New CARTI Center Opened

The Central Arkansas Radiation Therapy Institute (CARTI) recently dedicated its new center located in West Little Rock on the Baptist Medical Center campus. The center is located in the new Baptist Outpatient Center on Kanis Road. It is equipped with a Varian Ximatron simulator and a Varian 2100 linear accelerator, which can treat 99.9% of all cancers. CARTI/Baptist is staffed with two full-time radiation oncologists, registered radiation therapists and support staff personnel.

According to CARTI president and CEO Jan Burford, when the original Little Rock center first opened, services were centralized in one location mainly due to the amount of equipment needed and its costly nature. With recent improvements in technology, practically all cancers now can be treated with a single piece of equipment. This has made it easier for CARTI to branch out, making services more accessible for patients who otherwise must be transported lengthy distances for treatments.

CARTI, which operates a group of not-for-profit radiation therapy centers, opened its doors to Arkansas' cancer patients in 1976 with a facility on the campus of St. Vincent Infirmary Medical Center in Little Rock. Since then over 45,000 patients have received care at CARTI facilities, which are also located in Searcy, Mountain Home and Conway. Future plans call for development of a new center in North Little Rock and another on the campus of the University of Arkansas for Medical Sciences.

Managing Your Hospital Expansion

By: John Flake CCIM, Blake Lazenby & Jan Meyer Lyle CPA Flake & Kelley Management

Although most businesses rarely have an opportunity or need to construct their own facility, hospital construction for new facilities and renovations of old have become a necessity. Due to changes mainly in the structure of health insurance reimbursements, as well as the ever-changing and improving technology of medical equipment and procedures, medical facilities must evolve with other trends in the industry.

It is critical, due to the quickly changing environment, that management become fully engaged in the establishment of a protocol for implementation of these projects. Just as procedures exist for the care of cardiac patients, a consistent approach to administration of construction projects will save the hospital time, money, and a great deal of frustration.

The first step in planning for construction is to define, in writing, the primary objective. For instance, a goal might be to construct an outpatient surgery center within 8 months for a definite sum of money without interrupting the existing surrounding hospital activities. All future action will be predicated upon this objective. Assuming that an architect and construction manager are selected, a matrix showing the critical path of the project must be developed. Financing details, city approvals, and utility involvement should be included in the matrix. If financing is utilized, it might be required to have the property in question released from any existing encumbrances. The architect of record should provide the construction manager and hospital with a definite schedule for the completion of drawings. If the project is to be bid, the time dedicated to this approach should be reflected in scheduling.

Communication among the professionals involved and the hospital are critical. Depending upon the size of the project, regularly scheduled meetings are essential in order to ensure that all of the various disciplines can perform their tasks. Construction requires teamwork in today's ever changing environment of escalating costs and varying demands. To successfully complete an efficient project, it is necessary to understand the goals of each party involved. The team must share common goals to achieve the desired success with minimum stress to those involved. This can be done through constant surveillance, good communication, overlapping efforts and the use of good judgement. The ultimate goal of a good construction team is to allow the hospital administrators and directors to continue their everyday job functions without disruptions.

Once the general contractor has been selected and construction begins, it is extremely difficult to make major changes without financial consequences. Problems will inevitably arise in three areas. First, the general contractor will attempt to minimize their costs which could potentially lead to problems with construction quality. Secondly, the architect will typically try to hold on to certain aesthetic concepts at any cost, and finally the operations people tend to make changes continuously throughout the project to make the structure more functional. These potential problems, among others, may be resolved and/or avoided entirely with an experienced construction manager as a part of the team.

Once construction is underway the two main items to monitor are time and budget. Monitoring the daily schedule and variance reports is key to ensure the project is finished within the allotted time line. All critical dates must be met or adjusted with guarantees from the contractor/architect that progress will not be delayed. Change orders must also be monitored to ensure that costs do not exceed the amount budgeted for changes. Individual alterations may seem minor. However, cumulatively, these can equal material sums of money.

As construction nears completion, final inspections comparing the construction documents to the completed construction is imperative. Although, all construction documents have been approved by engineers, it is not guaranteed without review that the new facilities were built as such.

Upon approval of the work and payment of invoices, lien waivers aid in protecting the hospital from future financial responsibility or liens on property. This might be a somewhat burdensome step, but in the scheme of the overall project, requiring waivers from contractors and subcontractors is simple compared to the potential problems that will be avoided.

With proper management, construction on the hospital campus can allow for improvements to existing buildings and development of new facilities with little or no disturbance to the hospital's daily routine.

Profile:
James R. Teeter
Arkansas Hospital Association

For almost 70 years, the Arkansas Hospital Association (AHA) has served as the high ground to which the state's 103 hospitals swim when unity and collective effort is called into play. For close to half those years, Jim Teeter has been on the scene, serving as the organization's president and chief executive officer since 1994. "It's the most exciting, rewarding work I've ever done," says Teeter, winner of the 1998 Ken Graves Award presented to him for excellence in leadership by the Arkansas Society of Association Executives.

Saying that he's never experienced two days exactly alike during his 31 years at the AHA, Teeter has been witness to much change, not only at the AHA, but within the 103 hospitals it represents. Unchanged, however, is the AHA's mission of ensuring that outside forces don't deter Arkansas hospitals' commitment to providing compassionate care to the sick and injured in need of that care.

Fulfilling that mission calls for constant and vigorous hospital advocacy, and for a comprehensive government relations program that is respected and strong. The AHA invests heavily in both, realizing that it must at the same time meet its obligation to provide member hospitals with the best in communications, educational opportunities, data, research, and shared services. It's a balancing act that, while manageable, is a daily challenge.

As with any viable trade association, the AHA's membership services and political reach have stretched as member needs have evolved throughout the years. One can chart the activity by examining the organization's annual operating budget which has blossomed from about $75,000 when Teeter came aboard in 1968 to about $2 million today. Another measurement is the AHA's total assets which once did not appear on the radar screen, but are now $3.7 million.

To oversee the large number of new services and programs dictated by need and demand, the AHA has, in recent years, expanded its full-time staff from three members to thirteen. Teeter is convinced that "this investment in human resources is the smartest expenditure of dollars" the AHA has made. The people with whom he works every day "are job-dedicated professionals without equal." He credits them for "getting the job done in every aspect," noting that they often arrive early for work, stay late, take work home at night, and work weekends if need be. "Incurable workaholics," he says of them.

While not given to braggadocio, Teeter does credit himself for the recruitment of each member of the AHA "team" as he refers to it. "Our executive team comprises an Arkansas born, reared, and educated cast, and while it may sound provincial to say so, I'm very pleased with that." Teeter says that thanks, in part, to their deep roots in the state, AHA executives Phil Matthews, Paul Cunningham, Beth Ingram, and Don Adams know how to walk the walk and talk the talk, whether standing before the Arkansas General Assembly, the state's congressional delegation, a civic club, or a community gathering. And, he boasts, "In the aggregate, they have over 100 years of AHA experience to help them do that."

Hard working and harried hospital executives throughout the state have an appreciation for those combined years of AHA staff experience when it comes to hospital advocacy, for these are troublesome times for hospitals, says Teeter. In an era of immense change and turmoil brought about by such external forces as managed care, diminishing revenue from Medicare and Medicaid, and healthcare workforce shortages, the public's perception of hospitals has taken a beating.

A massive, ongoing research project begun in 1996 by the American Hospital Association reveals that the public believes insurance companies have taken control over critical medical decisions and that hospitals and physicians have ceased being advocates for patients' needs; that the quality of healthcare has declined; that hospitals are more committed to profits than to care; that hospital bills are filled with errors; that hospitals are wasteful; and that the cost of care is too high.

Most of the charges do not ring true, Teeter says, although he says he can see why the public perception has become negative. Unfortunately, perception has a way of becoming reality over time, he observes. So in efforts to combat the negativity by better informing the public--at least in Arkansas--the AHA has embarked upon a continuing public education campaign.

The campaign includes television, radio, and print messages pointing out that Arkansas hospitals are staffed with 44,000 compassionate healthcare professionals and other workers who provide more than 2 million days of patient care each year; that Arkansas hospital charges are among the lowest in the nation; that hospitals work hard to achieve accuracy in billing; and that they provide more than $120 million in charity care and write off another $250 million in bad debts each year. The campaign has been well received and has won several awards.

In terms of benefit to the Association's government relations endeavors, the AHA's public education campaign has lived up to the old adage that "Education doesn't cost, it pays!" From the governor to state legislators to the congressional delegation, elected officials have become more sensitive to healthcare issues, problems, and concerns. While Medicare and Medicaid payments are still often less than the actual cost of providing hospital services, the awareness of red ink and of hospitals' many contributions to society have helped in negotiations for fairer state and federal payments.

Another vitally important function of the AHA is membership education. Each year, the Association presents approximately 80 seminars, workshops, and other educational opportunities to hospital personnel. Many of the AHA's programs are accredited by the American College of Healthcare Executives to grant required continuing education credits to the state's hospital executives, saving many thousands of dollars in expenses associated with travel to similar programs held out of state.

While the space allotted for this article precludes a comprehensive picture of the AHA's endeavors and achievements over the years, here are a few that Teeter believes to be among the most significant and exciting:

• The construction and furnishing of a modern, mortgage free AHA headquarters building in western Little Rock
• The incorporation of AHA Services, Inc., a wholly-owned for profit subsidiary of the AHA, providing many cost saving programs and services to AHA members without jeopardizing the AHA's tax-exempt status. Products include group purchasing, patient data systems, medical equipment leasing, collection and billing services, long distance telephone service, employee benefit programs, and a variety of insurance products.
• The creation of the AHA Workers' Compensation Self-Insured Trust in which about 40 hospitals participate. Since 1995, the state's Workers' Compensation Commission has approved the distribution of almost $8 million in dividends to participating hospitals.
• Providing several pooled hospital equipment loan programs for the state's not-for-profit hospitals through the Arkansas Hospital Equipment Finance Authority, the most recent of which totaled $60 million.
• Enlistment as a major stakeholder in the Robert Wood Johnson Foundation's dispersal of $14 million to improve healthcare access in underserved communities in Arkansas.
• Engaging in a partnership with the Arkansas Medical Society to promote physician and hospital participation in the Arkansas Health Care Access Foundation which has provided millions of dollars in charity healthcare for uninsured Arkansans.
• Coordinating fund drives to raise hundreds of thousands of dollars to improve and expand physical therapy programs at the University of Central Arkansas and Arkansas State University.
• Development of a data program to provide hospital statistical information and to conduct needed surveys.
• Founding more than 20 AHA affiliated professional societies, including the newest, the Arkansas Association of Hospital Trustees.
• Creating the Diamond Awards, an annual competition to recognize excellence in hospital public relations and marketing.

Reprinted Courtesy of Mid South Association Idea Exchange

Calendar

• April 8-9 - Hot Springs
  Healthcare Financial Management Association
• April 16 - Searcy
  Arkansas Society for Healthcare Marketing and Public Relations
• April 22 - Little Rock
  Sentinel Events/Root Cause Analysis Workshop
• April 22-24 - Hot Springs
  Arkansas Association for Healthcare Engineering
• April 23 - Little Rock
  Legal Issues in Obstetrical Nursing Workshop
• April 28-29 - Little Rock
  ACHE "The Power of Benchmarking"
• April 30 - Little Rock
  Arkansas Society for Healthcare Educators
• May 5-7 - Fairfield Bay Resort
  Society for Arkansas Purchasing and Materials Management
• May 6-7 - Fayetteville
  Arkansas Association of Medical Staff Services
• May 9-14
  National Hospital Week
• May 3, 4, 6, 10, 11 - Various Locations
  Arkansas Association of Hospital Trustees Regional Dinner Meetings
• June 9-11 - Heber Springs
  Arkansas Hospital Administrators Forum/Arkansas Health Executives Forum Summer Management Conference
• July 8-9 - Little Rock
  JCAHO Accreditation Standards for Improving Organization Performance

DHHS Reaffirms EMTALA Enforcement

The Department of Health and Human Services' Inspector General, June Gibbs Brown, has announced a new emphasis on enforcing rules for the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) designed to ensure that hospital emergency room patients receive immediate care whether or not insurance will cover the bill. The Act requires that patients going to an ER be provided an appropriate medical screening examination and stabilizing medical treatment, if called for.

While the EMTALA law was originally intended to protect people without health insurance, it applies to all patients who go to an emergency room for care. However, federal officials say reports of patients with potentially serious health conditions who have left hospital ERs without treatment after being questioned about their health insurance are increasing. Brown said that is a violation of the law and indicated HHS is set to begin more vigorous enforcement, fining facilities that don't comply with the Act up to $50,000 per incident.

During December and March, the Arkansas Hospital Association hosted three regional meetings in Camden, Springdale and Jonesboro about EMTALA. The primary speaker for the meetings was David Wright, Medicare State Representative for the Dallas Regional Office of the Health Care Financing Administration (HCFA).

Wright covered a series of concerns related to the EMTALA Interpretive Guidelines issued by HCFA last summer. He responded to questions from the hospital representatives involving specific situations and the way EMTALA would be applied by HCFA investigators if any suspicion of a violation of the Act arose from those situations. He also informed those attending that the HCFA Regional Office has begun a series of quarterly conference calls for hospital association representatives in Arkansas, Louisiana, New Mexico, Oklahoma and Texas related specifically to EMTALA issues. Questions about EMTALA issues for discussion on future conference calls should be directed to Beth Ingram or Paul Cunningham at the AHA, 501-224-7878.