Monday, July 27, 2015

Growing Surgery at GBMC

GBMC has always been a great surgical hospital. We have always had outstanding surgeons, nurses, physician’s assistants and technicians and they work very hard. Since the downturn in the economy and employers putting higher co-pays and deductibles in their insurance plans, there has been a reduction in the rate of many elective procedures. This, coupled with the fact that Maryland hospitals are now paid on the basis of a global budget, has given some people the impression that GBMC is not interested in attracting new surgical patients. Nothing could be further from the truth.

GBMC wants every patient in our community who needs surgery to have their procedure at GBMC if we are capable of providing it. Under the leadership of our Chair of Surgery, Dr. Jack Flowers, the Surgery Service Line has been strategizing to continue to improve the quality and efficiency of surgery at GBMC and to attract new surgeons and new patients.  Many will recall that last summer, after storms knocked out the electric power at both GBMC and St. Joseph’s, both institutions had to cancel surgeries. Since then, GBMC has spent close to $3 million to upgrade and reroute our ventilation and air conditioning systems and connect our generators to the systems maintaining cooling and humidity control to the operating rooms and our central sterile supply areas. We have had at least one power outage this summer but surgeries were not affected by the storm because we are now prepared.

We are beginning a study of our operating rooms to make them more efficient and make it easier for the staff to get the work done. We are also adding surgeons to our team in growth areas.

Just this month, a new bariatric surgeon, Gustavo (Gus) E. Bello, MD, hit the ground running in our Comprehensive Obesity Management Program.  Dr. Bello completed his residency at the Pennsylvania State Milton S. Hershey Medical Center where he served as chief resident in General Surgery.  Prior to joining GBMC Dr. Bello served as the Medical Director of the Uniontown Hospital Weight Loss Surgery Center.


Todd M. Melegari, MD, recently joined the Orthopaedic Specialists of Maryland practice at GBMC. Dr. Melegari earned his medical degree at MCP Hahnemann School of Medicine and he completed his residency at the University of Medicine and Dentistry of New Jersey.   Dr. Melegari is board-certified in Orthopaedic Surgery and was previously employed with Easton Orthopaedic Group at Coordinated Health in Pennsylvania.

Please join me in welcoming Drs. Bello & Melegari to the GBMC family.

New Physician Leaders at GBMC

Alex Munitz, MD, GBMC’s Chair of Radiology and Phil Komenda, the Director of Imaging and Cardiac Services have announced the appointment of Ethan Spiegler, MD, FACP as medical director for the Division of Nuclear Medicine and John Werner, MD, DABR, as medical director for Interventional Radiology.

Dr. Spiegler is a well respected and highly regarded physician in the Nuclear Medicine field.  He was instrumental in bringing PET CT imaging into the community setting by overseeing and directing the first units with Advanced Radiology and St. Agnes. He was co-author of the ERASE trial to risk stratify patients with chest pain with acute perfusion imaging in the emergency department.

Dr. Werner, who will be working to expand our Interventional program, has published numerous peer-reviewed journal articles and has many years of experience in the field of Interventional Radiology. While attending medical school, he was also working at the NIH’s Laboratory of Neurogenetics. Upon graduating from medical school he went on to complete his Radiology Residency at Albany Medical Center (that place sounds familiar to me) where he served as chief resident and then completed his Vascular and Interventional Radiology Fellowship at Johns Hopkins.

We are pleased that these outstanding physicians have joined the GBMC team and we look forward to the expansion of both programs under their leadership.

On a separate note, one of our beloved employees, Eric Melchior, earlier this month retired as our executive vice president and chief financial officer.  Eric’s 15 year GBMC career was stellar and highly impactful.  His dedication and insight were instrumental in GBMC HealthCare’s growth and financial success during his tenure.

Please join me in wishing Eric and his wife, Lynnette, all the best in their retirement.  Eric will truly be missed.

I am also pleased to announce that Robert “Bob” Thornton has assumed the position vacated by Eric. Prior to joining GBMC, he was the president of Patronus Healthcare Business Solutions in Tampa, Florida.  Thornton was also employed for 15 years as the executive vice president of finance and CFO for Bayfront Health System, a large, urban, multi-facility healthcare system in St. Petersburg, Florida.  Under Thornton’s leadership, Bayfront financed a campus expansion including a new women’s center, a heart center, 12 new operating room suites and a new eight-bed cardiovascular intensive care unit. He was able to deliver these projects, which greatly enhanced Bayfront's capacity in key clinical areas, while improving the system’s overall financial reserves and credit profile.

New Chief of Plastic Surgery

Congratulations to Alyson Wells, M.D., F.A.C.S. who was recently named as the new Chief of Plastic Surgery.  Dr. Wells is the first female physician appointed as division chief within our Department of Surgery.  She is replacing the retiring William Crawley, M.D., D.D.S., F.A.C.S., who headed the division since 2009.  She has researched extensively and published many professional papers in the fields of facial plastic surgery, organ transplantation and cancer.
Dr. Wells, an active medical staff member at GBMC since 2003, will be overseeing the work of 30 board-certified plastic surgeons on staff with practices that cover the entire spectrum of plastic surgery.

2015 Employee Engagement and Safety Survey

Please participate and complete our annual Employee Engagement and Safety Survey, which starts on Monday, August 3.  Your participation in the survey is vital so that we can learn what we can do to make GBMC an even better place to work.

Last year’s survey responses were used to generate significant change across GBMC HealthCare.  A few of these improvements included:  The creation of many unit-specific action plans; Implementation of a comprehensive Talent Management system, which includes career development planning; the Four Aims Recognition Program and the Perfect Attendance Program; and many celebrations of our staff throughout our 50Th Anniversary year including last week’s Employee, Physician and Volunteer Barbecue!

So thank you in advance for completing the survey!

Tuesday, July 21, 2015

Celebrating in the Summer!

There’s no doubt that the work of healthcare is hard. We spend so much time working to achieve our vision, to provide the care to everyone, every time that we would want for our own loved ones  that we sometimes forget the importance of stepping back for a moment to reflect on and to celebrate what we have achieved, together as the GBMC team. So, the timing was just right last week for our annual physician crab feast and our employee and volunteer BBQ.  These two events were great opportunities for our physicians, staff and volunteers to come together to celebrate what we have accomplished together, while also having some fun and enjoying comradery!

On Tuesday evening, after the triennial medical staff meeting, 156 physicians gathered under the tent for the annual crab feast. It was a great time to get together with long time friends and also to meet the new members of our medical staff!


On Wednesday, our Philanthropy Team, led by Jenny Coldiron, and our Marketing and Communications Team, led by Greg Shaffer, put on a fabulous day-long barbecue! The festivities began very early in the morning. The Philanthropy Team delivered breakfast to the night shift on the inpatient units. Lunches were delivered to offsite GBMA practices and Gilchrist home care staff were given food coupons that they could use at their convenience.  At 11 AM, the barbecue began. Hamburgers, hot dogs, salads, ice cream and many drinks were served. There were spectacular karaoke performers and bean toss participants. It was a great opportunity to party a bit together and leave our work behind even if only for an hour or so.















It’s fun to let go occasionally and celebrate each other and all of our accomplishments together. I think we should make the barbecue an annual event. What do you think?

Thursday, July 9, 2015

Saving Medicare and Taxpayers (at least) $16,440,000 Annually While Improving Health and Care and Adding Joy


We formed the Greater Baltimore Health Alliance (GBHA) in 2012 so that our employed and private practicing physicians could participate in programs designed to help us reach our quadruple aim of better health outcomes and better care experience with less waste of resources and more joy for those providing the care. The first program with which GBHA contracted was the Medicare Shared Savings Program that came into being as part of the Affordable Care Act.

So how are we doing at making Medicare beneficiaries healthier and happier with their care? Are we saving any money? Are those individuals taking care of our patients any happier?

We now have more than two years worth of data and the results are pretty impressive. We serve roughly 12,000 Medicare beneficiaries in this program. In 2012, just before we started the program, Medicare costs for our patients were averaging $12,653 annually. In the first quarter of 2015, GBHA Medicare patients had an average annual cost of $11,283! Other accountable care organizations have also done well, but they have seen the average cost per beneficiary go up by approximately 1.4 percent (see the figure below).


This is a phenomenal accomplishment! Nationally, in the four decades from 1970 to 2010, Medicare spending per beneficiary grew at approximately the rate of growth of the Gross Domestic Product plus 2.7 percentage points annually, or in the range of 5.7 percent. . Not only are we not seeing the cost per beneficiary increase, but GBHA has actually reduced it by 10.8 percent over the past two years. With a $1,370 decrease per beneficiary and 12,000 beneficiaries served, we saved $16,440,000! That is not counting the projected five percent annual increase that was projected.
We have done this by reducing emergency department visits by 12 percent (see below),

and overall admissions to the hospital by 26 percent!


Our Patient Centered Medical Homes (PCMH) are doing an excellent job of improving the health of their patients. Our physician-led care teams are holding themselves accountable for delivering evidence-based care to everyone-not just Medicare beneficiaries. These care teams receive monthly “scorecards” to track their progress, and meet regularly to see how their patients are doing and decide what they could do next to move closer to perfection. GBHA is one of the few healthcare organizations in Maryland that is measuring its performance on the “diabetes composite score.”  The score is made up of tracking five items that, if present, have been shown to increase the health of diabetic patients (Hemoglobin A1c in range, blood pressure in range, cholesterol in range, non-smoking, and utilizing a daily aspirin or blood thinner). GBHA is now in the top 15 percent of organizations nationally in diabetes care, and we are working hard to see that all of our patients have evidence-based screening tests completed. For example, our care teams are working on “tests of change” to see that everyone who should have had a colonoscopy performance-based on demographics such as age, medical history and other factors – has had one.


Additionally, the patient satisfaction scores for patients of our employed physicians have never been higher.


What about the joy of those providing the care? This is the hardest thing to measure, but anecdotally, the primary care physicians are happier that they now have the support of a team to get the work done.  We are no longer judging our primary care physicians solely on the number of patients they have seen, but are now supporting them in their quest for value-driven care.

We have many more metrics of health outcomes and care engagement that show improvement and I am so grateful to everyone on the GBMC team that is driving us closer to our vision.

Our community is taking notice. We are achieving better health and better care at lower cost and our team is finding more joy in its work. We still have more improvement work to do but I am so proud of all that has been accomplished so far.  Thank you!

Thursday, July 2, 2015

Glass Ampules

We need more “both/and” solutions.

Everyone knows that serving the community’s healthcare needs and staying within GBMC HealthCare’s budget can be a challenge. We have committed to driving waste out of our care (it is one of our four Aims) because we owe it to the community and everyone’s loved ones to not squander their money. So it should not be surprising to anyone that when our pharmacists pointed out that we could save $50,000 annually by switching from pre-packaged Dilaudid syringes to Dilaudid ampules where nurses would have to break the ampule and draw the medication up in a syringe, that our leaders thought that this was a reasonable idea. But in the last year, a small number of our colleagues have gotten lacerations from breaking ampules. Adding more joy to our work is another one of our Aims (and we have significantly reduced employee injuries over the last two years by studying their causes and rooting them out). Certainly if our nursing staff is at higher risk for finger lacerations they are not going to be happier on the job or feeling more respected by our leaders. I think we may have fallen into an “either/or” trap. Either we would save money or we would keep our nurses safe.

While some argued that a few minor lacerations were not a big deal and that there were safe ways to break open the ampules, we reversed the decision and have gone back to using the syringes to keep our staff safe. But we still need to look for ways to both reduce waste and keep our staff safe. We must do more “both/and” thinking and not fall into the trap of either/or. I have asked my colleagues in surgical services to look for sources of waste to eliminate that won’t put our staff at risk.

What waste reduction ideas do you have? Please share them with us.

Recognition for Outstanding Care

Congratulations are in order this week for the Sandra and Malcolm Berman Comprehensive Breast Care Center and its staff, who under the direction of Dr. Lauren Schnaper, have once again earned a three-year full accreditation as a center of excellence from the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons.  Re-accreditation is given to health facilities that meet specific NAPBC-developed practice guidelines and technical standards, following a rigorous evaluation and review of its performance and compliance with industry standards. This designation is an honor and reflects GBMC’s ongoing commitment to excellence in cancer care.

HAPPY BIRTHDAY TO US!!!
Finally, I want to wish everyone in our GBMC family a safe and happy Independence Day. July 4th marks the birthday of our great country…the land of the free and the home of the brave. Let's take some time to reflect on what we can each do to make our country even better than it is today.

Thursday, June 25, 2015

Leadership and Better Health Outcomes

This week the GBMC Obstetrics team was recognized by the March of Dimes for having eliminated pre-term (before 39 weeks gestation) elective births.

No one questions inducing pre-term labor or doing a pre-term cesarean section for good medical reasons. But if you induce enough pre-term vaginal births or do enough pre-term cesarean sections for the convenience of the family or members of the care team, you will eventually harm a baby who has retained lung fluid and must receive intensive care. This has never been a big issue at GBMC but under the leadership of Dr. Victor Khouzami, GBMC’s Chairman of Obstetrics and Director of the Women’s Service Line, it has now been many months since we had a pre-term elective birth.

This achievement was recognized through the presentation of a banner from the March of Dimes, the Maryland Patient Safety Center and the Maryland Department of Health & Mental Hygiene.  The banner will be displayed within the hospital – indicating our strong commitment to improving the quality of care for moms and babies.

We are honored to receive this recognition AND I am extremely proud of our obstetrics team of physicians and nurses for this wonderful accomplishment.

THANKS TO ALL FOR PARTICIPATING in the FATHER’S DAY 5K

This past Sunday, I spent part of Father’s Day running at the 27th annual GBMC Father’s Day 5K. It was a great day and I was fortunate again to have my daughter, Caroline, running with me.

I was humbled to see so many dedicated members of the community and the GBMC staff come out and run for this terrific cause – raising money for the Neonatal Intensive Care Unit.  I want to thank the more than 800 participants and I am proud to report that this year’s event helped to raise more than $160,000 to help support the NICU babies and their families.  

I also had the opportunity to meet some of the “graduates” of our NICU and their parents and so many other wonderful people.  I was thrilled to hand out awards to the winners as well.

I must admit that the outpouring of community support was incredible and I truly felt so much pride for the wonderful volunteers as well as GBMC’s NICU doctors, nurses, technicians and others who dedicate their lives to the health of babies.  In 27 years, the GBMC Father’s Day 5K has raised more than $1.9 million for critically ill and premature babies and that has helped us over the years purchase lifesaving technology and services for our NICU babies and their families.  GBMC’s NICU is one of the largest in the area, caring for over 400 babies annually.  In honor of GBMC’s 50th anniversary celebration, this year’s race fundraising goal was $200,000 to mark the 200,000 babies born at GBMC since 1965, the year it was founded. So, if you want to contribute it’s still not too late to give – you can go to www.gbmc.org/5K and click on the "Register" link. Donations can be made this week and will close July 1.

I also want to thank everyone involved in our community Wellness Fair which featured health-related vendors, as well as a "Baby Doll/Stuffed Animal Hospital" for injured dolls and bears to receive loving treatment and repairs as needed. Additionally, MIX 106.5 Radio was on-site with its Friends and Neighbors van playing music and sharing prizes. The Maryland Zoo in Baltimore was also present with fun animal friends for the kids’ area. Great work everyone!!!

Friday, June 19, 2015

Running for GBMC’s Tiniest Patients

One of the biggest annual events for the GBMC HealthCare system is coming up.  On Sunday, June 21st, we’re holding the 27th Annual GBMC Father’s Day 5K & 1 Mile Fun Walk at the GBMC campus to benefit the hospital’s Neonatal Intensive Care Unit (NICU).

In honor of our 50th anniversary celebration, this year’s race fundraising goal is $200,000 to mark the 200,000 babies born at GBMC since 1965, the year it was founded.  Since 1965, approximately 20,000 babies have slept in its incubators, used its Human Milk Bank, warmed in its Giraffe beds and snuggled under its blankets.  Our NICU, under the direction of Howard Birenbaum MD, and Eva Stone, RN, provide outstanding care to premature and sick newborns. Not only is the event a great fundraiser but it is also a wonderful opportunity to see so many thriving children and adults who are NICU graduates.
 
As part of the 50th anniversary celebration with the community, this year's GBMC Father's Day 5K race will feature a Wellness Fair, open to not only race participants, but the entire community!  The Wellness Fair will be open from 7 a.m. - 12 p.m. in the South Chapman parking lot featuring health-related vendors, as well as a "Baby Doll/Stuffed Animal Hospital" for injured dolls and bears to receive loving care treatment and repairs as needed. Additionally, MIX 106.5 Radio will be on-site with its Friends and Neighbors van playing music and sharing prizes.

I encourage you to sign up today and visit http://www.kintera.org/faf/home/default.asp?ievent=1127786. I’ll be out there running, come join me! Your support will touch more than 500 critically ill and premature babies cared for every year in GBMC’s NICU and help us during our 50th anniversary year, in celebrating the healthcare system GBMC has become!

…also, Happy Father’s Day to all of the Fathers in our GBMC Family!


Friday, June 5, 2015

The World is One Village

Last weekend, I participated in the 3rd annual Middle East Forum for Quality Improvement in Health Care in Doha, the capital of Qatar on the Persian Gulf. The conference was sponsored jointly by the Institute for Healthcare Improvement (IHI) and Hamad Medical Corporation (HMC). The IHI was started more than 25 years ago by Drs. Donald Berwick and Paul Batalden. It is currently involved in projects in the Americas, Europe, Africa and Asia and is the world’s foremost organization for health
care improvement. Hamad Medical Corporation operates eight hospitals in Qatar and provides most of the care in that country. I gave a plenary address to the 2,500 delegates and also taught a workshop on patient flow with, my friend and colleague, Dr. John Boulton. John directs quality improvement at Hamad General Hospital in Doha. He visited GBMC as an IHI fellow in 2013.

I had never been to the Middle East before, so I was not sure what to expect and the trip was quite an adventure. I arrived in Doha after a 13-hour flight from Dulles. The Doha airport is very new and has all the amenities. The city has an incredible skyline with many 20 to 30-floor skyscrapers most of which have been built in the last decade. There is a sprawling landscape with homes for the 1.8 million inhabitants of the country, 300,000 of which are Qataris and the others are immigrant workers. Being in the desert, all of Qatar’s water comes from desalination. It is amazing how much green space there is in the city as it must all be irrigated by Doha’s complex system.

I stayed in a beautiful hotel in the center of the city that was attached to a very large indoor shopping mall that was complete with an ice skating rink! When I told a Qatari that I was surprised to find an indoor skating rink, he told me that since it was so hot there during the summer people stayed inside where it was air-conditioned or they went to the mall. While I was in Doha, it was above 100 degrees every day and it did not go below 80 at night. 

John gave me a tour of the sprawling campus that contains both Hamad General and the Women’s Hospital, where they deliver 12,000 babies per year. The two hospitals see a combined 1,500 emergency department patients per day! There are almost no primary care offices so everything goes
to the ED.

The amount of construction going on was incredible. There were cranes everywhere building schools, universities, hospitals, homes and office buildings. Since this was going on in the desert, sand was blowing everywhere. Qatar is scheduled to be the site of the 2020 Soccer World Cup Tournament, so the country is working hard to have its infrastructure in place by then. Outside of my hotel, an elevated metro line was being built. Transportation lines will be necessary for the World Cup and also to move Qatar’s growing population.

The Middle East Forum for Quality Improvement in Health Care meeting was at the Qatar National Convention Center (QNCC). The Center was completed a few years ago and it was huge. Disney on Ice was also performing at the QNCC while we were there. It was amazing to see families from all over the world with little children going to see the show.

The conference focused on patient safety, clinical quality, patient engagement and patient flow. Some of the highlights were the 200 posters presented mostly by teams from Hamad, a plenary by ex-astronaut, physician, diver and now hospital executive in Canada, Dave Williams, and one by Mark Gallagher, a Formula One racing executive. This presentation was a fascinating recounting of how Formula One had gone from having on average one driver death per year to no fatalities over the last eight years by studying the root causes of all mishaps and by applying human factors analysis to make the racing much safer.

I used the theme “The World is One Village” in my plenary address on flow. I wanted to leave the delegates from HMC with the message that the science of patient flow applies everywhere and we all struggle with the same issues (although the magnitude of the problem may be quite different.) There is a great need for dialogue and understanding in the world, and discussing how to solve the healthcare dilemmas of a country was a great opportunity for beginning this dialogue. I was also honored to be presenting as a plenary because my friend and mentor, Dr. Berwick, was presenting the day’s other plenary.

I learned so much during my trip and made many new friends. I was glad to have been a part of the conference, but I am also happy to be back home with a reinvigorated sense of pride for all that we do in our healthcare system at GBMC. I have greater appreciation for all that we have going for us.