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SUMMEr 2008
www.arkhospitals.org
Hospital Statistical issue
Washington Meeting Focuses
on local leadership and
National policies
preventing MrSA in the
Hospital Setting
A MAGAZINE FOR ARKANSAS HEALTHCARE PROFESSIONALS
PAGE
PAGE
12
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10
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Arkansas Hospitals
is published by
Arkansas Hospital Association
419 Natural Resources Drive • Little Rock, AR 72205
501-224-7878 / FAX 501-224-0519
www.arkhospitals.org
Beth H. Ingram, Editor
Board of Directors
Ray Montgomery, Searcy / Chairman
James Magee, Piggott / Chairman-elect
Luther Lewis, El Dorado / Treasurer
Robert Atkinson, Pine Bluff / Past-Chairman
Kirk Reamey, Ozark / At-Large
Peter Banko, Little Rock
Jamie Carter, West Memphis
Darren Caldwell, DeWitt
David Cicero, Camden
Les Frensley, Batesville
Pat Heinz, Little Rock
Tim Hill, Harrison
Ed Lacy, Heber Springs
Larry Morse, Clarksville
Kristy Noble, Berryville
Russ Sword, Crossett
Doug Weeks, Little Rock
Executive Team
Phil E. Matthews / President and CEO
Robert “Bo” Ryall / Executive Vice President
W. Paul Cunningham / Senior Vice President
Elisa M. White / Vice President and General Counsel
Beth H. Ingram / Vice President
Don Adams / Vice President
Distribution
10 Washington Meeting Focuses on Local Leadership and National Policies
50 Preventing MRSA in the Hospital Setting
Statistical Information
Advocacy
8
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9
10
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12
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18
19
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25
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27
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38 Washington Meeting on Leadership and Policies
40 Why We Went to Washington
41 AHA Rural Hospital Advocacy Agenda
Arkansas Hospitals by the Numbers
Southwest Reg. Medical Center to Close July 15
Distribution By Hospital Type and Control
A Number of Important Facts
Arkansas Hospitals by Congressional District
A Snapshot of Arkansas Hospitals
Hospital Charges By Payer Category
Comparative Utilization Indicators
Community Hospital Financial Indicators
Community Hospital Summary Financial Data
AHA Member Hospitals
Comparative Financial Indicators
Investor Owned, Operated Hospitals
Members of Not-For-Profit Hospital Systems
TOP 30 Hospital Admitting DRGs, 2006
Total Uncompensated Care Costs, 1981-2006
The Cost of Doing Business Tomorrow
Hospital Uncompensated Care Costs
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37
Medicare/Medicaid
42
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AHA Part of Federal Suit Against CMS
CMS Proposal Tightens MA Standards
Medicare SNF, LTCH Rule Changes
Access HAC, POA Information Online
Acute Care Episode Demonstration Project
Emergency Preparedness
45
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47
Hospital Evacuation Template Available
Booneville Hospital Evacuates Patients – Twice!
Resource Addresses Operations During Disasters
Review for Draft NIMS Document is Underway
NIMS Implementation Objectives
Quality
Features
Arkansas Hospital Association Accomplishments
Reports Needed from All Providers
Legal Notes: Concerning HIPAA
California Nursing Union Distributing Materials
Tips for a Brown Bag Lunch with the CEO
AHA Annual Meeting Announcement
2008 Award Nominations Now Being Accepted
Healthcare Among Americans’ Top Worries
Mid-Management Series Offers Bold Insights
17
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50
AFMC Announces 2007-08 Quality Awards
AHA Supports Wristband Safety Project
5 Million Lives Campaign Reaches 100 Percent
MRSA in the Hospital Setting
NewsSTAT
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Hospital CEO Turnover Rate Remaining Stable
Parity Bill Touches Specialty Hospitals
President Signs Genetic Nondiscrimination Act
Media Scrutiny of Hospital Collections
Drug Recall Notice on Doxil, Procrit and Remicade
Country Doctor of the Year Nominations
Departments
To advertise contact
Edition 63
38
12 A Snapshot of Arkansas Hospitals
Arkansas Hospitals is distributed quarterly
to hospital executives, managers, and trustees
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and other friends of the hospitals of Arkansas.
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Cover:
Rockclimbing
in the Ozarks
4
6
7
From the President
Education Calendar
Arkansas Newsmakers and Newcomers
Photo courtesy
of Arkansas
Dept. of Parks
and Tourism
Summer 2008 I Arkansas Hospitals
3
f r o m
t H e p r e s i D e n t
What Are We leaving Behind?
An article I read recently noted that the fertility rate in America is at its highest level (2.1) since
1971. In essence, this means that the average birth
rate per woman is 2.1 children – the rate at which
a generation will replace itself and reach sustainability.
America is currently
one of the only developed
nations that is sustaining
its population; nearly all
others (particularly those
in Europe and Asia) are in
decline, with aging populations outnumbering
the younger generations
that ultimately will bear
the responsibility of their
care.
The article made me
think about the responsibility, specifically the healthcare responsibilities,
even America’s younger generations will bear as
they grow into maturity.
Though America is at the “break even” point in
sustaining our population, if the American healthcare system remains as it is today, the younger generation is certainly going to have its hands full. It
will, by default, contribute financially to the support
of baby boomers who are entering their retirement
years. The economic impact, let alone the healthcare impact, that baby boomers’ retirement and
aging will cause our nation boggles the mind.
Though America has a “sustainable” number of
young people coming into their economically active
years, today’s sheer numbers of aging Americans
will create significant downward economic pressure
on them as Medicare rockets toward its financial
breaking point.
Our field already experiences extreme pressure
on revenues due to the shortfall in Medicare reimbursements. No other business in any other industry would or could sustain such continual pressure
while costs continue to rise. So far, hospitals, as
safety-net community-based healthcare providers,
have been able to withstand these pressures and continue to operate, but each year, the industry’s financial viability becomes more precarious as the gap
between input price increases and Medicare hospital
payment increases has grown (now at 23.3 percent).
To put this all into perspective, since 1997, when
the Balanced Budget Amendment was enacted,
Medicare’s inpatient payment rates have increased
a total of 25.3 percent, while inflationary price
increases for the goods and services hospitals must
purchase in order to provide care have increased
almost twice as much, 48.5 percent.
Add to that the cost of providing care for the
uninsured, most often care that is under-reimbursed
or not paid at all, and we can see the very dark
cloud on the very near horizon. Hospitals right here
in Arkansas are closing their doors because they are
not being reimbursed at rates that cover actual costs
of care of patients. No hospital can continually
operate in the red.
None of this is “new news” to those of us in the
healthcare field, but in this election year, healthcare
reform and candidates’ healthcare plans are being
scrutinized with great interest, care and concern.
As leaders in the healthcare field, it is time for us
to push hard and harder for real answers to the real
challenges of healthcare reform. It is time for every
person in our nation to help develop a national plan
that will cover all Americans’ health from cradle to
grave. It is time for our nation to forge a new healthcare path so that when the younger generation comes
into middle age, its people will say of us, “They left
us with solutions instead of with chaos.”
Watching these trends, knowing in our hearts
that America’s already broken healthcare system is
going to be tested past its limits over the next generation as baby boomers age, it is truly a time when
healthcare reform is needed.
Phil E. Matthews
President and CEO
Arkansas Hospital Association
4
Summer 2008 I Arkansas Hospitals
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August 12, Little Rock
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Hospital Staff Development
Workshop
August 13, Little Rock
AHA Mid-Management Certiﬁcate
Series: Financial Skills for
Managers
August 26, Little Rock
Basic/Intermediate CPT Coding
August 27, Little Rock
Basic/Intermediate ICD-9 CM
Coding
September 9, Little Rock
Changes and Challenges for
Environment of Care
September 18, Little Rock
Administrative Professionals
Workshop
September 23, Little Rock
AHA Mid-Management Certiﬁcate
Series: Dealing with Conﬂict
September 24, Little Rock
AHA Mid-Management Certiﬁcate
Series: Accountability for Results
Take your first steps.
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Whether an individual has been recently injured or has
been unable to walk for years, the AutoAmbulator may
be used to get people back on their feet. For more
information or to refer a patient, call 501-834-1800.
October 8-10, Little Rock
Arkansas Hospital Association
Annual Meeting and Trade Show
October 22, Little Rock
AHA Mid-Management Certiﬁcate
Series: Getting Results — Be an
Inspirational Facilitator, Trainer and
Coach
November 18, Little Rock
Hospital Staff Development
Workshop
November 20, Little Rock
AHA Mid-Management Certiﬁcate
Series: Government Relations 101
2201 Wildwood Avenue • Sherwood, Arkansas • 501-834-1800
December 2, 3, 9, Various Locations
CPT Coding Workshops
Program information available
at www.arkhospitals.org. Audio
conference information available at
www.arkhospitals.org/calendaraudio.htm.
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Summer 2008 I Arkansas
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Arkansas
Newsmakers
and Newcomers
Governor Mike Beebe has appointed Chris Barber,
FACHE, Administrator, St. Bernards Medical Center in
Jonesboro, to the State Kidney Disease Commission. His
term expires January 14, 2011. Barber is a member of the
Arkansas Health Executives Forum board of directors. In
addition, James R. “Jamie” Carter, Jr., CEO of Crittenden
Regional Hospital in West Memphis, was appointed to
the Governor’s Advisory Council on Trauma. His term
expires July 1, 2009. Carter is a member of the Arkansas
Hospital Association board of directors representing the
Northeast Hospital District.
Darren Caldwell, CEO of DeWitt Hospital, has been
named to the Arkansas Hospital Association board of
directors to represent the Southeast Hospital District,
with his term expiring in October 2008. He succeeds
Richard Goddard of Monticello. Caldwell returned to
the DeWitt facility as CEO in 2002 after serving as CEO
of Drew Memorial Hospital in Monticello since 1996. He
was previously DeWitt Hospital’s CEO from 1991 until
moving to Monticello.
Lee Christenson has joined Northwest Medical Center
– Springdale as the hospital’s new chief operating officer. Christenson comes to Springdale from Bullhead
City, Arizona, where he served as CEO of the 140-bed
Western Arizona Regional Medical Center. Prior to that,
he served in executive roles with hospitals in Pennsylvania
and Florida. He succeeds Joyce Heismeyer, who left
Northwest Health System in April to accept a position as
CEO of a hospital in her home state of Kansas.
Richard L. Goddard, FACHE, has resigned as CEO
of Drew Memorial Hospital (DMH) in Monticello.
Goddard, who represented the Southeast Hospital District
on the Arkansas Hospital Association board of directors,
has been at DMH for almost six years. Bart Millstead,
formerly with QHR, has been named interim CEO while
a search for a permanent CEO is underway.
Ken D. Haynes has been named the new president
of Saint Joseph Hospital, Saint Joseph East and Saint
Joseph Jessamine (scheduled to open in December 2008)
in Lexington, Kentucky. He is a former Senior Vice
President and Chief Operating Officer of St. Vincent
Health System in Little Rock.
Joyce Hedden, wife of former AHA Chairman Bill
Hedden of Magnolia, died February 29 at Magnolia
Hospital. Funeral services were held Monday, March
3. Memorials may be made to St. Jude’s Children’s
Hospital in Memphis or to the Magnolia Boys and Girls
Club.
Timothy E. Hill, President/CEO of North Arkansas
Regional Medical Center in Harrison, recently received
the American Hospital Association’s “Partnership for
Action Grassroots Champion Award” in Washington,
D.C. He was recognized for his leadership in generating
grassroots activity and for educating elected officials on
how major issues affect the hospital’s vital role to the
community. Hill is chairman of the AHAPAC, Arkansas’s
delegate to the American Hospital Association and a
member of the Arkansas Hospital Association board of
directors.
Jim Lambert, FACHE, has been named president and
CEO of Conway Regional Health System (CRHS). He
has served as chief operating officer of the facility for the
past 10 years and as interim president for the past seven
months. “Mr. Lambert is a highly qualified individual
with 26 years of healthcare administration experience,”
said Margaret Beasley, M.D., chairman of the CRHS
board of directors. “The board feels very confident that
he will continue to provide progressive leadership and
enhance the strength of our system as he takes on the
position of president and CEO.”
Gary Looper has resigned as CEO of Northwest
Health System (NHS) in Springdale. He is a member of
the Arkansas Hospital Association board of directors
representing the Northwest Hospital District. Looper
said about his departure, “It’s with mixed emotions that
I step down as CEO. Although there is personal joy in
returning home to my Texas roots and family ties, there
is also sadness as I leave behind a talented team. It has
been a pleasure and privilege to lead Northwest Health
System.” Dan McKay, vice president of NHS’s parent
company, Community Health Systems, will assume the
role of interim CEO while a search is underway.
continued on p.8
Summer 2008 I Arkansas Hospitals
7
s t a t i s t i c s
ARKANSAS HOSPITALS by the NUMBERS What These Statistics Mean for Your Hospital
In a time when those of us in the
healthcare field are constantly reviewing every available resource to keep
Arkansas’ hospitals efficient, effective
and afloat, it is vital to have hospitalrelated statistics close at hand. To that
end, we present your annual Arkansas
Hospitals statistical issue, a useful
resource and communication tool in
one concise guide. The information
provided in this issue is important to
all who participate or have interest in
the healthcare field. Please use it as you
communicate about the hospital and its
place in your area’s economy, social
structure, and caregiving network.
As you review the information gathered here, you gain a sense of where
our nation’s, region’s and state’s hospitals stand in the areas of financial
strength and utilization. You also
see how legislation and regulation are
vastly changing hospitals’ ability to
stay solvent.
Many of you have told us that
the comparative statistics offered here
give you the background and resources
you need to discuss the “health of
healthcare” as you visit with people
in your communities. In speaking
engagements before civic clubs and
organizations, in discussions with your
trustees, and in visiting with friends
and neighbors – these statistics are the
most up-to-date resources available
and offer you the background you
need to knowledgeably discuss current
healthcare trends and dilemmas faced
in Arkansas today.
This guide will help you explain
your hospital’s financial situation to
those who don’t understand today’s
challenges. It provides background
information as you discuss with elected
officials how their vote may affect the
local healthcare scene. It could help
you defend the launch of new services
or the purchase of new equipment.
Whenever you find yourself in need
of communicating the facts about
healthcare in today’s marketplace, you
can rely on this information as your
most trusted and valued resource.
Paul
Cunningham,
Arkansas
Hospital Association senior vice president, compiled these important statistics from information available from
the American Hospital Association and
other sources to provide this valuable
communication tool.
Please use it, and let us know how
it helps you communicate the “healthcare message.”
•
Southwest Regional Medical Center to Close July 15
Health Management Associates Inc. of
Naples, Fla., said it will close Southwest
Regional Medical Center in Little Rock on
July 15, according to its quarterly filing with
the Securities & Exchange Commission.
The move comes after nearly two years
of trying to sell the hospital. It will affect
approximately 150 physicians.
Representatives from HMA, which
operates 58 hospitals in 15 states, includcontinued from p. 7
Kristy Noble, FACHE, was selected May 9 by the Arkansas
Hospital Association board of directors to represent the
Northwest Hospital District on the AHA board of directors.
Noble is president of St. John’s Hospital – Berryville. Before
being named president in 2006, she served as senior vice president and vice president for community relations/development
at the facility. Noble succeeds Gary Looper of Springdale
who recently left his position to move to Texas. Noble’s term
expires October 2010.
Angela Richmond, administrator of Community Medical
Center of Izard County in Calico Rock, also has been named
8
Summer 2008 I Arkansas Hospitals
Gap, Va.; Mountain View Regional
Medical Center in Norton, Va.; and certain other healthcare operations affiliated
with those hospitals.
While a shutdown is planned, the filing
said the company was also “evaluating
various alternatives to divest Southwest
Regional Medical Center, but the timing
of such divestitures has not yet been determined.”
ing Summit Medical Center in Van Buren,
said in the discontinued operations section
of the filing that the hospital was being
closed because of “significant financial
losses.”
The hospital chain is also closing or has
sold Woman’s Center at Dallas Regional
Medical Center in Mesquite, Texas; Gulf
Coast Medical Center in Biloxi, Miss.; Lee
Regional Medical Center in Pennington
•
administrator of Fulton County Hospital in Salem. Both hospitals will remain independent under Richmond’s management.
Both facilities are Critical Access Hospitals.
Three Arkansas hospitals were named recipients of the
Governor’s Work-Life Balance Award. Tim Johnsen, president
and CEO of St. Joseph’s Mercy Health Center in Hot Springs,
accepted the Gold-level award for his hospital’s achievement,
and Ray Montgomery, CEO of White County Medical Center
(WCMC) in Searcy, accepted the Bronze-level award for
WCMC’s efforts. Baptist Health in Little Rock, with Russell
D. Harrington as president, continues its role as Work-Life
Ambassador for the program, which is considered a lifetime
achievement award.
•
s t a t i s t i c s
Distribution of Arkansas Hospitals
By Hospital Type and Control, 2007
Hospital Type
Bed Size
Community
Hospitals
Psychiatric
Hospitals
Rehabilitation
Hospitals
Licensed
Licensed
Number
Beds Number Beds Number
Specialty
Hospitals**
Licensed
Beds Number
All
Hospitals
Licensed
Beds
Number
Licensed
Beds
0-49
32*
922
0
0
1
40
14
391
47
1,353
50-99
11
815
6
433
5
312
2
136
24
1,696
100-199
17
2,746
1
102
1
120
0
0
19
2,968
200-299
6
1,529
0
0
0
0
1
280
7
1,809
300-399
2
718
1
345
0
0
0
0
3
1,063
400 +
7
2,753
0
0
0
0
1
576
8
3,329
* Includes 28 Critical Access Hospitals
** Includes Pediatric, Cardiac, Women’s, Long Term Care, Surgical and VA Facilities
Hospital Control
Not-for-Profit
42
6,722
1
60
2
160
5
394
50
7,336
Investor-owned
16
1,914
6
475
4
240
11
352
37
2,981
Governmental
17
847
1
345
1
72
2
637
21
1,901
Total
75
9,483
8
880
7
472
18
1,383
108
12,218
Source: Arkansas Hospital Association
Summer 2008 I Arkansas Hospitals
9
s t a t i s t i c s
Arkansas Hospitals
A N um b e r o f i m p o r t a n t f acts
108 Hospitals of all types are located in cities, towns and communities
across Arkansas. They include 47 general acute care community
hospitals, 28 Critical Access Hospitals, 10 long term care hospitals, eight psychiatric hospitals, seven rehabilitation hospitals,
three specialty surgical hospitals, two Veterans Affairs hospitals,
as well as a pediatric hospital, a cardiac hospital and a women’s
hospital.
101 Member organizations belong to the Arkansas Hospital
Association. They include 95 Arkansas hospitals, two out-of-state,
border city hospitals (Memphis and Texarkana), two outpatient
cancer treatment facilities, one inpatient hospice and a United
States Air Force medical clinic.
46 Arkansas counties are served by a single hospital.
43 Arkansas community hospitals have fewer than 100 beds. Twentyeight of them are designated by the federal government as Critical
Access Hospitals, having no more than 25 acute care beds.
21 Arkansas counties – almost 30 percent of all counties in the state
– do not have ready access to a local hospital. Those counties are:
Calhoun
Clay
Cleveland
Grant
Lafayette
Lee
Lincoln
4
Arkansas community hospitals have closed their doors since
January 2004.
47% Of AHA member hospitals are charitable, not-for-profit organizations, while 32 percent of the hospitals are owned
and operated by private, for-profit companies, and 21 percent are public hospitals owned and operated by a city,
county, state or federal government.
14,955
Arkansans sought inpatient or outpatient care from Arkansas’ hospitals each day in 2006 for illnesses, injuries
and other conditions requiring medical attention. (2006 is the latest year for which statistics are available.)
39,232
Babies were delivered in Arkansas hospitals in 2006. About 60 percent were covered by the state Medicaid program.
43,000
Arkansans are employed by hospitals across the state, which have a combined annual payroll of $1.7 billion
that helps to support about 7.7 percent of all non-farm jobs in the state through direct and indirect purchases of
goods and services.
Lonoke
Madison
Marion
Miller
Monroe
Montgomery
Nevada
Newton
Perry
Poinsett Prairie
Searcy
Sharp
Woodruff
$126 Million The cost of charity care provided in 2006 through Arkansas hospitals for patients without health insurance coverage.
$9.3 Billion The estimated overall economic impact that Arkansas hospitals provided for the state in 2006, based on direct
spending on goods and services and their impact on other businesses throughout the economy, jobs and employees’ spending.
10
Summer 2008 I Arkansas Hospitals
s t a t i s t i c s
Arkansas Hospitals by Congressional District
1st Congressional District
Arkansas Methodist Medical Center
Baptist Health Medical Ctr-Heber Springs
Baxter Regional Medical Center
Community Medical Ctr of Izard Co.
Crittenden Regional Hospital
CrossRidge Community Hospital
DeWitt Hospital
Five Rivers Medical Center
Forrest City Medical Center
Fulton County Hospital
Great River Medical Center
Harris Hospital
Helena Regional Medical Center
Lawrence Memorial Hospital
NEA Baptist Memorial Hospital
Piggott Community Hospital
SMC Regional Medical Center
St. Bernards Medical Center
Stone County Medical Center
Stuttgart Regional Medical Center
Surgical Hospital of Jonesboro
White River Health System
Total = 22
2nd Congressional District
Allegiance Specialty Hospital of LR
Arkansas Children’s Hospital
Arkansas Heart Hospital
Arkansas Hospice
Arkansas State Hospital
Arkansas Surgical Hospital
Baptist Health, Little Rock
Baptist Health, North Little Rock
Baptist Health Extended Care Hospital
Baptist Health Rehabilitation Institute
The BridgeWay
CARTI
Central Ark. Veterans Healthcare System
Chambers Memorial Hospital
Conway Regional Medical Center
Methodist Behavioral Hospital
Ozark Health Medical Center
Pinnacle Pointe Behavioral Health System
North Metro Medical Center
Rivendell Behavioral Health Services
River Valley Medical Center
Saline Memorial Hospital
Southwest Regional Medical Center
St. Anthony’s Medical Center
St. Vincent Infirmary Medical Center
St. Vincent Medical Center/North
St. Vincent Rehabilitation Hospital
UAMS Medical Center
White County Medical Center
314th Medical Group, LRAFB
Total = 30
3rd Congressional District
Advance Care Hospital Ft. Smith
Eureka Springs Hospital
HEALTHSOUTH Rehabilitation Hospital
Johnson Regional Medical Center
Mercy/Turner Memorial Hospital
Mercy Health Center
NARTI
North Arkansas Regional Medical Center
Northwest Medical Center Bentonville
Northwest Medical Center Springdale
Saint Mary’s Regional Medical Center
Siloam Springs Memorial Hospital
Sparks Health System
St. Edward Mercy Medical Center
St. John’s Hospital - Berryville
Summit Medical Center
VA Medical Center
Vista Health Fayetteville
Vista Health Ft. Smith
Washington Regional Medical System
Willow Creek Women’s Hospital
Total = 21
4th Congressional District
Advance Care Hospital
Ashley County Medical Center
Baptist Health Medical Center, Arkadelphia
Booneville Community Hospital
Bradley County Medical Center
Chicot Memorial Hospital
Dallas County Medical Center
Delta Memorial Hospital
Drew Memorial Hospital
HealthPark Hospital
Howard Memorial Hospital
HSC Medical Center
Jefferson Regional Medical Center
Levi Hospital
Little River Memorial Hospital
Magnolia Hospital
McGehee/Desha County Hospital
Medical Center of South Arkansas
Medical Park Hospital
Mena Regional Health System
Mercy Hospital of Scott County
National Park Medical Center
North Logan Mercy Hospital
Ouachita County Medical Center
Pike County Hospital
St. Joseph’s Mercy Health Center
Total = 26
Summer 2008 I Arkansas Hospitals
11
s t a t i s t i c s
A Snapshot of Arkansas Hospitals
Total AHA Member Organizations
101
AHA Member Hospitals (Arkansas)
95
AHA Member Border Hospitals (TX, TN) 2
AHA Member Non-Hospitals (Arkansas) 4
Arkansas Hospitals by Classification
(AHA members only)............................................... 95
Urban General Hospitals 25
Rural General Hospitals
22
Critical Access Hospitals
26
Specialty Hospitals
6
Psychiatric Hospitals
7
Long Term Care Hospitals
4
Rehabilitation Hospitals
3
VA Hospitals
2
AHA Members
by Congressional District
Arkansas Hospitals (Non-AHA Members)................. 13
Critical Access Hospitals
2
(excluding non-hospitals and border hospitals)
1st
22
2nd
30
3rd
21
Total Hospitals Licensed in Arkansas 108 4th
26
Rehabilitation Hospitals
4
Psychiatric
1
LTAC Hospitals
6
Utilization and Financial Indicators,
Community Hospitals, 2006
Admissions
Inpatient Days
1,943,363
Outpatient Visits
5,085,474
Births
39,232
Total Employees
43,074
Payroll
Billed Charges
$12,002,276,866
$4,429,611,124
Operating Costs
$4,437,596,804
Patient Service Margin
Other Operating Revenues
Operating Margin
Source: American Hospital Association Annual Survey 2006
Summer 2008 I Arkansas Hospitals
$1,690,198,514
Total Amount Collected
Cost of Charity Care Provided
12
373,067
$122,348,969
-0.18%
$154,744,439
3.2%
Patient care.
It’s all about connections.
I
t’s about more than one facility, or one clinic. It’s about connections…
between providers, patients and the entire health care community.
Connections improve efficiency, effectiveness, and most important, safety.
Connections help you give your patients the best possible care —
across all settings.
We don’t provide health care. We help make it better.
As a national leader in health care quality improvement,
AFMC is helping to ensure every patient gets
the right care at the right time, every time.
This material was prepared by the Arkansas Foundation for Medical Care Inc. (AFMC), the Medicare Quality Improvement Organization for Arkansas, under contracts with the Centers for Medicare & Medicaid
Services (CMS), an agency of the U.S. Department of Health and Human Services, and the Arkansas Department of Human Services, Division of Medical Services. The contents presented do not necessarily reflect
CMS and Arkansas DHS policies. The Arkansas Department of Human Services is in compliance with Titles VI and VII of the Civil Rights Act.
s t a t i s t i c s
Arkansas Hospital Charges By Payer Category — 2006
PATIENTS
Payer Categories
1 - Medicare
2 - HMO/Comm. Ins.
3 - Medicaid
4 - Self Pay
5 - Other/Unknown
6 - Other Gov. Programs
ALL CATEGORIES
# Discharges
190,562
107,846
87,569
27,963
11,403
4,760
430,103
% Discharges
44.31%
25.07%
20.36%
6.50%
2.65%
1.11%
100.00%
charges
Total charges
$4,143,785,662 $1,956,912,493
$1,071,959,565 $439,080,668 $182,389,576 $69,210,936 $7,863,338,902
Source: Arkansas Department of Health, Hospital Discharge Data, 2006
14
Summer 2008 I Arkansas Hospitals
Mean Charges
% Charges
$21,745.08 $18,145.43 $12,241.31 $15,702.20 $15,994.88 $14,540.11 $18,282
52.70%
24.89%
13.63%
5.58%
2.40%
0.80%
100.00%
Stay
Daily Rate
Mean Stay
Average charge
per Day
6.03
3.98
4.57
5.23
4.32
4.55
5.06
$3,607 $4,558 $2,678 $3,001
$3,699 $3,193 $3,603
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ROI_Arkansas Hospitals_7.875x10_v1.indd 1
6/12/2008 11:48:57 AM
s t a t i s t i c s
Rank
Comparative Utilization Indicators Per 1,000 Population
U.S. Community Hospitals, 2006
Hospital Beds
Admissions
Inpatient Days
1 District of Columbia
6.2 District of Columbia
239.7 District of Columbia
2 North Dakota
5.6 West Virginia
155.0 South Dakota
3 South Dakota
5.5 Pennsylvania
150.0 North Dakota
4 Mississippi
4.5 Alabama
148.7 Montana
5 Montana
4.3 Kentucky
145.7 New York
6 Nebraska
4.2 Louisiana
145.3 Nebraska
7 Wyoming
4.0 Mississippi
142.8 Mississippi
8 West Virginia
4.0 Missouri
142.2 West Virginia
9 Louisiana
3.7 Tennessee
141.3 Louisiana
10 Kansas
3.7 North Dakota
139.5 Wyoming
11 Iowa
3.5 Ohio
134.4 Pennsylvania
12 Kentucky
3.5 New York
133.2 Tennessee
13 Alabama
3.4 Arkansas
132.7 Delaware
14 Tennessee
3.4 Florida
131.2 Alabama
15 Arkansas
3.3 Massachusetts
129.7 Kentucky
16 New York
3.3 New Jersey
127.3 Minnesota
17 Missouri
3.2 Oklahoma
126.9 Iowa
18 Pennsylvania
3.2 South Dakota
124.0 Missouri
19 Minnesota
3.1 Illinois
123.4 Kansas
20 Oklahoma
3.0 Delaware
123.3 South Carolina
21 Indiana
2.9 Maryland
122.9 North Carolina
22 Ohio
2.9 Minnesota
122.6 Arkansas
23 Florida
2.8 Iowa
121.8 Massachusetts
24 South Carolina
2.7 Nebraska
121.7 Florida
25 WSC Region
2.7 South Carolina
120.8 Ohio
26 U.S.
2.7 Kansas
120.3 New Jersey
27 Illinois
2.7 Michigan
119.4 Georgia
28 North Carolina
2.6 Rhode Island
119.1 Connecticut
29 Georgia
2.6 U.S.
118.2 U.S.
30 Maine
2.6 Connecticut
116.0 Hawaii
31 Michigan
2.6 Indiana
115.0 Oklahoma
32 Wisconsin
2.5 North Carolina
114.7 Maine
33 Massachusetts
2.5 WSC Region
114.3 Rhode Island
34 New Jersey
2.5 Maine
114.2 Illinois
35 Texas
2.5 Montana
113.0 Michigan
36 Delaware
2.5 Wisconsin
109.6 Indiana
37 Alaska
2.3 Arizona
107.8 WSC Region
38 Hawaii
2.3 Texas
107.6 Virginia
39 Connecticut
2.3 Georgia
102.1 Wisconsin
40 Virginia
2.3 Wyoming
102.1 Maryland
41 Idaho
2.3 Virginia
101.9 Texas
42 Rhode Island
2.2 Nevada
98.4 Vermont
43 New Hampshire
2.1 Idaho
96.8 Nevada
44 Vermont
2.1 California
94.1 California
45 Maryland
2.0 Oregon
92.3 Arizona
46 Colorado
2.0 New Hampshire
90.5 New Hampshire
47 Arizona
1.9 Colorado
88.5 Idaho
48 Nevada
1.9 Washington
87.0 Colorado
49 California
1.9 Hawaii
86.9 Alaska
50 New Mexico
1.8 Utah
86.6 Oregon
51 Oregon
1.8 New Mexico
82.2 New Mexico
52 Utah
1.8 Vermont
80.8 Washington
53 Washington
1.7 Alaska
78.1 Utah
West South Central (WSC) Region: Arkansas, Louisiana, New Mexico, Oklahoma, Texas
Source: American Hospital Association, Hospital Statistics, 2008
16
Summer 2008 I Arkansas Hospitals
Outpatient Visits
1,683.6
1,307.8
1,198.9
1,032.2
958.8
942.4
926.8
875.8
829.3
817.6
812.7
796.0
784.8
773.4
770.1
765.5
760.4
741.4
732.4
713.6
692.3
691.3
688.6
687.3
674.5
668.8
664.4
657.2
655.9
655.0
644.7
644.1
637.5
629.1
618.6
602.0
598.9
577.8
577.7
564.0
554.9
525.4
523.8
501.4
490.3
489.8
462.5
455.4
454.9
407.5
389.9
388.8
379.9
Vermont
Iowa
West Virginia
Maine
Montana
Massachusetts
New Hampshire
Pennsylvania
Ohio
New York
Missouri
Michigan
District of Columbia
North Dakota
Alaska
Indiana
Illinois
Louisiana
Nebraska
Rhode Island
South Dakota
Wisconsin
Oregon
Kansas
New Mexico
Connecticut
Delaware
Kentucky
U.S.
Minnesota
Utah
New Jersey
North Carolina
Wyoming
Idaho
Arkansas
Tennessee
Virginia
Alabama
Washington
Colorado
WSC Region
Oklahoma
California
Georgia
Hawaii
Mississippi
South Carolina
Texas
Florida
Maryland
Arizona
Nevada
4,007.6
3,452.4
3,417.0
3,181.1
3,070.8
3,036.2
2,943.7
2,870.4
2,847.8
2,798.6
2,796.2
2,785.8
2,764.5
2,687.6
2,650.6
2,616.5
2,304.0
2,299.8
2,290.2
2,285.2
2,267.0
2,251.6
2,231.3
2,223.7
2,222.1
2,219.4
2,157.0
2,095.9
2,002.5
1,956.5
1,953.6
1,947.4
1,943.4
1,871.5
1,844.2
1,809.1
1,798.6
1,787.6
1,744.6
1,623.5
1,528.4
1,499.9
1,490.6
1,479.5
1,471.9
1,465.7
1,449.1
1,410.3
1,358.6
1,258.1
1,247.8
1,063.2
956.7
Q ua l it y
AFMC Announces 2007-08 Quality Awards
The Arkansas Foundation for
Medical Care (AFMC) recently recognized 60 healthcare facilities with
Quality Awards for their commitment
to excellence in healthcare. The awards
were presented during AFMC’s 15th
Quality Conference, held May 22 at the
Hot Springs Convention Center.
According to Dr. Nick Paslidis,
AFMC’s chief executive office, the
award recipients have done more than
just talk about improving healthcare —
they’ve taken real and effective action.
“These award winners are helping to
bring our state into an era of increased
communication and accountability in
healthcare,” Paslidis said. “The steps
they are taking now are already resulting in better care for their patients, and
are also preparing our state’s healthcare
system to meet the demands of the
future.”
• Ashley County Medical Center
(Crossett) – Most Improved Award
• Baptist Health Medical Center
– Arkadelphia (Arkadelphia) –
Innovator Award
• Community Medical Center of Izard
County (Calico Rock) – Innovator
Award
• Crittenden Regional Hospital (West
Memphis) – Innovator Award
• CrossRidge Community Hospital
(Wynne) – Best Achievement Award,
Hospital Quality Awards
Hospitals were eligible for four types
of Quality Awards: “Best Achievement,”
“Most Improved,” “Validation”
and “Innovator.” Results for “Best
Achievement,” “Most Improved,” and
“Validation” were determined based
on quality of care data submitted to
the Centers for Medicare & Medicaid
Services.
Innovator Awards were presented
to hospitals that shared innovative and
successful strategies with their peers and
acted as mentors to other facilities.
Hospital winners were:
Most Improved Award, Validation
Award
Forrest City Medical Center (Forrest
City) – Best Achievement Award,
Most Improved Award
Helena Regional Medical Center
(Helena) – Innovator Award
Medical Park Hospital (Hope) –
Most Improved Award
Mercy Medical Center of Northwest
Arkansas (Bentonville) – Validation
Award
Ozark Health Medical Center
(Clinton) – Validation Award
Saline Memorial Hospital (Benton) –
Innovator Award
Sparks Health System (Fort Smith) –
Innovator Award
St. Anthony’s Medical Center
(Morrilton) – Best Achievement
Award, Innovator Award
St. Edward Mercy Medical Center
(Fort Smith) – Validation Award
White County Medical Center
(Searcy) – Innovator Award
White River Medical Center
(Batesville) – Innovator Award
• Arkansas Methodist Medical Center
(Paragould) – Validation Award,
Innovator Award
Cross Ridge Community Hospital – Wynne
L to R: Alice South, Data Abstractor; Pat Hamilton,
Quality Director; Bryan Mattes, Associate
Administrator; Penny Chappell, Medical Records
Director; and Amelia Davis, Chief of Nursing
•
•
•
•
•
•
•
•
•
•
St. Edward Mercy Medical Center – Ft. Smith
L to R: Nancy Stufflebeam, RN, Quality
Improvement Analyst; Tammy Hanks, RN,
Quality Improvement Analyst; Samantha Cole,
RN, Quality Improvement Analyst; Melissa
Hanna, RN, Quality Improvement Manager;
Shirrell Henry, Director, Quality Improvement/
Patient Safety
•
Home Health Quality Awards
Home health agencies were eligible
for three types of Quality Awards:
“Best Achievement,” “Most Improved,”
“Telehealth,” and “Innovator.” In
the “Best Achievement” and “Most
Improved” categories, awards were presented for small, medium and large agencies. Results for “Best Achievement”
and “Most Improved” were determined
based on quality of care data. Innovator
Awards were presented to home health
agencies that demonstrated a system
change that resulted in improved processes and outcomes. The agency must
have served as a mentor to other agencies in implementing similar changes.
Hospitals receiving home health
winners were:
• ACMC Family Home Health
(Crossett) – Best Achievement
Award
• Arkansas Methodist Medical Center
Home Health Agency (Paragould) –
Innovator Award
• Baptist Health Home Health
Network (Little Rock) – Innovator
Award
• Bradley County Medical Center
HHA (Warren) – Most Improved
Award, Innovator Award
• Conway Regional HomeCare
Arkansas Methodist Medical Center –
Paragould
L to R: Barry Hendrix, MD; Debbie Brehmer,
LPN, Director of Education; Cindy Weaver, Data
Analyst; Lana Williams, Director of Quality and
Risk Management
•
•
•
•
Services (Conway) – Innovator
Award
Crittenden Regional Hospital Home
Health (West Memphis) – Innovator
Award
Ouachita County Medical Center’s
Doctors Home Care (Camden) –
Telehealth Award
Medical Center of South Arkansas
Home Health Care (El Dorado) –
Most Improved Award
White County Medical Center
Home Health South (Searcy) – Best
Achievement Award, Innovator
Award
Summer 2008 I Arkansas Hospitals
17
s t a t i s t i c s
2001
9,535 371,080 2,034,589 5.48 3,340,779 4,493,774 74.3%
3,180,501 58.4%
109,244 151,651 260,895 58.13%
40,840 4.69
$4,758,131,946 $2,687,321,039 $7,445,452,985 $438,812,612 $140,217,960 $4,144,999,443 $3,565,968,871 $3,300,453,542 $103,461,117 $42,618,122 $3,446,532,781 $1,396,283,127 $3,249,943,830 1.53%
5.70%
$2,340.97 $1,037.71 $1,021.83 $439.01 43.0%
7.8%
55.7%
36.1%
38.9
755.8
137.8
2,692 2002
9,942 383,509 2,110,323 5.50 3,614,451 4,838,504 74.7%
3,318,416 58.1%
119,478 159,314 278,792 57.14%
42,487 4.67
$5,484,336,913 $3,139,609,992 $8,623,946,905 $481,582,688 $193,429,493 $4,920,059,934 $4,245,047,753 $3,703,886,971 $134,834,877 $34,677,549 $3,873,399,397 $1,477,610,752 $3,612,279,530 2.47%
6.74%
$2,598.81 $1,116.16 $1,088.56 $445.28 40.9%
7.8%
57.1%
36.4%
38.6
778.7
141.5
2,710 2003
9,909 388,046 2,088,391 5.38 3,330,691 4,852,352 68.6%
3,315,086 58.1%
117,181 151,653 268,834 56.41%
43,492 4.79
$6,115,623,287 $3,592,960,043 $9,708,583,330 $531,161,829 $206,995,046 $5,790,602,643 $5,052,445,768 $3,917,980,687 $127,642,206 $49,276,715 $4,094,899,608 $1,510,600,000 $3,947,107,676 -0.74%
3.61%
$2,928.61 $1,181.86 $1,190.65 $455.67 38.3%
7.6%
59.6%
37.0%
39.2
766.1
142.3
2,726 2004
9,580 382,836 2,050,766 5.36 3,621,645 4,842,303 74.8%
3,266,473 58.6%
115,512 146,074 261,586 55.84%
42,629 4.76
$6,513,778,911 $3,861,410,128 $10,375,189,039 $565,220,366 $239,575,478 $6,360,783,014 $5,555,987,170 $4,014,406,025 $134,780,857 $57,186,707 $4,206,373,589 $1,528,324,259 $4,015,475,758 -0.03%
4.54%
$3,176.27 $1,228.97 $1,229.30 $467.88 38.1%
7.8%
61.3%
37.2%
40.0
744.9
139.1
2,753 2005
9,389 380,067 2,002,721 5.27 3,707,485 4,971,307 74.6%
3,269,871 58.4%
126,374 141,104 267,478 52.75%
42,802 4.78
$6,962,421,549 $4,238,194,924 $11,200,616,473 $566,152,497 $293,504,071 $6,945,017,078 $6,085,360,510 $4,255,599,395 $153,253,789 $51,496,442 $4,460,349,626 $1,608,181,270 $4,225,289,800 0.71%
5.27%
$3,425.40 $1,301.46 $1,292.19 $491.82 38.1%
7.7%
62.0%
37.8%
40.5
720.7
136.8
2,779 Percent Change
2006 2001-2006
9,309 -2.37%
373,067 0.54%
1,943,363 -4.48%
5.21 -4.99%
3,818,276 14.29%
5,085,474 13.17%
75.1%
0.99%
3,174,935 -0.18%
57.2%
-2.06%
108,651 -0.54%
144,619 -4.64%
253,270 -2.92%
57.10%
-1.77%
43,074 5.47%
4.95
5.66%
$7,346,539,305 54.40%
$4,655,737,561 73.25%
$12,002,276,866 61.20%
$583,842,333 33.05%
$340,914,742 143.13%
$7,572,665,742 82.69%
$6,647,908,667 86.43%
$4,429,611,124 34.21%
$154,744,439 49.57%
$74,174,385 74.04%
$4,658,529,948 35.17%
$1,688,987,123 20.96%
$4,437,596,804 36.54%
-0.18% -111.78%
4.74%
-16.86%
$3,780.32 61.49%
$1,395.18 34.45%
$1,397.70 36.78%
$531.98 21.18%
38.1%
-11.41%
7.7%
-0.93%
63.1%
13.33%
38.8%
7.47%
40.1
2.98%
691.3
-8.53%
132.7
-3.72%
2,811 4.42%
Arkansas Hospitals: Community Hospital Financial and Utilization Indicators 2001-2006
Indicator
BEDS AVAILABLE
ADMISSIONS
PATIENT DAYS
AVG. LENGTH OF STAY
NON-EMERGENCY OP VISITS
OUTPATIENT VISITS
NON-EMERGENCY AS A % OF TOTAL OP VISITS
ADJUSTED PATIENT DAYS
OCCUPANCY RATE
INPATIENT SURGERIES
OUTPATIENT SURGERIES
TOTAL SURGERIES
OUTPATIENT AS % OF TOTAL SURGERIES
TOTAL FTE EMPLOYEES
FTEs PER ADJUSTED OCCUPIED BED
GROSS REVENUE, INPATIENT
GROSS REVENUE, OUTPATIENT
GROSS PATIENT REVENUE
BAD DEBTS
CHARITY
TOTAL DEDUCTIONS
MEDICARE, MEDICAID & OTHER PAYER WRITE OFFS
NET PATIENT REVENUE
OTHER OPERATING REVENUE
NONOPERATING REVENUE
TOTAL NET REVENUE
PAYROLL EXPENSE
TOTAL EXPENSE
PATIENT REVENUE MARGIN
TOTAL MARGIN
CHARGE PER ADJUSTED INPATIENT DAY
RECEIPTS PER ADJUSTED INPATIENT DAY
EXPENSE PER ADJUSTED INPATIENT DAY
PAYROLL PER ADJUSTED INPATIENT DAY
PAYROLL AS % OF TOTAL EXPENSE
BAD DEBT AND CHARITY AS % OF TOTAL CHARGE
TOTAL DEDUCTIONS AS % OF TOTAL CHARGE
OUTPT. REVENUE AS % TOTAL PATIENT REVENUE
ADMISSIONS PER BED
PATIENT DAYS PER 1,000 POPULATION
ADMISSIONS PER 1,000 POPULATION
POPULATION (000’s)
Source: American Hospital Association, Hospital Statistics, 2008
Summer 2008 I Arkansas Hospitals
18
Summer 2008 I Arkansas Hospitals
19
Texas
United States
13,060,049,470 8,822,388,239 20,127,195,935 9,331,819,127 21,525,822,289 76,907,991,231 4.99%
5.72%
2.12%
7.39%
9.63%
4.76%
$74,174,385 $168,610,943 $62,006,706 $414,857,246 $86,916,871 $201,731,194 $220,933,144 $417,752,151 $107,318,600 $974,352,591 $538,267,214 $543,863,791 3.31%
3.41%
0.90%
4.24%
8.08%
2.99%
($2.44)
($46.24)
($42.70)
($42.92)
$55.28 ($9.35)
-0.18%
-3.37%
-3.69%
-2.45%
3.65%
-0.64%
$154,744,439 $495,512,730 $231,893,393 $882,120,238 $247,484,700 $415,142,709 $146,758,759 $249,141,208 $45,311,894 $559,495,345 $451,350,343 $342,132,597 8.06%
$2,805,244,946 $565,608,947 6.43%
$2,239,635,999 $3,850,147,633 -4.63%
($79.49)
4,429,611,124 7,303,127,415 5,050,590,696 13,181,289,566 5,588,764,429 11,424,407,740 34,820,627,585 4,437,596,804 7,552,791,081 5,237,172,195 13,503,914,459 5,384,898,786 11,497,417,852 36,431,139,219 ($7,985,680)
($246,371,522) ($186,581,499) ($322,624,893)
$203,865,643 ($73,010,112)
($1,610,511,634)
7,572,665,742 5.72%
$28,938,560,546
$8,992,031,048
3.94%
$19,946,529,498
$29,888,418,352
-1.97%
($31.78)
($9,941,888,854)
515,740,325,861
505,798,437,007
873,105,390,216
$12,002,276,866 $20,363,176,885 $13,872,978,935 $33,308,485,501 $14,920,583,556 $32,950,230,029 $111,728,618,816 $1,378,903,827,223
Arkansas
Louisiana
Mississippi
Missouri
Oklahoma
Tennessee
Source: American Hospital Association, Hospital Statistics 2008
For a total revenue margin of:
That resulted in total funds available to
reinvest in new equipment, update facilities, expand programs and repay debt
equaling:
Hospitals also collected other types of
revenue from sources including contributions, tax appropriations, investments
and the rental of office space. Those
amounted to:
As a result, the “operating margin”
rose to:
Which raised total operating income to:
Fortunately, hospitals also received
revenues from other operating sources,
such as cafeteria and gift shop sales,
adding this much to their revenues:
Yielding a “patient service” margin of:
In other words, hospitals made or lost
this much on each of the equivalent days
of care they provided to inpatients and
outpatients:
The remaining surplus (deficit) equaled:
At the same time, hospitals spent this
amount providing patient care services:
Therefore, actual payments were:
But, patients and payer groups didn’t
pay the full amount of billed charges for
various reasons. Government programs
like Medicare and Medicaid, workers’
comp programs and others never pay
the full hospital bill. Managed care
plans and other insurers typically pay
discounted amounts only, and individual
patients often can’t afford to pay some
or any of the out-of-pocket costs related
to their hospital bills. For those reasons,
hospitals had to forfeit this much of their
billed charges:
Hospitals charged this amount for
the inpatient and outpatient care they
provided:
s t a t i s t i c s
Community Hospital Summary Financial Data
Arkansas and Surrounding States, 2006
s t a t i s t i c s
AHA Member Hospitals:
Psych.
Rehab.
Home
Medicare
Licensed Swing
Recup.
A&D Unit
Unit
Unit
Health
City
Hospital
Classification
Beds Bed Unit Care Unit # Beds
# Beds
# Beds
Agency
Arkadelphia
Baptist Health Medical Center-Arkadelphia Critical Access
25 x
x
Ashdown
Little River Memorial Hospital
Critical Access
25 x
x
Batesville
White River Medical Center
Rural, SCH/RRC
200
14
12
15
x
Benton
Rivendell Behavioral Health Services
Psychiatric
77
77
Benton
Saline Memorial Hospital
Urban
167
17
19
x
Bentonville
Northwest Medical Center, Bentonville Urban
128
x
Berryville
St. John’s Hospital - Berryville
Critical Access
25 x
x
Blytheville
Great River Medical Center
Rural
168
20
Booneville
Booneville Community Hospital
Critical Access
25
x
Calico Rock
Community Medical Center of Izard County Critical Access
25 x
x
Camden
Ouachita County Medical Center
Rural
98 x
12
10
x
Clarksville
Johnson Regional Medical Center
Rural
80 x
10
12
x
Clinton
Ozark Health Medical Center
Critical Access
25 x
x
Conway
Conway Regional Medical Center
Urban
146
11 (gero)
x
Crossett
Ashley County Medical Center
Critical Access
25 x
8
x
Danville
Chambers Memorial Hospital
Rural
41 x
x
Dardanelle
River Valley Medical Center
Critical Access
25 x
DeWitt
DeWitt Hospital
Critical Access
25 x
x
Dumas
Delta Memorial Hospital
Critical Access
25
x
El Dorado
Medical Center of South Arkansas
Rural
166
11
20
x
Eureka Springs Eureka Springs Hospital
Critical Access
22 x
x
Fayetteville
HEALTHSOUTH Rehabilitation Hospital Rehabilitation
60
60
Fayetteville
Washington Regional Medical Center
Urban
366
19
x
Fayetteville
VA Medical Center
Veterans Admin.
51
Fayetteville
Vista Health Fayetteville
Psychiatric
61
Fordyce
Dallas County Medical Center
Critical Access
25 x
x
Forrest City
Forrest City Medical Center
Rural
118 x
18
x
Fort Smith
Advance Care Hospital Ft. Smith
Long Term Care
25
Fort Smith
Sparks Regional Medical Center
Urban
476
19
36
x
Fort Smith
St. Edward Mercy Medical Center
Urban
352
21
22
x
Fort Smith
Vista Health Fort Smith
Psychiatric
57
Harrison
North Arkansas Regional Medical Center Rural, SCH
174
14
x
Heber Springs Baptist Health Medical Center-Heber Springs Critical Access
25 x
x
Helena
Helena Regional Medical Center
Rural
155 x
18
x
Hope
Medical Park Hospital
Urban
79 x
12
Hot Springs
Advance Care Hospital
Long Term Care
27
Hot Springs
Health Park Hospital
Urban (Surgical)
20
Hot Springs
Levi Hospital
Urban
89
27
40
x
Hot Springs
National Park Medical Center
Urban
166
10
20
x
Hot Springs
St. Joseph’s Mercy Health Center
Urban
289
14
16
x
Jacksonville
North Metro Medical Center
Urban
113
18
21
x
Jacksonville
314th Medical Group, LRAFB
Dept. of Defense
0
Johnson
Willow Creek Women’s Hospital
Urban (Women’s)
30
Jonesboro
NEA Baptist Memorial Hospital
Urban
104
x
Jonesboro
St. Bernards Medical Center
Urban
438
27
60
x
Jonesboro
Surgical Hospital of Jonesboro
Urban (Surgical)
12
Lake Village
Chicot Memorial Hospital
Critical Access
25 x
x
Little Rock
Allegiance Specialty Hospital of Little RockLong Term Care
40
Little Rock
Arkansas Children’s Hospital
Urban (Pediatric)
280
14
Little Rock
Arkansas Heart Hospital
Urban
112
Little Rock
Arkansas State Hospital
Psychiatric
345
Little Rock
Arkansas Hospice
Inpatient Hospice
40
20
Summer 2008 I Arkansas Hospitals
Control
PNP
County
PNP
Corporate
PNP
Corporate
PNP
Corporate
City
PNP
PNP
PNP
PNP
PNP
PNP
PNP
Corporate
PNP
PNP
Corporate
City
Partnership
PNP
Federal
Corporate
County
Corporate
PNP
PNP
PNP
Corporate
PNP
PNP
Corporate
Corporate
PNP
Corporate
PNP
Corporate
PNP
PNP
DOD
Corporate
Corporate
PNP
Corporate
County
Corporate
PNP
Corporate
State
PNP
s t a t i s t i c s
Location, Classification, Facilities and Services
Psych.
Rehab.
Home
Medicare
Licensed Swing
Recup.
A&D Unit
Unit
Unit
Health
City
Hospital
Classification
Beds Bed Unit Care Unit # Beds
# Beds
# Beds
Agency
Little Rock
Baptist Health Extended Care Hospital Long Term Care
37
Little Rock
Baptist Health Medical Center-Little Rock Urban
827
35
20
50
x
Little Rock
Baptist Health Rehabilitation Institute
Rehabilitation
120
120
Little Rock
CARTI
OP Cancer Center
0
Little Rock
Central Arkansas Veterans Healthcare SystemVeterans Affairs
549
80
25
Little Rock
Pinnacle Pointe Behavioral Health System Psychiatric
102
102
Little Rock
Select Specialty Hospital, St. Vincent
Long Term Care
40
Little Rock
Southwest Regional Medical Center
Urban
79
17
Little Rock
St. Vincent Doctors Hospital
Urban
282
22
23
x
Little Rock
St. Vincent Infirmary Medical Center
Urban
615
33
x
Little Rock
UAMS Medical Center
Urban
400
Magnolia
Magnolia Hospital
Rural
49 x
x
Malvern
HSC Medical Center
Rural
72
18
0
x
Maumelle
Methodist Behavioral Hospital
Psychiatric
60
60
McGehee
McGehee-Desha County Hospital
Critical Access
25 x
x
Memphis, TN
Regional Medical Center at Memphis
Urban
620
Mena
Mena Regional Health System
Rural
65 x
12
12
x
Monticello
Drew Memorial Hospital
Rural
49 x
x
Morrilton
St. Anthony’s Medical Center
Critical Access
25 x
10
x
Mountain Home Baxter Regional Medical Center
Rural, RRC/SCH
268
0
19
19
x
Mountain View Stone County Medical Center
Critical Access
25 x
Murfreesboro
Pike County Hospital
Rural
32 x
x
Nashville
Howard Memorial Hospital
Critical Access
25 x
x
Newport
Harris Hospital
Rural
133 x
x
North Little Rock Arkansas Surgical Hospital, LLC
Urban (Surgical)
24
North Little Rock Baptist Health Medical Center-North Little Rock Urban
220
30
x
North Little Rock The BridgeWay
Psychiatric
98
14
84
Osceola
SMC Regional Medical Center
Critical Access
25 x
10
Ozark
Mercy Hospital/Turner Memorial
Critical Access
25 x
Paragould
Arkansas Methodist Medical Center
Rural
129 x
15
x
Paris
North Logan Mercy Hospital
Critical Access
16 x
Piggott
Piggott Community Hospital
Critical Access
25 x
x
Pine Bluff
Jefferson Regional Medical Center
Urban
471
25
20
27
x
Pocahontas
Five Rivers Medical Center
Rural
50
14
x
Rogers
Mercy Health Center
Urban
165
20
x
Russellville
Saint Mary’s Regional Medical Center
Rural, RRC
170
15
20
x
Salem
Fulton County Hospital
Critical Access
25 x
x
Searcy
White County Medical Center
Rural, RRC
438
27
36
31
x
Sherwood
St. Vincent Medical Center/North
Urban
69
x
Sherwood
St. Vincent Rehabilitation Hospital
Rehabilitation
60
60
Siloam Springs Siloam Springs Memorial Hospital
Urban
73 x
Springdale
NARTI
OP Cancer Center
0
Springdale
Northwest Medical Center, Springdale Urban
222
31
x
Stuttgart
Stuttgart Regional Medical Center
Rural
49 x
Texarkana, TX CHRISTUS St. Michael Health System
Urban
312
Van Buren
Summit Medical Center
Urban
103
Waldron
Mercy Hospital of Scott County
Critical Access
24 x
Walnut Ridge
Lawrence Memorial Hospital
Critical Access
25 x
Warren
Bradley County Medical Center
Critical Access
35 x
10
x
West Memphis Crittenden Regional Hospital
Urban
152
20
x
Wynne
CrossRidge Community Hospital
Critical Access
25 x
x
Control
PNP
PNP
PNP
PNP
Federal
Corporate
Corporate
Corporate
PNP
PNP
State
City
PNP
PNP
County
PNP
City
County
PNP
PNP
PNP
County
PNP
Corporate
Corporate
PNP
Corporate
Corporate
County
PNP
City
City
PNP
City
PNP
Corporate
County
PNP
PNP
Corporate
City
NFP
Corporate
PNP
PNP
Corporate
PNP
County
PNP
PNP
PNP
PNP=Private Non-Profit
DOD=Department of Defense
Summer 2008 I Arkansas Hospitals
21
s t a t i s t i c s
Comparative Financial Indicators
U.S. Community Hospitals
Rank Average Charge Per Hospital Stay
Average Operating Cost Per Hospital Stay Average Payment Per Hospital Stay
Margin of Patient Care Services
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
Alaska
$15,175
District of Columbia 14,875
New York
12,197
California
11,424
Washington
10,886
Nebraska
10,719
Massachusetts
10,639
Colorado
10,606
Hawaii
10,576
Delaware
10,462
New Hampshire
10,452
Connecticut
10,412
New Jersey
10,338
Oregon
10,171
Minnesota
10,146
Rhode Island
9,920
Maine
9,864
U.S.
9,705
Wisconsin
9,657
Indiana
9,539
Missouri
9,509
South Dakota
9,493
Pennsylvania
9,407
Maryland
9,351
Texas
9,333
Ohio
9,270
Michigan
9,253
Utah
9,170
Arizona
9,153
South Carolina
9,152
Vermont
8,986
Illinois
8,970
Montana
8,907
Virginia
8,791
Wyoming
8,727
North Carolina
8,700
Georgia
8,687
WSC Region
8,672
New Mexico
8,664
Nevada
8,582
North Dakota
8,564
Florida
8,495
Iowa
8,216
Tennessee
8,152
Kansas
8,049
Idaho
7,752
Mississippi
7,695
Louisiana
7,639
Oklahoma
7,481
Kentucky
7,380
Arkansas
7,281
West Virginia
7,152
Alabama
6,977
Alaska
District of Columbia
California
Nebraska
New York
New Hampshire
Colorado
Washington
Delaware
Connecticut
Minnesota
Oregon
Wisconsin
Maine
Utah
Hawaii
South Dakota
New Jersey
Indiana
U.S.
Massachusetts
Pennsylvania
South Carolina
Virginia
Maryland
Missouri
Arizona
Ohio
Rhode Island
Vermont
Montana
Michigan
New Mexico
Texas
North Carolina
Nevada
Wyoming
Illinois
Georgia
Florida
WSC Region
Kansas
North Dakota
Idaho
Tennessee
Iowa
Oklahoma
Kentucky
Mississippi
Louisiana
Arkansas
West Virginia
Alabama
Massachusetts
-11.93%
New York
-10.05%
Rhode Island
-9.61%
Hawaii
-7.71%
New Jersey
-6.22%
Texas
-4.63%
North Dakota
-4.55%
Illinois
-4.08%
Alaska
-3.71%
Mississippi
-3.69%
Connecticut
-3.45%
Louisiana
-3.42%
District of Columbia -3.26%
Iowa
-3.22%
WSC Region
-3.19%
Delaware
-3.06%
California
-2.95%
Michigan
-2.57%
Washington
-2.54%
Missouri
-2.45%
U.S.
-2.05%
Oregon
-1.66%
Ohio
-1.50%
Georgia
-1.28%
Minnesota
-0.92%
Tennessee
-0.64%
Maryland
-0.44%
Arkansas
-0.18%
West Virginia
0.13%
Alabama
0.15%
Pennsylvania
0.18%
Indiana
0.38%
Wyoming
0.52%
Vermont
0.52%
Maine
0.55%
Florida
0.61%
Arizona
0.84%
Montana
1.37%
Kansas
1.82%
North Carolina
1.91%
Colorado
2.49%
South Carolina
2.58%
Nevada
2.63%
Wisconsin
2.78%
South Dakota
2.99%
New Mexico
3.23%
Nebraska
3.33%
Oklahoma
3.65%
Idaho
4.70%
Kentucky
4.81%
New Hampshire
4.89%
Virginia
6.00%
Utah
7.38%
New Jersey
California
District of Columbia
Nevada
Pennsylvania
Colorado
Alaska
Florida
Arizona
Texas
New York
U.S.
South Carolina
WSC Region
Washington
Hawaii
Virginia
Connecticut
Illinois
Nebraska
Alabama
Missouri
Tennessee
Rhode Island
Ohio
Georgia
Minnesota
New Mexico
New Hampshire
Michigan
Indiana
Massachusetts
Kansas
Oklahoma
Louisiana
Kentucky
Mississippi
North Carolina
Utah
Arkansas
Delaware
Wisconsin
Oregon
South Dakota
Maine
Iowa
Vermont
Montana
Wyoming
North Dakota
West Virginia
Idaho
Maryland
$40,780
40,182
36,874
33,864
32,882
31,179
30,925
29,852
28,658
28,624
27,614
26,555
26,373
25,628
25,028
24,940
24,702
24,330
24,307
23,939
23,804
23,455
23,362
23,348
23,197
23,174
23,042
22,987
22,715
21,942
21,848
21,717
21,416
20,729
20,594
20,442
20,383
20,026
19,916
19,692
19,590
19,464
19,430
18,626
17,744
16,639
15,851
15,629
15,283
15,038
14,897
14,523
11,324
$14,632
14,405
11,097
11,088
11,083
10,990
10,877
10,616
10,151
10,065
10,054
10,005
9,934
9,919
9,901
9,819
9,785
9,732
9,575
9,510
9,505
9,424
9,394
9,352
9,310
9,282
9,231
9,134
9,051
9,033
9,031
9,021
8,953
8,921
8,869
8,814
8,772
8,618
8,577
8,547
8,404
8,198
8,191
8,134
8,100
7,960
7,764
7,753
7,421
7,386
7,268
7,162
6,988
est South Central (WSC) Region: Arkansas, Louisiana, New Mexico, Oklahoma, Texas
W
Source: American Hospital Association, Hospital Statistics, 2008
22
Summer 2008 I Arkansas Hospitals
Ca
Protein
D
B2
A
B12
P
K
Niacin
HelpYour Lactose
Intolerant Patients
Enjoy Dairy
www.3aday.org
Most people with lactose intolerance can enjoy dairy foods. They can reduce symptoms by drinking small portions of milk as part of a meal,
and gradually increase their intake over time. A meta-analysis of clinical studies showed that those diagnosed with lactose maldigestion
could consume up to 1 cup of milk with a meal and stay symptom-free.1 The 2005 Dietary Guidelines recommends three servings of low-fat
or fat-free dairy foods every day as part of a healthy diet. It also recommends lactose-free milk or yogurt containing live, active cultures as
alternatives to milk for those with lactose intolerance.2 Hard cheese, which is naturally low in lactose, is another calcium-rich choice.
For children, the 2006 American Academy of Pediatrics report, Lactose Intolerance in Infants, Children, and Adolescents, recommends
consumption of dairy foods in order to get enough calcium, vitamin D, protein and other nutrients essential for bone health and
overall growth. The AAP report recommends several dairy options for children that are often well-tolerated, including lactose-free
or lactose-reduced milk, yogurt or hard cheese such as Cheddar or Swiss.3
Encourage your patients to meet recommendations for 3 servings of dairy foods every day.
For more information on lactose intolerance visit www.nationaldairycouncil.org
1
Savaiano, D. A., Boushey, C. J., and McCabe, G. P., Lactose Intolerance Symptoms Assessed by Meta-Analysis: A Grain of Truth That Leads to Exaggeration, J. Nutr., 2006 136, 1107
2 U.S. Department of Agriculture and U.S. Department of Health and Human Services.
Dietary Guidelines for Americans 2005. 6th Edition. Washington, D.C.: U.S. Government Printing Office, January 2005. www.healthierus.gov/dietaryguidelines.com
3 Melvin B. Heyman, MD, MPH for the Committee on Nutrition. Lactose Intolerance in Infants, Children, and Adolescents. Pediatrics Vol. 118 No. 3 September 2006, pp. 1279-1286.
http://pediatrics.aappublications.org/cgi/content/full/118/3/1279
Copyright © 2007 National Dairy Council.®
s t a t i s t i c s
Arkansas Hospitals:
Investor Owned, Operated and/or Managed Hospitals
Investor Owner/Manager
Hospital City
Allegiance Health Management
River Valley Medical Center
Allegiance Specialty Hospital of Little Rock Eureka Springs Hospital
Five Rivers Medical Center
Ameris Health System
Great River Medical Center Blytheville
SMC Regional Medical Center Osceola
Arkansas Surgical Hospital, LLC
Arkansas Surgical Hospital North Little Rock
CCS Inc.
Rivendell Behavioral Health Services Benton
Capella Healthcare
Saint Mary’s Regional Medical Center Russellville
National Park Medical Center Hot Springs
Community Health Systems Inc. (Owned)
Forrest City Medical Center
Harris Hospital
Helena Regional Medical Center
Medical Center of South Arkansas *
Northwest Medical Center Bentonville
Northwest Medical Center Springdale
Willow Creek Women’s Hospital
Forrest City
Newport
Helena
El Dorado
Bentonville
Springdale
Johnson
Community Health Systems Inc. (Mgd)
Sparks Health System
Rebsamen Medical Center Chicot Memorial Hospital Mena Regional Health System
Howard Memorial Hospital Fort Smith
Jacksonville
Lake Village
Mena
Nashville
Health Management Associates
Summit Medical Center Van Buren
Southwest Regional Medical Center Little Rock
HealthSouth Corp.
HealthSouth Rehab. Hospital of Fort Smith # Fort Smith
HealthSouth Corp.
HealthSouth Rehab. Hospital of Jonesboro # Jonesboro
HealthSouth Corp.\ Washington Regional Health System
HealthSouth Rehab. Hospital of Fayetteville *# Fayetteville
Dardanelle
Little Rock
Eureka Springs
Pocahontas
HealthSouth Corp.\
St. Vincent Rehabilitation Hospital * Sherwood
St. Vincent Health System
Hospital Management Consultants (Mgd)
Booneville Community Hospital Booneville
JCE Healthcare Group
DeQueen Medical Center # DeQueen
MedCath
Arkansas Heart Hospital Little Rock
Psychiatric Solutions, Inc.
Pinnacle Pointe Behavioral Health System Little Rock
PHNS (Mgd)
Delta Memorial Hospital Dumas
Ouachita Reg. Dx & Surgical Center, Inc.
HealthPark Hospital Hot Springs
Select Medical Corp.
Select Specialty Hospital-Baptist Health Little Rock
Select Specialty Hospital-Fort Smith Fort Smith
Select Specialty Hospital-St. Vincent Little Rock
Shiloh Health Services
Medical Park Hospital Hope
Texarkana Behavioral Associates
Vista Health Fayetteville Fayetteville
Vista Health Fort Smith Fort Smith
Universal Health Services, Inc.
The BridgeWay North Little Rock
* A partnership arrangement
# Non-Member of AHA
24
Summer 2008 I Arkansas Hospitals
s t a t i s t i c s
Arkansas Hospitals
Members/Affiliates of Not-For-Profit Multi-Hospital Systems
Not-For-Profit System
Hospital City
Baptist Health
Baptist Health Medical Center-Little Rock
Baptist Health Medical Center-Arkadelphia
Baptist Health Medical Center-Heber Springs
Baptist Health Medical Center-North Little Rock
Baptist Health Rehabilitation Institute
Baptist Memorial Healthcare Corp.
NEA Baptist Memorial Hospital Jonesboro
Catholic Health Initiatives
St. Anthony’s Medical Center
St. Vincent Doctors Hospital
St. Vincent Infirmary Medical Center
St. Vincent Rehabilitation Hospital *
St. Vincent Medical Center North
CHRISTUS Health System
CHRISTUS St. Michael Health System Texarkana, TX
Magnolia Hospital ** Magnolia
Conway Regional Health System
Conway Regional Medical Center Conway
Conway Regional Rehabilitation Hospital Conway
Dubuis Health System
Advance Care Hospital Hot Springs
Advance Care Hospital Fort Smith Fort Smith
Olivetan Benedictine Sisters
St. Bernards Medical Center Jonesboro
Lawrence Memorial Hospital Walnut Ridge
CrossRidge Community Hospital Wynne
Sisters of Mercy Health System
St. Edward Mercy Medical Center
St. Joseph’s Mercy Health Center
Mercy Health System of NW Arkansas
St. John’s Hospital - Berryville
North Logan Mercy Hospital
Mercy Hospital of Scott County
Mercy Hospital/Turner Memorial
White River Health System
White River Medical Center Batesville
Stone County Medical Center Mountain View
Little Rock
Arkadelphia
Heber Springs
North Little Rock
Little Rock
Morrilton
Little Rock
Little Rock
Sherwood
Sherwood
Fort Smith
Hot Springs
Rogers
Berryville
Paris
Waldron
Ozark
* A joint venture between St. Vincent Health System and HealthSouth
** Managed Hospital
Impact of Self-Pay (Uninsured) Patients
On Arkansas Hospitals, 1999-2006
Indicator
1999
2000
2001
2002
2003
2004
2005
2006
Percent
Increase
Number Self-Pay
Patients Admitted
17,815 20,545 26,843
28,899
30,063
29,364
27,638
27,963
56.96%
Self-Pay As Percent
of All Patients Admitted 4.90%
5.50%
6.80%
7.30%
7.01%
6.82%
6.44%
6.50%
32.65%
Total Uncovered
Charges ($ Millions)
$151
$168
$248
$307
$354
$398
$419
$439 190.73%
Total Uncovered
Costs ($ Millions)*
$74
$78
$108
$129
$144
$154
$158
$162 118.92%
Source: Arkansas Department of Health, Hospital Discharge Data Program* Estimate based on statewide cost-to-charge ratio
Summer 2008 I Arkansas Hospitals
25
s t a t i s t i c s
TOP 30 Hospital Admitting DRGs, 2006
Diagnosis-Related Group
Patients
Billings
Days
Daily Rate
Mean ChargesMean Stay Average Charge
# DischargesTotal ChargesPer Discharge Per DischargePer Day
1 - 391-NORMAL NEWBORN
28,528
$45,235,229.82 $1,585.64 1.9
$855.84
2 - 373-VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES
20,654
$120,123,743.52 $5,816.00 1.8
$3,273.50
3 - 430-PSYCHOSES
17,408
$213,892,999.80 $12,287.05 11.8
$1,037.23
4 - 462-REHABILITATION
13,389
$262,333,193.29 $19,593.19 11.8
$1,661.31
5 - 127-HEART FAILURE & SHOCK
11,962
$157,849,064.45 $13,195.88 4.7
$2,802.11
6 - 089-SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC
11,089
$161,332,441.74 $14,548.87 5.1
$2,840.29
7 - 371-CESAREAN SECTION W/O CC
10,237
$104,549,426.55 $10,212.90 2.7
$3,750.73
8 - 544-MAJOR JOINT REPLACEMENT OR REATTACHMENT OF
LOWER EXTREMITY
8,616
$288,721,349.46 $33,509.91 3.9
$8,646.68
9 - 088-CHRONIC OBSTRUCTIVE PULMONARY DISEASE
8,455
$101,652,111.08 $12,022.72 4.4
$2,737.54
10 - 182-ESOPHAGITIS, GASTROENT & MISC DIGEST
DISORDERS AGE >17 W CC
7,707
$95,579,544.65 $12,401.65 11 - 014-INTRACRANIAL HEMORRHAGE & STROKE W INFARCT
5,960
$98,364,363.91 $16,504.09 5.9
$2,786.53
12 - 390-NEONATE W OTHER SIGNIFICANT PROBLEMS
5,910
$18,050,649.11 $3,054.26 2.4
$1,277.38
13 - 143-CHEST PAIN
5,783
$46,101,999.72 $7,971.99 1.8
$4,354.24
14 - 359-UTERINE & ADNEXA PROC FOR NON-MALIGNANCY
W/O CC
5,178
$64,685,546.58 $12,492.38 2.1
$5,891.17
15 - 320-KIDNEY & URINARY TRACT INFECTIONS AGE >17 W
CC
4,646
$53,054,604.08 $11,419.42 4.7
$2,434.02
16 - 296-NUTRITIONAL & MISC METABOLIC DISORDERS AGE
>17 W CC
4,407
$50,210,939.31 $11,393.45 4.4
$2,573.22
17 - 558-PERCUTANEOUS CARDIOVASCULAR PROC W DRUGELUTING STENT W/O MAJ CV DX
4,359
$148,711,419.52 $34,115.95 1.7
$20,004.23
18 - 416-SEPTICEMIA AGE >17
4,243
$100,311,472.40 $23,641.64 6.9
$3,447.16
19 - 174-G.I. HEMORRHAGE W CC
4,210
$62,559,930.14 $14,859.84 4.4
$3,372.61
20 - 183-ESOPHAGITIS, GASTROENT & MISC DIGEST
DISORDERS AGE >17 W/O CC
3,794
$33,506,400.63 $8,831.42 2.7
$3,268.15
21 - 138-CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS
W CC
3,542
$39,362,939.59 $11,113.20 3.7
$2,994.42
22 - 316-RENAL FAILURE
3,234
$61,657,331.40 $19,065.35 6
$3,158.19
23 - 370-CESAREAN SECTION W CC
3,200
$38,394,077.16 $11,998.15 3.5
$3,440.95
24 - 125-CIRCULATORY DISORDERS EXCEPT AMI, W CARD
CATH W/O COMPLEX DIAG
3,086
$51,422,401.61 $16,663.12 2.3
$7,097.64
4
$3,071.71
25 - 012-DEGENERATIVE NERVOUS SYSTEM DISORDERS
3,048
$61,063,244.13 $20,033.87 10.6
$1,881.17
26 - 395-RED BLOOD CELL DISORDERS AGE >17
2,873
$35,496,304.41 $12,355.14 3.9
$3,193.38
27 - 557-PERCUTANEOUS CARDIOVASCULAR PROC W DRUGELUTING STENT W MAJOR CV DX
2,866
$119,494,576.57 $41,693.85 3.4
$12,103.17
28 - 124-CIRCULATORY DISORDERS EXCEPT AMI, W CARD
CATH & COMPLEX DIAG
2,764
$56,053,777.37 $20,279.95 3.6
$5,599.22
29 - 079-RESPIRATORY INFECTIONS & INFLAMMATIONS AGE
>17 W CC
2,761
$61,690,088.22 $22,343.39 7.7
$2,919.55
30 - 294-DIABETES AGE >35
2,653
$30,373,056.30 Source: Arkansas Department of Health, Hospital Discharge Data, 2006
$11,448.57 4.4
$2,599.45
26
Summer 2008 I Arkansas Hospitals
s t a t i s t i c s
Total Uncompensated Care Costs, 1981-2006
Arkansas Community Hospitals
TotalUncompensated
UncompensatedCare
Year
Bad DebtsCharity CareCareCosts
1981
$37,468,377
$7,866,377
$45,334,754
$36,719,224
1982
49,470,792
12,091,949
61,562,741
48,340,086
1983
52,606,301
12,829,209
65,435,510
49,146,224
1984
68,882,777
14,646,808
83,529,585
63,123,963
1985
74,424,083
13,972,273
88,396,356
67,715,816
1986
99,454,411
19,867,102
119,321,513
89,591,634
1987
81,107,533
27,359,296
108,466,829
77,569,842
1988
98,109,823
37,827,847
135,937,670
92,256,210
1989
117,482,546
42,116,634
159,599,180
108,053,193
1990
125,031,048
61,275,220
186,306,268
121,232,135
1991
163,592,104
76,279,409
239,871,513
146,435,133
1992
184,749,580
71,188,541
255,938,121
155,801,537
1993
212,858,139
82,595,281
295,453,420
176,084,346
1994
236,455,744
111,093,357
347,549,101
193,446,750
1995
245,897,568
117,503,190
363,400,758
196,368,117
1996
260,404,561
128,720,073
389,124,634
209,366,948
1997
283,840,657
139,408,747
423,249,404
218,036,862
1998
305,070,830
147,302,300
452,373,130
227,116,454
1999
349,960,717
157,664,182
507,624,899
247,263,263
2000
400,358,728
139,956,601
540,315,329
250,923,257
2001
438,812,612
140,217,960
579,030,572
252,747,128
2002
481,582,688
193,429,493
675,012,181
282,739,761
2003
531,161,829
206,995,046
738,156,875
300,103,998
2004
565,220,366
239,575,478
804,795,844
311,477,513
2005
566,192,497
293,504,471
859,696,968
324,309,723
2006
$583,842,333
$340,914,742
$924,757,025
$341,910,046
Source: American Hospital Association
Summer 2008 I Arkansas Hospitals
27
s t a t i s t i c s
by Paul Cunningham, Senior Vice President, Arkansas Hospital Association
Hospital Profits
Are the Cost of Doing Business Tomorrow
Hospital operating margins –
profits – have come under intense
scrutiny during recent years.
Questions about the need for hospitals to be paid more than they
spend providing patient services
are raised so often that the subject
is now a focus of public policy
debates. It seems that everyone
– from Congress to state legislatures; from government agencies
and state officials to local businesses, the press and even the
neighbors across the street – has
an opinion, and many think hospi-
Like any business,
hospitals must be paid enough
to cover their operating costs.
tals don’t need to generate a profit,
especially those operated as charitable, not-for-profit hospitals.
The issue is complicated, at
best, and made more confusing
by differing opinions on the value
of community benefits provided through local hospitals – the
amount of charity care they provide, free community health programs they sponsor, etc. Even their
status as tax-paying or tax-exempt
organizations enters into the equation as a factor for weighing the
need for a profit.
Regardless of individual opinions, one fact is undeniable. Like
the corporate balance sheet, there
is a bottom line to the issue that
ultimately will translate into the
long-term success or failure of any
hospital: a hospital must be well
28
Summer 2008 I Arkansas Hospitals
managed financially to generate
more revenue than it spends if it
is to continue serving its community with the quality care the residents demand, expect and deserve.
Whether the IRS calls a hospital a
for-profit venture, where most of
the profits are distributed to shareholders, or a non-profit charitable
organization that reinvests profits
back into the organization, the
end result is the same. Without the
reserves allowed by surplus revenues over expenses, hospitals will
eventually wither away and close.
Like any business, hospitals
must be paid enough to cover their
operating costs. Payroll, utilities,
food, supplies, professional fees,
capital costs, pharmaceuticals and
other normal costs of doing business must be covered or they won’t
stay in business long. Realistically,
hospital profits are one of those
costs. They literally represent the
cost of doing business tomorrow.
Hospital charges not only
have to include the direct expense
incurred providing care to patients
– the medications, tests, labor,
room and board for the insured
and the uninsured – but they’ve
also got to cover costs for repairing or replacing worn-out facilities
and equipment next month, next
year or five years down the road.
A local hospital must be able to
make those improvements when
needed.
More importantly, profits allow
a hospital to keep pace with technological advances. Patients expect
their hospital to offer access to the
most recent technology that yields
better diagnostic information,
improves treatment outcomes, and
leads to more rapid recovery times.
They must also be able to employ
people with the expertise to oper-
ate these sophisticated, computerized biomedical machines. Profits
ensure the capability to do these
things.
Profits are also necessary to
provide new programs to meet
community healthcare needs; to
support care provided to patients
who can’t afford to pay; to hire
and retain highly trained healthcare professionals who are in short
supply across the country; and
to fund hospital-related research
and education projects. And, as
government programs and private
health plans continue to reduce
the amounts they pay for hospital services, profits are needed to
ensure those payment shortfalls
are covered in the future.
Last year, almost 40 percent
of Arkansas’ hospitals were paid
less than it cost them to provide
patient services. They made no
profit. Instead, they had to rely on
income from other sources like cafeterias, gift shops, interest income,
private donations and locally designated tax revenues to help cover
their expenses. Even with the
money from those sources, about
a quarter of them spent more than
they received in overall payments
for the year. But, they didn’t have
to close. They’re still at work providing care for their communities
because of the reserve funds built
up in past years from the profits
they’ve been able to make.
As hospital reimbursements
from governmental and private
payer groups continue to erode,
hospital profit margins will probably shrink, but hopefully won’t
disappear. They’re important for
meeting our future healthcare
needs. They’re essential for ensuring your hospital’s ability to do
business tomorrow.
•
s t a t i s t i c s
Hospital Uncompensated Care Costs
In 2006, roughly 28,000 patients
who had no insurance coverage received
inpatient care in an Arkansas hospital.
Tens of thousands more came or were
brought to hospital emergency rooms
seeking treatment for conditions ranging from major trauma to fevers and
ear infections. Some required immediate
attention, while others came simply to
see a doctor because they don’t have
a family physician to take care of less
urgent medical needs.
Most of the remaining 373,000
Arkansans who were hospitalized in
2006 had some type of healthcare coverage, but their plans generally didn’t cover
all of the bills. The patients themselves
were left with the responsibility to pay
the sometimes weighty deductible and
co-pay amounts.
Each year, Arkansas’ hospitals
provide millions of dollars of care to
patients who are unable or unwilling
to pay the out-of-pocket costs related
to their hospital bills. The costs related
to those services, which are estimated
based on the overall hospital cost-tocharge ratio, are grouped under two
categories, bad debt and charity care.
Together, they have increased 182 percent since 1990 and amounted to more
than $342 million in 2006.
In accounting terms, bad debt consists of services for which hospitals
anticipated but did not receive payment. Charity care, on the other hand,
is comprised of services for which hospitals neither received, nor expected
to receive, payment because they had
determined the patient’s inability to
pay. In practice, however, hospitals
have difficulty in distinguishing bad
debt from charity care.
Some hospitals use a formal process
to identify who can and cannot afford
to pay, in advance of billing, in order
to anticipate whether the patient’s care
could be funded through an alternative
source such as a charity care fund. On
the other hand, some hospitals use the
billing and collection process to identify
those patients who are unable to pay.
So, care delivered to a patient may be
classified as charity care by one hospital, but bad debt by another. But, this
doesn’t mean that care classified as bad
debt was provided to patients who can
afford to pay. On the contrary, bad debt
can be generated by people with limited resources, making the distinctions
between the two categories virtually
meaningless.
However, the two share common
ground when it comes to their astounding growth. Between 1990 and 2006,
bad debt costs absorbed by Arkansas
hospitals jumped 166 percent, while
charity care costs were up 216 percent.
Both had a direct bearing on the overall
hospital cost increase of 163 percent for
the same period.
Had enough patients been insured
during each year over that 17 year period to reduce the average rate of growth
in bad debt and charity care costs by 25
percent, total hospital spending in the
state could have been reduced by about
$600 million.
•
Arkansas Community Hospitals, Uncompensated Care Costs, 1990-2006
TotalNetOtherTotalTotalUncompensatedUncompensatedPercent
BilledChargesOperatingOperatingOperatingCost/ChargeUncollected CareCare
of Total
YearChargesCollectedRevenueRevenueCostsRatioBillsBad DebtCharityChargesCostsCosts
1990
2,589,534,073
1,690,629,299
61,503,639
2,651,037,712 1,685,046,599
65.07%
898,904,774
125,031,048
61,275,220
186,306,268
121,232,135
7.19%
1991
2,990,424,120
1,867,092,213
49,866,617
3,040,290,737 1,825,573,820
61.05%
1,123,331,907
163,592,104
76,279,409
239,871,513
146,435,133
8.02%
1992
3,414,216,360
2,100,789,964
59,268,328
3,473,484,688 2,078,393,611
60.87%
1,313,426,376
184,749,580
71,188,541
255,938,121
155,801,537
7.50%
1993
3,740,881,935
2,246,744,884
64,978,999
3,805,860,934 2,229,491,032
59.60%
1,494,233,248
212,858,139
82,595,281
295,453,420
176,084,346
7.90%
1994
3,917,220,495
2,283,950,742
68,254,344
3,985,474,839 2,244,921,469
57.31%
1,633,278,763
236,455,744
101,093,357
337,549,101
193,446,150
8.62%
1995
4,264,731,310
2,367,860,784
78,261,879
4,342,993,189 2,304,500,580
54.04%
1,896,870,526
245,897,568
117,503,190
363,400,758
196,368,117
8.52%
1996
4,672,563,251
2,569,357,972
91,915,545
4,764,478,796 2,514,053,912
53.80%
2,103,205,279
260,404,561
128,720,073
389,124,634
209,366,948
8.33%
1997
5,015,725,156
2,713,352,084
74,227,059
5,089,952,215 2,583,850,005
51.51%
2,302,373,072
283,840,657
139,408,747
423,249,404
218,036,862
8.44%
1998
5,581,832,069
2,859,625,078
83,252,406
5,665,084,475 2,802,389,937
50.21%
2,722,206,991
305,070,830
147,302,300
452,373,130
227,116,454
8.10%
1999
6,096,135,975
2,933,364,021
95,687,603
6,191,823,578 2,972,492,256
48.76%
3,162,771,954
349,960,717
157,664,182
507,624,899
247,519,263
8.33%
2000
6,840,121,635
3,117,677,033
95,650,547
6,935,772,182 3,176,562,841
46.44%
3,722,444,602
400,358,728
139,956,601
540,315,329
250,923,257
7.90%
2001
7,445,452,895
3,300,453,542
103,461,117
7,548,914,012 3,249,943,830
43.65%
4,144,999,443
438,812,612
140,217,960
579,030,572
252,747,128
7.78%
2002
8,623,946,905
3,703,886,971
134,677,549
8,758,624,454 3,612,279,530
41.89%
4,920,059,934
481,582,688
193,429,493
675,012,181
282,739,761
7.83%
2003
9,708,583,330
3,917,980,687
127,642,206
9,836,225,536 3,947,107,676
40.66%
5,790,602,643
531,161,829
206,995,046
738,156,875
300,103,998
7.60%
2004
10,375,189,439 4,014,406,025
134,780,857 10,509,970,296 4,015,475,758
38.70%
6,360,783,014
565,220,366
239,575,478
804,795,844
311,477,513
7.76%
2005
11,200,616,473 4,255,599,395
153,253,789 11,353,870,262 4,225,289,800
37.72%
6,945,017,078
566,192,497
293,504,471
859,696,968
324,309,723
7.68%
2006
12,002,276,866 4,429,611,124
154,744,439 12,157,021,305 4,437,596,804
36.97%
7,572,665,742
583,842,333
340,914,742
924,757,075
341,910,046
7.70%
742.43%
366.96%
456.37%
361.44%
182.03%
Increase
363.49%
162.01%
151.60%
358.58%
163.35%
Source: American Hospital Association
Summer 2008 I Arkansas Hospitals
29
Arkansas Hospital Association
Accomplishments, 2007-2008
1) Succeeded in gaining support from all or
most of the state’s congressional delegation on issues including SCHIP, opposing
CMS’ proposed across-the-board behavioral offset Medicare cuts, inclusion of
Medicare bad debt as part of the full value
of community benefits on the new IRS
990 form, opposition of the President’s
proposed Medicare/Medicaid cuts for FY
2009, mental health parity, lowering the
inpatient rehab facility threshold from 75
percent to 60 percent, limiting the growth
of physician-owned specialty hospitals,
delaying the implementation of Medicare
Recovery Audit Contractors, increasing
the Medicare GME caps and continuing the moratorium on Medicaid rules
affecting the use of intergovernmental
transfers.
2) Intervened in a hearing before the state
Insurance Commissioner to ensure that
hospitals’ rights to negotiate individual
payment rates with private health plans
are safeguarded.
3) Initiated preliminary discussions with
Governor Mike Beebe to build support for
legislation in the 2009 Legislative session
to fund a statewide trauma system.
4) Updated the AHA’s previous studies concerning Medicaid and found that in 2006,
the state’s hospitals lost $100 million on
inadequate Medicaid payments.
5) Worked to educate the Arkansas State
Chamber of Commerce about the impact
of Medicare cuts on employers’ healthcare premiums and succeeded in getting
a letter from the group opposing the
behavioral offset and other Medicare cuts
being proposed by CMS for FY 2008.
6) Finalized plans and implemented construction of an expansion to the AHA
Headquarters Building.
30
Summer 2008 I Arkansas Hospitals
7) Negotiated with representatives of the
Arkansas Department of Human Services
and the Arkansas Medicaid Program for
a $20 million annual increase in hospital
outpatient reimbursement.
15) Coordinated the expansion of hospital
communication capabilities for use in
the event of a flu pandemic or other
situations requiring their participation in
response to disasters or emergencies.
8) Regained approved provider status for
continuing education from the Arkansas
Nurses Association.
16) Added a Vice President and General
Counsel to the executive staff in order
to provide in-house legal services to the
association and legal information and
assistance as a value-added service to
members.
9) Educated and prepared member hospitals
for the arrival of new Medicare Recovery
Audit Contractors in early 2009.
10) Worked in conjunction with the Arkansas
Medicaid program to get a six-month delay
for Arkansas’ implementation of a new
Medicaid policy requiring the submission of
National Drug Code information of Medicaid
claims involving administered drugs.
11) Continued to push for improvements in
hospital quality and patient safety by joining
with the Arkansas Foundation for Medical
Care as a participating organization with
the Institute for Healthcare Improvement’s
5 Million Lives Campaign.
12) Worked with the state Insurance
Commissioner to resolve problems related
to dishonest advertising and solicitation
practices of Medicare Advantage plans.
13) Expanded use and knowledge of the AHA’s
new information management system
for improving, tracking and managing its
financial and member-related activities.
14) Provided critical analyses of the impact
of federal reimbursement changes and
continued to work closely with the state’s
congressional delegation to prevent reductions in Medicare/Medicaid reimbursement
and to advocate for Medicare and Medicaid
payments at levels adequate to cover hospitals’ costs of providing patient care services.
17) Provided legal information guidance for
members in complying with a host of
statutory, regulatory, and accreditation
requirements, which included adapting
to the new Joint Commission standards
and survey process, and providing support with scope of practice, regulatory compliance, emergency preparedness, emergency medical services, and
Medicare Conditions of Participation
issues.
18) Intervened on behalf of the state’s hospitals in a litigation matter involving
the confidential nature of occurrence
reports relating to in-hospital accidents.
19) Coordinated separate meetings with
Arkansas Blue Cross Blue Shield for psychiatric hospitals and for Critical Access
Hospitals to discuss the opportunity for
individual hospitals to negotiate with the
insurer on reimbursement issues.
20) Updated the AHA’s price/quality Web
site www.hospitalconsumerassist.com
to include all-payer data.
21) Monitored the development of rules covering dispute resolution procedures for
the Arkansas Rural Medical Practice
Student Loan and Scholarship Board
to ensure hospitals’ concerns were
addressed.
22) Conducted an in-state Mid-Management
Certificate Series of eight workshops conducted throughout the year to help groom
hospitals’ employees for advancement
into mid-level management positions and
awarded certificates to 30 individuals who
participated in at least five courses in the
eight-course series.
23) Provided in-state education for more than
4,000 hospital employees through workshops and Web-based instruction on subjects including compliance, revenue cycle
improvement, CPT and ICD-9 coding, supervisory skills, chargemaster maintenance,
ambulatory payment classifications, Joint
Commission standards updates, quality
and patient safety, legal issues, emergency
readiness, governance matters, information
technology and Medicare updates.
24) Supported hospitals’ participation in the
national Hospital Quality Alliance and continued to work in conjunction with the
Arkansas Foundation for Medical Care,
the CMS-designated Quality Improvement
Organization, on quality improvement projects aimed at enhancing outcomes for
patients treated in Arkansas hospitals.
25) Conducted a comprehensive wage and
salary survey covering more than 115
jobs/positions typically found in hospitals and made the report available
at no charge as a member service to
participating hospitals.
26) Communicated on an ongoing basis
with the AHA members, trustees, state
legislators and government leaders, and
the Arkansas congressional delegation
on issues impacting the state’s hospitals and healthcare systems through
the weekly newsletter, The Notebook,
the quarterly Arkansas Hospitals magazine, and the quarterly The Arkansas
Trustee, as well as special “Hotlines.”
27) Offered a new publication, “Strategies”,
to assist hospitals with risk management issues and concerns.
28) Strengthened relationships between
the AHA and offices of members of
the state’s congressional delegation
and their chief health aides, ensuring that they were continually updated
and briefed on hospitals’ issues and
concerns.
29) Offered a summer leadership conference and annual membership meeting to
educate hospital CEOs and management
teams about federal issues, healthcare
trends, diversity and inclusion, making
informed healthcare choices, improving
health, understanding and influencing
physician behavior, leadership skills, nursing workforce trends, patient safety and
accountability, health disparities, healthcare marketing challenges, national politics, and preparedness.
30) Offered specialized education targeted toward hospital governance leaders
through a 12-month Webinar series, a
Trustee College workshop and a series of
five regional meetings to discuss hospital
trustees’ role in maintaining and improving quality and patient safety in their
hospitals.
31) Sponsored a program recognizing hospitals for their excellence in advertising.
32) Provided up to $1,000 to help defray
expenses for hospital CEOs who attended
the American Hospital Association’s 2008
Annual Membership Meeting.
•
Reports Needed from All Providers:
Heparin Adverse Events
The Food and Drug Administration
(FDA) is summarizing important information relating to medical products that
contain potentially contaminated heparin
and is seeking assistance from healthcare
facilities and providers in identifying and
reporting adverse events related to these
products.
The agency also wants providers to
be aware of recent recalls of injectable heparin and heparin flushes and of
life-threatening reactions that have been
reported in association with contaminated heparin.
Current recall information is available at http://www.fda.gov/cder/drug/
infopage/heparin/default.htm#recalls
and will be updated as new information
becomes available.
Additional information on reported
adverse events can be found at http://
www.fda.gov/cder/drug/infopage/heparin/adverse_events.htm.
In addition to reporting any adverse
patient reactions that may be associated with injectable heparin and heparin
lock flush solutions, the FDA is asking that providers report heparin-related
adverse reactions associated with use of
other medical products which contain
or are coated with heparin, including
certain intravascular catheters, oxygenators, pumps, filters, and blood reservoirs
used during cardiac procedures, vascular
stents/grafts, and blood collection tubes.
A list of specific medical devices containing heparin is provided at http://www.
fda.gov/cdrh/safety/heparin-device-list.
html. This is not an inclusive list of all
firms that manufacture or distribute heparin-containing devices, nor is it a complete
list of medical devices that contain or
are coated with heparin. The FDA will
update the list as additional information
becomes available.
The Arkansas Hospital Association
will provide all member organizations
with more detailed information about the
issue and the FDA request for information on heparin-associated adverse events
as the heparin issue evolves.
•
Summer 2008 I Arkansas Hospitals
31
by Elisa M. White, Vice President and General Counsel, Arkansas Hospital Association
Legal Notes:
Concerning HIPAA
HIPAA Criminal
Prosecutions and Their
Affect on Hospitals
A recent guilty plea by a nurse
in Trumann, located in Northeast
Arkansas, serves as a reminder to
hospitals that they must be vigilant
in protecting patient information
and in monitoring employees’ uses
and disclosures of information.
The nurse, who pleaded guilty to
a criminal HIPAA violation, has
not yet been sentenced, but she
faces up to 10 years imprisonment, a fine of up to $250,000
and a term of supervised release
of not more than three years. She
has been fired from her job and
may lose her nursing license.
Unlike prior HIPAA criminal
cases, this was not a case of identity theft or stolen financial information. Instead, the Arkansas
nurse had a personal motive and
apparently did not use or disclose
the information for monetary
gain. Arkansas Democrat-Gazette
reports state that she wrongfully
disclosed patient information to
her husband, who threatened to
use the information against the
patient in an upcoming legal proceeding.
The U.S. Attorney’s Office for
the Eastern District of Arkansas
is taking HIPAA crimes very seriously, regardless of whether the
crime resulted in monetary gain.
Other recent reports from the
DOJ indicate that we may see
more HIPAA criminal prosecutions.
32
Summer 2008 I Arkansas Hospitals
Recently, the journal Modern
Healthcare reported that a federal grand jury in Los Angeles
indicted a former employee of
UCLA Medical Center for allegedly disclosing health records of
celebrity patients to the media. In
the UCLA Medical Center case,
the former employee received
payment for the disclosure, but
Arkansas hospitals should remind
their employees that all HIPAA
violations are serious. Even disclosing the information as “gossip” without payment could subject the employees and the hospital to criminal sanctions.
To avoid corporate liability,
hospitals should ensure that their
policies and procedures are up to
date, use and disclosure auditing mechanisms are in place, and
HIPAA education and enforcement are given the appropriate
focus within the organization.
How HIPAA Applies with
Prosecutors’ Subpoenas
Under the Arkansas Code,
prosecutors have the authority to
issue subpoenas in criminal matters they are investigating. See
Ark. Code Ann. §16-43-212(a).
A prosecutor is a “law enforcement official” under the HIPAA
Privacy Regulations, which define
“law enforcement official” as “an
officer or employee of any [government] agency or authority...
who is empowered by law to: (1)
investigate or conduct an official
inquiry into a potential violation
of law; or (2) prosecute or otherwise conduct a criminal, civil, or
administrative proceeding arising from an alleged violation of
law.” 45 C.F.R. §164.501.
Under HIPAA, a hospital may
disclose protected health information for a law enforcement
purpose to a law enforcement
official (such as a prosecutor)
in response to an administrative
request, including an administrative subpoena, as long as the
following three-part test is satisfied:
(1) The information requested
is relevant and material to a legitimate law enforcement inquiry;
(2) The information requested
is specific and limited in scope;
and
(3) De-identified information
cannot be used.
At the request of the Arkansas
Hospital Association (AHA), the
Arkansas Prosecuting Attorneys
Association, working with the
Arkansas Office of the Prosecutor
Coordinator, has revised the
standard “Exhibit A” used with
prosecutors’ subpoenas for medical records to include this HIPAA
three-part test.
A sample of the revised “Exhibit
A” is available from the AHA
upon request. AHA staff also is
available to assist member hospitals with any difficulties, questions
or concerns they may have about
the subpoena form.
•
California Nursing Union Distributing
Materials, Making Phone Calls in Arkansas
AHA Sponsors Audioconference
to Discuss Union Activities
In the spring, the Arkansas
Hospital
Association
(AHA)
learned that the National Nurse’s
Organizing Committee (NNOC/
California Nurses Association) distributed a very slick pamphlet to
many, if not all, RNs in Arkansas.
The publication references a growing national RN movement with
a common purpose, vision and
dream. It discusses the advantages
of NNOC/CNA membership for
RNs, states that NNOC/CNA now
has 80,000 RN members in all 50
states and asserts that RN ratios are
the only effective solution for safe
staffing and that NNOC/CNA has
sponsored legislation providing for
ratios in several states.
Interestingly, the publication takes
exception to a competitor union,
the Service Employees International
Union (SEIU), which has a presence
in one Arkansas hospital. It calls
SEIU a non-RN union and alleges
that the hospital industry has found
a willing ally in the union movement
in the form of SEIU. The pamphlet’s
last page contains a card to be signed
and returned to the California Nurses
Association in Oakland, California.
The card states that the individual
signing the card wants the union to
represent them in collective bargaining with their employer.
The AHA also has been informed
that in addition to distributing
pamphlets, representatives of the
California Nurses Association are
telephoning Arkansas nurses at their
homes from local phone numbers. These actions could signal the begin-
ning of some very serious union
activity targeted toward nurses in
our state.
According to James M. Gary, a
labor law partner with the Kutak
Rock law firm in Little Rock, organized labor has made organizing
hospital and healthcare employees
a national priority. The Change to
Win Federation has pledged threequarters of its resources to organizing
the more than 50 million workers in
its affiliated industries. The AFL-CIO
has publicly announced that it has
changed its primary focus from politics to organizing workers. By forming the National Nurses Organizing
Committee, CNA has created a vehicle for the express purpose of organizing Registered Nurses, Advance
Practice Nurses and RN organizations across the United States.
In response to this activity, the
Arkansas Hospital Association
offered to its members a free audioconference June 10 to discuss the
issue. The featured speaker was Mr.
Gary, whose law practice has focused
on representing companies nationwide in both traditional and labor
law, litigating labor and employment
cases in federal and state courts and
various administrative agencies.
Topics covered during the onehour audioconference included:
• Recent developments relating to
unionization in the hospital industry;
• How to anticipate, recognize and
assess issues ongoing in your hospital
that may be relevant to efforts to
unionize;
• Practical proactive steps that any
healthcare facility should take to
make union organizing unwelcome
and irrelevant to its healthcare
employees without interfering with
employee rights or alienating the
community; and,
• An easy guide to follow to ensure
compliance with state and federal
laws relating to union organizing
activity.
The AHA will continue to monitor
activities by NNOC/CNA or other
unions targeting healthcare workers
in the state.
•
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Phone 800-770-0183
Summer 2008 I Arkansas Hospitals
33
by Katie Badeusz, Ragan Communications, ragan.com
10 Tips for a Successful Brown Bag Lunch
with the CEO
Encourage Face-to-Face Communication
with a Companywide Brown Bag Lunch
Editor’s Note: Though the ideas presented here were compiled with a corporate setting in mind, they are readily adaptable to the hospital setting by
scheduling “brown bag lunches” on
each shift, and by allowing each floor
or department to send representatives to
the meeting rather than sending an entire
work group to one session.
With new communication channels
introduced all the time, it’s no surprise that
face-to-face communication has dropped to
the wayside. However, for many employee
communication topics, it can be the most
effective medium, according to Ragan corporate communications consultant Patrick
Williams.
“Face-to-face communication unites
and engages people behind a common
set of goals – it’s a key business process,”
Williams said.
A great way to get employees talking
the old-fashioned way is to hold a brown
bag lunch. A brown bag lunch is a chance
for employees to discuss business issues
with an executive, often the president or
CEO, over lunch. It also helps executives
listen and stay tapped in.
Before you start planning your brown
bag lunch, here are 10 tips to help make
it effective:
1. Make brown bag lunches a regular part of the communications plan.
Lunches should be held monthly if the
organization is around 5,000 employees or less and in one place, or weekly
if it is big and spread out. Remember,
keep the lunches informal. The term
“brown bag” is meant to define a tone
of informality, a discussion rather than
a presentation with formal Q&A.
34
Summer 2008 I Arkansas Hospitals
And, it doesn’t mean employees have
to bring their own lunch in a brown
bag. In fact, the lunches are generally
catered and held in the executive dining room.
2. Base lunch on employee research.
Before the lunch, the internal communications department should organize a focus group (around 8 to 12
people) with employees to uncover
their needs. Find out what would
encourage employees to participate in
the lunch – think time, place, size, topics, etc. Plan the lunch around what is
learned in the focus group.
3. Prepare for the brown bag lunch.
Have lunch participants meet with
fellow employees in their department
once the official luncheon announcement is made to discuss topics.
4. Organize attendees. Depending on the
kind of feedback you’re looking for,
two kinds of groups make for a successful brown bag lunch: a diverse
group (a few people from many different departments) and at least one
entire department (people from one
department should attend so they can
ask specific questions to the group).
5. Organize the lunch like a focus group.
The CEO shouldn’t give a speech at
the lunch. Instead, the event should be
similar to a focus group – this helps
the CEO take information away from
the meeting. For instance, send a letter
in advance explaining the purpose of
the lunch, topics for discussion and
the role of attendees. It’s the internal communicator’s job to teach the
CEO how to conduct a focus group.
According to Williams, a focus group
setting is a “forum for speaking and
listening – two central skills in the
face-to-face initiative.”
6. Take advantage of employee speaking
opportunities. Attendees should come
to the brown bag lunch ready to talk
about a variety of topics. Likewise,
the CEO should be ready to listen.
Brown bag lunches communicate in a
way that the Internet, company blogs,
podcasts, video and print publications
cannot – they’re more personal, they
allow employees to be more active
in key decision-making and they give
staff members a sense of community.
Make sure it’s clear to both employees
and the CEO that conversations need
to be a two-way street.
7. Make the meeting worth the CEO’s
time. The CEO’s most important job
is to make key decisions for the company. And important information that
helps the CEO make those decisions
comes from the employees because
they work with the products and
touch base with customers. In turn,
employees are knowledgeable on topics the CEO isn’t. Don’t just ask the
CEO questions; share information,
provide insight and look at what he or
she is trying to get out of the session.
8. Get the CEO talking on a regular
basis. Brown bag lunches can’t be the
CEO’s only contact with employees.
The CEO must follow up after the
lunch. For instance, a CEO blog,
podcast, video or quarterly meeting
should be a regular part of the CEO’s
schedule.
9. Make communication everyone’s
responsibility. A brown bag lunch
is a chance for the CEO to see if
company internal communications is
working. But the CEO can’t communicate alone. “It’s everyone’s job
to cascade the information from the
lunch to non-attendees,” according
to Williams.
10. Hold a ‘post-brown bag lunch’
meeting in every department. After
the CEO holds a companywide
brown bag lunch, it’s a good idea
for managers to hold their own
brown bag lunches, too. This way,
employees can take information
from the larger scale luncheon with
the CEO and discuss it at smaller,
more intimate lunches with their
department.
Keep in mind that the lunch’s success
should be measured afterward to help
plan future meetings. Ask attendees if
their ideas received follow-up and find
out from the CEO if the lunch was
informative. These questions will guide
the company internal communications
plan.
•
15 questions to ask in focus
groups:
9. Do you know what you can do to
help the company meet its goals?
1. For the most important information you want at work, where do
you want to get that information?
10. What do you see as your role in the
communication process?
3. Are you getting it?
11. If you were to get the sorts of
information you’ve been telling me
about and to have the voice you’re
seeking, how would that change
your performance?
4. Do you get the information you
need to do your job the best you
can?
12. What would you be willing to do
differently to improve communications with colleagues?
5. Do you know what your job is?
13. How would that help the company?
2. What is the information you
want?
6. Does anyone care about your performance?
7. Do you know what others are
doing so that you can work with
them – in your own area and in
other departments?
8. Do you know the company goals?
14. How would you evaluate your
supervisor’s communications skills;
your own?
15. What one thing would most
improve communications between
you and your supervisor?
•
AHA ANNUAL MEETING ANNOUNCEMENT
Arkansas Hospitals: Putting People First
Mark your calendar today
for the
Arkansas Hospital Association’s
78th Annual Meeting and Trade Show
October 8-10, 2008
Peabody Little Rock and Statehouse Convention Center
Learn from these leaders who will share their passions and experiences with hospitals and healthcare:
Lee Woodruff, co-author of In An Instant, recounts her story of her ABC News journalist husband Bob Woodruff’s injury
from a roadside bomb while covering the war in Iraq.
V. J. Smith, author of The Richest Man in Town, on what happens when you take the time
to be kind and compassionate.
Robert Reece will facilitate the ACHE three hour Category I workshop on the
“Hospital of the Future” – ACHE’s top educational workshop.
And, new this year…
Susan Keene Baker, author and leadership consultant, will present “Exceptional Patient Care,”
a six hour leadership session preceding the Annual Meeting.
Other leaders and experts will lead additional sessions.
Information will be available August 1 on the AHA Web site, www.arkhospitals.org.
Summer 2008 I Arkansas Hospitals
35
2008 AHA Award Nominations
Now Being Accepted; Deadline is August 1
Nominations are open for the 2008
Arkansas Hospital Association awards program. The A. Allen Weintraub Memorial
Award and Distinguished Service Award
will be presented during the Association’s
78th Annual Meeting Awards Dinner
Thursday, October 9, at the Peabody
Hotel in Little Rock. Arkansas’ C. E.
Melville Young Administrator of the
Year will be recognized by the Arkansas
Health Executives Forum. The Diamond
Awards, cosponsored by the Arkansas
Society for Healthcare Marketing and
Public Relations, also will be presented
at the Awards Dinner. In addition, the
ACHE Regent’s Awards will be presented
at the ACHE Breakfast meeting that same
morning.
for quality healthcare for Arkansans,
his recognition of duty to the community and his visionary influence.
• The AHA’s Distinguished Service Award
is 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 physicians,
nurses, trustees, auxilians, community
leaders and other deserving individuals.
The 2008 recipients of the Weintraub
and Distinguished Service Awards
will be chosen by the AHA Board of
Directors from those nominated.
Criteria for each award follow:
• The A. Allen Weintraub Memorial
Award, named for Allen Weintraub,
long-time administrator of St. Vincent
Infirmary Medical Center in Little
Rock, is the highest honor bestowed
upon an individual by the AHA. Those
nominated for this honor should be
hospital chief executive officers who
are contributing to their hospitals and
communities in a manner exemplary of
Allen Weintraub. Those who remember him always mention his care and
concern, not only for hospital patients
but also for his employees, his passion
• The C. E. Melville Young Administrator
of the Year Award is named for the late
C. E. Melville, administrator of Jefferson
Regional Medical Center in Pine Bluff.
The award recipient is selected by the
Arkansas Health Executives Forum’s
Awards Committee. The award recipient must be under age 40, a resident
of Arkansas for at least two years,
employed by an Arkansas healthcare
institution, and meet requirements for
active membership in the Arkansas
Health Executives Forum.
• The 2008 Diamond Awards honor-
ing excellence in hospital marketing
and public relations will be presented in
several categories, such as advertising,
annual report, Internet Web site, publications, special video production, and
writing. Diamond Awards (for hospitals with 0-99 beds, 100-249 beds, and
250 or more beds) will be presented in
each category. Entries were accepted in
early 2008 and have been judged individually by a panel of judges not affiliated with any Arkansas hospital.
• The 2008 ACHE Regent’s Awards
will honor outstanding healthcare
executive leadership in two areas –
early career and senior level. The two
recipients, selected by the Arkansas
Health Executives Forum’s Awards
Committee, will be presented their
awards at the ACHE Breakfast during
the AHA Annual Meeting and recognized at the annual Awards Dinner that
same evening.
Nominations and entries, accompanied by appropriate documentation, must
arrive at AHA headquarters no later than
August 1, 2008. Informational brochures
providing details of all awards have been
mailed to each hospital CEO and public relations/marketing officer. Please
call Beth Ingram or Lyndsey Dumas at
501-224-7878 with questions about the
awards or the award process.
•
Healthcare Among Americans’ Top Worries
Healthcare costs rank among
Americans’ top personal economic problems, and their struggles to deal with
those costs have affected both their financial well-being and their family’s healthcare.
A new Kaiser Family Foundation
poll finds that 28 percent of Americans
say that they or their families have had
36
Summer 2008 I Arkansas Hospitals
a serious problem paying for healthcare and health insurance as a result of
recent changes in the economy. That falls
behind paying for gasoline (44 percent)
and is nearly tied with concerns about
getting a good paying job or raise in pay
(29 percent).
Reports of families facing serious economic problems extend up into middle-
income families, with 28 percent of those
earning between $30,000 and $75,000
reporting a serious problem paying for
healthcare or health insurance as a result
of recent changes in the economy. Also,
24 percent now report skipping a recommended medical test or treatment in the
past year because of the cost, which is up
from 17 percent in 2005.
•
Mid-Management Series offers Bold insights
into Managerial Challenges
ARKANSAS HOSPITAL ASSOCIATION
If you had intentions of attending
the Mid-Management Certificate Series
for 2008, it is not too late to begin!
There are five programs remaining
in this year’s series; individuals seeking the Arkansas Hospital Association
Mid-Management Certificate are
required to complete five of the eight
programs for the year.
The series is designed for individuals new to hospital supervisory or
mid-level management positions. The
programs presented are also designed
to help “groom” employees who may
eventually be moving into middlemanagement positions.
In addition, experienced managers
seeking a “refresher course” find the
curriculum valuable. The programs
may be taken individually or as a series,
building toward the Mid-Management
Certificate.
Programs remaining in the 2008
series run August through November,
and include:
August 13 - financial skills for
managers
Bill Ward will lead this program,
designed to hone managers’ financial
awareness. Like it or not, healthcare
has become a business. Resources are
scarce and stretched to the breaking
point. Doing more with less is routine.
The need for sound business/financial
management tools – survival skills – is
paramount. This session will provide
participants with those tools, including
planning and budgeting, financial analysis and resource maximization, all of
which are essential if managers are to
achieve their institution’s mission and
contribute to “bottom line” results.
september 23 - dealing with
conﬂict
Tom Westbrook leads this session
as well as the next day’s program on
Accountability. In “Dealing with
Conflict,” he shows how conflict
is inherent in all environments and
explains how leaders must be able
to deal effectively with conflict and
learn how to shape and mold people’s differences for team productivity. This program examines the
often prickly topics of conflict and
disagreement and shows how best
to achieve personal and organizational goals when conflicts arise.
september 24 Accountability for results
Again led by Tom Westbrook,
those attending this session will
look at how, on every level of
every organization, projects begin,
tasks are assigned, efforts are made
and deadlines are met or missed. We
will examine why directions are given
but employees may not understand
them; why deliverables are promised
but sometimes not delivered; and how
agreements are misunderstood or perhaps not ever made. This session
will provide a systematic approach to
assist leaders to both plan and complete tasks, and empower employees
and teams to accept responsibility for
results with significant benefits to both
the organization and its employees.
october 22 - Getting results:
Be an inspirational facilitator,
trainer and coach
Inspiring employees is a difficult
job. Encouraging them to take risks
and unleash their individual potentials to increase productivity is even
more difficult. In this session, Jeanette
Wagner will help managers learn to
understand what motivates co-workers
and how to enhance their performance,
as well as how the manager’s role actually creates and sustains an organization’s environment.
2008
Mid-Management
Certificate Series
for
Managers & Supervisors
April 15
Leaping from Staff to Management:
You’re a Manager...Now What?
A series of
8 Educational Workshops
offering skills and knowledge
hospital managers need
as they lead!
April 16
Leaping from Staff to Management...the
Next Steps
May 21
The Legal Aspects of Management
August 13
Financial Skills for Managers
September 23
Dealing with Conflict
September 24
Accountability for Results
October 22
Getting Results: Be an Inspirational
Facilitator, Trainer and Coach
November 20
Government Relations 101
november 20 - Government
relations 101
Rounding out the 2008 MidManagement Certificate Series is this
session on learning to communicate
with state legislators and federal congressional leaders – a must for healthcare leaders today. Participants will
be introduced to the inner workings
of the legislative process in a workshop setting. In the afternoon, the
group will attend a Public Health
Committee meeting at the Arkansas
State Capitol.
Each program includes continental
breakfast, lunch, refreshments and all
program materials. The cost to representatives of AHA member institutions is $145 per person per session;
those attending from non-AHA member hospitals will pay $500 per person
per session.
Registration is limited. To register
or ask questions on any/all sessions,
please contact Donna Boroughs at
501-224-7878 or e-mail her at dboroughs@arkhospitals.org.
•
Summer 2008 I Arkansas Hospitals
37
A d v o cac y
American Hospital Association Annual Meeting
Focuses on Local Leadership
Summoning National Change
Arkansas sent 52 healthcare rep- Medicare Advantage program, say- respond to daily and seasonal flucresentatives to the 2008 American ing that over-payments to the private tuations in patient load. He urged
Hospital Association (AHA) Annual plans “have caused damage to tradi- AHA members to “use the next six
Membership Meeting April 6-9, tional [fee-for-services] Medicare and months to roll up your sleeves and
which was designed to bring hospi- harmed the millions of elderly and build a broad-based coalition” that
tal leaders from across the U.S. to disabled Americans who rely on it.”
presses Congress for action on health
Washington, D.C. to hear from key
Wyden predicted that the Senate reform based on the principles of the
policy makers and experts and advo- would vote to delay implementa- AHA board-approved roadmap for
cate for patients and communities.
tion of seven Medicaid regulations improving health and healthcare in
Arkansas’ delegation included hos- that could cut funding to safety-net America, Health for Life. Wyden’s
pital CEOs, governing board
goal is to have a health
members, members of hospital
reform package “ready to
administrative staffs, spouses
go” for the next presiand members of the Arkansas
dent.
Hospital Association’s execuCamp told hospital
tive team. Their mission was
leaders that the nation
to learn from the exchange of
cannot afford to ignore
healthcare ideas and to perthe root causes of skysonally visit with Arkansas’
rocketing healthcare costs,
congressional delegation about
which include the uninhealthcare issues hitting close
sured. “Until we truly
to home.
open up healthcare to all
Lawmakers addressing the
Americans, we will not
healthcare leaders included
see prices drop,” he said.
House Majority Leader Steny Timothy E. Hill (right), president/CEO of North Arkansas Regional He also said healthcare
Hoyer (D-MD), Senator Ron Medical Center in Harrison, recently received the American Hospital reform must include tax
Wyden (D-OR), who is co- Association’s “Partnership for Action Grassroots Champion Award” reform to help individuauthor of the Critical Access during the association’s annual meeting in Washington, D.C. With als afford insurance. He
Hospital Flexibility Act, and Hill is Robert “Bo” Ryall, executive vice president and chief lobby- called for removal of legal
Representative Dave Camp ist for the Arkansas Hospital Association.
and regulatory barriers
(R-MI), who is the ranking
that prevent individuals
Republican member of the
and small businesses from
House Ways and Means Committee’s providers by an estimated $50 bil- shopping for health plans, and a focus
health subcommittee.
lion over five years (S. 2819). He on preventive medicine and greater
Hoyer called for significant reform also said, “You (hospital leaders) are use of information technology.
to strengthen the Medicare and spot on with critical access hospitals.
Also addressing those attending
Medicaid programs without under- They need more flexibility!” His the annual meeting were Centers for
mining the essential benefits they bill, S. 1595, would allow CAHs to Medicare & Medicaid Services (CMS)
provide, specifically criticizing the adjust their 25-bed per-day cap to Acting Administrator Kerry Weems,
38
Summer 2008 I Arkansas Hospitals
A d v o cac y
who focused his remarks on payfor-performance measures and the
importance of interoperable electronic health records; former NBC
news anchor Tom Brokaw, who said
that healthcare reform is one of the
“huge challenges before us,” high
on Americans’ list of top concerns,
and will take an effort comparable
to the Manhattan Project to tackle;
and former House Speaker Newt
Gingrich (founder of the Center
for Health Transformation), who
said that new financing mechanisms would fall short of fixing the
system unless they are preceded
by “fundamental cultural change”
that emphasizes wellness, prevention and individual responsibility
for health.
Hospital leaders also heard
from AHA President and CEO
Rich Umbdenstock, Executive Vice
President Rick Pollack, and Board
Chairman Bill Patasnick, who is
president and CEO of Froedtert &
Community Health in Milwaukee,
Wisconsin.
Their comments focused on the
importance of hospitals embracing
the Institute of Medicine’s six aims
(achieving care that is safe, timely,
efficient, effective, equitable and
patient centered) as a part of a
national healthcare reform plan
that gives Americans the greatest
return possible in health, national
productivity, community stability
and quality of life.
Also highlighted were key issues
hospital leaders urged legislators
to act on during their visits to
Capitol Hill, including:
•
•
•
•
Extending Medicare provisions set to expire this summer.
Ensuring adequate payments
for physicians.
Protecting rural providers.
Preventing the administration
from implementing rules that
would cut Medicaid funding
to hospitals.
Arkansas Hospital Leaders Take Their
Message to Capitol Hill: Arkansas
Hospital Association Advocacy Message
Points (Washington, D.C. April 9, 2008)
April 9 was Advocacy Day on Capitol Hill, sponsored by the
American Hospital Association as a part of its annual meeting
agenda, and meant to put hospital leaders from across the nation
in personal touch with their state’s representative, senators and
their staffs so that healthcare realities “on the home front” could
be brought to light.
In speaking with Reps. Marion Berry, John Boozman, Mike
Ross and Vic Snyder and Sens. Blanche Lincoln and Mark Pryor,
Arkansas health leaders focused on the following:
1) Guard against the president’s proposed Medicare/Medicaid
reductions by working with budget committee members in your
respective chambers to ensure that the final budget package protects funding for both programs.
2) Support legislation (H.R.3533/S.226) to extend the moratorium
on CMS’ rule to cut Medicaid spending by changing the way that
intergovernmental transfers are allowed and used in lieu of state
general revenues as Medicaid matching dollars (or, preferably,
bar CMS permanently from implementing its rule).
3) Support Medicare legislation this year that will provide for costbased outpatient lab services for rural hospitals of fewer than 50
beds and independent labs’ ability to continue billing Medicare
directly for the technical component of certain physician pathology services provided to hospitals.
4) Support legislation containing provisions of Section 651 of the
House’s Children’s Health and Medicare Protection (CHAMP)
Act of 2007, which would effectively close the whole-hospital
exception to the physician self-referral rule.
5) Support HR 4105, which provides additional time for improvements to be made in CMS’ new Recovery Audit Contractor
(RAC) program.
6) Support The Strengthening the Safety Net Act of 2008, a new
bill by Oklahoma Congressmen John Sullivan and Dan Boren, to
continue providing premium Medicaid Disproportionate Share
Hospital (DSH) funding increases to 19 Low-DSH states.
•
•
Summer 2008 I Arkansas Hospitals
39
A d v o cac y
by Paul Cunningham, Senior Vice President, Arkansas Hospital Association
Why We Went to Washington:
Thoughts on the 2008 Annual Meeting of the American Hospital
Association, and Why It’s Important to Arkansas
Early in April, hospital execs,
managers and trustees from across
the country, as well as representatives from practically every state
hospital association, began loading
into trains, planes and automobiles
to make the yearly pilgrimage to
Washington, D.C. for the American
Hospital Association’s (AHA) Annual
Membership Meeting.
While there, they were able to
network with friends and colleagues
from other states about differing
approaches to common problems,
and they had the opportunity to hear
an impressive panel of speakers detail
some of the major challenges facing
hospitals in the coming year. Private
conversations and the public remarks
covered some common territory –
the possibility of Medicare/Medicaid
reimbursement cuts, Recovery Audit
Contractors (RACs), value-based
purchasing, and patient care quality
and safety.
Though everyone was sure to
come away with some new insights,
they probably didn’t particularly like
much of what they heard.
However, not liking what was said
isn’t necessarily a bad thing. It could
add a touch more focus and drive to
the real reason why the thousands of
hospital types assemble each year in
the nation’s capital: to make the case
for reasonable policy decisions that
will affect not only hospitals, but also
the communities they serve over the
next five to ten years.
In the end, we were all on a mis40
Summer 2008 I Arkansas Hospitals
sion to make sure that our House
members and Senators fully understand the impact of actions taken
on hospital matters in those chambers during the few actual legislative
days remaining in this session of
Congress.
When the “hospital troops”
spread out across Capitol Hill April
9 to visit with their state delegations,
they conveyed common messages of
equal importance to a large majority
of America’s hospitals. Briefly, they
pressed for Congress to:
• Guard against the president’s proposed Medicare/Medicaid reductions;
• Support legislation (H.R.3533/
H.R.5613/S.226) to extend for
another year the moratorium on
Centers for Medicare & Medicaid
Services’ (CMS) rule to cut
Medicaid spending administratively by, among other things,
changing the way that intergovernmental transfers are allowed
and used in lieu of state general
revenues as Medicaid matching
dollars;
• Support Medicare legislation this
year that would (a) prevent physician payment cuts, (b) provide for
cost-based outpatient lab services
for rural hospitals of fewer than
50 beds, (c) maintain independent
labs’ ability to continue billing
Medicare directly for the techni-
cal component of certain physician pathology services provided
to hospitals, (d) improve inpatient and outpatient payment for
small rural hospitals, Medicaredependent hospitals and sole community hospitals, including costbased payment for those with 50
beds or fewer, and (e) ensure
that Critical Access Hospitals
which contract with Medicare
Advantage plans are appropriately
reimbursed;
• Support legislation containing
provisions of Section 651 of the
House’s Children’s Health and
Medicare Protection (CHAMP)
Act of 2007, which would effectively close the whole-hospital
exception to the physician selfreferral rule; and
• Support H.R. 4105, which provides additional time for improvements to be made in CMS’ new
RAC program.
There’s one more thing that the
group from Arkansas emphasized.
A new bill, The Strengthening the
Safety Net Act of 2008, would add
to the Medicaid Disproportionate
Share (DSH) funding of 19 LowDSH states, including Arkansas. If
approved, it could help all the state’s
hospitals.
We made sure that all the
Arkansas lawmakers recognized
how important it could be.
•
A d v o cac y
AHA Rural Hospital Advocacy Agenda
As time for completing work
in the 110th Congress begins to
tick away, the American Hospital
Association (AHA) is making a final
push on a rural healthcare advocacy
agenda that addresses several of the
more challenging issues affecting
the nation’s rural hospitals. Many
of the bills which are part of the
package were introduced during
2007, the first year of the current
Congress.
The rural hospital package
includes the following:
• “The
Craig Thomas Rural
Hospital and Provider Equity
Act,” S. 1605, and the “Health
Care Access and Rural Equity
Act,” H.R. 2860, would reinstate
through the end of this year the
outpatient reimbursement policy
for rural hospitals (with fewer
than 100 beds) and sole community hospitals. The bill would
allow these hospitals’ Medicare
reimbursements to either be costbased or based on the prospective payment system, whichever
amount is greater.
It would also continue to
allow independent laboratories
to directly bill Medicare for the
technical component of physician pathology tests and reinstate
cost-based reimbursements to
Critical Access Hospitals (CAH)
for referral lab services that are
provided off hospital property.
In addition, the proposed legislation would extend a five percent Medicare payment increase
for home health services provided
in rural areas; increase payments
to hospitals that treat a disproportionately large number of
Medicare and Medicaid patients;
adjust payments to rural hospitals that have fewer than 2,000
annual patient discharges and are
located more than 15 miles from
another hospital; and improve
payments for ambulance services
in rural areas.
• “The 340B Program Improvement
and Integrity Act,” H.R. 206,
would allow CAHs, sole community and Medicare-dependent
hospitals to purchase inpatient
and outpatient pharmaceuticals
at significantly reduced rates,
a benefit they do not currently
enjoy because they did not receive
Medicare DSH hospital payments
under the inpatient PPS.
• “The Rural Health Services
Preservation Act,” S. 630/H.R.
2159, would require Medicare
Advantage plans to pay CAHs
at least 101 percent of costs for
inpatient and outpatient services.
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• “The Critical Access Hospital
Flexibility Act,” S. 1595, would
modify the CAH program’s
requirement of a 25 patient bed
limit and would allow CAHs to
choose to meet either the 25-bedper-day limit or a limit of 20-bedsper-day averaged throughout the
year.
• “The Critical Access to Clinical
Lab Services Act,” S. 1277, would
reinstate cost-based reimbursements
to CAHs for lab services provided
outside of hospital property.
• “The Sole Community Hospital
Preservation Act,” S. 2381/H.R.
1177, would include “hold harmless” protection to help ensure
adequate Medicare outpatient
reimbursement to sole community
hospitals.
• “The Medicare Rural Health Access
Improvement Act,” S. 2786, would
provide a cost- based reimbursement option for sole community
and Medicare-dependent hospitals,
adjust payments to rural hospitals that have fewer than 2,000
annual patient discharges and are
more than 15 miles from another
hospital, and increase payments to
hospitals treating a disproportionately large number of Medicare and
Medicaid patients.
•
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Summer 2008 I Arkansas Hospitals
41
M edica r e / M edicaid
AHA Part of Federal Suit Against CMS
Over Medicaid Payment Rules
In March 2008, the American
Hospital Association, National
Association of Public Hospitals and
Health Systems and Association of
American Medical Colleges joined
with the Alameda County Medical
Center to file a suit asking a federal
court to prevent the Bush administration from implementing a Medicaid
regulation that would cut some $5
billion from federal Medicaid spending over a five-year period. The suit,
which was filed in the U.S. District
Court for the District of Columbia,
sought rejection of the regulation,
charging that CMS overstepped its
authority and improperly issued the
rule.
The regulation, which affects several state Medicaid payment issues
and carries the potential to directly
impact Arkansas Medicaid hospital
payments by $75 million-$100 million annually, was proposed in early
2007. Despite Congress’ wishes, the
Centers for Medicare & Medicaid
Services (CMS) moved forward to
finalize it. Congress intervened May
25, 2007, and imposed a one-year
moratorium that kept CMS from
issuing a final rule. Nevertheless,
CMS went ahead and issued the rule
in final form the same day.
On May 19, 2008, Federal District
Court Judge James Robertson ruled in
favor of the plaintiffs, saying that the
Department of Health and Human
Services did violate the moratorium
by issuing the Medicaid rule. In
his decision, Judge Robertson found
that HHS violated the moratorium
in three ways: first, it sent a notification to the House and Senate stating
that it had placed the rule on display
on May 25, 2007, the same day
Congress enacted the moratorium
prohibiting that very thing; second,
it called for and received comments
on the rule within the moratorium
period; and third, it failed to withdraw the rule from Federal Register
publication. He ordered the rule
vacated and remanded the matter to
the agency, which could reissue the
regulation, subject to the full federal
rulemaking process.
America’s hospitals are also
attempting to get a legislative reso-
lution to the matter. That was a
key advocacy issue when the group
of Arkansas hospital officials visited with members of the state’s
congressional delegation during the
American Hospital Association’s
spring meeting in Washington, D.C.
Their message was that the moratorium prohibiting CMS’ implementation of the rule should be
extended.
In April, Arkansas’ four U.S.
Congressmen joined with 345 other
House members to pass H.R. 5613,
legislation containing provisions
to delay implementation of seven
new Medicaid regulations, including the rule affected by the moratorium. A similar Senate bill passed in
May with the support of Arkansas
Senators Blanche Lincoln and Mark
Pryor. Under the bills, the moratorium on the rule causing the lawsuit
as well as several other pending
Medicaid rules would be in place
until April 1, 2009. The two bills
must be reconciled into one before
going to the President, who has
threatened a veto.
•
CMS Proposal Tightens MA Standards
On May 8, CMS proposed
new, tighter market standards for
the Medicare Advantage (MA)
and Part D prescription drug programs in order to increase protections for beneficiaries. Specific
proposals include a prohibition on
cold-calling; cross-selling of nonhealthcare-related products to
prospective MA or Part D enrollees; sales activities at educational
events and certain other areas;
and an expansion of the current
42
Summer 2008 I Arkansas Hospitals
prohibition on door-to-door solicitation to cover other unsolicited
circumstances.
In addition, CMS’ proposal
would limit the value and type
of promotional items offered to
potential enrollees.
Under the proposed rule, CMS
could fine plans up to $25,000 for
violations for each enrollee affected, or likely to be affected, by the
violation. The rule also would
streamline eligibility determina-
tions for extra help to low-income
beneficiaries, limit beneficiary liability and add new protections
for beneficiaries enrolled in special needs plans. CMS will accept
comments on the proposed rule
through July 15.
Click on http://www.cms.
hhs.gov/HealthPlansGenInfo/ to
review the proposal. Find CMS’
May 8 press release at http://
www.cms.hhs.gov/apps/media/
press/release.asp.
•
M edica r e / M edicaid
Medicare SNF, LTCH Rule Changes
Quick on the heels of its proposed
rules covering acute care and rehabilitation care Medicare prospective
payment system (PPS) changes for
FY 2009, the Centers for Medicare
& Medicaid Services (CMS) recently
released two new sets of proposals affecting healthcare providers for
their next rate year.
America’s nursing homes would
sustain significant cuts under CMS’
proposed rule covering the Medicare
Skilled Nursing Facility (SNF) prospective payment program for FY
2009. CMS asserts that the cuts are
necessary to adjust for more-thanexpected service utilization following refinements made in FY 2006 to
the case-mix indices.
In the proposed SNF rule, CMS
also seeks to recalibrate payments
for non-therapy ancillary services.
It estimates that the fiscal impact
of these two changes would cut SNF
payments in FY 2009 by 3.3 percent
($770 million). This reduction largely would be offset by the proposed
SNF market basket update of 3.1
percent, resulting in a net reduction
of 0.3 percent ($60 million) from
this year’s payments.
The comment period on the proposed rule ran through June 30.
In addition, CMS released an
interim final rule with comment
period on several changes to the
long-term care hospital (LTCH) prospective payment system that were
mandated by Congress in the 2007
Medicare, Medicaid and SCHIP
Extension Act (MMSEA), which
authorized key LTCH provisions,
including a three-year moratorium
on new facilities and beds and three
years of regulatory relief on the socalled “25% Rule” and short-stay
outliers.
The MMSEA raised the 25%
Rule thresholds to allow a larger
percentage of LTCH referrals from
host hospitals and prevents the rule
from being applied to freestanding
LTCHs. The interim final rule took
effect June 5; however, CMS will
accept comments on the rule through
July 7.
CMS is expected to issue a separate rate year 2009 LTCH PPS final
rule.
More information on the two rule
changes is available on the CMS Web
site at http://www.cms.hhs.gov/apps/
media/press/factsheet.asp?Counter=3
077&intNumPerPage=10&checkDa
te=&checkKey=&srchType=1&num
Days=3500&srchOpt=0&srchData=
&srchOpt=0&srchData=&keyword
Type=All&chkNewsType=6&intPag
e=&showAll=&pYear=&year=&des
c=&cboOrder=date.
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Summer 2008 I Arkansas Hospitals
43
M edica r e / M edicaid
Access HAC, POA Information Online
The Centers for Medicare &
Medicaid Services (CMS) has
recently updated all Web pages of
the Hospital-Acquired Conditions
(HAC) & Present on Admission
(POA) Indicator Reporting section
to reflect considerations in CMS’
Inpatient Prospective Payment
System (IPPS) Fiscal Year (FY) 2009
Proposed Rule.
The HAC & POA Indicator
information is available at
http://www.cms.hhs.gov/
HospitalAcqCond/ on the CMS
Web site.
•
Acute Care Episode Demonstration Project
Announced by CMS
CMS has announced a new demonstration for hospitals to test the
use of a bundled payment for both
hospital and physician services.
The demonstration is specific for a
select set of episodes of care and is
designed to improve the quality of
care delivered through Medicare feefor-service.
According to the CMS announce-
44
Summer 2008 I Arkansas Hospitals
ment, the goal of the Acute Care
Episode (ACE) demonstration is to
use a global payment to better align
the incentives for both types of providers, leading to better quality and
greater efficiency in the care that is
delivered.
The demonstration will also test
the effect that transparent price and
quality information has on benefi-
ciary choice and provider referrals
for select inpatient care.
For more information, click
on the project and selection criteria, go to http://www.cms.hhs.gov/
DemoProjectsEvalRpts/MD/itemdetail.asp?filterType=none&filterByDI
D=99&sortByDID=3&sortOrder=de
scending&itemID=CMS1204388&in
tNumPerPage=10.
•
E me r genc y P r epa r edness
Hospital Evacuation Template Available;
Deadline for Evacuation Draft is August 1
The
Arkansas
Hospital
Standards and Recommendations
Committee approved May 6 an
evacuation template for hospitals to define procedures to protect the life and safety of both
patients and staff in the event of
a hazard that causes the facility
to decide whether to shelter-inplace or evacuate.
The document has been forwarded to each hospital participating in the Hospital
Preparedness Program grants
through the Arkansas Department
of Health (ADH).
Each hospital is expected to
prepare and submit a draft of its
policy, using the new template,
to Chris White at the ADH by
August 1.
The template also appears on
the AHA’s Web site, www.arkhospitals.org, under the “disaster readiness” tab. If you have
questions about the template,
please contact Kathy Blackman
at St. Bernards Medical Center
at kblackman@sbrmc.org or
Cathy Flanagin at cathy.flanagin@arkansas.gov.
•
Health
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1
Booneville Hospital
Evacuates Patients – Twice!
Booneville Community Hospital
(BCH) became the second Arkansas
Critical Access Hospital (CAH)
in as many months to evacuate
patients in response to a disaster following an explosion on the
afternoon of March 23 at Cargill
Meat Solutions, a local meat processing plant.
In fact, BCH executed two evacuations over a two-day period.
The initial move took place
Easter Sunday after a welder performing routine maintenance in the
plant accidentally started a fire that
eventually caused several explosions. That resulted in the evacuation of 12 hospital inpatients,
10 of whom were transferred to
Mercy Hospital of Scott County in
Waldron. Two other patients were
discharged to their homes.
By Monday morning, the 10
patients who had been sent to the
Waldron hospital were being cared
for once more at BCH. However,
that afternoon they were evacuated again due to a potential leak
from an ammonia tank inside the
burned-out plant. As of Tuesday,
all patients returned to BCH.
Hospital CEO Dzaidi Daud
reported no issues related to the
evacuation and transfer of the
patients.
Earlier in the year, patients at
Stone County Medical Center in
Mountain View, also a CAH, were
evacuated after a February 5 tornado tore through the community
causing substantial damage to the
facility.
Both occasions underscore
the attention to detail that hospitals across the state have given in
the development of their disaster
response plans over the past few
years and the paramount importance of conducting local and
regional drills to employ those
plans to ensure they work as they
should, when needed.
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Summer 2008 I Arkansas Hospitals
45
EMErGENCy PrEPArEDNESS
New resource Addresses
Financial operations During Disasters
Pandemic Binders 5/2/08 9:47 AM Page 4
accessing the Web site (below) and
downloading the materials.
In addition, NJHA has been
holding meetings with state regulators, health plans and Centers for
Medicare & Medicaid Services officials to discuss specific plans and
protocols that will be implemented
to ensure continuity of payments to
healthcare providers. While focusing on external agencies and payers,
hospitals must also concentrate on
efforts within their own facility to
prepare for any disaster that may
occur.
Previously released modules
include Supplies, Logistics and
Support Services, Communications
and Human Resources. As with all
of the modules, the Finance Planning
and Assessment Tool is available on
the NJHA Web site at http://www.
panfluplanning.com.
uplanning.co
Perhaps the greatest challenge
hospitals face during a natural or
manmade disaster is maintaining
cash flow. Whether it’s a flood or a
pandemic, it is critical that hospitals
continue to receive funds to facilitate payment to staff and suppliers
and cover other services such an
insurance and benefits.
This process can be far more
challenging than simply requesting
a cash advance from a bank or
payer. To assist hospitals, the New
Jersey Hospital Association (NJHA)
has released the fourth module of
its Pandemic Preparedness initiative,
Planning Today for a Pandemic
Tomorrow. The module is a comprehensive collection of checklists to
help guide facilities in maintaining
continuity of financial operations.
This module and others are available to Arkansas hospitals simply by
•
Final review for Draft NiMS Document is Underway
The Department of Homeland
Security’s (DHS) Federal Emergency
Management Agency (FEMA) is coordinating a final review of the National
Incident Management System (NIMS)
in conjunction with the recent release
of the National Response Framework
(NRF).
During 2006 and 2007, the NIMS
document was revised to reflect the
need for preparedness before response
and to eliminate the perception that
NIMS is only the Incident Command
System (ICS). Changes also expanded the Preparedness and Resource
Management components and clarified the concepts within Command
and Management, including multi46
Summer 2008 I Arkansas Hospitals
agency coordination and public information.
After the conclusion of the 2007
comment periods, further review of the
NIMS document was postponed while
the revision of the National Response
Plan (now known as the National
Response Framework) was undertaken. Minor changes made at that time
involved language changes in the NRF,
but they did not significantly alter the
2007 draft version of the document.
Since the NRF has now been
released, the NIMS was to undergo
one final national comment period,
May 1-June 2, 2008. Because hospitals
are essential to ensuring that the nation
can effectively and efficiently prepare
for, prevent, respond to, recover from
and mitigate the effects of any type of
incident, they were encouraged to be a
part of this review process.
The draft NIMS document is available online at www.regulations.gov. All
comment submissions will be posted,
without change, to the Federal eRulemaking Portal at http://www.regulations.gov.
The direct link to the site for the
Draft NIMS Regulation and Comment
Form is: http://www.regulations.gov/
fdmspublic/component/main?main=Do
cketDetail&d=FEMA-2008-0008.
Questions regarding the revised
NIMS document should be directed to
Andrew Slaten at (202) 646-8152.
•
E me r genc y P r epa r edness
NIMS Implementation Objectives
for Healthcare Organizations
The Incident Management Systems
Integration (IMSI) Division, formerly the
NIMS Integration Center, in collaboration with the Department of Health
and Human Services (HHS), is pleased
to announce the release of the FY 2008
NIMS Implementation Objectives for
Healthcare Organizations.
On September 16, 2006, IMSI released
the FY 2007 NIMS Implementation
Activities for Hospitals and Healthcare
Systems, which were made up of 17
objectives (activities), of which, four
were required to be eligible for FY 2007
Assistant Secretary for Preparedness and
Response (ASPR) funding by HHS.
IMSI and HHS have received many
comments and suggestions regarding the
17 objectives. As a result, a healthcare
working group – composed of federal,
state, local, and private sector stakeholders – was stood up to further define the
objectives.
From the existing objectives, the
stakeholders identified 14 activities for
FY 2008 and clarified language to ensure
the 14 objectives are most applicable to
healthcare organizations. These implementation objectives are intended for all
hospitals regardless of size, location, or
financial support.
As with the FY 2007 NIMS
Implementation Activities for Hospital
and Healthcare Systems, FEMA continues to strive toward a cohesive working relationship between hospitals and
their respective local government, public
health, and other emergency management and response agencies. Healthcare
organizations are strongly encouraged to
coordinate with local public health agencies to work through these implementation activities.
The ASPR Program, administered
through state Departments of Health,
has clearly outlined the components
that healthcare organizations are
required to meet during the FY 2008
funding cycle. Developing a relationship with local public health and
other emergency management agen-
cies enables hospitals and healthcare systems to gain further insight
regarding the availability of training
as well as capabilities (equipment
and procedures) provided by local
agencies.
The 14 NIMS Implementation
Objectives for Healthcare Organizations
are as follows:
Adoption
− Adoption of NIMS
− Federal Preparedness Awards
Preparedness Planning
− Revise and Update Plans
− Mutual-Aid Agreements
Preparedness Training and Exercises
− IS 700 NIMS, ICS 100 and 200
− IS 800B NRF (National Response
Framework)
− Training and Exercises
Communication and Information
Management
− Interoperability incorporated into
Acquisition Programs
− Standard and Consistent
Terminology
− Collect and Distribute Information
Command and Management
− Incident Command System (ICS)
− Include Incident Action Planning
and Common Communication
Plans
− Adopt Public Information principles
− Public Information can be gathered, verified, coordinated and
disseminated
Questions and comments can be
directed to the Incident Management
Systems Integration Division at: FEMANIMS@dhs.gov or 202-646-4390.
There is no requirement for healthcare personnel who have completed
IS-800A/B – National Response Plan
to also complete IS-800.B – National
Response Framework. It is suggest-
ed that healthcare personnel complete IS-800.B – National Response
Framework in order to be informed of
current information regarding response
for all levels of government as well as the
private sector. It is the decision of the
healthcare organization’s administration
to issue this requirement to staff
Note: There is no requirement for
healthcare personnel who have completed IS-800A/B – National Response
Plan to also complete IS-800.B –
National Response Framework. It is
suggested that healthcare personnel
complete IS-800.B – National Response
Framework in order to be informed of
current information regarding response
for all levels of government as well as the
private sector. It is the decision of the
healthcare organization’s administration
to issue this requirement to staff.
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Summer 2008 I Arkansas Hospitals
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Q ua l it y
AHA Supports Wristband Safety Project
At its March 14th meeting, the
Arkansas Hospital Association’s
(AHA) Board approved a statewide
wristband standardization quality
and patient safety initiative. Under
this initiative, participating hospitals that use color-coded wristbands
will agree to standardize the colors
used.
PURPLE wristbands will be
used for DNR, RED for allergy and
YELLOW for fall risk.
The AHA will not advocate that
hospitals start to use color-coded
wristbands if they do not already
use them, but those facilities that
use wristbands will be encouraged
to use the standard colors.
The impetus for this type of
project was an advisory issued by
the Pennsylvania Patient Safety
Authority, which arose out of a
“near miss” report in which clinicians almost failed to resuscitate a
patient who was incorrectly designated as a “DNR” because the
nurse had unknowingly placed a
yellow wristband on the patient.
In that hospital, the color yellow
signified “DNR,” but the nurse also
worked at another hospital in which
the color yellow signified “restricted
extremity” not to be used for phlebotomy or IV access.
A consortium of hospitals from
Pennsylvania decided to join together to reduce the risks associated
with the use of colored wristbands
by standardizing the meaning of the
colors, limiting the number of colors to avoid confusion, embossing
the bands to reinforce the message
conveyed, and removing or covering “charity” colored wristbands so
that they are not misinterpreted as
hospital alert bands.
At least 20 state hospital associations have begun similar projects,
including Kansas and Missouri. Both
Texas and Alabama are in the planning stages for their own wristband
standardization initiatives.
All states are using the same
three colors, although a few states
have added two more – GREEN for
latex allergy and PINK for restricted
extremity.
The AHA has begun developing toolkits, educational materials,
seminars and other resources for its
members and will work with a vendor that has sponsored initiatives of
this type in other states.
•
Arkansas Hospitals’ 5 Million Lives Campaign
Participation Reaches 100 Percent
A little more than a year ago, a
handful of Arkansas hospitals joined
in a meeting to officially kick off the
state’s participation in the Institute
for Healthcare Improvement’s (IHI)
5 Million Lives Campaign. At the
time, an optimistic goal was to
have up to 50 percent of the state’s
acute care hospitals sign up for the
national program, which is aimed at
protecting patients from five million
incidents of injury and harm related
to medical care over a two-year
period ending December 31, 2008.
This spring, the Arkansas
Hospital Association, a co-sponsor
of the campaign in Arkansas, along
with the Arkansas Foundation for
Medical Care (AFMC), received
word that 100 percent of the state’s
short-term acute care hospitals have
enrolled.
Hospitals choosing to participate
in the campaign are asked to voluntarily:
48
Summer 2008 I Arkansas Hospitals
• Deploy Rapid Response Teams…
•
•
•
•
•
•
at the first sign of patient
decline;
Deliver Reliable, Evidence-Based
Care for Acute Myocardial
Infarction…to prevent deaths
from heart attack;
Prevent Adverse Drug Events
(ADEs)…by implementing medication reconciliation;
Prevent Central Line Infections…
by implementing a series of interdependent, scientifically grounded steps;
Prevent Surgical Site Infections…
by reliably delivering the correct
perioperative antibiotics at the
proper time;
Prevent Ventilator-Associated
Pneumonia…by implementing a
series of inter-dependent, scientifically grounded steps;
Prevent Pressure Ulcers...by reliably using science-based guidelines for their prevention;
• Reduce
•
•
•
•
Methicillin-Resistant
Staphylococcus aureus (MRSA)
Infection…by reliably implementing scientifically proven infection
control practices;
Prevent Harm from High-Alert
Medications...starting with a
focus on anticoagulants, sedatives, narcotics, and insulin;
Reduce Surgical Complications...
by reliably implementing all of the
changes in care recommended by
the Surgical Care Improvement
Project (SCIP);
Deliver Reliable, EvidenceBased Care for Congestive Heart
Failure…to reduce readmissions;
and
Get Boards on Board…by defining and spreading the best known
leveraged processes for hospital
Boards of Directors so that they
can become far more effective in
accelerating organizational progress toward safe care.
•
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Make Security Awareness
a Top Priority
Securitas Security Services USA is committed to the advancement of security in the healthcare industry. This commitment is demonstrated through
our sponsorship of and participation in various national research initiatives,
professional association and industry task forces, and by the effective security solutions we deliver to healthcare institutions nationwide each day.
We offer a collaborative, proactive approach to maintaining a
safe and secure environment at hospitals and other healthcare institutions. Part of our overall security
plan includes promoting a state of security awareness for all employees in your organization. Incidents
occur every day, whether it’s a building fire, a break-in, a suspicious package, or a medical emergency.
What saves lives and property is pre-planning, teamwork and an attitude of security awareness.
Security awareness is a specific state of mind that affects everyday attitudes and behaviors — that
awareness can help reduce security risks. Watching out for suspicious people and caring for one’s personal belongings pay off – thefts of car keys, house keys, purses, wallets, laptops and cell phones from
workplaces lead thieves to valuable information about the owners’ identities and provide opportunities
to make fraudulent purchases.
As security professionals, it is always our goal to help prevent emergency situations through focused observation and reporting, and ongoing
security awareness training programs. But not being able to be in all places at all times means that any security program needs the eyes and ears
of all workplace employees as well.
Here are a few tips for improving security awareness at your healthcare facility:
1. Appoint a safety committee, including supervisors and security personnel, and encourage participation.
2. Establish clear lines of authority for both major and minor emergencies.
3. Hold frequent practice drills and review regularly the facility’s emergency response plans.
4. Send out periodic security and safety reminders, either through a periodic newsletter or email.
5. If possible, empower employees to correct minor hazards themselves, and to report any major hazard
immediately.
6. If you spot a stranger in a secure area, look for a visitor’s access badge. Don’t assume he or she has permission to be there.
7. Don’t leave important paperwork, cell phones, or data storage media on your desk overnight – store these
items away and out of sight.
8. Make sure all company documents are shredded or otherwise disposed of in a secure manner as directed by
the company.
9. Discuss company business only with appropriate people and avoid such
discussions in public places, such as restaurants and elevators, where you
may be easily overheard. That includes cell phone conversations.
10. Don’t leave personal items – or company property – in a parked car,
whether in plain sight or not.
Q ua l it y
by Pam Brown, RN, BSN, CPHQ, and Carl Abraham, MD
MRSA in the Hospital Setting:
Prevention is the Best Cure
Methicillin-resistant
Staphylococcus aureus (MRSA) is
not new – it actually emerged in the
1960s. But its presence has been on
the rise in recent years, and providers
have become increasingly aware
of the threat that it poses both in
hospitals and in the community.
MRSA occurs in a variety
of healthcare settings, including
hospitals and long-term care
facilities. More than 60 percent of
MRSA infections in hospitals can
be found in the intensive care units,
although infected patients can be
found throughout hospitals. As with
other nosocomial infections, patients
with MRSA usually experience an
increased length of stay and higher
costs, which potentially increase a
patient’s stress while in a hospital.
Higher mortality rates are also seen
in patients with MRSA.
Take preventive measures
Providers have a responsibility
to minimize each patient’s risk of
exposure to MRSA when he or
she enters a healthcare setting.
Prevention is the best line of defense.
This theme is emphasized by
organizations including the Centers
for Disease Control and Prevention,
the Arkansas Department of Health
and the Infectious Disease Society
of America, all of which strive to
communicate the importance of
MRSA management, as well as its
prevalence in the United States.
The Institute for Healthcare
Improvement uses its 5 Million Lives
Campaign to focus on five strategies
that follow the key recommendation
of these organizations as a means of
reducing occurrences of MRSA in
50
Summer 2008 I Arkansas Hospitals
healthcare facilities:
• Proper hand hygiene
• Appropriate cleaning of equipment
and patient care areas
• Active patient surveillance
• Contact precautions
• Proper management of medical
devices
First and foremost, healthcare
providers must adhere to proper
hand hygiene. This is the simplest
strategy to prevent the spread of
infection; however, multiple studies
show that compliance is still as
low as 50 percent in some settings.
The emergence of alcohol-based
solutions in healthcare settings,
along with traditional soap and
water, make hand hygiene even more
effective than in the past. To improve
compliance, hand hygiene supplies
should be placed in locations that
are easily accessible to all healthcare
providers. As further means to
improve compliance, many settings
now request that patients and
families ask their providers about
hand hygiene as part of the culture of
prevention.
A second key factor for reducing
MRSA in the healthcare environment
is to ensure that supplies and patient
care areas are cleaned appropriately.
A room where a patient with MRSA
has stayed is cleaned according to
specific protocols. However, what is
often overlooked is that healthcare
providers themselves can easily carry
the MRSA bacteria on their own
equipment. Personal stethoscopes are
probably one of the most common
means of transmitting MRSA and
should be cleaned carefully. Other
items to consider are personal pagers
and other electronic devices. Many
hospitals have dedicated items for
MRSA patients so that they are not
carried from room to room.
A third strategy is to implement
active surveillance to identify those
patients who have been colonized,
since they could be a source of
transmission. Questions to ask before
HOSPITAL STRATEGIES TO
REDUCE MRSA
• Proper hand hygiene: Place supplies in easily accessible locations.
• Appropriate cleaning of equipment and patient care areas: Check
stethoscopes, pagers and other electronic devices.
• Active patient surveillance: Identify all colonized patients.
• Contact precautions: Maintain as
much isolation as possible.
• Proper management of medical devices: Reduce patient’s number of
device days.
implementing active surveillance
include: 1) Should it be done only in
high risk areas such as intensive care?
2) What actions should be taken until
the results of surveillance are in? and
3) How do you reassure the patient
who did not come in for MRSA
treatment but is now in isolation
because the surveillance showed
colonization? Special attention should
be given to the nursing home resident
who is admitted to the hospital and
subsequently identified as having
MRSA. This resident may encounter
difficulties upon returning to the
nursing home after being released
from the hospital, depending on the
nursing home’s policies regarding
MRSA.
Q ua l it y
Contact precautions, though not
uncommon to hospital providers,
are an essential fourth strategy.
Gowns and gloves must be available
at the point of care. Appropriate
communication via patient records
and signage is important and should be
included in the hospital’s compliance
policy. If possible, contact isolation
should be maintained through use of
private rooms, although this may be
a challenge for hospitals that have a
limited availability of private rooms.
Providers must be aware that contact
precautions become more difficult
when patients leave their rooms for
diagnostic studies, therapies or other
reasons.
The final strategy to help reduce
the risk of MRSA is to ensure proper
management of devices such as central
lines, ventilators and urinary catheters.
For example, instead of using central
lines, BiPAP or CPAP may be used
to avoid device infection. Providers
should focus on reducing the number
of device days a patient experiences.
Hospitals that participated in the
Institute for Healthcare Improvement’s
100,000 Lives Campaign and focused
on interventions related to central
line and ventilator “bundles of best
practices” saw remarkable reductions
in infection rates from all organisms.
Minimize the risk
Healthcare providers can make
the largest impact on the prevalence
of MRSA in the healthcare setting
by engaging in strategies that reduce
or prevent the spread of infection.
Empiric treatment is a given for the
patients with known MRSA, but
minimizing the risk to others in the
healthcare environment is essential.
By focusing on these five strategies,
providers have the potential to create
a safer environment for the patients
entrusted to them.
References
1.
Kleven RM, et al. Invasive
methicillin-resistant Staphylococcus
aureus infections in the United
States. JAMA 298: 1763-1771, Oct
17, 2007.
2. Griffin FA. Reducing methicillinresistant Staphylococcus aureus (MRSA)
infections. The Joint Commission
Journal on Quality and Patient Safety
33(12): 726-731, Dec. 2007.
3. Institute for Healthcare
Improvement Web site: www.ihi.
org/IHI/Programs/Campaign/
MRSAInfection.htm.
Submitted by the Arkansas
Foundation for Medical Care. This article
was previously published in the Journal
of the Arkansas Medical Society.
•
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Summer 2008 I Arkansas Hospitals
51
Hospital CEO Turnover Rate
Remaining Stable
The 2007 hospital chief executive turnover rate was 15 percent,
a rate that falls within the 14
percent-16 percent turnover rate
recorded in the past five years,
according to a new report from the
American College of Healthcare
Executives.
The report annually tracks rates
of CEO turnover, including executives who left for reasons of retirement, resignation or firing.
•
Parity Bill Touches Specialty Hospitals
In a March 5 vote, the House
approved the Paul Wellstone Mental
Health and Addiction Equity Act
(H.R. 1424). The bill, supported by
the American Hospital Association,
would require group health insurance
plans offering mental health coverage
to provide mental health and substance use disorder benefits on a par
with medical and surgical coverage.
It would require insurers to cover
more conditions than a mental health
parity bill passed in the Senate (S.558)
last September and is opposed by
some business and insurance groups,
even though the legislation applies
only to group health plans already
providing mental health benefits and
exempts plans sponsored by businesses with fewer than 50 employees.
The measure also includes provisions (which actually apply only to
Medicare patients) that would place
a ban on the growth of physicianowned hospitals where the physician investor self-refers. Under the
bill, physician-owned hospitals are
The professional liability and
property protection for your
healthcare facility deserves the
expertise of specialists.
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bZY^XVaegd[Zhh^dcVaa^VW^a^inVcYegdeZginheZX^Va^hih^c
6g`VchVhVcYdcZd[i]ZaVg\Zhi^ci]ZHdji]ZVhi#
DjgXdkZgV\Zh^cXajYZ/
BZY^XVaEgd[Zhh^dcVaA^VW^a^in[dg]dhe^iVah!E=Dh!>E6h!Hjg\Zgn8ZciZgh!8a^c^XhVcYCjgh^c\=dbZh
BZY^XVaEgd[Zhh^dcVaA^VW^a^in[dgE]nh^X^VchVcYHjg\Zdch""VaaheZX^Vai^ZhegdiZXiZY
HeZX^Va^oZYegd\gVbh[dg\gdjeegVXi^XZhl^i]^ccZildg`hVcYVaa^ZY]ZVai]XVgZegd[Zhh^dcVah
=ZVai]8VgZ:ci^in:beadnbZciEgVXi^XZhVcYBVcV\ZY8VgZA^VW^a^in
=ZVai]8VgZDg\Vc^oVi^dc9^gZXidghVcYD[[^XZghVcYVaagZaViZYXdgedgViZVcYeZghdcVacZZYh
AD86A8aV^bh=VcYa^c\·')$,VcYAD86AZmeZgiaZ\VahZgk^XZh
DjgG^h`BVcV\ZbZciVcYXaV^bheZX^Va^hihVgZZmeZgih^cbZY^XVaegd[Zhh^dcVa!
\ZcZgVaa^VW^a^inVcYegdeZginadhhXdcigda#>[ndjVgZhZa["^chjgZY!djgG^h`
BVcV\ZbZcihiV[[XVcegdk^YZhZgk^XZhVheVgid[Vi]^gYeVginVYb^c^higVidg#
8VaaIdb=ZhhZaWZ^c[dgbdgZ^c[dgbVi^dc#*%&"++)",,%*#
RKFL is a sponsored service provider
of the Arkansas Hospital Association
and administrator for the AHA Worker’s
Compensation self Insurance Trust.
rkfl.com
P.O. Box 251510 U Little Rock, Arkansas 72225 U (501) 664-7705
52
Summer 2008 I Arkansas Hospitals
required to submit annual reports
outlining their ownership structure;
physician owners would be limited
to no more than an aggregate 40 percent of the total value of the investment interest in the hospital – or even
an entity whose assets include the
hospital and individual doctor investors could not hold more than a two
percent share in a hospital. On top
of all of that, if such a facility admits
a patient but doesn’t have a doctor
available, it would be required to let
the patient know.
•
President Signs
Genetic Information
Nondiscrimination
Act
In late May, President Bush signed the Genetic
Information Nondiscrimination Act into law. The
legislation, which was supported by an overwhelming number of federal lawmakers as well as healthcare organizations and insurance companies, makes
it illegal for employers and/or insurers to deny coverage to people based upon their genetic makeup.
Supporters of the bill say that it should allay
people’s fears of receiving genetic screening, which
can be used to discover and perhaps help prevent
certain diseases.
•
Media Scrutiny of Hospital Collections:
An Advisory from the American Hospital Association
A series of recent media stories
has once again raised public attention to the issue of hospital billing
and collection practices. With this
renewed media interest, it is more
important than ever that hospitals
redouble their efforts to communicate the work they do to help
patients navigate today’s broken
healthcare system. Every hospital
leader should be aware of these
issues, familiar with their own internal policies and prepared to discuss
them publicly.
As a field, we have discussed
the issues of billing, collections and
charity care and have developed
guidelines and principles, which the
field has widely embraced.
The
American
Hospital
Association’s (AHA) principles and
guidelines can be found at http://
www.aha.org/aha_app/issues/BCC/
index.jsp.
As the economy worsens, we recognize the challenges that hospitals
face when trying to provide for the
entire health needs of a community. We encourage hospital administrative teams and governing board
members to be certain that they
are familiar with the organization’s
policies and procedures, and how to
talk about them with patients, families and the public. You may wish
to review the following:
Hospitals exist to care for
our communities
• Hospitals are open to all patients
24 hours a day, seven days a
week, regardless of their ability to pay. Our job is to make
people better, and that’s what we
do, day in and day out.
• Hospitals provide more than
$31 billion in care for which we
receive no payment.
Hospitals recognize that challenges exist
• Hospitals live with the flaws of
our country’s broken healthcare
system every day. Hospitals treat
everyone who walks through
their doors, asking: “What can
we do to make this person better?” Providing care for less than
cost or no payment at all places
additional financial hardship on
hospitals, hampering their ability to care for the neediest and
to provide the around-the-clock
services their communities expect
and deserve.
• With the rise of “bare-bones”
health insurance plans, insurers
are pushing more of the financial
burden onto patients. Hospitals
are often left with the responsibility of explaining to the individual
what their health plan covers and
the extent of their financial obligation, as well as working with
them to meet it. Many people,
understandably, are uncomfortable asking for help. Hospitals
understand that and want to work
with each person individually.
• All of this is a reflection of a
patchwork system that no longer
works for patients and caregivers.
We need a complete overhaul of
healthcare in America. As organizations that see up close the
inadequacies of today’s system,
hospitals want to be part of the
solution to improve health and
healthcare in America, and they
stand ready to make that a reality.
• Hospitals are taking a variety of
steps to help address the problem
and better serve uninsured and
underinsured patients.
• In the absence of coverage for all,
hospitals must both serve and survive. Providing the patients and
communities we serve with safe,
high-quality healthcare is our top
priority.
• Non-emergency care, especially
for those who are uninsured or
who have inadequate coverage for
today’s medical costs, is a complicated issue that hospitals try to
handle in a fair and responsible
way based on the individual’s
needs and the hospital’s mission.
By talking with patients early in
the course of their care, hospitals are better able to help them
understand their coverage, and
any gaps in it, and what financial
assistance is available if they need
and qualify for it.
• Hospitals understand that not
everyone can pay their bill. To
better serve our patients, hospitals have implemented a variety
of policies and recommendations
to help those unable to pay their
bills. Actions hospitals are undertaking include:
◊Providing patients with pay-
ment information in clear,
easy-to-understand language;
◊Checking public assistance or
charity care programs to see if
a patient qualifies;
◊Informing patients promptly
about the charge for any item
or service provided;
◊Offering financial assistance to
under- and uninsured patients
when possible; and
◊Reviewing the practices of any
debt collection agency used by
the hospital to ensure that they
treat patients with dignity and
respect.
•
Summer 2008 I Arkansas Hospitals
53
Drug Recall Notice on Doxil,
Procrit and Remicade
The
Arkansas
Department
of Health has asked the Arkansas
Hospital Association to assist in notifying the state’s hospitals about a recall
of drugs related to a theft from JOM
Pharmaceutical Services, Inc. (JOM),
a service coordinator that provides
delivery services and customer support
to Centocor, Inc. and Ortho Biotech,
L.P.
On May 6, 2008, a transport trailer
carrying DOXIL(R) (doxorubicin HCl
liposome injection), PROCRIT(R)
(epoetin alfa) and REMICADE(R)
(infliximab) was stolen while the driver
was traveling from a distribution center in Kentucky to a specialty distributor. This incident has been reported
to local and federal law enforcement
offices, as well as the U.S. Food and
Drug Administration; however, the
transport trailer and product have not
yet been recovered.
To ensure patient safety, Centocor
and Ortho Biotech are voluntarily withdrawing products with lot numbers
matching those of the stolen product
from the market and communicating
this action to all authorized distributors
and all prescribing physicians, healthcare providers and patients. If the stolen
product were to be reintroduced into
distribution channels, the companies
cannot guarantee that products were
stored at appropriate temperatures, nor
can the companies guarantee the products were not damaged.
On May 7, 2008, JOM discon-
tinued shipment of products with lot
numbers matching those of the stolen product. Healthcare providers and
patients that received product shipped
from an authorized distributor on or
before this date should consider the
product safe for use. Healthcare providers and patients that are concerned
about products shipped after that date
with the affected NDC and lot numbers
can return the product by contacting
the companies at (888) 626-5660.
For detailed information regarding NDC and affected lot numbers
for the product, go to http://www.
prnewswire.com/news/index_mail.
shtml?ACCT=104&STORY=/
w w w / s t o r y / 0 5 - 1 5 2008/0004814740&EDATE.
•
Country Doctor of the Year
Nominations Being Accepted
Staff Care, Inc., a healthcare staffing
firm based in Irving, Texas, is accepting nominations for the 2008 Country
Doctor of the Year. The award honors the spirit, skill and dedication of
America’s rural medical practitioners.
Now in its 16th year, the Country
Doctor of the Year Award has been
presented to renowned rural physicians
such as Dr. Claire Louise Caudill (now
deceased), a legendary Kentucky physician who delivered more than 10,000
babies in her career; Dr. Elton Lehman,
of Mount Eaton, Ohio, known for his
unique treatment of Amish patients; and
Dr. David Nichols, who personally flies
his helicopter to remote Tangier Island
to care for its isolated population. Last
year’s recipient was Dr. Hiram T. Ward
of Murfreesboro, Arkansas.
In addition to a plaque honoring an
outstanding country doctor, Staff Care,
Inc. will provide the Country Doctor
of the Year with a “fill-in” physician
for two weeks at no charge, so the
award recipient can take time away
from his or her practice, a service valued
at $10,000.
Nominations for the award will be
accepted for physicians who practice in
communities of 20,000 or less and who
are engaged in such “primary care”
areas as general practice, family practice, internal medicine and pediatrics.
Nomination forms can be downloaded
from the Country Doctor of the Year
Award Web site at www.countrydoctoraward.com, or you may contact Staff
Care, Inc. for a nomination form at
(800) 685-2272. Completed nominations must be received no later than
September 15, 2008.
•
Our Advertisers, Our Friends
AHA Services.............................................................9
Arkansas Blue Cross Blue Shield................................2
Arkansas Foundation for Medical Care.....................13
Benefit Management Systems, Inc..........................45
Crews & Associates.................................................51
Dr. Suzanne Yee......................................................47
54
Summer 2008 I Arkansas Hospitals
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Hizware....................................................................23
Hughes, Welch & Milligan........................................44
Nabholz Construction...............................................56
Ramsey, Krug, Farrell & Lensing...............................52
Securitas..............................................................5, 49
St. Vincent Rehab Hospital........................................6
Staffcare..................................................................55
Supna Healthcare....................................................15
Teletouch Paging.....................................................33
TME, Inc..................................................................43
U.S. Foods...............................................................41
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