Arkansas Hospitals, Winter 2015

arkansas

hospitals WINTER 2015

www.arkhospitals.org

Physician Perspectives on Quality Keeping Hospitals Healthy With the APO Preparing for the Legislative Session

A MAGAZINE FOR ARKANSAS HEALTHCARE PROFESSIONALS ARKANSAS HOSPITALS I Winter 2015

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We’re a knowledgeable connector of people, physicians and health care places.

One way we keep physicians and patients connected is through a Personal Health Record (PHR), available for each Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas member. A PHR is a confidential, Web-based, electronic record that combines information provided by the patient and information available from their claims data.

A PHR can help physicians by providing valuable information in both every day and emergency situations.

To request access, contact PHR Customer Support at 501-378-3253 or personalhealthrecord@arkbluecross.com or contact your Network Development Representative.

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Winter 2015 I ARKANSAS HOSPITALS

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arkansas

hospitals is published by

Arkansas Hospital Association

419 Natural Resources Drive • Little Rock, AR 72205 501-224-7878 / FAX 501-224-0519 www.arkhospitals.org Elisa White, Editor-in-Chief Cindy Lewis, Editorial & Layout Assistant Emily Cavallo, Art Director

BOARD OF DIRECTORS

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

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

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.

departments 4 6 6 7

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From the President Editor’s Letter Education Calendar Newsmakers and Newcomers All About Hospitals

cover stories 8

The Critical Role of Physicians in Quality Improvement 10 Clinical Integration for

Quality Improvement 13 A Case for Physician Leadership

in Changing Perioperative Care

quality and patient safety 17 Focus on Quality 18 Arkansas Hospitals Shine in

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 89

Partnership for Patients Initiative 20 Addressing Cardiovascular

Health Disparities 22 Bridging the Gap Between

Technology and People with

Disabilities

from coverage to care 24 Arkansas’s Private Option is

the Key to Surviving Massive Medicare Cuts 28 Open Enrollment 2015: Hospitals

Prepare For Insurance Questions

news 30 31 32 34

Caldwell Wins Weintraub Award CEO Profile AHA Services Spotlight Hospitals Receive Awards for Safety Excellence

aha annual meeting 36 38 40 42

Teaming up for Care AHA Awards 2014 AHA Trade Show 2014 See You Next Year

legislative advocacy 45 After Historic Election, Arkansas

Prepares for Legislative Session

ARKANSAS HOSPITALS I Winter 2015

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from the PRESIDENT

ENGAGING

OUR LEADERS

Photo courtesy of Jason Burt

This is, indeed, an exciting time for our state. With every new Governor comes a new focus and a new direction for the executive branch of government, and while the structure and roles of the legislative branch of government remain the same, the individuals comprising it make every General Assembly different.

This is a time for optimism. It also is a time for action.

There is no doubt that the number one legislative priority for the Arkansas Hospital Association is the reauthorization of the Arkansas Private Option. We all know that the Arkansas Private Option has delivered on its promise to decrease the number of citizens in our state who have been unable to pay for their healthcare. It also has reduced uncompensated care in our hospitals by $69.2 million and reduced the number of uninsured Arkansans receiving inpatient services by 46.5 percent. While these results are significant for the first six months of implementation, reaching the required reauthorization hurdle of gaining the confidence and votes of 75 of 100 representatives and 27 of 35 senators cannot be accomplished without local engagement.

Hospitals must tell our stories. While it is difficult to say out loud, there is no question that hospitals will cut services,

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November 4, 2014, has come and gone, and Arkansas has elected a new Governor and is one member shy of completing the membership of the 90th General Assembly. While most of us are glad that the election rhetoric and seemingly endless television and radio advertisements have finished, this is the time of year when our elected officials – newly elected and experienced – begin to come together for the common good.

I ask you to deepen your relationships with our elected officials and to be open with them about the successes our hospitals have enjoyed and about the struggles that our hospitals continue to face. lay off employees or close if the Arkansas Private Option is not renewed.

A recent USA Today article outlined the impact on states that did not expand their Medicaid programs or create a program similar to our Private Option.

The story focused on the state of Georgia and the rural hospital closures that have occurred there because hospitals are folding under the pressure of Medicare reimbursement cuts and uncompensated care. It is imperative that we educate our elected officials and let them know that right here at home, in Arkansas, we are absorbing $2.5 billion in Medicare reductions over the next ten years and an estimated $400 million in uncompensated care in 2014. Without the Arkansas Private Option, the future viability of Arkansas’s hospitals is bleak.

My plea to you is to become more engaged than ever. I ask you to deepen your relationships with our elected

officials and to be open with them about the successes our hospitals have enjoyed and about the struggles that our hospitals continue to face.

Arkansas’s elected officials campaigned to represent their constituents, and they want their hospitals to continue to be top-notch acute care centers, to continue to be economic engines for their communities, and to be safe places to go when disasters strike. Our elected officials need and want data and information – and they want it from you.

The AHA staff stands ready to assist you in any way as you reach out to your local officials. Now is the time for action. Now is the time to engage.

Bo Ryall

President and CEO Arkansas Hospital Association

Can Laboratory Testing Improve Patient Care and Lower Costs?

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To learn more about AEL and its innovative technology to assist in utilization management call Pam O’Brien at 901.405.8200.

ARKANSAS HOSPITALS I Winter 2015

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EDITOR’S letter

Collaboration In the ever-changing world of American medicine, savvy practitioners and organizations understand the limitations of going it alone. New care delivery models are encouraging all members of the healthcare community to collaborate with one another, whether through formal business arrangements or more informal models.

Collaboration requires flexibility and a willingness to find common ground.

For our AHA member hospitals and their staffs, that common ground usually is found in the shared goal to provide exceptional patient care. This magazine features personal stories from three physicians who are actively involved in quality improvement

initiatives at their hospitals. Each physician offers his own perspective about the physician’s role in the QI process, but all three of our featured writers are dedicated to doing everything they can to take better care of patients.

There’s no substitution for effective collaboration. We here at the AHA

support all you do to take care of our friends and neighbors, and we want to help you do it better. Collaborate with us to make our magazine an even better tool for you. Send your feedback to elisawhite@arkhospitals. org or call 501-224-7878.

Elisa White, Editor-In-Chief

Arkansas Hospital Association

EDUCATION CALENDAR January 16, Little Rock 2015 CPT, HCPCS Level II & OPPS Updates for Hospitals January 23, Hot Springs Arkansas Association for Healthcare Engineering, Inc. (AAHE) Winter Meeting January 28-30, Tunica, MS Healthcare Financial Management Association (HFMA) Arkansas Chapter, 2015 Tri-State Institute February 19, Little Rock Arkansas Hospital Association Spring Compliance Roundtable

March 6, Searcy Arkansas Healthcare Human Resources Association (AHHRA) Spring Conference March 16-19, Chicago, IL American College of Healthcare Executives Congress on Healthcare Leadership March 16-18, Washington, D.C. National Association of Psychiatric Health Systems (NAPHS) Annual Meeting

April 10, Little Rock Arkansas Organization for Nurse Executives (ArONE) and Arkansas Association for Healthcare Quality (AAHQ) Patient Safety Spring Conference May 6-8, Hot Springs Arkansas Association for Healthcare Engineering, Inc. (AAHE) Annual Meeting May 3-6, Washington, D.C. American Hospital Association Annual Membership Meeting

Program information available at www.arkhospitals.org/events.

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ARKANSAS

NEWSMAKERS and NEWCOMERS ◼ TIM BOWEN has been named

President of INTEGRIS Grove Hospital, a 58 bed full-service hospital in Grove, Oklahoma. Bowen, who was named

by Becker’s Hospital Review as one of 25 leaders under 40 in healthcare in 2013, has been a valuable member of the Arkansas Hospital Association Board of Directors for the past two years. He began work at Mena Regional Health System in 2006 and was named CEO of the hospital in 2011 after serving as assistant administrator and compliance officer.

◼ CHI St. Vincent has named

ANTHONY HOUSTON as the new president of CHI St. Vincent Hot Springs. Houston comes to Arkansas from SSM St. Mary’s Hospital in Jefferson City, Missouri, where he most recently served as the executive vice-president and chief operating officer. During his time with SSM Health, Houston

also served as corporate director of operational finance. Prior to that, he was senior director for public finance for Fitch Ratings from 20062010 and was a senior associate at PricewaterhouseCoopers where he served as a consultant in their Healthcare Provider Planning Practice.

Houston is a graduate of the University of Cincinnati where he earned a Bachelor of Science and holds a Master’s degree in Health Services Administration from Xavier University. ◼ ANITA SPEARMAN, a member

of the auxiliary at Mercy HospitalBerryville, was honored by the Arkansas Hospital Auxiliary Association (AHAA) as the 2014 Auxilian of the Year at the AHAA Annual Meeting in October. This prestigious award is given to an auxilian who continuously goes above and beyond in their auxiliary and community service.

The seven-year volunteer recently

helped launch a series of Alzheimer’s seminars, as well as a support group for caregivers in Carroll County; she also volunteers weekly with Mercy Hospital Berryville’s surgery team. ◼ LAURA PICKENS, vice president

of marketing and public relations for St. Bernards Healthcare, has been announced as the recipient of the 2014 Rising Star Award for Outstanding Young Strategy Professionals under the age of 40 from the Society for Healthcare Strategy & Market Development (SHSMD) of the American Hospital Association. SHSMD President Mark Parrington presented the award to Pickens at the society’s annual conference in San Diego. Pickens currently is finishing her third term as president of the Arkansas Society for Healthcare Marketing and Public Relations, an affiliated group of the Arkansas Hospital Association.

all about HOSPITALS ◼ NATIONAL PARK MEDICAL

CENTER in Hot Springs held a groundbreaking ceremony on November 18 for a new 67,000 square foot stand-alone expansion to be built on 9 acres of land immediately west of the current hospital. The project will double the capacity of the existing emergency room and create a Heart Center of Excellence featuring stateof-the-art technology. The project is scheduled for completion in 2016.

◼ The UNIVERSITY OF

ARKANSAS FOR MEDICAL SCIENCES recently opened a comprehensive rehabilitation clinic on its northwest Arkansas regional campus in Fayetteville. The 2,735-square-foot clinic features innovative equipment such as an

experimental Assisted Movement with Enhanced Sensation (AMES) Device — one of only five such devices in the nation — for helping patients regain mobility or use of a paralyzed limb by enhancing sensory or motor connections. The clinic also will serve as an educational host for the university’s physical therapy doctoral degree program, which will welcome its first students in the fall of 2015. ◼ Voters in Mississippi County voted

to approve a half-cent sales tax increase to provide funding for GREAT RIVER MEDICAL CENTER in Blytheville and SOUTH MISSISSIPPI COUNTY REGIONAL MEDICAL CENTER in Osceola. The increase went into effect January 1, 2015, and will sunset

after five years. County officials expect the tax to generate approximately $12 million in revenues to fund repairs at both facilities, additional equipment purchases and physician recruitment. ◼ SALINE MEMORIAL

HOSPITAL recently unveiled a redesigned and refurbished main entrance and lobby. The project was funded by donors through the Saline Memorial Health Foundation.

In addition to new lighting and furnishings, the lobby area also includes a coffee bar called the Salt Works Café in honor of the first industrial business in Saline County, as well as a renovated gift shop, which is operated by the Saline Memorial Hospital Auxiliary, a major donor for the project.

ARKANSAS HOSPITALS I Winter 2015

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COVER STORY

Engaging In Quality

STRATEGY SESSION

The Critical Role of Physicians in QUALITY

IMPROVEMENT

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by Doug Bernard, M.D. About eight years ago, I remember being approached by a nurse working in the Coding Department of our hospital.

She wanted to spend some time educating me on the importance of documenting all of the co-morbid conditions in my hospitalized patients. I also remember thinking that this not only would take more of my time, but also would not improve the way I take care of patients. In fact, I was quite certain that I was providing an excellent quality of care for my patients and further documentation was only a “ploy� for the hospital to increase their reimbursement.

After I lectured this kind nurse on my misgivings related to her request, she smiled, asked me to consider her recommendations and gave me a printout listing our hospital ranking compared to similar hospitals in our state. This was my first introduction to what hospitals and physicians are finding to be the new meaning of quality.

ADMINISTRATORS AND PHYSICIANS AS TEAMMATES

No longer is quality a term that engenders a warm feeling between a patient and his or her doctor, but a term that is determined by published metrics and competitive rankings among hospitals and even physicians.

Additionally, all of us in healthcare are realizing that there are significant consequences to both our reputation and finances if these measures of quality are not achieved. Therefore, it is important for hospitals to engage and educate their medical staffs on their ongoing quality initiatives, recognizing that physicians “buying into” the processes to improve quality is the cornerstone to improving patient care.

So, how do hospitals engage physicians in improving quality? Given the increasing pressures on hospitals to improve the quality of patient care, the need to engage physicians in hospital quality improvement initiatives is critical. There is an increasing trend for hospitals to employ physicians, and these employment contracts often contain quality measures that are designed to further align doctors with the goals of the hospital. However, many feel that an employment contract with a physician will not improve the way a doctor practices medicine, or universally improve the quality goals that the employer/hospital has set.

Furthermore, independent physicians are now under increased financial and quality of life pressures and often find it difficult to attend additional meetings regarding hospital initiatives. Finally, I believe most physicians truly believe they are providing quality medical care to their patients … unless data is shown to them which may indicate otherwise.

DATA IS KEY

In soliciting physician involvement in quality measures, it is important to provide credible data. It is equally important to explain how the data was collected and exactly what it means to the physician and the hospital, not only in regard to quality measures but also any potential financial repercussions. Physicians are competitive by nature, and when given information that might place them in a less than favorable light, most providers will respond to the challenge. Physicians want their hospital(s) to succeed. If given the information on how improvements can be made along with comparative data to tap into their competitive nature, most members of a medical staff will respond favorably.

After assuming the role of Chief Medical Officer, one of my first goals was to develop a Physician Report Card. I felt that this would be an effective means to engage our physicians in our hospital’s quality initiatives. These reports have been used to educate the members of our medical staff on their performance on indicators such as mortality, length of stay, readmissions and even cost of care. The metrics of each physician are evaluated and compared to both internal and external peers at non-teaching hospitals with a similar number of beds.

Each physician was encouraged to sit down with our director of quality and review their reports so that they could understand the data, and more importantly, what could be done to improve any particular score, as well as how that report might be viewed by the public. While we are still early in changing our culture, the feedback from our physicians was entirely positive, and significant dialogue at our quarterly section meetings now revolves around quality. We are now providing our hospitalists with weekly feedback on these measures in addition to case mix index, so that any negative trends can be recognized and corrected in a proactive fashion.

Development of a monthly “rolling” report of these metrics has now been requested by many physicians on our medical staff, so that this data can be compared to their semi-annual report cards. Peer Review meetings per specialty are now scheduled every other month, and a Mortality Committee has been formed

to review every unexpected death. While implementing these efforts and changing the culture of quality in our hospital have not happened overnight, I am convinced that my colleagues have “bought in” to the initiatives we have developed.

FOCUS ON THE PATIENT

In addition to providing data, it is important for hospitals to communicate with the medical staff effectively, using clear and concise messaging regarding their efforts and commitment to improve quality as this culture change is taking place. Physicians may often feel left “out of the loop” regarding new initiatives for any number of reasons, which can lead to a breakdown in driving and maintaining these efforts. In conversations with peers regarding physician engagement, messaging through emails, posters and individual meetings can provide a means to avoid breaks in communication, and possibly encourage others who historically have not been involved in hospital committees to become involved and take on leadership roles. “Physician Champions” should be encouraged and recognized by hospitals and hospital boards for playing key roles in the development of quality initiatives that improve the care of their patients.

Additionally, it is important to stress to physicians that quality efforts are designed to improve patient care first and foremost. As mentioned earlier, most physicians believe the quality of their care is good. As healthcare continues to change, it is vital that hospitals effectively communicate the new and ever changing meaning of quality, and to realize that physicians, whether employed or independent, are key to driving these quality initiatives. Although hospital rankings, physician report cards and even financial penalties may serve to inspire our efforts for a numerical achievement in quality, the importance of providing evidence-based, compassionate medical care to our patients must be paramount.

Doug Bernard, M.D., serves as Chief Medical Officer of White River Health Systems in Batesville, Arkansas.

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COVER STORY

Clinical Integration for Quality Improvement

By Shane Speights, D.O. “The critical role of the physician in quality improvement” – truth be told, that phrase gives me heartburn. It conjures up visions of long meetings (if I miss another soccer game my wife is going to file for divorce) and discussions about government regulations (and yes they are out to get us, I just upgraded my aluminum foil helmet). I suspect many practicing physicians feel the same way. They are already overwhelmed with the daily heavy load of patients needing to be seen while staring down the barrel of a rapidly changing healthcare system and volatile, unknown changes in payment. It’s no wonder nationwide many physicians are seeking shelter under the umbrella of employment models hoping to weather the storm of change. And now we’re asking physicians to participate in “Quality Improvement”? I’ve had those conversations, and the initial response is typical and usually resistance.

At my hospital, I’m fortunate that the majority of my medical staff is forward thinking and can see the bigger picture.

I can say the same for the C-suite leadership. Both groups recognize the need for our system to work cohesively.

It certainly would have been a more difficult discussion had they been less engaged. Still, there were physicians who were scratching their heads at the concept and asking, “But I already provide great quality care to my patients; how do I need to improve?” Therein lies the problem.

Most physicians were not taught about quality metrics in medical school.

Physicians are taught how to manage disease, how to perform procedures, and how to connect with patients and their families on a personal level in an attempt to positively impact their health.

Core measures, PQRS, Value Based purchasing, Patient Centered Medical Home, Meaningful Use, blah, blah, blah.

It’s too much for a doctor who just wants to practice good medicine. For a health system or hospital wanting to engage its medical staff, understanding 10

Winter 2015 I ARKANSAS HOSPITALS

that last statement is the key to successful physician onboarding.

I am the Vice President of Medical Affairs for St. Bernards Healthcare, the largest health system in northeast Arkansas. About two years ago we were looking for a mechanism to make physician engagement more granular.

Not just another meeting, flyer on the wall, or email – we wanted something that would really take our physicians to the next level and create a sense of ownership. That search for the holy grail of motivators brought us to the Memorial Herman Health System, a large system of twelve hospitals and over 5,500 physicians that services the greater Houston, Texas area. I guess everything really is bigger in Texas.

Several years previously they had embarked on a similar quality search and created a Clinical Integration Program (CIP). This program was a collaboration between the health system and the physicians, which was established by the physicians separately from the hospital system with a goal to reduce hospital expenses by meeting certain quality

measures. It was completely run by the physicians, who incurred their own expenses and revenue. I know what you’re thinking, “How did this affect quality?” The “revenue” the program generated came from shared cost savings with the hospital system.

For example, evidence-based medicine is pretty clear on the use of albumin. There’s not really much of an indication for it these days, but unfortunately old habits die hard and it’s still widely given. It’s really expensive on the hospital side, and in head-to-head studies, it doesn’t fare any better than using the much less costly normal saline. Let’s say the CIP (aka the physicians) takes on albumin reduction as a goal. If the CIP meets the set goal, then the hospital agrees to share in the savings with the CIP. The result is better quality of care to the patient at a reduced cost to the hospital and the patient. Additionally, there is the obvious financial incentive on the side of the CIP. This model quickly scales to other areas such as: blood utilization, surgical supplies, medical supplies and drug costs.

Armed with that information and with some help from the Memorial Herman CIP, we started our own program in October of 2013. We set it up somewhat differently from the CIP model and established ours as a Clinical Efficiency Program (CEP). We had 161 of our 166 eligible physicians sign on to join our CEP. We identified six areas of focus (shown on page 12) for our first year that, if successful, would result in significant savings to the hospital with a positive impact on the quality of care being delivered to our patients.

The last two goals didn’t really have a savings amount per se, but the impact they had on Case Mix Index, inpatient vs. observation status and readmission rates were significant enough to include them.

As with any system of this size, we had to create an infrastructure continued on page 12

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Our annual CEP meeting was just held November 17. At that meeting, we discussed the results of the program, physician disbursement occurred and we looked at our goals for the next year. By all accounts, it was a great success.

The results of our CEP have laid the ground work for a better foundation of physician involvement and collaboration within our health system. That “ownership” piece I mentioned earlier is finally taking shape. One of the CEP physicians is a good friend and wasn’t happy with the CEP idea from the start.

“Why do you have to pay physicians to do what’s right?” he would ask. “Why can’t you just make us do the right thing?”

In my VP role I learned quickly that you don’t “make” physicians do things.

You put a problem in front of them, then empower them with knowledge and data, and guess what? They get it right. I appreciated his comments, and his heart is in the right place, but realistically, a physician’s time is valuable.

Most of us learned how valuable while moonlighting as residents or right out of residency when we took all the extra shifts or patients to boost our income.

Over time, that wears on you, and you reach a point where your time off is so valuable there’s actually a mental dollar amount assigned to it. Extra shift vs. kid’s soccer game? Extra shift + $500 vs. kid’s soccer game? Extra shift + $500 vs. divorce? This is really no different, except the meetings rarely go over an hour (I still make the soccer games), and the implications of the CEP can be far more impactful to patient care, quality and cost effectiveness than that extra shift.

The future of healthcare is unknown, but what is known is that it will take a cohesive relationship between physicians and health systems to be successful. We believe our CEP is a move in that direction. made up of physicians who could handle all the details and issues that would arise. Eleven committees were created: Leadership, Finance, Membership, Education, Quality, Surgical Supply, IT, Medical Supply, Evidence-Based Medicine and Employee Health. That’s right another committee meeting to attend, except physicians were paid 12

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to attend these meetings. How many physicians get paid to attend meetings?

No surprise, meeting attendance was not a problem, and by having the physicians attend regularly we were able to make a significant impact on the goals that were set.

So, it’s been a year … how’d we do for our first time?

Shane Speights, D.O., serves as the Vice President of Medical Affairs for St. Bernards Healthcare in Jonesboro, Arkansas. For questions or further information, you may contact Dr. Speights at sspeights@sbrmc.org.

COVER STORY

A Case for Physician Leadership in Changing Perioperative Care

By Chris Steel, M.D. Those familiar with the writings of John Kotter have heard on more than one occasion, “Our iceberg is melting.” This warning rings especially true for physicians in the perioperative arena. We all have been trained and spent most, if not all, of our careers in a fee-for-service (FFS) environment. We now are being told FFS is being replaced by pay-for-performance (PFP), as we move toward a population health based payment system. The insurers are quick to point out that they are more than happy to “share” the savings of the new system with the physicians. But none of us, including the insurers, know the implications of these changes to perioperative physicians over the next 5 to 10 years.

Rather than pontificate on whether this will increase, decrease or have no effect on surgical volume, as perioperative physicians, I believe we need to realize our limitations. Alone we cannot simultaneously improve quality, decrease the overall cost of care, all the while improving the patient’s overall health (the triple aim). As you can imagine,

achieving the triple aim requires not only perioperative physicians, but a team of administrators, nurses, care coordinators, discharge planners, physician extenders, dieticians, physical therapists and others.

All of these individuals not only need to be involved in the patient’s care, but they need to know their role, how it will be measured and their goal. Why can’t/

haven’t we done this in the past? There has been a lack of leadership from physicians and administrators, along with a payment system that has rewarded inefficiency without respect to quality.

Why is this time different? The old FFS model, perversely, financially rewarded hospitals and perioperative physicians continued on page 14 ARKANSAS HOSPITALS I Winter 2015

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for readmissions, wound infections and failed procedures requiring revisions. With this in mind, perhaps it’s not surprising that physicians and hospitals did not expend a large amount of financial and political capital establishing a system that would ultimately decrease their revenue. This is not to imply that physicians or administrators acted unethically in putting money over patient care. This only speaks to the fact that a hospital must generate revenue to pay its employees and keep its doors open. Investing in unproven, large-scale patient care strategies that may decrease revenue is a difficult sell. However, with the rise in PFP, bundledpayment initiatives and accountable care organizations (ACOs), hospitals, as well as perioperative physicians, now have financial incentives to achieve the triple aim.

At White River Medical Center (WRMC), we are members of the Perioperative Surgical Home Collaboration. This project was created by the American Society of Anesthesiology and mediated

by Premier, Inc. The goal of this project is to achieve a disruptive increase in quality in perioperative care, while containing the cost of the care delivered. At WRMC, the hospital’s administration has partnered with physicians to take on this project. Dr. Jeff Angel (orthopedic surgeon) and I (anesthesiologist) are the co-medical directors of our perioperative surgical home. Our team has divided into four smaller teams: preoperative, intraoperative, postoperative and data and metrics. Each team consists of two leaders, an administrative representative and approximately four to six additional members.

Our plan was to focus on one service line at a time. We started with total knee replacements and have slowly added service lines, now branching to general surgery as well. Each team meets every one to two weeks and evaluates 14

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our current process. We then meet with all of the surgeons who perform that specific procedure. Our goal is to establish standardized care at WRMC for each procedure, which encompasses the preoperative, intraoperative and postoperative care. This will replace the old model of each surgeon having a different process for preoperative, intraoperative and postoperative patients. We have developed protocols that all surgeons performing a specific procedure have agreed to, including but not limited to: body mass index, diabetes management, preoperative laboratory preferences and so on. Because the preoperative team contains nurses from the surgeons’ offices, the hospital’s preoperative clinic, nurse liaisons, CRNAs and schedulers, they can assure as few redundancies in the process as possible.

Regarding intraoperative care, the surgeons have agreed on standardization of multimodal pain control and general versus regional anesthesia protocols. This required CRNAs, scrub technologists, circulating nurses, post-op care nurses and nurse managers on the post-op team to implement these protocols in their specific care areas. Again, rather than the patient’s care being based on the surgeon’s or anesthesiologist’s preference, we instead base it on the patient’s co-morbidities. This allows us to achieve what we believe to be optimum care for every case.

Our post-op protocols standardize pain control, dietary advancement and ambulation in the post-operative period.

Again, this is not physician specific, but patient specific for the entire service line. Because the postoperative team consists of discharge planners, care coordinators, floor nurses, hospitalists and physician’s assistants, we are utilizing protocols to predict who needs a skilled nursing facility, long term care or home health. More importantly, we can predict which patients, with additional optimization, may not need the aforementioned services.

Our data and metrics team has created reports to show each team the leading and lagging indicators that they requested, along with other quality measures. This team includes members

from information technology, infection control, CRNAs and pharmacists. We believe it is essential to receive real-time feedback in order to make changes as quickly as possible. This ensures that each of the PSH teams immediately knows when there is a fallout, so it can be rectified. It also ensures that success and failure can be caught early, with the leading indicators, and acted on by the team before it begins to affect the lagging indicators. We hope to have a real-time dashboard with these data points updated automatically in the near future.

The relatively small size of our institution does lend itself to challenges in comparison to our colleagues such as a lack of: economy of scale, purchasing power, business development department, etc. Yet, what we previously believed to be a competitive disadvantage – a smaller number of physicians than our university colleagues – we now believe to be a distinct advantage. The greatest challenge for many large hospitals participating in the collaboration has been getting a large number of physicians to agree on a common pathway or protocol. Due to the relatively small number of surgeons at WRMC, changes to patient care protocols can be made more quickly here than at larger facilities.

As you might imagine, there will be a point of diminishing returns on standardization of minutia. At the moment, we are focusing on our low hanging fruit and we continue to see decreased length of stay, decreased pain scores, decreased readmissions and increased patient satisfaction. We ultimately hope to make these changes across all service lines. As standardization progresses, accurately calculating the hospital’s and physician’s costs via activity-based costing calculations will become much easier.

This will be a significant advantage in the bundled payment programs by allowing us to know exactly what our processes are and where our costs lie. I believe this practice will grow exponentially in importance as hospitals and physicians begin to participate in bundled payment plans and ACOs. As you can see, our iceberg is melting.

We admit that the FFS model is being

phased out. Can we admit as well that the days of anesthesiologists focusing all their attention only on what happens in the operating room are done? What about surgeons focusing on cutting edge surgical techniques, while adhering to long outdated preoperative, intraoperative and postoperative care myths? What about hospitals making decisions to perform certain procedures after looking only at reimbursement and soft costs?

What about all the components of the perioperative team working independently, based on their own practice patterns, without feedback regarding outcomes?

To improve perioperative care, hospitals will have to invest in business intelligence solutions to show physicians and other perioperative team members where to start this process and how to track improvement. Physicians are going to have to lead a unified effort with their colleagues, administration and other members of the medical team to focus on all areas of the perioperative experience.

Administrators are going to have to equip their physicians with the resources and skills to accomplish these tasks.

Those who embrace the old model of linear quality improvements for perioperative care soon will find themselves in the same position Nokia did in 2008. Through embracing small, linear improvements, they lost massive market share to companies such as Apple, who were willing to invest in disruptive innovation. It was Winston Churchill who stated, “To improve is to change; to be perfect is to change often.”

These disruptive quality changes are currently being implemented by many institutions in the Perioperative Surgical Home Collaboration. Some physicians and hospitals undoubtedly will continue to embrace linear quality improvements and reject these and other disruptive changes.

Time will tell how old models will survive in the new payment environment.

Chris Steel, M.D. serves as co-Medical Director of the Perioperative Surgical Home Collaborative at White River Medical Center in Batesville, Arkansas.

ARKANSAS HOSPITALS I Winter 2015

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

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Join the AHA members who made the decision to be our partner in healthcare.

“We couldn’t be more pleased with the quality of customer service, availability of products and level of medical expertise we receive as a partner with Arkansas Blood Institute.”

– Tim Bowen, CEO, Mena Regional Health System

16

Winter 2015 I ARKANSAS HOSPITALS

arkbi.org Del Holloway, Executive Director 800-934-9415

QUALITY AND PATIENT SAFETY The Agency for Healthcare Research and Quality is offering a set of tools to support health care providers who seek to use patient-centered outcomes research findings in shared decision-making. The tools and upcoming train-the-trainer workshops are part of AHRQ’s “SHARE Approach,” which is a five-step process aimed at increasing the use of evidence in shared decision-making between health care providers and patients.

The tools and a registration link for the workshop are available at: www. ahrq.gov/shareddecisionmaking.

T​ he Institute for Healthcare Improvement in collaboration with Dr. Mike Evans, Associate Professor of Family Medicine and Public Health at the University of Toronto, has produced a short, animated whiteboard video that introduces the basic concepts of quality improvement in health care. As stated on the IHI website, “Evans starts with a simple question: ‘Why should you care about quality improvement?’ He presents a brief history of QI (including a ‘Mount Rushmore’ of improvers), then touches on system design, the Model for Improvement, and the familiar challenge, ‘What can you do by next Tuesday?’ — all in less than nine minutes!” Access the video on the IHI website at www.ihi.org.

FOCUS ON QUALITY The 2014 Annual Report from The Joint Commission shows continued improvements in quality of care in hospitals across the United States. The list of Top Performers included a record 1224 hospitals, including 16 Arkansas hospitals. The annual report also summarizes the performance of 3,300 Joint Commissionaccredited hospitals on 46 accountability measures of evidencebased care processes closely linked to positive patient outcomes.

A study involving 9 academic medical centers published in the November 6 edition of The New England Journal of Medicine demonstrated that implementation of a standardized handoff bundle was associated with a 23 percent relative reduction in the incidence of preventable adverse events. The bundle included a mnemonic (“I-PASS”) for standardized oral and written handoffs, formal training in handoff communication, faculty development and a sustainability campaign. The study found that implementation of the bundle did not add time to patient handoffs.

The Journal of Applied Psychology recently published a study demonstrating that hand hygiene compliance rates among nurses decrease over the course of a normal work shift. During the first hour of work, average compliance rates were approximately 43 percent but dropped to 35 percent for the last hour of a 12-hour shift. More intense work shifts were associated with an even greater drop in hand hygiene compliance. However, more time off between shifts led to better compliance rates during a subsequent shift.

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QUALITY AND PATIENT SAFETY

Improving Care to Save Lives

SYSTEM ADVANCEMENT

Arkansas Hospitals Shine In Partnership for Patients Initiative

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Winter 2015 I ARKANSAS HOSPITALS

A report released by the Department of Health and Human Services on December 2 shows an estimated 50,000 fewer patients died in hospitals and approximately $12 billion in health care costs were saved as a result of a reduction in hospitalacquired conditions from 2010 to 2013. This progress toward a safer health care system occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events through the HHS Partnership for Patients (PfP) initiative.

Preliminary estimates show that in total, hospital patients experienced 1.3 million fewer hospital-acquired conditions from 2010 to 2013. This translates to a 17 percent decline in hospitalacquired conditions over the three-year period.

In keeping with the reputation of our hospitals’ dedication and commitment, Arkansas was 1 of 2 states in the AHA/ HRET HEN to accomplish that goal. Our results were second only to Louisiana.

For the past three years, as many as 45 Arkansas Hospital Association (AHA) member hospitals have participated in the Arkansas Hospital Association’s Hospital Engagement Network (HEN) as part of the American Hospital Association/Health Research and Education Trust HEN. There are 26 HENs across the country working with more than 3,700 hospitals to participate in this important three year national PfP initiative to improve patient safety. The PfP had the ambitious goals of reducing hospital-acquired conditions by 40 percent and readmissions by 20 percent by the end of the 2014. Results by many Arkansas hospitals exceeded this goal.

On December 4, CMS acknowledged the outstanding participation by the AHA and its members at “QualityNet: The CMS Healthcare Quality Conference.” The contribution by AHA member hospitals has been extraordinary. Based on the average costs and data tracking, HRET estimates that the reduction in total harm across all topics per 1000 patient days in Arkansas through June 2014 at 29 percent. This has translated to preventing 2144 adverse events at a cost savings of $10,877,934 in our state alone.

With the ambitious goal of achieving a 40 percent reduction in 10 topics and a 20 percent reduction in readmissions, the minimal expectation was to reach our goals in at least 9 of those 11 areas.

In keeping with the reputation of our hospitals’ dedication and commitment, Arkansas was 1 of 2 states in the AHA/ HRET HEN to accomplish that goal. Our results were second only to Louisiana.

What a great accomplishment for our patients! As a state, we couldn’t have done it without the hard work of all participating hospitals.

Those hospitals reaching a 40 percent reduction in Hospital Acquired conditions and a 20 percent reduction

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in readmissions in 80 percent of their eligible topics include: Ashley County Medical Center Baxter Regional Medical Center Bradley County Medical Center Chicot Memorial Hospital CrossRidge Community Hospital Delta Memorial Hospital DeWitt Hospital Drew Memorial Hospital Forrest City Medical Center Fulton County Hospital Great River Medical Center Harris Hospital Howard Memorial Hospital Jefferson Regional Medical Center Johnson Regional Medical Center Lawrence Memorial Hospital Magnolia Regional Medical Center McGehee Hospital Mena Regional Health System Mercy Hospital Fort Smith Mercy Hospital Berryville North Metro Medical Center Ouachita Medical Center Ozark Health Medical Center Saint Mary’s Regional Medical Center South Mississippi County Regional Medical Center Stone County Medical Center White River Medical Center The Arkansas Hospital Association and its member hospitals remain committed to improving patient care and outcomes into the future. For information on potential opportunities in 2015 to support your work in quality and patient safety through the AHA’s ARbestHealth quality program, contact Pam Brown, Vice President of Quality & Patient Safety, at pbrown@arkhospitals.org or Nancy Godsey, Director of Quality & Patient Safety, at ngodsey@arkhospitals. org or by calling the Arkansas Hospital Association at 501-224-7878.

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ARKANSAS HOSPITALS I Winter 2015

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QUALITY AND PATIENT SAFETY

Addressing Cardiovascular Health Disparities By the Arkansas Foundation for Medical Care Heart disease was the cause of approximately 25 percent of all Arkansans’ deaths in 2011. Arkansas ranks first in the nation for stroke mortality, and is in the top 10 for coronary heart disease deaths.

Heart disease and stroke cause one of every three deaths in the United States.

Americans suffer more than two million heart attacks and strokes each year, and 2,200 people die from cardiovascular disease every day. Further, heart disease and stroke are among the leading causes of disability, with more than three million people reporting serious illness and decreased quality of life.

According to the Arkansas Minority Health Commission, eliminating health disparities for Arkansas minorities would save $518.6 million annually in direct medical care expenditures.

The commission says increased use of preventive services, management of chronic disease and reduction in sick days are ways to minimize health disparities and reduce costs.

Heart disease is an equal opportunity killer. However, Arkansans do not receive equal diagnosis of and treatment for heart disease. Because of health care disparities, some Arkansans are dying disproportionately when compared to those who have access to health care.

The clearly modifiable risk factors for heart disease include high blood 20

Winter 2015 I ARKANSAS HOSPITALS

pressure, diabetes, obesity, inactivity and poor diet. These risk factors are on the rise in Arkansas.

Arkansas’s minority populations are disproportionately affected by these risk factors, thus increasing our state’s health disparities. Additionally, AfricanAmerican and Hispanic Arkansans have a higher prevalence than Caucasians for several risk factors including high blood pressure, diabetes and obesity.

Key social determinants such as high rates of poverty and unemployment, limited education, low literacy levels and poor nutrition profoundly affect the health of Arkansas communities, particularly in the Arkansas-Mississippi Delta region. These socio-economic determinants directly affect the burden of disease, its risk factors and indirectly influence health-related behaviors. Approximately 18 percent of Arkansas’s population has an income below the poverty line. Not surprisingly, population groups with the worst health outcomes have high rates of poverty and low levels of education.

Overall health, poverty and lack of insurance indirectly contribute to heart disease risk factors. These socioeconomic factors determine, in large part, whether a person will receive optimal diagnosis and treatment for heart disease.

Women are another large cohort that have heart disease disparities.

The Centers for Disease Control and Prevention says only 54 percent of women recognize that heart disease is their leading cause of death. In addition, the CDC says 64 percent of women who

die suddenly of coronary heart disease have no previous symptoms.

Little Rock cardiologist Anthony Fletcher, MD, says we can eradicate disparities in heart disease if we emphasize education for both the patient and the health care provider, while utilizing available guidelines.

“It’s important to focus on cardiovascular health in general because it’s the number one reason that people die in this country,” explains Fletcher. “For too long, women have been underdiagnosed and undertreated for cardiovascular disease. Many times this is because we misunderstand their symptoms,” he says.

Fletcher says that women don’t classically present with the typical symptoms of chest heaviness – the “elephant on my chest” feeling.

Many women present with shortness of breath, fatigue, dizziness or lightheadedness, indigestion and nausea, and pain in the stomach, neck or back. When compared to men, women’s heart disease symptoms are more likely to include pain at rest and pain triggered by mental stress. Some women present with no symptoms.

Women also are more likely to delay care and to deny that their symptoms are serious enough to warrant medical attention. Women often are less concerned about optimum treatment than they are about having their lives disrupted by medical care.

Women develop heart disease about 10 years later than men do. This is largely due to the protective effect of the hormones their bodies produce until menopause. “If a man has heart

disease in his 40s, women will typically be in their 50s,” Fletcher says. However women are more likely to die following a heart attack than men.

Fletcher says one of the major obstacles women have traditionally faced is misunderstanding symptoms and not realizing they had heart disease. In addition, for a long time, women thought cancer was the number one cause of illness and death. “I think women now have become more educated in understanding that heart disease is a major problem for them, and they should pay attention to their unique symptoms,” he says.

Fletcher emphasizes the need to screen and evaluate all members of the public, regardless of gender. “Many physicians believe the fallacy that women don’t have that much heart disease.

Many times, women presented [with symptoms of heart disease], but it would be chalked off as anxiety or something related to the GI tract,” Fletcher says. “I

think healthcare providers have become more sophisticated and understand that women also have heart disease and need to be screened appropriately,” he says.

In an effort to engage disparate populations in efforts to improve their cardiac healthcare, the Arkansas Foundation for Medical Care (AFMC) participated in the national “Million Hearts Campaign.” The campaign used innovative strategies to reach minority populations, healthcare workers and the public – both in their communities and in places of religious worship.

Educating healthcare providers included cultural competency and health literacy training; risk-stratifying electronic health record data to identify, manage and treat factors that have an impact on heart health; increasing provider-patient communication; and providing health promotion through social media.

Efforts to educate the wider community focused on interventions such as public blood pressure monitors,

“Health Hubs” in libraries, heart health promotions in barbershops and beauty salons, and smoking cessation campaigns. Cities, towns and communities were encouraged to issue heart health-related proclamations and resolutions, and promote community fitness challenges, local farmers’ markets and walking trails.

In the faith-based community, routine blood pressure checks were offered in churches; “Bless Your Heart” toolkits were distributed to help develop health ministries; and heart-healthy outreach efforts were provided at health fairs and church events to further promote hearthealthy activities.

The campaign also addressed inequities in transportation access, income and access to healthy food and community resources. Support groups facilitated peer-to-peer training on healthy eating, hands-on cooking demonstrations of heart healthy meals, home blood pressure monitoring and exercise programs.

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QUALITY AND PATIENT SAFETY

Bridging the Gap between Technology and People with Disabilities

By Evan Jones As a parent of a son with Asperger’s and another son with Down syndrome, Cristen Reat is always looking for ways to use technology and apps to help her children in their daily lives. Cristen co-founded BridgingApps, a program of Easter Seals Houston, to help create a community of parents, therapists, doctors, teachers and people with disabilities who share information about using mobile devices (smartphones and tablets) to improve the lives of people with special needs.

Caring for someone who has a disability, chronic illness, disease or injury can be demanding and overwhelming, but an extra pair of hands can be as close as the smartphone in your pocket. Whether you are a doctor, nurse, therapist, parent of a child with a disability or even a spouse of someone who had a stroke, there are many types of apps that can be used to manage information, assist with communication and improve health outcomes.

BridgingApps helps people of all ages and abilities learn how the devices they use every day can be leveraged to improve their physical, cognitive, 22

Winter 2015 I ARKANSAS HOSPITALS

Mia, age 7

Prolqouo2Go Blood Pressure Companion

and social outcomes. By providing app reviews based on skills, rather than age or diagnoses, caregivers and professionals can focus first on identifying the skills they are looking to address (such as writing or communication), and then on ways to use mobile devices and apps to develop and improve them.

assessing apps to track and manage chronic health conditions.

Many people with disabilities have medical issues that can be complicated and overwhelming to manage. Below are a few examples of health-related apps that BridgingApps has trialed and found successful with people who have disabilities:

Focus on Skills: Meet Mia

Mia is a 7 year old with an undiagnosed disability, and she is nonverbal. Mia has been working with BridgingApps and a speech therapist for the past year learning to use an iPad mini paired with a communication app to enable her to “talk” with her family, friends and classmates. Using Prolqouo2Go (above), Mia tells her mom what she will do at school.

Prolqouo2Go is just one of a number of apps that can be used to help improve communication skills for a range of situations. For example, adults who have suffered a stroke or children who are temporarily or permanently nonverbal (such as a child on a ventilator) may also need to address the same skill of communication to help direct and understand their care, reduce frustration and stay connected.

• SEIZURE LOG (left) – logs data on seizures and keeps records to manage epilepsy • BLOOD PRESSURE COMPANION (above) – tracks blood pressure, heart rate and weight

Seizure Log Using Apps to Track and Manage Health Conditions In addition to helping Mia find her voice, BridgingApps empowers caregivers and professionals by

For many caregivers and healthcare professionals, mobile devices can be a powerful tool in integrating a care team and engaging the patient in their own care. With thousands of apps coming onto the market every day, BridgingApps’ goal is to help users of all abilities find technology solutions to develop skills, reach goals and reach their full potential.

Learn more about BridgingApps or search for apps to meet your needs at www.bridgingapps.org.

ARKANSAS HOSPITALS I Winter 2015

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FROM COVERAGE TO CARE

Insurance for the Future

FINANCIAL FORUM

Arkansas’s Private Option is the Key to Surviving Massive Medicare Cuts

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Winter 2015 I ARKANSAS HOSPITALS

By Paul Cunningham, Executive Vice President, Arkansas Hospital Association When the Arkansas Legislature convenes this month, Arkansas’s Private Option plan for expanding health insurance to low income residents will take center stage once again. Truthfully, the spotlight on the state’s unique program hasn’t dimmed measurably at any time since it was first enacted two years ago, but legislative sessions are prime time for those both for and against the Private Option to shine. As Shakespeare wrote, “The play’s the thing.” There’s no better place to make a point than when people are closely watching.

It’s no secret that gaining the Legislature’s approval to fund the Private Option is again the top priority for the Arkansas Hospital Association, the 98 hospitals, health systems and other healthcare organizations comprising its membership, and the 43,000 people they employ. The reasons are well known. It helps patients, communities and hospitals, and for some hospitals it might be the only pathway to survival.

Since the Private Option began in January 2014, more Arkansans have health insurance coverage than at any time in the state’s history. A Gallup poll issued in October 2014 shows the uninsured rate in Arkansas fell from 22.5 percent to 12.4 percent since January. The 10 percentage point reduction leads the nation.

As of November 30, 2014, the total number of people eligible for the Private Option had risen to 223,456, including 188,083 who were enrolled in private health plans and an additional 25,117 Arkansans who had been assigned to the traditional Medicaid program because they were considered to have exceptional health needs. That’s an astonishing number when you consider the target market of eligible individuals was pegged at 250,000, and the program had been in place only 11 months.

Having more people with health insurance is good for assorted reasons.

Obviously, it allows people better access to healthcare services, which keeps them healthier and limits the effects of illness, injury and chronic conditions that are costly to treat, can keep them away from work and might even lead to long term disabilities. And you can’t deny the impact on hospitals.

Results of a survey conducted jointly by the Arkansas Hospital Association (AHA) and the Arkansas Chapter of the Healthcare Financial Management Association in August and September reveal the Arkansas Private Option is having a dramatic positive effect on the state’s hospitals, which reported marked reductions in the number of uninsured patients being cared for during the first six months of 2014 versus the same period the previous year. The reductions were felt across all service settings, including inpatient, emergency department and

Patient Utilization

2013

2014

% Change

Inpatient Admissions Total Uninsured Private Option Plans

135,552 9,180

136,436 4,913 4,038

0.7% -46.5%

Emergency Visits Total Uninsured Private Option Plans

431,517 102,469

439,779 66,075 25,638

1.9% -35.5%

Outpatient Clinic Visits Total Uninsured Private Option Plans

1,063,138 68,627

1,124,701 43,901 47,725

5.8% -36.0%

hospital outpatient clinics, and the losses on uncompensated care attributed to uninsured patients.

A combination of more insured patients and lower uninsured volumes (46.5 percent for inpatients, 35.5 percent in hospital emergency rooms and 36 percent fewer uninsured patients seen in outpatient clinics) caused hospitals’ uncompensated care losses related to uninsured patients to fall by 56.4 percent, dropping from $122.6 million in 2013 to $53.4 million in 2014 and yielding a total six-month benefit of $69.2 million.

Payments ($Millions) Uninsured Patients Private Option Plans Total Payments

yanked away from conversations about the Private Option.

Hospitals have expressed their concerns about the storm of Medicare cuts raining down on their shoulders in recent years, but nobody else seems too upset. Others who could pitch in and help seem to dismiss the idea that no good can come from hospitals losing more than 10 percent of their future Medicare revenues over the coming years, especially in a world where other revenue streams are drying up, particularly on the commercial insurance side of the hill. It’s

2014

2013

$21.4 $58.0 79.4

$22.0

Change % Change

22

-$0.6 $58.0 57.4

$75.3 $57.5 $132.8 ($53.4)

$144.6

$144.6 ($122.6)

-$69.3 $57.5 -$11.8 $69.2

-2.9% 260.6%

Costs ($ Millions) Uninsured Patients Private Option Plans Total Costs Net Losses

The survey validates that the private option is reducing uncompensated care significantly and saving many rural Arkansas hospitals from the threats posed by growing uncompensated care burdens.

By extension, keeping local hospitals healthy – and open – benefits the communities those hospitals serve, too.

The Key to Surviving Medicare Cuts

Retaining the Private Option is important for all the reasons above. But, for Arkansas’s hospitals, there is an even more compelling reason why it must be kept: Medicare payment reductions. It is a separate issue, but one that can’t be

-48.0% -8.2% -56.4%

worse in some cases. The more Medicare dependent a hospital is, the bleaker the picture gets.

The Medicare cuts in the Affordable Care Act (ACA), enacted in 2010, were originally estimated to cost hospitals nationwide about $155 billion over 10 years (the time frame used by the Congressional Budget Office to score such things). Arkansas’s share was projected at $1.5 billion. As things have developed, that is considerably less than the current price tag.

Major hospital groups across the country almost unanimously supported the ACA and for good reason. It limited continued on page 26 ARKANSAS HOSPITALS I Winter 2015

25

Medicare cuts in hospital spending being discussed in Congress and by the President at the time (more than $250 billion), plus the legislation then being drafted included key provisions for getting more people insured as a way to provide new revenues to offset the cuts and counter growing losses linked to uncompensated care.

What hospitals didn’t expect was the surprising array of cuts imposed subsequent to the ACA via The Budget Control Act of 2011, The Middle Class Tax Relief and Jobs Creation Act of 2012, The American Taxpayer Relief Act of 2012, or a set of highly questionable policy changes imposed by CMS that penalize hospitals. According to the American Hospital Association, the combined effect of those actions since the ACA was enacted in 2010 has pushed the total price tag up by $122 billion. Hospitals’ Medicare reductions from future revenues now approach $280 billion, higher than it was when discussions on the ACA began in 2009.

billion in lowered payment rates for inpatient and outpatient services.

Another $546 million will be wrested away from hospitals that provide inpatient rehabilitation and psychiatric care, whether in freestanding or community hospital-based facilities; those that offer hospital-based skilled nursing and/or home health services; and from freestanding long term acute care hospitals. Total 10-year cost: $1.646 billion • Quality-Based Payment Changes: The ACA did not stop there. The law established three payment policies related to the quality of care provided by individual hospitals, all of which could, and probably will, lead to lower Medicare reimbursements in many hospitals. Combined, these qualitybased payment policies could cost Arkansas hospitals more than $182 million over a 10-year span.

1. The Hospital Value-Based Purchasing (VBP) Program is a Centers for Medicare & Medicaid Services (CMS)

Source: American Hospital Association, 2014

Where the Medicare Cuts Come From

The assortment of Medicare reductions and their cost to Arkansas hospitals include: • Medicare Rate Reductions: The cuts found in the ACA rely primarily on clamping down on the annual updates allowed on rates that Medicare pays for hospital care in multiple settings.

Arkansas acute care community hospitals will absorb more than $1.1 26

Winter 2015 I ARKANSAS HOSPITALS

initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide to people with Medicare. Hospitals subject to the VBP program have their base operating DRG payments for each patient discharge reduced by a small percentage each year (the reduction is 1.0 percent for Fiscal Year (FY) 2013, 1.25 percent for FY 2014, 1.5 percent for FY 2015, 1.75 percent for FY 2016, and 2 percent

for FY 2017 and subsequent years).

The funds are essentially escrowed until future years when hospitals can be rewarded based on how closely they follow best clinical practices and how well hospitals enhance patients’ experiences of care. Those VBP incentive payments to hospitals will come from the aforementioned payment cuts. Because the incentive payments are re-distributional, many hospitals won’t qualify for incentive payments, but all will pay into the pool from which the incentives will come.

2. The Hospital Readmissions Reduction Program is strictly a penalty-based program with no bonus payments involved. Beginning October 2012, a hospital faced as much as a 1 percent penalty on every Medicare payment it received, if, based on a CMS analysis, the hospital was determined to have “excessive readmissions” for three measures, AMI (heart attack), congestive heart failure and pneumonia. The maximum penalty increased to 2 percent in FY 2014. This year, hospitals can lose as much as 3 percent of their Medicare payments under the program. Also, two new conditions were added this year: chronic lung problems, such as emphysema and bronchitis, and elective hip and knee replacements.

3. The Hospital Acquired Conditions (HAC) Program, which begins this year, requires CMS to reduce hospital payments by 1 percent for hospitals that rank among the lowest-performing 25 percent with regard to HACs, which include rates of infections in patients with catheters in major veins and their bladders as well as eight other patient injuries, including blood clots, bed sores and accidental falls.

For each hospital in its analysis, Medicare calculated a preliminary “hospital acquired-condition” score from 1 to 10, with the higher number indicating the hospital had a greater rate of patient harm. Any HAC payment penalty

adjustment would occur after base DRG payment adjustments have been calculated and made for the VBP and Readmission Reduction programs. Payment adjustment would impact hospitals that rank among the lowest-performing 25 percent with regard to HACs. They would receive 99 percent of the amount of payment that would otherwise apply to all discharges.

• DSH payment reductions: The ACA-mandated payment change with closest ties to the Private Option concerns Medicare Disproportionate Share Hospital (DSH) payments.

Initially created in the early 1980s, the purpose of the DSH program is to help hospitals, particularly those that serve a disproportionate number of low-income patients, offset the costs of providing care to those individuals. Because so many low-income uninsured patients were expected to gain health coverage under the ACA, negating the need for stabilizing these safety-net hospitals, the law included provisions to substantially reduce Medicare DSH payments. These reductions, which take effect this year, will eventually cost the state’s hospitals roughly $385 million. Without the Private Option and the new insured patients it brings to the table, these cuts can’t be replaced.

• Sequestration: By October 2010, Arkansas hospitals could already count almost $2 billion that was scheduled to be taken from Medicare revenues upon which they otherwise could depend for the coming decade.

Yet, before another year passed, Congress enacted The Budget Control Act of 2011 to address the debt-ceiling crisis that threatened a U.S. sovereign default. It added a new term to the hospital finance lexicon – sequestration.

Among its deficit reduction provisions, the law specified an incentive for Congress to act in order to cut the deficit at least $1.5 trillion over the coming 10 years. Barring a deficit reduction bill with at least $1.2 trillion in cuts, Congress could grant a $1.2 trillion increase in the debt ceiling but this would trigger across-the-board cuts – sequestrations – as of January

2, 2013. Medicare was not spared the cuts, but Congress did cap them at a 2 percent maximum.

While it could have been worse, the 2 percent cut filtered down to all Medicare payments, including those to Arkansas hospitals, which saw the sequestration cuts levied on top of the aforementioned quality related percentages. Originally on course to lose an added $400 million over 10 years due to sequestration, that figure went up to $500 million for the state’s hospitals when Congress extended the sequestration twice, first into FY 2023 and then to cover FY 2024.

• Medicare Bad Debt: The squeeze on Medicare continued early the following year with The Middle Class Tax Relief and Jobs Creation Act of 2012. Under that law, hospitals, which until then could be paid for 100 percent of their Medicare bad debt costs, were limited to 65 percent in all service settings.

The $17 million hit for Arkansas hospitals added to their injuries.

• Coding adjustments: The American Taxpayer Relief Act of 2012 also included Medicare payment reductions through a provision with origins dating back to FY 2008, when CMS refined the method it uses to categorize patients for purposes of payment under the inpatient prospective payment system (PPS). The agency claimed, but never proved, that the improved documentation and coding for patient severity of illness would result in higher hospital payments. In response, Congress initially required CMS to make prospective cuts to hospital payments to account for these supposed higher payments, as well as to make retrospective cuts, if necessary, to recoup overpayments from FYs 2008 and 2009. The ATRA raised the cost to the state’s hospitals from the original $221 million to $332 million.

The graphic to the right shows the overall 10-year impact of these cuts on hospital revenues in Arkansas.

Opponents of the Private Option point to the cost of the program over time. They say it will be too expensive once the state begins to pay up to 10 percent of the cost

in 2020, or that it will create a budget crisis for the federal government. Those in favor of keeping the program intact say that concern is based only on speculation and that given a chance Arkansas’s Private Option approach will prove to create benefits on multiple levels, including the local insurance market, once hard data is available to measure.

The fact is that scrapping the Private Option at this time also carries a cost that will be borne by people and communities across the state. There are consequences linked to not being paid for the services you deliver. Any businessman will tell you, lose enough money over a long period of time and at a minimum your business won’t be the same after a while; if things get bad enough, you’ll have no business.

If and when a local hospital closes – an inevitability in some cases – it eventually will lead to the loss of physicians, especially in small, rural towns. When physicians begin to leave, other ancillary services will follow naturally. The loss of those healthcare services will affect business development and retention.

Finally, abandoned businesses will induce a death rattle from within the community.

The stakes are high. Without the Private Option, there is little hope of backfilling the hole in hospital finances left by Medicare reductions. Hopefully, the legislature will weigh all the implications and choose to continue the Private Option. It is the right thing to do.

Cost of Existing Medicare Payment Cuts Arkansas Hospitals Ten-Year Impact (2012-2022) ($ Millions)

Legislated Cuts ACA Medicare Rate Updates

($1,600)

ACA Quality Programs

($182)

Sequestration

($500)

Limit on Bad Debt Expenses

($17)

Coding Adjustments

($111)

Regulatory Cuts Coding Adjustments

($221)

Total 10-year Impact

($2,600)

Total Impact as % of Future Medicare Revenues

-10.3%

ARKANSAS HOSPITALS I Winter 2015

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Open Enrollment 2015:

Hospitals Prepare for Insurance Questions More than 200,000 Arkansans are among the millions of Americans who have signed up for affordable healthcare coverage through the Health Insurance Marketplace or Arkansas Private Option (APO).

During the first six months of 2014, the number of people hospitalized without insurance fell by almost 50 percent in Arkansas compared with the same period last year.

On the surface, these appear to be cold statistics, but hospital administrators know better. They know these numbers mean that the communities they serve are getting healthier. They know fewer people are going without prescriptions or putting off checkups or going to emergency rooms for preventive treatment.

As more people sign up for the APO or for plans through the Health Insurance Marketplace, many more will have questions. One place those people may seek answers is the local hospital.

The Arkansas Hospital Association has prepared a guide with some things to keep in mind as administrators address questions from patients, family and friends who want to know more.

There’s a Story in the Numbers

During the first six months of this year, the number of people hospitalized without insurance fell by 46.5 percent compared with the same period last year, a recent Arkansas Hospital Association (AHA) study found.

The report is based on a survey conducted jointly by the Arkansas Chapter of the Healthcare Financial Management Association and the AHA in August and September. Hospitals responding to the survey represent nearly 80 percent of all hospital patient services by revenue and admissions.

According to the study, out of about 136,000 hospital admissions from January to June in 2014 and 2013, more than

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4,900 patients were uninsured this year compared with just over 9,100 in 2013.

The reductions are linked to the APO, the state’s plan for expanding health insurance to low-income individuals. The plan has been operational since January 1, 2014. In a six-month span, hospitals cared for fewer uninsured patients in all settings, including patients admitted for inpatient care, those presenting to hospital emergency rooms and outpatient clinic patients.

Citing a recently released study from the Kaiser Family Foundation, Bo Ryall, AHA President and CEO, notes that an estimated 1 in 3 Americans report having difficulty paying their medical bills within the past year. The study also found that, in 2013, only 33 percent of uninsured adults reported a preventive visit with a physician in the last year, compared to 74 percent of adults with employer coverage and 67 percent of adults with Medicaid.

According to the Kaiser Family Foundation, 16 percent of Arkansans are uninsured and stand to benefit from one of the plans.

Marketplace Basics

Through the Health Insurance Marketplace (HIM), uninsured individuals with incomes above 138% of the federal poverty level (FPL) can purchase insurance plans from commercial carriers that can be made more affordable by tax credits based on income level and family size.

Most people who purchase an insurance policy through the HIM will qualify for tax credits and savings on out-of-pocket costs and monthly premiums based on household size and income. No one is required to purchase insurance using the HIM, but this is the only place where a person can receive financial assistance through tax credits to pay the premiums.

Some residents may be directed through the HIM to enroll in the APO, a program that uses federal dollars to buy private health insurance for residents with minimal income. The APO is this state’s innovative approach to Medicaid expansion, and it is available to adults whose incomes are below 138% FPL. Federal law requires that every citizen have health insurance or pay a fine. However, the law makes it illegal for insurers to deny coverage for preexisting conditions and mandates that every health insurance plan cover the Essential Health Benefits, which are: • Ambulatory patient services • Emergency services • Hospitalization • Pregnancy, maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment such as counseling and psychotherapy • Prescription drugs • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services To be eligible for health coverage through the HIM, an applicant must live in this country and be a citizen, national or otherwise lawfully present, and the person cannot be incarcerated at the time of enrollment.

Additionally, there are some important dates to remember when discussing these healthcare initiatives with those who have questions: • December 31, 2014: Date when all 2014 Health Insurance Marketplace coverage ends.

• February 15, 2015: The last day to enroll in 2015 coverage for individuals with incomes above 138% FPL. • Enrollment in the APO is available year round for those with incomes below 138% FPL. If a person whose income is above 138% FPL misses the February 15 deadline, enrollment for individual insurance coverage generally is not available for the rest of 2015 unless the person qualifies for a special enrollment period. A special enrollment period is an allowance for people to sign up for insurance through the HIM outside the open enrollment period. This period applies to people who have had qualifying life events such as marriage, divorce, birth of a child, unexpected loss of employer coverage, etc.

Getting Covered, Staying Covered

Accessing the Health Insurance Marketplace is as simple as logging onto HealthCare.gov where the uninsured can compare plans before purchasing.

The website also features a searchable database for those who would like to find local, in-person assistance enrolling. Anyone without Internet access can reach the Health Insurance Marketplace by calling 800-318-2596 toll free.

People who purchased plans through the HIM in 2014 should get two important notices about their health coverage: one from the health insurance company and one from the Marketplace as a reminder to re-enroll.

Some people may be automatically re-enrolled in their 2014 plan or a similar one.

However, income and household information must be updated as soon as possible to be sure they get the right plan choices and amount of savings for 2015.

If a person’s insurance company notice says he or she won’t be automatically enrolled in 2015, that person can enroll in any plan available through the Marketplace.

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NEWS

Darren Caldwell

Named A. Allen Weintraub Memorial Award Recipient The Arkansas Hospital Association (AHA) Board of Directors awarded Darren Caldwell, CEO of DeWitt Hospital, the 2014 A. Allen Weintraub Memorial Award during the association’s annual Awards Dinner on October 9 in Little Rock. The award, which is the highest honor bestowed upon an individual by the AHA, is presented annually to an administrator who has provided exemplary service to both the hospital he or she leads and the community it serves.

Many members of the DeWitt Hospital and Nursing Home team were on-hand to congratulate their CEO, Darren Caldwell, on his Weintraub award. From left: Katie Sollars, Christie Jones, Rhonda Reed, Sherry Oldner, Suzette Boyd, Ginger Bogy, Darren Caldwell, Shannon Yancey, Jerrilynn Horton, Annie Scroggin, Cris Bolin, Tawana Watson and Angie Duncan.

Caldwell’s career is notable not only for his professional accomplishments, but also for his service to the people of southeast Arkansas. After serving as the assistant administrator at Delta Memorial Hospital in Dumas (1989-1991), he was named CEO for DeWitt Hospital, a position he held from 1991 through 1996. Then, in 1997 Caldwell became the CEO of Drew Memorial Hospital in Monticello, serving there for more than five years before returning to the CEO position at DeWitt Hospital in 2002.

During the past 12 years at DeWitt, he has overseen projects which include 30

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remodeling the existing structure and building a new facility for the hospital based rural health clinic. He was instrumental in securing a $400,000 grant for capital improvements to the critical access hospital through U.S. Congressman Marion Berry’s office and worked to increase the nursing home census by 35 percent after several years of no substantial change. Caldwell also has opened a second home health office in a neighboring community, extended the hospital’s ambulance service to a community 35 miles away and replaced all of the diagnostic equipment in the organization.

Twice he organized campaigns for 1.5-cent sales taxes to support DeWitt Hospital and Nursing Home. Both were successful, with voters giving approval ratings to the tax questions of 79 percent and 91 percent respectively.

And, for a 15-month span in 2012-2013, he filled the CEO position simultaneously for both DeWitt Hospital and Delta Memorial Hospital.

A member of the AHA Board of Directors since 2008, Caldwell was elected in 2013 to serve as the group’s treasurer. In addition, he has chaired the AHA’s Medicaid committee for the past three years, helping AHA and its member hospitals transition through various changes associated with the state’s multipayer Payment Improvement Initiative and the implementation of Arkansas’s Private Option plan to expand healthcare coverage to low income Arkansans.

Caldwell is the Chairman for the Greater Delta Alliance for Health Inc., a non-profit, horizontal hospital organization comprised of nine, southeast Arkansas rural hospitals, which is responsible for providing healthcare resources and workforce training for up to 19 counties in southeast Arkansas. He also is an Arkansas Red Cross Board member, Past President of the DeWitt Chamber of Commerce and DeWitt Rotary Club, member of the DeWitt Industrial Development Corporation, Dumas Chamber of Commerce, Drew County Chapter of the Cancer Society, Drew County Chapter of the Heart Association and the Arkansas County Advisory Committee to Phillips Community College.

• MY FIRST JOB IN HEALTHCARE I was hired right out of college as assistant to the long-time administrator at Delta Memorial Hospital, Howard Johnson, who is a former Weintraub award winner.

• THE MOST CHALLENGING THING IN HEALTHCARE Finding a balance among appropriate care, a budget to provide it and the time to educate the community about how these two things go together.

• MY FAVORITE PART OF THE CEO JOB Creating relationships with a variety of people. I enjoy pestering my employees more than I should also.

• WHAT I’D DO IF I WEREN’T A CEO I wanted to be a high school basketball coach at one time, but now I would be a toll booth operator. I have an engineering degree, so I can do the math to make change fairly easily.

CEO PROFILE:

Weintraub Award Winner 2014

Darren Caldwell, CEO

DeWitt Hospital and Nursing Home

Photo by Taylor James www.taylorjamesdesign.com

• ON MY DESK RIGHT NOW My desk has two tall stacks of files and other documents, wintergreen and cinnamon candy and a Razorback Magic Answer Ball, which is defective a large percent of the time. A fourth thing is dust … but don’t tell my mother.

• THE BEST ADVICE I EVER RECEIVED My mother told me I should not brag on myself when I think I do well because if I am good, others will do the bragging for me. I keep waiting to get some feedback.

• SOMETHING ABOUT ME THAT WOULD SURPRISE YOU In the sixth grade, I sang a solo of the Star Spangle Banner a capella in front of the entire school, and currently I am learning to crochet. So I guess that means I can hurt a person’s ears and eyes with my unexpected activities.

ARKANSAS HOSPITALS I Winter 2015

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NEWS

Spotlight:

Adopt Automated Solutions to Transform Accounts Payable Operations

The role of your hospital’s accounts payable (AP) department is to pay invoices on time and with accuracy. The time before payments are disbursed often is full of highly manual processes such as vendor validation, verification in procurement, confirmation of receipt of goods, verification of cash availability, check writing and other process controls. Consequently, a task seemingly so simple – paying bills – becomes the opposite of simplicity. The manual process sets bill payments forward in slow motion, incurring additional costs along the way.

A shift away from the manual AP business model is occurring, transitioning to a more modernday operation using technology and electronic, digital processes. As this shift happens, AP department goals of cost reductions, elimination of errors and improvement of timely payments become prevalent. While the movement toward a more efficient AP operation tends to be a slow process, the strategy behind automation in payments aims to bring significant value to healthcare institutions. A challenging step toward automating your hospital’s AP operation can be identifying end-to-end solutions that can fit to accommodate your organization’s goals today, with flexibility for tomorrow.

CommerceVantage™ is a comprehensive suite of AP solutions that redirects your hospital’s manual AP operation to an automated, cloudbased process. Discover ease in the modernization of invoice capture and approval workflow, plus payment 32

Winter 2015 I ARKANSAS HOSPITALS

optimization that simplifies and controls your payment processes. Enhanced from Commerce Bank’s founding AP solutions platform, ControlPay®, CommerceVantage™ offers innovative, complete solutions to streamline AHA member hospitals’ accounts payable processes and create new revenue for AP departments without changing current banking relationships.

CommerceVantage™ AP Card allows your AP department to capitalize on process efficiencies and generate monthly revenue share earnings by activating a secure payment program, utilizing the Visa® Network. Participating AHA member hospitals will earn a monthly revenue share based upon their spending level. Monthly revenue share is based on an aggregate volume from all Arkansas hospitals that participate in the Commerce Bank program. This flexible solution requires no software to host, and the Commerce Bank Vendor Enrollment team will actively contact and enroll vendors on your behalf.

With no cost to activate an AP card program, participating AHA hospitals can quickly and inexpensively experience a reduction in costs associated with AP. Your organization can also benefit from simple integration with your current ERP accounting system. Using electronic means to pay vendors can also assist in maintaining or improving payment terms.

A challenging step toward automating your hospital’s AP operation can be identifying endto-end solutions that can fit to accommodate your organization’s goals today, with flexibility for tomorrow.

CommerceVantage™ AP Automation fully modernizes your AP operation by simplifying invoice receipt and capture, approval workflow, coding and payment fulfillment by utilizing a single payment file. Your hospital’s AP department can eliminate paper invoice receipt, enhance process efficiencies and gain real-time visibility to your AP program and financial information, enabling your department to become more analytic in their function. In the shift toward AP analytics, it enables your AP

department to spend more time on strategic tasks such as spend analysis, reduce cycle times to capture discounts, influence buying decisions and optimize working capital overall.

Powered by Commerce Bank, a national leader in payments and revenue cycle management, CommerceVantage™ combines the latest in accounts payable technology and payment disbursement with an enduring commitment to effective account management. Commerce Bank’s dedicated in-house support teams work to help meet hospital goals and maximize efficiencies.

Commerce’s ongoing vendor enrollment service is essential to optimizing revenue share; this turnkey process also relieves hospital staff from the responsibility of contacting vendors.

Commerce Bank is a subsidiary of Commerce Bancshares, Inc. (NASDAQ: CBSH), a $22.7 billion regional bank holding company, as of September 30, 2014. For 150 years, Commerce Bank has been meeting the financial services needs of individuals and businesses and consistently ranked as one of America’s Best Banks

by Forbes Magazine. Commerce Bank provides a diversified line of financial services, including business and personal banking, wealth management, financial planning, and investments through its affiliated companies. Commerce Bank operates in more than 200 retail locations in the Central United States and has a nationwide presence in the commercial payments industry. Commerce Bancshares also has operating subsidiaries involved in mortgage banking, leasing, credit-related insurance, private equity and real estate activities.

For additional information about CommerceVantage™ or any other product endorsed by AHA Services, Inc., contact Tina Creel at tcreel@ arkhospitals.org.

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ARKANSAS HOSPITALS I Winter 2015

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NEWS

Hospitals Receive Awards for Safety Excellence Hospitals that have The AHA Workers’ Compensation Self-Insured Trust and Risk Management Resources presented nine hospitals with Safety Excellence Awards for the 2014 plan year in recognition of their outstanding efforts in implementing safety and loss control programs.

Hospitals that have been members of the trust for at least 5 years are eligible for the award based upon their cost containment accomplishments, as evidenced by a five year average loss ratio of less than 50 percent, as well as a five year average incident rate of less than 3.4 injuries per 100 full time employees. The 3.4 baseline for the

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award was set at 50 percent of the 2013 national injury and illness rate derived by the Bureau of Labor Statistics.

Congratulations to these leaders in workplace safety: • Arkansas Methodist Medical Center • Ashley County Medical Center • Chambers Memorial Hospital • Delta Memorial Hospital • Five Rivers Medical Center • Johnson Regional Medical Center • Magnolia Regional Medical Center • McGehee Hospital • Ouachita County Medical Center The AHA Workers’ Compensation SelfInsured Trust is a common self-insurer

been members of the trust for at least 5 years are eligible for the award based upon their cost containment accomplishments. fund for employers who are members of the Arkansas Hospital Association. Claims are administered on behalf of the trust by Risk Management Resources, a division of BancorpSouth Insurance located in Little Rock, Arkansas.

WHEN IT COMES TO YOUR PATIENTS’ HEALTH C ARE,

YOU HELP CALL THE PLAYS Encourage your patients to schedule important preventive care:

Blood pressure check Flu shot Cholesterol screening Colorectal cancer screening Mammogram Cervical cancer screening

Preventive care can detect problems early and help keep your patients healthy.

THIS MATERIAL WAS PREPARED BY THE ARKANSAS FOUNDATION FOR MEDICAL CARE INC. (AFMC) UNDER CONTRACT WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL SERVICES. THE CONTENTS PRESENTED DO NOT NECESSARILY REFLECT ARKANSAS DHS POLICY. THE ARKANSAS DEPARTMENT OF HUMAN SERVICES IS IN COMPLIANCE WITH TITLES VI AND VII OF THE CIVIL RIGHTS ACT. MP2-AMS.PREVHLTH.AD,4-12/14

ARKANSAS HOSPITALS I Winter 2015

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ANNUAL MEETING

Teaming Up for Care

COMMUNITY CONNECTION

AHA Annual Meeting Highlights Patient Engagement

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Winter 2015 I ARKANSAS HOSPITALS

The Arkansas Hospital Association’s 84th Annual Meeting and Trade Show focused on one of Arkansas hospitals’ primary priorities – engaging with patients to improve healthcare. Patients are being encouraged more than ever to partner with their providers for better care, and thanks to the Arkansas legislature’s continued funding of the Arkansas Private Option, more Arkansans than ever have the opportunity to access the healthcare system and become actively involved in improving their health.

Patient engagement also has been a central theme for the AHA’s ArbestHealth quality program in 2014.

AHA quality and patient safety staff have focused on this topic during their numerous hospital visits throughout the year. The ArbestHealth team also joined with national partners, the American Hospital Association and the Health Research and Educational Trust, to host two in-person seminars featuring national faculty.

The theme of the 2014 AHA Annual Meeting, “The Blueprint: Patients Partnering with Providers,” was a fitting reflection of the role that Arkansas hospitals, physicians, insurers and patients will play in the coming months and years. The meeting speakers offered thoughts and insights on these roles and how best to achieve this partnership.

Among other notable presenters, the meeting featured Dave deBronkart, known as “e-Patient Dave,” who offered an inspiring keynote address

The Annual Meeting offered plenty of opportunities to see old friends and make new ones. The AHA hopes everyone who attended the meeting left with a renewed sense of dedication to improving healthcare in Arkansas. sharing his experience in partnering with his physicians to treat his kidney cancer and becoming an “e-Patient.” Dave described the world of participatory medicine and urged all healthcare professionals to help patients become “empowered, engaged, equipped and enabled.”

Stephen Harden, Chairman and CEO of LifeWings Partners LLC, offered quality and patient safety leaders best practices from aviation and other high reliability industries to transform their healthcare organizations. The meeting also featured sessions on managing

competence and performance through technology and a workshop on using communication tools to increase employee engagement and create a culture of collaboration.

In addition to education, the Annual Meeting offered plenty of opportunities to see old friends and make new ones.

The AHA hopes everyone who attended the meeting left with a renewed sense of dedication to improving healthcare in Arkansas. Please make plans to attend next year’s Annual Meeting, which will take place at the Little Rock Marriott October 7 – 9, 2015

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Neta Sue Stamps (left), a member of the Mercy Hospital Berryville auxiliary, received the AHA’s 2014 Distinguished Service Award from Kristy Estrem (right), President of Mercy Hospital Berryville. In his nomination of Ms. Stamps, Cody Qualls, executive director of Mercy Health Foundation Berryville, said, “She serves others before herself and is a perfect example of both the love of Christ and perfect, compassionate care.”

Barbara G. Williams, Ph.D., R.N. (left), a member of the Conway Regional Health System’s Board of Trustees, was presented with the 2014 Arkansas Hospital Association Chairman’s Award by AHA Chairman of the Board, Doug Weeks. Dr. Williams was honored for her outstanding representation of hospital trustees at both the state and national level.

Steven Webb, FACHE, vice president of patient services at Baptist Health Medical Center-North Little Rock (BHMC-NLR), was named by the Arkansas Health Executives Forum as the C. E. Melville Young Administrator of the Year Award.

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Arka Hosp Assoc Award

ansas pital ciation ds 2014

Sharon Sly (right), immediate past president of the Arkansas Hospital Auxiliary Association, presents Robert Rupp, CEO of Harris Hospital, with the AHA’s Administrator of the Year Award for Hospitals Over 100 Beds. Leslie “Bubba” Arnold (not pictured), administrator/CEO of CHI St. Vincent Morrilton, was awarded the Administrator of the Year Award for Hospitals Under 100 Beds.

Melanie Edens (left), radiology director at NEA Baptist Memorial Hospital in Jonesboro, was presented with the Arkansas College of Healthcare Executives Early Healthcare Career Award by Chris Barber, Arkansas’s ACHE Regent.

Edward L. Lacy, FACHE, vice president and administrator of Baptist Health Medical Center-Heber Springs, received the Arkansas College of Healthcare Executives Senior Healthcare Career Award.

ARKANSAS HOSPITALS I Winter 2015

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ANNUAL MEETING

Arkansas Hospital Association Trade Show 2014 The Arkansas Hospital Association offers its sincere thanks to Anna Sroczynski, AHA Trade Show Director, and all of the outstanding sponsors, exhibitors and attendees who made the 2014 AHA Trade Show our most successful show to date. Special appreciation goes to the corporate sponsors of this year’s Annual Meeting, listed below in red.

360 Degree Medicine AAMSCO Identification Products ACE Sign Company Administrative Consultant Service, LLC Advanced ICU Care AHA Services, Inc. AHA Workers’ Compensation Self-Insured Trust Airgas, LLC American Consultants API Healthcare Archway Graphic Designs ArCom Systems Arkansas Association of Hospital Trustees Arkansas Blood Institute Arkansas Blue Cross Blue Shield Arkansas Foundation for Medical Care Arkansas Health and Wellness Solutions Arkansas Health Executives Forum Arkansas Trauma Education and Research Foundation ARORA BancorpSouth Insurance Services, Inc.

BKD, LLP Bottom Line Systems, Inc. careLearning Cedar Bridge Program Cerner Corporation Chem-Aqua, Inc. Clark Contractors Commerce Bank Commercial Sales & Service Community Hospital Corporation Compdata Surveys & Consulting CoreSource Correct Care, Inc. CPSI CPSI Business Services DivisionTruBridge Crews & Associates, Inc. Cromwell Architects Engineers DeRoyal Industries DMI Solutions, Inc. DocuVoice, LLC Dow Building Services EmCare, Inc. Emergency Staffing Solutions

MARK YOUR CALENDARS Mark your calendars now to join us for the 2015 Trade Show on October 8, 2015 at the Statehouse Convention Center in Little Rock.

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Engelkes & Felts, CPAs Evo Healthcare Environments EXIT Marketing EZ Way, Inc. Florida Hospital Association Management Corporation/Denial Management Services Friday, Eldredge & Clark, LLP Fukuda Denshi G & K Services Hagan Newkirk Financial Services Harding University MBA Program HBE Corporation HEALTHeCAREERS Network Heartland Bank Heartland Medical Sales and Services Hewlett Packard Enterprise Services Arkansas Medicaid Hill-Rom HKS Architects Hughes, Welch & Milligan, LTD Humanscale Ink Custom Tees, Inc. iVantage Health Analytics

LHC Group Liberty Mutual Insurance LifeLinc Anesthesia LifeShare Blood Centers Masimo McCarthy Building Companies, Inc. MCG Health, LLC McNeary, Inc. Meadors Adams & Lee, Inc. Medical Protective Company Merritt Hawkins, An AMN Healthcare Company Nabholz Construction Services Polk Stanley Wilcox Architects Powers of Arkansas Press Ganey Professional Credit Management Provista Publishing Concepts, Inc. Radiology Associates, P.A. RazorInsights Resource Interiors Robins & Morton School & Office Products of Arkansas, Inc. Shannon Specialty Floors SHARE/Office of Health Information Technology Signet Health Corporation SimplexGrinnell Sleep Management Services South Carolina Hospital Association/SCHR Southeast Imaging Southern Paramedic Service STL Communications, Inc. Stryker Medical TeamHealth TEG Architects TeleHealth Services Teva Select Brands The Medicus Firm The Right Solutions Trammell Piazza Law Firm, PLLC Triple-S Alarm Co., Inc. UAMS Center for Distance Health University of Arkansas at Little Rock MBA Program USDA Rural Development Valley Services, Inc. Verizon Wireless Vision Service Plan Voice Products, Inc. WD & D Architects Zebra Technologies International, LLC

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SEE YOU NEXT YEAR

Arkansas Hospital Association’s 85th Annual Meeting & Trade Show October 7-9, 2015 Little Rock Marriott

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LEGISLATIVE ADVOCACY

After Historic Election, Arkansas Prepares for Legislative Session

By Jodiane Tritt, Vice President of Government Relations, Arkansas Hospital Association While every election is unique, the results from the November 4, 2014, elections are historic for Arkansas. For the first time in 141 years, Arkansas has elected all Republicans to represent her citizens at the United States Capitol and has elected Republicans to each of the state’s constitutional offices, too. In the state Capitol, the Senate will now be composed of 24 Republicans and 11 Democrats, and the House of Representatives will be comprised of 64 Republicans and 36 Democrats. Republicans won 29 of the 38 contested races in the state House of Representatives, which was a gain of 13 seats over the previous legislature.

The Arkansas Hospital Association is politically active, but it is not partisan.

In fact, the numbers that are most important for the AHA are 27 of 35 senators and 75 of 100 representatives.

Those are the numbers of votes required in each chamber to continue to appropriate funding for the Arkansas Private Option (APO). In the Senate, 22 returning members voted in favor of the APO appropriation in the 2014 Fiscal Session. In the House, only 44 incumbents who supported the APO were reelected. Nine incumbents who voted for the APO were defeated in House races. In fact, there will be 40 brand new members of the House of Representatives and, after the special election to replace former Senator Michael Lamoureux who

resigned from the Senate to serve as Governor-Elect Asa Hutchinson’s Chief of Staff, five new members in the Senate.

With 45 new state legislators who need to be brought up to speed quickly about hospital concerns, coupled with the requirement of a super majority vote for most appropriations, including continued APO funding, it is more important than ever that supporters of Arkansas’s hospitals be engaged in legislative advocacy.

SETTING THE AHA’S LEGISLATIVE AGENDA

The AHA’s legislative agenda is not set lightly, nor is it done in a vacuum. In fact, AHA prepares for each legislative session through many hours of preparation after requesting input from hospitals

throughout the state. The AHA Board of Directors manages the process for vetting legislative proposals.

The chairman of the AHA Board of Directors appoints members to the Council on Government Relations, which meets in the fall of even-numbered years to consider the legislative agenda for the session that will begin the following January.

This Council is responsible for reviewing copious amounts of materials assembled

by AHA staff, discussing the pros and cons of particular positions and recommending a legislative package – in order of priority – to the Board of Directors for approval.

Because the AHA’s job is to represent the entire hospital industry, diversity is key when choosing members of the Council on Government Relations. The chairman ensures that hospital CEOs appointed to the Council represent hospitals in each geographic district of the state as well as the various sizes and types of facilities that the AHA is fortunate to represent.

This year, the Council met on November 7, 2014, and the AHA Board of Directors heard the recommendations from the Council and established the AHA legislative package at its meeting on November 14, 2014.

PRIVATE OPTION IS JOB ONE

It is no surprise that maintaining the Arkansas Private Option is the highest continued on page 46 ARKANSAS HOSPITALS I Winter 2015

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2014 Council on Government Relations Kristy Estrem, Chair

Mercy Hospital Berryville

Chad Aduddell

CHI St. Vincent Infirmary

Scott Barrilleaux

Drew Memorial Hospital

Buddy Daniels

Helena Regional Medical Center

David Deaton

Ozark Health Medical Center

Vincent Leist

North Arkansas Regional Medical Center

Jerry Mabry

National Park Medical Center

Jason Miller

The BridgeWay

Jack Mitchell

HEALTHSOUTH Rehabilitation Hospital of Fayetteville

Ray Montgomery

White County Medical Center

Brad Parsons

NEA Baptist Memorial Hospital

Eric Pianalto

Mercy Health System of Northwest Arkansas

Kyle Swift

Medical Center of South Arkansas

Bob Trautman

Saline Memorial Hospital

Doug Weeks

Baptist Health

priority for the Arkansas Hospital Association. The data supporting continuation of the APO is staggering.

Not only has the APO helped to offset at least a small portion of the federal payment cuts hospitals are enduring, it also is allowing more than 200,000 of our fellow Arkansans to have insurance and be able to pay for the medical care they need.

Arkansas has been spotlighted throughout the country for its innovative approach to caring for its uninsured population. The AHA will provide essential data and information to the new Governor and lawmakers throughout Arkansas’s 90th General Assembly, which convenes on January 12, 2015. But for an initiative as important and controversial as the APO, it is more important than ever to engage in advocacy efforts at home and at the Capitol. Hospital representatives,

particularly each hospital CEO, will need to provide data about the APO’s impact on your facility and in your community in order for Arkansas’s elected officials to have a full picture of what the APO means to the healthcare community and – most importantly – the patients whom hospitals serve.

The AHA also participates with other healthcare partners to either enact legislation that promotes a better system or to keep bad legislation from adversely affecting patient care. Other initiatives in our legislative package include supporting ongoing efforts to

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Winter 2015 I ARKANSAS HOSPITALS

HOSPITAL ADVOCATES ARE KEY

During the session, AHA advocacy and legal staff review each bill filed to determine the impact on hospitals and healthcare, then diligently strive to ensure the passage of only those bills that help the healthcare community serve its patients better. In the 2013 session, there were more than 1,500 Acts passed by the 89th General Assembly, and if history continues on its current trajectory, the 2015 session will yield close to the same.

AHA staff remain hopeful that data will drive the decision-makers to continue to support hospitals and the healthcare system. Advocates from each hospital must join AHA’s efforts to educate elected officials, community leaders, neighbors and friends on the proposed measures that will impact our facilities. Success is possible only through working together to support hospitals and patients.

Become a hospital advocate by accessing voterVOICE, the Arkansas Hospital Association’s grassroots action center at https://votervoice.net/ARHA/home and signing up for email alerts to stay up-to-date on legislative developments during the session and throughout the year.

AHA Services, Inc................................................Our 5 CDI Contractors, LLC............................................ 7 Our Advertisers, Friends Arkansas Blood Institute.................................... 43 Crews & Associates........................................... 21

Administrative Consultant Services, LLC..... 372 Arkansas Blue Cross Blue Shield..........................

AmericanFoundation Esoteric Laboratories....................

Arkansas for Medical Care................ 385 Arkansas Health Inc......................................

Networks................................. 21 18 AHA Services, Arkansas 25 ArkansasRelay..................................................

Blood Institute............................. 16 BKD, LLP............................................................

Arkansas Blue Cross Blue Shield...................312 Arkansas Department of Human Services... 34 Arkansas Foundation for Medical Care........ 35

enact meaningful tort reform, working with a variety of partners on legislation to allow community paramedics to receive compensation for appropriate work, opposing legislation that would add additional administrative burdens on hospitals without improving patient care, and ensuring that funding streams that must be authorized by the General Assembly for healthcare remain viable.

BKD, HaganLLP....................................................

Newkirk Financial Services, Inc................ 41 35 Crews LLP......................................................... & Associates................................... 14 Horne, 47 Hughes, Welch & Milligan ................................... 11 16 DOW Environmental Services.....................

Jay S. Stanley & Associates. ..............................

23 Hagan Newkirk Financial Services, Inc........ 43 The Midland Group............................................. 33 16 Harding University......................................

Mitchell Williams........................................ 44 Nabholz Construction Services.................... 48

Nabholz Construction Services........................... 48 Polk Stanley Wilcox............................................ 24 Polk StanleyVillage.

Wilcox. ................................... 33 Presbyterian ...........................................

31 RadiologyKrug, Associates, P.A...........................

Ramsey, Farrell & Lensing. ......................... 41 33 Southeast Imaging.............................................

40 Ramsey, Krug, Farrell & Lensing.................. 29 Stephens 45 Southern Insurance, ParamedicLLC....................................

Service....................... 29 WD&D 33 Welch,Architects...............................................

Couch & Company, PA..................... 16

William Marshall, Health Care Attorney...... 47

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

WILLIAM (BILL) MARSHALL HEALTH CARE ATTORNEY Contact Bill Marshall at Mitchell Blackstock Ivers Sneddon Marshall PLLC

501-378-7870

bmarshall@mitchellblackstock.com Bill’s first job after completing his education in 1974 was at the corporate headquarters of Hospital Corporation of America (HCA) in Nashville, Tennessee.

Bill has a BSBA in Accounting, an MBA, and a Juris Doctorate from the University of Arkansas all with honors. He is also a CPA (Inactive). After leaving HCA in 1981, Bill has practiced law in Little Rock, Arkansas, representing hospitals and other healthcare providers.

Bill has extensive experience in complex issues inherent in healthcare laws which affect hospitals. He provides representation related to transactions such as the purchase or sale of healthcare facilities and also the purchase of physician practices and the formation of physician hospital joint ventures. Bill also provides representation related to resolution of Medicare and Medicaid reimbursement disputes, development of hospital compliance policies, development of HIPAA compliance policies, compliance with the Stark and Anti–Kickback statutes, tax-exempt matters for nonprofit hospitals, development of PHO’s, Clinically Integrated Networks and ACO’s, and compliance with other laws which regulate hospitals. Bill Marshall has represented hospitals for 40 years.

ARKANSAS HOSPITALS I Winter 2015

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Arkansas Hospital Association 419 Natural Resources Drive Little Rock, AR 72205

Presorted Standard

U.S. Postage Paid Little Rock, AR Permit No. 2437

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Winter 2015 I ARKANSAS HOSPITALS