Katrina Revisited AHA Chairman on - Arkansas Hospital Association by yantingting

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									WINTER 2006                        www.arkhospitals.org




                                                               AHA Chairman
                                                                 on “Defining
                                                                   Moments,”
                                                                 Katrina, and
                                                                   Challenges
                                                                to Healthcare




                                                            Special Section:
                                                           Katrina Revisited
         A M A G A Z I N E F O R A R K A N S A S H E A LT H C A R E P R O F E S S I O N A L S
      ST SS ,
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PAGE   22




                                                  PAGE   26                                                                                             PAGE       28                            PAGE   33

                                                              24 New AHA Chairman on “Defining Moments,” Katrina, and Challenges to Healthcare
Arkansas Hospitals                                            33 AHA Annual Meeting: Awards Presented

                     is published by                          41 75 Years of AHA History… A Look Back Part 2
    Arkansas Hospital Association
 419 Natural Resources Drive • Little Rock, AR 72205
         501-224-7878 / FAX 501-224-0519
                                                                                            The Uninsured                                                                                Quality/Patient Safety
                www.arkhospitals.org
                                                              12 Medicaid Discussions with State Officials                                                                           14 Hospitals’ National Ranking Rises
                 Beth H. Ingram, Editor
                                                              12 Difficulty Paying Medical Bills Increases                                                                           14 Hospital Quality Improvement Indicators
           BOARD OF DIRECTORS                                 12 AHRQ Releases New Data on Uninsured                                                                                 15 Physician Voluntary Reporting Begins
         Robert Atkinson, Pine Bluff / Chairman
       Ray Montgomery, Searcy / Chairman-Elect                13 ER Visits Up 26% Since 1993                                                                                         16 Two AR Hospitals Earn Quality Awards
           Luther Lewis, El Dorado / Treasurer
        Timothy E. Hill, Harrison / Past-Chairman             13 Charity Care Understated by Hospitals                                                                               16 Surgical Care Improvement Project
           Robert R. Bash, Warren / At-Large
                                                                                                                                                                                     17 CMS Releases HCAHPS Survey
                 David Cicero, Camden                                               Katrina Revisited
               Ann Cloud, Siloam Springs
                David Dennis, Berryville
                                                              19 Agreement Eases Nurse Licensure Delays                                                                                        News — STAT!
               Dan Gathright, Arkadelphia
              Michael D. Helm, Fort Smith                     20 Arkansas Under Emergency Declaration                                                                                    2006 AHA Strategies
                                                                                                                                                                                     9
                 Ed Lacy, Heber Springs
                 James Magee, Piggott
                                                              20 Katrina Hits Home for Chairman’s Son
                                                                                                                                                                                     10 AHA/JCAHO Resolve Confidentiality Issues
                 Larry Morse, Clarksville                     21 Chef’s New Home at Ouachita Med Center
                  John Neal, Stuttgart                                                                                                                                               10 Medicare FY 2006 OPPS Final Rule
               Richard Pierson, Little Rock                   23 Prudhomme Salutes Pine Bluff Connection
               John N. Robbins, Conway                                                                                                                                               11 Change for Section 1011 Billing Data
                Steve Smart, El Dorado
                                                              27 St. Edward Mercy Provides Assistance
                  Russ Sword, Crossett                        28 Regional Networks Made a Difference                                                                                 11 Hospitals Intervene in JCAHO Recommendation

               EXECUTIVE TEAM                                                                                                                                                        11 New Report on Critical Access Indicators
          Phil E. Matthews / President and CEO                                                   Departments
       Robert “Bo” Ryall / Executive Vice President                                                                                                                                  11 US Philanthropic Giving Back on the Rise
       W. Paul Cunningham / Senior Vice President             4        From the President
                                                                                                                                                                                     17 Cancer Death Rates Continue to Decline
             Beth H. Ingram / Vice President
                                                              6        Education Calendar
              Don Adams / Vice President                                                                                                                                             17 New Breast Cancer Treatment from UAMS
                                                              7        Arkansas Newsmakers and Newcomers
                  DISTRIBUTION                                                                                                                                                       29 Records Retention Rules : a Reminder
    Arkansas Hospitals is distributed quarterly to
    hospital executives, managers, and trustees                                                                                                                                      46 Legal Issues in Life-Limiting Conditions
    throughout the United States; to physicians,
   state legislators, the congressional delegation,
                                                               WINTER 2006

                                                                                                                                                                                     Electronic Health Records
                                                                                                  www.arkhospitals.org
   and other friends of the hospitals of Arkansas.

                                                                                                                              AHA Chairman
               To advertise contact                                                                                             on “Defining
                                                                                                                                                               Cover Photo
                                                                                                                                  Moments,”
                                                                                                                                Katrina, and
                                                                                                                                                               Arkansas State        30 Report Lists Electronic Record Needs
                Adrienne Freeman                                                                                                  Challenges                   Capitol at
                                                                                                                               to Healthcare
             Publishing Concepts, Inc.                                                                                                                         Christmas,            31 Health IT Could Save $162 Billion
                   501 / 221-9986                                                                                                                              Little Rock
           adrienne@pcipublishing.com                                                                                                                                                31 Survey: Costs are HIT Barrier
                                                                                                                                                               Photo by Arkansas
             www.pcipublishing.com
                                                                                                                           Special Section:
                                                                                                                                                               Department of Parks   31 Rules Bolster E-prescribing, EHRs
                       Edition 53                                                                                         Katrina Revisited                    and Tourism
                                                                        A M A G A Z I N E F O R A R K A N S A S H E A LT H C A R E P R O F E S S I O N A L S




                                                                                                                                                                                              Winter 2006 I Arkansas Hospitals   3
F R O M          T H E         P R E S I D E N T



        Arkansas’ Hospitals —
        Never Take Them for Granted!
            Every day, we hop into our cars and speed off down            totaled $390 million in 2000, and grew to a whopping
        life’s highways…that is, until the car doesn’t work. All of       $475 million by 2003.
        a sudden, we’re in a frenzy. Our schedules are shot, our              The number of patients coming to our hospitals with
                                      nerves are frayed, and it feels     no way to pay their bill is on a rapid rise, and so is the cost
                                      like our personal indepen-          of that care. Hospitals can only provide care without pay-
                                      dence is up for grabs. We get       ment for a limited time before they can no longer afford
                                      the car fixed and vow we            to stay open.
                                      will never take our vehicle
                                      for granted again.                     What can be done? The answer is good communica-
                                                                          tion. Each of us involved in the healthcare field —
                                           Isn’t it true for all of us?   trustees, administrators, physicians, nurses, technicians,
                                       We take so many things in          support staff, auxilians and the AHA alike — all continue
                                       life for granted. Our cars,        to work with our legislators so they understand the dire
                                       electrical power, clean water,     need for raising Arkansas’ Medicaid per diem reimburse-
                                       traffic signals, phone service,    ment, which has not been raised for nearly ten years.
                                       our hospitals.
                                                                             But grassroots communication is also key. We must
                                       It’s true, some people             keep our communities well informed about the many serv-
                                    even take our hospitals for           ices our hospitals eagerly provide to hometown folks —
                                    granted; that is, until their         services too often taken for granted. And especially in
                                    own health or that of a loved         these tough financial times, Arkansans need to be remind-
                                    one makes a hospital visit            ed of the financial struggle hospitals face, and the reasons
        necessary. At such a time, the hospital’s caring doctors          behind that struggle.
        and nurses, its many and varied technicians, and its gov-
        erning board and administrators all become heroes.                   Informed citizens tend to partner with their hospitals in
                                                                          finding ways to raise funds, to be wiser in the use of
           But those of us whose lives are entwined with the              healthcare, to create solutions so all in the community
        healthcare field never take our hospitals for granted. We         receive the medical care they need. When citizens remem-
        work — you work — every day to keep the community                 ber that “the” hospital is “their” hospital, no longer tak-
        aware of the hospital’s vital presence, the economic back-        ing it for granted, a very precious partnership forms.
        bone it affords, the further economic development its very
        presence can attract. You know how much your commu-                   As one who is involved in the healthcare field, your role
        nity would suffer if your hospital was not there.                 in continually carrying the message to the community is
                                                                          vital, especially in tough financial times! I urge you to talk
            It’s no secret that hospitals across our nation, and cer-     with your legislators, your local service club members,
        tainly here in Arkansas, are facing tough financial times.        friends at the grocery store and people at the barber shop.
        As someone who believes in and follows Arkansas’ hospi-           Remind folks of how vital their local hospital is to the
        tals, you know what the cost of continually providing             community. When you do so, you ensure that your hos-
        more and more uncompensated care is doing to the bot-             pital will never be taken for granted.
        tom line — our hospitals’ ability to keep the doors open.
           According to a recent study by the Arkansas Center for
        Health Improvement, 17% of Arkansans did not have
        health insurance in 2004. The numbers keep climbing —
        though most of the uninsured are people working hard at
        either full- or multiple part-time jobs.
                                                                                                           Phil E. Matthews
           In Arkansas alone, uninsured patients accounted for                                             President and CEO
        $354 million in hospital bills in 2003, the last year for                                          Arkansas Hospital Association
        which data is available. According to recent comparative
        statistics, charity care and bad debt for Arkansas hospitals




4   Winter 2006 I Arkansas Hospitals
                                                             The U.S. DEPARTMENT
                                                         OF HEALTH AND HUMAN
                                                     SERVICES works to protect the
                                                 health of all Americans and provides
                                             essential human services, especially for
                                         those who are least able to help themselves.

                                   If you are one of the millions of Americans
                               who need the benefits and services we provide,
                            you can call on us.

                        Mental Health     1-800-273-TALK (1-800-273-8255)
                    Head Start Services 1-866-763-6481
              Temporary Assistance
           for Needy Families (TANF)      Arkansas - 1-800-482-8988
       Medicare                           1-800-MEDICARE (1-800-633-4227)
       Elder Care                         1-800-677-1116
       Medicaid                           Arkansas - 1-800-482-8988

       State Children’s Health
       Insurance Program (SCHIP)          Arkansas - 1-888-474-8275
       Other                              www.hhs.gov


9/05
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 Employee Benefits                                                HR Management Systems
                                                               • Cafeteria Plans                            Education
         Simplified.                                           • Health Insurance
                                                               • Life Insurance
                                                               • Long Term Disability
                                                                                                           CALENDAR
                                                                                                       January 10, Bismarck
                                                               • Short Term Disability                   Coding Update 2006 Workshop
                                                               • Long Term Care                        January 25, Little Rock
                                                               • Supplemental Insurance                  A Day with the Lawyers Workshop
                                                                  Cancer, Cardiac, Accident
                                                               • Vision Insurance                      January 30, Little Rock
                                                               • Retirement Plans                        APC 2006 Coding Update
                                                               • Group Auto & Home Insurance
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                                                               • Group Legal                           February 1-3, Tunica, MS
                                                               • Business Insurance                      Healthcare Financial Management
                                                                  Buy/Sell; Key Man; Split Dollar        Association Tri-State Meeting
 For more than 25 years, the professionals of Hagan Newkirk
 have partnered with healthcare providers throughout           • Deferred Compensation
 Arkansas to make administering employee benefits simple.                                              March 9, Little Rock
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 With our online enrollment and HR management systems,
 ALL your benefit information is just a key stroke away.                                               March 27-30, Chicago
                                                                   AHA SERVICES, INC.
                                                                                                         American College of Healthcare
                                                                   A Subsidiary of the                     Executives Congress on
                                                               Arkansas Hospital Association               Healthcare Leadership
                                                              Securities & Advisory Services Offered
                                                                  Through InterSecurities, Inc.        April 5-7, Hot Springs
                                                                         Member NASD, SIPC
                                                                        Form #LD 5413-11/03              Healthcare Financial Management
                                                                                                             Association Workshop
1501 N. University, Ste. 365 • Little Rock,AR • (501) 664-9381 • hagan-newkirk.com
                                                                                                       April 30-May 3, Washington, D.C.
                                                                                                         American Hospital Association
                                                                                                             Annual Meeting

                                                                                                       May 3-5, Hot Springs
                                                                                                         Society for Arkansas Healthcare
                                                                                                           Purchasing and Materials
                                                                                                           Management

                                                                                                       June 14-16, Branson, MO
                                                                                                         Arkansas Hospital Administrators
                                                                                                            Forum Summer Leadership
                                                                                                            Conference

                                                                                                       August 16, Little Rock
                                                                                                         Compliance Forum

                                                                                                       August 16, Little Rock
                                                                                                         Continuous Service Readiness
                                                                                                         Workshop

                                                                                                       August 16-18, Hot Springs
                                                                                                         Healthcare Financial Management
                                                                                                         Association Workshop

                                                                                                       October 4-6, Little Rock
                                                                                                         Arkansas Hospital Association
                                                                                                            76th Annual Meeting and
                                                                                                            Trade Show

                                                                                                       Program information available
                                                                                                       at www.arkhospitals.org


 6   Winter 2006 I Arkansas Hospitals
                                                 ARKANSAS
                                         NEWSMAKERS
                                         and NEWCOMERS
James R. (Jamie) Carter has been named CEO of             Robert R. Bash was named administrator of Bradley
Crittenden Memorial Hospital in West Memphis,             County Medical Center in Warren October 27, after
effective November 7. He succeeds Ross Hooper, who        having served as assistant administrator since
retired in September. Before moving to West               December 2003. He succeeded long-time administra-
Memphis, Carter was administrator of North                tor Harry Stevens. Prior to moving to Warren, Bash
Mississippi Medical Center in Iuka. He previously         was administrator of Booneville Community Hospital
held administrative positions with the North              and was also rural administrator of Sparks Health
Mississippi Physicians Association, Yalobusha             System in Fort Smith. Bash is a past-chairman of the
General Hospital and Nursing Home and the                 AHA and currently serves on the AHA board as the
Quitman County Hospital.                                  director at-large.
Governor Mike Huckabee has appointed Steve
Erixon, CEO of Baxter Regional Medical Center in                 IN MEMORIAM
Mountain Home, to the Governor’s Trauma Advisory
Council. His term expires July 1, 2009. The                 The Arkansas Hospital Association (AHA) lost
Governor also appointed C. C. McAllister to the             a longtime friend and colleague Saturday,
Emergency Medical Services Advisory Council.                October 15 with the death of Harry H. Stevens,
McAllister, CEO of Ouachita Valley Health System in         administrator of Bradley County Medical
Camden, will serve until July 1, 2008.                      Center (BCMC) in Warren. He was 80 years
                                                            old. Stevens, a Korean War veteran, was a 40-
Herbert K. “Kirk” Reamey, CEO of Ozark Health               year resident of Warren. He owned and operat-
Medical Center in Clinton, has been elected to a sec-       ed the Pine Lodge Nursing Home there from
ond three-year term as a Section for Small or Rural         1965 until 1975, when he sold the nursing home
Hospitals delegate to the American Hospital                 and began his career at BCMC. Stevens had
Association’s Regional Policy Board 7. His term             served as the administrator at BCMC since
expires December 31, 2008.                                  1986. In June 2004, Harry received the AHA’s
Ben Owens, president and CEO of St. Bernards                Chairman’s Award in recognition of his service
Healthcare in Jonesboro, was recently selected Business     and contributions to BCMC and to the AHA, as
Executive of the Year by the College of Business            well as to the city of Warren and other parts of
Alumni Chapter of Arkansas State University in              southeast Arkansas.
Jonesboro. Owens served as administrator/president of       Edward Rensch, Jr., former president and CEO
St. Bernards Medical Center for many years, before          of the Central Arkansas Radiation Therapy
moving to the corporate office of the organization.         Institute (CARTI) in Little Rock from 1983-
Jim Richardson, president and CEO of Saline                 1994, died September 2. Rensch’s career in
Memorial Hospital in Benton, has been elected to the        healthcare spanned almost 40 years. After mov-
Arkansas      Hospital     Association    Workers’          ing to Little Rock in 1966, Rensch was assistant
Compensation Self-Insured Trust board of directors.         administrator for St. Vincent Infirmary before
He succeeds Eugene Zuber of Newport and will serve          being named by Gov. Winthrop Rockefeller in
until the 2006 annual meeting.                              1967 as director of the Arkansas
                                                            Comprehensive Health Planning Agency. He
Stephen Smart, DDS, of El Dorado, has been appoint-         also served as associate coordinator of the
ed an at-large member of the American Hospital              Arkansas Regional Medical Program from
Association’s Committee on Governance. His term             1970-1973. In 1973, Rensch became the first
will expire in December 2008. Smart currently serves        executive director of CARTI and served in that
on the Arkansas Hospital Association board of direc-        capacity before being named the organization’s
tors representing the Arkansas Association of Hospital
Trustees, for which he is president.
                                                            president/CEO in 1983.   •


                                                                                         Winter 2006 I Arkansas Hospitals   7
          A wholly owned subsidiary of the Arkansas Hospital Association.


                                                            AHA Services is committed to providing

                                                            AHA member hospitals with access to

                                                            quality products and programs.

                                                            For information on any of our programs please contact Tina Creel or Phil Matthews



                                                            Phone 501-224-7878                          Fax 501-224-0519
                                                            http://www.arkhospitals.org/aha_services




8   Winter 2006 I Arkansas Hospitals
2006 Arkansas Hospital
Association Strategies
   The Arkansas Hospital Associa-           health records in hospitals and             Communicate results to member
tion each year sets forth strategies        provider practices.                         hospitals.
for the coming year, focusing on         6) Provide in-state educational oppor-     10) Ensure that all Arkansas-based
four major areas:        Advocacy,          tunities for member hospitals and           quality initiative programs utilize
Education, Data Gathering/Moni-             their employees and trustees cover-         existing data sources, include
toring, and Communication. The              ing such issues as quality reporting,       meaningful quality measures and
Fiscal Year 2005-2006 Strategies            medication errors, patient safety,          limit additional hospital data col-
are presented here.                         EMTALA, compliance, gover-                  lection/submission efforts and
                                            nance, emergency readiness,                 costs related to compliance.
ADVOCATE — Actively                         HIPAA, reimbursement, coding            11) Ensure that Arkansas hospitals are
Advocate for Arkansas’ Hospitals            and other topics.                           directly involved with efforts to
1) Develop strategies for methods                                                       establish and implement Regional
   to increase state Medicaid fund-                                                     Health Information Organizations
   ing of hospital services.                                                            for the sharing of clinical data for
2) Obtain the assistance of                                                             treatment and quality improvement
   Arkansas legislators and state                                                       purposes, and assisting in public
   Department of Health and                                                             health and research activities.
   Human Services officials to
   include sufficient funding in the                                                COMMUNICATE — Inform,
   FY 2008-2009 budget to cover                                                     Communicate, Network
   increased payments for hospital                                                  12) Inform all AHA member hospitals
   inpatient and/or outpatient                                                          on an ongoing basis about issues,
   services.                                                                            concerns, activities and actions
3) Communicate on an ongoing                                                            affecting hospitals and healthcare
   basis with Arkansas’ congres-         7) Educate the public on the impor-            at the state and federal levels, to
   sional delegation about federal          tance of their local community              ensure their knowledge about and
   issues impacting hospital opera-         hospitals and the medical and               involvement with those matters.
   tions, costs and revenues.               support staff members who serve         13) Work in conjunction with
4) Gain support of members of               their health needs.                         groups such as the Arkansas
   Arkansas’ congressional delega-                                                      Foundation for Medical Care,
   tion for legislative and regulato-    ANTICIPATE DATA NEEDS —                        Arkansas Blue Cross and Blue
   ry items included on hospitals’       Seek, Explain and Provide Data;                Shield, the Arkansas Medical
   advocacy agenda for the 109th         Address Data Reporting Issues                  Society and other healthcare-
   Congress.                             8) Conduct a follow-up study to                related organizations to further
                                            quantify continuing losses                  develop specific approaches to
EDUCATE — Provide Education                 accruing to Arkansas hospitals              reduce medical and medication
Opportunities                               due to inadequate Medicaid                  errors in Arkansas hospitals.
5) Educate, inform and assist all AHA       payments.                               14) Provide printed, online, and face-
   member hospitals about/with state     9) Monitor, address, and resolve               to-face resources for AHA mem-
   and federal efforts aimed at imple-      ongoing legislative, regulatory             ber hospitals so they may keep
   menting new health information           and policy issues concerning                abreast of current issues, legisla-
   technology — and specifically            requirements for public report-             tion, and communication needs in
   toward implementing electronic           ing    of    hospital     data.             the hospital field. •

                                                                                               Winter 2006 I Arkansas Hospitals   9
     AHA and JCAHO Resolve Confidentiality
     Issues After Intense Discussions
        Arkansas Hospital Association            information, the hospital can notify       of October 13, Arkansas hospitals
     (AHA) legal counsel Elisa White noti-       the JCAHO in writing and the               would be able to execute their revised
     fied the AHA October 11 that the            JCAHO will work with the hospital to       agreements electronically with the
     Joint Commission on Accreditation of        find an alternative that will both allow   JCAHO.
     Healthcare Facilities (JCAHO) agreed        the JCAHO to obtain the information           Arkansas was the only state initial-
     to a revision in its accreditation agree-   it needs for accreditation purposes and    ly pushing the privilege document
     ment that will safeguard Arkansas           maintain legal protections for the         issue with JCAHO; other states even-
     hospitals’ privileged documents from        requested item; and                        tually    joined    the    discussion.
     disclosure in the accreditation process.        3) If privilege is challenged based    According to AHA president and CEO
        As revised, Section 5 of the agree-      on any accreditation activity, the         Phil Matthews, “The AHA Board of
     ment now says that:                         JCAHO will help the hospital fight to      Directors provided direction and
        1) JCAHO will conduct all of its         maintain the privilege.                    strong support of our position.
     accreditation activities in accordance          White noted that the JCAHO con-        Protecting our privilege issue was of
     with all applicable privileges of confi-    tinued to refuse to negotiate on the       the utmost importance, and JCAHO
     dentiality and immunity under appli-        agreement’s indemnity clause, which        finally realized that it was a major
     cable state and federal law;                favors the JCAHO, and the limitation       issue with us. We are very pleased
        2) If the JCAHO requests privileged      of remedy clause. She advised that as      with the outcome.”   •


     Medicare FY 2006 OPPS Final Rule
     in Effect as of January 1, 2006
        The Centers for Medicare &               more than 50% of the total payment         $400 million from the CY 2005
     Medicaid Services (CMS) has                 to the hospital for a service.             OPPS to the CY 2006 OPPS.
     released its 2006 Outpatient                Coinsurance rates for OPPS services            The final rule sets the outlier
     Prospective Payment System (OPPS)           are being reduced gradually until the      threshold at $1,250 for 2006. Outlier
     final rule, applying a full 3.7% mar-       beneficiary’s share for any outpatient     payments are intended to partially
     ket basket update.                          service will be 20% of the hospital’s      compensate hospitals for certain high
        The update, together with other          total payment.                             cost services. To be eligible for an
     changes in the rule mandated by the            Under the final rule, the coinsur-      outlier payment, the estimated costs
     Medicare       Modernization      Act       ance rate for 31 additional medical        for a service must be greater than
     (MMA), will result in average pay-          and surgical Ambulatory Payment            1.75 times the payment amount for
     ment increases of about 2% to urban         Classifications (APCs) will decline to     the APC and greater than the APC
     hospitals and 3.9% to rural hospitals.      the 20% minimum, a 21% increase            payment amount plus the outlier
        As required by the MMA, the rule         in the number of APCs at the 20%           threshold.
     ends “hold harmless” payments for           coinsurance level over calendar year           The changes to the payment rates
     small rural hospitals and rural sole        (CY) 2005.        It also reduces the      and increased volume of services con-
     community hospitals (SCHs), howev-          maximum coinsurance rate for any           tribute to an overall increase in pro-
     er it provides an adjustment to rural       service to 40% of the total payment        jected payments to over 4,200 hospi-
     SCHs that will increase payments by         to the hospital for the APCs in 2006,      tals for Medicare outpatient services of
     7.1% in 2006.                               down from 45% in 2005.                     $27.6 billion in 2006 compared to
        The rule continues the decline in           Overall, average beneficiary co-        projected payments of $26.2 billion in
     coinsurance rates Medicare benefici-        payments for all outpatient services       2005, an increase of 5.2%. The final
     aries will pay for many hospital out-       are expected to fall from 33% of           rule takes effect January 1, 2006.
     patient services. Prior to the imple-       total payments in CY 2005 to 29%               See http://www.cms.hhs.gov/provi-
     mentation of the OPPS in August             in CY 2006. This represents a decline      ders/hopps/2006fc/CMS-1501-
     2000, the beneficiary often paid            in beneficiary liability of more than      FC.pdf for the complete report.   •

10   Winter 2006 I Arkansas Hospitals
      No Name Required: Note This Change
      for Section 1011 Billing Data
          Hospitals that are providing emer-                Entry system will no longer allow entry                through fiscal year 2008 to help reim-
      gency care services to undocumented                   in the name, address and zip code fields.              burse hospitals for their cost of provid-
      aliens should be aware that as of                     CMS last year indicated it would not                   ing uncompensated emergency care to
      November 10, 2005 the patient’s name                  require hospitals and other healthcare                 undocumented immigrants. However,
      and address are no longer required for                providers to ask “invasive” questions                  billing instructions issued earlier
      submission of Section 1011 payment                    about patients’ citizenship status and                 required providers to submit the
      requests.                                             disclose personal patient information to               patient’s name and address. CMS took
          TrailBlazer Health Enterprises, the               receive funds under Section 1011 of the                hospitals’ advice to remove the require-
      Centers for Medicare & Medicaid                       Medicare Modernization Act.                            ment on the grounds it was unnecessary
      Services (CMS) contractor for Section                     The Act allocated $250 million in                  and might discourage undocumented
      1011 payments, said its Direct Data                   Medicare reimbursements annually                       immigrants from seeking care.        •


      Hospitals Intervene in JCAHO Recommendation
      to Sell Data Analyses to Third Parties
         Yielding to pressure put on by                     Board of Commissioners, at its                         seek patient level data from hospitals,
      America’s hospitals and physicians                    November 18-19 meeting, agreed to                      once issues involving HIPAA privacy
      through the American Hospital                         withdraw an earlier recommendation                     concerns are addressed.
      Association, the American Medical                     to sell analyses of hospital data to third                 After considering hospitals’ con-
      Association, American College of                      parties.                                               cerns, JCAHO’s commissioners decid-
      Physicians, various state hospital asso-                  The decision followed six months                   ed to withdraw the original recom-
      ciations (including the Arkansas                      of intense discussion over a “data-min-                mendation and instead recommend to
      Hospital Association) and others, the                 ing” contract between a JCAHO sub-                     the JCAHO board that the JCAHO
      Joint Commission on Accreditation of                  sidiary and the Blue Cross Blue Shield                 refrain from selling analyses of hospi-
      Healthcare Organizations (JCAHO)                      Association. JCAHO will continue to                    tal data to third parties.    •


New Report Compares Critical Access Hospital Indicators
    Researchers for the federal Office of Rural Health Policy have issued a                The indicators are grouped in categories for profitability, liquidity, capital
report on comparative financial indicators for the nation’s Critical Access            structure, revenue, cost and utilization.
Hospitals (CAH).                                                                           Further information about the definition and interpretation of the indica-
    The report, which provides a state-by-state summary of CAH financial               tors can be found in a previous report, “Briefing Paper No. 7: Financial
indicators, compared with national medians, is available at http://www.flex-           Indicators for Critical Access Hospitals,” which can be downloaded from
monitoring.org/cahlist.                                                                http://www.flexmonitoring.org.   •


Healthcare Philanthropic Giving Back on the Rise in U.S.
     Donations to U.S. members of the Association for     the group. Pledges, planned gifts and other assets            Meanwhile, in Canada, giving to healthcare
Healthcare Philanthropy increased 3.5% to $6.1 bil-       accounted for $1.6 billion, or 26.5%.                     organizations declined 4.8% to $1.07 billion in
lion in 2004, up from $5.9 billion in 2003, the associ-       The number of donors grew 2.7% from 2003 and          2004. The report was based on a survey of more
ation said in a recent report.                            the number of gifts received increased 5%. Individuals    than 300 organizations belonging to the associa-
     Cash contributions accounted for 67%, or $4.1        provided 60% of all funds raised; businesses, includ-     tion. The association said hospitals make up the
billion, of the total funds raised by U.S. members of     ing corporate foundations, supplied 19.4%.                majority of its membership.   •

                                                                                                                             Winter 2006 I Arkansas Hospitals          11
     COSTS U N I N S U R E D


      Medicaid Discussions with Arkansas
      State Officials Continue
         Members of the Arkansas Hospital            pital per diem rates. The current          their Medicaid per diem rates if
      Association (AHA) executive team met           $675 per day cap has been in place         insurance premium taxes paid to the
      in November and again in December              since 1996. Some hospitals have had        state are above forecast levels.
      with top officials from the Arkansas           no Medicaid rate increase since then          However, since Act 2222 is
      Department of Health and Human                 and as each year goes by, more hos-        prospective in nature, exactly how
      Services and its Medicaid program              pitals see their Medicaid inpatient        much it could yield for hospitals
      regarding the need for additional              rates limited by the cap, which now        won’t be known until June 30, 2006.
      Medicaid funding for hospitals.                governs a vast majority of the state’s     The AHA hopes that an economic
         The AHA has been working on                 hospitals.                                 upturn in Arkansas, which has led to
      the issue with the governor’s office              The AHA worked last spring to           a surplus in state general revenues,
      and members of the state legislature           get support for a bill that was passed     will provide a window of opportuni-
      since the end of the 2005 legislative          and then signed as Act 2222 of 2005.       ty for the governor and the legisla-
      session to secure support for an               The law provides the opportunity for       ture to designate additional funds for
      increase in the cap on Medicaid hos-           hospitals to receive an increase in        Medicaid hospital payments.      •



       Business Leaders Troubled
       by Health Insurance Costs
           Rising health insurance costs are forc-   jump an additional 12% over the next       the self-employed and small businesses
       ing businesses of all sizes to pass a grow-   year, and that business owners will ask    to purchase private health insurance at
       ing portion of premiums, co-payments or       their employees to pay an average of       group rates would increase Americans’
       deductibles on to their employees,            21% of this increase.                      access to healthcare, and 41% said tax
       according to a new poll of business lead-         Respondents’ employees currently       incentives would help.
       ers, nearly 80% of which said they fear       pay, on average, 29% of their own             The poll was released at a Capitol
       their employees won’t be able to afford it.   health insurance premiums.                 Hill panel discussion on healthcare fea-
           The poll of 600 business owners               More than one-third of businesses      turing federal and state lawmakers and
       and benefit managers, released in the         that projected an increase in costs said   company CEOs. For more on the poll
       fall of 2005 by the Robert Wood               it’s likely their employees would drop     and its ramifications, go to http://cover-
       Johnson Foundation, found that com-           coverage as a result of increases. More    theuninsuredweek.org/media/docs/rele
       panies expect health insurance costs to       than half of respondents said allowing     ase091405.pdf.   •


       New Survey Shows More Arkansans Uninsured
           The Arkansas Center for Health            15% of Arkansans who were unin-            sured population work, but most of
       Improvement released the results of           sured in 2001.                             Arkansas’ employers are small busi-
       its most recent survey on Arkansas’              The report showed that more chil-       nesses with fewer than 50 employees
       uninsured population in mid-                  dren now have coverage, thanks to          each and only 26% of those employ-
       September. The findings showed                several years of expansion in              ers offer group health benefits.
       that 456,000 people in the state              Arkansas Medicaid’s ARKids First              Demographic breakdowns show
       had no health insurance coverage              program. But the numbers of unin-          that 39% of Hispanics in Arkansas
       in 2004, making up 17% of the                 sured is growing for all other groups.     lack coverage, compared with 17%
       state’s population. That’s up from               Sixty percent of the state’s unin-      of blacks and 15% of whites.      •

12    Winter 2006 I Arkansas Hospitals
COSTS U N I N S U R E D


 Oregon System Agrees to Settle
 Uninsured-Billing Class Action Lawsuit
     Providence Health System of            The settlement allows any uninsured         Additional reductions would be
 Portland, Oregon, agreed in early          patient charged for care at any of      offered to uninsured patients living
 November to settle a class action law-     Providence’s seven hospitals in the     below 400% of the federal poverty
 suit brought by attorney Richard           past four years to apply for an esti-   level and would waive bills of those
 Scruggs. The suit was brought on           mated 30% reduction in their bill,      living at or below 200% of the
 behalf of uninsured patients and           reflecting the average “preferred       poverty level and having limited
 alleged that not-for-profit Providence     provider” private insurance rate.             •
                                                                                    assets.
 violated its charitable mission by
 charging its highest prices to those
 least able to pay. The settlement still
 must go before a state Circuit Court
 judge in Portland.
     Under the settlement, Providence
 admitted no wrongdoing and said it
 chose to settle to avoid legal costs.




 Hospitals Spend
 $5.3 Billion
 More on
 Uncompensated
 Patient Care
     U.S. hospitals provided $26.9
 billion in uncompensated care in
 2004, up from $24.9 billion in
 2003, according to the latest
 American Hospital Association
 (AHA) Annual Survey of Hospitals.
     The survey measure includes
 charity care and bad debt, valued at
 the cost to the hospital of the services
 provided. The amount of uncom-
 pensated care provided by hospitals
 has increased by $5.3 billion, or
 more than 25% since 2000.
     The information on hospital
 uncompensated care comes from the
 AHA’s Annual Survey Data, 1980-
 2004. For more information, go to
 the “What’s New” section at
 http://www.aha.org.  •

                                                                                            Winter 2006 I Arkansas Hospitals   13
           Q U A L I T Y



     Arkansas Hospitals’ National Ranking Rises:
     Care Improving for Pneumonia,
     Heart Attack, Heart Failure, Surgery
     Submitted by the Arkansas Foundation for Medical Care

        Arkansas hospitals have dramati-         “One of our goals was to improve       pital performance on more than 20
     cally improved their national ranking    our ranking from 49th to 40th by          quality improvement indicators for
     in the care of Medicare patients.        2004, and Arkansas hospitals              Medicare patients. The indicators affect
     According to an analysis by the          exceeded our expectations. Our            care for patients who are hospitalized
     Arkansas Foundation for Medical          ranking improved to 35th,” said Pam       for surgery, heart attack, heart failure
     Care (AFMC), Arkansas hospitals          Brown, AFMC’s inpatient project           or community-acquired pneumonia.
     have gone from 49th in the country       manager. “More important, each                Paul Cunningham, senior vice pres-
     in 2000-2001 to 35th by the end of       percentage point of improvement           ident of the Arkansas Hospital
     2004 on 20 measures focusing on          represents hundreds of patients           Association, said that the state’s hospi-
     management of pneumonia, heart           receiving better healthcare and possi-    tals are very pleased to see the dramat-
     attacks, heart failure, and surgical     bly better outcomes. We still have a      ic improvements. He noted that the
     infection prevention.                    lot of work ahead of us, but these        AFMC analysis should be encouraging
        AFMC works with hospitals             results are encouraging.”                 news for hospitals and people in com-
     across the state to set goals to            State ranking is based on data from    munities throughout Arkansas.
     increase the number of patients who      50 states plus the District of Columbia       Cunningham said, “The improved
     receive important aspects of care.       and Puerto Rico. The data reflects hos-   rates reflect that hospital quality




     Arkansas Performance on Hospital
     Quality Improvement Indicators
        The state’s overall ranking rose to    ■ Oxygenation assessment                 ■ Beta-blocker prescribed
     35th in 2004, up from 49th in 2000-         • Baseline rate: 91%                     at discharge
     2001. Rankings are based on the             • Current rate: 98.7%                    • Baseline rate: 55.4%
                                                 • National current rate: 98.6%           • Current rate: 86.3%
     Arkansas Foundation for Medical
                                                                                          • National current rate: 89.2%
     Care’s analysis of the Centers for        ■ Pneumococcal vaccination status
     Medicare & Medicaid Services’ surveil-      • Baseline rate: 5.1%                  For surgical infection prevention
     lance data from 50 states, plus the         • Current rate: 45.7%                  ■ Prophylactic antibiotics received
     District of Columbia and Puerto Rico.       • National current rate: 44%             within one hour prior to surgical
     Data covered hospital performance on                                                 incision
                                              For heart attack patients                   • Baseline rate: 40%
     more than 20 quality indicators for
                                               ■ Aspirin on arrival                       • Current rate: 67.8%
     Medicare patients, including:                                                        • National current rate: 66.6%
                                                 • Baseline rate: 75.3%
     For pneumonia patients                      • Current rate: 81.2%                  For heart failure patients
      ■ Initial antibiotic received within       • National current rate: 88.4%
                                                                                        ■ Comprehensive discharge
        four hours of hospital arrival         ■ Aspirin prescribed at discharge          instructions
        • Baseline rate: 62.7%                   • Baseline rate: 82.2%                   • Baseline rate: 0.9%
        • Current rate: 76.6%                    • Current rate: 86.1%                    • Current rate: 15.5%
        • National current rate: 70.5%           • National current rate: 91.1%           • National current rate: 17%



14    Winter 2006 I Arkansas Hospitals
      Q U A L I T Y

managers, medical staff members             of the indicators related to heart       Arkansas hospitals are committed to
and patient care professionals have         attack (acute myocardial infarction,     continuing their quality improve-
been working closely together and           or AMI). The percentage of patients      ment efforts and that they intend to
with the AFMC to implement                  receiving aspirin on arrival — long      work along with the AFMC to build
changes that include ‘best practice’        considered standard, life-saving care    on the recent successes to make sure
processes and policies which can lead       — rose from 75.3 to 81.2 percent.        that hospital patients throughout the
to better patient outcomes.”                The national average is 88.4 percent.    state have access to the highest qual-
   Arkansas has shown considerable             “Arkansas hospitals have made         ity patient care.
improvement on most of the measures.        impressive progress, and I am confi-         As the state’s quality improvement
The state’s performance improved the        dent we will see more in the future,”    organization for Medicare and
most in the topic of community-             said Dr. William E. Golden, AFMC’s       Medicaid, AFMC works with hospi-
acquired pneumonia. For instance,           vice president for clinical quality      tals, physician offices, nursing homes
ideally all patients with pneumonia         improvement. “They have embraced         and home health agencies to ensure
should be assessed to see if they are       quality improvement as fundamental       that Arkansans receive high-quality,
due for a flu shot. In late 2000, only 5    to modern medical care and, as a         cost-effective healthcare. Priorities are
percent of hospitalized patients were       group, have jumped over the perform-     determined by the Centers for
assessed for flu immunization status        ance of peers in other states. AFMC      Medicare & Medicaid Services and the
and immunized appropriately. By             will continue to work with Arkansas      Arkansas Department of Health and
2004, the rate had risen to more than       hospitals and other health providers     Human Services, and include care for
45 percent — higher than the national       to implement systems changes that        people with medical conditions such as
average of 43.4. The percentage of          make care safer and consistent with      heart attack, heart failure, diabetes
pneumonia patients who received an          current clinical science.”               and asthma, as well as preventive care
antibiotic within four hours of arrival        Cunningham agreed, saying,            such as mammography, childhood
increased from 62.7 percent to 76.6         “While the information shows defi-       immunization, and flu and pneumonia
percent — compared to the national          nite progress, the AHA and its mem-      immunization for adults. AFMC is
rate of 70.5 percent.                       bers understand that there are more      also working to help healthcare
   However, there is still room for         gains to be made in the areas of qual-   providers make effective use of health
improvement, particularly on most           ity and patient safety.” He said that    information technology.    •


Physician Voluntary Reporting
Program Begins in January
   The Centers for Medicare & Medicaid Services (CMS)
announced on October 31 a voluntary quality reporting initiative
for physicians that could be a first step to a Medicare pay-for-per-
formance program for doctors.
   The initiative starts in January 2006 with 36 quality meas-
ures developed by the American Medical Association, the
National Quality Forum and other groups. More measures will
be phased in during 2006.
   The agency said the data will be for both its use and physi-
cians’ review, and will not be made available to the public.
   Hospitals already receive additional Medicare payments
for reporting data to the CMS, and the agency has begun a
pay-for-performance demonstration project involving large
medical groups.
   The CMS announcement did not address additional reim-
bursement for physicians who report the data under the latest
initiative. CMS said the initiative is part of its ongoing effort
with Congress to make sure Medicare is paying doctors ade-
quately without increasing overall program costs.     •

                                                                                               Winter 2006 I Arkansas Hospitals   15
            Q U A L I T Y


     Two Hospitals Earn Arkansas
     Hospital Quality Awards
        Two Arkansas hospitals are among        Bereavement Program of the St.             Arkansas Quality Awards group, was
     nine organizations that received           Vincent Center for Women &                 developed to provide opportunities for
     Arkansas Institute for Performance         Children in Little Rock were selected      organizations to measure progress in
     Excellence (AIPE) awards October 17        as winners of AIPE awards for excel-       performance excellence. Their awards
     at The Peabody Little Rock.                lence in organizational performance        recognize groups and institutions
        Arkansas Methodist Medical              and strategies.                            interested in improving quality, pro-
     Center in Paragould and the Perinatal         The AIPE, formerly known as the         ductivity and financial effectiveness.   •


     Surgical Care Improvement Project:
     Has Your Hospital Signed On?
        Three months ago a partnership of       effective methods for Medicare             Commission on Accreditation of
     leading public and private healthcare      Quality Improvement Organizations          Healthcare Organizations (JCAHO)
     organizations including the American       (QIOs) to help hospitals improve their     so that hospitals submitting SCIP data
     Hospital Association (AHA) launched        performance in surgical care.              can use the same vendors they use for
     a project to improve surgical care in          Last August, the SCIP became part      accreditation data collection and for
     hospitals nationwide.                      of the QIOs’ work plan. Now they will      submitting data to the Hospital
        The goal of the project is to reduce    work intensively on reducing surgical      Compare Web site. These tools will be
     surgical complications by 25% by the       complications with hospitals in every      ready soon.
     year 2010. This Surgical Care              state. The national SCIP partners are         Participating hospitals will submit
     Improvement Project (SCIP) targets         finalizing the process and outcome         data to the QIO warehouse, as they do
     complications related to surgical          measures hospitals will be asked to        now for public reporting for CMS’
     wound infections, blood clots, peri-       collect as they participate in SCIP, and   Hospital Compare program. Initially,
     operative heart attack and ventilator      a data collection tool is being devel-     the SCIP data won’t be publicly report-
     associated pneumonia.                      oped by the Centers for Medicare &         ed, but in the future some of the SCIP
        Since 2003, the SCIP has been lim-      Medicaid Services (CMS).                   measures will appear on the Hospital
     ited to a three-state pilot project with       In addition, everything is being       Compare Web site.
     the objective of identifying the most      coordinated       with      the    Joint      Before any hospital-specific data
                                                                                           are made public, hospitals will be
                                                                                           informed about what that informa-
                                                                                           tion is and given the choice of
                                                                                           whether to share their data publicly.
                                                                                           Hospitals are being asked to learn as
                                                                                           much as possible about the SCIP and
                                                                                           consider signing a letter of participa-
                                                                                           tion now.
                                                                                              In addition, hospitals that plan to
                                                                                           participate should begin educating
                                                                                           medical staff members about the proj-
                                                                                           ect and the modules in which the hos-
                                                                                           pital will enroll. The participation letters
                                                                                           can be found on the AHA Web site at
                                                                                           http://www.aha.org/aha/key_issues/pat
                                                                                           ient_safety/contents/050923SCIP.pdf.
                                                                                              For more information, go to
                                                                                           http://www.MedQIC.org/scip.        •
16   Winter 2006 I Arkansas Hospitals
      Q U A L I T Y


CMS Releases HCAHPS Survey
   The Centers for Medicare &                                                        Project, Joint Commission on
Medicaid Services (CMS) recently                                                     Accreditation of Healthcare Organi-
released its final Hospital CAHPS                                                    zations, National Quality Forum,
(HCAHPS) survey instrument, the first                                                U.S. Chamber of Commerce, CMS,
national survey to collect uniform                                                   and the Agency for Healthcare
patient feedback on hospital care.                                                   Research and Quality.
   The American Hospital Association                                                    Participation by hospitals will be
(AHA)-backed survey will be imple-                                                   voluntary, and results ultimately will
mented in 2006 as part of the Hospital                                               be publicly reported on the HHS
Quality Alliance (HQA), the public-                                                  Hospital Compare Web site at
private collaborative whose members                                                  http://www.hospitalcompare.hhs.gov/.
include the AHA, Association of           and Related Institutions, American            More information on the HCAHPS
American Medical Colleges, Federa-        Medical Association, American              survey and on HQA is available at
tion of American Hospitals, National      Nurses Association, AARP, AFL-             http://www.cms.hhs.gov/quality/hos-
Association of Children’s Hospitals       CIO, Consumer-Purchaser Disclosure         pital.•


Cancer Death Rates Continue to Decline
   Americans’ risk of dying from can-     Association of Central Cancer              from 1992 to 2002, while overall can-
cer continues to decline while the rate   Registries.                                cer incidence rates for both sexes have
of new cancers holds steady, accord-         The report provides updated infor-      been stable since 1992. Lung cancer is
ing to the “Annual Report to the          mation on U.S. cancer rates and            the leading cause of cancer deaths in
Nation” by the National Cancer            trends. According to the new report,       both men and women. For more on
Institute, Centers for Disease            death rates for all cancers combined       the report, go to http://jncicancerspec-
Control and Prevention, American          declined 1.5% per year in men from         trum.oxfordjournals.org/cgi/content/
Cancer Society, and North American        1993 to 2002, and 0.8% in women            abstract/jnci;97/19/1407.   •


New Breast Cancer Treatment Shown
to Reduce Need for Repeat Surgeries
from UAMS Communications
   A breast cancer treatment devel-       Radiofrequency Ablation (RFA)-             the tumor has been removed so that a
oped by University of Arkansas for        Assisted Lumpectomy. The findings of       second surgery in the area around the
Medical Sciences (UAMS) surgeon V.        the study were presented in late           lumpectomy and/or radiation therapy
Suzanne Klimberg, M.D., has been          October at the American College of         are unnecessary. Currently, about 40
shown in a clinical trial to reduce the   Surgeons’ 91st Annual Clinical             percent of patients require a second
need for repeat surgery following         Congress in San Francisco.                 surgery to remove additional malig-
lumpectomy by 86 percent.                    The RFA procedure, which sears a        nant tissue.
   Klimberg, director of the breast       one-centimeter margin, or perimeter,          UAMS is the first hospital to use
cancer program at UAMS’ Arkansas          of soft tissue following standard          RFA-assisted lumpectomy to treat
Cancer Research Center, is the princi-    lumpectomy removal of a breast             breast cancer. Klimberg’s recently con-
pal investigator of a multiphase clini-   tumor, is intended to give the patient a   cluded trial involved 25 breast cancer
cal trial for the new procedure called    cancer-free area around the site where     patients. •
                                                                                               Winter 2006 I Arkansas Hospitals   17
                                    HURRICANE KATRINA


   This Sign Means Hope




   This Is What You
                                      In areas ravaged by Hurricane Katrina, the hospital “H” also came to mean
                                      “hope” … and “heroes.”
   Can Do to Help:                    Thousands of hospital workers held the line, endured the storm and survived
                                      the deluge — to care for their patients.
Hospital employees in Louisiana,
                                      The stories are just beginning to be told:
Mississippi and Alabama suffered
                                      At one New Orleans hospital, staff went days without food and water while
devastating losses from Hurricane     evacuating patients — carrying some on stretchers, some on their backs —
                                      through floodwaters and up eight flights of stairs to waiting helicopters.
 Katrina. Some lost everything,
                                      In Mississippi, a surgeon performed emergency surgery by flashlight, with flood
  yet they continued caring for       water rising over his feet and medical equipment failing.

  their patients and neighbors.       At another hospital, food and supplies ran out, and many of the staff knew
                                      that they had lost their own homes. But they continued to accept new
See what you can do to help those     patients — treating evacuees and rescue workers alike.

      who helped so many.             The men and women of America’s Hospitals … heroes every day.

                                      America’s Hospitals.
Go to: www.TheCareFund.net            First in hope. First in care. Always there.




                                                                      www.aha.org
SPECIAL SECTION                       KATRINA REVISITED


 Temporary Agreement
 is Easing Nurse Licensure Delays
    The Arkansas State Board of            new policy, a temporary license will         reciprocal licensing of nurses among
 Nursing (ASBN) has agreed with an         be issued immediately upon request,          those states.
 Arkansas Hospital Association             and will be made final upon comple-              Some hospitals lost nurses to
 (AHA) request about issuing tem-          tion of a criminal background check          other employers because of the earli-
 porary state licenses to nurses who       by the Arkansas State Police.                er, lengthy delays. With the ASBN
 are currently licensed in another            This new policy should eliminate          promising immediate temporary
 state and wish to practice in             the long wait for Arkansas licenses          licensure for nurses who submit a
 Arkansas.                                 being experienced by many nurses             photocopy of their current license
    The ASBN notified the AHA of its       from states that are not a part of a         from another state, that problem
 decision in mid-October. Under the        multi-state compact, which allows            should be solved.   •


     Editor’s Note: Four short months      Conner, deployed to Mississippi and              Unbelievably, two weeks later,
 ago, on August 29, 2005, our nation       Louisiana in order to set up medical         another hurricane by the name of Rita
 and the world watched in horror as        relief operations.                           slashed into the Gulf area once again.
 the Gulf states of Mississippi,               Many, many others added their            This time, Texas and Louisiana
 Louisiana, and southern Alabama           names to the growing list of volunteer       received the brunt of the storm.
 were crushed by Hurricane Katrina         health professionals eager to work for           Hospitals in Little Rock, North
 and the unrelenting floods that fol-      several weeks to spell workers in hos-       Little Rock, Jacksonville and Benton
 lowed her landfall.                       pitals spread across the Mississippi and     and the Metropolitan Emergency
     The following weekend — Labor         Louisiana Gulf Coast, many of whom           Medical Services involved in the
 Day Weekend 2005 — was unlike any         had lost everything and needed time to       NDMS were called into action follow-
 Labor Day healthcare personnel had        take care of personal matters. Entire        ing Hurricane Rita to receive patients
 previously experienced in our state. In   facilities, including Stuttgart Regional     from Texas and Louisiana hospitals
 Hurricane      Katrina’s    aftermath,    Medical Center and Crossett’s Ashley         evacuating either due to rising water
 Arkansas hospitals immediately mobi-      County Medical Center, coordinated           or to predicted storm damage.
 lized, volunteering to do what they       the preparation and serving of meals             Through it all, the Arkansas
 could to help not only the devastated     for evacuees with local civic organiza-      Hospital Association served as hurri-
 Gulf Coast hospitals, but also the hur-   tions and area churches.                     cane communication headquarters and
 ricane victims who had lost everything        HSC Medical Center in Malvern,           liaison to our hospitals, the DHHS
 to the storm.                             Washington Regional Medical Center           Division of Health, Governor Mike
     Stories were being told across        in Fayetteville, Northwest Health in         Huckabee’s Office, the Arkansas
 Arkansas about the healthcare pro-        Springdale, hospitals in the Mercy           Department of Emergency Manage-
 fessionals and teams who launched         Health System, St. Bernards Medical          ment, CMS and the Medicare and
 into action, preparing to go south or     Center in Jonesboro and Little Rock          Medicaid offices, the American
 to help evacuees as they came north.      area hospitals rotated shifts of nurses      Hospital Association, other state hos-
 Hospitals such as North Arkansas          and physicians in camps and shelters         pital associations, our congressional
 Regional Medical Center in Harrison       set up throughout the state to house         offices and many, many other entities.
 and Baxter Regional Medical Center        evacuees.                                        We are proud of our healthcare per-
 in Mountain Home sent personnel in            Arkansas Hospice and several psy-        sonnel and the lifesaving comfort they
 ambulances loaded with food, water,       chiatric facilities offered their services   offered to hurricane victims. We hope
 medicines and even boats to navigate      by providing social workers, grief           you enjoy reading some personal
 the flooded city streets of New           counselors, and nurses.                      accounts in the pages that follow and
 Orleans.                                      These are a few of the many ways         that you will add these shining
     The Central Arkansas Veterans         Arkansas hospitals and healthcare            moments to your memories of the hur-
 Healthcare System coordinated citi-       facilities assisted with the heartbreak-     ricanes of 2005.
 zen evacuation efforts while the          ing needs of both the evacuees and
 National Disaster Medical System          those who worked at the damaged                  — Beth Ingram, Vice President,
 (NDMS) emergency manager, Billy           hospitals along the Gulf Coast.               AHA and Editor, Arkansas Hospitals



                                                                                                 Winter 2006 I Arkansas Hospitals   19
     SPECIAL SECTION                        KATRINA REVISITED


      Arkansas Included Under
      Emergency Assistance Declaration
         On September 8, federal Depart-         Katrina’s landfall in late August.             The Arkansas Hospital Associa-
      ment of Health and Human                      The declaration assures that those       tion worked with members of
      Services (HHS) Secretary Michael           states where a great majority of            Arkansas’ congressional delegation
      Leavitt issued an 1135(b) waiver           Hurricane Katrina evacuees continue         and state officials to achieve this dec-
      declaring    a    Public      Health       to seek shelter are included in the vari-   laration, and appreciates all those
      Emergency for eight states, including      ous Medicaid flexibility provisions that    who were instrumental in obtaining
      Arkansas, retroactive to Hurricane         Secretary Leavitt announced earlier.        the waiver for our state.   •


      Katrina Hits Home, Literally,
      for AHA Board Chairman’s Son
      Editor’s Note: Robert Atkinson is the      fairly easily,” Atkinson recalls. “We       both full-time and auxiliary — shel-
      new Chairman of the Board of the           were in reverse traffic flow conditions     tered through the storm in a building
      Arkansas Hospital Association, and         (where all lanes of Interstate Highway      near Slidell’s hospital. On Wednesday,
      also serves as president and CEO of        59 were re-directed northbound) all         two and one-half days after Katrina
      Jefferson Regional Medical Center in       the way to Hattiesburg, Mississippi. It     had done her worst, the Atkinsons
      Pine Bluff. His is a very personal story   took us six hours to reach Jackson          heard that Chris was all right.
      of dealing with Hurricane Katrina,         (Mississippi) — nearly three times             “Of course, there was major dam-
      from helping his son prepare his home      what it would normally take.” From          age everywhere. Chris told about
      to outrunning the storm to returning to    there, the Atkinsons made their way         watching trees snap off in the 120 mph
      deal with its overwhelming aftermath.      back to south central Arkansas.             winds,” Atkinson says. Slidell also
                                                     As Katrina neared, it became evi-       received more than 16 feet of water by
         August 28. Brooklyn Grace               dent that Slidell was directly in her       way of storm surge. “Nearly every
      Atkinson, first grandchild of Bob and      path. Located northeast of New              home received damage. Those nearest
      Becky Atkinson, was to be baptized in      Orleans on the north side of Lake           Lake Pontchartrain had little to go
      Slidell, Louisiana. The extended fami-     Pontchartrain, Slidell was a quiet com-     home to. Those farther away — like
      ly had gathered, but as the nation         munity of about 26,000.             After   Chris and Alison (three miles from the
      watched,        Hurricane       Katrina    Katrina, nearly all of its families faced   lake) — had homes still standing but
      approached the Gulf Coast.                 the fate of the younger Atkinsons.          with significant damage.”
         “We knew we would need to leave         Homes were destroyed; lives had to be          Returning to Slidell the weekend
      the Slidell area soon,” Atkinson said.     rebuilt.                                    following Katrina, Atkinson, sons
      “In preparation for the storm to come,         “One of the most remarkable             Chris and Tim and Alison’s dad and
      our daughter-in-law, Alison, and our       things I can tell you is that the human     brother all worked to do what they
      new granddaughter fled to Alison’s         spirit is a wonder,” Atkinson says.         could at the home. “When we first
      folks in Baton Rouge. Our son stayed       “People do have the desire and spirit       arrived, it was quite a sight to behold,”
      behind in Slidell. He is one of the sen-   to conquer even the worst of circum-        he says. “It almost looked like a black
      ior auxiliary policemen there, and was     stances. As Becky and I ventured back       and white photograph, because every-
      needed by the community.” After            to Slidell each weekend to help our         thing was caked with grey mud.”
      helping Chris and Alison prepare their     kids recover from the storm, we saw            A large tree had blown down,
      home for the storm, Bob and his wife,      that in the community and in its resi-      blocking the front walk. The garage
      Becky, joined thousands of others leav-    dents.”                                     door was banged up as a result of
      ing the area by car and began their            After Katrina struck, communica-        trees, furnishings, cars, etc. being
      escape north.                              tion was, of course, difficult. There       rammed into it as the water surged. A
         “Our son’s home is near the inter-      was no electricity, few ways to let peo-    boat had come to rest between the
      change of Interstates 10, 12 and 59, so    ple know what was happening. Chris          house and the backyard fence. Large,
      we were able to get to the highway         Atkinson and his fellow policemen —         heavy outdoor urns had floated into


20    Winter 2006 I Arkansas Hospitals
SPECIAL SECTION                       KATRINA REVISITED

 the yard up and over a six-foot fence.    believe it, we had a mountain more          ly to be able to return home.
 There was no power, no water.             than six feet high and many feet                “Television just can’t express the
     “The first thing we did was to        wide.”                                      amount of damage the storm and its
 remove the plywood from the win-             Keeping ahead of mold was the first      aftermath have done in the area,”
 dows so we could see what had hap-        priority. They sprayed germicide            Atkinson says. “People say it looks
 pened,” Atkinson says. “All of the        everywhere in the home. “We knew            like a war zone, and it does. All
 upholstered furniture was upside          we would end up removing all of the         around you, people’s lives — all they
 down, soaked. Furniture had been          wallboard, all of the insulation, all of    have owned and collected, all of their
 tipped over, and was covered in mud.      the carpets,” he said.                      dreams — are piled at the curbside.
 As we walked, our feet would stick in        With water having reached a height       When you are there in person, seeing
 the mud plastered into the carpets.”      of 3.5 feet in the home, there was          it 360 degrees around you, you real-
     Atkinson and his family were some     much to be removed.                         ize just how powerful Mother Nature
 of the first people into the devastated      The next weekend, Atkinson head-         can be.”
 city. They brought a U-Haul truck         ed to Hattiesburg, Mississippi and              But in helping Chris and his neigh-
 with them so they could remove any of     brought in new insulation to replace        bors, Atkinson says he has seen the
 Chris and Alison’s personal belongings    what had been soaked in the storm           better side of mankind. “Mother
 that survived above the water line.       and its residual flooding. In subse-        Nature is powerful,” he says, “but the
 “We saved between 10 and 20 percent       quent weekends, sheetrock was               human spirit is indomitable. We have
 of the kids’ stuff,” he said. “The rest   replaced, new cabinetry and carpets         seen the positive side of people’s spirit,
 of their life’s mementos, and those of    ordered, and painters brought in.           and truly the milk of human kindness
 all living on the Gulf Coast, were sim-      Chris, who serves as Human               flowing as people reach out to help
 ply washed away.”                         Resources Manager for Ochsner               others. It seems like people are saying,
     The first weekend was spent           Clinic/Medical Center in New                ‘we are going to lick this thing.’”
 removing all of the home’s cabinets,      Orleans, is commuting every day                 It will take years, but the Gulf
 appliances, bedding and furniture.        from Alison’s family cabin on the           will recover. As Atkinson says,
 “We took it to the curbside for eventu-   Tickfaw River near Hammond.                 Mother Nature is strong, but
 al pickup,” he says. “If you can          Alison says she is ready for her fami-      Human Nature perseveres.       •


 Pat O’Brien’s Loss is Ouachita
 County Medical Center’s Gain:
 Chef Finds a New Home
 Editor’s Note: The first portion of       lowing Hurricane Katrina. His fami-         a job as a certified nurse’s assistant at
 this story originally appeared as an      ly plans to stay in town permanently.       the Medical Center of South Arkansas
 October article in the Camden News.          Smith came to Camden with his            in El Dorado. His two older children
 We thank Editor Donna Collins for         wife and three sons, ages 12, 9 and         are in Camden Fairview schools.
 allowing us to reprint it here. The       1, because his mother-in-law lives             “My boys are in school, the schools
 second portion (after the asterisks)      here. But he said he is pleased with        and the people are treating them so
 was written by Arkansas Hospitals         the move for more reasons than he           kind,” he said. “They’re getting used
 staff members.                            expected.                                   to their classes so fast.”
                                              Smith is impressed with Camden’s            Smith said he plans to return to
 From the Camden News,
                                           family atmosphere. The people in            New Orleans in the coming weeks to
 by Stephanie Jones
                                           town are different from New                 settle insurance and property matters,
    The food in the Ouachita County        Orleans, he said.                           but he will return to live in Camden
 Medical Center dining hall now has a         “I love Camden. I really do,”            for good.
 Creole flair.                             Smith said. “When we got here,                 “The bills are still coming in — the
    Richard Smith, 47, formerly a          everybody had smiles for us.”               water bill, the electric bill,” and his
 chef at a restaurant in New Orleans,         He said Camden residents had been        family is not even there. “I’ve got to
 moved to Camden recently after            eager to reach out to his family and help   close all of that out,” he said.
 evacuating his Louisiana home fol-        them settle in. His wife quickly found         He also has to pick up his car,


                                                                                                 Winter 2006 I Arkansas Hospitals   21
     SPECIAL SECTION                         KATRINA REVISITED

      damaged by the flooding that fol-            those,” he said. “And right now I’m                                found was total devastation of his
      lowed the hurricane.                         working on a béarnaise sauce.”                                     home and belongings.
          Smith has been working at the hos-           Cooking has been a part of Smith’s                                “Unfortunately, he returned to
      pital for nearly a month, he said, and       life since his childhood. He said he                               find what was NOT left of his
      officials there have given him a lot of      first became interested in it when he                              home,” says Ouachita Valley Health
      freedom to make the dining hall menu         spent time in the kitchen with his step-                           System CEO C.C. “Mac” McAllister.
      his own, he said.                            father.                                                            “He had hoped to bring his car and
          “I love working at the hospital,” he         Smith      attended       Jumonville                           things from his home in New
      said. “The people have been real good        Culinary Technical Institute in St.                                Orleans back to Camden, but all he
      to me. I’ve been able to get into the        Martinville to get training before he                              brought back was bed frames. Even
      kitchen and do my own thing, and             began restaurant work. When the                                    the car was totally ruined.”
      spice it up, you know. They pretty           family was forced to leave (New                                       When speaking of Richard Smith
      much told me, ‘Whatever you want to          Orleans), he was a chef at Pat                                     and what he has meant to the health
      do in the kitchen, go ahead.’ The spice      O’Brien’s restaurant.                                              system, McAllister’s voice softens.
      and flavors, I’ve gotten a good                  The Smiths only evacuated after                                “He has adopted us, and we have
      response; it seems like everybody loves      they stayed in their home through the                              adopted him. He is a very friendly
      it,” he added.                               storm itself, Smith said. He said the                              guy,” he says.
          He said guests and hospital admin-       home was damaged primarily by the                                     McAllister also comments on what
      istrators have complimented his dishes.      force of the storm winds and rains, but                            “great cooking” can do for attendance
          Smith’s supervisor, Sarah Silliman,      wasn’t flooded.                                                    at meetings. “I am on the Community
      confirmed that everyone is pleased               “The flood water reached up to                                 Foundation Board, and we hold our
      with his work. “We’re very fortunate         the front steps,” he said. “But when                               meetings at the hospital,” he says.
      to have him,” she said.                      the roof caved in, that’s when things                              “All I can tell you is that since Richard
          Beef sirloin, roast beef and roast       got crazy.”                                                        has been providing the food for the
      pork, red beans and rice and shrimp                            ***                                              meetings, our attendance is up!”
      etouffée are a few of the dishes Smith           Since this article first appeared in                              Hurricane Katrina was what
      has been serving up.                         early October in the Camden News,                                  McAllister calls a “wake-up call” for
          “I’ve been doing a lot of pasta dish-    Richard Smith has made his return                                  Arkansas hospitals. “Through the
      es; everyone really seems to like            journey to New Orleans. What he                                    Arkansas Hospital Association, we all
                                                                                                                      got involved, doing what we could, in
                                                                                                                      whatever way we could,” he says.
                                                                                                                      “But what Hurricane Katrina really
                                                                                                                      did was show us that as bad as it was
                                                                                                                      and as real as it was, it was a dress
                                                                                                                      rehearsal for something that could be
                                                                                                                      much worse.”
                                                                                                                         He says the hurricane and handling
                                                                                                                      its evacuees caused the Sheriff’s
                                                                                                                      Department, Office of Emergency
                                                                                                                      Services and other local groups to work
                                                                                                                      together with national agencies (such
                                                                                                                      as FEMA — the Federal Emergency
                                                                                                                      Management Agency) in a way never
                                                                                                                      before possible. “It helped us all think
                                                                                                                      again about what we would do in a dis-
                                                                                              Photo by Jamie Jordan




                                                                                                                      aster situation,” he says.
                                                                                                                         What effect has the hurricane had
                                                                                                                      on Camden? “Our population is
                                                                                                                      growing as people move here to
                                                                                                                      begin a new life,” he says. And as
      From Pat O’Brien’s restaurant in New Orleans to head chef of his own kitchens at
                                                                                                                      for the hospital cuisine? Let’s just
      Ouachita County Medical Center in Camden, it has been an interesting three months for
      Richard Smith. After fleeing Hurricane Katrina’s destruction (his family’s home was                             say it’s a new experience to have
      devastated by storm winds), Smith and his family sought refuge at his mother-in-law’s                           folks calling to find out what’s cook-
      home in Camden. Now, the Smiths and their three children are permanent residents of                             ing, and have them lining up outside
      the Camden community, and those who have reason to dine at the Medical Center can                               the doors for a sample of Richard
      fully appreciate his culinary expertise!                                                                        Smith’s daily fare.  •

22    Winter 2006 I Arkansas Hospitals
SPECIAL SECTION                       KATRINA REVISITED


 Paul Prudhomme
 Provides Meals for
 Relief Workers
 in New Orleans —
 Thanks to a
 Truckload of
 Ingredients
 from Pine Bluff’s
 Doctors and the
 Community
     World-renowned chef Paul Prudhomme, his fami-
 ly and restaurant workers joined the thousands mak-
 ing a temporary escape from New Orleans during the
 height of Hurricane Katrina and its aftermath. They
 fled to the camp-in-the-woods of one of Pine Bluff’s
 physicians, a dear friend for many years. There, he
 spent two weeks waiting for New Orleans to dry out
 enough for his group to venture back. Upon their
 return, they immediately began cooking meals for the
 many relief workers in the New Orleans area. But
 getting fresh food into town was difficult, at best.
 Four weeks after the storm, Prudhomme’s Pine Bluff
 friends again came to the rescue, raising more than
 $15,000 and filling a semi-trailer truck full of fresh
 food and needed ingredients. This is the “thank you”
 message Prudhomme and his pals placed in the Pine
 Bluff Commercial, thanking the medical community
 and the people of the city who sent the personalized
 “food relief truck.”•


     Over 70% of Hospitals in AHA
     Use                                                    For Advertising
                                                             Information
                                                            Adrienne Freeman
    Delivering over One Million                           Publishing Concepts, Inc.
          messages daily                                       501 / 221-9986
                                                          adrienne@pcipublishing.com
                         Phone 800-770-0183

                                                            Winter 2006 I Arkansas Hospitals   23
     C E O          P R O F I L E
         Bob Atkinson was installed as                                                         by Nancy Robertson Cook
     the new Chairman of the Board
     for the Arkansas Hospital
     Association at its annual meeting
     in October. He is a great believer
     in the importance of hospitals
                                            New AHA Chairman on
     working together for the good of
     Arkansas’ healthcare facilities,       “Defining Moments,”
     their patients and communities.
         “I have been involved with the
     AHA almost since I arrived in
                                            Katrina, and Challenges
     Arkansas in 1992,” he says. “I
     have long felt that the associa-       to Healthcare
     tion’s leadership is its greatest
                                               Jefferson Regional                                         sonal impact on so
     strength. The Board members
                                            Medical Center (JRMC)                                         many Americans; their
     and the AHA staff have worked
                                            in Pine Bluff is but one                                      ensuing stories each
     together so well through the years
                                            of many Arkansas                                              come down to one
     and done a great job. They are a
                                            healthcare facilities                                         person, one family’s
     good team.”
                                            responding to cries of                                        account of what hap-
         He sees the main job of the
                                            desperation following                                         pened “to them.”
     AHA as keeping the state’s hospi-
                                            the confusion and dev-                                        JRMC will be a part
     tals and their administrative pro-
                                            astation wreaked by                                           of many of those sto-
     fessionals well informed. “There
                                            Hurricane       Katrina.                                      ries because of the
     are so many changes constantly
                                            JRMC’s rapid response                                         help it provided and
     occurring in healthcare,” he says.
                                            to evacuees is testa-                                         the compassion it
     “The AHA tells us what we need
                                            ment to one hospital’s                                        offered with welcom-
     to be concerned about, and rep-
                                            disaster planning and                                         ing arms.
     resents us well both at the state
                                            thoughtful considera- Robert Atkinson was installed as            “Pine Bluff took in
     and the national levels.”
                                            tion     for     human the 2005-2007 Chairman of the          between 2,000 and
         “In every life, there are defin-
                                            need…and in the Board of the Arkansas Hospital                3,000 evacuees in the
     ing moments...distinct milestones
                                            midst of the hospital’s Association in October. Atkinson storm’s aftermath,”
     that influence our character, illu-
                                            administering care and is president and CEO of                Atkinson says. “At
     minate our dreams and shape the                                  Jefferson Regional Medical
                                            compassion to those                                           first, it was in small
     direction of our lives,” he says.                                Center in Pine Bluff, a position
                                            fleeing        Katrina’s he has held since 1992.              groups of three and
     “Several of those defining
                                            chaos, one family’s                                           four cars, families and
     moments have taken place in my
                                            story was very personally unfolding          friends driving together to escape the
     life this year. The most meaning-
                                            for the medical center’s CEO and             impending storm. Then we received
     ful was the birth this summer of
                                            President Robert Atkinson.                   more and more people who had been
     my first grandchild, Brooklyn
                                               Atkinson’s eldest son, Chris, and         evacuated from New Orleans, directly
     Grace Atkinson. She represents
                                            his family from Slidell, Louisiana           after or in the next week after Katrina
     the very best of our family’s past
                                            found themselves in Katrina’s direct         hit.” Some of those had originally
     and future, and her arrival cer-
                                            path Sunday, August 28. “We were all         been evacuated to Fort Chaffee, near
     tainly defined my aspirations as
                                            gathered in Slidell that weekend for         Fort Smith.
     an influence in her life.
                                            our first granddaughter’s baptism,” he           Sheltered at the Pine Bluff
         “Another defining moment
                                            says. “But with Katrina’s approach,          Convention Center, those arriving in
     was being nominated to serve as
                                            we knew that would be postponed.             the earliest days had fewer medical
     chairman of the Arkansas
                                            Before we left, we helped Chris and          needs; most required a refill of their
     Hospital Association. I have a
                                            Alison prepare their home for the            prescription drugs. “We set up a
     deep respect for the AHA and the
                                            storm. We put plywood on all the             booth at the Convention Center
     guidance it provides to health-
                                            windows and did what we could to             where people could come for medical
     care professionals throughout the
                                            secure the house. Then, we began our         help,” Atkinson recalls. “At first we
     state. It is a privilege to be an
                                            drive home to Pine Bluff, and the work       served mostly as a first aid station,
     AHA member, and an honor to
                                            we knew would await us with incom-           administering lots of tetanus shots,
     serve as Chairman. I look for-
                                            ing evacuees.”                               refilling prescriptions and assessing
     ward to continuing the standard
                                                 The winds and flood waters that         people for injuries.”
     of excellence that has defined the
                                            buffeted Gulf Coast families had per-            But with the second wave of evac-
     healthcare industry for us all.”


24   Winter 2006 I Arkansas Hospitals
On Sunday, September 4, 2005, Pine Bluff welcomed 324       JRMC responded immediately by setting up a first aid station to offer minor
New Orleans evacuees who had previously been housed at      emergency care, physician referral and prescription assistance. JRMC’s
Fort Chafee. JRMC employee health nurse Alice Lawson, RN,   Ruth Rogers, RN, (center) gave updates on how to run the clinic. Volunteers
triaged each survivor as he or she got off the bus.         included a number of physicians such as Reid Pierce, MD (left).

  uees — those escaping the floods of          tions, but dispensing them was sim-          adults. And okra, black-eyed peas —
  New Orleans — Atkinson says the              ply the right thing to do.”                  all of these were new to me. I am sure
  needs rose tremendously.                         Atkinson says two of the things he       my classmates enjoyed a few good
      “Those arriving from New                 will most remember about Katrina             laughs because of me!”
  Orleans had had no way to wash, to           are the unbelievable power of Mother             Atkinson’s chosen career path was
  eat, to meet their critical medical          Nature, and the compassion of                one of science. He earned his bache-
  needs,” he says. “These 300-500 peo-         humans, one for the other.                   lor’s degree from Mississippi State
  ple showed considerably more stress              He is no stranger to Mother              University in general science, then
  and strain than those who had come           Nature’s power. At the tender age of         went on to earn his master’s in zoolo-
  before them. They needed a place to          six, he saw first-hand the effects of a      gy and physiology. “I planned to
  bathe, and food to eat. They needed          tsunami while living with his military       pursue my doctorate,” he says, “but
  medical assessment, referrals and the        family in Hawaii.                            it was 1972 and the war in Vietnam
  care that those of us in the medical             “I guess you could call me a Navy        was raging. I had an ROTC commit-
  field can specifically offer.”               brat,” he says. “We moved around a           ment to fill, and because of my sci-
      JRMC posted a team of around 30          great deal as I was growing up. I will       ence degrees was placed in St. Louis
  doctors and nurses at the Convention         never forget standing on the shore in        as administrative officer of a regional
  Center to begin offering medical hope        Hawaii, a boy of six, and watching the       medical laboratory.”
  as soon as people stepped off the buses.     ocean literally suck itself outward for a        He shakes his head as he tells how
  “Essentially, we were putting our dis-       mile or more. Fish were flopping             his planned career in science shifted,
  aster plan into place,” Atkinson says.       everywhere. We knew it was time to           instead, to one in administration.
  “And the evacuees’ reaction — their          head home. And soon afterward, a             “The Army really threw me a curve
  thanks — was truly heartwarming.”            tsunami wave crashed in, close to            ball,” he says. “I had no administra-
      As people told their stories, the        where we lived. It is something I will       tive experience. I read up on it,
  human side of the storm’s aftermath          never forget.”                               learned as much as I could, and with
  began to unfold. “People were so                 Atkinson spent many of his grow-         my science background found it easy
  concerned for those they had left            ing-up years in southern California,         to talk with the doctors and nurses at
  behind,” Atkinson says. “So many of          eventually attending high school in La       the lab.”
  them lost their homes, their friends,        Mirada. “Then, we had a big transi-              His new career path became clear.
  even family members.” Pine Bluff             tion,” he recalls. “We moved to              Upon completion of his military com-
  churches came to the rescue, offering        Jackson, Mississippi, where I would          mitment, Atkinson returned to the
  shelter and food — ”aid and comfort          finish high school. That was really an       South and attended the University of
  in the finest sense,” Atkinson says.         eye-opener!”                                 Alabama at Birmingham in pursuit of
  “JRMC’s biggest contribution was in              With a smile in his eyes, he remem-      a master’s degree in hospital adminis-
  helping get people back on their med-        bers being “a novelty” to the native         tration. Graduating in 1976, he spent
  icines. We estimate that we provided         Southerners. “I was so non-Southern,         the next two years in Birmingham as
  between $30,000 and $40,000 in pre-          I didn’t even know that iced tea was         an assistant administrator at St.
  scription medicines. We may or may           something ‘everybody’ drank. I saw           Vincent’s Hospital.
  not be reimbursed for those medica-          tea as a drink mostly enjoyed by                 In 1978, he accepted an offer from



                                                                                                       Winter 2006 I Arkansas Hospitals   25
      Humana, a for-profit hospital chain,       has been enjoyable in every way.           medical center’s liaison with the
      and moved his wife, Becky, and sons        “Becky and I were empty-nesters            greater community.”
      Chris and Tim to Huntsville, where he      when we moved to Pine Bluff,” he               The hospital is a central part of
      served as associate administrator and      says. “We have enjoyed becoming a          every community, he says, and is often
      COO      of    Humana       Hospital-      part of the community, and love the        the center of its economy. JRMC is
      Huntsville. His next assignment with       people here.”                              one of the top employers in Pine Bluff,
      Humana was in Muscle Shoals,                   There have been many changes in        and indeed in all of Jefferson County.
      Alabama, where he served as adminis-       hospital administration over the               He cites “the insurance situation”
      trator and was charged with building       course of Atkinson’s career. “The role     (growing numbers of uninsured and
      a new hospital from the ground up —        of the administrator used to be to han-    underinsured) as one of his biggest
                                                                                            concerns as an administrator. “With
                                                                                            the cost of healthcare on the rise, small
                                                                                            employers just can’t afford to provide
                                                                                            health insurance for their workers
                                                                                            anymore,” he says. “Health crises can
                                                                                            put families into bankruptcy, yet too
                                                                                            much charity care can force a hospital
                                                                                            to close its doors. There is a real bur-
                                                                                            den on hospitals to provide care at
                                                                                            reasonable costs while still being able
                                                                                            to provide needed services. It is a dif-
                                                                                            ficult spiral, and a big challenge for
                                                                                            our society.”
                                                                                                He also cites a change in the health-
                                                                                            care workforce as challenging.
                                                                                            “Many are simply losing heart,” he
                                                                                            says. “They are still extremely dedi-
                                                                                            cated, but with fewer workers we are
                                                                                            asking more and more of those still on
                                                                                            the job, and that is hard on them. The
                                                                                            average age of nurses is 41-42, and
      a hospital that would be used as a pro-    dle the hospital’s internal affairs,” he   many will retire soon. We must find
      totype for the Humana system for           says. “Now, that’s more the role of an     ways of recruiting and training the
      years to come.                             assistant administrator or vice presi-     healthcare workforce needed with our
          “That was a particularly interesting   dent. The role of the CEO is now           growing, aging population.”
      project,” he says. “We helped with         more external, networking with other           As both scientist and hospital
      design of the entire hospital, a very      healthcare providers, working with         administrator, Atkinson sees the future
      rewarding experience.”                     legislators, helping with physicians’      of healthcare as exciting and promis-
          His next position was with             concerns and issues, fighting the reim-    ing, even with its inherent challenges.
      Chalmette Medical Center in New            bursement fight, and serving as the        “There are new medicines, new tech-
      Orleans — a hospital, he                                                                 nologies that are saving people’s
      recalls, that took on seven feet                                                         lives every day. And new things are
      of floodwater in Katrina’s after-                                                        being discovered all the time — it’s
      math. He served as administra-                                                           almost like something out of Star
      tor at Chalmette from 1985-87,                                                           Wars,” he says.
      then accepted an offer from                                                                  Serving the healthcare field is
      Slidell to become administrator                                                          truly a calling, Atkinson says. “We
      of Slidell Memorial Hospital.                                                            have come so far; it is hard to
      Slidell is where his two sons                                                            imagine the advances that have
      spent their later teen years, and                                                        been made in just the past 75
      it is ultimately where elder son,                                                        years.     Knowledge, treatment,
      Chris, settled.                                                                          technology, all are growing expo-
          In 1992, Atkinson became                                                             nentially. Collectively, as members
      president and CEO of Jefferson                                                           of the field of healthcare, we can
      Regional Medical Center in Pine                                                          all be proud of the job we do and
      Bluff, Arkansas, a move he says                                                          the service we provide!”   •

26   Winter 2006 I Arkansas Hospitals
SPECIAL SECTION                        KATRINA REVISITED


 Hot Showers, Warm Meals, Finding Mama —
 It’s All in a Day’s Work at
 St. Edward Mercy Medical Center
    Chip Paris, Director of Marketing          For 72 hours after                                           One of the most
 and Planning for the St. Edward            the first wave of evac-                                      touching stories to
 Mercy Health Network in Fort Smith,        uees began arriving at                                       come out of St. Edward
 vividly recalls Labor Day weekend of       Fort Chaffee, it was a                                       Mercy     centers    on
 2005. “Friday, September 2, our            constant carousel of                                         Monte Wilson, Vice
 administrators were notified in the late   people in and out of the                                     President of Clinical
 morning by people at Fort Chaffee          hospital, Paris says.                                        Operations (Cardiology
 that our area would be receiving a         “We admitted around                                          and Surgical Services).
 number of evacuees from Hurricane          20      patients,      saw                                   Wilson, through his
 Katrina,” he says. “They could give us     between 300 and 400,                                         church and work at
 no definite time or numbers of people,     and helped more than                                         the hospital, found
 but we knew we had to be ready.”           1000 families, in all.”                                      himself in the middle
    The first wave of evacuees arrived         Not only were the                                         of many stories involv-
 by plane at Fort Smith, followed by        medical staff members                                        ing Katrina evacuees.
                                                                                  Monte Wilson
 what we all now remember as an             needed beginning that                                           “On Labor Day
 almost never-ending line of buses          Friday, but also those on the nutrition      weekend, he met a family — a mom,
 from the Gulf. “We received people         staff, who cooked and provided meals         dad and son — who had with them an
 from      both      Louisiana      and     for the evacuees. “We heard they were        11-year-old girl not belonging to their
                                            having a problem feeding the numbers         family,” Paris recalls. “This child had
                                            of people coming into the Fort,” Paris       been through a nightmare already.
                                            says, “so our nutritional staff immedi-      She, her mother and baby brother
                                            ately went into action. They cooked          escaped the hurricane and tried to
                                            600 hot meals complete with ice, cold        make it to one of the New Orleans
                                            drinks and all the fixings, transported      shelters. They made it to the I-10
                                            them to the Fort, set up a buffet line in    bridge, which many of us remember
                                            the grass, and began serving. All of         seeing on television. There, few cars
 Mississippi,” he says. “In all, thou-      this while still cooking for the patients    came by to help. But eventually, a
 sands of people passed through the         and regular hospital dining rooms.”          truck stopped and had room — only
 Fort Chaffee relief center.”                  He says that a number of the nutri-       for the mother and baby. This girl’s
     “By Saturday, we had triaged           tional staff, as well as off-duty medical    mother had to make the heart-wrench-
 patients at the Fort, and brought          staff and administrators went to the         ing decision to take her baby to safety,
 between 300 and 400 to the hospital        Fort to serve the meals.                     while leaving her daughter to try to
 for further assistance,” he says. “Of         “The whole thing was so amazing,”         find them later. This amazing 11-year-
 course, those people came with their       he says. “The evacuees and the greater       old made it on her own for several
 family members. We offered clean           Fort Smith community suddenly                days, then met this family, who took
 clothing, a hot shower and hot meals       became aware of the level of caring we       her in.
 to all who came through our doors,         see and know at our hospital every               “They wound up at Fort Chaffee.
 whether patient or relative.” The          day. I think it showed the community,        Monte Wilson met the family, and
 evacuees came with needs ranging           reminded them, of the great care and         brought the girl and two other kids
 from prescription refills to full-time     compassion we provide at St. Edward          who had been separated from their
 nursing care. “We also saw people          Mercy Medical Center.”                       families, home with him. He shared his
 who had ‘normal’ problems, like the           That level of caring was also             kids’ clothes with them, and gave them
 flu,” he says.                             shown by the Mercy hospital net-             beds to sleep in and plenty to eat.”
     Shirrell Henry, another member of      work, headquartered in St. Louis,                Then, a remarkable thing hap-
 the St. Edward staff, recalls the care     Missouri and of which St. Edward is          pened. Wilson, through his church,
 for a man who suffered a fractured leg     a part. “More than $300,000 was              heard that the two siblings’ family
 during the storm. “By the time he          raised by Mercy employees system-            had been located in Dallas, Texas.
 reached us, he was in bad shape,” she      wide,” he says. “Then, the corpora-          “Monte took the two kids, along
 says. “We had to amputate his leg. He      tion matched it. In all, we raised           with another church member and
 lost his leg, but we saved his life!”      $600,000 for hurricane relief.”              this 11-year-old, to Dallas to try to



                                                                                                  Winter 2006 I Arkansas Hospitals   27
     SPECIAL SECTION                                                KATRINA REVISITED

                              find their parents,” Paris says. The        know if the mom was there. But they         2000 workers at the hospital, there
                              siblings’ family was found, and they        began to ask a few people in the hall-      were many wonderful stories to tell.
                              were reunited. But no word on the           ways, and when they turned a corner,           “Of course, as a hospital, we drill,
                              young girl’s mother and brother.            the mother was simply THERE!                drill, drill on disaster preparedness,”
                                 “Then, they heard that the mother        Monte said it was an act of God.” At        Paris says. “Dealing with the after-
                              and baby might be in Austin,” Paris         the very least, it was a miracle!           math of Katrina made us take a long
                              says. “So even though it was 9:30 at           Most of the people who came              look at our plans, and we are glad to
                              night, they headed for Austin, arriving     through Fort Chaffee quickly moved          report that they were very flexible and
                              there between 1 and 2 in the morning.       on. After the experience was over,          worked well.” Though a few adjust-
                              Of course, once they located the shel-      many on the St. Edward staff continued      ments have been made, the disaster
                              ter in Austin, they found most every-       to trade anecdotes and stories about        plan stands ready for the next event.
                              one there asleep. And they didn’t even      what had happened — and among the           Let’s hope it doesn’t come soon.   •


                              Regional Networks Made All the Difference:
                              An Arkansas Children’s Hospital Retrospective
                                 “As we have thought it through in the time since              ing,” Gordon says. “We just went into action, matching
                              Hurricane Katrina, a couple of things have become very           resources to needs.”
                              clear,” says Scott Gordon, Executive Vice President and              He credits not only the ACH transport team, but also the
                              Chief Operating Officer for Arkansas Children’s Hospital         entire staff of the medical facility, in helping things to hap-
                              (ACH) at Little Rock. “One — when things need to move,           pen quickly. “Our nutritional services group helped bring
                              regional networks get the job done, and two — keeping your       food and water that could be transported to New Orleans.
                              internal communications strong is vital.”                        And our vendors were outstanding. Alltel provided satellite
                                                                                               phones for communication. Sikorsky kept teams available
                                                                                               in Baton Rouge so the helicopters’ engines could be flushed
                                                                                               and remain undamaged by the salt air.”
                                                                                                   “At the end of the day, all our people were proud to have
                                                                                               been a part of the effort,” Gordon says. That is where the
                                                                                               internal communication updates helped. “Every person on
                                                                                               staff wanted to know what we were doing, and we kept
                                                                                               good communication with our internal organization
                                                                                               throughout. 40-50 people received regular updates, and
                                                                                               passed the information on to their own staffs.”
                                                                                                   An internal de-briefing took place following the return of
     Photo by Kelley Cooper




                                                                                               ACH employees from the Gulf region. “It helped those who
                                                                                               had been on-site to discuss what they had been through, and
                                                                                               it helped those left to work here in Little Rock to be able to
                                                                                               ask questions, to better understand. It was a very powerful
                                                                                               session.”
                              The Arkansas Children’s Hospital transport team worked close-        In the end, the informal regional transportation network
                              ly with other regional transport groups to move patients from    was able to go into action well ahead of the federal emer-
                              hospitals affected by Hurricane Katrina.                         gency response. Gordon says this happened because people
                                                                                               knew each other, they were already organized to make things
                                  Gordon says, “We have a particularly strong regional net-    happen, and they knew not to over-commit or to make
                              work in the area of transporting patients. Regional trans-       unreasonable demands. “They proved that when things
                              portation directors know one another, know their hospitals’      need to move, local and regional relationships provide the
                              abilities for transport, their people’s and hospitals’ capaci-   most effective response in time of crisis,” he says. “We all
                              ties. Within one hour of identifying New Orleans’ need for       learned to recognize the value of informal relationships and
                              moving patients from hospitals, the informal regional net-       what they can do.”
                              work mobilized — in most cases before the hospitals there            He also notes that ACH is uniquely set to respond quick-
                              even realized they would have to evacuate their patients.”       ly — and that with that ability comes responsibility.
                                  As became evident in the early days of Katrina’s after-      “Moving patients, helping to evacuate hospitals, was vitally
                              math, the helicopter evacuation of patients became a lifeline.   necessary after Katrina,” he says. “We responded. This is
                              “No one asked, ‘Who is going to pay for this?’ prior to act-     what we’re all about.”   •
28                    Winter 2006 I Arkansas Hospitals
Arkansas Medical Records
Retention Rules : a Reminder
    Several recent calls to the Arkansas       In addition, the Arkansas Health       • Medical audits and correspon-
Hospital Association have concerned         Information Management Association          ding retrieval sheets, medical
hospital requirements for records           (AHIMA) recommends the following            staff utilization reports, tissue
retention. According to the 2005 edi-       permanent records:                          and transfusion committee work-
tion of the state’s Rules and                • Master patient index                     sheets — 5 years;
Regulations for Hospitals and Related        • Number index                           • Consent forms for release of
Institutions (Section 14.A.17): “All         • Admission list or patient register       information on microfilmed
medical records shall be retained in
                                             • Death register                           records, release of information
either the original or microfilm or
                                             • Statistical reports                      log — 3 years;
other acceptable methods for 10 years
after the last discharge. After 10 years,      AHIMA also gives these time-           • Daily census summary or discharge
a medical record may be destroyed           frames for retaining records:               list — 1 year;
provided the facility permanently            • Annual statistical reports — 30        • Transcription logs — 6 months;
maintains the information contained            years;
                                                                                      • Surgery schedules, daily census —
in the Master Patient Index. Complete        • Physician indexes, disease and
                                                                                        3 months; and
medical records of minors shall be             operation indexes, monthly statisti-
retained for a period of two years after       cal reports, quality improvement       • Reproduction of microfilm records
the age of majority.”                          — 10 years;                              sent to the floor — until discharge.           •




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                                                                                               Winter 2006 I Arkansas Hospitals                29
     E L E C T R O N I C H E A LT H R E C O R D S


      Report Lists Electronic Record Needs
         The federal government should                                                  Document Game: Connecting and
      develop a nationwide patient authen-                                              Transforming Your Healthcare
      tication standard that protects indi-                                             through Information Technology”
      viduals’ information and lead an                                                  (http://endingthedocumentgame.gov/
      effort to offer financial incentives to                                           PDFs/Recommendations.pdf), the 11
      providers in order to foster the elec-                                            commissioners focused on giving
      tronic exchange of health informa-                                                people the information they need to
      tion and to create a system of                                                    make wiser decisions about their
      instantly accessible health records                                               healthcare and helping consumers
      for all Americans, according to two                                               understand how electronic records
      key recommendations released                                                      and other technology are critical to
      October 25 by the Commission on                                                   achieving that goal.
      Systemic Interoperability (CSI).                                                     The CSI also calls on government
         In all, the Commission, which for-                                             to “act with urgency to revise or
      mulated       its   recommendations       American. Such a system would lead      eliminate regulations” that impede
      around the tenets of adoption, inter-     to dramatic improvements in patient     implementation of interoperable
      operability and connectivity, pin-        safety, quality of care, convenience,   electronic health records, most
      points a total of 14 steps for creating   satisfaction and health while helping   notably the Physician Self-Referral
      a connected system of instantly           to rein in soaring healthcare costs.    (Stark) law and the Federal Anti-
      accessible health records for every          In their report, “Ending the         Kickback Law.  •




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                                                             >   Home Delivery Pharmacy
                                                             >   Specialty Pharmacy
                                                             >   Health Information Management
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30    Winter 2006 I Arkansas Hospitals
E L E C T R O N I C H E A LT H R E C O R D S


 With Government Help, Study Projects
 Health IT Could Save $162 Billion
    Widespread adoption and effec-        now, the study estimates it would cost      of HIT and remove some major bar-
 tive use of electronic medical records   $98 billion for hospitals and $17.2 bil-    riers if we are going to reap the
 (EMR) and other health information       lion for physicians to adopt a stan-        tremendous benefits it could have on
 technology (HIT) could save the U.S.     dardized EMR system over the next 15        improving quality, managing dis-
 healthcare system up to $162 billion     years, much less than the $162 billion      eases, and extending people’s lives.”
 annually and prevent a third or more     per year in possible savings.                  Key barriers include the acquisi-
 of adverse drug events in outpatient        “The potential savings from HIT          tion and implementation costs for
 settings each year, a new study by       is mind-boggling, but it isn’t going to     healthcare providers, slow and
 RAND Corp. projects.                     happen overnight,” the lead author          uncertain financial payoffs, and dis-
    Assuming about 20% of hospitals       said. “The federal government will          ruptive effects on practices, the
 and physicians have an EMR system        need to step in to speed the diffusion      authors say.  •


 Survey: Costs are HIT Barrier
    Ninety percent of U.S. hospitals          The survey results suggest that the     quality of patient care. Some of the
 are using or considering the use of      use of health IT in caring for patients     technologies and systems hospitals are
 health information technology (HIT)      is evolving as hospitals adopt specific     using include bar coding devices, com-
 for clinical purposes, according to a    technologies based on their needs and       puterized physician order entry and
 new American Hospital Association        priorities, size and financial resources.   electronic medical records. To view the
 (AHA) survey, but most cite cost as a        While most are still in the beginning   survey in its entirety, go to:
 major impediment to broader adop-        stages, the survey shows hospitals are      http://www.ahapolicyforum.org/ahap
 tion, especially for small or rural      making investments in HIT, in large         olicyforum/resources/content/FINAL
 hospitals.                               part to make gains in the safety and        NonEmbITSurvey105.pdf.       •


 Proposed Rules Bolster E-prescribing, EHRs
    The federal Department of Health      safety for Medicare beneficiaries and       That proposed rule would establish the
 and Human Services (HHS) took a          all Americans.                              conditions under which such entities
 step toward meeting President Bush’s          Under the first proposed rule, the     may donate to physician EHR software
 goal of widespread adoption of addi-     Centers for Medicare & Medicaid             and related training services. This pro-
 tional information technology (IT) in    Services (CMS) would create excep-          posal would be relatively narrow until
 the healthcare field with an October     tions to the “physician self-referral”      nationwide product certification crite-
 5 announcement of two new sets of        law by establishing conditions under        ria are established and approved by the
 regulations that support adoption of     which hospitals and certain other enti-     Secretary. At that point, hospitals and
 electronic health records (EHRs) and     ties can give physicians hardware, soft-    certain other entities could donate a
 e-prescribing, which enables a physi-    ware or information technology, and         broader array of technology to physi-
 cian to transmit a prescription elec-    training services for e-prescribing and     cians, if the technology met the product
 tronically to a patient’s pharmacy of    EHRs, particularly when the support         certification criteria.
 choice.                                  involves systems that are “interopera-          CMS is considering imposing a cap
    HHS Secretary Mike Leavitt said       ble” and thus can exchange informa-         on the value of the technology that
 that the proposals should speed          tion effectively and securely among         may be donated by a single donor to
 adoption of health IT by hospitals,      healthcare providers.                       reduce the potential for abusive
 physicians and other healthcare              The second proposal came from           arrangements designed to pay physi-
 providers to improve quality and         HHS’ Office of Inspector General.                              •
                                                                                      cians for referrals.



                                                                                               Winter 2006 I Arkansas Hospitals   31
              I N   C O O P E R A T I O N   W I T H   T H E   A R K A N S A S   S T A T E   B O A R D   O F   N U R S I N G




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                                                                                             ≈ Day One: Galveston
                                                                                             ≈ Day Two: At sea (conferences)
                                                                                             ≈ Day Three: At sea (conferences)
                                                                                             ≈ Day Four: Montego Bay, Jamaica
                                                                                             ≈ Day Five: Grand Cayman,
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For more information about the cruise and the curriculum, please log                         ≈ Day Six: Cozumel, Mexico
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Travel toll-free at 800.727.1960.
A H A      A N N U A L             M E E T I N G



Mansfield Named Weintraub
Award Recipient
   Stephen Mansfield, President and            Mansfield is noted for achieving a        named one of Solucient’s Top 100
CEO of St. Vincent Health System in         successful turnaround in hospital oper-      Performance Improvement Leaders.
Little Rock received the Arkansas           ations in areas of community percep-         Solucient is a leading provider of
Hospital Association’s A. Allen             tion, patient satisfaction, employee         strategic business and clinical infor-
Weintraub Award at the AHA’s Annual         morale and improved financial per-           mation for the health care industry.
Awards Dinner, Thursday, October 20,        formance. In 1998 the organization           Mansfield is also responsible for
at the Peabody Hotel in Little Rock.        was millions of dollars in debt.             establishing St. Vincent Centers of
Mansfield has been President and CEO        Mansfield was able to accomplish an          Excellence in cardiac, orthopedic,
of St. Vincent Health System (SVHS)         $11 million turnaround.                      senior, spine, stroke and women’s
for the past five years.                       Under his leadership SVHS was             services.•




AHA Chairman Tim Hill presents Stephen Mansfield, President and CEO of St. Vincent Health System, with the Arkansas Hospital
Association’s 2005 A. Allen Weintraub Award at the AHA’s Annual Awards Dinner.



                                                                                                  Winter 2006 I Arkansas Hospitals   33
     A H A          A N N U A L              M E E T I N G



       AHA Awards Presented
         In addition to the Weintraub Award, the AHA’s highest                ients of the association’s Distinguished Service Award.
       honor, additional awards were presented at the Arkansas                   Dr. Harris, a radiologist, has been a consultant with St.
       Hospital Association’s Annual Awards Dinner in October.                Vincent Health System in Little Rock since his retirement
                                                                              from more than 30 years with the System. His early
         W. Turner Harris, M.D                                                research on bone-scanning methods contributed to
                                                                              NASA’s development of an in-space exercise program for
                                                                              astronauts to offset the negative effects posed by the
                                                                              absence of gravity. A Fellow in the American College of
                                                                              Radiology, Dr. Harris also is the founder and medical
                                                                              director of Volunteers in Medicine.
                                                                                 At the time of her death in April, Ms. Feltner was direc-
                                                                              tor of the medical records department at Sparks Regional
                                                                              Medical Center in Fort Smith. Over her 36-year career, she
                                                                              distinguished herself professionally at the state and
                                                                              national levels; served as a mentor to scores of medical
                                                                              records administration students at Arkansas Tech
                                                                              University; and provided extraordinary leadership in med-
                                                                              ical records departments at Washington Regional Medical
                                                                              Center (Fayetteville), St. Edward Mercy Medical Center
                                                                              (Fort Smith) and Sparks Health System.


                                                                              Statesmanship Award
                                                                              State senator Tim Wooldridge from Paragould received
       Distinguished Service Awards                                           the Arkansas Hospital Association’s (AHA) Statesmanship
                                                                              Award for 2005. The AHA Board of Directors selected
       W. Turner Harris, M.D., of Little Rock and Linda Feltner,              Wooldridge to receive the award in recognition of his con-
       formerly of Fort Smith, were selected by the Arkansas                  tributions to and leadership in Arkansas hospital and
       Hospital Association’s (AHA) board of directors as recip-              healthcare issues.

     Friends and family of Linda Feltner along with representatives of Sparks Health System in Fort Smith




34     Winter 2006 I Arkansas Hospitals
 A H A        A N N U A L              M E E T I N G




State Senator Tim Wooldridge and AHA Chairman Tim Hill           Jonathan Davis


      Wooldridge, who served four terms in the Arkansas         Jonathan has already proven himself an effective leader,
   House of Representatives before being elected to the         bringing significant improvements to a small, rural hos-
   state Senate in 1999, chairs the Revenue and Taxation        pital. His fiscal responsibility, concern for and value of
   Committee.                                                   his staff, and insistence of the highest quality care have
      During the 2005 legislative session, Senator              made St. Anthony’s an important institution in
   Wooldridge successfully sponsored the Medicaid
   Fairness Act, which was a key component of the AHA’s          Vickey Boozman
   legislative agenda. He also supported passage of
   Arkansas Act 134 of 2005 that prohibits smoking on
   hospital campuses throughout Arkansas.
      In addition, Senator Wooldridge was instrumental in
   helping pass legislation that provides for an additional
   source of Medicaid funding to help offset some of the
   losses that hospitals are experiencing in treating
   Medicaid patients, and legislation that restricts the
   amount of time that insurance carriers can audit and
   recoup payments to healthcare providers when services
   were provided and paid for on the basis of information
   provided by the carriers.
      Senator Wooldridge also championed legislation
   known as Garrett’s Law designed to provide additional
   protection and services to children born with illegal sub-
   stances in their blood.


   Young Administrator of the Year
   Jonathan Davis, Administrator/CEO of St. Anthony’s
   Healthcare Center in Morrilton, was the recipient of the
   Arkansas Health Executives Forum’s C. E. Melville Young
   Administrator of the Year Award, which also was present-
   ed during the Arkansas Hospital Association’s annual
   Awards Dinner.
      “In such a short time in hospital administration,



                                                                                              Winter 2006 I Arkansas Hospitals   35
     A H A        A N N U A L           M E E T I N G

     Morrilton and Conway County,” said Steve Mansfield,
     president and CEO of St. Vincent Health System, in his
                                                                     Chairman’s Award
     nomination letter.                                              Chairman Tim Hill presented a Chairman’s Award honor-
        During his three-year tenure at St. Anthony’s, Davis         ing Dr. Fay Boozman, former director of the Arkansas
     has improved the financial growth of the hospital,              Department of Health, who passed away last spring. The
     upgraded and improved technology, made magnetic reso-           award recognized Dr. Boozman’s priority for improving
     nance imaging available around the clock to patients and        healthcare services throughout Arkansas; his efforts to
     secured new surgical equipment that has made minimally          advance quality, effectiveness and efficiencies in the sur-
     invasive orthopedic procedures possible. In addition, he’s      veys and certifications affecting Arkansas hospitals; and
     responsible for opening a same-day surgery center, a new        his unwavering pledge and commitment to improve the
     facility for outpatient specialties, private labor-and-deliv-   health status of all Arkansans. Mrs. Vickey Boozman
     ery suites and remodeling the emergency room.                   accepted the award on behalf of the Boozman family.




     2005 Diamond Awards                                             The award-winning hospitals are:
                                                                     Arkansas Children’s Hospital, Little Rock
     The Arkansas Hospital Association’s 2005 Diamond                Arkansas Hospice, Little Rock
     Awards competition was co-sponsored by the Arkansas             Baxter Regional Medical Center, Mountain Home
     Society for Healthcare Marketing and Public Relations.          CARTI, Little Rock
                                                                     Central Arkansas Hospital, Searcy
     It is designed to recognize excellence in hospital public
                                                                     Conway Regional Medical Center, Conway
     relations and marketing. Diamond, Excellence and
                                                                     Jefferson Regional Medical Center, Pine Bluff
     Judges’ Merit Awards were possible in three divisions
                                                                     National Park Medical Center, Hot Springs
     (hospitals with 0-99 beds, hospitals with 100-249 beds          Ozark Health Medical Center, Clinton
     and hospitals with 250 or more beds) in twelve cate-            Saint Mary’s Regional Medical Center, Russellville
     gories. The competition drew 162 entries.                       St. Bernards Medical Center, Jonesboro
         Judging for each entry was based on goals and objec-        St. Joseph’s Mercy Health Center, Hot Springs
     tives, audience to whom directed, reasons for choosing          St. Vincent Health System, Little Rock
     the format, frequency and quantity, portions that were          UAMS Medical Center, Little Rock
     created internally/externally, results/evaluation and           White County Medical Center, Searcy
     total budget.                                                   White River Health System, Batesville
                                                                                                              Photos by Sarah Bussey


36   Winter 2006 I Arkansas Hospitals
A H A       A N N U A L            M E E T I N G


 John Neal and Ray Montgomery                               Corporate Partners
                                                            The Arkansas Hospital Association wishes to thank the
                                                            companies and organizations participating in the 75th
                                                            Annual Meeting and Trade Show. With their financial
                                                            support of the annual event, high quality educational
                                                            programming is made possible for the AHA member-
                                                            ship. Those contributing as major sponsors are indicat-
                                                            ed by asterisks at the following levels:
                                                            ****** Diamond, ***** Platinum, **** Gold,
                                                            *** Silver, ** Bronze and *Host. Thanks to all!

                                                            Administrative Consultant Service, LLC         Innerplan
                                                            AHA Services, Inc. ******                      Intellamed
                                                            AIG VALIC                                      Jackson & Harris, LLC
                                                            Air Products                                   Kutak Rock, LLP **
                                                            Alberici Healthcare Constructors               Kwalu, Inc.
                                                            American Data Network                          La-Z-Boy Concepts
                                                            American Pharmaceutical Partners, Inc.         LHC Group ***
                                                            American Red Cross Blood Services              Marshall Erdman & Associates
                                                            ArCom Systems, Inc.                            MDM Commercial
                                                            ARJO, Inc.                                     MedAssets *

AHAA Awards                                                 Arkansas Association of Hospital Trustees **
                                                            Arkansas Auxiliary of Gideons International
                                                                                                           MedBill Services, Inc.
                                                                                                           Medical Management Consultants, Inc.
                                                            Arkansas Blue Cross and Blue Shield *****      Metropolitan Healthcare Services
John Neal, CEO and administrator of Stuttgart Regional      Arkansas Foundation for Medical Care **        Mid-South Marking Systems
Medical Center, was named Administrator of the Year for     Arkansas Health Care Access Foundation,        Mobile Instrument Service & Repair
                                                                 Inc.                                      Modern Biomedical & Imaging, Inc.
hospitals with fewer than 100 beds by the Arkansas
                                                            Arkansas Health Executives Forum *             Modular Services Company
Hospital Auxiliary Association (AHAA) during the            Arkansas Managed Care Organization             MultiPlan, Inc.
AHAA’s annual meeting October 21. Ray Montgomery,                (AMCO)                                    Nabholz Construction *
                                                            Arkansas Medical Imaging                       National HVAC Service
president and CEO of White County Medical Center in         Arkansas Medical News                          NC Staffing
Searcy, received the association’s Administrator of the     Arkansas Regional Organ Recovery Agency        Optus Inc.
Year Award for hospitals having 100 beds or more.           Benefit Management Systems, Inc.               Patient Line Products
                                                            BKD, LLP ***                                   PCI (Publishing Concepts)
                                                            Business World Inc.                            Pinnacle Health Group

ACHE Regent’s Awards                                        C2P Group, LLC
                                                            Carstens
                                                                                                           PMAB
                                                                                                           PPOplus
                                                            Carter & Burgess                               Press Ganey Associates, Inc.
Phillip Gilmore of Malvern, Arkansas’ ACHE Regent, pre-     Community Health Centers of Arkansas, Inc.     QHR (Quorum Health Resources) **
sented two Regent’s Awards during the American College      CoreSource, Inc.                               Ramsey, Krug, Farrell & Lensing ***
                                                            Correct Care, Inc.                             Service Plus Telecommunications Inc.
of Healthcare Executives/Arkansas Health Executives         Crafton, Tull & Associates, Inc.               Service Professionals Inc.
Forum breakfast October 20 in Little Rock. Recipients       Data Systems Management, Inc.                  Sign Systems, Inc.
were Christina P. Hockaday, director of business develop-   DCS Global Systems                             Signet Health Corporation
                                                            DD&F Risk Management Group                     SimplexGrinnell
ment and administrative services for Conway Regional        Disability Determination for Social Security   Snell Prosthetic and Orthotic Laboratory
Health System, who received the early career healthcare     DMS Imaging                                    Sodexho Health Care Services
executive award; and Chris B. Barber, administrator, St.    EDS and Arkansas Medicaid                      Southeast Imaging
                                                            EmCare                                         Spectron Corporation
Bernards Medical Center in Jonesboro, who received the      emdeon Business Services                       Stephens Inc. *
senior level healthcare executive award.                    Emergency Service Partners                     Sterling Healthcare
                                                            Engelkes, Conner & Davis, Ltd. *               Swisslog Translogic
                                                            EZ Way Inc.                                    Tandus
                                                            First Choice Cooperative                       Team Health
                                                            First Uniform, Inc.                            Telcoe Federal Credit Union
                                                            G2N, Inc.                                      Teletouch Paging
                                                            Generation Product Company                     TERM Billing, Inc.
                                                            Genworth Financial                             The Crump Firm, Inc.
                                                            Graduate Program in Health Services            The Fleming Companies
                                                                 Administration-UAMS                       The Lawrence Group Architects
                                                            Guldmann Inc.                                  The MHA Group **
                                                            Hagan Newkirk Financial Services, LLC          The SSI Group, Inc.
                                                            Hammes Company                                 TIAA-CREF
                                                            HBE Corporation                                TME, Inc.
                                                            Healthcare Administration Technologies, Inc.   Trane Arkansas
                                                            Hill-Rom Company, Inc.                         TRO/The Ritchie Organization
                                                            Hill Wholesale Distributing Co., Inc.          United Excel
                                                            Hubble-Mitchell Interiors                      US Foodservice
                                                            Hughes, Welch & Milligan, Ltd.                 Voi Cert, The White Stone Group
                                                            IHC/Amerinet                                   Wilcox Group Architects
                                                            Inman Construction Corp.                       Wittenberg Delony & Davidson Architects
Christina P. Hockaday           Chris B. Barber             Innerface Sign Systems, Inc.                   Workplace Resource of Little Rock



                                                                                                       Winter 2006 I Arkansas Hospitals               37
     A H A        A N N U A L             M E E T I N G




                                                    The AHA honored longtime board member Frank Wise for his more than 25 years of
                                                    service. Here, board chairman Tim Hill presents Wise with a remembrance plaque.




                                                                                           During the Advocacy Luncheon, former U.S.
                                                                                           Senator David Pryor, current Dean of the
                                                                                           University of Arkansas Clinton School of Public
                                                                                           Service, explained the mission and function of
     With more than 100 healthcare vendors and educational groups on hand at this          the Clinton School, and also shared some
     year’s Trade Show, visitors had a chance to network, learn and share new ideas.       thoughts on today’s current political arena.




        Three very atypical
     “waiters” entertained
     at the Awards Dinner,
       singing well-known
     opera arias and a few
        favorite pop tunes.


38   Winter 2006 I Arkansas Hospitals
A H A        A N N U A L               M E E T I N G




At the ACHE Breakfast, Garrison Wynn helped us understand          Recalling the AHA’s rich 75-year history was the idea behind a spe-
“The Truth about Success” and gave the top seven characteris-      cial Diamond Anniversary video highlighting the past and present
tics top performers have in common. Those characteristics          work of the hospital association. Current and past AHA board
focus on growing, building and maintaining strong relationships.   members, presidents and executives detailed the AHA’s ongoing
                                                                   mission of supporting a healthier Arkansas.




Renowned healthcare consultant and keynote speaker Jamie
Orlikoff helped us look at today’s almost unwieldy healthcare
challenges and trends. Orlikoff reminded us that hospitals are
too often the unknown and unappreciated backbone of the
community. He encouraged the building of strong hospital-          This year’s early-bird educational session explored the reasons
community relationships, where challenges are laid on the          behind and some solutions for the growing physician shortage in
table and dealt with by thinking things through, together.         America. Our speaker was Kurt Mosley of the MHA Group.




                                                                                                       Winter 2006 I Arkansas Hospitals   39
     A H A        A N N U A L               M E E T I N G




     Helping us turn life’s challenges into
     opportunities was John Cassis’ goal in his
     closing presentation, “Catching a Second
     Wind.” His humorous anecdotes and
     gentle, yet pointed, suggestions closed      Former AHA president Roger Busfield (right) and his wife, Addie, with (from left) former AHA
     this year’s annual meeting on a highly       chairmen Frank Schweitzer and Howard Johnson and their wives, Plesine and Bonnie,
     positive note.                               respectively, at the reception honoring new AHA board chairman Robert Atkinson.




     Incoming board chairman Robert Atkinson, president and CEO of
     Jefferson Regional Medical Center in Pine Bluff, was honored with a
     congratulatory reception. Here Atkinson (left) is greeted by ACHE
     Regent Phil Gilmore (center) and C.C. “Mac” McAllister, CEO of the
     Ouachita Valley Health System (right).




                                                            Transparency and accountability are absolute necessities in today’s healthcare
                                                            field. Helping us understand both challenges and new ideas/programs proven to
                                                            work were Daniel Landon, Joe Kachelski and David Feinwachs of the Missouri,
                                                            Wisconsin and Minnesota Hospital Associations.                Photos by Sarah Bussey


40   Winter 2006 I Arkansas Hospitals
                                        by Paul Cunningham, Senior Vice President, Arkansas Hospital Association




75 Years of AHA History…
A Look Back                                                                                                           Part 2

Editor’s Note: The Arkansas Hospital         Labor to defend a court decision that      of his term, President Jimmy Carter
Association recently completed its 75th      struck down several costly Arkansas        tried to convince Congress to pass leg-
year of service to the state’s hospitals,    overtime laws.                             islation to force mandatory controls on
healthcare facilities, patients and fami-        There were the perennial manpower      hospital spending, without controlling
lies. For three-quarters of a century, the   issues, too. The AHA and its members       prices for the goods and services hospi-
people and organizations that make up        worked with several Arkansas colleges      tals had to buy. The AHA joined hos-
this association have banded together
for the common purposes of improving         Sparks Health System, Fort Smith
their communities’ healthcare quality
and raising the level of health services
for and health status of all Arkansans.
    In the Fall issue of Arkansas
Hospitals, Paul Cunningham detailed
the early years of the AHA’s service, from
1929 through the first part of the 1970s.
In this article, he concludes the look
back at the association’s first 75 years
and begins to look toward the future.

The Later ‘70s —
Tumultuous Times
   Nationally, healthcare issues were
overshadowed by other world events
during the final years of the 1970s:
Watergate, 12% inflation, the Three
Mile Island nuclear power plant melt-        and universities to find ways to pro-      pital groups across the country in 1978
down, U.S. embassy workers taken             duce more physical therapists and nurs-    to stave off these forced controls by
hostage in Tehran, Iran.                     es, and wrestled with the need for more    adopting their own Voluntary Effort
   Of course, there were plenty of in-       experienced nurses who were qualified      (VE) to Control Health Care Costs.
state matters raising concern for the        to teach in the state’s nursing schools.       The VE worked for a couple of
state’s hospitals. The Arkansas Hos-             At the same time, the association      years, setting the stage for a November
pital Association took issue through         tended to the daily routine, guiding       1979 House vote that killed the Carter
those years with every branch of state       hospitals through the 1977 and 1979        bill. Unfortunately, the VE program
government — administrative, legisla-        legislative sessions, dealing with con-    died shortly thereafter, a victim of the
tive and judicial. The AHA went toe-         tinuing Medicare and Medicaid pay-         same relentless increases in hospital
to-toe with the state Pharmacy Board         ment problems, and handling the            costs it was trying to bridle.
concerning jurisdiction over the inspec-     unexpected surprises that cropped up           In another major battle, the AHA
tion of hospital pharmacies; locked          30 years ago, just as they do today.       clashed with the state over its “certifi-
horns with legislators over a proposal           By the late-1970s, the two words       cate-of-need” (CON) law. Arkansas,
requiring some hospitals to publish          most commonly used in conjunction          which had operated a federal “capital
quarterly audited financial reports; and     with hospitals were “cost” and “con-       expenditure review” program under
fought to get Joint Commission inspec-       tainment.” As you might expect, the        Public Law 93-641 since 1972, gained
tions to stand in lieu of state surveys      concept wasn’t well received by hospi-     approval for a CON law in 1975. Both
for accredited hospitals. The AHA also       tals anywhere.                             programs were indirect attempts at
dug in against the state Department of           Beginning in 1977 through the end      hospital cost control by limiting hospi-



                                                                                                 Winter 2006 I Arkansas Hospitals   41
     tal capital spending to approved proj-      — plus a new term for the day’s equiv-       tem. The coup de grace was Blue Cross’
     ects only.                                  alent of plague, AIDS.                       1985 announcement of its own DRG
         The AHA persisted in its demands            The AHA had begun building a             payment system. AHA staffers and
     that the federal contract be dropped        framework in the 1960s for a strong,         committees worked to overcome prob-
     after the state passed its law. The two     durable member organization. Starting        lems with each of the changes.
     programs served the same purpose and        as primarily an advocacy and represen-           The AHA also brought several
     the AHA believed that the state didn’t      tation group, the AHA became more            “firsts” to Arkansas between 1980 and
     need both. Governor Bill Clinton final-     valuable during the 1970s with timely        1986. The most visible, or audible, was
     ly terminated Arkansas’ contract to         communications and powerful educa-           a first-ever statewide radio campaign
     perform the federal review.                 tional programs. By 1986, the AHA            designed to make the general public
         Blue Cross got into the picture,        had added a data component and set           more aware of their community hospi-
     too. Saying it had a moral corporate        up a subsidiary, AHA Services, Inc., to      tals and to better understand factors
     obligation to do what it could to con-      help member hospitals link up with           behind high hospital costs. Another
     trol hospital costs, the payer imple-       needed products and services.                was the AHA’s Hospital Equipment
     mented its own version of a capital             Hospital issues requiring attention      Loan Program, providing low interest
     expenditure review program, tying it        were piling up at a frenetic pace, and       financing for hospital equipment pur-
     to other local reviews.                     the AHA stepped up to help. The              chases using funds generated from
         All the hubbub over hospital cost       state’s Medicare claims review contrac-      bond issues.
     containment eventually led the AHA to       tor wanted to expand into performing             Later, when Arkansas hospitals
     expand its staff to include someone with    medical review of claims for private         encountered problems finding afford-
                                                                                              able workers’ compensation coverage,
                                                                                              the AHA established the AHA
                                                                                              Workers’ Compensation Self-Insured
                                                                                              Trust, the first program offered under
                                                                                              the umbrella of AHA Services.
                                                                                                  One of the AHA’s most significant
                                                                                              steps occurred at the outset of the
                                                                                              decade, in October 1980. That was
                                                                                              when the board approved the purchase
                                                                                              of land on Natural Resources Drive in
                                                                                              West Little Rock as the site of the asso-
                                                                                              ciation’s first headquarters building.
                                                                                              The board took a hard stand on the
                                                                                              building program, convincing other
                                                                                              AHA members to give their blessing to
                                                                                              what would prove to be an extremely
 UAMS, Little Rock                                                                            wise decision.
                                                                                                  As those building plans gradually
     a background in health and facility         payers, too. Allied health professional      came together over the next eight
     planning. By the time the AHA’s newest      groups pressed for state licensure.          years, the world lived through some
     staffer arrived in December 1980, the       Governor Clinton leaned toward forc-         tough times. Between 1986 and 1990,
     job emphasis had already changed. The       ing hospitals to pay a tax to fund indi-     disasters were the big stories, over-
     new focus centered on a four-letter         gent care. The state, which already          shadowing everything else. It started in
     word that touched on planning and           mandated that hospitals obtain a cer-        January 1986, with the explosion of
     much more. That word? Data.                 tificate-of-need for their capital expan-    the space shuttle Challenger, 73 short
                                                 sion projects, was proposing that they       seconds after liftoff. Before the end of
     Entering the Eighties                       pay a fee for the privilege of doing so.     the decade, we’d know about the
        Coming into the 1980s, a                     Payment issues pulled a hat trick        Chernobyl nuclear meltdown in the
     Hollywood actor became our 40th             during the early 1980s, as hospitals         U.S.S.R., the bombing of Pan AM
     President, surviving an attempted           dealt with major reimbursement               flight 103, the Exxon Valdez, the San
     assassination by the mid-point of the       changes on three fronts almost simulta-      Francisco earthquake, the bloodshed
     decade. Pope John Paul II also survived     neously. In 1983, Medicare was prep-         in Tiananmen Square and Black
     an assassin’s bullet, although Beatle       ping its move to a completely new way        Monday on Wall Street, when the
     John Lennon and India’s Prime               of paying hospitals based on something       stock market crashed.
     Minister Indira Gandhi did not.             called “diagnosis-related groups,” or            There were things going on in
     Mount St. Helens blew its top, the fed-     DRGs. Medicaid followed suit a year          Arkansas hospital circles that some
     eral deficit shot to $180 billion, and we   later, opting to pay hospitals prospec-      thought disastrous, too. Nationally,
     learned a new business jargon — gold-       tively set per diem rates, since the state   they came in the form of the Gramm-
     en parachute, poison pill, junk bonds       lacked the capabilities for a DRG sys-       Rudman-Hollings Act that provided



42   Winter 2006 I Arkansas Hospitals
for automatic federal spending cuts,        hospitals. Changes were sudden and             of its own, due mostly to insufficient
the 1986 Emergency Medical                  unpredictable.                                 Medicaid funding. By 1990,
Treatment & Active Labor Act                    It was a budget-driven world and           Medicaid had pretty much aban-
(EMTALA) imposing specific emer-            budgets were tight. Most of the time           doned its experiment with prospec-
gency service obligations on hospitals,     the state simply didn’t have enough            tively set rates and agreed with the
and the federal government’s release of     money. Medicaid generally stayed with-         Arkansas Hospital Association to
hospital mortality reports.                 in its limits by paying less. The Health       return to cost-based reimbursements,
    The major in-state worries involved     Department, on the other hand, began           at least for all but the largest hospi-
Blue Cross, when the company                charging unprecedented fees for an             tals. The AHA wouldn’t budge and
announced its intent to develop the         array of items — like hospital licenses        prepared a lawsuit to mandate that
state’s first Health Maintenance            — to get through the lean times.               all hospitals be cost-reimbursed.
Organization. Nobody knew how that              The state’s hospitals understood the           Having already cut several optional
might affect the future of healthcare       reasons behind the newly levied Health         programs in 1991, Medicaid pled its
services in Arkansas. The more imme-        Department fees, but they were more            case to the AHA and other groups,
diate concern was Blue Cross’ plan to       ambivalent about the final resolution in       which reluctantly accepted a plan for a
change the way it paid hospitals. Out-      1987 of hospitals’ long running squab-         provider tax based on Medicaid rev-
dated charged-based payments would          ble with the state about certificate-of-       enues as a way to raise state matching
be dropped in favor of a Blue Cross         need. It was in that year that Governor        dollars and increase overall program
version of a DRG system.                    Clinton signed a law stating that hospi-       funding. The tax went on the books in
    Medicare’s DRG system had been          tals would no longer have to obtain
up and running for two years with a         CONs for capital expansion projects.            St. Bernards Medical Center, Jonesboro
questionable track record. The AHA              Despite the bad news crammed into
and its members spent the next 18           those years, things ended on a good
months trying to assess the Blue Cross      note. On November 12, 1989, the
plan and help fashion it into something     Berlin Wall, an icon for the Cold War,
mutually agreeable rather than try to       began tumbling down. Two months
stop it. In the end, a new legal empha-     earlier, on September 13, after plan-
sis on sensitive anti-trust concerns lim-   ning and saving for it seven years and
ited the AHA’s advice and added to          building it for one more, the AHA
hospitals’ frustration and confusion.       moved into its new headquarters build-
The new payment model finally went          ing. Debt free.
into effect in February 1987.
    A challenge of the state law pro-       The Politics of the ‘90s
hibiting non-profit hospitals from              Arkansans as a group probably
operating retail pharmacies was part        remember the early 1990s for the poli-
of the AHA agenda for an even               tics more than anything else. After all,
longer time. The AHA believed the           it was Arkansas’ time to take center
law to be unconstitutional. The state       stage, politically speaking. Bill Clinton
had a different opinion. The legal          was elected President of the United            July 1991. It brought in more dollars
action, filed in October 1985, navi-        States in November 1992. The cadre of          and allowed Medicaid to pay cost-
gated the state’s winding legal system      state leaders who followed the                 based per diem rates to all hospitals,
for 40 months before the Arkansas           Governor to Washington would play              up to a point.
Supreme Court upheld the law in             major roles in setting national policy            The first hitch was the state’s insis-
January 1989.                               on all fronts, though it would prove to        tence on capping the per diems at
    State Medicaid policies constantly      be a bumpy ride at times.                      $584. Eventually, Medicaid again ran
kept hospitals flirting with disaster.          National healthcare reform was at          short of money and started tinkering
The program was covering 35 inpa-           the core of some of the most heated            with benefit limits. That was just
tient hospital days for its recipients in   political debates. First Lady Hillary          before the federal government’s ruling
1985, but was also requiring a prior        Rodham Clinton took charge and faced           that the state’s provider tax was illegal.
authorization for inpatient admissions.     off with Harry and Louise and the rest            Knowing that the decision spelled
Payments routinely fluctuated up and        of the insurance industry over the             big trouble if no replacement revenues
down, mostly down. During those             President’s ill-fated quest for that elusive   could be found, the newly formed
years Medicaid routinely blended            grail in 1993. And former Arkansas             Coalition for a Healthier Arkansas
changes in its payment methodology          Department of Health director Joycelyn         spearheaded the task of getting voters
with across-the-board cuts and              Elders raised awareness, questions and         to okay a 25-cent per pack cigarette
increases, depending on the budget sit-     eyebrows throughout her brief tenure as        tax in the November 1992 general
uation, along with a few recoveries of      U.S. Surgeon General.                          election. The funds would go to
overpayments and repayments of                  The politics of healthcare in              Medicaid. The AHA assumed the lead
monies erroneously taken away from          Arkansas stirred some choppy waters            role, pumping time, energy and money



                                                                                                    Winter 2006 I Arkansas Hospitals    43
     into the campaign. All signs pointed to     years, retired in June 1994. The board      vide certain drugs and IV solutions to
     success, until an 11th hour Arkansas        didn’t have to look far for its next cap-   patients being seen by their own home
     Supreme Court ruling kept the initia-       tain. Jim Teeter, a 26-year veteran of      health agencies. Respiratory thera-
     tive off the ballot                         the AHA, would take the helm and set        pists wanted additional licensing
        The problem fell straight into the       the course for the political storms yet     requirements. Trial lawyers opposed
     lap of new Governor Jim Guy                 to come.                                    the strengthening of laws providing
     Tucker, who recoiled and struck                 Fortunately, a short respite            confidentiality of hospital peer review
     back with the idea to restructure the       occurred. The state’s Medicaid pro-         and quality assurance activities. And,
     Medicaid tax to meet the federal            gram was in better shape financially        business and insurance groups pushed
     government’s smell test. In other           than it had been in years. The soft         with all their might against an Any
     words, he’d ask the providers to            drink tax, which was passed two years       Willing Provider law, something the
     pony up a larger ante.                      earlier, withstood an assault in 1994       AHA supported at the time.
        Heated meetings followed with            and was bringing in almost $140 mil-            Outside the legislative arena, the
     most participants disagreeing and           lion annually, when matched with fed-       AHA defended allegations by the
     some being disagreeable. Political          eral dollars.                               state’s nursing homes that hospitals
     chips landed on the table from every            The Arkansas Hospital Association       were providing skilled nursing servic-
     direction. In the end, the Medicaid         had been a key to passing the tax in        es illegally, worked through competi-
     coalition won over the legislature          1992 and played a major role in its         tive issues involving the Health
     with their idea for an alternative          1994 rescue. The state’s soft drink bot-    Department’s provision of home
     funding source — a soft-drink tax.          tlers hoped to dismantle the tax by put-    health services, negotiated an agree-
                                                                                             ment with the Board of Nursing on
                                                                                             rules involving the delegation of nurs-
                                                                                             ing tasks, and intervened with the
                                                                                             State Auditor on a matter involving
                                                                                             hospitals and their disposition of
                                                                                             unclaimed personal property.
                                                                                                 Nationally, the Beltway feud over a
                                                                                             balanced budget spanned two years
                                                                                             and one government shutdown. In the
                                                                                             end, President Clinton signed the mas-
                                                                                             sive 1,200 page Balanced Budget Act
                                                                                             of 1997, which the Republican con-
                                                                                             trolled Congress had passed.
                                                                                                 Lost amid the hoopla, fanfare and
                                                                                             backslapping over the agreement for
                                                                                             balancing the budget by sucking $116
Southwest Regional Medical Center, Little Rock                                               billion from future Medicare spending
                                                                                             ($44 billion from hospitals) were the
        There were other political maneu-        ting it in the voters’ hands, so the AHA    warnings of people who understood
     verings, too. The AHA got Dennis            again took the lead in a campaign to        that the actual cuts would be much
     O’Leary, president of the Joint             keep the soft drink tax on the books.       more severe than projected.
     Commission on Accreditation of              Voters were persuaded, backing the              AHA joined with other hospital
     Healthcare Organizations, into              tax by a 55%-45% margin in                  advocates in successfully convincing
     Arkansas not once, but twice to             November 1994.                              Congress to restore some of the
     address growing JCAHO concerns.                The storms returned a mere four          Medicare and Medicaid cuts through
     The association negotiated for more         months later with Medicaid’s unex-          laws passed in 1999 and 2000. In the
     than two years with the state               pected announcement predicting a            meantime, its Washington focus shift-
     Workers’ Compensation Commission            $70 million deficit by July 1997;           ed to the Justice Department’s crusade
     and members of the Arkansas State           Governor Tucker proposed to strip           to apply the federal False Claims Act
     Chamber of Commerce on a fair hos-          the state’s non-profit hospitals of $35     to hospital Medicare billing errors.
     pital fee schedule. And, it raised          million in sales tax exemptions that            Back at home, the association won
     $350,000 from the state’s hospitals to      would be re-routed to the Medicaid          support for a law allowing Joint
     establish a new Physical Therapy pro-       Trust Fund. The AHA successfully            Commission accreditation to stand
     gram at Arkansas State University.          changed his mind, but the expected          for hospital licensure surveys, too,
        Not everything of historic note for      shortfall grew to $232 million for the      and helped hospitals better under-
     the AHA that occurred between 1990          1998-1999 biennium.                         stand details related to rising concerns
     and 1995 was about politics, however.          The association responded to other       over quality, patient safety, compli-
     Roger Busfield, who navigated the           flash fires, too. Retail pharmacists        ance plans, and the newest hospital
     AHA through political waters for 20         thought hospitals didn’t need to pro-       emergency room requirements.



44   Winter 2006 I Arkansas Hospitals
Y2K Challenges Usher                        have to be considered among the              a 2001 move that resulted in an
in New Century                              AHA’s most significant. The AHA              Arkansas Medicaid “upper payment
    As 1999 came to an end, all eyes        worked to defeat an effort in 2000 to        limit” program as the most important
were on the clock and the coming of         abolish certain state and local sales        financial achievement. It would be
the Year 2000, affectionately known as      taxes that would have sapped $144            hard to argue with a program which
Y2K. Experts predicted massive system       million from annual state revenues.          has netted more than $100 million in
failures, the technological equivalent of   Then, in 2002 the association helped         supplemental Medicaid hospital pay-
war, famine, pestilence and death, for      defeat a proposed constitutional             ments that otherwise wouldn’t have
January 1, 2000. The AHA and its            amendment to “ax the sales tax” on           been available.
hospitals prepared for more than two        food and medicines. The amendment
years to avoid any and all calamities.      would have taken between $400 mil-           And Now, to the Future…
Within minutes of the stroke of mid-        lion and $600 million from state cof-            If we asked ten individuals who were
night, everyone knew the planning and       fers each year with no suggestions on        active with the AHA at different times
preparations had worked.                    how to replace it. Either of the tax         over the past 75 years what they would
    The association breathed a sigh of      reductions most likely would have led        choose as the AHA’s most significant
relief and moved on. The first order of     to a state Medicaid crisis.                  accomplishment, we’d probably get ten
business was to take up a cause that            Passing a state tort reform law in       different answers. What would you
had been a core value of the AHA since      2003 has to make everyone’s top ten          choose? Whatever the choice, it’ll be
its inception — improving the health of     list of significant achievements. The        trumped in the future by another one,
the people who live in our small, beau-     AHA joined in the fight early as part of     bigger and more outstanding. Maybe it
tiful state. As January 2000 dawned,
the AHA began almost immediately
working toward the first of two major
accomplishments that many agree to
be among the AHA’s most important
during its 75-year history. Both
achievements should positively impact
the health of Arkansans for years to
come.
    The first was the association’s role
in getting a spending plan for
Arkansas’ $1.62 billion share of the
National Tobacco Settlement Fund.
The AHA took a lead role, joined by
the original coalition of healthcare
providers who supported the failed
1992 attampt to pass a cigarette tax to      Siloam Springs Memorial Hospital, Siloam Springs
help fund Medicaid, and developed a
plan that would earmark Arkansas’           another coalition, the Committee to          will have something to do with the cur-
full tobacco-settlement amount for          Save Arkansas Jobs, in the successful        rent move to make hospitals more
health-related purposes over the fund’s     run at overhauling Arkansas’ civil liti-     transparent and accountable to their
25-year life. The AHA was actively          gation system. The law gave a way to         communities. Or, will it be related to
involved in the election campaign. On       help hospitals curb crippling medical        fascinating new information technology
November 7, 2000 voters said yes to         liability costs and thwarted a potential     that will serve as the basis for the full
CHART’s (Coalition for a Healthier          exodus of healthcare providers from          implementation and use of universal
Arkansas Today) ideas with a solid          the state.                                   electronic medical records?
65%-35% margin.                                Following the September 11, 2001             Those issues are key issues of today.
    The second achievement came in          terrorist attacks in New York and            They won’t go away, and will most
2005, when the AHA was responsible          Washington, and again following              likely expand. But, that’s okay, as long
for a law prohibiting the smoking of        Hurricane Katrina in August 2005,            as the requirements are reasonable, the
tobacco products in hospitals and on        America became fully aware of hospi-         results meaningful, and they serve to
their grounds. It was a way for the         tals’ strategic importance to the            improve the state’s healthcare quality
association’s board and members to          nation’s emergency response system.          and status.
show that Arkansas hospitals not only       The AHA has had a direct hand in                After all, that’s the very reason a
talk about improving community              working through countless emergency          small group of hospital leaders got
health, but also are willing to walk the    response issues aimed at better prepar-      together 75 years ago and formed the
walk and do something about it.             ing Arkansas hospitals for these often       Arkansas Hospital Association, and it’s
    Sandwiched between those two            overlooked essential responsibilities.       the reason we’ll keep moving forward
milestones are other successes that            Some AHA members might point to           for the next 75 years and beyond.     •

                                                                                                  Winter 2006 I Arkansas Hospitals   45
               AHLA Issues Complimentary Guide
               to Legal Issues in Life-Limiting Conditions
                 The American Health Lawyers                                       expertise on topics of interest both to                               experts on caring for those at the end
               Association (AHLA) has released A                                   healthcare attorneys and the broader                                  of life, endorsed the guide for many
               Guide to Legal Issues in Life-                                      healthcare community, including                                       different audiences: “This Guide
               Limiting Conditions. The document                                   health professionals, healthcare execu-                               deserves a place on the desk of any
                                                                                            tives, public health agencies,                               attorney, physician, nurse, case man-
                                                                                            pro bono attorneys, and con-                                 ager, or social worker who helps elder-
                                                                                            sumer groups. (You may read                                  ly or ill clients think about and plan
                                                                                            or download the first publica-                               for the future. It sits on mine.”
                                                                                            tion from the series —                                           Elisabeth Belmont assessed the pub-
                                                                                            Emergency         Preparedness,                              lication’s importance to the public.
                                                                                            Response & Recovery Check-                                   “Individuals with life-limiting condi-
                                                                                            list: Beyond the Emergency                                   tions find themselves facing a host of
                                                                                            Management Plan by going to                                  complex decisions, often at a time
                                                                                            http://www.healthlawyers.org/                                when they are in crisis.
                                                                                            Content/NavigationMenu/                                          “Making important decisions when
                                                                                            Public_Interest_and_Affairs/                                 a loved one is vulnerable and in need is
                                                                                            Public_Information_Series/                                   difficult at best. This guide provides
                                                                                            pi_EmergencyPreparedness.pdf)                                key questions to guide families in mak-
                                                                                                The new legal guide to life-                             ing decisions along what might be con-
                                                                                            limiting conditions provides an                              sidered the ‘customary’ chronic care
                                                                                            overview of the key legal and                                continuum. The guide stresses that
                                                                                            practical issues that arise in the                           individuals should plan for the future
                                                                                            care of individuals who face a                               and make informed choices now to
                                                                                            life-limiting condition or who                               ensure that their wishes are known at
                                                                                            care for a loved one with a life-                            a future time when their physical
                                                                                            limiting condition. As an aid to                             and/or mental functioning may be
                                                                                            the planning process, the guide                              impaired. This type of planning is par-
                                                                                            is organized around the contin-                              ticularly important in view of the
                                                                                            uum of care, beginning with                                  recent Terri Schiavo situation,”
               was produced as part of AHLA’s                                      healthy individuals who are able to                                   Belmont said.
               public interest commitment to serve                                 live at home and following the contin-                                    To view the guide in its entirety or
               as a public resource on selected                                    uum to independent retirement com-                                    to      download         it,   go    to:
               healthcare legal issues.                                            munities, assisted living, long term                                  http://www.healthlawyers.org/Content
                  The Guide is the second publication                              care, and an eventual return to the                                   /NavigationMenu/Public_Interest_and
               in a new Public Information Series                                  home with the aid of hospice services.                                _Affairs/Public_Information_Series/llc
               through which AHLA shares its                                           Dr. Ira Byock, one of the foremost                                _guide.pdf           •



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    46        Winter 2006 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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