Final by linzhengnd

VIEWS: 6 PAGES: 118

									                             AMERICAN HEALTH LAWYERS ASSOCIATION
                                   Board Teleconference Meeting
                                            May 22, 2008
                                     3:30 p.m. – 5:00 p.m. (ET)
                                      Dial-In #1-866-803-9847
                                   Conference Code: 2028330777

                                                        Agenda

  I.      Introduction and Approval of Agenda                    Ms. Belmont          Tab 1
          Call to Order and Overview of the Agenda

  II.     Approval of Minutes (Action)                           Ms. Belmont          Tab 2
          Board Minutes from January 11, 2008

  III.    President and EVP Status Reports                       Ms. Belmont/          Tab 3
                                                                 Mr. Leibold (written)
  IV.     Actions                                                                      Tab 4
          Approval of FY2009 Budget and Budget                   Ms. Carder-
          Assumptions                                            Thompson

 V.       Discussion Items                                                            Tab 5

          A. Report on the Election Results                      Ms. Belmont          [Tab 5A]
          B. Report on the Annual Meeting (oral)                 Mr. Hamme            [Tab 5B]

VI.       Committee Grids (Written Only)                                              Tab 6

          A. Practice Group Committee                            Ms Newman/           [Tab 6A]
                                                                 Ms. Robinson

          B. Finance Committee                                   Ms. Carder-Thompson[Tab 6B]
                                                                 Mr. Miller

          C. Public Interest Committee                           Mr. Shackelford      [Tab 6C]
                                                                 Ms. Hoggard

          D. Professional Resources Committee                    Mr. Griffith/        [Tab 6D]
                                                                 Ms. Conner

          E. Programs Committee                                  Mr. Hamme/           [Tab 6E]
                                                                 Ms. Hoover

          F. Membership Committee                                Ms Wisner/           [Tab 6F]
                                                                 Ms. Hoggard

          G. Quality Council                                     Mr. Barry/           [Tab 6G]
                                                                 Ms. Conner

          H. ADR Task Force                                      Ms. Conard/          [Tab 6H]
                                                                 Ms. Brinley

          I.   Diversity Council                                 Ms. Selby/Mr. Matyas [Tab 6I]
                                                                 Ms. Hoggard
VII.      New Business and Adjournment
  J:\BOARD OF DIRECTORS\FY2008\May 22, 2008\Agenda 5-22-08.doc
                   AMERICAN HEALTH LAWYERS ASSOCIATION
                       BOARD OF DIRECTORS MEETING
                           Four Seasons Hotel
                            Washington, D.C.
                            January 11, 2008
                             8:00 – 10:00 am

                                   MINUTES


Members Present                  Staff Present             Members Absent
Dennis M. Barry                  Peter Leibold             Michael L. Silhol
Elisabeth Belmont                Wayne Miller
Kathleen M. Boozang              Cynthia Conner
Elizabeth Carder-Thompson        Kerry Hoggard
Jane Reister Conard              Anne Hoover
Thomas W. Coons                  Trinita Robinson
Lois Dehls Cornell               Will Harvey
Anthea R. Daniels                Thad Lurie
Gregory M. Duckett               Clara Woodall
Gerald M. Griffith               Allison Beard
Joel M. Hamme                    Rita Brinley
Louise M. Joy                    Valerie Eshleman
John E. Lyncheski                Emily Morris
David E. Matyas                  Kathy Wone
Lewis Morris
Dinetia M. Newman
Peter A. Pavarini
Philip L. Pomerance
Kristen B. Rosati
Michael F. Schaff
Myra C. Selby
Richard L. Shackelford
Lisa Diehl Vandecaveye
John R. Washlick
Cynthia F. Wisner

I.    Call to Order and Overview of the Agenda

Ms. Belmont called the meeting to order at 8:20 am (ET).

II.   Approval of Minutes

Upon motion duly made and seconded, the Board voted to approve the minutes
of the November 15, 2007 Board meeting.
III.   President’s Oral Status Report

Ms. Belmont began with a brief overview of the Association’s strong financial
position. She also discussed the organization’s strategic initiatives, emphasizing
AHLA’s recent success in promoting outreach and the opening of new markets.

Ms. Belmont also reported on the planned one-day convener session on pan flu
preparedness scheduled for May, which will be followed by the publication of a
checklist to prepare our members, their clients and the public if or when a
pandemic hits our nation.

IV.    Action Items

       A. Change to Long Term Investment Policy

Ms. Carder-Thompson introduced Mary Ann Best and Rick Lesan from Bernstein
to discuss the association’s portfolio. Ms. Best discussed the philosophy and
Bernstein’s views on the need for AHLA to hold diversified holdings. She
commented that the association’s reserves are healthy and that further
diversification by adding real estate investments makes sense from Bernstein’s
perspective.

Mr. Lesan discussed the Association’s portfolio and the country’s current,
weakening economic conditions. Bernstein weathers these economic downturns
by a relentless focus on asset allocation.

Mr. Leibold introduced a recommendation by Bernstein that the Association add
a Real Estate Investment Trusts (REITs) component to its long term investment
portfolio. The target rate for such investments will be 10% of the portfolio, with a
minimum weight of 5% and a maximum weight of 15%. Bernstein will adjust the
asset allocation and rebalance the portfolio to decrease risk and increase return.

Upon motion duly made and seconded, the Board voted to approve the
recommended revisions to the Long Term Investment Policy.

       B. Approval of Business Law and Governance Practice Group

Ms. Newman discussed the corporate governance task force’s recommendation
that the Association approve the establishment of a Business Law and
Governance Practice Group. This new practice group will fill a need not currently
met by any of the existing practice groups in its coverage of transactions and
corporate governance issues.

Upon motion duly made and seconded, the Board voted to approve a Business
Law and Governance Practice Group.
V.     Update Items

       A. Progress on AMS and CMS Initiatives

Mr. Lurie reported on the technology infrastructure upgrade. The management
project is near completion, on budget, and should be implemented at or near the
end of the fiscal year.

       B. Review of November Financials

Ms. Carder-Thompson discussed the positive variance of net revenues from
budget as of November 30. Membership has increased from last year and is
holding a little above 10,000. The organization has performed well at operations
so far this fiscal year.

       C. Committee and Task Force Highlights

With respect to Programs, Mr. Hamme reported on the substantial progress
made thus far on planning the Annual Meeting in San Francisco. Dr. Peter
Orszag, the Director of the Congressional Budget Office, has agreed to be the
keynote speaker. The Planning Committee will attempt to have representatives
from both presidential campaigns engage in a dialogue on the future of health
policy after Dr. Orszag’s address.

With respect to Practice Groups, Ms. Newman discussed the success in
teleconferences this fiscal year, due to hard work by volunteers and staff and the
release of important new regulations. Ms. Daniels thanked the PG committee and
staff for this turnaround in scheduling numerous, successful teleconferences.

With respect to Membership, Ms. Wisner summarized the association’s visibility
and member recognition efforts. She praised the staff and Mr. Morris for
collaborating on efforts to assemble a government bundle package that would be
attractive to government members while ultimately benefiting the Association as
well.

With respect to the Advisory Council on Racial & Ethnic Diversity, Mr. Matyas
and Ms. Selby discussed a potential mentoring program. Mr. Matyas reported
that the council would like to do a beta test and determine who should be
involved in the mentoring program before it’s rolled out. Ms. Selby thanked the
Board and staff for their support of the Council. She highlighted the development
of a series of articles published in the Journal on access to health care by diverse
populations. A panel will discuss this issue at the Annual Meeting.

With respect to ADR Service, Ms. Reister Conard gave an update on the status
of the Service, which has 265 resolvers and 51 case filings thus far this year.
Although the numbers are a little below last year, Ms. Conard commented that
additional promotional efforts are being made.
With respect to Professional Resources, Mr. Griffith noted that the Archives
average 1,000 hits a day, and subscriptions are doing extremely well. He further
reported that the Committee, led by Michael Silhol, is exploring the development
of a health law wikipedia. A “wiki” would enable the Association to offer benefits
of interest to newer members and could be a valuable member benefit that would
afford members more opportunities to participate in the Association. A pilot
project is in the works to provide guidance on the most thoughtful way to launch
such a wiki.

With respect to Public Interest, Mr. Shackelford discussed the continued success
of the Public Information Series. He thanked the Committee and the staff for their
hard work and said that he is looking forward to the pan flu convener session to
be held in the spring.

VI.   Discussion Item

      Board Input on Sponsorship Policy: Seeking Consensus on
      Governing Principles

Mr. Leibold commended the Board for the thoughtful input received on the
sponsorship policy thus far. The input indicated that the initial draft was too
detailed and read too much like a regulation. Mr. Leibold suggested that he, Ms.
Carder-Thompson, as Chair of the Finance Committee, and Mr. Barry, as Chair
of the Quality Council, redraft the policy so that it is simpler and provides more
case-by-case discretion to analyze proposed sponsorship arrangements. The
revised policy will provide guidance to the Association’s leaders in analyzing
particular sponsorship opportunities rather than attempting to address every
possible circumstance in the policy itself. This subgroup will then return to the
Board with a redrafted policy at the June meeting.

After further discussion, Ms. Belmont thanked members for their input and
instructed Mr. Leibold and the subgroup to report back when they had finished
redrafting the policy.

VI.   Special Presentation

      Association Reserve Ratios

Ms. Belmont introduced Mike Tryon, whose firm conducts AHLA’s audit, to give a
presentation on the reserve ratios of other Associations and to provide his view
on a healthy reserve ratio for an Association of AHLA’s size.

Mr. Tryon provided a detailed analysis of AHLA’s revenues, expenses and
reserves between the years 2000 and 2007. He showed a historical trend
diagram demonstrating that the reserves grew from roughly 50% of a year’s
operating expenses to slightly over a year of operating expenses in that seven
year period. He also stated that in his experience other associations have
reserves along a continuum from 50% of a year’s operating expenses to two
years of operating expenses. Mr. Tryon discussed the reasons for keeping a
healthy reserve, including providing insurance against economic slowdowns, and
stated that the Board needed to discuss where it feels comfortable along the
continuum.

Ms. Best provided her perspective that the Association is both safer and stronger
when it keeps a healthy amount in reserves and that many other associations
have reserves of between a year and two years of operating expenses.

Board members engaged in a dialogue about the purpose of reserves, and Ms.
Belmont asked the Finance Committee to revisit the Association’s policy on
reserves and determine whether any changes were needed in the policy. After
this discussion, Ms. Belmont thanked Mr. Tryon and Ms. Best for attending the
business meeting.

VIII.   Committee Goals and Grids for Your Review

Committee chairs filed written reports, but did not make oral presentations about
committee activities.

IX.     Adjournment

There being no further business before the Board, the meeting was adjourned at
10:30 am (ET) on January 11, 2008.




Prepared by:
Peter M. Leibold




Approved by:
Jane Conard
Secretary
                                         TAB 3




                         President’s Report - Elisabeth Belmont

                                      Oral Report




Attachments, including

   •   Pan Flu Convener Session Agenda

   •   Pan Flu Convener Session Breakout Group Materials

   •   EVP Status Report
                                       UPDATED AGENDA
                   Pandemic and H5N1 Flu: A Prescription for Preparedness

                                       Thursday, May 1, 2008

4:00 – 5:00 p.m.       Tour of the U.S. DHHS Secretary’s Operations Center
                       200 Independence Ave. SW, Washington, DC

5:00-6:30 p.m.         Welcoming/Networking Reception
                       Vie de France, 600 Maryland Ave. SW, Washington, DC

                                           Friday, May 2, 2008
8:00-8:45 a.m.         Registration and Continental Breakfast

8:45-9:15 a.m.         Welcome, Charge for the Day, Overview of the Draft Publication: Community Pan-Flu
                       Preparedness: A Checklist of Key Legal Issues for Healthcare Providers
                       Elisabeth Belmont, Esq.
                       President, American Health Lawyers Association

9:15-9:45 a.m.         Introduction of Participants

9:45-10:15 a.m.        Speaker:
                       Pandemic Influenza: Update on National Preparedness and Response Oversight
                       Efforts
                       Hon. Daniel R. Levinson, Esq.
                       Inspector General, U.S. Department of Health & Human Services

10:15-10:45 a.m.       Speaker:
                       Overview of Current Preparedness Implementation Challenges in the Public and
                       Private Sectors
                       Richard E. Besser, M.D.
                       Director of the Coordinating Office for Terrorism Preparedness & Emergency Response
                       Centers for Disease Control and Prevention

10:45-11:00 a.m.       Charge to Workgroup Participants and Break to Gather into Workgroups

11:00-12:15 a.m.       Workgroup Deliberations
                         Breakout A- Implementation of Altered Clinical Pathways (ROOM 6113)
                         Breakout B- Protection of Employees and Maintaining Operations (ROOM 6115)
                         Breakout C- Public Health/Healthcare Provider Coordination (ROOM 6111)

12:15-1:45 p.m.        Speaker:
                       RADM W. Craig Vanderwagen, M.D.
                       Assistant Secretary for Public Health Emergency Preparedness
                       U.S. Department of Health & Human Services

1:45-2:00 p.m.         Charge to Workgroup Participants and Break to Gather into Workgroups

2:00-3:15 p.m.         Workgroup Deliberations
                         Breakout A- Implementation of Altered Clinical Pathways (ROOM 6113)
                         Breakout B- Protection of Employees and Maintaining Operations (ROOM 6115)
                         Breakout C- Public Health/Healthcare Provider Coordination (ROOM 6111)

3:15 -3:30 p.m.        Break to Reconvene Full Group

3:30-4:30 p.m.         Report Back, Discussion and Clarification

4:30-5:00 p.m.         Summation, Next Steps, and Adjournment
                                BREAKOUT GROUP A

              IMPLEMENTATION OF ALTERED CLINICAL PATHWAYS
                     DURING AN INFLUENZA PANDEMIC

                       Richard L. Shackelford, Esq. Facilitator

I.   PRACTICAL PREPAREDNESS STEPS FOR CURRENT IMPLEMENTATION

     A. Moving From Traditional Standards of Care to a Mass Casualty Approach

       1.    Traditionally, the standard of care for healthcare professionals focuses on
       doing whatever is reasonably possible to save every life. However, relevant
       government agencies recognize that an altered standard of care will be
       necessary in the event of a pandemic.

                 Agency for Healthcare Research and Quality

                 ● Altered Standards of Care and Mass Casualty Events: “A shift to
                   providing care and allocating scarce equipment, supplies, and
                   personnel in a way that saves the largest number of lives in
                   contrast to the traditional focus on saving individuals.”

                 Homeland Security Council

                 ● Implementation Plan for the National Strategy for Pandemic
                   Influenza: “The standard of care will be met [during a pandemic] if
                   resources are fairly distributed and are utilized to achieve the
                   greatest benefit.”

       2.      However, healthcare providers cannot afford to wait for national or state
       legislative or regulatory developments to address standards of care issues. The
       time horizon for any such government intervention is simply too long and too
       uncertain. Thus, healthcare providers should begin to engage in planning now to
       determine the functional requirements of a comprehensive system to manage a
       pandemic and other mass casualty events. This is a challenging undertaking for
       healthcare providers given the wide range of provider entities and organizations
       that exist in this country -- from public to private and with widely varying
       organizational structures and missions.

       3.     One very good resource for provider pandemic planning is the Medical
       and Health Incident Management (“MaHIM”) System developed by the Institute
       for Crisis, Disaster, and Risk Management at George Washington University.
       See       MaHIM       Final    Report,     dated       December      2002,   at
       www.gwu.edu/~icdrm/publications/MaHIM. The MaHIM System is intended to
       provide a comprehensive functional system description for mass casualty
       medical and health incident management with the goal of limiting morbidity and
       mortality in a population exposed to a major hazard like a pandemic. The MaHIM
   System does not seek to define the technical requirements of how to address a
   mass casualty event, but rather describes the functional requirements -- “what
   needs to be done”. Moreover, MaHIM, in recognition of the understandable
   inability of government to address all areas of provider preparedness, focuses on
   a framework for provider preparedness based upon authority generated by
   responsibility rather than exclusively upon statutory or regulatory power. As the
   authors note, past provider planning efforts have often begun with the question
   “who’s in charge?” and commonly stalled on this question. See MaHIM Final
   Report at 3-3.

B. Implementation Challenges and Potential Solutions

   1.     Potential Malpractice Claims: A pandemic presents severe treatment
   challenges that inevitably will cause providers to modify their normal treatment
   protocols. This increases a provider’s risk for malpractice claims.

             a. What types of malpractice claims are most likely to be asserted as a
                result of a pandemic?

             b. Which ones present the greatest risk?

             c. Will there likely be insurance coverage for such claims?

                ● If not, what steps should providers take to improve their
                  coverage position?

             d. What actions can be taken by providers to minimize the risk of such
                claims?

                ● Providers should develop triage protocols to prioritize pandemic
                  cases by level of acuity. Phone triage may be used to identify
                  patients who need inpatient care versus those who can be
                  referred to physician offices or other less acute facilities.
                  Signage can also be developed on “signs and symptoms” to
                  direct persons to more intensive screening areas.

                ● Flu algorithms can be developed similar to, for example, MI
                  algorithms.

                ● Treatment protocols focused on processing large numbers of
                  similar cases should be developed in order to make patient care
                  more efficient during a pandemic. For example, a protocol
                  could be developed for a modified H&P limited to visual
                  inspection, vital signs, and cultures. Similarly, a protocol could
                  be developed limiting the number of times a pharmacist must
                  check medications.




                                       2
              ● Providers should develop “short form” documentation
                requirements for pandemic patients focused solely on influenza
                issues, including a short form consent to treatment.

              ● Policies should be developed related to the dispensing of scarce
                medications including vaccines and antivirals. Such policies
                can raise significant rationing of care and other ethical issues.

              ● Providers should have candid discussions with their insurance
                carrier about the potential malpractice risks presented by a
                pandemic and discuss possible approaches to minimize such
                claims.

              ● Providers should discuss the potential malpractice risks
                presented by a pandemic with their malpractice defense counsel
                and their emergency preparedness counsel. Both counsel
                should be included in the consideration of modified treatment
                protocols and other proposed pandemic “shortcuts.”

2.     Insufficient Staff: In a pandemic there will be a critical shortage of
hospital workers due to a high absenteeism of hospital staff resulting from illness,
family care giving and fear of contagion.

          a. What are the most significant staffing issues that hospitals will likely
             face?

          b. What are the most significant staffing issues that long-term care
             providers will likely face?

          c. What are the most significant staffing issues that physicians will
             likely face?

              ● Providers should develop pandemic staffing contingency plans,
                identifying essential staff for a pandemic and other staff for non-
                pandemic essential services. For example, non-pandemic
                hospital services such as trauma care, obstetrics and cardiac
                care must still be provided or referred to other facilities (if
                possible during a pandemic). Clinical staff will be particularly
                difficult to locate in sufficient numbers. In addition to physicians
                and nurses, other critical clinical personnel include respiratory
                therapists, pharmacists, laboratory employees, blood bank and
                morgue staff. Providers will also need to identify crucial
                administrative, food services, housekeeping, security and
                facilities staff.

              ● Clinical personnel should be cross-trained to assist in providing
                care during a pandemic. Administrative staff should also be
                cross-trained to provide basic nursing services.


                                     3
            ● Providers should identify possible sources of temporary
              personnel in the community for assignment during a pandemic.
              For example, physicians and nurses in the community with
              special expertise in infectious diseases, pulmonary medicine
              and critical care medicine should be identified and call rosters
              developed for possible temporary assignment. Other possible
              sources of emergency staffing include retired personnel,
              medical and nursing students, the local Red Cross, and state
              and federal public health agencies.

3.    Insufficient Facilities Capacity: Provider facilities will be strained
beyond their capacity limits during a pandemic. This will result in critical
shortages of beds, supplies and equipment.

         a. What are the most significant facility-capacity issues that hospitals
            will likely face?

         b. What are the most significant facility-capacity issues that long-term
            care providers will likely face?

         c. What are the most significant facility-capacity issues that physicians
            will likely face?

            ● Providers should develop policies setting forth admission and
              discharge priorities by patient condition and acuity during a
              pandemic.     The policies should address triggers for the
              cancellation of elective procedures, prioritization guidelines for
              early discharge of current inpatients, and criteria on transfers to
              other treatment settings.

            ● Visitors will need to be restricted and mechanisms should be
              established for enforcing such restrictions, including the use of
              hospital security services. Hospitals should meet with local law
              enforcement officials to determine ways in which they can assist
              in this area.

            ● Provider facilities should begin developing plans for facility
              surge capacity, including the use of alternate care sites. For
              hospitals, potential “surge hospitals” include shuttered hospitals
              or closed wards, mobile medical facilities (e.g., trucks fitted with
              surgical and intensive care units), portable facilities (commonly
              referred to as “hospitals in a box”) and “facilities of opportunity”
              (e.g. veterinary hospitals, convention centers, exhibition halls,
              empty warehouses, airport hangars, schools, hotels, etc.). See,
              e.g., Surge Hospitals: Providing Safe Care in Emergencies.
              (Joint Commission, 2006).




                                    4
             ● Providers should identify areas of their facilities that could be
               vacated for use to cohort influenza patients.

             ● Hospitals should consult with their state hospital licensing and
               certificate-of-need (where applicable) agencies on plans and
               processes to expand bed capacity during a pandemic.

             ● Criteria should be developed for reduction in the routine use of
               laboratory, radiology and other diagnostic ancillary services.

             ● Providers should stockpile sufficient quantities of consumable
               supplies that will be needed in a pandemic (e.g. masks).

             ● Reserve morgue capacity should be identified.

4.     Use of Non-Employee Personnel (e.g. non-employed volunteers or out-
of-state forces): Due to staffing inadequacies, providers will need to bring in
additional staff who will not be familiar with the facility’s policies or treatment
protocols, and any out-of-state volunteer professionals are unlikely to be properly
licensed by the provider’s licensing authority.

          a. What are the three most likely problems associated with using non-
             employee personnel?

          b. Does the answer differ by type of provider?

          c. Does it matter whether the non-employee personnel are local or
             from out-of-state?

             ● Develop “quick study” kits for non-employee personnel that
               succinctly describe key hospital policies and treatment protocols
               and that provide key contact information (phone numbers, pager
               numbers, e-mail addresses, etc.) that are necessary to render
               care at the provider’s facility.

             ● Plans should be developed on how to house and feed an out-of-
               town work force.

             ● Providers should consider discussing with their insurance
               carriers on how insurance coverage may be affected by the use
               of non-employee personnel, including the use of unlicensed
               personnel (e.g. health care professionals coming from other
               jurisdictions).

5.     Protection and Safety of Staff: The risk of contagion will be a key
concern of provider staff. A pandemic will create unusually severe risks for all
staff.



                                     5
          a. What are the primary protection and safety concerns for staff?

          b. What are the most significant issues a facility will need to consider
             when balancing protection and safety of its staff versus trying to
             treat large numbers of very sick persons during a pandemic?

          c. Providers should establish guidelines for rapidly vaccinating or
             providing antiviral medications to health care personnel, including a
             priority list for essential clinical personnel for scarce vaccines and
             antivirals.

          d. Providers should assess their potential need for personal protective
             equipment and begin stockpiling sufficient numbers.

          e. Providers should develop policies to cohort essential clinical
             personnel such that personnel working in more critical areas do not
             contaminate less critical areas and vice versa.

          f. Providers should identify mental health and psycho-social
             counseling resources for counseling of staff during a pandemic to
             address issues of grief, stress, fear, etc.

          g. Providers should develop plans for reassignment of high-risk
             personnel (e.g. pregnant and immunocompromised persons).

6.      Patient Rights: Patients enjoy certain rights in provider settings (e.g. the
right to confidentiality) that inevitably will be curtailed during a pandemic. One of
the key challenges presented by a pandemic will be the way facilities balance
such individual patient rights against the need to accommodate the needs of all
patients.

          a. What patient rights are most at risk?

          b. What will be the primary conflicts between the protection of patient
             rights and the need to treat large numbers of very sick persons
             during a pandemic?

          c. Who should determine the proper balance between the protection
             of patient rights and meeting the medical needs of patients? Will
             there likely be disputes about this? Who should resolve such
             disputes?

          d. Providers should develop easy to read, one-page handouts for
             patients and their families relating to those patient rights that in
             normal operations are observed but that may not be fully complied
             with during a pandemic.




                                      6
II.   LEGISLATIVE, REGULATORY               AND     POLICY      ISSUES      FOR     LATER
      CONSIDERATION

      A. Liability Concerns

         1.      The most significant legal impediment to the implementation of alternative
         clinical pathways for a pandemic is the risk that healthcare providers will face
         civil, and possibly even criminal, liability for deviating from the traditional
         standards of care. This is true for both individual and institutional providers.
         Liability potentially exists for medical malpractice, criminal negligence, and for
         acting beyond the scope of or without a professional license.

         2.     A medical malpractice claim consists of an allegation that a healthcare
         provider has breached the provider’s duty to provide services at a certain level of
         care and skill, resulting in damage to the plaintiff. The applicable standard of
         care for a malpractice action is determined by each state as a matter of state law.

         3.      Most states also have criminal negligence statutes. Many of these
         statutes define criminal negligence as the failure by a person to be aware of a
         substantial and unjustifiable risk that a result will occur or that a circumstance
         exists. The risk must be of such a nature and degree that the failure to be aware
         of it constitutes a gross deviation from the standard of care that a reasonable
         person would observe in the situation. Other states define criminal negligence as
         a failure to act which demonstrates a willful, wanton or reckless disregard for the
         safety of others who might reasonably be expected to be injured thereby. See,
         e.g., GA. CODE ANN. § 16-2-1 (2005); N.Y. PENAL LAW § 15.05 (McKinney
         2005); OR. REV. STAT. § 161.085 (2003). The types of charges that may be
         brought for criminal negligence include homicide, assault and battery, and child
         or elder abuse.

         4.     The professional licensing of physicians, nurses and other individual
         healthcare providers is also a matter of state law. The necessity to act beyond
         the scope of one’s license during a pandemic, or the use of volunteer
         professionals from other jurisdictions who are therefore not licensed by the state
         in which the services are provided, create potentially significant legal
         impediments to altered clinical pathways.

         5.     While various forms of statutory immunity for healthcare providers are
         available, there are no comprehensive liability protections in place for healthcare
         providers for deviations from traditional standards of care or for acting beyond
         the scope of or without a license. Instead, immunity for actions taken during a
         mass casualty event like a pandemic currently depends on a patchwork of state
         and federal statutes. There are, unfortunately, gaps and limitations in the degree
         of immunity that is currently available.




                                              7
B. Sources of State Immunity

   Model State Emergency Health Powers Act (“MSEHPA”): Approximately 40
   states have adopted various provisions of this Model Act. The Act provides
   immunity following a declaration of an emergency by the state’s governor or
   public health authority for personnel who render assistance at the request of a
   state or its political subdivisions. Gross negligence and willful misconduct are
   excluded from immunity.

   The Model Intrastate Mutual Aid Legislation (“MIMAL”): This Model Act
   addresses voluntary health professional responders providing services within a
   state. Such responders under the operational control of a unit of government are
   considered employees of that government unit, therefore creating the possibility
   of sovereign immunity.

   Emergency Management Assistance Compact (“EMAC”): This Model Act,
   adopted in all 50 states, provides civil immunity for officers and employees of a
   responding state. Gross negligence and willful misconduct are excluded from
   immunity.

   Uniform Emergency Volunteer Health Professionals Act: This Model Act is
   being developed by the National Conference of Commissioners on Uniform State
   laws. The 2007 interim draft provisions on civil liability for voluntary health
   professionals provide comprehensive immunity for civil liability.

   Good Samaritan Statutes: Theses state statutes vary widely and typically
   immunize services at the scene of an emergency by a non-compensated
   volunteer.

C. Sources of Potential Federal Immunity

   Volunteer Protection Act (42 U.S.C. §§ 14501, et seq.): This federal statute
   provides immunity for non-compensated volunteers at a nonprofit facility.

   National Disaster Medical System (42 U.S.C. § 30hh-11(d)): This emergency
   system, enacted as part of the Pandemic and All Hazards Preparedness Act of
   2006 and the Homeland Security Act of 2002, enables various federal agencies
   to recruit private persons to assist during a pandemic or other disaster and
   receive federal employee immunity.

   Public Readiness and Emergency Preparedness Act (42 U.S.C. § 247d-6d):
   This federal statute provides broad immunity during a declared public health
   emergency where the Secretary of HHS also declares the use of a “counter
   measure,” i.e. a drug or biological product or device.




                                       8
D. Key Limitations of Immunity

   1.     As a result of this patchwork of state and federal immunity provisions,
   various gaps and limitations currently exist in immunity protection for healthcare
   providers seeking to apply altered standards of care during an influenza
   pandemic. These gaps and limitations include the following:

        •   Some immunity statutes apply only to volunteers who are donating their
            services free of charge.

        •   Some immunity statutes apply only following formal declarations of
            emergency by a state’s governor or the local public health authority.

        •   Many statutes protect only officially designated government personnel and
            do not offer protection to private volunteers.

        •   There is little existing protection for institutional providers, and in some
            cases immunity for individuals providing services on behalf of an
            institutional provider can vary based on whether the institution is nonprofit
            or private.

        •   Gross negligence and willful misconduct are typically excluded from
            immunity protection, and criminal liability, which in some states could
            theoretically result simply from providing services without a license, is also
            typically excluded.

E. Key Issues

   1.       Should there be a national standard providing for an altered standard of
            care during a pandemic? Why?

   2.       Should any national standard be set by specific legislation or by regulation
            pursuant to enabling legislation? If the standard should be set by
            regulation, which federal agency should be authorized to adopt the
            regulations?

   3.       Is the judicial system a better or worse choice for assuming the
            responsibility of articulating an altered standard of care for a pandemic?

   4.       Is there a role for the states? If so, what?

   5.       Should there be immunity for providers delivering healthcare services
            during a pandemic?

   6.       Should the immunity be broad in scope? Civil only? Negligence only?

   7.       Are the current state statutes adequate? Why not?



                                           9
8.    Should there be federal legislation creating national immunity standards?

9.    Should there be both entity and individual protection?

10.   Should immunity for individuals apply only to licensed personnel? If so,
      which ones?

11.   Should immunity for individuals apply only to volunteers who are donating
      their services?




                                   10
                             BREAKOUT GROUP B

               PROTECTION OF EMPLOYEES AND MAINTAINING
                    OPERATIONS DURING A PANDEMIC

                      Lisa D. Vandecaveye, Esq., Facilitator


I.   PRACTICAL PREPAREDNESS STEPS FOR CURRENT IMPLEMENTATION

     A.   Assuring Work Force Availability

          1.     How do we ensure that healthcare workers (both clinical and
                 administrative) are able to effectively perform services for the
                 duration of an influenza pandemic?

          2.     In the event of an influenza pandemic, healthcare workers of all
                 types will be critical – from the janitor to the CEO. While a great
                 deal of time and attention has been focused on licensure issues,
                 we need to consider the impact of a pandemic on other critical
                 workers and plan for continuation of critical services.

                 a.     Ensure all healthcare workers are recognized as critical to
                        the response. For purposes of this discussion, we are using
                        the term "healthcare workers" to cover all those who work in
                        a health-related facility.

                 b.     Establish a mechanism to identify healthcare workers to
                        qualify to pass through cordons and obtain preference for
                        critical supplies.

          3.     Daycare for children and adults will be critical to permit caregivers
                 to work without concern for how their families will cope.

                 a.     Some hospitals may desire to establish in-house daycare.
                        However, there may be infection control concerns, as well as
                        the need to be able to limit use of the daycare to staff.
                        Further, the same licensing and inspection issues may arise.
                        Finally, the hospital will need some protection against liability
                        in case the children in the center become ill.

                 b.     Are agencies available to set up temporary daycare upon
                        request?

                 c.     Can the Red Cross provide temporary workers to assist with
                        daycare needs?



                                       1                                               1
4.   A great deal of planning has been done for distribution of vaccine
     and antiviral treatments for caregivers. However, caregivers will
     not work if they fear bringing infection home to their families.

     a.    Plans should be developed for vaccination and antiviral
           treatment for those family members that reside with
           healthcare workers.

     b.    Consider pre-consent to antiviral and vaccine, so that
           administration is faster/requires less paperwork.

     c.    Consider establishing a plan that allows for self-
           administration of vaccine, or dispensing to an adult to
           administer to his or her family.

     d.    Hospitals should continue to encourage all employees to
           obtain seasonal flu vaccinations. While seasonal vaccine is
           unlikely to be effective against a pandemic strain, this
           approach helps employees become used to, and more
           comfortable with, the concept of vaccination against
           influenza. The vaccine should be offered to all employees
           with out regard to job duties. A process to permit declination
           of the vaccine will be important to accommodate medical
           conditions and religious concerns.

     e.    Pharmacies often stock minimal stores of rarely used
           medications such as antivirals that are intended to minimize
           the length and severity of influenza. Hospitals should
           develop a plan under which the hospital pharmacy will
           increase antiviral stocks based on influenza activity.

           ●      If the antivirals are stocked, is the staff trained to
                  administer or explain the administration?

           ●      Can the instructions be written in a pictogram format
                  that may address language barriers?

     f.    Increased emphasis on the basics of infection control – hand
           washing, use of sanitizers, etc. – should continue, and
           educational programs regarding the efficacy of these and
           barrier methods of infection control should be developed.

     g.    Appropriate corrective action should be taken against
           employees who fail to integrate basic infection control
           activities into daily routines.



                          2                                            2
5.   The anticipated economic effects of an influenza pandemic are
     significant. Many families are already struggling to pay household
     bills and provide for their families. Any disruption in pay can tip a
     family over the edge.

     a.    Deferral of rent obligations for those who rent may be
           necessary.

     b.    Consider offering incentives to companies now who establish
           a fund dedicated to ensuring continuing pay to workers in the
           event of a pandemic.

     c.    Hospitals should consider modifying their employee benefit
           plans to permit withdrawals or cash advances from protected
           funds as necessary in the event of a disaster or pandemic.
           Careful consideration of legal impact of such changes will be
           necessary.

     d.    Hospitals should approach banks and other financial
           institutions to discuss alternatives to ensure availability of
           funds for employees in the event of an influenza pandemic.

     e.    Hospitals might consider purchasing pre-paid cards for
           grocery stores and other critical supplies that can be
           provided to employees for use during a pandemic.

     f.    Consideration should be given to establishing, within the
           Employee Assistance Program, financial support for those
           affected by disaster.

6.   Maintaining a healthy workplace during an influenza pandemic and
     the length of service by individual health care providers are two
     distinct issues but are both important considerations.       It is
     anticipated that the response to a pandemic may be extended
     shifts.   However, when workers must wear bulky, personal
     protective equipment, extended shifts can be very difficult.

     a.    Funds should be made available to try to identify (i) what
           type of personal protective equipment is actually needed for
           influenza and (ii) reasonable work periods for healthcare
           providers wearing required personal protective equipment.

     b.    Should healthcare workers be free to refuse to serve during
           a pandemic, or is the willingness to sacrifice for the greater




                          3                                             3
           good a required attribute? Should there be penalties for
           refusing to serve or rewards for agreeing to serve?

     c.    Can a hospital impose a "working quarantine" on its
           personnel? Can and/or should a governmental official
           impose a working quarantine on hospital personnel?

     d.    Can or should a hospital require individuals who are
           deployed to a disaster or required to work during an
           influenza pandemic to be screened for Post Traumatic Stress
           Disorder (PTSD)? Should Critical Incident Stress Debriefing
           (CISD) training and planning be a required component of
           emergency preparedness?

     e.    Hospitals should review existing human resource policies
           and develop revised policies as necessary to address the
           ability of personnel to refuse an assignment during a
           pandemic. Employees should be affirmatively educated on
           these policies and new employees acquainted with such
           policies at orientation.

     f.    Hospitals should develop policies and plans regarding a
           working quarantine. Consideration should be given to:

           ●      Space. Space will be at a premium. How will
                  hospitals allocate space for quarantined workers?

            ●     Increased Census. The increased census will put
                  increased pressure on supplies, including food and
                  water. How will hospitals allocate these supplies?

7.   In the Toronto SARS experience, workers who were assigned to
      working with SARS patients experienced social shunning and
      isolation from their colleagues who feared contagion.

     a.    Hospitals should develop communication and psychological
           support programs to anticipate this problem.

     b.    Caring for large numbers of patients under extreme
           conditions with what can be anticipated to be significant
           mortality rates is extremely difficult for healthcare providers.
           The psychological impact can be expected to be significantly
           higher in a pandemic, given the need to ration care and
           change norms of care from “the best possible care for each
           person” to “the greatest good for the most people.”




                          4                                              4
          c.    Hospitals should be training additional personnel to provide
                CISD and should train caregivers regarding alterations in the
                ability to provide the full scope of care to help avoid
                psychological trauma in those treating pandemic victims.

          d.    Hospitals may also want to pre-credential religious leaders
                from the community to provide needed support.


B.   Union Environment Issues

     1.   Many of the employment practices during an influenza pandemic
          will constitute changes in day-to-day operations of a healthcare
          provider. These day-to-day changes may be considered changes
          to the “terms and conditions” of employment.           The current
          healthcare environment has seen an increase in the workforce with
          union representation. When the employer has a workforce or a
          portion of the workforce with union representation, the employer is
          contractually bound to an agreement with the union.            The
          employment agreement is negotiated between the union and the
          employer for a set term. The National Labor Relations Board
          enforces the National Labor Relations Act. When dealing with a
          unionized workforce, it can be more difficult to quickly implement
          changes in the terms and conditions of employment.

          a.    Negotiate emergency response provisions in collective
                bargaining agreements.

          b.    Provisions should be negotiated permitting the re-
                assignment of work tasks in a pandemic without an
                obligation of bargaining or right of grievance.

          c.    Provisions should be negotiated addressing the right to
                require vaccination or antiviral treatment, barring medical or
                religious objections. If an employee refuses vaccine or
                antiviral treatment, immediate termination or reassignment
                should be permitted if such refusal is reasonably anticipated
                to place either the employee or others at substantial risk.

          d.    Provisions should be negotiated to address resolution of
                disputes with union employees. For example, it may be
                necessary to either suspend or modify the grievance
                procedure.




                               5                                            5
           e.    Provisions should be negotiated to permit immediate
                 intervention and possibly termination in the event boycotts or
                 other disruptions or harmful activities are threatened.

           f.    Modification of rights to vacation, time off, and other release
                 from work may be necessary and provisions negotiated to
                 address these issues.

C.   Credentialing Issues

     1.    Currently, there are provisions for recognizing licensure during a
          disaster or in areas affected by a pandemic. However, there is a
          large population of trained healthcare workers who are not currently
          licensed either due to retirement or career changes. How can we
          access their knowledge and skills in the event of an influenza
          pandemic?

     2.    During an influenza pandemic, a hospital or healthcare provider will
          take all necessary steps to assist those who are injured or ill. In the
          case where temporary workers or retired workers are available, can
          the hospital or healthcare organization develop its own criteria for
          credentialing with the supervision of professionals?

           a.    Hospitals should develop a process describing primary
                 source verification efforts. A process for determining inability
                 to complete primary source verification should also be
                 developed with guidelines regarding documentation of efforts
                 and barriers.

           b.    Hospitals should consider developing a volunteer cadre that
                 is pre-credentialed with prior distribution of ID, uniform (if
                 desired) and personal protective equipment. Hospitals could
                 offer and document training. Potential volunteers include
                 retirees and community members with relevant training or
                 qualifications who are not currently engaged in healthcare
                 activities.

           c.    Hospitals should develop a policy that provides that students
                 currently on rotation through the hospital are deemed
                 credentialed and can immediately be deployed.

           d.    Teaching hospitals should discuss with relevant accrediting
                 bodies the ability of a hospital to suspend limitations on
                 resident work hours in the event of a pandemic.




                                6                                              6
          e.     Establish a hotline number or website that is immediately
                 available to human resources for volunteers and employees
                 to ask questions and volunteer their services.

          f.     Hospital affiliation agreements with teaching institutions
                 should be reviewed for language that would enable students
                 to be available to work in the event of an influenza pandemic
                 in accordance with their education and training level.

          g.     Teaching hospitals and academic medical centers should
                 review their agreements with residents to establish
                 expectations that the healthcare/medical residents may be
                 requested to work during a pandemic or be sent to other
                 clinical locations.

D.   Communication Opportunities

     1.   Effective communication is critical in any employment situation and
          is a challenge in a healthcare organization even under the ideal
          situation. Effective communication can be a valuable tool for
          healthcare workers, families and their significant others. On the
          other hand, ineffective communication can create unintentional
          barriers to quality healthcare. The importance of effective
          communication is even more acute during an influenza pandemic.

     2.   Every healthcare organization has a disaster plan. The focus of the
          disaster plan is communication of the operations and management
          of the disaster. In some disaster situations, the health of the
          healthcare worker may be compromised or affected by the recovery
          efforts. An individual employee has an expectation of privacy
          relative to his or her own healthcare condition. What are the
          impediments to treating healthcare workers during a disaster?
          Inadequate communication may result in a violation of an
          employee’s privacy. Is it possible for the healthcare worker to waive
          the right to privacy regarding healthcare information during a
          disaster? What happens when the healthcare worker has a pre-
          existing medical condition? Can we protect the privacy rights of a
          healthcare worker during a disaster?

     3.   What types of communication tools can be developed to assure
          clear and consistent information to the employees and family
          members of the workforce in order to calm fears and avoid social
          isolation without violating the privacy of the employee?

          a.     Develop communication tools that are developed and tested
                 with the disaster plan. During exercises, call-in and similar



                                7                                            7
                 communications should be stressed            to   ensure    that
                 downstream communication plans work.

           b.    Hospitals should develop guidelines to permit clear,
                 appropriate communications with employees in the event an
                 employee becomes ill (or is rumored to be ill) with the
                 pandemic contagion. Care must be taken to ensure that
                 adequate information is provided to allay fears without
                 inappropriately violating the ill employees’ privacy rights.

           c.    All multimedia opportunities should be explored, including
                 hotlines, the internet, television, radio and newspapers to
                 communicate accurate and complete information in a timely
                 manner.

           d.    All employees should be reminded not to discuss with any
                 media (other than internal resources) the activities within the
                 hospital. The status of the pandemic should be confidential
                 and communicated only in a coordinated manner as a part of
                 the disaster response process.

           e.    Use all opportunities to educate the healthcare reporters
                 about the influenza pandemic and about the communication
                 process in the event of a pandemic.

E.   Training Challenges

     1.    Training is important during both the preparedness and response
           stages of an influenza pandemic. The health and safety of
           healthcare workers may be dependent upon the appropriate
           training in the utilization of new and sometimes different equipment.

     2.   The type of work force training that is necessary may differ,
          depending on the type or strain of influenza. The protection of the
          healthcare worker is important for the worker to effectively aid the
          victim. If the worker is injured or becomes ill as a result of service
          during a pandemic, is there sufficient legal authority to permit the
          healthcare worker to obtain the necessary healthcare services and
          compensation? What would constitute “sufficient legal protections”
          to aid an injured healthcare worker as a result of an injury or illness
          following a pandemic response? The normal response of a first
          responder or healthcare worker is to immediately provide
          assistance. However, safety must be the first consideration.
          Hospitals should begin integrating into employee training increased
          emphasis on the actions that will help both patients and healthcare
          workers during an influenza pandemic (infection control,



                                8                                              8
                 appropriate use of personal protective equipment, and hand
                 washing) to ensure that these actions are second nature when a
                 pandemic hits.

                 a.   Human resources policies should require employees to use
                      personal protective equipment.       Supervisors should be
                      trained in appropriate interventions when employees fail to
                      use appropriate personal protective equipment.

                 b.   Policies and procedures should be developed to ensure that
                      appropriate personal protective equipment is distributed in
                      sufficient amounts to healthcare workers during the entirety
                      of a disaster response.

                 c.   Research into the type of personal protective equipment that
                      is necessary to protect against influenza and other
                      contagious diseases should be conducted, and clear
                      direction regarding the type of personal protective equipment
                      issued by appropriate public health officials.

                 d.   Employees should be required to drill in full personal
                      protective equipment to increase comfort with providing
                      services wearing personal protective equipment.

                 e.   Policies should be developed to provide for rehabilitation of
                      workers in full-cover personal protective equipment, as
                      appropriate. The employee may be faced with mental and
                      physical issues following the event. An example is the
                      utilizing of a Post Traumatic Stress Debriefing (PTSD) team
                      for the employees and volunteers.

                 f.   All employees should be trained in the basics of disaster
                      response. This training should include the organization’s
                      president and senior executives.

                 g.   The management of the Incident Command Center should
                      be identified based upon skill set and training, not on the job
                      title of the employee.


II.   LEGISLATIVE, REGULATORY            AND   POLICY     ISSUES     FOR     LATER
      CONSIDERATION

      A.   Assuring Work Force Availability




                                     9                                             9
     1.   Requirements that daycare be licensed and maintenance of
          extensive records. Alternative daycare arrangements will be
          required and regulation will need to be modified to permit flexibility.

     2.   Zoning in many cities regulates the conduct of business in
          residential neighborhoods and require business licenses, fire
          inspections, etc. prior to opening a business. These requirements
          will need to be suspended to permit opening of new daycare
          capabilities to assist healthcare workers.

     3.   Can the state and federal agencies license daycare in advance as
          part of a disaster plan?

     4.   There will not be time for preparation and distribution of
          prescriptions; neither will there be sufficient pharmacy capacity to
          permit customary dispensing.          Laws regarding prescription
          requirements will need to be waived, and plans authorizing use of
          other professionals (beyond nurses and physicians) to administer
          injections will be needed. State laws should permit delegation of
          authority to a third party for routine care of children. Healthcare
          workers who are guardians to incompetent individuals may also
          need to be able to delegate certain duties. For example, Michigan
          law permits delegation of certain parental rights to third parties.

     5.   The need for delegation of parental authority was discussed above.
          Hospitals should consider including (in the standard form
          delegating to a third party the care and treatment of minors) a
          provision that also grants prior consent to administration of vaccine
          to children.

     6.   Legislation protecting families from foreclosure is critical to ensure
          that this public health crisis does not become a bigger social crisis.

     7.   Legislation authorizing cash advances as necessary to permit
          healthcare workers to be on duty and to know their families are safe
          and able to buy essentials should be considered.

     8.   Legislation to authorize use of IRAs and similarly protected savings
          vehicles in a pandemic should be considered.

B.   Union Environment Issues

     1.   Should federal regulations clarify that, in the event of a mass
          casualty incident or influenza pandemic, changes to work
          processes or reassignment of work duties and responsibilities are




                               10                                             10
           not changes in terms and conditions of employment, which
           changes must be negotiated between the union and the employer?

     2.    Should regulations clarify that, in the event of mass
           casualty/influenza pandemic, changes to work hours and work
           quarantine is permissible and need not be negotiated?

     3.    During an influenza pandemic, staff will be overwhelmed and have
           little or no time to address non-critical issues. How should
           grievances be handled during a time of crisis? Can regulations or
           union agreements address an extension of time in the case of a
           disaster?

     4.    Hospitals need support that the steps taken to ensure appropriate
           patient care and support to staff during a pandemic do not result in
           charges of unfair labor practices. Is there a mechanism that will
           ensure workers are treated fairly not putting hospitals at risk of
           expending precious resources on these issues? Can regulations or
           union agreements address an extension of time in the case of a
           disaster?

     5.    Is there assistance that can be provided by the National Labor
           Relations Board to assure that unionized workers are unable to
           walk out or strike during a disaster?

C.   Credentialing Issues

     1.    The Emergency System for Advance Registration of Volunteer
           Health Professionals (“ESAR-VHP”) and the Joint Commission’s
           Standards provide that even workers who pre-register through
           ESAR-VHP must have primary source verification at the time of or
           within 72 hours for practitioners volunteering for duty in a disaster
           area (e.g., influenza pandemic). Should these standards be
           modified to provide that pre-registration through an ESAR-VHP
           program constitutes confirmation of primary sources?

     2.    The ability of a hospital to conduct primary source verification can
           vary widely, depending on the nature of the crisis. Should there be
           a special process for hospitals that are in the "zone of impact" (i.e.,
           a hospital that is fully stressed and is a primary site of the
           pandemic). The Joint Commission requirement of 72 hours for
           primary source verification from the time the volunteer practitioner
           presents to the organization may be impossible to meet. The Joint
           Commission Medical Staff Standard 4.110 notes that if verification
           cannot be completed within 72 hours in extraordinary
           circumstances, then it must be completed as soon as possible.



                                11                                             11
           The Note states: ”In this extraordinary circumstance, there must be
           documentation of the following: why primary source verification
           could not be performed in the required time frame; evidence of a
           demonstrated ability to continue to provide adequate care,
           treatment, and services; and an attempt to rectify the situation as
           soon as possible.” It is not clear what this standard means or what
           the organization must document.

D.   Communication Opportunities

     1.     The Privacy Standards of the Health Insurance Portability and
     Accountability Act of 1996 (HIPAA Privacy Standards) when properly
     understood by a covered entity should not create an impediment during an
     influenza pandemic. Perhaps the Office of Civil Rights should consider
     issuing Frequently Asked Questions (FAQ) that will clarify the provisions
     of HIPAA privacy during an influenza pandemic.

     2.     The Security Standards of the Health Insurance Portability and
     Accountability Act of 1996 (HIPAA Security Standards) may create an
     issue with the utilization of volunteers. Perhaps some consideration
     should be made for the temporary suspension of the HIPAA Security
     provisions during an influenza pandemic.

     3.      One of the primary communication difficulties during a disaster or
     perhaps an influenza pandemic is the inability to communicate with mobile
     phones due to increased utilization. Perhaps some consideration should
     be given for the registration of mobile phone numbers by and priority of
     first responders and healthcare providers.

E.   Training Challenges

     1.    Are the Workers Compensation Statutes written broadly enough for
           workers affected by an influenza pandemic?




                                12                                          12
                             BREAKOUT GROUP C

   PUBLIC HEALTH AND HEALTHCARE PROVIDER COORDINATION:
 THE PUBLIC/PRIVATE INTERFACE DURING AN INFLUENZA PANDEMIC

                      Melissa L. Markey, Esq., Facilitator

I. Practical Preparedness Steps for Current Implementation

   A. Goods and        Facilities:   Ensuring    the   Availability of     Essential
      Resources

   Within the context of a disaster, particularly a disaster that arises as the result
   of a public health emergency, allocation and availability of essential resources
   is a fundamental area of public/private interface. It is impossible for the
   government to obtain, maintain and distribute all essential resources that will
   be needed during a disaster. While the government can establish certain
   stockpiles, private industry must also participate. However, many private
   entities may prepare plans that are wholly dedicated to preserving the
   functioning of that entity without consideration of the greater public need.

   1. Americans typically respond to disaster by opening their hearts and
      offering to help. However, contributions without control cause chaos.
      How can the community plan to best use the generosity of others?

          a. Hospitals should take the lead in establishing a community-based
             resource donation and allocation plan so those who can contribute
             know where to bring resources.

          b. As discussed below, hospitals can also prepare to use volunteers
             through the pre-disaster establishment and training of volunteers.

          c. Hospitals should partner with other response agencies to create
             and implement a public education program regarding the Incident
             Command System and how to volunteer or contribute in the event
             of a disaster.

   2. In some cases, private industry may hesitate to provide access to critical
      resources due to concerns regarding intellectual property rights. How can
      healthcare providers work before a disaster to facilitate access to
      resources subject to intellectual property rights ("IP")?

          a. Healthcare should work with companies that own IP that is
             reasonably anticipated to have value in a pandemic (such as
             medications, etc.) to discuss means to ensure availability while
          protecting commercial interests. This may be an initiative that is
          best pursued at the industry level.

      b. Healthcare providers could develop standardized agreements with
         known/existing suppliers permitting the use of IP in which the
         parties agree to retain the confidentiality of the IP and cooperate to
         preserve the commercial value of the IP. This would be helpful for
         trade secrets, in particular.

      c. License agreements could be developed for use in disasters in
         which one entity is permitted to use another entity's IP in return for
         payment of a reasonable royalty. Cross-licenses and development
         agreements may be also be appropriate.

3. Should essential industries have rights to preferential access to/repair of
   critical resources?

   a. To ensure availability of essential services, healthcare institutions
      should      enter    into   agreements     with    utility companies,
      telecommunications companies and other critical suppliers to negotiate
      priority in repair and provision of services during a disaster. Some
      examples of critical supply vendors include:

      ●   Power sources
      ●   Water
      ●   Fuels
      ●   Patient care items
      ●   Communications
      ●   Transportation vendors
      ●   Laundry
      ●   Food services
      ●   Janitorial supplies
      ●   Temporary staffing agencies

   b. Healthcare institutions should be very wary of force majeure clauses.
      Disasters and force majeure events are the times when healthcare is
      most critically needed; healthcare providers need to be able to depend
      on their suppliers to maintain functionality of mission-critical systems.

   c. Healthcare providers should require suppliers to have and practice
      continuity of operations ("COOP") and disaster recovery ("DR") plans.
      For mission-critical suppliers, COOP should include a depth of
      authority of at least five qualified individuals for each critical role.

   d. Organize alternative means of access to report to work with pre-
      arranged routes and parking alternatives; arrange with local transport



                                    2
      agencies to provide shuttles to care locations. Trigger use of
      alternative transport through the organization's emergency
      preparedness response website.

   e. Purchase orders should be prepared and provided in advance or other
      actions taken to assure suppliers of payment so that suppliers will
      immediately ship necessary supplies.

4. How can we continue to ensure adequate blood supplies when traditional
   blood drives may not be permitted due to social distancing or other
   interventions intended to minimize the spread of disease?

   a. Healthcare providers should work with Red Cross and other blood
      sources to discuss alternatives to blood drives.

   b. Hospitals should consider developing as part of their disaster plan a
      means to increase autologous blood donations in order to minimize the
      need for blood drives.

5. Taking steps to ensure that critical response personnel are available. In
   most emergency preparedness plans, one of the first actions taken is to
   open the Emergency Operations Center ("EOC").            However, in a
   pandemic, that may not be advisable. Consider the following:

   a. Establish strict, epidemiologically sound grounds for determining
      whether individuals should be admitted into the EOC.

   b. Establish treatment/triage capabilities in the EOC with monitoring for
      influenza-like illness, exhaustion, mental fatigue and stress-related
      illnesses.

   c. Establish capability for a virtual EOC. The last thing you need in a
      pandemic is for an entire command structure to fall ill because they
      were all in the EOC.

6. Hospitals that own medical office buildings could incorporate into their
   leases a provision that allows the hospital to re-enter and use the leased
   space for hospital purposes in the event of a mass casualty or disaster
   situation.

7. Hospitals and the public health community should convene meetings with
   major manufacturing and other industrial partners to participate in
   community planning

8. Airlines should be approached regarding development of a program to
   allow donation of unused miles to a fund, to permit use of donated miles



                                    3
   by first responders and others who volunteer to assist at a disaster. A
   website should be established and publicity programs developed to permit
   immediate activation of this program in the event of a disaster

B. Volunteer Issues

Workforce issues are addressed in another breakout session. However, it is
reasonable to anticipate that volunteers will be needed to supplement the
standard healthcare workforce.

Ensuring that the response function has a sufficient number of workers with
needed skill sets, sufficient equipment and supplies, and sufficient respite and
recovery capabilities is an issue in every sustained disaster. Many experts
have discussed the basic concerns regarding the workforce, including waiver
of licensure, resolution of liability and worker's compensation issues, and
workforce management; many of these issues resonate with volunteers as
well. Governmental action is needed to ensure that these issues are
resolved. However, there are many actions that healthcare organizations can
take now to help ensure that a sufficient cadre of qualified volunteers is ready
to assist in a pandemic situation.

1. Several different volunteer organizations have been sponsored by the
   government to support disaster preparedness and volunteerism.
   However, certain protections have been extended only to the National
   Disaster Medical System which is limited in size and cannot always accept
   all those who wish to volunteer. Training raises similar issues; those in
   the response field understand that teams who train together work better in
   a disaster. Should similar protection and training opportunities be
   expanded to expand the pool of available, trained volunteers?

   a. Healthcare organizations should reach out to pre-existing groups who
      might be willing to assist. Examples include scout troops, church youth
      groups and community groups such as choirs and sports teams. Be
      open to unexpected volunteers – in Illinois, a group of bikers joined
      together to form a volunteer transport team.

2. There is a large cadre of individuals who are qualified healthcare providers
   but do not work in the medical setting. The Emergency System for
   Advance Registration of Volunteer Health Professionals (ESAR-VHP)
   programs have done an exceptional job of identifying those who are willing
   to respond; however, these individuals are not provided protective
   equipment such as N-95 respirators or Mark I kits because there are no
   employers to distribute and track these supplies. Should a process for
   distributing these supplies before disaster strikes be developed (and
   communicated) so that volunteers are ready to go to work quickly?




                                     4
   a. Hospitals should work with the ESAR-VHP program to identify
      healthcare workers who are no longer in the healthcare workforce and
      should invite those workers to form local, organized teams that practice
      together. Funding should be made available to provide necessary
      support for supplies for the team. This will also allow additional pre-
      credentialing and preparation of identification badges before the
      disaster strikes.

   b. Hospitals should negotiate with suppliers to provide supplies for
      response teams at reduced prices. If possible, hospitals should also
      try to negotiate for a credit or exchange program for medication that
      expires before it is needed.

   c. Hospitals should plan to integrate non-hospital caregivers in patient
      care roles. For example, in most states, paramedics' scope of practice
      includes many of the skill sets used by RNs; most ski patrollers are
      trained to the equivalent of EMT; and medical assistants who work in
      physician offices can perform many basic nursing functions. Hospitals
      should partner with Emergency Medical Services, other appropriate
      organizations and state licensing agencies to develop protocols that
      permit the use of pre-hospital and other care providers as fully as
      possible when necessary.

3. Consider adding, as core curriculum in schools, basic concepts of
   emergency preparedness and first aid.

   a. Hospitals should consider offering community-based sessions both at
      the hospital and through community groups such as senior centers
      addressing emergency preparedness, response and recovery.
      Sessions could include, for example, how to prepare a disaster bag
      and basics of first aid.

   b. Hospitals can partner with local school districts and offer to provide
      education programs at local schools on first aid and emergency
      preparedness.

4. Modify curricula for nursing, medical and allied health and other
   professionals so that the basic disaster interventions are taught early in
   the curriculum.

   a. Dialogue with appropriate education program credentialing bodies
      should be initiated to discuss integrating a "Basics of Disaster
      Response" program early in health-related training and educational
      programs. One component of such programs might include sessions
      on legal implications of disasters and education regarding the National




                                    5
        Incident Management System (NIMS), Incident Command System
        (ICS), and ESAR-VHP programs.

C. Legal Systems: Disaster-based and Ongoing Operations.

  Pandemic poses unique legal concerns. First, because gaining control over a
  public health emergency may require imposition of limitations on freedom of
  movement of those infected or exposed to infection, use of personal or
  business assets for community purposes and restrictions on movement and
  public gatherings.

  1. Isolation and Quarantine. Individuals subject to isolation or quarantine
     orders may participate in court hearings regarding such orders via
     telecommunication or similar technology.          However, other court
     proceedings will be needed as well.         There will still be criminal
     proceedings, parole hearings, and resolution of civil disputes. How will the
     judiciary deal with these ongoing needs while maintaining social
     distancing interventions?

     a. Healthcare providers should encourage bar associations and legal
        trade associations to convene working groups to address these issues
        and develop processes to ensure compliance with Constitutional
        requirements while best protecting the health of the public and those
        participating in the process. Public health experts and representatives
        of state government, including legislative, executive and judicial
        branches, should participate. Bench Books have been developed for
        several jurisdictions that are an invaluable resource in taking planning
        to the next level.

  2. Differing Interpretations of Law and Fact. Differing interpretations can
     disrupt and hinder emergency response. What can be done now to help
     assure consistency in legal interpretations during a disaster? How can
     hospital attorneys reach a common understanding with governmental
     lawyers regarding legal issues during a pandemic?

        a. Bar associations should convene working groups to develop
           consensus regarding disaster authority and processes. Working
           groups should include a wide cross-section of all affected
           industries. Again, Bench Books provide an invaluable resource.
           Once consensus is developed, it should be widely publicized.

        b. A common call list should be developed for each jurisdiction that
           includes the lead legal advisor for, on the governmental side, public
           health, emergency preparedness, licensing, survey and inspection
           and other related areas; on the private side, hospital, long term
           care, EMS and medical transport, and other groups such as



                                       6
         hospital and medical associations. Regular meetings should be
         held to address planning and to establish relationships.

      c. A call tree of attorneys participating in the above activities should
         be developed and triggered in a disaster.

      d. Healthcare attorneys could work with law schools and public health
         programs to offer a primer on disaster law so that more lawyers are
         familiar with the unique characteristics of disaster law.

      e. Exercises and drills should include consideration of legal issues.
         To accomplish this, bar associations and other legal groups should
         actively seek to open dialogue with emergency planners and should
         be involved in the planning and conduct of emergency exercises

3. Legal Enforceability of ICS Commands. The ICS program assumes that
   those in the response community will comply with the Incident
   Commander's directions. However, in pandemic situations, ICS will
   probably be issuing commands that will impact entities which are
   otherwise not normally subject to incident command. Are Incident
   Commander's orders legally enforceable? How?

      a. In most disasters, entities willingly follow directions of the Incident
         Commander. A pandemic, however, is a peculiarly challenging
         disaster. Decisions may have to be made that threaten the long-
         term viability of a given institution. For example, the decision may
         be made to designate one or more "flu hospitals." It can be
         reasonably anticipated that such a designation will have a long-
         term negative impact on the hospital's reputation. Hospitals should
         confront this issue head-on in planning and should commit to
         compliance with Command's decisions.

4. Pronouncement of Death. Many jurisdictions permit paramedics to
   pronounce death in certain situations.       However, the criteria for
   pronouncement may need to be changed in a pandemic. How can EMS
   providers prepare for an influenza pandemic?

      a. Medical directors of EMS agencies should develop protocols for
         pronouncement of death during a pandemic. Protocols regarding
         disposition of bodies may also need to be modified.

      b. Medical control protocols should also be modified to permit EMS to
         refuse to transport patients in a pandemic when appropriate. "Treat
         and release" authority should be granted.




                                     7
5. Suspending Recordkeeping Requirements. Hospitals and healthcare
   providers have many regulatory obligations, including reporting to state
   and federal agencies data ranging from births to deaths to quality
   information. There must be in place a plan to suspend these obligations
   when appropriate and a plan for resuming and updating recordkeeping
   when possible.

      a. Healthcare providers should establish policies and procedures
         regarding critical and non-critical documentation requirements.
         Processes for documentation should be scaled so that the
         maximum documentation reasonable under the circumstances can
         be completed without unduly detracting from the ability of
         caregivers to focus on providing care.

      b. States should be encouraged to convene workgroups of state
         regulatory personnel, healthcare providers, hospital, medical,
         nursing and EMS trade associations, and legal representatives to
         develop consensus regarding reasonable deviations from
         recordkeeping requirements.

6. Scope of Immunity. Many have addressed the fears of liability by offering
   immunity. However, imaginative lawyers can argue around that immunity.
   For example, the case in which healthcare personnel were found liable for
   negligent documentation on a simple negligence standard despite the
   existence of a statutory gross negligence standard for medical care
   rendered. In a pandemic, recordkeeping is likely to suffer but healthcare
   providers should not be at risk due to recordkeeping challenges.

      a. The workgroup discussed above should develop a position paper
         regarding documentation in disasters that would help establish a
         modified standard of care on this issue.

D.   Public Education: Getting the Public On Your Side

Difficult decisions will need to be made during a pandemic. Americans
typically expect the best of everything and there is no experience with
rationing of care. However, it is very likely that, during a pandemic, care will
need to be rationed.

1. How can the government work with private providers to help the public
   understand and prepare for the realities of a pandemic? How can
   providers and the government collaborate to discuss the difficult ethical
   and practical issues in a forum the public can access and understand?
   How can consensus be obtained on these issues?




                                     8
   a. Hospitals might partner with colleges and universities to develop
      programs to discuss issues of limited treatment and shifts in the
      standard of care in ethics courses, as well as health professions
      courses.

   b. Hospitals might partner with public health, local school districts, and
      others to develop a clear message for community members. Parent-
      teacher associations as well as other school-based events could
      provide a good venue for discussing these issues.

2. The government will need to rely on private citizens to provide support
   during a pandemic. Various mechanisms for volunteering have been
   developed, such as CERT. These teams will be valuable additions to the
   response effort. However, there are many other areas in which volunteers
   can be used, but training and organization will be necessary. Would it be
   helpful to organize teams for other purposes of response – for example,
   organize teams of cooks to prepare meals to be delivered to those
   quarantined at home? What other types of special response teams would
   be helpful?

3. Studies have shown that social distancing can help control a pandemic.
   Social distancing was used in both China and Canada during the SARS
   epidemic. However, unless there is a clear understanding of the reason
   for, and the importance of, travel, gathering and other restrictions, the
   American public may resist these orders. Is there a way to start preparing
   Americans for social distancing before pandemic arrives?

   a. Hospitals might extend current "cough etiquette" and similar teaching
      by partnering with religious organizations and schools to provide
      information on social distancing and respiratory etiquette.

   b. Hospitals, public health, school districts and local partners should
      partner to address suspension of classes and alternative means of
      continuing education during a pandemic.

E. Communications: The Critical Ability to Confer

The most common comment in After Action Reports is that response was
hindered due to communication problems.               Despite the widespread
recognition that communication is critical to effective response, there is still no
consistent communications capability among first responders. What further
can be done to address this issue?

1. Communication considerations typically focus on first responders. In a
   pandemic, the need for secure and effective communication may widen.
   For example, reliable communication between hospitals and their counsel



                                       9
   may be necessary. Further, secure, reliable communication with the
   public will be necessary. However, the communications industry is likely
   to be struck by illness as much as any other industry. How can we
   prepare now to support the communications industry, to ensure continued
   communication capabilities?

   a. Healthcare providers should establish resource and e-mail lists to
      facilitate easy access to resources. Include public health, regulatory
      officials, suppliers and others likely to be involved in response.

   b. Hospital information technology (IT) departments should establish a
      central contact list (including off-hours phone information) for all public
      health and emergency operations personnel across the community.
      This list can be downloaded to PDAs and phones, but updates should
      be pushed out as needed, and re-checked for accuracy at least
      monthly.

   c. Healthcare providers, public health, first responders and emergency
      planners should convene monthly or semi-monthly meetings of IT staff
      for public and private responders to develop trust and common
      approaches for technology and communications continuity.

   d. Healthcare providers and response agencies could establish two
      special areas on the organization's website – one for employees, one
      for community – that relate to emergency preparedness. Publicize this
      as the primary means of communicating during emergencies. Make
      sure this server is on the emergency generator.

   e. Evaluate alternatives for maintaining contact between patients and
      relatives.   Use of webcams, Carebridge.org (free, personalized
      websites that support and connect people during critical illness,
      treatment and recovery), etc. may limit exposure while allowing family
      and friends to "visit" remotely and maintain communications

   f. Hospitals should develop communications processes for disaster that
      offer multiple alternatives in the event technology fails. For example, a
      hospital might provide that, if telephone, internet and cellular
      communications fail, information regarding call-ins and volunteer
      deployment will be posted on the bulletin board at various stores.

2. Some "entertainers" and public personalities have made their reputation
   by sensationalizing issues. During a pandemic, clear, consistent and
   reliable information will be critical. How can private entities, such as the
   broadcast networks, news media and government work together to limit
   inaccurate or inflammatory information without running afoul of the First
   Amendment?



                                     10
         a. Hospitals should work with local and state response        personnel to
            convene a workgroup of media relations personnel            to establish
            protocols regarding public communications, including       defining the
            relative roles of the Public Information Officer ("PIO")   and hospital
            media relations personnel.

II.      Legislative, Regulatory and Policy Issues for Later Consideration

      A. Goods and Facilities: Ensuring the Availability of Essential
      Resources

      1. The government provides incentives for healthcare and first responder
         agencies to participate in community-based disaster planning through
         grant and funding requirements, as well as licensure, certification, or
         accreditation requirements.     Should there be a similar system to
         incentivize private, non-healthcare industries to participate in community
         planning?

      2. If an industrial entity has refused to participate in community-based
         planning, should the government act prior to the disaster to ensure that
         resources are used in conjunction with a community plan?

      3. Certain sectors are commonly recognized as critical to emergency
         preparedness and community-based planning, including healthcare. Is it
         acceptable for healthcare entities to plan internally to ensure adequate
         resources are available and to not offer those resources to other areas?

      4. Who should decide whether a private entity should be required to
         distribute assets for community response? What are the criteria for such
         decisions?

      5. Should special rules for IP rights be developed to protect IP owners who
         voluntarily offer their resources for the greater good during a disaster?
         Are mandatory licenses an option?

      6. What role should the federal government play, compared to state
         government, in ensuring free transport of essential goods?

      7. Should the prison industry be directed to assist in emergency
         preparedness by using the prison industry to prepare hospitality kits,
         modular care units, etc.

      8. Should steps be taken to establish a process for providing cost-free tickets
         for first responders and other essential personnel to transport them to a




                                          11
     disaster area? A reliable means of identifying authorized volunteers who
     have been deployed will be critical.

  9. Drugs and devices commonly have expiration dates. Should legislation be
     passed permitting the use of expired medications and devices in a
     pandemic, so long as those medications and devices remain safe and
     effective? Who would decide that the expired medications and devices
     are still safe and effective?

B. Volunteer Issues

  1. Recent experience has shown that the National Disaster Medical System
     (NDMS) is an excellent resource for trained, qualified personnel during a
     disaster. However, the Disaster Medical Assistance Team (DMAT) and
     other teams are underfunded and often are unable to accommodate all
     qualified volunteers. Should funding for NDMS be expanded and
     additional teams be supported?

  2. Should statutory protections, such as treatment of volunteers as
     temporary federal employees, be expanded to other groups?

  3. Should the Uniformed Services Employment and Reemployment Rights
     Act (USERRA) be extended to cover additional classes of disaster
     volunteers?

  4. Should government identification cards, such as driver's licenses, include
     information about qualifications and pre-credentialing for those willing to
     commit to volunteer in a disaster? Could the RealID initiative (RealID Act
     of 2005) and the proposed DHS funds be used to facilitate this?

  5. ESAR-VHP is a very valuable initiative. However, as it is currently
     structured and implemented, additional credentialing is required even of
     volunteers who are registered with ESAR-VHP. What modifications can
     be implemented that will allow ESAR-VHP registration to suffice as pre-
     credentialing?

C. Legal Systems: Disaster-based and Ongoing Operations

  1. Many decisions regarding limitations on rights and use of private facilities
     for public purposes will need to be made with incomplete information and
     without time for long discussions. Should there be a "Good Samaritan"
     type liability protection for attorneys who advise clients in good faith about
     the appropriate response to disasters?




                                       12
     2. Pronouncement of Death. As discussed above, the criteria for field
        pronouncement of death may need to be modified during a pandemic.
        Should central guidance regarding field pronouncement be issued?

     3. In certain disasters, classified information may need to be shared to permit
        Command to make reasoned decisions. Often, those decisions may have
        legal implications.      However, few hospital attorneys have security
        clearances to permit their participation in discussions of classified
        material. Most attorneys undergo a character and fitness review when
        seeking admission to the bar.           Consideration should be given to
        establishing a process for granting limited security clearance to disaster
        attorneys. Could some of the information gathered in bar applications be
        used to support a limited security clearance? How would updated
        information be provided?

     4. While not always necessary, qualified legal assistance will be critical in the
        event of a major public health emergency or other major crisis. A "Legal
        Officer" position should be added to the Command Staff in the Incident
        Command System.

D.      Public Education: Getting the Public on Your Side

        1. If social gatherings are prohibited, the economy will be significantly
           affected. How can effective social distancing be implemented while
           minimizing the economic impact as much as possible? How can the
           government communicate this aspect of preparedness effectively?

            a. Social distancing may force closure of schools and daycare
               centers. Plans need to be in place to ensure continued schooling
               for children during a pandemic. However, not every household has
               a computer or even a TV. Should there be plans to distribute the
               equipment necessary to permit distance schooling in the event of a
               pandemic? If so, how will households without landline telephones,
               cable or dish access be accommodated? How will attendance be
               measured? How will tests be given?

E.      Communications: The Critical Ability to Confer

        1. The most common comment in After Action Reports is that response
           was hindered due to communication problems. Despite the wide-
           spread recognition that communications are critical to effective
           response, there is still no consistent communications capability among
           first responders. What further can be done to address this issue?




                                          13
       2. Should first responders and other critical workers have the ability to
          register their cell phone number to receive preferential access to
          overloaded cellular networks in an emergency?

III.   Implementation Challenges

       A. While we are encouraging "all hazards" planning, there also needs to
          be recognition that a pandemic is a completely different kind of
          emergency that will present different problems.

       B. Due to the nature of a pandemic, it is more critical to have consistent
          laws across political jurisdictions. However, this may be a challenge
          due to the traditional autonomy of states in disaster response and
          social governance.      It will be important to establish necessary
          consistency without stepping unduly on states' rights.

       C. Response will be prolonged; ability to rely on neighboring jurisdictions
          to assist will be minimal; "responder fatigue" will be inevitable. Plans
          need to anticipate the extended response time, but without much
          experience in this area, it can be hard to anticipate issues.

       D. To obtain needed consistency, some autonomy of political jurisdictions
          may need to be surrendered. The increased need for consistency may
          also send mixed messages about disaster response being a primarily
          local obligation.

       E. Current economic challenges both increase the risks of a pandemic
          and decrease the likely willingness or ability of private industries or
          private individuals to donate or contribute. By the same token,
          financial incentives to encourage participation may be difficult due to
          concerns about the U.S. budget and may result in some incentives
          appearing to be inequitable because they preferentially benefit large
          corporations. As dollars become tighter, it is going to be more difficult
          to fund pandemic preparedness while the risk remains high.

       F. Many of the decisions and actions needed in disaster are contrary to
          the American's ordinary expectations. Disaster planners need to be
          prepared for resistance against recommended actions and for the
          "Chicken Little" characterization (no pun intended) of pandemic
          preparedness if H5N1 turns out to not be the pandemic trigger.




                                        14
                        EXECUTIVE VICE PRESIDENT’S REPORT

Introduction

The purpose of this Board Meeting is threefold:
• to review the Association’s progress on meetings its FY2008 objectives;
• to consider the Finance and Executive Committee’s recommendation with respect to
   the FY2009 budget assumptions and numbers; and
• to receive a brief update from Elisabeth Belmont on the Board elections and from Joel
   Hamme on the Annual Meeting.


             I.        Human Resources

AHLA’s staff turnover has been low. Recently, the Finance Department lost one
employee, and another has announced his intention to go to law school next Fall. Clara
will be looking to fill those positions over the summer. In addition, Maggie Russell who
works on Public Interest activities has just accepted a job in Alexandria and will be
leaving on June 2nd.

             II.       Membership

Membership numbers remain strong. As of the end of April, AHLA had 10,285 members,
and we are averaging roughly 200 more members than we had last year. This continued
strength is a testament to the benefits offered, the visibility provided to those
organizations with significant membership in the association, and the efforts of
committee and staff to welcome newcomers to AHLA.

The Board approved two new Fellows and eight new Emeritus Fellows for FY2009. In
addition, five existing Fellows will move to Emeritus status following the Annual
Meeting. The Fellows Coordinating Committee has recommended a series of changes to
its Charter to make it a prerequisite to have held a leadership post with the Association
before being accepted into the Fellows Program and to assure that someone who is
nominated for the Fellows does not currently hold a leadership position. The Executive
Committee approved those changes at its meeting on May 8.

Challenges

The challenge in membership remains to increase our outreach to Life Science companies
and privately practicing Life Sciences lawyers. Our growth overall is strong, and we want
to continue to look for ways to reach out to the Life Science bar and persuade its
members to join the Association, attend our Life Sciences Institute, and join the Life
Sciences Practice Group.

             III.      Professional Resources




J:\BOARD OF DIRECTORS\FY2008\May 22, 2008\Tab 2 EVP Report 5-08.doc                         1
Professional Resources is having a very strong spring after some delays slowed down
manuscript delivery in the fall. AHLA has had several strong sellers in a row, including
the recently released AHLA’s Guide to Healthcare Legal Forms, Agreements and
Policies; Clinical Research Practice Guide; Peer Review Hearing Guidebook; and
Federal Healthcare Laws and Regulations. We have also just released the Complete
Connected Pharmaceutical and Medical Device Laws CD and will be working on ways
to increase its sales. The Professional Resources staff also works extensively on the
delivery of member benefit for Practice Groups and the membership at large by editing
newsletters, organizing and editing analysis pieces for Health Lawyers News, publishing
Health Lawyers Weekly, and working with those who publish Health Law Daily.

The first editions of the Journal of Health and Life Sciences Law were received
favorably, and the staff is working hard to increase its circulation. Staff is also hard at
work implementing the strategic initiative on outreach so as to create new markets for
AHLA’s products and services. Staff is also hard at work finishing chapters of the Health
Law Practice Guide.

Challenges

The challenge in Professional Resources is to balance the many demands on its time:
finding new, strong products; opening new markets for AHLA products; editing member
benefit content; and continually revising AHLA’s strong selling products.

             IV.       Programs

In-Person programs have performed extremely well this year, as measured by revenue
generated. As of the March financials, seven programs had exceeded their budgeted
revenue targets while only one, Academic Medical Centers, had failed to meet its budget
goal. Another interesting metric is how revenue this year compares to revenue last year.
Five programs exceeded last year’s gross revenue. Two, Hospitals and Physicians, failed
to attain last year’s level, but last year was an all time high for those programs. One
program, Antitrust, was not held last year. The Programs Department paid special
attention to promoting three programs this year: Academic Medical Centers, Long Term
Care, and Medicare/Medicaid. AHLA made progress on the latter two programs, and the
first will remain an area of focus of us.

The entire Association is now hard at work preparing for the In-House Counsel and
Annual Meetings. Registrations and reservations at the hotel look strong. The social
activities look fantastic, and sponsors and exhibitors has expressed more interest this year
than in previous years. So, I am optimistic about the content and the potential success of
this year’s meetings.

Challenges

The most significant challenge in Programs remains strengthening the three programs
mentioned above and continuing to work diligently on increasing attendance at the Life



J:\BOARD OF DIRECTORS\FY2008\May 22, 2008\Tab 2 EVP Report 5-08.doc                        2
Sciences Law Institute. Attendance at that program, held May 7-9, was a disappointment,
however the program’s content was excellent once again. Elisabeth Carder-Thompson,
Bob Leibenluft, Anne, and I have developed a strategy to have a meeting this summer
with the general counsels at PhRMA, BIO, and AdvaMed to request that they each hold
an in-house counsel program the day before our next meeting, which is yet to be
scheduled. This year, we had an unexpected conflict with a PhRMA in-house counsel
program. We want to avoid that at all costs in future years. Therefore, I propose that we
schedule our next Life Sciences meeting only after consulting with these in-house
counsels both to avoid a conflict and to see if we can persuade them to hold their own
meetings the day before ours.

         V.       Practice Groups

                A. Enrollment and Services

Enrollment in the Practice Groups continues to grow. As of May 1, total enrollees are up
for the year, from 5,055 to 5539. Total enrollments have risen from 11,482 to12,383. The
Association has also seen increases in PG 15 and 16 members, demonstrating the success
of many of the Association’s recruitment and retention efforts. I believe that this
consistent growth reflects members’ satisfaction with the growing array of benefits
received.

The Practice Groups continue to increase the number of benefits and communications
that they produce for their members, including electronic alerts, newsletters, and other
informational publications. Staff continues to spend significant time facilitating this
growing flow of information to members.

The Life Sciences Practice Group is the only practice group that has lost members this
fiscal year, but the expected drop has not been as large as expected. All members of the
Life Sciences Practice Group received their membership for free last fiscal year as a
means of encouraging their interest in the subject matter. This year, when required to pay
$45 for membership, 626 individuals remain members, a decrease of roughly 25%.
However, the 626 who remain make Life Sciences a larger practice group than six other
far more established groups, an enviable achievement in one year. The Practice Group
leadership and staff have worked hard to provide meaningful benefits to members.

Challenges

The most significant challenge for the Practice Groups staff over the next six weeks will
be meeting leadership’s desire for additional benefits towards the end of the fiscal year
while also making the significant preparations needed for the Annual Meeting.

                B. Distance Learning Educational Programs

The Association has had an extremely successful year on teleconferences. As of April 1,
the Association was almost $160,000 above budget and just over $140,000 above last



J:\BOARD OF DIRECTORS\FY2008\May 22, 2008\Tab 2 EVP Report 5-08.doc                         3
year’s revenue. Teleconferences have succeeded for numerous reasons: frequent and
significant regulatory developments, volunteer enthusiasm, superior staff organization
and efficiency, and member interest. The volunteers and staff have scheduled a
substantial number of teleconferences in May and June to stay on top of numerous recent
developments, which adds to their already voluminous workload at this time of year.

Challenges

The major challenge on teleconferences is to continue the success that we have had this
year. It is always difficult to predict teleconference success because it is unclear whether
the pace of regulatory change will slow or quicken. This is especially true of FY2009.
Regulatory changes may decrease as the Bush administration comes to an end or it may
increase as the administration tries to make its last significant imprint on the healthcare
landscape.

             VI.       Public Interest

The Public Interest Committee and staff just organized a successful “convener session”
on pan flu preparedness. The session was co-sponsored by the Office of Inspector
General at HHS and the Centers for Disease Control. This co-sponsorship both increased
its visibility and reduced its costs. The input from this session will be incorporated into a
checklist of issues that will help providers, the government and consumers prepare for a
pan flu outbreak in the United States. The release of this checklist as part of the Public
Information Series carves out a niche for AHLA in establishing itself as a leader on
emergency preparedness.

In addition to publishing the pan flu preparedness checklist, the Public Interest
Committee will be releasing two other public information series publications this
summer, one on clinical research and the other on disabilities. The Committee has
completed an ambitious agenda related to the Public Information Series.

The staff also contributed significantly to the launching of the first ever National
Healthcare Decisions Day, organized by Nathan Kottkamp, one of our members. AHLA
participated in a national teleconference featuring some of the most significant experts in
end-of-life care.

Fundraising remains strong, $15,000 above budget and $6,000 above last year.

Challenges

The major challenge in Public Interest is to continue efforts to increase the visibility of
our impressive public interest activities both inside and outside the membership of the
association. Elisabeth will describe an idea that she will work on next year that will
generate more interest and visibility for the Public Information Series.


             VII.      Web & Technology


J:\BOARD OF DIRECTORS\FY2008\May 22, 2008\Tab 2 EVP Report 5-08.doc                            4
The staff continues to work daily on what will be the most ambitious, internal change at
the Association in the last decade. By leaving iMIS and moving to Protech for our
Association Management System (AMS), the staff will have to learn an entirely new
system. While undoubtedly there will be growing pains, the opportunities for data
collection made possible by the new system will far outweigh the transition issues. The
installation of the AMS has gone through familiar delays that often accompany working
with an outside vendor, but we believe that we are on track to launch this summer. The
relationship with the vendor for the new Content Management System (CMS) has been
smooth, and we will be ready to roll out the CMS after the AMS has been launched.

Challenges

The challenge here will be to implement these changes and educate staff with as little
disruption to members as possible and within budget. In the long run, I am confident that
these changes will improve the benefits members receive from the association. The trick
will be to make the transition as seamless as possible.

             VIII. Finance

The association’s finances are strong. The performance at operations this year has been
stellar, with almost every department beating its net revenue targets. It is too early to tell
whether our Operations performance will overcome the drag on our investment portfolio
caused by the negative effect of the fall in stock values, but the Board should be
reassured that the association’s fundamentals are healthy. As of March 31, net revenue at
Operations exceeded budget by almost $600,000 and exceeded last year’s strong
performance by almost $100,000.

At the June Meeting, the Board will vote on the amended Sponsorship policy, which has
been approved by the Finance and Executive Committees.

Challenges

The association’s biggest financial challenge this year has been to overcome the loss in
the Association’s long-term investment portfolio through positive net revenue at
operations. Often investment revenue increases our net revenue gains. This is the first
year in a while where the organization is trying to compensate at operations for losses in
the investment portfolio.

              IX.      Alternative Dispute Resolution

The Alternative Dispute Resolution Service is the one area where the Association has
experienced a slight downturn from budget and from last year. On the revenue side, it is
difficult to predict revenue in this area because it is unclear how many cases will ripen
into disputes that make use of the Service. On the expense side, one person converted
from a half-time to a full time person, adding staffing expense that was not present last



J:\BOARD OF DIRECTORS\FY2008\May 22, 2008\Tab 2 EVP Report 5-08.doc                          5
year. Thus, ADR is roughly $10,000 down on revenue and $20,000 up on expenses from
budget. We hope to close that gap by the end of the year, but I don’t know if ADR will
actually be able to achieve budgeted net revenue by June 30th.

The ADR Task Force has sponsored several teleconferences to boost the program’s
visibility, which have been successful. The Task Force has also given valuable advice on
motions from litigants related to conflicts of interest and other procedural and substantive
questions that come before the Service. The staff and the Task Force constantly work to
promote the Service’s visibility and market its superior ability to resolve cases.

Challenges

The greatest challenge for the ADR Service is to increase its visibility and marketing so
that more parties put the service in their contracts and more individuals become interested
in making themselves resolvers. As the Service grows, the challenge will be to ensure
that its growth does not make it any less responsive to parties or to resolvers.

               X.      Racial and Ethnic Diversity Council

The Council has had an active, energetic year working with staff and other committees to
promote diversity within the leadership and membership of the organization. The summer
internship will continue this summer. Maya Ganguly will work with staff for two months
this summer and will attend the Annual Meeting. The Council is circulating a proposal to
launch a mentoring program that will help members from diverse backgrounds to feel
rooted in the organization and help to launch them into leadership positions. The Council
and staff have launched several profiles in Health Lawyers News about members of the
Council and have continued to strengthen the Racial and Ethnic Diversity (RED)
receptions offered at various programs.

Challenges

The challenge of the Racial and Ethnic Diversity Council will be to continue to make
progress on diversifying our leadership and membership. The Practice Group
appointments this year demonstrate that the organization is taking the issue seriously as it
appoints future leaders. Diversifying the membership and leadership is a tough
assignment that requires commitment and dogged, follow-up. Success will be measured
in years, not months.

Conclusion

FY2008 has been a successful year for the Association. It has been a year where we are
preparing to launch ourselves into the future, through the drafting of a new strategic plan,
the launching of new technology systems, and the development of new benefits for
members. It will take time for us to achieve the goals that we are setting out now, but I
think we are off to a good start.




J:\BOARD OF DIRECTORS\FY2008\May 22, 2008\Tab 2 EVP Report 5-08.doc                        6
               DRAFT

AMERICAN HEALTH LAWYERS
       ASSOCIATION

FY2009 BUDGET ASSUMPTIONS

    AND ACTIVITY PLAN




    (For Board Approval on May 22, 2008)
                                             TABLE OF CONTENTS

EXECUTIVE SUMMARY/HIGHLIGHTS………………………………................ 1

SIGNIFICANT BOARD-INITIATED STRATEGIC EFFORTS… .....................7

MEMBER SERVICES & MEMBER PUBLICATIONS ........................................ 9
Member Dues and Growth ......................................................................................... 9
Membership Development ......................................................................................... 9
Member Publications................................................................................................ 14
Membership Publication Advertising & Mail List Revenue ....................................... 15
Considerations for FY2010………….. ...................................................................... 15

PRACTICE GROUPS ................................................................................... 16
Enrollment Fees…………….. ................................................................................... 16
Enrollee Benefits… .................................................................................................. 16
Webinars/Teleconferences…………… .................................................................... 17
Leadership Meetings & Recognition…………………………………………………….20
Retention & Recruitment .......................................................................................... 21
Considerations for FY2010 ...................................................................................... 22

PROFESSIONAL RESOURCES.............. .......................................................... 23
Overview of Financial Trends................................................................................... 23
Impact of LexisNexis ................................................................................................ 23
Frontlist Products ................................................................................................... 24
Backlist Products ................................................................................................... 24
Derivative Products .................................................................................................. 24
Connected CD Roms ............................................................................................... 25
Journal of Health & Life Sciences Law..................................................................... 25
Health Law Practice Guide & West CD Rom ........................................................... 25
Health Law Archive .................................................................................................. 26
Health Law “Wiki”………. ......................................................................................... 26
Member Publications…………….............................................................................. 26
CMS/Topical Tagging............................................................................................... 27
AHLA Resource Center............................................................................................ 27
Considerations for FY2010 ...................................................................................... 28

PROGRAMS……….. .................………………………………………………...29
In-Person Programs. ................................................................................................ 29
ADR Training…………….......................................................................................... 31
Program Revenue ................................................................................................... 32
Program Expense ................................................................................................... 33
Considerations for FY2010 ...................................................................................... 35

PUBLIC INTEREST ………………………............................................................. 36
Contributions........... ................................................................................................. 36
Public Interest Activities ........................................................................................... 36
Public Affairs and Visibility ....................................................................................... 38
Considerations for FY2010………............................................................................ 39

ALTERNATIVE DISPUTE RESOLUTION SERVICE ................................... 40
Administrative and Resolver Fees........... ........................................................... 40
Educational Sessions….. ......................................................................................... 40
Service Promotion ................................................................................................... 41
Technology Investment ............................................................................................ 41
Volunteer Resources................................................................................................ 41
Recognition & Acknowledgement ............................................................................ 41
Considerations for FY2010………............................................................................ 41

EXECUTIVE- BOARD & GOVERNANCE .................................................... 42
Board & Committees ................................................................................................ 42
Executive Initiatives.................................................................................................. 45
Recognition…….. ................................................................................................... 46
Considerations for FY2010 ...................................................................................... 46

OPERATIONS……. ...................................................................................... 47
Technology Services…………….............................................................................. 47
Personnel/Human Resources ........................................................................... 49
Finance & Administrative Services…….. ................................................................. 50
Fund Balance Investments ............................................................................... 51
Considerations for FY2010………............................................................................ 52
EXECUTIVE SUMMARY
The Association has drafted a comprehensive budget activity plan for the upcoming fiscal
year. The Budget Assumptions include initiatives designed to help the Association make
progress toward the achievement of its strategic goals. The plan has been constructed
with input from Board members and Committees, AHLA staff and the Finance Committee.
The Budget Assumptions incorporate the fiscal impact of ongoing activities as well as new
initiatives designed to help position the Association strategically. The Assumptions also
include important ideas surfaced at the Board’s mid-year meeting in Washington DC.
AHLA’s philosophy in developing its Budget Assumptions is to avoid overly optimistic
scenarios. Rather, the proposed Budget Assumptions are expected to be achievable and
realistic based upon current forecasts of AHLA’s member and customer environment, and
the economic outlook over the next year.

The Budget Assumptions have been developed in each major activity area -membership,
programs, professional resources, practice groups, public interest, ADR, executive and
operations - as the primary business plan for the year, and each committee's goal for
FY2009 should be to implement the activities within its jurisdiction included in the Budget
Assumptions. Each Board committee in FY2009 is charged with implementing the activities
included in the Budget Assumptions by the previous year's committee, and any new
initiatives by a committee should only be undertaken in response to a breaking event or
trend, e.g., the creation of Hurricane Katrina resources in FY2006.

The Budget Assumptions also include an overview paragraph at the end of each major
activity area that provides a summary of the significant changes projected for FY2010
compared to the Assumptions for FY2009. While the focus of these Assumptions is to
describe in detail the activity plan for FY2009, the summary of changes in FY2010 has
been added to link the Budget Assumptions more closely with the timeframe of AHLA's
Strategic Plan.

HIGHLIGHTS OF THE FY2009 BUDGET ASSUMPTIONS

NET REVENUE GOALS
The Association’s financial success during the last several years (and especially the last
five fiscal years), has resulted in building net assets that, prior to the recent economic
downturn, were projected to be slightly over 100% of annual operating expenses at the
end of FY2008, which is considered healthy by association standards. Much of this
financial success was the result of a leadership focus on diversifying and growing gross
revenues (averaging 5% - 10% growth in most areas over the last several years.)
Also over the last several years, the Board has supported a focus on increasing the value
of belonging to AHLA, which has caused the Board to look for ways to enhance the
benefits paid for by membership dues. An example of this in FY2006 was the conversion
of Health Lawyers Weekly to a member benefit and in FY2007 the addition of the Health
and Life Sciences Law Daily. In FY2008, the investment in member benefit has been the
purchase of a powerful association management system (database) and content


                                                                                             1
management system (Web). The Association will realize the benefit of this investment
through a superior ability to organize, communicate with, and serve members. It will
empower the organization to be data driven, to target market more effectively, and to make
informed decisions on how best to meet member needs and increase revenue sources in
FY2009 and beyond. Additionally, AHLA continues to make an investment in attracting life
science lawyers and consultants to our membership.
Based on the Association’s fiscal health, its emphasis on increasing member benefits, and
its continued substantial investment in technology, the goal of the FY2009 Budget
Assumptions will be for the Association to generate net revenues at Operations of
approximately 1% to 2%. Overall net revenues at Operations of 1-2% will result in total net
revenues of 3%-5% after the addition of dividends and interest income from our investment
portfolio, which are not included in operating revenues. Obviously, the performance of the
stock market can have a substantial impact either positively or negatively on the
organization’s total revenues.
A 1-2% goal at Operations will allow modest, and not aggressive, growth of reserves that
are currently at a healthy level, and is consistent with net revenues budgeted over the last
several years. This budget goal will also enable management to budget taking into
consideration a degree of uncertainty about revenues based on the current economic
outlook.


MEMBERSHIP (pages 9-15)
      Membership Numbers and Dues Revenue
      While we hope to achieve a 5% increase in the number of members in FY2008,
      which is comparable to the growth rate projected for FY2008, we will budget a
      smaller percentage of growth to take into consideration the potential effects of an
      economic downturn. Consistent with the strategy of authorizing smaller, cost-of-
      living dues increases on a regular basis rather than larger, infrequent dues
      increases, the Membership Committee is recommending inflationary dues
      adjustments in FY2009 for selected membership groups.

      Membership Initiatives
      AHLA will continue to focus on the recruitment of attorneys in the Life Sciences
      practice area, government attorneys, paralegals, and students.

      Improving Member Benefits
      Members have been pleased with the conversion of the Health Lawyers Weekly and
      introduction of the Health and Life Sciences Law Daily. Continual efforts will be
      made in FY2009 to determine new benefits that will serve to continually enhance
      the value of belonging to AHLA. One example will be continuing discussions in
      FY2009 about whether the Health Law Archive should be converted to a member
      benefit. Another will be rigorous education of members on the new tools, including
      an improved search function, provided by the enhanced website. A third will be a
      pilot program of “AHLA Dollars” in which new members will be given the option of



                                                                                               2
     spending AHLA dollars immediately on increased benefits like a new practice group,
     a publication or a teleconference.

PRACTICE GROUPS (pages 16-22)

     New Business Law and Governance Practice Group
     The new Business Law and Governance Practice Group will be in its first full year of
     operation in FY2009. It will be launched at the end of FY2008 and it is expected that
     the initial interest in the offerings of this new Practice Group will result in a slight
     increase in overall enrollments compared to FY2008.

     PG Enrollment Fees
     The fee to enroll in a Practice Group will remain at $45 in FY2009.

     PG Teleconferences/Webinars
     Practice Groups will exceed budget goals for FY2008 based on revenues through
     February and those projected to be held during the remainder of the fiscal year.
     While budget numbers for FY2009 will be between FY2008 budget and year-end
     projections, management will budget for 35 teleconferences/webinars for FY2009.
     This will be lower than 40 budgeted in FY2008 because it is unclear whether the
     federal government will provide the healthcare industry with the number of
     regulatory changes that provided teleconference subject matter in FY2008. In
     addition to registration revenue, AHLA will seek sponsorship of at least two
     teleconferences/webinars. Fees for teleconferences/webinars will not increase in
     FY2009.

     A larger percentage of teleconferences will be in webinar format in FY2009 because
     of the positive feedback and enhancements enjoyed by participants. Associated
     with these enhanced formats, expenses for teleconferences will increase.

PROFESSIONAL RESOURCES (pages 23-28)

     Non-Dues Publications and Electronic Product Offerings
     FY2008 was the first full fiscal year for evaluating the impact of the revenue share
     agreement with LEXISNEXIS for new and existing titles. Although 80% of new
     titles in FY2008 published in the second half of the fiscal year, it is anticipated that
     net revenues for these two categories of products are projected to slightly exceed
     budget, which reflects better net revenues from non-dues publications than in the
     past. It is also anticipated that the trend towards improved profitability of non-dues
     publications will continue throughout FY2009.

     Journal of Health and Life Sciences Law
     Professional Resources has completed the operation of bringing the content
     development and production for the Journal of Health Law in-house. The product
     has been renamed the Journal of Health and Life Sciences Law and has undergone
     a complete facelift. In FY2008, the principle challenge was the transfer of the


                                                                                                3
     subscriber base to LEXISNEXIS. In spite of increased editorial and marketing
     expenses to support this effort, the Journal is expected to result in net revenues in
     FY2008 and net revenues are projected to improve in FY2009.

     Health Law Archive
     The most significant change in the budget for Professional Resources in FY2008
     came from the sales of the Health Law Archive. Individual subscriptions and site
     licenses have exceeded the FY2008 budget and revenues in FY2009 will be
     comparable to those achieved during this first year of sales. During FY2009, the
     Professional Resources and Membership Committees, as well as the full Board, will
     engage in conversations about whether the undeniable benefit of making the
     Archive a member benefit outweigh the cost of foregone revenue from such a
     successful product. If the change is to be made, it will take place in FY2010 or
     thereafter.

PROGRAMS (pages 29-35)

     Responsive Programming
     In addition to supporting its ongoing in-person programs, AHLA will continue to
     expend resources on creating and marketing its Life Sciences Law Institute, as one
     of its newer offerings. Additionally, a Master’s Program will be planned as a way of
     meeting the educational needs of the most experienced members, and two ADR
     arbitration training sessions and two mediation training sessions will be held,
     consistent with FY2008.

     Going “Green” with Course Materials
     Beginning with the Fall 2008 programs, and continuing through the FY2009 in-
     person program year, attendees will be given the option of saving money by
     passing on the printed program binders .This change is recommended by the
     Programs Committee and is supported by staff, and should not only reduce
     expenses for program attendees (if they choose), but will also be a small
     contribution that the Association can make towards improving the environment. We
     will, however, need to remain flexible so that we can adjust our approach based on
     the reaction of our members. Each attendee, whether or not he or she selects to
     receive the binder, will receive electronic access to the materials prior to the
     program and will also receive a CD with the materials at the program. Registration
     fees will be determined in such a way that they will cover the cost of binders for
     those who elect to receive one in addition to the CDs.

PUBLIC INTEREST (Pages 36-39)

     Public Interest Activities
     The FY2009 Budget Assumptions assume that the Association will continue to
     promote the visibility of the following annual activities: the Public Information Series
     and related supplemental resources; Conversations with Policymakers
     teleconferences; in-person program sessions; ongoing initiatives with the Links to


                                                                                             4
     Academia Advisory Group; and fundraising efforts. In addition, the Association will
     capitalize to the degree possible on the good will generated by the FY08 Convener
     Session on Pan Flu Preparedness. One of the most significant priorities in FY09 for
     staff and the Public Interest Committee will be to develop even greater visibility for
     the consumer products currently in existence.

ALTERNATIVE DISPUTE RESOLUTION SERVICE (pages 40-41)

    ADR Administration
    In FY2006, the ADR Service was brought back in-house to be administered by AHLA
    staff. This transition has gone well and plans are to continue to focus on improving
    quality, increasing revenue over FY2008 levels, and continually increasing the level of
    satisfaction with the ADR Service by users and resolvers.

EXECUTIVE & GOVERNANCE (Pages 42-46)

    Board and Committees
    Expenses will be approximately the same in FY2009 compared to FY2008. The
    FY2009-FY2012 Strategic Plan will be newly approved by the Board, and while it will
    have no immediate financial implications, the Plan will help guide the strategic
    direction and activities for the next several years.

    Advisory Council on Racial and Ethnic Diversity
    Increasing the diversity of our members and volunteer leaders is crucial to the
    Association’s success. The Association will continue to work to expand its diversity,
    and new and diverse members will be encouraged to become more involved in the
    Association. The Council will focus on funding internships at AHLA, implementing a
    mentoring program for diverse members, and various other avenues in FY2009 to
    accomplish its goals.

OPERATIONS (pages 47-52)

    Investment in Information Technology Infrastructure
    The most significant Budget Assumption in this area for FY2009 is the ongoing
    implementation of AHLA’s new association management system (AMS) and content
    management system (CMS) solutions that will be deployed early in FY2009. Many of
    the Budget Assumptions for FY2009 that entail meeting member needs and
    producing electronic products are highly dependent on implementation of these new
    systems, and continual efforts in FY2009 will be made to “fine-tune” these systems to
    best meet our needs.

    Staffing
    A salary increase pool of 4.5% for FY2009 is proposed, which is consistent with
    association industry averages for salary increases and the same level approved in
    Budget Assumptions over the last several years. A bonus pool is also being
    recommended (with the exact percentage recommendation to be determined when


                                                                                            5
budget numbers are developed). Management is also continually reviewing the
employee benefits package in order to maximize its value to staff for recruitment and
retention purposes.

Based on an assessment of staff resources needed to accomplish the FY2009
Budget Assumptions and projections for continual growth of offerings as outlined in
these Assumptions, the budget numbers reflect the addition of one support level staff
position to help administer Practice Group benefits.




                                                                                        6
SIGNIFICANT BOARD-INITIATED STRATEGIC EFFORTS
At this year’s mid-year planning meeting, the Board focused its energies on providing input
into the 2009-2012 Strategic Plan. Thus, the Board-initiated suggestions for the FY2009
Budget may form the nucleus for strategic initiatives that appear in the next Strategic Plan.
In FY2008, the staff spent significant resources putting into place a new association
management system (AMS) and a new content management system (CMS) for the
website. Part of the motivation for implementing these new systems was to be able to
more effectively achieve certain Board priorities.

• Up and Comers and Diversity. The Board has clearly communicated its desire that the
  Association reach out to up and comers and to individuals of diversity to incorporate them
  into the Association’s activities. The need for this focus is reinforced in the Environmental
  Scan survey conducted for the next Strategic Plan, which again revealed a healthy
  tension between members’ appreciation for quality and their feeling that the Association
  could be “cliquey.” In FY2009, the Association will spend staff resources on equipping the
  new AMS with the information needed to facilitate achievement of this important goal.
  This will include tagging information in the system to include an “up and comer” and
  “diversity” designation, which will enable program planning committees, practice group
  leadership teams, and the Professional Resources Committee to search for potential
  participants more easily. In addition, the budget includes funding for an in-person meeting
  of the Advisory Council on Racial and Ethnic Diversity and resources needed to start up
  the Advisory Council’s pilot project on mentorship.

• Expanding Member Benefit. Over the last several years, the Board has advocated to
  increase member benefit as a means of growing membership. The formula has worked,
  as the Association has converted Health Lawyers Weekly to a member benefit and
  initiated a new Health and Life Sciences Law Daily. Simultaneously, membership has
  grown. While this may not be the only cause for growth, there is no doubt that the
  increase in benefits has had a beneficial impact. In FY2008, Health Lawyers initiated one
  of its most successful new products ever. The Archive exceeded predictions for
  subscriptions and revenue and has been extremely well received by subscribers. In
  FY2009, the Board and its committees will grapple with the issue of whether the
  Association can afford to convert the Archive to a member benefit in the future. The
  calculus will involve the loss of immediate revenue weighed against the gain in member
  loyalty and ultimately in membership numbers.

• Tools for the Next Generation of Health Lawyers. In interviews conducted for the
  2009-2012 Strategic Plan, the greatest concern of Board members about the
  Association’s future was its ability to connect with the newest generation of health
  lawyers. The Fellows expressed the same concern at their meeting at the Association’s
  2008 Annual Meeting in Chicago, IL. This will be a significant theme in the next Strategic
  Plan, but the Association will not wait until then to begin addressing this concern. It will
  start in the FY2009 budget. The Professional Resources Committee will be launching a
  six month pilot project on a health law “wiki.” The Advisory Council on Racial and Ethnic

                                                                                                 7
 Diversity and the newly named Payors, Plans and Managed Care Practice Group will
 each be sponsoring a pilot mentor program. The technology staff will also be researching
 the feasibility and desirability of incorporating social networking technology into the
 Association’s website.

• Visibility for AHLA’s Public Information Series. For the past several years, the Public
 Interest Committee has committed staff and volunteer resources to draft important and
 helpful resources for members and consumers on important healthcare issues as part of
 its Public Information Series. In FY2009, the Association will draft an installment in the
 Public Information Series, but will focus more resources on creating visibility for those
 that have already been created. These are extremely valuable, and both the Association
 and the public will benefit from the added visibility.

• Outreach to Aligned Communities. This was an initiative in last year’s Budget
  Assumptions, and it will be included as a strategic initiative in the 2009-2012 Strategic
  Plan. The Board and staff have reached consensus that this is the most effective way to
  increase visibility for AHLA’s products and services, increase revenue, and expand the
  potential base for membership. In FY2009, AHLA will continue to explore joint marketing
  agreements, joint publishing agreements, co-sponsorships of teleconferences and in-
  person programs, and co-branding of public information series documents with aligned
  organizations. Aligned organizations include associations of risk managers, compliance
  officers, financial officers, coders, and similar professions aligned with healthcare counsel
  to facilitate the compliance of healthcare organizations with federal and state law.

• Life Sciences. In FY2007, the Association successfully launched its Life Sciences effort,
  meeting a number of significant goals. The Board has expressed its support for
  continuing this effort, provided that the staff and Board regularly analyze its progress. In
  FY2009, the Association will continue to market its life sciences activities in an effort to
  expand membership, the practice group, the in-person program, publications, and
  teleconferences beyond the traditional membership. The goals for FY2009 will be
  continued growth in membership (100-200 new Life Science members); an in-person
  program with more paid attendees than the FY2008 program; growth in the Life
  Sciences Practice Group; as well as significant coverage of life sciences in the Health
  and Life Sciences Law Daily, the Health Law Weekly and in Health Lawyers News.




                                                                                              8
MEMBER SERVICES AND MEMBER PUBLICATIONS
MEMBER DUES AND GROWTH

Membership Numbers and Dues Revenue
Adjustments: Per the policy on Dues Adjustments, management compiled data related to
dues rates and structures of similarly sized professional associations and specialty law
associations. This annual assessment guides the Membership Committee in its decision-
making process. Consistent with the strategy of authorizing smaller, cost-of-living dues
increases on a regular basis rather than larger, infrequent dues increases, the Membership
Committee is recommending inflationary dues adjustments in FY2009 for selected
membership groups.

Rate of Growth: While our goal will be to achieve a 5% net growth in members in FY2009,
which equals the growth rate in FY2008 (87% retention/18% recruitment), budget numbers
will be built to reflect a smaller growth percentage based on current concerns of an
economic downturn.

MEMBERSHIP DEVELOPMENT

Membership Diversity
Increasing the diversity of our members and volunteer leaders is crucial to the
Association’s success. See Executive/Governance section of the Budget Assumptions for
information related to this key objective through activities of the Advisory Council on Racial
and Ethnic Diversity.

New Members
Individuals joining AHLA for the first time will be welcomed and encouraged to become
active participants in the Association. In FY2009, staff will pilot an initiative dubbed “AHLA
Dollars”. New members will receive these “Dollars” – a credit on their record – which can
be used during the year toward the cost of a practice group enrollment; program, webinar,
or teleconference registration; or a product (like post-program or post-teleconference CDs)
or publication. The Membership Committee will evaluate the level of usage (who, how and
for what they are used for) at the conclusion of the fiscal year to determine if the pilot
should become the norm in subsequent years.

New members and members attending their first annual meeting will be invited to attend a
special interactive networking reception at the Annual Meeting.

Lawyers New to Health Law
The Association will continue to build on its efforts to add value for young attorneys and
attorneys new to health law. The Association will identify and introduce new and/or
additional benefits for members admitted to the bar less than four years ago, e.g., ATT1
and IHC1. In addition to encouraging these members to attend the successful
Fundamentals of Health Law program, Practice Group leaders will be asked to help these


                                                                                             9
members become more active participants in Practice Group activities. The Association
will utilize tools and technology available through the new AMS/CMS to enhance
networking and communication among those in this group. The Association will also
determine the level of interest among ATT1/IHC in having discussion forums, blogs,
access to additional content, tutorials, interactive educational events, creative discounts,
etc. and will introduce several key benefits in FY2009 that meet members’ needs. (See
also ‘special inserts’ under Health Lawyers News.)

Dues Billing
Discounting of annual dues payments will be explored for those who opt to join or renew
online. In addition, members will be able to renew for multiple years online and when they
do so, they will be given a discount on dues in subsequent years, e.g., renew for $915 for
three years (member charged $330 for first year’s dues, $310 for second year’s dues, and
$275 for third year’s dues). Staff will also explore the feasibility of having members provide
AHLA with a credit card number so that their dues would automatically be billed each year.

The Association will determine if the new AMS/CMS improves efficiency so that we can
continue a pilot for a group billing option for firms and organizations. Staff will identify and
work with a central contact for each group, designating a specific month for sending the
group renewal so that upon payment by the firm, all members will have their membership
extended for an additional twelve months.

Membership Retention
The Association will continue sending new members a resource packet with ID card and
guides, and sending renewing members a member benefits guide and ID card. We will
utilize member type codes to deliver focused messages about membership benefits—both
in print and through email—and will continue to use an outside telemarketing firm to follow-
up with lapsed members.

Top Honors
It is anticipated that the Association will continue to recognize firms and organizations
having multiple members and to also provide opportunities for solo practitioners and those
from small firms to be acknowledged for their commitment to AHLA.

Fellows Program
In FY2009, the Fellows program will continue to promote the new class of Fellows;
nominate and select the 2009 class of Fellows; work with the Public Interest Committee to
advance the public interest mission; and collaborate with other leaders to support the
Association’s educational and practice group activities. The work of the Fellows
Coordinating Committee will be facilitated through conference calls and email. An
administrative fee will help offset the costs of holding an event for the Fellows at the
Annual Meeting and providing new Fellows with a gift.

Membership Directory
Since its launch in November 2005, the electronic Membership Directory has been well
received by members, with 6,000 downloads (members placing it on their desktop at their


                                                                                               10
offices and homes as well as on their laptops). Monthly updates keep the Directory current
and complete. Efforts will be made to promote the Directory to the membership so that the
number of downloads continues to increase and we find even more members using the
Directory on a regular basis. Links will continue to direct members to the website to receive
information about upcoming events and new product releases. The software and licensing
fees will remain consistent with FY2008 actual expenses.

Membership Recruitment
The Association will continue to send applications and a membership benefits brochure to
interested prospects. Opportunities for collaboration with specialty law associations, state
bar associations, and other health groups will continue to be explored. Several direct mail
campaigns to target audiences will be conducted; external lists will be tested along with
existing internal lists of prospective and lapsed members, and a variety of incentives will
be offered. Materials will be developed that highlight the benefits of membership for
various target audiences, including the following:

Life Sciences: A range of activities, including direct mail and electronic outreach
campaigns will be implemented. Expenses for consulting/contracted services, external
lists, and printed materials will be incurred. The purpose of investment in life sciences is to
grow both the Association’s membership and its revenues by adding counsel that
represent pharmaceutical manufacturers, pharmacists and pharmacy benefit managers;
biotechnology innovators and manufacturers; medical device manufacturers and
distributors; new attorney members in the life science industry; and non-attorneys like
pharma compliance officers, and consultants from accounting firms. The purpose of the
Life Sciences initiative is to enable the Association to provide interested individuals in both
communities with the health and life science law content needed to remain on top of their
respective fields. The Association will also again sponsor a dinner connected to the Fall
AdvaMed program. The metrics for FY2009 membership growth from attorneys and
consultants with an expertise in life sciences is 100-200 additional members.

Government Bundle: The Membership Committee recommends that the ‘government
agency bundle’ move from a pilot status to a permanent dues option. Efforts will be made
in FY2009 to retain existing agencies, to increase the number of Medicaid Fraud Control
Units participating, to grow the number of agencies that choose to join, and to enhance the
benefits for those enrolled in the program.

Student Organization Alliances: The Association will continue to focus on the creation of
more agreements with Student Health Law Organizations and increasing the number and
type of benefits for students, the faculty advisor, and the law school. The Association will,
whenever possible, utilize Fellows as resources in a speakers’ bureau for law schools.
Staff will explore the feasibility to establishing a pilot program that will seek to identify and
work with specific law schools having a strong health law program. The goal will be to have
the school underwrite the membership dues for a specific number of students, similar to
the way the government pilot is structured. The faculty advisor will receive an academic
membership and the student health law group will have access to a range of benefits from



                                                                                              11
the Association. When feasible, staff will make presentations and share materials with
schools participating in the pilot.

In-House Counsel: The Membership Committee and the In-House Counsel Practice Group
will continue to work together to reach more in-house counsel in order to grow this
segment of the membership. Recruitment through both direct mail and electronic mail will
be utilized, as well as the Health Lawyers News magazine.

Paralegals: With the establishment in October 2007 of an electronic membership option for
individuals employed as paralegals, the Association has begun to attract more members
from this target audience. AHLA will again feature a campaign in the fall that bundles a
membership and registration fee for the Fundamentals of Health Law program together for
a special price. On a regular basis, information about the paralegal category will be
highlighted in the Health Lawyers News magazine and in a Member Update email, e.g., an
invitation and application for paralegals, with members being encouraged to sponsor
paralegals from their firm/organization. Staff will explore the feasibility of exhibiting at a
national event for paralegals and/or advertising placement in key publications of interest to
paralegals.

State Health Law Alliances: The Association will continue to focus on (a) the negotiation of
more agreements with State Health Law Organizations and (b) increasing the number of
activities/amount of collaboration between AHLA and the state healthcare entities.

Members with Disabilities: The Association will continue to be an organization that is
aware of and conscientious about providing appropriate accommodations at its events. To
the extent possible, AHLA will identify attorneys with disabilities and encourage their
participation in the Association.

Practice Group Retention & Recruitment
The Association will continue to promote the benefits of Practice Group enrollment and
publicize the variety and quality of resources and activities. Overall expenses for
membership development activities will increase slightly compared to FY2008 actual
expenses.

Special efforts will be made to reach out to new and existing AHLA members not yet
affiliated with Practice Groups, informing them about the benefits of enrollment.

Several practice groups will be renamed (Fraud and Abuse; Long Term Care, Senior
Housing, In-Home Care and Rehabilitation; and Payors, Plans, and Managed Care). The
new Business Law and Governance Practice Group will be launched and promoted.

Materials highlighting Practice Group benefits, activities, and accomplishments will
continue to be distributed to members. Vice Chairs for Membership will be tasked with
assisting staff with outreach and recruitment efforts among new members. The
membership renewal process will continue to highlight the benefits of Practice Group
involvement. Articles in the monthly magazine and information on the Association’s


                                                                                           12
website and Practice Group web sub-sites will highlight the benefits of affiliation. Finally,
the Association will continue to promote PG-15 and PG-16 options throughout FY2009.

Marketing
Research: Members will be asked to update (or provide) demographic information for their
record through notices in the Health Lawyers News magazine, on the website, listserves,
email footers, etc. Several surveys will be conducted throughout the year, including the
following:
o brief surveys to past program attendees (to seek their input about topics and to
    announce that a date and location has been confirmed for the program);
o brief surveys to practice group enrollees to evaluate the quality of activities, reasons for
    enrollment, and/or reasons for non-renewal;
o survey to members and several focus groups to evaluate members’ and prospects’
    level of knowledge and understanding about membership benefits and the degree of
    satisfaction with those benefits;
o survey to past attendees and leaders related to potential annual meeting sites;
o focus group during the Fundamentals program to discuss ways to meet the
    professional needs of lawyers under 40 and determine what these members value
    most; and
o readership survey to members about the Health Lawyers News and other membership
    publications.

Expenses will be necessary for design, as well as for data collection, entry and tabulation.
A facilitator will be used from the Chicago area to reduce costs for the fundamentals focus
group.

Activities: The Association will continue to prepare and send the monthly Education at a
Glance, regular Member Update emails, and periodic ‘Current Issues in Health Law’
emails; use direct mail to promote AHLA publications, programs, and the Journal; display
the AHLA booth and/or pop-up displays during selected programs (AHLA as well as
selected other healthcare associations); distribute branded tchotchkes to promote AHLA
and its products and services; and place advertisements in AHLA’s internal publications
and pay/barter for placement in external publications. Expenses for purchase of graphic
images for use in the Association’s various marketing materials, practice group
newsletters, public information resources, etc. will increase slightly compared to FY2008
actual expenses to enable the Association to build a more complete library of graphic
images. The Membership Committee will continue to monitor the sponsorship and
advertising on information sent to members and prospects, advising and making
recommendations regarding the effect on member communications.

Outreach to Non-Members and Prospects: Staff will use email and other methods to reach
out to individuals from the listserve registration, the ‘A’ list for subscriptions and
publications, etc. Efforts will be made to rent outside lists (or do list exchanges when
feasible and appropriate) to use in direct mail promotions for the Association’s publica-
tions, programs, and membership outreach. Various approaches, e.g., split list tests,
piggybacks, etc. will be used, and results will be monitored and analyzed. Efforts will be


                                                                                                13
made to identify and reach members’ assistants in order to educate them about the new
CMS and to show them how to access content for the attorneys for whom they work.

Association Linkages: The Association will continue to implement its strategic initiatives of
“opening additional markets for Health Lawyers’ content” and “developing a
comprehensive outreach program to distribute Health Lawyers’ Public Information Series
to the broader healthcare community.”

MEMBER PUBLICATIONS

Health Lawyers News (HLN)
The monthly magazine will average 48-pages. Display and classified advertising will
continue to be included in order to help offset the costs of the magazine. Typically the
December issue is larger because of the inclusion of the Resource Guide and the
September issue is larger because of the wrap-up of the In-House Counsel program and
Annual Meeting. In addition, the magazine will include two 8-12 page inserts especially for
lawyers under forty, which will contain articles that focus on the actual practice of law, the
‘ABCs’ of healthcare law, list of useful acronyms, etc. When possible, content from the
practice groups’ newsletter may be incorporated into the inserts. Staff will use results from
a planned readership survey, along with leader input, to implement a partial or total
redesign of the publication.

Non-staff Writers: Expenses for non-staff writers will increase slightly compared to FY2008
actual expenses.
Art and Design: Expenses for occasional use of an illustrator, purchase of graphic images
for use on the cover and throughout the magazine, and photography for leader profiles will
be incurred.
Online Legal Research: Expenses for online legal research will reduce compared to
FY2008 actual expenses because LexisNexis agreed to provide AHLA with three
complimentary subscriptions to their online services, which will eliminate the cost of the
Westlaw subscription that AHLA currently purchases.
Printing: Overall printing costs will increase compared to FY2008 actual expenses.
Mailhouse: Expenses for handling the magazine will remain the same compared to
FY2008 actual expenses.
Postage: Overall postage costs will increase compared to FY2008 actual expenses,
because of an anticipated postal increase.
Production: The administrative overhead allocation will remain consistent with FY2008
actual expenses.
Miscellaneous: This line item will remain consistent with FY2008 actual expenses to allow
training, development and program travel for editorial and production staff in addition to
annual subscriptions to various health law related publications.

Health Lawyers Weekly (HLW) with Health Law Digest (HLD)
Management will market Health Lawyers Weekly to other healthcare industry groups such
as state bar associations, law schools with health law programs, legal organizations,
publishers of health law and policy news, and health policy associations.


                                                                                            14
Non-staff Writers: Expenses for non-staff writers will increase slightly compared to FY2008
actual expenses.
HLD Case Suppliers: This line item will remain consistent with FY2008 actual expenses.
Online Legal Research: Expenses for online legal research will reduce compared to
FY2008 actual expenses because LexisNexis agreed to provide AHLA with three
complimentary subscriptions to their online services, which will eliminate the cost of the
Westlaw subscription that AHLA currently purchases.
Miscellaneous: This line item will remain consistent with FY2008 actual expenses to allow
training, development and program travel for editorial and production staff in addition to
annual subscriptions to various health law related publications.

MEMBER PUBLICATION ADVERTISING & MAIL LIST REVENUE

Advertising
AHLA will continue to receive a commission from an independent contractor based on the
amount of sales for display advertising, ‘Focus On’ Sections, and other special advertising
supplements and inserts in the Health Lawyers News magazine. In addition, the Career
Center will continue to provide revenue from paid advertising in the online job bank,
monthly employment alert email, and classifieds in the Health Lawyers News magazine.

Mail List Revenue
AHLA will continue to receive a commission from the list broker based on the amount of
sales from interested parties. AHLA will continue to work with an outside vendor to
coordinate the Association’s efforts to solicit potential list rental parties. The list broker will
continue to be responsible for promotion and all marketing, billing and collection.

CONSIDERATIONS FOR FY2010

•   It is anticipated that outreach to those in Life Sciences and enhancement of member
    benefits will remain key initiatives and that as a result membership growth will continue.
•   Health Lawyers News will continue to be a primary mechanism for sharing healthcare
    legal and membership news and as such it is anticipated that it will continue to grow in
    content. Advertising revenue will continue to help offset some of the costs associated
    with production.
•   The Association will continue to build on its marketing efforts, increasing the occasions
    and ways it reaches out to members and other interested buyers.




                                                                                                  15
PRACTICE GROUPS
The Practice Group program at AHLA serves each of the Association’s strategic initiatives
in different ways. Practice Group sponsored teleconferences continue to strengthen the
quality and the diversity of the Association’s educational offerings. In FY2008, the Practice
Group program will launch its 16th Practice Group—Business Law and Governance. Due to
the tremendous amount of interest in this Practice Group, it is expected that the
Association’s Practice Groups will experience slight growth in FY2008 and FY2009. The
member briefings, e-alerts, and practice group sponsored publications create, nurture, and
leverage AHLA’s intellectual capital. The participation of practice group members in task
forces to develop public interest publications expands the Association’s commitment to
serving as a public resource. The opportunities for leadership and recognition in the
practice groups increase visibility for those volunteering their time and talents.

PRACTICE GROUP ENROLLMENT FEES

The fee to enroll in a Practice Group will remain at $45 for FY2009.

Various techniques for retaining Practice Group enrollments by those currently enrolled as
well as increasing enrollments by those who are currently not enrolled in a Practice Group
will continue to be explored for FY2009.

PRACTICE GROUP MEMBER BENEFITS

Management will continue to evaluate Practice Group benefits in FY2009 to confirm value,
determine ways to increase value, and better communicate value to enrollees and
potential enrollees.

Web Sites
The Practice Group Web site home page and all 16 Practice Group sub-sites are being
used by members to access current and past information. These sites contain copies of
newsletters, member briefings, email alerts, toolkits, links, and other information accessible
only to members of that Practice Group. A priority of the Practice Group Committee and of
staff in FY2008 and FY2009 will be to increase utilization of these sites by providing
additional Practice Group benefits on the Web. Management will budget the addition of
one support level staff position to ensure that all of the Practice Group websites are up-to-
date and fully operational, and that other new benefits outlined in these Budget
Assumptions are delivered. Staff time dedicated to website maintenance may increase
slightly as staff is trained on the new computer system that will be put in place as of April
2008. Currently, the amount of postings to the website has increased as have the e-Alerts
and member briefings. It is expected that this trend will continue.

Practice Group leaders have worked on a system to ensure that Web sites are consistently
reviewed, and recommendations for quality control are made to staff. In order to ensure
that those who want to write for Practice Groups have that opportunity, AHLA will provide
some of the newsletter content online if annual printed page content exceeds current


                                                                                           16
guidelines (see below for further explanation). Posting to the Practice Group Web sites
allows information to be distributed quickly and efficiently and supports the Practice
Groups in achieving their minimum benefits for the year.

Additionally, Practice Groups will continue to be encouraged to produce benefits that
educate both Practice Group members and other AHLA customers. The “toolkit” concept,
recommended by Practice Group leadership, will continue in FY2009 in coordination with
the implementation of the new CMS (see Web Budget Assumptions related to Content
Management project and the production of new Web products.) During FY2009, we can
expect at least one to two toolkits to be developed by Practice Group leaders and staff.
These “toolkits” provide additional benefit to Practice Group members and additional
content on the Web site, both of which should encourage membership growth.

Newsletters
During FY2008, the Practice Groups staff developed a new format for all of the newsletters
that are produced currently by the Practice Groups. In September 2007, the Practice
Groups staff launched the very first redesign of the newsletter with the HIT Practice Group.
In FY2009, each Practice Group will continue to send up to 20 pages of printed news to its
members a year, in either one 20-page newsletter or two 10-page ones—and an additional
4 pages will be added to promote AHLA products and services that would be of interest to
the members of the Practice Group. The Practice Group leaders will continue to determine
which articles should be included in the printed newsletters, mailed to enrollees, and made
available on the Web site. Additionally during FY2009, dialogue will be held between PG
leaders and staff about the impact of moving toward electronic delivery of newsletters.

Education Meetings/Luncheon Programs
Each Practice Group is expected to hold two meetings per year. Enrollees attending
Practice Group meetings at national programs will be charged a fee when there are
expenses incurred for food functions such as breakfasts, lunches, or receptions related to
the Practice Group meeting. Luncheon fees are collected to cover the cost of providing the
lunch, and are expected to change in FY2008. A luncheon fee differential was
implemented in FY2005 that resulted in Practice Group enrollees paying a lower luncheon
fee of ($38) compared to non-enrollees. For FY2009, that amount for Practice Group
enrollees will be reduced to $35. Also, the non-PG enrollees for FY2009 will remain at $45
to help defray net expenses associated with the luncheons. Volunteers and staff will
continue to seek sponsorship for the Practice Group luncheons, with the sponsor being
given the opportunity briefly to introduce him or herself at the beginning of the lunch or to
speak on an issue of substance if asked by leaders of the Practice Groups. This will help
to decrease the cost of the luncheon for the Practice Group members.

WEBINARS/TELECONFERENCES

Webinars/teleconferences continue to be the primary method for delivering education on
emerging legal and regulatory developments to members. The Association will budget for
35 Practice Group-sponsored webinars/teleconferences that will require a fee from
registrants in FY2009. Contingency plans will be made for more if needed to make the


                                                                                           17
budget, but 35 teleconferences will allow the staff to devote more time to the operations
and administration of the Practice Group activities. Also, in FY2008, the federal
government was generous with providing the healthcare industry with a wealth of
regulations that proved beneficial to AHLA and its Practice Groups. However, it is
expected that this trend may very well change, and therefore, a more conservative
estimate on the number of webinars/teleconferences is provided.

The Practice Group staff will continue to promote sponsorship for a few of the
webinars/teleconferences. In FY2008, we piloted two sponsored webinars which were well
received. These sponsored webinars were offered to the sponsoring Practice Groups of
the webinar for “free.” We will continue to work on offering at least two or three sponsored
webinars in FY2009.

While topics for the budgeted webinars/teleconferences have not yet been identified,
management will schedule webinars/teleconferences in response to important regulatory
or legislative developments. Additionally, webinars/teleconferences can serve as a forum
for debate and dialogue on issues facing the health industry and health lawyers as they
counsel the industry. The Practice Groups will continue to sponsor 3 teleconferences
during FY2009 that will be geared to advanced level listeners, as characterized by criteria
approved by the Practice Groups Board Committee in FY2008.

Fees
Fees for non-member registrants will increase slightly, but fees for members and PG
enrollees will not change in FY2009. We will continue to offer discounts for multiple
purchases and bundling of teleconferences in FY2009.

We will continue to offer discounts for members of sponsoring Practice Groups that will
serve as a direct benefit of Practice Group membership. AHLA members who are not
members of the sponsoring Practice Group will continue to receive the member price.

Non-Members of AHLA will continue to pay more than members. The differential and rate
for non-member registrants will increase in FY2009.

Note: Teleconference fees in FY2009 will be:

Sponsoring PG enrollees $145
Members of AHLA $190
Non-members of AHLA $275

Teleconference Web Enhancements
During FY2007 and FY2008, the Practice Group staff worked with the teleconference
vendor extremely hard on the production of webinars. During the summer of 2007, and for
the entire month of August 2007, Practice Group staff and leaders were trained on the
Webex system. This was done to offer a new product of webinars to the AHLA
membership. The speakers for Practice Group webinars now have the ability to post



                                                                                            18
PowerPoint slides that can be advanced by each of the speakers; allow listeners to send
questions directly to the presenters; and record the presentation.

The enhanced system currently allows the speakers to use an audio-response system that
will provide participant feedback in real-time. In FY2009, use of the polling feature will
allow for the participants to provide instant feedback to AHLA by using either their
phone/computer keypad. After their responses have been received, the system will provide
an instant report to AHLA that shows where the participants are on an issue. This
information is often used to plan future webinars.

Also, for FY2008 and FY2009, and through the enhanced system, we are proposing to
make available as a pod-cast, or in the form of a CD, the audio of the
webinar/teleconference for at least 72 hours after the webinar/teleconference has
concluded. This is for participants who have paid for the webinar/teleconference and were
unable to attend. There will not be a cost to the participants who have paid to have access
to the audio. For those who wanted to attend but missed the deadline for registering and
did not pay, there will be a charge to download the Podcast, purchase the CD with audio
and/or materials from the AHLA website.

Because a larger percentage of webinars is anticipated in FY2009, expenses are projected
to increase.

Sponsorship
AHLA staff in FY2007 began to investigate the possibility of sponsorships for PG events,
products and services. The staff sought non-attorney sponsorships of luncheons and
teleconferences. Thus far during FY2008, we have successfully sponsored
teleconferences, lunches, and a webinar. In FY2009, we will continue to seek sponsorship
for at least two teleconferences and for post-teleconference/webinar CDs, consistent with
AHLA’s sponsorship policy, slated to be approved in June 2008. Also, AHLA will continue
to seek joint sponsorships of teleconferences with other associations, which will increase
visibility for the Association and marketing for the telephone seminars. This effort will
support the Board’s desire to expand recognition of AHLA’s brand as the leading provider
of health law content.

Teleconference/Webinar CDs
In FY2009, AHLA will continue to offer teleconference/webinar CD’s to the AHLA
membership. This service is handled by the Practice Groups and Finance staff.

CLE Credits
AHLA offers CLE credits for teleconferences, requiring that enrollees complete a certificate
of participation and submit that form directly to their state bar for credit. AHLA is pre-
approved for CLE credits in Texas. Management will continue to evaluate the costs and
benefits of obtaining pre-approval for CLE credits in other states. Also, in FY2007, Illinois
began to charge for processing CLE’s for our members. In FY2009, there will be additional
money set aside in the event other states that have not charged the Association in the
past, begin to do so.


                                                                                          19
New Policy for the Additional Teleconference Listeners Who Desire to Obtain CLE
Credit—Effective 1/2/2008

A new feature added in FY2008 allows each person desiring CLE credit to register
separately, one person at the full price and others at a discounted rate. Additional
participants from the law firm/organization who register for the CLE price will (when they
register for the teleconference) supply their names plus the name of the person registering
from their firm who has registered at the full price. The Practice Group teleconference
registration form allows additional members to receive a group discount, provided that they
submit a separate registration form on the same day. As mentioned above, non-member
fees will increase slightly and member/PG registration fees will remain the same.

The registration form will then generate the normal e-mail confirmation to the full-price
person, and the CLE participants/extra listener(s) will receive an e-mail confirmation that
says AHLA has received their registration and their CLE credit information will be available
online in the My CLE section.

Marketing
Marketing for teleconferences/webinars is done primarily through the use of broadcast
email, the AHLA Web site, and announcements in Health Lawyers News. We will continue
in FY2009 to expand the e-mail marketing to include non-member customers (prospects
within our database as well as use of external lists). Minimal marketing expenses are also
associated with broadcast faxes sent for each telephone seminar.

LEADERSHIP MEETINGS & RECOGNITION

Practice Group Leadership Meeting
The meeting for FY2009 Practice Group Chairs (or Vice Chair in absence of a Chair) will
be held at the Annual Meeting. While the Association does not cover expenses for Vice
Chairs, they are welcome to attend the Leadership Meeting if they are already at the
Annual Meeting and want to participate. In addition to the Chairs, the Practice Group
Board Committee Chair as well as the Practice Group staff will be in attendance, and
Practice Group Board Committee members will be invited. Consistent with the treatment of
program Chairs and in recognition of the goals of the Board’s FY2007 RAVES (volunteer
recognition) initiative, round-trip airfare, one day’s meals and lodging, and one day per
diem will be covered for the Chair (or another representative if the Chair is unable to
attend) from each Practice Group. This orientation meeting will be held again in FY2009

Practice Group Leader Conference Calls
Three teleconference calls for Practice Group Chairs and Vice Chairs to trade lessons
learned and best practices with one another and the Practice Group Board Committee
were scheduled for FY2009, one in early fall 2008, one in late winter, and one in early
spring 2009.

Practice Group Leaders Recognition


                                                                                          20
Several initiatives to promote recognition of Practice Group leaders have been
implemented over the last several years, and they will be continued in FY2009.
Additionally, in FY2009, we will make additional efforts, consistent with the RAVES
initiative, to recognize PG members for their continued support of the Practice Groups.
There will be a mechanism in place to plan these activities, but there will be no direct costs
to AHLA. There may be a slight increase in the time it takes to plan these events, but these
measures will serve the strategic initiative of supporting and recognizing volunteers:

Reception: The Board of Directors will continue to sponsor a reception annually that will
include Practice Group Chairs, Vice Chairs and guests.
Health Lawyers News: Practice Group newsletter and member briefing writers and editors
will continue to be recognized monthly in Health Lawyers News.
Health Lawyers News Feature Articles: Feature articles appear monthly in the magazine
and provide members with relevant information on current events, trends in the legal or
healthcare industry, the practice of law, etc. Practice Groups are assigned a specific month
for submission of an article of their choice. The design and artwork for that issue of HLN
are structured around the topic being addressed, and special recognition is given to the
authors and the sponsoring Practice Group leaders.
Webinar/Teleconference Speakers and Moderator: A small “thank you” gift that includes
the AHLA logo and name will continue to be sent to all teleconference speakers and
moderators with a letter from staff thanking them for contributing their time and expertise.
Management will explore the possibility of providing small “thank you” gifts to newsletter
and member briefing authors and editors as a means of encouraging more authors to write
for the PGs.
Retiring Practice Group Chairs and Vice Chairs: A thank you plaque that includes the
AHLA logo and name, recipient’s name, and service being acknowledged will continue to
be presented to all retiring Practice Group Chairs and Vice Chairs at the Practice Group
annual luncheons
Discounts: The Association will explore a registration fee discount for Practice Group
leaders to their sister in-person programs.
Ribbons that designate that a participant is a PG Leader, or a member of a Practice Group
will be attached to the participants name badges when in attendance at AHLA
conferences.

Management will continue to explore further ways to recognize leadership in Health
Lawyers News.

Committee Activities
Expenses associated with projects and activities as developed by the Committee’s
leadership (e.g. co-sponsorship of projects with a Practice Group and the Public Interest
Committee when appropriate, development of Practice Guides, newsletters, meetings,
leadership conference calls, on-line forums and listserves, etc.) will be continued in
FY2009. Each Practice Group has an electronic presence that is expected to continue to
grow during FY2009 requiring additional resources. An inflationary increase in expenses
associated with these activities is expected in FY2009.



                                                                                            21
RETENTION & RECRUITMENT

Overall expenses for membership development activities will moderately increase in
FY2009. Activities will include attracting members to enroll in Practice Groups and
implementing initiatives to retain them.

Recruitment
Special efforts will be made to reach out to new AHLA members not yet affiliated with
Practice Groups, telling them about the benefits of registering for webinars/teleconferences
and of being a member of the Practice Groups. Direct mail campaigns, outlining the
benefits of membership as well as Practice Groups involvement, will be sent to prospective
members encouraging them to join. Additional initiatives targeted at current AHLA
members who are not enrolled in Practice Groups will be developed and implemented
during FY2009.

Retention
Materials highlighting Practice Group benefits, activities, and accomplishments will
continue to be distributed to members. The membership renewal process will highlight the
benefits of Practice Group involvement to members currently enrolled in Practice Groups
and to members who are not currently enrolled in Practice Groups, through a variety of
methods including e-mail, fax broadcast, and mail. Efforts to increase exposure to Practice
Groups will also be tested throughout the year by special offers and discounts upon
renewal and at other times throughout the year. Special Practice Group activities will be
publicized to non-members on the listserves and in other ways. Surveys will be developed
and distributed in order to evaluate the quality of activities, reasons for enrollment, and
reasons for non-renewal. In addition, articles in the monthly magazine and information on
the Association’s Web site and Practice Group Web sub-sites will highlight contributions of
Practice Group enrollees and Committee activities. Leaders will continue to contact new
members and to encourage them to enroll in and/or to become involved with Practice
Groups.

A continuing effort will be made in FY2009 to promote and evaluate the success of the
new category initiated in FY2005 for Web only enrollments for those who already pay for
four PGs at full enrollment fees (PG-15).

CONSIDERATIONS FOR FY2010

•   As more features become available for the Practice Groups to use, there may be an
    increased expense for additional use of the conference calling company.

•   It is expected that more sponsorship dollars will be made available to the Practice
    Groups to help provide additional benefits to PG members, such as more free
    teleconferences for PG members and a reduction in the price for PG luncheons.

•   In FY 2010, AHLA will explore the utility and member benefit of a
    webinar/teleconference that could be conducted locally as an Executive Briefing.


                                                                                          22
PROFESSIONAL RESOURCES

OVERVIEW OF FINANCIAL TRENDS

Revenues in Professional Resources have tracked inconsistently since 2003, for a number
of reasons. In part, the unreliability of manuscript delivery and the high level of financial
risk associated with the introduction of new titles make this component of the Professional
Resources budget inherently volatile. In addition, several organizational changes either re-
directed dollars from Professional Resources to another department (for example the
transfer of teleconference CD sales to Practice Groups in FY2008) or eliminated the
source of revenues entirely (the conversion of Health Lawyers Weekly to a member benefit
in 2006). Finally, the publication schedule for the Journal of Health Law was wildly
unpredictable, resulting in 3 issues publishing in one fiscal year and 5 issues in the
following year (FY2004), and creating significant fluctuations in expenses.

Over the past several years, Professional Resources staff has worked on several different
fronts to stabilize revenues and expenses across all product lines. The primary focus of
these efforts has involved solidifying and enhancing the revenues from relatively
predictable sources and products (eg: the Journal, the Health Law Practice Guide,
derivative products) so as to cushion non-dues publications revenues against the financial
pitfalls that this product line faces in any given year. We have also attempted to build a
solid array of renewable sources of income for non-dues titles, by adding new
subscription/standing order products to that line, such as the Health Law Archive and the
new Forms Manual, and by creating annual supplements for some of the cornerstone
products as needed to maintain currency.

IMPACT OF LEXISNEXIS AGREEMENT

FY2008 was the first full fiscal year for evaluating the impact of the revenue share
agreement with LEXISNEXIS (LN) on the Frontlist titles (new titles published during the
fiscal year) and the Backlist titles (existing publications). Although 80% of our new titles in
FY2008 published in the second half of the fiscal year, we are confident about the strength
of these titles and anticipate that revenues for these two categories of products will be on
budget. Direct costs of sales in FY2008 will be higher than budget, however, because of
the write-off of inventory for the previous edition of the US Laws and Regulations, an
expense that we have eliminated with the LN agreement and that will therefore not have
an impact in FY2009.

We anticipate that the trend towards improved profitability of non-dues publications will
continue throughout FY2009. In FY2009, our targeted increase in net revenue margins for
non-dues publications is 5% over FY2008 budgeted net revenues. Now that most direct
costs of sales have been eliminated (including most editorial work, composition, printing,
binding, storage and fulfillment), we will budget expenses for marketing as needed, and if a
surplus in revenues from non-dues publications allows, we will evaluate whether to invest


                                                                                             23
additional amounts in marketing, with a particular focus on growing the subscriber base for
the Journal of Health and Life Sciences Law.

FRONTLIST PRODUCTS (New publications published during the fiscal year)

AHLA will continue to develop new titles in partnership with LEXISNEXIS
This partnership has already allowed us to develop more robust, higher-end products in
both print and electronic formats, and we will continue to pursue those opportunities in
FY2009. One of the most promising ideas in the works is a series of Health Law
Transactional Toolkits, covering specific areas of practice such as Due Diligence, Health
Information Technology Contracting and Executive Compensation. We will continue to
generate new revenues from the Complete Connected CDs series, by introducing a new
edition of the Stark CD, and bundling the Civil False Claims Act Connected CD with the
new edition of the Salcido book. Finally, we will continue to create annual supplements or
releases for some of our core products, including the AHLA Healthcare Forms Manual and
the AHLA Healthcare Laws & Regulations. New products will frequently include an
electronic component, with statutory and practice materials, which will command a higher
price and provide us with the opportunity to revise the titles more frequently. We estimate
that we will publish 8-10 new products in FY2009.

BACKLIST PRODUCTS (Existing publications)

In FY2008, we were successful in clearly identifying backlist (existing) titles, and projecting
revenues from the backlist with better accuracy than in previous years. Again in FY2009,
we will carefully evaluate titles that are scheduled to publish at the end of FY2008 to
determine whether it makes fiscal sense to move them into FY2009 as a Frontlist title.
Existing titles will be evaluated for revision, and those chosen for updating will be revised
in accordance with the schedule for revisions. As is mentioned above, backlist titles will
also be revitalized with annual supplements if there are new developments in health law
that justify sending out an annual supplement rather than a completely new edition.

DERIVATIVE PRODUCTS (Post Program CDs with Audio Recordings and Program
Papers)

The FY2008 budget for derivative products was an aggressive one, given that the
revenues from the teleconference CDs (representing approximately 1/3 of total sales for
this category of product in FY2007) transferred to Practice Groups that year. In FY2008,
we are now forecasting that we will finish under budget for the sales of program papers
and post program CDs. However, we have succeeded in reducing the cost of producing
these products, by re-negotiating our contract with the audio vendor and by obtaining
sponsorship for two CDs. Accordingly, the net revenues on these products remain healthy
and in FY2009, we will stay that course. In particular, we will continue to pursue
sponsorships for the smaller programs, where the funding is necessary to cover the costs
of capturing the audio recording of the sessions. We will also experiment with different
price points and bundles in FY2009, to increase the number of unit sales for these



                                                                                             24
products and investigate the possibility of downloadable content from the website to
eliminate the need for (and associated costs of) a physical product.

CONNECTED CD ROMS

This line of products has proved to be a successful one for us, and we will continue to add
new titles to this series as are dictated by developments in health law. In FY2008, we are
scheduled to introduce a new title in this line, the Pharma and Medical Device Complete
Connected CD Rom. In FY2009 we are planning to publish a new edition of the Stark
Connected CD. The bundling of products in the subject area of fraud and abuse has
enhanced revenues on these products, and we will continue to design and schedule new
products so as to be able to package them together and increase revenues. For example,
in FY2009, we are planning to bundle a new version of the Salcido book with the FCA
Complete Connected CD.

JOURNAL OF HEALTH AND LIFE SCIENCES LAW (the Journal)

Professional Resources has now completed the operation of bringing the content
development and production for the Journal of Health Law in-house. The product has
been renamed the Journal of Health and Life Sciences Law and has undergone a
complete facelift. Our Managing Editor is well entrenched in her new role, and works
closely with the Editorial Board and staff to ensure that issues publish on schedule. The
quality of articles is ensured through a rigorous selection and peer review process, and
resources have been dedicated to provide for meticulous citation checking and copy
editing.

In FY2008, the principal challenge we faced was the transfer of the subscriber base to
LEXISNEXIS. That base dropped to slightly over 700 subscribers at the time of the
transfer in September 2007, but LN and AHLA have invested significant marketing
resources to recapture many of the lost subscribers as well as to attract new ones. LN has
assumed complete responsibility for production and distribution as well as mailing of all
renewal notices. In FY2009, we will continue to invest in telemarketing efforts to grow the
subscriber base, and we hope to reach 900 subscribers by the end of that fiscal year. In
addition we will increase the honorarium paid to our Managing Editor beginning in March
FY2008, because of the time commitment and level of expertise that she brings to this
position.

Over the next 2-3 years, we will continue to invest in this product, to improve its reliability,
the quality and practical value of its content, and its relevance to AHLA members. In spite
of increased editorial and marketing expenses to support this effort, we project that the
Journal will result in net revenues in FY2008, and that the net revenues achieved in
FY2008 will improve in FY2009.




                                                                                               25
HEALTH LAW PRACTICE GUIDE (HLPG) PRINT AND CD-ROM ROYALTIES

In August 2007, we succeeded in renegotiating our contract with Thomson/West to
increase the percentage of our royalties on these products. In exchange we agreed to
produce a new edition of the looseleaf HLPG by August 1, 2008. This has and will
continue to require a significant investment in editorial and financial resources on the part
of Professional Resources, through the end FY2008 and into the early part of FY2009.
Failure to deliver a new edition on time on our part will reverse the royalty rate to what it
was under the earlier contract. The development of a new edition is fraught with many of
the same perils as non-dues publications, and in particular, a number of authors have
abandoned their chapters or simply do not deliver updates as promised. While we are still
confident that we can produce a new edition on time, the budget in FY2009 will have to
reflect the uncertainty associated with that outcome.

We have also increased the frequency of supplementation for the print service, which
should improve the currency and scope of this product and improve sales and subscriber
retention rate. This additional supplement has also increased the volume of work for
Professional Resources staff.

HEALTH LAW ARCHIVE

The most significant change in the budget for Professional Resources in FY2008 came
from the sales of the Health Law Archive, which was introduced to the membership at the
2007 Annual Meeting. Individual subscriptions and site licenses have exceeded the
FY2008 budget, and we anticipate that revenues in FY2009 will be comparable to those
achieved during the first year of sales.

Integrating new content into the Archive required that we expand the hours worked by our
marketing assistant to create a full-time marketing/Archive Librarian position. In addition,
quality issues associated with the functionality and currency of the Archive have and will
continue to require staff time. Overhead costs associated with these efforts increased in
FY2008, but should hold steady in FY2009.

HEALTH LAW “WIKI”

In the spring of FY2008, Professional Resources will launch a 6-month pilot to create an
electronic encyclopedia of health law. This will involve regular meetings with a group of
approximately 12 volunteers, members of the Professional Resources Committee and the
Technology Department. The first phase of this project will focus heavily on developing an
outline and a template for entries, and locating existing content that will “seed” the initial
rollout of the product. We anticipate that volunteers will assume most of the responsibility
for overseeing and propelling this project, but Professional Resources and Technology will
need to provide some financial and staff support to assist this effort.

MEMBER PUBLICATIONS -Health Lawyers Weekly (the Weekly), Health and Life
Sciences Law Daily (the Daily), Year-in-Review, and Practice Group Publications


                                                                                            26
Several efforts are underway to increase the advertising revenues from the Weekly and
reduce the costs associated with member publications. The Weekly has become a
preferred venue for advertisers, and all of the advertising space currently available has
been sold out through the end of FY2008. Given the demand for this type of advertising
opportunity, we are investigating the possibility of adding a third “button” to the side banner
of the Weekly, and are surveying potential advertisers on their interest in purchasing that
space. Even if this particular suggestion is rejected, Professional Resources recommends
that we explore some reformatting of the Weekly so as to make more advertising space
available.

We have also approached the US Custom Briefings group to propose a revenue share
agreement on advertising space from the AHLA box in the Health and Life Sciences Law
Daily. This effort would require enhancing the functionality of that portion of the newsletter,
and we are hopeful that this will take place in FY2009.

Expenses for online legal research will reduce compared to FY2008 actual expenses
because LexisNexis agreed to provide AHLA with three complimentary subscriptions to
their online services, which will eliminate the cost of the Westlaw subscription that AHLA
currently purchases.

For the past two years, Professional Resources has undertaken to research and write the
Year-in-Review (and the Executive Summary) that is included in the program materials for
every Annual Meeting. The case summaries are pulled and sorted from the Health
Lawyers Weekly/Digest and sent to all the Practice Groups on a quarterly basis. All of the
quarterly updates are merged in April, to create the complete Year-in-Review document,
which attorney/editors on Professional Resources staff summarize to create the Executive
Summary. Streamlining this process as described above has simplified the task and
Professional Resources can now commit to taking on this responsibility on a yearly basis.

The legal editors also edit all of the Practice Group newsletters and Member Briefings. In
2008, the number of these publications increased approximately 20% over 2007, and
additional editorial resources may be needed in the future if this trend continues.

CONTENT MANAGEMENT SYSTEM/TOPICAL TAGGING

With the launching of the new website and content management system, the attorney staff
in Professional Resources will become more formally responsible for assigning topical tags
to all web content from all areas of operation. This includes all teleconference records,
materials, program records, Practice Group newsletters and Member Briefings, in addition
to content in the member publications, the Weekly, the Daily and the Health Lawyers
News. Although this will require additional staff time beginning in FY2009, we currently do
not anticipate that we will need to add staff resources. However, the time commitment
involved in this activity will need to be monitored and staffing needs re-assessed in
FY2010.



                                                                                             27
AHLA RESOURCE CENTER AND EXHIBITS

In FY2008, Professional Resources took over formal responsibility for planning and
organizing the Resource Center, including the bookstore and post-program CD table at
AHLA programs as well as at other conferences where we have been able to negotiate
free exhibit space. Professional Resources will continue to manage and staff the majority
of these events in FY2009. However, because the Resource Center and other exhibits
serve both Membership and Practice Groups, some of the expenses associated with this
effort (including shipping, travel, staff time, posters, and giveaways) will need to be
allocated to these departments in FY2009.

ADMINISTRATIVE

Overhead costs (administrative allocation) are projected to increase slightly over the
previous fiscal year, because of reallocation of overhead associated with the new edition of
the HLPG, and possibly absorbing some additional work associated with content tagging
and the development of the “wiki”. Ideally too, we will budget additional amounts for travel
related to new product development, assuming that the projected profits in FY2009 allow
us to increase expenses.

The development of personalized electronic libraries may also require additional resources
and generate direct costs, should this become a FY2009 goal for Professional Resources.
We are currently planning to survey a cross-section of our members before the end of
FY2008 to determine whether this is a project that will need to factor into the FY2009
budget.

CONSIDERATIONS FOR FY2010

   o The most significant change that is under consideration for FY2010 is the
     conversion of the Health Law Archive to a member benefit. As is pointed out in the
     first section of this document, Professional Resources has managed to build a
     significant measure of financial stability over the past several years. We are still
     anticipating that net revenues in FY2008 (which were budgeted at a very aggressive
     80% over actual net revenues in FY2007 in spite of the loss of teleconference CD
     revenues) will come in close to budget. Realistically, it would be difficult, if not
     impossible, for Professional Resources to sustain anywhere near this level of
     growth in the future if revenues from the Archive disappear. We recognize on the
     other hand that the advantages of this conversion to the overall health of AHLA as a
     member organization are undeniable. The financial quid pro quo for the loss of
     income to Professional Resources could very conceivably derive from
     improvements in membership satisfaction, growth and retention.

   o Other less significant considerations for 2010 include the outcome of the “wiki” pilot,
     which may become a permanent member benefit if the experiment is successful,
     and the results of the survey on personal electronic libraries.



                                                                                          28
PROGRAMS
AHLA’s in-person educational programs are central to the accomplishment of its mission
and vision and are important vehicles for achieving each of the Association’s strategic
initiatives. We will continue to evaluate our in-person programs to ensure the content and
the method by which they are delivered continue to meet the needs of our members and
non-member customers.


SCHEDULED IN-PERSON PROGRAMS

Tax Issues for Healthcare Organizations – September 2008, Washington, DC
Attendance at the Tax program has increased slightly over the last few years. This is a
well-established program for the Association and it is important that we continue to deliver
education to our members in this area.

Fraud and Compliance Forum – October 2008, Baltimore, MD
We experienced a significant increase in attendance at the FY2008 program and after
evaluation of the program and our co-sponsorship arrangement by the President,
President-Elect, President-Elect Designate, members of the program planning committee
and staff, AHLA agreed to again co-sponsor the Fraud and Compliance Forum with the
Health Care Compliance Association (HCCA). In FY2006, AHLA and HCCA agreed on a
sliding scale for the revenue split based on the number of attendees that each organization
brings to the program and we will negotiate with HCCA to retain this arrangement. The
agreement with HCCA is a one-year agreement and will be reviewed following the Fall
2008 program. Fraud and abuse is a core subject area that should be addressed by the
Association, and it is important for AHLA to maintain its reputation in this area.

Payors, Plans and Managed Care Law Institute –October 2008, Boston, Massachusetts
AHLA and AHIP have discontinued their arrangement to co-sponsor this program. We
surveyed past attendees of the program and members of the HMOs and Health Plans
Practice Group and based on the strong support for the program, we will hold the program
on our own in FY2009. We are seeking support from the BlueCross BlueShield Association
as well as hoping that AHIP will provide notice of the program to their members. The title of
the program has been changed to reflect the new title of the Practice Group.

Fundamentals of Health Law – November 2008, Chicago, IL
This program continues to draw a very strong attendance and serve as an excellent tool
for introducing the Association to new health lawyers. Many firms also consider the
Fundamentals program to be a standard training program for new lawyers. In FY2008, we
marketed the program to paralegals and offered a discount on the program and a special
paralegal membership rate which was well received and we plan to do this again in
FY2009.




                                                                                          29
Legal Issues Affecting Academic Medical Centers and Other Teaching Institutions –
January 2009, Washington, DC
Because of the developments in this area and the unique legal challenges faced by
teaching hospitals, the Academic Medical Centers program has a loyal audience, and
attendance at the program has been stable over the last several years. In FY07, this
program, however, resulted in net expense. We are anticipating that the program will not
make budget in FY2008 and if that is the case, we will budget more conservatively for
FY2009.

Hospitals and Health Systems Law Institute – February 2009, Phoenix, Arizona
The Hospitals program has established itself as one of the Association’s core programs.
The program is held in conjunction with the Physicians program, and overlapping these
programs seems to be well received by our members evidenced by the majority of
attendees (approximately 200) choosing to attend all three days of programming.

Physicians and Physician Organizations Law Institute – February 2009, Phoenix,
Arizona
The Physicians program has established itself as one of the Association’s core programs.
The program is held in conjunction with the Hospitals program, and overlapping these
programs seems to be well received by our members evidenced by the majority of
attendees (approximately 200) choosing to attend all three days of programming.

Long Term Care and the Law – February 2009, Los Vegas, Nevada
This program, in the past, has attracted a very loyal audience. The program experienced a
decrease in paid attendance for several years, but a slight increase in attendance in FY07
and it is anticipated that we will experience another slight increase in attendance in
FY2008. Management with the assistance of the program committee and other leaders
will continue to explore ways to increase the audience for this program and will budget
additional resources to market this program more heavily to both lawyers and non-lawyers
in the long term care community and in particular those who represent assisted living
facilities. AHLA has established good relations with and support of the program from the
American Health Care Association (AHCA) and the American Association of Homes and
Services for the Aging (AAHSA) in the past. In FY2008, we also had American College of
Health Care Administrators, American Seniors Housing Association, Assisted Living
Federation of America, and National Center for Assisted Living as cooperating sponsors.
We will continue to collaborate with them on content and on marketing initiatives.The Long
Term Care program continues to serve as a good outreach mechanism to their members
and other non-lawyers who value the information presented at the program.

Institute on Medicare and Medicaid Payment Issues – March 2009, Baltimore, MD
The Medicare and Medicaid program is one of the Association’s longest running programs
and consistently has strong attendance. This program attracts a high percentage of non-
members and serves as an outreach vehicle to non-lawyers who may benefit from the
programs, products and services that AHLA offers.

Life Sciences Law Institute – Spring 2009, location to be determined


                                                                                          30
The Life Sciences program was added in FY2005 as a one-day program and was
expanded to a two-day program in FY2006. We will continue the two-day program in
FY2009 as part of the Association’s coordinated effort to meet changing educational needs
of our current members as well as attract new constituencies to the Association.
Attendance at the program has increased slightly each year. We will continue to budget
more for marketing expenses for this program than we do for most others in order to
market to non-members.

In-House Counsel Program - June 2009, Washington, DC
Designed to address the unique issues faced by in-house counsel, this program plays an
important role in meeting the needs of one of the Association’s most significant
constituencies. Holding the In-House Counsel program in conjunction with the Annual
Meeting allows in-house members to network and share best practices with colleagues at
their own program and then attend the Annual Meeting for education on a broad range of
healthcare legal issues.

Annual Meeting - June 2009, Washington, DC
The Annual Meeting is the culmination of the educational year. It serves as an excellent
educational opportunity for our members as well as a vehicle for highlighting other
Association activities, products and services.

Masters Program – date, location to be determined
We will hold a Masters Program in FY2009 as a way of meeting the educational needs of
our most experienced members. The program will be budget neutral – although we do not
anticipate the program will generate net revenue, we will budget for the program to be self-
supporting. Attendance will be limited and participants will need to meet certain criteria in
order to be accepted into the program in order to ensure a high level of expertise and
participation by the attendees. The topic for the Masters program will be selected by the
Programs Committee. Based on their areas of expertise, Fellows will be included in the
program planning.

Antitrust in Healthcare
This program is held every other year and is co-sponsored with the ABA Health Law
Section and the ABA Section of Antitrust Law. It was held in FY2008 so is not scheduled to
be held in FY2009.

ADR TRAINING

The ADR Service will budget for two arbitration training sessions and two mediation
training sessions. The arbitration training sessions generally accept 50 attendees and the
mediation sessions generally accept 24 attendees. Since the arbitration and mediation
sessions are popular, having been sold out for the prior three years, an increase in
registration fees was approved for FY2008. We therefore propose no increase in FY2009
and revenues from fees are expected to be on par or slightly more than FY2008.




                                                                                           31
PROGRAM REVENUE

Registration Fees
Taking into consideration attendance information we have for the FY2008 programs,
attendance for the FY2009 programs will be budgeted at a level between actual and
budgeted attendance for FY2008.

The registration fee structure for our national programs will continue to include an early
and late registration fee for each of the following categories: member; non-member; and
member group. An on-site fee of $100 will be applied to each category. The differential
between the member and non-member rates will remain at $200. The Association will
continue to offer discounts to government employees, academicians and students for our
in-person programs. The Association will also continue to offer a $100 discount for in-
house counsel attendees, solo practitioners and paralegals at all programs except the
ADR Training Sessions, the Fraud and Compliance Forum, the In-House Counsel
program, and the Annual Meeting.

The cancellation fee will remain at $125.

The necessity of increasing registration fees will be determined on a program-by-program
basis as needed to offset increasing expenses for items such as hotel expenses, printing
and postage. We do not, however, anticipate increasing registration fees for the majority of
our in-person programs. We will instead charge an additional fee to attendees who would
like to receive the program binder. For the Fundamentals program, we will budget the
registration fee to include the binder and all attendees will receive it. Staff and the
Programs Committee recognize that not automatically providing binders for all attendees is
a significant change to our in-person programs and we will remain flexible if our approach
does not seem to meet the needs of our members.

Interactive Fees
In FY2009, AHLA will continue to charge a nominal “add-on” fee for the limited attendance,
interactive sessions if offered.

Spouse/Guest Fees
A nominal spouse/guest fee will be charged at all national programs to offset the expenses
incurred when spouses and adult guests attend breakfasts and receptions. The fees for
the Long Term Care program and the Medicare and Medicaid Institute will be slightly
higher than the fees for other programs due to the additional expense incurred for off-
property receptions at these programs. Spouse/guest fees will also be charged to
complimentary registrants such as faculty and Board members. (An exception will be made
for government speakers.)

Because of the number of activities offered for guests at the Annual Meeting, the
spouse/adult guest fee, the teen fee, and the youth fee for this program will be structured
to cover the expenses associated with the activities. Spouse/guest fees will also be


                                                                                          32
charged to complimentary registrants such as faculty, Board members and Past
Presidents. (An exception will be made for government speakers.)

Exhibitors/Sponsors
Health Lawyers will continue to try to attract exhibitors to all in-person programs,
consistent with the traditional feel and approach of an AHLA meeting. Exhibit sales are
currently handled internally. Exhibit revenue for FY2009 will be budgeted at approximately
the same level as projected actual revenue for FY2008.

Sponsorship is also handled internally. Volunteer leadership and staff have increased
efforts in confirming sponsors for our in-person programs and established several
packages for a select number of sponsors, which have resulted in a significant increase in
sponsorship revenue over the past several years. With the exception of the Antitrust
program (the ABA does not allow sponsorship) and the Annual Meeting (sponsorship is for
individual events and items), we engaged a sole sponsor for each of the programs held in
FY2008. For FY2009, we will budget between the FY2008 budget and the FY2008
projected actual revenue.

PROGRAM EXPENSE

Marketing
Total marketing costs for programs are expected to be higher than FY2008 due to
increases in printing and postage costs and increased efforts to test approaches for
increasing attendance, including the use of external lists for particular programs. Programs
will be promoted and advertised through general marketing as well as program specific
marketing.

Management will balance the delivery of marketing materials for each program to each
member with an effort to do additional marketing to the core audience within the
membership. In addition to print marketing, management will continue to market the
programs electronically through the use of broadcast email, announcements on the
website, and emails to the listserves. Marketing expenses will be relative to the expected
attendance at the program. As the budget allows, we will experiment with outside lists for
some of our programs. In particular, we expect to budget a higher than usual amount for
marketing the Long Term Care and the Law program and the Life Sciences Law Institute.

Course Materials
Beginning with the Fall 2008 programs, and continuing through the FY2009 in-person
program year, attendees will not automatically receive the program binder. Attendees will
have the option of purchasing the binder for an additional fee. One exception to this will be
the Fundamentals program at which all attendees will receive the binder. The budgeted
overall expense for printing will decrease from FY2008 to FY2009. We will, however, need
to remain flexible so that we can adjust our approach based on the reaction of our
members. Each attendee, whether or not they select to receive the binder, will receive
electronic access to the materials prior to the program and will also receive a CD with the
materials at the program.


                                                                                           33
Faculty and Program Planning
Management will continue to monitor the number of program chairs and speakers per
program, and budgets will take into consideration the location of the programs and the
number of potential local faculty members. In most cases, faculty expenses will be
budgeted to reflect projected actual expenses incurred in FY2008. We will continue to
budget for keynote speakers at the Medicare/Medicaid program (approximately $5,000)
and the Annual Meeting (approximately $30,000). While a keynote speaker will be included
in the budget for each of these programs, the Program Planning Committee, in
consultation with staff, will evaluate the expected value added to attendees before
contracting with a paid speaker, and sponsorship for keynote presentations will be
aggressively pursued.

In FY2007, the Programs Committee reviewed the speaker reimbursement policy in
conjunction with our discussion of the RAVES initiative, and the reimbursement policy was
changed from a “max per day” for incidental expenses such as meals, phone calls and
taxis to a “max for the program.” The max per program will continue to be based on $75
per day, but allows speakers to allocate the money over the duration of the program. (Ex.
Rather than receiving a maximum of $75 per day for 3 days, speakers will receive a
maximum of $225.)

Hotel
Hotel expenses are dependent on the number of food and beverage functions during a
program, the amount of audiovisual equipment needed by the faculty, and the location of
the program. However, hotel expenses continue to increase and for FY2009 will be
budgeted slightly higher than projected actual expenses for FY2008.

Miscellaneous
Expenses for items such as staff travel, continuing education fees, tote bags and
temporary help and convention assistants will remain consistent with projected expenses
for FY2008.

Exhibit/Sponsorship Fees
Exhibit sales and sponsorship will be handled internally and, therefore, no commission
fees will be paid.

Because of the number of exhibit booths, additional expenses are incurred at the Fraud
and Compliance program, the Medicare and Medicaid program and at the Annual Meeting
to contract with decorators for pipe and drape and booth set-up as well as for security.
Expenses associated with exhibits at these programs will be consistent with projected
expenses in FY2008.

Convention Cancellation Insurance
We will also include in the budget an estimate for convention cancellation insurance for
certain FY2009 programs, based on criteria outlined in AHLA’s Policy on Purchase of
Convention Cancellation Insurance, approved by the Finance Committee in FY06.


                                                                                           34
Visibility – Complimentary and Discounted Registrations
In response to the organization’s efforts to increase visibility, the number of complimentary
and discounted registrations that are offered to government and industry representatives
for our national programs have increased during the past few years. Although offering
complimentary registrations does have a direct effect on expenses, particularly hotel and
course materials, it is recommended that the Association continue to absorb these costs in
an effort to pursue linkages with government and industry officials. The Association will
continue to offer complimentary registrations to press in order to encourage coverage of
our programs.

Volunteer Recognition
In an effort to recognize the contributions of program chairs, speakers, and other
volunteers who contribute to the success of the Association, a reception will be held in the
President-Elect’s suite at the Annual Meeting in June 2009. Additionally, a small gift will be
given to each member of a program planning committee, and expenses for these items will
be included in the budget.

Program Chair Meeting
Although we have not held a call for a couple of years, one conference call for the Program
Chairs will be budgeted for FY2009. The phone conference call can provide chairs with
the opportunity to discuss issues such as Association policies, industry developments and
attendance trends.

CONSIDERATIONS FOR FY2010

   •   Based on the on-going arrangement with the ABA Health Law Section and the ABA
       Section of Antitrust Law, it is anticipated that the Antitrust program will be held in
       FY2010.

   •   In FY2009, the Programs Committee and management will review the co-
       sponsorship arrangement with HCCA for the Fraud and Compliance Forum and
       determine whether the arrangements should be continued in FY2010.

   •   The Programs Committee and staff will continue to review the overall programmatic
       offering and evaluate the need to add a program on a topic not currently on our
       schedule.




                                                                                           35
PUBLIC INTEREST

CONTRIBUTIONS

Solicitation of Donations
For FY2009, revenues to support public interest activities will continue to be derived from
donations from individual members and their firms/organizations. Efforts will continue to
increase the number and amount of contributions with special effort being made to provide
a wider array of benefits to, and acknowledgement of, those who provide support. AHLA
will continue to explore additional innovative ways to raise funds for charitable purposes,
including grants from various foundations (staff believes that because of the expanded
consumer resources that are available through the Public Information Series, foundational
support may be worth exploring again).

Mailings and/or emails to AHLA leadership (Fellows, Board of Directors, past presidents,
practice group leaders, and program planning committee members) will be sent to
encourage 100% participation from leadership. Full page donation forms will continue to be
published in Health Lawyers News and public interest donor ribbons will continue to be
“sold” during annual meetings through the “Only Ribbon You Can Buy” campaign. In
addition, members, donors and other interested parties will be updated on new and
existing public interest resources and initiatives via email, AHLA’s Feature Box on the
website, Health Law Daily, monthly Education at a Glance emails, press releases, and the
Public Interest Committee’s semi-annual newsletter. Overall expenses may be slightly
higher than FY2008 actuals.

PUBLIC INTEREST ACTIVITIES

Pandemic Flu Convener
In FY2006, the Public Interest Committee recommended that AHLA utilize a colloquium
format when most appropriate for the subject or topic being explored and would best
accomplish determined goals. Alternatively, the Committee recommended having AHLA
act as a neutral facilitator (or convener) to bring individuals representing differing points of
view together to address a well recognized healthcare legal related issue. If a topic
appears to necessitate a colloquium or convener-type format, the Public Interest
Committee will plan accordingly.

On May 2, 2008, AHLA, in conjunction with the OIG, CDC, and George Washington
University, sponsored a one day event on pandemic and H5N1 flu preparedness. This
public dialogue session gave leaders from the medical, legal, public health, academic and
governmental sectors the opportunity to create a checklist of legal issues that healthcare
entities and providers could use in pandemic preparation, response, and recovery. Based
on all of the discussions that took place during the convener session, print copies of
Community Pan-Flu Preparedness: A Checklist of Key Legal Issues for Healthcare
Providers will be published and disseminated to all state hospital, medical, and bar



                                                                                              36
associations for national implementation and use. This publication will also be
downloadable through AHLA’s website at no cost.

Life Limiting Conditions DVD
Staff will continue working with the Committee to secure funding for a DVD that will present
vignettes including the most common advance planning, “preparing for the future,” and
end-of-life issues. The DVD is intended to be used by attorneys for presentation to their
communities through church groups, community centers, libraries, independent living
centers, etc. The DVD will be supplemented by AHLA’s Guide to Legal Issues in Life-
Limiting Conditions and Life-Limiting Conditions One Pagers.

In-Person Programs
Educational sessions on public interest topics will be held during select programs and
opportunities to partner with government agencies such as the OIG, CDC, Office of
Minority Health, public health lawyers, the health law academic community, and legal
services organizations will continue to be pursued. At least one public interest session will
continue to be planned for AHLA’s annual meeting and selected in-person programs.

Conversations with Policymakers
Up to four teleconferences will be held during FY2009. While policy-centered
teleconferences will be offered when timely and appropriate, upcoming teleconferences
will be more practice oriented to increase registrant numbers. AHLA will continue to
explore holding teleconferences with the academic community, government agencies,
nonpartisan health policy organizations, and other relevant groups as opportunities arise.
Registration fees will be kept at a nominal level to reflect the public interest nature of these
activities. Expenses will be offset through contributions from members’ law firms and
organizations.

Public Information Series
AHLA will continue to build upon the success of the Public Information Series by initiating
the development, completion and marketing of an additional guidebook for FY2009. AHLA
will also consider working with the Alzheimer’s Association to develop an FAQ for its call
center employees based on AHLA’s Guide to Legal Issues in Life Limiting Conditions. Staff
and leaders will also continue to market and/or co-brand existing public information
resources—including the two newest guides on clinical trials and disabilities that will be
released during the 2008 annual meeting—to a broad range of target audiences. Staff
created a response mechanism for the Public Interest tab on the AHLA website and will
continue to monitor feedback from users who download and use the public information
resources.

Links to Academia
AHLA will continue to sponsor the Links to Academia Advisory Group in FY2009. In an
effort to increase involvement of academician members, the group created a speakers’
bureau in FY2008 so that program planning committees would have a roster of full-time
academician members who would be available to speak at annual meeting and other in-
person programs and on teleconferences and webinars. The Group also created a new


                                                                                              37
web page where AHLA members can submit paper topics for law students to consider for
their various writing assignments/opportunities.

For FY2009, the Group will continue to work on expanding its website for members of the
academic health law and policy research community; explore the initiation of AHLA-
sponsored and/or jointly sponsored teleconferences or educational sessions directed
toward full-time and adjunct professors; publish advice columns for academicians by
academicians; and explore the feasibility of having the AHLA sponsor a reception or
networking event in cities where an AHLA program is being held for law schools that have
signed an alliance agreement. The Group will also continue to collaborate with
Membership in developing resources and activities for students, academician members,
and student health law organizations.

Special Projects
The Public Interest Committee will continue working with the Advisory Council on Racial
and Ethnic Diversity to publish a two-part series for the Journal of Health and Life Sciences
Law regarding healthcare disparities among minority populations, especially in light of
emerging tailored patient therapies. Part I of this journal series is scheduled for publication
in October, 2008 and Part II in January, 2009. Staff may explore the feasibility of
involvement with the Federal Collaboration on Health Disparities Research, a collaboration
of federal partners working to find new or improved solutions to eliminate health disparities
through research that can influence practice and policy.

The Committee will continue to explore the collaboration on a pilot project related to pro
bono representation on advance planning with Legal Health, a division of the New York
Legal Assistance Group, and the Lance Armstrong Foundation’s LiveStrong Cancer
Survivor Care Program.

The Committee will also explore the idea of creating a David J. Greenburg scholarship for
law students. In so doing, the Committee will consider whether any such scholarship
should be tuition to attend an AHLA program or a monetary award and whether a writing
competition should be involved.

PUBLIC AFFAIRS AND VISIBILITY

Efforts will continue in FY2009 to increase the health policy community and members’
awareness of AHLA’s Public Interest activities through liaison with other organizations,
publicity for the Public Information resources, and promotion of the Association’s
programs, publications, and other initiatives. The Committee will explore the idea of
creating a consumer-oriented domain name that will have content related to the Public
Information Series and other public interest-related content that would be of interest to the
general public/individual consumer. AHLA will also continue (a) referring reporters to
current or lifelong leaders, or member experts for quotes/analysis on current
developments; (b) screening requests for complimentary press registrations and press
activities at programs and teleconferences; (c) writing and distributing press releases
about AHLA’s leaders, programs, publications, and other activities; and (d) utilizing Fellows


                                                                                             38
to help speak and write about public interest activities. Expenses may increase slightly
compared to FY2008.

CONSIDERATIONS FOR FY2010

The Association will continue to work with outside associations and organizations to co-
brand its Public Information Series resources and when possible will solicit funds to help
pay for distribution of materials in print. Public Information resources will continue, when
appropriate, to be translated into other languages.




                                                                                               39
ALTERNATIVE DISPUTE RESOLUTION SERVICE
AHLA’s Alternative Dispute Resolution Service (ADR Service) is an expression of AHLA’s
efforts to serve as a public service on selected healthcare law issues. It is a service that is
designed to reduce litigation and conflict within the healthcare community and provide for
cost-effective and fair resolution of disputes by resolvers who have expertise as dispute
resolvers and background in healthcare law.

The Service projects an increase in revenue in FY2009, based upon the reasonable
assumption that cases and number of dispute resolvers will continue to grow, and that
registrations for the four training sessions and the ADR teleconference planned for FY2009
will meet budget.

ADMINISTRATIVE AND RESOLVER FEES

Parties requesting a list of resolvers from the ADR Service pay an administrative fee for
the labor and investment required to facilitate the alternative dispute resolution process.
The administration filing fees for use of the Service were increased in FY2008 and no
increase is being planned for FY2009. Revenue from administrative filing fees is projected
to be slightly better than FY2008.

The Service will continue to charge resolvers an annual administrative fee to remain on the
resolver list, and has no plans to increase that fee in FY2009. Instead, focus will be placed
on increasing the number of dispute resolvers on the ADR roster. Resolver fee revenue in
FY2009 is estimated to be slightly more than FY2008.

EDUCATIONAL SESSIONS

The ADR Service will budget for two arbitration training sessions and two mediation
training sessions. The arbitration training sessions generally accept 50 attendees and the
mediation sessions generally accept 24 attendees. Since the arbitration and mediation
sessions are popular, having been sold out for the prior three years, an increase in
registration fees was approved for FY2008. We therefore propose no increase in FY2009,
and registration fees are expected to be on par or slightly more than FY2008.

To assist the ADR Service in promoting efficiency, Programs’ staff has handled the
logistics for the sessions, including the negotiation of space and badge preparation in
FY2008, and consulted with the ADR Service office on the timing and locations for the
ADR training sessions. This arrangement will continue in FY2009. The Manager of ADR
will work with the faculty to develop materials. The Membership and Marketing staff will
work with the ADR staff in marketing the Service, and Programs staff will work with the
ADR Staff to market the training sessions.




                                                                                             40
SERVICE PROMOTION

The ADR Task Force and ADR staff will focus on the most efficient and effective way to
encourage members and non-members to include the ADR Service in contracts that
contemplate the use of alternative dispute resolution to resolve disputes arising under such
contracts. The Association’s marketing sub-group will support them in these efforts. They
will also explore ways to increase the number of resolvers that enroll with the Service.

In FY2008, the Association sponsored two teleconferences to promote the Service to
AHLA members, and a similar activity is planned in FY2009. A nominal registration fee will
be charged. Other activities will include ads in Health Lawyers News, Health Lawyers
Weekly, and the new Health and Life Sciences Law Daily. The Association will also send
promotional emails for the training sessions and make other direct promotional appeals to
members and non-members. The Association will also promote speeches by ADR Task
Force members to other groups who want a speaker on health care ADR. The ADR Task
Force members and ADR staff will work aggressively to enlist the support of volunteers,
e.g., dispute resolvers to promote the ADR Service at healthcare events that they attend.
Other initiatives are planned, such as authoring ADR articles, and bartering with other
healthcare law magazines to swap advertising.

TECHNOLOGICAL INVESTMENTS

The ADR Service staff is consulting with the information technology staff to incorporate the
ADR database into the new Association Management System (AMS) during FY2008. It is
anticipated that the ADR database will be tested and ready for use in FY2009.

VOLUNTEER RESOURCES

The ADR Task Force and an increasing number of dispute resolvers serve as
ambassadors for the Service, using their ADR expertise and extensive healthcare law
experience to ensure that the Service has the crucial elements required in promoting the
growth of the Service. This effort is ongoing and will be continued in FY2009.

RECOGNITION & ACKNOWLEDGEMENT

The ADR Service will budget for thank you gifts to the members of the Task Force who do
not serve on the Board, as well as resolvers who participate in teleconferences or other
events.

CONSIDERATIONS FOR FY2010

The ADR Service expects to see continued growth, increased revenues and increased
expenses in FY2010. Promotion engaged in by the staff and members of the ADR Task
Force should result in growth in the number of resolvers and the inclusion of the ADR
Service in additional contracts.


                                                                                           41
EXECUTIVE- BOARD & GOVERNANCE
The initiatives described in this section provide governance oversight for AHLA and directly
serve two discreet strategic initiatives described in the Strategic Plan: 1) Increasing
Visibility for Volunteers; and 2) Expanding AHLA’s Activity and Visibility as a Public
Resource.

BOARD AND COMMITTEES

Board of Directors Meetings
Two (2) in-person and three (3) conference call meetings of the Board of Directors are
assumed for FY2009. The conference calls will be held in September, November, and
May. The mid-year meeting will take place in mid January, 2009 at the Ritz Carlton in New
Orleans, LA. Expenses for this event will be slightly higher than FY2008 because the
meeting in January 2008 was held in Washington, DC, and the association realized
savings associated with the lack of travel by staff and in-town Board members.

The Board meeting at the 2009 Annual Meeting will take place in Washington, DC.
Because the Board Meeting will be held in Washington, DC, it is hoped that expenses will
be less than San Francisco because of reduced travel expenses by staff and in-town
Board members. Board members will be approached to help obtain sponsorship for the
mid-year and annual Board dinners. In FY2008, for the first time, both dinners were
supported by sponsorship revenue. AHLA will budget for one Board dinner sponsorship in
FY2009 but will work assiduously to gain sponsorship for both.

Board Events at the Annual Meeting
While the cost of the mid-year and annual Board dinners have increased over the last
several years, leadership efforts to obtain sponsorship has helped to offset those
increases. The reason for the increase in costs has been additional invitees, including the
Fellows, and an upgrade in facilities and amenities.

The Board will continue to sponsor a gathering in the President-Elect’s suite at the Annual
Meeting and a reception for Practice Group leaders. These gatherings will be by invitation
only and will show the Board’s appreciation for the work of those who speak at the Annual
Meeting and those who volunteer significant time working on Practice Group projects. The
receptions are designed to communicate the esteem with which the Association holds
those who have volunteered time and talent on behalf of the Association. The gathering is
designed to further the strategic aim of recognizing and supporting volunteer leaders.

Fellows Program and Past Presidents’ Breakfast
AHLA will again sponsor a Fellows leadership meeting at the Annual Meeting in
Washington, DC. The Fellows leadership team will plan the agenda for this meeting during
their conference calls in FY2009. The expense of this program will be equivalent to the
amount budgeted for San Francisco in FY2008. In addition, the Association will continue to
fund a breakfast meeting of the Past Presidents and will budget a similar amount to that
budgeted in FY2008.

                                                                                          42
Advisory Council on Racial and Ethnic Diversity
Increasing the diversity of our members and volunteer leaders is crucial to the
Association’s success. Through efforts of the Advisory Council on Racial and Ethnic
Diversity, the Association will continue to work to expand its racial and ethnic diversity, and
prospective and current diverse members will be encouraged to become more involved in
the Association. Ribbons for the Diversity Council will again be distributed at the Annual
Meeting.

The Council will focus on funding up to two internships at AHLA in the summer where the
intern(s) will work with both the Professional Resources and Public Interest departments.
The Council will also focus on implementing a mentoring program for members from
diverse racial and ethnic backgrounds, building on efforts made during the announcement
and launch at the 2008 Annual Meeting. Networking receptions will continue so that we
can build on the success of these events in FY2009. The cost for posters to display at the
programs and for refreshments at the receptions will remain consistent with FY2008 actual
expenses.

The Advisory Council on Racial and Ethnic Diversity will continue working with the Public
Interest Committee to publish a two-part series for the Journal of Health and Life Sciences
Law regarding healthcare disparities among minority populations, especially in light of
emerging tailored patient therapies. Part I of this journal series is scheduled for publication
in October, 2008 and Part II in January, 2009.

The Council will further explore the idea of establishing a scholarship for a qualified law
student of diversity who has expressed and evidenced an interest in pursuing health law
as a career; however, the discussion of establishing a scholarship has also been closely
intertwined with “pipeline” issues (i.e. whether AHLA should address the question of
reaching out to students at a much younger age so that interest in the possibility of college
and law/graduate programs would be fostered at an early age and if so, how AHLA would
do that and how the success of such programs would be measured). One medium of
outreach to younger generations that may be considered is YouTube.com and similar
means of instant, online communication through which younger generations are more
familiar. Staff and members of the Council will continue to explore these medium and how
they might be used to facilitate greater awareness of health law careers.

The Council will continue to develop and expand on the content that is published in Health
Lawyers News and on the web. Content for future HLN issues and web sub-site pages
may feature diversity programs of various law firms, profiles of each of the Council’s
members, updates on the summer intern’s various projects, and partnerships with other
organizations committed to diversity in the legal profession (such as the Minority Corporate
Counsel Association). AHLA may incur some expenses for non-staff writers, purchase of
graphic images for use in promotional materials, etc. Staff will also explore possible
barter/exchange options with other publications if there is diversity-related content that
would be worth reprinting and/or posting on the Association’s website for the benefit of
AHLA members.


                                                                                             43
The work of the Diversity Advisory Council will be facilitated through conference calls, mail
and email, and through two in-person meetings when members are attending Association
programs.

Committee Meetings
The following schedule will generally guide management and committee chairs so that
appropriate resources can be planned and allocated. Over the past several years,
Committee meetings have increased from an average of once every other month to once
every six weeks. The Board will continue the effort initiated in FY2008 to reduce the
frequency of Committee and Task Force meetings, requiring less time and resources by
staff and volunteers to prepare for meetings. The assumptions regarding the Board
committees are as follows:

Executive Committee
In person meetings:                3 (June - Ann. Mtg; January - Mid Year Meeting; March
                                   – Budget Assumptions)
Telephone conference calls:        2 (October - Status, April – Budget Numbers)

Finance Committee
In person meetings:                3 (to review audit, and at Board meetings)
Telephone conference calls:        6

Membership Committee
In person meetings:                2 (at Board meetings)
Telephone conference calls         4

Public Interest Committee
In person:                         2 (at Board mtgs)
Telephone conference calls:        4

Professional Resources Committee
In person:                     2 (at Board mtgs)
Telephone conference calls:    4

Programs Committee
In person:                         3 (at Annual, at Mid-Year and in December to plan the
                                   Annual Meeting)
Telephone conference calls:        6 (more frequent calls to plan the Annual)
Practice Group Committee
In person:                         2 (at Board meetings)
Telephone conference calls:        6

ADR Task Force
In person:                         2 (mid yr. and annual mtg.)
Telephone conference calls:        3

                                                                                           44
Advisory Council on Racial and Ethnic Diversity
In person:                       2 (annual meeting and Fundamentals)
Telephone conference calls:      4

Fellows Coordinating Committee
In person:                     1 (annual meeting)
Telephone conference calls:    3 (2 for nominations)

Quality Council
In person:                          1 (at an in-person Board Meeting)
Telephone conference calls:         3

Links with Academia Task Force
Telephone conference calls:    3


EXECUTIVE INITIATIVES

Executive Initiatives
Executive initiatives will increase revenue by bringing AHLA products and services to the
attention of additional potential members and customers. The Executive Department will
continue its outreach role by undertaking special efforts in the area of Alternative Dispute
Resolution growth, membership growth, program and Practice Group sponsorship, and
affiliations on joint activities. These initiatives will seek to increase the number of contracts
that incorporate AHLA’s Alternative Dispute Resolution program and to expand markets for
AHLA’s teleconferences and in-person programs, publications, and membership while
ensuring that the programs, products, and membership remain true to AHLA’s mission and
vision.

The expenses of these initiatives will include the Executive Vice President’s time,
additional mailings, and the provision of complementary publications and seminar
registrations. The Executive Department will also coordinate with the Public Interest
Department to issue press releases for new members of the Board of Directors and for
newly elected officers. Expense may also be incurred as the Executive Vice President
increases his travel to members in order to increase the Association’s visibility and to
discuss its benefits, products and services.

The CEO will work to expand the visibility of the Association by speaking with the COO at
a national ASAE Conference and by speaking with volunteers on Public Information Series
topics at national meetings for other associations

The Executive Department will also budget for a reprinting of the Board Profile Book, which
has proven popular with Board and staff.




                                                                                              45
RECOGNITION

The Executive Department will budget for gifts for the Board to show appreciation for the
work done on behalf of the Association in the previous year.

CONSIDERATIONS FOR FY2010

   o The Executive Department expects to try to hold expenses at or below the rate of
     inflation in FY2010.

   o Depending on the outcome of the discussions held during FY2010 by the Advisory
     Council on Racial and Ethnic Diversity, and ultimately the Board of Directors, there
     may be a recommendation that the Association increase resources on this initiative
     to fund worthy ideas.




                                                                                            46
OPERATIONS
In order to effectively accomplish the strategic initiatives articulated in the Strategic Plan,
AHLA must have a strong business plan for its efficient utilization of staff resources,
deployment and use of technology, and have effective financial and administrative systems
in place to support staff and volunteers in accomplishing their goals.

TECHNOLOGY SERVICES

Technology systems at AHLA fall into three major areas: Internet/Web Services; the
Association Management System (AMS); and the AHLA computer network (staff PCs,
network servers, and other peripheral hardware and software).

While specific assumptions in each major area of technology are detailed below, the most
significant overarching budget assumption in this area for FY2009 will be the ongoing
effect of AHLA’s new association management system (Protech CRM4M) and content
management system (MOSS) solutions that will be deployed in early FY2009.

The technology upgrade commenced approximately 18 months ago and is finally nearing
completion. In FY2009, the engagement(s) will continue to have a fiscal impact,
specifically with relation to recognition of prior payments and increased internal efficiency
in a number of areas.

Internet/Web Services

New AHLA website: We expect the new website to positively impact the budget in a
number of areas by providing both greatly increased internal process efficiency and
enhanced services and products for the membership.

The new website will automatically process and confirm all registration and membership
transactions that take place online, which is a great deal more efficient than AHLA’s
current system of hand entering the information into the AMS and then charging the credit
card given through a physical terminal.

AHLA will leverage this new online transaction capability into a CD storefront as well,
selling audio recordings and materials from both programs and teleconferences. It is
anticipated that the online sales channel in conjunction with increased advertising may
increase revenues for these products.

In addition, the website will give AHLA the ability to offer a number of new electronic
products and services in the future.

Health Law Archive: The Archive was rolled out to start FY2008 and has greatly exceeded
all financial expectations. As of mid-February, the Archive boasts over 1,500 subscribers
with revenues having cleared budgetary expectations months ago. There is discussion of


                                                                                            47
converting the Archive into a member benefit, which would obviously impact Membership
and Professional Resources revenues. Further internal discussion and meetings with the
Board will both take place before any decisions are finalized.

Listserve Evolution: In moving to the new website, AHLA has made the decision to
upgrade technologies from Lyris ListManager to the MOSS discussion forum system.
While this may not have immediate budgetary impact, one possibility created by this
improvement is the ability to charge non-members to read and participate in the
discussions, which could generate an additional, if unknown, amount of new revenue.

Association Management System (Protech CRM for Members)

While improving data security and integrity, it should also increase overall efficiency of
internal staff. Smoother online transaction processing is expected to encourage members
to register, subscribe, and purchase products, online, resulting in significant time and
resource savings.

Exact Target Email Marketing Software: AHLA purchased a new email marketing software
package called Exact Target. This software integrates directly with Protech CRM and will
provide a much higher degree of accuracy with respect to open rates, clicks, and
conversions. It will also provide more granular reporting, allowing users to drill down into
mail and contact records for information.

Computer Network

New Workstations and Other Hardware: Approximately 10 workstations (PCs and laptops)
will be purchased to upgrade older workstations currently on the network that have been
fully depreciated. An additional server and a load balancer may be needed, depending on
the intensity and load of web traffic.

Upgrade/New Software: Software upgrades will be needed to stay current with office and
email technology. Additionally, more robust off-site back up alternatives will be explored in
FY2009, which will increase expense.

Network Maintenance and General Expenses: The computer network will continue to be
supported primarily in partnership with DelCor and overseen by our technology staff.
Computer expense for maintenance, support, supplies, Internet access fees and other
items not considered capital equipment purchases (which are depreciated), will be slightly
higher than FY2008 actual expense, largely associated with maintaining efficient
operations for a continually growing number of servers and peripherals as well as
expenses associated with increasing security features. These expenses largely reflect
support needed to ensure efficient functioning of the computer system and support for
continually expanding staff applications and reporting needs.




                                                                                           48
Training
As AHLA continues to grow and expand its infrastructure and offerings in FY2009, it will be
necessary to provide the appropriate and up-to-date training for the technology staff so
that they are equipped with the knowledge and the technical-know-how to better serve the
Association’s technology needs in-house. This will help ensure that AHLA has the
resources in-house to tackle new projects, thus serving the Association in a more effective
and efficient manner.

PERSONNEL/HUMAN RESOURCES
(Allocated to Association Activity Areas)

Staff Salaries
Management conforms to association salary norms and uses several salary survey
instruments as a benchmark when hiring and considering salary increases. It is proposed
that the budget include funds to allow for an average 4.5% increase effective October 1,
2008 for existing staff based on performance of job responsibilities and achievement of
organizational goals (increases for employees with at least one year’s tenure are
assumed). This rate of increase is consistent with the average salary increase reported in
several compensation surveys and with a survey of several Washington D.C. based
associations and recognizes that AHLA seeks to recruit and retain top quality personnel.

Based on an assessment of staff resources needed to accomplish the FY2009 Budget
Assumptions and projections for continual growth of offerings as outlined in these
Assumptions, the budget numbers reflect the addition of one support level staff position to
help administer Practice Group benefits.

Staff Bonus Pool
It is proposed that a bonus pool be included in the compensation budget to recognize staff
and to provide incentive for contributing to the achievement of organizational and budget
goals. The bonus pool may be released in full or in part by authorization of the Executive
Committee after staff accomplishment of FY2008 organizational and financial goals can be
assessed (anticipated October 2008). This bonus will be provided to staff for their
performance in FY2008 in accordance with their performance development plans for the
year.

Payroll Taxes
These taxes will increase proportionately with increases in staff compensation during
FY2009.

Employee Benefits
The employee benefits package for AHLA staff is continually reviewed to help ensure that
the most attractive benefits package possible is made available to the staff within existing
budget and administrative constraints. This review and adjustment, if necessary, is done to
add value for staff, to provide incentive for new employees to choose AHLA, and to provide
additional incentive for existing staff to remain at AHLA. At this time, no significant changes
are being considered. If changes are recommended that result in a different combination of


                                                                                            49
benefits, the total FY2009 expense for the benefits package will not exceed the amount
contained in these recommendations.

Benefits expense will be higher in FY2009 compared to FY2008 actual expense. Health
insurance premiums are expected to increase by approximately 10% beginning July 1,
2008 and efforts will be made to keep the additional net cost to the Association around 5%
- 10% by reviewing levels of coverage, different plans, and/or by considering small
adjustments to premium contributions by employees. Staff retirement plan contributions for
FY2008 will be slightly higher compared to FY2008 actual expense based on few
vacancies during FY2008 and salary increases that will factor into determining the
contributions. Other benefits, such as life, long-term disability and AD&D insurance
premiums are expected to have only inflationary increases in FY2009.

FINANCE & ADMINISTRATIVE SERVICES

Accounting Services
Audit, tax preparation and payroll processing will be slightly higher compared to actual
FY2008 expense due to inflationary increases. Support for the accounting and financial
software maintenance and enhancements will be approximately the same as FY2008
actual expense. A new financial reporting software program will be explored and possibly
purchased in FY2009 as the current package is an old version and support will eventually
be phased out.

General Administrative Services (Allocated to Association Activity Areas)

General Office Expenses: Most general administrative expenses will be consistent with
FY2008 actual expense. Printing of envelopes and letterhead, photocopying, telephone
and fax, and office supplies will be budgeted at FY2008 levels. Postage & shipping
expenses will be higher than FY2008 actual expenditures, largely associated with
increased activity and anticipation of a future rate increase.

Furniture and Equipment Depreciation: Expenses will be higher than FY2008 actual
expense, largely associated with depreciation of new hardware, software and office
equipment and furniture added during FY2008, amortization of leasehold improvements,
and new furniture and equipment budgeted for FY2009. New capital expenditures for
FY2009 will be largely associated with new technology related purchases (see Technology
section of budget assumptions). The implementation of these new technologies in FY2008
will substantially increase new computer system related depreciation expense in FY2009
(the total cost of software and development will be expensed over a 36 month period
beginning with anticipated implementation during spring of FY2008).

Office Space Rental & Taxes: Rental expense will be the same as FY2008 actual expense.
While cash payments for rent increase by a certain percentage each year, a deferred rent
accounting entry is made each month to expense an additional amount until mid-way
through the term of the lease, when the entry will serve to offset higher cash payments.
This is done to level expense recognition over the term of the lease.


                                                                                         50
Real estate taxes have increased with higher appraisals of our building’s market value.
Since we are responsible for paying a portion of these expenses according to our lease,
we anticipate that FY2009 real estate tax expense will be higher than FY2008.

AHLA’s current office lease will expire at the end of FY2010. During FY2009, management
will work with real estate experts to determine the pros and cons of various lease versus
buy alternatives. While analysis is not expected to have budgetary implications in FY2009,
it will be an important goal to address in FY2009 because of long-term financial and
strategic implications.

AHLA also maintains records and files off-site, and expenses for storage will be
approximately the same as in FY2008.

Insurance: Expenses will be higher than actual FY2008 for office insurance, workers'
compensation and directors/officers liability insurance due to increases projected by the
insurance industry. In addition to increased costs when policies are renewed, we will also
include in the budget an estimate for meeting cancellation insurance for certain FY2009
programs, based on criteria outlined in AHLA’s Policy on Purchase of Meeting Cancellation
Insurance, approved by the Finance Committee in FY2006.

Legal Fees: Expenses will be approximately the same compared to FY2008 budgeted
expenses.

Temporary Agency Fees: Approximately the same as FY2008 actual expense.

Recruitment Agency Fees: Same as budgeted FY2008 expense.

Training & Development: Expenses are expected to be approximately the same as
FY2008 actuals, largely associated with the new technologies that will be implemented in
FY2008. This budget will include expenses for staff training to increase efficiency; ongoing
computer/technology training on new software and hardware, and individual staff training
and development needs.

Credit Card Processing & Bank Fees: Expenses are expected to increase over FY2008
actual levels, largely associated with the continual increase in volume of payment by credit
card through the Web, especially with expanded capabilities of the new Web site that
allows for different types of transactions through the Web.

Unrelated Business Income Tax: No expenses are currently expected in FY2008, but
exposure to taxation will be continually monitored throughout the year as advertising and
sponsorship revenue is received.

Miscellaneous: These expenses, which include staff events and building/office-related
expense not captured elsewhere, will be approximately the same as FY2008 actual
expense.


                                                                                            51
FUND BALANCE INVESTMENTS

Interest & Dividend Income
Interest and dividends budgeted for FY2009 will be close to FY2008 actual amounts based
on leveling yields on the fixed income and money market portions of the Operating, Short-
Term and Long-Term Funds.

Gain/Loss on Equity Investments
Market value gains or losses on equities in the Long Term Fund (both realized and
unrealized) will not be included in the Budget numbers because these funds are invested
for the long term and their short-term performance for a one-year period cannot be
estimated (the Long-Term Fund can only be accessed by Board approval).

Investment Management Expense
Investment management expenses for the Short-Term and Long-Term Fund portfolios are
expected to be approximately the same as FY2008 actual expenses.

Fund Balance Transfer
The Finance Committee will determine whether to recommend a transfer from the
Operating to the Long-Term Fund at the end of FY2009 based on net revenue
expectations and the size of the Long-Term Fund in order to maximize investment
revenues while maintaining an acceptable level of risk and adequate cash flow for
upcoming needs.

CONSIDERATIONS FOR FY2010

   •   The implementation of new technologies in FY2008 will require continual monitoring
       and fine-tuning in FY2009 and FY2010 along with potential additional applications
       that may be added down the road to further enhance our efficiency and ability to
       meet member and customer needs.

   •   AHLA’s office space lease expires June 30, 2010. As mentioned above, analysis of
       various options will begin in 2008 and depending on the recommended course of
       action, a clearer idea of budget implications will be formulated during FY2009.




                                                                                       52
                           SUMMARY OF FY2009 BUDGET



The FY2009 Budget is presented on the following pages and represents the Association’s
best estimate of the financial impact of the activities reflected in the FY2009 Budget
Assumptions and Activity Plan that have been recommended by the Finance and Executive
Committee for approval by the Board on May 22nd.

The format of the budget report includes columns that reflect FY2007 actual results, FY2008
Budget, FY2008 activity through 2/28/08, FY2008 year-end forecast, FY2009 Budget, and
the percentage of variance between the FY2008 year-end forecast and the FY2009 Budget.
Additionally, a column has been added to reflect a broad projection for FY2010 that is based
on activities anticipated for FY2009 summarized in the FY2009 Budget Assumptions.

Some of the most significant variances between the FY2008 Budget and the FY2008 year-
end forecast compared to the FY2009 budget are outlined below.

Operating Revenues

The FY2009 Budget reflects $9,276,100 in operating revenues, which is approximately 2%
higher than budgeted for FY2008. While the FY2008 year-end forecast is higher, FY2008
will result in significantly higher teleconference revenues than budgeted, better dues and PG
fees revenues based on larger growth during the year than expected, and net revenues from
in-person conference expected to exceed budget based on the success of programs that
have taken place to present. The FY2009 Budget accounts for increased revenues in these
areas compared to the FY2008 Budget, but also takes into consideration a degree of
uncertainty regarding the current economic outlook and potential impact on revenues in
FY2009.

Operating Expenses

Operating expenses are budgeted to be $9,126,400, which is an increase of 5.2% over
FY2008 forecasted levels and an increase of less than 2% compared to the FY2008 Budget.
In addition to inflationary direct expense increases in many of the activity centers across the
association, staff compensation and benefits expenses will increase by $315,000 compared
to the FY2008 year-end forecast, associated with annual staff compensation increases and
inflationary increases in benefit costs. Administrative expenses allocated to activity centers
will increase by $165,000 compared to the FY2008 year-end forecast, largely because
depreciation for the new AMS and CMS technology systems will begin to be expensed in
FY2009 instead of FY2008 as originally planned.

Net Revenues at Operations

The FY2008 Budget reflects net revenues at operations of $149,700, which is 1.6% of total
operating revenues. The goal of the FY2009 Budget Assumptions is 1-2% net at Operations.

Overall Net Revenues

Overall net revenues, which include investment dividend and interest income and investment
management fees, are budgeted to be $459,700, which is 5% of operating revenues.
                                                        American Health Lawyers Association
                                                                    Overall Summary
                                                                  FY2009 Budget
                                                       (For Board Approval on May 22, 2008)


                                                                                                                               FY08 Forecast
                                                    FY2007          FY2008          FY2008          FY2008          FY2009      FY09 Budget       FY2010
                                                     Actual         Budget         Thru 2/28       Forecast         Budget         Variance     Projection
    Operating Revenues:
    Membership Dues & Practice Group Fees      $   3,082,480   $   3,205,000   $   2,229,725   $   3,270,000   $   3,350,000           2.4% $   3,435,000
    Non-Dues Membership                              270,866         228,000         131,863         216,000         230,500           6.7%       261,000
    Practice Group Teleconferences/Luncheons         741,528         735,000         623,526         866,000         790,000          -8.8%       820,000
    Professional Resources                           863,716         755,000         478,048         712,000         747,000           4.9%       797,000
    Conferences                                    3,899,036       3,777,250       1,923,360       3,928,453       3,717,600          -5.4%     3,880,000
    Public Interest                                   94,479          90,500          72,049          88,650          92,500           4.3%       100,500
    ADR Service                                      363,531         308,500         197,703         298,900         348,500          16.6%       363,500
    Other                                             17,237             -               409             -               -              N/A           -
    Total Operating Revenues                   $   9,332,872   $   9,099,250   $   5,656,682   $   9,380,003   $   9,276,100          -1.1% $   9,657,000

    Operating Expenses:
    Membership                                 $   1,464,669   $   1,613,900   $     869,463   $   1,261,420   $   1,380,700           9.5% $   1,430,700
    Practice Groups                                  818,754         839,500         542,533         919,500       1,048,000          14.0%     1,125,500
    Professional Resources                           810,185         606,000         379,103         551,000         577,000           4.7%       616,000
    Conferences                                    3,099,923       3,017,250       1,505,703       3,080,052       2,936,200          -4.7%     3,041,000
    Public Interest                                  293,392         316,000         178,198         274,250         348,000          26.9%       333,700
    ADR Service                                      231,694         236,000         178,456         284,000         320,000          12.7%       338,500
    Executive                                        563,462         628,000         376,952         628,000         672,500           7.1%       703,000
    Financial & Technology Services                1,729,873       1,713,000       1,137,901       1,673,300       1,844,000          10.2%     1,913,000
    Total Operating Expenses                   $   9,011,951   $   8,969,650   $   5,168,310   $   8,671,522   $   9,126,400           5.2% $   9,501,400
    Net Revenues (Expenses) from Operations    $    320,921    $    129,600    $     488,372   $    708,481    $    149,700          -78.9% $     155,600

    Investment Div. Interest                   $     383,868 $      300,000 $        254,789 $      300,000 $       350,000           16.7% $     350,000
    Gain/Loss on Equity Investments                1,016,140            -           (618,283)      (600,000)            -               N/A           -
    Investment Management Expenses                   (39,664)       (45,000)         (34,634)       (45,000)        (40,000)         -11.1%       (40,000)

    Total Net Revenues (Expenses)              $   1,681,266   $    384,600    $      90,245   $    363,481    $    459,700           26.5% $     465,600



1
                                                                  American Health Lawyers Association
                                                                                 Membership
                                                                               FY2009 Budget



                                                                                                                                            FY08 Forecast
                                                       FY2007             FY2008           FY2008             FY2008              FY2009     FY09 Budget       FY2010
                                                        Actual            Budget          Thru 2/28           Forecast            Budget        Variance     Projection

    Membership Dues                             $     2,651,331   $     2,748,500    $     1,888,462   $     2,795,000    $     2,855,000           2.1% $   2,925,000

    Non-Dues Membership Revenues Net:
    Fellows Program Fees                        $        7,500    $         9,000    $         7,450   $          9,000   $         9,000           0.0% $      10,000
    HLN - Prof Opps Ads (Net)                           27,117             22,500             16,928             22,500            22,500           0.0%        27,000
    HLN - Display Ads (Net)                            142,004            110,000             38,905             95,000           110,000          15.8%       125,000
    Career Center Ads (Net)                             51,361             52,500             39,212             52,500            52,500           0.0%        60,000
    HLW Advertising (Net)                                9,204              4,000              6,650              7,000             6,500          -7.1%         7,000
    Mailing List Revenues (Net)                         30,179             30,000             22,718             30,000            30,000           0.0%        32,000

    Total Non-Dues Memb Revenues                $      267,365    $       228,000    $       131,863   $       216,000    $       230,500           6.7% $     261,000

    Health Lawyers News Expenses:
    Health Lawyers News                         $      371,222    $       327,900    $       229,475   $       340,000    $       345,000           1.5% $     360,000
    Health Lawyers News Admin/Allocation               132,717            180,000             91,839           124,800            134,000           7.4%       135,000
    Total Health Lawyers News Expenses          $      503,939    $       507,900    $       321,314   $       464,800    $       479,000           3.1% $     495,000

    Health Lawyers Weekly/Digest Exp:
    Health Lawyers Weekly/HLD Exp:              $       35,039    $       104,000    $        65,720   $        65,720    $        65,700           0.0% $      65,700
    Weekly/Digest Admin/Allocation                     116,113            120,000             75,199           120,000            133,000          10.8%       134,000
    Total HLW/Digest Expenses                   $      151,152    $       224,000    $       140,919   $       185,720    $       198,700           7.0% $     199,700

    Membership Services Expenses:
    Research/Mktg                               $        7,687    $        40,000    $         6,314   $        25,000    $        30,000          20.0% $      30,000
    Membership Retention                                74,832             76,500             16,703            50,000             75,000          50.0%        80,000
    Membership Directory                                25,778             20,000             17,235            22,000             24,000           9.1%        26,000
    Recruitment                                         41,136             44,000             34,114            50,000             55,000          10.0%        60,000
    Life Sciences Initiative*                           17,213             42,500              2,988            15,000                -              N/A           -
    Fellows Program                                      4,598              9,000                -               9,000              9,000           0.0%        10,000
    Total Memb Services Exp Before Alloc               171,244            232,000             77,354           171,000            193,000          12.9%       206,000
    Memb Services Admin/Allocation                     638,334            650,000            329,876           439,900            510,000          15.9%       530,000
    Total Memb Svcs Expenses                    $      809,578    $       882,000    $       407,230   $       610,900    $       703,000          15.1% $     736,000

    Total Membership Exp Before Alloc                  577,505            663,900            372,549           576,720            603,700           4.7%       631,700
    Total Membership Allocation/Admin                  887,164            950,000            496,914           684,700            777,000          13.5%       799,000

    Total Membership Expenses                   $     1,464,669   $     1,613,900    $       869,463   $     1,261,420    $     1,380,700           9.5% $   1,430,700

    * Expenses associated with the Life Sciences initiative are included in other budget lines across AHLA activity centers in FY2009
2
                                                 American Health Lawyers Association
                                                             Practice Groups
                                                             FY2009 Budget



                                                                                                                 FY08 Forecast
                                      FY2007          FY2008          FY2008          FY2008          FY2009      FY09 Budget        FY2010
                                       Actual         Budget         Thru 2/28       Forecast         Budget         Variance      Projection

Practice Group Fees              $    431,149    $    456,500    $     341,263   $    475,000    $    495,000             4.2% $     510,000

Other Revenues:
Teleconferences                  $    640,503    $    605,000    $     549,045   $    725,000    $    630,000           -13.1% $     650,000
Post Teleconf CD Sales                    -            50,000              -           50,000          50,000             0.0%        55,000
Sponsorship                            20,400          10,000            6,500         21,000          30,000            42.9%        30,000
Luncheon/Misc. Fees                    80,625          70,000           36,896         70,000          80,000            14.3%        85,000

Total Other PG Revenues          $    741,528    $    735,000    $     623,526   $    866,000    $    790,000            -8.8% $     820,000

Total Revenues                   $   1,172,677   $   1,191,500   $     964,789   $   1,341,000   $   1,285,000           -4.2% $   1,330,000

Expenses:
Teleconferences                  $    100,499    $    135,000    $     109,997   $    185,000    $    170,000            -8.1% $     176,000
Post Teleconf CD Expenses                 -             3,500            1,047          3,500           3,500             0.0%         3,500
Recruitment/Retention/Research          1,385           3,000               35          3,000           2,000           -33.3%         2,000
PG Meetings                            15,328          18,000              784         18,000          30,000            66.7%        30,000
Activities                            160,713         130,000           48,293        145,000         167,500            15.5%       170,000

Total Exp Before Alloc           $    277,924    $    289,500    $     160,155   $    354,500    $    373,000             5.2% $     381,500
Admin/Allocation                      540,830         550,000          382,377        565,000         675,000            19.5%       744,000

Total Expenses                   $    818,754    $    839,500    $     542,533   $    919,500    $   1,048,000           14.0% $   1,125,500

Total Net Rev (Expenses)         $    353,923    $    352,000    $     422,256   $    421,500    $    237,000           -43.8% $     204,500




3
                                                       American Health Lawyers Association
                                                              Professional Resources
                                                                   FY2009 Budget



                                                                                                                  FY08 Forecast
                                             FY2007        FY2008         FY2008          FY2008        FY2009     FY09 Budget        FY2010
                                              Actual       Budget        Thru 2/28       Forecast       Budget        Variance      Projection
    Publications & Other Prod. Revenues:
    Frontlist (New Products)          $      342,978   $   230,000   $      70,061   $   160,000    $   180,000          12.5% $      190,000
    Existing Pubs & Product Sales             76,239        90,000          82,001        90,000        115,000          27.8%        125,000
    Order Fees                                19,802         5,000           3,641         5,000          7,000          40.0%          7,000
    Derivative Products                      161,535       120,000          62,461       100,000        105,000           5.0%        105,000
    Sponsorships                               2,000         5,000             -          18,000         20,000          11.1%         20,000
    Total Pubs & Other Prod Revenues $       602,554   $   450,000   $     218,164   $   373,000    $   427,000          14.5% $      447,000

    Royalty Generating Products:
    Health Law Practice Guide          $      56,345   $    60,000   $      74,934   $   105,000    $   100,000           -4.8% $     105,000
    CD-ROM                                    50,526        55,000          47,737        60,000         60,000            0.0%        65,000
    Journal of Health Law                    133,158       140,000          57,999        65,000         50,000          -23.1%        65,000
    On-line Royalties                         18,132        10,000          12,374        14,000         15,000            7.1%        15,000
    Total Royalties                    $     258,162   $   265,000   $     193,044   $   244,000    $   225,000           -7.8% $     250,000

    Subscription Generating Products:
    Digest/News Report                $          894   $       -     $         780   $       -      $       -               N/A $         -
    Archive                                    2,106        40,000          66,059        95,000         95,000             N/A       100,000
    Total Subscriptions                $       3,000   $    40,000   $      66,839   $    95,000    $    95,000           0.0% $      100,000

    Total Revenues                     $     863,716   $   755,000   $     478,048   $   712,000    $   747,000           4.9% $      797,000

    Publications & Other Products Expense:
    Frontlist (New Products)                 120,811        36,000           3,032         4,000         15,000         275.0%         15,000
    Existing Pubs & Product Sales             29,110           -            29,355        45,000         10,000         -77.8%         12,000
    Journal of Health Law                    118,732       100,000          22,092        32,000         34,000           6.3%         37,000
    Derivative Products                       60,950        30,000          15,133        30,000         40,000          33.3%         42,000
    Total Pubs & Other Products Exp    $     329,603   $   166,000   $      69,612   $   111,000    $    99,000          -10.8% $     106,000
    Subscription Generating Products:
    Archive                           $        4,729   $       -     $       2,587   $        -     $       -               N/A $         -

    Total Subscriptions Expense        $       4,729   $       -     $       2,587   $        -     $       -               N/A $         -
    Total Expenses Before Allocation   $     334,332   $   166,000   $      72,199   $   111,000    $    99,000          -10.8% $     106,000
    Non-Dues Pubs Admin/Allocation           475,853       440,000         306,905       440,000        478,000            8.6%       510,000
    Total Expenses                     $     810,185   $   606,000   $     379,103   $   551,000    $   577,000           4.7% $      616,000

    Total Net Revenues (Expenses)      $      53,531   $   149,000   $      98,944   $   161,000    $   170,000           5.6% $      181,000


4
                                                           American Health Lawyers Association
                                                                           Conferences
                                                                          FY2009 Budget



                                                                                                                           FY08 Forecast
                                            FY2007             FY2008           FY2008          FY2008          FY2009      FY09 Budget        FY2010
                                             Actual            Budget          Thru 2/28       Forecast         Budget          Variance     Projection

    Revenues:
    Tax Issues                         $     158,972   $        123,225    $     167,237   $     167,237   $     132,650          -20.7% $     142,000
    Fraud & Compliance                       299,387            355,675          444,563         444,563         370,400          -16.7%       395,000
    Managed Care                             101,323            159,250              -               -           168,200             N/A       180,000
    Fundamentals                             333,855            279,300          359,007         359,007         288,125          -19.7%       310,000
    Academic Medical Centers                 104,048            107,775          103,768         103,768          96,100           -7.4%       105,000
    Physicians                               212,264            172,500          181,698         181,698         175,700           -3.3%       185,000
    Hospitals & Health Systems               242,431            212,800          234,209         234,209         212,625           -9.2%       230,000
    Long Term Care                           285,773            284,675          310,030         310,030         279,650           -9.8%       295,000
    Medicare/Medicaid                        668,102            679,925              -           679,925         652,625           -4.0%       675,000
    Life Sciences                            108,706            145,250              -           145,250         100,000             N/A       108,000
    Masters Program                              -                  -                -               -            28,650             N/A           -
    In-House Counsel                         134,962            131,550              -           131,550         131,000           -0.4%       140,000
    Annual Meeting                         1,231,027          1,030,000              -         1,030,000       1,081,875            5.0%     1,110,000
    Hearing Officers Training                    -               18,325              -            18,325             -               N/A           -
    Antitrust                                    -               77,000           92,531          92,531             -               N/A         5,000
    Webcasts                                     -                  -             18,360          18,360             -               N/A           -
    Other Conference Revenue                  18,187                -             11,956          12,000             -               N/A           -

    Total Revenues                     $   3,899,036   $      3,777,250    $   1,923,360   $   3,928,453   $   3,717,600           -5.4% $   3,880,000

    Expenses:
    Tax Issues                         $     101,602   $       101,500     $      92,143   $    110,273    $     99,750            -9.5% $     108,000
    Fraud & Compliance                       184,688           271,000           288,060        318,000         270,000           -15.1%       275,000
    Managed Care                             119,219           162,000             2,374          3,000         110,850              N/A       120,000
    Fundamentals                             211,422           190,250           217,307        245,700         222,750            -9.3%       228,000
    Academic Medical Centers                 110,434           101,500           104,538        125,931         109,950           -12.7%       118,000
    Physicians                               152,213           126,000           122,384        158,826         135,750           -14.5%       140,000
    Hospitals & Health Systems               149,149           148,000           135,555        155,500         148,250            -4.7%       155,000
    Long Term Care                           278,347           275,000           233,044        275,000         258,000            -6.2%       265,000
    Medicare/Medicaid                        466,286           457,000            15,628        457,000         403,700           -11.7%       412,000
    Life Sciences                            126,072           104,000             5,960        104,000         100,000            -3.8%       100,000
    Masters Program                            2,054               -                 -              -            47,500              N/A           -
    In-House Counsel                         115,239           106,500             2,747        106,500         110,000             3.3%       115,000
    Annual Meeting                         1,043,664           886,500            27,947        886,500         919,700             3.7%     1,005,000
    Antitrust                                    -              76,000           104,552        104,552             -                N/A           -
    Hearing Officers Training                    -              12,000               -           12,000             -                N/A           -
    Webcasts                                     -                                12,270         12,270             -                N/A           -
    Other Conference Expenses                  7,914                -              4,564          5,000             -                N/A           -

    Total Expenses Before Allocation   $   3,068,303   $      3,017,250    $   1,369,074   $   3,080,052   $   2,936,200           -4.7% $   3,041,000
    Conferences Admin/Allocation              31,620                -            136,629             -               -               N/A           -
    Total Expenses                     $   3,099,923   $      3,017,250    $   1,505,703   $   3,080,052   $   2,936,200           -4.7% $   3,041,000

    Total Net Revenues (Expenses)      $    799,113    $       760,000     $     417,657   $    848,401    $    781,400            -7.9% $     839,000

5
                                                     American Health Lawyers Association
                                                                   Public Interest

                                                                FY2009 Budget



                                                                                                                    FY08 Forecast
                                       FY2007            FY2008           FY2008          FY2008        FY2009       FY09 Budget        FY2010
                                        Actual           Budget          Thru 2/28       Forecast       Budget          Variance      Projection

Revenues:
Contributions                      $    88,474   $        73,000    $       68,899   $    85,000    $    85,000             0.0% $       90,000
Sponsorships                             1,000            10,000             3,150         3,150          5,000            58.7%          7,500
Telephone Series Registrations           5,005             7,500               -             500          2,500           400.0%          3,000

Total Revenues                     $    94,479   $        90,500    $       72,049   $    88,650    $    92,500              4.3% $     100,500

Expenses:
Publications/Products                   16,922            40,000               -              -          40,000              N/A         10,000
Linkages w/Academia                        -               1,000               -              -           1,000              N/A          1,500
Teleconference Series                    2,233             6,500               -              250         1,000           300.0%            200
Contributions                           10,000               -                 -              -             -                N/A            -
Solicitations/Fundraising                  761             2,000             1,130          1,500         1,500             0.0%          2,000
Public Affairs Visibility/Comm             958             9,000             2,399          5,000         6,500              N/A          2,000
Public Dialogue Session                    -                 -                 -              -           5,000              N/A          5,000
Public Information Series                  -               7,500             1,012          2,500         5,000           100.0%          5,000

Total Expenses Before Allocation   $    30,874   $        66,000    $        4,541   $     9,250    $    60,000           548.6% $       25,700
Public Interest Admin/Allocation       262,518           250,000           173,657       265,000        288,000             8.7%        308,000
Total Expenses                     $   293,392   $       316,000    $      178,198   $   274,250    $   348,000             26.9% $     333,700

Total Net Revenues (Expenses)      $   (198,913) $       (225,500) $      (106,149) $    (185,600) $    (255,500)          -37.7% $    (233,200)




6
                                                 American Health Lawyers Association
                                                     Alternative Dispute Resolution Service
                                                                FY2009 Budget



                                                                                                                 FY08 Forecast
                                       FY2007             FY2008         FY2008          FY2008        FY2009     FY09 Budget        FY2010
                                        Actual            Budget        Thru 2/28       Forecast       Budget        Variance      Projection


Revenues:
User Fees                          $   245,211   $        198,000   $     146,520   $   200,000    $   237,500           18.8% $     245,000
Training Program Fees                   77,990             78,000          24,878        60,000         78,000           30.0%        82,000
Dispute Resolver Fees                   40,330             28,000          26,305        35,000         30,000          -14.3%        33,000
Misc Revenue/Teleconferences               -                4,500             -           3,900          3,000          -23.1%         3,500

Total Revenues                     $   363,531   $        308,500   $     197,703   $   298,900    $   348,500           16.6% $     363,500

Expenses:
Training Program:
 Marketing                         $       -     $          1,000   $         -     $     1,000    $     1,000            0.0% $       1,000
 Trainer Fees                           26,638             27,500           9,900        27,500         28,000            1.8%        29,000
 Travel & Hotel                         14,917              9,000           7,666         9,000         10,500           16.7%        11,000
ADR Service Administration:
 General Marketing                         -                8,000             -           8,000          9,000           12.5%         7,000
 Mailing Costs                          12,986             13,000           7,424        11,000         16,500           50.0%        17,000
 Consulting                              2,457                -               -             -              -               N/A           -
 Miscellaneous                           7,435              2,500           1,241         2,500          3,000           20.0%         3,500

Total Expenses Before Allocation   $    64,434   $         61,000   $      26,231   $    59,000    $    68,000           15.3% $      68,500
ADR Admin/Allocation                   167,260            175,000         152,225       225,000        252,000           12.0%       270,000
Total Expenses                     $   231,694   $        236,000   $     178,456   $   284,000    $   320,000           12.7% $     338,500
Total Net Revenues (Expenses)      $   131,837   $         72,500   $      19,246   $    14,900    $    28,500           91.3% $      25,000




7
                                                    American Health Lawyers Association
                                                                   Executive
                                                               FY2009 Budget



                                                                                                                FY08 Forecast
                                          FY2007        FY2008          FY2008          FY2008        FY2009     FY09 Budget        FY2010
                                           Actual       Budget         Thru 2/28       Forecast       Budget        Variance      Projection

Expenses:
Visibility/Comm./Strategic Planning   $       -     $     30,000   $         123   $     3,000    $     7,500         150.0% $        5,000
Board/Committees                          184,558        180,000          69,636       180,000        195,000           8.3%        195,000

Total Expenses Before Allocation      $   184,558   $    210,000   $      69,759   $   183,000    $   202,500           10.7% $     200,000
Executive Admin/Allocation                378,904        418,000         307,194       445,000        470,000            5.6%       503,000

Total Expenses                        $   563,462   $    628,000   $     376,952   $   628,000    $   672,500            7.1% $     703,000




8
                                                        American Health Lawyers Association
                                                          Financial & Technology Services
                                                                       FY2009 Budget



                                                                                                                        FY08 Forecast
                                         FY2007             FY2008           FY2008          FY2008          FY2009      FY09 Budget        FY2010
                                          Actual            Budget          Thru 2/28       Forecast         Budget         Variance      Projection

Expenses:
Finance & Administration:
Financial Services Expense          $     47,328    $        50,000     $      24,022   $     40,000    $      45,000           12.5% $      50,000
Total Expense Before Allocation           47,328             50,000            24,022         40,000           45,000           12.5%        50,000
Admin/Allocation                         903,818            891,000           623,287        898,300          975,000            8.5%       937,000
Total Fin. & Admin. Expense         $    998,475    $       991,000     $     671,331   $    978,300    $   1,065,000            8.9% $   1,037,000

Technology:
Web Development/Maintenance         $      52,269   $         98,000    $      42,370   $     75,000    $      85,000           13.3% $      95,000
Network/AMS/Computer Expense              166,441            175,000          110,267        175,000          195,000           11.4%       195,000
Technology Consultant                      73,345             20,000            2,339         10,000           10,000            0.0%           -
Total Expense Before Allocation           292,054            293,000          154,976        260,000          290,000           11.5%       290,000
Admin/Allocation                          486,672            479,000          335,616        475,000          534,000           12.4%       636,000
Total Technology Expense            $   1,070,781   $      1,065,000    $     645,568   $    995,000    $   1,114,000           12.0% $   1,216,000

Total Fin & Tech Exp before Alloc         339,383            343,000          178,998         300,000         335,000           11.7%       340,000
Total Alloc/Admin                       1,390,490          1,370,000          958,903       1,373,300       1,509,000            9.9%     1,573,000

Total Fin. & Tech Svcs Expenses     $   1,729,873   $      1,713,000    $   1,137,901   $   1,673,300   $   1,844,000           10.2% $   1,913,000




9
                                                           American Health Lawyers Association
                                         Personnel and Administrative Expenses Allocated to Activity Centers

                                                                         FY2009 Budget



                                                                                                                          FY08 Forecast
                                             FY2007            FY2008          FY2008          FY2008          FY2009       FY09 Budget       FY2010
                                              Actual           Budget         Thru 2/28       Forecast         Budget          Variance     Projection

     Personnel:
     Salaries                        $     2,908,481   $     2,985,000    $   2,039,263   $   2,980,000   $   3,227,000            8.3% $   3,410,000
     Payroll Taxes                           189,665           200,000          131,299         200,000         208,000            4.0%       220,000
     Employee Benefits                       476,740           510,000          305,147         485,000         545,000           12.4%       565,000

     Total Personnel Expense         $     3,574,886   $     3,695,000    $   2,475,709   $   3,665,000   $   3,980,000            8.6% $   4,195,000

     General Administration:
     General Postage                 $        16,912   $        15,000    $      15,654   $     17,000    $     18,000             5.9% $      20,000
     General Printing                            350             2,500              717          1,000           1,500            50.0%         2,500
     General Photocopying                      5,319            11,000              558          5,500           6,000             9.1%         6,500
     General Telephone                        31,122            30,000           12,412         18,000          18,000             0.0%        20,000
     General Office Supplies/Maint            58,673            62,000           42,195         62,000          65,000             4.8%        68,000
     Depreciation                             76,019           170,000           52,562         70,000         185,000           164.3%       190,000
     Rent & RE Expense                       552,472           545,000          375,057        555,000         555,000             0.0%       555,000
     Insurance                                59,691            75,000           46,132         75,000          80,000             6.7%        84,000
     Legal Fees                                3,973             6,000            1,591          3,000           5,000            66.7%         5,000
     Temporary Help                              -              20,000           20,045         20,000          30,000            50.0%        35,000
     Recruitment                                 -              30,000               28          5,000          25,000           400.0%        30,000
     Training & Development                    2,692            40,000            3,286         40,000          40,000             0.0%        25,000
     Tax Expense                                 141             1,000              100          1,000             500           -50.0%           500
     Bank/Credit Card Fees                   213,631           195,000          122,021        200,000         205,000             2.5%       215,000
     Miscellaneous and Other                  17,884            25,000           13,222         22,000          25,000            13.6%        25,000
     Total Admin/General Expense     $     1,038,877   $     1,227,500    $     705,580   $   1,094,500   $   1,259,000           15.0% $   1,281,500

     Total Allocated Expense         $     4,613,763   $     4,922,500    $   3,181,289   $   4,759,500   $   5,239,000           10.1% $   5,476,500




10
                    AMERICAN HEALTH LAWYERS ASSOCIATION
                         ELECTION RESULTS FOR FY2009


President-Elect Designate

Richard L. Shackelford


New Board Members (4)

Robert G. Homchick

Arthur N. Lerner

Charlene L. McGinty

Eric Zimmerman


At-Large Nominating Committee Members (2)

Barbara L. Miltenberger

Myra C. Selby


Fellows (2)

Dale H. Cowan

Richard G. Cowart


Emeritus Fellows (8)

Jamie H. Clements

James L. Hall, Jr. (deceased)

Robert L. Johnson

James E. Ludlam

Sherwin L. Memel (deceased)

Robert W. Miller

Joseph A. Murphy

Galen D. Powers
          TAB 5B




Report on the Annual Meeting
           (ORAL)

								
To top