Reducing Readmissions at WMHS

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It's working!  Our readmission rate for July was 8.51%; a dramatic improvement over the same month last year which was around 20%.  Why is it so important, you ask?  Any patient who is readmitted with a similar diagnosis within 30 days of a previous admission results in no payment for any subsequent admission within that 30-day period.  Such admissions are deemed avoidable and unnecessary.  We are making excellent progress as a result of exceptional teamwork, led by Dr. George Garrow, our Chief Medical Officer and Carol Everhart, our Director of Care Coordination.  These two individuals and their team have been chipping away at readmissions and reached single digits around April of this year.  They continue to focus on preventing avoidable readmissions through a variety of approaches including:  a more effective patient education program prior to discharge, a more thorough longitudinal discharge plan, follow up with the discharged patient at home through CareLink, a nursing home RN transitionist visiting patients in the hospital before they are returned to the nursing home and once at the nursing home, many more referrals to Home Care, high-risk patients being provided with the discharge medications before they leave the hospital, more immediate follow up primary care physician / nurse practitioner appointments once the patient is discharged, reconciliation of patient medications upon admission and upon discharge.  Just to name a few.  What does this mean in dollars and cents?  Our readmission rate for July annualized would save WMHS around $1.4M this fiscal year.  An absolutely awesome outcome for WMHS.  Great job everyone!

Hospitals are in for a Very Rough Road Ahead

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As I have blogged previously, health care cannot be sustained financially primarily due to the impact of the Medicare and Medicaid programs.  Earlier this week, I watched a videoconference on "Anticipating Lower Reimbursements."  A panel of experts was predicting that if hospitals are not taking seriously the calls to get cost out of their hospitals and health systems, their boards will be looking for new CEOs.  Several years ago at WMHS, we had an expense reduction strategy and attacked all of the "low hanging fruit."  We got out a great deal of excess spending; but by comparison, that was the easy stuff.  Now, the task is much harder. 
We know that we have to reduce our spending by at least 10% to 15% over the next five years as there will no longer be rate increases only reductions in our rates.  In the videoconference, some were predicting 25% over the same period; that equates to $75 million for WMHS.  In order to get our projected 2% per year starting with this fiscal year (July 1 to June 30), organizational transformation has begun and will continue over the next four fiscal years.  
Our annualized target for FY '13 is $6 M to $8M.  We are focused on a host of initiatives including changing how we work; creating labor savings through benchmarks with other hospitals and health systems; reducing senior management by two positions; eliminating many vacant positions; filling remaining vacant positions with displaced employees; continually seeking cost saving initiatives from leadership, staff and consultants; improving collections through a renewed commitment to revenue cycle management,  renegotiating supply and service  contracts; reducing the overall cost of care; improving the quality of care, addressing unexplained / unsubstantiated clinical variation; continuing to reduce medical errors and reducing readmissions.  (Just to name a few of the many initiatives underway at WMHS.)  We have a lot of work ahead of us, but getting everyone on board from employees to physicians to board members to the community will help us survive the deceleration of Medicare and Medicaid spending a lot faster.

Gambling in Maryland

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This week the Maryland General Assembly was called back for its second special session since the regular session ended in mid-April.  The first special session was to raise taxes.  This session is to approve a  video lottery facility (slots) in Prince Georges County at National Harbor (much to the dismay of those slots facilities already struggling) and to allow existing slots facilities to have table gaming.  They will also consider legislation establishing strict regulations on dog owners for injury caused by dangerous dogs, such as pit bulls.  Really?  With all of the pressing issues facing our State, they are going to deal with dog owner liability and gambling.    As far as I am concerned they are 0 for 2 in good reasons in calling special legislative sessions.  Remember, this is the same State that sold the 250 acre Rocky Gap Resort for $6.8 million and wrote off $41 million with a promise by the new owners to build a 300-room hotel and a 50,000 sq. ft. casino through an investment of another $52 million.   The new owners have since said that they couldn't get financing for the hotel and casino additions.  What a deal for the new owners.  Sometimes, I truly wonder why the State does the things that it does.  I am sure that some think the same of some of the decisions made at WMHS; the difference is the WMHS decisions all are made with sound reasoning and judgment, well, at least to me.

Bath Salts (Part II)

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There was a great article in yesterday's Cumberland Times News about the bath salts epidemic facing our community.  A link to the article is attached.  This week the Western Maryland Health System is sponsoring a community wide presentation on the bath salts issue.  The program is open to physicians, nurses, social workers, school nurses, principals and corrections staff.  Dr. George Garrow, Chief Medical Officer for WMHS, will present along with our Trauma Nurse Coordinator, Chuck Barrick; Dr. Christine Lee,  a WMHS staff Psychiatrist; Rebecca Myers, Program Director for the Health Department's Outpatient Addictions; and Capt. James Pyles, Maryland State Police.  There will be a case presentation, a review of the growing incidents as a result of bath salts and the impact on the ED, review of clinical issues related to bath salts and Q&A for attendees.  Following the community wide presentation is a similar presentation for 30 members of area law enforcement.  A training session will be held with some of the same panel expertise that participated in the community wide meeting.  This epidemic is spreading with overdoses related to bath salts being seen in our ED each day.  In addition, the head shops that sell the bath salts are opening throughout the region with increased frequency.
http://times-news.com/latest_news/x1555259886/Bath-salts-A-very-bad-problem

Lifelong Homes

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This morning I read an interview with Henry Cisneros, HUD Secretary under President Clinton.  In the interview, he was talking about his mother and baby boomers.  His 87-year-old mother lives in the same house that she and her husband bought when they were first married and it's across the street from her now deceased parent's home.
He notes the importance of making changes in her house in order to make it easier for her to function.   Such changes included as a ramp rather than stairs leading to the home, an elevated toilet, a walk-in shower, lower sinks, window guards, alarms and outdoor lighting.  He says that we should all be considering such changes for our elderly parents.  In addition, he said that 10,000 baby boomers turn 65 each day and that more needs to be done to support aging Americans.  Communities are being developed for the soon-to-be elderly with shopping centers in walking distance, supportive people around them, age related home improvements, along with adjacent parks, recreation and transit.  We need to remake our older communities with the aged in mind, but affordability has to be a major consideration.  Secretary Cisneros closes with people who live independently are much less of a burden on society and he's right.