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From
the AHA President…
After more than two years of bitter feuding over spending and tax
policies, the Congress has approved and the President has signed a
five-year balanced budget, and a tax cut plan. Interestingly, few
congressional Republicans or Democrats ever saw or read the bills
which comprised 1,600 pages.
Whatever, the legislation is expected to eliminate the deficit no
later than 2002; cut Medicare by $116 billion; cut Medicaid a net
$8.4 billion; and shower corporations and families with more than
$95 billion in tax cuts and credits, the first major tax relief in
16 years.
Of the total five-year Medicare savings, $44 billion will come from
reduced payments to hospitals for inpatient and outpatient services.
We estimate that Arkansas’ share of this loss will be approximately
$400-$450 million. About half of the spending reductions nationally
will come from holding Medicare payment increases to less than the
market basket ($17.1 billion) and re-instituting capital payment reductions
($5.3 billion).
Here in Arkansas, we feel that we did the best we could to control
the budget bill’s damage. Both Rep. Jay Dickey (R-Ark.) and Rep.
Marion Berry (D-Ark.) voted against the bill. Berry said that he voted
against it because the cuts in programs for healthcare providers went
too far, and that "every hospital CEO in the district wrote us
or called us in opposition to the bill." "The bill will
absolutely devastate rural healthcare providers. It gets almost all
its Medicare savings from hospitals and other healthcare providers,
and it disproportionately harms rural hospitals," said Berry.
So, thanks to all of you who helped us communicate our concerns to
Berry, Dickey, and the rest of the Arkansas delegation. You did a
great job! Against great odds, much was achieved. There’s room
here for only five examples:
- A proposal to expand the definition
of transfers to include all discharges from acute care to home
health, rehab, psychiatric, swing-beds, and long-term care facilities
was narrowed. The final agreement delays the new provision for
one year; excludes swing-beds; limits expansion of the transfer
definition to 10 DRGs — to be determined by the HHS Secretary
— and results in only one-third of the spending reductions
originally sought.
- Provider sponsored organizations
(PSOs) are now a new Medicare option. If you determine that a
Medicare PSO is right for your community, you can create one.
- More equitable managed care (AAPCC)
rates will be paid, with a monthly payment floor of $367 which
may help bring Medicare coordinated care options to rural areas.
- The Medicare-dependent hospital
program, which expired in 1995, is reinstated and extended through
2001, and Medicare will cover telemedicine consultations in underserved
areas.
- $24 billion will be earmarked
to expand healthcare coverage to low-income children.
It’s important to remember that
we will still have much left to do. There is a long list of details
to be fleshed out as rules and regulations to implement the new
law are written. The most important decisions — how the law
will actually be implemented — are yet to be made. We’re
counting upon you to help us influence those decisions!
James R. Teeter,
PresidentArkansas Hospital Association
....
AHA Annual Meeting, October
12-15
Plans are finalized for the Arkansas Hospital Association's 67th
Annual Meeting and Trade Show to be held October 12-15 at Arkansas'
Excelsior Hotel in downtown Little Rock.
Program highlights include an opening address by Governor Mike Huckabee;
healthcare futurist Leland Kaiser discussing community health; nurse
dramatist Julie Russell portraying patients with certain expectations;
Bryan Bushick, M.D., addressing patient satisfaction issues; CEO
Dan Wilford taking at look at trust between employers and employees;
and Charlotte Piontek and Russell White presenting Internet sites
and how useful they can be to healthcare organizations.
The annual CEO/Trustee Leadership Breakfast, to be held Monday,
October 13, will feature Larry Walker, special consultant to the
American Hospital Association's Center for Healthcare Leadership.
Larry has served in a number of leadership positions in the healthcare
industry, including chairman of the Mt. Hood Medical Center's board
of trustees and director of Legacy Health System of Portland, Oregon.
Larry's presentation, "A Time for Greatness: Leadership Vision
for the Next Millennium," will focus on the challenges trustees
face as they lead their organizations forward in setting a visionary
course through turbulent healthcare waters. He will explore the
new ways trustees must view their leadership roles and responsibilities;
highlight skills and critical success factors which will determine
trustees' success as transformational leaders able to chart a new
course to improve organizational and community health.
Information on the AHA Annual Meeting and the Trustee breakfast
is enclosed, along with a registration form. We hope to see you
there! (Call Beth Ingram at 501-224-7878 with questions.)
....
Nominations Open -- AHA Awards
Nominations are open for the 1997 Arkansas Hospital Association
awards program. Award recipients will be honored during the Association's
67th Annual Meeting October 12-15 in Little Rock. Award descriptions
are:
A. Allen Weintraub Memorial Award: Named for Allen Weintraub,
long-time administrator of St. Vincent Infirmary Medical Center
in Little Rock, this award is the highest honor bestowed upon a
hospital administrator by the AHA. Nominees must contribute to their
hospitals and communities in same manner as did Allen.
Distinguished Service Award: Presented to individuals who,
while not necessarily AHA members, have promoted a cause of the
healthcare industry, thereby becoming entitled to special recognition.
Examples of those eligible for this award are trustees, physicians,
nurses, auxilians, and other deserving individuals.
C. E. Melville Young Administrator Award: Presented to
a healthcare administrator under the age of 40, who is employed
in some type of responsible Arkansas hospital administrative capacity
for at least two years prior to nomination.
Nominations, accompanied by documentation of the nominees' accomplishments,
must arrive at AHA headquarters no later than Monday, September
1. The AHA Board of Directors will select award recipients at its
September 12 meeting. A list of previous award recipients and award
requirements is available by calling Beth Ingram at 501-224-7878.
....
Joint Leadership Conference,
September 19-21, Nashville, TN
National-known governance consultant Keith Pryor will keynote and
discuss keys to successful healthcare governance at the eighth annual
joint leadership conference for Arkansas hospital trustees, chief
executive officers and medical staff leaders, September 19-21 at
the Opryland Hotel in Nashville, Tennessee.
Additional program topics include mastering the transition to capitation,
healthcare fraud and abuse; best practices in CEO performance appraisal;
defining, measuring, and improving trustee leadership performance;
and the use of the Internet in healthcare. In addition to the educational
sessions, participants will enjoy golf, a tour of the Middle Tennessee
backroads, and dinner on the General Jackson, the world's
largest showboat.
Program and registration information has been mailed to all AAHT
members, as well as to all hospital CEOs. Early hotel reservations
are encouraged! Call Cheryl Duff at the Opryland Hotel reservation
department at 615-889-1000, mentioning the Tennessee Hospital Association
market code N-JLC.
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Hospital Ownership Guidelines
Approved
The American Hospital Association’s (AHA) board of trustees
has approved a set of principles and guidelines to help AHA members
deal with questions of public accountability around changes in ownership.
The guidelines, adopted July 20, are intended for use by hospitals’
boards of trustees and executives contemplating ownership changes.
They would be applicable to transactions among all kinds of hospitals
and health systems, both not-for-profit and investor-owned. AHA
president Dick Davidson said the guidelines are for the benefit
of communities the hospitals serve and are meant to be a road map
for hospital leaders in keeping their communities informed.
The board’s action came after more than a year of work and
debate on the issue by the association’s nine regional policy
boards made up of executives, trustees, physicians, and nurses across
America. The guidelines, which were developed in response to the
current wave of hospital and health system mergers and acquisitions,
address a number of often controversial issues that emerge with
changes in ownership, including:
- being accountable for the care
of the underserved in the community, and maintaining other essential
community services;
- identifying all options available
to the organization and being aware of any legal or operational
limitations;
- protecting the value of charitable
assets and identifying personal and internal conflicts of interest;
- ensuring that there is no private
inurement or personal financial gain by employees or trustees
of any not-for-profit entity involved in the transaction; and
- educating and informing constituencies,
including medical staff, employees, and the community, about the
changes taking place.
....
Patient Satisfaction Misleading
Standard patient-satisfaction surveys almost always yield high rates
of "satisfaction." But, as the American Hospital Association’s
(AHA) public-perception research shows, patients tell a different
story when they talk or write about their experiences. AHA focus-group
results show Americans deeply troubled about the changes they see
taking place throughout the healthcare system. The report, Eye
on Patients: A Report to the American Public, by the AHA and
the not-for-profit Picker Institute may be viewed on the Internet
at http://www.amhpi.com/eyeonpatients
.
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Arkansas Trustee Educational
Opportunity
Looking for another method of trustee education? The Arkansas Hospital
Association has formed an agreement with HGN, the Healthcare Governance
Network, through MEDIVISION’s multimedia approach, to
provide governance topics of discussion among nationally renowned
health system leaders. Participants may access the programs via
satellite telecasts, videotape distribution, and the Internet. Upcoming
interactive video events, all one-hour programs aired from 11 a.m.
to 12 noon CST, include:
- "Legal Responsibilities of
Healthcare Organization Trustees," August 27
- "Strategies for a Successful
Integrated Healthcare System," September 17
- "Strategic Planning: Essential
Steps Every Board Should Follow," October 21
- "Building Healthy Communities,"
November 19
- "Physicians as Trustees:
Unique Strengths and Challenges," December 3
For information about these programs,
visit the Healthcare Governance Network on the Internet at http://www.healthcare-governance.com
, or call (800) 572-3953. Call Tina Creel at AHA Services, (501)
224-7878, for information about MEDIVISION.
....
Seniors Getting Internet
Access
The federal Department of Health and Human Services (HHS) has announced
a new program designed to give senior citizens access to on-line
information about Medicare and Medicaid. Under the "Computers
for Seniors" program, the Health Care Financing Administration
will loan more than 500 computers with basic Windows and DOS operating
systems to senior centers across the country that are supported
through HHS’ Administration on Aging. The senior centers will
be responsible for installation of the computers and accompanying
modems and telephone lines, allowing their clients access to the
Internet.
HHS will encourage users to access two Internet sites: the Department's
Healthfinder web site (www.healthfinder.gov)
that gives answers to frequently asked questions about a variety
of related topics and HCFA’s site (www.HCFA.gov)
which gives information on Medicare/Medicaid laws and regulations
and consumer advisories.
....
Medicare Fraud
Medicare System Review
The American Hospital Association (AHA) is seeking a "full
regulatory review" of the Medicare billing system, which it
says is "big, complicated, bureaucratic, and choked with paper."
The AHA issued its call as a follow-up to a letter sent by the organization’s
president Dick Davidson in July requesting a six-month moratorium
on the use of the federal False Claims Act to crack down on fraudulent
billing. In another matter involving fraud investigations, federal
officials last month notified 16 of 49 teaching hospitals that an
audit of their billing practices would be dropped because contractors
hired to administer the Medicare program failed to give clear instructions
about proper billing procedures.
New Fraud Detectors
The federal Department of Health and Human Services (HHS) has awarded
a total of $2 million in grant money to a dozen advocacy groups
to recruit and train seniors to detect fraud and abuse in the Medicare
and Medicaid programs. The grants are part of a two-year demonstration
program funded under the 1997 omnibus appropriations bill. Funds
will be administered through HHS’ Administration on Aging.
Under the demonstration program, senior volunteers will work in
their communities and in local senior centers to help identify deceptive
healthcare practices such as overbilling, overcharging, or providing
unnecessary services. None of the 12 advocacy groups are located
in Arkansas.
Medicare Overpayments Total $23 Billion
According to new figures calculated by the Department of Health
and Human Services’ (HHS) Office of the Inspector General,
the Medicare program paid healthcare providers an estimated $23
billion in improper payments last year. The payments represent about
12% of the $194 billion paid out by Medicare in 1996, surpassing
previous HHS estimates that fraud, abuse, and bookkeeping errors
eat up 3% to 10% of Medicare spending.
The higher estimates are based on a recent audit of 5,000 Medicare
claims from 1996, which found billing problems common among all
types of healthcare providers, but especially in nursing home and
home health agencies. Critics also lay some responsibility for the
improper payments on Medicare fiscal intermediaries. They claim
the private insurance companies that process Medicare claims focus
too much on ensuring claims are submitted in a standard format,
rather than checking whether payments are made for appropriate services.
....
The Board/CEO Relationship
The American Hospital Association's Center for Healthcare Leadership,
in cooperation with Heidrick & Struggles, has begun a five-part
series of "Board/CEO Relationship-Builders," to be published
in Hospitals and Health Networks.
The series is drawn from interviews conducted by governance consultant
Barry Bader with CEOs and board leaders at 10 of the nation's most
successful health systems.
The first installment is an overview piece, with four others to
follow: (1) fostering a vision-driven and focused board; (2) cultivating
mutual accountability between well-informed boards and dynamic management
leadership; (3) the board as a learning organization; and (4) the
keys to board composition and member selection.
To receive a reprint of part one, call the AHA's Division of Trustee
and Community Leadership at 312-422-3336.
....
Got a Question? AHA Has Answers!
The American Hospital Association's Center for Healthcare Leadership
answers many governance-related questions. Both hospital CEOs and
trustees of AHA member institutions can benefit by calling 312-422-EXEC
seeking solutions to problems.
For instance, a trustee called seeking information on undertaking
a CEO search. The AHA provided valuable resources such as a list
of management companies with experience in rural organizations,
articles from Trustee magazine, a checklist of 20 questions
for interviewing potential CEO candidates, and an article, "Experts
Take the Sting Out of the CEO Search."
....
Effectively Accelerating
Quality Improvement
Healthcare organizations are pleased with the results they are getting
from quality improvement methods, but are "enormously frustrated
with how long it takes to get those results," says Mary Williams,
vice president of the Juran Institute, Wilton, Connecticut. The
faster an improvement idea is identified and implemented, the sooner
cost savings are realized and the faster patients, payers, and other
customers are delighted with improved outcomes and service.Ms. Williams
cautions, however, that accelerating improvement efforts carries
certain dangers. Implementing a change quickly without doing the
necessary homework may reap cost savings, but might also have a
negative impact on patient outcomes or overload already overworked
staff.
Experts contacted by The Quality Letter (May 1996) have found that
speed and quality can work hand in hand. To do this, they advocate
seven principles:
- Create a constant flow of innovative
ideas. Then emphasize implementation.
- Look for "better" practices,
rather than "the best" practice.
- Concentrate on vital areas.
- Reduce/eliminate quality jargon.
- Emphasize replication.
- Be willing to devote significant
time and resources for big results.
- Learn how to harness staff expertise
and creative energy.
....
Health Benefits Costs Steady
Nationwide, employers spent, on average, a total of 2.1% more on
health benefits in 1995 than in 1994, according to a study by Foster
Higgins, a New York City benefits consulting firm. Benefits costs
fell 1.1% in 1994, the first drop ever noted in the survey. With
managed care becoming the norm, competition among health plans and
a relatively low medical CPI were credited with keeping health benefits
costs low.
In 1994, managed care plans served 63% of all covered workers. In
1995, 71% were covered by managed care plans. The cost of HMO coverage
declined nationally by 3.8% — from an average of $3,385 per
active employee in 1994 to $3,255 in 1995, according to the survey.
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