From the AHA President. . .
In a speech the other day, U.S. Attorney General Janet Reno said that hospital complaints about the Justice Department's threats to use the False Claims Act in Medicare billing investigations have been heard loud and clear. She said, however, that she would not hesitate to use the law when a provider "acts in reckless disregard or deliberate ignorance" that fraudulent bills are being submitted. Reno also said this:

If a hospital sincerely believes it is being pursued for a simple mistake,its legal counsel should meet with government attorneys to explain the hospital's point of view. I want to make sure that we listen carefully. I don't want to be part of an institution bringing unjust or unsubstantiated cases any more than you want to have to defend them. There is always an open door at the U.S. Attorney's office and at main Justice.

Reno may have been saying to hospital execs, "Don't be so quick to make a monetary settlement when your letter arrives." Perhaps she wasn't saying that at all. But, the fact remains that too many hospitals - fearing the prospect of huge fines and lawsuits - have rushed to a settlement without their attorneys even questioning the government's accusations. The "demand/investigation letters" sent to hospitals in all states except Arkansas and seven others are menacing in tone. But, as Reno suggests, that's no reason for immediate settlement if hospital officials believe that honest errors are, indeed, the problem.

We in Arkansas still have no idea when hospitals will begin receiving demand/investigation letters pertaining to the "72-hour rule," lab unbundling, or pneumonia upcoding. Arkansas' two U.S. Attorneys have not given a hint of what to expect or when to expect it. "It would be inappropriate for me to discuss, or even acknowledge the existence of investigations involving other people or entities with you," one of them said.

That's an interesting statement, considering the fact that the Kansas U.S. Attorney's office initiated contact with the Kansas Hospital Association to discuss the government's investigation plans in that state. The U.S. Attorney's office in Kansas even stated its belief that most of the initiatives in other states have been too extreme and that such will not be the case in Kansas. Nor, will there be a "press event" unfairly impugning the integrity of Kansas hospitals.

Contrast that to the U.S. Attorney's actions in Maine. In that state, the total number of "72-hour rule" errors committed by 24 of the state's 42 hospitals over a five-year period amounted to 993 errors out of 2,910,156 claims submitted by the penalized hospitals. That is only 3/100ths of one percent of the claims filed by those hospitals! Yet, when the U.S. Attorney in Maine publicly announced $273,000 in settlements related to these errors, he said the errors persisted "despite previous audits and warnings by the Department of Health and Human Services." He told the media that "it was apparently common practice in Maine and elsewhere for many hospitals to double bill for these tests."

What the Maine U.S. Attorney described as a disregard for the rules by 24 Maine hospitals is clearly not supported by the data. It's unfortunate that this man chose to address an infinitesimal number of errors with exaggerated and inflammatory rhetoric, and that he doesn't share the Kansas philosophy that the public will be best served when the federal government works cooperatively with hospitals to resolve this issue. When and if Arkansas' U.S. Attorneys speak publicly about investigations or settlements in our state, let's hope they follow the Kansas example rather than Maine's.

James R. Teeter,
PresidentArkansas Hospital Association

....

AAHT Annual Meeting, March 20, Little Rock
Susan Berk, healthcare consultant, and Dan Mulholland, healthcare attorney, will present two dynamic and informative presentations at the March 20 annual meeting of the Arkansas Association of Hospital Trustees, to be held at the new Embassy Suites hotel in west Little Rock.

Corporate Compliance
Dan Mulholland, a partner in the Horty, Springer & Mattern law firm in Pittsburgh, will attack the issue of corporate compliance head-on. His thought-provoking (and frightening) presentation, "Send Lawyers, Guns and Money - Survival Strategies for the Brave New World," will explore the importance of having a hospital compliance program. Why? To avoid the possibility of the hospital incurring thousands and hundreds of thousands of dollars in payments to the federal government.

Mulholland will provide a survey of some recent federal enforcement efforts in the area of fraud and abuse, tax exemption rules, and antitrust. He will review the basics of corporate compliance, and offer practical advice about how to deal with government investigations and how to stay out of jail.

Community Health
Berk's presentation, "A Call to Action: the Power of Trustees in Initiating Community Health," challenges healthcare providers, payors, and corporations to predict, anticipate, create and strategically plan for the future. She will discuss:

• Why partnerships will be the key to survival and sustainability in the managed care environment.
  
• Redefining factors that contribute to healthier communities and the hospital's role in making it happen.
  
• The hospital as a stakeholder and not a rescuer in healthier communities.
  
• Overcoming the seduction of past success and moving toward a commitment to collaborate.
  
• Welding mission, vision, and goals to action outside the hospital walls.
  
• Initiating innovative partnerships, through assessment collaboration, and commitment to a broader strategic vision.
  
• The role of the individual trustee in initiating community partnerships.
  
• Moving from ideas to action at board meetings.

....

AAHT Board Action
At its January 16 meeting, the AAHT board discussed the following and submits it for vote at the March 20 business meeting:

Bylaws Change
Article IV, Section 2. Officers and Directors:

The officers of the Association shall be president, president-elect, secretary-treasurer, and past-president, and shall be elected by ballot by the members of the Association in an annual meeting.... Directors shall hold office for alternating periods of one and two years (after the first year), to ensure board continuity.

Article IV, Section 3. Duties of the President:

The president shall preside at all meetings of the Association and serve as chairman of the Board of Directors. He is a voting member of the Board but will cast his vote only in case of a tie. It shall be his duty to supervise the activities of the Association. He is invited to attend all board meetings of the Arkansas Hospital Association. AAHT will pay his travel expenses to attend the AHA board meetings....

Article VII, Section 1. Rate of Dues:

Membership dues will be $250 per hospital per year, and limited to AHA institutional membership.

Slate of Officers
The nominating committee proposes the following slate of officers for 1998-2000 (to take office March 20):

President - John Collier, Wynne
President-elect - Calvin Hagan, Little Rock
Secretary-Treasurer - Betty Massey, Batesville
Past-President - Curtis Shipley, Fayetteville
Arkansas Valley - Peggy Talkington, Russellville (1 yr.)
Metropolitan - Ray Kordsmeier, Conway (1 yr.)
North Central - Betty Massey, Batesville (1 yr.)
Northeast - Bruce Williams, West Memphis (2 yrs.)
Northwest - Rob Brothers, Rogers (2 yrs.)
Southeast - Lathan Hairston, Warren (2 yrs.)
Southwest - Susan Looper, Malvern (2 yrs.)

....

AAHT Regional Dinner Meetings
May 12-14, 19-21
Three years ago, the Arkansas Association of Hospital Trustees made the decision to offer an annual series of regional dinner meetings to be held in several locations across the state. These meetings offer hospital trustees and CEOs an opportunity to meet other trustees from their area, discuss problems and concerns they experience, and share ideas.

The 1998 series will focus on corporate compliance. Hospitals across the United States have begun to receive demand letters as part of a joint anti-fraud and abuse effort between the Department of Justice and the Office of the Inspector General. The letters accuse hospitals (and other providers) of defrauding the government by falsely filing Medicare claims. Is your hospital prepared to act when your letters arrive? Do you, as a hospital trustee, understand that violations may be punishable by triple damages, with additional fines of $10,000 for each false claim filed, and that your hospital may be excluded from federally funded healthcare programs?

In order to limit damage exposure, it is important that hospitals have proof of their good-faith attempts to comply with antifraud and abuse laws by educating their employees, adopting compliance plans, and installing software edits in their billing programs.

At the AAHT annual meeting March 20, Dan Mulholland will lay the groundwork for a hospital compliance program and identify ways in which a hospital must prepare for the assault by the federal government. The regional dinner meetings will offer further examination of the compliance issue and all its consequences, as well as time for discussion of the many questions trustees and CEOs may have.

Steve Spargo and Andrew Quinn, partners in Compliance Concepts, Inc., will lead the discussion at all six locations. Quinn is the former Assistant U.S. Attorney for the Middle District of Pennsylvania. In that position, he represented the United States as a federal prosecutor in numerous civil and criminal matters and was assigned to investigate 4,700 hospitals nationwide for Medicare overbillings. Spargo is the former Vice President of Finance at Allegheny General Hospital in Pennsylvania, one of the first hospitals to receive a demand letter from the government.

Each meeting will begin at 5:30 p.m. and should adjourn around 8:30. Hospital CEOs and trustees are encouraged to attend the session nearest your hospital:

May 12, Holiday Inn Select, Little Rock
May 13, Batesville Country Club
May 14, Harbor Oaks Country Club, Pine Bluff
May 19, Camden Country Club
May 20, Holiday Inn Civic Center, Fort Smith
May 21, Holiday Inn Northwest Arkansas, Springdale

Registration and programming information will be mailed soon. Call Beth Ingram at the Arkansas Hospital Association, 501-224-7878, with questions.

....

Arkansas Auxilian Contributions
Hospital auxilians and teen volunteers throughout the state have proved again that the power of collective volunteerism is invaluable to Arkansas' hospitals. Last year the 8,300 members of the 65 chapters of the Arkansas Hospital Auxiliary Association provided about one million volunteer hours of service to their hospitals, and donated more than $2.3 million that helped those hospitals operate programs, buy equipment, fund scholarships, and support community benefit initiatives. In addition, the auxilians served as a valuable resource for the Arkansas Hospital Association during the 1997 session of the Arkansas General Assembly, making contacts with individual legislators on issues important to hospitals. The Arkansas Hospital Association and its member hospitals salute all the state's hospital auxilians for their contributions and continuous support over the years.

....

www.arkhospitals.org -Arkansas Hospital Association's New Web Site
The Arkansas Hospital Association (AHA) recently launched its web site (www.arkhospitals.org) providing another medium for instantaneous communications with member hospitals. What can you find out from the AHA's web site?

• About AHA - information about the AHA, the board of directors, the Executive Committee, the AHA staff, institutional members and affiliate groups; (you can email the board, the staff, and individual hospital members from this area)
  
• Governmental Issues - state and national legislative and regulatory matters; link to members of the Arkansas Legislature and the state's congressional delegation, and email members directly; and review the archive of the AHA Legislative Bulletin
  
• Publications - view current and past issues of The Notebook, Arkansas Hospitals, the Legislative Bulletin, and, soon, The Arkansas Trustee
  
• News Flash - late-breaking and important news for AHA members
  
• Calendar - upcoming educational meetings and seminars, and registration information for specific events
  
• AHA Services - products and services available to AHA members, along with a list of companies endorsed by AHA Services
  
• Links - link to many governmental and regulatory agencies, news organizations, as well as various healthcare publications
  
• Search - input a word or phrase and search through the various information on the web page pertaining to that subject
  
• Feedback - allows the user to provide instantaneous feedback or response to the AHA about the topic of your choice
  
• Members Only - contains information intended for members only. Access requires a user name and password, which were communicated to hospital CEOs in a January 13, 1998 memorandum.

....

• Governance Survey
  In 1997, the American Hospital Association (AHA) and Ernst & Young LLP conducted the most comprehensive survey of healthcare governance to date. The surveys examined board composition, member selection criteria, committee structures, decision-making authorities, board-management relationships, expected future challenges, and other key topics in healthcare governance.
  
  The CEOs of all the nation's 5,141 community (short-term, non-federal) hospitals received the written hospital survey, which they were asked to complete with the board chair. About 40% of the surveys were completed and returned (2,079). With this large number of responses, users can have a high level of confidence in the general representation and accuracy of the overall results.
  
  The first full report on the survey, Shining Light on Your Board's Passage to the Future, is now available. Shining Light offers benchmarks and best practices for healthcare governance, and can help any hospital or health system improve its governance performance by answering key questions, including:
  
• What's the real story about how hospital and health system governance differ?
  
• What skills do healthcare governing bodies seek from their members?
  
• How are powers typically allocated between parent and subsidiary boards?
  
• What are the key practices for successfully transitioning to integrated system governance?

Call 800-AHA-2626 and ask for catalog number 196416; $35 for AHA members, and $45 for others.

....

Foster McGaw Award
Applications are being accepted for the 1998 Foster G. McGaw Prize, which recognizes healthcare organizations that demonstrate excellence in community service. The prize, considered one of the most significant in healthcare, is presented jointly each year by the American Hospital Association and the Baxter Allegiance Foundation, the philanthropic arm of Baxter International and Allegiance Corp. Applications must be postmarked by March 31. For more information or to receive a brochure, call Nancy Alston at (312) 422-3360. You can also visit the American Hospital Association's Web site (www.aha.org) to learn more about the application process.

....

AAHT Calendar of Events

March 20, Little Rock
AAHT Annual Meeting

May (various locations and dates)
AAHT Regional Meetings
12 Holiday Inn Select, Little Rock
13 Batesville Country Club
14 Harbor Oaks Country Club, Pine Bluff
19 Camden Country Club
20 Holiday Inn Civic Center, Fort Smith
21 Holiday Inn Northwest Arkansas, Springdale

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