Warnin' From the Ozarks
James R. Teeter
President and CEO
Arkansas Hospital Associatio

In June, I spent a few days vacationing on the sugar white beaches of Florida. It was a great time to just hang out with my family, pig out on fresh seafood, and get caught up on some pleasure reading which included some material on Ozark mountain culture.

From the mountain writings, I learned that in the early 1930s--during the worst of this country's Great Depression--some of Roosevelt's "make work" programs (CCC, WPA, etc.) sent lexicographers, social scientists, and dialecticians into the Ozarks to interview the inhabitants. Many of these interviews were published in actual dialect which, because of the extreme isolation of the region, went straight back to Elizabethan England and could be found nowhere else in contemporary America or England.

Anyway, they were interviewing this old fella whose whiskey still had blown up, and here's what he had to say:

I was a-settin' thar a-suckin' of my pipe an all of a suddint I seen th' biler was swole plumb to a strut, an pooched out like a cat full o' kittens. And the next thing I knowed the hull dang contraption blowed up louder 'n the crack o' doom and throwed bilin corn mush pert near all over the county. Hit's Gawd's own mercy I warn't scalded plumb ta death, and I shore taken it as a warnin!

Another old guy was telling of his first train ride and his first banana:

The conductor come thru a hollerin' chawklits, chawklits, bananners, bananners, three fer a nickel. So I had me a bananner and he come back thru later an ast how I had liked it. I tole him hit warn't so bodaciously good enough to make a fuss over. In the first place hit war mainly all cob, and when I'd throwed that away, what little they was left was bitter and sort of onery to eat.

To place all of this into the context of budget balancing actions in Washington, hit may be Gawd's own mercy if the hospitals of America (and the patients they serve) don't get scalded plumb to death, especially those hospitals that care for large numbers of the nation's poor and elderly.

According to a recent study commissioned by the American Hospital Association, 95 percent of hospital leaders surveyed say the spending cuts ($116 billion in Medicare, $8.4 billion in Medicaid) will cause real pain to real people. Among their predictions:

-- The elderly will have a more difficult time getting care, including having to travel farther for it.

-- The poor and the elderly will have to pay more for their care.

-- Hospitals will be forced to delay improvements and capital investments.

-- Hospitals will be forced to freeze or reduce staff salaries and lay off employees.

-- Services such as rural health clinics, emergency departments, adult day care programs, and obstetrics will have to be reduced or eliminated.

In other words, the folks in Washington may prove to be somewhat like the old guy eating his first bananner. They may have thrown away the cob of the nation's healthcare system, and if so, what little is left will be bitter and sort of onery to eat.

The irony of it all is that none of this may have been necessary. The economy is red hot. The Dow Jones has broken records. Retail sales are up. Interest rates are down. Inflation is steady. Unemployment is low. And, the flow of tax revenue pouring into Washington is such that some economists say the budget would have balanced itself within 18 months, even if the hull dang Congress had gone home two months ago without doing a thing!

Frazier Directs Human Services

Lee Frazier, former executive vice president at St. Vincent Infirmary Medical Center in Littled Rock, has begun work as director of the Arkansas Department of Human Services, the state's largest agency which has 8,000 employees, 11 divisions, and an annual budget of almost $2 billion.

On July 1, Frazier succeeded Tom Dalton who became Governor Mike Huckabee's special assistant for welfare reform as the state works to implement the new welfare plan and put welfare recipients to work.

After leaving SVIMC, Frazier was CEO of Trinity Healthcare, a 1-year-old healthcare management company in Little Rock.

Arkansas Welfare Reform Costly

An official with the Center for Law and Social Policy (CLSP), a Washington, D.C.-based research firm, reports that implementing welfare reform will probably cost Arkansas more than most other states. Mark Greenberg, senior staff attorney for CLSP, told representatives from a variety of educational and social service organizations that states will receive no more federal funds for their Aid to Families With Dependent Children (AFDC) programs than they received in 1994 or 1995, due to the new welfare block grants.

Under welfare reform, a qualifying family leaving welfare may receive child care payment assistance from the state. In some states, where average welfare payments are higher, the state may save money on that trade-off, paying less for child care assistance than had been paid for the family's welfare benefits. But, in Arkansas, where the average AFDC monthly payment for a family of three is $204, child care might easily cost more. The shortfall will have to be made up through other state revenue sources.

Former Department of Human Services director Tom Dalton, who leads the state's welfare reform program, acknowledged the move to put people to work will cost the state, at least in the short term. He said the challenge for the state is showing the private sector that welfare reform can benefit all Arkansas' employers economically by providing them with dependable, skilled workers.

"Stroke Belt" Includes Arkansas

The Arkansas Foundation for Medical Care (AFMC), the state's Peer Review Organization (PRO), has been awarded a special contract by the Health Care Financing Administration to conduct a regional stroke project with the PROs in 11 southern states. The purpose of the project is to improve public awareness and education about stroke among those states that make up the so-called "Stroke Belt"--where stroke incidence and mortality rates exceed national averages by 10% or more.

The coastal plains of Georgia and the Carolinas have the highest rate of stroke deaths in the nation with middle-aged people twice as likely as those in the rest of the country to die that way, according to a recent study. Scientists have known since the 1960s that the three states and five others in the Southeast have higher-than-average death rates from stroke. Dubbed the "Stroke Belt," the region also includes Arkansas, Tennessee, Louisiana, Mississippi, and Alabama.

Under the leadership of the AFMC, the Quality Improvement Organizations in 11 states will pool their resources and expertise to conduct a public awareness campaign on stroke signs and symptoms. In addition to efforts aimed at consumers, the project will also include clinical support to help providers. Clinical education efforts will focus on improving care for a high-risk patient group, specifically people with atrial fibrillation, an irregular beating of the heart that can contribute to a stroke.

Arkansas Newsmakers and Newcomers

Michael Morgan has been named president and CEO of St. Edward Mercy Medical Center in Fort Smith. He succeeds Sister Judith Marie Keith who retired after 27 years as president to explore other ministry options. A native of Oklahoma, Morgan was president and CEO of Mercy Regional Medical Center in Laredo, Texas.

Judy Adams, Administrator of Little River Memorial Hospital in Ashdown, has been appointed by Governor Huckabee to the Breast Cancer Control Advisory Board. Diana Hueter, CEO of St. Vincent Infirmary Medical Center in Little Rock, has been named to the Oversight Committee on Breast Cancer.

Edward L. Nilles has been named CEO of Bradley County Memorial Hospital in Warren. He succeeds Harry Stevens who retired June 30. Nilles has served as COO and associate executive director of Bossier Medical Center in Bossier City, Louisiana, and as assistant administrator of St. Michael Healthcare Center in Texarkana.

Ernie Helin has been named CEO of Ashley Memorial Hospital in Crossett. Helin has served as acting CEO for several months, previously serving as assistant administrator at Medical Center of South Arkansas in El Dorado.

Lee Gentry has been named administrator of Lawrence Memorial Health Services (Lawrence Memorial Hospital and Nursing Home) in Walnut Ridge. Gentry is the former corporate director of business development at River Oaks Health System in Jackson, Miss., and senior accountant at Central Arkansas Radiation Therapy Institute (CARTI) in Little Rock.

Thomas P. Harlan has been named CEO of American Transitional Hospital - Little Rock, a 38-bed hospital-within-a-hospital located at Columbia Doctors Hospital. The hospital was approved by the AHA board of directors for Type I-A membership in the association.

Jan Steele, a 16-year healthcare professional in northwest Arkansas, has been named Vice President of Mercy Health Center, according to Mike Packnett, CEO, St. Mary-Rogers Memorial Hospital in Rogers. The $16 million facility, expected to open in February 1998, is currently under construction near the Rogers/Bentonville city limits.

David Morton of Oklahoma City has been named the American Hospital Association's regional executive for Arkansas and Oklahoma. Morton's responsibilities include assisting with federal representation and advocacy.

In Memoriam

Marvin Altman, 80, president emeritus of Sparks Regional Medical Center in Fort Smith and past chairman (1948-49) of the Arkansas Hospital Association, died May 12.

Sister Mary Carol Drilling, 88, former administrator of St. Joseph's Regional Medical Center and Warner Brown Hospital (now the Medical Center of South Arkansas), died June 13.

Charles W. Silverblatt, M.D., former coordinator of the Arkansas Regional Medical Program, died June 12. Dr. Silverblatt secured the first grant for Central Arkansas Radiation Therapy Institute and the Area Health Education Center, helped obtain funding for the statewide Emergency Medical Services program, and assisted in the establishment of Arkansas' first physician assistant training program, among other innovative projects.

Rockefeller Outlines Volunteer Plan

Lt. Gov. Winthrop Rockefeller has introduced a plan to increase volunteerism in Arkansas. The lieutenant governor was joined by dozens of Arkansans who participated in the summer President's Summit for America's Future. President Clinton convened the three-day summit to tackle problems facing American youth.

The goal of Rockefeller and the Arkansas delegates who attended the summit and are leading the charge of volunteerism in Arkansas is to make life better for at least 20,000 children by the year 2000. The delegates have come up with a list of five "resources" designed to improve the lives of Arkansas children. The goal is to make sure 20,000 children have access to two of the five resources by the year 2000. Those resources are:

-- giving youngsters a healthy start by promoting drug screening, increasing health check-ups for children, and reducing teen pregnancies and sexual abuse. The delegates also will work on eradicating head lice, finding affordable housing for poor families, increasing the number of summer programs for children, and curtailing substance abuse and smoking;

-- finding safe places and activities for children outside the classroom. Among other things, the goal includes gang awareness and prevention, increasing neighborhood watch programs, developing affordable child care, and creating bilingual summer programs;

-- establishing an ongoing relationship with a caring adult. To achieve that, the delegates are striving for more mentor programs and attracting more adult volunteers;

-- giving children a marketable skill. The delegates hope to increase after-school programs and youth employment and promote national career days;

-- and, giving children an opportunity to give back to their communities by providing transportation and increasing funding and opportunities for volunteers.

AHA Educational Calendar

-- October 12-15 -- Little Rock
Arkansas Hospital Association Annual Meeting and Trade Show

-- October 13-14 -- Little Rock
Arkansas Hospital Auxiliary Association Annual Meeting

-- October 20-21 -- Chicago
American Hospital Association Regional Policy Board Meeting

-- October 28 -- Little Rock
Home Care Standards Education

-- November 11 -- Little Rock
JCAHO Standards for Hospitals

-- November 12 -- Little Rock
Ark. Council for Nurse Managers

-- November 13-14 -- Eureka Springs
Healthcare Financial Management Association

Call 501-224-7878 for programming information

CARTI Adds New Locations

The University of Arkansas for Medical Sciences (UAMS) and Baptist Medical Center have announced plans to construct CARTI units on their campuses in Little Rock. When these new units open, there will be six CARTI locations --three in Little Rock and one each in Conway, Mountain Home, and Searcy.

UAMS, in affiliation with The University Hospital of Arkansas, plans to break ground in October 1997 on a $5 million building to house its new CARTI unit. The three-story structure will serve an estimated 50 patients per day when it opens in the fall of 1998. The unit will also further the university's academic goals by allowing it to create a department of radiation and oncology essential to medical training. The unit is also expected to complement the Arkansas Cancer Research Center on the university campus. Baptist Health has already begun construction of a 123,000 square foot building that will house its CARTI unit. When it opens in April 1998, the unit is also expected to serve approximately 50 patients per day.

Arkansas Medicare MCO Enrollment Grows

Managed care for Medicare beneficiaries is no longer a West Coast phenomenon. The number of Medicare beneficiaries enrolling in managed care plans has recently made its first forays into Arkansas, South Carolina, and Tennessee. In Arkansas, there were no Medicare MCO enrollees as of December 1995. But, by December 1996, 4,898 beneficiaries had enrolled in a managed care program.

The number of Medicare beneficiaries enrolling in managed care plans is shooting through the roof in the East, with five states showing more than a 100% increase in new enrollees last year: Maryland 178%; Georgia 174%; Michigan 125%; Ohio 116%; and New Jersey 103%. Nationwide, the number of Medicare managed care enrollees totaled more than five million, with 386 managed care plans soliciting this business as of March 1997, according to HCFA. States which remain untouched by Medicare managed care are Alaska, Delaware, Idaho, Main, Mississippi, Montana, New Hampshire, South Dakota, and Wyoming.

Statistics about Medicare managed care growth also show:

-- In 1996, an average of 80,000 Medicare recipients joined HMOs each month.

-- 11% of Medicare beneficiaries are in HMOs.

-- The Congressional Budget Office estimates that 25% of all seniors will enroll in HMOs in the next five years.

-- A primary care doctor typically can handle 2,000 patients under age 65, but only 800 over 65.

-- Start-up costs for the average Medicare HMO ranges from $10 to $12 million, with most of that absorbed by sales and advertising.

-- Marketing costs per enrollee in a Medicare HMO range from $500 to $1,000.

-- HMOs with at least 25,000 Medicare enrollees are best suited for survival.

Hospital Rules Revision Continues

The Hospital Education Committee appointed by the Arkansas Department of Health (ADH), an advisory group charged with updating the ADH's 1988 Rules and Regulations for Hospitals and Related Institutions in Arkansas, has been meeting almost monthly for the past year.

Hospital representatives who were asked to serve on the committee include Eugene Zuber, Newport; Frank Wise, Salem; Ben Owens, Jonesboro; Mike Helm, Fort Smith; Robert Reddish, Lake Village; Jonathan Bates, M.D., Little Rock; Steve Reeder, Helena; Steve Lampkin, Little Rock; and Jim Teeter of the Arkansas Hospital Association.

Arkansas nursing execs who are members of the committee are: Freda Davis, Nashville; Norma Hayes, Magnolia; Leola Wren, West Memphis; Keitha Griffith, El Dorado; and Mike McLean, Fayetteville. In addition, two architects and five hospital engineers and physical plant specialists also serve on the committee.

Arkansas hospital officials are encouraged to contact any member of the Hospital Education Committee with suggested revisions to the rules and regulations. The goal of the ADH and its committee is to revise the rules and regulations in a way that provides more hospital flexibility in the rapidly changing healthcare environment influenced by managed care.