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April 26-29, 2009 | Washington, DC
The AHA Annual Membership Meeting brings hospital leaders together to confront health care’s challenges and opportunities. Follow blogs from H&HN Managing Editor Bill Santamour and Executive Editor and Associate Publisher Alden Solovy for daily updates from the meeting. All comments are welcome and may be posted to the blog. Comments may be edited for clarity or length. Click here to return to the H&HN blog homepage. |
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Do you walk the talk?
by Alden Solovy @ 12:20PM
Are you honest enough to admit your biases and prejudices? If not, you may be one of the leaders giving only lip service to addressing the challenges of increasing diversity in health care organizations and reducing ethnic and racial disparities in health care. That’s the message from Janice Dreachslin, a professor of health policy and administration at Penn State.
Diversity leadership skills can be cultivated, but it takes honesty and commitment. “The role of leadership is central and powerful,” she said. Ask yourself some powerful questions:
- What kind of person am I?
- What does my inner circle look like?
- Do I accept differences in other people?
- How do I react when my point of view is challenged?
- Do I walk the talk?
Then, take advantage of the resources like the Institute for Diversity in Health Management and the HRET Disparities Toolkit.
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Preparing for Schedule H
by Bill Santamour @ 12:00PM
Tax exemption is a “sacred designation” bestowed on not-for-profit hospitals for the benefits they bring to their communities, Scott A. Duke, CEO of Glendive (Mont.) Medical Center told colleagues this morning. “But it has come under fire, sometimes because of bad players, but often because it is misunderstood.” That makes it incumbent on hospitals to “voluntarily and proactively report to the community the true value of the benefits we provide,” said Rick de Filippi, AHA chair-elect and a member of the Cambridge (Mass.) Health Alliance hospital board.
Schedule H, which hospitals will be required to submit with their Form 990 for tax year 2009, is intended by the IRS to make sure hospitals are in compliance with their tax-exempt status, and Deborah T. Ashford, an attorney who is the AHA’s principal adviser on tax-exempt issues, urged hospitals to familiarize themselves with it before tax documents are sent out next year. Some hospitals may even want to do a mock Schedule H using their 2008 data, she said.
To help, the AHA is sending all its not-for-profit hospital members “Telling the Hospital Story: Going Beyond Schedule H,” a checklist to help CEOs and their leadership teams think through the various aspects for successfully completing Schedule H. “It is a starting point for organizing reporting efforts and will make the second step of making the IRS forms ‘come alive’ easier, not only as a required report but also as a catalyst for building organizational and public understanding of ways in which hospitals and health systems are holding themselves accountable for fulfilling their responsibilities to their patients and their communities.”
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Hospitals mobilize for swine flu
by Alden Solovy @ 9:35AM
While the meeting progressed, the threat of a swine flu emergency took hold in the minds of hospital leaders and the public. Leaders of the AHA swung into action. So did CEOs from hospitals across the nation.
Todd Linden, president and CEO of Grinnell (Iowa) Regional Medical Center, said that he and a board member had just participated in a call with clinical leaders back home. “We drill this kind of thing all the time,” he said. Michelle Rebelsky, M.D., a Grinnell trustee and an infectious disease physician said, “The good news is that this will come up on an influenza A screen.” The risk, she added, is that it potentially mutates as it moves from person to person.
Hospital CEOs have participated in calls and used their Blackberries to stay in touch with local preparations. Tom Jones, CEO of the West Virginia United Health System, Fairmont, said that the system’s clinical team has reviewed protocols and he’s monitoring activities back home.
Meanwhile, Rich Umbdenstock, AHA’s president and CEO, briefed members from the main podium. AHA has participated in calls with Craig Vanderwagen, HHS’ Assistant Secretary for Preparedness and Response and Chief Preparedness Officer “to assure HHS that hospitals are ready.”
Umbdenstock said that one key concern is the health of first responders. Another is that hospitals are careful in the use of resources like respirators and other equipment and don’t inadvertently contribute to the creation of a shortage. He said that AHA will continue to monitor developments nationally and will serve as a resource to government agencies and hospitals leaders.
Additional information and guidance is available from the Centers for Disease Control & Prevention, the World Health Organization and the BBC.
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It worked for Obama
by Bill Santamour @ 8:00PM
Leaders who want to rally public support for hospitals in their own communities and for health care reform nationally better know how to use the Internet effectively—and better understand that digital media are changing all the time, David Plouffe told AHA members Monday.
He ought to know. Many experts say Plouffe, Barack Obama’s campaign manager, fundamentally changed politics by recognizing the power of the Web to build and maintain a grassroots organization and to get Obama’s message out to millions of people every day “unfiltered” by journalists, commentators, other politicians or anybody else. Now that Obama is ensconced in the White House, the administration is using the same online networking strategy to gain support for its policy initiatives.
“This has real application to what you’re trying to do,” Plouffe said. Hospitals can build good will and support by describing to their online audience not only the medical services they provide, but also the many and varied benefits they bring to the community, the pressures they face and their stance on issues. “You can educate people about your position. When a group of co-workers is standing around the water cooler and somebody says, ‘I don’t know about this Obama health care plan,’ your supporters can answer that.”
The Internet can also promote transparency and trust in your organization. “People want authenticity; they know when you are being authentic and they listen and they respond.” As an example: the Obama campaign in Florida posted on its Web site exactly how it was spending contributions in that state. “People felt they were being leveled with,” he said. “They understood when we asked them to donate more money or why we needed them to volunteer more hours. They felt valued.”
Lest you think this doesn’t apply to you because your patient base skews older, think again. “People over 70 spend more time online than any other demographic group,” Plouffe said.
But take note: The way people use the Internet is constantly evolving, and new ways of delivering and receiving information emerge seemingly every day. “In a very short time, e-mail to desktops is going to seem like Jurassic Park,” Plouffe said to the alarm of at least one health care editor. If the next iteration of Facebook is Twitter, the next iteration of Twitter can’t be far behind. The trick is for health care leaders to make sure they’re not left behind. Keeping up can be daunting, but it can also be a key to embracing—and being embraced by—your community.
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A sensible approach to stimulus funds
by Alden Solovy @ 12:30PM
“If something doesn’t make sense without stimulus funds, then it doesn’t make sense with stimulus funds,” Marty Fattig said at an executive briefing on information technology this morning.
Fattig, CEO of Nemaha County Hospital, Auburn, Neb., said that potential new dollars for IT bring an increased need to stay focused on core goals: improving care and lowering costs. Panelists Rod Dykehouse and Bill Spooner agreed.
“It seems like we’ve gone from ‘yes we can’ to ‘gimme the dough,’” said Spooner, CIO for Sharp HealthCare, San Diego. Success will hinge on linking IT projects to strategic plans and bringing critical stakeholders to the table, like physicians and nurses, he noted.
For those hospitals that are relatively new to developing an electronic medical record, “making the [internal] case for change has been consolidated into a very short period of time” because of the availability of stimulus funds, said Dykehouse, CIO for ProHealth Care, Waukesha, Wis. That, he said, will be a major challenge.
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Eight simple principles for health reform
by Bill Santamour @ 12:00PM
AHA President and CEO Rich Umbdenstock told attendees at today’s federal forum opening plenary that the nation is ready and the time is right for health care reform. “There’s more public support, more political will and more need for it,” he said. No matter what their ideological leanings, “no one is campaigning for the status quo.”
Nancy-Ann DeParle, the newly appointed director of the White House Office of Health Reform, was the featured speaker at the plenary and she echoed Umbdenstock’s view. “A broad cross-section of health care stakeholders understands that the status quo is not an option,” she said, adding that President Obama is committed to achieving reform in 2009. “This is a unique moment, and the momentum is on our side.”
DeParle described eight simple principles that will guide the administration’s reform efforts:
- Any plan must address ways to control long-term growth in health care costs. “Reform that does not control costs is no reform at all,” she said.
- Families must be protected against bankruptcy or crushing debt from health care costs.
- Americans must be allowed to choose their own doctors, hospitals and health plans. “The Obama administration will not force patients to change providers or plans,” DeParle said.
- The nation must make a real investment in prevention and wellness.
- Any reform measures must take significant steps to ensure safety and improve quality of care.
- The nation must ensure affordable, quality health care for all Americans.
- Health care coverage must be maintained for Americans even when they lose or change jobs.
- Insurers must end barriers to coverage for people with pre-existing medical conditions. “This is rationing health care, plain and simple, and it will not be tolerated,” DeParle declared.
President Obama has said there will be no sacred cows when it comes to the health care debate, DeParle said, and the administration expects a vigorous discussion of the details. “But six months from now, the president will sit down to sign comprehensive health reform legislation into law,” she told the AHA members. “And I look forward to celebrating that achievement with you.”
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April 28, 2009 - I’ve worked in health care since 1976. I think the government needs to get out of health care. If we think health care needs reform now, just wait until the federal government gets in even deeper. The "Eight simple principles for health reform" are anything but simple. I think if the government got out of health care there would be a lot fewer people having to file bankruptcy due to health care costs. Clearly 25 percent of the hospital bill is to cover overhead! An open market approach to health care is the answer. Granted, some regulation is necessary but in the long run, health care in America would improve, no one would be without health care, and the cost would come down. To Ms. DeParle that rationing of health care will not be tolerated. How will the Obama plan prevent that? None of the single payer plans in countries such as Great Britain or Canada work! Listen to their doctors. I’m convinced that the only people who will have good health care are the politicians who push this stuff and their cronies who take the bait. - Thomas C. Christman Jr. April 28, 2009 - Sensible principles. - John G. Self, Chairman & Senior Client Advisor, JohnMarch Partners, Inc., Dallas April 28, 2009 - Why in the world does government refuse to listen to new approaches to medical programs which have proven to reduce health care? There is no SYSTEM in health care due to the fact that there has been NO change in hospital design since Invalides in Paris was built some 300 years ago. We had to go to the state and have a law passed that would allow us to design and build a hospital which solved many problems in reducing hospital costs. We can supply written reports that show the high cost of medical care can be reduced and furthermore, in house infections can be eliminated. We will be happy to give you the solution in health care which should be accessible to EVERYONE; not to only those who live in or near the medical centers. It is time to look at a satellite SYSTEM, which is the solution which needs to be addressed NOW. - Wm. R. Streed April 27, 2009 - No specific suggestions were provided so this is of little to no value. - Steven Nadler, Construction Services Manager, HDR, Chicago April 27, 2009 - Amen to those 8 points. As someone who works on the business side of health care, those sum up the most important things that must be accomplished. Allowing economics to determine how health care is run is what has gotten us to where we are. There are going to have to be controls on doctors, hospitals, pharmaceuticals and other medical devices and equipment. I understand that companies need to make a profit, but if they are in the health care business that shouldn’t be their only motivation. Also, we should be looking at the health care systems of other nations and using their best ideas. They are doing things better than we are, let’s not reinvent the wheel. While I believe they are probably spending too little, we are spending way too much. We have huge room for improvement in lowering costs and improving quality. - Kathy Humbracht |
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Where "H" stands for compassion
by Alden Solovy @ 9:10AM
I knew this would happen. That’s why I’m standing in the very back of the room, against the wall, in the dark. The lights have dimmed, and a video has begun playing. I am crying.
“Every day,” the narrator says, “people follow the blue ‘H’ sign to a place of care and comfort. This blue sign says: ‘I will take you to a place where the best people in this community will do the very best they can for you.’”
Only three weeks ago, my family experienced the love and care that occurs inside our nation’s hospitals. The video brought it home, and I must say again what I said to caregivers and hospital executives in my column about our tragedy: thank you.
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Breakfast, Bo and Byrd
by Bill Santamour @ 9:00AM
This morning’s breakfast sponsored by the AHA’s Section for Small or Rural Hospitals was heavily attended—to the point that hotel staff had to set up extra tables to accommodate everybody. It’s an indication of how committed these folks are to providing quality health care to their communities and how concerned they are that economic pressures back home are making it increasingly difficult to do so.
As the juice and java flowed, conversations tended to focus on the alarming increase in self-pay patients in the face of mounting unemployment and the hope that health care reform, whatever its final details are, will come soon enough to avert a real catastrophe in small towns and rural areas across the nation. As one administrator told me, “When you’re a 40-bed hospital and the number of patients who can no longer afford to pay their bills suddenly spikes, it only takes two or three months before you have no money to operate on.” Her colleagues around the table nodded their heads in agreement.
The speaker for the breakfast session was Bret Baier, who recently replaced Brit Hume as host of “Special Report” on Fox News after two years as the network’s chief White House correspondent. He described covering the federal government as “drinking out of a fire hose” because of the sheer volume of information that comes spewing forth every day. That encompasses information on issues ranging from the economic crisis to energy policy to the wars in Iraq and Afghanistan. “So what’s been the biggest story over the last two weeks?” Baier asked, a little chagrined. “Bo the White House dog.”
Though Baier didn’t make a lot of predictions about a potential battle over health care on Capitol Hill, he noted that Sens. Ted Kennedy (D-Mass.) and Max Baucus (D-Mont.) have vowed to introduce their reform bill by June and it could be voted on as early as September. Although some Democrats have suggested they’ll couch reform as budget reconciliation, which would require a simple majority vote to pass, the GOP could challenge that effort under the so-called Byrd rule and take the legislation apart piece by piece. “It’ll be very interesting to watch how it unfolds this summer,” Baier said.Submit a Comment | Back to Top
Taking our message to the public
by Alden Solovy @ 8:15AM
A new study released today shows that six in 10 hospitals are facing an increase in patients without insurance. Those patients are coming through the emergency department.
The AHA study isn't a surprise to those of us in health care, but influential leaders from politicians to members of the media need to understand the economic pressures facing hospitals.
So does the public. Rich Umbdenstock, AHA’s president and CEO, recorded a couple of YouTube videos. One focuses on the new study and another on the economy.
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April 28, 2009 - They come through the emergency departments because that is how the government wants it done! The government cannot begin to fix the problem it created in a meaningful way. They will “tinker” with it, and it will get worse. The last person I would have working on the health care “problem” is politicians, hospital CEOs, insurance company CEOs. Give me doctors, nurses, clinicians, and hospital patients. You guys don’t have a clue! - Thomas C. Christman Jr. |
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Priselac's call to action
by Alden Solovy @ 7:45PM
“I’m confident that we will be the generation of leaders that transform the health care system,” Thomas Priselac told the assembled members of the American Hospital Association during his investiture speech.
The investiture ceremony is, by design, a pivotal moment at the Annual Meeting. It’s a resounding call to action, combining our national symbology—the historic ethos of God and country—with a message of service. Sitting on stage with a backdrop of state flags, the board presides over an invocation, the presentation of the colors and an operatic rendition of the National Anthem.
Then the new chairman speaks. For me, the words were an exclamation point. The most important moment happened in the instant he began his remarks, the moment in which Priselac visibly held back a swell of emotion.
“Oh my,” he said after the standing ovation.
It is not easy work, running hospitals. It is not easy work, caring for the voiceless and vulnerable. It is not easy work, maintaining a voice as the political process swells around health care reform.
To see the depth of love and care for this work in the face of a national leader, well, that’s exactly what I came to see.
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Trustees' new accountability
by Bill Santamour @ 5:00PM
James E. Orlikoff introduced a new concept on how trustees should expand and carry out their responsibilities. He called it “microgovernance,” not to be confused with micromanagement, although it does involve a far more active focus on issues that were once considered the sole domain of CEOs and their management teams. It includes everything from quality and patient safety to coding and contracting to physician relations to information technology systems. Trustees will now be held much more accountable for those areas by the Internal Revenue Service, Congress, states’ attorneys general, the Centers for Medicare & Medicaid Services and others, and they better clearly understand how their roles must change.
“Considered separately, any of these issues may not indicate or justify changes in governance,” said Orlikoff, president of Orlikoff & Associates Inc. and a senior consultant of the Center for Healthcare Governance. “However, the combined weight of these issues as a whole signals a shift in the required level of board attention and involvement. This shift requires that boards integrate microgovernance as a necessary and appropriate approach in the overall governance model.”
The trick will be finding the right balance between microgovernance and the traditional strategic and generative responsibilities of the board, and Orlikoff outlined a seven-step action plan that begins with a warning: Don’t drift into microgovernance. Any changes in governance should be based on explicit choices by the board and the CEO. They should conduct a detailed assessment of how the responsibilities of trustees and management are changing, and these should be reviewed with the CEO at least once a year to maintain a healthy leadership partnership during economic and regulatory turmoil.
The seventh and final step in the action plan was also a warning: Do not confuse microgovernance with micromanagement. “Microgovernance is now a key component of board work; micromanagement is inappropriate and destructive.” Orlikoff briefly summed up the two thusly: microgovernance is “directing how the organization is managed” while micromanagement is “actually managing the organization.”
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Smile, you’re on YouTube
by Alden Solovy @ 2:10PM
Outside the International Ballroom in the Hilton Washington Hotel, in the buzz and din of the foyer, the AHA’s YouTube camera rolls.
Hold on a second. AHA and YouTube? You betcha.
“If you have a chance to make a difference, take it,” said Robert Haynes, CEO of Guadalupe Regional Medical Center, Seguin, Texas, after he finished recording his video. That’s why he decided to step in front of the camera. Making a difference, he said, is about telling stories.
This first-time effort is aimed at sharing the stories of how hospitals across the nation are coping with the economic crisis. The AHA created a dedicated YouTube channel and produced two hospital videos in advance of the Annual Meeting: one on Pioneer Medical Center, Big Timber, Mont., and the other on St. Barnabas Hospital, Bronx, N.Y. Videos produced onsite will be posted throughout the meeting.
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Be like George
by Alden Solovy @ 12:15PM
Have you heard of the “George Lynn Rule”? It’s a simple, elegant way to think about decisions that influence both the hospital’s mission and its margin.
Lynn is a former chairman of the AHA. The rule, according to Raymond Grady, came directly from George’s investiture speech at this very meeting four years ago.
Grady is a current member of the AHA board. He was joined at a Sunday morning session by Richard de Filippi, AHA chair-elect, and Steve Mayfield, who runs the AHA Quality Center, to present Hospitals in Pursuit of Excellence, the first of a series of new resources to help hospitals address the six IOM Aims. Grady also serves as chairman of the AHA’s national advisory board for the Hospitals in Pursuit of Excellence project.
“Lead with your mission,” Ray quoted George. “That will always give you the high ground.” By applying the George Lynn Rule, he added, quality initiatives will naturally take their place at the top of the agenda for any hospital.
“We really have to get in there and change the way care is provided,” Grady said. “Cost and quality are not mutually exclusive.
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Under the “big tent” in DC
by Alden Solovy @ 9:00AM
Dateline: Washington. When I was a young reporter, it was always a thrill to put a dateline on an article. Covering the news of the day was fresh and energizing and, as part of the Fourth Estate, it had the potential to make a difference.
That’s how it feels to attend the AHA Annual Membership Meeting. This is the American Hospital Association’s Big Tent. People who have dedicated their lives to fostering the best of American health care through the political process convene to shape the nation’s health care policy agenda. Sure, there are meetings across the country of folks who make health care better in different ways—quality gurus, financial mavens, nursing executives, physician leaders—but this is the sine qua non of hospital advocacy.
Leaders from across the nation are here. I confess that I’m more of a social interest reporter and not really a political junkie—let other reporters cover policy and politics. Still, this one of my two favorite meetings. The energy, the dedication, the passion—it’s palpable. If you’ve never been to the Annual Meeting, stay tuned. Read this blog. And be sure to put next year’s meeting on your calendar. It’s April 25-28, 2010.
By the way, my other favorite meeting—no surprise here—is the Health Forum-AHA Leadership Summit. It presents the best in hospital strategy and management. This year’s Summit will be July 23-25 in San Francisco. I’ll see you there.
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