2013 REPORT TO THE COMMUNITY A LETTER FROM THE PRESIDENT AND CEO Dear Friends and Neighbors, Each year, MedStar Health provides a wide range of services that target some of the most vulnerable and underserved communities in and the Washington, D.C., region. Our work helps to improve the overall health of the community by focusing on one person at a time. The 2013 Report to the Community: Close to You shows our commitment and how it has affected the lives of those we have touched. The testimonies, which showcase the scope and breadth of our work, demonstrate how we stay true to our promise, Knowledge and Compassion … Focused on You. To me, it includes knowing our communities and providing tailored services directly in neighborhoods that need us most—which means bringing care Close to You. But our dedication goes beyond our direct work in the community. As a not-for-profit regional healthcare provider, the report includes examples of how our research is advancing the body of medical knowledge and helping us discover new ways to practice medicine and deliver care. And our contribution to the next generation of highly skilled healthcare professionals is demonstrated through the training we provide to more than 1,000 medical students each year. Finally, as the trusted leader in caring for people and advancing health, we are committed to increasing access to health services and reducing the burden of healthcare costs for those facing financial hardship. The report concludes with an overview of the process we have put in place to secure this commitment. Whether it’s our work in the community, the research we conduct, the students we teach, or the services we provide at a free or reduced cost, the stories featured exemplify our investment in a healthy region OUR VISION that is Focused on You. To be the trusted leader in caring Sincerely, for people and advancing health

OUR MISSION To serve our patients, those who Kenneth A. Samet, FACHE care for them and our communities President and CEO

2013 REPORT TO THE COMMUNITY Heart disease is the leading cause of death in MedStar Harbor Hospital and MedStar Visiting Nurse Association: Maryland, and it accounts for nearly 25 percent Community Blood Pressure Screenings of deaths in Cherry Hill. In addition, 36 percent of City residents have been told they have high blood pressure. These types of statistics motivated Ensuring Good Heart MedStar Harbor Hospital to identify heart disease prevention and management as a priority in its most Health in Cherry Hill recent Community Health Assessment. Before the assessment, the hospital provided blood pressure screenings in Baltimore’s Cherry Hill/ Brooklyn Park area, but in 2013, it formalized a partnership with the MedStar Visiting Nurse Loyal participant, Evelyn Coleman, benefits from routine health Association to expand screenings. education and a blood pressure screening at Cherry Hill Senior Center. In partnership with MedStar VNA, the Community Blood Pressure Screening program serves seven Linda Lewis, RN, from MedStar VNA’s Immunization locations, including five senior centers, a homeless and Wellness program, and Lenora Addison, RN, program and a grocery store. In 2013, MedStar Harbor chief nursing officer at MedStar Harbor Hospital, Hospital and MedStar VNA conducted more than 270 conduct free monthly screenings for hypertension screenings. Only 28 percent of participants had healthy at these locations year-round. blood pressure, and 35 percent of participants had “For this program to work effectively, participants need elevated readings that required follow-up. to feel comfortable asking our screeners questions, so we work hard to use the same screeners consistently,” Hughan said. For the most part, participants are “regulars” who get screened a few times a year. In addition to the screenings, nurses help seniors see the positive outcomes of taking medications regularly “There are many challenges facing seniors in the and getting prescriptions filled. They also give participants Cherry Hill community–heart disease, diabetes and a wallet-sized card that allows them to document and monitor blood pressure on a monthly basis. limited access to fresh produce,” said Leslie Hughan, Community Relations manager of MedStar Harbor At the Cherry Hill Senior Center, Evelyn Coleman—who Hospital’s Community Blood Pressure Screening was diagnosed with cancer two years ago—attends regularly

program. “We see a lot of heart attacks.” and tracks her blood pressure with the card provided by the program. She explained, “I don’t have to run all the way down to the hospital when I have a problem with my blood pressure. I can get the care right in my community.”

3 4 Access to convenient and reliable transportation is Social workers also visit patients who are part of the MedStar Washington Hospital Center: Medical House Call Program a common barrier to care for homebound seniors. District’s Elderly and Persons with Disabilities Medicaid Dr. De Jonge would know. Along with Dr. George Taler, Waiver program at least once a month, and other patients Caring for Seniors the Hospital Center’s director of Long-Term Care, on an as-needed basis. They provide case management, Dr. De Jonge has operated the Medical House Call crisis intervention, caregiver support, and linkages to in Their Homes Program since 1999, allowing aging patients to receive other needed resources. care and services in the comfort of their own homes. Patients are also encouraged to contact the Medical “Getting to the doctor’s office can be difficult, The Medical House Call Program has served more than House Call Program’s on-call clinicians, available especially for seniors with severe and disabling 2,800 people in Washington, D.C., during that time, 24/7, whenever in doubt about the severity of a chronic illness,” said Dr. Eric De Jonge, director of performing in-home routine physicals and diagnostic symptom and whether they need to go to the hospital. Geriatrics at MedStar Washington Hospital Center. testing, as well as delivering medications and equipment. When they need urgent care, they are followed by The program’s patients are all residents of District the geriatrician or nurse practitioner with whom Wards 1, 2, 4, or 5 who live within a five-mile radius of they have an existing relationship. the hospital and have significant difficulty getting to a doctor’s office due to conditions limiting their mobility. When patients require hospitalization, geriatricians The average age of patients in the program is 82 years. from the program care for them at the hospital. Once they return home, a team member visits them Julie Beecher, director of Strategic Initiatives for the to conduct an assessment and follow up on any care Hospital Center’s Geriatrics/Medical House Call coordination issues. For homebound Frances Humes, Program, noted that, according to the Center for having care that comes to her is invaluable. Medicare and Medicaid Services, 50 percent of Medicare’s national spending is generated by five In September 2012, Humes called the hospital when percent of its beneficiaries—people with multiple she was having shortness of breath. The team came to chronic conditions and often infirm. As a result, the her home to assess her condition and then transferred Hospital Center has embraced the fact that the need her to the hospital, where they took X-rays and treated for in-home care will only increase. her for a small blood clot. “There’s such an intimate relationship that develops After her hospital stay, Humes had follow-up X-rays at when you visit someone in their home,” said Beecher. home, and through the Medical House Call Program’s “Our team is there with families through a process partnerships with District senior home care agencies, that can be scary and lonely.” was able to get a home care aide to assist her with her daily living activities. Each Medical House Call Program team consists of a physician, a nurse practitioner and a social worker “I’ve gotten the highest quality service I could have,” who collaborate to provide integrated health care to Humes said. “I receive good care at home, and I’m in these patients. communication with the hospital and Dr. De Jonge. I can talk to nurses whenever I need them.”

During a home visit, Frances Humes enjoys a conversation about her care with Nancy Sassa, CRNP. Through the Medical House Call Program, she receives a variety of high quality health services in the comfort of her home. 5 6 MedStar National Rehabilitation Hospital and MedStar Health Research Institute: Upper Extremity Amputee Training Study Reaching out for Recovery

As part of its mission, MedStar National Rehabilitation Study participants have either unilateral or bilateral Hospital helps people with disabilities live productive arm amputations at the below-elbow, above-elbow or More than 105,000 individuals with upper lives through assistive technology. In collaboration with shoulder level that are “chronic stable”—that is, more extremity (UE) amputations live in the . MedStar Health Research Institute, a research study than six months have passed since the amputation. Trauma is the most frequent cause—with vehicular aimed to explore the benefits of assistive technology for Wonseok Lee, who lost his hand at age 4 in a traumatic This environment also gives the user a variety and industrial accidents, followed by violence and veteran and civilian UE amputees is underway. The study, accident, came to Washington, D.C., for an internship of opportunities to learn how to manipulate their war injuries. Formal training to help newly disabled which is funded by the D.C. Department of Veterans at the Embassy of the Republic of Korea and to get device—allowing them to cut an apple, crack an people learn how to use their prosthetic devices, Affairs, will provide insight into how formal training involved in the amputee community. After another egg or open a package of flour,” Barth stated. however, is practically nonexistent. can improve independence and overall quality of life. amputee told him about the MedStar NRH program, Lee signed up for the study with occupational therapist Lee’s training helped him understand how capable Jessica Barth, MS, OTR/L, who works alongside he was of doing tasks he thought were impossible, Rahsaan Holley, MS, OTR. such as cutting steak with two hands. He also received something he considers more valuable than the Before joining the study, Lee had a cosmetic prosthetic physical training: confidence. hand. According to Lee, “It was more of an obstacle than something that helped me cope with my disability.” “I used to be really self-conscious,” said Lee. “I assumed others were disappointed in me because I had only one Barth connected Lee to a nonprofit organization in arm.” Because of this thinking, Barth conducted some Chicago that constructed a functional prosthetic arm of Lee’s training sessions at locations in the community for him. Lee also received 10 two-hour treatment to help him gain real-life practice and build confidence sessions with Barth over three weeks to learn how in his ability to use his device in public. to make the most of his new device. Today, Lee can’t imagine his life without the program. Because UE amputees often suffer from overuse injuries “I’m now able to think of my amputation as having in their functioning arms, Lee’s training sessions always potential, rather than being an obstacle,” stated Lee. included activities to strengthen his shoulder. “I’m comfortable with my body image and identity as an amputee.” The bulk of the training occurred at MedStar NRH’s main campus—specifically, within one of the hospital’s Upon completion of this study, results will be published, two kitchens. “Cooking is something everyone needs which will help shape future practice and expand the to do in some capacity, and there are lots of different body of knowledge in effectively treating individuals textures in a kitchen. with upper extremity amputations.

Jessica Barth, MS, OTR/L helps Wonseok Lee practice with his new prosthetic device that 7 allows him to live more independently. 8 Pulmonary and Critical Care Associates of Baltimore He was seeking other interventions when MedStar Health Research Institute: Lung Volume Reduction Coil Study (PCCAB), MedStar Health Research Institute and his pulmonologist put him in touch with MedStar Harbor Hospital have been working locally King and Dr. Krimsky. Breathing More Easily to study the effects of the LVRC procedure. According to Stuart King, PCCAB research coordinator, “We’re Speakman had the LVRC procedure on his the only facility in Maryland, the District, , right lung in August 2013. He noticed a marked or Delaware doing this trial.” improvement in his breathing quality and recently underwent the procedure on his left lung. “Most people don’t have to think about Dr. William Krimsky, chief of Pulmonology at breathing all day long—they just do it,” MedStar Harbor Hospital, performs the procedure, “Being able to take a shower without having a said Mark Speakman, who has chronic while King takes potential participants through the panic attack and walking up stairs without having obstructive pulmonary disease (COPD). intake, evaluation and screening processes, which are to stop and catch my breath—the ability to do “When you have stretched-out lungs, fairly intensive. Some of the eligibility requirements daily tasks like these—make a huge difference you lose the elasticity that helps you get include completing a pulmonary rehabilitation for me,” Speakman said. “And I’m one of the the carbon dioxide out and the oxygen in.” program, being cancer-free for the past five years first people in the study to get this procedure and being nicotine-free for at least eight weeks. done. It’s a really worthwhile procedure that can benefit so many people.” The World Health Organization (WHO) predicts Since it began in the spring of 2012, the study has that COPD will become the third-leading cause enrolled approximately 45 participants nationwide. Even before his procedure, Speakman was of death worldwide by 2030. This condition is not King screens a large number of patients from MedStar active in a number of online support groups simply a “smoker’s cough,” but an under-diagnosed hospitals. Given the promising results that Speakman for COPD patients but now aggressively spreads and life-threatening lung disease. and others have seen, hospitals nationwide are actively the good news about LVRC. “Being part of this seeking study participants who can potentially benefit study has given me another reason to be upbeat,” Already approved and in regular practice in Europe, Speakman added. “Some people look at COPD the lung volume reduction coil (LVRC) procedure from the LVRC technology. “LVRC research offers patients without many options the potential for as a death sentence. I’m looking to see allows some patients with COPD to breathe more what I can do next!” easily without undergoing traditional lung volume innovative forms of therapy done in a controlled reduction surgeries. The procedure involves inserting setting,” said Dr. Krimsky. a tiny metal coil in the nonfunctioning areas of a Since his COPD diagnosis in 2005, Speakman patient’s lung, which attaches to the damaged tissue had undergone a number of treatments for the and decreases the surface area as it coils, reducing disease that resulted in a collapsed lung and the affected lung’s volume. This procedure allows postoperative complications. the healthy tissue to expand and work more efficiently.

Mark Speakman shares with Research Coordinator Stuart King (right) how the lung reduction coil procedure has improved his quality of life. 9 10 The CPS program is led by Avram Mack, MD, professor “We cannot learn from what we do not know, and Medical Education of Clinical Psychiatry and director of Medical Student what we do not know can seriously harm our patients,” Education in ’s Department said Stephanie Wappel, MD, a third-year medical Opening Minds to of Psychiatry, and Eileen Moore, MD, associate professor resident and future internal medicine chief resident of Medicine at MedStar Georgetown University Hospital at MedStar Georgetown University Hospital. a Culture of Safety and associate dean of Community Education and Advocacy at Georgetown University School of Medicine. Education around everything—from diagnosis to drug interactions to coordinating care—can determine Through educational tools, including lectures, whether a patient experiences a positive outcome. workshops and simulation training sessions, these and other MedStar physicians prepare nursing students, Dr. Wappel once observed one of her medical students medical students and medical residents to embrace prevent a patient from undergoing a procedure that safety, quality and continuing education. the patient’s physician thought he had canceled in a new electronic ordering system. While it has become common practice for hospitals to teach residents about patient safety, it’s rare to see “That student did what they teach us all to do. If you such a program designed for medical students. MedStar see something that isn’t right, stand up, and say Georgetown University Hospital has found that such a something,” Dr. Wappel explained. culture leads to the prevention of medical errors. CPS educators have noticed medical students “There are six people on my team,” Maniya said, sharpening their safety-oriented behaviors during “which means we have six sets of eyes looking at the the three-year period they spend in CPS courses. same patient and data for potential harm—multiplying According to Drs. Mack and Moore, educating our chance of catching mistakes by six.” medical students sends more highly skilled practitioners into the field, which benefits entire communities. Medical error prevention is a science that has grown since the Institute of Medicine’s 1999 book, To Err Is “These students often teach their teachers,” Dr. Mack said. “When they come armed with an acceptance Being an effective physician requires more than Human: Building a Safer Health System, acknowledged that even the most well-trained physicians make of this culture, it helps foster acceptance of the an aptitude for math and science, and a great culture among others.” bedside manner. A physician must be able to mistakes. CPS students are learning how to prevent Dr. Avram Mack discusses ways to create communicate with patients, collaborate with other medical errors by adopting a mindset of safety and processes and systems to overcome human providers and thrive in a medical environment quality in all aspects of their work. factors that contribute to medical errors. governed by processes and procedures.

Physicians need to be open to learning at every As medical students, they are mastering the knowledge opportunity, whether it’s using new technologies or and skills that will make them highly effective practitioners. adopting improved methods. Omar Maniya, a third-year Formed nearly four years ago, MedStar Georgetown MD/MBA student at Georgetown University, represents University Hospital’s Center for Patient Safety (CPS) is one of more than 1,000 medical students receiving clinical making a meaningful contribution to the effort. The program education each year at MedStar Health. exemplifies the hospital and the health system’s commitment to quality by creating a culture of openness and vigilance. 11 12 While the Walk for the Health of It program is open MedStar Hospital Center: Walk for the Health of It to people of all ages, the majority of participants are between 60 and 90 years old, and residents of Charles Moving Toward and St. Mary’s counties. Fitness and Friendship In Charles County, where the mall is located, 40 percent of the population has high blood pressure, and the death rate due to heart disease in the county is higher than the state median. Statistics like these, as well as a recently completed Community Health Assessment, led MedStar Southern Maryland Hospital Center to select heart Norma Scott, certified nursing disease as a community health priority. assistant, checks a participant’s blood Walk for the Health of It promotes heart health among pressure after completing the morning walk. the southern Maryland community at large. Program coordinators are developing methods to track health Without the program, life would be different for Colleen indicators over time, but for now, participant retention Kirk, who began walking with the group in October 2011. and feedback clearly demonstrate positive changes in health. For example, those with diabetes report they “My doctor warned me that I needed to do something have been better able to control their symptoms by about my type 2 diabetes. Participating was the perfect Since 1990, MedStar Southern Maryland applying what they learned in the program. way to get my blood sugar levels down, meet people Hospital Center’s Walk for the Health and exercise,” Kirk said. Carol Pyle, Community Outreach coordinator, and of It program has provided community Before joining the program, her blood sugar was high, members with a clean, well-lit environment Norma Scott, certified nursing assistant, both at MedStar Southern Maryland Hospital Center, are and after walking two miles every day for a year, her to exercise and socialize. Every Monday blood sugar was in a much healthier range. through Friday, more than 50 walkers present at every meeting. Each morning, they provide gather in the St. Charles Towne Center free blood pressure screenings in the mall’s food Most meaningful to Kirk, who now walks three times Mall in Waldorf, Md. court, administering more than 15,000 screenings a week, have been the personal connections. in 2012 alone. “It’s a community of people who count on each other For more than 20 years, the program has been showing up. It’s mentally and physically healing,” successful, and Pyle attributes its longevity to the she added. dedicated participants who help expand the program by word of mouth. For example, because of the close relationships the Walk for the Health of It program fosters, many “Many participants are on a fixed income and can’t participants plan activities outside the program. afford to go to the gym. They’re coming to us because The group has committees, monthly birthday parties, it’s close to them; it’s safe, and it’s free,” Pyle stated. an annual picnic, a Facebook page, a monthly newsletter, and monthly trips—all of which bring health and wellness close to the participants. Walk for the Health of It helps participants lead healthier lives through peer support, physical activity and free health assessments. 13 14 Shepherd’s Clinic provides affordable and accessible One patient, Greg Hartzler-Miller, said, “I don’t know MedStar Union Memorial Hospital: Shepherd’s Clinic primary care to low-income residents living in northern what I would have done if I’d had to pay for this type of Baltimore City, Md., who are ineligible for government care. Not only did it save my life, but it also saved my Saving—and Stabilizing—Lives health insurance. No one is turned away, despite their wife and me from serious debt.” inability to make a financial contribution. In 2011, Hartzler-Miller and his wife, Cyndi, were As part of its commitment to the community, MedStar working part-time, and without employer-sponsored Although the Affordable Care Act Union Memorial Hospital has provided charity care for benefits, health insurance was out of reach. After a is designed to increase insurance Shepherd’s Clinic patients since 1991. The hospital has friend recommended the clinic, the couple began coverage, there are still some people also covered the costs of the medical staff who provide receiving routine preventive care. direct services at the clinic. who lack access to care. Partnerships “We didn’t think being uninsured would be a big deal,” are one mechanism to ensure that In 2013, Shepherd’s Clinic faced financial strain due to Hartzler-Miller said. “We didn’t know we were going to those without health insurance have growing demand for services. MedStar Union Memorial have big-time health problems.” access to a variety of health services. Hospital responded to this need, increasing its support Consider the long-standing partnership of the clinic by funding not only the role of the medical After several days of stomach discomfort, fevers and between MedStar Union Memorial director, but three additional positions. The hospital also cold sweats, Hartzler-Miller made an appointment at Hospital and Shepherd’s Clinic. expanded charity care eligibility to include services like the clinic. Following his evaluation, Dr. DeLong sent specialized blood work and anesthesiology. him to MedStar Union Memorial Hospital, where he underwent an emergency gallbladder removal, which Melissa DeLong, MD, general medicine faculty at required days of treatment in the hospital. MedStar Union Memorial Hospital and medical director of Shepherd’s Clinic, explained the financial and health Dr. DeLong noted, “Without this prompt care, benefits the clinic gives its patients. “We work to keep Mr. Hartzler-Miller would have been in grave danger. people well so they can have productive and healthy Waiting mere hours longer before receiving care lives,” she stated. could have led to a very different outcome.” When patients require any hospital-based services like Hartzler-Miller received follow-up care from the diagnostic testing, specialty visits or even surgeries, surgeon at MedStar Union Memorial Hospital, as Shepherd’s Clinic sends them to the hospital, where well as the clinic. their visits are covered through financial assistance. “I came out of the surgery feeling blessed in so many In 2013, the clinic had more than 5,000 medical visits, ways,” he said. “Knowing that the hospital had an and approximately 50 percent of them resulted in agreement with the clinic meant everything. At the patients being referred to MedStar Union Memorial hospital, I never felt like I was a charity case.” Hospital for specialty services. Hartzler-Miller’s relationship with the clinic—his new “Another component of the referral program involves medical home—has improved his overall well-being. discharging hospital patients for follow-up care at the “Life goes on. I’m so grateful,” he said. clinic. This practice enables high-risk patients who Cindy and Greg Hartzler-Miller listen as meet the clinic’s criteria to transition smoothly into Dr. Melissa DeLong reviews the services offered follow-up care,” according to Glenda Skuletich, at Shepherd’s Clinic. She explains how patients administrative director. receive care, despite their inability to pay. 15 16 Offered at local senior centers in Ateaze, Edgemere, Many participants from Heart Smart Seniors MedStar Franklin Square Medical Center: Heart Smart Seniors Essex, Fleming, Overlea-Fullerton, Parkville, reported making changes in their everyday life, Rosedale, Seven Oaks, and Victory Villa, the Heart like reading food labels to reduce fat and sugar Increasing Knowledge, Smart Seniors program was tailored to promote consumption, and starting a walking program heart health among senior populations. to increase physical activity. Decreasing Heart Disease The Heart Smart Seniors classes focused on Regina Cather engaged in Heart Smart Seniors at different topics each month, including heart health the Rosedale Senior Center to gain motivation to and self-management, exercise, nutrition, smoking exercise by learning alongside others. “It’s very hard to and secondhand smoke, blood pressure, and convince seniors when we’re as old as we are to change medications. Kristin Scilipoti, health educator, our ways,” says Cather. “But it’s worthwhile to do it.” led the classes, leaving the floor open to the many questions seniors had, no matter the topic. One way the program has been worthwhile for Cather has been her newfound determination to ignore the “If participants have the knowledge they need, it leads salt shaker. “Now, when I think of it and I think I’m to behaviors that affect their health in the long run,” going to grab it, I don’t,” she said. “I use herbs and said Scilipoti. “Knowledge is always the first piece.” pepper instead. That’s a step in the right direction.” Each class equipped participants with tools to make She also takes a Baltimore County Department of good decisions about their health, from integrating Aging t’ai chi class and walks on the treadmill at the In the southeastern portion of safety precautions during regular exercise and taking senior center’s gym, which is close to her home. Baltimore County, Md., one out medications properly to creating healthy meals, and overcoming barriers to quit smoking. Currently, Scilipoti is leading a new class at the of every four deaths is caused senior centers called Active Living Every Day, by heart disease. MedStar Franklin At the first and last sessions, nurses measured which focuses on regular movement and exercise. Square Medical Center responded participants’ blood pressure, height, weight, waist Cather joined or, as she put it, “progressed,” to to this issue by providing general circumference, and body mass index (BMI), while this new program to continue building on her health education classes in the a phlebotomist drew blood to test cholesterol and experience during Heart Smart Seniors. community, including a one-year glucose levels. Outcome data showed a significant program, Heart Smart Seniors. drop in the total cholesterol levels among more Heart Smart Seniors classes than 70 participants in the program, and pre- and help participants achieve their post-survey responses indicated an increase in fitness goals through group overall knowledge related to heart health. interactions and peer support.

Health Educator Kristin Scilipoti and Heart Smart Seniors participant Regina Cather discuss lifestyle changes Cather can make to improve her health. 17 18 The hospital’s many long-standing community MedStar St. Mary’s Hospital: St. Mary’s County Community relationships made it possible for MedStar St. Mary’s Alcohol Coalition’s Can You Afford It? Campaign Hospital to team up with partners ranging from the county’s Licensed Beverage Association to its public Making Smart Decisions school system, as well as local alcohol retailers. Together, these and several other stakeholders formed the St. Mary’s County Community Alcohol Commission (CAC) whose mission is to reduce Underage binge drinking is a serious As the only hospital in St. Mary’s County, MedStar underage and binge drinking in the county. problem in many parts of the U.S., and St. Mary’s Hospital knows the issue of underage and peer pressure and ease in obtaining binge drinking well: Nearly 90 percent of community One of the main components of the CAC is the alcohol are contributing factors. respondents indicated substance abuse as a “severe” Can You Afford It? media campaign. Its materials “I’ve had to do a lot of death notifications,” or “very severe” concern in the hospital’s most recent pair this question with high-impact photography set stated Stone. “I might not have had to bring parents Community Health Assessment. against a bright green background to grab the viewer’s this devastating news if youth had tools to make the attention. The approach is used in print and online right decisions.” According to CAC member Chris Shea, In addition, the percentage of alcohol-related treatment advertisements, billboards, posters and share cards, who has a background as an addictions counselor, admissions to specialized facilities among those under vehicle wraps, community events, and social media clinical director and CEO of treatment agencies, alcohol age 21 in the county is higher than the state average. —all to generate awareness of the price of alcohol remains a persistent issue, in part due to parents’ lack As a result, the hospital has identified substance engagement among several populations and situations. of education regarding accessibility to alcohol. abuse as a community health priority. The vehicle wraps alone have a potential reach of In 2012, St. Mary’s County was awarded a Maryland more than 10,000 commuters daily. “We’re trying to reach and educate parents in a way that they hear our message, understand it and take Strategic Prevention Framework Incentive Grant to Lori Werrell, MPH, CHES, director of MedStar action on it,” shared Shea. implement strategies to reduce underage drinking, St. Mary’s Hospital’s Health Connections, and Jenna binge drinking and alcohol-related vehicular crashes in Mulliken, Health Connections program coordinator, The CAC is using its Facebook page and blog to give youth and young adults. A local county planning group hope to see a deep-seated change in the county parents information on laws associated with hosting appointed MedStar St. Mary’s Hospital to administer through this campaign. parties for youth and how to talk to their teens about the grant, which is funded by the Substance Abuse and underage and binge drinking. Mental Health Services Administration through the “You have to change the environment. We want these Alcohol and Drug Abuse Administration. messages to affect the culture around underage and The CAC also advertises safe, family-oriented activities binge drinking,” they said. through social media, and members volunteered at several Project Graduation events in 2013. In addition to coordinating the Can You Afford It? media campaign, the CAC works with St. Mary’s CAC member Anne-Marie Merz, a former social County Sheriff’s Office to support local businesses worker and addictions counselor, commented, “I’d like by training employees at restaurants, bars and stores to give the teenagers something else to do. I want them selling alcohol on how to recognize fraudulent IDs. to know there’s something else besides drinking alcohol CAC member Corporal James Stone brings the reality that they can have fun doing.” of underage alcohol use and abuse to the table.

19 20 MedStar Georgetown University Hospital’s Community “The biggest barriers to seeing a healthcare provider MedStar Georgetown University Hospital: Nutrition and Physical Activity Education Health Assessment identified obesity as one of three in this community are availability and transportation. priorities for its community benefit service area, We try to remove those barriers by bringing care close Dishing up Awareness Ward 6. With its Nutrition and Physical Activity to them at different sites,” noted Janae West, Patient Education program, the hospital is working to ensure Services coordinator. of Childhood Obesity kids and families throughout eastern Washington, D.C., Childhood obesity has more than tripled eat well and get moving. Feedback indicates that the activities have been in the past 30 years. In Washington, D.C., effective in reaching young audiences and their parents. 35 percent of youth are overweight or obese Physicians, nurses, social workers, and educators At an annual health fair held at Matthews Memorial —a figure that ranks ninth in the nation. from MedStar Georgetown University Hospital’s KIDS Baptist Church in southeast Washington, D.C., Tyra Mobile Medical Clinic/Ronald McDonald Care Mobile Murrow shared how the services provided by the participated in community events throughout Ward 6. mobile clinic are making a difference in her life. Promoting healthy eating and physical activity to kids and their parents, these events ranged from the “I eat a lot of fried foods, but that’s about to change,” seventh annual Ward 6 Family Day at Canal Park to she said. She explained that what she learned would an annual safety and wellness event, both in southeast also affect how she feeds her children, who enjoyed Washington D.C. Nearly 40 community members of exercising in a fun way at the event: hula hooping. all ages attended the events, with an average age range Her daughter, 8-year-old Trinity Murrow, said, of the children between 8 and 12 years old. “I learned you should eat healthy food. When I “We want to get the word out to kids and parents go to school next week, I’m going to eat salad and who aren’t aware of available services,” commented no French fries.” Jamie Trotter, program coordinator. A popular activity at these events is modeled after the U.S. Department of Agriculture’s MyPlate illustration. By having kids place Velcro food choices on the corresponding quarter of the plate—either fruits, grains, vegetables, or proteins—mobile clinic staff teach kids to think about what goes on their plates, as well as how to build healthy meals by filling half the plate with vegetables and fruits. Due to the nature of the program’s events, it is not always possible to collect data and conduct follow-up with participants, but the staff measure participants’ BMI and track materials disseminated at each event. MedStar Georgetown University Hospital is also securing approval for several additional programs to improve nutrition and increase physical activity within the District. After constructing their healthy plates, Jamie Trotter, program coordinator, (center) shows Autumn Smith 21 and Trinity Murrow fun ways to stay physically active. 22 MedStar Montgomery Medical Center took a proactive The ABCS Project has seen significant outcomes MedStar Montgomery Medical Center: ABCS Project approach to link individuals with risk factors for heart already. By September 2013, health promoters had disease to primary care. As part of its Emergency screened more than 8,800 people, more than 700 of Spreading Trust Department/Primary Care Connect program, the whom did not have regular doctors and received hospital partnered with five other organizations in referrals to clinics because they screened as high risk. Preventive care is often difficult to Montgomery County to form a network led by the Through the ABCS access for the uninsured, leaving many Primary Care Coalition (PCC), a nonprofit organization Jiamo Germain went to MedStar Montgomery to wait until their conditions require a dedicated to ensuring high quality care for low-income, Medical Center’s ED after receiving care for a leg trip to the emergency department (ED). uninsured, ethnically diverse residents of the county. wound. Without a home, income or insurance, and With heart disease, it’s easy to ignore with signs of hypertension and diabetes, Germain symptoms or delay care. Funded by a grant from the Maryland Department qualified for a referral from the ABCS program. of Health and Mental Hygiene, this network targeted uninsured patients coming to the ED and promoted The health promoter referred Germain to the clinical the ABCS of heart health: appropriate Aspirin therapy, navigator at Proyecto Salud Clinic in Olney, who Blood pressure control, Cholesterol management, and scheduled a new patient appointment for Germain. Smoking cessation. Data indicate that these are prevalent He’s been an active patient at the clinic ever since, health concerns within the community, where 32 percent visiting his primary care physician at least twice a of adults have high cholesterol levels; 22 percent have month to receive lab work and medication for his high blood pressure, and 14 percent of individuals smoke. diabetes and high blood pressure. As part of the ABCS Project, MedStar Montgomery Germain receives all of this care at no cost. Additionally, Medical Center’s health promoters examined medical Proyecto Salud Clinic staff referred him to a low-cost records of county residents who received care in the program for even more specialized care for his leg. hospital’s ED during the grant period that began in “The ABCS program has helped me tremendously,” November 2012. They directed uninsured patients Germain said. “They’re good to me at the clinic.” with any of the four ABCS risk factors to one of seven partnering primary care clinics based on both location By participating in the ABCS program, he has prevented and cultural factors. high-risk complications—and related high-cost care —for his diabetes and high blood pressure. With the farthest two clinics spanning a distance of nearly 20 miles from each other, clinics are accessible In addition to providing routine health care to many who from many parts of the county, including Gaithersburg, would otherwise go without, the program fosters trust. Rockville, Aspen Hill, Olney, Silver Spring, and Wheaton. “Our program’s target population is cautious of the In addition to giving referrals, health promoters provided healthcare system,” said Tara Clemons, the hospital’s screenings. They also provided outreach at health fairs, Community Benefits outreach coordinator. “But when EDs and local clinics. Mary Joseph, PCC project manager, someone from their community reaches out to them, expressed, “The only way we’re able to address the health they’re more willing to accept care.” needs of Montgomery County’s diverse population is by having these providers unite.”

The ABCS Project helped Jiamo Germain find a primary care doctor and access medications to 23 24 control his high blood pressure and diabetes. Outpatients who receive positive test results in the MedStar Washington Hospital Center/MedStar Health Research Institute: Emergency Department are linked to the Hospital Ryan White Program Center’s onsite clinic. Physicians work with the Ryan White team when an inpatient is identified as Expanding Access to Care HIV positive, ensuring that a social worker visits the Jasmine Reid, Antonio Pineda and Allison Daly patient before s/he is discharged. collaborate to ensure that patients with HIV have Through the EIS and WICY programs, the following timely access to primary and specialty care services. services are provided at the Hospital Center: • Access to specialty care • Education and medication adherence services • Nutrition counseling • Mental health services The WICY program also provides cervical cancer screening and family planning services to pregnant HIV-positive women. Oral health care and pediatric primary medical care are available through referral agreements with Mary’s Center, a community health MedStar Washington Hospital Center is all too center, and MedStar Georgetown University Hospital’s familiar with the high rates of HIV in Washington, D.C. Pediatric Infectious Diseases program. Since 2001, the Health Resources and Services Admin- Through a WICY subcontract with Metro TeenAIDS, istration’s Ryan White Program has provided funding social workers and community health workers provide to MedStar Washington Hospital Center and MedStar emotional and psychosocial support, as well as adherence Health Research Institute to serve uninsured and services, to youth ages 13 to 24 living with HIV/AIDS. underinsured adults, infants, children, and youth The organization also facilitates adolescents’ transition living with HIV/AIDS through its Early Intervention from receiving care at Children’s National Medical Services (EIS) and its Women, Infants, Children and Center or MedStar Georgetown University Hospital Youth (WICY) programs. It allows individuals living to the Hospital Center when they age out of those with HIV/AIDS who do not have sufficient healthcare facilities at 18. coverage or financial resources to receive comprehensive primary medical care free of charge. “It’s a big change to go from a children’s setting to an adult setting. Our partnership ensures that teens don’t The Hospital Center has more than 500 patients in get lost in follow-up,” stated Jasmine Reid, program its Ryan White Program. Patients learn about the coordinator and nurse case manager. “We’re making program through internal hospital referrals and sure they don’t fall through the cracks.” When compared to other U.S. cities, HIV rates in outreach activities, where staff conduct free HIV testing the District of Columbia continue to be among the and link individuals who are HIV positive to care. highest in the nation. In 2011, there were more than 15,000 District residents living with the human immunodeficiency virus (HIV), which represents more than two percent of its population. 25 26 These partners included CARES (a financial Bringing this workshop to residents of Govans MedStar Good Samaritan Hospital: Prevention and Management assistance center and food pantry) and the Senior Manor, Bena and Kansler taught goal-setting Network of Baltimore—both of which are under and problem-solving strategies, how to work with Getting Smart About Diabetes Govans Ecumenical Development Corporation healthcare professionals, and stress management (GEDCO); Govans Manor, a public housing and relaxation techniques—including breathing, community managed by the Housing Authority of guided imagery and muscle relaxation. Like so many communities in the U.S. today, Nearly 13 percent of adults in Baltimore City are living Baltimore; St. Mary’s of the Assumption Church; diabetes is a major health concern in the with diabetes. Furthermore, the rate of diabetes-related and the Baltimore County Department of Aging. When the workshop ended, all participants agreed Greater Govans area of Baltimore, Md. deaths in Baltimore City is higher than that of the state they had tools to better manage their condition as a MedStar Good Samaritan Hospital is helping of Maryland. Based on such findings, MedStar Good Collectively, this partnership reached more than result of the class. During the workshop, participants area residents get smart about this condition Samaritan Hospital identified diabetes as a health 100 participants, including individuals with diabetes, expressed a desire to exercise, but many were restricted through community-based diabetes prevention priority for the Greater Govans community. those with prediabetes and those simply interested due to limited access to convenient and affordable and management services. in learning more about diabetes. exercise programs. In response, Bena began leading One of the Healthy People 2020 objectives, which aim a chair exercise program at Govans Manor in the fall to improve the health of all Americans, is to reduce the “Even though diabetes is only the seventh-leading of 2013. The classes include cardio fitness, strength diabetes death rate by 10 percent. Community outreach cause of death in Baltimore, it’s a contributing risk training and flexibility exercises, as well as meditation. staff from MedStar Good Samaritan Hospital worked factor to the #1 cause—heart disease—and the #3 toward this goal in 2013 by holding 11 education classes cause—stroke—as well as other complications that Isla Murrill, a resident of Govans Manor who has lived in collaboration with diverse community partners. impact people’s lives and healthcare dollars,” explained with diabetes since 2004, signed up for the Living Well Debbie Bena, Community Outreach nurse. She added … Take Charge of Your Diabetes program to improve that the two problems people struggle with the most her diet and get her diabetes under control. Through the are controlling their diet and blood sugar. program, she learned about healthy sugar substitutes and how to cook in ways that would be healthier for her. The classes covered risk factors for prediabetes and In addition to positive changes in her diet, Murrill has diabetes, diabetes complications, glucose monitoring, seen encouraging outcomes in her overall well-being. medications, foot care, and healthy lifestyle choices, including nutrition, exercise and weight management. “I feel good about myself and have a positive attitude. At the end of the series, 90 percent of participants said I’m more informed so I can be my own health advocate they were “very likely” to make at least one behavioral when I go to my doctor,” Murrill stated. change, like reducing portion sizes, increasing exercise or monitoring blood glucose consistently. Murrill now participates in the chair exercise class Bena started and has brought friends. Her favorite Bena and Karen Kansler, RN, Community Outreach part is the meditation techniques she learned, which coordinator, led all of the hospital’s diabetes program- help her relax and manage stress. ming. For the first time in 2013, these programs included a six-week session of Living Well … Take By bringing its diabetes programming into the Govans Charge of Your Diabetes, an evidence-based program community, the hospital has helped educate and promote developed by Stanford University. sustainable health behaviors—improving the health of the community, one person at a time.

Choon Kim and Isla Murrill learn how simple chair exercises can 27 help keep diabetes under control. 28 “Our Financial Services departments follow When patients are ineligible for their state’s Medicaid Financial Assistance guidelines in keeping with MedStar’s mission program but participate in a federal eligibility program of caring for people,” said Sue Whitecotton, like receiving food stamps, they are automatically vice president of Patient Financial Services. eligible under “presumptive charity” within the Our Neighbors’ Health “Our policy helps bridge the gap for the guidelines of MedStar’s financial assistance policy. uninsured populations in our communities.” In addition, based on income guidelines and Guided by a patient financial assistance policy, household level, patients may qualify for free or a system-wide process is in place to help patients reduced care based on a sliding fee scale. enroll in insurance plans, including Medicaid, entitlement programs (like Social Security disability) Determining eligibility might seem daunting to and other safety net services that ensure access to many patients, so communicating effectively is a continuum of health services. paramount. Patients learn about the financial assistance program through a variety of ways. Through a simple screening process, Whitecotton Signs are posted in common areas of the hospitals, and her team assess a patient’s eligibility for Medicaid. and information is placed in newsletters. Notices “If the patient is eligible, financial patient advocates are also placed in local newspapers annually. work with case workers from our local Social Services departments to help them apply for Medicaid. A system-wide financial assistance policy helps ensure that patients served by MedStar’s hospitals These state case workers are conveniently located receive the compassionate care they deserve, regardless at MedStar’s hospitals. Patients find the one-on-one of financial hardship. “Our goal is to reduce our interactions very helpful,” said Whitecotten. When patients’ anxiety and allow them to focus on their these programs are not an option for individuals, health rather than how they are going to make ends MedStar closes the gap. The team pursues financial meet,” said Whitecotton. assistance at the same time they are determining Medicaid eligibility.

Sue Whitecotton explains how MedStar Health’s financial Patients who experience financial assistance policy helps ensure hardship often have difficulty accessing patients receive the healthcare quality health services. MedStar Health services they need, regardless responds to this issue by providing of their income. care that is free or at a reduced cost to individuals who meet eligibility guidelines through a financial assistance policy. 29 30 BOARD OF DIRECTORS CORPORATE EXECUTIVES ENTITY PRESIDENTS William R. Roberts (Chair) Barbara R. Heller, EdD, RN, FAAN Kenneth A. Samet, FACHE Traci K. Anderson President and Chief Executive Officer Vice President, Strategic Initiatives, President and Chief Executive Officer President, MedStar Visiting Nurse Association WR Roberts Company Nursing & Health Sciences, Laureate Education, Inc. Michael J. Curran Bradley S. Chambers Chandralekha Banerjee, MD Mark T. Jensen Executive Vice President President, MedStar Union Memorial Hospital Chief of Infection Control Co-Founder, Bowie & Jensen, LLC Chief Administrative and Financial Officer Senior Vice President, MedStar Health MedStar Good Samaritan Hospital John R. Kirkpatrick, MD, MBA, FACS M. Joy Drass, MD Michael J. Chiaramonte Andrew J. Berry Professor of Surgery, Georgetown University Executive Vice President President, MedStar Southern Maryland Hospital Center President, Drew Berry & Associates Operations – Washington Region Senior Vice President, MedStar Health Roberta M. Loker Anthony J. Buzzelli Loan Officer, Primary Residential Mortgage, Inc. Stephen R. T. Evans, MD Robert J. Gilbert Vice Chairman, Deloitte (Retired) Executive Vice President President, MedStar Ambulatory Services Catherine A. Meloy Medical Affairs and Chief Medical Officer William Couper President and Chief Executive Officer Richard L. Goldberg, MD Retired President, MidAtlantic – Bank of America Goodwill of Greater Washington Oliver M. Johnson, II President, MedStar Georgetown University Hospital Executive Vice President and General Counsel Senior Vice President, MedStar Health John J. DeGioia, PhD William J. Oetgen, Jr., MD, MBA (Vice Chair) President, Georgetown University Senior Vice President, Science and Quality Maureen P. McCausland, DNSc Jeffrey A. Matton American College of Cardiology Senior Vice President and Chief Nursing Officer President, MedStar Good Samaritan Hospital Donovan Dietrick, MD Senior Vice President, MedStar Health Director of Obstetrics and Gynecology Residency Program Kenneth A. Samet, FACHE Carl J. Schindelar, FACHE MedStar Franklin Square Medical Center President and Chief Executive Officer, MedStar Health Executive Vice President Edward M. Miller, MD, FACP Operations – Baltimore Region President, MedStar Physician Partners Marc N. Duber Sara E. Watkins Executive Vice President and Chief Operating Officer Senior Vice President, Capacity Partners Christine M. Swearingen Peter W. Monge, FACHE The Bernstein Companies Executive Vice President President, MedStar Montgomery Medical Center The Honorable Togo D. West, Jr. Planning, Marketing and Community Relations Senior Vice President, MedStar Health Chair, TLI Leadership Group Eric R. Wagner Samuel E. Moskowitz, FACHE Executive Vice President President, MedStar Franklin Square Medical Center External Affairs and Diversified Operations Senior Vice President, MedStar Health Dennis W. Pullin, FACHE President, MedStar Harbor Hospital Senior Vice President, MedStar Health John D. Rockwood President, MedStar National Rehabilitation Network Senior Vice President, MedStar Health John Sullivan President, MedStar Washington Hospital Center Senior Vice President, MedStar Health Neil J. Weissman, MD, FACC President, MedStar Health Research Institute Christine R. Wray, FACHE President, MedStar St. Mary’s Hospital Senior Vice President, MedStar Health 31 32 CORPORATE AND OPERATIONAL LEADERSHIP FY13 Total Investment: $309.7 M Community Benefit Support Gregory Argyros, MD David B. Mayer, MD Research Each year, MedStar Health invests in the Interim Vice President, Medical Affairs Vice President, Quality and Safety MedStar Washington Hospital Center $7.0 M health of the community by providing Jennie P. McConagha more than a quarter of a billion dollars Bruce A. Bartoo Chief of Staff and Vice President Community in community benefit. Services include Senior Vice President and Operational Communications Services† Chief Philanthropy Officer teaching the next generation of health Stephen T. Michaels, MD $54.2 M professionals, providing care for those Stuart B. Bell, MD Vice President, Medical Affairs who cannot afford to pay, delivering Vice President, Medical Affairs MedStar St. Mary’s Hospital and Medical MedStar Union Memorial Hospital MedStar Southern Maryland Hospital Center community health programs and services, Education and conducting research to advance care. Martin L. Binstock, MD Susan K. Nelson $139.3 M Vice President, Medical Affairs Vice President, Finance and Charity Care/ MedStar Good Samaritan Hospital Accounting Operations Bad Debt* Allan M. Birenberg, MD David P. Noe $109.2 M Vice President, Medical Affairs Vice President, Human Resources MedStar Harbor Hospital Edward W. Robinson Lisa M. Boyle, MD Vice President, Performance Improvement and Vice President, Medical Affairs Operational Support MedStar Georgetown University Hospital Anthony O. Sclama, MD Joel N. Bryan Vice President, Medical Affairs * Includes unfunded government-sponsored Vice President, Treasurer MedStar Franklin Square Medical Center programs; D.C. hospitals only. Diane L. Caslow Larry L. Smith † Includes subsidies, community health improvement Vice President, Strategic and Business Planning Vice President, Risk Management services, community building activities, financial contributions, and community benefit operations. James C. Farley Mark S. Smith, MD Senior Vice President, MedStar Medical Group Director, MedStar Institute for Innovation Frederick Finelli, MD Pegeen A. Townsend Vice President, Medical Affairs Vice President, Government Affairs MedStar Montgomery Medical Center Michael R. Yochelson, MD Jean M. Hitchcock Vice President, Medical Affairs Vice President, Public Affairs and Marketing MedStar National Rehabilitation Network Debora J. Kuchka-Craig Vice President, Managed Care

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