Tuesday, June 22, 2010

An appreciation of Thai

Some of you may have already seen the piece on Thai in the Post Health section on Tuesday June 15, 2010. It was written by our friend John Donnelly, a journalist whose writing I have long admired as he covered BCC’s track and field team. When he asked me if I were interested in him writing something on Thai, I said absolutely knowing it would be wonderful. What is below is a longer and even more personal version of the piece that was published in the Post:

On May 29, at 8:18 p.m., Dr. Thai McGreivy posted a guest blog on the Street Rat Crazy Saloon site titled, ``OK, my first short health care thoughts.’’ The item wasn’t so short, it wasn’t just about health care, but it was vintage McGreivy – provocative and piecing together seemingly disconnected big issues.

He wrote that municipalities were in budget crises and they might take aim at Emergency Medical Services. It made sense, he said, because spending had risen rapidly for EMS, but those extra costs weren’t resulting in improved survival rates.
Less than two days later, on Memorial Day, McGreivy, 43, suffered a massive heart attack while biking on Goldsboro Road in Bethesda en route for a long ride to Poolesville. EMS paramedics rushed to the scene, where he lay unconscious with no pulse. They did everything possible, including getting him to an emergency room at Suburban Hospital as quickly as possible. There, a team revived his heart.

McGreivy, an emergency room physician himself, remained in a coma as his heart showed signs of recovery. Four days after his collapse, doctors performed a critical test – a CAT scan on his brain, and the results were heartbreaking: severe brain damage due to a long period of oxygen deprivation. Nearly one week after his heart attack, officials pronounced him brain dead and his family authorized doctors to harvest all salvageable organs for those in need.
In death, McGreivy gave life – two kidneys and enough tissue for roughly 20 medical applications -- and his family and friends are grateful for the exemplary work of the EMS crew. They kept him alive against all odds.

But his guest blog post wasn’t wrong – not in terms of the metrics of public health. And therein lies a story about a relatively young man who left a mark on the quality of health care around the region precisely because he was unafraid to challenge anyone or anything, especially when it came to health care. In a very real sense, long before the national health reform debate, McGreivy was a one-man reformer – about a host of national issues around budgets and health and energy.

McGreivy, a husband, father of four boys, California born, was passionate about figuring out what made things work and what were the underlying factors that influenced outcomes, ranging from emergency rooms to global economic crises.

``His mind never stopped – ever,’’ said his wife, Katherine, softly laughing. ``I loved him dearly, but sometimes he was exhausting. He never stopped thinking and analyzing, and he always wanted to talk about ideas, and after hours of this, I would be, like, `Can’t we just gossip about the neighbors?’’’

He was chief financial officer of Medical Emergency Professionals (MEP), a 100-plus-employee company based in Germantown that runs five emergency rooms in Maryland – Shady Grove Adventist Hospital and Germantown Emergency Center in Rockville; Washington County Hospital in Hagerstown; Western Maryland Health System in Cumberland; and St. Mary’s Hospital in Leonardtown.

In all, the group, which started in 1997, oversees the emergency-room treatment of 300,000 patients a year; it contracts with each hospital, assuming all costs of ER service (which often run at a huge deficit to hospitals in part because of the numbers of uninsured) for no fee.
In each hospital, McGreivy and his partners strove to find cost-saving efficiencies while also improving patient care. In both Hagerstown and Cumberland, their system saved hospitals hundreds of thousands of dollar a year and shaved time off how long patients had to wait to see a doctor or nurse. At St. Mary’s Hospital, surveys showed patient satisfaction doubled over the past five years, now reaching levels of more than 90 percent reporting being satisified with their care.

McGreivy, said hospital CEO and President Christine R. Wray, ``was a tremendous catalyst to help St. Mary's Hospital change for the good. He was a terrific advocate in pursuit of excellence through data analysis.’’

Dr. Angelo Falcone, CEO of MEP, said McGreivy frequently pushed his peers. ``He always talked about how we had to make the hard decisions from an efficiency standpoint, and make sure they positively impact patients’ health,’’ he said.

One example rose in the Hagerstown hospital recently – a puzzle as to why doctors were seeing fewer patients than targets set by the group. At first, McGreivy and others hired $20-an-hour scribes to take notes for doctors, but that did not get the desired results. McGreivy studied it some more, discovering an anomaly at the hospital: physician assistants were seeing an unusually high number of patients. This was a problem because some of those patients could have gone straight to the doctor, and the doctors, in the meantime, had too much time on their hands. They could have been more productive – a cost savings to MEP and also, ultimately, to patients.

``There were a lot of moving parts in trying to figure out what was going on – 15 to 20 variables,’’ said Dr. Michael Cetta, MEP’s chief of business development. ``But he was able to think out of the box, and identify why it wasn’t working as well as possible. At our last management meeting, just a few weeks ago, he had figured it out, and now we are trying to fix it.’’

That was just one part of McGreivy’s impact, said his peers.
Justin Shaper, chief technology officer at PSR, a Dallas-based company that worked with MEP to help it manage its business, recalled how he and McGreivy developed software to standardize reviews of doctors’ charts of patients. Today, MEP and roughly a dozen other doctors’ groups around the country now use this more scientific approach to better evaluate doctors’ performance.

``There are a lot of overachievers out there, but what was special about Thai was that he never lost sight of the human connection in things – he kept coming back to the patient quality of care,’’ Shaper said, talking on his cell-phone while driving into downtown Dallas. He started to choke up. ``I’m sorry,’’ he said finally. ``Let me tell you a story about a dinner that we had together.’’

Seven years ago, Shaper, his wife, and their two children were eating a meal with McGreivy during a break in a conference in the Florida Keys, in Islamorada. ``At one point, Thai, who is an emergency room physician, one of a group of people who work under phenomenal pressure, who make life-and-death decisions, who make life better for people every day, he turns to my kids and says, `I hope you know your dad is helping save people’s lives.’’’
Shaper wept over the phone. ``That was the thing about Thai – while he was really into all these intellectual things, he still had an appreciation for what others were doing, and he let them know they were a part of doing something important.’’

And so it was, too, in his blog on EMS for Street Rat Crazy Saloon, when after writing about the questionable costs of EMS services, he wrote, ``I truly think most of the men and women in EMS are heroes.’’

In the hours before doctors removed McGreivy’s organs on June 6, Katherine McGreivy, in a waiting room with Falcone, decided to look up her husband’s most recent blogs on an iPhone. She found the EMS post.

``It gave me goose bumps,’’ she said. ``While we’re waiting for the whole surgery and the donation, we’re reading about his thoughts on EMS, and do they make a difference in outcome. Because he was saved from an almost certain sudden death, two people are getting a kidney, many others are getting tissues. It did make a difference – with him. He was still giving life even in his death.’’

A memorial service for McGreivy is scheduled for Thursday June 17 at 3 p.m. at the Bethesda Theatre at 7719 Wisconsin Avenue, Bethesda. The family has set up a memorial fund in honor of McGreivy that will fund educational scholarships for excellence and intellectual curiosity in science, mathematics and economics. In lieu of flowers, our family will request donations to this fund.

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