SPRING 2008 www.arkhospitals.org Arkansas Hospitals Respond in TornadoвЂ™s Aftermath Providing Cancer Patients With вЂњHope Away From HomeвЂќ Action Ideas for Increasing Staff Participation at Meetings A M A G A Z I N E F O R A R K A N S A S H E A LT H C A R E P R O F E S S I O N A L S PAGE PAGE 9 PAGE 16 12 PAGE Arkansas Hospitals is published by Arkansas Hospital Association 419 Natural Resources Drive вЂў Little Rock, AR 72205 501-224-7878 / FAX 501-224-0519 www.arkhospitals.org Beth H. Ingram, Editor BOArD OF DIrECTOrs 8 Hospitals Respond in TornadoвЂ™s Aftermath 12 Providing Cancer Patients with вЂњHope Away From HomeвЂќ 28 Action Ideas for Increasing Staff Participation at Meetings Features 10 Thoughts on the PresidentвЂ™s Budget Proposal 24 Working with Disruptive Board Members 26 Legal Note: Physician On-Call Coverage Ray Montgomery, Searcy / Chairman James Magee, Piggott / Chairman-elect Luther Lewis, El Dorado / Treasurer Robert Atkinson, Pine Bluff / Past-Chairman Kirk Reamey, Ozark / At-Large Jamie Carter, West Memphis David Cicero, Camden Les Frensley, Batesville Pat Heinz, Little Rock Tim Hill, Harrison Ed Lacy, Heber Springs Larry Morse, Clarksville Doug Weeks, Little Rock Russ Sword, Crossett EXECUTIVE TEAM Phil E. Matthews / President and CEO Robert вЂњBoвЂќ Ryall / Executive Vice President W. Paul Cunningham / Senior Vice President Elisa M. White / Vice President and General Counsel Beth H. Ingram / Vice President Don Adams / Vice President DIsTrIBUTIOn Arkansas Hospitals is distributed quarterly to hospital executives, managers, and trustees throughout the United States; to physicians, state legislators, the congressional delegation, and other friends of the hospitals of Arkansas. 24 Governor Collects $2.2 Billion Benchmarking to High Performers Financial Challenges are Top CEO Concern State Revises Death Certificate Form Advocacy NewsStAt 11 11 15 15 16 16 17 17 18 19 20 20 22 22 25 25 25 27 30 32 33 33 34 36 36 ACH on 100 Best Workplace Listing Wal-Mart, LR System Partner Up Preventing Accidents and Injuries in the MRI AHA Services Launches New Web Site Hospital Executive/Trustee Leadership Conference Call for 2008 Diamond Award Entries Harding University Pharmacy Program New OIG Advisory Opinions Arkansas Hospital Utilization Moves Downward AHA Will Intervene on PPA Matter 2008 Mid-Management Series Begins April 15 United Healthcare Revises Notification Policy IRS Approves Revised 990, Schedule H Look for Hospital Spending to Double by 2017 2008 HHS Federal Poverty Guidelines Blue Cross Promotes Executives 2006 Health Spending Eases Will Older Physicians Opt Out of Patient Care? Arkansas PAC Contributions Recognized Hospitals to Provide ACASA Materials Many Labor-Related Resources Available 37 Arkansas Receives NDC Billing Extension 37 Community Match Physician Recruitment Program 38 A Look Back at 2007 Healthcare Legislation 39 FDA Recalls Contaminated Syringes 39 Arkansas Hospital Infection Committee Meets 39 Report Recommends Broadband Network Quality 40 TrusteesвЂ™ Responsibilities for Quality 41 Governor Appoints Healthcare Roundtable 41 Financial Incentive Program Guide Medicare/Medicaid 42 CMS Memo on Interpretive Guidelines 42 Proposed Rule for LTCHs 42 вЂњFreestandingвЂќ Emergency Dept. Requirements 43 CMS Amends RAC Program Schedule 43 Arkansas Medicaid Outpatient Rate Update 43 Medicare Spending Tops $400 Billion 44 CMS Revamping Regional Offices 44 CAHs Allowed OPPS Reporting Participation 44 Guide for Medicare Code Editor 45 9th Statement of Work Changes QIOsвЂ™ Focus 46 Arkansas Medicaid Fixing EOB Problem To advertise contact Katrice Summerlin Publishing Concepts, Inc. 501/221-9986 ksummerlin@pcipublishing.com www.pcipublishing.com www.thinkaboutitnursing.com Edition 62 46 Value Based Purchasing Report Issued Cover Photo Hot Springs National Park Photo courtesy of Arkansas Dept. of Parks and Tourism departments 4 6 7 From the President Education Calendar Arkansas Newsmakers and Newcomers Spring 2008 I Arkansas Hospitals 3 F R O M T H E P R E S I D E N T Healthcare: Is it Time for a March on Washington? I have been wondering recently if it is time for those of us involved in AmericaвЂ™s healthcare вЂ“ including citizens affected by both intensified policy restrictions and CongressвЂ™s inability to effect positive change regarding health insurance for all вЂ“ to hold a Healthcare March on Washington. Changing healthcare policy, the continuing cuts to Medicaid and Medicare reimbursements, growing numbers of uninsured and the number of businesses dropping health insurance for their employees all have people extremely concerned. More than that, their very lives and livelihoods are at risk. It seems as though more people each year forego early retirement and work until they are 65 just to qualify for Medicare coverage. According to every national poll taken within the past six months, the need for policy improvement and affordable insurance availability rank among AmericaвЂ™s highest concerns. And in this all-important election year, candidates making their bid for the presidency continue to mention healthcare, but are (so far) presenting improvement plans that are all too sketchy and vague. ItвЂ™s time for both talk AND action. Therefore, your Arkansas Hospital Association board of directors urged all of the stateвЂ™s hospital administrators and trustees to attend the annual American Hospital Association membership meeting in Washington, DC April 6-9. At press time, more than 30 were signed up for the trip. These visits are a win-win for hospital CEOs. How better to get your elected officialsвЂ™ direct attention than to sit down with them, face-to-face, in meetings designed to detail Arkansas hospitalsвЂ™ needs, concerns and challenges? Taking part in the annual membership meeting also gives administrators and trustees both a voice in and vital information regarding healthcare policy-setting in America today. Participants will be bringing home knowledge from executive briefings on topics such as The Joint Commission, health information technology, the future of Medicare and Medicaid, and potential effects of the 2008 election. Scheduled educational opportunities for hospital trustees cover issues such as succession management, quality and patient safety, and вЂњthe gremlins of governance.вЂќ Beth Ingram is serving as our point person on coordinating CEO attendance for the Washington meeting. To reach Beth, contact her at 501-224-7878 or e-mail her at bingram@arkhospitals.org. In this vital election year, those of us in the hospital field are going to Washington, together, to join healthcare administrators and trustees from across the nation in our own virtual вЂњmarch on WashingtonвЂќ April 6-9. AmericaвЂ™s healthcare policy depends upon it вЂ“ and upon your continued interest and participation as the year progresses! ItвЂ™s not quite a march on Washington, but it could make a significant impact on future healthcare policy in this vital election year. We feel the most important events are the times set aside to meet with the stateвЂ™s Washington delegation and their key aides on health matters. The AHA will host a reception for congressional aides Monday evening, April 7; and on Wednesday, April 9, attendees will meet with Senators Blanche Lincoln and Mark Pryor for breakfast, followed by visits with their respective congressman in his Capitol Hill office. 4 Spring 2008 I Arkansas Hospitals Phil E. Matthews President and CEO Arkansas Hospital Association Peace of mind. Security solutions through people Securitas USA is uniquely able to help healthcare institutions provide uninterrupted, quality services in a safe and secure environment. We are committed to the healthcare industry, and have invested significant time and resources to provide security professionals who understand the specialized needs of healthcare facilities and perform to the highest standards. Nearly 1,000 healthcare organizations nationwide rely on us for security solutions that meet the environment of care standards of The Joint Commission and other regulatory bodies. We want to work collaboratively with your staff as a long-term partner helping to provide security for your institution. Tap into the unparalleled experience of Securitas Security Services USA, Inc. Protecting the Future of America Since 1850 www.securitasinc.com For more information, please contact: Dwain Prosser, Business Development Manager 501-221-1011 or dwain.prosser@securitasinc.com or Wayne Gibson, Branch Manager вЂў 870-910-5375 or Wayne.Gibson@securitasinc.com Employee Benefits Simplified. 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The full time healthcare division of Ramsey, Krug, Farrell & Lensing is the largest and most experienced group of medical professional liability and property specialists in Arkansas and one of the largest in the Southeast. Our coverages include: вЂў Medical Professional Liability for hospitals, PHOs, IPAs, Surgery Centers, Clinics and Nursing Homes вЂў Medical Professional Liability for Physicians and Surgeons-- all specialties protected вЂў Specialized programs for group practices within networks and allied healthcare professionals вЂў Health Care Entity Employment Practices and Managed Care Liability вЂў Health Care Organization Directors and Officers and all related corporate and personal needs вЂў LOCAL Claims Handling вЂ” 24/7 and LOCAL expert legal services Our Risk Management and claim specialists are experts in medical professional, general liability and property loss control. If you are self-insured, our Risk Management staff can provide services as part of a third party administrator. Call Tom Hesselbein for more information. 501-664-7705. RKFL is a sponsored service provider of the Arkansas Hospital Association and administrator for the AHA WorkerвЂ™s Compensation self Insurance Trust. P.O. Box 251510 вЂў Little Rock, Arkansas 72225 вЂў (501) 664-7705 6 Spring 2008 I Arkansas Hospitals April 6-9, Washington, D.C. American Hospital Association Annual Membership Meeting April 15, Little Rock Leaping from Staff to Management, Mid-Management Certiп¬Ѓcate Series April 16, Little Rock Leaping from Staff to Management: The Next Steps, Mid-Management Certiп¬Ѓcate Series April 22, Little Rock Compliance Forum %NDOrsed by !(!3%R6)#%3 INC !3UBSIDIAry OFTHE !rKANSAS(OSPITAL !SSOCIATIOn rkfl.com Education CALENDAR April 23, Little Rock Arkansas Health Executives Forum April 24, Little Rock Crisis Communications Workshop April 25, Little Rock Hospital Emergency Preparedness Conference May 2, Hot Springs Arkansas Organization of Nurse Executives Workshop May 8-9, Hot Springs Arkansas Association for Hospital Engineering Annual Meeting May 13, Little Rock Credentialing Clinic May 14-16, Hot Springs Society for Arkansas Healthcare Purchasing and Materials Management Annual Meeting May 21, Little Rock The Legal Aspects of Management, Mid-Management Certiп¬Ѓcate Series May 28, Little Rock Hot Topics in Risk Management Workshop June 18-20, Branson, Missouri Executive/Trustee Leadership Conference Program information available at www.arkhospitals.org. Audio conference information available at www.arkhospitals.org/calendaraudio.htm. Arkansas Newsmakers and Newcomers James R. вЂњJamieвЂќ Carter, CEO of Crittenden Regional Hospital in West Memphis, has been elected to the AHA Board of Directors by the Northeast District. He will serve the unexpired term of Leah Osbahr, which ends October 2011. Carter, who has been at the West Memphis facility since November 2005, also serves on the GovernorвЂ™s Advisory Council on Trauma. Shane Frazier has been named Service Line Administrator for Post-Acute and Behavioral Health Services at St. Vincent Health System and Facility Administrator for St. Vincent Doctors Hospital in Little Rock. He succeeds Angie Cabantac who recently retired. Frazier began his work in the St. Vincent Health System in 2001 as Director of Nursing for Behavioral Health Services. He has a BSN from the University of Central Arkansas and an MBA from the University of Arkansas at Little Rock. Leland Farnell has been named interim CEO for Mena Regional Health System, succeeding Vince DiFranco. Farnell will serve until April 30 when the hospitalвЂ™s management contract with QHR expires. He has more than 23 years of experience as a hospital CEO in community hospitals in North Carolina, Georgia and South Carolina. W. Lee Gentry, FACHE, has been named administrator of Baptist Health Extended Care Hospital, which is located inside Baptist Health Medical Center in Little Rock. Gentry is a former president/CEO of Lawrence Memorial Hospital in Walnut Ridge, vice president of operations at St. JosephвЂ™s Mercy Health Center in Hot Springs, and COO of Northwest Regional Medical Center in Clarkesdale, Mississippi. Phillip Gilmore, FACHE, president/CEO of HSC Medical Center in Malvern and president of the Arkansas Health Executives Forum, announced that AHEF has received the American College of Healthcare Executives (ACHE) Award of Chapter Distinction. ACHE president Thomas Dolan congratulated the organization saying, вЂњAchieving this award is a great accomplishment and solid evidence of the significant hard work of your leadership throughout the past year.вЂќ Governor Mike Beebe has named Edward L. Lacy, FACHE, vice president/administrator of Baptist Health Medical Center вЂ“ Heber Springs, to the Oversight Committee on Breast Cancer Research. вЂЇLacyвЂ™s term expires January 1, 2011. Brett A. Kinman has been named CEO at Forrest City Medical Center, succeeding Stephen Doherty who served in an interim capacity during the search period. Kinman was previously assistant CEO at Scenic Mountain Medical Center in Big Spring, Texas, and COO at Harris Hospital in Newport. He has ten years of healthcare management experience. Franklin G. Schupp has been named president of SMC Regional Medical Center in Osceola. He succeeds Keith Broach. Schupp was previously president of health development and associates for Ameris, the company that operates SMC. He also has experience as a CEO and development director with Cumberland Health Systems, Metropolitan Hospital in Chattanooga (TN), and Medshares, Inc. M. Kent Strum is serving as interim administrator for Delta Memorial Hospital in Dumas, succeeding James Fairchild. Strum is from Jackson, Mississippi, with healthcare experience as a CEO and consultant. вЂў Spring 2008 I Arkansas Hospitals 7 Hospitals Respond in TornadoвЂ™s Aftermath Aerial photo of the destruction at Stone County Medical Center in Mountain View following a February 5 tornado that tore through Arkansas. The F4 tornado that tracked on the ground for 123 miles across North Central Arkansas in the late afternoon of February 5 left a wide footprint of destruction from the Arkansas River Valley northeast to the Missouri border. Among the most severely damaged areas in the stormвЂ™s path were communities where two of the stateвЂ™s 28 Critical Access Hospitals are located: Mountain View and Clinton. In the midst of and immediately after the storm, Stone County Medical Center (SCMC) in Mountain View (part of the White River Health System in Batesville) continued to care for injured patients despite receiving significant damage. The tornado hit 8 Spring 2008 I Arkansas Hospitals the hospital just as the Leadership Team was concluding its regularlyscheduled meeting. Fortunately, the entire team was on hand. The emergency department at SCMC sustained severe damage, enough to temporarily close the facility to inpatients until repairs were completed. But during and after the storm, the surgery department remained open as an emergency assessment, treatment and transfer center after the tornado tore through the community. No patients or employees of the hospital were injured as a result of the storm. The 17 patients who were in the hospital at the time the storm hit were evacuated to Stone County Nursing and Rehabilitation Center, to other facilities for care, or discharged to their homes. Just 24 days after the tornado, SCMC began admitting patients for care, opening 12 of the hospitalвЂ™s 25 beds after approval by the Arkansas Department of Health. вЂњThese rooms, along with our surgery department were spared from the storm,вЂќ said Karen Craft, SCMC Administrator. Structural engineers continue to assess the damage to the facility and are developing a plan to rebuild and renovate the hospital. A modular medical building previously used as a temporary facility in Corpus Christi, Texas, was assembled on the hospital campus to provide space needed to continue operations during the rebuilding process. The ER, laboratory, X-ray, respiratory therapy, pharmacy and other ancillary services are moving into that space. Additionally, three physicians whose offices were damaged in the storm were scheduled to reopen their clinics in the building in mid-March. Craft said, вЂњOur hospital family and community have come together to rebuild the hospital after the horrific February tornado. I am so proud to be associated with this group of physicians and employees. They demonstrated compassion, courage and commitment on that night and every day following. I am confident about our future.вЂќ tornadoвЂ™s touchdown, the hospital saw 51 patients, assessing and treating many onsite and working with area ambulance services to transport other more severely injured people to hospitals in Conway and Little Rock. Reamey said that the hospital staff and volunteers continued their medical treatment of storm victims until midnight, but pressed on into the morning hours and the following days, providing assistance to area residents in the form of food, shelter and other non-medical care. He also commented on the local disaster response plan and said that it worked well in his community, with all parties handling their roles those families who suffered injuries or loss,вЂќ stated Mike McCoy, Saint MaryвЂ™s CEO. вЂњThe compassionate staff of Saint MaryвЂ™s is regularly trained and well prepared for emergency situations. I am very proud and grateful for how our staff and physicians responded during this time to care for the injured and keep concerned family members informed. We have a great team of staff, clinicians and physicians who consistently help us to fulfill our mission of delivering quality healthcare with courtesy and compassion.вЂќ And, just as theyвЂ™ve been trained to do, many other hospitals, physicians, nurses and staff across the SCMC employees erected a flagpole and sign to show the community of Mountain View that a tornado will not destroy the hospital. Undamaged in a community fraught with destruction, Ozark Health Medical Center (OHMC) in Clinton became the focal point for local residents as they sought out care and assistance in the stormвЂ™s aftermath. Ozark Health CEO, Kirk Reamey, who serves as a member of the Arkansas Hospital Association board of directors, reported to the board that within two hours of the and responsibilities admirably. The Atkins area was hard hit as well by the tornado. Saint MaryвЂ™s Regional Medical Center in nearby Russellville was well prepared for the event вЂ“ quickly putting into action many aspects of its wellrehearsed disaster plan. вЂњThe tornado event of February 5 reminded us that natural disasters can cause much damage and pain. Our prayers remain with state provided supplies, transportation, treatment and care for tornado victims and families following the tornado. The February 5 disaster was a true test of the plans that hospital representatives, emergency medical personnel, the Office of Emergency Services, community leaders and others have worked on together to care for and make our communities safer no matter what type of disaster occurs. вЂў Spring 2008 I Arkansas Hospitals 9 by Paul Cunningham, Senior Vice President, Arkansas Hospital Association Thoughts on the PresidentвЂ™s Budget Proposal, and How it Affects Hospitals When President Bush released his proposed federal budget for Fiscal Year 2009, he didnвЂ™t necessarily set the full advocacy agenda for AmericaвЂ™s hospitals for the year, but he certainly gave it an immediate focus. The proposal would cut $182 billion from future Medicare spending over the next five years. About $135 billion would come from hospital payments. Frankly, we canвЂ™t afford for that to happen. Even in the best of times, cuts of that size would devastate many hospitals and create havoc over the entire healthcare delivery system. But, these particular cuts are being pushed at a time when the economy is tanking. That means other hospital payment sources will likely dry up, multiplying the disastrous effects. More than that, the demand for hospital services verges on rising to historic levels as roughly 20 million baby boomers вЂ“ and that may be a conservative estimate вЂ“ will reach the milestone age of 60, and beyond, by 2013. As early as 2011, the oldest boomers will become eligible for Medicare, and by 2015, at least 10 million of them will join the circle of beneficiaries, despite their later eligibility ages. Everyone understands that MedicareвЂ™s long-term financial outlook is shaky, due in part to the projected growth in per-capita costs, but mostly because of increases in the beneficiary population, which, 10 Spring 2008 I Arkansas Hospitals according to the data, is about to get much bigger. To make matters worse, while 60 may be the new 50 on a sort of ethereal, transcendental plane, many of the old physical problems will still hang around to nag even the healthiest of boomers. Dealing with some of those less coveted perks of aging will become a new way of life and, for many, will be the ultimate boomer bummer. In another five or 10 years, an assortment of maladies will begin to catch up with literally millions more Medicare patients. TheyвЂ™ll find themselves with conditions ranging from chronic obesity, arthritis, diabetes and knee/joint/ back pain to acute bouts with heart attack, cancer and stroke. ThereвЂ™s no denying that the longer we live, the more likely it is that a physical ailment of some type will eventually latch onto us and refuse to let go. In mid-February, the President sent Congress a bill that would take a three-step approach to strengthening Medicare. It includes improved health information technology and electronic medical records; transparency in price and quality information; and incentives for providers to deliver and Medicare beneficiaries to choose high-quality, low-cost healthcare. All could be sound moves; however, he wants to jumpstart the salvage job with his proposed budget cuts. Would that cut Medicare spending? Well, yes, but at what cost? When maladies begin to strike baby boomers in the form of heart attack, cancer, stroke and other conditions, theyвЂ™ll need Medicare, just as older patients do today. But, even more, ailing boomers will need the peace of mind of knowing that healthcare services, including hospital care, are available to treat them in their own communities. If the budget proposal goes through, local healthcare may not be available, especially in rural states like Arkansas where hospitals that already struggle to survive every day on paper-thin margins wonвЂ™t make it. That wonвЂ™t only hurt Medicare beneficiaries, but it will affect everyone else who lives in those communities, too. In submitting the AdministrationвЂ™s bill, Department of Health and Human Services Secretary Michael Leavitt said that the President hopes the steps will assist Medicare beneficiaries in making healthcare choices, which will lead to Medicare savings. In a convoluted way of thinking, it might work. Do away with $135 billion in hospital reimbursements (about $940 million in Arkansas) and future decisions about where to obtain high quality, low cost healthcare services will be much easier, since those choices, due to hospital closings, will be severely limited. вЂў FORTUNE Magazine Names Arkansas ChildrenвЂ™s Hospital to its вЂњ100 Best Companies to Work ForвЂќ Listing FORTUNE magazine announced in January that Arkansas ChildrenвЂ™s Hospital in Little Rock has been ranked 76th on the 11th annual вЂњ100 Best Companies to Work ForвЂќ list.вЂЇ вЂњArkansas ChildrenвЂ™s Hospital is honored to be ranked among FORTUNEвЂ™s вЂ�100 Best Companies to Work ForвЂ™ survey,вЂќ said ACH President and CEO Jonathan Bates, M.D.вЂЇ вЂњOur employees take much pride in providing care, love and hope to our kids here at ACH.вЂЇ Their survey response, which comprised the largest portion of the survey, is what matters most, and they feel that ACH is a very rewarding place to work.вЂќ In addition, Arkansas ChildrenвЂ™s Hospital was recognized under the category вЂњUnusual PerksвЂќ for offering a pre-kindergarten fitness program by trained staff and ranked number one in the Onsite Child Care category for companies that have вЂњan onsite child-care centerвЂќ with вЂњleast expensive, average monthly rates.вЂќвЂЇвЂЇ A driving factor for the list this year is that these companies excel in creating jobs.вЂЇ The 100 companies on the 2008 list added 67,000 employees to their payrolls in the past year and employ a total of nearly 1.6 million employees; up 16 percent from the number employed by companies comprising last yearвЂ™s list. вЂњThe FORTUNE вЂ�100 Best Companies to Work ForвЂ™ ranking achieved by Arkansas ChildrenвЂ™s Hospital we hope will help us attract more physicians, nurses and other quality staff to our hospital.вЂЇ We believe one of the positives for Arkansas is that this recognition will help other companies recruit outstanding employees to their business and our state,вЂќ added Bates. Any company that is at least seven years old with more than 1,000 U.S. employees is eligible. For an online nomination form, go to www.greatplacetowork.com. EditorвЂ™s Note: Let us hear about your hospitalвЂ™s national recognition! Please send information and photos to Beth Ingram at bingram@arkhospitals.org. вЂў Wal-Mart, LR System Partner Up Bentonville-based Wal-Mart Stores Inc. announced plans in February to partner with Little RockвЂ™s St. Vincent Health System to set up walk-in, primary care clinics in four Wal-Mart Supercenter locations in the Little Rock area. The Little Rock clinics are among the first in Wal-MartвЂ™s effort to establish a series of such вЂњco-brandedвЂќ clinics across the country in conjunction with local hospitals. Essentially, St. Vincent and other partnering hospitals will be leasing space in the selected stores and providing all operational resources, from healthcare personnel to the filing of insurance claims. According to Wal-Mart officials, the company hopes to have 400 of the hospital-operated clinics in place by 2010. The retailer has offered walk-in clinics in some stores for the past few years, but those clinics are not associated with hospitals, as the newer clinics will be. вЂў Spring 2008 I Arkansas Hospitals 11 by Nancy Robertson Cook Providing Cancer Patients with вЂњHope Away from HomeвЂќ Ask any member of the 20 th Century Club in Little Rock what the groupвЂ™s purpose is, what they stand for, and youвЂ™ll get a unanimous answer: вЂњWe try to make the lives of cancer patients easier, plain and simple.вЂќ Well, perhaps not plain, and certainly not simple. This 65-years-young independent civic group, with more than 100 active and 300 sustaining members, has taken upon itself the monumental goal of raising $3 million within a yearвЂ™s time. Their purpose: to build a state-of-the-art, homelike lodge to house financiallyburdened cancer patients undergoing treatment in one of Little RockвЂ™s many medical facilities. Their mantra: вЂњWeвЂ™re building a bridge of hope.вЂќ The group has been known for more than 20 years as a 12 Spring 2008 I Arkansas Hospitals resource for no-cost housing for financially strapped, out-of-town cancer patients receiving treatment in the Little Rock area. In the past, they have helped about 250 patients annually, providing 1500-2400 room nights of nocost housing per year. When the new facility is built, those numbers will approximately triple. вЂњDoctors and hospital staff from all over the state send their patients to cancer treatment facilities in Little Rock every day,вЂќ says Lynda Johnson, a partner with the Little Rock law firm of Friday, Eldredge and Clark and steering and planning committee chairman for the new lodge. вЂњThey know that if their patients have financial difficulties, our group can be counted upon to help with housing during periods of treatment.вЂќ вЂњEven a solid, middle-class family can quickly become financially devastated when cancer is the diagnosis, though they may have medical insurance,вЂќ says Hope Lodge president Lisa Johnson. вЂњOftentimes, people come expecting their treatment to last 1-2 days, but it extends to 4-6 weeks. The out-of-pocket cost of hotels and eating out during these treatment periods can be a tremendous financial burden on patients and their families.вЂќ Lynda and Lisa, along with fellow group member Dana Kleine, serve as leaders of the groupвЂ™s capital campaign effort, announced in January. вЂњI have been involved with fundraising for many years, and there are so many worthy non-profit organizations and projects,вЂќ Dana says, вЂњbut this project has just struck a chord with me. We are all passionate about building this new lodge for cancer treatment patients.вЂќ A Capital Campaign to Raise $3 Million Currently, the capital campaign is in full force. вЂњWe hope that hospitals, hospital foundations, physicians and auxiliary groups will realize the service our lodge provides to people in their communities as they come to Little Rock for cancer treatment,вЂќ Lynda says, вЂњand will consider contributing to the building of this $3 million facility. It is a great way for them to help their own communities вЂ“ their hometown folks вЂ“ since it is these patients that we serve through the lodge. We would appeal to hospitals and the medical community (including primary care physicians, oncologists and other physicians) to help us serve their patients better.вЂќ Physicians, who work through hospital social workers and discharge staff members, refer patients to the lodge. They are carefully screened for financial need and hardship. вЂњToday, when patients are referred to us, they go through our patient liaison, who sets up the reservation in our interim housing facility (the Baptist Health Plaza Hotel),вЂќ Lisa says. вЂњWhen they realize there is a no-cost lodging facility available to them, you can see them move from panic to relief.вЂќ вЂњOur patient liaison is the groupвЂ™s only paid staff person, and she is part-time,вЂќ Lynda explains. вЂњOtherwise, all monies raised go directly to operations of the interim lodge, building of the new lodge or patient services.вЂќ It has been documented that more than 98 percent of funds raised by the group go to help patients. The fundraising campaign is beginning where it should, Dana says, within the membership of the 20th Century Club itself. вЂњWe are seeking, and know we will achieve, financial commitments from 100 percent of our active membership,вЂќ she says. вЂњPeople will be giving at the levels they can afford to give, but every mem- Dana Kleine ber is behind this project and dedicated to it.вЂќ вЂњIt is like I tell my children,вЂќ she says. вЂњTo whom much is given, much is expected. We are all so blessed, we each have something we can contribute to this project.вЂќ These organizational leaders are particularly proud of the fact that the 20 th Century Club is made up of dedicated volunteers with many talents, coming from many backgrounds and professions. вЂњWe are an all-women group with diverse and wide-ranging talents,вЂќ Lisa and Dana say. вЂњWe are combining our talents for the greater good, and with the building of this new lodge, we will leave the world a better place.вЂќ вЂњThis organization and our work for cancer patients is near and dear to all of our hearts,вЂќ Lynda says. вЂњWe want to raise this money and get the building built! It will be a great legacy for our group to leave to our community.вЂќ As the Word Gets Out The group is discovering that as word about their new facility gets out, people are looking for ways to help. вЂњWe received a call the other day from an electrical contractor,вЂќ Dana says. вЂњHe offered to provide all of the new buildingвЂ™s electrical fixtures and equipment at cost; such a generous donation.вЂќ вЂњIn-kind donations from contractors and those in the construc- Lynda Johnson Lisa Johnson tion industry are most appreciated,вЂќ Lynda says. вЂњEvery donation of equipment and services helps us move closer to getting the new lodge built. Currently, we plan to break ground in December 2008 and open the facility to patients by December of 2009.вЂќ The New Lodge The new lodge will be located in the heart of the I-630 medical corridor in Little Rock, at the corner of Maryland and Cedar Streets. It will include 21 patient suites, up from the eight patient rooms in the former Hope Lodge. Each patient suite will have its own private bathroom and will contain both a double bed and a single bed, so patients can have their caregiver in the room with them. The patient suites also house mini-kitchens, so each patient can make their suite a вЂњhome away from home.вЂќ Key to the new facility is the fully-equipped communal kitchen and dining room, where patients and caregivers can cook their own meals and share conversation and experiences with others like them. вЂњOnce a week, our group members prepare a home-cooked meal for those staying in the lodge,вЂќ Lisa says. вЂњWe eat with the patients, check on how their treatment is going, listen when they want to talk. Once you do one dinner, youвЂ™re hooked!вЂќ The communal kitchen is one feature the patients really apprecicontinued on page 14 Spring 2008 I Arkansas Hospitals 13 continued from page 13 ate. вЂњIt offers a place of camaraderie, a place to share experiences,вЂќ she says. вЂњWhen people are getting cancer treatments, it often makes them feel nauseated, and going out to a restaurant or for fast food is just not a good option. Here, they can have a bowl of chicken soup, a meal that is easy on the stomach.вЂќ Also central to the new facility will be the great room, where people can gather to talk or watch television, a library with up-to-date cancer literature, medical and leisure books to borrow, and computers so they can do research or check their e-mail. And soothing outdoor spaces are also going to be important. вЂњWe actually have a Bridge of Hope designed as a water feature on the property,вЂќ Lisa says. вЂњThere is also a courtyard and veranda where people can spend some time outdoors in a protected environment...where they can meditate, enjoy the sunshine, be at peace.вЂќ вЂњBefore setting out to plan this new facility, we checked with social workers throughout the medical sector to make certain there was truly a need for a facility this size,вЂќ Lynda says. вЂњWe were told that they feel the facility will be filled to capacity from the very first day.вЂќ A History of service The 20 th Century Club was founded in 1941 with the idea of supporting the Red Cross and the USO by making bandages, clothing and food items to be used in the war effort. As the organization matured, its purpose gained a pinpoint focus: working to ease the lives of cancer patients. 14 Spring 2008 I Arkansas Hospitals In 1984, the group identified a need for short-term housing for out-of-town patients coming to Little Rock facilities for cancer treatment. They envisioned a lodge of hope, a safe harbor, and raised money to provide such a place. Soon, they purchased a home in Little RockвЂ™s historic Quapaw Quarter and named it Hope Lodge; it was a place where up to eight radiation and chemotherapy patients at a time could stay at no charge, relieving the financial burden of the cost of lodging during cancer treatment. But patients received much more than a safe harbor at Hope Lodge. They also were graced with homecooked meals, shoulders to lean on, people who would take the time to listen to their experiences, and the compassionate kindness of gentle strangers dedicated to their comfort. For more than 20 years, Hope Lodge served as a beacon of hope for Arkansans (and others) coming to Little Rock from rural communities to receive their cancer treatments. But the cost of upkeep on a historical building is high, and the need for more housing was great. Also, the buildingвЂ™s designation as a historical home made it impossible to add elevators, private baths and room for family caregivers. So, in 2005, the 20 th Century Club sold Hope Lodge and began providing the finances necessary to house cancer patients at the Baptist Health Plaza Hotel. Home-cooked meals and the shoulders to lean on were still provided, but the group became increasingly aware that it needed to provide a dedicated home away from home for the stateвЂ™s cancer patients forced to travel to receive their treatments. The idea of building a state-ofthe-art facility, created specifically with the needs of cancer patients in mind, was born. The capital campaign for the new facility was announced in January at this yearвЂ™s Hope Ball, the groupвЂ™s one and only annual fundraiser that provides the money for the lodgeвЂ™s patient services and daily operations. Into the Future The group is confident that ground for the new facility will be broken in December of this year, and that after a 9-12 month construction period, the new lodge, as yet unnamed, will be ready to receive patients and caregivers. вЂњSo many patients have told us they donвЂ™t know what they would have done without no-cost housing while theyвЂ™re receiving treatment,вЂќ Lisa says. вЂњMany have said that if they hadnвЂ™t had a place to stay, they would have been financially forced to remain at home and would not have been able to travel to receive treatment. That puts our service into true perspective.вЂќ And she sums up the 20 th Century ClubвЂ™s work by reiterating what one patient said, bringing the focus back to their mission: вЂњAfter being diagnosed, I came here for a place to heal. After being shown the love and compassion I received here, IвЂ™m leaving the lodge with a reason to live.вЂќ *** To offer monetary or in-kind donations for the new lodge, please contact steering and planning committee chair Lynda Johnson by e-mail at ljohnson@fec.net or by phone at 501-370-1553, or visit the lodge on the Web at www. hopeawayfromhome.org. вЂў Joint Commission Sentinel Event Alert: Preventing Accidents and Injuries in the MRI Suite Magnetic resonance imaging (MRI) was applied to health care in the late 1970s to provide never-before-seen two- and threedimensional views of body tissue and structure. Today, more than 10 million MRI, or MR, scans are done in the United States each year. While the capabilities of the MRI scanner are well-recognized, its inherent dangers may not be as well known. The most common patient injuries in the MRI suite are burns and the most common objects to undergo significant heating are wires and leads. Other objects associated with burns are pulse oximeter sensors and cables, cardiorespiratory monitor cables, safety pins, metal clamps, drug delivery patches (which may contain metallic foil), and tattoos (which may contain iron oxide pigment). Less common injuries involve pacemakers. The American College of Radiology recommends that implanted cardiac pacemakers and implantable cardioverter/defibrillators should be considered a relative contraindication for MRI. Any exception should be considered on a caseby-case basis and only if the site is staffed with individuals with the appropriate radiology and cardiology knowledge and expertise. Five MRI-related cases in the Joint CommissionвЂ™s Sentinel Event database resulted in four deaths and affected four adults and one child. One case was caused by a projectile; three were cardiac events, and one was a misread MRI scan that resulted in delayed treatment. The Joint Commission offers recommendations and strategies to healthcare organizations for reducing MRI accidents and injuries in its most recent Sentinel Event Alert. The complete Alert may be found at www.jointcommission. org by clicking on the вЂњsentinel eventвЂќ tab. вЂў AHA Services Launches New Web Site AHA Services, Inc. has a new Web site, just launched at www. ahaservicesinc.com. AHA Services, Inc. is a wholly owned subsidiary of the Arkansas Hospital Association, and links AHA members with purchasing, education and management resources. The group purchasing advantages offered by these companies to AHA members saves Arkansas hospitals thousands of dollars each year. вЂњWe launched this Web site to give AHA members a place to easily access the companies we endorse,вЂќ says Tina Creel, vice president of AHA Services, Inc. вЂњWhen people go to our new Web site, they will be able to find information about what each of these companies offers, as well as find ways to contact our endorsed companies if they have questions about their services.вЂќ Also on the Web site are links to all publications available from AHA Services, Inc., and a form where members can select the companies about which theyвЂ™d like to learn more. вЂњWhen people fill out these forms, we will get back to them with the information they seek,вЂќ Creel says. вЂњItвЂ™s a way our members can have 24-hour access to information about our resources, educational Webinars, endorsed companies and the group purchasing plans they offer.вЂќ вЂў Spring 2008 I Arkansas Hospitals 15 Hospital executive/Trustee Leadership Conference Planned for June 18-20 Join your peers for the annual Hospital Executive/Trustee Leadership Conference (formerly named the Arkansas Hospital Administrators Forum/Arkansas Health Executives Forum Leadership Conference) to be held June 18-20 at the Chateau on the Lake in Branson, Missouri. For the first time, the summer conference will offer a forum for hospital executives and trustees to come together to forge a better understanding of healthcare issues. The faculty is highlighted by Stephen Mayfield, senior vice president for quality and performance improvement for the American Hospital Association and director of the AHA Quality Center, who will discuss collaborative leadership for quality and healthcare optimization. Carl Abraham, M.D., an infectious disease specialist from Jonesboro, will discuss community strategies for managing infectious disease risks, with a focus on his experience with MRSA (Methicillinresistant Staphylococcus Aureus). In addition, Karen Craft and Tony Thompson of White River Health System will discuss lessons learned from the devastating tornado that damaged Stone Co. Medical Center in Mountain View earlier this year. Along with the planned educational activities, Branson offers many opportunities for family entertainment вЂ“ golfing, outlet malls, fishing, boating, swimming, tennis, a full range of musical entertainment for all ages and tastes, and much, much more вЂ“ which make the trip to Branson memorable. Registration information will be available soon, but you are encouraged to make hotel reservations now by calling Chateau on the Lake 1-888-333-5253. Mention the Arkansas Hospital Association for special room rates. Contact Beth Ingram at (501) 224-7878 for additional information. вЂў Call for 2008 Diamond Award Entries; April 11 Deadline The 2008 Arkansas Hospital Association (AHA) Diamond Awards Call for Entries has been announced. The open nominations are cosponsored by the Arkansas Hospital Association (AHA) and the Arkansas Society for Healthcare Marketing and Public Relations. Last year, 23 hospitals received awards presented at the AHAвЂ™s Annual Awards Dinner held in conjunction with the AHA Annual Meeting and Trade Show. This yearвЂ™s recipients will receive their awards during the October 9, 2008, Awards Dinner at the Peabody Hotel in Little Rock. The 2008 Diamond Awards honor excellence in hospital marketing and public relations and will be presented in several categories, such as advertising, annual report, Internet Web site, publications, special video production, and writ16 Spring 2008 I Arkansas Hospitals ing. Diamond Awards (for hospitals with 0-99 beds, 100-249 beds and 250 or more beds) will be presented in each category. Entries will be judged by a panel of judges not affiliated with any Arkansas hospital. Nominations and entries, accompanied by appropriate documentation, must arrive at AHA headquarters no later than April 11, 2008. A brochure providing details of the awards competition was mailed to hospital CEOs and marketing and public relations directors. Please call Lyndsey Dumas at (501) 224-7878 with questions about the awards or award process. вЂў 2008 Diamond A ward Call for Entries Sponsored Arkansas Hosp by the ital Associatio n & Arkansas Socie ty for Healthc are Marketing an d Public Relat ions For Excellence in Marketing and P Hospital ub the 2008 Diamon lic Relations, d Award goes to ... Harding University Receives Pre-Candidate Accreditation Status for its College of Pharmacy Harding University in Searcy has earned pre-candidate accreditation status for its College of Pharmacy and will seat its first class of 60 students this fall. More than 245 applications were received for the inaugural class. Students graduating from the four-year program will earn their doctor of pharmacy (Pharm.D.) degree. вЂњA newly instituted doctor of pharmacy program of a college or school of pharmacy must be granted each of two pre-accreditation statuses at the appropriate stage of its development,вЂќ said Dr. Julie Hixson-Wallace, dean of the College of Pharmacy. Representatives from the Accreditation Council for Pharmacy Education (ACPE) conducted the first pre-candidate accreditation visit in mid-Novem- ber, and the first stage of accreditation was approved in January. This means that Harding has properly planned for its doctor of pharmacy program and designed it according to ACPE guidelines and standards. A second site visit will be held in the spring of 2009. That visitation will determine whether Harding has met the requirements to advance to candidate status. вЂў New OIG Advisory Opinions The Department of Health and Human ServicesвЂ™ Office of the Inspector General on January 14 released two advisory opinions regarding arrangements between hospitals and physician groups with potential to violate the antikickback statute. One arrangement allowed anesthesiologists and the other cardiac surgeons to share in a portion of the hospitalвЂ™s cost savings in exchange for implementing cost-saving strategies. In both cases, OIG said it would not impose administrative sanctions on the parties involved, concluding, вЂњProperly structured, arrangements that share cost savings can serve legitimate business and medical purposes.вЂќ The OIG noted that the opinions, which are available at http:// oig.hhs.gov/w-new.html, affect the parties involved and should not be interpreted to apply to all hospitals. вЂў Spring 2008 I Arkansas Hospitals 17 Arkansas Hospital Utilization Moves Downward 2004-2006; Spending Continues to Increase The newly released Hospital Statistics 2008, published by the American Hospital Association, shows that utilization for Arkansas community hospitals trended downward between 2004 and 2006, the latest period for which full-year data is available. Despite the lower use, the total hospital spending continued a steady increase at around 3.5 percent per year for the period. Hospital admissions were off 1.84 percent from 2004 levels, and inpatient days of care fell almost 3.0 percent. Adjusted patient days vided through ArkansasвЂ™ hospitals increased more than 12 percent from 2004 to 2006 and has been up about 110 percent since 2000. Total expenses related to deductibles and co-pays not covered by insurance, plus care provided to self-pay patients who canвЂ™t afford the out-of-pocket costs, has risen 41 percent since 2000. The table accompanying this article compares selected utilization and financial indicators of the stateвЂ™s community hospitals for 2003, 2004 and 2005. вЂў Community Hospital Indicator 2004 2005 2006 Beds Available for Use 9,580 9,389 9,309 382,836 380,067 373,067 Admissions Inpatient Days 2,050,766 2,002,721 1,943,363 Non-Emergency OP Visits 3,621,645 3,707,485 3,818,276 Total Outpatient Visits 4,842,303 4,971,307 5,085,474 Adjusted Inpatient Days 3,266,473 3,269,871 3,174,935 58.6% 58.4% 57.2% Inpatient Surgeries 115,512 126,374 108,651 Outpatient Surgeries 146,074 141,104 144,619 Total FTE Employees 42,629 42,802 43,074 4.76 4.78 4.95 Inpatient Charges $6,513,778,911 $6,962,421,549 $7,346,539,305 Outpatient Charges $3,861,410,128 $4,238,194,924 $4,655,737,561 $10,375,189,039 $11,200,616,473 $12,002,276,866 Bad Debt Expense $565,220,366 $566,152,497 $593,842,343 Charity Care Provided $239,575,478 $293,504,071 $330,914,742 Payments for Patient Care $4,014,406,025 $4,255,599,395 $4,429,611,124 Total Operating Costs $4,015,475,758 $4,225,289,800 $4,437,596,804 Occupancy Rate (Staffed Beds) FTEs/Adjust. Occupied Bed Total Patient Care Charges Patient Care Margin 18 of care, which translates outpatient (OP) visits into patient day equivalents, also dropped about 3.0 percent. However, hospital emergency rooms and outpatient departments continued to get busier as the stateвЂ™s hospitals hit a new record with more than five million outpatient visits. The indicator that continues to present the most concern among hospital officials is growth of services provided to underinsured and uninsured patients. The amount of charity care pro- Spring 2008 I Arkansas Hospitals -0.03% 0.71% -0.18% AHA Will Intervene On PPA Matter In February, the Arkansas Hospital Association (AHA) petitioned the state Insurance Commissioner with a Request to Intervene in a hearing to be held on a December 2007 Order involving the Patient Protection Act (PPA) of 1995. In her Order, Commissioner Julie Bowman said that the Act вЂ“ the stateвЂ™s Any Willing Provider (AWP) law вЂ“ does not require that every Arkansas hospital receive an identical reimbursement for the same services. A pre-hearing conference was held February 14 to decide the standing of AHA and other parties to intervene. The CommissionerвЂ™s order was released following a departmental investigation into a complaint registered by the Arkansas Surgical Hospital involving вЂњdiscriminatory payment ratesвЂќ under the PPA. The law prohibits insurers from imposing a monetary advantage or penalty under a health benefit plan that would affect a patientвЂ™s choice among hospitals. The Commissioner subsequently its payment structure; the burden the found that the PPA does not, and was hospital must carry in order to prove not intended to, equalize all hospital that a violation of AWP occurred; and reimbursements or prohibit negotiawhether the payment differences were tion of reasonable, yet different reimbased upon вЂњquality or cost reasonsвЂќ bursement terms between health plans or were вЂњsolely related to the different and their network providers, based size and scope of services providedвЂќ by upon legitimate criteria. the hospital. Her finding agreed with the AHA The hospital also has asked to interpretation that the Act requires all inspect all evidence that was considproviders be given an equal opportuered by the Commissioner in making nity to participate in a health planвЂ™s her determination. provider network, as long as they are During the February 14 session, willing to accept the terms and conBowman granted Intervenor status to ditions of the plan; but it does not the AHA, the Sisters of Mercy Health address reimbursement issues. System and the Surgical Hospital of In January 2008, Sam Perroni, an Jonesboro and denied similar requests attorney representing Arkansas Surgical from two other petitioners. She also Hospital, requested a hearing before postponed the formal hearing date the Commissioner regarding her order. ARKANSAS TIMES PRODUCTION FAX TIMES from FebruaryFAX 25 to April 14,T2008. Perroni askedARKANSAS the commissioner to takePRODUCTION Q T OOQ FROM: TO: In addition to the Arkansas evidence on several points, including FROM: TO: Arkansas Times CO.: CO.: Arkansas Times Q Surgical Hospital, the primary parties whether the payment differences would CO.: CO.: NN PP Q (501) 375-2985 ext. PH: (501) 375-2985 in theext.hearing will be three affect a patientвЂ™s choice in violation of PH: involved (501) 375-9565 FAX:(501) FAX:Arkansas Blue CrossFAX: FAX: health 375-9565 plans (Arkansas Blue Cross AWP; whether Blue Shield, QualChoice and United Blue Shield actually вЂњnegotiatedвЂќ with PUBLICATION:______________________ ISSUE DATE:____________ nlr bp ISSUE DATE:____________ Health Care). 07 Arkansas PUBLICATION:______________________ Surgical Hospital regarding ARTIST:________ ARTIST:________ вЂў Take your first steps. Again. Employee Benefits Administrators вЂўClaims Administration вЂўHIPAA & COBRA Administration вЂўActuarial Services вЂўFully Insured & Self Insured Products The AutoAmbulator is a sophisticated device unparalleled in its ability to help people replicate normal walking patterns. Whether an individual has been recently injured or has been unable to walk for years, the AutoAmbulator may be used to get people back on their feet. For more information or to refer a patient, call 501-834-1800. Contact Hope Bishop to prepare an Employee Benefit Package that best suits your company. Benefit Management Systems, Inc. 2201 Wildwood Avenue вЂў Sherwood, Arkansas вЂў 501-834-1800 1212 Highway 51 North Madison, Mississippi 39110 601-856-9029 www.benefitmgt.com THIS AD HAS INCURRED PRODUCTION CHARGES THIS AD HAS INCURRED PRODUCTION CHARGES I understand that this proof is provided so that I may correct any typographical errors. I have read and authorized this ad for I understand that this proof is provided so that I may correct any typographical errors. I have read and authorized this ad for Spring 2008 I Arkansas Hospitals publication. The Arkansas Times bears no liability. Production charges will be billed to me on my advertising invoice. 19 publication. The Arkansas Times bears no liability. Production charges will be billed to me on my advertising invoice. 2008 Mid-Management Series Begins April 15 For the third consecutive year, ship skills and competencies. The the Arkansas Hospital Association Mid-Management Series offers the (AHA) will offer a Midbenefit of presenting an excellent Management Certificate Series over opportunity for the new manager an eight-month period, beginning to obtain that training, while at this spring. The the same time first workshop for improving the ARKANSAS HOSPITAL ASSOCIATION the eight-part 2008 hospitalвЂ™s ability series will be held to retain good 2008 April 15, with the managers and Mid-Management final session schedfront-line staff. Certificate Series for uled November This series Managers & Supervisors 20. builds on the A key purpremise that pose of the Midmanagers repreA series of 8 Educational Workshops Management sent their hospioffering skills and knowledge hospital managers need Series is to provide tal and are the as they lead! mid-level hospiprimary influtal managers with ence on employthe tools needed eesвЂ™ desires to to strengthen the work for the direct relationship organization. between them and Studies show their employees, that strained and, in turn, to reduce employee supervisor/employee relationships turnover for AHA member hospiare the No. 1 reason staff memtals. bers leave their jobs, underscoring In addition, the Mid-Management the supervisorвЂ™s ability to create Series provides individuals who an environment of mutual trust, move into management positions, respect and open communication often with little training, the needas a key driver of employee comed assistance in developing leadermitment and productivity. April 15 Leaping from Staff to Management: YouвЂ™re a Manager...Now What? April 16 Leaping from Staff to Management...the Next Steps May 21 The Legal Aspects of Management August 13 Financial Skills for Managers September 23 Dealing with Conflict September 24 Accountability for Results October 22 Getting Results: Be an Inspirational Facilitator, Trainer and Coach November 20 Government Relations 101 series dates and topics include: April 15: Leaping from Staff to Management: YouвЂ™re a ManagerвЂ¦Now What? April 16: Leaping from Staff to Management: YouвЂ™re a ManagerвЂ¦the Next Steps May 21: The Legal Aspects of Management August 13: Financial Skills for Managers September 23: Dealing with Conflict September 24: Accountability for Results October 22: Getting Results: Be an Inspirational Facilitator, Trainer and Coach November 20: Government Relations 101 Series and workshop information has been mailed to AHA member hospitals. It is also available on the AHA Web site at http://arkhospitals.org/calendar. htm. Please contact Beth Ingram at (501) 224-7878 or bingram@arkhospitals.org for additional information or to register for the series. вЂў United Healthcare revises Notiп¬Ѓcation Policy Responding to hospitalsвЂ™ concerns, United Healthcare is revising its new inpatient admissions notification policy to allow contracting hospitals to provide notification of all weekend and federal holiday inpatient admissions by the next business day through June 30, 2008. Hospitals will still need to notify 20 Spring 2008 I Arkansas Hospitals United of any weekday admissions within 24 hours in order to receive full reimbursement of their contracted rates. United also said it will conduct a pilot study of 200 facilities to identify and address any operational issues with the new policy, which went into effect December 3, 2007. Under the policy, hospitals that provide notification between 24 hours and 72 hours of admission will see a reduction of 50 percent of the average daily payment rate for each day preceding the notification. If the notification is provided after 72 hours, or not at all, the reimbursement reduction will be 50 percent of the contracted rate for the entire admission. вЂў We salute 2007 Nursing Compassion Award Winner Patrick Stage, Runner-up Nancy Meneley and all of our nominees! Exciting plans are in the works for the upcoming Nurses Week celebration May 6-12! WeвЂ™re organizing activities across the state to recognize nurses including: Arkansas Naturals Game May 7 Arkansas Twisters Game May 10 Arkansas Travelers Game May 12 Plus retailer discounts and much more! Visit thinkaboutitnursing.com for more information. Thinkaboutitnursing.com Education Recruitment J A C K S O N V I L L E My Choice. C A B O T 2007 NURSING COMPASSION AWARD NOMINEES Name Hospital City Kathy Alsobrooks Arkansas Department Searcy of Health Connie Beaumont Ozark Health Medical Clinton Center Lola Bertling Brookwood Nursing DeQueen & Rehabilitation Cardeattee Area Agency on Aging Pine Bluff Buckhannon of Southeast Arkansas Deanna Marie Drew Memorial Hospital Monticello Jacobs Bullington Linda Chadick Heritage Physician Hot Springs Group Amanda Charles Area Agency on Aging Pine Bluff of Southeast Arkansas Kathy Cheatham Department of Health Melbourne Barbara Clark Millard-Henry Clinic Russellville Liz Cochran Arkansas Hospice North Little Rock Kathy Cox Twin Lakes Medical Mtn. Home Carla Dorr Waldron Mindy Doyle White River Medical Batesville Center Andrew Fletcher Arkansas Methodist Paragould Hospital Kindal Funr Mena Medical Home Mena Health and Hospice John N. Green Mtn. Home Ginger Harris Henderson State Arkadelphia University Ginny Hartnett Mena Regional Mena Health Systems Debra Holmes Oak Ridge Nursing El Dorado Home Pamela Hoskins Golden Living Center Monticello Twyla Jamerson Area Agency on Aging Pine Bluff of Southeast Arkansas Susan Jasay Area Agency on Aging Pine Bluff of Southeast Arkansas Ethel Johnson Christus St. Michael Texarkana Health System Patsy Johnson Lafayette County Lewisville Health Dept David Kelly Area Agency on Aging Pine Bluff of Southeast Arkansas Gail Kyle Woodruff County McCrory Nursing Home Bobbie Lewis Convalescent Home Clarksville Rebecca Lloyd Arkansas Department Blytheville of Health Nancy Meneley Baptist Hospital Little Rock Becky Messenger Carol Mitchell Diane Morgan Vickey Greco Mullally Kay Newton Elizabeth Owens Kathy Phelps Christine Phillips Lori Ratliff Sherry Rickard Janet Riepenhuff Ella Romine Marnie Roy Richard Savage Chyral Sims Sabrina Spalding Michael Springer Patrick Stage Arkansas Hospice Little Rock Delta Memorial Dumas Home Health Central Arkansas Little Rock Veterans Healthcare System St. BernardвЂ™s Jonesboro Medical Center Lincoln County Star City Millcreek of Arkansas Fordyce Hembree Cancer Fort Smith Center Jeffeson Regional Pine Bluff Medical Center Area Agency on Aging Pine Bluff of Southeast Arkansas St. BernardвЂ™s Jonesboro Medical Center Conway Regional Conway Medical Center Arkansas County De Witt Home Care Northwest Medical Bentonville Center Bradley County Warren Medical Center Saint MaryвЂ™s Regional Russellville Medical Center Veterans Hospital Little Rock Little Rock Cardiology Little Rock Clinic Carrie Stark Henderson State Arkadelphia University Debbie Stewart Cave City Nursing Home Cave City Janet Thornton Arkansas School for Hot Springs Mathematics, Sciences & Arts Faye Tompkins Hillcrest Care & Prescott Rehabilitation Center Claudia Kay Turner Crittenden Regional West Hospital Memphis Joyce Vest Area Agency on Aging Pine Bluff of Southeast Arkansas Melissa Vidal St. Vincent Infirmary Little Rock Medical Center Patsy Wald Cindy White Area Agency on Aging Pine Bluff of Southeast Arkansas Betty Wood Dr. Franklin Roberts Magnolia Family Practice Beverly Young Dr. Pennington Warren Family Practice Spring 2008 I Arkansas Hospitals 21 IRS Approves Revised 990, Schedule H The Internal Revenue Service (IRS) has released its final revised Form 990 and 16 related Schedules, including a new Schedule H for hospitals. Agreeing with the sentiment expressed by 307 members of the House of Representatives, the American Hospital Association (AHA) and an overwhelming majority of hospitals that filed comments, the IRS decided to include the reporting of Medicare underpayment and patient bad debt as a community benefit on the new hospital Schedule and granted a one-year transition, making the form applicable for tax year 2009 instead of 2008. Including the underpayments (and allowing additional space for hospitals to calculate and describe the full value of their programs and activities) should promote greater transparency and community accountability. The IRS also eliminated from the form some burdensome questions that were unrelated to community benefit, particularly the chart labeled вЂњBilling Information.вЂќ Some hospitals had commented that providing the information requested would require 1,000 or more hours of staff work. Eliminating that burdensome chart was the centerpiece of the House membersвЂ™ and AHAвЂ™s letters to IRS. The tax agency did not, however, release with the revised Schedule H either the instructions or worksheets that hospitals will need to complete it. The AHA will continue to work with IRS on these instructions and worksheets and will monitor hospitalsвЂ™ progress in collecting and reporting the required information. It will advocate for more time if IRS delays encumber hospitalsвЂ™ ability to respond with complete and accurate information. The biggest disappointment is IRSвЂ™ failure to make questions on joint ventures applicable to the entire tax-exempt sector. Unlike other parts of the tax-exempt sector that joint venture with physicians, hospitals are already regulated by several different agencies. Instead, IRS chose to require only hospitals to answer questions on joint ventures on multiple forms, unnecessarily increasing their filing What to Do Now вЂњIn the face of this uncertainty, the most productive steps taxexempt hospitals can take to be ready for reporting are: to review their charity care, billing, and collection policies to be sure they are up-to-date; to continue efforts to identify and document charity care that would otherwise be in bad debt; and to review their internal community benefit reporting procedures to make sure that they are getting as much information as possible.вЂќ Elizabeth M. Mills, McDermott, Will & Emery, LLP burden and thereby undermining IRSвЂ™ own goal to lessen such burdens. The revised IRS forms and background materials are available at http://www.irs.gov/charities/ article/0,,id=176613,00.html. вЂў Look for Hospital Spending to Double by 2017, CMS Says In a report soon to be released, the Centers for Medicare & Medicaid Services (CMS) estimates that hospital spending will double by 2017, totaling more than $1.3 trillion and making up about a third of all healthcare spending. The information will be released online by the journal Health Affairs (www.healthaffairs.org). 22 Spring 2008 I Arkansas Hospitals The report also shows that in 2007, healthcare spending overall in the nation is estimated to have grown by 6.7 percent to $2.2 trillion, and projections show that rate is expected to hold nearly steady over the next 10 years, to 2017. That figure will represent about 20 percent of the nationвЂ™s GDP (the monetary value of goods and services produced in the US). In addition, the 2007 rate of hospital spending is estimated to have grown by 7.5 percent to $696.7 billion, up 0.4 percentage points from 2006. The report also projects growth in Medicare spending over the next 10 years, as baby boomers age and enter eligibility for Medicare coverage. вЂў AhWd )" aX :aeb[fS^e [` 3:3 GeW Teletouch Paging 6W^[hWd[`Y ahWd A`W ?[^^[a` _WeeSYWe VS[^k Phone 800-770-0183 For Advertising Information contact Katrice summerlin Publishing concepts, Inc. by phone at 501/221-9986 or by email at ksummerlin@ pcipublishing.com tunning When a skillful blend of art and surgical science come together, itвЂ™s beautiful. Call Dr. Suzanne Yee at 501.224.1044 to schedule your consultation. 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Bader, Edward A. Kazemek, and Roger W. Witalis, FACHE вЂњHow do you deal with a board member who dominates most discussions вЂ“ just never stops talking?вЂќ вЂњWhat do you do when a board member regularly ignores the agenda and forces discussion on extraneous issues?вЂќ вЂњWhat can you do with a board member who can be quite offensive in the way he speaks to or attacks some of the other members?вЂќ вЂњWhat should we do about board members who miss more meetings than they attend, donвЂ™t come prepared, or arrive late and leave early?вЂќ These are some of the most common questions we get from board chairs and CEOs that we meet in our work. The board members who exhibit these behaviors are a real challenge for the board and the chairperson. They can and often do have a negative impact on the boardвЂ™s overall effectiveness and efficiency. Far too many board members just grin and bear it or vent their frustrations in private after the board meeting. The first thing to remember is any behavior that interferes significantly with the effective and efficient process of governance should be considered вЂњdisruptiveвЂќ and treated as a matter requiring immediate attention. However, it is also advisable to spend a little time analyzing possible causes for the undesirable behavior of some board members before taking action. ItвЂ™s useful to keep in mind that it is rare for a board member to come to a meeting with a personal goal to disrupt the meeting. For instance, the domineering board member may feel very passionate about his/her ideas and want to make sure others accept his/her perspectives. The member who strays from the agenda may feel that certain issues canвЂ™t wait until a future meeting or isnвЂ™t aware that there are procedures for adding items to the agenda ahead of time. 24 Spring 2008 I Arkansas Hospitals The member who has an offputting or aggressive communication style may be exhibiting normal behavior expected in his/her work environment and feel that being forceful and direct is what board members are supposed to do. Those who are chronic absentees, donвЂ™t prepare, or come late and leave early may be overloaded with other responsibilities and havenвЂ™t faced the fact that they canвЂ™t meet the demands of being a board member. Attempting to understand the reasons behind some board membersвЂ™ behavior usually goes a long way toward figuring out how to modify the behavior. Figuring out how best to deal with disruptive behavior usually falls on the shoulders of the board chair or the chair of the governance committee, with appropriate support from the CEO and other board members. Providing one-on-one, honest, timely, andrespectfulfeedbacktoaвЂњdisruptiveвЂќ board member (sometimes more than once) is the most impactful approach to bring about the desired change. Of course, this is easier said than done. Therefore, itвЂ™s useful to put some вЂњpreventive measuresвЂќ in place to reduce the number of times these uncomfortable conversations have to take place. Preventive Measures 1. Engage the full board in the development of a вЂњcode of conductвЂќ for board member behavior and participation in meetings. Encourage everyone to enforce the codeвЂ™s guidelines during meetings and, periodically, check in at the end of board meetings on how well the guidelines are being followed. 2. During the recruitment process, make sure that board member candidates understand and agree to the boardвЂ™s code of conduct. 3. Incorporate the code-of-conduct guidelines into the annual board self-assessment discussion to hold the board accountable for following them. Also, consider some form of individual board member evaluation as part of the board self-assessment and use that information to counsel disruptive members. This can dramatically reduce disruptive behavior going forward. 4. Educate board members on constructive ways to raise issues, monitor processes, influence the board agenda, and question policies vs. personalities. 5. Distribute the meeting agenda at least a week before the meeting and make sure it spells out clearly the subjects to be covered and the time allotted for each item. Leave some time for discussion on other issues/concerns on the minds of board members. Finally, on those rare occasions when nothing seems to work in modifying the disruptive behavior of a board member, ask the individual to leave the board. This may seem harsh, but remember вЂ“ the overall effectiveness and efficiency of the board comes first. Reprinted with permission from The Governance Institute. Provided by Bader & Associates and www. GreatBoards.org. вЂў 2008 HHS Federal Poverty Guidelines The newest update to the Department of Health and Human Services (HHS) poverty guidelines was published in the Federal Register in January. The guidelines are used as an eligibility criterion for many federal programs that HHS administers. For more information regarding the 2008 poverty guideline, please visit http://aspe.hhs.gov/ poverty/08poverty.shtml. A copy of the Federal Register Notice is available on the National Archives Web site (NARA) at: http://a257.g.akamaitech. net/7/257/2422/01jan20081800/ edocket.access.gpo.gov/2008/pdf/08 256.pdf. вЂў Blue Cross Promotes Executives The Arkansas Blue Cross & Blue Shield (ABCBS) Board of Directors has named P. Mark White as chief executive officer-elect and Michael W. Brown as chief operating officerelect. Both will assume their respective roles on January 1, 2009. In announcing the appointments, Blue Cross chairman Hayes McClerkin said, вЂњThis announcement coincides with the established retirement date for Sharon Allen, current president and COO, on January 29 [this year] and the planned retirement of Robert L. Shoptaw, CEO, at the end of 2008.вЂќ Both Allen and Shoptaw announced their plans for retirement to the board three years ago. Upon his retirement, Shoptaw will assume the position of chairman of the board, succeeding McClerkin, who has served as chairman since 1997. The ABCBS board also announced that McClerkin will become chair of the boardвЂ™s executive committee on January 1, 2009. White and Brown are longtime employees of ABCBS. White, who joined the company in 1970, has served as executive vice president and chief financial officer since 1994. Brown has been executive vice president of external operations since 2006. He has been with ABCBS since 1974 and has held numerous positions during that time. вЂў 2006 Health Spending Eases The federal Centers for Medicare & Medicaid Services (CMS) reported recently that U.S. healthcare spending reached a total of $2.1 trillion in 2006 (the latest year for which figures have been compiled), but the growth rate was the slowest since 1999. Overall spending on healthcare increased 6.7 percent in 2006, compared to 6.5 percent in 2005. However, it continued to outpace overall economic growth and general inflation, which grew 6.1 percent and 3.2 percent, respectively, in 2006. The health spending share of the nationвЂ™s Gross Domestic Product (GDP) remained relatively stable in 2006 at 16.0 percent, up by only 0.1 percentage point from 2005. At the aggregate level in 2006, businesses, households, other private sponsors and governments paid for about the same share of health services and supplies as they did in 2005. However, spending shifts did occur within major sponsor categories due to implementation of the Medicare Part D benefit. MedicareвЂ™s share of federal spending increased from 29 percent in 2005 to 34 percent in 2006, while MedicaidвЂ™s share decreased from 45 percent to 40 percent. Total Medicaid spending declined for the first time since the programвЂ™s inception, falling 0.9 percent in 2006. The introduction of Medicare Part D, which shifted drug coverage for dual eligibles from Medicaid into Medicare, contributed to the decline in Medicaid spending growth. Other reasons for the decline include continued cost containment efforts by states and slower enrollment growth due to more restrictive eligibility criteria and a stronger economy. Hospital spending grew 7.0 percent in 2006, a decrease of 0.3 percentage points from 2005 and a continued deceleration from 2002 (when growth was 8.2 percent). The 2006 growth rate was partially driven by lower utilization of hospital services, especially within Medicare as fee-for-service inpatient hospital admissions declined. Spending for physician and clinical services slowed to 5.9 percent in 2006 due to a deceleration in price growth fueled by a near freeze on Medicare payments to physicians (whose fee schedule update was 0.2 percent in 2006) that influenced private payers as well. The healthcare spending data can be found on the CMS Web site at h t t p : / / w w w. c m s . h h s . g o v / NationalHealthExpendData/01_ Overview.asp. вЂў Spring 2008 I Arkansas Hospitals 25 by Elisa M. White, Vice President and General Counsel, Arkansas Hospital Association Legal Note: Physician On-Call Coverage In 2007, the Department of Health and Human Services Office of Inspector General (OIG) issued Advisory Opinion No. 07-10 approving a nonprofit hospitalвЂ™s arrangement to pay physicians for providing on-call coverage and indigent care services. However, this Opinion is far from a stamp of approval for on-call pay arrangements. In the Opinion, the OIG warned that compensating physicians for providing on-call coverage can create вЂњconsiderable riskвЂќ of improper remuneration in violation of the Anti-Kickback Statute. The Anti-Kickback Statute makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a federal healthcare program. For purposes of the statute, вЂњremunerationвЂќ includes the transfer of anything of value, directly or indirectly, overtly or covertly, in cash or in kind. Because hospitals face substantial civil and criminal penalties for violation of the Anti-Kickback Statute and other fraud and abuse laws, they should thoroughly evaluate the need for an on-call payment arrangement, and any such program should be carefully structured. In Advisory Opinion No. 07-10, the OIG found that although the hospitalвЂ™s compensation arrangement had the potential to generate remuneration prohibited under the federal Anti-Kickback Statute, it would not impose sanctions due to the arrangementsвЂ™ structure and operation. While this Opinion, like all advisory opinions, is legally binding only on the requesting parties, it provides guidance for evaluating the Anti-Kickback Statute risk of a call pay arrangement. The hospital that obtained the Opinion is a nonprofit, tax-exempt institution with an emergency depart26 Spring 2008 I Arkansas Hospitals ment that accepts all patients regardless of their ability to pay. Approximately 25 percent of the hospitalвЂ™s emergency department patients are uninsured, with 1 in 10 of the uninsured emergency department patients subsequently admitted to the facility. A lack of available physicians to provide call coverage had compromised the hospitalвЂ™s ability to meet community needs for emergency services. In an effort to address this problem, the hospital instituted an arrangement under which physicians on its Medical Staff in certain specialties receive per diem payments for participating in a call rotation schedule, responding promptly to emergency department calls, and providing inpatient care to emergency department patients admitted to the hospital until their proper discharge and regardless of their ability to pay. The OIG noted that it may be possible to structure an on-call arrangement to meet the personal services safe harbor, but many of these arrangements, including the one described in this Opinion, fail to fit into this safe harbor because aggregate compensation is not set in advance. Failure to meet an Anti-Kickback Statute safe harbor does not render an arrangement illegal; instead, the OIG will The OIG concluded the Opinion with a final warning that вЂњon-call coverage compensation should be scrutinized closely to ensure that it is not a vehicle to disguise payments for referrals.вЂќ take into account all of the facts and circumstances in determining whether an Anti-Kickback violation has occurred. According to the Opinion, the key inquiry in analyzing on-call and indigent care payment arrangements is whether the compensation is: (i) fair market value in an armвЂ™s-length transaction for actual and necessary items or services; and (ii) not determined in any manner that takes into account the volume or value of referrals or other business generated between the parties. The OIG found the compensation arrangement in Advisory Opinion No. 07-10 вЂњpresents a low risk of fraud and abuse,вЂќ noting the following facts: вЂў The hospital certified that the payments under the arrangement were consistent with fair market value for the actual services needed and were provided without regard to referrals or other business between the parties. вЂў Although different per diem rates were paid for each specialty, the rates varied based upon the different extent of the uncompensated responsibilities that are likely to fall on physicians in that specialty. вЂў Each physician was required to provide 1ВЅ days of uncompensated on-call coverage monthly. вЂў All physicians in a specialty were paid the same per diem rate regardless of their referral patterns to the institution. вЂў All Medical Staff physicians in a given specialty were given the ability to participate. вЂў Monthly call obligations were distributed as evenly as possible. вЂў Physicians were required to see each patient regardless of their ability to pay. вЂў Prompt completion of medical record documentation was a condition to continued payment under the arrangement. вЂў An independent analysis by a reputable consultant concluded that the compensation was fair market value for the services furnished. вЂў All costs of the on-call/indigent care payment arrangement were paid by the hospital and not by a federal healthcare program. вЂў Prior to entering into the arrangement, the emergency department was understaffed and the emergency care was being outsourced, so there was proof that the hospital had a legitimate unmet need for on-call and indigent care services. вЂў Since inception of the arrangement, the hospital has experienced greater efficiency in the emergency department, improved on-call performance, and greater overall patient satisfaction. In addition to listing helpful fac- tors in the arrangement at issue, the Opinion also noted certain problematic call payment structures, including without limitation, вЂњlost opportunityвЂќ payments that do not reflect bona fide lost income and compensation for professional services for which the physician receives separate reimbursement from insurers or patients. The OIG concluded the Opinion with a final warning that вЂњon-call coverage compensation should be scrutinized closely to ensure that it is not a vehicle to disguise payments for referrals.вЂќ Advisory Opinion No. 07-10 can be accessed through the OIG Web site at http://oig.hhs.gov/fraud/ advisoryopinions/opinions.html. Suggested topics for the Legal Note may be submitted to elisawhite@arkhospitals.org. The Legal Note is provided solely for informational purpose and does not constitute legal advice. Readers are encouraged to consult with their own attorneys about any legal issues, including those discussed in this article. вЂў Will Older Physicians Opt Out of Patient Care? by Kurt Mosley New Survey Sounds Warning What would happen if physicians age 50 or older suddenly decided to turn in their stethoscopes? Given the sheer number of physicians in this age cohort, the results would be disturbing, to say the least. According to the American Medical Association (AMA), 47 percent of all doctors in the U.S. вЂ“ some 387,160 physicians вЂ“ are 50 or above. Of the 4,097 physicians in Arkansas who are active in patient care, 1,700 (41 percent) are over 50. Clearly, any exodus of older physicians from medicine would incapacitate our current healthcare delivery system, both nationally and in the Natural State. While no such immediate exodus is anticipated, the aging of the physician population is cause for concern. Merritt, Hawkins & Associates tracks the concerns and career plans of older physicians through our Survey of Physicians 50 to 65 Years Old. The 2007 Survey was recently released and reveals some interesting findings. Fourteen percent of the 1,175 physicians we surveyed plan to retire in the next one to three years. Another seven percent plan to find a medical job in a non-clinical setting, while three percent plan to find a job in a non-medical setting. In all, about one-quarter of doctors surveyed said they plan to opt out of patient care sometime in the next one to three years. In addition, 12 percent said they plan to work part-time (20 hours a week or less), eight percent plan to significantly reduce their workload and four percent plan to work locum tenens. People do not always do what they say they will in surveys. Nevertheless, these numbers are sobering. Should only ten percent of older physicians retire or opt out of patient care in the next one to three years, tens of thousands of doctors would be removed from the national physician work force, and Arkansas could be severely impacted. Should an additional ten percent choose to work part-time or slow down significantly in the next one to three years, many additional FTEs would be lost. At that point, the number of exits from medicine would exceed the number of entrants. Given that the U.S. already is experiencing a physician shortage in many areas, a significant reduction in the number of older physicians in the near future would be particularly inopportune. Consider that virtually all of the major presidential candidates support health policies that would extend healthcare access to millions of people who lack such access now. The enhanced demand for medical services would tax the current physician workforce and very likely would overburden a workforce diminished by retirement and other forms of attrition. Though this fact often seems to fly under the radar, health policies must be implemented by people, and any policy that expands access without also expanding the supply of physicians, nurses and other health professionals will most likely fall short of expectations. By extension, any plan that causes a significant number of older doctors to walk away from their patient career also will be unlikely to succeed. A copy of Merritt, Hawkins & AssociatesвЂ™ 2007 Survey of Physicians 50 to 65 Years Old is available at www.merritthawkins.com. Kurt Mosley is vice president of business development for Merritt, Hawkins & Associates, a physician search firm and a division of AMN Healthcare, the largest healthcare staffing company in the United States. He can be reached at kmosley@mhagroup.com or you may call him at (800) 876-0500. вЂў Spring 2008 I Arkansas Hospitals 27 Action Ideas for Increasing staff Participation at Meetings by Susan Keane Baker Oh no. ItвЂ™s time again for the dreaded staff meeting. YouвЂ™ve worked on the agenda, youвЂ™ve estimated how much time each discussion item should take, and youвЂ™ve even brought in donuts. And you know that some of your colleagues are going to sit there stone-faced throughout the meeting. What are they thinking? That they could be getting their real work done if not for these meetings you insist on having? Are they replaying last nightвЂ™s episode of Law and Order in their minds? Or have they, unbeknownst to you, mastered the skill of sleeping with their eyes open? Something needs to be done! Encouraging greater staff participation is risky, because it means giving up some of your control, but your meetings will be more relevant and better learning experiences for everyone вЂ“ including you. To increase participation at meetings, consider the following strategies: 1. Give your listeners a reason to care by taking time to explain why the subject being addressed is important. And be excited yourself about the topic and the meeting. DonвЂ™t serve donuts every time вЂ“ create some anticipation by providing interesting 28 Spring 2008 I Arkansas Hospitals refreshments. If your local newspaper or magazine publishes a вЂњbest ofвЂќ column, purchase the items there and bring it in along with the article. вЂњHere is the best coffee cake in the city, according to the Boston Globe.вЂќ 2. Make it easy for staff to contribute agenda items whenever it occurs to them. At Dr. Paul QuartararoвЂ™s practice in Stamford, Connecticut, a box marked вЂњAgenda Items for Staff MeetingвЂќ was conspicuously visible at the registration area. As patients raised questions or concerns, staff members could jot a quick note and toss it into the box. This was far more effective than someone asking before each meeting: вЂњAnything you want to talk about at the staff meeting?вЂќ The typical response had been, вЂњOh yeah, there was something, but now I forget what it was.вЂќ 3. Elton Mayo wrote: вЂњThe extent to which we do or do not fully contribute is governed more by attitude than necessity, fear or economic influences.вЂќ You can change attitudes by letting your staff become the experts by involving them in some advance research. Ask them to contact colleagues at two other organizations to see how an issue is being addressed. When patient-related issues arise, ask them to take on the role of the patient. One manager purchased ear mufflers and asked for volunteers to wear them around their home for a weekend (to simulate and understand being hard of hearing). The employees found that they began to agree with statements without understanding them and started to give any answer rather than saying вЂ“ for the ninth time вЂ“ вЂњWhat did you say?вЂќ The reports of their experiences made for lively conversation at the staff meeting, with the result that all staff members were alerted to speak more slowly, repeat their questions, and even write down questions when they received a nonsensical reply from a patient. 4. Hold a dress rehearsal. Ask staff members for their ideas in one-on-one discussions. When you hear something that would benefit everyone, ask the person to state their thoughts again when the group meets. If someone expresses fear about speaking in front of the group, ask permission to quote them in the meeting. вЂњWhen Frank and I spoke about this, he mentioned ...вЂќ 5. Place staff membersвЂ™ names on the agenda as co-presenters. A new policy is listed as being discussed by a physician leader and a staff person, for example. Both should be aware of this of course. The physician and staff member should have a conversation ahead of time during which the physician reviews the policy and the staff member plans the reaction. The staff memberвЂ™s role can be to co-present the information or be the first to respond with questions or comments. 6. Present the information in different ways. Tie the topic to something you read in the newspaper. In a January 2001 Training and Development article titled вЂњTen Steps to Being Positively Engaging,вЂќ Basil Deming suggested that meeting participants be asked to paraphrase or explain what has just been said. If they canвЂ™t do it after hearing it, they canвЂ™t be expected to do it later, such as back on the job. Deming recommended vignettes, case studies, role play or simulations as techniques that can take information from dull and dry to dynamic and relevant. Ask participants to recap what is already known before delving into the new material. DemingвЂ™s example: вЂњLast week, we learned from Human Resources that there are two types of adverse actions. What are they?вЂќ (Reply) вЂњYes, performance based and conduct based actions. What does the term performance-based action mean?вЂќ (Reply) вЂњYes, the problem lies in a personвЂ™s performance of job duties, for example, repeatedly failing to meet reasonable work deadlines. This morning, weвЂ™re going to take a closer look at performance-based actions.вЂќ 7. When a staff member makes a presentation, take the time to send a personal note of thanks. This will inspire future contributions. I once worked with a Vice President of Nursing, Terry Roderick. Whenever I made a presentation for the hospitalвЂ™s board of directors, Terry would send me a handwritten note afterwards telling me what she liked about my presentation. At one point, I wrote back to her: вЂњTerry, I have to do a good job вЂ“ because I want you to send me a note!вЂќ 8. Ask for advice from those who attend. вЂњWhat could we do to make the staff meetings more interactive?вЂќ Commit to trying the ideas you hear. The participation you create through these techniques will mean that no one will be sleeping at your meetings! Copied with permission of the author, Susan Keane Baker. Source: www.susanbaker.com. EditorвЂ™s Note: The Arkansas Hospital Association is proud to announce that Susan Keane Baker will offer a leadership workshop on вЂњExceptional Patient CareвЂќ October 8 as part of our new Annual Meeting schedule. Watch your mailbox for upcoming information about the AHAвЂ™s 78th Annual Meeting and Trade Show October 8-10 in Little Rock! вЂў Spring 2008 I Arkansas Hospitals 29 Arkansas PAC Contributions Recognized During 2007, the Arkansas Hospital Association Political Action Committee (AHAPAC) received $21,334.50 in contributions, primarily from hospital executives and employees throughout the state. These donations, which are shared between the Arkansas Hospital Association and the American Hospital Association, make possible the financial support those organizations are able to provide to political candidates seeking state or federal elective offices. Contributions of any amount from all contributors to the AHAPAC are seriously needed and deeply appreciated. However, special acknowledgement is given to individuals who contribute at certain threshold levels. Those individuals qualify for recognition as members of the American Hospital AssociationвЂ™s Ben Franklin Club, ChairmanвЂ™s Circle or its Capitol Club. Ben Franklin Club membership is awarded for individuals who contributed $1,000 or more to Ben Franklin Club: Phil Matthews, Arkansas Hospital Association Bo Ryall, Arkansas Hospital Association ChairmanвЂ™s Circle: Don Adams, Arkansas Hospital Association Jonathan R. Bates, M.D., Arkansas ChildrenвЂ™s Hospital Bill Bradley, Washington Regional Medical System Roger Busfield, Arkansas Hospital Association, Retired David Cicero, Ouachita County Medical Center Tina Creel, AHA Services, Inc. Paul Cunningham, Arkansas Hospital Association Dean Davenport, BKD, LLP, Retired Bob Gant, Conway Regional Medical Center John A. Guest Russell D. Harrington, Jr., Baptist Health Michael D. Helm, Sparks Health System, Retired Timothy E. Hill, North Arkansas Regional Medical Center Beth Ingram, Arkansas Hospital Association Luther J. Lewis, Medical Center of South Arkansas Penny McClain, Siloam Springs Memorial Hospital Raymond W. Montgomery, II, White County Medical Center John Neal Scott Peek, Chambers Memorial Hospital Ron Peterson, Baxter Regional Medical Center Ronald K. Rooney, Arkansas Methodist Medical Center Stephen C. Smart, Medical Center of South Arkansas 30 Spring 2008 I Arkansas Hospitals AHAPAC. ChairmanвЂ™s Circle membership is awarded for individuals who contributed $500 or more to AHAPAC during the year, while the Capitol Club membership is earned with a $250 donation. Individuals from Arkansas who qualified for membership in each of these clubs in 2007 are shown below. Douglas Weeks, Baptist Health Medical CenterLittle Rock Elisa White, Arkansas Hospital Association Ted Woodrell, Sparks Health System Capitol Club: Robert P. Atkinson, Jefferson Regional Medical Center Robert R. Bash Gary L. Bebow, White River Health System Vincent B. DiFranco Richard L. Goddard, Monticello Edward L. Lacy, Baptist Health Medical CenterHeber Springs Mark Lowman, Baptist Health James L. Magee, Piggott Community Hospital Mike McCoy, Saint MaryвЂ™s Regional Medical Center Larry Morse, Johnson Regional Medical Center Ben E. Owens, St. Bernards Healthcare Barry Pipkin, Universal Health Services Herbert K. Reamey, III, Ozark Health Medical Center Diane Roberts, North Arkansas Regional Medical Center Nancy Robertson, Robertson Cook Communications, Inc. Allen F. Smith, Baptist Health Rosiland Smith, Arkansas ChildrenвЂ™s Hospital Russ D. Sword, Ashley County Medical Center John Tucker, Five Rivers Medical Center вЂў Save the Date! May 22, 2008 Hot Springs Convention Center - Hot Springs, AR Health Care Quality: The Future is Connected atient care. ItвЂ™s about more than one facility, or one clinic. ItвЂ™s about connection....between providers, patients, and the entire health care community. Join us this May to learn innovative, creative new ways to improve health care across the state through вЂњconnections in care.вЂќ P Find out more: www.afmc.org/qualityconference 1-877-375-5700 This material was prepared by the Arkansas Foundation for Medical Care Inc. (AFMC), the Medicare Quality Improvement Organization for Arkansas, under contracts with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services, and the Arkansas Department of Human Services, Division of Medical Services. The contents presented do not necessarily reflect CMS and Arkansas DHS policies. The Arkansas Department of Human Services is in compliance with Titles VI and VII of the Civil Rights Act. Spring 2008 I Arkansas Hospitals 31 by Paul Cunningham, Senior Vice President, Arkansas Hospital Association Hospitals Urged to Provide Patients with ACASA Materials Hospital emergency rooms are places where people tend to show up in pretty dire conditions following traumatic injury. Face-to-face encounters between doctors, nurses (and other hospital ER workers) and patients who have survived some type of horrific traumatic episode are as common as the miracles that spring from the care and assistance those healthcare professionals render. Those miracles donвЂ™t just happen, theyвЂ™re the byproduct of ER teams who not only are experts at repairing bodies, but also are ready, willing, able and committed to making sure everything that can be done to fully restore patientsвЂ™ minds and spirits to a pre-trauma state is done. That mind-set applies to all victims of trauma, whether they happen to be suffering the aftereffects of automobile accidents, gunshot wounds, fires and falls, which are all too common, or if they are victims of another type of trauma, one that occurs too often yet is mentioned less frequently. TheyвЂ™re the victims of sexual assault, one of the most traumatic experiences a person can endure. A few years ago, the U.S. Department of Justice (DOJ) published statistics showing that 1.3 women are raped in the U.S. every minute. That translates to 78 rapes per hour, 1,871 per day, 5,619 per month and 683,000 per year. Those facts are a little dated, so the actual numbers are probably greater, and they donвЂ™t include sexual assaults against men. Plus, they reflect only the reported rapes. A big majority go unreported. Chances are that a victim of a reported rape will get medical treat32 Spring 2008 I Arkansas Hospitals ment. Most do, and they tend to get it in a hospital ER, which makes those patient encounters much more prevalent than you might expect. In fact, the DOJ says that sexual assault is the fourth leading cause of violencerelated non-fatal injuries treated in hospital ERs. But these ER patients are treated a bit differently than others. When a sexual assault victim presents to a hospital ER, the medical staff first assesses and responds to any serious or life-threatening injuries, as they do for all ER patients. However, after the patient is stabilized, treated and readied for release, transfer or admission, there might also be a formal evidentiary examination, depending on the patientвЂ™s consent, the applicability of state laws and the judgment of law enforcement officials or prosecutors as to whether an examination will be useful and can be justified. Beyond the immediate care, some hospitals employ certified Sexual Abuse Nurse Examiners (SANE), nurses who are specially trained to care for sexual assault victims, and a few have SANE programs that focus on counseling patients about needs that extend beyond the initial care, like referral to a private physician for follow-up case care, counseling services and other providers in the community. Fortunately, thereвЂ™s now one more step that all the stateвЂ™s hospitals can take to make things a little easier for the sexual assault victims who come to them needing care. The Arkansas Coalition Against Sexual Assault (ACASA) recently contacted the Arkansas Hospital Association about assistance with making information readily available to better inform victims of sexual assault of their rights. ACASA has received a grant from DOJ for that purpose and is working primarily with police agencies throughout the state on this effort. However, because so many sexual assault victims are treated in hospital ERs, the group also has requested the hospitalsвЂ™ assistance in the form of posting materials in their ERs and distributing informational cards to victims who are treated there. The materials include a poster holding tear-off slips, both of which contain a listing of victimsвЂ™ rights, such as the availability of assistance, including medical, housing, counseling, financial, social, legal and emergency services; eligibility for compensation under the Arkansas Crime Victims Reparations Act; protection of the victim, including protective court orders; and access to public records related to the case. The AHA board heard about the request during its January 11 meeting and quickly approved a motion to encourage all member hospitals to assist. ACASA will soon be contacting hospital CEOs and providing the materials. Cooperating by helping to get this information into the hands of sexual assault victims sounds like a small thing, but it could open some doors that will allow more victims to make their own miraculous recovery from effects of this senseless, violent, brutal crime which could otherwise stay with them for a lifetime. For more information, go to http://www.acasa.ws/. вЂў Many Labor-Related Resources Available from American Hospital Association The current edition of the want to download a recent release attempt to pressure a targeted American Hospital AssociationвЂ™s titled Corporate Campaigns: Five hospital or health system to publication Health Care Labor Questions Every Hospital Leader expedite an organizing campaign Report may be of particular interShould Ask to Prepare for and by means of a вЂњcard checkвЂќ est to hospital governance board Manage a Corporate Campaign. or similar process, instead of a members, as they seek to stay This eight-page resource was private ballot election. Often, on top of labor activities, the unusually aggressive trends and events affecting tactics impede the abilhealthcare. The publicaity of a hospital to serve (EALTH#ARE,ABOR2EPORT tion provides updates on the short and long-term Labor activity, trends & events !(!SUPPORTSOVERTURNING the latest regulatory, legneeds of its patients or LIMITATIONSONEMPLOYER SPEECHONUNIONORGANIZING islative and marketplace communities. T developments, including The resource is for important findings from AHA members, and it Five Questions National Labor Relations assesses whether a hospiEvery Hospital Leader Should Ask Board (NLRB) statistics tal is vulnerable to a camto Prepare For and Manage a Corporate Campaign and other survey data. paign and what its parThe newsletter is ticular vulnerabilities are, produced jointly with including its relationships ASHHRA, the AHAвЂ™s with community leaders human resources perand institutions. sonal membership group, and prepared for the AHA by F. Curt The resource also offers guidIRI Consultants to Management, Kirschner, Jr., a partner in the ance about how a hospital can Inc. San Francisco office of the law respond to a corporate campaign, When you look for the curfirm of OвЂ™Melveny & Myers. It including possible lawsuits, if a rent issue of the newsletter at examines вЂњfive questions every union engages in unlawful activithe AHAвЂ™s Web site, www.aha. hospital leader should askвЂќ in ties. It may prove particularly org, also have a look at other preparing for and responding to helpful for hospital trustees who resources designed to help hospia corporate campaign. want to understand and prepare tals address employee workplace Corporate campaigns are a their hospitals for union corpoissues. For example, you might unionвЂ™s public, multi-faceted rate campaigns. 43560_P01_08 7/3/07 11:53 AM Page 1 &EBRUARY h7HATCANNURSES DOTOBRINGRATIOS TOYOURSTATEv ASKS#.!../# he AHA on January 16 п¬Ѓled an amicus brief in Chamber of Commerce v. Brown, a U.S. Supreme Court case that is attempting to overturn a California law forbidding employers to use any state funds to inп¬‚uence employees about whether to select a union as their bargaining representative. Hospitals, the AHAвЂ™s brief points out, are at the center of the caseвЂ™s employer free speech controversy because they rely on Medicaid dollars and other state funding programs and are frequent subjects of union organizing drives. вЂњWhen hospitals are deterred by the state from communicating to their employees about the appropriate hospital-employee relationships within their community,вЂќ the brief concludes, вЂњit is not just the hospitals that are adversely affected. The employees who lack the information necessary to make a fully informed choice also are harmed.вЂќ A copy of the AHAвЂ™s amicus brief in the case can be found on the AHAвЂ™s Web site at http://www.aha. org/aha/content/2008/pdf/080116-amicusbrief.pdf Legal proceedings to overturn the CA law, AB 1889, were initiated in 2002 by the U.S. and California Chambers of Commerce, California Hospital Association, several other associations and speciп¬Ѓc employers. These groups argue, !(!(EALTH#ARE,ABOR2EPORT&EBRUARY Nurse stafп¬Ѓng ratios are вЂњthe only safe stafп¬Ѓng solution for nurses and patientsвЂќ declares a California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) marketing brochure. The CNA/NNOC recently launched a direct mail campaign to gain support among nurses for the unionвЂ™s efforts to organize and enact mandated stafп¬Ѓng ratios legislation around the country. As the brochure explains, вЂњThe California law has brought renewed hope and energy to all RNs. RNs across the nation have seen the future вЂ“ and they know it works.вЂќ Hospitals will want to be familiar with the CNA/NNOC organizing and advocacy efforts and pay attention to the rhetoric used as they get actively involved in the stafп¬Ѓng ratios debate. among other things, that the law is preempted by the National Labor Relations Act (NLRA) вЂњbecause it regulates noncoercive employer speech that Congress speciп¬Ѓcally intended to protect by leaving it free from governmental regulation.вЂќ The NLRA protects and encourages noncoercive employer speech about union organizing so that employees may make an informed decision in exercising their NLRA right to join or refrain from joining a union. As the groups argue in their brief, вЂњ[u]nder settled preemption principles, CaliforniaвЂ™s backdoor effort to alter supreme federal labor policy cannot stand.вЂќ Any other outcome, the brief concludes, would allow for the вЂњbalkanization of The brochure speciп¬Ѓcally attacks вЂњhospital industry rhetoricвЂќ arguing that nurse stafп¬Ѓng ratios in California are a вЂњп¬‚oor, not a ceiling вЂ“ and not a substitute for acuity.вЂќ CNA/NNOC also suggests that вЂњno hospitals have closed due to the ratios.вЂќ According to the brochure, when challenged by a judge, вЂњthe hospitals were unable to produce any evidenceвЂќ to support the claim that hospitals have had to close as a result of the stafп¬Ѓng ratios mandate. The brochure targets nurses with вЂњwhat you can do with NNOC/CNA to bring ratios to your state.вЂќ In the brochure, CNA/NNOC reports that nurse stafп¬Ѓng ratio bills similar to CaliforniaвЂ™s вЂњare being introducedвЂќ in Arizona, Illinois, Maine, Ohio, and Texas and that RNs in other states вЂњare also actively working to enact mandated ratios.вЂќ The brochure includes a detachable response card that nurses can return to become a member of CNA/NNOC or for Continued: See OVERTURNING, Page 2 Continued: See RATIOS, Page 4 CORPORATE CAMPAIGNS: F. CURT KIRSCHNER, JR., OвЂ™MELVENY & MYERS LLP for the AMERICAN HOSPITAL ASSOCIATION 0AGE ВҐ)2)#ONSULTANTSTO-ANAGEMENT)NC вЂў Government Collects $2.2B in Settlements, Judgments in Fiscal Year 2006 During fiscal year 2006, the federal government won or negotiated approximately $2.2 billion in judgments and settlements, according to the Health Care Fraud and Abuse Control ProgramвЂ™s (HCFAC) annual report released by the OIG. Approximately $1.5 billion was transferred to the Medicare Trust Fund as a result of these efforts. In addition, $177.1 million in federal Medicaid money was transferred separately to the Treasury as a result of these efforts. The HCFAC account has returned more than $10.4 billion to the Medicare Trust Fund since the program began in 1997. According to the report: вЂў U.S. AttorneysвЂ™ Offices opened 836 new criminal healthcare fraud investigations вЂў Federal prosecutors had 1,677 healthcare fraud criminal investigations pending вЂў Criminal charges were filed in 355 cases вЂў A total of 547 defendants were convicted for healthcare fraud вЂў The Department of Justice opened 915 new civil healthcare fraud investigations and had 2,016 civil healthcare fraud investigations pending at the end of the fiscal year. вЂў Spring 2008 I Arkansas Hospitals 33 by Pam Brown, RN, BSN, CPHQ, and William E. Golden, M.D., MACP, Arkansas Foundation for Medical Care Benchmarking to High Performers Drives Effective Improvement In the late 1990s, national data ers are using a different standard not impact other parts of the indicated that Arkansas hospitals to benchmark their performance. country. However, standards of trailed national averages on many вЂњAchievable Benchmark of Care,вЂќ care are not regionally defined performance measuresвЂ…вЂ“вЂ…but that developed by the University of within the United States. The is no longer the case. Substantial Alabama at Birmingham, shows same standard of care is expecteffort was made to disseminate that identification of perfor- ed whether the hospital is in clinical standards, as well as mance by providers in the top California, Utah, Iowa, New the basic techniques in process 10 percent of measured facilities York or Arkansas. change and quality improvement. gives an indication of achievThe Arkansas Foundation Those activities paid off: aggre- able performance by a healthcare for Medical Care (AFMC) uses gate performance by Arkansas facility. Thus, quality improve- the nationwide, top 10 percent hospitals are rising from below ment initiatives develop a vision standard for benchmarking to average and are coming closer to of performance beyond the aver- communicate performance to achieving the national average on age, but to a level of excellence Arkansas hospitals. The recently many indicators. However, as Ar- as defined by what has been completed Medicaid Inpatient kansas facilities and clinics have achieved by other institutions. Quality Incentive program gained comfort in clinical meaAt the state level, Arkansas pro- rewarded institutions for achievsurement and quality improve- viders seem motivated when they ing performance at ArkansasвЂ™ ment, it has become clear that are presented with blinded data 75th percentile for the previous pursuit of average performance is that show their state rankings year. Many institutions respondnot sufficient to make long-term and also identify their relation- ed with strong internal qualmeaningful change. ship to the stateвЂ™s top 10 percent ity improvement initiatives to Quality improvement activities in performance, since local peers achieve this benchmark through originally focused on comparing often experience similar barriers redesign of their clinical prolocal compliance to national guidelines for clinical care. Rates of FIGURE 1. performance for a particular provider were compared to national, 100.00% state and, in some casPPS 90th PERCENTILE: 89.84% es, county averages. PPS AVERAGE: 79.98% Outlier status tended to focus on substantial deviation from aver50.00% age performance. But too many вЂњaverageвЂќ clinical units nationwide simultaneously engage in quality im0.00% X2 X1 W2 W1 V2 V1 U2 U1 T2 T1 S2 S1 R2 R1 Q2 Q1 P2 P1 O2 O1 N2 N1 M2 M1 L2 L1 K2 K1 J2 J1 I2 I1 H1 G2 G1 F2 F1 E2 E1 D2 D1 C2 C1 B2 B1 A2 A1 provement measures; Individual PPS hospital rates thus, pursuing the average is a prescription for continual lagging on the clinical performance to improvement. Similarly, when cesses. (Figure 1 displays blinded scorecard. national benchmarking first aggregate data by facility.) began to be utilized, a defense Choosing a higher response to discount any gaps in Benchmarking challenges performance usually focused on standard One problem with a benchIncreasingly, Arkansas provid- regional influences that might mark approach can be the lack of 2006 Appropriate Care Measure (ACM) rates for Prospective Payment System (PPS) Arkansas hospitals 34 Spring 2008 I Arkansas Hospitals data for some important issues in healthcare delivery. A lack of benchmark data is especially problematic in performance related to patient safety. It is understandably difficult for an institution to find meaningful comparative data on rates of falls or other вЂњavoidableвЂќ events. It is hoped that the creation of regional Patient Safety Organizations (PSOs) could protect the reporting of such data but still allow organizations to compare their efforts with appropriate peer groups. Another dilemma is that it is often difficult to understand what is being measured and the source of the data. In Arkansas, hospitals have made great progress in improving their performance in core measures specified by the Centers for Medicare & Medicaid Services (CMS), which include acute myocardial infarction, heart failure, pneumonia and the surgical care improvement project measures. As a state, Arkansas has improved in these measures, and several providers are at or above the national average. Yet, reports released from other national benchmarking organizations continue to rank Arkansas as 48th in the management of heart disease, stroke and other measures. Why does one report show that Arkansas hospitals are improving, while another indicates they are falling behind? Often the data used differs, including the components being measured, time frame of the data, and whether administrative or actual medical records are assessed. In addition, some rankings include only inpatient information, while others look at both inpatient and outpatient data. Some benchmarking reports are based on patient interviews, while others include subjective and objective information. Benchmarking uses With a clear understanding of what constitutes each benchmarking report, providers and facilities can use these tools to accelerate and guide performance. However, some organizations use benchmarking for more than regulatory compliance: вЂў Benchmarking can be used in strategic managementвЂ…вЂ“вЂ…for clinical excellence, as well as business or marketing goals. вЂў Benchmark data drives many of the payor incentive pro- where health professionals can share experiences and processes that have led to breakthroughs in clinical performance. Thus, benchmarking can identify highperforming institutions that can serve as models and resources for other facilities. Subsequent peer-to-peer networking can promote sharing of best practices and advice obtained from hands-on experience on how to best support change in a clinical setting. When individual hospitals show that they can reach higher levels of performance, it fosters a вЂњcan doвЂќ attitude and motivates others to ask, вЂњHow can we achieve that level of performance?вЂќ When individual hospitals show that they can reach higher levels of performance, it fosters a вЂњcan doвЂќ attitude and motivates others to ask, вЂњHow can we achieve that level of performance?вЂќ grams that roll out to the providers, where payments can be based on whether providers achieve upper percentiles in performance. Ultimately, benchmark data should guide models for improvement and not just be targets to be achieved. Programs such as the Collaborative Area Learning Sessions (CALS), organized by AFMC, can provide a forum References 1. Kiefe CI, et al. Improving quality improvement using achievable benchmarks for physician feedback: A randomized controlled trial. JAMA. 2001 June; 285(22): 2871-9. 2. Weissman N W, et al. Achievable benchmarks of care: the ABCв„ўs of benchmarking. Journal of Evaluation in Clinical Practice. 1999; 5(3): 269-81. вЂў Spring 2008 I Arkansas Hospitals 35 Healthcare CEO Survey Shows Financial Challenges are Top Concern Rising labor costs, bad debt and other financial challenges are the current top concern of hospital CEOs, according to a survey by the American College of Healthcare Executives (ACHE) released January 7. Second on the list was providing care to the uninsured; third was hospital-physician relationships. According to survey results, worries about Medicaid funding and coping with rising costs for both staff and supplies tied as the top issues contributing to CEOsвЂ™ financial worries. The survey was conducted by both phone and fax in the fall of 2007. вЂў State Revises Death Certificate Form The Arkansas Department of Health (ADH) has notified the Arkansas Hospital Association that, effective January 1, 2008, all certifications of deaths must be completed on the new, revised Death Certificate form provided by the ADH, Vital Records Division. The new pads of certificates have been distributed to all County Health Units and funeral directors. The ADH is asking all hospitals that store blank pads (e.g. at nursing stations, in the emergency room, or in the HIM department), to ensure that the current form is replaced with the new form. Pads may be ordered from Vital Records County Registrars in local County Health Units. Questions should be directed to Mike Adams, Vital Records State Registrar (501) 661-2371, Grace Carson, Assistant Director (501) 661-2275 or Steve Whisnant, Field Representative (501) 661-2635. вЂў experience the difference Hospitals in Arkansas Have Another Choice Eide Bailly is pleased to offer Arkansas hospitals a new option. If you thought there wasnвЂ™t a difference in Audit Firms, come discover the Eide Bailly experience. Eide Bailly serves more than 1,200 health care clients in 22 states, including Arkansas. Our clients benefit from our health care expertise and friendly service. Together we can turn your challenges into possibilities. Many possibilities await you. Call or visit our website today. 800.280.0354 w w w. e i d e b a i l l y. c o m Rick Wagner, Partner PEOPLE. PRINCIPLES. POSSIBILITIES. 36 Spring 2008 I Arkansas Hospitals A d v o c A c y Arkansas receives nDC Billing Extension The Arkansas Medicaid program received notice December 31 that CMS has granted the stateвЂ™s request for an extension in meeting federal requirements to implement a new National Drug Code (NDC) billing policy. Medicaid program offi cials filed for the extension after learning from the Arkansas Hospital Association and hospital officials that many of the stateвЂ™s hospitals could not be ready to comply with the new policy to bill affected services using the appropriate drug codes by the January 1 effective date. Based on that information, CMS granted a six-month delay, until July 1, 2008, on implementing the policy for hospital claims. MedicaidвЂ™s Official Notice of the change, dated January 14, 2008, states, вЂњEffective for dates of service beginning July 1, 2008, providers billing an institutional outpatient claim electronically or billing a paper claim on the CMS-1450 (UB-04) must bill according to the Official Notice dated October 24, 2007, Implementation of the Federal Deficit Reduction Act of 2005, Requiring National Drug Codes (NDC) When Billing Drug Procedure Codes.вЂќ The Official Notice can be found on the Arkansas Medicaid Web site at https://www.medicaid. state.ar.us/ under the Provider section. The Deficit Reduction Act of 2005 required the submission of NDCs, as well as appropriate HCPC/CPT codes on Medicaid claims containing drug procedure codes on the CMS-1500 and UB-04 billing forms. The purpose of the new requirement is to assure that the states obtain a rebate from those manufacturers who have signed a rebate agreement with the CMS. вЂў Community match Physician recruitment Program The New Community Match Physician Recruitment Program was created by Arkansas state law in an effort to attract more physicians to medically underserved areas in the state. This program is an excellent resource to assist communities in physician recruitment efforts. How does it work? The physician is required to commit four years to practicing in a medically underserved community in Arkansas in exchange for an extra $20,000 per year for each year of service for a maximum amount of $80,000. Half of this is funded by the community and the other half is matched by the State. This is a $10,000 per year commitment from the community and a $10,000 per year commitment from the State for a total of four years. The funds are given to the physician at the beginning of each year of service. What type of medicine must the physician practice? The physician may practice one of the following Primary Care specialties: Family Medicine, General Internal Medicine, General Internal Pediatrics, General Pediatrics, General OB\GYN, General Surgery, or Emergency Medicine. What physicians are eligible? A bona fide resident of Arkansas who is a graduate from an accredited medical school in the United States and is currently enrolled in a residency or other training program in an area of Primary Care, or completed training no more than two years prior to applying, is eligible to apply. What communities are eligible? Any community that has an underserved medical need is eligible to apply. How do Communities and Physicians apply? The community and the physician must apply jointly. Applications are due March 31, 2008. The Rural Medical Practice Board will process all applications and determine who will be admitted to the program. Please visit http://www.uams. edu/COM/ruralprograms/ for additional information and applications. You may also contact the Rural Programs Administrator, Morgan Hogue, at 501-526-4266 or by e-mailing mahogue@uams. edu. вЂў Spring 2008 I Arkansas Hospitals 37 A d v o c a c y by Paul Cunningham, Senior Vice President, Arkansas Hospital Association A Look Back at 2007 Healthcare Legislation The United States Congress ended the first half of its 110th session with a brief but intense burst of energy focused on healthcare matters. In dramatic fashion, Congress brought its 2007 work to a close on December 19 with an 11th-hour flurry of activity, passing an abbreviated Medicare legislative package containing several temporary measures to govern the program until more permanent decisions are made later this year. The President signed the new Medicare, Medicaid, and SCHIP Extension Act of 2007 on December 29. The Senate ignited the fuse December 18, giving its nod to a bill based on, but somewhat different than one that came out of the House earlier. The House followed suit on the amended bill the next day. Among other things, the law sends both sides in the quarrelsome deliberations surrounding expansion of the State ChildrenвЂ™s Health Insurance Program into neutral corners by extending SCHIP through March 31, 2009, with adequate funding for states to maintain current enrollment levels. Hospitals across the country will again reap dividends from working together in a united front through their state and national associations. They faced some giants and giant odds in the 2007 funding wars, but emerged with several big wins, including sixmonth extensions of cost-based outpatient lab services for rural hospitals of fewer than 50 beds 38 Spring 2008 I Arkansas Hospitals and independent labsвЂ™ ability to continue billing Medicare directly for the technical component of certain physician pathology services provided to hospitals. Congress also rejected 0.5 percent cuts in MedicareвЂ™s inpatient and outpatient hospital payment updates for FY 2008 that were in the original House version. The biggest victory may be related to a lengthy fight over the inpatient rehabilitation facility (IRF) 75 percent Rule. The new law permanently sets the IRF compliance threshold at 60 percent, effective for cost reporting periods starting July 1, 2006; allows co-morbid conditions to count toward the threshold; and eliminates proposed cuts to hip and knee replacement payments. However, to pay for the okay on those items, it freezes the IRF market basket update from April 1, 2008, through FY 2009. Another payment update, this one for long-term care hospitals (LTCH), will be frozen for the last quarter of the 2008 rate year. In return, the LTCHs get regulatory relief for three years from the 25 percent Rule governing host-hospital admissions, a limited moratorium on new facilities and beds and new patient and facility criteria. Not surprisingly, Congress managed to sidestep for a while longer the complexities of dealing with Medicare physician fees. Those were to have been reduced 10 percent beginning January 1. Instead, the fees will be raised 0.5 percent, but only for six months. In addition, the package includes a provision that extends for the same six-month period as the five percent bonus payments to physicians practicing in areas with physician shortages. The physician quality reporting system is also extended, and there are some revisions in the Physician Assistance and Quality Initiative fund. To help offset costs of many provisions adopted in todayвЂ™s pay-go legislative world, the law removes $1.5 billion from the controversial Medicare Advantage (MA) stabilization fund in 2012. The fund was originally established to subsidize MA plans operating in regions of the country where Medicare managed care plans were previously unsuccessful, or not offered. All things considered, the Medicare, Medicaid, and SCHIP Extension Act of 2007 is the equivalent of an end-of-season bowl win for AmericaвЂ™s hospitals. The temporary arrangements included in the Act set the stage for 2008. Congressional leaders are now arguing over ways to address long-term solutions to issues like solving the physician payment puzzle, making permanent some of the ActвЂ™s extensions, tackling the whole-hospital exception to physician self-referral rules and extending a current moratorium preventing CMS from moving forward with new Medicaid rules that could cost public hospitals almost $4 billion over five years. Left as is, the moratorium will expire in May 2008. вЂў Q u a l i t y FDA Recalls Contaminated Syringes The U.S. Food and Drug Administration (FDA) on January 25 announced a nationwide recall of heparin and saline flush syringes made by AM2 PAT Inc. The FDA said two lots of the pre-filled syringes have been found to be contaminated with Serratia marcescens, a bacterium that can cause serious injury or death. Some patients exposed to the recalled syringes have developed blood infections, the FDA said. The agency advised healthcare facilities and consumers that have the recalled syringes to stop using them immediately. Healthcare facilities should immediately quarantine the products in their inventory and return them to the distributor. Consumers should return them to wherever they got them and let their healthcare providers know that they have been exposed to syringes recalled by the FDA. Any adverse reactions to the products should be reported to the FDAвЂ™s MedWatch Program at http://www.fda.gov/medwatch/. вЂў Arkansas Hospital Infection Committee Meets During the 2007 legislative session, the Arkansas General Assembly enacted Act 845, which created a state Advisory Committee on Healthcare Associated Infections. The law, which had the backing of the Arkansas Hospital Association, set up a program for hospitals to voluntarily report their rates for selected types of infections. The committee is to assist the Arkansas Department of Health (ADH) in developing a methodology for collecting, analyzing, and disclosing the infection rate data, and it met for the first time on Thursday, December 6. The legislation, sponsored by State Representatives Johnnie Roebuck of Arkadelphia and Tracy Pennartz of Fort Smith, asks hospitals and ambulatory surgery centers to collect and voluntarily submit infection rates for coronary artery bypass surgical site infections, total hip and knee arthroplasty surgical site infections, knee arthroscopy surgical site infections, hernia repair surgical site infections, and central line-associated bloodstream infections in an intensive care unit. The committee is charged with developing a surveillance methodology for infection reporting. It must submit the methodology to healthcare facilities on or before September 1, 2008. The ADH is to compile the data and issue a report annually, with the first one being issued by January 1, 2009. The infection data will be reported only in the aggregate. The 15-member Advisory Committee includes Dr. Paul Halverson (ADH), Dr. Terry Yamauchi (Arkansas ChildrenвЂ™s Hospital), Dr. James Phillips (ADH), Craig Gilliam (Arkansas ChildrenвЂ™s Hospital), Pamela Higdem (John L. McClellan Memorial Veterans Hospital), Jamie Huneycutt (Willow Creek WomenвЂ™s Hospital), Debbie Ledbetter (St. Bernards Medical Center), John May (Baptist Health Medical Center), Dr. Tom Monson (John L. McClellan Memorial Veterans Hospital), Monte Wilson (Mercy Ambulatory Surgery Center), Tamara Wright (Baptist Health Medical Center-Heber Springs), Dr. Malcolm Smith (Physician), Leah Tooke (Nurse), Dr. Anita Williams (Consumer) and Juanita Currie (Consumer). вЂў Report Recommends Broadband Network A new report from a congressional advisory committee calls for a national, interoperable broadband network to improve communications between emergency responders and healthcare facilities. The Federal Communications Commission panel that developed the report said the network should be built on standardized Internet protocols that can rapidly and securely transmit information, such as video and graphics, and recommends Congress establish a federal interagency committee to provide consistent federal guidance and standards to ensure compatible communications systems. It also calls for mobile applications to create вЂњvirtual hospitalsвЂќ at the scene and greater use of telemedicine technologies for both dayto-day and emergency response. Go to http://energycommerce. house.gov/Press_110/JAC.Report_ FINAL%20Jan.3.2008.pdf to read the report. вЂў Spring 2008 I Arkansas Hospitals 39 Q u A l i t y TrusteesвЂ™ responsibilities for Quality Corporate Responsibility and Health Care Quality: A Resource for Health Care Boards of Directors In the fall, the U.S. Department of Health and Human Services Office of Inspector General (OIG) and the American Health LawyersвЂ™ Association (AHLA) jointly published a document entitled, вЂњCorporate Responsibility and Health Care Quality: A Resource for Health Care Boards of Directors.вЂќ This 11-page paper is the third in a series of co-sponsored documents by the OIG and the AHLA. Trustees who serve on the governing boards of hospitals and other healthcare organizations have fiduciary duties to those organizations that include responsibility for oversight of quality of care and patient safety. This paper discusses the important role of hospital trustees in maintaining and improving quality and safety at a time when healthcare quality is emerging as an enforcement priority for regulators. At a time when the OIG, other federal agencies and various state agencies are collaborating to address quality of care issues, the paper offers practical assistance for trustees in understanding and fulfilling their responsibilities and ensuring that appropriate compliance mechanisms are in place to monitor quality of care and patient safety. The paper, which includes a list of 10 questions that trustees can use to evaluate the hospitalвЂ™s quality and safety ini40 Spring 2008 I Arkansas Hospitals tiatives, is available on the OIG Web site at http://oig.hhs.gov/ fraud/docs/compliance guidance/Corporate ResponsibilityFinal %209-4-07.pdf. United States Department of Health and Human Services Ofп¬Ѓce of Inspector General вЂў American Health Lawyers Association Arkansas Trustee regional Meetings Begin in April Trustee education is very important, but hospital trustees are very busy people. So, what do you do? In an effort to bring educational programming to Arkansas hospital trustees, the Arkansas Association of Hospital Trustees will offer a series of regional dinner meetings in late April and May. The meetings will be presented in five areas of the state, making it easier for busy trustees to attend the meetings and network with other trustees in the area. At each location, Elisa White, Arkansas Hospital Association vice president and general counsel, will discuss the role of hospital trustees in maintaining and improving quality and safety at a time when healthcare quality is emerging as an enforcement priority for regulators. To accompany her talk, attendees will receive a comprehensive packet of information on a variety of issues targeted specifically for trustees. Each meeting will begin with a reception at 5:30 p.m., followed by dinner and educational session at the following locations: April 23 вЂ“ Batesville May 6 вЂ“ El Dorado May 13 вЂ“ Hot Springs May 20 вЂ“ Stuttgart May 28 вЂ“ Fort Smith Program brochures have been mailed to CEOs and members of the Arkansas Association of Hospital Trustees. Please call Beth Ingram at 501-224-7878 for additional information. вЂў Q u a l i t y Governor Appoints 30-Member Healthcare Roundtable Arkansas Governor Mike Beebe has made appointments to his 30-member Roundtable on Healthcare, designed to find new approaches, ideas and strategies for improving both health and healthcare for Arkansans. The Roundtable, which held its second meeting February 7, is formed of representatives of business, healthcare, consumers, the ministry and other entities. It will meet every other month through 2008 working toward discovering ways to improve the stateвЂ™s health system. This information will be used as a mechanism to inform and engage the Arkansas General Assembly when it convenes in January 2009 and, potentially, the congressional delegation. Leading the Roundtable is Arkansas Surgeon General Dr. Joe Thompson. Joining Thompson as members of the panel are: Jerry Adams, Conway, Accelerate Arkansas Sharon Allen, Little Rock, Arkansas Blue Cross and Blue Shield Helen Baldwin, Little Rock, Arkansas Prostate Cancer Foundation Phil Baldwin, Arkadelphia, Southern Development Bancorporation Dr. Jonathan Bates, Little Rock, Arkansas ChildrenвЂ™s Hospital Bishop James E. Bolden, Jacksonville, Evangelistic Ministries Dr. Thomas Bruce, Little Rock, retired UAMS and Clinton School dean Leslie Campbell, Hot Springs, Golden Ventures Dr. Jim Citty, Searcy, family practice physician Patty Clary, Magnolia, consumer Larnell Davis, Pine Bluff, Jefferson Comprehensive Care System Linda Dillman, Fayetteville, Wal-Mart Dr. Susan Hanrahan, Jonesboro, ASU College of Nursing and Health Professions Russ Harrington, Little Rock, Baptist Health Caryol Hendrix, Hackett, Employer Health Coalition Alan Hughes, Little Rock, Arkansas AFL-CIO Ray Kordsmeier, Conway, Conway Regional Health System Dr. Drew Kumpuris, Little Rock, cardiologist Mike Malone, Fayetteville, Northwest Arkansas Council Pam Marshall, Tontitown, consumer Joe Meyer, Little Rock, Alltel Dr. Eddie Ochoa, Little Rock, pediatrician Ben Owens, Jonesboro, St. Bernards Healthcare Dr. Nick Paslidis, Little Rock, Arkansas Foundation for Medical Care Ray Scott, Little Rock, former director, Department of Human Services Sandy Stroope, Harrison, Harrison Boat World Robert Taylor, mayor of Marianna Ken Tillman, Searcy, Arkansas Farm Bureau The Rev. Guy Whitney, North Little Rock, First United Methodist Church Dr. I. Dodd Wilson, Little Rock, University of Arkansas for Medical Sciences вЂў Financial Incentive Program Guide The Agency for Healthcare Research and Quality (AHRQ) has published a document to guide employers, health plans and other healthcare purchasers in using financial incentives to improve healthcare quality and reduce costs. The guide includes examples of financial incentives already being offered, criteria for selecting performance measures and suggestions for increasing the likelihood that a consumer will be attracted by the incentives. The guide includes 21 questions health insurance purchasers should take into account when considering whether to implement an incentives program. Click on http://www.ahrq.gov/qual/ value/incentives.htm to review the information. вЂў Spring 2008 I Arkansas Hospitals 41 M e d i c A r e / M e d i c A i d CMs Memo on Interpretive Guidelines The Centers for Medicare and Medicaid Services (CMS) issued a memorandum to its State Survey Agency Directors on the use of Interpretive Guidance by surveyors for long-term care facilities. In a footnote, CMS states that вЂњ[a]lthough surveyors must use the information in Guidelines, they must be cautious in their DEPARTM ENT OF HE ALTH & Centers for HUMAN Me SERVICES 7500 Securit dicare & Medicaid Services y Boulevard Baltimore , Mail Sto , Maryland p S2-12-25 21244-185 0 Center for Medicaid and State Operations/ Survey & Certificatio n Group DATE: TO: FROM: SUBJECT: January 18, 2008 State Surve y Agency Dir ectors Director Survey and Certification Group Use of Interp retive Guida nce by Surve yors for Lo ng Ref: S&C08- Term Care Facilities Memoran dum Summ The Centers ary for the Interpreti Medicare & Medic aid Services ve Guidance (CMS) has compliance been asked with the reg to Surveyors for Long to ulatory req uirements for Term Care Facilities in clarify the use of x Surveyo reviewing for nursing hom rs must cit es. e all defici requirement enc ies s. based on a violation of statutory and /or regulator Backgroun y d: safety stand The Social Security ards that pro Act mandate and/or Me s the establ dicaid progra viders and suppliers ishment of must meet 483 further ms. Speci mi nim um in ord fic health and ref language is ine this statutory obliga provision of the nursi er to participate in the found in the ng tion. CMS' guidelines State Opera authoritative home regulations at Medicare serve tions Manua 42 C.F.R. interpretation Part protocols, def as, and also provid e surveyors l (SOM). The SOM spe of the regulatory initions of reg with, cifi evaluate com pliance wit ulatory terms, and inte specific survey protoc es that the interpretiv e h the regula rview probes ols such as tions. investigative that they can Discussion use dur ing surveys : to nursing ho The survey process is me the best ass CMS contin requirements are bei urance we hav ng uo of improvin usly investigates wa met and that residents e that protections set ys g forth in the interpretive the quality of care and to improve the long are receiving quality ter ser guidance to quality of survey pro life of nursi m care survey proces vices. nursing ho cess. The s with the ng home res interpretive me surveyors is one goal interpretati ide nts . Provid metho guida on and determ ultimately ination of the nce facilitates survey d used by CMS to im ing updated pro prove the homeвЂ™s com viding a consistent app gravity and pervasive orsвЂ™ consistent regula tory ness of identif pliance wi roa ch to the manner th the requir in which sur ied deficiencies; ements. veyors ass ess a nursi ng x 10 use. Guidelines do not replace or supersede the law or regulation, and therefore, may not be used as the basis for a citation.вЂќ Read the memo at http://www.cms.hhs.gov/ SurveyCertificationGenInfo/ downloads/ SCLetter08-10.pd SCLetter08-10.pdf. вЂў Proposed rule for LTCHs The Centers for Medicare & Medicaid Services issued a January 24 proposed rule providing a 2.6 percent increase in Medicare prospective payment rates for long-term care hospitals (LTCH) in rate year 2009. The rule proposes a 2009 standard rate of $39,076.28, which reflects a full 3.5 percent market basket ES N SERVIC & HUMA HEALTH vices MENT OF dicaid Ser DEPART 12-25 are & Me for Medic ard, Mail Stop S2rs nte Ce lev on Group 0 urity Bou 21244-185 7500 Sec Certificati , Maryland urvey & Baltimore erations/S Op and State Medicaid Center for DATE: TO: -10 08 Ref: S&C- 18, 2008 January Directors y Agency State Surve p cilities Director tion Grou rm Care Fa d Certifica for Long Te Survey an Surveyors idance by Gu ive ret of Interp T: Use ary SUBJEC use of dum Summ clarify the Memoran en asked to for MS) has be cilities in reviewing (C ces rvi Care Fa dicaid Se rm Me Te & ng are dic for Lo mes. nters for Me Surveyors nursing ho x The Ce retive Guidance to y requirements for ulatory and/or reg the Interp with the regulator of statutory e a violation on complianc sed ba ficiencies de all e cit yors must alth and x Surve ents. nimum he edicare ent of mi M requirem establishm participate in the . Part ndates the er to 42 C.F.R rity Act ma must meet in ord me regulations at cu Se l regulatory ive The Socia ers and suppliers of the nursing ho the : of nd on ou Backgr vision t provid interpretati ies that the interpret e e pro tha tiv s c ifi rita ard ec nd tho M specif investigativ safety sta icaid programs. Sp ligation. CMS' au M). The SO ols such as ob to ed and/or M refine this statutory erations Manual (SO cific survey protoc use during surveys r spe t they can 483 furthe found in the State Op e surveyors with, probes tha vid is iew e pro erv ag o int gu als lan ve as, and terms, and y ser tor es in ula lin th the of reg guide ns set for definitions th the regulations. t protectio ty services. protocols, wi we have tha al quali mpliance assurance nts are receiving with the go st evaluate co ss be ce the pro is y reside dated y process t and that long term care surve nts. Providing up : The surve being me the the reside ve ve me pro pro ho Discussion requirements are im im ways to me of nursing used by CMS to d nursing ho ously investigates and quality of life tory nu one metho ent regula re CMS conti g the quality of ca home surveyors is surveyorsвЂ™ consist d deficiencies; ng ng ates ntifie of improvin guidance to nursi ess a nursi nce facilit rvasiveness of ide ass ida rs gu yo ive interpretive ss. The interpret of the gravity and pe nner in which surve ce ma nation the mi to h ter survey pro ac de on and ent appro interpretati viding a consist uirements. pro ultimately with the req mpliance homeвЂ™s co update adjusted by a congressionally mandated market basket freeze for one quarter in 2008 and a 0.9 percent reduction in 2009 to offset coding behavior in 2006. The agency proposes to return the effective date for the LTCH annual update to October 1 from July 1, which would make the 2009 rate effective for a 15-month period from July 1, 2008, through September 30, 2009. CMS estimates total Medicare payments to LTCHs would increase by $124 million in 2009 to about $4.44 billion. The agency expects to implement other LTCH provisions found in the 2007 Medicare Extension Act in a future rule. вЂў вЂњFreestandingвЂќ Emergency Department Requirements FROM: 42 Spring 2008 I Arkansas Hospitals In response to вЂњincreasing interestвЂќ in provider-based, off-campus emergency departments and hospitals that specialize in the provision of emergency services, CMS recently issued a memorandum to its State Survey Agency Directors offering guidance on the applicable regulatory standards that govern the circumstances under which these вЂњfreestandingвЂќ emergency departments meet the CMS Conditions of Participation that qualify them to participate in Medicare as a hospital, or part of a hospital. See the memorandum at http:// w w w. c m s . h h s . g o v / s u r v e y c e rtificationgeninfo/downloads/ SCletter08-08.pdf. вЂў M e d i c a r e / M e d i c a i d CMS Amends RAC Program Schedule The Centers for Medicare & Medicaid Services (CMS) has amended the Proposed Statement of Work (SOW) for the Recovery Audit Contractor (RAC) program, significantly changing its implementation schedule. The November 7, 2007, Statement of Work is available for viewing, along with the new implementation map at http://www.cms.hhs. gov/rac/. While the American Hospital Association and the Arkansas Hospital Association are carefully analyzing the changes in the amended SOW, initial review found several positive changes, including: вЂў An extended rollout schedule with different states coming under review in March 2008, October 2008 and January 2009. вЂў No claims with dates of service prior to October 1, 2007, will be reviewed. вЂўHospital- and provider-specific medical record request limits will be set by CMS. The Arkansas Hospital Association continues to offer workshops and Webinars on the RAC program to help member hospitals understand the implications the program will have on Medicare reimbursements and day-to-day operations. On April 5, the AHA will offer a Webinar about the program. In addition, the April 22 Compliance Forum will feature a very candid discussion of the RAC program by James Kopf, president of Healthcare Oversight, Inc. For program details, please see www.arkhospitals.org/calendar.htm. вЂў Arkansas Medicaid Outpatient Rate Update The Arkansas Medicaid program posted a December 26 public notice regarding its proposed increase for hospital outpatient rates. The proposal would raise by 58 percent Medicaid payments for drugs/injections, emergency room care, outpatient assessments, non-emergency room outpatient visits, emergency outpatient hospital supplies, treatment/observation room fees for hospital outpatient services and four categories of outpatient surgical services. The increase was determined after a Medicaid review of (1) the hospital/medical inflationary cost increase index changes between July 1, 1992 (the last time that Medicaid outpatient rates were changed by an acrossthe-board reduction), and January 1, 2008, and (2) the most recent Arkansas Hospital Association analysis of Medicaid hospital outpatient costs. Medicaid also plans to increase the rates for hospital outpatient laboratory, X-ray and other tests to 100 percent of the current physician Medicaid maximum. The proposed rate increases are subject to legislative review and must be approved by the federal Centers for Medicare & Medicaid Services (CMS). Once all approvals are secured, the new rates will have a January 1, 2008, effective date. вЂў Medicare Spending Tops $400 Billion Medicare spending grew 18.7 percent to $401.3 billion in 2006, as prescription drug spending shifted to Medicare from Medicaid and private coverage, the Centers for Medicare & Medicaid Services reported in January. ThatвЂ™s the largest annual increase in Medicare spending since 1981 and twice the growth seen in 2005. Total U.S. spending for hospital care grew 7.0 percent in 2006 to $648.2 billion, down from a 7.3 percent increase in 2005, as growth in the underlying cost of hospital services slowed to 4.1 percent from 4.3 percent, CMS said. Spending for physician and clinical services grew 5.9 percent in 2006 to $447.6 billion. ThatвЂ™s down from 7.4 percent in 2005, due in part to a freeze in Medicare payments. The report appeared in the January/February issue of Health Affairs. вЂў Spring 2008 I Arkansas Hospitals 43 M e d i c A r e / M e d i c A i d CMS Revamping Regional Offices On December 28, 2007, CMS published a notice in the Federal Register summarizing a recent regional reorganization under which Regional Office (RO) organizational codes have been abolished, but the Regional Offices themselves are retained. The Arkansas Hospital Association has learned that services which the ROs provide to Medicare beneficiaries, Medicaid recipients and other stakeholders will continue to come from the same 10 ROs. However, those services are now to be provided under a new model designed to provide for four Consortium Administrators who would manage specific CMS functions in the field as follows: вЂў The Consortium for Medicare Health Plans Operations вЂў The Consortium for Financial Management and Fee for Service Operations вЂў The Consortium for Medicaid and ChildrenвЂ™s Health Operations вЂў The Consortium for Quality Improvement and Survey and Certification Operations The Regional Administrators (RA) in the remaining six offices will have the core responsibility of leading outreach efforts in the following geographic areas: Boston RA (Boston and New York), Atlanta RA (Atlanta and Dallas), San Francisco RA (San Francisco), Seattle RA (Seattle and Chicago), Philadelphia RA (Philadelphia) and Denver RA (Denver and Kansas City). вЂў CAHs Allowed OPPs reporting Participation The Centers for Medicare & Medicaid Services (CMS) has reversed a previously stated policy and now will allow critical access hospitals (CAH) to submit and publicly report outpatient quality data along with other hospitals. The American Hospital Association (AHA) pushed for this change after many CAHs nationwide indicated a desire to participate in the program, despite being exempt from the Medicare outpaary Prelimin tient hospital prospective payment system (OPPS). More information will be available from CMS later this year, including when CAHs can begin reporting data. Hospitals participating in MedicareвЂ™s OPPS are required to submit data on seven outpatient quality measures to receive a full payment update in FY 2008. The Florida Medicare Quality Improvement Organization, which has been selected as the national program contractor for the outpatient reporting program originally said that CAHs, which do not participate in the OPPS because they receive cost-based reimbursement, would not be allowed to submit the outpatient measures. However, AHA urged CMS to let the small hospitals participate in the quality reporting because of their commitment to public transparency and quality improvement. вЂў 07/31/07 Guide for Medicare Code Editor Edits are Code ic d e M f o s Definition 3 2007 October PBLвЂ“011 44 Spring 2008 I Arkansas Hospitals CMS has published a userвЂ™s guide for the Medicare Code Editor, which detects and reports errors in coding claims data. The guide, effective through September 2008, contains a description of each coding edit with corresponding ICD-9-CM code lists. The 70-page guide is available online at http://www.cms.hhs.gov/ AcuteInpatientPPS/downloads/ MCEonIPPSUserGuide.pdf. вЂў We SUPPORT Healthcare... SYNERGYВ® can help... В» Created by U.S. Foodserviceв„ў for the healthcare operator. В» Provides a comprehensive approach to foodservice cost management. В» Provides tools for customers to manage many of the services they offer. В» Focuses on the key cost drivers in the operation. В» Helps customers identify opportunities to achieve their service delivery and customer satisfaction goals. В» For more information contact Kevin Hogue @ 501-235-4310 Experts in Financial Health The public finance experts at Crews & Associates enjoy a rich tradition of helping healthcare organizations throughout Arkansas. By tailoring innovative financial solutions designed just for you, we take pride in helping you deliver quality care. Contact Paul Phillips today at 501.978.6309 or 800.766.2000 and let our own team of healthcare experts prescribe the financial cure for your organization. 9th Statement of Work Changes QIOsвЂ™ Focus Centers for Medicare & Medicaid Services (CMS) announced on February 5 its new statement of work (SOW) for MedicareвЂ™s 53 quality improvement organizations (QIO). The work plan, which is effective August 1, incorporates recent recommendations by the Institute of Medicine and Government Accountability Office that QIOs focus more on protecting Medicare patients, patient care transitions, patient safety and prevention. The quality organizations will be required to provide direct quality improvement support to nursing homes, hospitals and physician offices; use standardized tools; and meet periodic milestones to maintain their contracts. Details on the SOW can be found on the CMS Web site at http://www. cms.hhs.gov/Quality ImprovementOrgs/04_9thsow. asp#TopOfPage. вЂў New Hospital Construction вЂў Medical Equipment Purchases/Leases Healthcare Reп¬Ѓnancings crewsfs.com NOT A DEPOSIT вЂў NOT FDIC INSURED вЂў MAY LOSE VALUE вЂў NOT GUARANTEED BY THE BANK NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY Spring 2008 I Arkansas Hospitals 45 M e d i c a r e / M e d i c a i d Arkansas Medicaid Fixing EOB Problem State Medicaid program officials have informed the Arkansas Hospital Association that its claims processing system has been assigning a Medicaid Explanation of Benefit (EOB) code 942 as a beneficiary responsibility, meaning that the provider can attempt collection of the amount from the patient. The error has occurred for several years but was only discovered recently, after a Medicaid recipient pointed it out. EOB code 942 states вЂњinjection requires specific diagnosis code.вЂќ It implies the beneficiary would have Medicaid specific coverage knowledge. Medicaid now believes that assigning the responsibility to the patient was an error, and it should have been assigned as a provider responsibility. Steps are now being taken to make the correction. вЂў Value Based Purchasing Report Issued Secretary of Health and Human Services Michael Leavitt has delivered to Congress his Report on the Medicare Hospital Value-Based Purchasing Program (VBP), suggesting ways for implementing a value-based purchasing program for hospitals under the Medicare inpatient prospective payment system beginning in fiscal year 2009. The plan was required by the Deficit Reduction Act of 2005. Centers for Medicare & Medicaid ServicesвЂ™ (CMS) Acting Administrator Kerry Weems said, вЂњThe agencyвЂ™s proposal builds on MedicareвЂ™s current pay-for-reporting program, which was originally implemented in 2005.вЂќ That program requires hospitals to report on specific inpatient quality measures to receive a full IPPS payment update. Now, CMS wants to include financial incentives for better performance. According to CMS, under the VBP program, a percentage of a hospitalвЂ™s base operating payment for each discharge or DRG payment would be contingent on the hospitalвЂ™s actual performance on a specific set of measures. The transition from pay-for-reporting to an incentive based completely on performance would occur over a threeyear period. Public reporting of quality measures on MedicareвЂ™s Hospital Compare site, a key component of the Reporting Hospital Quality program, would remain an essential component of VBP. To view the entire press release, go to http://www.hhs.gov/news/ press/2007pres/2007.html. вЂў Our Advertisers, Our Friends Arkansas Blue Cross Blue Shield................................2 Arkansas Foundation for Medical Care.....................31 Benefit Management Systems, Inc..........................19 Crews & Associates.................................................45 Dr. Suzanne Yee......................................................29 Eide Bailly.................................................................36 46 Spring 2008 I Arkansas Hospitals Hagan Newkirk Financial Services, Inc.......................6 Hughes Welch & Milligan.........................................17 Kaleidoscope Grief Center........................................29 The MHA Group.......................................................47 Nabholz Construction...............................................48 Ramsey, Krug, Farrell & Lensing.................................6 Securitas....................................................................5 St. Vincent Rehabilitation Hospital...........................19 Teletouch Paging.....................................................23 TME, Inc..................................................................23 U.S.вЂ€Foods...............................................................45 Arkansas Hospital Association 419 Natural Resources Drive Little Rock, AR 72205 Presorted Standard U.S. Postage Paid Little Rock, AR Permit No. 2437