Thursday, January 16, 2020

Moving Towards More Rational Drug Pricing

The U.S. healthcare system is facing many challenges — the aging population is putting new stresses on the system, poorly designed mental health systems are unable to meet the growing need for their services, and the opioid epidemic is affecting every aspect of healthcare. Notwithstanding these issues, perhaps our biggest challenge is the dramatic escalation in the price of pharmaceuticals. Drug companies are raising prices for medications that have been on the market, in some cases for decades, and new drugs are coming to the market with prices well above their cost of production. I’m not arguing that pharmaceutical companies shouldn’t make a profit, but experts have pointed out that the majority of the cost of research and development is funded by taxpayer dollars through National Institutes of Health (NIH) grant support. So, the question is: how much profit is enough for the pharmaceutical industry and its shareholders?

The federal government has shown no inclination to pass legislation addressing this issue, but the state of Maryland has. Last year, the Maryland Prescription Drug Affordability Board was created through legislation that passed in the General Assembly. The Board will study prescription drug pricing, and with the approval of the Legislative Policy Committee of the General Assembly, may begin to set upper price limits for drugs purchased by state, county, or local governments beginning in 2022. In December 2023, the Board will recommend whether the General Assembly should pass legislation to expand upper price controls to all prescription drugs sold in the state.

The Board held its first meeting this past Monday. Former Maryland Health Secretary, Van Mitchell, is the chair of the five-member panel, which also includes Dr. Joseph Levy, Dr. Eberechukwu Onukwugha, Dr. George Malouf, and Dr. Gerard Anderson.

I wish the Board well as they begin their deliberations.

A Disappointing Loss but a Great Season Nonetheless
Congratulations to Felicity Kirby, Oncology Nurse Coordinator, and Alyssa Bonney, Hospice Aide, who each won a pair of tickets for last week’s Ravens playoff game. Jessica Booth, Clinical Social Worker, won the Ravens themed basket courtesy of Karma Fashion Boutique.

Unfortunately, last Saturday’s game did not turn out like we hoped, but the Ravens had a great 2019 NFL season. The future is looking bright for this team and their leader, Lamar Jackson! They will learn from this fabulous season and I’m excited to see what improvements they make next year.

My deepest appreciation to all our employees and volunteers who participated by donating to the GBMC HealthCare System - GBMC, GBMC Health Partners, and Gilchrist! Because of your generosity, we collected approximately $4,000!

Thursday, January 9, 2020

Rallying Around a Great Team in Charm City

I have been walking around the halls of GBMC with a Ravens lapel pin that my colleague and Environmental Services Associate, Sedrick Haire, gave me. Sedrick knows that I am a New York Giants fan (I grew up in New Jersey and have never changed my sports allegiances). He and many others find it humorous that I have jumped on the Ravens bandwagon and am now rooting for a Super Bowl win. You may ask, “why?”

Well, my family and I have lived in Baltimore for almost 10 years and have really enjoyed our time here. We’ve been embraced by so many wonderful people and have come to love the city. We live in the city and take advantage of the great parks, museums, restaurants, music venues, and the waterfront. There is no doubt that Baltimore has problems…but what place doesn’t have problems? I get upset when I hear people bad-mouthing Baltimore and ignoring its fabulous attributes. Baltimore deserves a big win to boost the city’s morale and to show the rest of the country that we are winners.

The other reason I am rooting for the Ravens is that I know a good team when I see one. I love the way that star quarterback, Lamar Jackson, has made believers out of the entire franchise. With the buzz around the city and throughout the GBMC HealthCare System, the “purple pride” is growing on our campus.

With the Ravens getting ready to host the Tennessee Titans in the AFC Divisional round of the playoffs, I just have one question to ask: “Who wants a chance to get their hands on tickets to this weekend’s Ravens playoff game?”

If you haven’t already donated your $4 for a chance to land two (2) tickets to the game this Saturday night (Jan. 11), you’re running out of time. All entries must be submitted by 11:59 p.m. TODAY (Thursday, Jan. 9). Your donations will help support GBMC HealthCare (GBMC, GBMC Health Partners, and Gilchrist).

Remember that you can enter as many times as you wish. Each entry costs $4. This is an internal raffle that is only open to GBMC HealthCare System employees and volunteers. You can buy the raffle tickets online or, if you would like to pay in cash, visit the Human Resources Department in suite 5360 in the hospital. The TWO lucky winners will be chosen and announced by 2 p.m. on Friday, January 10. Tickets must be picked up no later than 5 p.m. on Friday, Jan. 10.

Also, courtesy of our friends at Karma Fashion Boutique, you will have the chance for a Ravens raffle basket prize valued at $100. One lucky winner will be chosen to receive this amazing prize!

So, are you ready to enter? Click here! 

Good luck to all participants and go Ravens!

Friday, January 3, 2020

What Matters to (or for) her?

This past Saturday, I was doing Lean Daily Management (LDM) rounds and I became quite distressed when I entered Unit 36, our Integrative Care Unit (ICU). An elderly woman, wearing a hospital gown, approached and asked me for help. In an anguished voice, she told me that she did not belong on the unit and that she “had her own car.” At her side was a security guard, and a nurse. They were speaking to her by her name in a very gentle tone and it was clear to me that she was suffering from dementia. The speed at which she was moving around the hall made me curious about why she was on the unit. Patients with dementia become more anxious when they are in a new place and surrounded by people they have not seen before. I wondered if this was the best place for her to be.

I don’t think I could work on the ICU as I do not have the patience. What I saw in the actions of the staff there that day was profound — they were patient with her beyond belief. It was a display of kindness, caring, and dare I say it, love. I am so grateful to the nurses, techs, and security guards that work there every day.

But I needed to know: What was she doing on the unit? Were we really helping her? What was the “medical” reason that she was there for? Her nurse told me that we were treating a urinary tract infection. 

It is not my role to enter into the medical decision making concerning individual patients, but as a leader at GBMC, it is my role to make sure that we are living our vision phrase: to every patient, every time, we will provide the care we would want for our own loved ones. Is this the care I would want for an 85-year-old loved one of mine with dementia? 

Again, it is not my role to get involved in deciding what patient gets sent from an extended care facility to GBMC, and it is not my role to decide who gets admitted to the hospital, but it is my job to make sure that we are asking the right questions. What is the goal? What matters to the patient and her family? What are the risks inherent in our actions? Do the benefits to the patient outweigh the risks to the patient (and to the staff)?

I had to ask the nurse if she thought the patient would be better off in her usual place of residence with oral antibiotics. The nurse responded “yes.”

I left the unit asking myself what I could do to continue to reduce the number of times that the Emergency Department and the inpatient units of GBMC are used as the pathways of least resistance, and to continue to build a system of care that starts every interaction with the question: What really matters?

Tuesday, December 31, 2019

Reflecting on what we have accomplished over the last decade!

As 2019 comes to an end and we gear up for 2020, it’s important to look back at GBMC HealthCare System’s accomplishments over the last decade.

2010 was a year of change for GBMC. After the departure of Larry Merlis, (who did an excellent job leading GBMC), Dr. John Saunders took over as interim president in the winter of that year. I arrived in June and we began planning for change. In the fall of 2010, the Board of Directors conducted a visioning retreat to set a new course for our company. That retreat created our vision statement, and our now well-known vision phrase “to every patient, every time, we will provide the care that we would want for our own loved ones.”  

The new vision statement created the game plan for every change that has followed since. We began our redesign with embracing the patient-centered medical home as a fundamental building block. These advanced primary care groups no longer focused just on visits but became accountable for their patients’ health outcomes. Carolyn Candiello, Vice President of Quality and Patient Safety, and Dr. Saunders, our former chief medical officer (CMO) of the GBMC HealthCare System, began building a robust quality and patient safety program for the system as GBMC adopted continuous performance improvement as its business model.

Under the direction of Cathy Hamel, President of Gilchrist and Vice President of Continuing Care at GBMC HealthCare and Dr. Tony Riley, Chief Medical Officer of Gilchrist, began adding programs to improve elder care from complete independence, through home and facility care, chronic symptom management and end-of-life care. Our hospital, which had always been excellent, became even more patient-focused. In 2017, our physician company changed its name from Greater Baltimore Medical Associates (GBMA) to GBMC Health Partners, and with Ben Beres, former GBMA Chief Operating Officer, and Dr. Harold (Hal) J. Tucker, Chief Medical Officer and President of GBMC Health Partners, at the helm, the physician enterprise became much stronger and better able to meet the needs of our patients. We added physician specialists to our practices and made them more accessible to our patients and to our primary care physicians for consultation. Keith Poisson, our Chief Operating Officer, oversaw the creation of highly functioning service lines with dyadic leadership teams and built a very strong strategic planning and strategy deployment process. Over the decade, our core competency truly became redesigning care and we added or strengthened programs needed by the community like our Sexual Assault Forensic Evaluation and Domestic Violence program and our Comprehensive Obesity Management Program.

Through the decade, Jenny Coldiron, Vice President of Development and President of the GBMC Foundation, has built a community-based health system philanthropy program that is second to none and which allows us to do so much for the community that we could not accomplish without this financial support.

In 2015, we celebrated GBMC’s 50th Anniversary and remembered our past while continuing to build for the future. With the arrival of Dr. JoAnn Ioannou as Senior Vice President of Patient Care Services and Chief Nursing Office in that same year, we implemented a professional excellence model that elevated the role of nurses within our system. This fact was highlighted by the annual Art of Nursing recognition celebrations.

In 2017, our system responded to the opioid epidemic and the mental health crisis by adding masters-prepared behavioralists, addiction specialists and psychiatrists to the patient-centered medical homes and by adding peer counselors to the Emergency Department to work with substance addicted patients.

GBMC did an outstanding job at managing risk through the work of Susan Martielli, our General Counsel and Risk Manager. By collaborating closely with clinical leaders and our quality and patient safety team, Susan helped make our care much safer and our Ruxton Insurance Company much more successful.

Through the decade, GBMC became a much more responsive employer and became known as a company that goes out of its way to celebrate its people. These efforts are led daily by Anna-Maria Palmer and our wonderful Human Resources team.

GBMC has always been known for its excellent medical staff. Over the past decade the staff has become even better in part because of the very strong oversight of the medical staff leadership. We have been blessed that Dr. John Saunders, Dr. Harold Tucker, and our first female Chief of Staff, Dr. Melissa Sparrow, have been such outstanding leaders.

This year, the Greater Baltimore Health Alliance began functioning as a Care Transformation Organization to work with our advanced primary care offices and some private practicing primary care physicians in the Maryland Primary Care Program. This program was created to financially incentivize advanced primary care to drive better health and better care at lower cost for the citizens of our state.

This spring, we opened our first patient-centered medical home in Baltimore City: GBMC Health Partners at the Helping Up Mission. We are now providing the same advanced primary care that we offer in our other practices to 500 Helping Up Mission clients and more than 1,500 alumni who have struggled with addition, poverty, and homelessness. The practice will soon open its doors to all residents of the Jonestown neighborhood of East Baltimore, an area with a critical void of preventative care.  The continued growth of GBMC Health Partners, not only in primary care but also in specialty care is being overseen by Dr. Tucker and Erlene Washington, Chief Operating Officer of GBMC Health Partners, who has been a great addition to our team.

This year we updated our master facilities plan and submitted a certificate of need application for a three-story hospital addition. We named the program to build the addition The Promise ProjectStacey McGreevy, Vice President of Support Services, and her team are overseeing the construction planning.

In late September of this year, we hosted nine examiners from the Malcolm Baldrige Performance Excellence Program. The examiners visited all three of our work systems: Greater Baltimore Medical Center, Gilchrist, and GBMC Health Partners and assessed our use of the Baldrige criteria. Although we did not achieve the Baldrige award, we were recognized for our role-model practices in leadership, earning a category best practice recognition.

Also, this fall, GBMC achieved the Davies Award of Excellence from the Healthcare Information and Management Systems Society (HIMSS). This is the highest achievement for the use of electronic records. Dave Hynson, our Vice President and Chief Information Officer, and his team exhibited great collaboration with our clinicians to achieve this recognition.

Through these changes, GBMC maintained its A and A2 bond ratings and its very strong financial position grew even stronger. Our finances are overseen daily by Laurie Beyer, Executive Vice President and Chief Financial Officer, and our excellent finance team.

Other notable 2019 milestones:
Best Hospital & Best Audiology Services  – The Baltimore Sun readers
110 “Top Docs” in Baltimore magazine
7 Nurses recognized for “Excellence in Nursing” in Baltimore magazine
Best-in-State Employer – Forbes
GBMC among the nation’s “100 Hospitals and Health Systems with Great Oncology Programs” – Becker’s Hospital Review magazine
The American Heart Association (AHA) Stroke Honor Roll Elite
GBMC’s Sub Acute Unit received the highest possible rating on U.S. News & World Report’s 2019 list of the Best Nursing Homes
Most Wired Hospital - College of Healthcare Information Management Executives (CHIME)
Magna Cum Laude – Epic’s Honor Roll Program
AHA Membership Milestone
The Joint Commission’s Gold Seal of Approval® for Advanced Certification for Total Hip and Total Knee Replacement

I know that I have left out many GBMC accomplishments over the past decade and that there are many more examples of our work in care redesign that I could have included. With these highlights, you can see we have undergone a significant transformation over the past decade. What others do you want to mention? Please share your thoughts.

I’d like to share the brief video above of some of the notable GBMC events of the 2010s. I want to thank our Marketing and Philanthropy Departments and especially Tyler Scheff, our Digital Marketing Producer, who worked so hard in putting this video summary together. Nice job everyone!

I am grateful for the fabulous efforts of the entire GBMC HealthCare family and I look forward to many more successes in 2020 and beyond as we continue to drive towards our vision.

Best wishes to you and your loved ones for a happy & healthy 2020!

Tuesday, December 24, 2019

Welcoming a Great New Leader

Last week, I was happy to welcome Baltimore County Executive Johnny Olszewski and members of his team for our Lean Daily Management walk and an opportunity to meet with our staff and volunteers.

Mr. Olszewski was impressed with our focus on standard work and continuous performance improvement along with our core competency of redesigning care. During our walk, he learned about many improvement initiatives throughout the hospital. The County Executive is early in his first term in office and said that he and his team would take the learning from Lean Daily Management and adapt the concepts to their management of Baltimore County.

I told Mr. Olszewski that the GBMC team will work alongside him to make Baltimore County an even better place to live and work. He is a bright, young leader, but he cannot do the job alone. The entire community needs to get engaged to fix the problems and build on Baltimore County’s strengths. We are so grateful to the County Executive for caring and taking time from his very busy schedule to come and see how we are moving towards our vision.

On behalf of the entire GBMC family, I want to extend best wishes for a safe, healthy, and happy holiday season for those celebrating Christmas, Hanukkah, or Kwanzaa. Enjoy your time with family members and think about the things that are important in your lives. For those staff members working during the holidays, a special “thank you” for taking care of those who can’t be at home during the holiday season. I will see many of you on LDM on Christmas Day.  I am so lucky to be associated with my GBMC colleagues and I am very grateful for all of you. Happy Holidays to everyone!

Friday, December 20, 2019

GBMC Recognized Again for Excellence in Information Technology

I am proud to announce that GBMC has received the Healthcare Information and Management Systems Society (HIMSS) Davies Award of Excellence. This recognition acknowledges organizations that have applied health information technology to substantially improve clinical care delivery, patient outcomes, and population health.

Readers of this blog will recall that within months of our Epic go-live, GBMC achieved the highest level of recognition (level 7) from HIMSS for both inpatient and ambulatory electronic records. The Davies award requires implementation and evidence of significantly improved outcomes, in part, because of the use of the technology.

Among the examples that we presented to the Davies examiners was our use of informatics to improve the treatment of stroke. We recognized that we had not been using tissue plasminogen activator (tPA) as often as we should have. Treating thrombotic stroke patients with tPA within three to four hours of the incident can greatly improve recovery rates and speed. Our Aim was to leverage our electronic health records (EHRs) to improve recognition of qualified patients for tPA treatment and to administer it more safely and efficiently through workflow improvements.

Our measures were door to CT scan time and door to needle time. One of our tests of change was the development of a nurse-driven triage protocol and provider order set to make it easier to do follow the correct processes.

To drive the use of the new protocol and to ensure the effectiveness of the new functionalities in the EHR, we created a clear governance strategy to implement these workflow changes. With these new workflows, we were able to recognize more patients who might be experiencing a stroke and expedite tPA treatment to qualified patients, surpassing our goal of 11% usage rate, thereby exceeding national and state average performance, while also adhering to the American Heart Association’s Get With The Guidelines standards.

Thanks to faster identification through our new design, more than half of our ischemic stroke patients were discharged to their home or to acute rehab.

I am honored that we have received this and award and I want to congratulate Dave Hynson, Vice President and Chief Information Officer, Cindy Ellis, Epic IT Application Director, Mary M. Swarts, BSN, RN, Clinical Informatics Quality and Safety Specialist, and all who were involved in helping us achieve this recognition.

A quick reminder from the GBMC Cybersecurity Team…
As you are getting ready to enjoy the 2019 Holiday Season with your family and friends, there are a few things that our cybersecurity team would like for you to remember to keep your personal information safe when purchasing items online.

All devices connected to the internet have the potential to be exploited by wrongdoers. This can result in stolen credit card data, passwords/passphrases, and even your social security number. Please review these pointers to help keep your information safe.
1. To avoid theft, do not keep your phone in your back pocket. Keep it in your front pocket, jacket, purse, or backpack.
2. Be cautious when using public Wi-Fi without the protection of a reliable mobile Virtual Private Network (VPN) client installed on your device. A VPN can help protect you while shopping. Also avoid "Free for Life" offers, and look for the country of origin of the VPN.
3. Check with your wireless provider or anti-virus software vendor about VPN services.
4. Be careful when using apps like Venmo, PayPal, and social media to transfer money to friends and family.
5. This is the time of year when there’s an increase in social media giveaway scams.
6. Cybercriminals create a sense of urgency with words like “limited-time” or “free giveaway” offerings or by telling victims they need to share the content with others to open more offers and free giveaways.
7. While shopping online…be careful of impersonating sites, otherwise known as “site spoofing” and of adding extensions to your internet browsers as some are malicious and can be used to steal personal information. If you are prompted to install an extension when visiting a site, do not click on the link and promptly close the page. Recently 60,000 shoppers were tricked by a spoofed Walmart site that prompted a Chrome extension installation.

I want to thank our Information Technology and Cybersecurity team for working hard to educate us about the threat of attacks on our computer systems and for continually working to minimize the harm from attacks. Our ITS team does an excellent job in defending our networks while preserving the efficient delivery of healthcare. As technology and threats change, they are continually adjusting.

Please remember that cybercrime is a serious and relevant threat to you and to GBMC. Don’t click links unless you are sure they are safe, don’t go to websites you aren’t familiar with, and ask IT for guidance if something doesn’t quite “seem right.” Let’s work together to keep our healthcare system safe from cybercrime. Thank you!

Earlier this week, I attended the Daily Record Icon Awards ceremony with Harry S. Johnson, Esq., previous Chair of the Board of Directors and current member of our GBMC HealthCare Board, where he was honored with the Icon award.

According to the Daily Record, “the Icon award recognize business leaders around Maryland who are over the age of 60. The award salutes them for their notable success and demonstration of strong leadership. The honorees also have moved their businesses and the state of Maryland forward by growing jobs and community involvement.”

I can’t think of anyone who is more deserving of this award than Harry Johnson! Please join me in congratulating Harry.

A Well-Earned Retirement
This week, I attended the retirement celebration for Phyllis Tyler, an outstanding Infection Control Practitioner. Phyllis spent 50 years at GBMC and was recognized at this year’s employee recognition celebration. Please join me in thanking Phyllis for her tremendous work in keeping our patients safe over all her years of service.

Friday, December 6, 2019

Welcoming a Maryland Leader to Our Campus

Last week, I had the privilege of welcoming Robert R. Neall, Secretary of the Maryland Department of Health, to the GBMC campus for our Lean Daily Management (LDM) walk and for a tour of our Family Care Associates (FCA) practice. The Secretary was very complimentary of our use of LDM to drive improvement and was impressed with our use of the patient- centered medical home concept.

During Secretary Neall’s visit to the FCA practice, Dr. Sarah Whiteford, one of our lead physicians, did an excellent job of explaining to him how the office was designed to reduce waste, highlighting the fact that there is no patient waiting room. Secretary Neall was impressed with the patient flow and ease of access in the evening as well as during weekends and holidays. Dr. Whiteford also showed him how the rooms are replenished with supplies from the “off-stage” area outside the room.

Sarah Fogler, our Senior Director of Population Health, discussed GBMC’s Care Transformation Organization and how our primary care teams are driving measurable improvements in the management of chronic disease, especially diabetes. Secretary Neall was grateful for our work in redesigning care, as he is the leader responsible for Maryland’s Primary Care Program (MDPCP), which is funded through an agreement with the Centers for Medicare and Medicaid Innovation.

Secretary Neall was intrigued by the design principles used in the practice and how the use of these principles has led to better health outcomes and a significantly improved patient and provider experience.

I was grateful for all the time that the Secretary spent with us and was delighted to show him our successes. Prior to his departure, the Secretary told me how much he truly appreciates our work in transforming care and how impressed he was with our use of hospital revenue to move upstream to better manage and prevent chronic diseases. We should all be very proud of what we have accomplished in building a system of care that the patient experiences as a whole!