Corporate Finance Attorney Job in Shulman Rogers Gandal Pordy and Ecker P.A. - Potomac, MD

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Job Title: Corporate Finance Attorney
Location: Potomac
State: MD
Practice Area: Corporate, Finance
Level: Mid Level

Description: Are you looking to work in a dynamic, fast-paced, entrepreneurial environment? Do you want direct client contact? Our 90+ attorney firm is the place for you. Rapidly expanding commercial finance practice is seeking a detail-oriented, organized, mid-level Corporate Finance Attorney with 4+ years of loan transaction and financing experience, representing lenders and borrowers alike. Ability to draft and negotiate loan documents is a must. Knowledge of UCC secured transactions, government contract lending and asset based loans is a plus. Experience handling syndicated financing and club transactions is helpful.

Excellent career opportunity for qualified candidates with superior academic credentials and strong drafting skills. For consideration, please submit resume to: mbowen@shulmanrogers.com.

If you are interested in applying for employment with Shulman Rogers and believe you need special assistance or an accommodation to apply for a posted position, contact our Human Resources Department at 301-230-5249.

Hearing impaired users please have your relay service provider contact our Human Resources Department at 301-230-5249.
Source: Firm Web Site
Firm Name: Shulman Rogers Gandal Pordy and Ecker P.A.

Contact Details
Email: mbowen@shulmanrogers.com
Phone: 301-230-5249

Government Contracts Attorney Job in Shulman Rogers Gandal Pordy and Ecker P.A. - Potomac, MD

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Job Title: Government Contracts Attorney
Location: Potomac
State: MD
Practice Area: Government Contracts
Level: Senior Level

Description: Shulman, Rogers, Gandal, Pordy & Ecker, P.A. is seeking both a partner and senior-level associate to join our Government Contracts practice. Attorneys possessing leadership qualities and a high level of motivation and initiative will have the opportunity to expand and lead this practice. Qualified candidates must have strong academic credentials, big law firm experience and, for partner-level candidates, a book of business. The successful candidates must be able to offer a full range of legal services to the firm’s government contracts clients, including handling bid protests, contract disputes, investigations, litigation in the U.S. Court of Federal Claims, debarment and suspension matters and preferably cyber-security and international issues.

Shulman Rogers’ 90+ attorneys offer a broad range of sophisticated legal services to our regional, national and international clients. The firm has grown in recent years both organically and through lateral recruitment of former big law firm attorneys who are attracted to our platform, collegial atmosphere and suburban location. To reward and motivate performance, our compensation system is based on productivity, not seniority. All resumes will be held in the strictest confidence. For consideration, please submit resume to: mbowen@shulmanrogers.com.
Source: Firm Web Site
Firm Name: Shulman Rogers Gandal Pordy and Ecker P.A.

Contact Details
Email: mbowen@shulmanrogers.com

Associate Attorney Job in Silverman Thompson Slutkin White LLC - Baltimore, MD

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Job Title: Associate Attorney
Location: Baltimore
State: MD
Practice Area: Insurance Coverage, Litigation
Level: Mid Level

Description: We currently seek attorney with 4 to 6 years of experience with insurance coverage litigation. Familiarity with complex commercial coverage disputes is preferred. Excellent research and writing skills are a must. Competitive compensation package with a great opportunity for growth in a dynamic and fast-paced litigation environment.
Source: Firm Web Site
Firm Name: Silverman Thompson Slutkin White LLC

Contact Details
Title: Hiring Partner
Email: firm@mdattorney.com
Fax: 410-547-2432
Address: 201 N. Charles Street, 26th Floor
City: Baltimore
State: MD
Country: USA
Zipcode: 21201

Estate & Probate Attorney Job in Stein Sperling Bennett De Jong Driscoll PC - Rockville, MD

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Job Title: Estate & Probate Attorney
Location: Rockville
State: MD
Practice Area: Estate Planning
Level: Mid Level

Description: We have an immediate opening for an estate planning and probate attorney to join our dynamic and growing estate planning practice group. The successful candidate should have an LLM in Taxation with 2-3 years of experience in estate planning preferred. In this position, the attorney will develop, draft and implement estate plans of varying levels of complexity. Some understanding and background in working with clients in the administration of estates and trusts is also preferable. Qualified candidates should forward their resume to recruiting@steinsperling.com.
Source: Firm Web Site
Firm Name: Stein Sperling Bennett De Jong Driscoll PC

Contact Details
Email: recruiting@steinsperling.com

Business Law Attorney Job in Gordon Feinblatt LLC - Baltimore, MD

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Job Title: Business Law Attorney
Location: Baltimore
State: MD
Practice Area: Business, Mergers and Acquisitions
Level: Mid Level

Description: We are seeking an Associate in our Business Law Practice Group. Successful candidate will work on a wide variety of business and commercial matters typical for a fast-paced general business practice, including mergers and acquisitions, joint ventures, financings, business entity creation and governance, employment issues, intellectual property protection, commercial contracts and dispute resolution. Significant client interaction will be expected, along with strong writing ability and an aptitude for business generation. Transactional experience is a plus but others also will be considered.
Source: Firm Web Site
Firm Name: Gordon Feinblatt LLC

Contact Details
Title: Human Resources Director
Email: rseabrease@ gfrlaw.com
Fax: 410-576-4246
Address: 233 East Redwood Street
City: Baltimore
State: MD
Country: USA
Zipcode: 21202

How Much is KO Public Affairs Making From Question 7?

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The Maryland State Ethics Commission posted the lobbying disclosures for August's special session to expand gambling in Maryland.

The Baltimore Sun reported that $3.6 million was spent by casino and labor interests to sway legislators.  The Washington Building and Construction Trades Council, a group favoring a sixth casino at National Harbor, spent the most by far $2.7 million.
However, what we don't know is how much KO Public Affairs, the politically connected firm representing the council and MGM Resorts, had made from their efforts.  
Steve Kearney, Governor O'Malley's former communications chief, and Damien O'Doherty a top aide to former Baltimore County Executive Jim Smith, founded KO Public Affairs.  They are also the founders of the self described straight news site Center Maryland, along with Chair of the Maryland Economic Development Corporation businessman Martin Knott and former Baltimore Sun reporter Howard Libit. 
Remember during the special session, a KO Public Affairs employee with a Center Maryland media credential was caught on the floor of the Senate  during the gambling debate.
Nice how KO can get away with lobbying without having to disclose. 

MGM-Building Traders Lobbying Report

Red Maryland Radio: 9/20/2012

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Hope you caught another great episode of Red Maryland Radio last night on the Red Maryland Network.

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On tonight's show

• 4th District Congressional Candidate Faith Loudon joins us to talk about her campaign;
• The State is talking about  campaign finance reform, and Comptroller Peter Franchot is making waves about instant campaign finance reporting. We discuss the merits of that and discuss the financing of campaigns in the context of constitutional governance.

All that and more this week. Be sure to listen every Thursday night at 8, on the Red Maryland Network.......and don't forget that you can subscribe to the Red Maryland Network on iTunes. 

Vote No On 7 Mailer Debunks Education Spending Shell Game

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Red Maryland has obtained a mailer from the anti-gambling expansion group Get the Facts Vote No on 7, which rebuts the claims of the pro gambling expansion group Maryland Workers for National Harbor's claims regarding education funding.
Q7 Education (2)

The mailer asks readers “How do we know there is a loophole that works against education funding?”
They answer by astutely showing how the Annapolis spending shell game works.
Implicit in the pro-gambling expansion ad blitz is that the added gambling revenue will mean extra money for education.  That isn’t the case
Gambling revenue is put into the Education Trust Fund.  However, like most special funds, the governor and the legislature raid the ETF to cover general fund deficits and for spending on other programs.  Case in point Governor O’Malley’s $861 million raid on the Transportation Trust Fund to balance the budget.  No wonder he’s been asking for a gas tax increase.
In fact, as you can see from the revenue and expenditure table in the bill’s fiscal note, gambling revenue in the ETF supplants rather than augments general fund expenditures, so it can be spent on other stuff. 


We were told this back in 2008 as well with the fiscal note on the original slots-enabling legislation.

This is a point picked up by The Baltimore Sun editorial board, Blair Lee, the Capital Gazette, and the liberal Maryland Budget and Tax Policy Center.
While Get the Facts Vote No on 7 is right to point out this loophole, both sides are exploiting the commonly held fallacy that more money spent on education means better educated kids.  As G.K. Chesterton said, “fallacies do not cease to be fallacies because they become fashions.”
While Education Week’s curious metrics ranks Maryland schools tops in the nation, it still ranks dead last, according to the same Education Week report, in the poverty gap for 8^th-grade math, and a middling 22 for high school graduation rate.  Also, nearly 60 percent of Maryland high-school graduates attending state community colleges need remedial math, and 15 percent attending state four-year colleges need remedial math instruction. 
In 2002, Maryland enacted the Bridge to Excellence or Thornton law, mandating massive increases in state education funding.  The ostensible goal was to erase the achievement gaps between wealthy white students and their poor minority peers.  
Ten years and billions of dollars later, the gaps have proved persistent, and in some cases, widened.
So feel free to double down on gambling, but don’t fool yourself into thinking splitting that pair of tens is going to do anything for Maryland students.  

Red Maryland Radio: 9/27/2012

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Hope you caught another great episode of Red Maryland Radio last night on the Red Maryland Network.

Listen to internet radio with redmaryland on Blog Talk Radio
On tonight's show

• We go into excruciating detail about the Gonzales Poll that came out this week.
• On Tuesday's show, Ethan Grayson refer to liberatarianism making him the "Ultimate Conservative." Greg puts on his professor hat...
• And Greg apologizes to Jimmy.

All that and more this week. Be sure to listen every Thursday night at 8, on the Red Maryland Network.......and don't forget that you can subscribe to the Red Maryland Network on iTunes. 

Judicial Watch asks for State Ethics Investigation of O'Malley

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Earlier this week conservative government watchdog Judicial Watch sent a letter to the Maryland State Ethics Commission requesting an investigation of Governor O'Malley for violating a state law prohibiting the intentional "use the prestige of office or public position" for "private gain".  Judicial Watch  claims "'Private gain' obviously includes personal political objectives, such as seeing a favored candidate win or achieving a desired election result on a ballot question."
Judicial Watch submitted as evidence a letter dated September 18, 2012, O'Malley sent to members of the Democratic State Central Committee urging them to vote for and rally support for Democratic congressional candidates and yes votes on the Maryland Dream Act, gay marriage, redistricting, and expanded gambling.  It appears that O'Malley was addressing the Montgomery County Democratic Central Committee.  O'Malley sent the letter on official state letterhead.  
Judicial Watch also enclosed a January memorandum from the State Ethics Commission reminding state employees the prohibition on using state time or resources for political purposes. 
This is the second time in the last few months O'Malley has used state resources for political purposes. In July, O'Malley used his state funded blog for sloppily made political attacks against Change Maryland.

Full copy of Judicial Watch's letter below
State Ethics Commission (MD) - Complaint Alleging Violation of Section 15-506

WMHS Family and Friends Auction

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While planning the 16^th annual WMHS Golf Classic, which includes a pre-event dinner featuring silent and live auctions, the question was raised as to how we could include more of our employees in the fun and festivities.  The result:  A WMHS Family and Friends Auction featuring both a silent auction and a Chinese basket auction.  The Foundation asked health system departments to consider creating themed baskets/boxes/buckets, etc., and over two dozen absolutely amazing “treasure chests” have been created and filled to the brim for bidding.  The teamwork, fun, generosity, and imagination have been absolutely incredible.   We expected modest offerings…perhaps ten baskets….but no!  Twenty-six themed baskets, many containing over $200 worth of items, from “Family Fun Night” to “Chocolate Lovers” to “Wellness” and “Picnic Time.” Each basket is unique and attractive.  The auction will take place September 5 and 6 in our auditorium.   Many thanks to our employees, who have once again shown their generosity and team spirit.

Nike LeBron and the Urban League

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This is going to be one of those blogs that might be a bit controversial, but what the heck.  I read last week that the National Urban League is taking on Nike for coming out with the $315 LeBron Nike X Plus basketball shoe.  Yes, $315 is quite a bit over the top for a pair of sneakers; however, with all of the issues facing the black community, this is what the Urban League chooses to focus on............sneakers?  At a time when the black community nationwide is suffering from unemployment, the highest among any group at almost 15%; children being born into a single parent family is nearing 80%; the dropout rate among black youth is the highest among any group; there are more black males in our prison system that any other group; black on black murder is the highest than it's ever been and the National Urban League is focused on Nike and a pair of sneakers.  Where is the outrage on the devastating social issues facing the black community?  Where is the outrage toward LeBron James, whose name is adorning the $315 sneakers?   It seems there is quite a disconnect between the National Urban League and the black community and the black community deserves better.

If It Were Only That Easy

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In Friday's USA Today, there was an editorial about hospital acquired infections based on an interview with the former head of the CDC's Infection Division.  William Jarvis makes it out to be that hospitals are sitting idly by, infecting everyone who comes through the door.  There is no doubt that hospitals can be dangerous places, especially for infections.  But to say that we are failing to address these issues is ridiculous.  Never before in the history of health care and medicine have hospitals done more to address infections.  The widespread use of antibiotics, which allows the good bacteria that keeps C-Diff under control, is being addressed in every hospital, every day.  In addition, WMHS and hospitals across the country have stepped up hand washing and facility cleaning tenfold to stop the spread of infection.  Have we eliminated infection, no, but we have stepped up infection control like never before. 
The editorial states that this is the most important issue facing hospitals today and that it should be virtually our only focus.  Well the good news is that it is a primary focus, along with a hundred other "most important" issues facing today's hospitals.  We are faced with preventing ALL potential complications, eliminating medical errors, keeping our patients safe, reducing readmissions, increasing patient satisfaction, covering specialty call in our EDs, keeping our hospitals functioning effectively 24/7 as competing 9 to 5 centers "skim the cream,” continuing to recruit and retain specialists and sub-specialists, maintaining our financial viability in a financially challenging environment and the list goes on and on.  As I heard on a TV program last night, "it is obvious that you have never worked in a hospital."  That is the obvious statement for Dr. Jarvis and USA Today's editor.

Labor Day Weekend

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Labor Day weekend is fast approaching, which reflects the end of summer.  Have a wonderful weekend and please be safe, especially if you are heading to the DC area.  I just read that DC has the worst drivers in the nation.  I don't know, have those who deemed DC as the city with the worst drivers ever been to NYC?  After a trip to NYC some years ago, my daughters said that they had 12 near death experiences before we even got to the Lincoln Tunnel on our way home.  Again, have a great weekend and you will hear from me after Labor Day.

This Shouldn't Be Happening

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Last week, I blogged about the National Urban League's campaign against Nike over a sneaker and said that they should be focusing on more substantial issues such as black-on-black crime.  Over the weekend, while I was in Hilton Head, an 8-year-old boy was gunned down on Saturday morning while he was playing in a neighbor's front yard with other children.  It just so happens that the yard he was playing in was owned by the father of one of his playmates who had fired shots at two other guys the night before.  The Saturday morning attackers were a father (age 38) and son (age 19) who came to retaliate against the playmate's father.  The two decided on Saturday morning to drive by and spray the neighborhood with an automatic weapon hitting and killing the 8 year old.  Killing a little kid out playing in the yard.  A third grader who loved to read and was full of life and in Hilton Head where this stuff isn't supposed to happen.  If the Urban League wants an issue to tackle, here's one neatly packaged for them to champion.

Fracking Opponents Omit Truth about Fracking in Dimock PA

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According to the Gazette’s Reporter’s Notebook, Delegate Shane Robinson and Environment Maryland (the folks who bring you higher energy bills) are calling for an outright ban on fracking in Maryland.

A study released Thursday by the Environment Maryland Research and Policy Center highlights the cost of water contamination as the fracking mixture comes in contact with drinking water sources. The report cites examples of health issues in Dimock, Pa., where companies have spent $300,000 providing clean drinking water and cleaning up methane that seeped into the supply of 14 households. Also cited in the report are millions of dollars in health risks due to air pollution near drill sites, and millions in public infrastructure costs to move all that natural gas — now at record low prices — to market.

Environment Maryland’s “study,” published earlier this week, mentioned Dimock several times.  However, back in July the EPA announced that based on their water sampling in Dimock, the “EPA has determined that there are not levels of contaminants present that would require additional action by the Agency.”
Oops.
But that isn’t the only salient fact left out of Environment Maryland’s report either. From Ronald Bailey at Reason:

A 2008 report by the Groundwater Protection Council, a nonprofit organization whose members consist of state groundwater regulatory agencies, found that the layers of impermeable rock over top of the Marcellus Shale act as a barrier so that the water and chemicals used in fracking could not migrate upward into groundwater aquifers. In addition, a September 2010 report by the Pennsylvania Department of Environmental Protection reviewed its complaint database and concluded “that no groundwater pollution [PDF] or disruption of underground sources of drinking water have been attributed to hydraulic fracturing of deep gas formations….”

 Since 2006, Cabot Oil and Gas has drilled nearly 60 wells in a nine square mile area around Dimock, using the fracking technique. In January 2009, several homeowners noticed that water from their wells was now bubbling. The Pennsylvania Department of Environmental Protection investigated and concluded that natural gas was in fact migrating from several Cabot gas wells into local groundwater and into homeowners’ wells. But poor well construction was to blame. A properly cased well prevents drilling fluids, fracking fluids, or natural gas from seeping into an aquifer and contaminating groundwater. The casing also prevents groundwater from leaking into the well where it could interfere with the gas production process.

In Dimock, gas was escaping through defective casings and cement that lined some of Cabot’s gas wells. To make matters worse, in September 2010, Cabot spilled 8,000 gallons of stored fracking fluids, which drained into nearby Stevens Creek. Earlier this month, Cabot agreed to pay affected homeowners more than $4 million which amounts to twice the value of their houses. Cabot’s blunders illustrate an important point: Fracking, that is, the actual act of fracturing the shale below Dimock, did not directly pollute ground and surface waters. [emphasis mine].
 

Important to note here as well is that Environment Maryland is working with and funded in part by the same radical environmental interest foundation that funded lobbying efforts to pass Governor O’Malley’s offshore wind farm boondoggle.
Natural gas is eating wind energy’s lunch on price. Electricity generated from wind (without the government subsidies the industry claims it needs to survive) costs four times more than natural gas.  
So is it any wonder the same environmental special interests are pushing for a government ban on fracking, while simultaneously lobbying for ratepayers to foot the bill for their favored—and more costly—form of energy.

Un-friending

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For the first time, I de-friended or un-friended someone on Facebook.  As most of you should know by now, I am just right of center, politically speaking.  More and more, I see myself identifying more with the independents as the gridlock in Washington DC worsens.   So, the friend that I un-friended is still a nice guy and I do like him, but I got sick to death of the incessant far left leaning postings on Facebook, sometimes ten a day.  One or two, no problem, but it got ridiculous.  Postings from MoveOn.org, the Progressives, MSNBC and the list goes on.  Finally, I responded to one posting as it was really over the top and in return I got a barrage of attacks from his way left leaning friends so it was time to un-friend him.  Again, a nice guy, but one with a waaaaaay different political ideology.

Scaring Seniors

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Today, I read a quote based on the Republican and Democratic National Conventions that says it all; "rarely have so many speeches been based on such shaky foundations."   Reading and listening to the rhetoric from both sides of the aisle would be amusing if it wasn't so irresponsible.  Both parties just love to scare, especially seniors as to what Medicare is and what it isn't.  To what lengths will these groups stoop to get elected; obviously when you think that they have reached a new low, one or the other will stoop even lower than before.  Why can't they simply tell the truth as to what is in their respective plans and what isn't, instead of allowing the other party to do it for them, all the while scaring the hell out of people?  I can't wait for this Presidential election to be over.

This Shouldn't Be Happening

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Last week, I blogged about the National Urban League's campaign against Nike over a sneaker and said that they should be focusing on more substantial issues such as black-on-black crime.  Over the weekend, while I was in Hilton Head, an 8-year-old boy was gunned down on Saturday morning while he was playing in a neighbor's front yard with other children.  It just so happens that the yard he was playing in was owned by the father of one of his playmates who had fired shots at two other guys the night before.  The Saturday morning attackers were a father (age 38) and son (age 19) who came to retaliate against the playmate's father.  The two decided on Saturday morning to drive by and spray the neighborhood with an automatic weapon hitting and killing the 8 year old.  Killing a little kid out playing in the yard.  A third grader who loved to read and was full of life and in Hilton Head where this stuff isn't supposed to happen.  If the Urban League wants an issue to tackle, here's one neatly packaged for them to champion.

Relationships

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Just this week, I was asked by the principal in the architectural firm used by the health system and the same firm that designed our new hospital as to why we choose him and his firm.  The answer was an easy one.  Our previous architects were with a large firm.  They had all the right answers when they were first engaged, but as time went on, we became an afterthought.  We would be anticipating a worked product and when they arrived to present it to us, it was like they drew it up on a napkin in the car on their way to Cumberland.  After a few of those interactions, they were warned and subsequently fired.  Shortly thereafter, we began the search for a new firm.  We ended up with a smaller firm in Baltimore, Hord Coplan Macht (HCM), based on how we felt that they would work with us.   It was based on fit, trust and what the perceived relationship would be like.  They had all the necessary expertise, but these guys and gals were genuine; they were sincere, seemed trustworthy at the time and have proven that time after time.  
Large national firms can talk a great game, but have proven over time that they think that they are smarter and better than smaller boutique firms--and many times smarter than the client.  When we were preparing to move forward on the new hospital, we didn't hesitate for a minute to engage HCM.  They had never designed a new state-of-the-art hospital in its entirety, but they did for us.  They brought in experienced architects who had previous new hospital experience.  Adding our relationship with HCM and the new talent, it worked fabulously.  To this day, we have a great working relationship and I gladly serve as a reference for HCM repeatedly.  I can't say enough great things about the individuals as well as the firm in general.  It continues to be a pleasure to work with these folks.

Gambling Arrests

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I read the craziest thing in the Baltimore Sun over the weekend.  One hundred and twenty people have willingly signed on to be arrested for trespassing if they enter a Maryland casino.  These are individuals with a gambling addiction who see this as the only way to keep from entering a casino.  Since implementation, seven of those who agreed to be arrested have been arrested for trespassing at a casino.  The State of Maryland needs to be of greater assistance to these folks as there is only one place that they can register for the gambling exclusion program that isn't a casino.  Really? 

Continue to Rest in Peace Detective Zadroga

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I was ready to blog about ten different items this AM, but when I entered the date and it hit me, September 11th.  Today marks the anniversary of the most horrific attack on America.  I often think about those who so tragically lost their lives, most memorably for me was NYPD Detective James Zadroga.  Detective Zadroga didn't lose his life on 9/11; he lost it five years later from a related cancer when his lungs could no longer exchange air.  He was at the World Trade Center site for hundreds of hours investigating and simultaneously subjected to toxic dust.   In less than two years after 9/11, he couldn't breathe without oxygen support.
You see he lived around the block from me growing up.  He was a little kid, I was a big kid.  His dad was a cop and so was mine.  Although he didn't lose his life on that tragic day, he eventually lost his life as a result of that tragic day.  If there is any good that came from his death, it was the Zadroga Act.  It is estimated that over 400 people have since lost their lives as a result of those same toxins, many who were heroes involved in the rescue, the search and the subsequent clean up at the WTC site.  The Zadroga Act provides for compensation to those families whose loved ones died of cancer or respiratory disease as a result of 9/11.  Today, the federal government will announce 50 additional cancers being added to the list covered under the Zadroga Act.   Continue your peaceful rest, Jimmy.

Listening to Facilitate Change

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I just read an excerpt from Margaret Wheatly's book, "Turning to One Another: Simple Conversations to Restore Hope for the Future."  In it, she describes the need for our willingness to be disturbed.  She writes that we need to have our beliefs and ideas challenged by what others think.  We also have to be able to admit what we don't know although we have never been trained to do so.  Most of us have been trained to state our opinion as if it were true.  To this point, we felt that we haven't had the time or the interest to listen to those who think differently.  Unfortunately, our worlds have become exceedingly complex and it is sometimes very challenging to understand its complexity.  In this day and age, we have to listen to others and listen to what they have to say.   As you enter into a conversation, try to listen for what's new.   Usually, we listen for differences because we don't want to change.  We like our comfort zone; if we have to change, that requires energy.
In order to be successful today, we have to move beyond our comfort zone into what Ms. Wheatly calls that "very uncomfortable place of uncertainty." She continues, "of course it's scary to give up what we know, (but) great ideas and inventions miraculously appear in the space of not knowing."
As health care changes and reform continues to evolve, the last thing that we want to do is to keep struggling through it; we need to listen to what is changing and adapt to how such change can benefit our patients, our physicians and each other.

Care Wastes $750 Billion Per Year

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Last week, there was a story in all of the major media outlets regarding US health care wasting $750 billion per year.  That is approximately 30 cents of every health care dollar.  The culprits are needless care, outdated paperwork, fraud and other waste according to the Institute of Medicine (IOM).  The US has seen a virtual explosion of technical advancements in medicine and yet our outcomes don't reflect it. 
Now for the rest of the story.  What IOM fails to describe is a national payment system that has been driven by volume not value, at least until recently for some of us; the practice of defensive medicine due to little to no protection for physicians in many states including Maryland; outdated paperwork required by our government (in some cases paperwork that can only be completed on a typewriter, talk about byzantine) and a demonstrated lack of guidelines and requirements for the practice of medicine on the part of physician groups and associations, again, at least until recently.  Can the health care industry make a dramatic impact on such "waste?"  Of course, but it takes a village.  At WMHS, we have done some amazing things to improve quality, address over utilization, reduce readmissions, address unnecessary admissions, enhance patient education and the discharge process, case manage high utilizers of our ED and other services and the list goes on.  Our health system is now paid on a value- based payment methodology; however, many of our physicians are still paid on the fee-for-service or volume-based payment system.  We have seen a dramatic turnaround in the last year alone in addressing what the IOM calls waste and poor quality.  There has to be a more dramatic, concerted effort across government and our industry before any substantial savings can result throughout the health care industry.  However, it continues to be extremely satisfying to know that WMHS is so far ahead of the pack in this instance.

State of the System

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Each year, just as the President of the United States does a State of the Union, I do a State of the System report for WMHS.  I have attached that report which addresses a very challenging Fiscal Year 2012, our plans for FY 2013, my prediction for the next several years to come and how we are responding to very dramatic changes to the health care industry.  I hope by reading this report, you will get a better understanding of the challenges facing WMHS and our industry as a whole.
I will be taking the next two weeks off from blogging as I will be traveling.  I look forward to resuming The Ronan Report on October 1, 2012.



State of the SystemA Summary of Today’s Healthcare EnvironmentFrom Barry P. Ronan, President and CEO
September 2012  It has become obvious that health care spending is unsustainable at a federal level given record high deficits and at a state level with balanced budget pressures.  The Western Maryland Health System has begun to ensure that we are appropriately prepared for the changes ahead.  We are moving forward to be better positioned under health care reform, placing greater emphasis on integration, accountability, and better coordination of the delivery of care.  For the last year, we have been focusing on the Triple Aim of health care reform: improving quality, reducing cost, and improving the overall health of our community.
During Fiscal Year 2012, we saw an increase in underinsured and uninsured patients, especially those whose insurance coverage has either run out or their employers are increasing their co-pays and deductibles.  This has resulted in record amounts of bad debt and charity care for the Western Maryland Health System.  During the same year, we also saw an increase in supply costs; higher costs for physician recruitment and retention; provider taxes being assessed by the state on hospitals, including the Western Maryland Health System; and a decline in overall reimbursement. 
When these changes were anticipated for FY’12 and FY’13, the Western Maryland Health System took the opportunity offered by the state in 2011 to participate in a ten-hospital demonstration project called Total Patient Revenue (TPR).  TPR provided us the opportunity to work within a global budget to increase the value of the care and services that we provide.  We focused on decreasing the volume of services, tests, and procedures provided while improving quality and efficiency in the delivery of patient care.  At our most recent System Board meeting, we were able to demonstrate that our financial situation for FY’12 would have been far worse under the previous fee-for-service payment model.
In addition to all of these changes occurring, the long-standing rate regulatory system, from which our health system benefits greatly (usually in excess of over $15 million per year) is in jeopardy of being lost in Maryland.  As a result, the Western Maryland Health System experienced only a .21 percent increase in its rates in FY 2013. 
There is also greater risk, as well as reward, through the quality-based reimbursement and potentially preventable complications programs in Maryland. Maryland hospitals that do really well related to core measures, patient satisfaction, and complications avoidance are rewarded, while those that see little to no progress are penalized.  In 2011, the impact was a $1.2 million reduction in our rates.  For fiscal year 2012, we have made considerable progress in each area (patient satisfaction; core measures; and reduced complications, such as falls, pressure ulcers, and infections).  We have improved our position, resulting in a gain of almost $300,000 in rates and a $1.5 million turnaround from last year.
All of the changes facing our industry, as well as those that the Western Maryland Health System has experienced, have had a substantial financial impact.   Our expense for bad debt and charity care increased in excess of $5 million, and there was an unbudgeted Medicaid assessment of $500,000.  Not qualifying for an anticipated Medicare drug program resulted in a $2 million loss for the health system.   The need to expand our primary care practices with physician and advanced practice professionals added cost in excess of $1.5 million.   All of these factors contributed to a double-digit million dollars’ loss from operations for FY 2012 for the health system. 
Some might say that our financial situation is related to building the new hospital, and I can assure you that is not the case.  In fact, our costs, especially for labor, would be significantly higher without the benefit of our advanced technology, the centralization of our services and the state-of-the-art automation system wide on our new hospital campus. We continue to meet all of our required payments as well as bond covenants month after month. 
The failed economy is the direct cause of our financial issues.  The federal government’s commitment to rein in Medicare spending and the state’s balanced budget requirement have impacted our revenue both directly and indirectly.
To ensure that the Western Maryland Health System does not experience a similar loss in FY 2013, the health system has engaged in a significant expense reduction/revenue enhancement initiative through the assistance of two national firms.  The health system continues to focus on expense reduction in areas of labor management and physician preference supply items, such as orthopedic and cardiac implantables, through Premier.  We also engaged the services of Grant Thornton to assist us in physician practice improvements by increasing the number of visits in each practice and clinic and improving our revenue picture for the overall physician practice enterprise.
During Fiscal Year 2013, the health system has projected an admission decrease of almost eight percent due to a change in how we deliver care; again focusing on the value of the patient experience, not the number of days in the hospital or the volume of tests or procedures received.  We have substantially improved quality and successfully reduced readmissions of patients by focusing on a more longitudinal approach to discharge planning, more individualized patient education, and increased referrals to our Care Link and Home Care programs. 
We have also reduced potentially preventable conditions system wide, improved case management of our frequent patients to our ED, opened a heart failure clinic to better treat patients in a clinic setting and prevent admissions, expanded primary care in the region, introduced observation beds to eliminate one-day patient stays, improved reconciling of patient medications, reduced the length of stay for patients, planned for the opening of a new Diabetic Medical Home program in October, and introduced the nursing home transitionist to reduce unnecessary admissions and readmissions from area nursing homes.
We will also continue our commitment to better quality, reduced cost, and doing what is right for our patients in FY’13.  Our goal is to position this health system so we are able to sustain the anticipated financial challenges ahead.  In order to get health care spending in line, we are expecting reductions in our rates of 2 to 3 percent each year over the next 5 years, resulting in a $30 million to $45 million decrease in payments.  We will also work with patients to reduce risk factors associated with poor choices, such as an unhealthy diet, smoking, excessive drinking, and a lack of exercise.  Our focus is a healthier population. 
The time is now for all of our partners to work together to meet the Triple Aim of health care reform and for WMHS to be appropriately positioned to withstand the current and future financial challenges.