Mid-Shore Health Futures: UM Medical System and Shore Health Team Up to Fight Opioid Drug Epidemic

With such successful awareness campaigns as “Talbot Goes Purple” and “Recovery For Shore” events alerting the Mid-Shore community of the dangers and tragedies that come with this unprecedented wave of the opioid abuse creating havoc in rural Maryland, we thought it might be a good time to check in with University of Maryland’s Shore Regional Health, and its parent organization, the University of Maryland Medical System, to understand more about the crisis and more importantly, their approach to education and treatment for those seeking help for themselves or their loved ones.

That gave us the opportunity to spend some time with the University of Maryland’s leading expert on addiction and treatment, Dr. Eric Weintraub, who heads up the alcohol and drug abuse division of the University’s Medical Center, and Donna Jacobs, the MMS’s vice president for community health,to discuss the current state of the epidemic and their community outreach efforts.

One example of that kind of outreach will take place on November 29 at Chesapeake College’s Todd Theatre, and three other locations in Maryland, as hundreds of stakeholders gather to talk at the Not All Wounds are Visible: A Community Conversation about Addiction and Substance Abuse . This event is open to the public and provides an opportunity to hear from and talk to healthcare professionals and community leaders about addiction and substance abuse, including opioid and other drug addictions, as well as recovery programs and strategies.

This video is approximately nine minutes in length. For more information about Not All Wounds are Visible: A Community Conversation about Addiction and Substance Abuse please go here

 

Mid-Shore Health Futures: Deborah Mizeur on Rural Health Recommendations, Timeline and Vigilance

The last time the Spy checked in with Deborah Mizeur, the co-chair of the State of Maryland’s Rural Health Delivery Workgroup, was when things had just begun to get started. The Workgroup members were approved by Governor Hogan, the Maryland Health Care Commission was assigned to provide staff assistance, and the charge seemed simple enough; oversee a study of healthcare delivery in the Middle Shore region and to develop a plan for meeting the health care needs of the five counties — Caroline, Dorchester, Kent, Queen Anne’s and Talbot.

That was thirteen months ago, and at that time, it was clear that while Mizeur was optimistic, there were many unknowns about whether a very diverse group of well-meaning citizens and professionals with very different philosophies on health care delivery, could come together to form a consensus on rural health on the Eastern Shore and perhaps throughout the state.

The selection of Ms. Mizeur and Joseph Ciotola, the health officer and EMS director for Queen Anne’s County, to co-lead this effort was an inspired one. Both of them seasoned health policy experts who lived on the Mid-Shore, Ciotola an Mizeur worked tirelessly to build consensus with the group as it slowly came to agree on both the Workgroup’s findings, recommendations and a timeline for implantation.

Last week, Deborah took a break from her Apotheosis herb farm kitchen and office to talk to the Spy about where things go after the Workgroup presents its final recommendation to the Governor and Maryland Legislature to consider in the upcoming lawmaking season.

As Mizeur notes in her Spy interview, the Workgroup realized that all of their recommendations could not be done simply with the approval of Annapolis, but instead must be accomplished over the course of years. It was also important to prioritize what had to come first, and the committee was unanimous in wanting two important steps to take place.

The first was for the state to immediately provide incentives for physicians and other health workers to work in rural areas of the state. The second was the formation of regional health collaboratives that would connect all the major private and public health providers in such locations as the Mid-Shore to coordinate and improve services and eventually move forward with the implications of Rural Health Care Complex in the region, which allows residents a “one-stop” shop for their comprehensive health needs. In addition to those primary objectives, the Workgroup was also in total agreement that the hospital  in Chestertown should continue to provide inpatient services as well.

Just those few steps, warns Mizeur, will take the full support of Governor Hogan, the University of Maryland health system, and most importantly the residents and voters of the Mid-Shore to continue to add their voices of support and diligence to make sure all parties keep their commitments.

If that happens, Deborah Mizeur is convinced the the future of healthcare on the Shore can look very bright.

This video is approximately nine minutes in length. To review the Workgroup’s full report please go here. To view the Spy’s first interview with Deborah Mizeur please go here

 

Mid-Shore Health Future: Maryland Rural Health Workgroup Director Ben Steffen

In many ways, Ben Steffen seems like the perfect person to head up a work study group on the future of Maryland’s rural hospitals. While he certainly has the professional experience to carry out those duties, including his current role in running the Maryland Health Care Commission, his most unique qualification is the fact that he grew up in the isolated farmland of Northeastern Iowa. It was in that kind of health care environment that Ben experienced first hand the special requirements of rural health care and the complexity of deliveries those services.

Now he is faced with the extremely challenging task of managing a state task force to decide what Maryland needs to do for the rural hospitals in towns like Chestertown and Cambridge to meet those special needs. Over the course of only one year, he will need to share with his 36 member committee the extraordinary data collected on these health care centers as well as guide them through a decision-making process to develop long-term recommendations for the Mid-Shore.

In his Spy interview, Ben talks about the Maryland Health Care Commission’s interest in rural hospital issues, the process of the workgroup, and his thoughts about rural hospital solutions, including “critical care” models and transportation challenges.

The first meeting of the workgroup will be held at Chesapeake College August 30th from 1pm to 5pm.

This video is approximately fifteen minutes in length 

 

Mid-Shore Health Future: Dr. Jerry O’Connor on Shore Hospitals

Dr. Jerry O’Connor, a surgeon who has practiced for 32 years at the University of Maryland Shore Medical Center at Chestertown, has some very serious concerns about the future of the Chestertown hospital. After three decades of watching the medical center be downsized and merged into the UM Health system, he has decided to speak out about those concerns as Shore Health begins a final review process for its long term strategic master plan.

One of Dr. O’Connor’s issues is related to the process that Shore Health has used in this planning effort, which he feels has ignored or marginalized the concerns of many medical professionals in Chestertown. But his main concern is the possible loss of in-patient care in Kent County. He believes this is a result of Shore Health, and other Maryland health care providers, relying on GBR (global budget revenue) and population health metrics which focuses on numbers rather than people.

In his Spy interview, Dr. O’Connor remains guardedly optimistic that Shore Regional Health leadership has not closed the door on a workable solution for Chestertown. In particular, he is eager for decision-makers to look more carefully at making Chestertown a “Critical Access Hospital” allowing for a more flexible reimbursement structure. While that might take some time, he feels Shore Health can in the meantime do far more outreach and consultation with doctors in Kent County before a final plan of action has been decided.

This video is approximately fifteen minutes in length

 

 

Mid-Shore Health Future: The Serious Medicine of Laughter with Ken Sadler

Clown work is no laughing matter if you ask Ken Sadler. The Louisiana native, retired insurance executive and longtime Oxford resident has significant credibility in expressing his opinion since he has served as the Shore Health’s CLO (chief laughter officer) for almost a decade.

Each week, Sadler, a.k.a. Dr. Goodwrench makes his rounds in the inpatient wards of the hospital to administer humor to those that are willing to take this powerful medicine. Those that do have a good chance of experiencing lower blood pressure, less pain, and a happier outlook as a result.

In this Spy profile, we talk to Ken about how he started his “practice,” the science of laughter, and the national Caring Clowns organization that certifies hospital clowns throughout the country.

This video is six minutes in length. For those interested in becoming a partner in Dr. Goodwrench practice, please contact Ken at 410-310-9218 or email him at kensadler73@gmail.com

Mid-Shore Health Future: Setting the Price with HSCRC’s Donna Kinzer

As the Mid-Shore’s UM-Shore Regional Health starts to finalize reorganization plans this fall, including the future role of health care in Chestertown, Cambridge, and Easton, the Spy thought it would be interesting to understand more clearly the economic forces at play that required organizational reconstruction in the first place.

And on that question, we could find no better place to turn to than Maryland’s Health Services Cost Review Commission, or affectionately known as HSCRC. While the name might sound bureaucratic and even rather benign, the truth is that the HSCRC is at the heart of a revolutionary change taking place on the Eastern Shore and every other region in the state.

Why? It is because this tiny state agency, located next to a Burlington Coat Factory and a Panda Express near Baltimore, single-handedly decides the rates and global budgets for hospital services located at a hospital – for both inpatient and outpatient services. In other words, it doesn’t matter who pays your medical expenses, private health insurance, Medicare, or Medicaid, those charges only exist with the full approval of the HSCRC. It’s a big deal.

In fact, Maryland is the only state in the country that can control significant aspects of its health economy. And while it has been able to set health care costs since 1977, it was only in January of 2014 that the HSCRC instituted a new “All Payer” model that permanently terminated its pay for services model.

The end of pay for services has been replaced by a revenue model that encourages and economically rewards health systems that appropriate care options beyond inpatient care. At the same time, that same model pushes regional hospitals to increase community health programs that dramatically reduce the need for inpatient care with those with chronic illnesses.

Sitting on top of this revolution is Donna Kinzer, HSCRC’s executive director. A health policy consultant and analyst for several decades prior to joining HSCRC, her passion for redefining health care comes from a personal family tragedy. While caring for her terminally ill husband when she was 39 years old, Donna witnessed first hand how the old “hospital door to hospital door” model was grossly inadequate for both the patient and as a sustainable business model.

This video is approximately fourteen minutes in length

Mid-Shore Health Future: UM Shore Regional Health CEO Addresses Rumors About Chestertown Hospital Changes

“With regard  to Chestertown, the Shore Health Center of Chestertown will continue to be a viable organization for the foreseeable future. We have an obligation to the community to provide excellent health care,” Ken Kozel, President and CEO of UM Shore Regional Health, said at Monday’s town council meeting.

While no hospital closure is in sight, other changes will take place with the kind of medical services to be provided at Chestertown’s hospital.

“No decisions have been made with this process. We are evaluating what our future needs will look like in the realm of national change,” noted Kozel.

Kozel was invited by Mayor Chris Cerino to address rumors circulating about the future of the Chestertown Hospital. Rumors have run the gamut of a full hospital closure to a stand-alone Emergency Department only without inpatient care.

He said that UM Shore Regional Health is currently evaluating how Mid-Shore communities would best be served by the health organization and placed the evaluation process in the context of nationwide changes in how health services are provided.

Kozel also described the unique position Maryland holds in the national healthcare landscape—the Medicare waiver, which allows Maryland to continue setting hospital reimbursement rates. In turn, that changes how hospitals do business. Medicare reimbursement is no longer directly related to hospital admissions—erasing the incentive of admitting more patients for inpatient care—to focusing on keeping people healthy before they get sick and focusing more on the outpatient area.

The UM Shore Regional Heath CEO said that a research committee comprised of 22 residents and physicians from Mid-Shore counties will profile specific community needs to determine where specialty services should be located for the benefit of all.

Questioned by the council about projected changes, Kozel said, “Let me clear about one thing, Shore Health can not be all things to all people. The days of us providing every level of service in all locations are far gone.”

He added that UM Shore Regional Health will include community involvement during several steps of the process.

This is a two part video of Mr. Kozel’s update of UM Shore Regional Health’s process to evaluate how medical services would be delivered throughout the mid-shore counties.

 

The Mid-Shore’s Health Future: Maryland Rural Health Association’s Michelle Clark

With over ten years of experience working with, and for, the rural counties of Maryland on health accessibility issues, Michelle Clark has had a front row seat as executive director of the state’s Rural Health Association while watching the extraordinary changes that have occurred during that time.  Over the course of a decade, Clark has seen both improvements as well as almost insurmountable obstacles in providing access to communities far away from the dominant urban counties that capture the lion’s share of health resources, including doctors, at the state level.

In her Spy interview, Michelle talks about the current state of rural health care, the extraordinarily unique role Maryland is playing in the nation as the only all-payer state, and what rural communities are doing to adjust to an entirely new health services paradigm, which she notes is like living in, “an experiment.”

This video is approximately eight minutes in length

Editor’s Note: Over the next few months the Spy will be interviewing a number of local stakeholder and rural health experts on the special challenges the Mid-Shore faces in terms of accessibility to medical services, facilities, and other special needs as the region awaits the University of Maryland Shore Regional Health’s reorganization draft report later this year. 

Editorial: The Mid-Shore’s Future Healthcare

As is the case with all small communities, words (fact or fiction) travel fast when it comes to a potential threat to nearby hospitals and medical centers. A perception of not having ready access to primary health services is troubling and stressful for many, and particularly those of retirement age. So, it wasn’t surprising to witness rumors fly from Dorchester County to Kent County on the future of the University of Maryland’s Regional Shore Health as the institution enters the final planning stage of its long-term strategic reorganization.

The issues related to the allocation of health services in rural regions is not a new one, but that doesn’t mitigate the fact that these kinds of debates strike at the very core of one’s sense of quality of life and security. As older people face the balance of their lives intertwined with ongoing medical needs, service locations and who their providers are, are not of secondary importance. Indeed, it is this kind of critical information people weigh when deciding where to retire.

With that in mind, it is understandable that even the mention of losing health services activates an instinctive response on the part of many to resist that perceived change. In a community like Chestertown, which had already lost a maternity ward to downsizing three years ago, there also had been a collective perception that what remained of services at the Chester River Health Center would be preserved. The news that this may not be the case has predictably set into motion a climate of anxiety and apprehension.

The good news is that the Regional Shore Health’s CEO Ken Kozel quickly responded to these heightened concerns and made clear this week that no final decisions had been made on how the health care organization would be reallocating services throughout its five-county market. By all accounts, including our own conversations with board trustees and staff, that statement rings true as the organization’s leaders wait for the final report from consultants and their own internal committee tasked in making recommendations to the Regional Shore Health’s governing board.

The bad news is that the hard work has just begun for Regional Shore Health’s leadership. Over the next several months, those leaders will not only determine plans based on the committee’s findings but also evaluate the tangible and intangible community health, social and economic impacts of those plans. It is hard to imagine a more challenging place for nonprofit leaders to find themselves in than at the center of what will be a very complex and difficult decision process.

In the midst of these kinds of circumstances the only adequate response for the Spy* is to provide the same kind of in-depth coverage we have applied to other regional concerns of this magnitude, including our recent work on the Conowingo Dam. Over the next few months, we plan to share with our readers a full portfolio of material and stakeholder interviews to provide the kind of information needed for any individual to make an intelligent assessment on Regional Shore Health’s options and final decisions.

The Spy believes that real public education is best served when everyone has access to the best information. That will be our job over the next few months.

* Full disclosure: The UM Regional Shore Health Foundation sponsors, in part, the Spy’s ongoing news coverage of health and addiction recovery issues on the Mid-Shore.