The comments are open as to which parking garage will be open first:

1) Midland Memorial's 5 story garage, which was approved in September 2009.

2) Basic Energy's MDC Funded garage which was funded in May of 2009.

I've never said Midland Memorial Hospital was perfect, but over the past three years I have seen more positive articles written about the new systems in place at MMH in MAJOR national news outlets than one would expect from a small town hospital.

The Wall Street Journal offers up the latest article in "tomorrow's" edition. Here is an interesting item from the article regarding the "stick and carrots" in the Stimulus Bill to do what MMH is already doing:

The federal government has offered both a carrot and a stick, neither of which, some fear, will make modernization more affordable. It has earmarked nearly $20 billion in stimulus funds as an incentive for hospitals to use electronic records by 2011. And it will penalize those who don't use them, cutting a percentage of their Medicare payments starting in 2015. Once fully phased in, the penalties could amount to a loss of $3.2 million annually in Medicare funding for the average 500-bed hospital, according to a new report from PriceWaterHouseCoopers. But the incentive payments for using health information technology -- about $6 million by the fourth year for the same hospital -- are "a small carrot compared to the amount of resources it will take to deploy this technology over the next five years," the report says.

Here are some interesting statistics regarding MMH in the article:

At Midland Memorial, doctors and nurses can retrieve patient records, lab results and X-ray images instantly. In the past, it could take hours and even days to gather them all. The system helped the hospital catch up on a $16.7 million coding and billing backlog for about 4,500 patient records in four weeks, which might have taken five or six months to do.

In the 18 months after the system went live hospital-wide in June 2006, the hospital reduced medication errors and patient deaths. Infection rates dropped 88% thanks to guidelines in the record system that prompted nurses to follow infection-control procedures, such as changing a dressing or following correct procedures when inserting a new IV.

Bed sores were also reduced as the system prompted nurses to turn patients in their beds at a set number of hours depending on their condition to prevent the sores. And Midland was able to increase by 77% its staff compliance with guidelines to care for patients on ventilators, which, if not followed, can lead to pneumonia.

Vote how you like, but MMH has been moving forward, not backwards in it's delivery of healthcare to the citizens of Midland.

Among the comments on the Hospital Bond, there are lots of criticisms of the Hospital Administration, Hospital Staff, Management, level of care, and the oft used anecdotal quote that "Local Dr's tell me to goto _______ hospital, not MMH."

I may not be an investigative journalist, but I like to base my opinion on some kind of reliable data or measure to see exactly how poorly, or well, our hospital may be performing. HealthInsight.org is a non-profit organization that helps improve the quality of health care system in Nevada and Utah, and as part of that mission, they have developed a methodology of

"[computing] hospital rankings using publicly reported data downloaded from the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website (www.hospitalcompare.hhs.gov - last accessed 3/26/09). This data set contains hospital-specific performance on 25 quality measures for over 4,500 hospitals nationwide."

There are some caveats to using the data, but it can provide some useful comparisons and trend analysis to see if any of the statements of our commenter's hold any water. Specifically the data is in presented in percentiles, so hospitals are ranked against themselves, and some small hospitals which only perform one type of service will rank higher than full service hospitals. Generally speaking, I would start worrying about a hospital which is in the bottom third of hospitals, or in the 33rd percentile or lower. So, what do the figures say?

Midland Memorial Hospital is in the 51st percentile of performance Nationally. Which means it is barely in the top half of hospitals in the US. But what about Lubbock, only the Lubbock Heart Hospital, LP is ranked higher than MMH (63rd percentile). UMC and Covenant are 45th and 37th respectively. Dallas isn't a bad bet, with Baylor (86th) Parkland (73th) and Methodist (69th). Houston isn't that bad either, with Hermann (71th), St. Lukes (64th) and St. Joseph (62nd). Though you may want to avoid the short drive to Odessa. Ector County's Medical Center Hospital clocks in at the 18th percentile and ORH in the 8th.

So what about trends?

From Q4 of 2006 MMH has risen from a performance rating of 81 with a National Percentile ranking of 33 to a performance rating of 91 and with a National Percentile ranking of 51. To me that is a pretty good trend line, which means the current administration must be doing something right.

Ector County isn't so lucky, over the same time period, they have risen from a 77 to an 82 performance ranking, but because so many hospitals have raised their performance levels also, their percentile rank has actually dropped from 20th to 18th.

Digging into the individual data points, a comparison of MMH and UMC Lubbock reveals that UMC beats the pants off of MMH in room cleanliness, quietness, getting a 9 or 10 on outpatient surveys which then translates into only 66% of patients recommending MMH to 79% recommending UMC to friends and family. Oddly enough, UMC nurses got 3% better for communication, but MMH doctors were 3% better at communication. The rest of the health care based measures were pretty much a dead heat (save poor Pneumonia treatment scores at UMC). Which makes me wonder if the perception that Lubbock is a better hospital comes from non-professional staff, facilities and facility upkeep, because treatment and professional staff are similar (with Midland performing better in many areas) according to HSS Survey data.

Just looking at the data, I would have to say that MMH has made some great strides in the last 3 years and if the comparison to UMC Lubbock is instructive, MMH may be perceived as a poorer hospital just because of the way it looks, because the objective care measures and staff competence measures don't correlate to the wide gap between UMC's perception and MMH's perception.

In my previous Hospital thread there are several comments that I think make wrong assumptions about the willingness of the Citizens of Midland to pass certain bond issues. Going back to the MRT's article which outlines several of the recent bond issues since 1980, one might get the impression that Midland has a real aginner mentality when it comes to our civic facilities, especially our schools, since the community voted three bonds down.

In my opinion, Midland is more than willing to approve bonds for our various local taxing entities, but they are not willing to fund certain projects or give out blank checks for undeterminiate projects.

The failed MISD bond issues in 1996 ($110M), 2000 ($72.2M) and 2002 ($91-167M) suffered from an unpopular and ill defined project (a new Midland High) or a majority of the issue didn't include specific projects, but a range of projects that may be undertaken if necessary.

If you look at the remainder of the list, they all passed, even the recent jail bond. I would argue the jail bonds that failed in the past were because Midlanders didn't want us to become a "Prison City" like Colorado City or Pecos. However, when it came down to providing facilities to serve the detention and inmate needs of our own community, that passed.

In the case of the Hospital, the plan is pretty well defined and using the strategies of the Airport and Successful School bonds, they have shown the 50 year old boilers and totally blocked plumbing.

As for costs, at $175M for 350,000 S.F. of new construction and 100,000 S.F. of rennovations, that meets LEED certification, the costs aren't out of line. This would be the 2nd or 3rd LEED Certified Hospital in Texas and one of only a handful of LEED Certified Hospitals in the United States. As a point of reference, the Dell Children's Medical Center of Central Texas was the first LEED Certified Hospital in Texas and the 500,000 S.F. facility (pediatrics only mind you) cost $200M. I'm sure the emergency department and other full service hospital accommodations makes up the difference in $/SF ratios between MMH and Dell Children's.

(as an aside: To say that having a facility that is on par with Dell Children's and is one of a handful of hospitals to have LEED and GGHC certifications in addition to meeting all the current regulatory and design standards of hospitals isn't going to attract some staff is like saying fielding a fast new car at the track isn't going to attract drivers.)

So, if history holds, for this bond to go down, there has to be something community wide that is unpopular about the hospital's project....and I don't see it, feel it or hear it.

What I do see is a bunch negativity about the hospital administration....and yet a jail bond passed with about the same level of negativity towards Sheriff Painter and the Commissioner's Court.

This is why I think the Hospital Bond is going to pass.

[Disclaimer, a member of my immediate family works for Midland Memorial Hospital, so assign your bias rating carefully!]

$115 Million Dollars. It's a hard number to choke down, especially for a civic project that is going to impact our property taxes for a very long time. However, I will vote for this bond next week in early voting.

I know the perception of Jessica's Well Contributor's is that they oppose pretty much all taxes, but perception and reality don't really match up, because individually we have supported some local tax initiatives. So, though I will be voting for the hospital bond, don't think I'm giving up my opinions on the mismanagement of federal, state and local tax dollars by our various entities, including the Hospital.

For instance:

To their credit, the Hospital District hasn't used a property tax bond to fund facilities in a very long time, but they have enjoyed a small building and purchasing spree using revenue bonds. Taxing entities love revenue bonds because they don't have to go to the electorate to get them approved. In the case of Midland Memorial, when they were "in the black" with good Medicare/Medicaid/indigent reimbursements, they took excess property tax revenues and leveraged them to borrow money for things like buying the West Campus and building the new medical office building, instead of lowering the property tax rate, or saving for a project like this.

These "excess revenue" bonds weren't a blessing. According to the Texas Bond Review Board, as of 8/31/08, the Midland County Hospital District had $28,456,304 in outstanding revenue secured debt with the latest maturity date being 2016. When the hospital got about $2.6M less dollars in reimbursements from the state in 2008, those revenue bond payments made the red ink flow and the heads roll at the Hospital late last year.

[Are you taking notes revenue bond lovers in Midland County and the City of Midland?]

Just to put it in perspective, if the $115 Million Dollar bond issue passes, the Hospital District will be the 3rd largest bond indebted Hospital District in the State based on principal outstanding ($132M). That puts us behind Harris County ($322M + commercial paper), El Paso County ($271M), but ahead of Tomball Hospital Authority ($121M), Richardson Hospital Authority ($105M), and Oak Bend Medical Center (~$100M).

So I guess the question remains, with all the reported mismanagement and the mountain of debt the community would take on, is it worth it?

I say Yes, for several reasons:

1. Face it, quality health care is the cornerstone of any community. When we can no longer attract doctors and provide quality health care in our own community we all suffer.

2. When prominent names in the community dedicate $60M in private funds to the effort, that tells me something. Among the taxing entities, only Midland College seems to draw that kind of philanthropic support.

3. Midland Memorial has undertaken many projects in the past few years that have brought our hospital to the forefront in technology and cost effectiveness, but they can't keep that edge if the facilities can't keep up.

4. Most issues people compain about in the health care realm can't be controlled by our local hospital district, so I don't consider those in my own analysis.

As for the outcome, I think the measure will pass by a slightly larger margin than the Jail Bond did. Though the Hospital has gone all out with a media campaign, this issue isn't generating that much heat locally. Yeah signs are scattered about and the paper has printed many positive stories and a few ranting letter to the Editor against, but otherwise this thing is cold. Even the website set up for the bond shows only 64 views on their most watched YouTube videos. This is going to be decided by the small pool of habitual voters, and I think they'll support the hospital.

Now, discuss....

Midland Memorial Hospital is a vital part of our community. Much like Midland College, it is a local institution that underpins the growth of Midland and is a critical part of our community infrastructure. Overall the Hospital and the College have been decent stewards of the taxpayers money, and they generally enjoy favorable treatment when it comes time to expand and build.

I have been a big fan of the efforts of MMH to modernize their Information Technology infrastructure and implement a comprehensive Electronic Health Records systems. Their successful efforts, using Open Source code and pouring the savings on coding into information infrastructure and customization, resulted in the implementation a $22 million dollar system for a little over $7 million. Since it went live, it has been a great service to patients of MMH and has returned a significant savings to the local taxpayer.

Today, those efforts were rewarded by InfoWorld as one of the Top Ten organizations that have implemented and integrated technologies in innovative ways in pursuit of concrete business goals for 2008.

It is a very high honor, and yet it is just one of a growing number of accolades heaped upon our little Hospital for cost effective modernization and technical innovation.

This spring, the Health Information Management and Systems Society recognized Midland for having one of the highest levels of automation. The $7 million price tag for an assembled system, as opposed to $22 million for a top-of-the-line system, makes it sweeter. Sure, "Cadillac" EHR systems probably have more features and less need for tweaking code and building interfaces, says Whiles, "but I'll put ours up against anyone's."

I can't predict at this moment how the local electorate will react to the bond election for the new $140 million dollar patient tower, but you can't say our hospital isn't making a difference in increasing the efficiency and streamlining the cost of health care in America.

Now to be fair, five new physicians is better than none (even if you were hoping for ten) but it is always fun to read spin language.

It doesn't really matter in the larger sense in that it is all tax money anyway. Either the MDC spends our tax dollars attempting to recruit physicians to the area or the hospital district does. This is similar to negotiations between MISD and the City of Midland concerning the "rent" paid for the use of Grande Communications stadium. While it is very important to each of those entities on whose books the unavoidable losses land, it matters not to the ones who are actually coughing up for the losses.

It is unclear from the article whether these reimbursements to the hospital from the MDC are strictly for the cost of recruiting or if they are also made up of some sort of cash incentive to the potential recruit. If there is incentive money it probably can't be enough to make a difference.

And it would be interesting to have some clarification of this:

In attempts to find four new full-time pediatricians, one had been successfully recruited. But that person left within a short period of time "due to the volume of work expected in her new practice."

Was the volume of work expected too high or too low? If it was too high, I am forced to try and think of any other business where one runs away from a generous supply of customers. If it is too low then why are we recruiting them?