Summer Management Conference, June 9-11

The Arkansas Hospital Administrators Forum/Arkansas Health Executives Forum Summer Management Conference will be held June 9-11 at the Red Apple Inn in Heber Springs.

Michael Sheehan, a specialist in message development, government testimony preparation, and crisis management response, will present "Building Bridges/Building Messages." In his presentation, he will explore reasons why public confidence in hospitals and health systems is an issue; help to recognize why positive messages are not breaking through the information clutter; and demonstrate strategies to balance facts and figures with an emotional packaging.

Sheehan has coached more presidents, vice presidents, cabinet secretaries, governors, and members of Congress than anyone in the country. Much of his firm's current work is in healthcare focusing on helping hospital CEOs and senior managers address negative messages both internally and externally.

Registration materials and additional program details will be mailed in April. Contact Beth Ingram at 501-224-7878 for information.

Arkansas' Donor Registry: Family Consent is the Goal

Research by organ procurement organizations consistently reveal that family members are more likely to agree to donation when they already know or can be shown that their loved one wanted to donate. According to a 1993 Gallup Poll, Americans were more than twice as likely to donate if they had knowledge that the family member had requested donation. Some studies have shown that as many as 95% of families would consent to donation with prior knowledge of the decision.

In early 1993 officials of the Arkansas Regional Organ Recovery Agency (ARORA) realized that a key ingredient was missing from the organ donor process. It didn't have anything to do with hospital protocol, managing operating room time or questioning who was best trained to approach a potential donor's family. Time and time again, ARORA's procurement coordinators were hearing the same story. The surviving family didn't know what their loved one would have wanted to do, so their answer to organ and tissue donation was a reluctant "no."

"We had to eliminate that answer," says Dr. Charles Wagner, ARORA Medical Director. "An easily accessible, computerized donor registry was the obvious solution."

Research led to the Arkansas Donor Registry, a collaborative effort between ARORA and the Department of Motor Vehicles, a division of the Arkansas State Revenue Office (SRO). The Registry is a strictly confidential computer database of people indicating their wish to be an organ/tissue donor upon death.

According to ARORA executive director Michael Manley, findings show that overwhelming numbers of the general public believed that by indicating "donor" on a driver's license ensured their wish to be a donor. But, if this wish hadn't been conveyed to family members, there was no way to carry out the wish.

"We now have an answer for that 'I don't know how they felt about it' question," says Dr. Wagner. "The final decision concerning donation is still up to that family, but now we can present them with valuable information indicating what their loved one wanted to do."

A "Donor Registry Form," designed by ARORA, is now displayed at each of the 143 State Revenue Offices, as well as health fairs, civic events and other functions. When a customer applies for a license or renewal and says "yes" to organ donation, he is encouraged to complete one of the forms and send it to ARORA. During the first year, approximately 5,000 people completed the forms, with 1,644 coming from an SRO.

Through a two-year action plan, which included volunteers, mostly organ transplant recipients, staffing the SROs and visiting with the public about organ and tissue donation. Through this plan, the Registry grew to over 12,000 names in 1996.

Act 75 of 1997 "officially" created the Arkansas Donor Registry and legally gave organ procurement agencies access to driver's license data. At that point, the Registry grew to over 500,000.

In August 1998, the Health Care Financing Administration introduced new regulations requiring hospitals to report all deaths to their local organ procurement agency to determine the suitability for donation. "Our best case scenario had always been that a hospital would call us with a death report and we would just enter that patient name into the Registry database," explained Manley. "Then if the name appeared on the list we would present that information to the family. With the knowledge that their loved one wanted to be a donor, they would in turn give consent."

According to Manley, 35% of Arkansans have said "yes" to organ donation. And, with the new HCFA regulations, the agency is receiving hundreds more calls each month, thereby increasing organ and tissue donation.

AHA Workers' Comp Dividends

The Arkansas Hospital Association Workers' Compensation Self-Insured Trust (AHAWCSIT) has mailed dividend checks totaling $2.2 million to 36 hospitals participating in the program. The dividends are being paid for the fund years 1993, '94 and '95. This marks the third dividend distribution to AHAWCSIT members in 1998. In January 1998, the trust paid $1.2 million in dividends, and another $658,000 was distributed in September. The current dividend amounts per hospital ranged from $2,200 to $199,000.

January 1, 1999, the AHAWCSIT merged with The Virginia Insurance Reciprocal (TVIR) and began operating as the AHA Workers' Compensation Program, administered by TVIR. For information about the program, contact Tina Creel at AHA Services, 501-224-7878.

ADH to Distribute New Rules and Regulations for Hospitals

After two years of exhaustive monthly committee meetings by Arkansas hospital CEOs, engineers, nurses and architects, the Board of Health January 28 approved the Arkansas Department of Health's revised Rules and Regulations for Hospitals and Related Institutions. The committees met with ADH officials for many, many hours hammering out the new regulations, the first overhaul in over ten years.

Once approved, the rules must clear several other paths before final distribution. It is anticipated that hospitals will receive copies of the new document around July 1, 1999.

Arkansas Hospital Name Changes

Methodist Hospital of Jonesboro has announced a name change. The hospital is now known as the Regional Medical Center of NEA. Board chairman Bobby Hogue said the new name better describes the services the hospital provides to people throughout Northeast Arkansas and the Missouri bootheel area. In 1998, more than half the hospital's patients came from outside Craighead County. The name change will be applied to the hospital's home health and hospice programs as well, resulting in Regional Home Care of NEA and Regional Hospice of NEA.

A new name has also been given a Texarkana hospital. St. Michael Health Care Center is now Christus St. Michael Health Care Center. The name change is related to changes taking place in the headquarters of the Houston-based Sisters of Charity Health Care System which operates the facility. That system and the Incarnate Word Health System of San Antonio have merged into a new system called Christus Health. Christus Health also manages Magnolia Hospital. The new system will have total assets of more than $3.4 billion, employ about 23,000 people, and rank among the 20 largest healthcare systems nationwide.

El Dorado Hospital Gets New Partner

Triad Hospitals, Inc., a new for-profit company, will acquire about 40 hospitals from Columbia-HCA, including three from Arkansas. It will affect the ownership of the Medical Center of South Arkansas in El Dorado, but shouldn't have any impact on the hospital's operations. MCSA president Luther Lewis said the new publicly-traded company's acquisitions will include Columbia's 50% holding in the hospital, which is jointly owned by the SHARE Foundation. The change should be finalized this year.

Lewis said the president of the new company will be Denny Shelton, who has headed the Columbia group that worked with MCSA since the partnership arrangement was completed more than two years ago. He said there should be no downside to the change in partners and MCSA should still receive the same partnership benefits that were available through Columbia, including volume-buying contracts for supplies. Two other Arkansas hospitals, DeQueen Regional Medical Center and Medical Park Hospital in Hope, are also included among those being bought by the new company.

Arkansas Healthcare Costs Rising

An article in the November 29 Arkansas Democrat-Gazette reported that some Arkansas firms are predicting a rise as much as 9% or more in their 1999 health insurance costs. One company, Little Rock-based Alltel Corp., said it expects to pay an average of 9.6% more to the 80 health maintenance organizations that cover its employees; and employees' share of their healthcare bills will probably increase 31% in spite of the increase.

KPMG Peat Marwick LLP's Center for Survey Research in Arlington, VA has forecasted an average nationwide insurance premium hike ranging between 5% and 7%. However, rates in Arkansas could rise faster. Healthsource Arkansas, which has 33,000 Arkansas enrollees, believes their 1999 premiums will rise 7% to 9%, and Arkansas Blue Cross Blue Shield, the state's largest health insurer, believes average increases of 9% or more will be common.

Healthcare analysts lay much of the blame for the steep increases on the number of new drugs on the market and the overall rising cost of pharmaceuticals. But, another factor is the public's general rejection of cost-cutting techniques employed by managed care companies, such as limiting consumer choice. Ken Sample, executive director of American Health Care Providers, Inc., a company leaving the Arkansas market, said Arkansas' rural nature is another reason why premium growth here may outpace other areas in the U.S. Sample says it's much easier for managed care organizations (MCO) to demand discounts in areas where there are multiple providers. In those cases, the MCO can guarantee more patients in exchange for the discounts. In rural areas where there are few providers, doctors and hospitals don't have to accept the discounts in order to get patients.

The Democrat-Gazette also reported another reason why premiums are expected to increase: underpricing by insurers as they've jockeyed for market position over the past few years. Managed care companies have been willing to reduce their prices, or keep premiums flat, and incur losses, in order to keep their contracts. As the losses have grown, weaker companies are leaving market areas, making it easier for the remaining companies to raise rates without the threat of more competition. Victor Lazzaro, vice president for health plan operations for Prudential Insurance Co. of America, said that trend is apparent in Arkansas.

Supreme Court EMTALA Decision

A January U.S. Supreme Court ruling could make it easier for patients to sue hospitals under the Emergency Medical Treatment and Active Labor Act (EMTALA), the so-called patient-dumping law. The court ruled that plaintiffs do not have to prove a hospital that failed to stabilize a patient acted with "improper motive"--such as asking about a patient's insurance status before treatment. The law requires Medicare-participating hospitals with emergency rooms to appropriately screen and stabilize patients with emergency medical conditions before transferring them to other facilities regardless of the patient's ability to pay. The ruling in Roberts vs. Galen of Virginia, Inc. reversed a Sixth Circuit Appeals Court decision. American Hospital Association Washington counsel Maureen Mudron said the appeals court based its decision on a precedent set by a case in which EMTALA screening requirements were at issue, while the Roberts case was based on EMTALA's stabilization requirements.