I WILL TALK THE NEXT FEW DAYS ABOUT THE PRIVATIZATION OF OUR FEDERAL MEDICARE AND MEDICAID ENDING THESE NEW DEAL PROGRAMS AND MARYLAND LEADS THE WAY WITH JOHNS HOPKINS' HEALTH POLICY! NOW COMING TO YOUR STATE AND YOU BETTER RUN!
People in Vermont had better run from this model as it has been in effect in Maryland where we have citizens with 30 year difference in life expectancy because they can access no level of health care and an exemption from Medicare oversight has allowed a tiered system of access for those people who would have aged into Medicare and all of its benefits. It has created the most profit-driven health system in the nation with the Maryland Assembly actually receiving the Federal funds for Medicare and Medicaid and placing them in a pool and then simply deciding not to allocate those funds for health care and using these funds as a slush fund. IT IS SIMPLY A GREAT BIG SLUSH FUNDS THAT USED TO BE FEDERAL PROGRAMS WITH REGULATED REQUIREMENTS FOR ACCESS. Maryland has decided this year not to spend Medicaid money on hospital access only preventative care so
BYE BYE FEDERAL GUIDELINES FOR MEDICAID THAT REQUIRED MEDICAID PATIENTS ACCESS TO HOSPITAL CARE! SAME FOR MEDICARE.
What Maryland is doing is creating a tiered level of access that states no matter how much you earned all your life if you have been brought to poverty by corporate fleecing of your homes, retirement, pensions, and long term unemployment----you will be rated for health care as you are these last few years----Medicaid. So, when you reach the age for Medicare you will still receive Medicaid. This has the goal of ending access to Federally protected Medicare and the quality of care always received and sends most people into old age only receiving what will be preventative care. Remember, Medicaid funding has been gutted both by Obama and Clinton neo-liberals in Congress and by Maryland State Assembly so it is no longer the Federal program it was. Now this global model removes all of the quality care everyone with a working history received when they reached 65 and treats them as are today financially.
Maryland goes further by giving this global fund to hospitals with the instruction that hospitals can decide how they want to spend it...no requirements to meet the needs of patients or citizens in their community. So, if they want to spend it on high end medical procedures then no Medicaid patients need apply. No doctors handling Medicaid patient at the same time all Americans are being pushed to poverty.
I AM REALLY, REALLY, REALLY DISAPPOINTED IN NATIONAL PHYSICIANS FOR BACKING THIS MARYLAND MODEL. I THOUGHT THEY REALLY WANTED TO WORK FOR THE AMERICAN PEOPLE AND ACCESS AND NOT FOR A CORPORATE PROFIT MODEL.
The difference from the model Vermont was going to do which was actually a Expanded and Improved Medicare for All that would create a model geared towards quality care for all and this is COMPLETE OPPOSITE GOALS. Vermont's original policy meant to keep quality care and access for all and the Maryland policy means to give a lump sum to a hospital with complete control for how it is spent and it ends the Federal programs Medicare and Medicaid and all the health requirements that payroll taxes were paid for decades by American workers.
THIS MODEL ENDS FEDERAL MEDICARE AND MEDICAID AND HANDS ALL CONTROL OF HEALTH ACCESS TO LOCAL HEALTH SYSTEMS TO DECIDE HOW THOSE FUNDS ARE SPENT LEAVING THEM GUARANTEED FUNDING EACH YEAR WITH PROFITS HOWEVER THEY WANT.
Vermont to launch global budget pilot for hospitals
Morgan True Apr. 14 2014, 7:29 pm
One or more Vermont hospitals may switch to a system that would dramatically change they way they receive payment, starting by the end of this year.
Rutland Regional Medical Center has asked state regulators to transition to “global budget” payment model and the Green Mountain Care Board intends to test the idea. Other hospitals are considering the plan.
Global budgets are set payments determined by regulators to care for the population a hospital serves, rather than the hospital billing for each individual service it provides.
Vermont has long regulated hospital budgets, and since 2012 the Green Mountain Care Board has set hospital budgets by approving a maximum dollar figure for a hospital’s total revenue.
Currently, when a hospital exceeds its budget it could lead to greater scrutiny from the board and also impact the following year’s budget.
Under a global budget model, a hospital loses money if it exceeds its budget. That’s because a global budget is the sum of all payments made to a hospital or hospital system from all payers over a given period, typically the previous year. If they go over budget there’s no additional money.
The budget is based on a hospital’s historical revenues, which are adjusted for inflation and changes in the age and size of the population a hospital serves.
Advocates say they have the potential to reduce overall health care spending by changing the financial incentives for providing care.
Maryland began a global budget pilot in 2009, which has demonstrated promise in controlling costs, while still providing quality care, according to a former Maryland hospital regulator who now consults for the Green Mountain Care Board.
As Richard Slusky, the board’s director of payment reform puts it, “Everything that was revenue for hospitals becomes a cost they need to manage.”
Thomas Huebner, CEO of Rutland Regional Medical Center. Courtesy photo
So why would Vermont’s hospitals be interested in such a payment model?
“(Global budgets) align incentives in a way that drives unnecessary utilization out of the health care delivery system, but also allows the health care delivery system to survive,” said Tom Huebner, CEO of Rutland Regional Medical Center.
Vermont is already exerting downward pressure on the growth in health care spending in anticipation of providing residents with state-sponsored health coverage.
Global budgets offer hospitals a consistent revenue stream, according to Huebner and other advocates.
Rutland Regional is at the forefront of the push for global budgeting in Vermont. The hospital is working in concert with the Green Mountain Care Board, state agencies and the Legislature, and Huebner plans to initiate a global budget pilot starting in October, when the hospital’s fiscal year begins.
“This needs to be tested, that’s why we’re proposing piloting it,” Huebner said. “We’re not proposing rolling this out statewide until we’ve tested it.”
Rutland Regional is a logical choice to test the new system because of its relatively stable patient population.
“We’re pretty isolated and insular in the sense that there’s not a lot of people going in and out of the area for care,” Huebner said. “Because we have such a well-defined service area, it’s an easier area to do that kind of pilot.”
Southwestern Vermont Medical Center in Bennington has also shown interest in participating in the global budget pilot, but for Southwestern and other Vermont hospitals global budgeting could be more difficult.
“(Southwestern) has been discussing it with the state,” said Kevin Robinson, a hospital spokesman. “The question is really whether it will work in our region.”
Unlike Rutland, Southwestern and some other Vermont hospitals have significant numbers of out-of-state patients. The hospital is currently working on an analysis to determine if they should participate, Robinson said.
Roughly 25 to 30 percent of Southwestern’s patients come from New York or Massachusetts. The recent closure of nearby North Adams Regional Hospital in North Adams, Mass., could drive that percentage even higher, he said.
Out-of-state patient populations served by Vermont hospitals could be addressed by limiting the pilot to patients covered by Vermont payers, said Al Gobeille, director of the Green Mountain Care Board.
That would mean only Vermont-based private health plans, the state’s Medicaid program and Medicare would participate, leaving some portion of hospital revenue outside the global budget.
Getting all the Vermont payers on board by October will be a challenge, Gobeille said, and Medicare is out of the question, because there’s no way the state could obtain a federal waiver in time.
“The question that needs to be answered is whether there’s a way to align the incentives properly even if we only have 90 percent of the payers covered,” he said.
It will also take time for the participating hospitals and payers to settle on care quality requirements and what the actual payments will be.
“When we did the Accountable Care Organizations it was a similar process and it took close to a year to get all the payers on board,” Gobeille said.
But Gobeille still thinks Vermont can get the pilot off the ground before October, he said, adding, “It’s one of those things where we don’t lose anything for trying.”
The global budget pilot begs another question: How does this initiative gel with other payment reform efforts already underway – most notably the fledgling shared savings programs payers and Accountable Care Organizations agreed to this year?
Huebner and the Green Mountain Care Board see the efforts of Accountable Care Organizations in delivery reform as complementary to what would make hospitals successful with global budgets.
But the Vermont Medical Society has raised concerns about the volume of reporting for doctors who must show they’re meeting the quality standards for shared savings programs.
Global budgets would also require stringent oversight and potentially additional reporting requirements for clinicians.
The quality standards and oversight are crucial to the success of global budgets. That’s because a hospital could feel pressure to reduce services, transfer costly patients or refuse care for patients with complex medical needs in order to stay within their budget.
So if hospitals can’t reduce services or cherry-pick healthy patients, how do they improve outcomes and still stay on budget?
Hospital administrators, policymakers and regulators say cost reductions will come through better care management and care coordination.
“That means doing things like making sure when (sick patients) leave us, they’re getting to their follow-up appointments; that they’re getting on their medication and staying on them; that they’re home health visit occurs in a timely basis,” Huebner said.
That work is done through care coordinators, he said, or groups of primary care doctors, specialists, nurses and home health agents who have shared protocols and review cases where a patient has had to be readmitted, he said.
The model has shown promise with Rutland’s congestive heart failure patients, a very fragile group requiring lots of hospital services, he said.
National congestive heart failure patients are readmitted within a month of discharge 25 percent of the time. Through better care management practices Rutland reduced its rate to 15 percent, Huebner said.
Now the hospital intends to expand the model to other high-need conditions such as pneumonia, pulmonary disease and other chronic conditions.
Chronic condition management is where the greatest savings are to be gleaned.
“That’s the first place you look is folks with those big chronic disease, who if you really get your arms around them you can avoid hospitalizations, and of course we’re the most expensive place to get care,” he said.
Critics question the model’s potential for reduce costs in other areas. They say Vermont hospitals already manage care well.
As Vermont drives costs down, it’s also driving dollars out of health care. But providers have fixed costs, which likely means downsizing for the industry.
That’s what makes payment reforms such as global budgets so important, Huebner said.
“We need to have a system that allows enough money to stay in it, so that we are here to take care of people,” he said, “but also incents us to do the right thing for patients, and that’s the key.”
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Federal Medicare and Medicaid funds used to subsidize the costs of private insurance rates while people receiving those funds often could not access care?
THAT'S ALL THIS IS ----TAKING OUR FEDERAL MEDICARE FUNDS TO USE AS AN ARTIFICIAL PRICE REDUCTION WHILE DENYING MARYLAND CITIZENS ACCESS TO THE LEVEL OF CARE THEY SHOULD HAVE RECEIVED UNDER MEDICARE GUIDELINES.
Citizens in Maryland will tell you admissions are down because people cannot access care in Maryland with this model. Doctors are given incentives to stop people from being readmitted so if a person is chronically ill that hospital tells that doctor to let that patient go. If a patient is admitted for procedures they are forced to leave inpatient status no matter the readiness and pushed to home health care where the level of quality of care is very much tied to a patient's ability to afford private insurance. The American people are now paying $300 a month for MediGap Insurance-----that is the insurance that augments the 20% of care that Medicare does not pay. So, if you are receiving Social Security you are seeing $100 a month taken for the Medicare Insurance then you are paying $300 a month for MediGap and still having to pay a substantial amount for PHARMA all for a medical plan that was supposed to cover your health needs when you retired. The amount of money the American people paid in payroll taxes over decades was enough to pay all of the above with no extra charge. THEY ARE FLEECING BABY BOOMERS BECAUSE THE HEALTH INDUSTRY WAS ALLOWED TO FLEECE THE MEDICARE AND MEDICAID TRUSTS FOR TRILLIONS OF DOLLARS IN CORPORATE FRAUD. This is why Maryland created this model and it is why Maryland has such extreme health disparity.
Maryland has one of the highest health industry fraud and corruption levels and has openly used what this model created as a pool of Medicare and Medicaid funding for any state funding purpose it wanted. We have no public health oversight and accountability so the data provided from the likes of Johns Hopkins leaves no accurate accounts of results but every time an outside government accountability audit is done MARYLAND ALWAYS FAILS AND THAT INCLUDES HEALTH DATA.
Western Maryland is the most Republican of areas and indeed Republicans love this plan as their citizens are shouting WE CANNOT ACCESS HEALTH CARE. PLEASE FIGHT FOR EXPANDED AND IMPROVED HEALTH CARE FOR ALL WHICH IS THE OPPOSITE OF THIS 'GLOBAL MODEL'.
I will end by saying this-----think about what GLOBAL MODEL means. The goal of Affordable Care Act is consolidation of the health industry into global health systems which is what Maryland health reform was all about. So, this is a model of access to care that will be used globally-----in developing world nations. So, Johns Hopkins which created these policies has as a goal of moving American health care to this level. Think about Trans Pacific Trade Pact and all of the world health justice advocates shouting how bad it is for world health care-----THAT IS WHAT THIS GLOBAL MODEL IS ABOUT-----IT IS THE TRANS PACIFIC TRADE PACT MODEL FOR GLOBAL HEALTH CARE. The US was first world in health care------Reagan Clinton neo-liberalism took the US to second world access to health care------and this global model tied to TPP will take Americans to third world access to health care.
STOP ALLOWING THEM TO DO THIS BY GETTING RID OF GLOBAL CORPORATE POLS BOTH NEO-CON AND NEO-LIBERAL.
Rural Maryland citizens are shouting because they cannot access any health care and it is all done as if Maryland Democrats did this........O'Malley and Johns Hopkins are not Democrats-----Hopkins wrote this policy as a neo-conservative corporation and this is neo-conservative health policy----
SHAME ON NATIONAL PHYSICIANS FOR BACKING THIS POLICY AS HEALTH CARE FOR ALL.
Economic Scene Lessons in Maryland for Costs at Hospitals
J.M. Eddins Jr. for The New York Times Dawn Snyder, a registered nurse, runs a heart failure clinic at Western Maryland Health System.
By EDUARDO PORTER Published: August 27, 2013
CUMBERLAND, Md. — This hardscrabble city at the base of the Appalachians makes for an unlikely hotbed of health care innovation.
Yet Western Maryland Health Systems, the major hospital serving this poor and isolated region, is carrying out an experiment that could leave a more profound imprint on the delivery of health care than President Obama’s reforms.
Over the last three years, the hospital has taken its services outside its walls. It has opened a diabetes clinic, a wound center and a behavioral health clinic. It has hired people to follow up with older, sicker patients once they are discharged. It has added primary care practices in some neighborhoods.
The goal, seemingly so simple, has so far proved elusive elsewhere: as much as possible, keep people out of hospitals, where the cost of health care is highest. Here, the experiment seems to be working.
Hospital admissions here are down 15 percent. Readmissions have fallen, too. In 2011, 16 percent of people who had been discharged went back into the hospital. Now, that figure is 9 percent. Many patients report that they are happier with the care.
And Western Maryland has reaped financial rewards. In the fiscal year ending in June, the system made an operating profit of $15 million on about $370 million in revenue, said Barry P. Ronan, the chief executive. That’s a spectacular return, given that the average margin at hospitals across the state is a meager 0.8 percent.
Western Maryland’s initiatives to take charge of people’s health, rather than simply provide services for a fee, fit a core objective of federal health care reform: changing hospitals and related facilities into something resembling an Accountable Care Organization.
Yet the innovations taking place in this corner of Appalachia rest on a policy that the architects of President Obama’s health care reforms never tried to emulate. Indeed, this innovation was only possible because in Maryland, hospital fees are subject to government price controls.
Western Maryland Healthcare System is one of 10 rural hospitals that agreed with the state’s Health Services Cost Review Commission to accept a guaranteed budget every year to take charge of the health care of the community they serve.
If revenue comes in under the budget one year, the hospitals are allowed to increase prices the next to make up for the deficit. If revenue exceeds the budget, however, they must reduce prices to give the surplus back.
The system, adopted by Western Maryland in 2010, helps spur innovation. But it was only possible because Maryland has a commission that sets the fee that hospitals can charge patients regardless of whether they are covered by Medicare or private insurance, or are uninsured. Everyone pays roughly the same.
Price controls are not unique to Maryland. Medicare has regulated prices for decades. Other states — including New York, New Jersey and Connecticut — experimented with them in the 1970s, only to drop them in the 1980s and ’90s when, for a time, managed care seemed to keep a lid on prices. In West Virginia, price controls have been in place since the 1980s.
Maryland has the longest track record, however. Price controls were put in place in the mid-1970s, when hospital costs had been rising at an alarming pace.
They addressed “the price dominance of hospitals, which are often monopolies or oligopolies and have a lot of price-setting power,” John Colmers, who heads the commission, told me.
At a stroke, the controls turned hospitals into something like public utilities — with regulated prices and a low but stable profit. Four decades on, the state’s experience offers fairly solid evidence that the hospital-as-utility model can work.
Not only could it help usher in changes called for by the Affordable Care Act, as it has at Western Maryland, it could also address head-on Obamacare’s main weakness, providing a direct means to rein in the cost of care.
From 1977 to 2010, Maryland’s price-regulated hospitals experienced the slowest rise in costs per patient in the country, according to the commission. Before the advent of price controls, the cost per each patient admitted into a Maryland hospital exceeded the national average by 26 percent. In 2011, it was 4 percent lower.
What’s more, costs are more evenly spread. On average, hospitals across the country charge private patients about 44 percent more than patients on Medicare and Medicaid. The uninsured — who don’t have the clout to negotiate lower fees — must pay a sticker price that includes a 220 percent markup over costs, on average.
This, hospitals say, makes up for uncompensated care and the fact that Medicare and Medicaid pay almost 8 percent less than cost.
In Maryland, Medicare and Medicaid get only a 6 percent volume discount compared to private payers. And the sticker price markup over costs is only 33 percent. All hospitals contribute proportionately to a pot to cover uncompensated care — and this cost is incorporated into their regulated rates.
Unsurprisingly, health insurance in Maryland is among the cheapest in the country. Health plans that will operate on the new health exchanges created under the federal reforms will charge among the lowest premiums of any state.
Could price controls work nationwide? Studies have found that they helped manage costs in other states that later abandoned them, including New York, Massachusetts and New Jersey.
They didn’t work everywhere, however. Maryland hospitals bought into the system because Medicare accepted paying the higher rates set by the commission as long as increases in the cost per patient — measured from the base year of 1981 — came in lower than Medicare’s national average. This provided hundreds of millions in extra revenue from the federal government.
But in Washington State, regulation couldn’t keep costs down in the face of resistance from the hospital industry. And even Maryland’s regulations have had trouble controlling the volume of care.
The commission has no control over physicians’ decisions, the primary drivers of health expenditures. It hasn’t figured out how to transport the global budget used in Western Maryland to urban settings, where hospitals could cut costs simply by encouraging patients to go to the hospital down the block.
Indeed, Maryland’s cost controls are an example of how difficult calibrating regulation could be.
As Maryland’s hospitals have done a better job keeping healthier people out, they have ended up with sicker, more expensive patients, raising their unit cost. At hospitals like Western Maryland, a fixed budget means that each person kept out of the hospital automatically raises the cost of each patient in it.
This is threatening the Medicare waiver, which relies on keeping costs per patient low. It has forced the commission to authorize very small price increases of late. “Hospitals have taken it in the stomach in the last four years,” said Carmela Coyle, president of the Maryland Hospital Association.
The problems seem fixable, though. Global payments might be brought to urban areas by defining the population each hospital must serve and shaping compensation schemes for patients who are treated elsewhere. Mr. Ronan at Western Maryland suggests that global payments could be extended to physicians, too.
Maryland is now negotiating a new measure with the federal government to keep the Medicare waiver — one that will take account of the growth of hospitals’ total costs, rather than the cost per patient.
The rewards seem worth it. Robert Murray, a former head of Maryland’s rate-setting commission, estimated that if every hospital in the nation followed Maryland’s price guidelines, we would have saved $2 trillion between 1976 and 2008 in lower hospital costs.
Given that health care consumes 18 percent of the nation’s economic output, Maryland’s experiment seems worth a try.
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What has happened in Western Maryland is exactly what I described in my blog yesterday------where the Hispanic immigrant complaining about blame for failing to care for a patient she had absolutely no training or knowledge. That is what has happened in Western Maryland and citizens are hopping mad.
Remember, these rural areas in Western and Eastern Maryland are low-income and they are indeed unable to access any level of care. I listened to a Maryland Assembly pol from the Eastern Shore state that they can get no doctors because they are all working at these big hospital systems all tied to global health tourism. Think what happens with global model funding when these hospital systems are tied heavily to global health tourism as Johns Hopkins is. Where is that money spent? They decide that and there is no oversight and accountability to prove what happens and
THIS IS YOUR FUTURE MEDICARE AND MEDICAID------LOCALLY CONTROLLED BLOCK GRANTS WITH NO FEDERAL MEDICARE AND MEDICAID AGENCY REGULATING TO MAKE SURE YOU GET WHAT THE CONSTITUTION STATES.
That is the goal of global model-----it takes all of the power of health decision and hands it to these local health systems like Hopkins to do with the money what it wants.
It is no coincidence that citizens in Baltimore die 30 years earlier than areas around the nation because of this model.......Hopkins kept the Medicare and Medicaid funds it received and used them to become a global health corporation.
So, Maryland pools all the Federal funds for Medicare and Medicaid then restricts the level of access to care to those senior and low-income patients in order to subsidize private health plans and say this brings down cost. Well, I would say that even Maryland citizens having to buy private health plans would say that they see no price savings so where did that price savings go?
IN THE POCKET OF THESE HEALTH INSTITUTIONS ====SEE WHY JOHNS HOPKINS IS A GLOBAL CORPORATION!
University of Maryland Medical System Corporation
Western Maryland Health Care Corporation
Maryland’s Total Patient Revenue System Prompts Western Maryland Health System to Launch New Skilled Nursing Care at Three Facilities
Posted on August 12, 2014 by MEP
Maryland state incentives for hospitals to reduce unnecessary admissions and readmissions have led Western Maryland Health System (WMHS) to launch a new skilled nursing program at three facilities near Cumberland. These services aim to reduce the sort of unnecessary and expensive hospital admissions that cost the U.S. healthcare system billions every year.
WMHS is partnering with MEP Health to deliver high quality skilled nursing care at Devlin Manor Healthcare Center and Allegany Health Nursing and Rehabilitation in Cumberland, and WMHS Frostburg Nursing and Rehabilitation Center in Frostburg.
A New York Times story last year featured Western Maryland System and Maryland’s unique “Total Patient Revenue” system as a potential example for the rest of the country on how to lower healthcare costs. A USA Today story in January similarly suggested that Maryland “may be the model for curbing healthcare cost,” again citing WMHS as an example.
“Western Maryland Health System has a long track record of being at the forefront of helping to solve healthcare’s thorniest challenges,” said MEP CEO Angelo Falcone. “We’ve had a long partnership with them through management of both their Emergency Department and an Observation Care Unit within the hospital. It’s been an incredibly fruitful partnership that has resulted in better healthcare for the residents of Cumberland and the surrounding areas. We couldn’t be happier to partner with them on this initiative as well.”
The skilled nursing programs will target patients at heightened risk of readmission to the hospital, or those with specific conditions which often lead to return visits to the ER. Many of these conditions could be prevented or managed in the outpatient setting, with this program, that emphasizes early diagnosis and intervention within the skilled nursing facility.
”MEP has been, and continues to be, a valued partner,” said Nancy Adams, COO of WMHS. “We are proud to be working with them on this valuable and important initiative as we strive to continually innovate while we seek to improve the care of the people in our community.”
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As Western Maryland Medical System was receiving all of the Federal and State funding for its global corporate model the few remaining Maryland State Hospitals were allowed to deteriorate. The same happened in Baltimore where Maryland State Hospital was closed because of quality of care and no resources. All of Maryland's public health centers are closed and closing and people are now only able to access these ACOs-----managed care. Keep in mind, when Maryland uses this global model of funding each hospital system with a bolus of money it does not state how many patients must be seen-----that hospital can take whatever kinds of patients is wants and patients now have to travel to find the kinds of services needed and places that take the level health plan they have. It is crazy.
The state audit of this public hospital comes just as this merger and acquisition of health institutions is going strong----
Just like our public schools in Baltimore left unfunded and resourced for decades now closing and being privatized to charters because they were not performing.
THERE GOES ALL THE MARYLAND PUBLIC HOSPITALS!
Deficiencies in leadership, policies 'jeopardized' patient care at Western Md. Hospital Center
Western Maryland Hospital Center The Western Maryland Hospital Center at 1500 Pennsylvania Ave., Hagerstown.
Posted: Saturday, August 9, 2014 2:50 pm | Updated: 5:50 pm, Sat Aug 9, 2014.
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- Posted on Aug 9, 2014
by CJ Lovelace
Poor administrative oversight and multiple failures to follow or establish important policies and procedures were major contributing factors to 43 state and federal deficiencies at the state-run residential care facility in Hagerstown, according to surveys completed by the Maryland Office of Health Care Quality.
The Herald-Mail obtained a copy of the survey findings last week.
Inspectors compiled a 134-page initial report after visiting the facility at 1500 Pennsylvania Ave., for a federally-mandated annual Medicare/Medicaid recertification survey from April 28 to May 2.
The survey consisted of reviews of patient medical records, interviews with residents, families and facility staff, as well as on-site observations of residents and staff practices. Administrative reports and facility policies also were reviewed.
Completed on May 7, the report noted numerous deficiencies due to poor executive leadership and management practices, as well as failures to investigate and report allegations of abuse to appropriate personnel and/or agencies as required.
The Maryland Department of Health and Mental Hygiene has fined the facility $150,000 for violations, including several for failed governance and quality assurance practices, as well as issues with safeguarding medication.
Western Maryland Hospital Center provides nursing-home care, hospital care and rehabilitation services for patients with chronic health problems, including brain and spinal cord injuries. As of Friday, it had 38 nursing-home residents and 16 hospital patients.
Mona Gahunia, chief medical officer with the state health department, said Friday that there was "no direct patient harm" as a result, and most of the issues were related to policies and procedures that were not being updated or a lack of re-education for staff members on current policies.
DHMH enlisted the services of a consultant, Mid-Atlantic Long Term Care, to develop a plan of correction that would return the center to full and continuous compliance with state and federal regulations, Gahunia said.
The center, which has contracted with Meritus Health to manage the facility through December, submitted its action plan to the Office of Health Care Quality on June 27, resolving 81 percent of the problems in a resurvey on July 31, Gahunia said.
A handful of remaining deficiencies, or "tags," are "isolated" and present "minimal harm" to patients, she said.
Gahunia said the center on Tuesday submitted a follow-up plan of correction on the remaining issues, which are related to nursing services and resident care plans, and they have been corrected as of Thursday to meet the deadline set by federal regulations.
Surveyors from OHCQ still have to follow-up on the plan and certify that all issues have been corrected before the center is back in full compliance, Gahunia said.
"They could come at anytime," she said.
A look at the problems
Among the noted violations, surveyors determined that "the facility failed to report allegations of abuse as required," failed to thoroughly investigate abuse allegations and did not notify attending physicians or state agencies when an injury of "unknown origin," such as an unattended fall, was discovered.
The survey described an incident where a resident suffered an arm injury by unknown means, and a nurse proceeded to medicate the patient without first completing an assessment on the resident's complaint of arm pain, according to the survey.
The patient's medical record showed that an attending doctor wasn't immediately notified, delaying an X-ray until the next day when a shoulder fracture was discovered after a trip to the emergency room, the report shows.
Surveyors asked facility staff for documentation relaying information about the injury to the next shift or appropriate staff members, but the documentation did not contain information regarding the severity of the injury or notification to the patient's doctor or family.
In another instance, a written complaint about alleged abuse involving "intimidating behavior" and bullying by a nurse wasn't properly investigated and documented, the survey found.
Surveyors noted other cases where required reports of alleged abuse cases were never submitted to appropriate state agencies regarding the investigation into the incidents.
Other deficiencies identified included a failure to develop a policy to identify risk factors that constitute abuse, failure to provide services that meet professional nursing standards, "which jeopardized the health and safety of residents," and failures related to medication, such as improper administration to patients and not locking unattended carts.
Several violations were found against the former leadership of the hospital, including a failure to ensure effective use of resources to maintain the health and safety of residents, and a failure in governance of the facility when systemic concerns of abuse, communication, reporting and safety were identified, according to the report's findings.
"The cumulative effect of these facility governance concerns resulted in the facility's inability to ensure the provision of quality care and services in a safe environment for residents," surveyors wrote, noting the previous nursing director resigned in December 2013 and a full-time replacement had not been made at the time of the survey.
Cynthia Pellegrino, who served as the chief executive officer of the facility since 1997, has since left the facility.
DHMH officials said Pellegrino resigned June 23 at the department's request, but Pellegrino said Friday that she decided to retire.
Pellegrino provided the following statement:
"When I left Western Maryland Hospital Center, a piece of my heart and soul were left behind. I believe with it, my 38-year passion for rehabilitation and health care," Pellegrino said. "I walked away proud of my many accomplishments in my career, from building and operating a rehab hospital to the development of special programs and a vision of healing at Western Maryland.
"I would request my privacy during this difficult time of transition and wish only the best for my employees, patients, residents and volunteers," she said.
Pellegrino provided no further comment.
Meritus takes over management
It's been a little more than a month since Meritus Health took over interim management at the hospital center, providing day-to-day operational oversight through new temporary leadership in the on-site positions of chief executive officer, chief medical officer and chief nursing officer, among other positions.
Gerard Walsh, who formerly served as an executive at Shore Regional Health/University System of Maryland Medical System, has been appointed interim CEO of the facility.
Joining Walsh are recently retired Washington County physician and current Meritus board member George C. Newman II as CMO, and Laura Mercer, a registered nurse and director of Meritus Medical Center's medical/surgical departments, serving as CNO.
Joseph P. Ross, president and CEO of Meritus Health, said in a statement Thursday that the health system has assembled a management team that focuses on quality improvement to address the issues highlighted by the state.
"Western Maryland Hospital Center is really a hidden gem for this community, and we've had great cooperation from the staff there to nearly complete the work at hand," Ross said.
DHMH officials in June said that the facility previously had been operating without a CMO or CNO, likely a contributing factor to the poor reviews of management practices.
The deal with Meritus, worth up to $806,000 for six months, ends in December, and DHMH is still weighing its options to ensure a positive direction for the facility into the future, Gahunia said.
"Things are going really well," she said. "The progress that the facility has made within just a few months really speaks to the combined expertise" of Meritus, Mid-Atlantic and the staff at the center.
Gahunia said re-education measures have been put into place for all staff members, and the implementation of a quality assurance and performance improvement plan will ensure continual compliance with state and federal regulations.
"The bigger message is that we have put into place a culture of patient safety and accountability of all staff to provide the highest quality patient care," she said.
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As you see below the global model of pooling funds always uses the Federal Medicare and Medicaid funding to augment corporate profit at the expense of the citizens of Maryland. Here you see ever higher costs for nursing home care, cuts to Medicaid spending and more funds going to hospitals which are free to use those funds as they want. The idea of decreases in cost only have to do with how much of these Federal funds from Medicare and Medicaid are saved and sent to hospitals for their use. So, cut access to seniors and low-income and you have more money in the pool to send to hospitals. See how expansions from all those 'savings' occurred for Maryland hospitals?
Think about the FARM BILL and how BIG AG subsidy has left that industry unable to lose money and actually has profits soaring-----think how the oil industry subsidy keeps the oil industry from ever losing money and then think of how a guaranteed bolus of government money every year from the state to be used however you want creates that same subsidized model for constant profits for what will become very profit-driven global health system corporations.
SAME THING FOLKS AND THERE IS NO OFFICIAL MEDICARE OR MEDICAID TO BE FOUND-----IT IS ALL BLOCK GRANTS!
O’Malley proposes raising hospital rates, nursing home tax
SUBSCRIBER CONTENT: Jan 28, 2011, 6:00am EST
Emily Mullin, Staff
To replenish the state’s cash-strapped Medicaid program, Gov. Martin O’Malley is proposing to increase a tax on nursing homes for the second time in as many years and give Maryland’s hospitals a pay raise that could double the hike they received in rates this year.
Through a proposed reimbursement rate increase of 4 percent in the fiscal year that begins July 1, Maryland’s hospitals could generate as much as $254 million of the $264 million O’Malley called for cutting in Medicaid pay to hospitals in his budget released Jan. 21. Maryland’s hospitals were granted a 2.2 percent pay raise this year.
Meanwhile, the proposed hike in the so-called “bed” tax on nursing homes from 4 percent to 5.5 percent would bring nearly $13 million into Medicaid, said John Folkemer, the state’s deputy secretary for health care financing.
O’Malley’s plans come as enrollment in Medicaid has ballooned, federal stimulus cash for the health program for low-income and disabled residents has run dry, and the state is dealing with a projected $1.35 billion budget shortfall for fiscal 2012. Maryland’s Medicaid budget is nearly $7 billion — about half the size of the state’s operating budget and up almost 15 percent over last year.
But the proposed changes also come as health care providers face more cuts from the federal Medicare program for seniors, doctors pause to consider whether to treat more patients covered by public programs, and the nation continues to wrestle with the escalating cost of health care.
The bottom line is that increased rates — whether they be in hospital reimbursement or taxes on nursing homes — could eventually trickle down to patients in the form of higher costs for medical services. For every 1 percent hospital rates are increased in Maryland, another $136 million is paid to the hospitals, according to the state’s Health Services Cost Review Commission, which sets hospital rates and would have to approve O’Malley’s plan. Insurers often pass those increases onto their customers in the form of higher premiums.
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