Arkansas Hospital Association Ark Trustee Fall Winter 1997

From the AHA President. . .
With 1997 coming to a close, I'd like to tell you how much all of us here at the Arkansas Hospital Association appreciate having had the opportunity of working with you and your hospital's CEO. Together, we have accomplished much. But, there's much more to do.

As our challenges mount, I'm reminded of the aging woodcutter whose burden grew heavier and heavier. He was carrying a heavy load of wood one day when he suddenly grew weak and dizzy. Putting the bundle down, he cried bitterly, "O Death, release me from this terrible existence!" Immediately, the Angel of Death appeared.

"You called me?" she asked. Astonished and frightened beyond imagination, the old woodcutter could only stammer. "Yes, your excellency—your honor—your majesty—would you mind—er—ah—helping me get this bundle back on my shoulders?"

While we get that bundle back on our shoulders and prepare for the coming year, here is a Christmas tree of thoughts to ponder!

In
1998,
let's count
our blessings.
Give thanks before
every meal. Be positive
and enthusiastic. Keep our
promises. Respect tradition. Learn
to listen. Keep a tight rein on our temper.
Choose our friends carefully. Take care of our
reputation. Say "thank you" a lot. Say "please" a
lot. Never deprive someone of hope. Be modest. Avoid
negative people. Vote. Spend time doing what's right. Refrain
from burning bridges. Pay our bills on time. Keep our watches 5
minutes fast. Pay our fair share. Read carefully anything that requires
our signature. Remember that overnight success usually takes about 15
years. Avoid violent television shows. Refuse to buy the products that sponsor
them. Have impeccable manners. Buy great books even if we never read them. Be
the first to say "hello." Respect everyone who works, no matter how trivial
their job. Pray for wisdom and courage.
Speak our love.
Speak it again.
Do it again.
Yet again.
Again.
Now.

Put an End to Healthcare Fraud Accusations!
The Arkansas Hospital Association (AHA), in conjunction with the American Hospital Association and other state associations, is working through the holiday congressional break to educate U.S. senators and congressmen about healthcare fraud and abuse. The overall purpose is to build support for legislation being pushed by the American Hospital Association that would halt the practice of using the False Claims Act in most cases where a problem stems from billing errors, not intentional fraud.

Three years ago, the federal government targeted 4,700 hospitals for fraud and abuse investigations related to improperly billed Medicare claims. Since then, the AHA has warned CEOs of its member hospitals on several occasions to expect a letter or letters from the Department of Justice accusing their hospitals of defrauding the Medicare program and seeking recoupment of Medicare payments under the False Claims Act.

The letters accuse a hospital of filing a false claim, openly threaten it with punitive damages equal to three times the amount of each alleged false claim plus up to a $10,000 penalty per claim, and then willingly agrees to settle the matter if the hospital admits the wrongdoing and repays an amount determined by the government to be equitable.

Thus far, no Arkansas hospital has been officially cited for overpayments due to "false" claims. The AHA believes, however, that the citations are forthcoming, since hospitals in nearby states have been cited in two separate investigations —the 72-hour Window Project and the Laboratory Unbundling Project.

The AHA has provided to each Arkansas hospital CEO a checklist of actions to take when and if the hospital is accused of filing false claims. The association urges you to study this information, and to take the matter seriously. It is worthy of note that healthcare fraud was, once again, the topic of President Clinton's radio address December 13.

Corporate Boards	Healthcare Boards
Accept accountability for independent governance	Accept accountability while working in partnership with management
Hold management accountable for commercial success	Hold management accountable for success measured according to: financial and market performance; customer satisfaction; clinical outcomes and health status; and achievement of organizational values
Participate actively and influence agendas	Participate actively with a focus on the issues that matter to the future of the organization and community
Have 8-10 members	Charge a governance committee with responsibility for board education, self-assessment, and nominations; must be willing to not recommend reappointment of members who don't contribute
Establish a governance committee	Range of 11-17 may be more appropriate; must be small enough to work efficiently but large enough to include diversity that reflects health system's mission and community
Budget 40 hours per year for board work	Budget a significant amount of well-spent time, which will vary from board to board
Hold periodic executive sessions for board members only	Hold periodic executive sessions with only the board and CEO (no other senior management); foster full board participation in annual executive appraisal process
Compensate directors with cash or stock	Weigh benefits of compensation carefully against public perceptions and core values
Limit number of other boards on which directors serve	Beware of recruiting "trophy" directors who lack the time to successfully contribute to board work
Require directors to own a significant amount of company stock	Recruit directors with a demonstrated record of service to the organization's mission or communities

Arkansans to Attend Washington Meeting
Arkansas hospital CEOs, administrators and trustees will join others from across the nation to celebrate the American Hospital Association's Centennial at the 1998 Annual Membership Meeting, January 31-February 3, in Washington, D.C. Following a gala centennial celebration, meeting attendees will hear presentations from speakers such as Elizabeth Dole, president of the American Red Cross; U.S. Rep. Bill Thomas (R-CA), chairman of the House Ways and Means Committee's health panel; and Judy Woodruff, CNN correspondent, will again moderate the annual "congressional crossfire" session.

Trustees will have four additional opportunities for education at the annual meeting. Topics include, "What Makes Boards and CEOs Click in Successful Health Systems?"; "Restoring the Public Trust: Embracing Corporate Compliance and Ethics"; and "Accountability in Hospital Conversions: Guidance for Hospital Governance Teams."

Arkansas attendees will host an appreciation dinner for congressional aides and visit with the congressional delegation at a special lunch. For information about the meeting, call Beth Ingram at 501-224-7878.

AHA Goes On-line
In January, the Arkansas Hospital Association's new Internet web site will be available to trustees, CEOs, hospital personnel, and the public. Users will have access to the AHA's publications, statistics, legislative information, educational programs, information about the AHA and its membership, and helpful links. The site can be found at:

AAHT Update
The Arkansas Association of Hospital Trustees' board will meet January 16 in Little Rock to discuss 1998 plans for the association. Among the issues to be discussed are nominations for a slate of officers; educational plans for a one-day meeting in late March or early April, regional dinner meetings, and the fall CEO/Leadership Conference; and membership recruitment and retention.

AAHT 1998 membership dues statements have been mailed to all hospital CEOs. At present, AAHT membership is retained by over 500 trustees in 53 Arkansas hospitals. AAHT members receive the Arkansas Trustee, Arkansas Hospitals, access to educational material from the American Hospital Association, educational programming information for state and regional meetings, networking opportunities with other trustees across the state and region, and legislative updates during the Arkansas legislative session.

If you are interested in an AAHT board position representing your area of the state, or have questions about the organization, please contact Beth Ingram at 501-224-7878, prior to January 16.

Trammel Receives AHA Award
Dick Trammel, a charter member of the board of Northwest Arkansas Radiation Therapy Institute in Springdale and a charter member of the Arkansas Association of Hospital Trustees, received the Arkansas Hospital Association's Distinguished Service Award October 14. The award was presented at the AHA's annual awards dinner which was attended by many of Trammel's friends and supporters.

Trammel, nominated by NARTI executive director Eddie Bradford, is the only charter board member still active on the hospital's board today. He has served as chairman of every major board committee, actively participated in the annual Phillips Classic, and continues his support for fund-raising through the Cancer Challenge, the major charitable event for support of all cancer programs in Northwest Arkansas. In addition to his healthcare involvement, Trammel also generously shares his talents with numerous community activities in Rogers and Springdale.

Board Responsibilities
In response to the question, "If you could recommend only one thing to improve the performance of boards, what would it be?," a healthcare governance consultant replied, "Job descriptions for boards, board members and board leaders."

Why job descriptions? Because an extremely common cause of governance ineffectiveness is confusion among board members about their roles and responsibilities. Further, there often is confusion about the board's roles and responsibilities in relation to those of management, the medical staff and other physician organizations, other boards, and committees of the board.

The most fundamental characteristic of excellent governance is that all board members have a shared understanding of their job. Every board has a somewhat different definition and allocation of its roles and responsibilities, as well as a different mix of skills, personalities and challenges. Board job descriptions serve several important purposes, including:

• New board member recruitment: Written board job descriptions help focus the search for new trustees on individuals with the skills and talent that are most appropriate to the functions and needs of a board. A well-written, up-to-date job description will let candidates know precisely what is expected of them should they join the board.

• New board member orientation: A good position description details the role and work of the board and its members. This helps new members become oriented more quickly and completely, to ask more informed questions, and become more effective trustees.

• Board self-evaluation: A board job description, along with annual board goals and objectives, provides a foundation for evaluating board performance.

• Keeping governance on track: A board job description allows board members to point out when a board is drifting away from performing some of its key roles and responsibilities. It also enables board members to fine-tune the group's performance on an ongoing basis.

• Preventing conflict among multiple boards: Job descriptions help prevent conflict between multiple boards as well as decision-making gridlock.

• Clarifying the practical distinction between governance and management: This key relationship often is framed by implicit assumptions about relative roles, expectations and job functions. A board, as well as a CEO, job description helps both sides understand and respect the limits of each other's responsibilities as well as identify areas of joint responsibility.

Dr. Koop's Top Ten List
C. Everett Koop, M.D., former U.S. Surgeon General, developed the following Top Ten Issues in Healthcare Today:

Immunity for Volunteers
After several years of consideration, the U.S. Congress recently passed the Volunteer Protection Act of 1997. The new law establishes heightened levels of protection for volunteers, such as hospital and health system trustees who provide services to nonprofit and governmental organizations.

The act provides liability immunity for any action or omission by a volunteer performing within the scope of his or her responsibilities on behalf of a nonprofit organization or governmental entity if: (1) the volunteer was properly licensed, certified or authorized to carry out the activities in question; and (2) the harm was not caused by willful or criminal misconduct, gross negligence, reckless misconduct or a conscious, flagrant indifference to the rights or safety of the individual harmed.

January 31-February 3, Washington, D.C.
American Hospital Association Annual Membership Meeting

Late March and May (dates to be announced)
AAHT Annual Meeting and Regional Dinner Meetings