Care with Compassion Top-Down Union Organizing in Health Care 2007 by pengxiuhui

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									FALL 2007

                       Care with Compassion
                         Top-Down Union
                 Organizing in Health Care
                       2007 Diamond Award
                        Winners Announced

                                                                                                                                  PAGE   16      PAGE    33

PAGE   8                                                    PAGE           12

 Arkansas Hospitals                                     12 Care with Compassion
                                                        16 Top-Down Union Organizing in Healthcare
                     is published by
    Arkansas Hospital Association                       32 2007 Diamond Award Winners Announced
 419 Natural Resources Drive • Little Rock, AR 72205
         501-224-7878 / FAX 501-224-0519
                          CEO Profile                                                                       Quality
                                                        8     Leading Change in Tenuous Times                                            42 Risk Management/Patient Safety Publication
                 Beth H. Ingram, Editor
                                                                                                                                         42 Aerosol Hand-Rub Dispenser Okayed
            BOARD OF DIRECTORS                          Medicare/Medicaid                                                                42 Hospital Mortality Data is Posted
        Robert Atkinson, Pine Bluff / Chairman
                                                        36 Arkansas Medicaid NPI Deadline                                                43 AFMC Named Community Leader
       Ray Montgomery, Searcy / Chairman-Elect
                                                        36 Tamper-Resistant RX Pads Required                                             43 HQA Adopts Outpatient Quality Indicators
           Luther Lewis, El Dorado / Treasurer
       Timothy E. Hill, Harrison / Past-Chairman        36 New Plans Proposed to Address Fraud and Abuse                                 44 Study Reveals Climbing MRSA Rates
             Kirk Reamey, Ozark / At-Large
                                                        37 Legal Note: Seclusion and Restraint                                           44 CDC Infection Prevention Guidlines Revised
                 David Cicero, Camden
                                                        38 Seven Medicare Part C Vendors Suspend Selling                                 44 FDA Notice Concerns Propofol
                 Les Frensley, Batesville
              Richard Goddard, Monticello
                                                        38 Proposed 2008 Physician Fees: Expect a Drop
                Peg Kuhnly, Hot Springs                 38 Notice of Discharge Form Available Online
                                                                                                                                         Health Information Technology
                 Ed Lacy, Heber Springs                 39 Medicare Web Site Posts Answers                                               46 Three Arkansas Hospitals Make “Most Wired” List
                Gary Looper, Springdale                                                                                                  46 IRS Clarifies HIT Arrangements
                                                        39 Sharing of NPI Made Easier
                 James Magee, Piggott
                 Larry Morse, Clarksville               39 Medicaid Now Accepting UB-04                                                  NewsSTAT
               Richard Pierson, Little Rock             40 CMS Issues Final Rule for IRF Services                                        18   Ark. Healthcare Facilities Receive Quality Awards
               John N. Robbins, Conway
                                                        40 Proposed Rule Allows “Revisit” User Fees                                      19   AHA Staff Promotions, Additions
                 Russ Sword, Crossett
                                                        40 2008 Outpatient Hospital Rule is Proposed                                     20   Governor Honors Hospitals’ Quality Achievement
               EXECUTIVE TEAM                                                                                                            21   Ark. to Receive Preparedness Grants
         Phil E. Matthews / President and CEO           Departments                                                                      22   AHA Headquarters Begins Expansion Project
     Robert “Bo” Ryall / Executive Vice President       4     From the President                                                         22   Ark. Lawmakers Demonstrate Hospital Support
     W. Paul Cunningham / Senior Vice President
                                                        6     Education Calendar                                                         22   Ark. Hospital Administrators Forum Disbands
   Elisa White / Vice President and General Counsel
                                                        7     Arkansas Newsmakers and Newcomers                                          23   Final FY 2008 IPPS Rule
             Beth H. Ingram / Vice President
                                                                                                                                         24   QIO Offers Help with Program
              Don Adams / Vice President                Emergency Preparedness
                                                                                                                                         26   ACEP Summit on the IOM Reports
                                                        41 OSHA Releases Pandemic Guidance
                  DISTRIBUTION                                                                                                           28   Cross-Cultural Curricula Recommended
     Arkansas Hospitals is distributed quarterly to     41 NDMS Conference Call Protocol
                                                                                                                                         28   Online Governance Education Program
 hospital executives, managers, and trustees through-
          out the United States; to physicians,                                                                                          30   Medical Benefits of Interpretation Services
    state legislators, the congressional delegation,                                                                                     30   Plan to Distribute Advance Directives
    and other friends of the hospitals of Arkansas.
                                                                                                                                         31   IRS Releases Revised Form 990
                                                             FALL 2007

               To advertise contact                                                                                                           Governor Appoints State’s First Surgeon General
                    Greg Jones                                                                                                           31   “Card Check” Fails in U.S. Senate
             Publishing Concepts, Inc.                                                                                                   32 AHA Earns National Recognition for Marketing
                                                                                                                                         33 Gov. Beebe Provides Damaged Hospital Assistance
                                                                                           Care with Compassion
                                                                                                                  Cover Photo
                                                                                                                                         34 Hospital On-Call Pay Practices Reported
                                                                                              Top-Down Union
                                                 Organizing in Health Care
                                                                                            2007 Diamond Award
                                                                                                                   Fall foliage          35 Determining Consent for Minors
                                                                                                                  in Northwest
                       Edition 60                                                                                                        35 AHA DATABANK Program
                                                                                             Winners Announced

                                                               A MAGAZINE FOR ARKANSAS HEALTHCARE PROFESSIONALS                          35 IRS Reports Community Benefit Practices

                                                                                                                                                     Fall 2007 I Arkansas Hospitals        3
F R O M           T H E         P R E S I D E N T

     Better Healthcare: Whose Responsibility Is It?
        Personal responsibility. A small term that has big ethi-      their health, groups traditionally associated with health-
     cal implications. Most of us would say it is a “given” in        care need to work together to expedite better health and
     our society: Each person needs to take responsibility for        healthcare, and our nation must provide the legal, finan-
     themselves and their actions.                                    cial and expectational foundation for a healthy citizenry.
        Group responsibility. Another small term with even               As we have said so many times, 80% of our nation’s
     bigger ethical implications. Many of us would hope it is a       healthcare spending is directly related to chronic illness,
     “given,” but we just aren’t sure: Is the group responsible       such as obesity and diabetes. So much of this spend-
                                     for each of its members?         ing – based upon this unhealthiness – is avoidable. In
                                                                      addressing people’s individual behaviors (smoking, poor
                                           National responsibil-
                                                                      eating habits, lack of exercise, drug and alcohol abuse),
                                       ity. Now, we’re getting
                                                                      much chronic illness could be avoided. In addressing our
                                       tricky.    Another small
                                                                      physical and social environments (exposure to toxins, air
                                       term, with huge ethical
                                                                      pollution, poverty, lack of education, etc.) we could, as
                                       implications.      Does a
                                                                      a nation, vastly improve individual health and lower the
                                       nation have responsibil-
                                                                      rate of chronic illness.
                                       ity for every person who
                                       lives within its borders?         The AHA, in its vision for a Healthy America, says
                                                                      that as a society we must provide access to education and
                                           Herein lies the lively
                                                                      preventive care, we must help all people reach their high-
                                      discussion taking place
                                                                      est potentials for health, and we must reverse the trend
                                      today over healthcare in
                                                                      of avoidable illness. This will mean asking individuals to
                                      America. Does every per-
                                                                      take personal responsibility to achieve healthier lifestyles.
                                      son have responsibility to
                                                                      Each one of us, healthy or not, must take action to sup-
                                      live the healthiest life pos-
                                                                      port a healthier America.
                                      sible? Do our “groups”
     – communities, schools, hospitals, media, physicians,               When we pull together, when we take personal, group
     insurance companies and others – have a responsibility to        and national responsibility seriously, our nation will
     enhance or even provide healthcare? And on a national            become healthier, more productive, more vibrant. We
     level, are we of a mind to see to it that every person living    will see to it that everyone has prompt access to needed
     in America has access to affordable, accurate, efficient          healthcare, that every person is treated with dignity and
     healthcare?                                                      respect, and that better health for our nation is viewed as
                                                                      a common goal. We will move together in a more posi-
        As most of you know, the American Hospital
                                                                      tive direction, rather than in the too-often-fragmented
     Association, working with many of the groups listed
                                                                      fashion in which healthcare is approached today.
     above and with each state hospital association, has been
     on a quest to define what reasonable, fair and accessible            So whose responsibility is a healthy America? It is the
     healthcare should look like in America. In recent days,          responsibility of every individual, every employer, every
     the AHA has outlined its vision for healthcare in America        insurer, every healthcare supplier, every community,
     and is spreading the word far and wide.                          every level of government, every doctor, every hospital,
                                                                      every provider of care.
        As with the idea-gathering discussions that took place
     earlier this year, the AHA is coming to hospital associa-           The time for discussion and planning is now. The
     tions across America to explain its vision, its plan. Rich       responsibility rests with each of us. How will you
     Umbdenstock, president of the AHA, scheduled just such           respond?
     a discussion with the Arkansas Hospital Association
     board September 14.
        At that meeting, we learned that the AHA’s national
     vision is based on each person’s basic healthy life. Called
     “Health for Life: Better Health, Better Health Care,”                                        Phil E. Matthews
     the plan pivots on the three main guiding principals                                         President and CEO
     above. People need to take personal responsibility for                                       Arkansas Hospital Association

4   Fall 2007 I Arkansas Hospitals
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                                                                       Fall 2007 I Arkansas Hospitals   5
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Employee Benefits                                                                   HR Management Systems                      Education
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                                                                                   Long Term Care                          Annual Meeting and Trade Show
                                                                                   Supplemental Insurance
                                                                                    Cancer, Cardiac, Accident            October 11, Little Rock
                                                                                   Vision Insurance                        Arkansas Organization of Nurse
                                                                                   Retirement Plans                        Executives Annual Meeting
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                                  The full time healthcare division of Ramsey, Krug, Farrell
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                                  & Lensing is the largest and most experienced group of                                   Association Fall Meeting
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                                  Arkansas and one of the largest in the Southeast.                                      November 15-16, Little Rock
                                                                                                                           Society for Arkansas Healthcare
    Our coverages include:                                                                                                 Purchasing and Materials
    • Medical Professional Liability for hospitals, PHOs, IPAs, Surgery Centers, Clinics and Nursing Homes                 Management Fall Meeting
    • Medical Professional Liability for Physicians and Surgeons-- all specialties protected
    • Specialized programs for group practices within networks and allied healthcare professionals
    • Health Care Entity Employment Practices and Managed Care Liability
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    • Health Care Organization Directors and Officers and all related corporate and personal needs                         Getting Results: Be an Inspirational
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                                                                           of the Arkansas Hospital Association
                                                                           and administrator for the AHA Worker’s
                                                                                                                         Program information available
                                                                           Compensation self Insurance Trust.
                                                                                                                         at      Audio                                                                                                            conference information available at
    P.O. Box 251510 • Little Rock, Arkansas 72225 • (501) 664-7705

6      Fall 2007 I Arkansas Hospitals
                                                   and NEWCOMERS
Peter D. Banko, FACHE, has been named president and CEO of St.          managing director of The BridgeWay Hospital in North Little
Vincent Health System. He previously served as vice president and       Rock. Nolan has been with Universal Health Services for four
COO of CHRISTUS Spohn Health System in Corpus Christi, Texas.           years and previously served as CEO at River Oaks Hospital in
Prior to that time, he was affiliated with PhyAmerica Physician          New Orleans and Lakeside Behavioral in Memphis. While in New
Group in North Carolina. Banko is a graduate of the University of       Orleans, she experienced both Hurricanes Katrina and Rita, and
Notre Dame and Cornell University, where he earned his MHA.             successfully led patient and staff evacuations each time.

Governor Mike Beebe has appointed Jennifer Lang, Ph.D., admin-          Franklin E. Wise, administrator of Fulton County Hospital in
istrator of Methodist Behavioral Hospital in Maumelle, to the new       Salem, has retired after 14 years with the organization, culminating
Children’s Behavioral Health Care Commission. The Commission            a 42-year healthcare career. He served for many years as admin-
was created by Act 1593 of 2007 to advise the Arkansas Department       istrator of North Arkansas Regional Medical Center in Harrison
of Human Services and the Department of Health on improving the         before moving to Salem. Wise, an esteemed member of the
system of mental healthcare for children.                               Arkansas Hospital Association (AHA), has served as chairman of
                                                                        the organization’s board and member of the executive committee,
Claude E. “Chip” Camp, FACHE, was named CEO of Harris                   while also participating on many AHA councils and committees
Hospital in Newport effective May 1, succeeding Butch Naylor.           throughout the years. He also served as president of the Arkansas
Camp is a former CEO of White County Community Hospital in              Hospital Administrators Forum as well as the Mid-West Health
Sparta, Tennessee, and previously held administrative positions with    Congress, which has since ceased operations.
hospitals in New Mexico, Oklahoma, Mississippi, and Alabama. He
has an MHA from the University of Alabama at Birmingham.                In addition, Wise worked as a member of a number of commit-
                                                                        tees for the Arkansas Department of Health and the Arkansas
Russell D. Harrington, Jr., FACHE, president of Baptist Health, has     Foundation for Medical Care. In 1991, he was honored with the
announced that Greg Stubblefield has been named administrator            A. Allen Weintraub Memorial Award, the highest honor the AHA
of Baptist Health Medical Center – Arkadelphia. He has served in        can bestow upon a hospital chief executive officer.
an interim capacity for the past few months, following the death
of longtime administrator Dan Gathright. Stubblefield has been           Judith Wooten, FACHE, COO of Arkansas Hospice in Little Rock,
affiliated with Baptist Health since his administrative residency in     achieved Fellow status with the American College of Healthcare
2002.                                                                   Executives in June.

Tad Hatton has been named chief operating officer for Northwest          Herbert K. “Kirk” Reamey, III, FACHE, CEO of Ozark Health
Medical Center – Willow Creek Women’s Hospital in Johnson. He           Medical Center in Clinton, has been named to the Arkansas
succeeds Linda Worman. Hatton previously served as associate            Hospital Association (AHA) Board of Directors as the At-large
administrator at Northwest Medical Center in Springdale. He has         Delegate succeeding Robert R. Bash of Warren, who recently
more than ten years of healthcare operations and finance experience,     resigned his position. Reamey will fulfill the remainder of Bash’s
including serving as division controller for Triad Hospitals, Inc. in   term, which expires in October 2009. Reamey has been CEO of the
Plano, Texas.                                                           Clinton facility for the past two years, following a seven-year term
                                                                        as CEO of Magnolia Hospital. He currently serves on the American
Scott Landrum, FACHE, has been named CEO at Rebsamen                    Hospital Association’s Regional Policy Board 7 and is a former
Medical Center in Jacksonville, after serving in an interim capacity    president of the Arkansas Hospital Administrators Forum.
since February. “Scott has progressive ideas for the future growth
of Rebsamen and we are excited to work with him,” said Mack             Terry Amstutz, FACHE, CEO of Magnolia Hospital, and Christy
McAlister, chairman of the hospital board. A Kentucky native,           Hockaday, CEO of St. Anthony’s Medical Center in Morrilton,
Landrum brings more than 30 years of healthcare experience and          were recently named by the AHA Board of Directors to the Arkansas
was most recently CEO of Campbell Health System in Weatherford,         Rural Medical Practice Student Loan and Scholarship Board. The
Kentucky.                                                               AHA has two appointments to the board.

John Neal has resigned as CEO/administrator of Stuttgart Regional       Harold Mitchell has been named administrator of Bradley County
Medical Center. Bob Phillips, has been named interim administra-        Medical Center in Warren. He succeeds Robert R. Bash who
tor while a search is conducted. Neal came to Stuttgart in 1999         recently resigned. Mitchell is the former chief financial officer of
from executive positions with Mercy Hospital/Turner Memorial in         the facility.
Ozark and Haskell County Hospital in Stigler, Oklahoma. Neal was
Arkansas’ delegate to the American Hospital Association Regional        Eugene Zuber has been named administrator of Advanced Care
Policy Board 7 and served on the Arkansas Hospital Association          Hospital of White County in Searcy. The 27-bed long-term acute
board of directors by virtue of that appointment. He also was           care hospital, scheduled to open this summer, will be located at
chairman of the Arkansas Hospital Association Political Action          White County Medical Center. Zuber was administrator of the for-
Committee.                                                              mer Newport Hospital, which closed in 2005 and was purchased
                                                                        by Harris Hospital in Newport. Zuber is a former chairman of the
Barry Pipkin, division vice president for Universal Health Services,    Arkansas Hospital Association’s board of directors and was named
Inc., has announced the appointment of Jennifer Nolan as CEO/           the A. Allen Weintraub Memorial Award recipient in 1996.       •
                                                                                                             Fall 2007 I Arkansas Hospitals    7
      C E O          P R O F I L E

       Leading Change in Tenuous Times:
       Collaboration is the Key

                                                         pital administrator is done          Montgomery believes the biggest
                                                         in tandem with our medical       changes in healthcare he’s seen are
                                                         staff, our board of directors,   the introduction of DRGs and man-
                                                         our leadership team and our      aged care reimbursements. He is
                                                         community.”                      very interested in the new pay-for-
                                                            He will be installed in       performance programs.
                                                         his newest leadership role           He sees the current focus on
                                                         – Chairman of the Board          healthcare costs as slightly misplaced.
                                                         of the Arkansas Hospital         “Over the years, healthcare has cer-
                                                         Association – on October         tainly become more complex, and
                                                         11. Montgomery said he           the costs of healthcare have certainly
                                                         hopes to continue facilitating   risen. Our mission is quality health-
                                                         change during this remark-       care for all,” he said. “Yet we must
                                                         able time for healthcare.        pay attention to the financial side.”
                                                         “We’re at a time when we         He said he believes healthcare has
                                                         see healthcare transform-        been exploited. “There are too many
                                                         ing. Our focus will continue     hands in the cookie jar. We have a
                                                         to be on quality of care.        responsibility to care for people in a
                                                         We know we must meet the         fiscally cost-efficient manner, yet the
    Raymond W. Montgomery                                needs and expectations of        current system of inadequate reim-
                                                         our consumers.”                  bursements has put extreme pressure
                                                          He also sees the AHA con-       on our hospitals. We need to trans-
          When Ray Montgomery, President        tinuing its focus on reimbursement        form the system to assure adequate
       and CEO of White County Medical          issues, state and national insurance      resources and the ability to do our
       Center in Searcy, looks back over        issues and finding a way to somehow        mission – caring for people.”
       his career in hospital administra-       address the excessive costs of health-        And as for healthcare’s future?
       tion, he remembers the partnerships      care in our nation. “We want to lead      “All of us in healthcare, particularly
       and collaborations with others most      change in healthcare, rather than         those of us who are working as a part
       fondly. Montgomery said he has           being forced into transformation. It      of the AHA board, must continue in
       been blessed in his leadership roles,    is our responsibility to let our com-     our roles as leaders of change. After
       able to work as an agent of change       munities know how much hospitals          all, we are the technical experts; it is
       when a vision has been created by        do for the economy and for medical        up to us to set the course. And we
       people who understand the facility’s     care. It is also incumbent upon us        must do so through collaboration.”
       history and future needs.                to help our hospitals survive in these        During his career, Montgomery
          “I see myself as a part of a larger   tenuous financial and heavily regu-        has served as a respiratory therapist,
       team,” he said. “My work as a hos-       lated times.”                             a financial planner, a strategic plan-

8    Fall 2007 I Arkansas Hospitals
ning expert and as hospital admin-           merger allowed White County to                as jobs were saved and created.
istrator. He worked for hospitals            more efficiently utilize the limited               Today, White County Medical
in Kansas, Oklahoma and Texas                number of healthcare personnel avail-         Center has two hospital campuses
before coming to Arkansas. When              able in the community and provide a           and a combined total of 438 licensed
Montgomery first came to White                broader range of services. The new-           beds. The hospital’s services include
                                                                                           acute care, physical rehabilitation,
                                                                                           geriatric psychiatry, a heart institute
                                                                                           and an inpatient hospice unit. The
                                                                                           hospital also offers state-of-the-art
                                                                                           surgical services as well as obstetri-
                                                                                           cal care. More than 150 physicians
                                                                                           comprise the medical staff. White
                                                                                           County Medical Center is the second
                                                                                           largest employer in Searcy, with more
                                                                                           than 1300 associates living, working
                                                                                           and raising families in Searcy and the
                                                                                           surrounding communities. The hos-
                                                                                           pital serves a six-county area includ-
                                                                                           ing Cleburne, Independence, White,
                                                                                           Jackson, Woodruff and Prairie coun-
                                                                                               He calls himself an optimist and
                                                                                           points unwaveringly to God as the
                                                                                           true visionary, leader and facilitator
Members of Ray Montgomery’s family volunteer at the 11th annual A Day of Caring            of all he does. “We do our work as
coordinated by White County Medical Center. The free medical mission served nearly         implementers of change, but the real
1500 under- and uninsured residents in the region in July 2007. Pictured here are Ray      direction comes from God,” he said.
Montgomery and his wife Rebecca, daughter Sarah, friend Dana, and grandson Cole.               Montgomery said he’s been influ-
                                                                                           enced by many people. “Wayne
County Medical Center in 1988, he            est additions are a 40-bed assisted           Hartsfield has been one of my men-
was assistant administrator. He was          living facility, an 18 bed adult psychi-      tors. He has shown me servant lead-
named President and CEO of the               atric unit and a new long-term acute          ership skills. He’s been on WCMC’s
facility in 1992, and is in his 16th year
in this role.
   When       Montgomery           joined
WCMC, the facility was at a cross-
roads. Hard financial times had
caused a complete re-visioning of the
hospital’s role, both in the commu-
nity and as an employer.
   “The board and medical staff saw
a need for change, and envisioned a
dynamic future for WCMC,” he said.
“As it is so often in life, the visions of
others allow us to come in as facilita-
tors of change. And that has been my
role at WCMC.”
   During his administrative tenure,
he has helped design and orches-
trate two major hospital renovations.
The first – a $16 million expansion
that doubled the size of the existing        Buddy Muirhead, President of the White County Medical Center Auxiliary and other Auxiliary
hospital – was completed in 1998.            representatives present a check for $40,000 to WCMC President and CEO Ray Montgomery
WCMC then doubled in size again in           at the hospital’s 40th Anniversary Celebration in January 2007. The funds were given to
                                             help the hospital purchase a PulseCheck system for the emergency department.
2004 with the completion of a $38
million expansion. This project was
done without incurring any debt.             care hospital, all opening this fall.         board since the hospital opened, and
   WCMC acquired Central Arkansas            Montgomery sees these moves as par-           he’s been on many other boards from
Hospital in the fall of 2005. The            ticularly valuable to the community,          education to business.”

                                                                                                          Fall 2007 I Arkansas Hospitals   9
      C E O          P R O F I L E

     White County Medical Center
     representatives Ray Montgomery,
     President and CEO; Debbie Hare,
     Director of Quality Management;
     and Stuart Hill, Vice-President,
     Treasurer; receive an award from
     Governor Mike Beebe for achieve-
     ment in the Arkansas Medicaid
     Inpatient Quality Incentive pro-
     gram. White County Medical
     Center is one of 29 hospitals in
     the state that was recognized in
     this program that ties Medicaid
     payment to hospital clinical per-

        He added, “I have had
     great role models like my
     father, Ray Montgomery, who
     emphasized the importance of              and experience.”                           Church, and he and his wife serve as
     diversity and treating everyone equally      Living a balanced life is impor-        mentors for college students, open-
     special. Another role model has been      tant to Montgomery. He and his             ing their home to several students
     Dr. Jimmy Carr, White County Medical      wife, Rebecca, have a blended fam-         each semester so they can live and
     Center Assistant to the President. Dr.    ily with three grown children and          enjoy a family atmosphere with the
     Carr has an incredible work ethic and     one grandchild. “God balances me           Montgomerys.
     at 93 is working towards retirement at    while Rebecca encourages me,” he              Long active in the AHA, he has
     his third career.”                        said. “Then, everything else falls into    served as the North Central Hospital
        Montgomery also gives credit to his    place.” He lives by the familiar creed     District delegate to the AHA board of
     colleagues. “My administrative team       of putting God first, family second and     directors, as president of the Arkansas
     works so well together. Stuart Hill       career third – and he sees his career in   Hospital Administrators Forum and as
     and LaDonna Johnston have been on         healthcare as a ministry, not as a job.    Chairman of the American Hospital
                                                                                          Ray Montgomery, President and CEO of White
                                                                                          County Medical Center, along with River
                                                                                          Oaks Village Director Doug Duncan and ROV
                                                                                          residents prepare to break ground for a new
                                                                                          40 unit assisted living facility in June 2006.
                                                                                          River Oaks Village is an independent living
                                                                                          facility owned and operated by WCMC and
                                                                                          will also be adding 14 apartment units dur-
                                                                                          ing the construction. The independent living
                                                                                          apartments were completed earlier this year
                                                                                          and the assisted living facility is scheduled to
                                                                                          begin taking residents September 2007.

                                                                                          Association Governing Council for
                                                                                          Small or Rural Hospitals. He is a
                                                                                          fellow of the American College of
                                                                                          Healthcare Executives and a mem-
                                                                                          ber of the VHA Oklahoma/Arkansas
                                                                                          board of directors.
                                                                                              “It is an honor and a privilege to be
                                                                                          selected to serve as AHA Chairman of
                                                                                          the Board,” he said. “The AHA allows
                                                                                          hospitals to compare best practices
     this team the longest. Stuart brings         His community work includes             and allows each of us to network with
     a mastery of healthcare finance while      membership in the Searcy Chamber of        some of the greatest minds in health-
     LaDonna brings a no-nonsense passion      Commerce, Lions Club, White County         care. And the AHA’s unifying efforts
     for high quality care. Being successful   United Way Leadership Council and          are all-important. The AHA serves
     in the current and future healthcare      the Searcy Leadership Institute. He        as one of Arkansas hospitals’ greatest
     arenas requires this level of wisdom      serves as an elder at Fellowship Bible     resources.”  •
10    Fall 2007 I Arkansas Hospitals
                                                                                                    Teletouch Paging
              FAL L 200

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                                                           Care w               ion
                                                                          wn Un
                                                                Top-Do th Care
                                                               zing in
                                                         Organi              Award
                                                             2007 Di Announced

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                                                    AN     SAS HE
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                                                                                                                          Fall 2007 I Arkansas Hospitals   11
                                                                                                             by Susan Meyers

      Care with Compassion:
      Does Your Hospital Offer Palliative Care?

     Editor’s Note: Trustee Magazine, a publica-
     tion of the American Hospital Association
     (AHA) targeted to the C-suite, published a
     comprehensive article on palliative care, “Care
     with Compassion,” in its May 2007 issue. The
     article presents a clear picture of the rapid
     growth trend and benefits of palliative care
     programs for hospitals and their leaders. The
     American Hospital Association urges you to
     use this article to:
     • Prompt a report/discussion with your hos-
          pital leadership regarding how your hos-
          pital measures up to its competitors with
          regard to palliative care
     • Bolster support and strategic placement of
          your program

     Hospitals are generally equipped and
 staffed to provide acute care, but often
 fall woefully short when it comes to
 managing chronic illnesses. And, as the
 patient population ages, some hospitals
 are finding that they are not prepared to         “As an acute care hospital, we see a   center today is pushing the envelope
 handle the social, physical, emotional,     lot of very complex patients,” Petasnick    in terms of technology and scientific
 and quality-of-life issues presented by a   says. “We felt that a palliative care       advances,” he says. “The other side of
 growing influx of chronically ill patients   program would allow us to provide a         medicine is the patients and what we
 with complex diseases.                      full continuum of care and meet the         are doing to keep them comfortable.
     “In a nutshell, hospitals are los-      needs of patients who are chronically       Palliative medicine cuts a wide swath
 ing a key element of providing quality      ill in a more caring way. Palliative care   across hospital care. It helps fulfill the
 care, and that’s compassion,” says Bill     provides a compassionate and cost-ef-       humane part of healthcare and should
 Petasnick, CEO, president, and member       fective means of providing care in the      be brought to the same level of impor-
 of the board of directors for Froedtert     most appropriate venue, with the most       tance as clinical technology.”
 Hospital, Milwaukee, Wisconsin. He          appropriate support, and in a way that          According to the Center to Advance
 is also chair-elect of the American         is more conducive to a patient’s quality    Palliative Care (CAPC), located at the
 Hospital Association Board of Trustees.     of life.”                                   Mount Sinai School of Medicine in
 In answer to this unmet need, Froedtert          Michael Wiener, a trustee with         New York City, 70 percent of hospitals
 Hospital, the major teaching hospital       Mount Sinai Medical Center (in New          in the United States with 250 or more
 for the Medical College of Wisconsin,       York City), which started a palliative      beds have a palliative care program, and
 organized one of the first palliative care   care program about ten years ago,           55 percent of hospitals with more than
 programs in the country in 1993.            agrees. “Every major clinical medical       100 beds report having a program. The

12   Fall 2007 I Arkansas Hospitals
number of existing programs has more         seeks to relieve that suffering by offer-   care unit.
than doubled in the last six years –         ing a great deal of genuinely patient-          “Our palliative care program has
from 632 in 2000 to more than 1,300          centered care involving listening and       made an enormous difference in the
programs today.                              responding to physical, emotional, and      quality of care for those patients whose
    CAPC was started in 1999, origi-         practical needs identified by the patient    lives have been compromised by the
nally funded by the Robert Wood              and family.”                                chronic suffering associated with long-
Johnson Foundation. The organization             While palliative care and hospice       term illness,” says Kenneth Davis,
has played a leading role in helping         overlap in their patient-centered phi-      M.D., president and CEO at Mount
to increase the availability of qual-        losophy of care, they are different in      Sinai Medical Center. “These are com-
ity palliative care programs, provid-        that palliative care is provided at any     plex patients, and it takes skilled clini-
ing healthcare professionals with the        time during a person’s illness – often      cians who have a clear understand-
tools, training, and technical assis-        from the time of diagnosis – and is         ing of how to decrease suffering and
tance necessary to start and sustain         frequently delivered along with cura-       maximize a person’s quality of life to
successful palliative care programs          tive and life-prolonging treatments.        provide optimal care.”
in hospitals and other healthcare set-       Hospice care is designed for terminally         “Clinicians trained in palliative
tings. Validating the value and rapid        ill patients who are no longer seeking      medicine have critical skill sets, includ-
growth of palliative care medicine, the      curative therapies and who have a life      ing sophisticated pain and symptom
National Quality Forum, Washington,          expectancy of six months or less.           management, well-honed communica-
D.C., recently released suggested best           Palliative care is usually offered      tion skills, and expert knowledge about
practices for palliative care programs,      to patients by a team of physicians,        the continuum of care outside the hos-
and in September 2006, the American          nurses, and social workers. This team       pital,” says David Weissman, M.D.,
Board of Medical Specialties recog-          might also include chaplains, massage       director of the palliative care medicine
nized hospice and palliative medicine        therapists, pharmacists, nutritionists,     program at Froedtert (which he helped
as an official subspecialty.                  or any other appropriate care pro-          initiate and develop) and professor of
    “If a hospital does not currently        vider. Spiritual support, counseling,       medicine in neoplastic diseases at the
have a program, its board should be          and complementary medicine are also         Medical College of Wisconsin. “While
talking about how to develop its own         important components of many pro-           some of these skills overlap with geri-
program, or at least how it can be affil-     grams that can bring additional relief      atrics, oncology, and critical care, their
iated with a palliative care program in      to patients and families. The care team     additional knowledge focuses on the
the area,” Petasnick advises.                can help ease case management bur-          needs of patients with serious, complex
    “Increasingly, it’s the minority of      dens on primary care physicians and         illness.”
hospitals that don’t have a program,”        other staff and provide assistance with         The palliative care team at Froedtert
says Diane E. Meier, M.D., director          care coordination between the hospital      acts as a consultative service that con-
of CAPC and the Hertzberg Palliative         and home and among care providers,          sists of physicians trained in providing
Care Institute at the Mount Sinai            as well as time-intensive patient-family    palliative care, nurses, psychologists,
School of Medicine. “The public is           communication.                              pharmacists, nutritionists, and chap-
more aware of palliative care, and they          Several years after a hospital          lains. The hospital has established a
are asking for it. Hospitals that haven’t    has begun offering palliative care to       dedicated “virtual” unit on the inter-
developed a palliative care program          patients, the need for a dedicated unit     nal medicine floor, to which pallia-
will fall behind both in terms of the        may be necessary, as some patients          tive care patients with special needs
quality of care they provide, as well as     will likely require care from nurses and    can be admitted and followed closely.
their efficiency and competitiveness.”        doctors specially trained for palliative    The program currently serves approxi-
                                             care, notes Meier. Dedicated palliative     mately 1,000 patients each year. “It
What It Is, What It Isn’t                    care units include space for families, to   was difficult getting it started at first,”
     One of the biggest impediments to       give them privacy for meetings, meals,      Weissman says. “But once other phy-
hospitals’ acceptance of palliative care     and rest.                                   sicians and clinicians started seeing
is their lack of understanding about                                                     the value and benefits of the care we
what it entails, Meier says. Palliative      Quality of Care                             provided, it began to catch on fairly
care first involves relieving pain and            When Mount Sinai introduced its         quickly.”
suffering to ensure the best quality of      palliative care program in 1997, it             And those benefits are many.
life possible for patients and their fami-   anticipated receiving about 50 refer-       According to Weissman, palliative care
lies. “There has been widespread docu-       rals in its first year, but was quickly      consultation teams are better at: identi-
mentation and recognition of the high        deluged with 250. Now the hospital          fying and treating physical and psycho-
level of pain and suffering experienced      follows well over 1,000 new patients        logical pain and symptoms than clini-
by patients with chronic, complex            each year and is in the process of devel-
illness,” Meier says. “Palliative care       oping a dedicated inpatient palliative                        continued on p. 14

                                                                                                    Fall 2007 I Arkansas Hospitals    13
      continued from p. 13                      Meier says. “Often, no one sits down           • A hospital maintains or improves
                                                and actually talks to patients and fami-   its quality of care while increasing bed
     cians used to providing acute care only;   lies about the options before them.        capacity and throughput and reducing
     helping patients and their families set    Once this education happens and they       costs through shorter lengths of stay and
     goals; making clinical decisions and       understand the reality of their illness,   lower ancillary and pharmacy costs.
     discharge plans; communicating and         the process of care changes, with many         Starting a palliative care program
     assisting primary care teams in                                                              often requires a great deal of
     determining care alternatives and                                                            reflection before hospital leaders
     levels of care; offering support and                                                         can support it, Weissman notes.
     counseling to patients, families,         “If a hospital does not currently                  This includes: realizing that qual-
     and healthcare professionals who                                                             ity care of complex patients is part
     are struggling with difficult care         have a program, its board should                   of the hospital’s mission; wanting
     decisions; and increasing overall         be talking about how to develop                    to be seen as a local leader in
     patient, family, and professional                                                            compassionate, patient-centered
     satisfaction.                                its own program, or at least                    hospital care; recognizing that
                                                                                                  palliative care can reduce costs
     Financial Benefits                          how it can be affiliated with a                   and improve capacity; having a
          Palliative care should also be        palliative care program in the                    board member who has/had a
     viewed in the context of the spiral-                                                         personal experience with a friend
     ing price of care for high-cost, high-      area,” advises Bill Petasnick,                   or relative with a chronic illness;
     technology tests and treatments of                                                           and enlisting a local champion
                                                  CEO, president, and member
     little or no benefit, which often                                                             who advocates for improved care
     cause unnecessary stress and suffer-         of the board of directors for                   for the chronically ill.
     ing without significantly influenc-                                                                The emergence of a physi-
     ing the course of a patient’s illness.
                                                Froedtert Hospital, Milwaukee,                    cian champion to advocate, help
     Weissman estimates that Froedtert                             WI.                            develop, and lead the program
     Hospital saves between $200 and                                                              can be a key component of a
     $500 per day per patient as a con-                                                           palliative care program’s success,
     sequence of avoiding unnecessary                                                             Weissman says. Successful pro-
     tests and procedures.                       patients choosing care in the setting grams also employ a physician trained
          “Palliative care does not restrict of their home. Multiple studies show in palliative medicine. Palliative medi-
     healthcare services but allocates them a very large cost avoidance associat- cine postgraduate fellowship training
     where they are most needed,” Weissman ed with palliative care for hospitalized programs have grown substantially over
     explains. “We have a huge aging pop- patients.”                                       the last few years. There are more than
     ulation, healthcare costs are out of                                                  50 fellowship programs currently avail-
     control, and the over utilization of Starting Your Own Program                        able throughout the country, as well as
     healthcare resources is widely recog-          According to CAPC, developing a short-term preceptorship programs.
     nized, especially in patients near the end palliative care program requires a rela-       Froedtert Hospital, with the Medical
     of life. As medicine has become highly tively low start-up investment and can College of Wisconsin, has been a pri-
     fragmented and over-specialized, we are have an immediate impact on overall mary player in designing and imple-
     seeing an ever-increasing use of high resource use and intensive care unit menting education strategies for health
     technology and the higher costs that (ICU) utilization. Direct program costs professionals in pain management and
     accompany it. The palliative care team are more than offset by the financial palliative care. Weissman, who is rec-
     helps patients and families establish benefit to the hospital system. CAPC ognized internationally for his work
     important values and achievable goals states that hospitals with palliative care in this field, has received funding from
     for the medical care they are receiving programs reap the following benefits the Robert Wood Johnson Foundation
     by initiating open communication about that help reduce healthcare costs:             to improve medical residency training
     the pros and cons of different treatment       • Patients receive appropriate levels through the National Residency End of
     choices. The trade-offs are put out on of care. This often reduces length of Life Education Project. Since 1998, 394
     the table. Once this has been done, we stay, especially in the ICU.                   residency programs have participated
     can discuss which tests and procedures         • Proactive care plans expedite treat- in a one-year curriculum reform project
     might really be helpful, and which are ment. Hospitals plan daily resource use to develop new educational programs
     not. The end result is that you will see a by following the agreed-upon care pro- in palliative medicine throughout the
     dramatic drop in healthcare utilization tocol, often reducing costs for redun- country.
     and cost.”                                  dant, unnecessary, or ineffective tests       The National Quality Forum, which
          “The secret is communication,” and pharmaceuticals.                              has established a set of 38 best practices

14     Fall 2007 I Arkansas Hospitals
  ( for improving        served in this role for the past three             starting or strengthening a palliative
  palliative care programs, suggests that     years. The other facilities include:               care program,” Weissman says. “It
  healthcare organizations that provide       Fairview Health Services, Minneapolis,             gets them organized, answers all the
  palliative care offer the following ser-    Minnesota; Mount Carmel Health                     common questions, and provides a
  vices:                                      System, Columbus, Ohio; Palliative                 structure for how to think through the
  • Comprehensive, 24-hour availabil-         Care Center of the Bluegrass, Lexington,           common barriers to program imple-
      ity of palliative care through an       Kentucky; University of California, San            mentation and growth.”
      interdisciplinary team of trained and   Francisco; and VCU Massey Cancer                       Ellen Katz, a trustee of Mount Sinai
      certified palliative care profession-    Center, Richmond, Virginia.                        Medical Center and a strong propo-
      als.                                        Hospital teams can apply for a two-            nent of palliative medicine, says that
  • Timely communication of patients’         day training session and an ongoing                once someone sees palliative care in
      goals and care plans in transfers       mentorship with these hospitals. The               action, it’s hard to imagine healthcare
      between healthcare settings.            two-day training session walks teams               without it. “It’s a critical component
  • Assessments of patients’ pain, anxi-      through the development and imple-                 of hospital care if you want to provide
      ety, and other symptoms that respect    mentation of their own strategic plan,             the best care possible to your patients,”
      their cultural and individual prefer-   an organizational model that fits their             she says. “It allows clinicians to play a
      ences.                                  hospital or health system’s needs, staff-          kinder, more sensitive and supportive
  • Social and spiritual care plans for       ing plans, instruction on how to collect           role in caring for patients and their
      patients.                               and interpret financial data, and the               families. Everyone wins because every-
  • Continuing professional education         implementation of marketing strategies             one gains a better sense of satisfaction
      and support for caregivers on topics    to promote and grow their program.                 – from the patients and families, to the
      such as symptom management and          After the on-site training, the PCLC               professional caregivers.”             •
      communication.                          staff continues to provide one-on-one
      To help hospitals develop their own     mentoring for a full year to assess                   This article is reprinted from the
  programs, CAPC has designated six           progress, trouble shoot, and provide               May 2007 issue of Trustee Magazine,
  hospitals as Palliative Care Leadership     resources.                                         and is copyrighted. Author Susan
  CentersSM (PCLC). Froedtert and the             “This leadership training can be a             Meyers is a writer based in Omaha,
  Medical College of Wisconsin have           real boost for hospitals contemplating             Nebraska.

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                                                                                                                  Fall 2007 I Arkansas Hospitals               15
                                            by John E. Baird, Ph.D., Senior Partner, Baird/Borling Associates

     “I Have an Offer You Can’t Refuse:”
     Top-Down Union Organizing in Healthcare

        For the past 50 years, union        the      Service
     membership in private industry         Employees
     has been steadily declining. In the    International
     mid-1950s, more than one-third of      Union           in
     all workers were union-represent-      Washington,
     ed; today, less than 7.5 percent       D.C. Inside the
     of workers in private industry are     envelope was a
     unionized.                             bound, profes-
        Alarmed by declining member-        sionally printed
     ship and diminished revenues,          proposal for a
     unions have begun to market            “partnership”
     themselves more strategically,         between        the
     focusing their organizing efforts on   health system
     industries that are not now heav-      and the SEIU.
     ily unionized (particularly health-       A few days
     care), on areas of the country that    later, at the
     are largely union-free (particularly   request of the
     Florida, Texas, and Colorado) and      SEIU,       union
     on multiple-facility health systems    leaders       met
     that would quickly yield a large       with the health
     number of new dues-paying mem-         system’s senior
     bers.                                  executives to
        At the same time, unions also       discuss the pro-
     have developed a new approach to       posed “part-
     organizing that is quite different     nership.” The
     than the traditional “grass-roots”     SEIU laid out
     approach that depends on building      their      terms:
     support among employees, con-          the health sys-
     vincing them to sign union autho-      tem would 1)
     rization cards, and then winning       provide        the
     a secret ballot election conducted     SEIU with the
     by the National Labor Relations        names         and                     the employees signed documents
     Board. Today, many unions are          home addresses of all 25,000 of       saying they wanted the union to
     “convincing” the leadership of         their employees; 2) give SEIU rep-    represent them – no secret ballot
     healthcare organizations to allow      resentatives unlimited access to      election would be held.
     them to unionize employees with-       all facilities to talk to employees      The health system executives
     out opposition, often without a        about why they should unionize;       expressed great reluctance to vio-
     secret ballot election.                3) “remain neutral” (that is, say     late their employees’ rights to pri-
        The experience of one health        nothing) concerning the SEIU or       vacy, allow union representatives
     system in the Midwest has been         the potential impact of unioniza-     to disrupt patient care, remain
     typical. In January 2003, their CEO    tion; and 4) agree to recognize the   silent on so important an issue,
     received a FedEx envelope from         SEIU as employees’ legal repre-       and deny employees their rights
     the international headquarters of      sentative whenever a majority of      to a secret ballot vote. They then

16   Fall 2007 I Arkansas Hospitals
asked, “What if we don’t agree to       • Picketing and demonstrations:         Catholic Healthcare West, Kaiser,
your proposed partnership?” The           union supporters often pick-          Tenet, and others to accept “neu-
SEIU officials answered, “Well, then       et and demonstrate in front           trality agreements” with one or
we’ll have a war.” In this and other      of health system facilities and       more unions. Employees in those
health systems, this “war” (called        occasionally in front of individ-     health systems’ facilities quickly
a “corporate campaign”) has been          ual executive’s homes. On occa-       were unionized and started paying
waged to force health system leaders      sion, demonstrators will picket       union dues.
to accept the “partnership” unions        in front of a hospital, and then         While there is no sure-fire way
are demanding.                            go to the Emergency Room and          to prevent or combat a corporate
   Some health systems that have          demand to be treated for vari-        campaign waged by one or more
experienced “corporate campaigns”         ous ailments. Then the union          unions, health system leaders can
include Catholic Healthcare West,         publicizes how overcrowded            take some proactive steps, before
Catholic Healthcare Partners, HCA,        health system emergency rooms         a union “partnership” is proposed
Tenet, Resurrection Health Care           are and how long patients have        to their organization. For example,
in Chicago, Advocate Healthcare           to wait to be seen.                   they can and should:
in Chicago, Kaiser, Yale Medical        • Agency investigations: unions
Center, Beverly Enterprises, and          call various agencies, such as        • Educate all key constituencies,
dozens of others. In each case, a         OSHA, EPA, Department of                including physicians, employ-
variety of strategies and activities      Labor, Department of Public             ees, board members, local
were used by one or more unions to        Health, or the Department of            media, and local community
“convince” health system leadership       Transportation, and ask them            leaders, concerning what “cor-
to accept their “partnership” pro-        to investigate health system            porate campaigns” are intended
posal. These have included:               practices. Then they publicize          to do and how they are being
                                          the fact that investigations are        used today in healthcare.
• In-depth reports: the SEIU par-         taking place, damaging the rep-       • Study the attacks unions are
  ticularly prepares in-depth analy-      utation of the health system            making on target organizations
  ses of health system practices,         even when the investigations            elsewhere and then examine
  and then distributes the glossy,        reveal no wrongdoing.                   their own practices regarding
  multi-page booklets to com-           • Pressuring the business: unions         these issues, such as billing and
  munity leaders, political lead-         often picket and disrupt fund           collection practices, pricing
  ers, religious leaders, and others.     raising activities, fight hospitals’     structures, executive compensa-
  Typically, these reports accuse         efforts to obtain Certificates of        tion, and so on to assess and
  the health system of “discrimina-       Need for expansion, organize            rectify possible vulnerabilities.
  tory pricing” (charging patients        patient boycotts, fl ood facil-        • Develop and communicate a
  without health insurance more           ity switchboards, and do any-           philosophy concerning unions
  than patients with insurance are        thing else they can to disrupt          and why the organization
  charged), “aggressive” debt col-        the operations of health system         believes remaining union-free
  lection practices, executive greed,     facilities.                             is beneficial to employees and
  racist spending (investing more       • Pressure from payers: unions            the patients and physicians they
  money in facilities serving subur-      often contact insurance compa-          serve.
  ban communities than in facilities      nies and other payers to claim
  serving inner-city, largely minori-     that the target health system            Given the success of “top-down”
  ty communities), violating church       over-charges for some proce-          organizing in healthcare, it seems
  teachings regarding employee            dures, encouraging the payers         likely that unions will expand the
  unionization, and many other            in turn to pressure the health        use of this strategy to other tar-
  offenses, real or imagined.             system to lower their prices and,     geted health systems in the near
• Attacks in the media: unions use        consequently, their revenue.          future. Thus, it is important that
  every available outlet to publicize                                           system leaders begin now, proac-
  criticisms of how target health          Through these and many other         tively, to prepare for the “war” a
  systems provide care, staff their     strategies, unions try to force tar-    union soon may wage on them.          •
  facilities, treat their employees,    geted health systems to accept
  serve their physicians, or fulfill     their “partnership” terms, thereby        John Baird presented a work-
  their mission to their communi-       allowing the union to organize          shop on union organizing as part
  ties. Many unions set up Web          their employees without opposi-         of the AHA’s Mid-Management
  sites (see, for example, www.         tion. In many cases, these “cor-        Certificate Series. For more infor- to attack their       porate campaigns” have been suc-        mation about his company see
  targets.                              cessful, forcing such systems as

                                                                                           Fall 2007 I Arkansas Hospitals   17
Arkansas Healthcare Facilities
Receive Quality Awards
    Thirty-five Arkansas hospitals, some winning awards in multiple
categories, were among the recipients of 95 Quality Improvement
Awards handed out May 31 during the Arkansas Foundation for
Medical Care’s (AFMC) 14th Quality Conference, which was held
at the Statehouse Convention Center in Little Rock.
    AFMC presented its Quality Achievement Awards to recognize
improvement in one or more of its hospital quality improvement
    Northwest Medical Center of Bentonville and St. Mary’s
Hospital-Rogers were recognized for Best Achievement Awards as
Medicare prospective payment system (PPS) hospitals.                    Sharlene Mourot, RN, quality director, and Christy Hockaday, chief
    Mercy Hospital/Turner Memorial (Ozark) and St. Anthony’s            executive officer, accept St. Anthony’s Medical Center’s Quality
Medical Center (Morrilton) received Best Achievement Awards in          Improvement Award during AFMC’s 14th Quality Conference, held
the Critical Access Hospital (CAH) category.                            May 31.
    Most Improved Achievement Awards were presented to
Northwest Medical Center of Bentonville and Saint Mary’s Regional
Medical Center (Russellville) in the PPS hospital category, while St.
Anthony’s Medical Center and CrossRidge Community Hospital
(Wynne) were named winners among the state’s CAHs.
    Validation Awards went to Medical Center of South Arkansas
(El Dorado, PPS), St. Bernards Medical Center (Jonesboro, PPS),
CrossRidge Community Hospital (Wynne, CAH), Lawrence
Memorial Hospital (Walnut Ridge, CAH), Ozark Health Medical             Staff members of St. Mary’s Hospital accept their Quality Improvement
Center (Clinton, CAH), and Piggott Community Hospital (CAH).            Award during AFMC’s 14th Quality Conference, held May 31.
                                                                        L to R: Michele Stewart, vice president, chief nurse executive;
     In addition, the following hospitals received Innovator Awards:    Catherine Kite, vice president, performance management; Lee Ann
                                                                        Hupp, supervisor; George Flynn, CEO; Paula King, quality measures
     Arkansas Methodist Medical Center, Paragould
     Baptist Health Medical Center, Heber Springs
     Baptist Health Medical Center, Little Rock                             Washington Regional Medical Center, Fayetteville
     Baptist Health Medical Center, North Little Rock                       White County Medical Center, Searcy
     Baxter Regional Medical Center, Mountain Home                          White River Medical Center, Batesville
     Conway Regional Health System
     CrossRidge Community Hospital, Wynne                               Hospital-based services recognized for their quality included:
     Jefferson Regional Medical Center, Pine Bluff                         Baptist Home Health Network (Innovator)
     Lawrence Memorial Hospital, Walnut Ridge                              Bradley County Medical Center Home Health Agency
     Magnolia Hospital                                                     (Warren, Innovator)
     Medical Center of South Arkansas, El Dorado                           Crittenden Regional Hospital Homecare (West Memphis,
     Medical Park Hospital, Hope                                           Innovator)
     Mercy Hospital/Turner Memorial, Ozark                                 Ouachita County Medical Center Doctors Home Care
     National Park Medical Center, Hot Springs                             (Camden, Innovator, Best Achievement)
     NEA Medical Center, Jonesboro                                         National Park Medical Center Home Touch Healthcare
     Ozark Health Medical Center, Clinton                                  (Innovator)
     St. Anthony’s Medical Center, Morrilton                               Communities Home Health of Northwest Medical Center,
     St. Bernards Medical Center, Jonesboro                                Springdale (Innovator)
     St. Edward Mercy Medical Center, Fort Smith                           In addition, St. Bernards Senior Health Clinic took home a
     St. Joseph’s Mercy Health Center, Hot Springs                      Best Achievement Award in the Physician Office category, while
     St. Vincent Infirmary Medical Center, Little Rock                   Lawrence Hall Nursing Center was awarded Best Achievement,
     Stuttgart Regional Medical Center                                  and St. Joseph’s Mercy Health Center Transitional Care Unit
     Summit Medical Center, Van Buren                                   received an Innovator Award for Nursing Home Care.           •
18    Fall 2007 I Arkansas Hospitals
     Elisa White Joins AHA Staff;
     Other Promotions, Additions
        Elisa White, who has served            Medicare, Medicaid and third party     tion of Administrative Assistant
     as outside legal counsel for the          reimbursement; licensure; managed      and Webmaster. Kensey Reynolds
     Arkansas Hospital Association             care; medical staff and patient care   Honey has been hired as reception-
     (AHA) since July 2005,                             issues; state and federal     ist.
     became the newest                                  regulations; quality and          Lyndsey Dumas has been with
     member of the AHA                                  patient safety; as well as    the Arkansas Hospital Association
     executive team July 16,                            other concerns.               for three years, and graduated
     when she joined the                                   A former teacher, she      from the University of Central
     association as its vice                            graduated from Arkansas       Arkansas with both bachelor’s
     president and general                              State University with         and master’s degrees in Business
     counsel.                                           bachelor’s and master’s       Administration.
        As the new in-house                             degrees, and holds a              Amber Estrada, who joined
     legal counsel, White,                              Juris Doctorate from the      the AHA this year, is a sopho-
     formerly a partner in Elisa White                  University of Arkansas        more at Ashford University in its
     the Little Rock office                              at Little Rock School of      online degree program, and is pur-
     of Kutak Rock, LLP, advises the           Law. She lives in Little Rock with     suing a degree in Organizational
     AHA board and membership on               her husband, David.                    Management.
     legal issues that may potentially            Other recent changes in the             Kensey Reynolds Honey joined
     affect all or certain subgroups of        AHA staff include the promotions       the AHA in July, and has attended
     the state’s hospitals. She is direct-     of Lyndsey Dumas to the position       both the University of Arkansas
     ly involved with matters related          of Director of Educational Services    and the University of Arkansas at
     to compliance; fraud and abuse;           and Amber Estrada to the posi-         Little Rock.•

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                                                                                                Fall 2007 I Arkansas Hospitals   19
     Arkansas Governor Honors
     Hospitals’ Quality Achievement
        Arkansas is leading the way in        Arkansas Medicaid presented a pro-      Health System is one of several hos-
     improving U.S. healthcare with           gram detailing the IQI on August 15th   pitals that has seen not only qual-
     an innovative new program that           during the Medicaid Management          ity improvement, but also financial
     ties Medicaid payment to hospital        Information Systems conference          rewards, from IQI.
     clinical performance. The Arkansas       in San Diego, California. Nena             This summer, Arkansas Governor
     Medicaid Inpatient Quality Incentive     Sanchez, AFMC’s vice president for      Mike Beebe hosted a ceremony at the
     (IQI) is one of only two programs in     Medicare & Medicaid Operations,         State Capitol recognizing 29 partici-
     the country to reward hospitals that     and Marilyn Strickland, assistant       pating hospitals that qualified for the
     improve care, and state healthcare       director of the Arkansas Medicaid       incentive payments for the year end-

     leaders believe the incentive is a       program, co-presented in the ses-       ing June 30, 2007. Combined, the
     strong step toward strengthening         sion “Value Driven Healthcare and       bonus payments, which were based
     healthcare quality, accountability,      Pay-For-Performance in Medicaid,”       on a hospital’s level of achievement
     and financing.                            which was well-received with many       and validation scores on pneumonia
        In May 2006, an Arkansas              questions from the audience.            and heart failure quality measures,
     Hospital Association committee              The P4P program was official-         totaled $3.9 million.
     composed of quality review profes-       ly implemented March 24, 2007,             Qualifications were determined
     sionals from member hospitals began      when the Centers for Medicare &         from data submitted by participating
     working in conjunction with state        Medicaid Services (CMS) gave its        hospitals to the QualityNet Clinical
     Medicaid officials and representa-        approval for the state Medicaid Plan    Warehouse, the national repository
     tives from the Arkansas Foundation       amendment allowing an inpatient         that stores information about quality
     for Medical Care (AFMC) to design        rate increase and the incentive pay-    of care. AFMC, the designated fed-
     a Medicaid pay-for-performance           ments.                                  eral Medicare Quality Improvement
     (P4P) program. The program was              “This program has helped us to       Organization for Arkansas and
     designed to tie incentive payments of    focus on specific quality indicators,    the state’s medical review contrac-
     up to $50 per day to hospital clinical   and to make sure each one is imple-     tor, then validated data specific to
     performance in meeting certain qual-     mented on every patient. This has       Medicaid recipients and determined
     ity thresholds.                          definitely had a positive impact over-   the level of achievement.
        Arkansas’ project is gain-            all on patient outcomes,” said Dr.
     ing national recognition as well.        David Hall, senior vice president for   • Of the 29 hospitals, 21 exceeded
     Representatives from the Arkansas        medical affairs at St. Vincent Health     the bonus payment requirements:
     Foundation for Medical Care and          System in Little Rock. St. Vincent        four met the criteria for all seven

20   Fall 2007 I Arkansas Hospitals
  indicators, and 17 met six of the         the measure for discharge instruc-      measures,” which are specific aspects
  seven quality indicators.                 tions.                                  of care proven to improve outcomes
• Qualifying hospitals improved at a      • Close to 100 percent of qualifying      for patients. The hospitals also had
  higher rate than those that did not.      hospitals counseled heart failure       to pass validation to receive the pay-
  Qualifying hospitals showed a 17          and pneumonia patients to stop          ment. Four hospitals achieved the
  percent average relative improve-         smoking. Of qualifying hospitals,       required improvement level in all
  ment, compared to six percent for         99 percent of heart failure patients    seven measures.
  hospitals that did not qualify.           and 98 percent of pneumonia                Some Arkansas hospitals, includ-
• For qualifying hospitals, the com-        patients who smoke received coun-       ing the state’s 28 critical access hos-
  bined data for all seven quality          seling when discharged. This is a       pitals, UAMS Medical Center and
  measures were above state and             six percent and 16 percent relative     Arkansas Children’s Hospital were
  national averages. For non-qual-          improvement, respectively.              ineligible for the incentive payment
  ifying hospitals, only four of the                                                program because they are paid under
  seven measures were above nation-          To receive the incentive payments,     a different Medicaid reimbursement
  al averages.                            which are linked to the hospital’s        category. A small number of out-of-
• Qualifying hospitals improved the       Medicaid per diem rate, hospitals         state hospitals in bordering cities that
  most in heart failure care, with a      had to pass specific requirements for      treat Arkansas patients were eligible
  36 percent relative improvement in      at least five out of seven “quality        to take part in the initiative.    •

Arkansas to Receive Emergency
Preparedness Improvement Grants
   Once again, Arkansas will receive          The     Arkansas      Hospital         be affected in a short period of time.
funds targeted toward improving            Association is aware that hospital        Cooperative efforts of Arkansas hos-
emergency preparedness in the state.       emergency preparedness takes a            pitals utilizing the grant funding
Of most interest to hospitals are          lot of time and effort on the part        we have received over the past five
grant funds to be distributed by           of each hospital’s bioterrorism           years have enabled us all to be better
the Arkansas Department of Health          coordinator as well as administra-        prepared.
(ADH). The ADH is scheduled to             tion, and appreciates the effort             “While we are not ready to face
receive $9,389,729 from Health and         and participation from hospitals.         500, 1000 or tens of thousands of
Human Services’ (HHS) Centers for             John Neal, former CEO of               people looking to us as the pro-
Disease Control and Prevention for         Stuttgart Regional Medical Center         vider of treatment and protection,
public health emergency prepared-          and a member of the hospital              we are definitely better off than we
ness and supplemental pandemic             grant’s Rules and Standards               were. I personally cannot imagine
planning, as well as $4,063,403            Committee, says about hospital            any CEO, administrator, or facil-
from the HHS Assistant Secretary for       participation:                            ity management team not making
Preparedness and Response Hospital                                                   this a priority in their planning and
Preparedness Program (formerly                 “Healthcare delivery involves rou-    devoting the time that is necessary
known as HRSA or Health Resources          tine medical services, prevention, and    to be better prepared for the real-
and Services Administration).              education for our patients and com-       ity of mass casualty or unexpected
   It is hoped that there will be          munities. But the healthcare deliv-       treatment. The necessary time and
increased funding for hospitals to         ery systems we all develop do not         personnel devoted to the training,
participate in regional and state plan-    include mass trauma, casualty and         planning and cooperative efforts of
ning, drills, education, and training.     treatments for the numbers of peo-        all healthcare providers striving to
As it has for the past five years,          ple who may be affected by terror-        meet the unknown demands of mass
the Arkansas Hospital Association          istic acts or viral outbreaks caused      casualty is an investment that helps
worked closely with the ADH to             by terrorism. Hospitals acting alone      us all be better prepared to meet our
protect the funding for our member-        cannot sufficiently plan for or treat      local and statewide healthcare mis-
ship.                                      the numbers of people that would          sions.” •

                                                                                                 Fall 2007 I Arkansas Hospitals   21
       Arkansas Hospital Association
       Headquarters Begins Expansion Project
         At its April 13 meeting, the         additional office space,
      Arkansas Hospital Association           and a small conference
      board of directors approved an          room. Renovations of
      expansion/renovation of the exist-      the existing building will
      ing AHA headquarters in Little          include a reception room,
      Rock. The approximately 4,200           office space, kitchen, and
      square-foot addition will include       work room remodel.
      a state-of-the-art educational          Construction is expected
      center that will accommodate at         to begin in October 2007,
      least 60 individuals, a new board       with a completion date in
      room, an AHA Services suite,            fall 2008.•

       Arkansas Lawmakers Demonstrate
       Hospital Support
         During May’s American Hospital       support from the state’s senators     cut Medicare payment for hospital
      Association Membership Meeting in       and representatives in preventing     services nationwide by nearly $25
      Washington D.C., hospital repre-        those measures.                       billion over five years.
      sentatives from Arkansas expressed         All members of Arkansas’ con-          Though the final rule did not
      their concerns to the state’s lawmak-   gressional delegation, including      reflect changes requested by hospital
      ers about the potential effects of      Senators Blanche Lincoln and Mark     leaders nationwide, the Arkansas
      Medicare’s proposed inpatient pro-      Pryor and Congressmen Marion          Hospital Association once again
      spective payment system (IPPS) rule     Berry, Vic Snyder, John Boozman,      expresses its appreciation to each
      for Fiscal Year 2008. Chief among       and Mike Ross, signed on to “Dear     member of the Arkansas congressio-
      the concerns was the effect the IPPS    Colleague” letters in their respec-   nal delegation for the assistance and
      rule could have on their hospitals.     tive chambers opposing provisions     support shown to the state’s hospital
      Arkansas’ hospital leaders sought       in the proposed rule that would       community.  •

       Arkansas Hospital Administrators Forum
       Disbands after 44 Years
          During its June 22 annual busi-     as the Arkansas chapter of the        Forum really has no need to con-
       ness meeting, members of the           American College of Healthcare        tinue existing as a separate entity.
       Arkansas Hospital Administrators       Executives (ACHE).                       Under the dissolution move,
       Forum voted to disband the orga-          In recent years, the Forum has     the Forum transfers all existing
       nization.                              delegated all duties for the sum-     funds to the Arkansas Hospital
          Formed in 1963, the prima-          mer conference to the Arkansas        Education and Research Trust,
       ry purpose of the Forum was to         Hospital Association.                 which will finance the annual
       provide “professional improve-            In 2002, the Arkansas Health       Summer Leadership Conference
       ment of hospital administrators.”      Executives Forum was named the        beginning in June 2008. Members
       It historically has sponsored the      state’s recognized ACHE chapter       and participants will not see any
       Summer Leadership Conference           and became a co-sponsor of the        changes, other than the name of
       each year and previously acted         summer event. As a result, the        the organization.  •
22   Fall 2007 I Arkansas Hospitals
                            by Paul Cunningham, Senior Vice President, Arkansas Hospital Association

Final FY 2008 IPPS Rule and What It
Means for Arkansas Hospitals
   On August 1, the Centers for        CMS not to implement the cuts.            patients discharged on or after
Medicare & Medicaid Services           The House even voted 412-12 to            October 1, 2007. Beginning in
(CMS) released its final rule cover-    restrict CMS from spending money          FY 2009, cases including these
ing the Medicare hospital inpatient    on the prospective implementation         conditions would not be paid at
prospective payment system for         of the behavioral offset.                 a higher rate unless they were
Fiscal Year (FY) 2008. Under the          Expect to hear more on the             present on admission.
rule, hospitals will get a 3.3 per-    matter as the hospital community        • Quality measures and reporting.
cent market basket rate increase       works with Congress to overturn           Hospitals must report addition-
for the year.                          those particular cuts.                    al quality measures in calendar
   However, CMS all but negates           The rule also includes provisions      year (CY) 2008 in order to qual-
the increase by refusing to bend       to prohibit Medicare from pay-            ify for the full market basket
on the most controversial part of      ing the additional costs of certain       update in FY 2009. Failure to
the rule that was first pitched last    preventable conditions (including         report will result in a two per-
April. So, it will proceed, at least   certain infections) acquired in the       cent penalty. CMS will measure
for now, with a demoralizing plan      hospital, expands the list of public-     30-day mortality for Medicare
to cut hospital payments nation-       ly reported quality measures, and         patients with pneumonia and
wide by $1.6 billion in FY 2008,       reduces Medicare’s payment when           plans to adopt two measures
and more than $20 billion over         a hospital replaces a device that is      relating to surgical care improve-
five years, through a prospectively     supplied to the hospital at no or         ment in the CY 2008 outpatient
imposed 2.4 percent “behavioral        reduced cost.                             prospective payment system
offset.” The offset is expected to        In addition, CMS eliminates the        final rule. In addition, CMS will
cost Arkansas hospitals an estimat-    three percent add-on capital pay-         finalize two additional surgi-
ed $14 million in Medicare reim-       ment to large urban hospitals, and        cal care improvement measures
bursements during FY 2008 and          phases out the indirect medical           by program notice after they
$220 million through FY 2012.          education adjustment to capital           receive NQF endorsement.
   CMS included the offset as          payments over three years.              • Replacement medical device
a pre-emptive measure to coun-                                                   reimbursement. Payments for
ter concerns that the new set of          Highlights of the Final Rule           replaced medical devices that
Medicare       Severity-Diagnosis      include:                                  were recalled and replaced by
Related Groups (MS-DRGs) will          • MS-DRGs. 745 new severity-ad-           manufacturers below cost will
provide opportunities for hospitals       justed diagnosis-related groups        be reduced.
to document and code information          (Medicare Severity DRGs or           • Specialty hospitals. In keep-
contained in the medical record           MS-DRGs) will replace the              ing with the plan contained
in a way that may result in higher        current 538 DRGs. Payments             in CMS’ August 2006 Report
payments. In a statement colored          will increase for hospitals serv-      (
with Pinocchioan hyperbole, CMS           ing more severely ill patients         PhysicianSelfReferral/06a_
said that changes incorporated in         and decrease for those serving         DRA_Reports.asp) to Congress
the final rule were “widely praised        patients who are less severely         on specialty hospitals, the rule
in the public comments” and are           ill. (This is intended to remove       creates new disclosure require-
“consistent with commenters’              incentives for “cherry-picking.”)      ments for these hospitals and
views on how program reforms              Aggregate program payments             allows CMS to terminate a pro-
should occur.” That would seem            should not change.                     vider agreement for noncompli-
to overlook comments from the          • No pay for “never” events. The          ance with those requirements.
nation’s hospitals, which were gen-       rule implements a provision
erally united in their opposition         of the Deficit Reduction Act             Click on http://www.cms.hhs.
to the offset, as were a major-           of 2005 requiring hospitals to       gov/AcuteInpatientPPS/down-
ity of U.S. senators and congress-        report secondary diagnoses that      loads/CMS-1533-FC.pdf to access
men who signed a letter urging            are present on the admission of      the full text of the rule. •
                                                                                          Fall 2007 I Arkansas Hospitals   23
                                            From the Arkansas Foundation for Medical Care (AFMC)

     Arkansas QIO Offers Help with Hospital
     Payment Monitoring Program

     Problems with the proper utilization of                                 inpatient criteria, the hospital
                                                                             may change the beneficiary’s sta-
     Medicare observation continue to be identi-                             tus from inpatient to outpatient
                                                                             and submit an outpatient claim
     fied on AFMC Medicare inpatient review. The                              (TOBs 13x, 85x) for medically
                                                                             necessary Medicare Part B ser-
     information below focuses on one area of                                vices that were furnished to the
     confusion that appears to be ever-growing.                              beneficiary, provided all of the
                                                                             following conditions are met:

                                                                             • The change in patient status
                                                                               from inpatient to outpatient
                                                                               is made prior to discharge or
       Changing Observation to           important that physicians, case       release, while the beneficiary
       Inpatient, and Inpatient          managers, utilization review          is still a patient of the hos-
       to Observation                    staff, and hospital billing staff     pital.
       (Condition Code 44 - it only      understand that this policy can-    • The hospital has not submit-
       goes one way!)                    not be applied in reverse. At no      ted a claim to Medicare for
                                         time can the admission status of      the inpatient admission.
          Medicare review under the      a Medicare patient who has been     • A physician concurs with the
       Hospital Payment Monitoring       admitted to observation be retro-     utilization review committee’s
       Program (HPMP) continues to       actively changed to inpatient. In     decision.
       identify more and more occur-     other words, a physician cannot     • The physician’s concurrence
       rences of observation misunder-   write an order to go back and         with the utilization review
       standing and incorrect billing.   retroactively change observation      committee’s decision is docu-
       Perhaps the implementation of     services that have already been       mented in the patient’s medi-
       Medicare Condition Code 44        provided, to inpatient services.      cal record.
       has “muddied” the water.
          Condition      Code     44,                                           When a hospital has deter-
       “Inpatient Admission Changed      Condition Code 44 Policy            mined that it may submit an out-
       to Outpatient,” implemented on    (changing inpatient to obser-       patient claim according to the
       October 12, 2004, allows physi-   vation)                             conditions described above, the
       cians and hospitals to change                                         entire episode of care should be
       a Medicare patient’s admission       In cases where a hospital uti-   treated as though the inpatient
       status from inpatient to out-     lization review committee deter-    admission never occurred and
       patient/observation under cer-    mines that an inpatient admis-      should be billed as an outpatient
       tain conditions. However, it is   sion does not meet the hospital’s   episode of care.

24   Fall 2007 I Arkansas Hospitals
 Changing observation to               • The hours the patient was         tient from the beginning” can
 inpatient                               treated in observation, prior     only be interpreted as “make the
                                         to being changed to inpatient     patient inpatient now.” Again,
    A Medicare patient’s status          status, must be shown on the      the inpatient admit date reflected
 can be changed from observation         inpatient claim using revenue     on the claim, in this case, must
 to inpatient at any time following      code 0762.                        be the date the “make the patient
 the order for observation, but, as                                        inpatient” order is written, and
 stated above, never after the fact.                                       the inpatient claim must show
 When observation is changed to        What we see on review               the hours the patient was man-
 inpatient, the claim must reflect                                          aged in observation under rev-
 the true/actual circumstances of         Incorrect status change orders   enue code 0762.
 the admission and the following       and incorrectly billed observa-        Another common error seen
 rules apply:                          tion days are becoming more         on review is an order to “change
                                       common. The most common             a patient’s status from observa-
 • The inpatient admit date is         error is an order written at some   tion to inpatient from the begin-
   the date (real time) the status     point following the observation     ning” that is written at the time
   change was made.                    order to “make the patient inpa-    of discharge so that the admis-
 • The principal diagnosis is the      tient from the beginning.” This     sion is billed as an inpatient.
   condition, after study, that        cannot be done. Observation         This is a billing error. In this
   caused the inpatient admis-         services that have already been     situation, it is only correct to
   sion (possibly not the reason       provided cannot be retroactively    bill this case as observation, as
   for the admission to observa-       changed to inpatient services. An   observation cannot be changed
   tion).                              order to “make the patient inpa-    to inpatient after the fact.   •

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                                                                                     Fall 2007 I Arkansas Hospitals   25
        ACEP Summit on the IOM
        Future of Emergency Care Reports
           The Institute of Medicine’s          • Pediatric emergency medicine        mend a strategy for the optimal
        reports, The Future of Emergency        • Trauma                              organization and funding of the
        Care, constitute a comprehensive        • Emergency medical services          research effort. This study should
        review and analysis of the delivery                                           include consideration of: train-
        of emergency care in the United            Throughout the daylong dis-        ing of new investigators; develop-
        States. The three reports were          cussions about the recommenda-        ment of multi-center research net-
        released in June 2006 and the IOM       tions, a robust debate emerged        works; funding of General Clinical
        subsequently convened workshops         over the specifics of the IOM          Research Centers (GCRC’s) that
        in Salt Lake City, Chicago, New         recommendations and what par-         specifically include an emergen-
        Orleans, and Washington, DC,            ticipants viewed as appropri-         cy and trauma care component;
        to disseminate the findings and          ate modifications. Strong cases        involvement of emergency and
        recommendations, and to receive         were made for recommendations         trauma care researchers in the
        feedback from interested parties.       that seemed to have ramifica-          grant review and research advisory
           In the spring, ACEP convened a       tions that crossed all areas of the   processes; and improved research
        summit of organizations involved        report (such as Pediatrics Report     coordination through a dedicated
        in emergency care. Joining              Recommendation 7.1, calling           center or institute. Congress and
        ACEP in the Summit were the             on the Secretary of Health and        federal agencies involved in emer-
        American College of Surgeons,           Human Services to examine gaps        gency care research (including
        Society of Academic Emergency           in emergency care research, includ-   DOT, DHHS, DHS, and DoD)
        Medicine, American Academy of           ing pediatric emergency care).        should implement the study’s rec-
        Neurological Surgeons/Congress             Summit participants agreed         ommendations.
        of Neurosurgeons, American              on six recommendations, one for
        Academy of Orthopaedic Surgeons,        each of the five specific areas         2. Hospital-Based Care
        American Academy of Family              originally identified and one that        Hospital-Based Report Recom-
        Physicians, American Academy of         is overarching. Participating orga-   mendation 2.1. Congress should
        Emergency Medicine, American            nizations are reviewing these rec-    establish dedicated funding, sep-
        Trauma       Society,    American       ommendations with their respec-       arate from DSH payments, to
        Public     Health     Association,      tive boards. Once each group has      reimburse hospitals that provide
        American Academy of Pediatrics,         indicated its approval of these       significant amounts of uncompen-
        Emergency Medicine Residents’           recommendations, the govern-          sated emergency and trauma care
        Association, Emergency Nurses           ment relations staff of the respec-   for financial losses incurred by
        Association, National Association       tive organizations will develop a     providing those services.
        of EMS Physicians, National             strategic plan to implement the          a. Congress should initially
        Association of EMTs, and the            agreement.                            appropriate $50 million for the
        National Association of State                                                 purpose, to be administered by
        EMS Officials.                           Consensus Agreement                   the Centers for Medicare and
           The Summit’s objective was           from the IOM Summit                   Medicaid Services.
        to develop a group consensus               Summit participants agreed to         b. CMS should establish a
        about the priorities of the IOM         jointly advocate for these six rec-   working group to determine the
        recommendations. More specifi-           ommendations:                         allocation of those funds, which
        cally, the 15 organizations met                                               should be targeted to providers
        to identify at least one priority       1. Emergency Medicine Research        and localities at greatest risk; the
        recommendation in each of five              Hospital-Based Report Recom-       working group should then deter-
        key areas that would serve as the       mendation 8.2. The Secretary of       mine funding needs for subse-
        basis of a joint federal legislative/   the Department of Health and          quent years.
        regulatory agenda:                      Human Services should conduct            Summit participants support
                                                a study to examine the gaps and       additional funding for care pro-
        • Emergency care research               opportunities in emergency and        vided by hospitals and physicians
        • Hospital-based care                   trauma care research, and recom-      that provide significant uncom-

26   Fall 2007 I Arkansas Hospitals
      pensated emergency and trauma                     and appropriate $88 million over   community mass casualty event.
      care. The IOM’s specific funding                   five years to this program.            The Centers for Medicare
      level should only be regarded as                                                     & Medicaid Services should
      a floor for additional support.                    5. EMS                             convene a working group that
                                                           EMS Report Recommendation       includes experts in emergency
      3. Pediatric Emergency Medicine                   3.7. CMS should convene an         care, inpatient critical care,
         Pediatrics Report Recom-                       ad hoc work group with exper-      hospital operations manage-
      mendation 3.7. Congress should                    tise in emergency care, trauma,    ment, nursing, and other rel-
      appropriate $37.5 million each                    and EMS systems to evaluate        evant disciplines to develop
      year for the next five years to the                the reimbursement of EMS and       boarding and diversion stan-
      EMS-C Program.                                    make recommendations regard-       dards, as well as guidelines,
                                                        ing inclusion of readiness costs   measures, and incentives for
      4. Trauma                                         and permitting payment without     implementation, monitoring,
         Hospital-Based Report Recom-                   transport.                         and enforcement of these stan-
      mendation 3.5/EMS Report 3.4.                                                        dards.
      Congress should establish a dem-                  6. Boarding                           Summit participants recog-
      onstration program, administered                     Hospital-Based Report Recom-    nized the severity of the crowd-
      by the Health Resources and                       mendation 4.5. Hospitals should    ing and boarding problem and
      Services Administration, to pro-                  end the practices of boarding      agreed that this recommenda-
      mote regionalized, coordinated,                   patients in the ED and ambu-       tion can serve as the basis for
      and accountable emergency care                    lance diversion, except in the     a strategy to address boarding
      systems throughout the country,                   most extreme cases, such as a      and its causes.•

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                                                                                                       Fall 2007 I Arkansas Hospitals   27
     Cross-Cultural Curricula Recommended for
     All Graduate Medical Education Programs
        A new report from the                    unprepared to care for
     Commonwealth Fund recommends                patients with specific cul-
     cross-cultural curricula be integrated      tural characteristics.
     into all graduate medical education            Carol Aschenbrener,
     to better prepare resident physicians       M.D., executive vice pres-
     to provide quality care to diverse          ident for the Association
     populations.                                of American Medical
        The authors say the curricula            College’s medical educa-
     should focus on practical tools and         tion division, comment-
     skills, and be based on standard prin-      ed, “Cultural competen-
     ciples that are useful across clinical      cy is about understand-
     disciplines. They say faculty should        ing people and mutual
     be trained in the same principles,          understanding is key to
     and that evaluation of residents’           effective patient care.
     general and cross-cultural commu-           AAMC is currently part-
     nication skills should be mandatory         nering with the California
     and formalized.                             Endowment Fund and                         cal education.”
        The recommendations are based            four California medical schools to            To read a synopsis of the report,
     on a 2003 national survey of resi-          explore how experiences that foster        go to http://www.commonwealth-
     dent physicians in their last year          cross-cultural understanding could
     of training that found many felt            be incorporated into graduate medi-        show.htm?doc_id=48086.      •

     AHA’S Online Governance Education
     Program Continues
        The AHA’s Trustee Education              in their own boardrooms, just as they      dynamic and focused leadership envi-
     Program, designed to help hospital          would in a live presentation.              ronment.
     and health system trustees provide
     effective strategic leadership to meet         Upcoming presentations include:            December 18, 12 noon, Central
     today’s dynamic and rapidly chang-             October 23, 12 noon, Central            Time: Tough Leadership for Tough
     ing healthcare environment, continues       Time: Supercharging Your Hospital          Times: Governing Through the
     with monthly Webinars through the           Governance Committees: This session        Storms of Change: In this session,
     end of the calendar year.                   will explore ways to maximize the role     participants will learn how converg-
        The convenient Webinars, pre-            and value of board committees as a         ing trends in government payments,
     sented by Larry Walker, president           strategic development asset, and will      regulation, technology, workforce,
     of The Walker Company, feature              highlight some of the ways leading         quality and patient safety, account-
     innovative distance learning pow-           healthcare organizations have re-ener-     ability and transparency, medical
     ered by a Microsoft PowerPoint Net          gized their committee structures, pro-     liability, and others intersect to cre-
     Conference™        program presented        cesses, and leadership contributions       ate a storm of challenges to be
     over the Internet and using a standard                                                 overcome.
     speaker phone.                                 November 27, 12 noon, Central
        Subscribers simply call a toll-free      Time: Governing Leadership Essentials         Webinar registration is available
     800 number and simultaneously log           for a Complex Healthcare World: This       at
     onto a Web page that displays the pre-      session will explore the challenges and    ducworkshops.htm, or contact Beth
     sentation. Trustees listen to the speaker   requirements of building a highly effec-   Ingram at bingram@arkhospitals.
     and watch the presentation on a screen      tive governance team and ensuring a        org for more information.   •

28    Fall 2007 I Arkansas Hospitals
       And Arkansas hospital patients
       are seeing the benefits.
        Together with Arkansas Medicaid and the Arkansas Hospital Association,
        the Arkansas Foundation for Medical Care is leading an innovative new
        program called the Medicaid Inpatient Quality Incentive.

        Through this program, 29 hospitals that treat Arkansas patients received
        merit payments for significantly improving care for heart failure and
        pneumonia patients. Their care now tops state and national averages.

        As one of only two states to reward high-quality hospital care,
        Arkansas sets the standard when it comes to improving inpatient care.

        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) under contract with the Arkansas Department of Human Services, Division of Medical Services. The contents presented do not necessarily reflect Arkansas DHS policy. The Arkansas
Department of Human Services is in compliance with Titles VI and VII of the Civil Rights Act. QM2-AHAIQI.AD,3-9/07
     Medical Benefits of Providing
     Interpretation Services
         A new video from the Robert         • Reduce healthcare disparities        medically trained interpreters are
      Wood Johnson Foundation’s                associated with language bar-        contributing to safety and clinical
      Speaking Together project describes      riers.                               outcomes for patients who speak
      the role that language services play                                          or understand little English.
      in delivering high quality health-                                               The hospitals are participants
      care.                                                                         in the national project to improve
         This short video introduces                                                healthcare language services and
      Speaking Together’s efforts to:                                               reduce healthcare disparities asso-
       • Improve the quality and avail-                                             ciated with language barriers.
         ability of healthcare language                                                To view the video and
         services                                                                   access a guide for its use, go to
       • Integrate quality improvement                                              http://www.speakingtogether.
         with language services                                                     org/5667/179591.
       • Pilot performance measures for                                                Another initiative supporting
         evaluating language services                                               hospitals with language assistance
       • Test interventions to improve         The video features Cambridge         resources is the Missouri Hospital
         the timeliness and quality of       Hospital in Massachusetts and          Association’s www.healthtransla-
         interpretive services; and          Phoenix Children’s Hospital, where Web site. •

     Plan Designed to Distribute/Explain
     500,000 Advance Directives
         Aging with Dignity, the United         Ruth Sullivan, president-elect
     Health Foundation, AHA, and other       of the Society for Healthcare
     national and local organizations        Consumer Advocacy and director
     will distribute 500,000 advance         of patient and family advocacy for
     directives in the coming year in        Shore Health System in Eastern
     a campaign to help patients and         Maryland, told reporters at a brief-
     families make important advance         ing on the campaign, “The conver-
     decisions about their end-of-life       sations need to be with families, so
     care.                                   at the end of life, families are not
         The “Five Wishes” directive,        torn apart.”
     now available in 20 languages,             SHCA is an American Hospital
     addresses an individual’s medical,      Association affiliate. Copies of the
     personal, emotional, and spiritual      translated Five Wishes documents
     needs before a healthcare crisis. It    were sent in June to all U.S. hospi-
     is recognized as a legal and binding    tals, as well as hospital consumer
     document in 40 states and used as       advocates and volunteers.
     a model to prepare directives in the       To learn more, go to http://
     other ten.                       •

30   Fall 2007 I Arkansas Hospitals
IRS Releases Revised Form 990
   The Internal Revenue Service                                                                                                                                                                                                       approximately 1.3 million public         interested in Schedule H, which
(IRS) has been grappling for sev-                                                                                                                                                                                                     charities or other types of non-         solicits numerical and financial
eral years with the question of                                                                                                                                                                                                       charitable organizations in the          information related to community
how to improve oversight of the                                                                                                                                                                                                       U.S. that are exempt from paying         benefit, billing and collections, and
 TLS, have you
                                                        Version B
                                                       I.R.S. SPECIFICATIONS             TO BE REMOVED BEFORE PRINTING
                                                                                                                                                             6                                                                        state and federal income taxes.          management companies and joint
 transmitted all R                                                                                                                                                    Action                      Date          Signature

                                                                                                                                                                                                                                      These include public charities (not      ventures. Also included are activ-
 text files for this                                   INSTRUCTIONS TO PRINTERS
 cycle update?                                         FORM 990, PAGE 1 of 12
                                                       MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.    PRINTS: HEAD TO HEAD                                              O.K. to print
                                                       PAPER: WHITE WRITING, SUB. 20.                  INK: BLACK
                                                       FLAT SIZE: 216 mm (81⁄2 ")  835 mm (327⁄8 ),
                                    Date               FOLDED TO 216 mm (81⁄2 ")    279 mm (11")     PERFORATE: ON FOLD                                               Revised proofs
                                                       DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT                                                      requested

                                                                                                                                                                                                                                      including churches), non-charita-        ity-specific schedules that involve
                                                                                                                                                                                                                                      ble tax-exempt organizations, and        executive compensation, related
 Form                              990                             Return of Organization Exempt From Income Tax
                                                                                                                                                                                                      OMB No. 1545-0047               private foundations.                     organizations, asset transfer/ter-
                                                                                                          f                                                                                                                              The agency decided in 2005 that       mination of exempt entity, gover-
                                                            Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung
                                                                                       benefit trust or private foundation)
                                                                                                                                                                                                     Open to Public

                                                                                                      so 7
 Department of the Treasury
 Internal Revenue Service (77)                                The organization may have to use a copy of this return to satisfy state reporting requirements.                                         Inspection
 A                              For the 20XX calendar year, or tax year beginning                                                          , 20XX, and ending                                         , 20

                                                                                                                                                                                                                                      its best move would be to revise         nance, and tax-exempt bonds.
                                                       Please C Name of organization                                                                                           D Employer identification number
 B Check if applicable:

                                                                                                    ta 0
                                                      use IRS
                               Address change         label or
                                                      print or  Number and street (or P.O. box if mail is not delivered to street address)                  Room/suite
                               Name change              type.

                                                                                                 raf 4/20
                               Initial return            See
                                                                                                                                                                               E Telephone number

                                                                                                                                                                                                                                      the IRS Form 990. On June 13, the           The IRS proposes to finalize the
                                                                City or town, state or country, and ZIP + 4
                                                       tions.                                                                                                                     (           )
                               Amended return
                               Application pending               F Name and address of Principal Officer:
 G Website:                                                                                                                                             J    Books

 H Enter amount of gross receipts $                                                             D /1
                                                                                                  I Accounting method:
                                                                                                             Accrual            Other
                                                                                                                                                             In care of
                                                                                                                                                             Located at
                                                                                                                                                                                                                                      agency released its long-awaited         form and schedules by December
 K Organization type (check only one)                                                501(c) (       )     (insert no.)       4947(a)(1) or      527          Telephone number             (          )
  Part I
                               Year of Formation:
                                   1 Briefly describe the organization’s mission:
                                                                                                                                                             M State of legal domicile

                                                                                                                                                                                                                                      draft revision of the new form,          31, 2007. Although instructions
                                  2 List the organization’s three most significant activities and the activity codes (Part IX):
                                                                                                                                                                                                                                      which will be completed by all           are not expected to be final until
     Activities & Governance

                                     a                      Code                   b                         Code                  c                         Code
                                  3 Enter the number of members of the governing body (Part III, line 1a)                                                  3
                                  4 Enter the number of independent members of the governing body (Part III, line 1b)                                      4
                                  5 Enter the total number of employees (Part VIII, line 9a)
                                  6 Enter the number of individuals receiving compensation in excess of $100,000 (Part II, line 2)
                                  7 Enter the highest compensation amount reported on Part II, Section A (sum of columns D and E) 7
                                                                                                                                                                                                                                      tax-exempt organizations, includ-        summer of 2008, plans call for
                                  8a Enter officer, director, trustee, and other key employee compensation (Part V, line 5, column (B)) 8a
                                   b Divide line 8a by line 17

                                   b Enter net unrelated business taxable income from Form 990-T, line 34
                                 10 Check this box
                                  9a Enter total gross unrelated business revenue from Part IV, line 14, column (C)                                      9a
                                                        if the organization discontinued its operations or disposed of more than 25% of its assets and attach Schedule N.
                                                                                                                                                                                                                                      ing hospitals, and also released 15      implementing the new form and
                                 11     Contributions and grants (Part IV, line 1g, column (A))
                                                                                                                                                                                       Amount                 % of Total

                                                                                                                                                                                                                                      specific schedules that organiza-         schedules for tax year 2008.

                                 12     Program service revenue (Part IV, line 2g, column (A))
                                 13     Membership dues and assessments (Part IV, line 3, column (A))
                                        Investment income (Part IV lines 4, 5, 6, 8, 10d)
                                        Other revenue (Part IV, lines, 3, 7, 9d, 11c, 12c, and 13e, column (A))
                                        Total revenue add lines 11 through 15 (must equal Part IV, line 14, column (A))                                                                                          100%
                                                                                                                                                                                                                                      tions must complete depending on            Click on
                                 17 Program service expense (Part V, line 24, column (B))
                                 18 Management and general expenses (Part V, line 24, column (C))
                                                                                                                                                                                                                                      the types of activities they engage      charities/article/0,,id=171216,00.

                                 19a Fundraising expenses (Part V, line 24, column (D))
                                 19b Percentage of contributions (divide line 19a by line 11) %
                                 20 Total expenses (must equal Part V, line 24, column (A))                                                                                                                      100%
                                 21 Net income (line 16 minus line 20)
                                                                                                                                                                              Beginning of Year               End of Year
                                                                                                                                                                                                                                      in, and instructions for each.           html to see the proposed form and
 Net Assets or
 Fund Balance

                                 22 Total assets (Part VI, line 17)

                                 23 Total liabilities (Part VI, line 27)
                                 24a Net assets or fund balances line 22 minus line 23
                                 24b Total expenses (line 20) as percentage of net assets (line 24a)
                                                                       (i) Gross Revenue                            (ii) Expenses
                                                                                                                                                      (iii) Net to organization                   (iv) Divide column (iii)
                                                                                                                                                                                                       by column (i)
                                                                                                                                                                                                                                         Hospitals will be especially          schedules.
 Gaming &

                                 25     Gaming                (Schedule G, Part III, line 1 column (d))       (Schedule G, Part III, line 7)          (Schedule G, Part III, line 8)
                                 26     Fundraising (other (Schedule G, Part I, line 1b column (iii) (Schedule G, Part I, line 1b column (iv) (Schedule G, Part I, line 1b column (v)
                                        than gaming)       total)                                    total)                                   total)

 For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.                                                                                   Cat. No. 11282Y                        Form   990      (20XX)

“Card Check” Fails in U.S. Senate
    The Employee Free Choice Act (S.                                                                                                                                                                                                     The bill, which passed the House      union election system that is based on
1041/ H.R. 800) - the “card check”                                                                                                                                                                                                    March 1 by a wide margin despite a       the bedrock principle of democracy:
bill - failed in the Senate June 26.                                                                                                                                                                                                  veto threat from the White House,        free and fair elections where ballots
During a procedural vote to deter-                                                                                                                                                                                                    would have amended the National          are cast in private, free from interfer-
mine whether the bill itself would be                                                                                                                                                                                                 Labor Relations Act to require employ-   ence or influence by either side.
brought up for consideration, support-                                                                                                                                                                                                ers to recognize a labor union solely       It is possible the bill could re-emerge
ers failed to attract the necessary 60                                                                                                                                                                                                through the card check process.          at a later date, but it is unlikely that it
“yeas,” instead garnering only 51.                                                                                                                                                                                                       That would change the current         will reappear this year.  •

Governor Appoints State’s First Surgeon General
   Arkansas Governor Mike                                                                                                                                                                                                                Dr. Thompson has                      which supports public- and pri-
Beebe in early July named Dr.                                                                                                                                                                                                         served as the state’s                    vate-sector efforts to improve
Joe Thompson of Little Rock as                                                                                                                                                                                                        chief health officer for                  health.
Arkansas’s first Surgeon General.                                                                                                                                                                                                      the past two years.                         Thompson, who has a pediatric
   “Arkansas’s Surgeon General                                                                                                                                                                                                        The state Legislature                    practice at Arkansas Children’s
will be the pre-eminent champion                                                                                                                                                                                                      abolished the “chief                     Hospital and serves on the faculty
for health education in our state,”                                                                                                                                                                                                   health officer” posi-                     at the University of Arkansas for
                                                                                                                                                                                                                                                               Joe Thompson
Beebe said. “Joe has long been                                                                                                                                                                                                        tion during the 2007                     Medical Sciences, was one of the
a leader in the tireless effort to                                                                                                                                                                                                    General Assembly, replacing it           architects of the state’s Tobacco
improve the health and healthcare                                                                                                                                                                                                     with the post of Surgeon General.        Settlement Proceeds Act. That Act
of our people and is a natural fit to                                                                                                                                                                                                     Thompson will continue to             directed money from the tobacco
be the first Arkansan to hold this                                                                                                                                                                                                     serve as a director of the Arkansas      settlement agreement in Arkansas
position.”                                                                                                                                                                                                                            Center for Health Improvement,           to health-related programs.        •
                                                                                                                                                                                                                                                                                            Fall 2007 I Arkansas Hospitals   31
     2007 Diamond Award Winners Announced, Honor
     Hospital Public Relations and Marketing Efforts
        Recipients of the Arkansas                                                    C
                                                                                      CARTI, Little Rock
     Hospital      Association’s   2007                                               C
                                                                                      Conway Regional Health System
     Diamond Awards have been select-                                                 H
                                                                                      HSC Medical Center, Malvern
     ed. The competition, co-spon-                                                    J
                                                                                      Jefferson Regional Medical
     sored by the Arkansas Society for                                                    Center, Pine Bluff
     Healthcare Marketing and Public                                                  M
                                                                                      Magnolia Hospital
     Relations, is designed to recognize                                              M
                                                                                      Medical Center of South
     excellence in hospital public rela-                                                  Arkansas, El Dorado
     tions and marketing.                                                             N
                                                                                      North Arkansas Regional Medical
        Diamond, Excellence, and                                                          Center, Harrison
     Judges’ Merit Awards were pos-                                                   S
                                                                                      Saline     Memorial      Hospital,
     sible in three divisions (hospitals                                                  Benton
     with 0-99 beds, hospitals with 100-                                              S
                                                                                      St. Bernards Medical Center,
     249 beds, and hospitals with 250                                                     Jonesboro
     or more beds) in twelve categories.                                              S
                                                                                      St. Edward Mercy Medical
        The competition drew 184                                                          Center, Fort Smith
     entries – a record number since the                                              S
                                                                                      St. Joseph’s Mercy Health Center,
     competition began in 1995.                                                           Hot Springs
        The top awards, Diamond, will       nally/externally results/evaluation
                                            nally/externally, results/evaluation,     S
                                                                                      St. Vincent Health System, Little
     be presented during the Arkansas       and total budget.                             Rock
     Hospital Association’s 77th Annual                                               Stuttgart Regional Medical
     Meeting and Trade Show at the            The award-winning hospitals for             Center
     Peabody Hotel in Little Rock. The      all three awards are:                     UAMS Medical Center, Little
     Awards Dinner will be Thursday            Arkansas Children’s Hospital,              Rock
     evening, October 11, 2007.                   Little Rock                         Washington Regional Medical
        The two other awards, Certificate       Arkansas Heart Hospital, Little            System, Fayetteville
     of Excellence and Judges’ Merit,             Rock                                White County Medical Center,
     will be mailed to recipients follow-      Arkansas Hospice, Little Rock              Searcy
     ing the annual meeting.                   Arkansas Methodist Medical             White River Health System,
        Judging for each entry was based          Center, Paragould                       Batesville
     on goals and objectives, audience to      Baptist Health Medical Center,
     whom directed, reasons for choosing          Little Rock                         Congratulations to all the 2007
     the format, frequency and quantity,       Baxter Regional Medical Center,      Diamond Award Winners!       •
     portions that were created inter-            Mountain Home

     Arkansas Hospital Association Earns
     National Recognition for Marketing Excellence
        The     Arkansas     Hospital       healthcare marketing.                   campaign featuring hospital testimo-
     Association (AHA) recently was            The AHA received a certificate as     nials along with signs indicating vari-
     named a winner in two categories       a Silver Winner for a poster devel-     ous hospital services.
     of a national competition spon-        oped in conjunction with its Smoke         The association worked with Exit
     sored by the Healthcare Marketing      Free Campus campaign and a Bronze       Marketing of Little Rock to develop
     Report, a national newspaper for       Winner certificate for the AHA image     the ads.•

32    Fall 2007 I Arkansas Hospitals
       Governor Beebe Provides Tornado-Damaged
       Hospital Financial Assistance
          The tornado that blew                                                                          Arkansas      Governor
       through Dumas, Arkansas                                                                        Mike Beebe recognized the
       on February 24 of this year                                                                    problem and, during a July
       spared the new Delta Memorial                                                                  5 tour of Dumas to assess
       Hospital (DMH) from major                                                                      recovery efforts, presented
       damage, but the critical access                                                                DMH CEO James Fairchild
       hospital has encountered its                                                                   with a $250,000 check from
       own set of difficulties in the                                                                  the Governor’s Emergency
       wake of the storm.                                                                             Fund to provide some much-
          The tornado destroyed more                                                                  needed financial assistance.
       than two-dozen businesses and                                                                  In his remarks, Governor
       left about 800 area residents                                                                  Beebe said, “The folks at
       without jobs. As a result, DMH                                                                 Delta Memorial have been
       has seen a steep rise in the                                                                   taking care of storm vic-
       number of uninsured patients.                                                                  tims for more than four
       Officials at Delta Memorial                                                                     months, oftentimes without
       expect the trend to continue                                                                   compensation. We want to
       over the next year, especially for                                                             ensure that they can con-
       patients needing primary care,                                                                 tinue providing these vital
       obstetrics, and inpatient and Governor Mike Beebe (left) presents $250,000 relief check to     healthcare services in the
       outpatient services.               James Fairchild of Dumas.                                   future.” •

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                                              PEOPLE. PRINCIPLES. POSSIBILITIES.
                                                                                                         Fall 2007 I Arkansas Hospitals   33
     Hospital On-Call Pay Practices Reported
        In May, the Arkansas Hospital         diversion.                               CEOs in late February 2007 via fax
     Association surveyed member hospi-          Hospital leaders cited a lack of      and email.
     tals regarding their policies covering   staffed critical care beds as the most     See the survey results on the
     on-call pay for emergency room cov-      common reason for diversion. The         American Hospital Association
     erage. The results showed that about     survey also found that hospital work-    Web site at http://www.aha.
     25 percent of the responding hospitals   force shortages, including an estimat-   org/aha_app/index.jsp?SSO_
     reported that they pay a per diem or     ed 116,000 registered nurse vacancies    COOKIE_ID=0a2f011430e263766
     a fixed annual amount for on-call         as of December 2006, are affecting       02573e04fdeb96b9fcc 43afb2d2.   •
     coverage.                                patient care.
        That differs from a recent survey        Regarding disaster
     conducted by the American Hospital       readiness, hospitals
     Association, in which more than one-     are taking a variety
     third of hospital leaders surveyed       of actions to bolster
     reported paying for some physician       preparedness, includ-
     specialty emergency department (ED)      ing participating in
     call coverage.                           large-scale      drills,
        The report on the survey findings,     establishing back-
     2007 State of America’s Hospitals        up communication
     – Taking the Pulse, also found 55        plans and developing
     percent of hospitals experienced         resource plans with
     gaps in physician specialty coverage,    other hospitals.
     with coverage issues most prevalent         The survey, which
     in orthopedics and neurosurgery. In      had a 17 percent
     addition, nearly half of EDs are “at”    response rate, was
     or “over” capacity, with a majority of   sent to about 5,000
     urban hospitals experiencing time on     community hospital

      UAMS will Establish a New North Central
      Area Health Education Center
         The University of Arkansas for       Medical Center in Mountain Home          this year approved two years of
      Medical Sciences (UAMS) plans           will play key roles in the AHEC.         funding for the new AHEC totaling
      to establish the state’s eighth Area       The AHEC will serve ten counties      $2.6 million. The two colleges will
      Health Education Center (AHEC)          in north central Arkansas: Baxter,       provide space for the AHEC in new
      through a one-of-a-kind collab-         Fulton, Sharp, Independence,             buildings being constructed on each
      orative arrangement that will uti-      Stone, Cleburne, Van Buren,              campus. Until those facilities are
      lize the resources of two separate      Searcy, Marion, and Izard.               completed, the AHEC will occupy
      community colleges and hospitals           Charles O. Cranford, D.D.S.,          temporary space as programs are
      located in those same communi-          vice chancellor for regional pro-        selected and put in place.
      ties.                                   grams and executive director of the         The local hospitals will be
         The new AHEC North Central           AHEC Program, said that the addi-        the clinical training grounds for
      will operate in conjunction             tion will serve the dual purpose of      rotations of UAMS students of
      with the University of Arkansas         expanding UAMS’ services into an         medicine, pharmacy, nursing,
      Community College at Batesville         underserved part of the state, while     and other healthcare profes-
      and Arkansas State University —         increasing the number of health-         sions. UAMS currently operates
      Mountain Home. In addition to           care providers and improving the         AHECs in El Dorado, Fayetteville/
      the local higher education facili-      quality of healthcare, especially in     Springdale, Fort Smith, Helena/
      ties, White River Medical Center        small and rural communities.             West Memphis, Jonesboro, Pine
      in Batesville and Baxter Regional          The Arkansas Legislature earlier      Bluff, and Texarkana. •

34   Fall 2007 I Arkansas Hospitals
Determining Consent for Minors
   Under certain, limited circum-         or foster parent. Although no dis-         other than a parent is standing
stances, a minor may consent to his       tinction is made between a custo-          in loco parentis, that person may
or her own treatment without the          dial and non-custodial parent, the         consent to treatment. The Arkansas
need for an adult’s consent. These cir-   statute states that the father of an       Supreme Court has defined a person
cumstances include marriage, court-       illegitimate child cannot consent for      standing in loco parentis as some-
ordered emancipation, incarceration,      the child based solely on his status       one who “puts himself or herself
and treatment for certain conditions.     as a parent.                               in the situation of a legal parent by
   Otherwise, non-emergency treat-            As long as the mother is autho-        assuming the obligations incident to
ment of a minor requires the consent      rized to consent to treatment, the         the parental relation without going
of an adult.                              child’s maternal grandparent(s) may        through the formalities of adop-
   According to Ark. Code Ann.            consent in the parents’ absence. The       tion.” See, e.g., Babb v. Matlock,
§ 20-9602, any guardian or par-           same is true of the child’s pater-         340 Ark. 263 (2000). Whether
ent may consent to treatment of a         nal grandparent(s) if the father is        someone is standing in loco par-
minor child. A “parent” includes an       authorized to consent.                     entis depends upon the facts of the
adoptive parent, stepparent, and/             Finally, in cases where someone        situation. •

   The     Arkansas        Hospital       ticipation to make DATABANK a                 Hospitals that choose to par-
Association (AHA) has offered             more valuable tool.                        ticipate submit specific data on a
its member hospitals access to a             CHA has assumed full opera-             monthly basis and, in return, are
free one-of-a-kind online database        tion of the Arkansas DATABANK              able to receive a series of reports
of timely hospital utilization and        program, including an increase in          about their own operations imme-
financial performance indicators           the number of educational oppor-           diately. Peer group comparisons
since 2002. The AHA is one of             tunities related to the program,           also can be viewed and printed
more than 30 state hospital asso-         which is a Web-based benchmark-            online once certain peer group
ciations that offer this program          ing database that provides users           thresholds have been met.
through the Colorado Hospital             information on management indi-               The data contained on the
Association (CHA), which devel-           cators like average length of stay,        DATABANK reports can be used
oped the DATABANK program                 outpatient statistics, charges and         for budgeting, marketing, and inter-
more than 20 years ago.                   expenses per day and per stay,             nal management purposes within
   Because many of the state’s hos-       uncollected charges, number of             the hospital. More information
pitals do not participate, the AHA,       days in accounts receivable gross,         about the Arkansas DATABANK
in conjunction with CHA, is mak-          profitability, and a number of per-         program changes will be distrib-
ing a renewed effort to expand par-       sonnel statistics.                         uted by the AHA and CHA.          •

IRS Reports Community Benefit Practices
    A new 63-page interim report from     with 97 percent of responding hospi-       Senate Finance Committee issued a
the Internal Revenue Service, released    tals noting the uncompensated care         “discussion draft” divided into rec-
on July 18, summarizes responses          that they give to low-income patients.     ommendations aimed at four sepa-
from almost 500 tax-exempt hospitals         After uncompensated care, the next      rate hospital groups: hospitals exempt
to a May 2006 questionnaire about         largest community benefit expenditure       under 501(c)(3); hospitals exempt
how they provide and report benefits       categories were medical education and      under 501(c)(4); hospitals exempt
to the community.                         training, research, and community          under 501(c)(3) and (c)(4); and, all
    The report indicates the surveyed     programs.                                  hospitals (nonprofit, for-profit, and
hospitals provided a combined $9.3           The report can be accessed at http://   government).
billion in community benefit spending.                 The draft is available at http://
The most often cited type of commu-       pdf/070719-IRSReport.pdf.        
nity benefit was uncompensated care,          On the same day, staffers from the      prg071907a.pdf.  •
                                                                                                Fall 2007 I Arkansas Hospitals   35
     M E D I C A R E / M E D I C A I D

     Arkansas Medicaid NPI Deadline
        EDS, the state’s Medicaid claims        number with the Arkansas Medicaid                                tronically must appear exactly as
     contractor, notified all Medicaid pro-      provider number.                                                 shown in the NPI Reporting Summary
     viders who have not yet reported              Arkansas Medicaid recommends                                  section of the NPI tool. To print
     their National Provider Identifier          that those providers who have not                                this information, go to https://www.
     (NPI) number and/or taxonomy code          reported an NPI use its Web site,                       and double click
     to the Medicaid program, notify- ,                               on the “Provider” icon to enter your
     ing them that, as of October 15th,         to facilitate reporting. After access-                           Arkansas Medicaid Provider number
     Arkansas Medicaid will no longer           ing the page, first double click on                               password. Next click on “Report NPI”
     accept electronic claims if they don’t     the “Provider” icon to enter your                                and enter your Tax ID or SSN. You
     include the provider’s NPI. In order       Arkansas Medicaid Provider number                                will then be able to select “Print” to
     to avoid interruption in claims pro-       and password and follow the steps to                             view the NPI Reporting Summary.
     cessing and payment from Arkansas          report the NPI.                                                     Questions or problems regarding
     Medicaid, this information must be            Providers are also urged to print                             NPI numbers should be directed to
     filed with the state before October         and maintain the NPI information                                 the NPI Help Desk at (501) 301-
     14, 2007. Once reported, EDS will          that they report, as all information                             7611 (for local or out-of-state calls)
     be able to successfully link the NPI       submitted when billing claims elec-                              or toll free at (866) 311-5502.     •

      Tamper-Resistant RX Pads Required
          Beginning October 1, a new law        not even aware of the law and do                                  be honored, since the law can’t be
      intended to stop or reduce Medicaid       not use the pads. The American                                    implemented until final regulations
      prescription fraud will go into effect,   Pharmacists Association on July 17,                               are issued. At press time, CMS has
      requiring physicians to begin using       2007, made a formal request to delay                              not yet published even proposed
      electronic prescribing or tamper-re-      implementation. The request might                                 rules for the measure.         •
      sistant prescription pads for their
      Medicaid patients. The law, which
      was tucked away in section 7002(b) of       The       Arkansas      Hospital                              dard pricing as well as a flat-rate
      the U.S. Troop Readiness, Veterans’         Association (AHA) is aware of                                 shipping charge. Interested par-
      Care, Katrina Recovery, and Iraq            several national suppliers who                                ties may order online at www.
      Accountability Appropriations Act           have the tamper resis-                                                     custom-printing.
      of 2007, which the president signed         tant pads. However,                                                        com or by phone at
      last spring, will deny federal reim-        in order to ensure the              fering

                                                                                Now Of Tamper Resistant Prescription Pads
      bursement to states for Medicaid            availability of a local
      patients’ prescriptions that are not        supplier, the AHA and                                                        In a letter to state
      written on the tamper-resistant pads.       the Arkansas Medical                                                         Medicaid Directors,
      The law was designed to make it             Society have partnered                                                       CMS advises that
      more difficult for patients to obtain        with Custom Printing,                                                        a state can elect to
      controlled substances through forged        Inc., of North Little                                                        reimburse physi-
      prescriptions and to save the govern-       Rock. Custom Printing                                                        cians for the cost
      ment money.                                 provides online order-                                                       of the prescription
          President Bush first recommend-          ing which allows a                  Order online at
                                                                                                                               pads as an admin-
      ed the tamper-resistant pads in his         physician office to key                  AHA Members receive a 5% discount.
                                                                                                                               istrative expense.
                                                                                 1724 Pike Avenue • North Little Rock, AR 72114 • 501.375.7311

      2008 budget and projected that the          in the specific informa-                                                      Arkansas Medicaid
      prevention of fraudulent prescrip-          tion it needs on the pad and view                             realizes the burden this has caused
      tions could save taxpayers an esti-         a sample prior to ordering. These                             and wants to provide reimburse-
      mated $510 million over 10 years.           prescription pads meet all three                              ment for the purchase of these
      Pharmacist and physician groups are         industry recognized tamper-resis-                             pads. However, a mechanism by
      concerned that there is too little          tant features. Custom Printing                                which a claim can be submitted
      time to prepare for implementing            is also providing AHA members                                 for the cost of the pads has yet to
      the law. Most doctors are probably          a 5% discount off their stan-                                 be determined.

36    Fall 2007 I Arkansas Hospitals
M E D I C A R E / M E D I C A I D

                      by Elisa White, Vice President and General Counsel, Arkansas Hospital Association

  Legal Note:
  Seclusion and Restraint

     The Medicare Conditions of          that the report to CMS must be        Ms. Cortez will evaluate the facts
 Participation require that hospitals    made by telephone, Ms. Cortez         of the case and determine whether
 report restraint or seclusion-related   has informed the AHA that with        an investigation is necessary.
 deaths. See 42 C.F.R. §482.13(g).       hospitals in five states calling, it      A copy of the “Hospital
 These include deaths that occur         is sometimes very difficult to get     Restraint/Seclusion Death Report
 while the patient is in restraint or    through to her. So, Ms. Cortez        Worksheet” with Ms. Cortez’s
 seclusion or within 24 hours after      suggests that hospitals e-mail or     contact information is posted on
 the patient has been removed from       fax a “Hospital Restraint/Seclusion   the AHA Web site, http://www.
 restraint or seclusion.                 Death Report Worksheet” to her  •
     Hospitals also must report          if a report is needed. She pre-
 deaths that occur within one week       fers that the worksheet
 after restraint or seclusion where it   be e-mailed, but she will
 is reasonable to assume that use of     accept a fax report.
 restraint or placement in seclusion        However, if the hospi-
 contributed directly or indirectly      tal sends the worksheet
 to a patient’s death, including, but    by fax, it must call Ms.
 not limited to, deaths related to       Cortez and leave the fol-
 restrictions of movement for pro-       lowing information: (a)
 longed periods of time or related       patient’s name; (b) date
 to chest compression, restriction       of death; and (c) name
 of breathing, or asphyxiation.          and telephone number of
     Arkansas hospitals should           hospital contact person.
 report these deaths no later than       The date and time the
 the close of business the next busi-    death was reported to
 ness day following knowledge of         the CMS Regional Office
 the patient’s death to the CMS          must be documented in
 Regional Office in Dallas. Juanita       the patient’s medical
 Cortez is the contact person at the     record.
 CMS Regional Office for these               All worksheets are
 reports. Her contact information        sent to the CMS Central
 is: Juanita Cortez, fax: (214) 767-     Office when they are
 0270, E-Mail: juanita.cortez@cms.       received. When a report                                of a restraint or seclusion-
     Although the regulation states      related death is received,

                                                                                         Fall 2007 I Arkansas Hospitals   37
     M E D I C A R E / M E D I C A I D

       Seven Medicare Part C Vendors
       Suspend Selling
         The Centers for Medicare            Universal American Financial          the health plans readily available
      and Medicaid Services (CMS)            Corporation, Coventry, Sterling,      to medical providers and contact-
      announced during a June 15 tele-       and Blue Cross/Blue Shield of         ing beneficiaries to ensure they
      phone briefing that seven insur-        Tennessee. Combined, they have        understand the plans.
      ers with a huge majority of the        1.5 million Medicare enrollees           To have the suspension lifted, a
      Medicare Advantage (Part C) pri-       in private fee-for-service plans,     plan must provide a complete list
      vate fee-for-service plan market       200,000 of which signed up as a       of sales representatives, if request-
      have agreed to suspend marketing       part of company or union retire-      ed to do so by CMS, and must
      of the plans.                          ment health benefit plans. The         authorize the agency – if it seeks to
         The announcement followed           other 1.3 million are in the indi-    do so – to make the list available
      CMS’ receipt of more than 2,700        vidual, “non-group” market.           to state insurance departments.
      complaints about the fee-for-ser-         According to CMS, the compa-       Sales reps will have to pass a writ-
      vice plans that were registered by     nies are working with Medicare        ten test showing their familiarity
      Medicare beneficiaries during the       officials on new marketing guide-      with Medicare and the product
      five months which ended April 30,       lines for the elderly and disabled.   they are selling. Lists of planned
      2007. The beneficiaries charged that    The agency has allowed the plans      sales events provided to CMS must
      they were duped or strong-armed        until October 15 to comply.           include “delegated” brokers and
      by the companies’ sales agents into       The voluntary sales suspension,    agents as well as those sponsored
      joining the plans without under-       which does not apply to the Part C    by the plan.
      standing how they worked or the        HMO and PPO plans, will end as           For more information, see
      restrictions involved.                 CMS certifies that each company
         The seven insurers are Humana,      has adopted the guidelines, which     NEWS/ Medicare/2007/7-06-16-
      United Healthcare, Wellcare,           include making information about      SevenCompanies.htm.     •

       Proposed 2008 Physician Fees:
       Expect a Drop
         The Centers for Medicare            tainable growth rate formula.         ng&itemID=CMS1200867&int
       & Medicaid Services in early             The proposed rule, which can       NumPerPage =10, also outlines
       July proposed an estimated            be found at http://www.cms.           proposed payment changes for
       Medicare payment update for             Part B drugs and other services
       physicians that would cut fees        PFSFRN/itemdetail.asp?filterTy        under the physician fee sched-
       by 9.9 percent in 2008, based         pe=none&filterByDID=0&sort            ule. 2008 quality measures for
       on Medicare’s controversial sus-      ByDID=4&sortOrder=descendi            physicians are also outlined.    •

       Detailed Notice of Discharge Form
       is Available Online
          The Centers for Medicare &         Medicare” and the “Detailed           Original Medicare whenever a
       Medicaid Services (CMS) recent-       Notice of Discharge” are post-        hospital requests QIO review
       ly posted to its Web site the final   ed along with the Manual              of a discharge decision without
       form hospitals must use (effec-       Instructions for this process.        physician concurrence.
       tive date was July 2) to notify       Also posted is the Notice of             To find the forms and
       Medicare beneficiaries about          Hospital Requested Review             manuals for their use, go to
       their discharge appeal rights.        (HRR), which replaces HINN  
          In addition, the final versions    10. The HRR should be issued          BNI/12_HospitalDischarge
       of the “Important Message from        by hospitals to beneficiaries in      AppealNotices.asp.    •
38    Fall 2007 I Arkansas Hospitals
M E D I C A R E / M E D I C A I D

 Medicare Web Site Posts Answers
 to Discharge Form Questions
    The Centers for Medicare &             The Q&A notice addresses 13
 Medicaid Services in July posted       topics, including implementation,
 to its Web site a series of ques-      authorized representatives, docu-
 tions and answers to help hospitals    mentation of the IM follow-up
 comply with the new “Important         copy, and inpatient-to-inpatient
 Message from Medicare” (IM) and        transfers.
 “Detailed Notice of Discharge”            The Q&A list is available at
 forms that hospitals now must use     /
 to notify Medicare beneficiaries        DownloadsWeichardtFrequently
 about their discharge appeal rights.   Asked Questions July2007.pdf.   •

 Sharing of National Provider Identifiers
 is Made Easier
    Healthcare providers looking        ment. The notice also describes      Accountability Act, entities that
 for help in ways to share their        which NPI data in the National       acted in “good faith” to become
 National Provider Identifier (NPI)      Plan and Provider Enumeration        NPI compliant can accept leg-
 numbers should check into new          System will be disclosed and under   acy numbers through May 23,
 information being offered by the       what conditions. CMS plans reg-      2008, according to a recently
 Centers for Medicare & Medicaid        ular updates to the data.            announced CMS contingency
 Services (CMS).                           Though the deadline has           plan.
    The agency has placed a notice      passed for healthcare providers         The notice is available
 on its Web site describing how it      and most health plans to imple-      at
 will share NPI data with health-       ment NPIs for standard elec-         NationalProvIdentStand/
 care providers and others who          tronic transactions under the        D o w n l o a d s / D a t a
 need it to process claims for pay-     Health Insurance Portability and     DisseminationNPI.pdf.      •

 Medicaid Now Accepting UB-04
    Arkansas Medicaid began             Provider Identifier number and           If you have questions regard-
 accepting the new HCFA-1500            other important changes.             ing this notice, please contact the
 (version 08/05) UB-04 (CMS1450)           As of now, claims received on     EDS Provider Assistance Center at
 or the 2006 ADA Dental Claim           the old versions will be returned    1-800-457-4454 (toll-free) within
 Forms July 1, 2007. These forms        to the provider to resubmit on the   Arkansas or locally and out-of-
 accommodate       the   National       new claim forms.                     state at (501) 376-2211.    •

                                                                                        Fall 2007 I Arkansas Hospitals   39
      M E D I C A R E / M E D I C A I D
     CMS Issues Final Rule for IRF Services
        The Centers for Medicare &                from participating in Medicare’s IRF            Now, hospitals must depend
     Medicaid Services (CMS) posted a             prospective payment system.                  on congressional action to put the
     2008 Final Rule (http://www.cms.hhs.             Currently, the IRF rule contains a       brakes on CMS’ plans. The American
     gov/inpatientrehabfacpps/downloads/          provision that allows a patient to count     Hospital Association is calling
     cms1551F-display.pdf) for inpatient          toward 75 percent Rule compliance if         on lawmakers to cosponsor H.R.
     rehabilitation facilities (IRF) on July      he/she is admitted for a co-morbidity        1549/S. 543, the “Preserving Patient
     31.                                          that falls within the 13 qualifying admit-   Access to Inpatient Rehabilitation
        While the rule grants a 3.2 percent       ting conditions and causes a significant      Hospitals Act.” The bills would roll
     market basket update for IRF payments,       decline in the patient’s functional abil-    back the patient threshold level to
     a total of about $150 million, CMS will      ity. This provision is set to expire on      60 percent, rather than 75 percent.
     not further delay its move back to fully     July 1, 2008, when the 75 percent Rule          The      Arkansas        Hospital
     implementing the “75 percent Rule”           becomes fully operational again.             Association expresses its apprecia-
     which governs qualified IRF admis-                CMS chose not to make it perma-          tion to Senators Lincoln and Pryor
     sions. That means as of July 1, 2008, 75     nent, despite its own analysis that found    and to Congressmen Berry, Snyder,
     percent of admissions to an IRF must         that seven percent of cases from July        Boozman, and Ross for their sup-
     be patients having one of 13 qualifying      2005 through June 2006 – approxi-            port on this matter. All have signed
     admitting conditions. Failure to meet        mately 31,000 patients – were admitted       on as cosponsors for the bills in their
     the threshold will disqualify the hospital   to IRFs with qualifying co-morbidities.      respective chambers.    •
     Proposed Rule Allows “Revisit” User Fees
     in Certification Process
         The Centers for Medicare &               Department of Health and Human                 The fees are estimated at $37.3
     Medicaid Services (CMS) published a          Services’ (HHS) budget request               million annually and would recov-
     proposed rule in the June 27 Federal         included both new mandatory savings          er the costs associated with the
     Register that would allow the agency         proposals and a requirement that user        Medicare Survey and Certification
     to charge revisit user fees to healthcare    fees be applied to healthcare provid-        program’s revisit surveys. The fees
     facilities cited for deficiencies during      ers that have failed to comply with          would take effect on the date of
     initial certification, recertification, or     Federal quality of care requirements.        publication of the final rule, and
     substantiated complaint surveys.                The “revisit user fees” would             would be available to CMS until
         The proposed rule states that, con-      affect only those providers or sup-          expended.
     sistent with the President’s long-term       pliers for which CMS has identified             The proposed rule can be
     goal to promote quality of healthcare        deficient practices and requires a            accessed at http://www.cms.hhs.
     and to cut the deficit in half by fis-         revisit to assure that corrections have      gov/SurveyCertificationGenInfo/
     cal year (FY) 2009, the FY 2007              been made.                                   Downloads/Userfeereg.pdf.      •

     2008 Outpatient Hospital Rule is Proposed
         The Centers for Medicare &               update in Medicare payment rates for         two percent reduction in their payment
      Medicaid Services (CMS) in July             services paid under the program’s out-       update.
      released its proposed rule updating         patient prospective payment system in           The American Hospital Association
      Medicare payment rates for hospital         2008. It also proposes ten hospital out-     has posted a Special Bulletin detailing
      outpatient services in calendar year        patient quality measures, which were         the proposals for member hospitals
      2008. The agency also issued a final         previously adopted by the Hospital           on its Web site at
      rule linking the Medicare payment           Quality Alliance, for public report-         aha_app/issues/Medicare/advocacy-
      system for ambulatory surgery cen-          ing. The measures include five emer-          medicare.jsp.
      ters (ASCs) to the hospital outpatient      gency department acute myocardial               The outpatient hospital proposed
      prospective payment system, effective       infarction measures, two surgical care       rule is available at: http://www.cms.
      for services in calendar year 2008,         improvement measures, and one mea- 
      under which CMS would pay ASCs at           sure each for the treatment of heart         downloads/cms1392p.pdf            and
      approximately 65 percent of the outpa-      failure, community-acquired pneumo-          the ASC final regulation is avail-
      tient hospital rate.                        nia, and diabetes.                           able at
         The proposed hospital outpatient             In 2009, hospitals that fail to report   ASCPayment/Downloads/CMS-
      rule includes a 3.3 percent inflation        data for these measures would receive a      1517-Fdisplay.pdf.  •
40      Fall 2007 I Arkansas Hospitals

 OSHA Releases Pandemic Guidance
    The Occupational Safety and        vious pandemic preparedness          for Hospital First Receivers
 Health Administration (OSHA)          guidance issued by OSHA, the         guidance, this document is
 has released a new publica-           Centers for Disease Control and      likely to become the inspec-
 tion called Pandemic Influenza         Prevention, and Department of        tion standard that OSHA will
 Preparedness and Response             Health and Human Services,           use in the future. This should
 Guidance        for   Healthcare      the agency said.                     become a “must read” for
 Workers       and     Healthcare         The 104-page document             healthcare facility and organi-
 Employers.                            addresses fl u diagnosis and          zation infectious disease super-
    Although OSHA issued gen-          treatment, infection control,        visors, healthcare managers,
 eral guidance for workplaces          healthcare worker vaccination,       and healthcare professionals.
 in February, the new guidance         personal protective equipment,          The document is avail-
 focuses specifically on health-        preparedness planning, and           able at
 care workers and their employ-        OSHA standards.                      Publications/OSHA_pandem-
 ers. It is consistent with all pre-      Like the OSHA Best Practices      ic_health.pdf.•

 NDMS Conference Call Protocol
    The 2007 Atlantic hurricane           At the time, the calls were          absorb the cost of the calls.
 season is well underway, and          very helpful in keeping every-       • Calls will happen each day
 the Hurricane Forecast Team           one posted and up-to-date on            (including weekends if neces-
 at Colorado State University          disaster preparations, NDMS             sary) at 3 p.m. Participation
 continues to believe it will be       activation, procedures, patient         is not mandatory, but each
 an active one.                        flow, etc.                              NDMS facility is encour-
    Seventeen named storms                The procedure for those              aged to participate on each
 were predicted to develop in the      daily calls, unless otherwise           call.
 Atlantic basin between June 1         directed, will be as follows:        • The VA Medical Director’s
 and November 30. Nine of the          • The calls will be activated           department will take charge
 storms are expected to become            by the state’s VA Medical            of the call, along with the
 hurricanes and, of those nine,           Director (Michael Winn)              NDMS emergency manager,
 five should develop into major            when it becomes apparent             Rex Oxner.
 hurricanes with sustained winds          that central Arkansas is in       • The VA Medical Director’s
 of 111 miles per hour or bet-            line to receive patients, but        department will take min-
 ter.                                     hospitals have not been acti-        utes of each call and for-
    Arkansas hospitals should be          vated by NDMS. The first             ward them to all partici-
 aware that if a major hurricane          call will act as a “heads up”        pants within 24 hours of
 that could have an effect on             that evacuees may be com-            the conclusion of each call.
 Arkansas hospitals should occur          ing and that medical care            That way, everyone will be
 this year, the National Disaster         will be needed, and that             kept completely up-to-date.
 Medical System (NDMS) will               there exists the possibility of   • The calls will end when it
 activate the daily phone confer-         NDMS activation.                     becomes apparent that the
 ences which it conducted with         • The same conference call              emergency is over.
 the state’s NDMS facilities              number and participant code          If you have questions about
 in the fall of 2005 following            (800-244-2500; Participant        the program, please contact
 Hurricanes Katrina and Rita.             code: 6109980#) will be used      Beth Ingram at (501) 224-7878
 (All of these facilities are locat-      for each call. The Arkansas       or at bingram@arkhospitals.
 ed in central Arkansas.)                 Hospital Association will         org. •

                                                                                      Fall 2007 I Arkansas Hospitals   41
            Q U A L I T Y

        New Risk Management/Patient Safety
        Publication Now Available
          The Arkansas Hospital                cian practices and hospitals.           with the AHA membership on a
        Association announces publi-              The monthly publication is           variety of compliance, nursing,
        cation of a new risk manage-           developed by Sue Dill Calloway,         risk management, legal, and
        ment newsletter, Strategies,           RN, JD, of the OHIC Insurance           documentation issues and is
        which addresses risk manage-           Company in Columbus, Ohio.              making this publication avail-
        ment issues specific to physi-         Calloway is a popular presenter         able to our membership.    •

        Aerosol Hand-Rub Dispensers Okayed, Now
        Meet Fire Code
           The International Fire Code         other fire code and regulatory           closely with the ICC, National
        (IFC) has been revised to allow        changes since 2002 to allow hand        Fire Protection Association, Joint
        aerosol alcohol-based hand rubs in     rubs in hospital corridors, as recom-   Commission, Centers for Medicare
        hospital corridors.                    mended by the Centers for Disease       & Medicaid Services, and others to
           Up to 18 ounces of Level 1          Control and Prevention to facilitate    promote the various code and regu-
        aerosol per dispenser and ten gal-     effective hand hygiene and reduce       latory changes.
        lons of liquid or aerosol hand rub     infection.                                 For more on the IFC revision,
        per area are allowed under the            The American Society for             see the ASHE member advisory
        change, approved May 25 by the         Healthcare Engineering (ASHE), an       at
        International Code Council (ICC).      American Hospital Association per-      handrub/pdfs/ABHRIFCrevjbdse.
        The IFC revision is consistent with    sonal membership group, worked          pdf.•

        Hospital Mortality Data is Posted
           On June 21, The Hospital            duced using a statistical model            According to CMS, deaths that
        Quality       Alliance,      which     that relies on Medicare claims          occur outside the hospital within
        includes the American Hospital         and enrollment information. The         30 days are included along with
        Association, added to the Hospital     model predicts patient deaths for       deaths that occur in the hospital,
        Compare Web site mortality data        any cause within 30 days of hos-        because some hospitals discharge
        for heart attack and heart failure     pital admission for heart attack or     patients sooner than others. The
        patients. The data shows consum-       heart failure, whether the patients     rates are calculated using sophis-
        ers how heart attack and heart         die while still in the hospital or      ticated risk-adjustment that takes
        failure patients fared 30 days after   after discharge.                        into account one year of billing
        admission to a hospital, including        The thirty-day mortality is used     history for each patient.
        time after discharge.                  since this is the time period when         Also added to the Web site were
           Hospitals are grouped as the        deaths are most likely to be related    additional data on steps hospitals
        same, better or worse than the         to the care patients received in the    have taken to prevent surgical
        national mortality rate for the        hospital, as defined by the Centers      infections and pneumonia. Click
        two conditions. The 30-day risk-       for Medicare & Medicaid Services        on http://www.hospitalcompare.
        adjusted mortality rates are pro-      (CMS).                         for more information.  •

42   Fall 2007 I Arkansas Hospitals
     Q U A L I T Y

AFMC Named Community Leader
   The Arkansas Foundation for         price reporting, and quality-driven     – Arkansas, Rhode Island, and
Medical Care (AFMC), the Medicare-     incentives, the initiative calls on     Rochester, New York – through
designated Quality Improvement         communities to develop stakeholder      a national selection process to
Organization (QIO) for Arkansas,       incentives, and to promote public       receive grant funding and partici-
was named a Community Leader           availability of information on health   pate in the initiative.
for Value-Driven Health Care in        quality and costs with the goal of         Participants are exploring
April. Only three other QIOs in the    improving healthcare in the region.     the use of shared data between
nation have been named Community           AFMC received the Community         Medicaid and other health plans,
Leaders – those in Virginia, New       Leader designation in recognition of    providers, and purchasers as a way
York, and Alabama.                     its role in convening stakeholders in   to coordinate quality improvement
   The Value-Driven Health Care        the Regional Quality Improvement        strategies to help improve patient
Initiative is a nationwide, volun-     (RQI) Initiative in Arkansas, a part-   outcomes and reduce healthcare
tary program launched in 2006 by       nership between AFMC and the            costs.
the U.S. Department of Health and      Arkansas Medicaid program. RQI             For a complete list of stake-
Human Services to improve quality      was launched in 2006 by the Center      holders participating with AFMC
and lower costs of healthcare. Based   for Health Care Strategies, Inc.        in the initiative, visit http://www.
on the principles of health informa-   (CHCS), a national, nonprofit orga-
tion technology, quality reporting,    nization, which chose three regions     ity_improve/rqi/measure.aspx.       •

HQA Adopts Outpatient Quality Indicators
   America’s hospitals, which have     patient care, as well. Under the            ferred; (3) Fibrinolytic therapy
been reporting quality of care indi-   program, hospitals must report the          received within 30 minutes of
cators for inpatient services since    outpatient data to receive the full         arrival for patients treated in
2003, are on the verge of adding       annual update to the hospital out-          the emergency department and
outpatient quality measures to their   patient prospective payment system          then transferred; (4) Median
reports.                               payment rate beginning in January           time from emergency depart-
   The Hospital Quality Alliance       2009.                                       ment arrival to electrocardio-
(HQA) on July 11 adopted ten              Hospitals that fail to report the        gram (ECG) for patients treated
performance measures of hospital       outpatient quality data will incur a        in the emergency department
outpatient quality, which will join    reduction in their annual payment           and then transferred; (5) Median
the 32 inpatient clinical process      update factor of 2.0 percentage             time from emergency depart-
and outcome measures, as well as       points.                                     ment arrival to transfer for pri-
other patient experiences of care         The new measures are consid-             mary percutaneous coronary
measures, that already are report-     ered preliminary, pending further           intervention (PCI)
ed and displayed on the Hospital       work to complete definitions and         •   Heart Failure: (6) Angiotensin
Compare Web site.                      specifications, and to finalize the           converting enzyme (ACE) inhib-
   Although several of the new         National Quality Forum’s endorse-           itor or angiotensin receptor
measures are similar to existing       ment. As a result, the HQA may              blocker (ARB) for left ventricu-
inpatient care measures, imple-        refine its recommended list as fur-          lar systolic dysfunction (LVSD)
menting them for patients who are      ther information becomes avail-         •   Surgical Care Improvement: (7)
not admitted to the reporting hos-     able.                                       Timing of antibiotic prophylax-
pital will provide a broader view of      For now, the new outpatient              is; (8) Selection of prophylactic
care, particularly in smaller, often   measures and the type of care they          antibiotic – first or second gen-
rural, hospitals.                      relate to are:                              eration cephalosporin
   Many U.S. hospitals have been       • Heart Attack: (1) Aspirin at          •   Pneumonia: (9) Appropriate
providing information on inpatient        arrival for patients treated in          empiric antibiotic prescribed for
quality measures through the HQA          the emergency department and             community-acquired bacterial
initiative since October 2003. Last       then transferred; (2) Median             pneumonia
year, Congress mandated that the          time from emergency depart-          •   Diabetes       Mellitus:    (10)
Centers for Medicare & Medicaid           ment arrival to fibrinolysis for          Appropriate empiric antibiotic
Services establish a program for          patients treated in the emergen-         prescribed for community-ac-
reporting quality of hospital out-        cy department and then trans-            quired bacterial pneumonia      •
                                                                                            Fall 2007 I Arkansas Hospitals   43
            Q U A L I T Y

     Study Reveals Climbing MRSA Rates
        A survey of more than 1,200           facilities participated in the sur-      to patient through a variety of
     U.S. healthcare facilities last fall     vey, including acute care, reha-         mechanisms, such as contact
     found 46 in every 1,000 patients         bilitative care, long-term care,         with unwashed hands, contami-
     were infected with Methicillin-          long-term acute care, children’s,        nated gloves, and medical equip-
     resistant Staphylococcus aureus          and Veteran’s facilities.                ment.
     (S. aureus) or carried the bacte-           According to APIC, MRSA                 For     more     information,
     ria, according to a study released       accounts for 50 percent-70 per-          go to
     in July by the Association for           cent of S. aureus infections in          Content/NavigationMenu/
     Professionals in Infection Control       healthcare facilities, up from           ResearchFoundation/
     and Epidemiology (APIC).                 two percent in the late 1970s.           NationalMRSAPrevalen ceStudy/
        A total of 1,237 healthcare           MRSA can spread from patient             MRSA_Study_Results.htm.      •

     CDC Infection Prevention Guidelines
     Revised, Now Online
        The     newest     revision   to      II updates information on
     Centers for Disease Control and          the basic principles of hand
     Prevention’s guidelines for pre-         hygiene, barrier precautions,
     venting the spread of infection          safe work practices, and iso-
     in healthcare settings are now           lation practices, with new
     available at         emphasis on administrative
     ncidod/dhqp/gl_isolation.html.           involvement in developing and
        The document updates and              supporting infection control
     expands guidelines issued for            programs. It also addresses
     hospitals in 1996 to include new         surveillance of healthcare-
     issues such as SARS and avian flu        associated infections. Part III
     and healthcare settings other than       provides guidance for applying
     hospitals.                               precautions developed by CDC
        Part I of the guidelines reviews      and the Healthcare Infection
     the scientific literature that sup-      Control Practices Advisory
     ports the recommended preven-            Committee in various health-
     tion and control practices. Part         care settings.  •

     FDA Notice Concerns Propofol
        The federal Food and Drug                Propofol is an intravenous sed-          Healthcare professionals who
     Administration (FDA) has issued a        ative-hypnotic agent for use in the      administer propofol for sedation
     notice to healthcare professionals       induction and maintenance of anes-       or general anesthesia should care-
     about several clusters of patients who   thesia or sedation. To minimize the      fully follow the recommendations
     experienced chills, fever, and body      potential for bacterial contamination,   for handling and use in the prod-
     aches shortly after receiving propofol   propofol vials and prefilled syringes     uct’s full prescribing informa-
     for sedation or general anesthesia.      should be used within six hours of       tion.
     Multiple vials and several lots of       opening, and one vial should be used        Read the complete MedWatch
     propofol used in patients who expe-      for one patient only.                    2007 Safety Summary, includ-
     rienced these symptoms were tested          Patients who develop fever, chills,   ing a link to the FDA Drug
     and there was no evidence that the       body aches, or other symptoms of         Information Page regarding this
     propofol vials or prefilled syringes      acute febrile reactions shortly after    issue at:
     used were contaminated with bacteria     receiving propofol should be evalu-      watch/safety/2007/safety07.htm -
     or endotoxins.                           ated for bacterial sepsis.               Diprivan. •
44   Fall 2007 I Arkansas Hospitals
 We SUPPORT Healthcare...
                                                                    New AHA, SNF
SYNERGY® can help...
» Created by U.S. Foodservice™ for the healthcare operator.
» Provides a comprehensive approach to foodservice cost
» Provides tools for customers to manage many of the
  services they offer.
» Focuses on the key cost drivers in the operation.                     Arkansas home health agencies and
» Helps customers identify opportunities to achieve their           skilled nursing facilities should be aware
  service delivery and customer satisfaction goals.                 of a coming change for electronically
» For more information contact Kevin Hogue @ 501-235-4310           reporting Minimum Data Set (MDS) and
                                                                    Outcome and Assessment Information Set
                                                                    (OASIS) data to the Arkansas Department
                                                                    of Health via AT&T’s dial-up service. In
                                                                    July, CMS began switching on a state-by-
                                                                    state basis from AT&T’s dial-up service for
                                                                    the assessment submissions and reports to
                                                                    broadband. Arkansas is scheduled to make
                                                                    the changeover in October.
                                                                        In order to use the broadband service,
                                                                    HHAs and SNFs will need to update
                                                                    AT&T’s Global Network Client to ver-
                                                                    sion 7.0, dated May 24, 2007. Version
                                                                    6.9 will work with Microsoft operating
                                                                    systems other than Vista. Check the cur-
                                                                    rent version in use by launching the client,
                                                                    left-click on “Help” on the top menu bar
                                                                    and select “About.” The version number
                                                                    and date will be displayed. To obtain a
                                                                    copy of the new client version, log onto
                                                                    the Quality Improvement and Evaluation
                                                                    System’s technical support office (QTSO)
                                                                    Web site,, and click the
                                                                    MCDN Information link in the blue out-
                                                                    lined box on the right side of the page.
                                                                        As an alternative to downloading, you
                                                                    may request a CD copy by emailing mcdn.
                                                           Those on a corpo-
                                                                    rate wide area network (WAN) or a local

       Our Process Works                                            area network (LAN) will probably need to
                                                                    get the network administrator to configure
                                                                    the network to allow access to its broad-
       Relax. We’ll take care of you...                             band connection through the new client.
                                                                    Instructions for doing that are provided on
       We keep healthcare staffing simple. Our Staff is dedicated   the QTSO Web site.
       to providing staffing solutions that allow you to relax.         Providers who are able to install the
                                                                    new client and begin using the broadband
       Whether you’re in need of staff or are looking for           connection without assistance from AT&T
       employment opportunities, we’ll take care of you.            may begin using the new client any time
         Customized Service Plans  Federal JACHO Guidelines         after July 1st. If you need assistance you
                                                                    will have to wait until your designated
               Reference Checks and Proficiency Tests               month to call AT&T. The Help Desk
                                                                    number for facilities is 800-905-2069.
                                                                    The Help Desk number for States is 877-
                                                                    486-7240. Providers in an area where
                                                                    there is no broadband service available
                                                                    will have to submit a waiver request to
                                                                    CMS to continue using the phone modem
                                                                    method. The waiver form is also on the
                                                                    QTSO Web site.     •

                                                                           Fall 2007 I Arkansas Hospitals   45
          H E A L T H                                    I N F O R M A T I O N                                                      T E C H N O L O G Y

               Three Arkansas Hospitals Make
               “Most Wired” List
                  The Agency for Healthcare                                       and Stuttgart Regional Medical                                              outcomes in key areas including
               Research and Quality (AHRQ),                                       Center were all recognized                                                  mortality rates, patient safety,
               through the American Hospital                                      for technology advancements.                                                and average length of stay.
               Association, has released its 9th                                  Baptist Health and UAMS made                                                   For more information, click
               annual “100 Most Wired” list,                                      the “Most Wired” list; Stuttgart                                            on
               which this year includes three                                     Regional was listed among the                                               hhnmag_app/jsp/articledisplay.
               Arkansas hospitals and health                                      “Most Improved.”                                                            jsp?dcrpath=HHNMAG/Article/
               systems.                                                              The survey analyzed hospi-                                               data/ 07JUL2007/0707HHN_C
                  Baptist Health and UAMS,                                        tals’ uses of technology, noting                                            overStory_07Winners&domain=
               both located in Little Rock,                                       that those hospitals show better                                            HHNMAG.                    •

                 IRS Clarifies Permissible Health
                 Information Technology Arrangements
                   The Internal Revenue Service                                    private benefit or inurement.”                                             misunderstandings that were
                (IRS) issued a June 22 question-                                      The memorandum is not                                                   circulating about the May 11
                and-answer document that clari-                                    meant to describe the only per-                                            notice.”
                fies its May 11 memorandum                                         missible health IT arrangements,                                              The May 11 memorandum
                allowing tax-exempt hospitals                                      but the facts and circumstances                                            was issued in response to tax-
                to share health information tech-                                  of any such arrangements would                                             exempt hospitals’ concerns that
                nology with physicians.                                            need to be reviewed by the IRS                                             they risked their tax-exempt sta-
                   The document explains that                                      to determine if it is permissible,                                         tus if they shared health IT with
                health IT arrangements between                                     the Q&A states.                                                            physicians as new Stark and
                hospitals and medical staff phy-                                      Lawrence Hughes, American                                               anti-kickback rules permit.
                sicians that are not entirely con-                                 Hospital Association (AHA) reg-                                               Learn more at http://www.
                sistent with the conditions in the                                 ulatory counsel, said, “AHA is                                   
                memorandum “will not neces-                                        pleased that the IRS was respon-                                           pdf/2007IRSQandA-HITMemo.
                sarily result in any impermissible                                 sive to its request to clear up                                            pdf.     •

Our Advertisers, Our Friends
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Arkansas Blue Cross Blue Shield...............................2            Hagan Newkirk Financial Services, Inc. .....................6                      St. Vincent Rehabilitation Hospital ..........................19
Arkansas Foundation for Medical Care....................29                 MHA Group .............................................................47          Synergy Medical .....................................................25
Benefit Management Systems, Inc. ........................19                 Nabholz Construction ..............................................48              Teletouch Paging ....................................................11
Concept Medical Staffing........................................45          Nurses Compassion Awards ...................................15                     TME, Inc..................................................................11
Crews & Associates, Inc. ........................................27        NMHCrx ....................................................................5       U.S. Foods ..............................................................45
Dr. Suzanne Yee......................................................27    PCI ..........................................................................15

    46        Fall 2007 I Arkansas Hospitals
Arkansas Hospital Association
419 Natural Resources Drive     Presorted Standard
Little Rock, AR 72205           U.S. Postage Paid
                                 Little Rock, AR
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