[Applause]
Wow thank you so much I cannot let Hanna
down so to start off I’ll tell you a
story
several years ago my brother-in-law who
is Norwegian decided to have a
destination wedding in Miami Beach in
July it was a hundred degrees in the
shade we were moving from
air-conditioned room to air-conditioned
room to air-conditioned room finally we
got to the car and now I’m driving next
to my 75 year old mother-in-law who is
Norwegian and she is wilting in front of
my eyes and as we get on the freeways
she barely lifts her head enough to look
out the window and notice a pattern
among the billboards that are whizzing
by as they all look like this only
four-minute weight in our emergency
department and the next one three
minutes and we’ll take care of you come
on in we’ve got a great cardiology
department we have the only sunburn room
in South Florida that’s a real one and
as we’re going I’m starting to talk to
my mother-in-law and I say you know
these billboards really reflect the
incredible customer service of the
United States health care system but as
they passed by one after another they
start to blur together and they start to
look like this hotel billboard and my
mother-in-law looks at me and she
her head and she says Josh how do you
tell the difference in this country
between a hospital and a hotel now
before you make fun of my dear
mother-in-law who is Norwegian
we’re gonna have a little quiz I’m gonna
read you a slogan and I want you to
shout out whether it’s a hospital slogan
or a hotel slogan okay I’m counting on
major participation here
you ready first thing that comes to your
mind you’ll love the way we care for you
something to feel good about our best
every day first best always for the
journey that is life not so easy is it
okay here we go
couple more we love having you here
taking care of you today
into the next century okay let’s let’s
see
none of them are hospice okay here
here’s the answer the first five are all
hospitals the bottom two or hotels we
love having you here is the Hampton Inn
and taking care of you today into the
next century is the motto of Sheridan so
how many people got them alright not a
single person is raising their hands why
do so many hospitals resemble hotels
maybe it has to do with the fact that we
pay hospitals like hotels based on the
number of people who are staying there
and it’s worth asking the question is
this incentive good for the country
because after all hospitals and hotels
are not the same they may both have room
service but in the hotel you’re much
more likely to be able to check out in
the morning okay that’s a bad
inappropriate
inappropriate metaphor because actually
last year in 2015 us life expectancy
dropped for the first time in decades
were ranked 31 in the world of course
when it comes to cost we’re number one
sad line at the top that’s the United
States cost in every other countries
underneath we pay far more than any
other country for health care even
though we’re 31st in the world for life
expectancy higher costs shorter lives
does it make you wonder maybe we
shouldn’t just pay hospitals after
someone gets sick so make you wonder
maybe we should encourage hospitals to
invest in the health of their
communities what if we stopped paying
hospitals like hotels so that was the
question that I had when I got back to
Maryland I was the secretary of
Maryland’s health department working for
Governor Martin O’Malley and we had a
hospital funding crisis on our hands
the typical way to deal with that kind
of crisis is to find a way to get more
money to pay hospitals whenever they
take care of a patient but we had the
opportunity to do something very
different to go from paying hospitals a
fee for every service to giving every
one of our 46 hospitals a global budget
which raises a very important question
what is a global budget
I learned the answer to that in Western
Maryland this is Western Maryland
Regional Medical Center in beautiful
Cumberland it was one of the first
hospitals that went on to a global
budget it is a big beautiful new
hospital I walked right into the lobby
and noticed it was almost deserted where
were the patients in fact the day I
visited it was only 55 percent full and
over in the corner of my eye I see
someone walking across this huge Lobby
with a spring in his step and a smile on
his face and it’s the CEO Barry Ronan I
think to myself if I were the CEO of a
half-empty Hospital I would be at my
desk crushing up my LinkedIn profile
thinking about my next child but this
guy was smiling why he explained to me
that under a global budget
he knows his annual revenue in advance
across all payers public and private
Medicare Medicaid Blue Cross Kaiser and
all the rest it doesn’t matter how many
people come to the emergency department
it doesn’t matter how many people come
in the hospital it doesn’t matter the
number of CT scans or MRIs and without
the need to keep the beds filled he can
actually invest in prevention indeed he
showed me a clinic in his hospital that
he’d set up to take care of anyone in
the county with asthma diabetes and
heart failure with nurses social workers
dietitians all free of charge and that
clinic was so successful it dropped the
number of people who needed
hospitalizations so the point where they
closed Ward’s of the hospital for lack
of business and he pulled me aside that
CEO and he said you know we kind of have
an unofficial motto for our patients
here now we hope to never see you again
now that probably wouldn’t work out very
well for a Sheridan this is Carroll
Hospital Center in Westminster the CEO
there Leslie Simmons did an interview
with one of our faculty members of the
Johns Hopkins Bloomberg School of Public
Health and she said that when she went
on a global budget it transformed her
understanding of what hospitals could do
to keep patients healthy she expanded
the number of hours that social workers
spend with patients in the emergency
department to address the social reasons
that they were sick she decided that
instead of just giving prescriptions to
patients who were leaving she should
give actual medicines so they were sure
to be able to take it instead of giving
the phone number of a doctor to call she
made sure everybody left with an
appointment and a date and a place and
we’re together
this is Meredith’s hospital center in
Hagerstown and this hospital came to my
rescue and I was the state health
secretary because we had a dispute
between the school system and the health
department and the school health program
was completely up in the air in this
county and then I got a phone call from
the CEO emeritus Joe Ross and he said
Josh we’re gonna hire all the school
nurses here at the hospital and I said
why would you do that
and he said Josh we’re on a global
budget we looked at our data we have so
many kids coming in for asthma attacks
to our Hospital and they’re all
preventable we can run that school
Health Program at a break-even we can
concentrate on asthma and we can save
and make money on the backend by
preventing all those hospital visits and
that’s exactly what they did huge
declines in emergency department visits
and hospital admissions across
Washington County for asthma and it made
me wonder what’s stranger a global
budget for a hospital or the fact that
in every other state hospitals are paid
more the more kids that are struggling
to breathe now I realize what’s going on
in Maryland’s a bit of an experiment and
I’m deeply grateful of the support we
had from the Center for Medicaid and
Medicare services it’s a hospital
Association and everything that they did
to make this work
Johns Hopkins played a really important
role at the beginning and all the way
through to the present in this and we
knew because it was a bit of an
experiment that we had to be careful we
put in a number of different kinds of
safeguards including assurances that the
quality of care would improve even as we
were controlling costs with global
budgets and then we started getting
results in the first year we found that
we saved Medicare a hundred and sixteen
million dollars in hospital costs alone
and the quality of care improved and
then just in January we got results for
the first couple years they showed that
hospitals in Maryland are growing much
more slowly than the state’s economy and
we’ve saved already 319 million dollars
in Medicare compared to the overall cost
trends in the country even more
impressive we’ve had a 48 percent
reduction in potentially preventable
complications among patients in the
hospital and we’ve had a massive decline
in readmissions which is something that
we were very much looking forward to now
this is still just the beginning in
Maryland
and there’s a lot more to do and while
I’m deeply grateful for all the people
who have made this work and it certainly
just wasn’t the health department as
many people at Hopkins the other
hospitals and all across the system who
made it work and while it’s nice to get
some credit which we do from time to
time for thinking a little bit
differently what’s really important is
not just a work that we’ve done but the
idea the idea that hospitals don’t just
have to wait for people to become sick
but hospitals don’t just have to think
about growing the business or the next
wing of the hospital or who it’s going
to be named after that hospitals can
actually be part of the solution for
health in their communities that
hospitals don’t have to act like hotels
well we started with Maryland but in
January Pennsylvania said within three
years they’d take 30 hospitals and put
them to global budgets or as I like to
say today Maryland tomorrow Pennsylvania
and after that well I don’t know what’s
going to make my mother-in-law impressed
but we can always hope thank you very
much
[Applause]
Wow thank you so much I cannot let Hanna
down so to start off I’ll tell you a
story
several years ago my brother-in-law who
is Norwegian decided to have a
destination wedding in Miami Beach in
July it was a hundred degrees in the
shade we were moving from
air-conditioned room to air-conditioned
room to air-conditioned room finally we
got to the car and now I’m driving next
to my 75 year old mother-in-law who is
Norwegian and she is wilting in front of
my eyes and as we get on the freeways
she barely lifts her head enough to look
out the window and notice a pattern
among the billboards that are whizzing
by as they all look like this only
four-minute weight in our emergency
department and the next one three
minutes and we’ll take care of you come
on in we’ve got a great cardiology
department we have the only sunburn room
in South Florida that’s a real one and
as we’re going I’m starting to talk to
my mother-in-law and I say you know
these billboards really reflect the
incredible customer service of the
United States health care system but as
they passed by one after another they
start to blur together and they start to
look like this hotel billboard and my
mother-in-law looks at me and she
her head and she says Josh how do you
tell the difference in this country
between a hospital and a hotel now
before you make fun of my dear
mother-in-law who is Norwegian
we’re gonna have a little quiz I’m gonna
read you a slogan and I want you to
shout out whether it’s a hospital slogan
or a hotel slogan okay I’m counting on
major participation here
you ready first thing that comes to your
mind you’ll love the way we care for you
something to feel good about our best
every day first best always for the
journey that is life not so easy is it
okay here we go
couple more we love having you here
taking care of you today
into the next century okay let’s let’s
see
none of them are hospice okay here
here’s the answer the first five are all
hospitals the bottom two or hotels we
love having you here is the Hampton Inn
and taking care of you today into the
next century is the motto of Sheridan so
how many people got them alright not a
single person is raising their hands why
do so many hospitals resemble hotels
maybe it has to do with the fact that we
pay hospitals like hotels based on the
number of people who are staying there
and it’s worth asking the question is
this incentive good for the country
because after all hospitals and hotels
are not the same they may both have room
service but in the hotel you’re much
more likely to be able to check out in
the morning okay that’s a bad
inappropriate
inappropriate metaphor because actually
last year in 2015 us life expectancy
dropped for the first time in decades
were ranked 31 in the world of course
when it comes to cost we’re number one
sad line at the top that’s the United
States cost in every other countries
underneath we pay far more than any
other country for health care even
though we’re 31st in the world for life
expectancy higher costs shorter lives
does it make you wonder maybe we
shouldn’t just pay hospitals after
someone gets sick so make you wonder
maybe we should encourage hospitals to
invest in the health of their
communities what if we stopped paying
hospitals like hotels so that was the
question that I had when I got back to
Maryland I was the secretary of
Maryland’s health department working for
Governor Martin O’Malley and we had a
hospital funding crisis on our hands
the typical way to deal with that kind
of crisis is to find a way to get more
money to pay hospitals whenever they
take care of a patient but we had the
opportunity to do something very
different to go from paying hospitals a
fee for every service to giving every
one of our 46 hospitals a global budget
which raises a very important question
what is a global budget
I learned the answer to that in Western
Maryland this is Western Maryland
Regional Medical Center in beautiful
Cumberland it was one of the first
hospitals that went on to a global
budget it is a big beautiful new
hospital I walked right into the lobby
and noticed it was almost deserted where
were the patients in fact the day I
visited it was only 55 percent full and
over in the corner of my eye I see
someone walking across this huge Lobby
with a spring in his step and a smile on
his face and it’s the CEO Barry Ronan I
think to myself if I were the CEO of a
half-empty Hospital I would be at my
desk crushing up my LinkedIn profile
thinking about my next child but this
guy was smiling why he explained to me
that under a global budget
he knows his annual revenue in advance
across all payers public and private
Medicare Medicaid Blue Cross Kaiser and
all the rest it doesn’t matter how many
people come to the emergency department
it doesn’t matter how many people come
in the hospital it doesn’t matter the
number of CT scans or MRIs and without
the need to keep the beds filled he can
actually invest in prevention indeed he
showed me a clinic in his hospital that
he’d set up to take care of anyone in
the county with asthma diabetes and
heart failure with nurses social workers
dietitians all free of charge and that
clinic was so successful it dropped the
number of people who needed
hospitalizations so the point where they
closed Ward’s of the hospital for lack
of business and he pulled me aside that
CEO and he said you know we kind of have
an unofficial motto for our patients
here now we hope to never see you again
now that probably wouldn’t work out very
well for a Sheridan this is Carroll
Hospital Center in Westminster the CEO
there Leslie Simmons did an interview
with one of our faculty members of the
Johns Hopkins Bloomberg School of Public
Health and she said that when she went
on a global budget it transformed her
understanding of what hospitals could do
to keep patients healthy she expanded
the number of hours that social workers
spend with patients in the emergency
department to address the social reasons
that they were sick she decided that
instead of just giving prescriptions to
patients who were leaving she should
give actual medicines so they were sure
to be able to take it instead of giving
the phone number of a doctor to call she
made sure everybody left with an
appointment and a date and a place and
we’re together
this is Meredith’s hospital center in
Hagerstown and this hospital came to my
rescue and I was the state health
secretary because we had a dispute
between the school system and the health
department and the school health program
was completely up in the air in this
county and then I got a phone call from
the CEO emeritus Joe Ross and he said
Josh we’re gonna hire all the school
nurses here at the hospital and I said
why would you do that
and he said Josh we’re on a global
budget we looked at our data we have so
many kids coming in for asthma attacks
to our Hospital and they’re all
preventable we can run that school
Health Program at a break-even we can
concentrate on asthma and we can save
and make money on the backend by
preventing all those hospital visits and
that’s exactly what they did huge
declines in emergency department visits
and hospital admissions across
Washington County for asthma and it made
me wonder what’s stranger a global
budget for a hospital or the fact that
in every other state hospitals are paid
more the more kids that are struggling
to breathe now I realize what’s going on
in Maryland’s a bit of an experiment and
I’m deeply grateful of the support we
had from the Center for Medicaid and
Medicare services it’s a hospital
Association and everything that they did
to make this work
Johns Hopkins played a really important
role at the beginning and all the way
through to the present in this and we
knew because it was a bit of an
experiment that we had to be careful we
put in a number of different kinds of
safeguards including assurances that the
quality of care would improve even as we
were controlling costs with global
budgets and then we started getting
results in the first year we found that
we saved Medicare a hundred and sixteen
million dollars in hospital costs alone
and the quality of care improved and
then just in January we got results for
the first couple years they showed that
hospitals in Maryland are growing much
more slowly than the state’s economy and
we’ve saved already 319 million dollars
in Medicare compared to the overall cost
trends in the country even more
impressive we’ve had a 48 percent
reduction in potentially preventable
complications among patients in the
hospital and we’ve had a massive decline
in readmissions which is something that
we were very much looking forward to now
this is still just the beginning in
Maryland
and there’s a lot more to do and while
I’m deeply grateful for all the people
who have made this work and it certainly
just wasn’t the health department as
many people at Hopkins the other
hospitals and all across the system who
made it work and while it’s nice to get
some credit which we do from time to
time for thinking a little bit
differently what’s really important is
not just a work that we’ve done but the
idea the idea that hospitals don’t just
have to wait for people to become sick
but hospitals don’t just have to think
about growing the business or the next
wing of the hospital or who it’s going
to be named after that hospitals can
actually be part of the solution for
health in their communities that
hospitals don’t have to act like hotels
well we started with Maryland but in
January Pennsylvania said within three
years they’d take 30 hospitals and put
them to global budgets or as I like to
say today Maryland tomorrow Pennsylvania
and after that well I don’t know what’s
going to make my mother-in-law impressed
but we can always hope thank you very
much
[Applause]
Please follow and like us: