AHA Annual Meeting, CEO/Trustee Leadership Breakfast, October 4-7

Plans are finalized and the program brochure is enclosed with this newsletter for the Arkansas Hospital Association's 68th Annual Meeting and Trade Show, October 4-7 at Arkansas' Excelsior Hotel in Little Rock.

Program highlights include an opening address by Governor Mike Huckabee; health policy analyst Emily Friedman presenting the keynote address, "Coming Home to Roost;" and discussions about hospital/physician partnerships, challenges (both personal and professional), the future of solo hospitals, Arkansas' political landscape and the November elections, and solutions to medication errors.

The annual CEO/Trustee Leadership Breakfast on Monday, October 5, will feature a provocative discussion by Frances Hesselbein, president and CEO of the Peter F. Drucker Foundation for Nonprofit Management and 1998 Presidential Medal of Freedom recipient. The former national executive director of the Girl Scouts of the USA from 1976 to 1990, Ms. Hesselbein transformed the declining nonprofit organization into a thriving vital enterprise that has regained its vitality as an American business.

In her most recent book, The Organization of the Future, she addresses key points associated with leadership, volunteerism, and creating a knowledgeable society. She shares her brilliant insight and philosophy that gives you the knowledge to manage successfully in corporate and nonprofit organizations, and to motivate people for maximum performance.

In addition to the educational sessions, the AHA annual meeting will honor its past-chairmen at a dinner on Sunday evening. The Arkansas Symphony Orchestra will perform under the direction of David Itkin, featuring Kristi Tingle, Broadway vocalist.

Please mark your calendar, review the enclosed program and registration information, and plan to join us for the annual meeting. Call Beth Ingram at 501-224-7878 with questions.

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Nominations Open for 1998 AHA Awards

Nominations are open for the 1998 Arkansas Hospital Association awards program. Award recipients will be honored at the October 6 Awards Dinner during the Association's 68th Annual Meeting in Little Rock. Award descriptions are:

A. Allen Weintraub Memorial Award: Named for Allen Weintraub, longtime administrator of St. Vincent Infirmary Medical Center in Little Rock, this award is the highest honor bestowed upon a hospital administrator by the AHA. Nominees must contribute to their hospitals and communities in same manner as did Allen.

Distinguished Service Award: Presented to individuals who, while not necessarily AHA members, have promoted a cause of the healthcare industry, thereby becoming entitled to special recognition. Examples of those eligible for this award are trustees, physicians, nurses, auxilians, and other deserving individuals.

C. E. Melville Young Administrator Award: Presented to a healthcare administrator under the age of 40, who is employed in some type of responsible Arkansas hospital administrative capacity for at least two years prior to nomination.

Nominations, accompanied by documentation of the nominees' accomplishments, must arrive at AHA headquarters no later than Tuesday, September 1. The AHA Board of Directors will select award recipients at its September 11 meeting. A list of previous award recipients and award requirements is available by calling Beth Ingram at 501-224-7878.

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From the AHA President. . .

The last time I checked, about 23% of Arkansas' 2.5 million residents had no healthcare insurance. Here as elsewhere, folks without health insurance suffer poorer health, have less access to physician and hospital services, and have a pattern of using health services later in the course of an illness than those of us blessed with insurance.

Moreover, is the uncompensated cost of caring for the uninsured. Last year, Arkansas hospitals provided $112,500,000 in voluntary charity care. They simply wrote off another $303,900,000 in bad debts. Since 1990, the financial weight of charity care and bad debts in Arkansas has increased by 86%. Throughout America, about 42 million persons have no health insurance, and the uncompensated cost to hospitals is at least $18 billion a year.

After the Clinton administration's healthcare plan went down in flames, the hospital community realized that Americans will probably never have a comprehensive universal healthcare plan. So the American Hospital Association set up its Campaign for Coverage, an attempt by hospitals to reduce the uninsured by 4 million people by the end of this year. While the campaign - in which several Arkansas hospitals are participating - has provided coverage to almost 2 million persons, the number of uninsured has continued to grow.

Unfortunately, the U.S. Supreme Court didn't help matters recently when it rejected the appeal of 84,000 retired General Motors (GM) workers who'd sued to restore their health benefits. Among them were 50,000 who took early retirement with written promises that healthcare would be "fully paid by GM" for the retiree, spouse, and eligible dependents.

The written assurance was meaningless prose, trumped by a clause hidden in benefit documents that gave GM "the right to amend, change, or terminate the plans and programs." That's exactly what GM did. It curtailed coverage, raised deductibles, and hiked premiums. Early retirees now pay up to $1,500 a year for care they were promised would be free.

The excuse for health insurance cuts at General Motors was fairly standard: rising costs have made health coverage less affordable than when the promises were made. Never mind that health insurance costs rose only 2.6% for the past five years vs. 12.4% from 1988-93.

GM is not the only employer shafting its retirees. Others include Pabst, the Milwaukee brewer, which has eliminated coverage for nearly 800 retirees, and Morrell and Company, the meat packer, which terminated promised coverage for 3,300 of its retirees. But, what th' heck, bidness is bidness. Retirees who don't like it can call 1-800-WHO CARES.

Is all this employer backpedaling a trend? Well, William M. Mercer Inc., a human resources consultant, recently studied nearly 1,500 employers. Each has more than 500 workers. Mercer found that in the past two years, 12% of the employers increased retiree premiums, 6% boosted copayments, and 8% shifted retirees into managed care plans. In addition, only 38% now offer any health coverage to early retirees, down from 46% in 1993.

For the nearly 5 million retirees receiving employer-paid health benefits, the cuts always come as a stunning blow. But, they're also a blow to hospitals, physicians, and other medical providers who are likely to pay the price through more uncompensated care. We in Arkansas - a state to which so many retired Americans migrate to live out their "golden years" - are sure to feel the squeeze. Sooner or later.

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Joint Leadership Conference September 18-20, Nashville

Nationally-known governance consultant Jamie Orlikoff will keynote and discuss keys to successful healthcare leadership at the 9th Annual Southeast Joint Leadership Conference September 18-20 at the Opryland Hotel in Nashville, Tennessee. The conference is designed for hospital chief executives, trustees, and medical staff leaders.

Additional program topics include building trusting relationships among hospital executives, trustees, and employees, and a thorough discussion of healthcare mergers. In addition to the educational sessions, participants will enjoy golf, museum and historical tours, and special evening entertainment including an event at the Ryman Auditorium.

Program and registration information will be mailed to all AAHT members, as well as to all Arkansas hospital CEOs the first week in August. Early hotel reservations are encouraged. Call 1-615-889-1000, requesting reservation code N-THOS to obtain the special rate.

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Arkansas Hospital Outreach Activities

Although Arkansas' hospitals don't spend much time boasting about their community outreach efforts, they're extending the "hospital without walls" concept further from their own campuses each week. At the spring meeting of the Arkansas Association of Hospital Trustees, consultant Susan Berk of Encino, Calif., asked trustees and CEOs from the participating hospitals to describe ways they are partnering with local community organizations to improve access to healthcare services and have a positive impact on health status.

A sampling of the responses showed that Arkansas hospitals are involved in a variety of projects such as:

• partnering with the local transit authority to deliver patients to the hospital and local clinics and return them to their homes;
• equipping a mobile health van to travel to local schools and businesses for wellness checks, immunizations, education, etc.;
• working with local school athletic trainers to ensure delivery of proper medical treatment;
• instituting a diabetes planning program that evolved from a small group meeting to a large city-wide event that meets in the civic auditorium;
• providing a hospital summer camp to teach school children about healthcare, accident prevention, and infection control practices;
• working through churches to provide preventive care for those individuals who fear or refuse to come to a hospital;
• raising funds through the hospital's foundation for a childhood immunization program;
• partnering with the local community mental health center to provide a haven for abused women and children;
• sponsoring, along with the junior auxiliary (or another civic organization), a "safety town" for children ages 5-7; and,
• utilizing the hospital's physical therapy department to provide free physicals to school athletes.

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EMTALA Update

During a recent seminar on the Emergency Medical Treatment and Active Labor Act (EMTALA) sponsored by the Arkansas Hospital Association (AHA), several speakers provided detailed explanations of the law and actions necessary for hospitals to fully comply with its requirements. Attorneys Harold Simpson, Diane Mackey (AHA legal counsel), and Lynda Johnson; and Val Buck and Wanda Theus of the Arkansas Department of Health (ADH) reviewed various aspects of the act. Among their remarks, the group discussed the following items:

• From 1990 through May 1998, the ADH has been notified of 85 possible COBRA violations, 25% of which have been substantiated.
• The most common EMTALA problem among hospitals is inappropriate screening of patients and insufficient documentation of those services.
• There are three basic requirements for EMTALA: screening, stabilization, and limits on transfer.
• The six keys to EMTALA readiness are: know the requirements, have detailed policies and forms in place, educate medical/hospital staff, emphasize EMTALA compliance, monitor constantly for EMTALA compliance, and respond promptly to suspected problems.
• Quality assurance is extremely important to successful EMTALA compliance.
• Hospitals may be fined for not reporting another hospital suspected of an EMTALA violation.

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AAHT Calendar of Events

September 2, Little Rock
Medicare Fraud and Abuse: Preventive Measures to Avoid Becoming a Victim

October 4-7, Little Rock
Arkansas Hospital Association Annual Meeting; CEO/Trustee Leadership Breakfast

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Arkansas Hospitals Offer Diverse Range of Services

Arkansas hospitals offer a diverse range of services to meet the healthcare needs of all Arkansans. In addition to the general medical/surgical services and emergency services with which most people are familiar, many hospitals offer skilled nursing services for patients needing something less than an acute level of care. Other services are focused on taking care of patients' physical rehabilitation, psychiatric and chemical dependency conditions. Most of the state's hospitals also offer nursing care through their home health agencies, and many sponsor primary care health clinics located in different regions of their service area.

Thirty-seven Arkansas community hospitals having fewer than 100 beds are certified to provide skilled nursing services to Medicare patients under Medicare's "swing bed" program. The program allows smaller hospitals to "swing" the use of a licensed bed from acute care to a step-down skilled nursing use without actually moving the patient to another part of the hospital. Twenty-eight larger community hospitals have distinct units licensed where they provide a similar recuperative level of service. These Recuperative Care Units must be located in a given area of a hospital, according to Medicare rules.

Many community hospitals are also licensed to operate other types of "distinct-part" units to complement their general acute care services. Nineteen hospitals have rehabilitation units where patients recover from debilitating illnesses and injuries, thirty-four are licensed to care for patients' emotional and mental heath needs through distinct-part psychiatric units, and five others have chemical dependency units.

Rehabilitation and psychiatric services on a larger scale are available through fourteen freestanding specialty hospitals that specifically serve patients with those needs. The state's five freestanding rehabilitation hospitals specialize in the rehabilitative medicine and nursing, and therapy needs of patients recovering from stroke, head and spinal cord injuries, orthopedic procedures and other conditions. Nine hospitals licensed specifically as psychiatric facilities offer inpatient and outpatient diagnosis and treatment services for persons with mental health disorders.

There is also a specialty hospital in Arkansas licensed to care for people who need acute nursing services for a long duration, normally more than 25 days. This long-term hospital typically serves patients with pulmonary conditions needing ventilator services, suffering complex medical problems related to multi-system failures, or recovering from large open wounds.

While specialty hospitals in the state take care of special needs of the general population, two Veterans Administration hospitals in Arkansas cater to the general healthcare needs of a special population, the state's military veterans. The VA hospitals offer a comprehensive range of services for veterans, including medical, surgical, rehabilitation, psychiatric, and long-term care services.

In addition to all the services above, which are normally provided within hospitals' walls, Arkansas hospitals are reaching out into their communities to deliver services. Eighty percent of Arkansas hospitals offer home health services, and 27 hospitals sponsor rural health clinics located in different communities.

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Sexual Misconduct/Harassment Policies

In a response to a June 26 Supreme Court ruling that employers are responsible for the sexual misconduct of their supervisors, even if they don't know about the behavior, the American Hospital Association issued the following recommendations for healthcare organizations:

• Every hospital should have a sexual harassment policy that is disseminated among all employees. It's not enough just to have a policy. Your employees must know its contents.
• Every hospital must attempt to monitor the conduct of its supervisory employees, including their training.
• Every sexual harassment policy should include a complaint procedure that gives employees several alternatives to take their grievances.
• Hospitals must prevent fear of retaliation and make it understood that complaints will be acted upon.
• Hospitals must make it clear to employees what types of activities are prohibited and the penalties for disobeying.

In addition, transferring an acuser may be seen as a reprisal. Only do this if the employee requests a move and the new position is not a demotion.