantly reduced the number of less healthy options that we make available in our Cafeteria.  So, in a way, I am restricting an individual's choice by limiting those unhealthy options in our facility with the same idea in mind as that of Mayor Bloomberg. 

As a society, we cannot sustain the amount of unhealthy living that is occurring daily.  If individuals are not going to be responsible for their own well being, then we are going to have to help them.  There is a lot more at stake for hospitals in the near future as we will be incentivized to ensure that the population we serve continues on an ever improving wellness track.  In the event that there is a decline in the health of our population, the hospital will be penalized.  So, in closing, I have become what is known in political circles as a "flip-flopper."  I have come 180 degrees in my opinion of Mayor Bloomberg's latest edict in a matter of minutes.

Update on WMHS Clinical Quality Council

At yesterday's WMHS Board meeting, I gave an update on the progress that we are making with the President's Clinical Quality Council.  Just short of a year ago, we identified a dozen members of our medical staff who are leaders among the physicians and are early adopters as well as innovators.   This group has been meeting with members of senior management for about ten months addressing a variety of areas requiring change.  As a result, we now have a truly engaged Council of physicians.  Some of our achievements to date have been: enhancing physician education on key topics related to the care of the patient; using data to improve care; better alignment of care delivery; reduced readmissions; a stronger focus on patient-centered care; a reduction in practice variance; an enhanced awareness of the changes facing health care; better quality and patient safety along with a reduction in the cost of care.  There continues to be a lot of work ahead of us, but with closing in on one year since the inception of the Council, I am very pleased with our progress.