SUMMER 2021
PRICE TRANSPARENCY:
What it means for Hospitals, Health Plans, and Consumers
F E AT U R E S
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4 At Large, District 4 Regent’s Messag Stephen Davis
ACHENTX Adopts New Diversity, Equity & Inclusion Statement
5 Texas – Northern Regent’s Message Dr. Trinette K. Pierre
8 COVID-19’s Mental Toll
23 Ajith Pai, PharmD, FACHE 24 Event Encore 36 National News 38 Membership Annoucements 40 Calendar of Events
14 Price Transparency
20 The Professional Impact of the ACHE Credential
Editors
Marty Heath, FACHE Tom Peck, FACHE Vanessa Lee
Contributing Writers
Marty Heath, FACHE Tom Peck, FACHE Ajith Pai, FACHE Melinda Schmidt, MBA, RN Kean Villarta Byron Westbrook
Creative Direction
Caleb Wills, calebsemibold.com
Advertising/ Subscriptions
info@achentx.org
Questions and Comments: ACHE of North Texas Editorial Office, c/o Executive Connection 300 Decker Drive, Suite 300 | Irving, TX 75062 p: 972.413.8144 e: info@achentx.org w: achentx.org 2021 Chapter Officers President
Amanda Thrash, FACHE, VP of Professional
& Support Services, Texas Health Plano
President Elect
Dustin Anthamatten, FACHE, VP of
Operations, Methodist Charlton
Medical Center
Immediate Past President
W. Scott Hurst, FACHE, CEO & President,
Patient Physician Network
Secretary
Nancy Vish, President, Baylor Heart
& Vascular Hospital
Treasurer
Felixia Colón, FACHE, Senior Vice President
& Group Operations Officer, SCP-Health
Kyle Armstrong, FACHE, Chief Operating Officer, Baylor University Medical Center David Berry, FACHE, President Strategic Capital Projects, Children’s Health Aaron Bujnowski, FACHE, Director (Partner) & IDN Practice Area Lead, The Chartis Group Jaquetta Clemons, FACHE, Vice President, Finance/CFO – Shared Service, Baylor Scott & White Health Stephan Davis, FACHE, MHA Director and Assistant Professor, University of North Texas Health Science Center Fraser Hay, FACHE, President, Texas Health HEB Hospital Carolyn Hunter, Chief Operating Officer Medical City Las Colinas Valerie Johnston, FACHE, Associate Professor, Texas Christian University Thomas Peck, FACHE, President, Tom Peck Communications Trinette Pierre, FACHE, Executive Consultant/Advisor, Career Consultant, Professor & Unit Mgr, TRImani Consulting, LLC/Parkland Health & Hospital System Jared Shelton, FACHE, President, Texas Health Presbyterian Hospital Allen Benton Sprayberry, FACHE, Senior Director of Operations, Steward Health Care
The ACHE of North Texas e-magazine, The Executive Connection, is published triannually and includes information on the latest regulatory and legislative developments, as well as the quality improvement and leadership trends that are shaping and influencing the healthcare industry. Readers get indepth reporting on the issues and challenges facing hospital and health system leaders today. We make it our job to tell you about the great things the organization and Chapter are doing every day to ensure the health of our community. If you have any news and updates that you want to share with other members, please e-mail your items to info@northtexas.ache.org. Microsoft Word or compatible format is preferable. If you have a graphic or picture that you'd like to include, please send it as a separate file. The following are the types of information that our members shared in past ACHE of North Texas magazines, Advocacy Issues, Legislative Issues, Educational Opportunities, Awards / Achievements, Promotions (Members On the Move), Committee Updates, journal submissions, conference submissions, and workshop participations, sharing mentoring experiences, etc.
Keith Thurgood, Professor, UT-Dallas
Message from Our ACHE Regent At Large, District 4 the course. One by one, we are increasing the diverse representation of individuals who hold one of the most prestigious and coveted credentials in healthcare, and the mark of distinction in the field of healthcare management.
Dear Colleagues, I hope you all remain safe and well as you continue to lead our organizations amid the pandemic. After such a challenging year, and as we begin to see glimmers of light at the end of a continuing tunnel, it has been wonderful to connect with ACHE of North Texas members in-person over the summer. As I shared at the ACHE of North Texas networking blitz, this is such an exciting time to be a part of work related to diversity, equity, and inclusion at ACHE. At the national level, ACHE has made diversity a constant priority with three key aims – to increase the diversity of our membership, to increase the diversity of our fellows, and to retain diverse members and fellows. As a fellow and faculty member of ACHE, and as Regent-at-Large for ACHE District 4, a role created to foster diversity in the governance of ACHE, I am honored to be a part of this work.
To know that we are making measurable progress in this space is humbling, inspiring, and encouraging. And yet, we know that so much more needs to be done. Until there is truly equitable access to advancement opportunities for all members of historically underrepresented and excluded groups, and until the vision that we all feel included and experience belonging is translated into reality, we know that we have significant work to do. I am proud to do this work with the members, fellows, and leaders of ACHE of North Texas.
Sincerely, One initiative that has been particularly special for me to be a part of over the past year is ACHE’s offering of the virtual Board of Governors (BOG) examination review course. This new educational program occurred as a result of the pandemic. Serving as ACHE faculty and teaching nine of the ten BOG exam knowledge areas for hundreds of ACHE members striving to achieve fellow designation has been one of the greatest honors of my career. I am proud to report that not only are our course participants diverse, but we have also seen healthcare leaders from historically underrepresented and excluded groups achieve success in attaining fellow designation following completion of
Stephan Davis, DNP, MHSA, FACHE MHA Director and Assistant Professor Chair – Diversity, Equity, and Inclusion Committee UNT Health Science Center, School of Public Health Regent-at-Large, ACHE District Four Immediate Past Chair, ACHE LGBTQ Healthcare Leaders Community LinkedIn: Linkedin.com/in/DrStephanDavis
ACHENTX Adopts New Diversity, Equity & Inclusion Statement After months of thoughtful discussion, internal and external research, and active listening, the board of directors of ACHENTX approved the chapter’s new Diversity, Equity & Inclusion statement. The statement, posted on the chapter’s website, reads as follows:
As the area’s leading professional association dedicated to advancing the field of healthcare leadership, ACHE of North Texas strives to be a model of diversity and inclusion. Our members will embrace, value, and respect the power of diversity in all its forms, while holding each other accountable to these values as described in the ACHE Code of Ethics. We are steadfastly committed to supporting our members in advocating for diversity and inclusion in their organizations. We passionately speak out against any action or speech that degrades, diminishes, or devalues a person based on ethnicity, race, sex, gender identity and expression, sexual orientation, age, physical or mental ability, or religious beliefs. We embed these values into the fabric of our organization through our intentional selection of leaders, our focus on listening and open communication, our attention to the content of our educational offerings, and our dedication to community outreach.
The statement was developed through the collaborative efforts between an ad hoc committee of the board and the DE&I Committee. “ACHE of North Texas Board is committed to being at the forefront of change when it comes to establishing a diverse, equitable and inclusive culture in healthcare,” says Amanda Thrash, ACHENTX president. “As healthcare leaders, we have a responsibility to take these words and put them into action for the benefit of our patients, employees and the North Texas community.” ”This statement is an impactful step in ensuring we build and sustain an environment that embraces all of our members,” says Jennifer Clark, chair of ACHENTX’s Diversity, Equity and Inclusion Committee. “To stand firmly on the importance of diversity, equity, and inclusion while cultivating today’s healthcare leaders, we can shift the healthcare landscape.” A separate DE&I page on the chapter’s website will elaborate on components of the statement and the chapter’s efforts to deliver on the values espoused in the statement. The chapter is also developing an action plan that will monitor the progress toward achieving overall DE&I goals.
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Message from Our ACHE Regent, Northern Most Beloved ACHE Colleagues, I pray this message finds you all healthy, safe, and productive. Can you believe we’ve already closed the books on half of 2021? During the first half of the year, we’ve experienced the spectrum of highs and lows. The trials have hopefully made us stronger. The triumphs should have made us hopeful. In-person learning and networking, recreational events, and office-based working are back on many of our agendas. COVID vaccinations have been administered to many. Others are still deciding if the choice of being vaccinated is an appropriate option for their families. We’ve heard debates on both sides of the argument related to vaccine hesitancy, yet the science continues to prove vaccinations help keep our communities alive. In the midst of this ongoing debate, we as healthcare leaders are tasked with a very important assignment: Promoting healthier communities by lessening the effects of this horrible disease. How do we do so? Practice – Praise – Patience. Practice – Healthcare leaders are viewed as experts in all things COVID. Our communities, families, friends, and coworkers look to us for guidance and valid information regarding the vaccine and how it affects human bodies. While we can advise on evidence-based outcomes related to the COVID vaccine, our talk amounts to very little if we do not practice what we preach. We must ensure our families and we ourselves are vaccinated to decrease the potential of our frontline team members who must put themselves in harm’s way to care for COVID-diagnosed patients. We are the first line of defense; therefore, we must act as leaders and ensure we are leading by example by getting the
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vaccine – if not for ourselves, for our loved ones and those who are tasked with rendering care to our COVID patients. Praise – Please continue to give open praise to those in your communities and in your organizations who have received the vaccination. While we may not be able to give monetary prizes and gifts to those who have received the vaccine, we can continue to be cheerleaders for those who have done so. Using simple methods, such as posting “I got my 2nd dose” compliance pictures and videos on social media and sending emails thanking your team members who complete the vaccination process, go a long way to promote compliance. I’ve used this practice and it has worked to boost compliance in my family and within my organization. Patience – While we as healthcare professionals and leaders know the importance of getting the COVID vaccine, there are many in our circles who may not feel comfortable for various reasons. This includes some who work in healthcare organizations. I must admit, my immediate response was to lash out at these individuals while reminding them they are putting me and my team at risk. Thankfully, I was reminded by a still, small voice, that people are afraid of what they do not know and what I relayed had to be conveyed in love. I began by gently but efficiently educating those in my professional and personal circles, as well as those I encountered in stores who happened to see my ID badge or my hospitalbranded mask who stopped me to ask about the vaccine. I
A Publication of the American College of Healthcare Executives of North Texas Chapter | SUMMER 2021
relayed the importance of receiving the vaccine and how it could save their families not only from loss, but from long-term bodily harm the virus has been proven to cause. The old adage, “you can catch more bees with honey…” proved to be true. Many agreed to get the vaccine. Others are still contemplating and “researching.” The takeaway is that we must remember we have a unique vantage point regarding the pandemic and COVID-19; therefore, we must be patient with others who may not understand the importance of vaccination. Be patient, but also be vigilant and diligent in educating our communities and loved ones. As I close, I want to remind us all to please be champions and living examples of diversity, inclusivity, and equity in action. As a community, we rely on one another for survival. Limiting ourselves to those who look like us, think like us, worship like us, and believe like we do robs us from the beautiful experience that results from embracing all the wonderful people around us. Please ask yourselves how you can change your practice to promote diversity, equity, and inclusion in your professional and personal lives. Take steps to support and promote better inclusivity and give a more resonating voice to those who, if heard, may change our world for the better. Remember, we may not all agree, but we all should respect. As always, I must remind you to take care of yourselves in the midst of caring for others. Our families, communities, friends, and loved ones need us. Our patients need us. Our teams need us. We must ensure we’re caring for ourselves to ensure we have the physical, mental, and spiritual strength needed to care for others. Remember to Take care of YOU. Thank you for all you do for our communities and for ACHENTX. We’re blessed to have you as a part of our lives. Be blessed and be safe. Dr. Trinette K. Pierre, DHA, BSN, RN, CCC, CEC, CHLC, FACHE, NEA-BC Regent – Texas Northern
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As this issue of ACHENTX’s newsletter goes to the designer, the Delta variant of COVID-19 is wreaking havoc on North Texas healthcare facilities and area healthcare workers. While organizational infrastructures are being stretched beyond capacity, caregivers are suffering tremendous mental anguish, resulting in some requesting transfers and others simply walking away from their careers. The fallout for the latest surge is dire for North Texas hospitals and health systems – hundreds of nursing and respiratory therapy vacancies, jeopardizing the ability of those organizations to provide appropriate care and compromising the quality of care that is being provided. How bad are the mental health implications of COVID-19 on healthcare professionals? Consider these recent findings: • In the UK, the University of York and the Mental Health Foundation conducted a global review of studies that revealed hospital workers dealing with COVID patients had high levels of depression, PTSD, anxiety and burn-out as well as other physical health problems. The review also verified that children and adolescents are struggling with a host of mental health issues during the pandemic. • Mental Health America (MHA) pointed out that while many throughout the U.S. are coping with the fear and uncertainty of COVID-19 from their homes, essential workers, including healthcare workers, must expose themselves to the virus every day. Healthcare workers are also experiencing conditions that have been compared to a war zone, continuously witnessing the direct effects of the pandemic as it spreads throughout communities. • From June-September 2020, MHA conducted a survey to listen to the experiences of healthcare
workers during COVID-19 and to create better resources to help support their mental health as they continue to provide care. More than 1,100 healthcare workers responded to the survey. Here’s what they said: o Stressed out and stretched too thin: 93 percent of healthcare workers were experiencing stress, 86 percent reported experiencing anxiety, 77 percent reported frustration, 76 percent said they were exhausted and burned out, 75 percent said they were overwhelmed. o Worried about exposing loved ones: 76 percent of healthcare workers with children reported that they were worried about exposing their child to COVID-19, nearly half were worried about exposing their spouse or partner, and 47 percent were worried that they would expose their older adult family members(s). o Emotionally and physically exhausted: Emotional exhaustion was the most common answer for changes in how healthcare workers were feeling over the previous three months (82 percent),
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followed by trouble with sleep (70 percent), physical exhaustion (68 percent), and workrelated dread (63 percent). Over half selected changes in appetite (57 percent), physical symptoms like headache or stomachache (56 percent), questioning career path (55 percent) compassion fatigue (52 percent), and heightened awareness or attention to being exposed (52 percent). Nurses reported having a higher exposure to COVID-19 (41 percent) and they were more likely to feel too tired (67 percent) compared to other healthcare workers (63 percent). o Not getting enough emotional support: 39 percent of healthcare workers said they did not feel like they had adequate emotional support. Nurses were even less likely to have emotional support (45 percent). o Struggling with parenting: Among people with children, half reported they are lacking quality time or are unable to support their children or be a present parent.
ACHENTX asked local behavioral health expert, Loren Fouch, LCSW, LCDC, CEO of Millwood Hospital in Arlington, to explain the challenges local healthcare professionals are facing as a result of COVID-19. ACHENTX: Frontline healthcare workers have had a very traumatic year and a half. What should their leaders know about PTSD and its impact on morale, productivity and turnover? Fouch: First, it’s important for healthcare leaders to know that Post Traumatic Stress Disorder (PTSD) is a psychological disorder that is a progression, it doesn’t always exhibit itself overnight. The condition is a response to trauma or threat, real or perceived. Because PTSD is not temporary, it interferes with everyday life and personal relationships, it can’t just be turned off. Leaders need to know that it can impact performance at work, such as an increase in medical errors, calling in sick more frequently, increasing dread of coming into work. They need to recognize these signs and encourage impacted employees to reach out for available support resources. If leaders don’t effectively respond to PTSD among employees, their organizations are likely to experience higher turnover. In short, employers that can’t or won’t protect workers from mental stressors risk losing those employees. According to the National Institute of Mental Health, there are several symptoms of PTSD that employers should be aware of:
• Re-experiencing symptoms: flashbacks, bad dreams, frightening thoughts. • Avoidance symptoms: staying away from places, events, or objects that are reminders of the traumatic experience, avoiding thoughts or feelings related to the traumatic event • Arousal and reactivity symptoms: being easily startled, feeling tense or “on edge,” having difficulty sleeping, having angry outbursts • Cognition and mood symptoms: trouble remembering key features of the traumatic event, negative thoughts about oneself or the world, distorted feelings like guilt or blame, loss of interest in enjoyable activities. ACHENTX: What’s burnout and compassion fatigue? Fouch: In today’s clinical environment you often hear the terms burnout and compassion fatigue. Burnout is an emotional state and more transitory than PTSD. The World Health Organization defines occupational burnout as a syndrome resulting from chronic work-related stress, with symptoms characterized by “feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.” According to Psychology Today, compassion fatigue, also known as secondary or vicarious trauma, occurs among people who have long exposure to other people’s trauma. The more individuals such as healthcare workers, open themselves up to other’s pain (empathy), the more likely they will come to share those victims’ feelings of heartbreak and devastation. This sapped ability to cope with secondary trauma can lead to total exhaustion of one’s mental and physical state. Symptoms of compassion fatigue can include exhaustion, disrupted sleep, anxiety, headaches, stomach upset, irritability, numbness, a decreased sense of purpose, emotional disconnection, selfcontempt, and difficulties with personal relationships.
Leaders need to acknowledge that all staff throughout the organization are under stress. They should be visible to employees in their work areas and continually express thanks and gratitude for the job they are doing. This can be verbal or tangible such as gift cards, a free meal, etc. Extending thanks to vendor partners is also important to boosting morale. ACHENTX: What can health system leaders do to address burnout and PTSD with their teams? Fouch: First, acknowledge their feelings allowing themselves as leaders to be vulnerable Validate their emotions and reassure them they are not alone. Create an environment where it’s OK to not be OK. Make them aware of the resources the organization has available to them and provide those resources to them. Communicate regularly about the full menu of Employee Assistance Program services. Emphasize the importance of self-care and provide tips on how to do it. Be encouraging to staff at all levels of the organization. Set healthy boundaries, model appropriate self-care behaviors. De-stigmatize seeking behavioral health treatment. Help employees understand the full continuum of behavioral health services from inpatient and outpatient care to support groups, family therapy, and more. ACHENTX: What’s the best advice you can give to healthcare leaders as they strive to care for their employees during the pandemic? Fouch: Take care of yourself so you can take care of your staff. You can’t be there for staff if you’re not resilient yourself. Set the example – this is how I take care of myself when I’m stressed or feeling traumatized.
ACHENTX: The burden of responding to the pandemic hasn’t been limited to frontline staff. How has it impacted staff in other parts of the healthcare system? Fouch: PTSD and burnout are prevalent throughout the healthcare infrastructure. Stress is on the system at all levels. Environmental services staff have been stressed about cleaning entire facilities, both patient care areas and staff areas because of their deep sense of responsibility to keep everyone safe. Administrators have experienced stress related to not being able to provide the necessary resources for caregivers and for patients due to supply chain issues.
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On January 1, 2021, the Healthcare Price Transparency
How transparency affects hospitals
Rule became law under the statutory authority of the
The Healthcare Price Transparency regulation applies to all hospitals in the U.S. and requires them to post, as of January 1, 2021, information about five types of charges -- gross charges, payer-specific negotiated charges, de-identified minimum negotiated charges, de-identified maximum negotiated charges and discounted cash prices. This goes well beyond the previous rule that required hospitals to post their chargemasters, a hospital-generated list of prices that bear little relation to what it costs a hospital to provide care and that few consumers or insurers actually pay.
Patient Protection and Affordable Care Act (ACA). The Rule is rooted in an executive order on healthcare price and quality transparency that was issued in June 2019. The move was part of a larger push to use price transparency to curtail price increases and enable patients to compare the cost of services when making healthcare decisions.
The rule requires posting pricing for 70 CMSspecified services and at least 230 additional services in two formats, a machine-readable file (a format easily processed by computers), and a shoppable services file that enables consumers to compare prices and shop for lower-cost options. If a posted service is considered a bundled service, the posted price must reflect all costs involved, from the hardware used to the operating room time, to drugs given and the fees of hospital-employed physicians.
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A Jan. 21, 2021, article in recycleintelligence.com, “Not All Hospitals Complying with New Price Transparency Rule,” reports on a study which found that hospitals are struggling to comply with the new requirements of the CMS regulation. In fact, the study revealed inconsistent and incomplete pricing information on the websites of the 20 largest hospitals in the U.S., according to number of beds. Most notably, while all 20 hospitals published some type of pricing information, some failed to show pricing information of 300 shoppable services. Other common compliance issues identified by the analysis included data not being able to be downloaded in a usable format, hospitals not providing Healthcare Common Procedure Coding System (HCPCS) codes for services, and variability in hospital terms for the pricing information. The study’s authors said, “While transparency in hospitals’ pricing may be beneficial to the average consumer and healthcare researchers, the implementation of this policy by hospitals has many hurdles to overcome before it can be useful.”
How transparency will affect health plans Beginning Jan. 1, 2022, the regulation will expand to include price transparency requirements for self-funded group health plans, group and individual health insurance coverage, and health insurance issuers in the individual and group markets. The rule phases in specific compliance requirements for payers: • Public Rate Files (in-network rates, out-of-network rates, pharmacy medication rates) must be posted by Jan. 1, 2022 • An Online Consumer Tool that enables members to search by code, term or provider and receive the provider-specific negotiated price, accumulator balances and estimated cost sharing covering in-network, out-of-network, and pharmacy rates for 500 services must be posted by Jan. 1, 2023 • An updated Online Consumer Tool that covers all services must be posted by Jan. 1, 2024.
“While transparency in
hospitals’ pricing may be beneficial to the
average consumer and
Assuring compliance and avoiding the costs of non-compliance for hospitals
healthcare researchers, the implementation of this
Regulators have begun auditing hospital websites to see if mandated machinereadable files and consumer shoppable files, each containing the required information, have been posted. Regardless of the challenges presented to hospitals to comply with the rule, CMS has outlined specific penalties they may levy against healthcare organizations that do not comply: • Letter to non-compliant hospital or health system detailing the non-compliance with a request for a corrective action plan. • $300 per day penalty for non-compliance. • Escalating monetary penalties for continued noncompliance. • Reporting non-compliant hospitals and health systems on the CMS website. • Ceasing Medicare payments for services levied against flagrant non-compliant facilities.
policy by hospitals has many hurdles to overcome before it can be useful.”
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The three public rate files must be in machine-readable format and updated monthly. The in-network rate file must include plan ID, provider ID, medical code, Place of Service (POS) code and negotiated rate for each service. The out-of-network file must include the same identifiers as the in-network file, plus billed charge and allowed amount. The pharmacy file must include identifiers for pharmacy, national drug code (NDC), negotiated rate, and net discounted price.
Assuring compliance and avoiding the costs of noncompliance for health plans Healthcare Bluebook, developer of an online tool that enables consumers to find the best prices for healthcare services, reports enforcement of the rule will use the same framework as for the ACA market reform requirements. • Failure to comply would subject a health plan to monetary penalties of $100 per day per violation per affected member. • The rule includes a good faith allowance for data error or omission provided it is corrected, a temporary website interruption, or a reliance on third-party information. • Potential changes to requirements and timing may be impacted a new administration that may amend the implementation.
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Because price transparency has major implications for a health plan, providers and plan sponsors should consider creating a strategic taskforce on price transparency. Critical voices at the table should include the CEO, COO, CFO, CIO, Chief Marketing Officer, Chief Member or Patient Experience Officer, and a senior member of the public relations team. If the hospital or plan has a patient or member advisory council that provides input into operations, that council’s voice should also be heard and incorporated into planning for compliance. Building a credible, proactive messaging platform that addresses both external and internal stakeholders is critical to successfully positioning your benefit plan in the pricing transparency environment.
Transparency will have strategic implications for health plans and hospitals beyond compliance concerns Price transparency has far-reaching implications beyond just complying with components of the regulation. While consumers and members are the intended primary audience, competitor hospitals and health plans as well as employers are poised to digest, analyze and act upon the reported data. Pricing data will reveal the high- and low-cost providers in the market. Payer contracting strategies will seek to exploit this vulnerability as leverage for future negotiations.
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Health systems are likely to cite outcomes quality data or clinical severity of caseloads to justify higher prices. Consumer demand based on non-cost attributes (e.g., brand loyalty, perceived quality, convenience of access) will also give health systems leverage to negotiate a differentiated rate structure. However, health systems will find it difficult to justify the broad discrepancies in price variation that currently exist in payer contract negotiations. How valuable will provider price information be to consumers and members? Will they use it? “It’s very good news for consumers,” said George Nation, a professor of law and business at Lehigh University who studies hospital pricing, referring to the transparency rules. “Individuals will be able to get price information, although how much they are going to use it will remain to be seen.” Industry experts agree that pricing data alone won’t make much of a difference for most consumers. Why? Because many people have insurance coverage that pays defined copayments for components of care like physician office visits, medications or hospital stays that have no relation to the amounts charged by a hospital. Additionally, patients will continue to depend on advice from their physicians about how to and where to receive care. Loyalty to a hospital brand or to particular physicians will cause some patients to disregard price as the decisive factor in pursuing care. Even if consumers use the pricing information to help inform their decision about where to get care, they may find that the low-cost provider is not in their insurance company’s contracted network, making the hospital outof-network and much more expensive. In addition, some employers are using cost incentives to drive utilization to preferred providers, with high out-of-pocket costs passed along to employees who choose to use non-preferred providers. Finally, prices posted by hospitals and health plans will only represent one piece of the final amount consumers will pay for their care. Prices posted by hospitals for specific services, and cost-sharing information posted by insurers will be ballpark figures. An estimate on the cost of a surgery, for example, might prove inexact. If all goes as expected, the price quoted likely will be close, but unexpected complications could arise, adding to the cost.
the Consolidated Appropriations Act of 2021 (HR133). The Act addresses surprise billing at the federal level. It protects patients from receiving surprise medical bills resulting from gaps in coverage for emergency services and certain services provided by out-of-network clinicians at in-network facilities, including by air ambulances. It holds patients liable only for their i-network cost-sharing amount, while giving insurers and providers an opportunity to negotiate reimbursement. The Act also allows insurers and providers to access an independent dispute resolution process in the event disputes arise around reimbursement. The legislation does not set a benchmark reimbursement amount. Finally, the Act requires both health plans and providers to assist members and patients in accessing health care cost information. Healthcare Bluebook summarizes health plan responsibilities under the Act as providing a pre-care Estimate of Benefits to members, insuring provider directory information is up-to-date and accurate, and providing a price transparency tool for members. In conclusion Overall, it is unclear whether transparency will lead to decreased prices or consumer savings. However, greater transparency could shine a spotlight on the factors that affect pricing, including rate negotiations between providers and insurers. While many in the healthcare industry agree with the spirit of the effort to be more transparent about hospital and payer pricing in an effort to create more educated consumers, they also agree that this is the first step in what is sure to be a long journey toward using pricing data to impact the overall cost structure of healthcare in the U.S.
Hospital Prices Just Got a Lot More Transparent. What Does This Mean for You?, Kaiser Health News, January 5, 2021. ibid 3 Not All Hospitals Complying with New Price Transparency Rule, RevcycleIntelligency.com, Jan. 20, 2021. 4 ibid 5 ibid 6 ibid 7 Legislative Advisory: Detailed Summary of No Surprises Act, American Hospital Association, January 14, 2021. 1
2
No Surprises Act ends surprise billing In addition to the Price Transparency rule, the No Surprises Act was signed into law on Dec. 27, 2020, as part of
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A Publication of the American College of Healthcare Executives of North Texas Chapter | SUMMER 2021
Our Mission
To extend the healing ministry of Jesus Christ.
christushealth.org
A Catholic health system in the United States, Mexico, Chile, and Colombia with more than 60 hospitals, 600 services and facilities, 45,000 associates and 15,000 physicians.
In one of the most competitive and fastest growing industries, healthcare professionals are notoriously afforded opportunities to augment their specialized areas of expertise, which often leads to notable career advancement and heightened operational efficiency within an organization. One such opportunity is the pursuit of the distinguished FACHE credential, an advanced qualification indicative of Healthcare Management mastery in ten core knowledge competencies. Attainment of the FACHE credential enables one to achieve the ultimate reward of becoming a Fellow of the American College of Healthcare Executives, and lifetime membership among an elite group of healthcare professionals. As the healthcare industry continues to evolve, healthcare professionals are actively pursuing and securing the FACHE credential in effort to champion a greater standard of excellence within executive leadership. I took a moment to speak with a diverse group of DFW healthcare leaders who generously shared their insights on the professional impact of the FACHE credential.
How long have you been an ACHENTX member and what motivated you to pursue your FACHE Credential? Ron Norris, MBA, MHSM, FACHE Director of Hospital Operations, UT Southwestern Medical Center: I have been an ACHENTX member for over ten years. My mentor was a Fellow and from day one, he told me that the FACHE credential was the gold standard for healthcare leaders. Having the FACHE credential shows that I am a board -certified professional healthcare management. I have met all the educational and professional requirements of the American College of Healthcare Executives. Jennifer “J” Alexander, FACHE Manager, Operations Imaging, UT Southwestern Medical Center: I joined ACHE in 2012 when I began my graduate journey. My drive to pursue the FACHE came from being an ambassador for the ACHE North Texas Chapter. I am a committed and driven representative of this organization for what it stands for and what I associate with a great NEED. This call to action is to develop and mentor new upcoming healthcare leaders and champion their learning and growth in the healthcare relay. Melinda Schmidt, MBA, RN, (FACHE Candidate) Clinical Consultant, Vivify Health: I have been an ACHE member for five years and currently focused on obtaining my Fellows. My motivation is as an RN, to advocate for those that cannot and believe a Fellows encompasses the best direction to fulfilling my role. What challenges did you experience while preparing for the Board of Governors Exam? Ron Norris, MBA, MHSM, FACHE Director of Hospital Operations, UT Southwestern Medical Center: The Board of Governors exam is one of the most challenging exams I have ever taken. It’s a very comprehensive exam that covers a vast array of healthcare subjects. It was challenging to carve out time to study between working full time, being a new director and having a family at home. Jennifer “J” Alexander, FACHE Manager, Operations Imaging, UT Southwestern Medical Center:
The challenges for me were knowing all ten core knowledge areas: Business, Finance, Governance and Organizational Structure, Healthcare, Human Resources, Healthcare Technology and Information Management, Laws and Regulation, Management and Leadership, Professionalism and Ethics, and Quality and Performance Improvement. Every professional is proficient at a couple of these topics, so it takes some time to get familiar with ones that you don’t know. Melinda Schmidt, MBA, RN, (FACHE Candidate) Clinical Consultant, Vivify Health: My greatest barrier has been scheduling time in my calendar to have planned focus time to study.
What strategies did you use to prepare for the Board of Governors Exam? Ron Norris, MBA, MHSM, FACHE Director of Hospital Operations, UT Southwestern Medical Center: I paid for and scheduled my exam six months in advance. Next, I attended a FACHE review course and committed to study/ reading one hour a day. Attending a FACHE review course was the best thing to prepare for the exam; the review was phenomenal. Jennifer “J” Alexander, FACHE Manager, Operations Imaging, UT Southwestern Medical Center: I used a multidisciplinary approach. I subscribed to the ACHE National online course, went to the local chapter ½ day review, and read the Well Managed Healthcare Organization. What I thought really helped were the flashcards, not necessarily the paper ones that you buy, but the ones that can be used on Quizlet. Quizlet has the function of making the terms into test like strategy. Melinda Schmidt, MBA, RN, (FACHE Candidate) Clinical Consultant, Vivify Health: I found the Board of Governors Review to be extremely beneficial to my studying as it required me to attend the weekly meetings. I am highly driven and prior to each meeting, I reviewed the material and study questions.
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Ron, as a Fellow who has been recertified, what is the most effective way to prepare for the FACHE based on your experience? Ron Norris, MBA, MHSM, FACHE Director of Hospital Operations, UT Southwestern Medical Center: I have recertified twice; my advice is don’t procrastinate. We are fortunate that our chapter ACHENTX has so many learning opportunities. I have also attended face to face seminars, that speakers are always top-notch, and the subject matter is always pertinent to current healthcare topics. How has becoming a fellow helped your career? Ron Norris, MBA, MHSM, FACHE Director of Hospital Operations, UT Southwestern Medical Center: The FACHE credential brings constant value to a healthcare leader; when someone knows you are a Fellow, it gives you immediate credibility. The continuing education opportunities help you continue to grow as a leader. Jennifer “J” Alexander, FACHE Manager, Operations Imaging, UT Southwestern Medical Center: Knowledge is power. Your trajectory is totally built on what you expose yourself to and your continued journey to learn and grow. For an example, when I am in a room of executives, I understand the governance structure. While there may be a lot of visibility of the Chief Executive Officer (CEO) of a company, the reality is that they are chosen by a Board of Directors. Many may think that the CEO has a lot of power and influence, but the Board controls the aim. This is important for those who would like to be influential, but not necessarily the CEO of a company. There is plenty of room and other avenues to demonstrate your value and impact in. healthcare. Getting your Fellow is a “knowledge” tool in your toolbox.
heavy on the candidate’s mind, but be kind to yourself, relax and progress at a nice, even pace. Full disclosure here, I offer this advice from a voice of experience. Many of my colleagues know that I work quickly, which what did the first time I took this exam. There is no shame in taking the exam a second time, which is what happened to me. Blasting through questions is not an intelligent test-taking strategy (I know this), but I also know that I am not perfect and needed to re-adjust my strategy. Course correction and forgiveness is a sign of personal growth. Failure is not an option for me, but grace and learning opportunities are. I openly share this with you because none of us hit it out of the park on the first try. So, no matter what you are trying to achieve, I believe that you will get there. Take care time, relax, and be positive. Remember, it is the journey, not the destination, and we are all in this together! Melinda Schmidt, MBA, RN, (FACHE Candidate) Clinical Consultant, Vivify Health: Take a chance on yourself and invest in your future! Are you considering a FACHE credential? Be sure to address these readiness requirements in order to secure your eligibility to sit for the Board of Governors Exam (BOG). Potential candidates must: - Hold an advanced degree and possess 36 hours of CEU credits within three years prior to submitting an application for consideration - Serve a minimum of five years in an executive healthcare management role - Provide proof of participation in four volunteer activities within three years prior to submitting an application for consideration - Provide two professional references - Submit a $250 application fee For further information about FACHE or how you can prepare for the BOG exam, please refer to info@achentx.org.
What advice would you give to those who aspire to earn their FACHE credential? Ron Norris, MBA, MHSM, FACHE Director of Hospital Operations, UT Southwestern Medical Center: The simple answer, do it. It will be one of the best career decisions. You will ever make. Jennifer “J” Alexander, FACHE Manager, Operations Imaging, UT Southwestern Medical Center: You need to have the right mindset, be focused, and study. Ten areas incorporate a lot of material, and it takes time to let all this information soak in. Test-taking can be toll taking and weigh
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A Publication of the American College of Healthcare Executives of North Texas Chapter | SUMMER 2021
ACHE of North Texas proudly recognizes our own, Ajith Pai, PharmD, FACHE, President of Texas Health Harris Methodist Hospital, Cleburne – for his recent article published in the ACHE national Healthcare Executive Magazine. Click magazine cover image below to access Ajith’s article, “Optimizing Value Through Pharmacy Empowerment.”
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Cocktails with the Chiefs July 22, 2021 Kean Villarta On Wednesday, July 22nd, ACHE of North Texas held its popular “Cocktails with Chiefs” event in Downtown Dallas. The event, which was sold out and waitlisted, started off with a networking hour where members, students, and executives shared their excitement to be back in-person for gatherings after such a challenging year. This year’s event featured special panelists: Jim Allard, DNP, FACHE, RN, NEA-BC, Chief Nursing Officer at Medical City Children’s Hospital and Medical City Women’s Hospital – Dallas; Kevin Greene, Assistant Vice President and Administrator at Cook Children’s Medical Center – Prosper; Brett Lee, FACHE, President at Texas Health Hospital Frisco; and Benton Sprayberry, FACHE, Vice Present of Operations – South Region at Steward Healthcare. The panel was moderated by Felicia Miller, MBA, Executive Vice Present and Chief Talent Officer at Parkland Health and Hospital System. The panelists discussed a variety of timely topics, such as leading during the height of COVID-19 and how their organizations have adjusted to serve their employees, patients, and families. Sprayberry shared Steward’s remote monitoring program where patients can be monitored from Steward’s corporate offices, while Lee spoke about THR’s “Hospital at Home” program. The panelists also shared their thoughts on Artificial Intelligence and leveraging technology to improve patient care and experience. As part of Cook Children’s expansion initiatives, Greene spoke about “tech zones” in their Medical Office Building where clinicians and IT work together to educate families; Dr. Allard spoke about HCA’s “Hearts at Home” program that remotely monitors children with congenital heart diseases.
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The panelists also shared their thoughts on resiliency and leadership. Staffing was a major issue during the pandemic; in addition to redeploying staff to meet adequate staffing, organizations had to find different ways to boost employee morale and engagement such as structured rounding, employee recognition, being transparent and visible, and offering on-site and stress relieving activities like yoga. The panelists and moderator also stressed the importance of working together in tough times, being a good colleague, having empathy, and diversity and inclusion in healthcare. A special thank you to Sound Physicians and Steward Health Care for hosting this event.
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Mentorship Program Orientation May 6, 2021
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Mentorship Program Orientation May 6, 2021
SBL Architecture, Inc. Healthcare Architecture, Interior Design, and Master Planning 1000 Ballpark Way Suite 200, Arlington, Texas 817.792.2100 www.SBLinc.com
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Network Blitz July 13, 2021
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LinkedIn Bits and Bytes June 29, 2021
Let’s get social
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National News Connect with Your Peers We are pleased to offer members three new, free online communities for physician executives, Asian healthcare leaders and LGBTQ healthcare leaders. The communities’ platform makes it easier than ever for peers to connect in real time, tackle issues together and ask important career-related questions. Members can participate in discussion threads, share resources and best practices, and crowdsource innovative ideas and solutions. To join, follow these steps: 1. Log in to my.ache.org. 2. Under “Helpful Links” on the right-hand side, click the last option, “My Communities.” 3. Click the “Add” button to choose the online communities you wish to join. An MD or DO degree is required to join the Physician Executive Community. 4. Watch your inbox for your welcome email and instructions to access your new community! The email will arrive within 24 hours.
transitioning to an administrative role, there’s something for everyone. All sessions within the CRC’s On-Demand Content Library were recorded at the 2021 Congress on Healthcare Leadership. We encourage members to explore the On-Demand Content Library and other resources and tools available just for them in the Career Resource Center.
Healthcare Consultants Forum Member Directory: Connecting Executives to Consultants The Healthcare Consultants Forum Member Directory offers a robust search functionality to help you identify a consultant who meets your needs. This directory will also be available in the upcoming September/October issue of Healthcare Executive magazine. If you are a consultant looking to gain visibility with decision-makers, consider joining the Healthcare Consultants Forum. The forum also offers resources tailored to a healthcare consultant’s specific career development needs.
We hope you will join these communities. If you have any questions, please email communitymanager@ache.org.
ACHE Blog and Podcasts ACHE’s Exclusive On-Demand Content Library Can Help Advance Your Career Did you know that as a member, you have access to guided presentations to assist with your healthcare management career development? Our Career Resource Center has compiled a library of member-only, on-demand sessions that provide information and resources for healthcare leaders at all stages of their careers. Whether you are a student entering the field, a leader aspiring to a position in the C-suite, or a clinician
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Gain best practices and learn from your peers through our blog and the Healthcare Executive Podcast. Both the blog and podcast provide up-to-date content on the issues most pressing to healthcare executives. Be sure to share these with your colleagues. Follow the Healthcare Executive Podcast wherever you access podcasts.
A Publication of the American College of Healthcare Executives of North Texas Chapter | SUMMER 2021
Putting your health above it all. At Texas Health, we will be there for you and your loved ones. With an experienced staff and technologically advanced care, our dedication is to your health. Whether you need 24-hour emergency care or wellness services, we’re equipped to handle your health care needs. Advanced Surgical Procedures ■ Behavioral Health Cancer ■ Diabetes ■ Digestive Health Emergency Department ■ Heart & Vascular Neurosciences ■ Orthopedics ■ Weight Loss Surgery Women & Infants ■ Wound Care
1-877-THR-WELL | TexasHealth.org
Doctors on the medical staffs practice independently and are not employees or agents of Texas Health hospitals or Texas Health Resources. © 2018
WELCOME ACHENTX’S NEWEST MEMBERS APRIL Nitish Chimalakonda John K. Cross Merle J. Dominguez Coke Elms Sasha Fannin Robert A. Hinton Melissa A. Houttuin-Sullivan Nathan Hozer Frank Hundley Chudney Lambert, MHA Melissa Loving Cris Manning Kane Mitchel Justin Peter Natasha M. Pizarro, BS Esther Smith Sydney R. Smith Missy Staben, BS Jordan Tyler Kristi Zenon, BS
MAY Dillan Brewer David H. Cox Dheera Dammanna Cornelius Davis Andrew Denny Dawn Doggett, MBA Nathan Fowlkes Kevin Greene, MHA Paul S. Hackett, MD Delayna Hodge Sara S. Ibanez Carlous Ivey, MBA, MHA Maria Juarez Ken Kenneth, DBA Marvin Moore Natalia Nagy Patrick I. Omoragbon, RN
Chirag B. Patel Allison Potter Parvathy Nair Prasannan Hermenia F. Ricks Matt Riesen, CPA Campbell U. Roe Keltovise Sanders, MBA Carlos Sepulveda Jeffrey Stewart Morgan Thome Lawanda Thompson Kim Waters
JUNE Mauricia Agyemang, RN Inam Al-Ibrahim Andy Anderson Leticia Cole Julia Colf, MBA, MSN, RN Sarah Connors, MHA Benjamin Cowen, MBA Michael Esquenazi Craig S. Glazer, MD, MS Mia Y. Harvey Carolyn M. Hunter, MBA, MHA Farukh Ikram Nsanga Kabwe, MD, MBA, MPH Collin Kidd Olive Makibia Tamara N. Martin, MHA, LPN Gabriela Mendieta Creagh E. Milford, DO Doug Omundson Carlee R. Painter Lance Parker, MHA Yushma Poudel Kourtni N. Retzloff, BS Brandon M. Rule Kristopher Russell Amanda Russo Lisa Stang Julie A. Stoyanoff
MICHELLE TABB Aaron Thesman Brittany N. Wall, DNP, RN, APRN Leslie A. Wilson, MHA Claire Wingfield
JULY
Timia Acklin Joe Alvarado, DNP, RN, NEA-BC Eric D. Beshires, MD, MBA CHRISTOPHER BLAIR, RN, MBA Susan Boydell Stephanie Calvert Patti R. Corder Tsion Demissie, BS Dalton Divakaran Jay Duty, MHA Nitya Eleti Tiffani J. Fox Lauren Goodman Bjard A. Jones Kate Kelley Tu Le Marcelo E. Lopez, DDS Samantha R. Lopez Toby Murzone Krysta R. Myers Dianna Prachyl Jordan M. Richardson, MHA Ishwara R. Sankara Meagan L. Simmons Neeti Singh Kristin Stanley, DNP, RN, APRN James Stayer Michael K. Thomas Cody Tilger, MBA Gilson Umunnakwe, Jr. Madison G. Verzwyvelt Janet F. Von Roeder Andrew J. Zenger
MAY Brandon C. Fowler, MHA, FACHE
ACHENTX’S
NEWEST
JULY Aaron R. Fox, FACHE Stephanie Gary, FACHE Tyler Krohn, MD, FACHE Keely A. Scamperle, FACHE
FELLOWS
RECERTIFIED FELLOWS APRIL
MAY
JUNE
Glenn W. Bodinson, FACHE Teresa R. Danna, RN, FACHE Beverly Hardy-Decuir, DNP, RN, FACHE Teresa L. Huskey, FACHE(R) Edwin K. Hutchenrider, Jr., FACHE Jim R. Kendrick, Jr., FACHE Jeffrey A. Light, FACHE Conor J. McGuire, FACHE Katie McMillen, PharmD, FACHE Jarvis J. Morgan, FACHE Jay N. Powell, FACHE David E. Racette, FACHE Timothy C. Ruse, FACHE Michael D. Sanborn, FACHE Michael Seifu, FACHE Sarah L. Toba, FACHE
Erol R. Akdamar, FACHE Kelvin A. Baggett, MD, FACHE Patricia Bowling, EdD, RN, FACHE Carol Crowell, RN, FACHE Nancy C. Cychol, FACHE Beverly Dawson, RN, FACHE(R) Tracy Giacoma, RN, FACHE Chad Greeno, FACHE Brett Hadley, FACHE Sara K. Little, FACHE Clifton N. Orme, FACHE Kristin M. Tesmer, FACHE Thanh Tran, FACHE Nancy A. Vish, PhD, FACHE Keith V. Zimmerman, FACHE
Megan E. Chavez, FACHE Stanley Davis, FACHE Nora G. Frasier, RN, FACHE Martin K. Heath, FACHE Mark C. Hood, FACHE Akela McDonald, FACHE Jason Wren, FACHE
JULY Elaine W. Auerbach, FACHE John T. Barnhart, II, FACHE Vicki J. Dennis, FACHE John C. Mizerany, FACHE(R) Skyler W. Reed, FACHE William M. Turner, FACHE Kathryn D. Van Der Linden, LFACHE
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All these listed events are scheduled to be held virtually. Please keep monitoring our Weekly Announcements for other virtual and in-person events in the works.
Thursday September 16
Multi-Chapter Event: Panel 1: Culture of Safety Panel 2: Ensuring Your Community’s Emergency Preparedness Panel 3: Behavioral Healthcare: Approaches to Increase Value for the Organization and Meet Community Needs Panel 4: Population Health Management: Justice, Access and Financial Implications
Tuesday October 21
Fourth Quarter Education Panels
Thursday October 23
Lean Six Sigma Yellow Belt Course
Click here to learn more or register for an event
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A Publication of the American College of Healthcare Executives of North Texas Chapter | SUMMER 2021
We Appreciate the Support of Our ACHENTX Platinum Sponsor
We Appreciate the Support of Our ACHENTX Gold Sponsors
