WINTER 2014
www.arkhospitals.org
Coders: Get Ready for ICD-10! AHA Annual Meeting and Awards
A M A G A Z I N E F O R A R K A N S A S H E A LT H C A R E 2014 PRO F E S SHospitals I O N A L1 S Winter I Arkansas
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Winter 2014 I Arkansas Hospitals
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Arkansas Hospitals 419 Natural Resources Drive • Little Rock, AR 72205 501-224-7878 / FAX 501-224-0519 www.arkhospitals.org
BOARD OF DIRECTORS
Peggy Abbott, Camden Chris Barber, Jonesboro David Berry, Little Rock Tim Bowen, Mena Kristy Estrem, Berryville John Heard, McGehee Ed Lacy, Heber Springs Jim Lambert, Conway James Magee, Piggott Ray Montgomery, Searcy Robert Rupp, Newport Sharon Sly, Siloam Springs Barbara Williams, Conway
EXECUTIVE TEAM Robert “Bo” Ryall / President and CEO W. Paul Cunningham / Executive Vice President Beth H. Ingram / Senior Vice President Tina Creel / Vice President, AHA Services, Inc. Don Adams / Vice President, Rural and Mental Health Services Elisa M. White / Vice President and General Counsel Jodiane Tritt / Vice President, Government Relations Pam Brown / Vice President, Quality and Patient Safety
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.
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ICD-10 Preparations AHA Annual Meeting and Awards
is published by
Doug Weeks, Little Rock / Chairman Walter Johnson, Pine Bluff / Chairman-Elect Darren Caldwell, DeWitt / Treasurer Larry Morse, Clarksville / Past-Chairman Ron Peterson, Mountain Home / At-Large
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FEATURED SECTIONS
Arkansas Hospital Association
Beth H. Ingram, Editor
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CEO Profile
24 Community Care Networks
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25 Medicaid to Cover Inpatient Care for Inmates
CEO Profile: Robert Rupp
27 Hospitals a Part of Donate Life’s Parade Float
ICD-10
28 Better Future for Our Patients and Communities
11 Coders: Get Ready for ICD-10!
31 AHA Services Spotlight: BancorpSouth
12 Looking Forward to 2014 and ICD-10
32 AHA Guiding Principles/Goals 2013-2014
13 Shift to ICD-10 Confusing and Costly for Hospitals
34 Mental Health/Substance Abuse Parity Rule
13 CMS Updates ICD-10 Resources
34 Hospital CMO Workshops Planned
AHA Annual Meeting and Awards
Quality/Patient Safety
14 A New Year, New AHA Leadership
36 Hospitals Honored for Reducing Elective Delivery
14 New AHA Board Members
36 Raising the Number of Patient Safety Certified
15 Magee Named Weintraub Memorial Recipient
37 Patient- and Family-Centered Care
16 Key and Beyer Recognized for Service 16 Governor Beebe Receives Statesmanship Award
Medicare/Medicaid
17 ACHE and AHEF Present Annual Awards
38 Hospitals Earn $2 Million for IQI Successes
17 AHAA Administrators of the Year
40 SFY 2014 Medicaid Assessment Finalized
18 Thank you to our Partners and Exhibitors!
40 Ordering and Referring Denial Edits
19 Annual Meeting 2013 Pictorial
41 Medicaid Inspector General’s Website 42 Update on Two-Midnight Rule
NewsSTAT 21 AHA Receives Continuing Education Approval
Emergency Preparedness
21 $1 Million Milestone for Mercy Hospital Auxiliary
43 Websites Offer Resources for Philippines
22 Collateral Damage from Medicare Spending Cuts
43 At a Moment’s Notice
23 HMA Regional Service Center in Fort Smith
Miscellaneous 42 Top 10 Health Technology Hazards for 2014 46 Listen UP!
Departments
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 85
Cover Photo Queen Wilhelmina State Park in late November ice.
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From the President
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Arkansas Newsmakers and Newcomers
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All About Arkansas Hospitals
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Education Calendar
Photography courtesy of William Rainey of Mena www.buffaloriverphotos.com
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F R O M
T H E
P R E S I D E N T
Looking to Arkansas With the Health Insurance Exchange in operation for nearly three months now, we are reminded why other states continue to look to Arkansas for our creative and innovative approaches to solutions.
Photo courtesy of Jason Burt
We took the things that are good about healthcare reform and put together an Arkansas plan that is good for Arkansans and good for our patients.
It’s all due to a hallmark piece of legislation supported by a wide group of stakeholders, led by Governor Mike Beebe, with unprecedented bipartisan support from our legislature. This benchmark legislation was Arkansas’ way of mitigating some of the negative consequences of the federal Affordable Care Act, and addressing the most critical economic, fiscal and health issue facing our state – finding a sensible way to meet the mandate that everyone have healthcare coverage and assuring all Arkansans the ability to get the healthcare they need to become, remain, or find a path toward being healthy. The federal healthcare law mandated health insurance coverage, but many Arkansans could not afford it. To provide healthcare coverage to more low income, uninsured adults, this legislation, called the Private Option, set a new standard in creative healthcare policy. The Private Option ensures that the federal government will pay 100% of the costs for this coverage in the first three years. The coverage is available to Arkansans making up to 138 percent of the federal poverty level (FPL). What does this look like in “people terms?” 138 percent of the FPL means any individual earning $15,000 a year or less, or in family terms, about $30,000 in earnings for a family of four. Previously, many of these individuals or family members had to work two or more jobs just to keep a roof over their heads and food on the table. Health insurance not offered by employers was simply not affordable. Now, with Arkansas’ legislation, healthcare coverage has become a reality.
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What does this mean for our hospitals? The Private Option allows Arkansas hospitals to recoup some of their losses due to uncompensated care. It provides a mechanism for Arkansans to be insured, which means that some of the care provided to patients in Arkansas hospitals that has historically been uncompensated will now be paid for. The AHA estimates that approximately $200 million of the predicted $400 million of uncompensated care expected in 2014 will now be covered. We know that the October 1 Federal Insurance Marketplace sign-up began with a softer launch than the nation was expecting, but we continue to be hopeful that the federal registration websites will soon become fully operational. Here at home in Arkansas, we’ve been enrolling since Day One. After the first two months of registration for the Private Option, more than 60,000 eligible Arkansans had already enrolled, and those numbers continue to climb every day. One resource you might like to share is a free, direct registration phone line offered by BancorpSouth, where certified insurance agents will help people choose the best plan for their needs and circumstances, and walk them directly through enrollment. Available toll free at 855-649-7023, this is a service offered by one of AHA Services, Inc.’s endorsed companies, and is a great service for those who fear or just don’t know how to operate online enrollment. Is it any wonder other states are looking to Arkansas for leadership? We’re glad they may benefit from our state/federal collaboration, but most of all, we’re glad that Arkansans will benefit. It’s a good feeling to know that people now have access to preventive healthcare, and can have the peace of mind that healthcare insurance provides. Healthier Arkansans, patients with peace of mind…it’s what this creative legislation was all about!
Bo Ryall President and CEO Arkansas Hospital Association
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ARKANSAS
NEWSMAKERS and NEWCOMERS Governor Mike Beebe has named Greg Stubblefield, vice president for clinical services, Baptist Health in Little Rock, to the Emergency Medical Services Advisory Council. His term expires July 2014. The Governor also reappointed Kathryn Blackman, MSN, RN, vice president, patient clinical services, St. Bernards Healthcare, Jonesboro, and Christi Whatley, vice president, operations, Mercy Hospital Hot Springs, to the Governor’s Trauma Advisory Council. Both terms expire July 1, 2015. Marcy Doderer, FACHE, president and CEO of Arkansas Children’s Hospital since July, has been named to the Becker’s Hospital Review list of “130 Women Hospital and Health System Leaders to Know.” These 130 women demonstrate outstanding leadership within the hospital and healthcare industry and were chosen based on a wide range of management and leadership skills, including oversight of hospital or health system operations, financial turnarounds and quality improvement initiatives. Also on the list is Pamela Stoyanoff, executive vice president and COO of Methodist Health System in Dallas. She previously served in an executive position with St. Vincent Health System in Little Rock. Arkansas Business recently named Kathy Jones, vice president and CFO, Arkansas Hospice, Inc. of North Little Rock, Nonprofit CFO of the Year. She has a 27-year career in healthcare and says her department functions to ensure that “our frontline staff has everything they need to care for the patient.” Steve Rose, vice president and CFO of Conway Regional Health System, was a CFO of the Year finalist in the Large Private Companies category. Awards were presented November 6 in Little Rock. 6
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Michael Layfield resigned November 1 as CEO of Drew Memorial Hospital in Monticello. Ronald K. Rooney, FACHE, has been retained as interim CEO until a permanent successor is named. Rooney was president and CEO of Arkansas Methodist Medical Center in Paragould until his retirement in December 2011. Eric Pianalto has accepted the position of president, Mercy Hospital Northwest Arkansas after serving in the interim since July 31. He has served as a Mercy leader for more than 19 years, including a 10-year tenure in Northwest Arkansas along with roles in Fort Smith, Oklahoma and Mercy’s four-state health ministry. Prior to serving as interim president, Pianalto served as chief operating officer of Mercy Clinic in Arkansas and Oklahoma. Rev. Edward Pruett, board-certified chaplain at St. Bernards Hospice in Jonesboro, received the Hospice Heart Award from the Hospice and Palliative Care Association of Arkansas. Bo Ryall, president and CEO of the Arkansas Hospital Association, has been named to the Health Care Industry Council of the Federal Reserve Bank of St. Louis. The St. Louis Fed has four District Industry Councils (transportation, real estate, healthcare and agribusiness), each designed to provide the Fed with important feedback regarding economic conditions within a key Eighth District industry sector. The members’ observations – along with the economic data and additional information – help ensure that conditions of Main Street America are represented in monetary policy deliberations in Washington.
Charles R. Shuffield of Fort Smith died September 30. He was president of Sparks Regional Medical Center from 1979-1997 and chairman of the Arkansas Hospital Association (AHA) in 1984-85. Shuffield was a member of the AHA board for eight years, and in 1997 received the A. Allen Weintraub Memorial Award, the highest honor the organization can bestow upon a hospital chief executive. He also was president of the AHA PAC, served as president of the Arkansas Hospital Administrator’s Forum, was named to the Governor’s Task Force on State Hospitals and participated in many other councils and committees. Shuffield will be remembered for his honesty, compassion and personable leadership style. Memorials may be made to the Degen Foundation of Sparks Regional Medical Center or to the Charles Shuffield Endowed Scholarship in Healthcare Administration through the University of Arkansas Fort Smith Foundation, Inc.
Charles Stewart, FACHE, has been named Health Management Associate’s Arkansas Market CEO for Sparks Health System in Fort Smith and Summit Medical Center in Van Buren. Stewart was most recently Missouri Market CEO for Health Management hospitals Poplar Bluff Regional Medical Center and Twin Rivers Medical Center in Kennett, Missouri. His 30 years of experience in hospital management include administrative positions with hospitals in Tennessee, Alabama, Mississippi and North Carolina. Renie Taylor, administrator/COO of Stone County Medical Center (SCMC) in Mountain View, retired October 1. Gary Bebow, CEO, White River Health System, has announced Stan Townsend will succeed Taylor. Townsend was the past CEO/owner of SCMC before its sale to White River Health System in April 1999.
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all about
ARKANSAS HOSPITALS Booneville Community Hospital began in early November an expected two-month transition to become Mercy Hospital Booneville, with Mercy Fort Smith leasing the 5-year-old hospital from the Booneville Community Hospital Trust Inc. Mercy’s electronic health record system is being installed in the Booneville facility and strategic plans made to expand services to patients in the region by coordinating care between that facility and Mercy’s other critical access hospitals in Waldron, Paris and Ozark. “While community hospitals are critical resources in the community, it is becoming increasingly difficult for them to operate independently,” said Ryan Gehrig, president of Mercy Hospital Fort Smith. “Working together, we can maintain and improve the services this vital facility offers the community.” Baptist Health announced a long-term lease agreement with HSC Medical Center in Malvern that begins January 1, 2014. At that time, the hospital will be renamed Baptist Health Medical Center – Hot Spring County and will become Baptist Health’s eighth hospital. In addition, the system also announced it will open a 100-bed acute care hospital in Conway in 2016. The BridgeWay Hospital in North Little Rock celebrated its 30th anniversary November 14 with a recep-
tion and groundbreaking for an expansion project. The hospital opened as a 60-bed facility in 1983 and provides comprehensive care to children, adolescents and adults. Comprised of inpatient and outpatient programs, The BridgeWay has served more than 20,000 people since opening its doors and is scheduled to serve additional people when a new 20-bed unit opens to serve older adults with behavioral health issues. Jason Miller, COO, said at the reception, “Today, The BridgeWay and our dedicated staff continue to remind us that Arkansans don’t have to look far across the state to find excellent care. Serving those in every county, we provide the very best of care.” Catholic Health Initiatives and its affiliate, St. Vincent Health System in Little Rock should finalize an agreement by December 31 to purchase Mercy Hospital Hot Springs. According to an October 14 press release, “Mercy and CHI recognize the extremely challenging healthcare environment in Arkansas and agree that enhancing the Catholic Health ministry and strengthening access to healthcare is a key objective of the proposed transaction. Upon successful completion of the transaction, Mercy Hot Springs would be operated as part of an integrated network with SVHS in Little Rock.”
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EDUCATION CALENDAR January 9, Little Rock Pharmacy Collaborative Workshop January 16, Little Rock CMS Levels of Care Workshop January 17, Little Rock 2013 CPT, HCPCS Level II and OPPS Workshop January 22-24, Tunica, MS HFMA Tri-State Winter Institute January 28, Little Rock Compliance Quarterly Roundtable January 29, Little Rock ICD-10 Workshop Series, Session I January 30, Little Rock When MACs and RACs Attack! Workshop February 7, Little Rock Arkansas Association for Healthcare Engineering Winter Meeting February 12, Little Rock Chief Medical Officer Workshop February 26, Little Rock ICD-10 Workshop Series, Session II
March 7, Little Rock Arkansas Healthcare Human Resources Association Spring Meeting March 7, Little Rock CMS Conditions of Participation Workshop March 12-13, Little Rock Hospital Preparedness Conference March 14, Little Rock ICD-10 Workshop Series, Session III March 21, Little Rock Arkansas Society for Directors of Volunteer Services March 23-27, Chicago, IL American College of Healthcare Executives Congress on Healthcare Leadership April 3-4, Little Rock AFMC Quality Conference April 16, Little Rock Arkansas Health Executives Forum Spring Meeting April 16-18, Hot Springs Society for Arkansas Healthcare Purchasing and Materials Management Annual Meeting
April 25, Little Rock Arkansas Association for Healthcare Quality Spring Conference April 30, Little Rock ICD-10 Workshop Series, Session IV April 30 – May 2, Hot Springs Healthcare Financial Management Association Spring Workshop May 4-7, Washington, DC American Hospital Association Annual Membership Meeting May 7-9, Little Rock Arkansas Association for Healthcare Engineering Annual Meeting May 13, Little Rock Chief Medical Officer Leadership Workshop
Program information available at www.arkhospitals.org/events. Webinar and audio conference information available at www.arkhospitals.org/events.
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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
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CEO PROFILE
CEO Profile: Robert Rupp It’s not unusual to see successful military leaders who are able to readily transition into hospital leadership roles. Over the years, many have joined the ranks of hospital CEOs in Arkansas. Part of that could be tied to the long standing military mantra, “Mission first; people always.” The underlying philosophy is that without the mission the organization wouldn’t exist, but without the people the organization absolutely could not accomplish its mission. That’s true of endeavors in practically all types of organizations, but perhaps more so in hospitals, because personal interactions and touch are such integral parts of healthcare and healing. Robert Rupp, who retired from the United States Air Force (USAF) ten years ago and is the chief executive of a hospital in rural Arkansas, carried that philosophy with him in his move to civilian life and views his role as a hospital CEO in a very similar fashion. His guiding principle is “to take care of the people and the people will take care of the mission.” Rupp says that his key mission is to focus on his staff. “I need to ensure they have the tools and equipment they need to do their jobs every day. Having happy employees who are engaged and take pride in what they do and where they work will ensure we provide safe, quality care for our patients.” Rupp is chief executive officer of the 133-bed Harris Hospital in Newport, a community of about 8,000 people located in Jackson County in the North Central part of the state, where he has held the position for two years. While he has been in hospital administration since 2007, Rupp has actively been engaged in the health profession for more than 23 years. Much of that time was
Robert Rupp
with Hill Regional Hospital in Hillsboro, Texas. From there, he served as assistant CEO and interim CEO at two hospitals in Louisiana and Texas, before accepting the CEO position in Newport in October 2011. In his two years at Harris Hospital, Rupp has been very busy. He completed a medical office building renovation for physician clinics, completed the conversion to electronic medical records for both the hospital and physician clinics this past year, upgraded the hospital nurse call system, started a hospitalist program, instituted a “30 Minutes or Less ER Program,” and rejuvenated the hospital’s newsletter to the community. In other words, Rupp hit the ground running!
I see the AHA’s role as a parallel to what hospital administrators try to do every day for their communities and hospitals. The AHA assists us with resources, education and up-to-date information on the changing landscape of healthcare. spent in the Air Force where he trained and served as a medical assistant and radiology technician. He retired as a First Sergeant from the military in 2004, stationed at Lackland AFB in San Antonio, Texas, after 21 years of service to our country. During that time he graduated from Wayland Baptist University in San Antonio with a bachelor’s degree with a concentration in healthcare administration. He earned a MBA from Webster University in 2003. After his retirement from military service, he began his healthcare career as special projects director/administrative specialist
Rupp says his role “is to improve the health of our community by managing the resources entrusted to me. With all the challenges and sweeping changes we are facing in healthcare, it is easy to lose focus of our mission…our patients.” He says he “tries to keep our leadership team, physicians and employees focused on ‘sticking to the basics’ – don’t try to get too fancy!” In addition to his hospital duties, Rupp was elected in October 2013 to the Arkansas Hospital Association’s board of directors as the Alternate Delegate to the American Hospital Association’s continued on page 10 Winter 2014 I Arkansas Hospitals
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Regional Policy Board (RPB) 7. In that capacity, he will attend RPB meetings and engage in healthcare policy discussions with other representatives from Arkansas, Oklahoma, Texas and Louisiana several times each year. Rupp is a member of the American College of Healthcare Executives. Active in his community, he is a board member of the Newport Chamber of Commerce, Newport Christian Clinic, and Newport Country Club. He’s a member of the Aircraft Owners and Pilots Association and is a Paul Harris Fellow with the Rotary Club. Rupp and his wife of more than 30 years, Alieta, have two daughters and four grandchildren. Alieta is very active in the Newport community assisting with the Christian Clinic and the Food Bank of Newport, as well as being involved in several civic groups. When asked about the role the Arkansas Hospital Association plays, Rupp says, “I see the AHA’s role as a parallel to what hospital administrators try to do every day for their communities and hospitals. The AHA assists us with resources, education and up-to-date information on the changing landscape of healthcare. They build relationships that bring all the hospitals together, addressing our concerns as ‘one voice.’ They help administrators tackle the issues that are most important to our facilities and business, allowing me and my staff to focus on our mission, which is to provide safe, quality care for our patients.”
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ICD-10 PREPARATIONS
Coders: Get Ready for ICD-10! The countdown to ICD-10-CM implementation is well underway and many healthcare professionals have yet to start preparing or are still not sure where to begin. ICD-10 or a clinical modification of ICD-10 is the classification system currently being used by the majority of the world. The US is the only industrialized nation not using an ICD-10-based classification system. There are two main reasons that the transition to ICD-10-CM/PCS is necessary: Payors cannot pay claims fairly using ICD-9-CM since the classification system does not accurately reflect current technology and medical treatment. Significantly different procedures are assigned to a single ICD-9-CM procedure code. Limitations in the coding system translate directly into limitations in the diagnosis-related groups (DRG). The healthcare industry cannot accurately measure quality of care using ICD-9-CM. It is difficult to evaluate the outcome of new procedures and emerging healthcare conditions when there are not precise codes. Most importantly, we have a mission to improve our ability to measure healthcare services provided to our patients, enhance clinical decision-making, track public health issues, conduct medical research, identify fraud and abuse and design our payment systems to ensure services are appropriately paid. ICD-10-CM is a clinical modification of the World Health Organization’s ICD-10, which consists of a diagnostics classification system. ICD-10-CM includes the level of detail needed for morbidity classification and diagnostics specificity in the United States. It also provides code titles and language that com-
The AHA is working with coding expert Karen Scott to bring a series of workshops designed to get coders ready for ICD-10. By working together, we can ensure a smooth transition. This series of classes provides indepth training on both coding systems. pliment accepted clinical practice in the US. The system consists of more than 68,000 diagnosis codes ICD-10-PCS was developed to capture procedure codes. This procedure coding system is much more detailed and specific than the short volume of procedure code included in ICD-9-CM. The system consists of 87,000 procedure codes. Together ICD-10-CM and ICD10-PSC have the potential to reveal more about quality of care, so that data can be used in a more meaningful way to better track the outcomes of care. ICD-10-CM/PCS incorporates greater specificity and clinical detail to provide information for clinical decision making and outcomes research. While this is a major transition for both providers and payers, the steps involved and training required are quite manageable with early preparation. The AHA is working with coding expert Karen Scott to bring a series of workshops designed to get coders ready for ICD-10. By working together, we can ensure a smooth transition. This series of classes provides in-depth training on both cod-
ICD-10 Workshops January 29
Session I: Overview of the coding systems
February 26
Session II: Infectious and Parasitic Diseases, Neoplasms, Diseases of the Blood and Immune Systems, Endocrine, Nutritional and Metabolism Disorders
March 14
Session III: Mental, Behavioral and Developmental Disorders, Nervous System, Eye and Ear
April 30
Session IV: Circulatory and Respiratory
May 21
Session V: Musculoskeletal, Skin and Subcutaneous
June 25
Session VI: OB/Newborn/ Congenital
July 23
Session VII: Digestive, Genitourinary
August 27
Session VIII: Signs and Symptoms, Injury and Poisonings, External Causes, Factors Influencing Health Status
ing systems. The morning sessions will consist of ICD-10-CM diagnosis training and the afternoon sessions will focus on ICD-10-PCS coding. Each of the eight sessions will cover specific body systems and the total program will provide approximately 48 hours of training.
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ICD-10 PREPARATIONS by Catherine Munn, MPH, RHIA, CPHQ, Senior Consultant, Cognosante and Amy Webb, Director of Communications, Arkansas Department of Human Services
Looking Forward to 2014 and ICD-10 As 2013 draws to a close many of us will reminisce about the activities of the previous year. However, the vast majority of us will begin to look to 2014 in anticipation of one of the largest transformations that healthcare has ever been challenged with: the transition from ICD-9 to ICD-10. Hopefully, much of the work has been completed. The ICD10 impact assessments that you have completed should be your playbook since it identifies the areas and systems that need remediation moving forward. Providers should have identified the major payers for their practice and what diagnoses they need to focus on based on patient volume and payer mix. Many of you have conducted medical record audits to identify gaps in documentation that will be problematic as you begin to deal with a coding methodology that is much more complex when it comes to specificity and laterality. Now as the industry prepares to enter 2014, Arkansas Medicaid is ramping up testing and validation efforts so that all of our hard work has not been in vain. Like many other payers, the behind-the-scenes work with remediating the systems and processes is complete, and we will now begin the testing phase. Arkansas Medicaid plans to begin provider testing in the first quarter of 2014. We are encouraging our providers to monitor the Medicaid ICD-10 Website: http://humanservices.arkansas.gov/ dms/Pages/ICD-10.aspx for updates and information regarding testing to ensure you can submit a claim and that Arkansas Medicaid can receive and adjudicate the claim. There has been much discussion in the industry that the compli12
Winter 2014 I Arkansas Hospitals
We are encouraging our providers to monitor the Medicaid ICD-10 Website: http://humanservices. arkansas.gov/dms/Pages/ICD-10.aspx for updates and information regarding testing to ensure you can submit a claim and that Arkansas Medicaid can receive and adjudicate the claim. ance date for ICD-10 is going to be delayed. That would be considered wishful thinking by most. The Centers for Medicare and Medicaid (CMS) has been very clear; there will be no further delay to the implementation of ICD-10. While many in the industry continue to discount the advantages of ICD10, CMS has provided a listing of some of the data uses that will be enhanced with ICD-10: • Measuring the quality, safety and efficacy of care • Designing payment systems and processing claims for reimbursement • Conducting research, epidemio-
logical studies, and clinical trials • Setting health policy • Operational and strategic planning and designing of healthcare delivery systems • Monitoring resource utilization • Improving clinical, financial and administrative performance • Preventing and detecting healthcare fraud and abuse • Tracking public health and risks While much of the work of ICD10 is behind us; we still have more work to do. The coming year will bring with it a different set of challenges, but the advantages to our patients and our communities will make it a worthwhile journey.
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ICD-10 Reference Websites • www.CMS.gov/ICD10 • https://implementicd10.noblis.org/ • www.AHIMA.org • www.ICD10monitor.com • www.ICD10watch.com • www.AAPC.com • www.WEDI.org • www.humanservices.Arkansas.gov/ICD10 • http://www.cms.gov/Medicare/Coding/ICD10/ downloads/ICD10SmallandMediumPractices508.pdf • http://www.himss.org/ASP/topics_icd10playbook.asp
ICD-10 PREPARATIONS
Shift to ICD-10 Confusing and Costly for Hospitals Organizations that have put off preparing for the October 2014 roll out of the long-delayed ICD-10 code face a staggering training task to ensure coders and physicians are ready for the transition to mitigate productivity and revenue declines. According to an economic impact statement accompanying the first federal rule proposing the ICD-10 shift, providers are likely to spend about $356 million on training and could see $571 million in productivity losses. The delay in implementation has increased costs for hospitals that began prepar-
ing for the original transition date of Oct. 1, 2013. According to Modern Healthcare, hospitals will spend up to 30 hours and $2,400 to fully train an experienced, hospitalbased ICD-9 coder in the complexities of ICD-10. Training should include simulations with actual claims in both ICD-9 and ICD-10 to give coders practice and the organization advance warning of losses in coder productivity and revenue leakage. Hospitals should have a backup plan in place in case there is a temporary cash crunch due to payment delays.
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CMS Updates ICD-10 Resources The Centers for Medicare & Medicaid Services has posted a draft ICD10 definitions manual and code editor for the fiscal year 2014 Medicare Severity-Diagnosis-Related Groups (version 31). Healthcare providers can use the manual and editor, available at http://cms.hhs.gov/Medicare/ Coding/ICD10/ICD-10-MS-DRGConversion-Project.html, to better understand the impact of the ICD-10 coding system for medical diagnoses and inpatient procedures on the MSDRG system. Hospitals and other entities covered by the Health Insurance Portability and Accountability Act must convert to the ICD-10 coding system by Oct. 1, 2014.
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arkbi.org Del Holloway, Executive Director 800-934-9415
Winter 2014 I Arkansas Hospitals
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AHA ANNUAL MEETING AND AWARDS
A New Year, New AHA Leadership Doug Weeks, FACHE, senior vice president of hospital operations at Baptist Health in Little Rock, was installed as the 2013-2015 chairman of the Arkansas Hospital Association during the association’s 83rd annual meeting October 9-11 in Little Rock. Weeks, profiled in the fall 2013 issue of Arkansas Hospitals, has been with Baptist Health for almost 25 years and has long participated in AHA activities for much of that time. A member of the AHA board since 2007 representing the Metropolitan Hospital District, he also serves on the Executive and Finance Committees of the board. In addition, he is a member of the Council on Government Relations and the Medicaid Committee.
Doug Weeks
Walter Johnson
When taking over the reins as AHA chairman, Weeks said that he looked forward to the challenges and many opportunities ahead in working with our member hospitals, payors, other providers and government agencies. Elected to the board as chairelect was Walter E. Johnson, president and CEO of Jefferson Regional
Medical Center in Pine Bluff since October 2010. Johnson joined JRMC in September 1994. He began his healthcare career in the mid ‘80s with Humana. Upon receiving his master’s degree in health administration from the University of Alabama at Birmingham, he served in various leadership and senior management positions at Humana and HMA. Johnson was elected to the AHA board of directors in October 2010 as the alternate delegate to the American Hospital Association Region 7. He also is a member of the Medicaid Committee, and the Executive and Finance Committees of the board. He will become chairman of the AHA in October 2015.
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New AHA Board Members At its October 10 meeting, the Arkansas Hospital Association House of Delegates elected the following members to the AHA 2013-2014 Board of Directors: • Walter Johnson, Jr., president and CEO, Jefferson Regional Medical Center, Pine Bluff, as Chairman-elect • Ron Peterson, FACHE, president and CEO, Baxter Regional Medical Center, Mountain Home, as At-Large Director • James Magee, executive director, Piggott Community Hospital, as Delegate to the American Hospital Association Region 7 14
Winter 2014 I Arkansas Hospitals
Ron Peterson
James Magee
• Robert Rupp, CEO, Harris Hospital, Newport, as Alternate Delegate to the American Hospital Association Region 7 In addition, Ed Lacy, FACHE, vice president/administrator of Baptist Health Medical Center –
Robert Rupp
Sharon Sly
Heber Springs, was re-elected to a four-year term representing the North Central Hospital District. Representing the Arkansas Hospital Auxiliary Association on the AHA Board will be Sharon Sly of Siloam Springs.
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AHA ANNUAL MEETING AND AWARDS
James Magee Named A. Allen Weintraub Memorial Award Recipient The Arkansas Hospital Association awarded James L. Magee, CEO of Piggott Community Hospital, the 2013 recipient of the A. Allen Weintraub Memorial Award during the Association’s annual Awards Dinner on October 10 in Little Rock. Magee is an active member of the AHA, as well as a well-known member of his northeast Arkansas community. He is immediate past-chair of the Arkansas Hospital Association board of directors where he also has served as Northeast District Director. He serves on the AHA’s Executive Committee and the Finance Committee, as well as the AHA Services Inc.’s board of directors. A former Piggott banker, he was chairman and CEO of Farmer’s Bank and Trust and chaired the Industrial Development Commission of Arkansas under former Governor Bill Clinton. In addition, he was a board member of FreedHardeman College, the Mid-South School of Banking, the Federal Reserve Bank of St. Louis, Memphis Branch, the Arkansas State Chamber of Commerce and the Arkansas Bankers Association. At Piggott Community Hospital, Magee is an advocate for quality healthcare for all citizens, having begun his association with the hospital as a board member and then as CEO in 1997. He is a strong supporter of employee education and continuously supports his employees. It is his credo that if you set up situations properly and if you place the proper employees in those positions, those who work with you will “do it right the first time.” In his 16 years as CEO of the hospital, he has acquired funding and
James Magee (left) receives the A. Allen Weintraub Memorial Award from AHA Chairman Larry Morse
A former Piggott banker, he was chairman and CEO of Farmer’s Bank and Trust and chaired the Industrial Development Commission of Arkansas under former Governor Bill Clinton. expanded the facility by improving emergency care, outpatient services and admissions. He’s added rural health clinics, home health programs throughout the area, medical equipment facilities, telemedicine, specialty physician services, wound care management and an ambulance service.
During the devastating ice storm all across northern Arkansas in 2009, Clay County was particularly hard hit and without utilities far longer than any other county. During the first weeks of the storm, Magee lived at the hospital – literally, showing his employees just what type of leader he was. And for those efforts, his employees honored him twice for his heroic response for the hospital and the community. As evidence of his support for the citizens of Piggott, he gives a book of life lessons to local graduating seniors complete with a handwritten note of encouragement. He also is past-president of the Piggott Lions Club and the Piggott Chamber of Commerce. And for all these reasons, the Arkansas Hospital Association congratulates James Magee as the A. Allen Weintraub Memorial Award recipient for 2013.
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AHA ANNUAL MEETING AND AWARDS
Carolyn Key and Gloria Beyer Recognized for Distinguished Service Gloria Beyer of Berryville and Carolyn Key of Camden are the recipients of the 2013 Distinguished Service Awards presented October 10 at the Awards Dinner held during the AHA Annual Meeting in Little Rock. Ms. Beyer, a member of the Mercy Hospital Berryville auxiliary since 2009, has donated many hours of time and effort to the hospital. Having logged a total of 2,311 service hours through mid-July, she works in the hospital Gift Shop and information desk. In addition, she prepared tray favors for the patients, judged a hospital special event, donated a handcrafted quilt to the annual charity ball auction and participated in other hospital fund-raising efforts, as well as the Employee Health and Fitness Day activities. Ms. Beyer was chosen to receive the hospital’s 2013 Auxilian of the Year Award and the first Auxiliary “Above and Beyond” recipient in May 2013. In his nomination of Gloria Beyer, Cody Qualls, executive director of Mercy Health Foundation Berryville, said, “You
Gloria Beyer and Kristy Estrem, CEO
Carolyn Key and family
will not find another applicant with a heart or a love for her local hospital larger than that of Gloria’s.” Carolyn Key, RN is director of hospital-wide education at Ouachita County Medical Center in Camden, where she has been employed for 45
years. In her nomination of Mrs. Key, hospital CEO Peggy Abbott said, “Carolyn, a leader in the hospital and the community, continues to provide advice to the senior leadership at OCMC and is a compassionate, caring person who seems tireless. We value her leadership and commitment.” Beginning her career as a nurse at St. Vincent Infirmary in 1952, Mrs. Key joined OCMC in 1968 where she held several nursing positions before moving to hospital education. She currently is responsible for hospital-wide education, as well as community and patient education. She spearheaded many “firsts” at OCMC, including staffing a new hospital conference center, partnering with the UAMS Rural Hospital telemedicine program, employee and physician continuing education, and many others. She is known for her compassion, friendly smile, helpful attitude for all employees and patients, and her many contributions as a community volunteer.
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Governor Mike Beebe Receives 2013 Statesmanship Award For the second time in five years, the Arkansas Hospital Association has awarded Governor Mike Beebe with the Statesmanship Award. In presenting the award to the governor at the AHA Annual Meeting in October, AHA president and CEO Bo Ryall said, “For his support of hospi16
Winter 2014 I Arkansas Hospitals
tals over his entire career and his valiant efforts in the most recent Legislative Session to pass the Private Option and extend healthcare insurance coverage to more Arkansans, it gives me great pleasure to present to Governor Beebe, the Arkansas Hospital Association’s 2013 Statesmanship Award.”
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Governor Beebe
AHA ANNUAL MEETING AND AWARDS
ACHE and AHEF Present Annual Awards Barnett recently made a career change after serving in several administrative positions at UAMS since 2005. Connie Hill, FACHE
Michael Givens (right) of Jonesboro presents the C. E. Melville Young Administrator of the Year Award to Brian Barnett of Little Rock.
Brian Barnett, FACHE, executive administrator, Arkansas Specialty Orthopaedics in Little Rock, was named the 2013 recipient of the C. E. Melville Young Administrator of the Year Award during the Arkan-
sas Hospital Association’s annual meeting. Barnett recently made a career change after serving in several administrative positions at UAMS since 2005. He is president of the Arkansas Health Executives Forum, the local chapter of the American College of Healthcare Executives. Chris Barber, FACHE, CEO of St. Bernards Healthcare in Jonesboro and Arkansas’ ACHE Regent, announced two Regent’s Awards
Brad Parsons, FACHE
during the October 10 ACHE/AHEF Breakfast. Brad Parsons, FACHE, CEO/administrator, NEA Baptist Medical Center in Jonesboro, received the ACHE Early Healthcare Career Award, and Connie Hill, FACHE, administrator, St. Bernards Heart and Vascular; Director of Noninvasive and Nuclear Services, St. Bernards Medical Center, Jonesboro, received the ACHE Senior Healthcare Career Award.
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AHAA Administrators of the Year Sharon Huffmire, immediate past president of the Arkansas Hospital Auxiliary Association, presented two awards during the opening session of the Arkansas Hospital Association’s annual meeting. Given in two categories, the awards were presented to Margaret West, CEO of Magnolia Regional Medical Center, “Administrator of the Year Award for Hospitals Under 100 Beds,” and to Vincent Leist, president of North Arkansas Regional Medical Center in Harrison, “Administrator of the Year Award for Hospitals Over 100 Beds.”
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Vince Leist of Harrison receives the Administrator of the Year Award for Hospitals Over 100 Beds from AHAA president Sharon Huffmire.
Margaret West of Magnolia shares her award for Administrator of the Year for Hospitals Under 100 Beds with her hospital auxiliary members. Winter 2014 I Arkansas Hospitals
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AHA ANNUAL MEETING AND AWARDS
Thank you to our Corporate Partners and Exhibitors! Once again, our corporate Partners and Trade Show Exhibitors helped the AHA offer a top-notch educational program to members. These businesses and organizations bring the latest in technology and services to our healthcare audience. We also want to thank our attendees and their guests for visiting the Trade Show. (Sponsors are highlighted in red print.)
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AAMSCO Identification Products Administrative Consultant Service, LLC Advanced Health Information Network AHA Services, Inc. AHA Workers’ Compensation Self-Insured Trust Airgas Medical Services, Inc. American Data Network American Red Cross ArCom Systems, Inc. ArjoHuntleigh Arkansas Association of Hospital Trustees Arkansas Blood Institute Arkansas Blue Cross Blue Shield Arkansas Foundation for Medical Care-AFMC Arkansas Health Care Access Foundation, Inc. Arkansas Health & Wellness Solutions Arkansas Health Connector/Arkansas Insurance Department Arkansas Health Executives Forum ARORA B.E. Smith BancorpSouth Insurance Services, Inc. BKD, LLP careLearning CDI Contractors, LLC Cedar Bridge Chem-Aqua Chenal Restoration DKI Clifford Power Systems Commerce Bank Community Health Centers of Arkansas Community Hospital Corporation CoreSource Correct Care CPSI Crews & Associates, Inc. Cromwell Architects Engineers, Inc. CSS Health Technologies Danner Medical Waste Datamax DocuVoice Dow Building Services EmCare Inc. Emergency Staffing Solutions Emmi Solutions Engelkes & Felts, CPA’s The Estopinal Group Architects Exit Marketing EZ Way, Inc. Fleming Companies 18
Winter 2014 I Arkansas Hospitals
Friday, Eldredge & Clark, LLP Graybar Electric Company Hagan Newkirk Financial Services Harding University HBE Corporation HEALTHeCAREERS Network Healthland Heartland Medical Sales & Services Herman Miller Healthcare Hill Rom HKS HP Enterprise Services Hubble Mitchell & Associates Hughes, Welch & Milligan, LTD Inman-EMJ Construction Innovatient Solutions Johnson Controls Johnsonite Flooring LHC Group LifeShare Blood Centers The Linen King Lonseal Martin-Wilburn Partners Masimo Medefis, Inc. Medical Protective Company Medical Waste Services LLC The Medicus Firm Merritt Hawkins An AMN Healthcare Company Midwest Health Care Inc. Mitchell, Williams, Selig, Gates & Woodyard Nabholz Construction Services Nihon Kohden America Patient Point Pinnacle Health Group, Pinnacle Locum Tenens Polk Stanley Wilcox Architects
Press Ganey Professional Credit Management, Inc. Professional Data Service-PDS Prognosis Health Information Systems Provista Publishing Concepts, Inc. Radiology Associates, P.A. Rehab Care RevPoint Health Robins & Morton Saint Louis University School of Public Health Service Professionals, Inc. The Sessions Group Shannon Specialty Floors Signet Health Corporation SOCS-Simplified Online Communication System Southeast Imaging STL Communications Inc. SunRx TEAMHealth TeleHealth Services Tri-Tec Medical TruBridge UAMS, Center for Rural Health UAMS/South Central Telehealth Resource Center USDA Rural Development VALIC Financial Advisors Valley Services, Inc. VHA Oklahoma/Arkansas Vision Service Plan Voice Products Western Waterproofing Company Windstream Communications Wittenberg, Delony & Davidson Architects
AHA ANNUAL MEETING AND AWARDS
Once again, the AHA Trade Show was a sell-out with record attendance by both vendors and annual meeting attendees.
Doug Weeks, Senior Vice President, Baptist Health, greets guests at a reception in his honor as the incoming Chairman of the Arkansas Hospital Association.
Keynote speaker Jack Uldrich tries to stump the audience asking questions about future healthcare technology in his session on “Why Future Trends in Healthcare will Demand Unlearning.”
The Arkansas Hospital Auxiliary Association joins with members of the Arkansas Hospital Association for the opening session of the Annual Meeting.
Arkansas Governor Mike Beebe (left) receives the AHA’s 2013 Statesmanship Award from AHA president and CEO Bo Ryall.
Larry Morse (left), Administrator of Johnson Regional Medical Center in Clarksville, receives his past-chair award from incoming chair Doug Weeks of Little Rock. Winter 2014 I Arkansas Hospitals
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N E W S S T A T
AHA Receives Continuing Education Approval The Arkansas Hospital Association has received approval to provide continuing education from two organizations. They are: • The Arkansas Nurses Association has approved AHA’s application to be an Approved Provider of continuing nursing education
for a period of three years, expiring September 30, 2016. • The American College of Healthcare Executives has approved AHA’s application for preapproval of ACHE Qualified Education credit (non-ACHE) for a period of three years, through
October 23, 2016. The preapproval is for all AHA face-toface seminars and webinars. Please contact Beth Ingram at bingram@arkhospitals.org or Lyndsey Dumas at ldumas@arkhospitals.org with continuing education questions.
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$1 Million Milestone for Mercy Hospital Berryville Auxiliary What does $1 million look like? Take a stroll around the Mercy Hospital Berryville campus and you’ll get a good idea. From security cameras to hospital beds, rehab bicycles to flag poles, and ICU heart monitoring systems to urology equipment, volunteers with Mercy AuxiliaryBerryville have made their mark on patient care – and they’ve reached a milestone. With a $50,000 donation for gift shop renovations in October, the Auxiliary raised its one millionth dollar to benefit patients and their families. The next time you’re greeted by one of the blue-vested volunteers at the hospital entrance, their smile may be even brighter. “We want to make our community feel loved and special,” said auxiliary president Joy Flake. “We give our time to help others and hope to make everyone’s experience in our hospital a little bit more comfortable.” It all began in 1982 with the donation of a stretcher, soon to be followed by dozens of big-ticket items that helped Mercy expand and provide exceptional service. Volunteers have also spanned the region, donating their efforts to
Kristy Estrem (left), president and CEO of Mercy Hospital Berryville, graciously accepts a check representing $1 million in contributions from Auxiliary president Joy Flake.
various community projects. In total, volunteers with the auxiliary have given more than 546,000 hours of service. Today, there are nearly 300 active members. Some volunteers work in the auxiliary’s gift store. Others run bake sales or sell nuts, sheets, throws, flat irons or jewelry. The biggest chunk of change, however, comes from the auxiliary’s thrift store on the square in Green Forest. It accounts
for approximately 80 percent of the auxiliary’s fundraising efforts. On Monday, November 4, Mercy staff and community members recognized the past and present volunteers in a ceremony outside Mercy Hospital Berryville. It’s impossible to calculate just how impactful the auxiliary has been for Mercy, but patients can agree everyone has a million reasons to say thanks.
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N E W S S T A T by Paul Cunningham, Executive Vice President, Arkansas Hospital Association
The Collateral Damage from Medicare Spending Cuts The term “unintended consequences” usually implies that there’s a big “UH-OH!” in the offing. It typically is used to indicate that actions which accomplished specific purposes in one area also had some unanticipated, questionable effects elsewhere. Not quite so surprising, the original actions far too often seem to be instigated by government leaders at some level. Read any article about people who have lost their existing insurance coverage because their health plans didn’t meet the standards for coverage set up under the Affordable Care Act (ACA) and you get the gist. Those particular unintended consequences stemmed from the highest level. “Collateral damage” can be used in similar situations, but there actually is a difference that hinges on expectations. With collateral damage, the ill effects might be incidental, but aren’t necessarily unanticipated. Instead, they’re rationalized as acceptable losses under the circumstances, like inadvertent casualties among civilians or friendly forces in the conduct of military operations. It is a designated sacrifice for the “greater good,” tolerable to everyone, perhaps, except those who are unknowingly auto-assigned to the “lesser” group. Both terms carry negative connotations, for good reason. Not that we never hear talk about unintended benefit or collateral advantage, but those conversations are few and far between. Not so with their counterparts, both of which can be aptly applied to concerns about the fallout radiating from a relentless series of assaults on hospital finances, with both 22
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With collateral damage, the ill effects might be incidental, but aren’t necessarily unanticipated. Instead, they’re rationalized as acceptable losses under the circumstances, like inadvertent casualties among civilians or friendly forces in the conduct of military operations. Congress and CMS leading the charge (i.e. the government leaders). Each time an Arkansas hospital announces a round of layoffs, local media start sounding like a bad parody of the recurring Saturday Night Live “What Up with That?” sketch, asking why. They don’t understand that the answer is far too complicated for a sound bite or brief quote. The fact is that hospitals across Arkansas are struggling to deal with the affects of some very damaging Medicare payment reductions already in place. The cuts, both deep and wide, are creating a cluster of operational challenges. Too many hospitals are walking a fine line between needs, on one hand, to cut costs – most visibly in the largest component of their budgets, their workers – and on the other, to spend considerably more on things like quality improvement and information technology to safeguard against revenues falling off at a faster pace in the future. At the same time, patient volumes are slipping, for an assortment of reasons. That worsens the financial woes, which are heightened when a hospital feels pressure to invest time and money outrageously just to hang onto payments already booked for care already provided that government review-
ers are trying to pry away. Then, after hospitals spend the resources and win their appeals, everybody ends up back at square one. Despite the handicaps, hospitals continue to retain a focus on serving their patients and communities, which isn’t as easy as it sounds. But, it seems far too easy for Congressional leaders and CMS officials, who publicly lament job losses resulting from the massive cuts, to callously shrug them off as unintended consequences. How could they possibly have predicted it? The biggest clue might be found in a memo from CMS’ Office of the Actuary. The April 2010 memo, written one month after the ACA was enacted, analyzed the devastating impact of the law’s provisions to take $155 billion from hospitals’ Medicare payments. The saving grace for hospitals was the hope offered by the ACA of getting 31 million newly insured people to help ease the pain. It was the primary reason why the major hospital groups supported the legislation. Generally, hospitals were prepared to cope with the ACA, but they didn’t foresee Congress and the administration joining hands in 2012 for an additional $100 billion blow. That’s the combined effect of the Middle Class Tax Relief
N E W S S T A T Act and the American Taxpayer Relief Act. The hole got considerably deeper, backfilling it became much more difficult, timing for new insured patients grew extremely sensitive and prospects for the viability and survival of some hospitals dimmed. The key is to get that to register in Washington where another 10-year cycle of possible Medicare reductions costing hospitals up to $133 billion are on the table as Congress entertains ideas on funding the government, raising the debt ceiling, fixing the lingering problems with Medicare physician fees and revamping allocations for a budget sequester that will extend into another year. So, at what point do the unintended consequences of those actions chosen over other viable budgeting options become collateral damage? Is it when hospital layoffs turn into hospital closures? When the closures spark the loss of physicians in small towns? When the loss of physicians and ancillary services begins to affect business development and retention? Or, when abandoned businesses induce a death rattle from entire communities? If and when hospitals begin to close in the name of spending cuts, the same leaders whose actions set things in motion will show regret for the unintended consequences. However, the systematic targeting of hospital payments comes across like a conscious decision to accept the collateral damage and let the losses mount, especially in small, rural states like Arkansas.
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HMA Regional Service Center Opens in Fort Smith Governor Mike Beebe recently joined Fort Smith Mayor Sandy Sanders, members of the Chamber of Commerce, as well as executive officials from Health Management Associates, and officials representing Sparks Health System and Summit Medical Center (Van Buren) for the grand opening of the Arkansas [HMA] Regional Service Center in Fort Smith. The Regional Service Center serves approximately 23 Health Management hospitals, 150 providers, rural health, ambulance, and home health centers with services in scheduling, pre-arrival, revenue integrity, case management, coding, billing, collections, cash services,
information technology and other shared services. More than 300 local residents are employed at the Center and growth is expected to continue. Health Management Associates, Inc. is the parent company of Sparks Health System and Summit Medical Center.
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N E W S S T A T by Beth Ingram, Senior Vice President, Arkansas Hospital Association
Community Care Networks – Saving Patients One at a Time We all agree that our current system of healthcare is not sustainable, that it is broken and must be fixed. Barry Bittman, MD says revamping the payment system alone is not the fix. “The target has to be the health and well-being of the patient,” he says. Bittman has the really cool title and job as chief innovation officer at Meadville Medical Center in Meadville, Pennsylvania. He has found a very simple solution to dramatically cut costs while improving patient satisfaction and overall health.
Health Coach Idea
By partnering with a local college through the hospital’s Community Care Network, he has begun changing the way pre-health careers students are trained at one school and is now working with others across the country, including two Arkansas hospitals in Fayetteville and Batesville. He began his program by partnering with Allegheny College students, teaching them to become “health coaches” in an elective course to work with the hospital’s most vulnerable patients. Bittman found that the student health coaches could visit the patients in their homes, encourage them to reach health goals in a specific care plan, and talk them through problems that could otherwise lead to an unwarranted hospital admission. These students see the “sickest of the sick,” those flagged by the hospital as “frequent flyers,” the costliest patients who because of their complexity of care need extra attention and compassion. Students and patients begin talking and trusting one another. Eventually, the visits lead to the patients
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Jody Smotherman, Pharm.D. (right), Director of Quality and Case Management at WRMC, assists Lyon College student Mattie Erby enter patient information.
offering more information than they would in a typical hospital or physician visit. That information concerning medications, falls, blood pressure management, diet and living conditions can be critical in piecing together a patient’s story. The beauty of the plan is even though the students are unpaid, they receive college credit and realworld experience, both very valuable commodities for them and for the university. Curbing preventable readmissions and overutilization are ways to cut costs, but more importantly improve patient outcomes – and Bittman’s plan seems to work. Some of the outcomes at Meadville include a tremendous rise in medication compliance, diabetes patients’ A1C levels are becoming therapeutic, inpatient hospital stays for patients in the program have been cut by half, there’s a 25% decline in ER visits, a savings in
hospital reimbursements, and patient satisfaction scores are much higher.
White River Medical Center and Lyon College, Batesville
Two Arkansas hospitals and universities have established a Community Care Network (CCN) patterned after Bittman’s program at Meadville Medical Center. In collaboration with Lyon College, White River Medical Center in Batesville has developed a CCN with Michelle Brewer, APRN directing the program. Dr. Chris Steel serves as the WRMC CCN medical director. After a semester of classroom work, the aspiring pre-med students will become volunteers at WRMC. Their primary focus will be to follow discharged patients to assure that they are following physician instructions. The benefits of improved health and reduced costs to the community and local employers are obvi-
N E W S S T A T ous. In addition, WRMC believes the program will greatly enhance their ability to recruit doctors to the area, which is a major problem for rural hospitals. “WRMC’s CCN strives to improve the care of our most vulnerable patients, provide pre-health students a controlled environment to learn basic history-taking and problem-solving skills, while caring for the patients in our care area, and to identify and enlist the help of federal, state, civic, and religious organizations to aid in the care of the most vulnerable patients,” says Brewer. Patients work with a hospital intraprofessional team to learn disease management and selfcare strategies. The team, which includes care coordinators, pharmacist, dietitian, nurses, doctors, therapist, discharge planners, etc., develops an individualized posthospitalization plan to ensure the best outcome for each patient. Each patient (or their support person) will verbalize understanding of his/ her health status, discuss symptoms or health problems to be reported to the primary care provider, demonstrate home medication regimen, and attend follow-up appointments. Lyon College and WRMC began their first health coaching class in the fall 2013 semester. Upon successful completion of this class, students will participate with vulnerable patients in the community. Reinforcement of education will occur
at home as needed by the health coaches who will utilize written discharge instructions and education material provided by WRMC and/or the WRMC Health Library. Health coaches will contribute to cost reduction by ensuring patient adherence to the post-hospitalization plan of care. The health coaches will communicate with the hospital Care Coordinator for problem solving and link patients to community resources as needed.
Washington Regional Medical Center and University of Arkansas, Fayetteville
In addition, Washington Regional Medical Center in Fayetteville has partnered with the University of Arkansas on a similar program. Dr. Mark Thomas, Director of Clinic Medical Affairs and Medical Director of Palliative Care at Washington Regional, is the new program’s physician champion. Dr. Bittman visited Fayetteville in September 2013 to help Washington Regional and the University of Arkansas develop a health coach program. After the visit Dr. Thomas was keenly aware that, in order for the program to work, he needed the partnership with the University and the commitment from Washington Regional’s leadership team to develop the community care network that would train, supervise and deploy the student coaches. Moreover, he also understood that the expertise of
the doctors, nurses and therapists in the community care network would provide the solid ground needed for the particular magic of the health coaches to occur. These feelings were confirmed on a recent visit by Dr. Thomas and his colleagues to Meadville, where they observed a weekly debriefing of student health coaches. “One senior bio-chemistry major had just spent the last two weeks helping her 84-year-old client prepare for a sixweek trip to Nevada to visit family,” Dr. Thomas recalls. “The problem was that the patient was on 16 different medications prescribed by three different physicians, taken as often as four times a day. The health coach helped him obtain and organize his refills. At the end of her presentation the student said that she would miss her client, but gave him her cell phone number, just in case he had any problems. This is a win-win-win,” said Dr. Thomas. “The health system potentially avoids a costly readmission due to missing medications. The patient successfully surmounts the hurdles of his complex medical treatment. And the health coach learns what real healthcare is all about: caring for people.” Dr. Bittman will discuss his Community Care Network and health coaching idea during the AHA’s Hospital Executive Leadership Conference in June. Information will be available at www. arkhospitals.org/events.
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Medicaid to Cover Inpatient Care for State Inmates As of January 1, 2014 the Arkansas Department of Corrections (ADC) and its sister agency, the Department of Community Corrections (DCC), will make some changes related to healthcare services provided for inmates in state custody. This change is two
pronged, with the major portion related to a new contractor. Currently, ADC and DCC contract with Corizon, Inc. to provide comprehensive healthcare services for inmates, including both inpatient and outpatient care. Corizon then contracts with individual healthcare pro-
viders. That will change on January 1 when Correct Care Solutions (CCS) becomes the new state contractor, which will entail new provider contracts, but there is more to it. In an effort to save state dollars, the new contract with CCS will continued on page 26 Winter 2014 I Arkansas Hospitals
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N E W S S T A T Currently, ADC and DCC contract with Corizon, Inc. to provide comprehensive healthcare services for inmates, including both inpatient and outpatient care. apply only to outpatient services. Inpatient care for the state inmates will be covered under the state’s traditional Medicaid program, a relatively small portion of the care provided to the population covered by the department. According to ADC, 404 inmates were admitted as hospital inpatients in 2012; Medicaid covered 48 of those admissions. This change, which does not apply to prisoners in the custody of counties or cities, was first mentioned in the November 11, 2013 issue of The Notebook, but additional information was provided
during a November 21 conference call. In brief, at the time an inmate is in a hospital for more than 24 hours, therefore becoming an inpatient, Medicaid will kick in as the payer and will cover the inpatient care from admission through discharge at the existing rates (those covering the per diems and payments for ancillary services) and under existing policies that apply for all other Medicaid patients. The move expands on similar Medicaid policies in effect for pregnant women and a few others. It is possible because the Affordable Care Act makes an individual’s income the absolute eligibility benchmark for Medicaid coverage. Since inmates have no income, they qualify. Under existing criteria, a person must not only be poor, but also must be disabled or at least 65 in order to qualify for Medicaid, which limited the options for the state. In contrast, Medicare policies
generally prohibit paying for medical items and services furnished to a beneficiary who is incarcerated or in custody at the time any items and services are furnished. Procedurally, a person in custody who meets the admission criteria for inpatient care typically will not have a Medicaid billing number at the time, so his/her eligibility status will be transmitted to CCS as “Medicaid pending.” CCS will file an application with Medicaid, where full eligibility will be established and a number assigned. At that point, Medicaid will notify ADC or DCC with written verification of eligibility and a billing number. The department(s) will then notify the hospital so that a bill may be submitted. According to ADC officials, a contact person will be identified prior to January 1 to handle questions about this change. Once that individual is known, hospitals will be notified.
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Winter 2014 I Arkansas Hospitals
N E W S S T A T by Nancy Robertson Cook, Director of Communications and Quality Services, Arkansas Hospital Association
Arkansas Hospitals, AHA a Part of Donate Life’s Rose Parade Float Parade float honoring baby Eli and so many others who donated life, are the recipients of lifegiving organs, or are living donors themselves. Eli’s floragraph came to Arkansas unfinished in early December. It made its way to St. Bernards in Jonesboro, where his delivering physician now practices, to Little Rock and UAMS, where he was born and to Arkansas Children’s Hospital where loving nurses and physicians cared for him, to Searcy, where grandparents live and to Mercy Hospital Fort Smith, which raised money so that the family and others could travel to PasaAHA President and CEO Bo Ryall included a message dena, California for the reading, “The AHA is proud to help Light Up the World.” parade and its festivities. At each stop along the way, There will be 81 floragraphs on nurses, physicians, family memthe Donate Life America float in the bers and friends finished parts of Rose Parade January 1. One of them Eli’s floragraph. will be of little Elijah Cole McGinThe Arkansas Hospital Associaley, from East End, Arkansas. tion (AHA) has the honor of being Eli was born a twin, with condia part of the Donate Life “Light tions physicians explained were not Up the World” float carrying Eli’s compatible with life. He and his floragraph. The first hospital assotwin brother, Walker, were born ciation to be so honored, the AHA four years ago. Eli, short on oxyhas a single dedicatory rose placed gen, when put into the bassinette in the float’s Dedication Garden. It with his brother, pinked up and will join roses from many of Arkanwas calm. When he passed after 31 sas’ donor hospitals, along with hours of life, his parents simultaneroses from hundreds of other hospiously thought of offering his organs so another infant could live. His tals, individuals and organizations across the nation. heart valves saved another’s life. Each dedicated rose is housed in This year, Walker and his para single vial that carries a unique, ents will help decorate the Donate personal message of love, hope and Life “Light Up the World” Rose
remembrance honoring donors, recipients and others touched by organ, eye and tissue donation. Altogether, thousands of roses create a Dedication Garden that is a featured design element on the Donate Life float each year. The AHA was selected for this honor by ARORA, the Arkansas Regional Organ Recovery Agency, for its support of organ, eye and tissue donation and its work with hospitals in publicizing the hospital staffs’ organ donation registration programs. AHA CEO Bo Ryall recently participated in a national conference call hosted by the American Hospital Association, the American College of Healthcare Executives and the Organ Donation and Transplantation Alliance, designed to help state organ procurement organizations (OPOs) find ways to better align with their local hospitals and hospital associations. Ryall dedicated the following message to be carried on the float, “The AHA is proud to help Light Up the World.” For Eli. For his family. And for the many who have registered as donors, will register, or will receive tissue or an organ in their lifetimes. Donate Life, and Light Up the World!
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N E W S S T A T
A Better Future for Our Patients and Our Communities….That’s Why We’re Here
Gary Kaplan, MD
Gary Kaplan, MD, FACP, is chairman and CEO of Seattle-based Virginia Mason Health System, where he has led the implementation of the Virginia Mason Production System, based on the Toyota Production System, to reduce costs and improve quality, safety and efficiency. Under Dr. Kaplan’s leadership, Virginia Mason was named a Distinguished Hospital for Clinical Excellence by Healthgrades for three consecutive years, a Top Hospital by The Leapfrog Group for seven consecutive years, and was one of two hospitals named a Leapfrog Top Hospital of the Decade for patient safety and quality. The list of achievements for both Dr. Kaplan and Virginia Mason Health System goes on and on – and for good reason. Dr. Kaplan also is a Senior Fellow with the Estes Park Institute, whose mission is to educate teams of physicians, board members and healthcare managers so that they can better serve their patients and their local communities, and can exercise leadership in the field. 28
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For the October 2013 conference program, Estes Park fellow and conference moderator Steve Rivkin videotaped an interview with Dr. Kaplan. Here are highlights from that interview…. Q: How does a hospital become exceptional in quality and safety? Is there a short answer for that? KAPLAN: Well, it’s not an easy process, certainly, but I think if I were to sum it up in a few words I would say you need the will, you need the ideas, and you need to be able to execute. As we have looked at this and tried to reflect on our journey over the past decade, it requires a willingness to be transparent, to create a sense of urgency as a leader. That’s not something that is always in the comfort zone of leadership teams. But you need to create that sense of urgency and to ensure there is the level of alignment within particularly the top team and the board. Those factors are critical and with those factors then come the opportunity to fully engage a workforce and empower them to actually become, if you will, nuts about quality and safety. And that is the primary purpose of why they are there. Q: Let’s talk about that journey that you mentioned. In Virginia Mason’s past there was a moment of crisis in care. A mother of four was injected with an antiseptic instead of a contrast dye to help guide a stent, and she died. What did you learn from such a troubling incident? What do you take away? KAPLAN: Let me say, Steve, that this was probably the darkest moment in our organizational history, now 93 years. It was certainly for me, and I’ve been at Virginia
Mason 35 years now. It was the saddest time in my career. [Mary McClinton] was a community leader, and a mother, a grandmother, and we failed her. She came to us for a procedure that was actually a tertiary procedure, but one we do almost every week at Virginia Mason. And she died of a preventable error. For us that was totally humbling. We were already two to three years into our journey to create very high quality, and actually achieve our vision of becoming a quality leader, not just in Seattle but anywhere. So we said as good as we think we are we are nowhere near as good as we need to be. And what evolved from that was a singular purpose. For the next three years we declared an overarching organizational goal to prevent avoidable harm and injury to our patients. And so it was a rallying cry. It was a source of tremendous sadness and passion. Since that time we’ve fully engaged with the McClinton family and we actually come together once a year to award and recognize a team at Virginia Mason that is, amongst many, doing great work in safety. So it was one of those pivotal times in our history where we thought we were on the right trajectory – I think we were – but we sure needed to speed it up. We sure needed to get serious about this. And our quest has been to become the safest hospital in the world. Q: Gary, I know your organization defines key components of quality. Is there at Virginia Mason a cheerleader or a champion who encourages those values and keeps the focus on those components?
N E W S S T A T And by accepting and embracing change, realizing it’s hard work, and being willing to challenge our old assumptions; that’s what’s going to be necessary to really create a better future for our patients and our communities. KAPLAN: Well, frankly I think that’s my job as CEO, but I’m only one person and what I’m very grateful for is the opportunity to work with fabulous teams across the organization, but particularly our senior leadership team. Many of us have been together for many years. Many of us went on our very first journey of discovery in Japan in 2002 together. We’ve learned together. And so we are a team of cheerleaders. I work hard to avoid group think. I work hard to ensure I’m getting diversity of opinions on just about everything, and amongst our team there is a lot of diversity of opinion. But when push comes to shove and when it’s about our quality and safety purpose and vision I think we all have to be cheerleaders for that effort. We have to lead by example and there are numerous ways we do that. Q: You’ve written about developing culture, a strong quality culture. What is at the core of that? KAPLAN: I think it ties to my prior answer in that it really is about changing the minds of leadership. I mean Ed Schein, who actually has become a good friend and is really the grandfather of the organizational culture and movement, as well as a great theorist, says it’s really leaders who set the culture through our own behaviors. So I think that’s critically important to building our culture, changing the
minds of leaders who then work to share their values and perspectives across the organization. But it goes far beyond leaders and requires a shared vision. It requires alignment from the boardroom to the front lines, and in recent years we’ve learned that it’s actually about changing our mindset about what it really means to have a culture totally centered around patients – driven by patients. A lot of people pay lip service to it, and I would have included myself in that category. But over the past decade we’ve learned that we can talk about it, but it’s something else if we truly engage our patients. And that takes a workforce that is living and working in an environment of respect. I could tell a long story, which I won’t because we don’t have time, but at Virginia Mason over the last two years we’ve had mandatory respect for people training for all 6,000 of our people, including all of our physicians, and it’s been a real eye opener. We thought we were respectful and had a respectful environment, but we have seen a gap and we are working hard to close that. That’s all part of this culture we’re trying to build. Q: I’m curious how you both initiate and sustain that sort of effort in changing mindsets. Talk about clinicians and other caregivers for a moment. You said that a different mindset is required, your definition of quality, a new approach to delivering care, how do you sustain that sort of effort within. KAPLAN: Well, it’s a singular constancy of purpose, and that again takes leadership – not just senior leadership but leadership at the front lines where we all understand, buy in to the values in our vision. It has to be a truly shared vision and not one that came from a small group of people that is stuck in a drawer somewhere. We’ve worked hard to align expectations and you’ve heard me talk about
our compact work. We’ve spent tremendous amounts of time working on ensuring there are the gives and the gets and we understand what our responsibilities are both as an organization to our people and as individuals to the organization. But at the end of the day it takes those of us who carry the mantle of leadership to stay focused and to hold ourselves and our teams accountable. That’s what’s allowed us to keep improving and maintaining our vision. Q: Two more questions. There are some studies that show that five percent of patients consume 50 percent of all healthcare resources. And these are patients with chronic conditions, behavioral issues, those near the end of life. How has this impacted delivery of quality and safety? KAPLAN: I think that cohort of patients does consume, if you will, a disproportionate level of care. That said, they also represent a disproportionate opportunity for us to make a difference in their lives, whether it’s their chronic disease and allowing them to remain functional. As you know our definition of quality looks at outcomes, not just technical, clinical outcomes, but also functional outcomes – how people return to recreational pursuits, return to work, those kinds of things. And when we add appropriateness to our quality equation at Virginia Mason we’re talking about all types of appropriateness – whether or not care was indicated. But also, I would ask, did we engage in shared decision-making, did we engage our patients and help them to understand that they truly have choices? And today we’ve built it into our standard processes for all of our primary care practices to engage in conversations about end of life care and end of life choices. To us that’s all part of appropriate care and because of that it’s all part of our definition of quality. continued on page 30 Winter 2014 I Arkansas Hospitals
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Ramsey, Krug, Farrell & Lensing is a sponsored service provider of the AHA Services and administrator for the AHA Worker’s Compensation Self Insurance Trust.
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Q: And finally, what other thoughts would you send home with our attendees? KAPLAN: If I had one message it would be accept change as a way of life. It is critically important that we, the leadership of healthcare today, the board, the medical staff leaders and others in leadership roles, stay focused on our opportunities. We have unprecedented opportunities to create a better healthcare system. And by accepting and embracing change, realizing it’s hard work, and being willing to challenge our old assumptions; that’s what’s going to be necessary to really create a better future for our patients and our communities. And that’s why we’re here. Virginia Mason Medical Center, founded in 1920, is a nonprofit regional healthcare system in Seattle that serves the Pacific Northwest. Virginia Mason employs 6,000 people and includes a 336-bed acute-care hospital; a primary and specialty care group practice of more than 460 physicians; satellite locations throughout the Puget Sound area; and Bailey-Boushay House, the first skilled-nursing and outpatient chronic care management program in the U.S. designed and built specifically to meet the needs of people with HIV/AIDS. Benaroya Research Institute at Virginia Mason is internationally recognized for its breakthrough autoimmune disease research. Virginia Mason was the first health system to apply lean manufacturing principles to healthcare delivery to eliminate waste and improve quality and patient safety. https:// www.virginiamason.org/
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SPOTLIGHT:
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The Cycles Continue
Medical professional liability for hospitals and other healthcare providers has been subject to numerous underwriting cycles over the past 40 years. These cycles are typically characterized by multiple years of premium reductions accompanied by an expansion of underwriting carriers and more liberal policy terms. Loss ratios eventually rise to an unprofitable level typically resulting in sharp and abrupt premium increases and a significant decrease in the number of insurance carriers. Healthcare providers in Arkansas and nationwide currently find themselves in the midst of the soft market segment of the current underwriting cycle. At least ten carriers currently offer hospital medical professional coverage in Arkansas and premiums have steadily declined since 2007. This is in sharp contrast to the 20012003 hard market period when only three carriers remained in Arkansas following the exodus of at least four major carriers due to a number of factors including carrier insolvency. It is difficult to determine when the next hard market period will emerge. However, there are several factors hospitals should consider in the management of its carrier and broker selection to achieve the best protection and lowest cost over the long term:
1. Does the proposed carrier have a long history of providing professional liability coverage to Arkansas hospitals during both
the hard and soft periods of the market cycle? History has shown that certain carriers will be absent in the hard and more difficult periods only to reappear once improvement in the market has occurred. 2. Is the broker or agent highly experienced in Arkansas medical professional liability with a long history of assisting hospitals with their coverage needs through all phases of the market cycle? Almost any agent with a license can obtain a professional liability quote during a soft market period only to be left without access to viable carriers when the market firms or the individual hospital hits a rough patch in their claim activity. 3. Are claims handled by highly experienced medical liability adjustors based in Arkansas that understand the dynamics of the Arkansas legal environment? Many carriers handle their claims with out of state adjusters with little experience or knowledge of Arkansas. The improper handling of claims can result in excessive loss and expense that can ultimately drive up premiums not to mention the potential reputational damage to the healthcare institution. 4. Does your carrier have a significant market presence in Arkansas
Its 12 dedicated staff members are highly trained and experienced in areas of healthcare liability and property underwriting, local claims and risk management. and a greater spread of risk or is this a one-off account in the state? Carriers with limited market presence in the state can have a greater tendency to apply negative underwriting actions resulting from poor loss experience to an individual hospital than a carrier that views their risk exposure as spread among numerous accounts in a program state. The Healthcare Division of BancorpSouth Insurance Services and its predecessor agency, Ramsey, Krug Farrell and Lensing has a 25-year history of serving Arkansas hospitals, doctors and other healthcare professional. Its 12 dedicated staff members are highly trained and experienced in areas of healthcare liability and property underwriting, local claims and risk management. Please call the BancorpSouth Healthcare Division Service Team at 501-664-7705 for more information.
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N E W S S T A T
Arkansas Hospital Association Guiding Principles/Goals 2013-2014 ADVOCACY
• Work with the Arkansas Department of Insurance and the Department of Human Services and other stakeholders to implement the Arkansas Private Option and Health Insurance Exchanges. • Protect Arkansas hospitals’ interests and financial viability as government and private payer organizations move from volume-based payments toward more value-based purchasing strategies to combine hospital and physician care and change from quality-related process to outcome measures. • Provide direct input for the Department of Human Services in its effort to increase the number of hospital inpatient and outpatient services affected by the move to bundled prices and episodic care. • Ensure that future expansions of Medicaid-specific quality measures for use in the state’s Quality Incentive Payment Program are reasonable and subject to input and agreement by the state’s hospitals. • Advocate for federal regulatory support aimed at the full clinical alignment of integrated healthcare delivery, with incentives for better access, appropriate utilization and fair allocation of resources. • Work with state Medicaid officials to ensure that provisions of Act 562 of 2009 continue to provide maximum possible benefit to hospitals from the Arkansas Medicaid hospital assessment program. • Advocate for state and national legislative, regulatory and judicial actions in support of reasonable tort reform. • Maintain and improve on AHA’s positive relationships and communications with the members of Arkansas’ congressional delegation and their key health aides to 32
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build support for legislative and regulatory issues that are developed and pursued during the 113th Congress as part of hospitals’ national advocacy agenda. Actively oppose any attempts by Congress and the Centers for Medicare & Medicaid Services to effect changes in federal rules and regulations that would adversely affect the Medicaid UPL programs that enhance hospital reimbursements. Improve relationships with the state’s business and business development communities, continuing to better their understanding that hospitals are large employers that pay excellent wages and strongly influence economic development. Increase contributions to the AHAPAC over the 2012-13 totals. Meet with state lawmakers throughout the year to enhance relationships and increase their knowledge of issues of critical importance to hospitals.
COMMUNICATION
• Maintain and improve current relationships with officials of the Arkansas Departments of Health, Human Services and Insurance, and other government agencies affecting hospitals, such as the Arkansas Medical Board, to ensure that hospitals’ concerns are heard and addressed in relation to state rules and regulations proposed and implemented under their authority to implement Arkansas’ private plan coverage expansion are fair to hospitals. • Provide thoughtful, meaningful input to all applicable state agencies in regard to effective regulatory reform of outdated and arcane or costly state regulations impacting Arkansas hospitals. • Facilitate improved and ongoing
communications with Novitas, Inc., the state’s Medicare Administrative Contractor, to ensure that issues related to processing and payment of Medicare claims are identified and addressed in a timely manner. • Work with private third party payer organizations to ensure fair and equitable reimbursements for hospital care. • Continue to improve ongoing communications with officials of CMS’ Dallas Regional Office and develop a positive relationship with the state’s Medicare Recovery Auditors, Medicaid Integrity Program Contractors and the Medicare Administrative Contractor. • Communicate regularly with member hospitals through hotlines, weekly newsletters and quarterly publications to keep them informed on state and national issues which have potential impact on their future operations.
EDUCATION
• Provide leadership and clinical integration programs to help identify and develop physician executives in the state. • Provide educational programming and opportunities designed to assist members with marketplace challenges and compliance with constantly changing regulatory requirements in the healthcare arena. • Educate member hospitals to better equip them to respond to natural and/or man-made emergency situations related to weather, disease outbreaks, chemical/nuclear/biological terrorist attacks and other forms of emergency situations.
DATA COLLECTION AND SHARING
• Gather, distribute and publicize hospital statistical data for use in
discussions with and presentations to legislators, congressional offices, and community organizations. • Report and publicize statistical data in the summer issue of Arkansas Hospitals, providing information for member hospitals to use throughout the year. • Conduct various surveys based on membership requests and needs.
A Spotless Reputation
QUALITY
• Provide a collaborative hospital quality forum for the sharing of best practices and expanding knowledge as shown through quantitative and qualitative results. • Assist hospitals in managing a portfolio of quality projects to improve patient safety within their organizations by providing tools and resources to effectively and efficiently manage the growing number of voluntary and involuntary initiatives. • Demonstrate good stewardship and contract compliance by meeting all contract funded activities for the AHA Quality and Patient Safety Program.
AHA SERVICES, INC.
• Increase participation and utilization of AHA Services Inc. endorsed companies through education of hospital members. • Continue to share revenue from AHA Services Inc. with AHA to offset expenses and keep membership dues at the current low rate. • Continue to negotiate with vendors for beneficial discounts and value-added services for members.
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N E W S S T A T
Final Mental Health/Substance Abuse Disorder Parity Rule On November 8, the Departments of Health and Human Services, Labor and the Treasury jointly issued a final rule increasing parity between mental health/ substance use disorder benefits and medical/surgical benefits in group and individual health plans. The
final rule implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, and ensures that health plan features such as co-pays, deductibles and visit limits are generally not more restrictive for mental health/substance abuse disorders
than they are for medical/surgical benefits. The law does not require, however, that employers provide mental health coverage. Effective 60 days after publication in the November 13 Federal Register, the rule will apply for plan years beginning on or after July 1, 2014.
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Hospital CMO Workshops Planned The Arkansas Hospital Association has planned two 2014 workshops for hospital physician leaders. On Wednesday, February 12, Dr. Joe Nichols of Health Data Consulting (and a CMS ICD-10 contractor), will provide an indepth overview of ICD-10, why physicians must champion this unprecedented event in their hospitals and what impact the coding changes will have on the hospital, as well as on their practice.
In addition, Julie Ginn Moretz, associate vice chancellor for patient- and family-centered care, UAMS in Little Rock, and Pam Brown, AHA’s vice president for quality/patient safety, will talk about the quality aspects of patient engagement. Moretz will tell why she became a leader in engaging families and patients in their care, and Brown will discuss how to make new ideas work in your hospital.
And, on Tuesday, May 13, the AHA will host a physician leadership workshop (requested by attendees at the first CMO workshop last September). Respected ACHE workshop facilitator and author Tom Atchison will lead the workshop for the entire four-hour period. Tom is a frequent speaker for the AHA and always receives excellent evaluations from participants. More information with details on how to register will be available at www.arkhospitals.org/events.
SAVE THE DATE
“Hospital Executive Leadership Conference” June 11-13 Chateau on the Lake Resort Branson, Missouri Maureen Swan – Strategic planner and healthcare analyst Barry Bittman, MD – Changing the way we care for patients Jim Kopf – No, you’re not paranoid, they ARE after you! Dan Mulholland – Finding ways to survive audits Program and registration information will soon be available at http://www.arkhospitals.org/events/arkansas-hospital-trusteeexecutive-summer-leadership-conference
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Q U A L I T Y / P A T I E N T
S A F E T Y
Hospitals Honored for Reducing Early Elective Deliveries who will deliver a 3 x 6 foot vinyl banner for indoor or outdoor use. The banner celebrates your hospital’s commitment to improving the quality of care for moms and babies. Eleven Arkansas hospitals have qualified, so far, for this honor. The AHA and March of Dimes are proud of them for meeting the criteria and we hope you will consider submitting your application for recognition, as well. No matter where you are in this journey, it is an important one.
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Saline Memorial Hospital was the first to earn the AHA/March of Dimes Healthy Babies banner.
Working to reduce early elective deliveries has been the mantra of Arkansas birthing hospitals. Now, the Arkansas Hospital Association (AHA) and the Arkansas March of Dimes Chapter are partnering to recognize hospitals in their work to reduce early elective deliveries, those deliveries that are scheduled for convenience prior to the baby reaching 39 weeks gestational age.
Hospitals may apply for this recognition by completing the March of Dimes 39+ Weeks Banner Checklist, available by emailing Cindy Harris at the AHA, charris@arkhospitals.org. Please ask for the March of Dimes Hospital Checklist. Hospitals that pass the March of Dimes’ review of submitted materials will be visited by a team from the March of Dimes and the AHA,
Honored Hospitals
Washington Regional Medical Center Saline Memorial Hospital Conway Regional Medical Center Mercy Hospital Hot Springs Mercy Hospital Fort Smith Mercy Hospital Northwest Arkansas Saint Mary’s Regional Medical Center Medical Center of South Arkansas Ouachita County Medical Center White County Medical Center UAMS
Raising the Number of Arkansas’ Patient Safety Certified The Arkansas Hospital Association (AHA), through its Hospital Engagement Network (HEN) collaborative, has partnered with the National Patient Safety Foundation (NPSF) to provide AHA member hospitals an exciting opportunity to expand their Patient Safety expertise. In mid-November, 110 AHA member hospital quality professionals received welcome letters and packets that marked the beginning 36
Winter 2014 I Arkansas Hospitals
of their journey toward Patient Safety Certification. Currently, there are only two people in the state holding this certification. Participation in the NPSF/AHA program includes access to a new, 10-module course of study in Patient Safety, access to the practice test to pursue certification, and a oneyear membership in the American Society of Professionals in Patient Safety. NPSF is reducing the cost of the program for the American Hos-
pital Association’s Hospital Engagement Networks and has made it possible for the Arkansas Hospital Association to provide this to our member hospitals. In addition, those who take and pass the certification test by March 30, 2014 will have the opportunity for the cost of the certification exam reimbursed. Forty-five hospitals are participating in this cohort. AHA is hoping to repeat this certification opportunity in 2014.
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Q U A L I T Y / P A T I E N T
S A F E T Y
Patient- and Family-Centered Care: The Whys and How-Tos ARbestHealth, the Quality and Patient Safety arm of the Arkansas Hospital Association, presented its latest round of Regional Quality Forums in mid-November. The two featured topics were Patient- and Family-Centered Care and How to Manage Multiple Quality Improvement Initiatives. Julie Ginn Moretz, associate vice chancellor for patient- and family-centered care at the University of Arkansas for Medical Sciences (UAMS), moved to Arkansas in May. Nationally known for her work in Family Services Development and bringing the family into the hospital care team, Moretz illustrated the need for hospitals to think in new ways about patient and family involvement. She told the story of her son, Daniel, who was born with heart problems and needed multiple surgeries throughout his young life. She explained how she fought for the right to get out of the waiting room and next to her son’s bedside to become a part of his care team during his hospitalizations, even his stays in the ICU. Daniel’s story became the basis of the WHY: Why should hospitals invite patients and their families to be part of the care team, and advisors to hospital leaders on all issues affecting patients? The HOW-TO adopt patient- and family-centered care and extend patient and family engagement in policy, protocol and even hospital design through patient advisory councils, bedside reporting, open visiting in the ICU and many other examples were presented by panels of hospital representatives in each of the Forum’s three locations: Jonesboro, Little Rock and Fort Smith. Examining best practices in handling multiple quality initiatives
The latest round of Regional Quality Forums, held in Jonesboro, Little Rock and Fort Smith November 12-14, was designed to bring the latest in quality and patient safety efforts to sites across the state convenient for Arkansas hospital teams. Each forum included national and/or regional speakers, hospital panels discussing best practices, and a State of the State in Quality overview.
Hospital teams repeatedly provide feedback on the value of having the opportunity to share and learn as well as the ability to attend a meeting regionally near them. was also presented by local hospital experts, as panels explained their tools and tips. As a part of each Regional Quality Forum, the State of the State in Quality is presented by spokespersons from the AHA, Arkansas Foundation for Medical Care (AFMC), the Arkansas Depart-
ment of Health (ADH) and others. Pamela Brown, AHA’s vice president for quality and patient safety and AFMC’s Steve Chasteen, quality manager, were the presenters for these sessions. A favorite of participating hospitals is the “Not Your Normal Roundtable Discussion” series, where hot topics are discussed, challenges and best practices shared, and ideas exchanged. As always, the November discussions were lively and helpful. Hospital teams repeatedly provide feedback on the value of having the opportunity to share and learn as well as the ability to attend a meeting regionally near them. ARbestHealth’s Regional Quality Forums are open to all Arkansas hospitals, and are held three times per year. Please look for registration opportunities at www. arkhospitals.org/events.
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M E D I C A R E / M E D I C A I D by Steve Chasteen, Director of Quality Programs and Steve Shuler, writer, Arkansas Foundation for Medical Care
Arkansas Hospitals Earn More than $2 Million for IQI Successes Arkansas hospitals are halfway through this fiscal year’s Arkansas Medicaid Inpatient Quality Incentive (IQI) program, aimed at increasing the quality of care for Arkansas Medicaid beneficiaries. This is the eighth year for the IQI program, which has received national attention for its innovative involvement with the healthcare community. The IQI program is indicative of a growing movement in rewarding hospitals for committing to quality care and providing evidence-based care to their patients. In FY 2013, 16 Arkansas hospitals received more than $2 million in performance bonus payments as a result of their success in the IQI program. The award winners all improved their quality of care in 80 percent of measures related to care coordination, obstetrics and venous thromboembolism. Arkansas Medicaid, AFMC and the IQI advisory board selected the measures. Arkansas Medicaid, along with the Arkansas Hospital Association (AHA) and the Arkansas Foundation for Medical Care (AFMC), began IQI in FY 2007 to offer performance bonus payments to hospitals that show year-over-year improvement in certain measures. Since that time, Arkansas Medicaid has awarded $28.4 million to hospitals that have participated in the program and successfully improved their quality of care. Currently, hospitals are participating in the performance period of IQI’s program for FY 2014. The performance period covers cases in the third and fourth quarters of 2013. To qualify for performance bonus payments, hospitals must 38
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The IQI program offers an exciting chance for Arkansas hospitals to get paid to improve their quality of care not just for Arkansas Medicaid beneficiaries, but for all patients in Arkansas. show improvement in their quality of care in three areas: care coordination, obstetrics, and tobacco use screening and treatment. There are a total of nine performance measures in these three areas. Care coordination • CCD1: Reconciled medication list received by discharged patients • CCD2: Transition record with specified elements received by discharged patients • CCD3: Timely transmission of transition record Obstetrics • OBS4: Early elective delivery • OBS5: Exclusive breast milk feeding • OBS6: Cesarean section: nulliparous women Tobacco use screening and treatment • TOB1: Tobacco use screening • TOB2: Tobacco use treatment provided or offered • TOB3: Tobacco use treatment provided or offered at discharge One obstetrics measure (OBS6) and all three tobacco use screening and treatment measures are new performance measures for FY
2014. These four measures were submission measures in FY 2013. The two venous thromboembolism measures do not appear in FY 2014’s IQI program. In order to qualify for the performance bonus payments, hospitals must submit data on every measure and have a minimum of five Arkansas Medicaid cases for each eligible measure. Only data from Arkansas Medicaid cases will be used to determine performance rates. There are two thresholds for measuring improvement of care. In order to qualify for performance bonus payments, hospitals must meet one of the two thresholds. For the first threshold, hospitals must show sufficient improvement in 80 percent of all eligible measures; that is, hospitals must perform in quarters three and four of 2013 at or above the 75th percentile from quarters three and four in 2012. For the second threshold, hospitals must show a 35-percent reduction in failure rate based on data submitted in quarters three and four of 2012. There are two exceptions to these thresholds. For OBS4 (early elective delivery), hospitals must be at 7.5 percent or below for quarters three and four of 2013. For OBS6 (cesarean section: nullipa-
rous women), hospitals must show a 25-percent reduction in failure rate based on data submitted in quarters three and four of 2012. Hospitals are also required to submit an additional submission measure: newborn deliveries at 32 weeks gestation or earlier. This submission measure will not be used to determine a hospital’s overall score. The submission measure is required to show a baseline for FY 2014 should the IQI program choose to elevate it to a performance measure for FY 2015. Hospitals must also pass validation of their reporting in order to receive their performance bonus payments. Two charts each quarter will be selected at random from each measure set: care coordination, obstetrics (mother), obstetrics (newborn) and tobacco use screening and prevention. Those charts will be used to judge a hospitals performance in improving their quality of care. To pass validation, a hospital must show sufficient improvement in 80 percent of measures in both quarters. The IQI program offers an exciting chance for Arkansas hospitals to get paid to improve their quality of care not just for Arkansas Medicaid beneficiaries, but for all patients in Arkansas. This quality care improvement can help hospitals increase their bottom line and improve their reputation in their communities. For more information about the IQI program, contact Steve Chasteen, AFMC’s director of quality programs, at schasteen@afmc.org or 501212-8737.
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M E D I C A R E / M E D I C A I D
SFY 2014 Medicaid Assessment Amounts Finalized Arkansas Medicaid finalized in mid-November its calculation of the upper payment limit (UPL) amount available for the SFY 2014 edition of the state’s Medicaid Assessment Program, as well as the expected per hospital assessment fees and supplemental UPL payments that will apply for the year. The legally required Medicaid notices to hospitals containing their individual information have been distributed and all hospitals should have received their numbers. Based on AHA staff’s original conversation with the Medicaid staff, here’s the picture before any changes: • Total UPL dollars available for the Medicaid assessment (inpatient and outpatient) fell from approximately $217 million in SFY 2013 to about $192 million in SFY 2014 • Total assessment fees are reduced as well, from $67.6 million to $59.5 million • The net UPL payout, after the assessment, will be around $132 million for this year, or about 11% less than the net for SFY 2013 • The primary reasons for the decline are due to: 1. More recent Medicare Cost Reports (MCR) that were
used for calculating the overall UPL gap. The newer MCRs, now available for some hospitals, reflect the increase in the max Medicaid payment from $675/day to $850/day which occurred in SFY 2007. The 26% increase in the Medicaid per diem cap reduced the UPL gap between the Medicaid payment per discharge and the Medicare payment per discharge. 2. Newer audited MCRs were used, reflecting lower Medicaid inpatient utilization. That mirrors the broader decline of inpatient utilization in recent years. Since the inpatient UPL gap is volume driven based on the number of Medicaid discharges, there was a negative impact on the aggregate UPL amount. 3. The inflation factor, used to adjust the cost report year to the current year, also fell, along with the applicable overall inflation rate. The end result is that most hospitals were predicted to see a reduction in total payments for SFY 2014; most also would have seen a reduced assessment fee from last
year, since it will take fewer dollars to draw down the available funds. It is uncertain if the new data will change the counts and/or the amounts. As is always the case, any change in net benefit will affect some hospitals more than others, particularly those hospitals where there has been a dramatic change in Medicaid inpatient volume when compared to total volume based on information in their MCRs. The way in which the state’s UPL amount available for the assessment program is calculated each year is prescribed by law, as is the manner for distributing supplemental payments among eligible hospitals. It is not a function of the Medicaid budget process primarily because no state general revenues are used for the program. Nevertheless, hospitals are strongly encouraged to carefully review the preliminary numbers, especially Medicaid paid days/discharges, used in the calculation for your hospital. If you find discrepancies that could have an effect on payments for the year, contact Brian Jones at the Medicaid office (Brian.Jones@arkansas.gov) or Craig Nunemaker (Craig.Nunemaker@arkansas.gov) within the time for responding.
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Ordering and Referring Denial Edits Beginning January 6, 2014, CMS will automatically deny certain Medicare claims for clinical laboratory tests, imaging procedures, and durable medical equipment and supplies if they do not contain a valid National Provider Identifier for the ordering or certifying physician or eligible professional. The policy was 40
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announced on November 6. The requirement was included in an April 2012 final rule implementing several program integrity provisions of the Patient Protection and Affordable Care Act, but delayed to give physicians and EPs more time to enroll in the Medicare program or to revalidate their Medicare enrollment.
The provision generally only impacts hospitals with home health agencies or enrolled as durable medical equipment suppliers. For more information, see the announcement at http:// www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/ Downloads/2013-11- 06 -eNewsSE-PDF.pdf.
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Collaborate Anywhere Anytime
Arkansas Medicaid Inspector General’s Website now Available The Arkansas Medicaid Inspector General has announced the creation and launch of the Office of the Medicaid Inspector General’s new website (http:// omig.arkansas.gov/). One of the site’s main features is an online complaint where citizens can report suspected allegations of Medicaid fraud, waste and abuse. The website also contains information and educational materials for the public, Medicaid beneficiaries and Medicaid providers. AHA members should note the section under the “Providers” tab that contains self-disclosure protocol and a list of excluded providers. A model compliance program will be available on the site soon. Jay Shue, Medicaid Inspector General, stated that the new website will provide information and resources to Arkansas citizens and also provide a mechanism for his agency to receive and consider fraud and abuse allegations. The cost of designing and implementing the website was paid for by grant funding. Information Network of Arkansas assisted the Medicaid Inspector General in obtaining the grant funding and developing and launching the new website.
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M E D I C A R E / M E D I C A I D
Update on Two-Midnight Rule CMS in early November issued additional guidance related to its twomidnight inpatient hospital medical review and admission criteria. Specifically, the CMS website (http:// cms.gov/Research-Statistics-Dataand-Systems/Monitoring-Programs/ Medical-Review/InpatientHospitalReviews.html) now indicates that, in general, the agency will not conduct post-payment patient status reviews for claims with dates of admission October 1, 2013 through March 31, 2014, three months longer than previously announced. The American Hospital Association (AHA) and American Medical Association continue to press CMS to delay enforcement of the policy until October
2014 and to convene a meeting with affected stakeholders to develop alternate policy solutions. According to AHA staff, the new guidance attempts to provide the hospital field with much needed clarification on the two-midnight policy, but lacks clarity and certain parts appear to be inconsistent with guidance previously issued by the agency. CMS posted two documents on the website setting forth more details on the “probe and educate” audits that will be conducted by Medicare Administrative Contractors, which were announced in the agency’s September 26 guidance (http://cms.gov/ Research-Statistics-Data-and-Systems/Monitoring-Programs/Medical-
Review/Downloads/2MidnightInpati entAdmissionGuidanceandPatientStatusReviewsforA-.pdf).
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Rep. Jim Gerlach (R-PA) December 11 introduced the Two Midnight Rule Delay Act of 2013 (H.R. 3698), AHA-supported legislation to delay until October 1, 2014 enforcement of the Centers for Medicare & Medicaid Services’ (CMS) two-midnight policy for hospital admission and medical review criteria. The legislation also calls on CMS to implement a new payment methodology for short inpatient stays in fiscal year 2015. During the enforcement delay, Medicare audit contractors would not be allowed to deny claims for medically-appropriate care based on the length of an inpatient stay, a determination that services could have been provided in an outpatient setting, or for requirements for orders, certifications and associated documentations.
Top 10 Health Technology Hazards for 2014 1. Alarm hazards: In April 2013, the Joint Commission cited 98 alarm-related events over a 3.5 year period, with 80 events resulting in death and 13 in permanent loss of function. 2. Infusion pump medication errors: Infusion devices are the subject of more adverse incident reports to the FDA than any other medical technology. Reports submitted to the FDA from 2005 through 2009 include 710 deaths. 3. CT radiation exposures in pediatric patients: Retrospective studies being published indicate an increased risk of future cancers for children exposed to CT. 4. Data integrity failures in EHRs and other health IT systems: Reports show numerous ways that data integrity can be compromised, resulting in the pres42
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5.
6.
7.
8.
ence of incomplete, inaccurate or out-of-date information. Occupational radiation hazards in hybrid ORs: While radiology department and cath lab staffs are generally well versed in the risks and safety precautions, clinicians working in less controlled environments may be at greater risk for radiation exposures. Inadequate reprocessing of endoscopes and surgical instruments: Flexible endoscopes, with narrow, hard-to-clean channels, can be particularly challenging devices to decontaminate. Neglecting change management for networked devices and systems: Planned and proactive changes to one device or system have adversely affected other networked medical devices and systems. Risks to pediatric patients from “adult” technologies: Because
of their smaller size and ongoing physiological changes, children may suffer adverse effects when subjected to adult-oriented healthcare techniques. 9. Robotic surgery complications due to insufficient training: Pressure to use robot-assisted surgical procedures without adequate consideration of the surgical team’s proficiency has contributed to patient complications. 10. Retained devices and unretrieved fragments: A recently published analysis of 9,744 paid malpractice settlements and judgments associated with surgical “never events” from 1990 to 2010 found that, of the four surgical event types studied, nearly half of the incidents involved the retention of a surgical team. Source: ECRI Institute
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E M E R G E N C Y
P R E P A R E D N E S S
Websites Offer Resources for Assisting the Philippines On Nov. 8, 2013 Typhoon Hiayan struck the Philippine islands of Leyte, Samar and Cebu leaving a path of devastation that is difficult to imagine. Haiyan brought sustained winds of 147 mph with gusts of 170 mph and waves as high as 45 feet. In some places, as much as 15.75 inches of rain fell. According to the National Disaster Risk Reduction and Management Council, 1,774 people have been reported dead (at press time), 2,487 were reported injured and 82 were missing and the death toll was expected to rise significantly in coming days. More than 580,000 people have been displaced and
an estimated 41,000 houses have been damaged. Hospitals wishing to contribute to the relief effort for victims of the November 8 typhoon in the Philippines are encouraged to visit the American Red Cross directly through its website, www.redcross. org. Hospitals are also encouraged to visit the U.S. Agency for International Development website, www. usaid.gov/haiyan, which contains information on how best to donate with links to credible organizations supporting international relief efforts in the country. It also contains information on how to volunteer assistance. USAID is coordinat-
ing the U.S. government’s efforts in support of relief. “The people of the Philippines are devastated by this enormous disaster and will need help for some time to come,” said American Hospital Association president and CEO Rich Umbdenstock. “Hospitals, and the people that make them beacons of hope and caring, are among the most generous places in the world and are often the first place people turn in times of disaster. The international hospital community has reached out to the Philippine medical community to offer our assistance.” AHA has made a $50,000 donation to the American Red Cross.
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by Sue Durio, Vice President of Marketing Communications, Texas Hospital Association, Austin
At a Moment’s Notice When disaster struck the small community of West, Texas, preparation, communication and collaboration helped save lives. Wednesday, April 17, seemed like any other day at Hillcrest Baptist Medical Center in Waco, Texas. As David Argueta, the hospital’s vice president of operations, headed home, however, that routine workday changed in an instant with a phone call from the hospital: A fire had broken out at the West fertilizer plant, and first responders were en route. He immediately called Chief Executive Officer Glenn Robinson, FACHE, who was just settling in for the evening. It was clear to both that this had the potential makings for a major disaster. “West is like many small rural communities,” Robinson said.
“The farmers need ammonia to grow the crops. The fertilizer company is an integral component of the local infrastructure and a major employer. Other companies locate nearby, and housing grows up around these employers.” Just before 8 p.m., the two received word of an explosion at the plant. They immediately called a Code Alert. “We were talking with the people we trusted on the ground, and when we heard the potential number of casualties from them, we moved the Code Alert to Code Green, or full disaster,” said Argueta.
Robinson and Argueta quickly returned to the hospital. “I arrived at the hospital at about 8:15 p.m., and there already were 50 nurses and doctors gowned, gloved and standing ready at our main ambulance entrance,” Robinson said. Within 15 minutes, the hospital was receiving its first patients. That night, 250 Hillcrest doctors, nurses and volunteer staff responded. A Level II trauma center, Hillcrest treated 123 patients and admitted 28. Other Central Texas hospitals snapped into action as well, putting in place their emergency precontinued on page 44 Winter 2014 I Arkansas Hospitals
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E M E R G E N C Y
P R E P A R E D N E S S
paredness plans to receive evacuated patients, care for the injured and reunite families. A total of 300 patients were treated at Hillcrest, Hill Regional Hospital in Hillsboro, Providence Healthcare Network in Waco, Scott & White Memorial and McLane Children’s Scott & White hospitals in Temple, Baylor Medical Center at Waxahachie, JPS Health Network in Fort Worth, and Parkland Health & Hospital System in Dallas. Every patient who was transported survived. “I am proud of what was accomplished that night. The entire emergency preparedness system worked well, and we’re just one part of that,” said Robinson. “The spirit of collaboration throughout the evening and the next morning was a great example of how well the whole system performed.”
Key Takeaways
Of the millions who followed the disaster as it unfolded on the national news, perhaps none watched with more interest – or more pride in how the response was being managed – than the hospitals’ own colleagues. While Texas hospitals have long demonstrated their expert care in the face of disasters, the West explosion was the first no-notice event in Texas since the Texas A&M University bonfire disaster in 1999. It also resulted in the largest loss of first responders since 9/11. “No one practices for fertilizer plant explosions,” said Texas Hospital Association President/CEO Dan Stultz, M.D., FACP, FACHE. “After this, Glenn could teach a course.” So what lessons were learned? Robinson and Argueta offer a few key takeaways. • Even the best communication systems will be stressed. “We logged 13,000 calls in 24 hours,” said Robinson. “We’ve conducted a number of internal after-action reviews; parts of our automated notification system didn’t work, so we’ve decided to
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invest in a comprehensive mass notification system.” • In a disaster, it takes a village. When one of the West community’s three ambulances was lost in the explosion, 10 area ambulance services, including one from Limestone Medical Center in Groesbeck, sent help. Patients were arriving in squad cars. High winds grounded choppers until about 9 p.m., further impeding patient transfer efforts. “We were a community. I was talking with Brett Esrock at Providence, and he said they could take more. As we worked through the night, anticipating more patients to come, we worked with Providence to redirect a bus of walking wounded there to make sure we were best using all of our resources,” said Robinson. • The national media onslaught is immediate and relentless. “One moment your life is normal, and the next, everyone around the world is talking to you,” said Robinson. Rather than tie up the hospital’s phone lines with media calls, he gave out his cell number. “First I spoke to CNN, and within an hour, I had USA Today, MSNBC, Wall Street Journal and dozens of other media calling,” he said. In addition, the Hillcrest team quickly created a safe perimeter for taking care of patients and designated a well-staffed media room with Internet and Ethernet access so critical for streaming live video from the building. “We were able to control the message by keeping the factual points succinct and clear and by proactively scheduling media updates as new information was available,” said Argueta. • Social media is a game changer. Through social media, word of the explosion went viral within minutes. The Hillcrest team leveraged its well-established social media presence to feed the desire for the latest news. “We didn’t
start tweeting until about nine hours into it,” said Robinson, “but once we started, it reduced the number of media calls tremendously because it answered the questions they had.” Over the initial 24-hour period, the hospital posted 20 tweets in addition to fielding hundreds of media phone interviews and conducting seven press briefings. • Don’t overlook the power of ancillary personnel. “West is a closeknit community, and the whole town was affected,” said Argueta. “There was an immediate influx of family and friends.” Hillcrest’s chaplains quickly set up a family area, and its concierges assisted with directional assistance, family navigation, search and delivery of supplies, and acting as runners. Other support services played critical behind-the-scenes roles, like keeping food prepared for patients, staff, families and media, and cleaning and turning over areas continually to accommodate the large patient demand. • The right mix of providers is hard to predict but critical. “In addition to our surgeons and specialists, another group of doctors who helped us so much were our primary care doctors,” said Robinson. “We opened up a recovery room in one of our clinics next to our facility for them to work. We probably could have taken care of twice that many [patients] that evening, perhaps even tripled it, because of the number of doctors there.” • Pay it forward. Hillcrest was the beneficiary of many acts of kindness from other hospitals, including some that experienced mass casualty events themselves. The hospital received goodwill gestures from Massachusetts General and Brigham and Women’s hospitals in Boston, which were in the middle of treating patients following the Boston Marathon bombing that same week; LewisGale Hospital Montgomery in Blacksburg, Va.,
whose staff treated many of the Virginia Tech shooting victims in 2007; and Mary Black Health System in Spartanburg, S.C., where Robinson worked previously. Since the West incident, Hillcrest, too, has paid it forward, sending items to hospitals treating casualties due to the tornadoes in Granbury and Moore, Okla. Ultimately, Robinson and Argueta learned that the system works. Hillcrest plays an active role in the governance and planning for the Heart of Texas Regional Advisory Council (RAC), its five-county emergency management system, and this involvement paid off. “The relationships fostered within that group were a huge asset in the midst of this chaos,” said Robinson. “The RAC is truly part of our family. The staff office at our Herring campus, and they are deeply involved with our emergency management planning and operations.” In addition, the hospital and system mock drills proved to be invaluable. “We had practiced mass casualty drills and hazardous substance drills, and this event had all those components,” said Argueta. “There was a familiarity throughout the hospital regarding the roles and what was necessary, and as a result of planning and preparation through the years, our staff responded appropriately and definitively.” This article originally appeared in the May/June 2013 issue of Texas Hospitals magazine. Reprinted with permission from the Texas Hospital Association.
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Listen UP! Do you know what the number one skill in sales and service is? I gave you a hint in the title. Right – listening skills. Do we really LISTEN? Most of us ‘hear,’ but do we really listen to what people are saying? Are there any methods, tricks, ideas, tips or techniques to make us better listeners? Yes, there are. Listed below are some of the often used skills of better listeners. What do you think the difference is between listening and hearing? Bottom line: Hearing is physical. Listening is mental. What do some folks do that others don’t in order to be a good listener? It’s pretty simple. Take a TV commercial. Most of us normally hear it, but do we always listen to it? Probably not. Especially if it’s about something we’re not particularly interested in for ourselves. Take the Super Bowl. We talk about the commercials before they’re even on TV. How many can you remember now? My guess is you’ll recall those that were of ‘interest’ to you. We probably ‘heard’ them. We may have watched them. But again, how many did we really listen to? Pay attention to? Below are six easy steps to becoming a better listener. While there are more, starting with these will help you. Listen up! 1. Decide to be a Better Listener – That’s like an attitude. It’s a decision. Will everything be of
by Nancy Friedman, The Telephone Doctor
interest or value to you? Maybe not, but not listening can be dangerous. We need to LISTEN to those you talk with. We need to acknowledge. We can only intelligently answer and acknowledge if we are listening. 2. Welcome the Customer – On the phone, in person, in business or at a social event. We need to make the person feel welcomed. That in turn helps make you a much better listener. So bring a welcoming phrase to the table and use it to make the customer feel as though he’s a long lost friend! 3. Concentrate – Listening is not the time for multi-tasking. And today, we can all turn to the left or right and catch someone texting and probably trying to have an in person conversation as well. Your concentration must be on the conversation - in person or on the phone. Do nothing else but ‘listen.’ Don’t text, don’t hold side conversations, and keep your eyes (and ears) on the person talking. 4. Keep an Open Mind – Well, why do we need to do this? I’ll tell you why. There are some of us who think we know what the other person is going to say before they say it and so we interrupt (or interject) our comments before the person can answer. That’s not keeping an open mind. That’s not listening to what they’re saying. It’s important to put your teeth in your tongue
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and not interrupt. By keeping an open mind you’ll gain more information as well. And your listening skills will be sharper. 5. Give Verbal Feedback – Talking with someone and not acknowledging what they’re talking about is very frustrating for them, especially on the phone, because we don’t even have body language to check out. So come up with a few feedback lines such as: “I see.” “Hmmm, that’s good.” “Ok.” “Interesting.” A few simple words and phrases will help the person feel you’re listening and listening well. In person, you have the ability to nod and smile, and they can SEE your expressions. However, on the phone, we need verbal feedback. And be careful we’re not saying the same word over and over. 6. Take Notes as You Talk – This is my favorite. And yes, even in person. That’s perfectly acceptable! Taking notes lets the person know you’re interested in what they’re saying. It’s a good sign of respect. Taking notes so you can refer back is also a big compliment. Don’t forget to do it. It really helps your listening skills. There you are. Six pretty easy steps to becoming a good listener. And watch how many times you need to say: “I’m sorry, what did you say?” That’s not a great sign you’re listening. Good luck!
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Arkansas Hospital Association 419 Natural Resources Drive Little Rock, AR 72205
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