Friday, February 22, 2019

A Grand Experiment

As readers of this blog know, Maryland is different from the other 49 states in the union because we don’t get reimbursed from Medicare for hospital services by the national prospective payment system. Instead, Medicare pays hospital rates that are set for all payers by the Health Services Cost Review Commission (HSCRC). The rates vary significantly from one hospital to another.

In the other states, Medicare and Medicaid generally pay below what private insurers pay and hospitals negotiate payment rates with the private insurers, trying to pass the costs not covered (by Medicaid in particular) on to the private insurers. In Maryland, hospitals don’t negotiate rates with private payers because they are set by the HSCRC.

Since 2014, Maryland hospitals have been working to improve health outcomes and the care experience of patients while keeping the annual increase in the cost of care for hospital services below 3.58% (the projected annual increase in our State’s economy). Maryland has succeeded in reducing hospital-acquired conditions and in keeping cost increases below 3.58% annually over the past 5 years.

Beginning on January 1, 2019, Maryland’s hospitals have committed to a new waiver extension. You can read the details by clicking here. The agreement commits Maryland to improving the health of our citizens while controlling the cost of care. A new element to the waiver will be Maryland’s need to reduce the rate of increase for the total cost of care to Medicare beneficiaries relative to the rate of increase in the total cost of care for Medicare beneficiaries in the rest of the country. By the fifth year of this new waiver, Maryland is required to generate $300 million in savings annually. Until this year, Maryland’s performance has been judged based on hospital costs only, but now it will include physician billing, nursing home billing, and all that is included in Medicare Part B billing.

Since hospitals are now responsible for charges outside of the hospital itself, it will be more important than ever to get physicians on board. For this reason, the new waiver will include THREE programs designed to incentivize providers of care to generate better health outcomes at lower costs. The first is the Maryland Primary Care Program (see my blog from Jan. 4 by clicking here). The Maryland Primary Care program will create more advanced primary care practices which are better equipped to keep patients with chronic diseases out of the hospital and as healthy as possible. The other two programs that involve physician leadership in improvement are the Episode of Care Improvement Program (ECIP) and the Hospital Care Improvement Program (HCIP).

The ECIP incentivizes clinical teams to improve outcomes and lower costs for an episode of care, like an artificial hip transplant. Medicare will ‘bundle’ the total costs for a hip transplant and if the team can reduce the total costs, the hospital that the team is associated with will keep a portion of the savings. For example, if the team can eliminate stays on a rehab unit and send the patient home from the hospital with physical therapy, thereby saving the cost of the rehab unit stay, the team will receive a percentage of the savings.

In HCIP, clinician-led groups work to improve clinical outcomes within a hospital stay by designing better processes, using care coordination, and creating better handoffs at discharge. Teams will work to drive out waste, resulting in reduced costs. Hospitals that reduce their costs will keep the savings, thereby increasing their profitability and making rate increases in subsequent years less necessary.

Everyone agrees that the current healthcare system in the U.S. is wasteful and unsustainable. The Centers for Medicare and Medicaid Services are using Maryland as a laboratory to see if changing financial incentives can help care providers to transform the system and drive better value to the people we are serving. It is a very exciting time to be in healthcare in our state! The GBMC HealthCare System is a key player in this transformational movement as we continue driving toward our four aims of the best health outcomes with the best care experience and the least waste of resources with the most joy for those providing the care – the definition of what we want for our own loved ones and for every patient, every time. Let’s use the new waiver to move us faster toward our vision. 

Friday, February 15, 2019

GBMC has the Best Grounds Crew!

Over the past couple of weeks, I’ve had several people stop me, most recently during this past Monday’s Lean Daily Management (LDM) walk, to let me know how grateful they are for the excellent work our grounds crew has done during the recent winter storm events. They’ve told me how “stunning” our facility looks after inclement winter weather. They reflected that they wished that the rest of the region could be as good at snow and ice removal as GBMC.

Every winter, our grounds crew does an outstanding job of clearing snow and ice on our grounds, and our facilities team makes sure that everything remains in working order. Over the years, there have been several stories about how all our staff members have rallied together during blizzards and ice storms to ensure the hospital remained operational to serve those in need of our care. Time and time again, the GBMC team has clearly demonstrated its commitment to our mission of health, healing, and hope for the community. I have witnessed the teamwork, camaraderie and “can do” attitude of our people firsthand many times since I arrived in 2010.

On Monday, our grounds crew did its usual phenomenal job of snow and ice removal to make our campus safe and passable. They were out all day, clearing ice from GBMC roads and walkways. GBMC ran like a well-oiled machine. I can’t think of anything that exemplifies teamwork more than this.

Let me take this opportunity to thank everyone for their commitment and effort to get the job done for our patients and our community during the recent storms. Special thanks must go to our beloved grounds team: George Dillon and Tony Weber. From early in the morning to very late at night, these guys worked collaboratively with our vendors, Bright View, to keep our campus safe and passable. Thanks also must go out to Jim Keyzer, Mitchell Scholtes and all of our facilities team!

Again, my appreciation to all who work so hard to get the job done for our patients and our community during the recent storms.

Thank you, everyone!

Friday, February 8, 2019

There is No Substitute for Compassion

This week, I have spent a lot of time thinking about the use of automation and technology in healthcare. Many are trying to sell us various products such as online primary care, remote monitoring, and decision tools using artificial intelligence, just to name a few. I have no doubt that we can use technology to improve the value of our care, but this week I was reminded that only humans can love and demonstrate their love for others, especially when the other is in a time of need. On Wednesday, we celebrated the winner of the annual Nancy J. Petrarca Compassionate Caregiver Award. This year’s winner is Carolyn Insley, the Executive Assistant to Jenny Coldiron, our Vice President for Philanthropy. Carolyn is an important player on our philanthropy team.

John Adams, MD, the deceased former Chair of the Department of Pathology at GBMC, started the Compassionate Caregiver Award after losing his friend, Nancy Petrarca, to cancer. His vision and philanthropy created the endowment that underwrites the rounds that bear his name.

I can think of no one more deserving of this award than Carolyn. While she is not a caregiver to patients, Carolyn cares for the GBMC Team every day. Carolyn is an outstanding example of a caregiver to the caregivers. She has overseen the Adams Rounds and its predecessor, the Schwartz Rounds, from their beginning. She treats everyone with care and she never says no when she is asked for help. Carolyn does an outstanding job supporting Jenny and she has been a wonderful colleague to me. She quietly and graciously does so many things to aide our efforts to raise funds and she is frequently the point person in our efforts to soothe the pain of someone who has lost a loved one or who is going through a difficult time.

So, please join me in congratulating Carolyn. We will see many new hi-tech tools in healthcare, but there is no substitute for the compassion that Carolyn displays every day!

I am also very proud of all 87 of this year’s nominees and the other four finalists: 
Tara Archer –  Gilchrist Kids Volunteer
J. Christopher Greenawalt, MD – Hospitalist
Kory Joyner – Security Officer
Lisa Brengle Krueger, RN –  SAFE Nurse

Thank you all for your caring and your leadership!

Help us reach our goal!!!

Our nation’s blood supply has been critically depleted because of multiple snowstorms, frigid temperatures around the country, and the recent government shutdown, which reduced the number of blood drives in our region. Blood drives help surgical patients, those who’ve suffered traumatic injuries, and patients who need blood because of illnesses such as cancer. I encourage you to watch our two Facebook Live shows “To Your Health” and “Greater Living Live, to learn more about the value of blood drives and why I am asking for your help!

This Valentine’s Day, GBMC is hosting its first American Red Cross Blood Drive for 2019. Currently, we have about 90 people registered to participate, but we really need to reach our goal of 120 donors. The drive is from 5:30 a.m. to 4:30 pm and will take place in our Civiletti Conference Center. To register, click here.

Please have a heart and sign up to donate. It’s easy, won’t take much time, and you will literally be helping to save lives. I am confident that the GBMC family will rise to the occasion and make this blood drive the best one yet! Thank you!

Friday, February 1, 2019

Healthcare Price Transparency

This week, I was made aware of the need to make prices more visible to patients. I received a letter from the Maryland Insurance Commissioner, Al Redmer, because a GBMC patient was stunned when he received a bill for more than $5,000 for a leg compression device to prevent blood clots. His insurance had paid $3,000, but since the durable medical equipment company was “non-participating,” he was left with a $2,000 responsibility. “Non-participating” means that the durable medical equipment company had not contracted with the insurer and reserved the right to charge anything the insurance company didn’t cover directly to the patient. Evidently, we had ordered this device without investigating how much it cost or how much the patient would have to pay out of pocket. I am sure that whoever ordered the equipment did so in good faith, trying to help the man. Mr. Redmer had also sent a letter to the president of the man’s insurance company requesting an explanation.

On Tuesday, I heard a speech from the Administrator of the Centers for Medicare and Medicaid Services, Seema Verma, who discussed how she and the Secretary of Health and Human Services, Alex Azar, were focused on driving healthcare costs down. She highlighted that, as of January 1, 2019, all Medicare participating hospitals were required to publish their chargemasters online to make prices available to patients. GBMC has dutifully done this. If you want to view the GBMC charge master link, click here. I would recommend that you visit other hospital websites and see if you can compare their prices. This will be challenging due to the variation in cost for procedures, so you may want to compare something like a Mumps Measles and Rubella vaccine. With some research, you will be able to find this because it is a vaccine that does not vary across hospitals making it an apple-to-apple comparison.

As in the case of the man referred to in the letter from Commissioner Redmer, the charges by themselves are not enough for a consumer to know what they will pay out of pocket because it will vary dramatically according to the insurance plan. For example, GBMC employees who have taken our platinum plan don’t pay anything out of pocket, no matter what the charge is, if they use GBMC. This is obviously not true for someone with a “high deductible” plan. (By the way, this is a reason why many think we should explore a single-payer plan, to simplify the rules and to spend much less on insurance administration. It would be as if everyone had Medicare and there was only one set of rules. The Canadians have a single-payer system and they save a lot on administration and spend 40% less per capita on healthcare with much the same outcomes as ours).

Maryland is the only state in the U.S. where hospital rates are set by a commission known as the Health Services Cost Review Commission (HSCRC). All payers pay the same price for a given service in Maryland. In the other states, hospitals set their prices very high on their chargemasters to be able to negotiate downward with Blue Cross and other insurers. The gap between what the chargemaster says and what individual insurers actually pay is not as big in Maryland as it is in the other 49 states. In all states, however, the person with no insurance is billed the full charge as found on the chargemaster. People who cannot pay these charges apply for discounts based on their means.
GBMC has some of the lowest hospital charges in the region and with our global budget and more patients coming, our prices have actually gone down. Making patients and employers (who could steer their employees towards high-value hospitals) aware of price differentials is a good start, but we all have so much more work to do to build a more value-driven healthcare system. If you want to know more, please visit a recent New York Times article on hospital prices here.

I would like to thank everyone who recently took time out of their busy schedule to email or speak to me in person and offer their thoughts about last week’s blog. I truly appreciate the feedback and it was nice to hear from so many of you. I encourage you all to please submit your remarks in the comment section of the blog and to help keep the conversation going about improving our nation’s healthcare system.