Arkansas Hospitals, Fall 2015 by Arkansas Hospital Association

arkansas

hospitals www.arkhospitals.org

FALL 2015

Pulling Together for the Future AHAâ&#x20AC;&#x2122;s New Board Chairman on the Strength of Our Association Leveraging the Nurse Perspective Special Report:

Hospital Finances and Health Reform A Magazine for Arkansas healthcare Professionals Arkansas Hospitals I Fall 2015

Weâ&#x20AC;&#x2122;re a knowledgeable connector of people, physicians and health care places. One way we keep physicians and patients connected is through a Personal Health Record (PHR), available for each Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas member. A PHR is a confidential, Web-based, electronic record that combines information provided by the patient and information available from their claims data. A PHR can help physicians by providing valuable information in both every day and emergency situations. To request access, contact PHR Customer Support at 501-378-3253 or personalhealthrecord@arkbluecross.com or contact your Network Development Representative.

Fall 2015 I Arkansas Hospitals

arkansasbluecross.com

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10 16 24 37

arkansas

hospitals is published by

Arkansas Hospital Association

419 Natural Resources Drive • Little Rock, AR 72205 501.224.7878 / FAX 501.224.0519 www.arkhospitals.org Elisa White, Editor-in-Chief Nancy Robertson Cook, Editor & Contributing Writer Cindy Lewis, Editorial & Layout Assistant Emily Cavallo, Art Director

Board of Directors

Doug Weeks, Little Rock / Chairman Walter Johnson, Pine Bluff / Chairman-Elect Darren Caldwell, Newport / Treasurer Ron Peterson, Mountain Home / At-Large Peggy Abbott, Camden Chris Barber, Jonesboro Jerry Berley, Warren David Berry, Little Rock John Heard, McGehee Ed Lacy, Heber Springs Jim Lambert, Conway Corbet Lamkin, Camden James Magee, Piggott Dan McKay, Fort Smith Ray Montgomery, Searcy Robert Rupp, El Dorado

Executive Team Robert “Bo” Ryall / President and CEO W. Paul Cunningham / Executive Vice President Tina Creel / Vice President of AHA Services, Inc. Elisa M. White / Vice President and General Counsel Jodiane Tritt / Vice President of Government Relations Pam Brown / Vice President of Quality and Patient Safety Lyndsey Dumas / Vice President of Education

departments 4 6 7 8

From the President Editor’s Letter Event Calendar

Newsmakers and Newcomers

All About Hospitals

cover story 10 Rowing Together, Forward

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.

quality and patient safety 14 16 21 24

Focus on Quality Nurses at the Table The AHA’s Clinical Staff Reflections on the New QIO Regional Structure

news 33 NewsSTAT 34 CEO Profile: Walter Johnson –

“It’s Going to Take All of Us, Working Together”

36 Arkansas State Nursing

Board Website

37 Planning for the Unthinkable 40 AHA Services Presents:

The Nurse’s Role in The Patient Experience

hospital finances and health reform 46 The Private Option Report:

Improving the Health of Arkansans and the Arkansas Economy

49 The Medicaid Report: Hospitals

Continue To Serve All Patients Despite Losses

26 Be Recognized for Your Excellence

legislative advocacy pcipublishing.com Created by Publishing Concepts, Inc. David Brown, President • dbrown@pcipublishing.com For Advertising info contact Michelle Gilbert • 1.800.561.4686 ext.120 mgilbert@pcipublishing.com edition 92

member benefits feature 28 Leverage Data to Create an

52 A CEO’s Perspective

on Reform

Effective Compensation Plan Arkansas Hospitals I Fall 2015

from the President

NURSING: THE HUB of the Wheel Photo courtesy of Jason Burt

First, I want to say thank you to all of our hospital nurses, because every day you are making an immensely important, positive difference in our patients’ lives and those of our patients’ family members. Likewise, your knowledge and actions as part of the healthcare team have helped move team-based care from a mere concept into a reality in the hospital setting. Some things we’d like for you to know: • You take your clinical knowledge for granted, but we don’t. • You deal with an increasing amount of compliance reporting, and we notice. • You are the patient’s link to understanding the healing process, and we rely upon you. • You ease fears and calm nerves daily, and we appreciate you. • You help us, our parents, our children and our friends heal, and we are grateful. Now more than ever, healthcare is based upon teamwork, and in the dayto-day care of patients, nurses often serve as the hub of the wheel for the care team. They guide patients and their families. They teach us how we should care for

Fall 2015 I Arkansas Hospitals

In this issue of Arkansas Hospitals magazine, we are putting the spotlight on nurses, nursing and the importance of nurses’ compassionate care to the hospital patient’s experience.

ourselves and our family members as we transition from hospital to home life once again. Keeping up with the latest in clinical practice breakthroughs, nurses put new theories into practice, often refining systems as they go to create efficiencies others could not see but can certainly appreciate. When we at the AHA were considering expanding our role to include Quality Improvement, we knew we had to have clinical direction not previously available on our staff. It became apparent very quickly that the most experienced and best were already working with our hospitals. Pam Brown and Nancy Godsey bring so much to our AHA team and are our own nurse experts. Their clinical knowledge is an asset that has benefitted our policy, legal, regulatory and advocacy efforts. And, of course, it benefits the quality efforts within our hospitals every day. Each of us has a particular “nurses made the difference” story to tell. On a personal note, I’d like to thank the nursing staff who have taken care of my parents on and off over the past five years. My parents have always received good care, and at their regional hospital, a number of nurses from my hometown

of Star City are on staff. It’s so nice when the nurses stop by at shift change to check on my folks, even when they work on other floors or in other parts of the hospital. When they drop in to say, “Hi!,” they probably have no idea how much that means to my parents as patients/caregivers, and to us as family members. It’s like we’re getting personalized care from our hospital and our community. I’m sure it’s that way all over Arkansas. Nurses’ kind words and bright smiles bring a touch of home, or at least the loving kindness of home. On any given shift, there is so much to do, so many patients to see, so many records to review, so much to document. And yet, as nurses enter each patient room, their mere presence brings hope. Hope for relief, hope for understanding, hope for healing. We want to recognize you – our hospital nurses – for all you do. We want you to know we notice and offer a welldeserved thank you.

Bo Ryall

President and CEO Arkansas Hospital Association

Can Laboratory Testing Improve Patient Care and Lower Costs? Yes. Let us show you how. AEL is a medically-led, communitybased laboratory with personal service A partner for hospitals to reduce the cost of referrals and in-house testing by using the most modern technology.

To learn more about AEL and its innovative technology to assist in utilization management call Pam Oâ&#x20AC;&#x2122;Brien at 901.405.8200. Arkansas Hospitals I Fall 2015

editor’s letter

The Key to Success This edition of Arkansas Hospitals began as a salute to nurses, but it evolved into a celebration of teamwork. This comes as no surprise when we consider that the nurse often is the “face” of the care team for the patient. For hospital patients, our nurse is the one checking on us regularly throughout the day and night, answering questions and coming when we press that red call button at our bedside. These dedicated professionals also help facilitate communication between healthcare providers and the most important member of the team – the patient. Even a cursory review of the literature shows that team-based care is going to be an essential part of the

healthcare system’s effort to reduce costs and improve quality, and nurses, in turn, are an essential part of the team. This is the focus of our cover story by Ann Scott Blouin, as she reflects on the future of nursing care. Not only are hospitals focusing on teamwork, but the Arkansas Hospital Association is also dedicated to the power of many individuals coming together to support a common goal – improvement of our healthcare system. This perspective is shared

by two CEOs featured in this edition, our incoming board chairman, Walter Johnson, and a long-time board member, Ray Montgomery. We salute our nurses and all of the other team members who serve Arkansas patients every day. As Henry Ford observed, “Coming together is a beginning. Keeping together is progress. Working together is success.” Here’s to success!.

Elisa White, Editor-In-Chief

Congratulations to the Winners

of the Arkansas Hospital Association 2015 Diamond Awards for Excellence in Hospital Marketing and Public Relations! Arkansas Heart Hospital, Little Rock Arkansas Hospice, North Little Rock Arkansas Methodist Medical Center, Paragould Baptist Health Medical Center-Heber Springs Baptist Health Medical Center-Little Rock Baxter Regional Medical Center, Mountain Home Conway Regional Health System Howard Memorial Hospital, Nashville Jefferson Regional Medical Center, Pine Bluff Mena Regional Health System

National Park Medical Center, Hot Springs North Arkansas Regional Medical Center, Harrison Ouachita County Medical Center, Camden Sparks Regional Medical Center-Fort Smith Sparks Regional Medical Center-Van Buren St. Bernards Medical Center, Jonesboro UAMS Medical Center, Little Rock Unity Health-White County Medical Center, Searcy Washington Regional Medical System, Fayetteville White River Health System, Batesville

Join the AHA and Arkansas Society for Healthcare Marketing and Public Relations as we honor the recipients at the AHA Annual Meeting Awards Banquet October 8 at the Little Rock Marriott. For ticket prices and information, contact Jennifer Kostelecky, 501.224.7878 or email her at jkostelecky@arkhospitals.org.

Fall 2015 I Arkansas Hospitals

Arkansas Hospital Association

Event Calendar October 16, Jacksonville Arkansas Hospital Engineers’ Scholarship Trust Trap Shooting Tournament Arkansas Game and Fish Foundation Shooting Sports Complex October 21, Little Rock How Microsoft Works with Multiple Personalities AHA Classroom

How Microsoft Works with Multiple Personalities October 21, 2015 with Melissa Esquibel, Certified Microsoft Trainer, Arkansas Hospital Association, Little Rock

October 23, Little Rock Society for Arkansas Healthcare Purchasing and Materials Management (SAHPMM) Fall Conference AHA Classroom

Do you support multiple people? Do they all have their individual preferences for presentations, documents, spreadsheets and/or itineraries? Microsoft Office allows you to manage multiple people (and their personal preferences) in just a few clicks. Using OneNote, Outlook, Word, Excel and PowerPoint, you will learn about use of Custom Themes, Templates, QuickParts and QuickSteps. Also included in the workshop: Empowering Teams and Managing Projects in Everyday Microsoft Office.

October 28-30, Little Rock Healthcare Financial Management Association (HFMA) 2015 Conference Crowne Plaza

2 for the price of 1 registration available for member hospitals! For more information, contact Lyndsey Dumas, 501.224.7878 or ldumas@arkhospitals.org.

November 2, Mountain Home Arkansas Association of Hospital Trustees (AAHT) 2015 Fall Regional Dinner Series Baxter Regional Medical Center November 4, Little Rock Metro CEO District Meeting AHA Boardroom November 9, Jonesboro Arkansas Association of Hospital Trustees (AAHT) 2015 Fall Regional Dinner Series St. Bernards Medical Center November 10, Camden Arkansas Association of Hospital Trustees (AAHT) 2015 Fall Regional Dinner Series Ouachita County Medical Center November 12, Little Rock Arkansas Hospital Auxiliary Association (AHAA) Board Meeting AHA Boardroom November 13, Little Rock Arkansas Hospital Association Board Meeting AHA Boardroom November 24, Little Rock Metro Bio Meeting AHA Classroom

December 3, Little Rock Arkansas Association of Hospital Trustees (AAHT) 2015 Fall Regional Dinner Series Arkansas Children’s Hospital

December 10, Little Rock Healthcare Financial Management Association (HFMA) 2015 December CPE Session AHA Classroom

December 9, Little Rock CPT® 2016 Procedure Coding Changes Workshop AHA Classroom

December 16, Jonesboro CPT® 2016 Procedure Coding Changes Workshop Hilton Garden Inn December 24-25, Little Rock Arkansas Hospital Association Offices Closed

CPT Coding 2016 Workshops – 2 Locations! December 9, Arkansas Hospital Association, Little Rock; December 16, Hilton Garden Inn, Jonesboro 2016 CPT® Coding and Compliance Updates! This comprehensive, oneday seminar will provide the necessary instruction to help you keep pace with changes in procedural terminology and help your team achieve more accurate reimbursement submissions. Added, revised and deleted codes, changes to code set, 2016 Compliance and OIG Work Plan Update.

2 locations for your convenience! For more information, contact Lyndsey Dumas, 501.224.7878 or ldumas@arkhospitals.org.

November 26-27, Little Rock Arkansas Hospital Association Offices Closed

Program information is available at www.arkhospitals.org/events. Arkansas Hospitals I Fall 2015

arkansas

Newsmakers and Newcomers ◼ Following a management agreement

between CHI St. Vincent and Conway Regional Health System, Matt Troup, FACHE, vice president of ancillary and support services for CHI St. Vincent, has succeeded Jim Lambert, FACHE, as chief executive officer of Conway Regional Health System, effective August 17.

◼ Lambert, a member of the

AHA board of directors, has been named president of the Arkansas Health Alliance, a new company that will work with independent community hospitals and healthcare systems to lower costs while providing higher quality and lower priced care for communities.

◼ Ray Montgomery, FACHE,

president of Unity Health-White County Medical Center in Searcy, has been named chair of the Rural Subcommittee of the

American Hospital Association’s Task Force on Ensuring Access in Vulnerable Communities. ◼ Larry Morse has been named

interim CEO at DeWitt Hospital and Nursing Home, following the departure of Darren Caldwell, who has accepted a new position as the vice president and administrator of Unity HealthHarris Medical Center in Newport. Morse is immediate past-chairman of the Arkansas Hospital Association board of directors and is a former administrator of Johnson Regional Medical Center in Clarksville.

◼ Robert Rupp, project CEO with

Community Health Systems, has been named CEO of Medical Center of South Arkansas in El Dorado. Rupp was most recently interim CEO at Helena Regional Medical Center and Harris Hospital (now, Unity Health-Harris Medical Center)

in Newport. Rupp serves on the Arkansas Hospital Association board of directors as alternate delegate to the American Hospital Association’s Regional Policy Board 7. ◼ Tim Hill has been named

UAMS vice chancellor for regional programs. He had served in the position in an interim capacity since the retirement in May of Mark Mengel, MD. Hill has been with UAMS for the past four years as director of the Center for Rural Health and the Center for Healthcare Enhancement and Development. A former hospital CEO, Hill served hospitals in Harrison and Little Rock.

◼ Leah Osbahr has been named

CEO of Helena Regional Medical Center. Osbahr was most recently CEO of Washington County Memorial Hospital in Potosi, Missouri, and earlier served as CEO of Lawrence Health Services in Walnut Ridge.

all about hospitals ◼ Twenty-six Arkansas

hospitals hosted M*A*S*H (Medical Applications of Science for Health) Camps for high school students this summer. M*A*S*H Camp is a two week summer enrichment program that allows rising high school juniors and seniors to shadow science and health professionals and attend workshops to enhance their experience in the healthcare field.

◼ CHI St. Vincent announced

August 11 that it signed a fiveyear management agreement with Conway Regional Health

Fall 2015 I Arkansas Hospitals

System that became effective in mid-August. The partnership calls for each health system to keep its name and board of directors. ◼ Arkansas Children’s

Hospital has announced plans to build a new hospital campus in Springdale. The hospital will sit on a 37-acre campus donated by two northwest Arkansas families. The proposed 225,000 square foot facility will include: 24 inpatient beds; an emergency department/ urgent care center with 21 exam rooms; 30 clinic exam rooms; 5 operating rooms; imaging and

diagnostic services; and a helipad with refueling station. ◼ St. Bernards Medical

Center has been recognized for the third consecutive year as one of the Best Places to Work in Arkansas in a program created by Arkansas Business and Best Companies Group. The survey and awards program identifies, recognizes and honors employers in the state that create a unique and rewarding environment for their employees. Honorees are chosen through a twopart survey process managed by Best Companies Group.

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Arkansas Hospitals I Fall 2015

Cover Story

Rowing Together, Forward “What mattered more than how hard a man rowed was how well everything he did in the boat harmonized with what the other fellows were doing.” – Daniel James Brown, The Boys in the Boat: Nine Americans and Their Epic Quest for Gold at the 1936 Berlin Olympics

Strategy session

Reflections on the Future of Nursing in the Era of Healthcare Transformation 10

Fall 2015 I Arkansas Hospitals

by Ann Scott Blouin, RN, PhD, FACHE, Executive Vice President of Customer Relations, The Joint Commission Nine roughshod boys from the University of Washington set an example 79 years ago worth following today. The 1936 Berlin Olympics are remembered for myriad reasons – among them Jesse Owens’s four gold medals, Adolf Hitler and the budding rise of the Nazis. Yet as much as the author touches upon these storylines, Daniel James Brown’s book, The Boys in the Boat: Nine Americans and Their Epic Quest for Gold at the 1936 Berlin Olympics, instead focuses on the story of the 1936 United States men’s Olympic rowing crew. Sons of farmers, fishermen and loggers, the boys narrowly beat out Italy and Germany to win the gold medal.

Yet that’s not why I believe Brown focused on them for his book, nor why I mention them now. I believe the reason lies in the quote at the start of this article. These were not just nine individual rowers in a boat. They were a team: a team that showcased the power of people working together for a single goal. You may think rowing a boat has little to do with nursing care, but I would argue the analogy may have everything to do with where nursing and patient care is (and needs to be) going.

Coming Together

In surveying the national healthcare and professional nursing landscape, payment reform and innovation continue to transform the opportunities and challenges healthcare organizations face every day. Technology advances are no longer on the horizon. They’re already here, with more coming. Nurses work in more settings than ever before, with increasing complexity and specialization. In the midst of all this, it’s easy to focus inwardly. In my opinion, nurses tend to be selfless by nature, with their priority being to help people at their most vulnerable. So the idea of only worrying about doing one’s best for his or her patient, regardless of the setting or circumstances, seems like an ideal solution. And indeed it is the centerpiece of our value system as professionals caring for people who need us. Yet I harken back to the quote at the start of this article. As much as one hard-working and talented nurse can do, it takes more than one person to provide truly safe and high quality care, just as it takes more than one effective rower to move a boat forward smoothly and efficiently. A team with a wellcommunicated and singular plan of care allows for better handoffs between and among healthcare staff and settings. A truly effective team is also far more prepared for when things don’t go according to plan. On January 15, 2009, US Airways Flight 1549, an Airbus A320 piloted by Captain Chesley B. “Sully” Sullenberger, made an unpowered emergency water landing in the Hudson River after

As much as one hard-working and talented nurse can do, it takes more than one person to provide truly safe and high quality care, just as it takes more than one effective rower to move a boat forward smoothly and efficiently. A team with a well-communicated and singular plan of care allows for better handoffs between and among healthcare staff and settings. multiple bird strikes caused both jet engines to fail. Incredibly, all 155 persons on board survived. If there was ever a pilot you’d want in that type of situation, Sullenberger was it. A former Air Force fighter pilot, he’d worked for US Airways for 29 years and had logged a total of 19,663 flight hours at the time of the incident. Yet, as impressive as his credentials and actions were that afternoon, he certainly wasn’t alone. First Officer Jeffrey Skiles attempted to restart the engines by going through the three-page emergency procedures checklist. Air traffic controller Patrick Harten held all waiting departures on the ground. And the crew ensured the passengers were prepared for impact. As was said when the Guild of Air Pilots and Air Navigators awarded the entire flight crew Master’s Medals: “The reactions of all members of the crew, the split second decision-making and the handling of this emergency and evacuation was ‘text book’ and an example to us all.” It was a total team effort; a “text book” one thanks in part to the concept of Crew Resource Management (CRM). CRM, by definition, is the effective use of all available resources for personnel to assure a safe and efficient operation, reducing error, avoiding

stress and increasing efficiency. The concept was developed as a response to new insights into the causes of aircraft accidents following the introduction of flight data recorders (FDRs) and cockpit voice recorders (CVRs) into modern planes. Information gathered from these devices suggested many accidents did not result from a technical malfunction of the aircraft or its systems, nor from a failure of aircraft handling skills or a lack of technical knowledge on the part of the crew. Instead, the data showed accidents were most often caused by the inability of crews to respond appropriately to the situation in which they found themselves. In essence, CRM says everyone has their jobs, but it takes a team of people to get the plane off the ground. When conceptualized in those terms, it’s easy to see how this concept can be adapted into a team approach for healthcare. Instead of getting a plane into the air, you’re achieving the safest, highest quality care for a patient possible, whatever the unexpected situation presents. CRM is really about anticipating and containing adverse events, training staff to actively look for things that could cause adversity before they even continued on page 13 Arkansas Hospitals I Fall 2015

PHASE I

PHASE II

PHASE III

Assessment

Planning, Training & Implementation

Sustainment

Pre-Training Assessment SITE ASSESSMENT CULTURE SURVEY

Culture Change

Ready? YES

DATA/ MEASURES

Climate Improvement

ACTION PLAN

T R A I N I N G

COACH & INTEGRATE Intervention

Test

MONITOR THE PLAN CONTINUOUS IMPROVEMENT

Set the Stage ★ Decide What to Do ★ Make it Happen ★ Make it Stick A TeamSTEPPS Initiative occurs in three continuous phases: Phase I — Assessment; Phase II — Planning, Training, & Implementation; and Phase III — Sustainment. A healthcare organization or work unit can shift toward a culture of safety using team tools and strategies by progressing through each of the three phases and completing key actions within each phase. The TeamSTEPPS Initiative provides guidelines, tools and resources for completing each phase and for gathering data necessary for progression to the next phase. Keys to success at each phase include involvement of the right people, the use of informationdriven decision making and careful planning before acting.

Three Phases of the TeamSTEPPS Delivery System The three phases of TeamSTEPPS are based on lessons learned, existing master trainer or change agent experience, the literature of quality and patient safety and culture change. A successful TeamSTEPPS initiative requires a thorough assessment of the organization and its processes and a carefully developed implementation and sustainment plan.

the entire organization, a phased-in approach that targets specific units or departments, or selection of individual tools introduced at specific intervals (called a “dosing strategy” in TeamSTEPPS parlance). As long as the primary learning objectives are maintained, the TeamSTEPPS materials are extremely adaptable.

Phase 1 — Assess the Need

The goal of Phase 3 is to sustain and spread improvements in teamwork performance, clinical processes and outcomes resulting from the TeamSTEPPS initiative. The key objective is to ensure opportunities exist to implement the tools and strategies taught, practice and receive feedback on skills, and provide continual reinforcement of the TeamSTEPPS principles on the unit or within the department.

The goal of Phase 1 is to determine an organization’s readiness for undertaking a TeamSTEPPS-based initiative. Such practice is typically referred to as a training needs analysis, which is a necessary first step to implementing a teamwork initiative.

Phase 2 — Planning, Training, and Implementation

Phase 2 is the planning and execution segment of the TeamSTEPPS initiative. Because TeamSTEPPS was designed to be tailored to the organization, options in this phase include implementation of all tools and strategies in

Fall 2015 I Arkansas Hospitals

Phase 3 — Sustainment

Find the TeamSTEPPS Implementation Guide on the Agency for Healthcare Research and Quality (AHRQ) website: www.ahrq.gov/professionals/education/curriculumtools/teamstepps/instructor/index.html, and click on “Implementation Guide: Detailed.”

happen, and to have backup plans if the unexpected happens. For instance, in pre-procedure checks before a patient’s surgery, you may notice that there is only one unit of blood for the patient. CRM and an effective safety culture should prompt someone to speak up and ask if everyone on the team is comfortable with that amount of blood. The same thoughts around preparation and risk management should occur with a patient who had a previous serious reaction to anesthesia. CRM would help coordinate preparations so that anticipation occurs and a backup plan is in place. Having an effective, well-coordinated team approach with a group of experienced staff is one step in the journey toward zero harm. Without this teamwork, staff works in silos, handoffs become uncoordinated and mistakes happen – tests get repeated, important information is not passed on, critical lab results are missed. No matter the mistake, the end result is always the same: The patient and his or her family potentially suffer the consequences of care which is not effectively and proactively planned.

Taking the Helm

Nurses are in unique positions to lead this team effort and coordinate care, due to our understanding of the variety of roles and responsibilities in healthcare settings. Many nurses have taken leadership roles in moving toward improved teamwork and communication to reduce patient harm. In an effort to help healthcare organizations and professionals

improve communication and teamwork skills, the Agency for Healthcare Research and Quality (AHRQ) created TeamSTEPPS. This system provides ready-to-use materials and a training curriculum in a multimedia format with tools to help a healthcare organization plan, conduct and evaluate its own team training program for higher quality and safer patient care. Among TeamSTEPPS’ core concepts is “deference to expertise,” or deferring to the expert. This concept says that while personnel should have respect for hierarchy, it’s more important that they listen to those with the required expertise than to someone just because of their title or rank. For example, a pilot may outrank a mechanic, but based on TeamSTEPPS (and CRM), if the mechanic says a plane is not fit to fly, the plane does not take off. The mechanic is the expert, and as such, everyone on the team defers to him/her. When it comes to patients, nurses are often the experts on the background related to the spoken and unspoken needs of their patients. Nursing staff frequently interact with their patients, allowing them to see a more comprehensive view of the patient and family situation. This positions nurses as cornerstones in the team effort,

and often equates to nurses being the ideal team leaders. I’ll always remark that an effective physician asks the nurses caring for his or her patients, “Tell me what you see.” Adding everyone on the patient care team’s observations, concerns and questions results in a better, more fully developed plan of care, regardless of the healthcare setting. When the team all comes together — when nurses and other staff work together as one — each team member’s talents and efforts are at their very best,

patient care can achieve its highest level of reliability, and healthcare becomes what we envision. As Brown writes about the 1936 Olympic rowing team’s efforts: “All were merged into one smoothly working machine; they were, in fact, a poem of motion ….” This poem of motion is the future of healthcare, as we collaborate to continuously improve for our patients, rowing together, forward.

Ann Scott Blouin, RN, PhD, FACHE, is the executive vice president of customer relations at The Joint Commission. In this position, she focuses on building external customer and stakeholder relationships, primarily in the hospital and health system market. Previously, Dr. Blouin has held positions as program administrator, vice president for nursing, and executive vice president for operations at two Chicago area community teaching hospitals and a Chicago academic medical center. She is a Fellow of the American College of Health Care Executives and member of the American Organization of Nurse Executives, American Nurses Association and Sigma Theta Tau, the National Honor Society for Nurses.

Arkansas Hospitals I Fall 2015

Quality and Patient Safety

The American Society for Healthcare Risk Management created an Equity of Care Assessment Tool to help determine your organization’s cultural competency; to assist in identifying potential gaps in equity of care; and to help focus efforts on work that will enhance healthcare risk management. This tool is a good first step in conducting an equity of care gap analysis. Access the tool at www.ashrm.org/resources/pdf/FinalEquity-of-Care-Assessment-Tool.pdf.

New guidelines from the National Patient Safety Foundation (NPSF) are designed to help healthcare organizations improve the way they investigate medical errors, adverse events and near misses. To emphasize that preventing harm requires action to be taken, the guidelines have renamed the investigation process Root Cause Analysis and Action or RCA “squared.” Endorsed by a number of organizations, the report, RCA 2: Improving Root Cause Analyses and Actions to Prevent Harm, is available for download on the NPSF website at www.npsf.org/rca2.

Focus on Quality Four health systems in central Ohio continue to update their award-winning website, www.healthinfotranslations.org, which contains health education resources in 19 languages for healthcare professionals and others to use in their communities. The materials cover a range of health topics and may be downloaded in any language and given to patients without copyright restrictions.

The Agency for Healthcare Research & Quality (AHRQ) has an in-depth tool for measuring fall rates and fall prevention practices in various units within your hospital. Using the premise, “If you can’t measure it, you can’t improve it,” the toolkit asserts that fall rates and fall prevention practices must be counted and tracked as one component of a quality improvement program. This practical guide also takes you to the National Database of Nursing Quality Indicators (NDNQI) data website, which includes a link to definitions of falls and patient days, so that fall rates may be calculated. Find the resource at http://www. ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtk5.html.

A new resource about the effect of patient and family engagement practices on patient experiences is now available on the Hospitals in Pursuit of Excellence (HPOE) website. The Microsoft PowerPoint presentation covers the findings of a 2013-2014 survey conducted by the Health Research & Educational Trust and the Gordon and Betty Moore Foundation. A link to this slide deck is available at http://www.hpoe.org/resources?type=13.

Fall 2015 I Arkansas Hospitals

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Arkansas Hospitals I Fall 2015

Quality and Patient Safety

Nurses at the Table

Governance Focus

An Important Voice in the Boardroom

By Kimberly McNally, MN, RN, President, McNally & Associates Hospitals and healthcare systems are moving to a value-based care model focused on the Triple Aim of better care and better health at lower cost. To achieve these goals, exceptional leadership at the CEO and board levels is essential. Governance experts tell us that high-performing boards are composed of individuals with a variety of professional backgrounds, life experiences and personal characteristics who can bring a diversity of opinions and independent thought to important deliberations. The nursing voice brings a richness of experience that can enhance any boardâ&#x20AC;&#x2122;s effectiveness.

Fall 2015 I Arkansas Hospitals

Value of the Nursing Perspective

Gone are the days when successful hospital boards focused solely on the financial results of facility operations. Amid a growing appreciation of the direct impact of leadership and management decisions on patient care, hospital trustees recognize that evaluating and improving quality is a fundamental duty. In the hospital setting, nurses have more one-on-one interaction with patients than any other clinician, giving them unique insight into the strengths and weaknesses of hospital systems and making them an effective proxy for the voice of the patient. This makes the nursing perspective vital to any discussion of quality improvement. Nursing leader, university professor and former AARP Board Chair Joanne Disch, PhD, RN, FAAN, describes a specific viewpoint or “nursing lens” that people educated as nurses bring to decision making. This nursing lens is a way of thinking informed by understanding people and their needs throughout the lifespan. It involves understanding issues from a systems perspective and includes developing a set of interpersonal skills to engage diverse stakeholders. Most people are quick to recognize and praise nurses’ clinical and patient care skills, but the value of this nursing lens in the boardroom is often overlooked. The 2011 Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health (the IOM Report), emphasizes the importance of nurse leadership in improving America’s healthcare system. From the report: “By virtue of its numbers and adaptive capacity, the nursing profession has the potential to effect wide-reaching changes in the healthcare system. … Private, public and governmental healthcare decision makers at every level should include representation from nursing on boards, on executive management teams and in other key leadership positions.” Governance has been called a team sport. Because of nursing’s universal team approach in addressing adversity,

Across the country, nurses are being prepared for community and hospital board seats. Be counted among the forward thinking organizations poised for the future by recruiting at least one nurse for the position of trustee to leverage the nursing perspective in your boardroom as you lead change to advance health in your community.

nurses instinctively offer a team-based orientation to their interactions in the boardroom. On the hospital floor, the respect of team members for one another is vital in achieving success. So it is with boards; adding individuals with a natural bent toward team building and team participation can only increase the board’s effectiveness. Quality improvement research consistently identifies buy-in of frontline staff as essential for achieving and sustaining change. Comprising a large proportion of the hospital workforce and working with many other divisions day-to-day, nurses bring a front-line perspective on engaging employees. They can offer insight into ways to facilitate successful project implementation. They also provide important insights on discussions related to the workforce needs of the future. The board sets the culture for the hospital or health system and assures the necessary resources for physicians, nurses and other team members to carry out the organization’s quality and patient safety vision. To sometimes difficult but necessary hospital boardlevel conversations about quality of care, nurses bring an essential point of view on safety and the patient experience – both critical elements in producing high value outcomes.

Without the voices of clinicians at the board level, the hospital’s quality work runs the risk of being hampered, at best, and misguided, at worst. Physicians and nurses offer different perspectives in the governance process. Both have value. Physicians focus primarily on treatment and cure of a particular injury or disease, as well as adding their insight into the complexity of managing care across the clinical continuum. Nurses bring expertise and additional insight into that continuum, including elevation of the patient experience, addressing challenges associated with care transitions and heightening attention to promoting wellness and preventive care as a cost saving measure for both hospital and patient. This expertise makes nurse leaders excellent resources on the hospital board. Consistently rated as the most trusted healthcare professionals, nurses bring deep knowledge and experience with patient care delivery and community health to the table. With their experience in building, maintaining and fostering care management systems, they know the importance of integrating behavioral health and the social determinants of health with an individual’s and the community’s physical health. continued on page 18 Arkansas Hospitals I Fall 2015

An Interview with Barbara Williams, PhD, RN: Conway Regional Health System Board Chairperson Barbara Williams, Chair of the Department of Nursing at the University of Central Arkansas, currently serves as chairperson of the board of Conway Regional Health System. She has served as president of the Arkansas Association of Hospital Trustees (AAHT), a member of the Arkansas Hospital Association board of directors and a delegate to the American Hospital Association’s Regional Policy Board 7. In 2014, Dr. Williams received the Arkansas Hospital Association Chairman’s Award for her distinguished service to healthcare in Arkansas.

What is your leadership background?

“The most relevant leadership experiences that I had earlier in my life that benefit me now as a board member were when I worked with others – organizations and individuals who in other experiences would have been competitors – to build coalitions to reach a higher good, a common goal. In some of those early experiences, I was so much in the framework of competition that I had to do a lot of soul searching and work to identify areas of common interest. These experiences taught me to view the table as round and that the world is not as black and white or dualistic as I once thought.”

Tell us the story of how you joined the Conway Regional Health System board.

“I was appointed to the Conway Regional Health System board in 2010, the first nurse to be asked to serve on it. The board leadership at that time, to their credit, was seeking to become a more diverse board in terms of age, race and professions represented.”

Give us an example of a board dialogue and recent decision that benefitted from your nursing lens.

“We formed a new committee to address Quality Oversight and Compliance. There was an automatic recognition that physicians needed to be involved. I brought attention to the fact that the involvement of nurses was also critical. Up until that point, nurses were not considered important in the leadership drive to improve quality and compliance.”

What advice do you have for CEOs and boards committed to recruiting a nurse to their hospital board?

“Seek out nurses to determine their commitment and interest in serving. Nurses in academic roles are good possibilities, as are nurses who are consultants and in other forms of practice. In the healthcare world of tomorrow, most physicians will be affiliated with the healthcare system in some way…don’t be fearful of nurses who also have a tie. Many hospitals are already allowing physicians who work in practices owned by the healthcare systems to serve. We should consider nurses in the same manner.”

Fall 2015 I Arkansas Hospitals

Including a Nurse Leader on Your Board

Nurse leaders have deep expertise in the myriad of clinical, operational and systems issues confronting hospitals today and make excellent board prospects. A common question I hear is,“The CNO attends the board meeting; isn’t that good enough?” The CNO is a vital member of the management team and should attend and contribute to board and committee meetings. However, the role of a trustee is different from that of a hospital administrator. To find board prospects who are nurses, look to those who hold executive positions in healthcare organizations, lead quality improvement initiatives and serve as expert clinicians, researchers, policy analysts and/or consultants across healthcare settings. In small communities, hospitals might consider recruiting a nurse from a nearby community, from the local college or perhaps a recently retired nurse leader. Another resource is a newlycreated American Nurses Foundation database that matches qualified nursing leaders with boards seeking nurse involvement. Organizations can submit a request to http://anfonline.org/ nurseboardleadership.

A National Trend: Increasing the Number of Nurses on Boards

Because of the trend toward inviting nursing voices to be included on the hospital board, nurses across the country are taking the initiative to prepare themselves to assume board roles. In response to the IOM Report, which recommends nurses play more pivotal roles on boards and commissions in improving the health of all Americans, there are important efforts taking place at the national and state levels to ease and assure inclusion of the valuable nursing voice on America’s hospital boards. At the national level, the Nurses on Boards Coalition, supported by the Robert Wood Johnson Foundation and AARP, is implementing a strategy to bring nurses’ beneficial perspective to governing boards as well as to healthoriented state and national commissions.

The goal is to put 10,000 nurses on boards by the year 2020 in order to tap this valuable resource for the betterment of healthcare governance. This coalition was founded by 21 nursing and healthcare organizations with the aim of increasing the presence of nursing on corporate and nonprofit health-related boards, thereby adding to the breadth of these boards’ makeup and expertise.

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As hospitals and health systems focus on achieving the Triple Aim, recruiting and selecting trustees with a nursing background will add an important voice to our governance. Nurse leaders have the educational background, clinical expertise, leadership training and wisdom necessary to make significant contributions. Organizations that do not include nurses on their boards are missing this important perspective. Across the country, nurses are being prepared for community and hospital board seats. Be counted among the forward thinking organizations poised for the future by recruiting at least one nurse for the position of trustee to leverage the nursing perspective in your boardroom as you lead change to advance health in your community.

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Kimberly McNally, President of McNally & Associates, is a nursing leader, executive coach, retreat facilitator and governance consultant. She currently serves on the boards of the American Hospital Association, Health Research and Education Trust, UW Medicine and Seattle Cancer Care Alliance. She also serves on the American Hospital Association’s Center for Healthcare Governance National Board of Advisors and as a governance consultant to the National Association of Community Health Centers.

Arkansas Hospitals I Fall 2015

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Quality and Patient Safety

The AHA’s Clinical Staff: Our Team Helping Your Teams By Nancy Robertson Cook The national healthcare quality and patient safety movement was well in place when, in 2011, it took a quantum leap into the foreground. With the birth of the Centers for Medicare and Medicaid Services (CMS) Hospital Engagement Network (HEN) program, hospitals and hospital associations around the country began shifting to a laser-focus on quality improvement and patient safety.

“As an association, we had been working with quality improvement measures and quality project cohorts as they unrolled on a national basis,” says Bo Ryall, president and CEO of the Arkansas Hospital Association. “We sponsored and supported local and national quality improvement projects to assist our members (Wristband Standardization, 5 Million Lives, the

first cohort of the Comprehensive Unit-Based Safety Program and its application to reduction of Central LineAssociated Blood Stream Infections – CUSP/CLABSI). But when the HEN project, an overarching quality improvement movement, came into play, we decided to add clinicians to our staff so our members would have the best support possible.”

First on board was Pamela Brown (RN, BSN, CPHQ), a familiar face for many years to those working in hospital quality and infection prevention. Pam’s unique skill set made her the natural choice for the AHA’s first-ever Vice President of Quality and Patient Safety. Her 33-year nursing career has allowed her to experience a variety of continued on page 22 Arkansas Hospitals I Fall 2015

The AHA’s Clinical Staff: Career RNs Nancy Godsey (left) and Pamela Brown are the leaders of the Arkansas Hospital Association Quality and Patient Safety team.

roles, ranging from 12 years as a staff and charge nurse, to five years in home health case management, to 11 years as quality improvement team leader and assistant vice president of quality programs at the Arkansas Foundation for Medical Care. “Each and every one of these, including my last four years here at the AHA, has grown my knowledge and passion for nursing!” she says. “I am so lucky to get to work with my peers across the state and with my partner in crime, the Thelma to my Louise, Nancy Godsey!” she grins. Nancy explains the reference. “In our work with the HEN, the national coordinators christened each state hospital association’s team with a ‘most likely to’ title. Ours was ‘Most Likely to Impersonate Thelma and Louise!’” Nancy Godsey is also amazed at the route her nursing journey has taken. “I would never have seen myself in this particular nursing role either,” Nancy says. “When I went into nursing 40+ years ago, my passion was at the 22

Fall 2015 I Arkansas Hospitals

bedside, caring for people who were sick, and for their families.” Nancy’s nursing journey has moved from the bedside to cardiac rehab to infection control, to staff education and into quality improvement. “I sometimes miss the feeling that I have helped patients and families through their difficult times,” she says. “What Pam and I remember daily is the importance of AHA’s close relationships with our hospitals, and the positive differences we are making to assist them with quality improvement. Through our on-site assistance services to member hospitals, we know we are touching many lives. Though we aren’t impacting patients one by one anymore, we believe our work helps us have an indirect impact on more patients on a larger scale.” Working closely with AHA member hospitals to improve patient safety and quality is the mission of the association’s quality team. “Our friends and colleagues on the front lines are the ones fighting the battle,” Pam says.

“If we can support them and make their job easier in this complex, convoluted healthcare environment, that’s important. Another priority is making sure we work with other stakeholders to streamline the work that must be done.” The AHA’s quality team is seen as reliable, helpful and transparent. Member hospitals have had the opportunity to join any number of cohorts, from the HEN to CUSP/CLABSI (Central Line-Associated Blood Stream Infections) and CUSP/CAUTI (CatheterAssociated Urinary Tract Infections), to the Pharmacist Led Collaborative, with more opportunities expected this fall. “We will do anything we can to help our hospitals find ways to manage their call to duty,” Nancy says. “Today’s mandates are tough. It’s important to help our hospitals navigate through them.” The “Pam and Nancy team” has been a presence for many years. Meeting for the first time when they were each working with Select Specialty Hospital housed at St. Vincent Infirmary, they shared an instant bond over their desire to improve hospital quality. “We’ve worked together hand in glove since then,” Pam says. Through more than a decade at AFMC, and now four years at the AHA, the team has worked to help Arkansas hospitals improve their growing number of processes associated with patient safety and quality. Through the years, there has been a tremendous increase in reporting requirements for hospitals. “This is not an earth-shattering statement or one that will come as a surprise to those doing the work,” Nancy says. “And as those involved in hospital quality and/ or infection prevention know, CMS continues to up the ante by tying reimbursement to the measures.” As requirements increase, the AHA quality team responds. With national projects overseen at the state leveI, new and ongoing projects designed to improve quality through process and communication improvement, and customized projects designed for member hospitals with specific quality or patient safety requests, Pam and Nancy say they are willing to do anything, large or small, to help AHA member hospitals.

“Being in this work for a number of years, we have witnessed the evolution of core measures, outcome measures, the readmission program, hospitalacquired conditions and more,” Nancy says. “The bottom line is, with our complex systems, complex surgeries, complex testing…it takes a high level of reliability to ‘do no harm’ to our patients. So we keep working on our processes and helping our hospitals tap into the latest quality improvement methods.” So the work in quality and safety continues, and hospital employees try, and then try harder, and then try harder still to ensure the best outcomes for their patients. “We have worked for years with hospital quality teams,” Pam says. “Today, we are also working closely with infection preventionists (IPs). Their role is expanding and under intense scrutiny because healthcare-acquired infections (HAIs) fall under their purview. Together, we are working to bring the number of HAIs to zero.” “IPs and quality teams’ roles are going to continue to become more challenging and demanding, but at the end of the day, each of you is making a difference every time an HAI is prevented,” Nancy says. “Don’t get discouraged; we need you! You are fighting a never-ending battle against an invisible enemy! Today you are fighting new germs that are resistant to antibiotics, and we need you to continue the fight! We realize everyone in healthcare roles from CEO to housekeeping are in thankless positions. We want to take this opportunity to say, on behalf of the whole AHA team, ‘Thank You!’ and ‘Keep Up the Fight!’” As CMS ratchets up the pressure, the AHA quality team doubles down to help our hospital teams meet the ever-changing requirements set out by CMS. It’s our team helping your team, and we are glad for the opportunity to do so.

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Quality and Patient Safety

Reflections on the New QIO Regional Structure By Julia Kettlewell, Arkansas State Program Director, TMF QIN-QIO, Arkansas Foundation for Medical Care (AFMC) In 2014, TMF Health Quality Institute in Austin, Texas, was awarded one of 14 national Quality Innovation Network-Quality Improvement Organization (QIN-QIO) contracts by CMS under a new consolidation structuring that brings several former state QIOs under the same umbrella.

Editorâ&#x20AC;&#x2122;s Note: The first year of the Centers for Medicare & Medicaid Servicesâ&#x20AC;&#x2122; (CMS) new Quality Innovation NetworkQuality Improvement Organization regional structure is complete. We asked Julia Kettlewell to reflect on the structural changes as the second year of the 11th Statement of Work (SOW) begins.

Fall 2015 I Arkansas Hospitals

The TMF QIN-QIO engages providers, patients, caregivers and stakeholders in Learning and Action Networks (LANs) focused on various quality improvement initiatives. These networks serve as information centers for learning, collaborating and elevating the voice of the patient during the current fiveyear QIN-QIO contract, which is the 11th SOW. Texas, Arkansas, Missouri, Oklahoma and Puerto Rico are involved in our regional contract.

In Arkansas, AFMC aligns its work with that of other healthcare organizations, including the Arkansas Hospital Association (AHA), to best serve our hospitals and forward the triple aim of better population health, better care for patients and lower costs.

Four Goals, Four Key Roles CMS has four goals for the QIN-QIOs. The goals and specific tasks for our region under the 11th SOW are:

1. Promote effective prevention and treatment of chronic disease • Improve cardiac health and reduce cardiac healthcare disparities; • Reduce disparities in diabetes care; and • Improve prevention coordination through meaningful use (MU) of health information technology (HIT), and collaborate with regional extension centers. 2. Make care safer by reducing harm caused by delivery of care • Reduce healthcare-associated infections in hospitals; and • Reduce healthcare-acquired conditions in nursing homes. 3. Promote effective communication and coordination of care • Coordinate care; and • Improve medication safety and adverse drug event prevention efforts. 4. Make care more affordable • Improve quality utilizing the valuebased modifier, quality reporting and the physician feedback reporting program. The TMF QIN-QIO has four key roles: • Champion local results-oriented change that is data-driven and actively engages patients and other partners. These changes are proactive, intentional innovations that spread sustainable best practices. • Facilitate LANs that support an “all teach, all learn” environment. Focus on improvement at the bedside level. • Serve as technical experts to teach, advise and consult, and manage knowledge so learning is never lost. • Communicate effectively to optimize learning, patient activation and sustained behavioral change. The TMF QIN-QIO has been awarded two additional task orders since the contract began. Arkansas, Missouri, Texas and Puerto Rico are working to improve Medicare beneficiary immunization rates through better tracking, documentation and reporting, with a special focus on reducing

For several years now, AFMC, ADH and AHA have aligned to address Central Line-Associated Bloodstream Infections (CLABSIs) and CatheterAssociated Urinary Tract Infections (CAUTIs), and this collaboration continues in the 11th SOW. immunization healthcare disparities. A second recent task order involves improving identification of depression and alcohol use disorder in primary care and during care transitions for behavioral health conditions. Work began on this task June 15. During the first year, AFMC recruited eligible providers, including physician practices, hospitals, nursing homes and home health agencies, as well as stakeholders and partners, to participate in LANs; formed collaboratives for nursing homes and hospitals; and engaged patients and families in quality improvement work. Some of the greatest collaboration is occurring in the support provided to Arkansas hospitals in the area of infection control. For several years now, AFMC, ADH and AHA have aligned to address Central Line-Associated Bloodstream Infections (CLABSIs) and CatheterAssociated Urinary Tract Infections (CAUTIs), and this collaboration continues in the 11th SOW. The TMF QIN-QIO is currently working with 23 Arkansas prospective payment system (PPS) hospitals to reduce healthcare-associated infections, including CLABSI, CAUTI and c. difficile, by providing regional LAN collaborative events and one-on-one local technical assistance. We work jointly with the AHA and other groups to address healthcare quality issues.

Texas

•

Arkansas

•

Patient and family engagement in the care process is incorporated into all QIN-QIO tasks. The TMF QIN-QIO has formed a patient and family engagement coalition of patients and families from all four states and Puerto Rico. This group meets quarterly to provide feedback on tools, resources and approaches. Meaningful use of HIT is another task affecting hospitals. Critical access hospitals and eligible hospitals can receive technical assistance to meet electronic health record incentive program requirements related to clinical quality measures reporting. We also encourage hospitals to work with us to improve immunization rates in the Medicare population for influenza, pneumococcus and shingles. Lastly, CMS recently issued final rules adding new provider groups and settings for quality data reporting, including ambulatory surgical centers, inpatient psychiatric facilities and PPSexempt cancer hospitals. They are now eligible to receive quality improvement assistance from the TMF QIN-QIO. Contact Julia Kettlewell, your TMF QIN-QIO representative in Arkansas ( jkettlewell@afmc.org), to get involved. AFMC is here to help with quality improvement efforts and provide information to keep you informed and prepare you for future changes in the Medicare program.

Missouri

•

Oklahoma

•

Puerto Rico

Arkansas Hospitals I Fall 2015

Quality and Patient Safety

Be Recognized for Your Excellence: Apply for a Governor’s Quality Award in 2016

The Arkansas Governor’s Quality Award Program has announced training dates for its 2016 award cycle. The awards process uses the Baldrige Excellence Framework, a set of criteria used nationally for measuring performance and for planning and helping healthcare organizations achieve and sustain the highest levels of patient safety and loyalty. Training dates are: • Applicant Training I, Organizational Profile – October 20 • Applicant Training II, Processes – November 18 and December 10 • How to Write an Application for the Governor’s Quality Award – November 18 • Applicant Training II, Results – January 12 • Deadline to apply for award – April 5

Applicant training is open to everyone. These sessions can help your organization improve, regardless of whether you decide to apply for an award. For more information and registration, go to www. arkansas-quality.org or call Sue Weatter, executive director, at 501.372.2222.

SAVE YOUR HOSPITAL SO MUCH MONEY, THE BOARD APPLAUDS YOU. With more vendors, options and increased savings, there are plenty of reasons to let us guide you. Call us today, and we’ll make you the rockstar around the hospital.

419 Natural Resources Drive, Little Rock, AR 72205 501-224-7878 Office • 501-224-0519 Fax • ahaservicesinc.com AHA SERVICES, INC. IS A WHOLLY OWNED SUBSIDIARY OF THE ARKANSAS HOSPITAL ASSOCIATION

Fall 2015 I Arkansas Hospitals

T O D AY, A L C O H O L W I L L C O N T R I B U T E T O

241 deaths in the United States. Nationally, approximately

88,000 deaths

related to alcohol consumption occur each year. From 2003–2012,

more than 1,700 Arkansans died

in crashes involving a drunken driver.

It’s time for Arkansas to address the negative effects of alcohol. AFMC and Arkansas Medicaid are ready to help. Our teams have developed tools and materials to assist you in identifying and managing patients affected by alcohol misuse. To find out more, visit us at afmc.org/alcohol.

THIS MATERIAL WAS PREPARED BY THE ARKANSAS FOUNDATION FOR MEDICAL CARE INC. (AFMC) PURSUANT TO A CONTRACT WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL SERVICES. THE CONTENTS PRESENTED DO NOT NECESSARILY REFLECT ARKANSAS DHS POLICY. THE ARKANSAS DEPARTMENT OF HUMAN SERVICES IS IN COMPLIANCE WITH TITLES VI AND VII OF THE CIVIL RIGHTS ACT.

Arkansas Hospitals I Fall 2015

SPECIAL FEATURE

Engaging Employees

Member Benefits

Leverage Data to Create an Effective Compensation Plan 28

Fall 2015 I Arkansas Hospitals

By Theresa Worman, Executive Vice President, Compdata Surveys & Consulting Having compensation and benefits programs that align with your organizational objectives can contribute to the overall success of your healthcare organization in many distinct ways.

When fairly and competitively compensated, employees become engaged in their jobs, loyal to their employer and motivated to do their best work. In healthcare, that can equate to less voluntary turnover and increased patient satisfaction, as engaged employees contribute to a more caring and safe environment. Reduced turnover also means much less time spent training new employees, leaving more time to focus on patient care. With payroll as the single largest item in the budget, it is critical that those payroll dollars be spent effectively. How can your compensation plans maximize effectiveness and contribute to the overall goals of the organization?

Resources Available to AHA Members

In 2014, the Arkansas Hospital Association (AHA) and AHA Services entered into a partnership with Compdata Surveys & Consulting to provide the AHA Compensation and Benefits Survey and to share Compdata’s compensation expertise at conferences and seminars. The partnership allows AHA to provide members with significant improvements to the annual compensation survey.

“Our members appreciate the increased data available through the new survey and will continue to reap the benefits of having Compdata Consulting as a presenter at our conferences,” commented Tina Creel, vice president of AHA Services. The improved survey includes pay data on more than 400 job titles and covers entry-level positions up through the president and CEO of the hospital. Executive titles offer additional aspects of compensation programs such as perquisites, or long- and short-term incentives, for example, while clinical positions include information on shift differentials, per diem rates, on-call pay and other determinants. An example: Pay data on the title of “Staff Nurse” is enhanced by breaking out pay and hireon rates by years of experience and also includes special pay items such as shift differentials, PRN rates, float pools and agency rates. The online format of the survey allows members to run an unlimited number of custom reports and sort pay data by bed size, workforce size, revenue and profit status, and it provides local, state-wide and multi-state regions, where available. There is also a comprehensive section on benefits and pay practices, which

When fairly and competitively compensated, employees become engaged in their jobs, loyal to their employer and motivated to do their best work. are often as important to employees as cash compensation and generally make up 30-35% of payroll costs. All of this data is provided free-ofcharge to members who participate in the survey each January. Because AHA recognizes the value of compensation information to its members, it provides this as a benefit of membership and encourages all hospitals to submit data each year. Obtaining data like this can be quite expensive if a hospital makes a purchase on its own. Other surveys that attempt to cover this kind of information range from $550 - $2,000 continued on page 30

Annual Voluntary Turnover Rates Arkansas

2015

2014

South Central U.S. Region

2015

2014

Critical Access Hospital Hospital Physician Clinic All Categories

13.3% 12.2% 14.3% 13.7%

12.1% 14.9% 14.7% 14.8%

Critical Access Hospital Hospital Physician Clinic All Categories

12.1% 14.6% 16.1% 14.8%

11.1% 13.3% 14.0% 13.4%

2015 Actual

2016 Projected

2.4% 2.3% 2.4% 2.3% 2.2% 2.2% 2.4% 2.0% 2.2%

2.5% 2.5% 2.6% 2.4% 2.3% 2.4% 2.4% 2.2% 2.3%

Pay Increase Budgets Arkansas Behavioral Healthcare Critical Access Hospital Home Care Hospice Hospital Long-Term Care Other Healthcare Physician Clinic All Categories

2015 Actual 2.3% 2.5% 2.4% 2.2% 2.1% 2.0% 2.5% 2.5% 2.3%

2016 Projected 2.6% 2.6% 2.2% 2.0% 2.4% 2.6% 2.4%

South Central U.S. Region Behavioral Healthcare Critical Access Hospital Home Care Hospice Hospital Long-Term Care Other Healthcare Physician Clinic All Categories

Arkansas Hospitals I Fall 2015

Measures to Reduce Medical Insurance Costs Arkansas

South Central U.S. Region

Increased Deductible Levels Increased Employee Co-Insurance Level Increased Employee Portion of Premium (as a % total cost) Introduced a Managed Care Program Offered a Choice of Deductible Levels Reduced Benefits Required Mail Order for Maintenance Prescriptions

for participants and can cost as much as $3,000 for non-participants.

Case Study: High Nurse Turnover

A high turnover rate can be a daunting challenge for any organization to resolve, and addressing the issue requires a comprehensive plan. Take a hospital in the Midwest, for instance, that was experiencing high turnover rates among its nursing staff. While the hospital was quite successful in attracting new talent, turnover was occurring at substantial rates within the first two years of employment. Adding to their worries, a new hospital was being built nearby, which provided even more competition for the high quality RN talent.

57.4% 22.2% 51.9% 14.8% 22.2% 3.7% 14.8%

Compdata Consulting conducted an analysis of the hospitalâ&#x20AC;&#x2122;s compensation program and uncovered the root of the problem. Recent graduates would join the hospital right out of school, work a couple of years, then move to another hospital. Human Resources shared that RNs were leaving for higher pay. The initial understanding was that the hospitalâ&#x20AC;&#x2122;s hire-on rate was in line with the market but tapered off after a couple of years. However, further analysis revealed the initial hire-on rates were significantly below market value. The successful recruiting was due to the influx of nurses in the labor market due to multiple nursing colleges in the area, not a competitive pay rate. New graduates would accept the position merely as a

Participation Yields Survey Results AHA members who participated in the 2015 AHA Healthcare Compensation and Benefits Survey are now enjoying full access to the online survey results. Data are collected for the survey each year in January. Participants are given four or five weeks to submit the data for each of their locations. The survey submission is returned to a participating hospital in subsequent years to aid in participation the following year. The pre-population of survey data is only maintained for those who complete the survey each year. Skipping a year will result in starting the participation process from scratch the following year. Data are verified for accuracy, and survey results are released to participants in April of each year. If you missed your chance to participate in the 2015 survey, mark your calendar now. Submit data in the 2016 survey this January to receive free survey results in April! For additional information, contact Paul Cunningham at pcunningham@arkhospitals.org.

Fall 2015 I Arkansas Hospitals

48.5% 24.4% 60.8% 3.0% 22.0% 8.1% 12.7%

way to gain experience before moving to another organization for a higher paying job. To help the hospital retain these valuable individuals and reap the benefits of keeping trained employees, the consultants helped to develop a compensation strategy that would bring their nurse pay in line with the market. Early indications show this new strategy has had a positive impact on turnover rates. The increased pay rates were still lower than the recruiting and training costs associated with constant turnover. The hospital has benefited from lower costs and a more loyal and engaged staff.

Case Study: Compensation Not Competitive with Labor Market A large hospital in northern Florida was successful in building a strong sense of community among employees and enjoyed a successful organizational culture and a productive work climate. While the employees appreciated this work environment and wanted to be loyal, several years with limited or nonexistent pay increases left them feeling undervalued and disgruntled. A contributing factor was the hospitalâ&#x20AC;&#x2122;s use of a reactive approach to correct dire issues by administering raises to certain employees in certain departments and not others. The real and perceived inequalities of the compensation program made employees question their loyalty to the hospital. Many experienced employees felt overlooked compared to some new hires who had been vocal about their compensation from the beginning.

The organization realized something had to be done to prevent the loss of longtime key employees. The hospital partnered with Compdata Consulting to develop an updated compensation philosophy while securing market data and establishing a robust plan of action. Compensation data was also utilized to perform a gap analysis to determine how the hospital stacked up against competitors. A close look at the compensation structure revealed certain pockets of the organization were paid lower than market average while others were aligned, due to the reactive tactics the hospital had utilized in recent years. The first step they took to bring their program in line with the competition was to create new pay ranges using market data. Once the ranges were set, the hospital was able to institute an aggressive plan for adjusting pay to competitive levels immediately. After making the compensation plan structurally equitable, management received communications training and developed a plan for notifying employees of the newly revised compensation structure. Employees perceived the plan to be fair, and the new system helped to preserve the communityminded, loyal and engaged mindset of the facilityâ&#x20AC;&#x2122;s workforce. Theresa Worman is executive vice president for Compdata Surveys & Consulting, which provides compensation and benefits information and comprehensive compensation consulting services throughout the United States. For more information about the AHA survey that begins in January, you may contact Theresa at TWorman@CompdataConsulting. com or 1.800.300.9570, or visit her in person at the AHA Annual Meeting October 7-9.

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When providing continued care for those living with spinal cord injury it is essential to connect with other professions and specialists. Physicians and their patients have access to a certified physical medicine and rehabilitation specialist, otherwise known as a physiatrist. Phone and telemedicine consultations assist in diagnosis to help make care determinations. Knowing how to provide SCI care and how to detect secondary complications such as neurogenic bladder, neurogenic bowel, pressure ulcers and autonomic dysreflexia can be a challenge. Most of these conditions require immediate treatment. Treatment varies for a patient with SCI as compared to patients without disability. If left untreated these conditions can progress and could lead to expensive emergency room visits or hospitalization. Use of the Triumph Call center can avoid emergency care and often the need to travel to Little Rock to see a SCI specialist.

SCI Care Delivery and Education in Rural Arkansas Communities.

Arkansas Spinal Cord Foundation (ASCF) launched an initiative designed to stimulate health care cost-savings through an efficient around-the-clock and evidence-based mode to advance spinal cord injury (SCI) care delivery in rural communities across Arkansas. The program also provides SCI educational webinars with CME and CEU credits offered to clinicians and care providers; and are available for individuals with SCI, their families and caregivers. ASCF supports its collaborating partner UAMS Center for Distant Health Triumph Call Center in its effort to anchor and function as the preeminent resource for spinal cord injury (SCI) telemedicine health care. This resource provides quality care improvement through consultations, hands-on guidance, and provides the foundation's SCI education platform. The 24/7 access is available to enhance quality of life and increase immediate care among SCI patients, families and rural providers. Telemedicine appointments and video assessments are available just by accessing the Call Center.

Treatment varies for a patient with spinal cord injury (SCI) as compared to patients without disability. ASCF Advancing SCI Health Care in Rural Communities is made possible through grant funding provided by the Craig H. Neilsen Foundation. 32

Fall 2015 I Arkansas Hospitals

News Approaches to Population Health in 2015: A National Survey of Hospitals is now available from the American Hospital Association’s Hospitals in Pursuit of Excellence (HPOE) website. To support hospitals embarking on their population health journey, the Health Research & Educational Trust (HRET) and the Association for Community Health Improvement, in partnership with the Public Health Institute, conducted a nationwide survey of hospitals and healthcare systems to assess the state of population health efforts in 2015. The survey elicited responses from more than 1,400 hospitals and addresses the structure of population health initiatives, partnerships with community organizations and the process of assessing community health needs. The full survey results are featured in a slide deck available at http://www.hpoe.org/resources/ hpoehretaha-guides/2650.

The American Hospital Association has raised concerns to the Department of Justice’s antitrust division about Anthem’s proposed acquisition of Cigna and Aetna’s proposed acquisition of Humana. These companies are four of the five largest health insurers in the country, and the mergers would bring the number of major national health insurance players down from five to three, with United Health as the other major company. According to a letter from the AHA, the proposed mergers have “the very real potential” to substantially reduce competition and the insurers’ willingness to partner with healthcare providers and consumers. Additional information will be posted at www.aha.org as the situation develops.

News STAT October typically marks the beginning of flu season. The CDC’s Advisory Committee on Immunization Practices 2015-16 recommendations for the prevention and control of seasonal influenza can be accessed in their complete form at http://www.cdc.gov/mmwr/preview/mmwrhtml/ mm6430a3.htm. This report updates the 2014 ACIP recommendations regarding the use of seasonal influenza vaccines. Additional information about the 2015-16 flu season is available from the CDC at http://www. cdc.gov/flu/about/season/flu-season-2015-2016.htm.

The Arkansas Department of Health’s In-Home Services Office will be transitioned to a private sector provider. The process is expected to take at least six months and comes in the wake of financial constraints and competition from the private sector over the last five years. More information is available at http://www.arkansas.gov/health/newsroom/ index.php?do:newsDetail=1&news_id=1127.

Hospitals & Health Networks Daily reported recently on the Four Measures that Are Key to Retaining Nurses. The guiding principles article, written by Karlene Kerfoot, RN, indicates that by providing independence, matching nursing skills to the patient mix and reducing overtime, hospitals can help to ensure their nurses stay on the job. Discussed in the piece is the price of turnover, as well as proactive measures healthcare executives can implement to improve their nurses’ job satisfaction. Access the article at http://www.hhnmag.com/Daily/2015/August/data-staffing-sharedgovernance-retain-nurse-staff-blog-kerfoot. Arkansas Hospitals I Fall 2015

News

Walter Johnson

“It’s Going to Take All of Us, Working Together” By Nancy Robertson Cook As the incoming Arkansas Hospital Association (AHA) Board Chairman, Walter Johnson is grateful for and humbled by the AHA’s dynamic culture of volunteerism. It’s an important asset, he says, as hospitals face perhaps their most challenging and volatile times ever. “From our board, to its committees, to our affiliated groups that cut across the spectrum of hospital business sectors, the AHA encourages and supports involvement at all levels,” he says. “As hospitals, in turn, encourage and support their staff’s participation in the work of the AHA, we gain strength as a hospital voice. It’s going to take all of us, working together, to meet the challenges of changing reimbursement and coverage models at the federal, state and local levels.” “The ‘hospital voice’ is necessary and instrumental as the healthcare environment changes so quickly in Arkansas,” Johnson says. “We work for the best care and coverage for our patients, but must assure it is not to the detriment of hospitals. Through the participation of hospital leaders and staff members, we stay on top of healthcare issues at all levels, and we become key drivers in the discussion of healthcare policy.” As CEO of Jefferson Regional Medical Center (JRMC) in Pine Bluff, Johnson is celebrating his 21st year with the hospital and his 21st year as an Arkansan. After almost 14 years with Humana, Health Management Associates, and others where he served in Alabama, Georgia and Florida, he made the change from the proprietary world to the community hospital setting. “I received a call from the first guy who hired me at Humana, encouraging me to apply for a 34

Fall 2015 I Arkansas Hospitals

position at JRMC,” he says. “That was 21 years ago; in that time, we have seen remarkable changes in healthcare. Early on, I was encouraged to be involved with the AHA through its committee work, and likewise encouraged the JRMC staff – and now, all hospital leaders and staffs – to become active. That is my main mission for the AHA over the next two years…to see more people become engaged in our work.” During this time of extreme change, the way healthcare stakeholders operate is evolving. “State agencies like Medicaid and the Department of Health, the insurers and the medical society used to mainly work in silos,” he says. “But now we see, largely through the efforts of the AHA, a change that involves all of these main groups coming together on various projects. Working jointly is more the norm than it used to be. This is going to be a key driver in our communication efforts over the next two years.” Community involvement, led by the local hospitals, will also expand in coming months, he believes. “At JRMC, we have invited folks from the community onto our existing committees so we can get them involved in healthcare,” he says. “Again, when you ask people to be involved, you expand your knowledge base, expose new people to how the healthcare world works and ignite their interest.” Whether at the local hospital level or that of

the AHA, this involvement not only helps expand the hospital voice, it also helps groom future members of boards and gives them an understanding of healthcare policies and processes. JRMC is nationally recognized for its work in the Centers for Medicare & Medicaid-sponsored Hospital Engagement Network (HEN) patient safety and quality improvement efforts. Looking at major healthcare focuses already on the drawing board, Johnson says he believes all providers will continue their focus on quality and safety, and that the AHA will continue its efforts in those areas. The concept of involvement applies here, as well. “There are a lot of metrics relating to patient safety and quality,” he says. “The key is to seek efficiency in the areas on which you choose to focus. No one hospital can focus on every metric, but each can improve by becoming involved in these national efforts.” Over the term of his chairmanship, Johnson’s key message will be one of personal involvement. Whether engaged in AHA projects, on AHA committees or simply in connecting with the AHA on a personal level, each hospital’s leaders and staff members can keep up with and play key roles in Arkansas healthcare policy and processes. “It’s going to take all of us working together to get through these volatile times,” he says. “Please join us, and encourage your fellow workers to do so!”

• What do you most appreciate about the AHA? “It’s a volunteer organization of caring, dedicated people providing service to each of their communities.” • What about you would surprise most people? “I am a pretty good handyman and a darn good floor and wall tile installer. When I was younger, I drew a lot. This really helps with tile design.” • What keeps you up at night? “I try really hard to put the lid back on the box at night and get good rest. Getting a good night’s sleep is important.” • What are you reading? “I recently completed Pirate Hunters by Robert Kurson. It’s a true story based on two divers who set out on a search specifically for one sunken pirate ship. There’s a lot to the search, and this book details their adventures along the way.”

CEO Profile: AHA Board Chairman

Walter Johnson, CEO

Jefferson Regional Medical Center

• What do you do to de-stress? “That’s easy! Be on a beach or on a boat! I like this quote from Kenneth Grahame’s Wind in the Willows: ‘There is nothing, my young friend – absolutely nothing – half so much worth doing as simply messing about in boats.’” Arkansas Hospitals I Fall 2015

News

Arkansas State Nursing Board Website Offers Valuable Resources Nurses in Arkansas, or those who want to become so, will find a world of information available to them on the Arkansas State Board of Nursing website. A division of Arkansas.gov, the Board of Nursing website is located at www.arsbn.arkansas.gov. the Arkansas State Board of Nursing magazine, continuing education information, laws and rules, as well as educational videos and numerous forms you might need. If you haven’t visited the site lately, you’ll be pleased to see its easy-to-use format. The website is a product of the Arkansas State Board of Nursing, University Tower Building, 1123 South University, Suite 800, Little Rock, AR 72204.

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Fall 2015 I Arkansas Hospitals

News

Planning for the Unthinkable: Healthcare Response to Armed Violent Intruders By Mike Murray, Mitigation Dynamics, Inc. When my colleagues and I first entered into the world of healthcare consulting several years ago, we were shocked at the frequency of violence. Among other things, we discovered that one out of every nine ED nurses were the victims of assault every week. In addition to being punched, grabbed, pushed or slapped, domestic assaults, sex offenses and even shootings were not uncommon. While digesting this, we thought to ourselves, “If healthcare settings were ever considered a ‘safe haven’ by society, this perception must certainly be in jeopardy now.”

Despite our extensive law enforcement experience, it was fair to say that the initial data related to that violence truly shocked our conscience. As a result, we were instantly compelled to make a difference…a difference we continue to make today. In 2014, there were over 70 incidents involving armed, violent intruders in the United States. This translates to an

incident occurring every 4 to 6 days. At Mitigation Dynamics, Inc. (MDI), we define an “armed violent intruder” as a person on hospital property with the means (weapon), opportunity (patients, visitors, physicians and staff), and apparent intent (thought process) to inflict serious physical injury or death upon others. MDI classifies these incidents as “low propensity, high consequence.”

Once an armed, violent intruder fires the first shot, seconds count, and the consequences are shocking. • The armed, violent intruder at Virginia Tech University murdered 32 people and wounded 25 others within 7 minutes; • The armed, violent intruder at the movie theater in Aurora, Colorado continued on page 38 Arkansas Hospitals I Fall 2015

murdered 12 people and wounded 58 others within 5 minutes; and • The armed, violent intruder at Sandy Hook Elementary School murdered 26 people and wounded 2 others within minutes. Collectively, these incidents equate to murder attempts at these locations every 6-10 seconds. It is not likely that armed, violent intruder incidents will stop in the near future. However, we know that with the implementation of an effective policy, comprehensive training and the utilization of scenario-based drills, a hospital, and its staff within, can drastically minimize the overall effects of these incidents. Large open areas, easy access, security limitations and multiple potential victims all synchronize to make a hospital an easy target. How a hospital responds to a crisis such as this is dependent upon how well that organization has prepared. What will you do? How will you respond? What guidance will you provide? Unfortunately, few hospitals have comprehensive, realistic and practical policies or procedures related to an armed, violent intruder response (let’s put it in realistic terms: dealing with an active shooter). Furthermore, most of the policies in place would not withstand professional scrutiny should an incident occur. The problems with existing hospital policies are not a result of dismissiveness by hospital administrators or staff. On the contrary, the lack of adequate preparations are typically a product of misinformation or a false sense of reality.

Create Effective Policies

MDI strongly recommends that hospitals establish and utilize principally-based policies and procedures. Policies that consist of “always” and “never” are destined to fail under dynamic circumstances, such as an active shooter. Similarly, procedures that consist of “if this, then that” verbiage are also problematic. Principally-based policies and procedures create the opportunity for

Fall 2015 I Arkansas Hospitals

With the implementation of effective policy/protocols, the utilization of comprehensive training and scenario-based drills, your staff will be prepared for the unthinkable. After all, seconds save lives! an organization to provide personal tools to their staff. This ultimately provides empowerment for staff members to make their own individual decisions based on the totality of circumstances with which they are confronted, while maintaining the spirit of the organization’s policy. Various templates are available on the market, and it is an appealing solution to implement one of these off-the-shelf products; however, there is no such thing as a “one size fits all” solution. This further supports the necessity for organizations to employ a principally-based doctrine. Consulting with qualified risk professionals provides opportunities to create or evaluate existing policies and procedures. All of these should be designed to meet the particular needs of your facility, while enhancing employee engagement, limiting liability and creating a safe environment for all patients, visitors, physicians and staff. Policy and procedures can and should dictate certain aspects of a response. For example, in the event of an armed, violent intruder - an active shooter - occurrence, should an overhead announcement be made? If so, should The Joint Commission-recommended “Code Silver” be utilized, or would simple, plain language be more appropriate? Perhaps a combination of both should be considered. Outside the parameters of these required aspects, however, the policy and procedures should allow for individual decision-making, ultimately empowering staff to evaluate, process

and decide what the best response is for their particular circumstance at every given moment.

Comprehensive Training

It has been said that “any training is better than no training.” To the contrary, it is our professional opinion that training specifically related to high consequence, life-threatening events is certainly worthy of a vetting process. Topics such as response to an active shooter require specialty training - training that, in addition to general concepts such as “RUN” or “HIDE,” also provides proactive strategies and tools for the healthcare professional. These strategies and tools have proven to work effectively time and time again under high-stress, dynamic circumstances. Conceptually, each employee of the hospital should be exposed to consistent, comprehensive training that encompasses how personal tools learned from that training are supported by the relative policy, such as response to an active shooter. Ideally, this would also allow for an interactive discussion between the trainers and attendees, as well as facilitate additional comprehension, retention and overall confidence in the prescribed process. Additionally, the training should be able to be delivered effectively via various platforms, such as lecture, classroom and web or scenariobased solutions.

Scenario-Based Drills

It’s safe to say your favorite professional sports team is not simply handed a playbook to read, then

expected to perform effectively on the following game day. The same can be said for your organizational team (staff) in any given situation. Yet, if we’re honest, we oftentimes simply disseminate policy, then ask our staff to read it and sign off on it. Sound familiar? While unintentional, this type of checkthe-box practice unnecessarily creates the formula for operational failure, financial liability and damaged reputation. Not to mention possible loss of life in an active shooter scenario. In conjunction with wellwritten policies and expert training, every facility should conduct annual scenario-based drill(s) to ensure all employees understand what their individual response protocol would be in the event of an active shooter event. These drills can be large or small, or even in the form of a tabletop exercise, depending on the specific needs of the hospital. Conducting these types of drills in topic areas specific to the particular attendees allows for observation, discussion, review and understanding of the appropriate actions and response during an active shooter event. This also allows for each of the attendees to envision what his/her individual response or subsequent actions might be. This “envisioning” has proven to be both empowering and engaging, all the while having the impact of making the policy come alive and offer meaning for each of the attendees. It is an indisputable fact that the threat of active violence within the healthcare setting is ever-present on a daily basis. However, with the implementation of effective policy/protocols, along with the utilization of comprehensive training and scenario-based drills, your staff will be prepared for the unthinkable. After all, seconds save lives!

Mike Murray is the director of training and logistics for Mitigation Dynamics, Inc., an international risk mitigation firm in Lee’s Summit, Missouri that specializes in strategic consultation, personal protection and training for corporate, healthcare, governmental, academic and faith-based entities. A 21-year law enforcement veteran, Mike has supervised various units such as patrol, investigations and administration. In addition, he has served as an operator, sniper and hostage negotiator, as well as incident commander for his agency’s S.W.A.T. team. You may contact Mike at Info@MitigationDynamics.com or 816.251.4567.

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THIS MATERIAL WAS PREPARED BY AFMC HEALTHIT, A DIVISION OF THE ARKANSAS FOUNDATION FOR MEDICAL CARE (AFMC), PURSUANT TO A CONTRACT WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL SERVICES. THE CONTENTS PRESENTED DO NOT NECESSARILY REFLECT ARKANSAS DHS POLICY. THE ARKANSAS DEPARTMENT OF HUMAN SERVICES IS IN COMPLIANCE WITH TITLES VI AND VII OF THE CIVIL RIGHTS ACT. MP2-AHA.DMO.AD,8/15

Arkansas Hospitals I Fall 2015

News

Presents…

The Nurse’s Role in the Patient Experience By Christy Dempsey, Chief Nursing Officer, Press Ganey The patient experience is unarguably taking on increasing importance in healthcare today. For reasons ranging from improved patient outcomes to increased fiscal strength, focus on the patient experience is high on every healthcare professional’s agenda. Patient experience is not simply patient satisfaction. Rather, the patient experience encompasses clinical, operational, cultural and behavioral aspects of care provided in every setting, by every person, every day. (It’s so much more than smiling, making eye contact and closing the curtain for privacy.) The patient experience involves connecting clinical excellence with outcomes, because reimbursement is becoming more outcomes-driven. It means connecting operational efficiency with quality, because the best organizations provide the highest quality in the most efficient (and lowcost) manner. It means connecting engagement of caregivers with their actions, because engaged members of the healthcare team exhibit the caring behaviors critical to optimizing patient outcomes. Finally, it means connecting the healthcare organization’s mission, vision and values with engagement of all who work there, because the mission (why you exist), the vision (where you’re going) and the values (how you’ll get there) are the shared purpose for the organization, indeed the keystones to how organizational goals around patient care and fiscal growth are achieved. The nurse’s role in maximizing the patient experience cannot be overstated. Because of their frequent, personal interactions with patients, nurses conceivably play the largest role in the day-to-day patient 40

Fall 2015 I Arkansas Hospitals

experience. Cross-domain analytics utilizing patient experience data and National Database of Nursing Quality Indicators (NDNQI®) data related to job satisfaction, perception of quality and hospital-acquired conditions (such as falls, pressure ulcers, and central line-associated bloodstream infections) are yielding important information related to the linkage between the nurse and patient outcomes and experience. There is also research to demonstrate that patients who perceive a better experience have better outcomes.

As shown in the rising tide phenomenon of nurse communication, nurses are the very foundation for the patient experience. Press Ganey’s analysis has identified five HCAHPS dimensions that connect directly with the nursing team and consistently cluster together: • Communication with nurses; • Responsiveness of hospital staff; • Pain management; • Communication about medication; and • Overall rating. (See Fig. 1 on page 43.) continued on page 42

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Communication with Nurses leads the other four measures. This means that when a hospital aims improvement efforts at the communication with nurses dimension, it likely will see associated gains in performance in the other four dimensions in the cluster. HCAHPS encompasses 30% of a hospital’s value-based purchasing score, and future Consumer Assessment of Healthcare Providers and Systems (CAHPS) expansion means more scrutiny on the patient experience going forward. The role of nurses in successful CAHPS scores means understanding the nurse’s unique contribution to the patient’s care in every setting. Further, patients who perceive a better experience also have lower readmission rates, lower lengths of stay, higher safety scores and lowered instances of hospitalacquired conditions. Nurses understand at many levels that patients suffer. But acknowledging that patients suffer is not enough. Inherent suffering associated with the diagnosis and treatment of illness may be mitigated but not eliminated. Avoidable suffering caused by dysfunction in the healthcare system, on the other hand, must be eliminated in order to optimize the patient experience. Nurses make the difference when providing compassionate and connected care.

Compassionate Connected Care™ Whether it’s new construction, refinancings or equipment leasing, contact Paul Phillips at (501) 978-6309 or pphillips@crewsfs.com and let our own team of healthcare professionals prescribe the right capital structure for your organization.

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Member

Compassionate Connected Care is a Press Ganey framework that identifies the four domains of the patient experience: clinical, operational, cultural and behavioral, that make up the totality of the patient experience. Hundreds of clinicians, nonclinicians and patients were solicited to provide one-sentence statements defining what Compassionate Connected Care looks like from their perspectives. These statements were distilled

Figure 1

COMMUNICATION WITH NURSES: A RISING TIDE MEASURE

Discharge

This cluster drives 15% of a hospital’s VBP score

0.5

Hospital Rating Clean/ MD Communication Quiet

0.7

0.6

Spearman p2

0.4

0.3

0.2

0.1

Results of Hierarchical Variable Clustering Analysis on HCAHPS Data

Meds Explanation

Pain Management RN Responsiveness Communication

into six themes. Each of these themes can and should be owned by all members of the nursing team in order to optimize the patient experience. • Acknowledge Suffering Nurses should acknowledge that patients are suffering and show them that this is understood. Actively listen before responding. • Body Language Matters Non-verbal communication skills are as important as the words nurses use. Sitting down matters, and it doesn’t take more time. • Anxiety is Suffering Anxiety and uncertainty are negative outcomes greatly affecting the patient experience, and they must be addressed. Patients are scared. The nurse’s goal must be to make them feel safe, and that they are in the best place to receive the best care by the best team. The concept of “managing up” (communicating clearly, comfortably and respectfully with each member of the nursing team to decrease negative behaviors

and/or inconsistencies in patient care delivery) should be in play; manage one another up in order to help the patient feel safe. • Coordinate Care Nurses should demonstrate to patients that their care is coordinated and continuous, and that the nursing team is always there for them. Patients need to know that those taking care of them are talking to one another. • Caring Transcends Diagnosis Real caring goes beyond delivery of medical interventions to the patient. What does the nurse know about their patient that has nothing to do with the reason they are in the hospital? • Autonomy Reduces Suffering Autonomy helps preserve dignity for patients. Patients have lost almost all control of their environment and their personal care. Providing information and choices gives at least some control back to the patient. Best practice strategies such as purposeful rounding, bedside shift reporting and managing each other up

are ways to put these six important themes into practice. While time is of the essence in order to accomplish the myriad tasks associated with patient care today, it takes, on average, 56 minutes to connect with a patient in a way that demonstrates they are more than just their diagnosis. Identifying one thing about the patient that has nothing to do with the reason they are in the hospital provides the opportunity to connect with the person who happens to be a patient at the moment. Above all, nurses must understand and be acknowledged for their importance and the immense impact they have on the lives of those who are in their care. It’s imperative that nurses always remember and embrace their role in the patient experience as one that is much more than a score or a script. Indeed, the most effective nurses recall daily the reason they went into nursing: to experience the unique connection to patients and their families in conjunction with their clinical skills. continued on page 44 Arkansas Hospitals I Fall 2015

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Fall 2015 I Arkansas Hospitals

This relationship of nurse to patient is something no other discipline offers in the unique way nursing provides. The compassionate connection to the people for whom we care is the ultimate model for healthcare. There is no other staff member better equipped to influence outcomes and the patient experience. Nurses are the very foundation of the patient experience and are champions in impacting not only clinical outcomes, but also operational, cultural and behavioral aspects of the care provided in every setting by every person every day. Christina Dempsey, MSN,MBA,RN,CNOR,CENP is Chief Nursing Officer at Press Ganey, responsible for providing clinical guidance to help clients transform the patient experience. She leads the team in their efforts to reduce patient suffering and develop compassionate and connected care across the continuum. Christy is also a registered nurse with over three decades of healthcare experience in nursing, perioperative and emergency services management, medical practice, supply chain and materials management, and physician-hospital collaboration. In addition to her role as CNO of Press Ganey, Christy is a faculty member of the Missouri State University Department of Nursing. Press Ganey Holdings is a leading provider of patient experience measurement, performance analytics and strategic advisory solutions for healthcare organizations across the continuum of care. For information on how Press Ganey can benefit AHA member hospitals, please contact Tina Creel, vice president, AHA Services, Inc., 501.224.7878 or tcreel@arkhospitals.org.

Welch, Couch & Company, PA is a full service accounting firm offering a wide range of services to the healthcare industry. • Financial Statement and Employee Beneﬁt Plan Audits • Medicare and Medicaid Cost Report Preparation • Reimbursement and Compliance Issue Consulting • Critical Access Hospital Consulting • Revenue Cycle Analysis • Feasibility Studies • IRS Form 990 Preparation • Strategic Planning for Acquisitions, Sales, Mergers and Expansions

At Welch, Couch & Company, PA, we have made a commitment to providing professional services to the healthcare industry. Our experienced professionals work closely with clients and their staff to ensure they are receiving the level of service you should expect out of your CPA ﬁrm. Batesville, Arkansas Bill Couch, CPA, FHFMA 870.793.5231 www.welchcouch.com

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Arkansas Hospitals I Fall 2015

Special Report

The Private Option Report

Financial Forum

Improving the Health of Both Arkansans and the Arkansas Economy

Fall 2015 I Arkansas Hospitals

Arkansas’s decision to invest in health insurance coverage for its citizens through the state’s innovative “Arkansas Private Option” program is paying dividends. In addition to providing access to healthcare and better health outcomes for more than 230,000 individuals, the Arkansas Private Option (APO) contributed nearly $511 million to the state’s Gross Domestic Product (GDP) in 2014 alone. During that same period, real disposable personal income grew by approximately $245 million. And a new study confirms that these economic benefits will continue to accrue if the state continues to provide insurance coverage for APO beneficiaries.

Figure 1.

Statewide Economic Growth Above Baseline:

2014

2015

2016

2017

2018

2019

2020

Total Employment

7,010

7,247

7,191

6,989

6,726

6,436

6,159

Real Disposable Personal Income (millions)

$245.2

$273.5

$293.4

$306.8

$315.4

$320.5

$323.7

Gross Domestic Product (GDP) (millions)

$511.1

$540.8

$553.7

$557.4

$556.2

$552.5

$548.0

The decision to implement the APO has grown the state economy more than it would have grown without the program, and it will continue to do so in the future. – REMI APO Study, 2015

The APO study was prepared by Regional Economic Models, Inc. (REMI), a policy analysis and forecasting firm with significant experience in evaluating the impact of state decisions to expand coverage under the Affordable Care Act. Using their economic policy model, REMI evaluated the impact of $991,000,000 in direct APO program expenditures on the state’s economy and in seven sub-state regions. The important APO-linked statewide projected growth in total employment, disposable personal income and GDP is shown in Fig. 1. The report contains similar information for each of seven designated regions of the state, including: the Central Region (Cleburne, Conway, Faulkner, Grant, Lonoke, Perry, Pope, Prairie, Pulaski, Saline, Van Buren, White and Yell counties); the Northeast Region (Clay, Craighead, Crittenden, Cross, Fulton, Greene, Independence, Izard, Jackson, Lawrence, Mississippi, Poinsett, Randolph, Sharp, St. Francis, Stone and Woodruff counties); the Northwest Region (Baxter, Benton, Boone, Carroll, Madison, Marion, Newton, Searcy and Washington counties); the South Central

Region (Clark, Garland, Hot Spring, Montgomery and Pike counties); the Southeast Region (Arkansas, Ashley, Bradley, Chicot, Cleveland, Dallas, Desha, Drew, Jefferson, Lee, Lincoln, Monroe and Phillips counties); the Southwest Region (Calhoun, Columbia, Hempstead, Howard, Lafayette, Little River, Miller, Nevada, Ouachita, Sevier and Union counties); and the West Central Region (Crawford, Franklin, Johnson, Logan, Polk, Scott and Sebastian counties). A copy of the report is available from the Arkansas Hospital Association (AHA). Prior to the APO, Arkansas had one of the leanest Medicaid programs in

the nation, with no coverage available for childless, non-disabled adults or for parents whose incomes exceeded 17% of the federal poverty level. The implementation of the APO program in January of 2014 is widely credited as the impetus for the dramatic reduction of the state’s uninsured rate. Arkansas’s uninsured rate decreased by nearly one-half (from 27.5% to 15.6%) between 2013 and 2014. This reduction in the number of uninsured patients across all hospital patient care settings translates into another key benefit for the state: uncompensated care losses among continued on page 48

Significant Reductions in Uninsured Volumes: Admissions – Down 48.7%

ER Visits – Down 38.8%

Outpatient Visits – Down 45.7%

Arkansas Hospitals I Fall 2015

Change, %

Change

(in milions)

2013

Year Ended December 31, 2014

2014

APO Financial Impact: Costs3

Payments1 APO2

185.8

–

185.8

–

Uninsured

53.7

63.6

(9.8)

‐-15.5%

239.6

63.6

176.0

276.8%

Total Payments

hospitals related to uninsured patients in 2014 dropped by $149 million, or 55.1%. This reduction is helping hospitals as they struggle to offset the continuing effects of harsh Medicare payment cuts established nationally by Congress in recent years. These results were confirmed by a survey conducted by the Arkansas Chapter of the Healthcare Financial Management Association (HFMA) and the AHA utilizing the accounting firm BKD, LLP. This important benefit of the APO sheds light not only on the state’s economy as a whole, but on its healthcare sector – the largest nonfarming employer in the state. The survey, conducted in April, 2015, represents more than 80% of all hospital patient services in Arkansas in 2014, broken out by revenue and admissions. Hospital participants in the survey reported 11,698 uninsured patients were admitted for inpatient care in 2014, compared to 22,786 inpatient admissions in 2013. The volume of uninsured patients seen in the hospitals’ outpatient clinics showed similar declines in 2014, falling by 45.7%. In hospital emergency rooms – where there was only a 5% increase in overall visits in 2014 – the number of uninsured patients seeking care declined by 38.8%. The small increase in emergency room usage shows that hospitals are doing a good job of getting patients to the right care setting. The APO provides no payment to hospitals for non-urgent care delivered in the emergency room. When Arkansas legislators in 2013 developed the APO in response to 48

Fall 2015 I Arkansas Hospitals

APO2

191.1

–

191.1

–

Uninsured

170.0

334.0

(164.0)

-49.1%

Total Cost

361.1

334.0

27.0

8.1%

Net Loss

($121.5)

($270.5)

$149.0

-55.1%

Payments include an estimate of expected payments not yet receive d as of the survey date for services rendered prior to December 31, 2014. 2 80% of Arkansas Insurance Exchange patients were estimated to be attributable to APO based on enrollment data provided by the Arkansas Department of Human Services. 3 Based on individual hospital cost to charge ratios. 1

The Private Option has given many of our rural hospitals a better chance to remain open for their communities. – Bo Ryall,

President and CEO, Arkansas Hopsital Association

the need for Medicaid reform, they were drawing an entirely new map for healthcare. Arkansas chose to expand coverage to low-income adults by using federal Medicaid funds to purchase qualified health plans (QHPs) on the state’s health insurance marketplace for nondisabled childless adults under age 65 with incomes below 138% of the federal poverty level (FPL) and parents whose incomes are between 17% FPL and 138% FPL. “Medically frail’’ adults in this group are covered through Medicaid instead of marketplace QHPs. “Arkansas continues to lead the nation in reducing the numbers of uninsured people. That has had a direct, positive impact on hospitals,” AHA President and CEO Bo Ryall says. “The latest data show once more that the new insurance coverage provided through the Private Option has reduced uncompensated care losses for hospitals in the state, giving every Arkansas hospital a way to better manage the effects of Medicare payment reductions that have grown over the past few years. More importantly, the Private Option

has given many of our rural hospitals a better chance to remain open for their communities. Arkansas has not seen rural hospital closures like other states, and this can be directly attributed to insurance coverage for a previously uninsured population.” Ray Montgomery, president/CEO of Unity Health and a member of the Governor’s Advisory Council on Medicaid Reform, says, “The Arkansas Private Option is making a difference in the amount of uncompensated care we see in our hospital and in hospitals across the state. Whether we have the APO or not, Unity Health in Searcy, alone, will suffer from $66 million in payment reductions from federal cuts over the next 6 years. The Arkansas Private Option allows us to at least receive payments for patients who previously had no ability to pay for services, otherwise.” (See more from Ray Montgomery on page 52.) For hospitals and other healthcare providers, the fact that the APO is improving the health of their patients and communities is its most important benefit. Stimulating the state’s economy is merely icing on the cake.

Special Report

The Medicaid Report:

Hospitals Continue To Serve All Patients Despite Losses By Susan M. Miller, CPA, FHFMA, Partner, and Derek R. Pierce, CPA, FHFMA, Director, BKD, LLP Editor’s Note: The Arkansas Private Option (APO) provides services to individuals under private health plans rather than through the traditional Medicaid program. Because Medicaid payments cover only a portion of the cost of care, the APO is a better option for hospitals because it allows them to provide much-needed care to their patients without incurring Medicaid-related losses and uncompensated care. Health plans offered through the APO typically pay the full cost of the healthcare provided, which not only helps hospitals mitigate the impact of large Medicare cuts at the federal level, but also avoid the losses associated with Arkansas Medicaid underpayments. This article provides details about Medicaid’s chronic underpayment of Arkansas’s hospitals throughout the last decade and why any return to pre-APO structure could spell financial disaster for Arkansas hospitals.

More than a decade ago, the Arkansas Hospital Association first engaged BKD, LLP (BKD) to conduct a study to document hospitals’ losses attributable to inadequate Arkansas Medicaid reimbursements. That study was based on data for 2002 and was subsequently updated three times, with data for 2004, 2006 and 2011. This year, the AHA and BKD performed a similar study to update those findings utilizing 2013 data.

$108,719,000 That’s the unreimbursed cost of services provided in 2013 to Arkansas Medicaid recipients recorded by the 44 Arkansas acute care hospitals included in this study. The balance of Arkansas’s 98 licensed hospitals, including UAMS, Arkansas Children’s Hospital and Arkansas’s critical access hospitals and others, are reimbursed under a different methodology based on cost and are not included in this study, which breaks down the losses by rural and urban location and bed size. The unreimbursed Medicaid costs are separate and in addition to the costs of uncompensated care related to uninsured patients who can’t afford to pay for the hospital care they receive.

Arkansas hospitals provide stateof-the-art healthcare to thousands of low-income Arkansans each year. The inpatient and outpatient data from the hospitals included in this study show that these hospitals are significantly underpaid for both inpatient and outpatient services by the Arkansas Medicaid program, and the level of those underpayments has grown steadily over the past decade. (See Fig. 1.) Even after considering supplemental Upper Payment Limit (UPL) and Provider

Access reimbursements, Arkansas hospitals lost over $108 million in 2013 caring for Arkansas Medicaid patients. This continues a trend of increasing losses only partially tempered by the establishment of the Provider Access program in 2009. The Arkansas Medicaid program, on average, reimbursed these hospitals less than 80% of the cost of care which they incurred in 2013 associated with Medicaid continued on page 50

Figure 1

Fig. 1 shows the unreimbursed cost of services provided to Arkansas Medicaid recipients, which has increased dramatically over the past 10 years. Arkansas Hospitals I Fall 2015

Figure 2

Arkansas Medicaid Payment Summary (In millions)

$127.1 $223.3

$29.9

Traditional Payments Losses UPL

$108.7

Provider Assessment

The study identified $488 million in costs of care to Medicaid recipients; however, hospitals were not reimbursed for nearly $109 million of these costs.

beneficiaries. These reimbursements include payments generated from federal matching programs and are not totally funded by the state. These hospitals spent $488 million caring for Medicaid patients, but were reimbursed only $223 million under Medicaid’s traditional payment methodology. Most hospitals were able to participate in the state’s UPL and

Provider Access programs and shared in supplemental payments available through those channels, reducing the total losses by $157 million, (an increase of approximately $35 million since the most recent study, which included approximately the same number of hospitals). (See Fig. 2.) Based on traditional Medicaid rates alone, Medicaid covered 65% of

hospitals’ inpatient care costs relating to covered days. When considering inpatient care to Medicaid patients who exceed their 24-day coverage limit (which Medicaid does not pay), the payment ratio drops to 52% of costs. For outpatient services, Medicaid rates, which are based on a fee schedule that has not been updated in 25 years, cover only 33% of costs. Fortunately, the UPL and Provider Access funds partially offset these losses, bringing the inpatient and outpatient payment rations to 91% and 52%, respectively, and the overall payment ratio is 78% of costs. In 2015, the UPL program for private hospitals ended and the resulting “gap” under the upper payment limit was absorbed by the Provider Access program, resulting in lesser payments to hospitals. And without the benefit of the Provider Access Program, Arkansas’s hospitals would have lost $236 million in 2013 on Medicaid covered services, rather than the $108.7 million loss reported in this study.

Arkansas’s Provider Access Program For many years, the Arkansas Medicaid program has reimbursed the majority of Arkansas hospitals less than the cost of treating Medicaid recipients. Although the state recognized that this underfunding of the Medicaid program could threaten the ability of Arkansas hospitals to continue providing services to their patients and communities, no additional state funding was available to increase hospital payments. So, in 2009, through the efforts of the Arkansas Hospital Association, the Hospital Access Program was established to partially offset hospitals’ Medicaid-related losses. For every dollar in state funds spent on Medicaid, states draw down additional dollars from the federal government according to the state’s federal medical assistance percentage, which determines the share of Medicaid costs the federal government pays.

Fall 2015 I Arkansas Hospitals

In Arkansas, for every $3 contributed by the state, the federal government supplies approximately $7 in additional Medicaid funding. State-level funds usually come from state general revenues, but under programs such as the Hospital Access Program, providers themselves supply the funds necessary to pull down the federal match. The maximum amount a state may pay to providers for Medicaid services is referred to as the Upper Payment Limit (UPL). Generally speaking, the UPL is calculated by comparing the amount Medicare would have paid for these services to the amount actually paid by Medicaid for the services. Arkansas Medicaid pays rates far below the allowable maximum, creating a gap between those standard Medicaid rates and the UPL (the “UPL gap”). Under the Hospital Access Program, Arkansas Medicaid collects state-level

funds through hospital assessments, which are calculated as a percentage of the hospital’s net patient revenues, and draws down matching federal funds to establish a pool of money equal to the UPL gap for the year. The assessments and associated federal matching funds are used to make Hospital Access Payments to participating hospitals. The amount received by each hospital is based upon the percentage of Medicaid patients seen by that hospital during the year. The more Medicaid services a hospital provides, the higher the access payments received. Although the Hospital Access Program increases the amount of federal funding for the Arkansas Medicaid program and improves Medicaid funding for many hospitals, it does not fully cover the cost of care provided to Arkansas Medicaid beneficiaries.

Figure 3

TRADITIONAL ARKANSAS MEDICAID PROGRAM PERCENT OF COSTS COVERED 60%

50%

40%

30% Under 50

50 to 100

100 - 200

200+

All

BED SIZE

STUDY FINDINGS – INPATIENT

Hospitals continue to be paid far below the cost of providing care to their patients by the Arkansas Medicaid program under the traditional reimbursement process. Further, despite the Provider Access program, the amount of unreimbursed cost continues to grow. As shown in Fig. 3, all size ranges of Arkansas hospitals lose money from their provision of services to Arkansas Medicaid beneficiaries. The amount of inpatient payments and losses by hospital location type is reflected in Fig. 4.

OUTPATIENT Figure 4

TRADITIONAL ARKANSAS MEDICAID INPATIENT PROGRAM (In millions)

$175 $150 $125 $100 $75 $50 $25 $-

All

Urban Payments

Rural Losses

Figure 5

TRADITIONAL ARKANSAS MEDICAID OUTPATIENT PROGRAM (In millions)

$200 $150 $100 $50 $-

All

Urban Payments

Rural Costs

As with inpatient services, hospitals incurred tremendous losses from outpatient services in 2013. Unlike inpatient services, there is no UPL program to reduce this burden except for only four hospitals that are considered “non-state public” hospitals. All Arkansas hospitals included in this study incurred losses from outpatient services provided to Arkansas Medicaid recipients. The losses totaled $110 million from traditional Medicaid payments. Outpatient payments to hospitals were roughly 33% of the costs of providing care in 2013. The average loss per hospital was over $2.5 million with 34 of the 44 hospitals experiencing annual losses of more than $1 million. Fig. 5 shows that losses incurred by Arkansas hospitals for providing outpatient services to Medicaid beneficiaries exceeded the payments for those services.

MOVING FORWARD

This study highlights factors that are critical to preserving the future of Arkansas hospitals as the state looks for cost savings opportunities in the context of Medicaid reform. Hospitals continue to be woefully underpaid by traditional Medicaid. Any reforms that exacerbate this problem or risk the continued availability of the UPL and Provider Access programs (which are essential to partially offset these losses) put Arkansas hospitals and their patients at risk. Arkansas Hospitals I Fall 2015

Legislative Advocacy

A CEO’s Perspective on Reform: Hospital Voices Vital to the Process By Raymond Montgomery II, FACHE Editor’s Note: As deliberations continue in Little Rock about the path of health reform in Arkansas, we asked Ray Montgomery, who serves as a hospital representative on the Governor’s Advisory Council on Medicaid Reform, to offer his thoughts as a hospital administrator and strong supporter of quality care.

Hospitals are the ultimate healthcare safety net and have unique roles to play within the complex healthcare delivery system. While most people see hospitals as acute care centers, hospitals are much more than that. Hospitals are large employers, safe havens when disaster strikes, community meeting venues and much more. I am honored to serve on the Governor’s Advisory Council on Medicaid Reform and to represent our patients, our hospitals and the overall healthcare system. The healthcare delivery system is ever-changing, both nationally and statewide. Here in our home state, the Legislative Health Care Reform Task Force is contemplating which legislative actions are needed to reform the Medicaid payment system. While the Legislative Task Force is utilizing consultants and gathering information, the Governor’s Advisory Council on Medicaid Reform meets in parallel and consists of about 40 individuals who represent healthcare providers, advocates and consumers. These two bodies are seeking strategies to provide healthcare for low-income and other vulnerable populations that will: • Promote accountability, personal responsibility and transparency; • Remove disincentives for work and social mobility; • Encourage and reward healthy outcomes and responsible choices; • Promote efficiencies that will deliver value to the taxpayers; and • Assert the state’s responsibility for local control, and protect Arkansas consumers and businesses from federal mandates. In mid-August, these bodies met together at the Arkansas Capitol to hear 52

Fall 2015 I Arkansas Hospitals

the governor’s vision and direction for potential solutions. Our governor was deferential to the Legislative Task Force, but recommended that, as deliberations

continue, seven elements be considered: 1. Implement mandatory employersponsored insurance premium assistance;

2. Establish premiums for individuals with incomes of more than 100% of the federal poverty level; 3. Require work training referrals for the unemployed or under-employed; 4. Eliminate non-emergency medical transportation; 5. Limit access to private market coverage to working individuals; 6. Seek all avenues of potential cost savings; and 7. Strengthen program integrity. Arkansas hospitals have done a good job educating our legislators about the fact that the Arkansas Private Option has been good for patients, good for the healthcare system and good for our hospitals. With that, as the decisions are being made to reform and improve our healthcare system, it is imperative that we continue to be a part of the discussions and eventual solutions. The Legislative Task Force has hired consultants, The Stephen Group, to come up with a menu of options

that might be used in our state to optimize our Medicaid program. In addition, the Department of Human Services, Division of Medical Services has issued a Request for Information to allow Medicaid managed care companies to respond to and make presentations on how other states have utilized Medicaid managed care programs. Each of these managed care companies has touted its abilities to keep the state costs of Medicaid programs under control. This should be a concern to Arkansans. The added administrative cost and profits reported in the hundreds of millions of dollars by the managed care organizations (MCO companies) will be taken away in the form of reduced services to our citizens, as well as payment reductions to providers. Our state agencies, current commercial insurance companies actively involved in patientcentered medical homes, Episodes of

Care and other successful initiatives, and providers (physicians and hospitals) are quite capable of implementing the care management programs promoted by these MCOs. In fact, we have successfully been doing so for decades. The consultants must have a written report delivered to the Task Force no later than October 2015, with the Task Forceâ&#x20AC;&#x2122;s recommendation to the governor due by December 31. I encourage all of Arkansasâ&#x20AC;&#x2122;s healthcare providers to educate our elected officials and our communities on the good work that we have done to continually improve our healthcare system, and on the imperative that we should be a part of the continued progress that we will make, together. Your legislative representatives, who will make the ultimate decision about the future of healthcare in Arkansas, still need your input as well as that of the consultants and Legislative Task Force. continued on page 54

21 Arkansas Hospitals Have Already Chosen Us. Come see why!

Take a VIP tour of our new Little Rock donor center, located at the corner of Markham and Shackleford, while at the AHA Annual Meeting. Call Patti Barker, Hospital Relations Director, at 405-313-9578, to schedule a time or stop by our booth at the Trade Show on Thursday to learn more. Providing the right blood for the right patient at the right time.

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Each Medicaid program throughout the country is unique to the particular state in which it operates. The adage that “if you’ve seen one state Medicaid program, you’ve seen only one state Medicaid program” is very real. One of Arkansas’s greatest assets has been the ability for groups of diverse healthcare providers to work with each other and with the Department of Human Services, Division of Medical Services to come up with affordable solutions to serve our most vulnerable populations. As consultants for the Legislative Task Force study other states’ efforts and bring a menu of ideas from these other states, it is our biggest role to continue to raise our Arkansas voices and the voices of our patients. Please join me in contacting our elected officials about our concerns and solutions. Ray Montgomery is the President and CEO of Unity Health – White County Medical Center. During his 26 years of service at Unity Health, he has been a champion for quality and patient safety. The hospital has earned the Arkansas Governor’s Quality Award twice, more than any other healthcare facility in the state. Mr. Montgomery is a recipient of the A. Allen Weintraub Memorial Award, the highest honor for a hospital executive on a state level, and has served on the Arkansas Hospital Association board for more than 15 years. On a national level, he has served on the Board of the American Hospital Association and as Chairman of the AHA’s Regional Policy Board 7. He currently chairs the rural subcommittee of the American Hospital Association’s Ensuring Access in Vulnerable Communities Task Force.

RANKED ONE OF THE BEST LAW FIRMS FOR HEALTH CARE LAW IN ARKANSAS One of few Health Law Firms in Arkansas to be Ranked in the top tier

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501-378-7870

bmarshall@mitchellblackstock.com Bill’s first job after completing his education in 1974 was at the corporate headquarters of Hospital Corporation of America (HCA) in Nashville, Tennessee. Bill has a BSBA in Accounting, an MBA, and a Juris Doctorate from the University of Arkansas all with honors. He is also a CPA (Inactive). After leaving HCA in 1981, Bill has practiced law in Little Rock, Arkansas, representing hospitals and other healthcare providers. Bill has extensive experience in complex issues inherent in healthcare laws which affect hospitals. He provides representation related to transactions such as the purchase or sale of healthcare facilities and also the purchase of physician practices and the formation of physician hospital joint ventures. Bill also provides representation related to resolution of Medicare and Medicaid reimbursement disputes, development of hospital compliance policies, development of HIPAA compliance policies, compliance with the Stark and Anti–Kickback statutes, tax-exempt matters for non-profit hospitals, development of PHO’s, Clinically Integrated Networks and ACO’s, and compliance with other laws which regulate hospitals. Bill updates Hospital Compliance Plans to comply with the OIG Guidance, since so many of them do not. Bill Marshall has represented hospitals for 40 years. Arkansas Hospitals I Fall 2015

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