Improving Our Emergency Department

GBMC has an outstanding Emergency Department and the community knows this. While the region is seeing about the same number of ED visits as last year, our ED visits have increased by 10%! This is because people know the quality of our care and that we are working to become the healthcare system where every patient gets the care we want for our own loved ones. Emergency Medical Technicians and ambulance drivers know that we are welcoming to them and that we are actively working to improve our efficiency every day.

We also know that we need to make changes to our physical plant. From all the sounds coming from our Emergency Department concourse, you can tell that there are renovations taking place. We started this work a few weeks ago.

The changes are designed to reduce delays in admitting patients by improving flow. Stacey McGreevy, our Vice President of Support Services, Russ Sadler, our Manager of Capital Resources and their teams have been working hard to make the transition as easy as possible for our patients and employees.

The Emergency Department Entrance renovation will allow for wider hallways, greater patient privacy, a re-designed registration area, and improvements to overall workflow to provide better patient through-put during the registration process. By relocating the main registration desk, creating more efficient triage rooms, and adding a secondary waiting area for triage and registration, we will be better able to register patients without having long lines resulting in cramped hallways. The design team included physicians, nurses, and registrars.

I want to thank everyone involved with these renovations as well as our patients and employees for their patience while we improve.  The target date for completion of the project is June 30, 2019.

THANK YOU TO OUR SOCIAL WORKERS!!!
March is National Professional Social Work month and I want to extend my appreciation to our fabulous GBMC social workers.  I am always amazed by the resourcefulness and fortitude of this group. Our social workers deal daily with the many challenges that come with the social determinants of health and without them, our system would come to a near standstill.
They have helped GBMC attain low readmission rates and have designed a system that assures that our patients with advanced illness receive the continued support they need after they leave our hospital. Please take the time to say, “thank you” for all they do!

P.S. March 29 is Doctors’ Day – do you have a physician you’d like to honor or recognize for exceptional care? If so, please go to https://www.gbmc.org/doctorsday

Celebrating Patient Safety Awareness Week

This week is Patient Safety Awareness Week (March 10-16).  This annual recognition is meant to urge the public to learn more about healthcare safety and for hospitals to share their work on patient safety and safety culture. The goal is for healthcare systems to improve patient safety while developing lasting partnerships among staff, patients, and the community.

Safety is at the core of our vision. We owe it to our patients to keep them free from harm when they are in our care. We have come so far in eliminating error, but we still have so much to do.

We have worked hard to create a just culture, in which we begin from the premise that humans will make mistakes and they should not be punished unless they are consciously violating safe practices. We console those who make an error and we coach those who drift away from safe practices. We build systems to catch human error so that the mistake doesn’t reach the patient. A good example of this is scanning all medications to make sure that the drug has been ordered by a provider and verified by a pharmacist to prevent giving a patient the wrong medicine.

We are delighted to work in partnership with our patients. Patients and family members play an important role in preventing harm. At GBMC, we educate patients on their disease processes, we teach them about their medications, and we encourage them to ask questions. An informed patient, who is comfortable speaking up, is less likely to experience harm.

Here are some facts that the GBMC family can be proud of:
--We were one of only eight hospitals in Maryland to receive an ‘A’ in The Leapfrog Group’s Hospital Safety Grades in 2018. These grades measure how well hospitals protect patients from harm.
--We’ve only had ONE surgical site infection for hip and knee replacement surgeries since January 2016. Prior to that, we had averaged approximately one surgical site infection per month.
--Unit 36 and Unit 58 have been Central Line Associated Bloodstream Infection (CLABSI)-free for over four years.
--Unit 45 has not had a Catheter Associated Urinary Tract Infection (CAUTI) since 2012 and Unit 35 has been CAUTI-free since 2013.

These results did not happen by chance. We put evidence-based standard work in place to prevent these episodes and we hold ourselves accountable to follow the standard work. Whether staff members have direct or indirect contact with patients, everyone plays an important role in preventing harm. I want to thank all our GBMC physicians, nurses, advanced practitioners, and everyone in our system for their tireless efforts as we work towards zero harm.

Come Out and Walk for A Great Cause!
Did you know that one in three women and one in six men in the U.S. have experienced some form of sexual violence in their lifetime? To raise awareness on this very important issue, we are holding our annual Walk a Mile in Their Shoes event during Sexual Assault Awareness Month.

This powerful event, which takes place on Saturday, April 6, is hosted by the GBMC Foundation and presented by the GBMC Volunteer Auxiliary. It’s a great opportunity to educate the community about sexual assault and domestic violence. Participants will walk one mile around GBMC’s campus to shed light on this extremely important issue.

Walk a Mile in Their Shoes, which financially supports our SAFE and Domestic Violence Program, has continued to grow over the past four years. We are proud of the impact that this program is having, and we are grateful for all the community support that allows GBMC to provide these necessary services across the region.

I want all of you to consider walking with us and/or financially supporting the event. For more information, please visit: www.gbmc.org/walkamile

Advanced Practitioners Week
This year GBMC is celebrating advanced practitioners in a very unique way. The theme of the week was “The Resilient Practitioner: Wellness and self-care for those who care for others.” The theme was inspired by the book, “The Resilient Practitioner: Burnout and Compassion, Fatigue Prevention and Self-Care Strategies for the Helping Professions.” The week-included a variety of wellness and resilience-based activities such as: flower arranging, pet therapy, yoga, eating cupcakes, and making essential oil sprays. Today, we ended with a ceremony to honor advanced practitioners who exceed expectations in skill and professionalism. GBMC is the home to more than 150 advanced practitioners who apply their skill and hard work every day to move us closer to our vision. Happy Advanced Practitioner Week!

Someone Who Has Overcome

Last week, we hosted our annual Black History Month celebration. This event honors the culture and accomplishments of African Americans in our society and celebrates the spirit and life work of the late Rev. Dr. Martin Luther King, Jr. with the presentation of the Spirit of King award. This year’s program, entitled “Songs of our Souls: We Shall Overcome,” featured Maryland Delegate C.T. Wilson, along with music from the Milford Mill Academy String Orchestra and Honors Chorale.

After the opening musical numbers, Delegate Wilson began this year’s program with his keynote. C.T. is from Charles County, and was featured in the Netflix docu-series “The Keepers.” He successfully advocated for legislation to extend the statute of limitations in child abuse cases in Maryland. When I first met him a few years ago, I was immediately impressed with his passion to help those without a voice. C.T.’s personal story is one of true hardship and perseverance. Thrown out of his home at the age of 4 by a drug-addicted mom who explained to him, "It's time for you to be a man." His life went from bad to worse. Orphaned at a young age, he was moved from foster family to foster family, and then when he was adopted at age nine, he was sexually abused by his adopter. Somehow, he got through the pain and suffering to build a better life for himself, his community, and his family. Today he is the state's primary advocate in the fight against child abuse and he has sponsored legislation to give child victims more time to file lawsuits against their abusers.

Prior to the start of the event, Delegate Wilson and I spoke briefly about GBMC’s vision of being the community-based true system of care that can deliver on our promise “to every patient, every time we will provide the care that we would want for our own loved ones.” I told him of our work to help victims of sexual abuse and domestic violence. I also mentioned that since the closing of Franklin Square Hospital’s Pediatrics department about a year ago, GBMC’s SAFE (Sexual Assault Forensic Examination) program has seen an increase in childhood assault and sexual abuse cases. As a result, we recently created a Child Protection Team, comprised of a pediatrician and social worker, who evaluate and treat all children where abuse is suspected. The team serves as a liaison between GBMC and governmental agencies which investigate child abuse and they educate medical providers and families on the recognition, reporting, and prevention of child abuse. Dr. Michelle Chudow is the medical director of the Child Protection Team and she works closely with the SAFE program team, led by its clinical program manager, Laura Clary, RN, FNE-A/P, SANE-A, to make sure that adolescent victims of sexual abuse or assault get the care they need. Delegate Wilson praised us for our efforts and encouraged us to continue to work to protect children from abuse.

Delegate Wilson’s presentation (click here to watch) was very moving and served as a motivator for everyone present. We all fought back tears because his story is so hard to hear. In the end, however, we all realized his resilience and strength. He told those gathered that he was not looking for pity, but rather a commitment to work for justice for all. I am very grateful that Delegate Wilson came to our event in the middle of the legislative session and shared his story with us. We will not forget it and we will redouble our efforts to help the abused and to educate our community towards the goal of eliminating abuse.

After Delegate Wilson’s speech, we presented the Spirit of King award which recognizes an individual who embodies the spirit and life's work of the late Rev. Dr. Martin Luther King, Jr. and who is dedicated to serving their local community. The winner of this year’s Spirit of King award was Lisa Anglin, care coordinator at our GBMC Health Partners Primary Care – Perry Hall patient-centered medical home. Please join me in congratulating Lisa and all the nominees!

I am grateful to my colleagues on the Diversity and Inclusion Council for hosting this event and helping to bring us closer together. Thanks also to the Milford Mill Academy String Orchestra and Honors Chorale and our Black History Month committee for putting together the outstanding celebration.

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. 

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!

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!

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.

THANK YOU!!!
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.