Special Section: Katrina Revisited AHA Chairman on “Defining

Transcription

WINTER 2006
www.arkhospitals.org
AHA Chairman
on “Defining
Moments,”
Katrina, and
Challenges
to Healthcare
Special Section:
Katrina Revisited
A M A G A Z I N E F O R A R K A N S A S H E A LT H C A R E P R O F E S S I O N A L S
AT
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Arkansas Hospitals
is published by
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24 New AHA Chairman on “Defining Moments,” Katrina, and Challenges to Healthcare
33 AHA Annual Meeting: Awards Presented
41 75 Years of AHA History… A Look Back Part 2
Arkansas Hospital Association
The Uninsured
419 Natural Resources Drive • Little Rock, AR 72205
501-224-7878 / FAX 501-224-0519
Beth H. Ingram, Editor
BOARD OF DIRECTORS
Robert Atkinson, Pine Bluff / Chairman
Ray Montgomery, Searcy / Chairman-Elect
Luther Lewis, El Dorado / Treasurer
Timothy E. Hill, Harrison / Past-Chairman
Quality/Patient Safety
12 Medicaid Discussions with State Officials
14 Hospitals’ National Ranking Rises
12 Difficulty Paying Medical Bills Increases
14 Hospital Quality Improvement Indicators
12 AHRQ Releases New Data on Uninsured
15 Physician Voluntary Reporting Begins
13 ER Visits Up 26% Since 1993
16 Two AR Hospitals Earn Quality Awards
13 Charity Care Understated by Hospitals
16 Surgical Care Improvement Project
Robert R. Bash, Warren / At-Large
Katrina Revisited
David Cicero, Camden
Ann Cloud, Siloam Springs
David Dennis, Berryville
Dan Gathright, Arkadelphia
Michael D. Helm, Fort Smith
Ed Lacy, Heber Springs
James Magee, Piggott
Larry Morse, Clarksville
John Neal, Stuttgart
Richard Pierson, Little Rock
John N. Robbins, Conway
Steve Smart, El Dorado
Russ Sword, Crossett
20 Arkansas Under Emergency Declaration
20 Katrina Hits Home for Chairman’s Son
21 Chef’s New Home at Ouachita Med Center
23 Prudhomme Salutes Pine Bluff Connection
DISTRIBUTION
Arkansas Hospitals is distributed quarterly to
hospital executives, managers, and trustees
throughout the United States; to physicians,
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and other friends of the hospitals of Arkansas.
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Edition 53
2006 AHA Strategies
10 AHA/JCAHO Resolve Confidentiality Issues
10 Medicare FY 2006 OPPS Final Rule
11 Change for Section 1011 Billing Data
28 Regional Networks Made a Difference
11 Hospitals Intervene in JCAHO Recommendation
Departments
Robert “Bo” Ryall / Executive Vice President
Don Adams / Vice President
9
27 St. Edward Mercy Provides Assistance
EXECUTIVE TEAM
Beth H. Ingram / Vice President
News — STAT!
19 Agreement Eases Nurse Licensure Delays
Phil E. Matthews / President and CEO
W. Paul Cunningham / Senior Vice President
17 CMS Releases HCAHPS Survey
4
From the President
6
Education Calendar
7
Arkansas Newsmakers and Newcomers
11 New Report on Critical Access Indicators
11 US Philanthropic Giving Back on the Rise
17 Cancer Death Rates Continue to Decline
17 New Breast Cancer Treatment from UAMS
29 Records Retention Rules : a Reminder
46 Legal Issues in Life-Limiting Conditions
WINTER 2006
Electronic Health Records
AHA Chairman
on “Defining
Moments,”
Katrina, and
Challenges
to Healthcare
Special Section:
Katrina Revisited
Cover Photo
Arkansas State
Capitol at
Christmas,
Little Rock
Photo by Arkansas
Department of Parks
and Tourism
30 Report Lists Electronic Record Needs
31 Health IT Could Save $162 Billion
31 Survey: Costs are HIT Barrier
31 Rules Bolster E-prescribing, EHRs
A M A G A Z I N E F O R A R K A N S A S H E A LT H C A R E P R O F E S S I O N A L S
Winter 2006 I Arkansas Hospitals
3
F R O M
T H E
P R E S I D E N T
Arkansas’ Hospitals —
Never Take Them for Granted!
Every day, we hop into our cars and speed off down
life’s highways…that is, until the car doesn’t work. All of
a sudden, we’re in a frenzy. Our schedules are shot, our
nerves are frayed, and it feels
like our personal independence is up for grabs. We get
the car fixed and vow we
will never take our vehicle
for granted again.
Isn’t it true for all of us?
We take so many things in
life for granted. Our cars,
electrical power, clean water,
traffic signals, phone service,
our hospitals.
It’s true, some people
even take our hospitals for
granted; that is, until their
own health or that of a loved
one makes a hospital visit
necessary. At such a time, the hospital’s caring doctors
and nurses, its many and varied technicians, and its governing board and administrators all become heroes.
But those of us whose lives are entwined with the
healthcare field never take our hospitals for granted. We
work — you work — every day to keep the community
aware of the hospital’s vital presence, the economic backbone it affords, the further economic development its very
presence can attract. You know how much your community would suffer if your hospital was not there.
It’s no secret that hospitals across our nation, and certainly here in Arkansas, are facing tough financial times.
As someone who believes in and follows Arkansas’ hospitals, you know what the cost of continually providing
more and more uncompensated care is doing to the bottom line — our hospitals’ ability to keep the doors open.
According to a recent study by the Arkansas Center for
Health Improvement, 17% of Arkansans did not have
health insurance in 2004. The numbers keep climbing —
though most of the uninsured are people working hard at
either full- or multiple part-time jobs.
In Arkansas alone, uninsured patients accounted for
$354 million in hospital bills in 2003, the last year for
which data is available. According to recent comparative
statistics, charity care and bad debt for Arkansas hospitals
4
totaled $390 million in 2000, and grew to a whopping
$475 million by 2003.
The number of patients coming to our hospitals with
no way to pay their bill is on a rapid rise, and so is the cost
of that care. Hospitals can only provide care without payment for a limited time before they can no longer afford
to stay open.
What can be done? The answer is good communication. Each of us involved in the healthcare field —
trustees, administrators, physicians, nurses, technicians,
support staff, auxilians and the AHA alike — all continue
to work with our legislators so they understand the dire
need for raising Arkansas’ Medicaid per diem reimbursement, which has not been raised for nearly ten years.
But grassroots communication is also key. We must
keep our communities well informed about the many services our hospitals eagerly provide to hometown folks —
services too often taken for granted. And especially in
these tough financial times, Arkansans need to be reminded of the financial struggle hospitals face, and the reasons
behind that struggle.
Informed citizens tend to partner with their hospitals in
finding ways to raise funds, to be wiser in the use of
healthcare, to create solutions so all in the community
receive the medical care they need. When citizens remember that “the” hospital is “their” hospital, no longer taking it for granted, a very precious partnership forms.
As one who is involved in the healthcare field, your role
in continually carrying the message to the community is
vital, especially in tough financial times! I urge you to talk
with your legislators, your local service club members,
friends at the grocery store and people at the barber shop.
Remind folks of how vital their local hospital is to the
community. When you do so, you ensure that your hospital will never be taken for granted.
Phil E. Matthews
President and CEO
The U.S. DEPARTMENT
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6
Program information available
at www.arkhospitals.org
ARKANSAS
NEWSMAKERS
and NEWCOMERS
James R. (Jamie) Carter has been named CEO of
Crittenden Memorial Hospital in West Memphis,
effective November 7. He succeeds Ross Hooper, who
retired in September. Before moving to West
Memphis, Carter was administrator of North
Mississippi Medical Center in Iuka. He previously
held administrative positions with the North
Mississippi Physicians Association, Yalobusha
General Hospital and Nursing Home and the
Quitman County Hospital.
Governor Mike Huckabee has appointed Steve
Erixon, CEO of Baxter Regional Medical Center in
Mountain Home, to the Governor’s Trauma Advisory
Council. His term expires July 1, 2009. The
Governor also appointed C. C. McAllister to the
Emergency Medical Services Advisory Council.
McAllister, CEO of Ouachita Valley Health System in
Camden, will serve until July 1, 2008.
Herbert K. “Kirk” Reamey, CEO of Ozark Health
Medical Center in Clinton, has been elected to a second three-year term as a Section for Small or Rural
Hospitals delegate to the American Hospital
Association’s Regional Policy Board 7. His term
expires December 31, 2008.
Ben Owens, president and CEO of St. Bernards
Healthcare in Jonesboro, was recently selected Business
Executive of the Year by the College of Business
Alumni Chapter of Arkansas State University in
Jonesboro. Owens served as administrator/president of
St. Bernards Medical Center for many years, before
moving to the corporate office of the organization.
Jim Richardson, president and CEO of Saline
Memorial Hospital in Benton, has been elected to the
Arkansas
Hospital
Association
Workers’
Compensation Self-Insured Trust board of directors.
He succeeds Eugene Zuber of Newport and will serve
until the 2006 annual meeting.
Stephen Smart, DDS, of El Dorado, has been appointed an at-large member of the American Hospital
Association’s Committee on Governance. His term
will expire in December 2008. Smart currently serves
on the Arkansas Hospital Association board of directors representing the Arkansas Association of Hospital
Trustees, for which he is president.
Robert R. Bash was named administrator of Bradley
County Medical Center in Warren October 27, after
having served as assistant administrator since
December 2003. He succeeded long-time administrator Harry Stevens. Prior to moving to Warren, Bash
was administrator of Booneville Community Hospital
and was also rural administrator of Sparks Health
System in Fort Smith. Bash is a past-chairman of the
AHA and currently serves on the AHA board as the
director at-large.
IN MEMORIAM
The Arkansas Hospital Association (AHA) lost
a longtime friend and colleague Saturday,
October 15 with the death of Harry H. Stevens,
administrator of Bradley County Medical
Center (BCMC) in Warren. He was 80 years
old. Stevens, a Korean War veteran, was a 40year resident of Warren. He owned and operated the Pine Lodge Nursing Home there from
1965 until 1975, when he sold the nursing home
and began his career at BCMC. Stevens had
served as the administrator at BCMC since
1986. In June 2004, Harry received the AHA’s
Chairman’s Award in recognition of his service
and contributions to BCMC and to the AHA, as
well as to the city of Warren and other parts of
southeast Arkansas.
Edward Rensch, Jr., former president and CEO
of the Central Arkansas Radiation Therapy
Institute (CARTI) in Little Rock from 19831994, died September 2. Rensch’s career in
healthcare spanned almost 40 years. After moving to Little Rock in 1966, Rensch was assistant
administrator for St. Vincent Infirmary before
being named by Gov. Winthrop Rockefeller in
1967 as director of the Arkansas
Comprehensive Health Planning Agency. He
also served as associate coordinator of the
Arkansas Regional Medical Program from
1970-1973. In 1973, Rensch became the first
executive director of CARTI and served in that
capacity before being named the organization’s
president/CEO in 1983.
•
7
A wholly owned subsidiary of the Arkansas Hospital Association.
AHA Services is committed to providing
AHA member hospitals with access to
quality products and programs.
For information on any of our programs please contact Tina Creel or Phil Matthews
Phone 501-224-7878
Fax 501-224-0519
http://www.arkhospitals.org/aha_services
8
2006 Arkansas Hospital
Association Strategies
The Arkansas Hospital Association each year sets forth strategies
for the coming year, focusing on
four major areas:
Advocacy,
Education, Data Gathering/Monitoring, and Communication. The
Fiscal Year 2005-2006 Strategies
are presented here.
ADVOCATE — Actively
Advocate for Arkansas’ Hospitals
1) Develop strategies for methods
to increase state Medicaid funding of hospital services.
2) Obtain the assistance of
Arkansas legislators and state
Department of Health and
Human Services officials to
include sufficient funding in the
FY 2008-2009 budget to cover
increased payments for hospital
inpatient and/or outpatient
services.
3) Communicate on an ongoing
basis with Arkansas’ congressional delegation about federal
issues impacting hospital operations, costs and revenues.
4) Gain support of members of
Arkansas’ congressional delegation for legislative and regulatory items included on hospitals’
advocacy agenda for the 109th
Congress.
EDUCATE — Provide Education
Opportunities
5) Educate, inform and assist all AHA
member hospitals about/with state
and federal efforts aimed at implementing new health information
technology — and specifically
toward implementing electronic
health records in hospitals and
provider practices.
6) Provide in-state educational opportunities for member hospitals and
their employees and trustees covering such issues as quality reporting,
medication errors, patient safety,
EMTALA, compliance, governance, emergency readiness,
HIPAA, reimbursement, coding
and other topics.
Communicate results to member
hospitals.
10) Ensure that all Arkansas-based
quality initiative programs utilize
existing data sources, include
meaningful quality measures and
limit additional hospital data collection/submission efforts and
costs related to compliance.
11) Ensure that Arkansas hospitals are
directly involved with efforts to
establish and implement Regional
Health Information Organizations
for the sharing of clinical data for
treatment and quality improvement
purposes, and assisting in public
health and research activities.
COMMUNICATE — Inform,
Communicate, Network
7) Educate the public on the importance of their local community
hospitals and the medical and
support staff members who serve
their health needs.
ANTICIPATE DATA NEEDS —
Seek, Explain and Provide Data;
Address Data Reporting Issues
8) Conduct a follow-up study to
quantify continuing losses
accruing to Arkansas hospitals
due to inadequate Medicaid
payments.
9) Monitor, address, and resolve
ongoing legislative, regulatory
and policy issues concerning
requirements for public reporting
of
hospital
data.
12) Inform all AHA member hospitals
on an ongoing basis about issues,
concerns, activities and actions
affecting hospitals and healthcare
at the state and federal levels, to
ensure their knowledge about and
involvement with those matters.
13) Work in conjunction with
groups such as the Arkansas
Foundation for Medical Care,
Arkansas Blue Cross and Blue
Shield, the Arkansas Medical
Society and other healthcarerelated organizations to further
develop specific approaches to
reduce medical and medication
errors in Arkansas hospitals.
14) Provide printed, online, and faceto-face resources for AHA member hospitals so they may keep
abreast of current issues, legislation, and communication needs in
the hospital field.
•
9
AHA and JCAHO Resolve Confidentiality
Issues After Intense Discussions
(AHA) legal counsel Elisa White notified the AHA October 11 that the
Joint Commission on Accreditation of
Healthcare Facilities (JCAHO) agreed
to a revision in its accreditation agreement that will safeguard Arkansas
hospitals’ privileged documents from
disclosure in the accreditation process.
As revised, Section 5 of the agreement now says that:
1) JCAHO will conduct all of its
accreditation activities in accordance
with all applicable privileges of confidentiality and immunity under applicable state and federal law;
2) If the JCAHO requests privileged
information, the hospital can notify
the JCAHO in writing and the
JCAHO will work with the hospital to
find an alternative that will both allow
the JCAHO to obtain the information
it needs for accreditation purposes and
maintain legal protections for the
requested item; and
3) If privilege is challenged based
on any accreditation activity, the
JCAHO will help the hospital fight to
maintain the privilege.
White noted that the JCAHO continued to refuse to negotiate on the
agreement’s indemnity clause, which
favors the JCAHO, and the limitation
of remedy clause. She advised that as
of October 13, Arkansas hospitals
would be able to execute their revised
agreements electronically with the
JCAHO.
Arkansas was the only state initially pushing the privilege document
issue with JCAHO; other states eventually
joined
the
discussion.
According to AHA president and CEO
Phil Matthews, “The AHA Board of
Directors provided direction and
strong support of our position.
Protecting our privilege issue was of
the utmost importance, and JCAHO
finally realized that it was a major
issue with us. We are very pleased
with the outcome.”
•
Medicare FY 2006 OPPS Final Rule
in Effect as of January 1, 2006
The Centers for Medicare &
Medicaid Services (CMS) has
released its 2006 Outpatient
Prospective Payment System (OPPS)
final rule, applying a full 3.7% market basket update.
The update, together with other
changes in the rule mandated by the
Medicare
Modernization
Act
(MMA), will result in average payment increases of about 2% to urban
hospitals and 3.9% to rural hospitals.
As required by the MMA, the rule
ends “hold harmless” payments for
small rural hospitals and rural sole
community hospitals (SCHs), however it provides an adjustment to rural
SCHs that will increase payments by
7.1% in 2006.
The rule continues the decline in
coinsurance rates Medicare beneficiaries will pay for many hospital outpatient services. Prior to the implementation of the OPPS in August
2000, the beneficiary often paid
10
more than 50% of the total payment
to the hospital for a service.
Coinsurance rates for OPPS services
are being reduced gradually until the
beneficiary’s share for any outpatient
service will be 20% of the hospital’s
total payment.
Under the final rule, the coinsurance rate for 31 additional medical
and surgical Ambulatory Payment
Classifications (APCs) will decline to
the 20% minimum, a 21% increase
in the number of APCs at the 20%
coinsurance level over calendar year
(CY) 2005.
It also reduces the
maximum coinsurance rate for any
service to 40% of the total payment
to the hospital for the APCs in 2006,
down from 45% in 2005.
Overall, average beneficiary copayments for all outpatient services
are expected to fall from 33% of
total payments in CY 2005 to 29%
in CY 2006. This represents a decline
in beneficiary liability of more than
$400 million from the CY 2005
OPPS to the CY 2006 OPPS.
The final rule sets the outlier
threshold at $1,250 for 2006. Outlier
payments are intended to partially
compensate hospitals for certain high
cost services. To be eligible for an
outlier payment, the estimated costs
for a service must be greater than
1.75 times the payment amount for
the APC and greater than the APC
payment amount plus the outlier
threshold.
The changes to the payment rates
and increased volume of services contribute to an overall increase in projected payments to over 4,200 hospitals for Medicare outpatient services of
$27.6 billion in 2006 compared to
projected payments of $26.2 billion in
2005, an increase of 5.2%. The final
rule takes effect January 1, 2006.
See http://www.cms.hhs.gov/providers/hopps/2006fc/CMS-1501FC.pdf for the complete report.
•
No Name Required: Note This Change
for Section 1011 Billing Data
Hospitals that are providing emergency care services to undocumented
aliens should be aware that as of
November 10, 2005 the patient’s name
and address are no longer required for
submission of Section 1011 payment
requests.
TrailBlazer Health Enterprises, the
Centers for Medicare & Medicaid
Services (CMS) contractor for Section
1011 payments, said its Direct Data
Entry system will no longer allow entry
in the name, address and zip code fields.
CMS last year indicated it would not
require hospitals and other healthcare
providers to ask “invasive” questions
about patients’ citizenship status and
disclose personal patient information to
receive funds under Section 1011 of the
Medicare Modernization Act.
The Act allocated $250 million in
Medicare reimbursements annually
through fiscal year 2008 to help reimburse hospitals for their cost of providing uncompensated emergency care to
undocumented immigrants. However,
billing instructions issued earlier
required providers to submit the
patient’s name and address. CMS took
hospitals’ advice to remove the requirement on the grounds it was unnecessary
and might discourage undocumented
immigrants from seeking care.
•
Hospitals Intervene in JCAHO Recommendation
to Sell Data Analyses to Third Parties
Yielding to pressure put on by
America’s hospitals and physicians
through the American Hospital
Association, the American Medical
Association, American College of
Physicians, various state hospital associations (including the Arkansas
Hospital Association) and others, the
Joint Commission on Accreditation of
Healthcare Organizations (JCAHO)
Board of Commissioners, at its
November 18-19 meeting, agreed to
withdraw an earlier recommendation
to sell analyses of hospital data to third
parties.
The decision followed six months
of intense discussion over a “data-mining” contract between a JCAHO subsidiary and the Blue Cross Blue Shield
Association. JCAHO will continue to
seek patient level data from hospitals,
once issues involving HIPAA privacy
concerns are addressed.
After considering hospitals’ concerns, JCAHO’s commissioners decided to withdraw the original recommendation and instead recommend to
the JCAHO board that the JCAHO
refrain from selling analyses of hospital data to third parties.
•
New Report Compares Critical Access Hospital Indicators
Researchers for the federal Office of Rural Health Policy have issued a
report on comparative financial indicators for the nation’s Critical Access
Hospitals (CAH).
The report, which provides a state-by-state summary of CAH financial
indicators, compared with national medians, is available at http://www.flexmonitoring.org/cahlist.
The indicators are grouped in categories for profitability, liquidity, capital
structure, revenue, cost and utilization.
Further information about the definition and interpretation of the indicators can be found in a previous report, “Briefing Paper No. 7: Financial
Indicators for Critical Access Hospitals,” which can be downloaded from
http://www.flexmonitoring.org.
•
Healthcare Philanthropic Giving Back on the Rise in U.S.
Donations to U.S. members of the Association for
Healthcare Philanthropy increased 3.5% to $6.1 billion in 2004, up from $5.9 billion in 2003, the association said in a recent report.
Cash contributions accounted for 67%, or $4.1
billion, of the total funds raised by U.S. members of
the group. Pledges, planned gifts and other assets
accounted for $1.6 billion, or 26.5%.
The number of donors grew 2.7% from 2003 and
the number of gifts received increased 5%. Individuals
provided 60% of all funds raised; businesses, including corporate foundations, supplied 19.4%.
Meanwhile, in Canada, giving to healthcare
organizations declined 4.8% to $1.07 billion in
2004. The report was based on a survey of more
than 300 organizations belonging to the association. The association said hospitals make up the
majority of its membership.
•
11
COSTS U N I N S U R E D
Medicaid Discussions with Arkansas
State Officials Continue
Members of the Arkansas Hospital
Association (AHA) executive team met
in November and again in December
with top officials from the Arkansas
Department of Health and Human
Services and its Medicaid program
regarding the need for additional
Medicaid funding for hospitals.
The AHA has been working on
the issue with the governor’s office
and members of the state legislature
since the end of the 2005 legislative
session to secure support for an
increase in the cap on Medicaid hos-
pital per diem rates. The current
$675 per day cap has been in place
since 1996. Some hospitals have had
no Medicaid rate increase since then
and as each year goes by, more hospitals see their Medicaid inpatient
rates limited by the cap, which now
governs a vast majority of the state’s
hospitals.
The AHA worked last spring to
get support for a bill that was passed
and then signed as Act 2222 of 2005.
The law provides the opportunity for
hospitals to receive an increase in
their Medicaid per diem rates if
insurance premium taxes paid to the
state are above forecast levels.
However, since Act 2222 is
prospective in nature, exactly how
much it could yield for hospitals
won’t be known until June 30, 2006.
The AHA hopes that an economic
upturn in Arkansas, which has led to
a surplus in state general revenues,
will provide a window of opportunity for the governor and the legislature to designate additional funds for
Medicaid hospital payments.
•
Business Leaders Troubled
by Health Insurance Costs
Rising health insurance costs are forcing businesses of all sizes to pass a growing portion of premiums, co-payments or
deductibles on to their employees,
according to a new poll of business leaders, nearly 80% of which said they fear
their employees won’t be able to afford it.
The poll of 600 business owners
and benefit managers, released in the
fall of 2005 by the Robert Wood
Johnson Foundation, found that companies expect health insurance costs to
jump an additional 12% over the next
year, and that business owners will ask
their employees to pay an average of
21% of this increase.
Respondents’ employees currently
pay, on average, 29% of their own
health insurance premiums.
More than one-third of businesses
that projected an increase in costs said
it’s likely their employees would drop
coverage as a result of increases. More
than half of respondents said allowing
the self-employed and small businesses
to purchase private health insurance at
group rates would increase Americans’
access to healthcare, and 41% said tax
incentives would help.
The poll was released at a Capitol
Hill panel discussion on healthcare featuring federal and state lawmakers and
company CEOs. For more on the poll
and its ramifications, go to http://covertheuninsuredweek.org/media/docs/rele
ase091405.pdf.
•
New Survey Shows More Arkansans Uninsured
The Arkansas Center for Health
Improvement released the results of
its most recent survey on Arkansas’
uninsured population in midSeptember. The findings showed
that 456,000 people in the state
had no health insurance coverage
in 2004, making up 17% of the
state’s population. That’s up from
12
15% of Arkansans who were uninsured in 2001.
The report showed that more children now have coverage, thanks to
several years of expansion in
Arkansas Medicaid’s ARKids First
program. But the numbers of uninsured is growing for all other groups.
Sixty percent of the state’s unin-
sured population work, but most of
Arkansas’ employers are small businesses with fewer than 50 employees
each and only 26% of those employers offer group health benefits.
Demographic breakdowns show
that 39% of Hispanics in Arkansas
lack coverage, compared with 17%
of blacks and 15% of whites.
•
COSTS U N I N S U R E D
Oregon System Agrees to Settle
Uninsured-Billing Class Action Lawsuit
Providence Health System of
Portland, Oregon, agreed in early
November to settle a class action lawsuit brought by attorney Richard
Scruggs. The suit was brought on
behalf of uninsured patients and
alleged that not-for-profit Providence
violated its charitable mission by
charging its highest prices to those
least able to pay. The settlement still
must go before a state Circuit Court
judge in Portland.
Under the settlement, Providence
admitted no wrongdoing and said it
chose to settle to avoid legal costs.
The settlement allows any uninsured
patient charged for care at any of
Providence’s seven hospitals in the
past four years to apply for an estimated 30% reduction in their bill,
reflecting the average “preferred
provider” private insurance rate.
Additional reductions would be
offered to uninsured patients living
below 400% of the federal poverty
level and would waive bills of those
living at or below 200% of the
poverty level and having limited
assets.
•
Hospitals Spend
$5.3 Billion
More on
Uncompensated
Patient Care
U.S. hospitals provided $26.9
billion in uncompensated care in
2004, up from $24.9 billion in
2003, according to the latest
American Hospital Association
(AHA) Annual Survey of Hospitals.
The survey measure includes
charity care and bad debt, valued at
the cost to the hospital of the services
provided. The amount of uncompensated care provided by hospitals
has increased by $5.3 billion, or
more than 25% since 2000.
The information on hospital
uncompensated care comes from the
AHA’s Annual Survey Data, 19802004. For more information, go to
the “What’s New” section at
http://www.aha.org.
•
13
Q U A L I T Y
Arkansas Hospitals’ National Ranking Rises:
Care Improving for Pneumonia,
Heart Attack, Heart Failure, Surgery
Submitted by the Arkansas Foundation for Medical Care
Arkansas hospitals have dramatically improved their national ranking
in the care of Medicare patients.
According to an analysis by the
Arkansas Foundation for Medical
Care (AFMC), Arkansas hospitals
have gone from 49th in the country
in 2000-2001 to 35th by the end of
2004 on 20 measures focusing on
management of pneumonia, heart
attacks, heart failure, and surgical
infection prevention.
AFMC works with hospitals
across the state to set goals to
increase the number of patients who
receive important aspects of care.
“One of our goals was to improve
our ranking from 49th to 40th by
2004, and Arkansas hospitals
exceeded our expectations. Our
ranking improved to 35th,” said Pam
Brown, AFMC’s inpatient project
manager. “More important, each
percentage point of improvement
represents hundreds of patients
receiving better healthcare and possibly better outcomes. We still have a
lot of work ahead of us, but these
results are encouraging.”
State ranking is based on data from
50 states plus the District of Columbia
and Puerto Rico. The data reflects hos-
pital performance on more than 20
quality improvement indicators for
Medicare patients. The indicators affect
care for patients who are hospitalized
for surgery, heart attack, heart failure
or community-acquired pneumonia.
Paul Cunningham, senior vice president of the Arkansas Hospital
Association, said that the state’s hospitals are very pleased to see the dramatic improvements. He noted that the
AFMC analysis should be encouraging
news for hospitals and people in communities throughout Arkansas.
Cunningham said, “The improved
rates reflect that hospital quality
Arkansas Performance on Hospital
Quality Improvement Indicators
The state’s overall ranking rose to
35th in 2004, up from 49th in 20002001. Rankings are based on the
Arkansas Foundation for Medical
Care’s analysis of the Centers for
Medicare & Medicaid Services’ surveillance data from 50 states, plus the
District of Columbia and Puerto Rico.
Data covered hospital performance on
more than 20 quality indicators for
Medicare patients, including:
For pneumonia patients
■ Initial antibiotic received within
four hours of hospital arrival
• Baseline rate: 62.7%
• Current rate: 76.6%
• National current rate: 70.5%
14
■ Oxygenation assessment
• Baseline rate: 91%
■ Pneumococcal vaccination status
• National current rate: 44%
For heart attack patients
■ Aspirin on arrival
■ Aspirin prescribed at discharge
■ Beta-blocker prescribed
at discharge
For surgical infection prevention
■ Prophylactic antibiotics received
within one hour prior to surgical
incision
• Baseline rate: 40%
For heart failure patients
■ Comprehensive discharge
instructions
• National current rate: 17%
Q U A L I T Y
managers, medical staff members
and patient care professionals have
been working closely together and
with the AFMC to implement
changes that include ‘best practice’
processes and policies which can lead
to better patient outcomes.”
Arkansas has shown considerable
improvement on most of the measures.
The state’s performance improved the
most in the topic of communityacquired pneumonia. For instance,
ideally all patients with pneumonia
should be assessed to see if they are
due for a flu shot. In late 2000, only 5
percent of hospitalized patients were
assessed for flu immunization status
and immunized appropriately. By
2004, the rate had risen to more than
45 percent — higher than the national
average of 43.4. The percentage of
pneumonia patients who received an
antibiotic within four hours of arrival
increased from 62.7 percent to 76.6
percent — compared to the national
rate of 70.5 percent.
However, there is still room for
improvement, particularly on most
of the indicators related to heart
attack (acute myocardial infarction,
or AMI). The percentage of patients
receiving aspirin on arrival — long
considered standard, life-saving care
— rose from 75.3 to 81.2 percent.
The national average is 88.4 percent.
“Arkansas hospitals have made
impressive progress, and I am confident we will see more in the future,”
said Dr. William E. Golden, AFMC’s
vice president for clinical quality
improvement. “They have embraced
quality improvement as fundamental
to modern medical care and, as a
group, have jumped over the performance of peers in other states. AFMC
will continue to work with Arkansas
hospitals and other health providers
to implement systems changes that
make care safer and consistent with
current clinical science.”
Cunningham agreed, saying,
“While the information shows definite progress, the AHA and its members understand that there are more
gains to be made in the areas of quality and patient safety.” He said that
Arkansas hospitals are committed to
continuing their quality improvement efforts and that they intend to
work along with the AFMC to build
on the recent successes to make sure
that hospital patients throughout the
state have access to the highest quality patient care.
As the state’s quality improvement
organization for Medicare and
Medicaid, AFMC works with hospitals, physician offices, nursing homes
and home health agencies to ensure
that Arkansans receive high-quality,
cost-effective healthcare. Priorities are
determined by the Centers for
Medicare & Medicaid Services and the
Arkansas Department of Health and
Human Services, and include care for
people with medical conditions such as
heart attack, heart failure, diabetes
and asthma, as well as preventive care
such as mammography, childhood
immunization, and flu and pneumonia
immunization for adults. AFMC is
also working to help healthcare
providers make effective use of health
information technology.
•
Physician Voluntary Reporting
Program Begins in January
The Centers for Medicare & Medicaid Services (CMS)
announced on October 31 a voluntary quality reporting initiative
for physicians that could be a first step to a Medicare pay-for-performance program for doctors.
The initiative starts in January 2006 with 36 quality measures developed by the American Medical Association, the
National Quality Forum and other groups. More measures will
be phased in during 2006.
The agency said the data will be for both its use and physicians’ review, and will not be made available to the public.
Hospitals already receive additional Medicare payments
for reporting data to the CMS, and the agency has begun a
pay-for-performance demonstration project involving large
medical groups.
The CMS announcement did not address additional reimbursement for physicians who report the data under the latest
initiative. CMS said the initiative is part of its ongoing effort
with Congress to make sure Medicare is paying doctors adequately without increasing overall program costs.
•
15
Q U A L I T Y
Two Hospitals Earn Arkansas
Hospital Quality Awards
Two Arkansas hospitals are among
nine organizations that received
Arkansas Institute for Performance
Excellence (AIPE) awards October 17
at The Peabody Little Rock.
Arkansas Methodist Medical
Center in Paragould and the Perinatal
Bereavement Program of the St.
Vincent Center for Women &
Children in Little Rock were selected
as winners of AIPE awards for excellence in organizational performance
and strategies.
The AIPE, formerly known as the
Arkansas Quality Awards group, was
developed to provide opportunities for
organizations to measure progress in
performance excellence. Their awards
recognize groups and institutions
interested in improving quality, productivity and financial effectiveness.
•
Surgical Care Improvement Project:
Has Your Hospital Signed On?
Three months ago a partnership of
leading public and private healthcare
organizations including the American
Hospital Association (AHA) launched
a project to improve surgical care in
hospitals nationwide.
The goal of the project is to reduce
surgical complications by 25% by the
year 2010. This Surgical Care
Improvement Project (SCIP) targets
complications related to surgical
wound infections, blood clots, perioperative heart attack and ventilator
associated pneumonia.
Since 2003, the SCIP has been limited to a three-state pilot project with
the objective of identifying the most
effective methods for Medicare
Quality Improvement Organizations
(QIOs) to help hospitals improve their
performance in surgical care.
Last August, the SCIP became part
of the QIOs’ work plan. Now they will
work intensively on reducing surgical
complications with hospitals in every
state. The national SCIP partners are
finalizing the process and outcome
measures hospitals will be asked to
collect as they participate in SCIP, and
a data collection tool is being developed by the Centers for Medicare &
Medicaid Services (CMS).
In addition, everything is being
coordinated
with
the
Joint
Commission on Accreditation of
Healthcare Organizations (JCAHO)
so that hospitals submitting SCIP data
can use the same vendors they use for
accreditation data collection and for
submitting data to the Hospital
Compare Web site. These tools will be
ready soon.
Participating hospitals will submit
data to the QIO warehouse, as they do
now for public reporting for CMS’
Hospital Compare program. Initially,
the SCIP data won’t be publicly reported, but in the future some of the SCIP
measures will appear on the Hospital
Compare Web site.
Before any hospital-specific data
are made public, hospitals will be
informed about what that information is and given the choice of
whether to share their data publicly.
Hospitals are being asked to learn as
much as possible about the SCIP and
consider signing a letter of participation now.
In addition, hospitals that plan to
participate should begin educating
medical staff members about the project and the modules in which the hospital will enroll. The participation letters
can be found on the AHA Web site at
http://www.aha.org/aha/key_issues/pat
ient_safety/contents/050923SCIP.pdf.
For more information, go to
http://www.MedQIC.org/scip.
•
16
Q U A L I T Y
CMS Releases HCAHPS Survey
The Centers for Medicare &
Medicaid Services (CMS) recently
released its final Hospital CAHPS
(HCAHPS) survey instrument, the first
national survey to collect uniform
patient feedback on hospital care.
The American Hospital Association
(AHA)-backed survey will be implemented in 2006 as part of the Hospital
Quality Alliance (HQA), the publicprivate collaborative whose members
include the AHA, Association of
American Medical Colleges, Federation of American Hospitals, National
Association of Children’s Hospitals
and Related Institutions, American
Medical Association, American
Nurses Association, AARP, AFLCIO, Consumer-Purchaser Disclosure
Project, Joint Commission on
Accreditation of Healthcare Organizations, National Quality Forum,
U.S. Chamber of Commerce, CMS,
and the Agency for Healthcare
Research and Quality.
Participation by hospitals will be
voluntary, and results ultimately will
be publicly reported on the HHS
Hospital Compare Web site at
http://www.hospitalcompare.hhs.gov/.
More information on the HCAHPS
survey and on HQA is available at
http://www.cms.hhs.gov/quality/hospital.
•
Cancer Death Rates Continue to Decline
Americans’ risk of dying from cancer continues to decline while the rate
of new cancers holds steady, according to the “Annual Report to the
Nation” by the National Cancer
Institute, Centers for Disease
Control and Prevention, American
Cancer Society, and North American
Association of Central Cancer
Registries.
The report provides updated information on U.S. cancer rates and
trends. According to the new report,
death rates for all cancers combined
declined 1.5% per year in men from
1993 to 2002, and 0.8% in women
from 1992 to 2002, while overall cancer incidence rates for both sexes have
been stable since 1992. Lung cancer is
the leading cause of cancer deaths in
both men and women. For more on
the report, go to http://jncicancerspectrum.oxfordjournals.org/cgi/content/
abstract/jnci;97/19/1407.
•
New Breast Cancer Treatment Shown
to Reduce Need for Repeat Surgeries
from UAMS Communications
A breast cancer treatment developed by University of Arkansas for
Medical Sciences (UAMS) surgeon V.
Suzanne Klimberg, M.D., has been
shown in a clinical trial to reduce the
need for repeat surgery following
lumpectomy by 86 percent.
Klimberg, director of the breast
cancer program at UAMS’ Arkansas
Cancer Research Center, is the principal investigator of a multiphase clinical trial for the new procedure called
Radiofrequency Ablation (RFA)Assisted Lumpectomy. The findings of
the study were presented in late
October at the American College of
Surgeons’ 91st Annual Clinical
Congress in San Francisco.
The RFA procedure, which sears a
one-centimeter margin, or perimeter,
of soft tissue following standard
lumpectomy removal of a breast
tumor, is intended to give the patient a
cancer-free area around the site where
the tumor has been removed so that a
second surgery in the area around the
lumpectomy and/or radiation therapy
are unnecessary. Currently, about 40
percent of patients require a second
surgery to remove additional malignant tissue.
UAMS is the first hospital to use
RFA-assisted lumpectomy to treat
breast cancer. Klimberg’s recently concluded trial involved 25 breast cancer
patients.
•
17
HURRICANE KATRINA
This Sign Means Hope
This Is What You
Can Do to Help:
In areas ravaged by Hurricane Katrina, the hospital “H” also came to mean
“hope” … and “heroes.”
Thousands of hospital workers held the line, endured the storm and survived
the deluge — to care for their patients.
Hospital employees in Louisiana,
The stories are just beginning to be told:
Mississippi and Alabama suffered
devastating losses from Hurricane
At one New Orleans hospital, staff went days without food and water while
evacuating patients — carrying some on stretchers, some on their backs —
through floodwaters and up eight flights of stairs to waiting helicopters.
Katrina. Some lost everything,
yet they continued caring for
their patients and neighbors.
See what you can do to help those
In Mississippi, a surgeon performed emergency surgery by flashlight, with flood
water rising over his feet and medical equipment failing.
At another hospital, food and supplies ran out, and many of the staff knew
that they had lost their own homes. But they continued to accept new
patients — treating evacuees and rescue workers alike.
who helped so many.
The men and women of America’s Hospitals … heroes every day.
Go to: www.TheCareFund.net
America’s Hospitals.
First in hope. First in care. Always there.
www.aha.org
SPECIAL SECTION
KATRINA REVISITED
Temporary Agreement
is Easing Nurse Licensure Delays
The Arkansas State Board of
Nursing (ASBN) has agreed with an
(AHA) request about issuing temporary state licenses to nurses who
are currently licensed in another
state and wish to practice in
Arkansas.
The ASBN notified the AHA of its
decision in mid-October. Under the
new policy, a temporary license will
be issued immediately upon request,
and will be made final upon completion of a criminal background check
by the Arkansas State Police.
This new policy should eliminate
the long wait for Arkansas licenses
being experienced by many nurses
from states that are not a part of a
multi-state compact, which allows
reciprocal licensing of nurses among
those states.
Some hospitals lost nurses to
other employers because of the earlier, lengthy delays. With the ASBN
promising immediate temporary
licensure for nurses who submit a
photocopy of their current license
from another state, that problem
should be solved.
Editor’s Note: Four short months
ago, on August 29, 2005, our nation
and the world watched in horror as
the Gulf states of Mississippi,
Louisiana, and southern Alabama
were crushed by Hurricane Katrina
and the unrelenting floods that followed her landfall.
The following weekend — Labor
Day Weekend 2005 — was unlike any
Labor Day healthcare personnel had
previously experienced in our state. In
Hurricane
Katrina’s
aftermath,
Arkansas hospitals immediately mobilized, volunteering to do what they
could to help not only the devastated
Gulf Coast hospitals, but also the hurricane victims who had lost everything
to the storm.
Stories were being told across
Arkansas about the healthcare professionals and teams who launched
into action, preparing to go south or
to help evacuees as they came north.
Hospitals such as North Arkansas
Regional Medical Center in Harrison
and Baxter Regional Medical Center
in Mountain Home sent personnel in
ambulances loaded with food, water,
medicines and even boats to navigate
the flooded city streets of New
Orleans.
The Central Arkansas Veterans
Healthcare System coordinated citizen evacuation efforts while the
National Disaster Medical System
(NDMS) emergency manager, Billy
Conner, deployed to Mississippi and
Louisiana in order to set up medical
relief operations.
Many, many others added their
names to the growing list of volunteer
health professionals eager to work for
several weeks to spell workers in hospitals spread across the Mississippi and
Louisiana Gulf Coast, many of whom
had lost everything and needed time to
take care of personal matters. Entire
facilities, including Stuttgart Regional
Medical Center and Crossett’s Ashley
County Medical Center, coordinated
the preparation and serving of meals
for evacuees with local civic organizations and area churches.
HSC Medical Center in Malvern,
Washington Regional Medical Center
in Fayetteville, Northwest Health in
Springdale, hospitals in the Mercy
Health System, St. Bernards Medical
Center in Jonesboro and Little Rock
area hospitals rotated shifts of nurses
and physicians in camps and shelters
set up throughout the state to house
evacuees.
Arkansas Hospice and several psychiatric facilities offered their services
by providing social workers, grief
counselors, and nurses.
These are a few of the many ways
Arkansas hospitals and healthcare
facilities assisted with the heartbreaking needs of both the evacuees and
those who worked at the damaged
hospitals along the Gulf Coast.
Unbelievably, two weeks later,
another hurricane by the name of Rita
slashed into the Gulf area once again.
This time, Texas and Louisiana
received the brunt of the storm.
Hospitals in Little Rock, North
Little Rock, Jacksonville and Benton
and the Metropolitan Emergency
Medical Services involved in the
NDMS were called into action following Hurricane Rita to receive patients
from Texas and Louisiana hospitals
evacuating either due to rising water
or to predicted storm damage.
Through it all, the Arkansas
Hospital Association served as hurricane communication headquarters and
liaison to our hospitals, the DHHS
Division of Health, Governor Mike
Huckabee’s Office, the Arkansas
Department of Emergency Management, CMS and the Medicare and
Medicaid offices, the American
Hospital Association, other state hospital associations, our congressional
offices and many, many other entities.
We are proud of our healthcare personnel and the lifesaving comfort they
offered to hurricane victims. We hope
you enjoy reading some personal
accounts in the pages that follow and
that you will add these shining
moments to your memories of the hurricanes of 2005.
•
— Beth Ingram, Vice President,
AHA and Editor, Arkansas Hospitals
19
SPECIAL SECTION
KATRINA REVISITED
Arkansas Included Under
Emergency Assistance Declaration
On September 8, federal Department of Health and Human
Services (HHS) Secretary Michael
Leavitt issued an 1135(b) waiver
declaring
a
Public
Health
Emergency for eight states, including
Arkansas, retroactive to Hurricane
Katrina’s landfall in late August.
The declaration assures that those
states where a great majority of
Hurricane Katrina evacuees continue
to seek shelter are included in the various Medicaid flexibility provisions that
Secretary Leavitt announced earlier.
The Arkansas Hospital Association worked with members of
Arkansas’ congressional delegation
and state officials to achieve this declaration, and appreciates all those
who were instrumental in obtaining
the waiver for our state.
•
Katrina Hits Home, Literally,
for AHA Board Chairman’s Son
Editor’s Note: Robert Atkinson is the
new Chairman of the Board of the
Arkansas Hospital Association, and
also serves as president and CEO of
Jefferson Regional Medical Center in
Pine Bluff. His is a very personal story
of dealing with Hurricane Katrina,
from helping his son prepare his home
to outrunning the storm to returning to
deal with its overwhelming aftermath.
August 28. Brooklyn Grace
Atkinson, first grandchild of Bob and
Becky Atkinson, was to be baptized in
Slidell, Louisiana. The extended family had gathered, but as the nation
watched,
Hurricane
Katrina
approached the Gulf Coast.
“We knew we would need to leave
the Slidell area soon,” Atkinson said.
“In preparation for the storm to come,
our daughter-in-law, Alison, and our
new granddaughter fled to Alison’s
folks in Baton Rouge. Our son stayed
behind in Slidell. He is one of the senior auxiliary policemen there, and was
needed by the community.” After
helping Chris and Alison prepare their
home for the storm, Bob and his wife,
Becky, joined thousands of others leaving the area by car and began their
escape north.
“Our son’s home is near the interchange of Interstates 10, 12 and 59, so
we were able to get to the highway
20
fairly easily,” Atkinson recalls. “We
were in reverse traffic flow conditions
(where all lanes of Interstate Highway
59 were re-directed northbound) all
the way to Hattiesburg, Mississippi. It
took us six hours to reach Jackson
(Mississippi) — nearly three times
what it would normally take.” From
there, the Atkinsons made their way
back to south central Arkansas.
As Katrina neared, it became evident that Slidell was directly in her
path. Located northeast of New
Orleans on the north side of Lake
Pontchartrain, Slidell was a quiet community of about 26,000.
After
Katrina, nearly all of its families faced
the fate of the younger Atkinsons.
Homes were destroyed; lives had to be
rebuilt.
“One of the most remarkable
things I can tell you is that the human
spirit is a wonder,” Atkinson says.
“People do have the desire and spirit
to conquer even the worst of circumstances. As Becky and I ventured back
to Slidell each weekend to help our
kids recover from the storm, we saw
that in the community and in its residents.”
After Katrina struck, communication was, of course, difficult. There
was no electricity, few ways to let people know what was happening. Chris
Atkinson and his fellow policemen —
both full-time and auxiliary — sheltered through the storm in a building
near Slidell’s hospital. On Wednesday,
two and one-half days after Katrina
had done her worst, the Atkinsons
heard that Chris was all right.
“Of course, there was major damage everywhere. Chris told about
watching trees snap off in the 120 mph
winds,” Atkinson says. Slidell also
received more than 16 feet of water by
way of storm surge. “Nearly every
home received damage. Those nearest
Lake Pontchartrain had little to go
home to. Those farther away — like
Chris and Alison (three miles from the
lake) — had homes still standing but
with significant damage.”
Returning to Slidell the weekend
following Katrina, Atkinson, sons
Chris and Tim and Alison’s dad and
brother all worked to do what they
could at the home. “When we first
arrived, it was quite a sight to behold,”
he says. “It almost looked like a black
and white photograph, because everything was caked with grey mud.”
A large tree had blown down,
blocking the front walk. The garage
door was banged up as a result of
trees, furnishings, cars, etc. being
rammed into it as the water surged. A
boat had come to rest between the
house and the backyard fence. Large,
heavy outdoor urns had floated into
SPECIAL SECTION
KATRINA REVISITED
the yard up and over a six-foot fence.
There was no power, no water.
“The first thing we did was to
remove the plywood from the windows so we could see what had happened,” Atkinson says. “All of the
upholstered furniture was upside
down, soaked. Furniture had been
tipped over, and was covered in mud.
As we walked, our feet would stick in
the mud plastered into the carpets.”
Atkinson and his family were some
of the first people into the devastated
city. They brought a U-Haul truck
with them so they could remove any of
Chris and Alison’s personal belongings
that survived above the water line.
“We saved between 10 and 20 percent
of the kids’ stuff,” he said. “The rest
of their life’s mementos, and those of
all living on the Gulf Coast, were simply washed away.”
The first weekend was spent
removing all of the home’s cabinets,
appliances, bedding and furniture.
“We took it to the curbside for eventual pickup,” he says. “If you can
believe it, we had a mountain more
than six feet high and many feet
wide.”
Keeping ahead of mold was the first
priority. They sprayed germicide
everywhere in the home. “We knew
we would end up removing all of the
wallboard, all of the insulation, all of
the carpets,” he said.
With water having reached a height
of 3.5 feet in the home, there was
much to be removed.
The next weekend, Atkinson headed to Hattiesburg, Mississippi and
brought in new insulation to replace
what had been soaked in the storm
and its residual flooding. In subsequent weekends, sheetrock was
replaced, new cabinetry and carpets
ordered, and painters brought in.
Chris, who serves as Human
Resources Manager for Ochsner
Clinic/Medical Center in New
Orleans, is commuting every day
from Alison’s family cabin on the
Tickfaw River near Hammond.
Alison says she is ready for her fami-
ly to be able to return home.
“Television just can’t express the
amount of damage the storm and its
aftermath have done in the area,”
Atkinson says. “People say it looks
like a war zone, and it does. All
around you, people’s lives — all they
have owned and collected, all of their
dreams — are piled at the curbside.
When you are there in person, seeing
it 360 degrees around you, you realize just how powerful Mother Nature
can be.”
But in helping Chris and his neighbors, Atkinson says he has seen the
better side of mankind. “Mother
Nature is powerful,” he says, “but the
human spirit is indomitable. We have
seen the positive side of people’s spirit,
and truly the milk of human kindness
flowing as people reach out to help
others. It seems like people are saying,
‘we are going to lick this thing.’”
It will take years, but the Gulf
will recover. As Atkinson says,
Mother Nature is strong, but
Human Nature perseveres.
•
Pat O’Brien’s Loss is Ouachita
County Medical Center’s Gain:
Chef Finds a New Home
Editor’s Note: The first portion of
this story originally appeared as an
October article in the Camden News.
We thank Editor Donna Collins for
allowing us to reprint it here. The
second portion (after the asterisks)
was written by Arkansas Hospitals
staff members.
From the Camden News,
by Stephanie Jones
The food in the Ouachita County
Medical Center dining hall now has a
Creole flair.
Richard Smith, 47, formerly a
chef at a restaurant in New Orleans,
moved to Camden recently after
evacuating his Louisiana home fol-
lowing Hurricane Katrina. His family plans to stay in town permanently.
Smith came to Camden with his
wife and three sons, ages 12, 9 and
1, because his mother-in-law lives
here. But he said he is pleased with
the move for more reasons than he
expected.
Smith is impressed with Camden’s
family atmosphere. The people in
town are different from New
Orleans, he said.
“I love Camden. I really do,”
Smith said. “When we got here,
everybody had smiles for us.”
He said Camden residents had been
eager to reach out to his family and help
them settle in. His wife quickly found
a job as a certified nurse’s assistant at
the Medical Center of South Arkansas
in El Dorado. His two older children
are in Camden Fairview schools.
“My boys are in school, the schools
and the people are treating them so
kind,” he said. “They’re getting used
to their classes so fast.”
Smith said he plans to return to
New Orleans in the coming weeks to
settle insurance and property matters,
but he will return to live in Camden
for good.
“The bills are still coming in — the
water bill, the electric bill,” and his
family is not even there. “I’ve got to
close all of that out,” he said.
He also has to pick up his car,
21
SPECIAL SECTION
KATRINA REVISITED
those,” he said. “And right now I’m
working on a béarnaise sauce.”
Cooking has been a part of Smith’s
life since his childhood. He said he
first became interested in it when he
spent time in the kitchen with his stepfather.
Smith
attended
Jumonville
Culinary Technical Institute in St.
Martinville to get training before he
began restaurant work. When the
family was forced to leave (New
Orleans), he was a chef at Pat
O’Brien’s restaurant.
The Smiths only evacuated after
they stayed in their home through the
storm itself, Smith said. He said the
home was damaged primarily by the
force of the storm winds and rains, but
wasn’t flooded.
“The flood water reached up to
the front steps,” he said. “But when
the roof caved in, that’s when things
got crazy.”
***
Since this article first appeared in
early October in the Camden News,
Richard Smith has made his return
journey to New Orleans. What he
Photo by Jamie Jordan
damaged by the flooding that followed the hurricane.
Smith has been working at the hospital for nearly a month, he said, and
officials there have given him a lot of
freedom to make the dining hall menu
his own, he said.
“I love working at the hospital,” he
said. “The people have been real good
to me. I’ve been able to get into the
kitchen and do my own thing, and
spice it up, you know. They pretty
much told me, ‘Whatever you want to
do in the kitchen, go ahead.’ The spice
and flavors, I’ve gotten a good
response; it seems like everybody loves
it,” he added.
He said guests and hospital administrators have complimented his dishes.
Smith’s supervisor, Sarah Silliman,
confirmed that everyone is pleased
with his work. “We’re very fortunate
to have him,” she said.
Beef sirloin, roast beef and roast
pork, red beans and rice and shrimp
etouffée are a few of the dishes Smith
has been serving up.
“I’ve been doing a lot of pasta dishes; everyone really seems to like
From Pat O’Brien’s restaurant in New Orleans to head chef of his own kitchens at
Ouachita County Medical Center in Camden, it has been an interesting three months for
Richard Smith. After fleeing Hurricane Katrina’s destruction (his family’s home was
devastated by storm winds), Smith and his family sought refuge at his mother-in-law’s
home in Camden. Now, the Smiths and their three children are permanent residents of
the Camden community, and those who have reason to dine at the Medical Center can
fully appreciate his culinary expertise!
22
found was total devastation of his
home and belongings.
“Unfortunately, he returned to
find what was NOT left of his
home,” says Ouachita Valley Health
System CEO C.C. “Mac” McAllister.
“He had hoped to bring his car and
things from his home in New
Orleans back to Camden, but all he
brought back was bed frames. Even
the car was totally ruined.”
When speaking of Richard Smith
and what he has meant to the health
system, McAllister’s voice softens.
“He has adopted us, and we have
adopted him. He is a very friendly
guy,” he says.
McAllister also comments on what
“great cooking” can do for attendance
at meetings. “I am on the Community
Foundation Board, and we hold our
meetings at the hospital,” he says.
“All I can tell you is that since Richard
has been providing the food for the
meetings, our attendance is up!”
Hurricane Katrina was what
McAllister calls a “wake-up call” for
Arkansas hospitals. “Through the
Arkansas Hospital Association, we all
got involved, doing what we could, in
whatever way we could,” he says.
“But what Hurricane Katrina really
did was show us that as bad as it was
and as real as it was, it was a dress
rehearsal for something that could be
much worse.”
He says the hurricane and handling
its evacuees caused the Sheriff’s
Department, Office of Emergency
Services and other local groups to work
together with national agencies (such
as FEMA — the Federal Emergency
Management Agency) in a way never
before possible. “It helped us all think
again about what we would do in a disaster situation,” he says.
What effect has the hurricane had
on Camden? “Our population is
growing as people move here to
begin a new life,” he says. And as
for the hospital cuisine? Let’s just
say it’s a new experience to have
folks calling to find out what’s cooking, and have them lining up outside
the doors for a sample of Richard
Smith’s daily fare.
•
SPECIAL SECTION
KATRINA REVISITED
Paul Prudhomme
Provides Meals for
Relief Workers
in New Orleans —
Thanks to a
Truckload of
Ingredients
from Pine Bluff’s
Doctors and the
Community
World-renowned chef Paul Prudhomme, his family and restaurant workers joined the thousands making a temporary escape from New Orleans during the
height of Hurricane Katrina and its aftermath. They
fled to the camp-in-the-woods of one of Pine Bluff’s
physicians, a dear friend for many years. There, he
spent two weeks waiting for New Orleans to dry out
enough for his group to venture back. Upon their
return, they immediately began cooking meals for the
many relief workers in the New Orleans area. But
getting fresh food into town was difficult, at best.
Four weeks after the storm, Prudhomme’s Pine Bluff
friends again came to the rescue, raising more than
$15,000 and filling a semi-trailer truck full of fresh
food and needed ingredients. This is the “thank you”
message Prudhomme and his pals placed in the Pine
Bluff Commercial, thanking the medical community
and the people of the city who sent the personalized
“food relief truck.”
•
Over 70% of Hospitals in AHA
Use
Delivering over One Million
messages daily
Phone 800-770-0183
For Advertising
Information
Adrienne Freeman
Publishing Concepts, Inc.
501 / 221-9986
[email protected]
23
C E O
P R O F I L E
Bob Atkinson was installed as
the new Chairman of the Board
for the Arkansas Hospital
Association at its annual meeting
in October. He is a great believer
in the importance of hospitals
working together for the good of
Arkansas’ healthcare facilities,
their patients and communities.
“I have been involved with the
AHA almost since I arrived in
Arkansas in 1992,” he says. “I
have long felt that the association’s leadership is its greatest
strength. The Board members
and the AHA staff have worked
together so well through the years
and done a great job. They are a
good team.”
He sees the main job of the
AHA as keeping the state’s hospitals and their administrative professionals well informed. “There
are so many changes constantly
occurring in healthcare,” he says.
“The AHA tells us what we need
to be concerned about, and represents us well both at the state
and the national levels.”
“In every life, there are defining moments...distinct milestones
that influence our character, illuminate our dreams and shape the
direction of our lives,” he says.
“Several of those defining
moments have taken place in my
life this year. The most meaningful was the birth this summer of
my first grandchild, Brooklyn
Grace Atkinson. She represents
the very best of our family’s past
and future, and her arrival certainly defined my aspirations as
an influence in her life.
“Another defining moment
was being nominated to serve as
chairman of the Arkansas
Hospital Association. I have a
deep respect for the AHA and the
guidance it provides to healthcare professionals throughout the
state. It is a privilege to be an
AHA member, and an honor to
serve as Chairman. I look forward to continuing the standard
of excellence that has defined the
healthcare industry for us all.”
24
by Nancy Robertson Cook
New AHA Chairman on
“Defining Moments,”
Katrina, and Challenges
to Healthcare
Jefferson Regional
sonal impact on so
Medical Center (JRMC)
many Americans; their
in Pine Bluff is but one
ensuing stories each
of many Arkansas
come down to one
healthcare facilities
person, one family’s
responding to cries of
account of what hapdesperation following
pened “to them.”
the confusion and devJRMC will be a part
astation wreaked by
of many of those stoHurricane
Katrina.
ries because of the
JRMC’s rapid response
help it provided and
to evacuees is testathe compassion it
ment to one hospital’s
offered with welcomdisaster planning and
ing arms.
thoughtful considera- Robert Atkinson was installed as
“Pine Bluff took in
tion
for
human the 2005-2007 Chairman of the
between 2,000 and
need…and in the Board of the Arkansas Hospital
3,000 evacuees in the
midst of the hospital’s Association in October. Atkinson storm’s aftermath,”
administering care and is president and CEO of
Atkinson says. “At
Jefferson Regional Medical
compassion to those
first, it was in small
Center in Pine Bluff, a position
fleeing
Katrina’s he has held since 1992.
groups of three and
chaos, one family’s
four cars, families and
story was very personally unfolding
friends driving together to escape the
for the medical center’s CEO and
impending storm. Then we received
President Robert Atkinson.
more and more people who had been
Atkinson’s eldest son, Chris, and
evacuated from New Orleans, directly
his family from Slidell, Louisiana
after or in the next week after Katrina
found themselves in Katrina’s direct
hit.” Some of those had originally
path Sunday, August 28. “We were all
been evacuated to Fort Chaffee, near
gathered in Slidell that weekend for
Fort Smith.
our first granddaughter’s baptism,” he
Sheltered at the Pine Bluff
says. “But with Katrina’s approach,
Convention Center, those arriving in
we knew that would be postponed.
the earliest days had fewer medical
Before we left, we helped Chris and
needs; most required a refill of their
Alison prepare their home for the
prescription drugs. “We set up a
storm. We put plywood on all the
booth at the Convention Center
windows and did what we could to
where people could come for medical
secure the house. Then, we began our
help,” Atkinson recalls. “At first we
drive home to Pine Bluff, and the work
served mostly as a first aid station,
we knew would await us with incomadministering lots of tetanus shots,
ing evacuees.”
refilling prescriptions and assessing
The winds and flood waters that
people for injuries.”
buffeted Gulf Coast families had perBut with the second wave of evac-
On Sunday, September 4, 2005, Pine Bluff welcomed 324
New Orleans evacuees who had previously been housed at
Fort Chafee. JRMC employee health nurse Alice Lawson, RN,
triaged each survivor as he or she got off the bus.
uees — those escaping the floods of
New Orleans — Atkinson says the
needs rose tremendously.
“Those arriving from New
Orleans had had no way to wash, to
eat, to meet their critical medical
needs,” he says. “These 300-500 people showed considerably more stress
and strain than those who had come
before them. They needed a place to
bathe, and food to eat. They needed
medical assessment, referrals and the
care that those of us in the medical
field can specifically offer.”
JRMC posted a team of around 30
doctors and nurses at the Convention
Center to begin offering medical hope
as soon as people stepped off the buses.
“Essentially, we were putting our disaster plan into place,” Atkinson says.
“And the evacuees’ reaction — their
thanks — was truly heartwarming.”
As people told their stories, the
human side of the storm’s aftermath
began to unfold. “People were so
concerned for those they had left
behind,” Atkinson says. “So many of
them lost their homes, their friends,
even family members.” Pine Bluff
churches came to the rescue, offering
shelter and food — ”aid and comfort
in the finest sense,” Atkinson says.
“JRMC’s biggest contribution was in
helping get people back on their medicines. We estimate that we provided
between $30,000 and $40,000 in prescription medicines. We may or may
not be reimbursed for those medica-
JRMC responded immediately by setting up a first aid station to offer minor
emergency care, physician referral and prescription assistance. JRMC’s
Ruth Rogers, RN, (center) gave updates on how to run the clinic. Volunteers
included a number of physicians such as Reid Pierce, MD (left).
tions, but dispensing them was simply the right thing to do.”
Atkinson says two of the things he
will most remember about Katrina
are the unbelievable power of Mother
Nature, and the compassion of
humans, one for the other.
He is no stranger to Mother
Nature’s power. At the tender age of
six, he saw first-hand the effects of a
tsunami while living with his military
family in Hawaii.
“I guess you could call me a Navy
brat,” he says. “We moved around a
great deal as I was growing up. I will
never forget standing on the shore in
Hawaii, a boy of six, and watching the
ocean literally suck itself outward for a
mile or more. Fish were flopping
everywhere. We knew it was time to
head home. And soon afterward, a
tsunami wave crashed in, close to
where we lived. It is something I will
never forget.”
Atkinson spent many of his growing-up years in southern California,
eventually attending high school in La
Mirada. “Then, we had a big transition,” he recalls. “We moved to
Jackson, Mississippi, where I would
finish high school. That was really an
eye-opener!”
With a smile in his eyes, he remembers being “a novelty” to the native
Southerners. “I was so non-Southern,
I didn’t even know that iced tea was
something ‘everybody’ drank. I saw
tea as a drink mostly enjoyed by
adults. And okra, black-eyed peas —
all of these were new to me. I am sure
my classmates enjoyed a few good
laughs because of me!”
Atkinson’s chosen career path was
one of science. He earned his bachelor’s degree from Mississippi State
University in general science, then
went on to earn his master’s in zoology and physiology. “I planned to
pursue my doctorate,” he says, “but
it was 1972 and the war in Vietnam
was raging. I had an ROTC commitment to fill, and because of my science degrees was placed in St. Louis
as administrative officer of a regional
medical laboratory.”
He shakes his head as he tells how
his planned career in science shifted,
instead, to one in administration.
“The Army really threw me a curve
ball,” he says. “I had no administrative experience. I read up on it,
learned as much as I could, and with
my science background found it easy
to talk with the doctors and nurses at
the lab.”
His new career path became clear.
Upon completion of his military commitment, Atkinson returned to the
South and attended the University of
Alabama at Birmingham in pursuit of
a master’s degree in hospital administration. Graduating in 1976, he spent
the next two years in Birmingham as
an assistant administrator at St.
Vincent’s Hospital.
In 1978, he accepted an offer from
25
26
Humana, a for-profit hospital chain,
and moved his wife, Becky, and sons
Chris and Tim to Huntsville, where he
served as associate administrator and
COO
of
Humana
HospitalHuntsville. His next assignment with
Humana was in Muscle Shoals,
Alabama, where he served as administrator and was charged with building
a new hospital from the ground up —
has been enjoyable in every way.
“Becky and I were empty-nesters
when we moved to Pine Bluff,” he
says. “We have enjoyed becoming a
part of the community, and love the
people here.”
There have been many changes in
hospital administration over the
course of Atkinson’s career. “The role
of the administrator used to be to han-
a hospital that would be used as a prototype for the Humana system for
years to come.
“That was a particularly interesting
project,” he says. “We helped with
design of the entire hospital, a very
rewarding experience.”
His next position was with
Chalmette Medical Center in New
Orleans — a hospital, he
recalls, that took on seven feet
of floodwater in Katrina’s aftermath. He served as administrator at Chalmette from 1985-87,
then accepted an offer from
Slidell to become administrator
of Slidell Memorial Hospital.
Slidell is where his two sons
spent their later teen years, and
it is ultimately where elder son,
Chris, settled.
In 1992, Atkinson became
president and CEO of Jefferson
Regional Medical Center in Pine
Bluff, Arkansas, a move he says
dle the hospital’s internal affairs,” he
says. “Now, that’s more the role of an
assistant administrator or vice president. The role of the CEO is now
more external, networking with other
healthcare providers, working with
legislators, helping with physicians’
concerns and issues, fighting the reimbursement fight, and serving as the
medical center’s liaison with the
greater community.”
The hospital is a central part of
every community, he says, and is often
the center of its economy. JRMC is
one of the top employers in Pine Bluff,
and indeed in all of Jefferson County.
He cites “the insurance situation”
(growing numbers of uninsured and
underinsured) as one of his biggest
concerns as an administrator. “With
the cost of healthcare on the rise, small
employers just can’t afford to provide
health insurance for their workers
anymore,” he says. “Health crises can
put families into bankruptcy, yet too
much charity care can force a hospital
to close its doors. There is a real burden on hospitals to provide care at
reasonable costs while still being able
to provide needed services. It is a difficult spiral, and a big challenge for
our society.”
He also cites a change in the healthcare workforce as challenging.
“Many are simply losing heart,” he
says. “They are still extremely dedicated, but with fewer workers we are
asking more and more of those still on
the job, and that is hard on them. The
average age of nurses is 41-42, and
many will retire soon. We must find
ways of recruiting and training the
healthcare workforce needed with our
growing, aging population.”
As both scientist and hospital
administrator, Atkinson sees the future
of healthcare as exciting and promising, even with its inherent challenges.
“There are new medicines, new technologies that are saving people’s
lives every day. And new things are
being discovered all the time — it’s
almost like something out of Star
Wars,” he says.
Serving the healthcare field is
truly a calling, Atkinson says. “We
have come so far; it is hard to
imagine the advances that have
been made in just the past 75
years.
Knowledge, treatment,
technology, all are growing exponentially. Collectively, as members
of the field of healthcare, we can
all be proud of the job we do and
the service we provide!”
•
SPECIAL SECTION
KATRINA REVISITED
Hot Showers, Warm Meals, Finding Mama —
It’s All in a Day’s Work at
St. Edward Mercy Medical Center
Chip Paris, Director of Marketing
and Planning for the St. Edward
Mercy Health Network in Fort Smith,
vividly recalls Labor Day weekend of
2005. “Friday, September 2, our
administrators were notified in the late
morning by people at Fort Chaffee
that our area would be receiving a
number of evacuees from Hurricane
Katrina,” he says. “They could give us
no definite time or numbers of people,
but we knew we had to be ready.”
The first wave of evacuees arrived
by plane at Fort Smith, followed by
what we all now remember as an
almost never-ending line of buses
from the Gulf. “We received people
from
both
Louisiana
and
Mississippi,” he says. “In all, thousands of people passed through the
Fort Chaffee relief center.”
“By Saturday, we had triaged
patients at the Fort, and brought
between 300 and 400 to the hospital
for further assistance,” he says. “Of
course, those people came with their
family members. We offered clean
clothing, a hot shower and hot meals
to all who came through our doors,
whether patient or relative.” The
evacuees came with needs ranging
from prescription refills to full-time
nursing care. “We also saw people
who had ‘normal’ problems, like the
flu,” he says.
Shirrell Henry, another member of
the St. Edward staff, recalls the care
for a man who suffered a fractured leg
during the storm. “By the time he
reached us, he was in bad shape,” she
says. “We had to amputate his leg. He
lost his leg, but we saved his life!”
One of the most
For 72 hours after
touching stories to
the first wave of evaccome out of St. Edward
uees began arriving at
Mercy
centers
on
Fort Chaffee, it was a
Monte Wilson, Vice
constant carousel of
President of Clinical
people in and out of the
Operations (Cardiology
hospital, Paris says.
and Surgical Services).
“We admitted around
Wilson, through his
20
patients,
saw
church and work at
between 300 and 400,
the hospital, found
and helped more than
himself in the middle
1000 families, in all.”
of many stories involvNot only were the
ing Katrina evacuees.
medical staff members
Monte Wilson
“On Labor Day
needed beginning that
weekend, he met a family — a mom,
Friday, but also those on the nutrition
dad and son — who had with them an
staff, who cooked and provided meals
11-year-old girl not belonging to their
for the evacuees. “We heard they were
family,” Paris recalls. “This child had
having a problem feeding the numbers
been through a nightmare already.
of people coming into the Fort,” Paris
She, her mother and baby brother
says, “so our nutritional staff immediescaped the hurricane and tried to
ately went into action. They cooked
make it to one of the New Orleans
600 hot meals complete with ice, cold
shelters. They made it to the I-10
drinks and all the fixings, transported
bridge, which many of us remember
them to the Fort, set up a buffet line in
seeing on television. There, few cars
the grass, and began serving. All of
came by to help. But eventually, a
this while still cooking for the patients
truck stopped and had room — only
and regular hospital dining rooms.”
for the mother and baby. This girl’s
He says that a number of the nutrimother had to make the heart-wrenchtional staff, as well as off-duty medical
ing decision to take her baby to safety,
staff and administrators went to the
while leaving her daughter to try to
Fort to serve the meals.
find them later. This amazing 11-year“The whole thing was so amazing,”
old made it on her own for several
he says. “The evacuees and the greater
days, then met this family, who took
Fort Smith community suddenly
her in.
became aware of the level of caring we
“They wound up at Fort Chaffee.
see and know at our hospital every
Monte Wilson met the family, and
day. I think it showed the community,
brought the girl and two other kids
reminded them, of the great care and
who had been separated from their
compassion we provide at St. Edward
families, home with him. He shared his
Mercy Medical Center.”
kids’ clothes with them, and gave them
That level of caring was also
beds to sleep in and plenty to eat.”
shown by the Mercy hospital netThen, a remarkable thing hapwork, headquartered in St. Louis,
pened. Wilson, through his church,
Missouri and of which St. Edward is
heard that the two siblings’ family
a part. “More than $300,000 was
had been located in Dallas, Texas.
raised by Mercy employees system“Monte took the two kids, along
wide,” he says. “Then, the corporawith another church member and
tion matched it. In all, we raised
this 11-year-old, to Dallas to try to
$600,000 for hurricane relief.”
27
SPECIAL SECTION
KATRINA REVISITED
find their parents,” Paris says. The
siblings’ family was found, and they
were reunited. But no word on the
young girl’s mother and brother.
“Then, they heard that the mother
and baby might be in Austin,” Paris
says. “So even though it was 9:30 at
night, they headed for Austin, arriving
there between 1 and 2 in the morning.
Of course, once they located the shelter in Austin, they found most everyone there asleep. And they didn’t even
know if the mom was there. But they
began to ask a few people in the hallways, and when they turned a corner,
the mother was simply THERE!
Monte said it was an act of God.” At
the very least, it was a miracle!
Most of the people who came
through Fort Chaffee quickly moved
on. After the experience was over,
many on the St. Edward staff continued
to trade anecdotes and stories about
what had happened — and among the
2000 workers at the hospital, there
were many wonderful stories to tell.
“Of course, as a hospital, we drill,
drill, drill on disaster preparedness,”
Paris says. “Dealing with the aftermath of Katrina made us take a long
look at our plans, and we are glad to
report that they were very flexible and
worked well.” Though a few adjustments have been made, the disaster
plan stands ready for the next event.
Let’s hope it doesn’t come soon.
•
Regional Networks Made All the Difference:
An Arkansas Children’s Hospital Retrospective
Photo by Kelley Cooper
“As we have thought it through in the time since
Hurricane Katrina, a couple of things have become very
clear,” says Scott Gordon, Executive Vice President and
Chief Operating Officer for Arkansas Children’s Hospital
(ACH) at Little Rock. “One — when things need to move,
regional networks get the job done, and two — keeping your
internal communications strong is vital.”
The Arkansas Children’s Hospital transport team worked closely with other regional transport groups to move patients from
hospitals affected by Hurricane Katrina.
Gordon says, “We have a particularly strong regional network in the area of transporting patients. Regional transportation directors know one another, know their hospitals’
abilities for transport, their people’s and hospitals’ capacities. Within one hour of identifying New Orleans’ need for
moving patients from hospitals, the informal regional network mobilized — in most cases before the hospitals there
even realized they would have to evacuate their patients.”
As became evident in the early days of Katrina’s aftermath, the helicopter evacuation of patients became a lifeline.
“No one asked, ‘Who is going to pay for this?’ prior to act-
28
ing,” Gordon says. “We just went into action, matching
resources to needs.”
He credits not only the ACH transport team, but also the
entire staff of the medical facility, in helping things to happen quickly. “Our nutritional services group helped bring
food and water that could be transported to New Orleans.
And our vendors were outstanding. Alltel provided satellite
phones for communication. Sikorsky kept teams available
in Baton Rouge so the helicopters’ engines could be flushed
and remain undamaged by the salt air.”
“At the end of the day, all our people were proud to have
been a part of the effort,” Gordon says. That is where the
internal communication updates helped. “Every person on
staff wanted to know what we were doing, and we kept
good communication with our internal organization
throughout. 40-50 people received regular updates, and
passed the information on to their own staffs.”
An internal de-briefing took place following the return of
ACH employees from the Gulf region. “It helped those who
had been on-site to discuss what they had been through, and
it helped those left to work here in Little Rock to be able to
ask questions, to better understand. It was a very powerful
session.”
In the end, the informal regional transportation network
was able to go into action well ahead of the federal emergency response. Gordon says this happened because people
knew each other, they were already organized to make things
happen, and they knew not to over-commit or to make
unreasonable demands. “They proved that when things
need to move, local and regional relationships provide the
most effective response in time of crisis,” he says. “We all
learned to recognize the value of informal relationships and
what they can do.”
He also notes that ACH is uniquely set to respond quickly — and that with that ability comes responsibility.
“Moving patients, helping to evacuate hospitals, was vitally
necessary after Katrina,” he says. “We responded. This is
what we’re all about.”
•
Arkansas Medical Records
Retention Rules : a Reminder
Several recent calls to the Arkansas
Hospital Association have concerned
hospital requirements for records
retention. According to the 2005 edition of the state’s Rules and
Regulations for Hospitals and Related
Institutions (Section 14.A.17): “All
medical records shall be retained in
either the original or microfilm or
other acceptable methods for 10 years
after the last discharge. After 10 years,
a medical record may be destroyed
provided the facility permanently
maintains the information contained
in the Master Patient Index. Complete
medical records of minors shall be
retained for a period of two years after
the age of majority.”
In addition, the Arkansas Health
Information Management Association
(AHIMA) recommends the following
permanent records:
• Master patient index
• Number index
• Admission list or patient register
• Death register
• Statistical reports
AHIMA also gives these timeframes for retaining records:
• Annual statistical reports — 30
years;
• Physician indexes, disease and
operation indexes, monthly statistical reports, quality improvement
— 10 years;
• Medical audits and corresponding retrieval sheets, medical
staff utilization reports, tissue
and transfusion committee worksheets — 5 years;
• Consent forms for release of
information on microfilmed
records, release of information
log — 3 years;
• Daily census summary or discharge
list — 1 year;
• Transcription logs — 6 months;
• Surgery schedules, daily census —
3 months; and
• Reproduction of microfilm records
sent to the floor — until discharge.
•
Caring for what
matters most…
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29
E L E C T R O N I C H E A LT H R E C O R D S
Report Lists Electronic Record Needs
The federal government should
develop a nationwide patient authentication standard that protects individuals’ information and lead an
effort to offer financial incentives to
providers in order to foster the electronic exchange of health information and to create a system of
instantly accessible health records
for all Americans, according to two
key recommendations released
October 25 by the Commission on
Systemic Interoperability (CSI).
In all, the Commission, which formulated
its
recommendations
around the tenets of adoption, interoperability and connectivity, pinpoints a total of 14 steps for creating
a connected system of instantly
accessible health records for every
American. Such a system would lead
to dramatic improvements in patient
safety, quality of care, convenience,
satisfaction and health while helping
to rein in soaring healthcare costs.
In their report, “Ending the
Document Game: Connecting and
Transforming Your Healthcare
through Information Technology”
(http://endingthedocumentgame.gov/
PDFs/Recommendations.pdf), the 11
commissioners focused on giving
people the information they need to
make wiser decisions about their
healthcare and helping consumers
understand how electronic records
and other technology are critical to
achieving that goal.
The CSI also calls on government
to “act with urgency to revise or
eliminate regulations” that impede
implementation of interoperable
electronic health records, most
notably the Physician Self-Referral
(Stark) law and the Federal AntiKickback Law.
•
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Pharmacy Benefits Manager
>
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Health Information Management
Total Healthcare Solutions
Better health outcomes for members.
Better cost outcomes for plans.
For more information, please contact NMHC
at 800-251-3883 or online at www.nmhc.com
30
E L E C T R O N I C H E A LT H R E C O R D S
With Government Help, Study Projects
Health IT Could Save $162 Billion
Widespread adoption and effective use of electronic medical records
(EMR) and other health information
technology (HIT) could save the U.S.
healthcare system up to $162 billion
annually and prevent a third or more
of adverse drug events in outpatient
settings each year, a new study by
RAND Corp. projects.
Assuming about 20% of hospitals
and physicians have an EMR system
now, the study estimates it would cost
$98 billion for hospitals and $17.2 billion for physicians to adopt a standardized EMR system over the next 15
years, much less than the $162 billion
per year in possible savings.
“The potential savings from HIT
is mind-boggling, but it isn’t going to
happen overnight,” the lead author
said. “The federal government will
need to step in to speed the diffusion
of HIT and remove some major barriers if we are going to reap the
tremendous benefits it could have on
improving quality, managing diseases, and extending people’s lives.”
Key barriers include the acquisition and implementation costs for
healthcare providers, slow and
uncertain financial payoffs, and disruptive effects on practices, the
authors say.
•
Survey: Costs are HIT Barrier
Ninety percent of U.S. hospitals
are using or considering the use of
health information technology (HIT)
for clinical purposes, according to a
new American Hospital Association
(AHA) survey, but most cite cost as a
major impediment to broader adoption, especially for small or rural
hospitals.
The survey results suggest that the
use of health IT in caring for patients
is evolving as hospitals adopt specific
technologies based on their needs and
priorities, size and financial resources.
While most are still in the beginning
stages, the survey shows hospitals are
making investments in HIT, in large
part to make gains in the safety and
quality of patient care. Some of the
technologies and systems hospitals are
using include bar coding devices, computerized physician order entry and
electronic medical records. To view the
survey in its entirety, go to:
http://www.ahapolicyforum.org/ahap
olicyforum/resources/content/FINAL
NonEmbITSurvey105.pdf.
•
Proposed Rules Bolster E-prescribing, EHRs
The federal Department of Health
and Human Services (HHS) took a
step toward meeting President Bush’s
goal of widespread adoption of additional information technology (IT) in
the healthcare field with an October
5 announcement of two new sets of
regulations that support adoption of
electronic health records (EHRs) and
e-prescribing, which enables a physician to transmit a prescription electronically to a patient’s pharmacy of
choice.
HHS Secretary Mike Leavitt said
that the proposals should speed
adoption of health IT by hospitals,
physicians and other healthcare
providers to improve quality and
safety for Medicare beneficiaries and
all Americans.
Under the first proposed rule, the
Centers for Medicare & Medicaid
Services (CMS) would create exceptions to the “physician self-referral”
law by establishing conditions under
which hospitals and certain other entities can give physicians hardware, software or information technology, and
training services for e-prescribing and
EHRs, particularly when the support
involves systems that are “interoperable” and thus can exchange information effectively and securely among
healthcare providers.
The second proposal came from
HHS’ Office of Inspector General.
That proposed rule would establish the
conditions under which such entities
may donate to physician EHR software
and related training services. This proposal would be relatively narrow until
nationwide product certification criteria are established and approved by the
Secretary. At that point, hospitals and
certain other entities could donate a
broader array of technology to physicians, if the technology met the product
certification criteria.
CMS is considering imposing a cap
on the value of the technology that
may be donated by a single donor to
reduce the potential for abusive
arrangements designed to pay physicians for referrals.
•
31
I N
C O O P E R A T I O N
W I T H
T H E
A R K A N S A S
S T A T E
B O A R D
O F
N U R S I N G
Cruise Your Way to Required C.E. Contact Hours
Who said Continuing Education can’t be
fun? We are changing that forever.
Join ThinkAboutItNursing and Poe Travel
for a CE Cruise that will cure your
overworked blues with some salsa and sun
on board Carnival’s “Conquest.” While you’re
soaking up the Caribbean culture, you can
earn 15 required C.E. contact hours AND
write the trip off on your taxes. How is that
for paradise?
Prices for this cruise and conference are
based on double-occupancy (bring your
friend, spouse or significant other please!)
and start as low as $923 per person (not
including airfare). A $250 non-refundable per-person deposit is
required to secure your reservation, BUT please ask us about our
Cruise LayAway Plan.
Cruising for C.E.
Contact Hours
This eight-day cruise is slated to sail
from Galveston on April 23, 2006,
and will visit the following ports:
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For more information about the cruise and the curriculum, please log
on to our website at www.thinkaboutitnursing.com or call Laura
Norris at 501.221.9986 or call Teresa Grace or Jayne White at Poe
Travel toll-free at 800.727.1960.
Day One: Galveston
Day Two: At sea (conferences)
Day Three: At sea (conferences)
Day Four: Montego Bay, Jamaica
Day Five: Grand Cayman,
Cayman Islands
≈ Day Six: Cozumel, Mexico
≈ Day Seven: At sea (conferences)
≈ Day Eight: Galveston
A H A
A N N U A L
M E E T I N G
Mansfield Named Weintraub
Award Recipient
Stephen Mansfield, President and
CEO of St. Vincent Health System in
Little Rock received the Arkansas
Hospital Association’s A. Allen
Weintraub Award at the AHA’s Annual
Awards Dinner, Thursday, October 20,
at the Peabody Hotel in Little Rock.
Mansfield has been President and CEO
of St. Vincent Health System (SVHS)
for the past five years.
Mansfield is noted for achieving a
successful turnaround in hospital operations in areas of community perception, patient satisfaction, employee
morale and improved financial performance. In 1998 the organization
was millions of dollars in debt.
Mansfield was able to accomplish an
$11 million turnaround.
Under his leadership SVHS was
named one of Solucient’s Top 100
Performance Improvement Leaders.
Solucient is a leading provider of
strategic business and clinical information for the health care industry.
Mansfield is also responsible for
establishing St. Vincent Centers of
Excellence in cardiac, orthopedic,
senior, spine, stroke and women’s
services.
•
AHA Chairman Tim Hill presents Stephen Mansfield, President and CEO of St. Vincent Health System, with the Arkansas Hospital
Association’s 2005 A. Allen Weintraub Award at the AHA’s Annual Awards Dinner.
33
A H A
A N N U A L
M E E T I N G
AHA Awards Presented
In addition to the Weintraub Award, the AHA’s highest
honor, additional awards were presented at the Arkansas
Hospital Association’s Annual Awards Dinner in October.
W. Turner Harris, M.D
ients of the association’s Distinguished Service Award.
Dr. Harris, a radiologist, has been a consultant with St.
Vincent Health System in Little Rock since his retirement
from more than 30 years with the System. His early
research on bone-scanning methods contributed to
NASA’s development of an in-space exercise program for
astronauts to offset the negative effects posed by the
absence of gravity. A Fellow in the American College of
Radiology, Dr. Harris also is the founder and medical
director of Volunteers in Medicine.
At the time of her death in April, Ms. Feltner was director of the medical records department at Sparks Regional
Medical Center in Fort Smith. Over her 36-year career, she
distinguished herself professionally at the state and
national levels; served as a mentor to scores of medical
records administration students at Arkansas Tech
University; and provided extraordinary leadership in medical records departments at Washington Regional Medical
Center (Fayetteville), St. Edward Mercy Medical Center
(Fort Smith) and Sparks Health System.
Statesmanship Award
Distinguished Service Awards
W. Turner Harris, M.D., of Little Rock and Linda Feltner,
formerly of Fort Smith, were selected by the Arkansas
Hospital Association’s (AHA) board of directors as recip-
State senator Tim Wooldridge from Paragould received
the Arkansas Hospital Association’s (AHA) Statesmanship
Award for 2005. The AHA Board of Directors selected
Wooldridge to receive the award in recognition of his contributions to and leadership in Arkansas hospital and
healthcare issues.
Friends and family of Linda Feltner along with representatives of Sparks Health System in Fort Smith
34
A H A
A N N U A L
M E E T I N G
State Senator Tim Wooldridge and AHA Chairman Tim Hill
Wooldridge, who served four terms in the Arkansas
House of Representatives before being elected to the
state Senate in 1999, chairs the Revenue and Taxation
Committee.
During the 2005 legislative session, Senator
Wooldridge successfully sponsored the Medicaid
Fairness Act, which was a key component of the AHA’s
legislative agenda. He also supported passage of
Arkansas Act 134 of 2005 that prohibits smoking on
hospital campuses throughout Arkansas.
In addition, Senator Wooldridge was instrumental in
helping pass legislation that provides for an additional
source of Medicaid funding to help offset some of the
losses that hospitals are experiencing in treating
Medicaid patients, and legislation that restricts the
amount of time that insurance carriers can audit and
recoup payments to healthcare providers when services
were provided and paid for on the basis of information
provided by the carriers.
Senator Wooldridge also championed legislation
known as Garrett’s Law designed to provide additional
protection and services to children born with illegal substances in their blood.
Jonathan Davis
Jonathan has already proven himself an effective leader,
bringing significant improvements to a small, rural hospital. His fiscal responsibility, concern for and value of
his staff, and insistence of the highest quality care have
made St. Anthony’s an important institution in
Vickey Boozman
Young Administrator of the Year
Jonathan Davis, Administrator/CEO of St. Anthony’s
Healthcare Center in Morrilton, was the recipient of the
Arkansas Health Executives Forum’s C. E. Melville Young
Administrator of the Year Award, which also was presented during the Arkansas Hospital Association’s annual
Awards Dinner.
“In such a short time in hospital administration,
35
A H A
A N N U A L
M E E T I N G
Morrilton and Conway County,” said Steve Mansfield,
president and CEO of St. Vincent Health System, in his
nomination letter.
During his three-year tenure at St. Anthony’s, Davis
has improved the financial growth of the hospital,
upgraded and improved technology, made magnetic resonance imaging available around the clock to patients and
secured new surgical equipment that has made minimally
invasive orthopedic procedures possible. In addition, he’s
responsible for opening a same-day surgery center, a new
facility for outpatient specialties, private labor-and-delivery suites and remodeling the emergency room.
Chairman’s Award
2005 Diamond Awards
The award-winning hospitals are:
The Arkansas Hospital Association’s 2005 Diamond
Awards competition was co-sponsored by the Arkansas
Society for Healthcare Marketing and Public Relations.
It is designed to recognize excellence in hospital public
relations and marketing. Diamond, Excellence and
Judges’ Merit Awards were possible in three divisions
(hospitals with 0-99 beds, hospitals with 100-249 beds
and hospitals with 250 or more beds) in twelve categories. The competition drew 162 entries.
Judging for each entry was based on goals and objectives, audience to whom directed, reasons for choosing
the format, frequency and quantity, portions that were
created internally/externally, results/evaluation and
total budget.
Chairman Tim Hill presented a Chairman’s Award honoring Dr. Fay Boozman, former director of the Arkansas
Department of Health, who passed away last spring. The
award recognized Dr. Boozman’s priority for improving
healthcare services throughout Arkansas; his efforts to
advance quality, effectiveness and efficiencies in the surveys and certifications affecting Arkansas hospitals; and
his unwavering pledge and commitment to improve the
health status of all Arkansans. Mrs. Vickey Boozman
accepted the award on behalf of the Boozman family.
Arkansas Children’s Hospital, Little Rock
Arkansas Hospice, Little Rock
Baxter Regional Medical Center, Mountain Home
CARTI, Little Rock
Central Arkansas Hospital, Searcy
Conway Regional Medical Center, Conway
Jefferson Regional Medical Center, Pine Bluff
National Park Medical Center, Hot Springs
Ozark Health Medical Center, Clinton
Saint Mary’s Regional Medical Center, Russellville
St. Bernards Medical Center, Jonesboro
St. Joseph’s Mercy Health Center, Hot Springs
St. Vincent Health System, Little Rock
UAMS Medical Center, Little Rock
White County Medical Center, Searcy
White River Health System, Batesville
Photos by Sarah Bussey
36
A H A
A N N U A L
M E E T I N G
Corporate Partners
John Neal and Ray Montgomery
The Arkansas Hospital Association wishes to thank the
companies and organizations participating in the 75th
Annual Meeting and Trade Show. With their financial
support of the annual event, high quality educational
programming is made possible for the AHA membership. Those contributing as major sponsors are indicated by asterisks at the following levels:
****** Diamond, ***** Platinum, **** Gold,
*** Silver, ** Bronze and *Host. Thanks to all!
AHAA Awards
John Neal, CEO and administrator of Stuttgart Regional
Medical Center, was named Administrator of the Year for
hospitals with fewer than 100 beds by the Arkansas
Hospital Auxiliary Association (AHAA) during the
AHAA’s annual meeting October 21. Ray Montgomery,
president and CEO of White County Medical Center in
Searcy, received the association’s Administrator of the
Year Award for hospitals having 100 beds or more.
ACHE Regent’s Awards
Phillip Gilmore of Malvern, Arkansas’ ACHE Regent, presented two Regent’s Awards during the American College
of Healthcare Executives/Arkansas Health Executives
Forum breakfast October 20 in Little Rock. Recipients
were Christina P. Hockaday, director of business development and administrative services for Conway Regional
Health System, who received the early career healthcare
executive award; and Chris B. Barber, administrator, St.
Bernards Medical Center in Jonesboro, who received the
senior level healthcare executive award.
Christina P. Hockaday
Chris B. Barber
Administrative Consultant Service, LLC
AHA Services, Inc. ******
AIG VALIC
Air Products
Alberici Healthcare Constructors
American Data Network
American Pharmaceutical Partners, Inc.
American Red Cross Blood Services
ArCom Systems, Inc.
ARJO, Inc.
Arkansas Association of Hospital Trustees **
Arkansas Auxiliary of Gideons International
Arkansas Blue Cross and Blue Shield *****
Arkansas Foundation for Medical Care **
Arkansas Health Care Access Foundation,
Inc.
Arkansas Health Executives Forum *
Arkansas Managed Care Organization
(AMCO)
Arkansas Medical Imaging
Arkansas Medical News
Arkansas Regional Organ Recovery Agency
Benefit Management Systems, Inc.
BKD, LLP ***
Business World Inc.
C2P Group, LLC
Carstens
Carter & Burgess
Community Health Centers of Arkansas, Inc.
CoreSource, Inc.
Correct Care, Inc.
Crafton, Tull & Associates, Inc.
Data Systems Management, Inc.
DCS Global Systems
DD&F Risk Management Group
Disability Determination for Social Security
DMS Imaging
EDS and Arkansas Medicaid
EmCare
emdeon Business Services
Emergency Service Partners
Engelkes, Conner & Davis, Ltd. *
EZ Way Inc.
First Choice Cooperative
First Uniform, Inc.
G2N, Inc.
Generation Product Company
Genworth Financial
Graduate Program in Health Services
Administration-UAMS
Guldmann Inc.
Hagan Newkirk Financial Services, LLC
Hammes Company
HBE Corporation
Healthcare Administration Technologies, Inc.
Hill-Rom Company, Inc.
Hill Wholesale Distributing Co., Inc.
Hubble-Mitchell Interiors
Hughes, Welch & Milligan, Ltd.
IHC/Amerinet
Inman Construction Corp.
Innerface Sign Systems, Inc.
Innerplan
Intellamed
Jackson & Harris, LLC
Kutak Rock, LLP **
Kwalu, Inc.
La-Z-Boy Concepts
LHC Group ***
Marshall Erdman & Associates
MDM Commercial
MedAssets *
MedBill Services, Inc.
Medical Management Consultants, Inc.
Metropolitan Healthcare Services
Mid-South Marking Systems
Mobile Instrument Service & Repair
Modern Biomedical & Imaging, Inc.
Modular Services Company
MultiPlan, Inc.
Nabholz Construction *
National HVAC Service
NC Staffing
Optus Inc.
Patient Line Products
PCI (Publishing Concepts)
Pinnacle Health Group
PMAB
PPOplus
Press Ganey Associates, Inc.
QHR (Quorum Health Resources) **
Ramsey, Krug, Farrell & Lensing ***
Service Plus Telecommunications Inc.
Service Professionals Inc.
Sign Systems, Inc.
Signet Health Corporation
SimplexGrinnell
Snell Prosthetic and Orthotic Laboratory
Sodexho Health Care Services
Southeast Imaging
Spectron Corporation
Stephens Inc. *
Sterling Healthcare
Swisslog Translogic
Tandus
Team Health
Telcoe Federal Credit Union
Teletouch Paging
TERM Billing, Inc.
The Crump Firm, Inc.
The Fleming Companies
The Lawrence Group Architects
The MHA Group **
The SSI Group, Inc.
TIAA-CREF
TME, Inc.
Trane Arkansas
TRO/The Ritchie Organization
United Excel
US Foodservice
Voi Cert, The White Stone Group
Wilcox Group Architects
Wittenberg Delony & Davidson Architects
Workplace Resource of Little Rock
37
A H A
A N N U A L
M E E T I N G
The AHA honored longtime board member Frank Wise for his more than 25 years of
service. Here, board chairman Tim Hill presents Wise with a remembrance plaque.
With more than 100 healthcare vendors and educational groups on hand at this
year’s Trade Show, visitors had a chance to network, learn and share new ideas.
Three very atypical
“waiters” entertained
at the Awards Dinner,
singing well-known
opera arias and a few
favorite pop tunes.
38
During the Advocacy Luncheon, former U.S.
Senator David Pryor, current Dean of the
University of Arkansas Clinton School of Public
Service, explained the mission and function of
the Clinton School, and also shared some
thoughts on today’s current political arena.
A H A
A N N U A L
M E E T I N G
At the ACHE Breakfast, Garrison Wynn helped us understand
“The Truth about Success” and gave the top seven characteristics top performers have in common. Those characteristics
focus on growing, building and maintaining strong relationships.
Renowned healthcare consultant and keynote speaker Jamie
Orlikoff helped us look at today’s almost unwieldy healthcare
challenges and trends. Orlikoff reminded us that hospitals are
too often the unknown and unappreciated backbone of the
community. He encouraged the building of strong hospitalcommunity relationships, where challenges are laid on the
table and dealt with by thinking things through, together.
Recalling the AHA’s rich 75-year history was the idea behind a special Diamond Anniversary video highlighting the past and present
work of the hospital association. Current and past AHA board
members, presidents and executives detailed the AHA’s ongoing
mission of supporting a healthier Arkansas.
This year’s early-bird educational session explored the reasons
behind and some solutions for the growing physician shortage in
America. Our speaker was Kurt Mosley of the MHA Group.
39
A H A
A N N U A L
M E E T I N G
Helping us turn life’s challenges into
opportunities was John Cassis’ goal in his
closing presentation, “Catching a Second
Wind.” His humorous anecdotes and
gentle, yet pointed, suggestions closed
this year’s annual meeting on a highly
positive note.
Former AHA president Roger Busfield (right) and his wife, Addie, with (from left) former AHA
chairmen Frank Schweitzer and Howard Johnson and their wives, Plesine and Bonnie,
respectively, at the reception honoring new AHA board chairman Robert Atkinson.
Incoming board chairman Robert Atkinson, president and CEO of
Jefferson Regional Medical Center in Pine Bluff, was honored with a
congratulatory reception. Here Atkinson (left) is greeted by ACHE
Regent Phil Gilmore (center) and C.C. “Mac” McAllister, CEO of the
Ouachita Valley Health System (right).
Transparency and accountability are absolute necessities in today’s healthcare
field. Helping us understand both challenges and new ideas/programs proven to
work were Daniel Landon, Joe Kachelski and David Feinwachs of the Missouri,
Wisconsin and Minnesota Hospital Associations.
Photos by Sarah Bussey
40
by Paul Cunningham, Senior Vice President, Arkansas Hospital Association
75 Years of AHA History…
A Look Back
Editor’s Note: The Arkansas Hospital
Association recently completed its 75th
year of service to the state’s hospitals,
healthcare facilities, patients and families. For three-quarters of a century, the
people and organizations that make up
this association have banded together
for the common purposes of improving
their communities’ healthcare quality
and raising the level of health services
for and health status of all Arkansans.
In the Fall issue of Arkansas
Hospitals, Paul Cunningham detailed
the early years of the AHA’s service, from
1929 through the first part of the 1970s.
In this article, he concludes the look
back at the association’s first 75 years
and begins to look toward the future.
The Later ‘70s —
Tumultuous Times
Nationally, healthcare issues were
overshadowed by other world events
during the final years of the 1970s:
Watergate, 12% inflation, the Three
Mile Island nuclear power plant meltdown, U.S. embassy workers taken
hostage in Tehran, Iran.
Of course, there were plenty of instate matters raising concern for the
state’s hospitals. The Arkansas Hospital Association took issue through
those years with every branch of state
government — administrative, legislative and judicial. The AHA went toeto-toe with the state Pharmacy Board
concerning jurisdiction over the inspection of hospital pharmacies; locked
horns with legislators over a proposal
requiring some hospitals to publish
quarterly audited financial reports; and
fought to get Joint Commission inspections to stand in lieu of state surveys
for accredited hospitals. The AHA also
dug in against the state Department of
Labor to defend a court decision that
struck down several costly Arkansas
overtime laws.
There were the perennial manpower
issues, too. The AHA and its members
worked with several Arkansas colleges
Part 2
of his term, President Jimmy Carter
tried to convince Congress to pass legislation to force mandatory controls on
hospital spending, without controlling
prices for the goods and services hospitals had to buy. The AHA joined hos-
Sparks Health System, Fort Smith
and universities to find ways to produce more physical therapists and nurses, and wrestled with the need for more
experienced nurses who were qualified
to teach in the state’s nursing schools.
At the same time, the association
tended to the daily routine, guiding
hospitals through the 1977 and 1979
legislative sessions, dealing with continuing Medicare and Medicaid payment problems, and handling the
unexpected surprises that cropped up
30 years ago, just as they do today.
By the late-1970s, the two words
most commonly used in conjunction
with hospitals were “cost” and “containment.” As you might expect, the
concept wasn’t well received by hospitals anywhere.
Beginning in 1977 through the end
pital groups across the country in 1978
to stave off these forced controls by
adopting their own Voluntary Effort
(VE) to Control Health Care Costs.
The VE worked for a couple of
years, setting the stage for a November
1979 House vote that killed the Carter
bill. Unfortunately, the VE program
died shortly thereafter, a victim of the
same relentless increases in hospital
costs it was trying to bridle.
In another major battle, the AHA
clashed with the state over its “certificate-of-need” (CON) law. Arkansas,
which had operated a federal “capital
expenditure review” program under
Public Law 93-641 since 1972, gained
approval for a CON law in 1975. Both
programs were indirect attempts at
hospital cost control by limiting hospi-
41
tal capital spending to approved projects only.
The AHA persisted in its demands
that the federal contract be dropped
after the state passed its law. The two
programs served the same purpose and
the AHA believed that the state didn’t
need both. Governor Bill Clinton finally terminated Arkansas’ contract to
perform the federal review.
Blue Cross got into the picture,
too. Saying it had a moral corporate
obligation to do what it could to control hospital costs, the payer implemented its own version of a capital
expenditure review program, tying it
to other local reviews.
All the hubbub over hospital cost
containment eventually led the AHA to
expand its staff to include someone with
— plus a new term for the day’s equivalent of plague, AIDS.
The AHA had begun building a
framework in the 1960s for a strong,
durable member organization. Starting
as primarily an advocacy and representation group, the AHA became more
valuable during the 1970s with timely
communications and powerful educational programs. By 1986, the AHA
had added a data component and set
up a subsidiary, AHA Services, Inc., to
help member hospitals link up with
needed products and services.
Hospital issues requiring attention
were piling up at a frenetic pace, and
the AHA stepped up to help. The
state’s Medicare claims review contractor wanted to expand into performing
medical review of claims for private
UAMS, Little Rock
a background in health and facility
planning. By the time the AHA’s newest
staffer arrived in December 1980, the
job emphasis had already changed. The
new focus centered on a four-letter
word that touched on planning and
much more. That word? Data.
Entering the Eighties
Coming into the 1980s, a
Hollywood actor became our 40th
President, surviving an attempted
assassination by the mid-point of the
decade. Pope John Paul II also survived
an assassin’s bullet, although Beatle
John Lennon and India’s Prime
Minister Indira Gandhi did not.
Mount St. Helens blew its top, the federal deficit shot to $180 billion, and we
learned a new business jargon — golden parachute, poison pill, junk bonds
42
payers, too. Allied health professional
groups pressed for state licensure.
Governor Clinton leaned toward forcing hospitals to pay a tax to fund indigent care. The state, which already
mandated that hospitals obtain a certificate-of-need for their capital expansion projects, was proposing that they
pay a fee for the privilege of doing so.
Payment issues pulled a hat trick
during the early 1980s, as hospitals
dealt with major reimbursement
changes on three fronts almost simultaneously. In 1983, Medicare was prepping its move to a completely new way
of paying hospitals based on something
called “diagnosis-related groups,” or
DRGs. Medicaid followed suit a year
later, opting to pay hospitals prospectively set per diem rates, since the state
lacked the capabilities for a DRG sys-
tem. The coup de grace was Blue Cross’
1985 announcement of its own DRG
payment system. AHA staffers and
committees worked to overcome problems with each of the changes.
The AHA also brought several
“firsts” to Arkansas between 1980 and
1986. The most visible, or audible, was
a first-ever statewide radio campaign
designed to make the general public
more aware of their community hospitals and to better understand factors
behind high hospital costs. Another
was the AHA’s Hospital Equipment
Loan Program, providing low interest
financing for hospital equipment purchases using funds generated from
bond issues.
Later, when Arkansas hospitals
encountered problems finding affordable workers’ compensation coverage,
the AHA established the AHA
Workers’ Compensation Self-Insured
Trust, the first program offered under
the umbrella of AHA Services.
One of the AHA’s most significant
steps occurred at the outset of the
decade, in October 1980. That was
when the board approved the purchase
of land on Natural Resources Drive in
West Little Rock as the site of the association’s first headquarters building.
The board took a hard stand on the
building program, convincing other
AHA members to give their blessing to
what would prove to be an extremely
wise decision.
As those building plans gradually
came together over the next eight
years, the world lived through some
tough times. Between 1986 and 1990,
disasters were the big stories, overshadowing everything else. It started in
January 1986, with the explosion of
the space shuttle Challenger, 73 short
seconds after liftoff. Before the end of
the decade, we’d know about the
Chernobyl nuclear meltdown in the
U.S.S.R., the bombing of Pan AM
flight 103, the Exxon Valdez, the San
Francisco earthquake, the bloodshed
in Tiananmen Square and Black
Monday on Wall Street, when the
stock market crashed.
There were things going on in
Arkansas hospital circles that some
thought disastrous, too. Nationally,
they came in the form of the GrammRudman-Hollings Act that provided
for automatic federal spending cuts,
the 1986 Emergency Medical
Treatment & Active Labor Act
(EMTALA) imposing specific emergency service obligations on hospitals,
and the federal government’s release of
hospital mortality reports.
The major in-state worries involved
Blue Cross, when the company
announced its intent to develop the
state’s first Health Maintenance
Organization. Nobody knew how that
might affect the future of healthcare
services in Arkansas. The more immediate concern was Blue Cross’ plan to
change the way it paid hospitals. Outdated charged-based payments would
be dropped in favor of a Blue Cross
version of a DRG system.
Medicare’s DRG system had been
up and running for two years with a
questionable track record. The AHA
and its members spent the next 18
months trying to assess the Blue Cross
plan and help fashion it into something
mutually agreeable rather than try to
stop it. In the end, a new legal emphasis on sensitive anti-trust concerns limited the AHA’s advice and added to
hospitals’ frustration and confusion.
The new payment model finally went
into effect in February 1987.
A challenge of the state law prohibiting non-profit hospitals from
operating retail pharmacies was part
of the AHA agenda for an even
longer time. The AHA believed the
law to be unconstitutional. The state
had a different opinion. The legal
action, filed in October 1985, navigated the state’s winding legal system
for 40 months before the Arkansas
Supreme Court upheld the law in
January 1989.
State Medicaid policies constantly
kept hospitals flirting with disaster.
The program was covering 35 inpatient hospital days for its recipients in
1985, but was also requiring a prior
authorization for inpatient admissions.
Payments routinely fluctuated up and
down, mostly down. During those
years Medicaid routinely blended
changes in its payment methodology
with across-the-board cuts and
increases, depending on the budget situation, along with a few recoveries of
overpayments and repayments of
monies erroneously taken away from
hospitals. Changes were sudden and
unpredictable.
It was a budget-driven world and
budgets were tight. Most of the time
the state simply didn’t have enough
money. Medicaid generally stayed within its limits by paying less. The Health
Department, on the other hand, began
charging unprecedented fees for an
array of items — like hospital licenses
— to get through the lean times.
The state’s hospitals understood the
reasons behind the newly levied Health
Department fees, but they were more
ambivalent about the final resolution in
1987 of hospitals’ long running squabble with the state about certificate-ofneed. It was in that year that Governor
Clinton signed a law stating that hospitals would no longer have to obtain
CONs for capital expansion projects.
Despite the bad news crammed into
those years, things ended on a good
note. On November 12, 1989, the
Berlin Wall, an icon for the Cold War,
began tumbling down. Two months
earlier, on September 13, after planning and saving for it seven years and
building it for one more, the AHA
moved into its new headquarters building. Debt free.
The Politics of the ‘90s
Arkansans as a group probably
remember the early 1990s for the politics more than anything else. After all,
it was Arkansas’ time to take center
stage, politically speaking. Bill Clinton
was elected President of the United
States in November 1992. The cadre of
state leaders who followed the
Governor to Washington would play
major roles in setting national policy
on all fronts, though it would prove to
be a bumpy ride at times.
National healthcare reform was at
the core of some of the most heated
political debates. First Lady Hillary
Rodham Clinton took charge and faced
off with Harry and Louise and the rest
of the insurance industry over the
President’s ill-fated quest for that elusive
grail in 1993. And former Arkansas
Department of Health director Joycelyn
Elders raised awareness, questions and
eyebrows throughout her brief tenure as
U.S. Surgeon General.
The politics of healthcare in
Arkansas stirred some choppy waters
of its own, due mostly to insufficient
Medicaid funding. By 1990,
Medicaid had pretty much abandoned its experiment with prospectively set rates and agreed with the
Arkansas Hospital Association to
return to cost-based reimbursements,
at least for all but the largest hospitals. The AHA wouldn’t budge and
prepared a lawsuit to mandate that
all hospitals be cost-reimbursed.
Having already cut several optional
programs in 1991, Medicaid pled its
case to the AHA and other groups,
which reluctantly accepted a plan for a
provider tax based on Medicaid revenues as a way to raise state matching
dollars and increase overall program
funding. The tax went on the books in
St. Bernards Medical Center, Jonesboro
July 1991. It brought in more dollars
and allowed Medicaid to pay costbased per diem rates to all hospitals,
up to a point.
The first hitch was the state’s insistence on capping the per diems at
$584. Eventually, Medicaid again ran
short of money and started tinkering
with benefit limits. That was just
before the federal government’s ruling
that the state’s provider tax was illegal.
Knowing that the decision spelled
big trouble if no replacement revenues
could be found, the newly formed
Coalition for a Healthier Arkansas
spearheaded the task of getting voters
to okay a 25-cent per pack cigarette
tax in the November 1992 general
election. The funds would go to
Medicaid. The AHA assumed the lead
role, pumping time, energy and money
43
into the campaign. All signs pointed to
success, until an 11th hour Arkansas
Supreme Court ruling kept the initiative off the ballot
The problem fell straight into the
lap of new Governor Jim Guy
Tucker, who recoiled and struck
back with the idea to restructure the
Medicaid tax to meet the federal
government’s smell test. In other
words, he’d ask the providers to
pony up a larger ante.
Heated meetings followed with
most participants disagreeing and
some being disagreeable. Political
chips landed on the table from every
direction. In the end, the Medicaid
coalition won over the legislature
with their idea for an alternative
funding source — a soft-drink tax.
years, retired in June 1994. The board
didn’t have to look far for its next captain. Jim Teeter, a 26-year veteran of
the AHA, would take the helm and set
the course for the political storms yet
to come.
Fortunately, a short respite
occurred. The state’s Medicaid program was in better shape financially
than it had been in years. The soft
drink tax, which was passed two years
earlier, withstood an assault in 1994
and was bringing in almost $140 million annually, when matched with federal dollars.
The Arkansas Hospital Association
had been a key to passing the tax in
1992 and played a major role in its
1994 rescue. The state’s soft drink bottlers hoped to dismantle the tax by put-
Southwest Regional Medical Center, Little Rock
There were other political maneuverings, too. The AHA got Dennis
O’Leary, president of the Joint
Commission on Accreditation of
Healthcare Organizations, into
Arkansas not once, but twice to
address growing JCAHO concerns.
The association negotiated for more
than two years with the state
Workers’ Compensation Commission
and members of the Arkansas State
Chamber of Commerce on a fair hospital fee schedule. And, it raised
$350,000 from the state’s hospitals to
establish a new Physical Therapy program at Arkansas State University.
Not everything of historic note for
the AHA that occurred between 1990
and 1995 was about politics, however.
Roger Busfield, who navigated the
AHA through political waters for 20
44
ting it in the voters’ hands, so the AHA
again took the lead in a campaign to
keep the soft drink tax on the books.
Voters were persuaded, backing the
tax by a 55%-45% margin in
November 1994.
The storms returned a mere four
months later with Medicaid’s unexpected announcement predicting a
$70 million deficit by July 1997;
Governor Tucker proposed to strip
the state’s non-profit hospitals of $35
million in sales tax exemptions that
would be re-routed to the Medicaid
Trust Fund. The AHA successfully
changed his mind, but the expected
shortfall grew to $232 million for the
1998-1999 biennium.
The association responded to other
flash fires, too. Retail pharmacists
thought hospitals didn’t need to pro-
vide certain drugs and IV solutions to
patients being seen by their own home
health agencies. Respiratory therapists wanted additional licensing
requirements. Trial lawyers opposed
the strengthening of laws providing
confidentiality of hospital peer review
and quality assurance activities. And,
business and insurance groups pushed
with all their might against an Any
Willing Provider law, something the
AHA supported at the time.
Outside the legislative arena, the
AHA defended allegations by the
state’s nursing homes that hospitals
were providing skilled nursing services illegally, worked through competitive issues involving the Health
Department’s provision of home
health services, negotiated an agreement with the Board of Nursing on
rules involving the delegation of nursing tasks, and intervened with the
State Auditor on a matter involving
hospitals and their disposition of
unclaimed personal property.
Nationally, the Beltway feud over a
balanced budget spanned two years
and one government shutdown. In the
end, President Clinton signed the massive 1,200 page Balanced Budget Act
of 1997, which the Republican controlled Congress had passed.
Lost amid the hoopla, fanfare and
backslapping over the agreement for
balancing the budget by sucking $116
billion from future Medicare spending
($44 billion from hospitals) were the
warnings of people who understood
that the actual cuts would be much
more severe than projected.
AHA joined with other hospital
advocates in successfully convincing
Congress to restore some of the
Medicare and Medicaid cuts through
laws passed in 1999 and 2000. In the
meantime, its Washington focus shifted to the Justice Department’s crusade
to apply the federal False Claims Act
to hospital Medicare billing errors.
Back at home, the association won
support for a law allowing Joint
Commission accreditation to stand
for hospital licensure surveys, too,
and helped hospitals better understand details related to rising concerns
over quality, patient safety, compliance plans, and the newest hospital
emergency room requirements.
Y2K Challenges Usher
in New Century
As 1999 came to an end, all eyes
were on the clock and the coming of
the Year 2000, affectionately known as
Y2K. Experts predicted massive system
failures, the technological equivalent of
war, famine, pestilence and death, for
January 1, 2000. The AHA and its
hospitals prepared for more than two
years to avoid any and all calamities.
Within minutes of the stroke of midnight, everyone knew the planning and
preparations had worked.
The association breathed a sigh of
relief and moved on. The first order of
business was to take up a cause that
had been a core value of the AHA since
its inception — improving the health of
the people who live in our small, beautiful state. As January 2000 dawned,
the AHA began almost immediately
working toward the first of two major
accomplishments that many agree to
be among the AHA’s most important
during its 75-year history. Both
achievements should positively impact
the health of Arkansans for years to
come.
The first was the association’s role
in getting a spending plan for
Arkansas’ $1.62 billion share of the
National Tobacco Settlement Fund.
The AHA took a lead role, joined by
the original coalition of healthcare
providers who supported the failed
1992 attampt to pass a cigarette tax to
help fund Medicaid, and developed a
plan that would earmark Arkansas’
full tobacco-settlement amount for
health-related purposes over the fund’s
25-year life. The AHA was actively
involved in the election campaign. On
November 7, 2000 voters said yes to
CHART’s (Coalition for a Healthier
Arkansas Today) ideas with a solid
65%-35% margin.
The second achievement came in
2005, when the AHA was responsible
for a law prohibiting the smoking of
tobacco products in hospitals and on
their grounds. It was a way for the
association’s board and members to
show that Arkansas hospitals not only
talk about improving community
health, but also are willing to walk the
walk and do something about it.
Sandwiched between those two
milestones are other successes that
have to be considered among the
AHA’s most significant. The AHA
worked to defeat an effort in 2000 to
abolish certain state and local sales
taxes that would have sapped $144
million from annual state revenues.
Then, in 2002 the association helped
defeat a proposed constitutional
amendment to “ax the sales tax” on
food and medicines. The amendment
would have taken between $400 million and $600 million from state coffers each year with no suggestions on
how to replace it. Either of the tax
reductions most likely would have led
to a state Medicaid crisis.
Passing a state tort reform law in
2003 has to make everyone’s top ten
list of significant achievements. The
AHA joined in the fight early as part of
a 2001 move that resulted in an
Arkansas Medicaid “upper payment
limit” program as the most important
financial achievement. It would be
hard to argue with a program which
has netted more than $100 million in
supplemental Medicaid hospital payments that otherwise wouldn’t have
been available.
And Now, to the Future…
If we asked ten individuals who were
active with the AHA at different times
over the past 75 years what they would
choose as the AHA’s most significant
accomplishment, we’d probably get ten
different answers. What would you
choose? Whatever the choice, it’ll be
trumped in the future by another one,
bigger and more outstanding. Maybe it
Siloam Springs Memorial Hospital, Siloam Springs
another coalition, the Committee to
Save Arkansas Jobs, in the successful
run at overhauling Arkansas’ civil litigation system. The law gave a way to
help hospitals curb crippling medical
liability costs and thwarted a potential
exodus of healthcare providers from
the state.
Following the September 11, 2001
terrorist attacks in New York and
Washington, and again following
Hurricane Katrina in August 2005,
America became fully aware of hospitals’ strategic importance to the
nation’s emergency response system.
The AHA has had a direct hand in
working through countless emergency
response issues aimed at better preparing Arkansas hospitals for these often
overlooked essential responsibilities.
Some AHA members might point to
will have something to do with the current move to make hospitals more
transparent and accountable to their
communities. Or, will it be related to
fascinating new information technology
that will serve as the basis for the full
implementation and use of universal
electronic medical records?
Those issues are key issues of today.
They won’t go away, and will most
likely expand. But, that’s okay, as long
as the requirements are reasonable, the
results meaningful, and they serve to
improve the state’s healthcare quality
and status.
After all, that’s the very reason a
small group of hospital leaders got
together 75 years ago and formed the
Arkansas Hospital Association, and it’s
the reason we’ll keep moving forward
for the next 75 years and beyond.
•
45
AHLA Issues Complimentary Guide
to Legal Issues in Life-Limiting Conditions
The American Health Lawyers
Association (AHLA) has released A
Guide to Legal Issues in LifeLimiting Conditions. The document
was produced as part of AHLA’s
public interest commitment to serve
as a public resource on selected
healthcare legal issues.
The Guide is the second publication
in a new Public Information Series
through which AHLA shares its
expertise on topics of interest both to
healthcare attorneys and the broader
healthcare community, including
health professionals, healthcare executives, public health agencies,
pro bono attorneys, and consumer groups. (You may read
or download the first publication from the series —
Emergency
Preparedness,
Response & Recovery Checklist: Beyond the Emergency
Management Plan by going to
http://www.healthlawyers.org/
Content/NavigationMenu/
Public_Interest_and_Affairs/
Public_Information_Series/
pi_EmergencyPreparedness.pdf)
The new legal guide to lifelimiting conditions provides an
overview of the key legal and
practical issues that arise in the
care of individuals who face a
life-limiting condition or who
care for a loved one with a lifelimiting condition. As an aid to
the planning process, the guide
is organized around the continuum of care, beginning with
healthy individuals who are able to
live at home and following the continuum to independent retirement communities, assisted living, long term
care, and an eventual return to the
home with the aid of hospice services.
Dr. Ira Byock, one of the foremost
experts on caring for those at the end
of life, endorsed the guide for many
different audiences: “This Guide
deserves a place on the desk of any
attorney, physician, nurse, case manager, or social worker who helps elderly or ill clients think about and plan
for the future. It sits on mine.”
Elisabeth Belmont assessed the publication’s importance to the public.
“Individuals with life-limiting conditions find themselves facing a host of
complex decisions, often at a time
when they are in crisis.
“Making important decisions when
a loved one is vulnerable and in need is
difficult at best. This guide provides
key questions to guide families in making decisions along what might be considered the ‘customary’ chronic care
continuum. The guide stresses that
individuals should plan for the future
and make informed choices now to
ensure that their wishes are known at
a future time when their physical
and/or mental functioning may be
impaired. This type of planning is particularly important in view of the
recent Terri Schiavo situation,”
Belmont said.
To view the guide in its entirety or
to
download
it,
go
to:
http://www.healthlawyers.org/Content
/NavigationMenu/Public_Interest_and
_Affairs/Public_Information_Series/llc
_guide.pdf
•
Our Advertisers, Our Friends
AHA Services, Inc. ....................................................8
Farm Bureau............................................................29
Poe Travel................................................................32
Arkansas Blue Cross Blue Shield ...............................2
Hagan Newkirk Financial Services, Inc. .....................6
QualChoice ................................................................8
Arkansas Foundation for Medical Care......................5
Nabholz Construction ..............................................48
Teletouch.................................................................23
Crews & Associates, Inc. ..........................................6
NMHCrx ..................................................................30
TME, Inc..................................................................13
46
419 Natural Resources Drive
Little Rock, AR 72205
Presorted Standard
U.S. Postage Paid
Little Rock, AR
Permit No. 2437

Special Section: Katrina Revisited AHA Chairman on “Defining

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