ARKANSAS HOSPITAL STATISTICS, FACTS AND ......doesn’t always mean doing the easy thing, and we know there are difficult challenges and adjust-ments ahead. As we went to Washington,

Summer 2010 I Arkansas Hospitals 1A M A g A z i n e f o r A r k A n s A s h e A lt h c A r e P r o f e s s i o n A l sA M A g A z i n e f o r A r k A n s A s h e A lt h c A r e P r o f e s s i o n A l s

SUMMER 2010 www.arkhospitals.org

ARKANSAS HOSPITAL STATISTICS,FACTS AND FIGURES

What These Statistics Meanfor Your Hospital

2 Summer 2010 I Arkansas Hospitals

Summer 2010 I Arkansas Hospitals 3

w

Arkansas Hospitals

PAGE 45PAGE 11 PAGE 27 PAGE 34

Statistical Information8 Arkansas Hospitals by the Numbers8 Distribution of Arkansas Licensed Hospitals 9 Key Numbers Behind Important Facts10 AHA Members by Congressional District11 A Snapshot of Arkansas Hospitals12 Charges by Payer Category13 Comparative Utilization Indicators14 Community Hospital Indicators15 Community Hospital Summary Financial Data16 AHA Member Hospitals18 Comparative Financial Indicators 20 Hospital Ownership - Investors21 Hospital Ownership - Not-for-Profits 22 Member Organizations: Public Hospitals 22 AHA Member Organizations 23 Charges and Lengths of Stay for Top 30 DRGs 25 Hospital Uncompensated Care Costs

Features26 AHA Accomplishments 2009-201027 Scrub Those Copier Hard Drives 28 AHA Annual Meeting Announcement 29 Award Nominations Being Accepted30 Mid-Management Series Resumes Sept. 1631 AHA Services, Inc. Announces New Services34 Hospitals Complete Trauma Application Process34 Crucial Conversations® Training: Get Unstuck35 Proposal Being Considered for Charity Care 36 Advisory on K2 Marijuana Use Symptoms36 “Protecting Patient Data” Report Available

Legal Notes32 RAC Medical Record Requests32 EMTALA and Selective Call33 Presidential Memorandum on Hospital Visits

Advocacy/Legislation37 Grassroots Champion Award to James Cicero38 Washington, D.C. Meeting Highlights39 27 Meet with Congressional Delegation

Quality/Patient Safety40 TeamSTEPPS in Arkansas42 2010 Quality Awards42 Robbins AFMC Interim President and CEO

Healthcare Reform43 Real Measure of Health Reform Success?44 Healthcare Reform Highlights44 Historic Health Reform Now Law46 HHS is Building Health Insurance Portal

Medicare/Medicaid47 Berwick’s Innovative Approach Seen as Asset47 CMS Preparing For J-7 MAC Implementation48 CMS Proposes FY 2011 IPPS Reductions48 Law Changes “3-Day Window” Bundling50 Aetna Medicare Advantage/Drug Plans 50 Medicaid Hospital Access Payments Begin51 CAH “Direct Supervision” Policy Clarification51 New Initiative to Reduce Radiation Exposure51 Medicare FFS Filing Time Period is Amended52 State Medicaid Reforms Under Exploration52 RAC Posts New Validation Issues

Emergency Preparedness53 Arkansas Withdraws from NDMS53 “Active Shooter” Guidance

HIT “Meaningful Use”54 Proposed Rule for EHR Certification54 You’re Hiring - IT Staff

Departments4 From the President5 Education Calendar7 Arkansas Newsmakers and Newcomers

Cover Photo Lake Sylvia in Perryville, Arkansas

Photo courtesy ArkansasDept. of Parks and Tourism

Arkansas Hospital Statistics, Facts and Figuresis published by

Arkansas Hospital Association419 Natural Resources Drive • Little Rock, AR 72205

501-224-7878 / FAX 501-224-0519www.arkhospitals.org

Beth H. Ingram, Editor

Nancy Robertson Cook, Copy Editor/Contributing Writer

BoArd of directorsJames Magee, Piggott / Chairman

Larry Morse, Clarksville / Chairman-Elect

David Cicero, Camden / Treasurer

Ray Montgomery, Searcy / Past-Chairman

Kirk Reamey, Clinton / At-Large

Robert Atkinson, Pine BluffDarren Caldwell, DeWitt

Jamie Carter, West MemphisKristy Estrem, BerryvilleRandy Fortner, Benton

Bob Gant, ConwayCarolyn Hannon, Mountain Home

Tim Johnsen, Hot SpringsJeff Johnston, Fort SmithEd Lacy, Heber SpringsJim Lambert, Conway

Ron Peterson, Mountain HomeDoug Weeks, Little Rock

executive teAmPhil E. Matthews / President and CEO

Robert “Bo” Ryall / Executive Vice President

W. Paul Cunningham / Senior Vice President

Elisa M. White / Vice President and General Counsel

Beth H. Ingram / Vice President

Don Adams / Vice President

distriButionArkansas Hospitals is distributed quarterly

to hospital executives, managers, and trustees throughout the United States; to physicians,

state legislators, the congressional delegation, and other friends of the hospitals of Arkansas.

To advertise contactGreg Jones

Publishing Concepts, Inc.501/221-9986 ext.105

[email protected]

ThinkNurse.com

Edition 71

FEATURED SECTION


Healthcare reform is still uppermost in our minds, and we are just beginning to walk down its long and winding road.

We know the reform process will not be easy, but I am so glad that we have started walking down this reform road. This is something we had to do; it was the right thing to do.

But doing the right thing doesn’t always mean doing the easy thing, and we know there are difficult challenges and adjust-ments ahead.

As we went to Washington, D.C. for the annual meeting of the American Hospital Association in late spring, your Arkansas Hospital Association (AHA) was pleased to be accompanied by a group of hospital administrators, personnel, nursing staff members, trustees and auxilians from across the state.

At that national meeting, healthcare reform was the main topic of conversation. Government leaders like Health and Human Services Secretary Kathleen Sebelius and legislators from both parties discussed the issue and what they expect to see as it unfolds.

There is a tremendous effort going into writing the rules and regulations of the new law, and all of us realize we are into only the first steps of this journey, a journey that will be with us throughout the entirety of our careers in the healthcare field.

While in Washington, perhaps our most important meetings were those held with our congressional delegation and their staff members. We held a breakfast meeting with Senators Lincoln and Pryor to discuss our concerns regarding hospitals of all sizes, from urban healthcare facilities to critical access hospitals. Also on the agenda were meetings with each of our representatives, who still have time to make some accomplishments before three of the four retire at the end of this term.

We held a reception and meetings with delegation aides and staff members. These are the people we regularly work with on healthcare issues; they are our main contacts and we have developed excellent working relationships with them. They take our local concerns to our senators and representatives, and explain the local impact proposed legislation will have back home.

Regarding healthcare reform, I can tell you that the mood in the healthcare community is and remains good. We know we must be a vocal part of the road ahead.

We have many new hospital CEOs in Arkansas. We want these new CEOs to know about the association and let us help them keep abreast of legislative issues relating to hospitals, specifically Medicare and Medicaid issues, at both the federal and state levels.

As an organization representing the state’s member hospitals, we realize not everyone will always agree on everything, but the AHA continues to be a unifying force when it comes to the “big issues” in healthcare.

As always, we encourage every hospital leader to get to know their state legislators now, so that as the next legislative session begins, they will know their local hospital’s concerns and challenges.

Healthcare reform may, indeed, become an issue in the national mid-term elections, and could well have an impact on our state elections come November.

Please support those candidates that support healthcare, and remember to make your voice heard. In the meantime, the AHA will continue to speak for Arkansas’ hospitals, and to keep you informed as to the major issues at hand.

Phil E. MatthewsPresident and CEO Arkansas Hospital Association

F r o m t h e P r e s i d e n t

Healthcare Reform’s Long and Winding Road


EduCation CalendarAugust 11-13, Hot Springs

Healthcare Financial Management Association (HFMA) Quarterly Education Meeting

August 20, Little RockProactive Strategies for Managing Inpatient MS-DRG RAC Targets

August 20, North Little RockArkansas Organization of Nurse Executives Summer Conference

August 26-27, Little RockCrucial Conversations® Training

August 31, Little RockArkansas Society for Healthcare Marketing and Public Relations (ASHMPR) Summer Conference

September 16, Little Rock2010 Mid-Management Healthcare Leadership Series: Legal Aspects of Management

September 28, Little RockArkansas Health Executives Forum (AHEF) Quarterly Meeting

October 6, Little Rock 2010 Mid-Management Healthcare Leadership Series: Executive Leadership Workshop (Achieving a Culture of Excellence, Listening Bootcamp, The Credibility/Likeability Makeover, and Service Recovery Skills to Restore Patient Satisfaction)

October 6-8, Little Rock Arkansas Hospital Association 80th Annual Meeting and Trade Show

October 14, Little Rock Society for Arkansas Hospital Purchasing and Materials Management Fall Educational Meeting

October 21, Little Rock2010 Mid-Management Healthcare Leadership Series: Leading Through Reform Without Losing Your Work Force

October 22, (Location TBD)Arkansas Association of Healthcare Engineering Fall Conference

October 27-29, Little Rock Healthcare Financial Management Association (HFMA) Quarterly Education Meeting

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To explore all the angles, visit Stephens Insurance at www.stephensinsurance.com or call John Harbour Jr. at 501.377.8306.

Program information available at www.arkhospitals.org/events.Webinars and audio conference information available atwww.arkhospitals.org/events.


This material was prepared by the Arkansas Foundation for Medical Care Inc. (AFMC) in partnership with University of Arkansas for Medical Sciences.

Arkansas now has a Health Information Technology Regional Extension Center, set up to offer technical assistance, guidance and information on best practices to help health care providers achieve meaningful use of certified EHR technology. You and your practice may be eligible for incentive payments or reimbursements of $44,000 to $63,750 from the

federal government’s stimulus program to offset the costs of launching an EHR system.

As the state’s designated HITREC, the Arkansas Foundation for Medical Care will provide:

n On-site technical assistance with EHR adoptionn Education on selection, implementation and use of an EHR system

n Group purchasing of EHR systems and technical support to leverage volume discounts

n End-to-end project management support of EHR implementationn Access to current information regarding meaningful use and

best practices from around the country through the National Learning Consortium

n Support for practice and workflow redesign to achieve meaningful use of EHR system

Go to www.hitarkansas.comto find out more!

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ArkAnsAs Newsmakers and Newcomers

Jeff Johnston, president and CEO of St. Edward Mercy Health System in Fort Smith, has named Steve Loveless, COO, to lead a regional team responsible for the oversight and management of the system’s three critical access hospitals in Waldron, Ozark and Paris. Loveless succeeds Ron Summerhill who retired April 1 as regional admin-istrator of the facilities. He had been with the sys-tem for 35 years and succeeded Jim Maddox upon his retirement one year ago.

Dan McKay has been named CEO of Northwest Health System in Springdale. He succeeds Doug Arnold who resigned in March. McKay previously served as interim CEO at the Springdale system in 2008. He most recently served as vice president of operations for Division IV at Community Health Systems, which owns Northwest Health System, and held CEO positions at hospitals in Missouri and South Carolina.

John Robbins, FACHE, has been named interim president and CEO of the Arkansas Foundation for Medical Care, the state’s quality improvement organization. He succeeds Dr. Nick Paslidis who resigned that position March 22. Robbins is a for-mer CEO of Conway Regional Health System and served as the Arkansas Hospital Association’s rep-resentative on the AFMC Board of Directors.

Michael Givens, FACHE, has been named COO at St. Bernards Medical Center in Jonesboro. Givens has served in various capacities at St. Bernards since 2001. Most recently, he was vice president for patient services. As COO, he will be responsible for planning, organizing and directing operations at the 438-bed acute-care medical center. Givens is a

board member of the Arkansas Health Executives Forum and received the ACHE Regent’s Early Career Healthcare Executive Award in 2006.

Mike Schimming has been named CEO of

North Metro Medical Center in Jacksonville, suc-ceeding interim CEO Don Cameron. Schimming was the hospital’s CFO for the past year before moving into his new role. He has more than 15 years of senior healthcare and 27 years financial experience and has directed financial and adminis-trative operations in hospitals in Arkansas, Texas, Missouri and Florida.

Joe Mitchell, CEO of River Valley Medical Center in Dardanelle, has assumed interim CEO duties at Eureka Springs Hospital following the departure of David Wheeler. A search is being conducted for a permanent CEO at the facility.

John Heard, CEO of McGehee Desha County Hospital, and Christy Hockaday, CEO of St. Anthony’s Medical Center in Morrilton, were recent-ly reappointed to the Arkansas Rural Medical Practice Student Loan and Scholarship Board for 2010-201l.

Walter Johnson, president and CEO of Jefferson Regional Medical Center (JRMC) in Pine Bluff, has announced that Brian Thomas has been named senior vice president and COO. In 1998, Thomas served as administrative director of operations and physician practices at JRMC. Following his time in Pine Bluff, Thomas served as COO at J.F.K. Memorial Hospital in Indio, California, and as COO at Crestwood Medical Center in Huntsville, Alabama. •


statistics

Healthcare reform means many changes for Arkansas’ hospitals, and in a time of flux, knowing the statistics relating to the state’s hospital scene is a must. With the economy still in a state of recovery, those of us in the healthcare field are constantly reviewing every available resource to keep Arkansas’ hospitals efficient, effective and afloat. This makes it vital to have hospital-related statistics close at hand.

To that end, we present your annual Arkansas Hospitals statistical issue, a useful resource and commu-nication tool in one concise guide. The information provided in this issue is important to all who partici-pate or have interest in the healthcare field. Please use it as you communi-cate about your hospital and its place in your area’s economy, social struc-ture, and care-giving network.

As you review the information gathered here, you gain a sense of where our nation’s, region’s and

state’s hospitals stand in the areas of financial strength and utilization. You also see how legislation and regulation continue to change hospitals’ day-to-day operations and policy-making.

This guide will help you explain your hospital’s financial situation to those who don’t understand today’s challenges. It provides background information as you discuss with elected officials how their vote may affect local healthcare back home. It could help you defend the launch of new services or the purchase of new equipment.

Many of you have told us that the comparative statistics offered here give you the background and resources you need to discuss the “health of healthcare” as you visit with people in your communities.

In speaking engagements before civic clubs and organizations, in discussions with your trustees, and in visiting with friends and neighbors

– these statistics are the most up-to-date resources available, and offer you the background you need to knowledgeably discuss current healthcare trends and dilemmas faced in Arkansas today.

Whenever you find yourself in need of communicating the facts about healthcare in today’s marketplace, you can rely on this information as your most trusted and valued resource.

Compiled by Paul Cunningham, Arkansas Hospital Association senior vice president, these useful statistics derive from the most recent information available from the American Hospital Association and other sources. His goal is to provide Arkansas hospitals with a valuable informational and communication tool, especially useful in these tough economic times and at this time of great change on the healthcare front.

Please use it, and let us know how it helps you communicate the “healthcare message.” •

Number Licensed Beds






0-49* 33 905 0 0 1 40 2 50 9 256 45 1,251

50-99 10 755 5 318 6 362 2 91 0 0 23 1,526

100-199 16 2,332 2 227 1 120 1 163 0 0 20 2,842

200-299 5 1,188 0 0 0 0 1 280 0 0 6 1,468

300-399 2 718 1 345 0 0 0 0 0 0 3 1,063

400+ 7 3,681 0 0 0 0 1 538 0 0 8 4,219

Not-for-Profit 44 7,091 1 60 2 160 1 280 4 99 52 7,690

Investor-owned 17 1,725 6 485 5 290 4 234 5 157 37 2,891

Governmental 12 763 1 345 1 72 2 608 0 0 16 1,788

Total 73 9,579 8 890 8 522 7 1,122 9 256 105 12,369

Bed SizeCommunity Hospitals

Psychiatric Hospitals

Rehabilitation Hospitals

Specialty Hospitals**

LTACHospitals All Hospitals

Source: Arkansas Hospital Association*Includes 29 Critical Access Hospitals ** Includes Pediatric, Cardiac, Women’s, Surgical and VA Facilities

Hospital Control

Distribution of Arkansas Licensed Hospitals By Type, Size and Control, 2010

ArKAnsAs hosPitALs by the nUmBers -What These Statistics Mean for Your Hospital


statistics

46 Arkansas counties are served by a single hospital.

43 Arkansas community hospitals have fewer than 100 beds. Twenty-nine of them are designated by the federal government as critical access hospitals, having no more than 25 acute care beds.

22 Arkansas counties – almost 30 percent of all counties in the state – do not have a local hospital (however, two hospitals are located in Bowie County, Texas, which borders Miller County, Arkansas). Those counties are:

4 Arkansas community hospitals have closed their doors since January 2004.

56% Of AHA member hospitals are charitable, not-for-profit organizations, while 30 percent of the hospitals are owned and operated by private, for-profit companies, and 14 percent are public hospitals owned and operated a city, county, state or federal government.

14,654 Arkansans sought inpatient or outpatient care from Arkansas’ hospitals each day in 2008 for illnesses, injuries and other conditions requiring medical attention.

39,013 Newborns were delivered in Arkansas hospitals in 2008. The Arkansas Medicaid program covered more than 60 percent of them.

43,727 Arkansans are employed by hospitals across the state, which have a combined annual payroll of $1.7 billion that helps to support about 7.7 percent of all non-farm jobs in the state through direct and indirect purchases of goods and services.

$185 million The amount Arkansas hospitals spent in 2008 providing charity care for patients without health insurance coverage.

$9.6 Billion The estimated overall economic impact that Arkansas hospitals provided for the state in 2008, based on direct spending on goods and services, their impact on other businesses throughout the economy, jobs, and employees’ spending.

Calhoun Lee Miller Perry SharpClay Lincoln Monroe Pike WoodruffCleveland Lonoke Montgomery Prairie Grant Madison Newton PoinsettLafayette Marion Nevada Searcy

105 Hospitals of all types are located in cities, towns and communities throughout Arkansas. That group is composed of 73 general acute care community hospitals (including 29 critical access hospitals), nine long term acute care hospitals, eight psychiatric hospitals, eight rehabilitation hospitals, two hospitals that specialize in certain types of surgical procedures, two Veterans Affairs hospitals, as well as a pediatric hospital, a cardiac hospital and a women’s hospital.

102 Hospitals and other healthcare organizations belong to the Arkansas Hospital Association. They include 97 Arkansas hospitals, two out-of-state, border city hospitals (Memphis and Texarkana), an outpatient cancer treatment center, one inpatient hospice and a United States Air Force medical clinic.

ARKANSAS HOSPITALS:Key Numbers Behind Important Facts

*2008 is the latest year for which information is available


statistics

1st Congressional districtArkansas Methodist Medical CenterBaptist Health Med. Center - Heber SpringsBaptist Health Medical Center - StuttgartBaxter Regional Medical CenterCommunity Medical Center of Izard CountyCrittenden Regional HospitalCrossRidge Community HospitalDeWitt HospitalFive Rivers Medical CenterForrest City Medical CenterFulton County HospitalGreat River Medical CenterHarris HospitalHelena Regional Medical CenterLawrence Memorial HospitalNEA Baptist Memorial HospitalPiggott Community HospitalSMC Regional Medical CenterSt. Bernards Medical CenterStone County Medical CenterWhite River Health SystemToTal = 21

2nd Congressional districtAdvanced Care Hospital of White CountyAllegiance Specialty Hospital of Little RockArkansas Children’s HospitalArkansas Heart HospitalArkansas Hospice*Arkansas State HospitalArkansas Surgical Hospital, LLCBaptist Health Medical Center - Little RockBaptist Health Medical Center - North Little RockBaptist Health Extended Care HospitalBaptist Health Rehabilitation InstituteThe BridgeWayCARTI *Central Arkansas Veterans Healthcare SystemChambers Memorial HospitalConway Regional Health SystemConway Regional Rehabilitation HospitalMethodist Behavioral HospitalNorth Metro Medical CenterOzark Health Medical CenterPinnacle Pointe Behavioral HealthCare SystemRivendell Behavioral Health ServicesRiver Valley Medical CenterSaline Memorial Hospital

St. Anthony’s Medical CenterSt. Vincent Infirmary Medical CenterSt. Vincent Medical Center/NorthSt. Vincent Rehabilitation HospitalUAMS Medical CenterWhite County Medical Center19th Medical Group, LRAFB *ToTal = 31 *Non-hospital member

3rd Congressional districtAdvance Care Hospital of Fort SmithEureka Springs HospitalHEALTHSOUTH Rehab. Hosp. of FayettevilleJohnson Regional Medical CenterMercy Health System of Northwest ArkansasMercy/Turner Memorial HospitalNorth Arkansas Regional Medical CenterNorthwest Medical Center BentonvilleNorthwest Medical Center SpringdaleOzarks Community HospitalSaint Mary’s Regional Medical CenterSiloam Springs Memorial HospitalSparks Health SystemSt. Edward Mercy Medical CenterSt. John’s Hospital - BerryvilleSpringwoods Behavioral Health HospitalSummit Medical Center Veterans Healthcare System of the OzarksVista Health FayettevilleVista Health Fort Smith

Washington Regional Medical SystemWillow Creek Women’s HospitalToTal = 22

4th Congressional districtAdvance Care Hospital of Hot SpringsAshley County Medical CenterBaptist Health Med. Center - ArkadelphiaBooneville Community HospitalBradley County Medical CenterChicot Memorial HospitalDallas County Medical CenterDelta Medical CenterDeQueen Medical CenterDrew Memorial HospitalHealthPark HospitalHoward Memorial HospitalHSC Medical CenterJefferson Regional Medical CenterLevi HospitalLittle River Memorial HospitalMagnolia Regional Medical CenterMcGehee/Desha County HospitalMedical Center of South ArkansasMedical Park HospitalMena Regional Health SystemMercy Hospital of Scott CountyNational Park Medical CenterNorth Logan Mercy HospitalOuachita County Medical CenterSt. Joseph’s Mercy Health CentertotAL = 26

AHA Members by Congressional District


statistics

Number of Arkansas LicensedAHA-member hospitals

Breakdown of AHA member hospitals by typecommunity Hospitals .............................. 44

Urban ........................................ 24rural ......................................... 20

critical Access ........................................ 29

Number of Arkansas-based non-hospital AHA-member organizations

Arkansas-based AHA member organizations

Number of AHA member organizations perCongressional District

1st ............................................................ 212nd ........................................................... 313rd ............................................................ 224th ............................................................ 26

Number of border city AHA member hospitals Total AHA member organizations

Other Arkansas-licensed hospitals(non-AHA members)

rehabilitation hospitals ............................ 4Long-Term care hospitals ....................... 4

Total Arkansas licensed hospitals

Psychiatric ............................................... 8Long-Term care ...................................... 5rehabilitation ........................................... 4special Focus* ........................................ 7

Utilization and Financial Indicators, Community Hospitals, 2008Admissions .............................................................................376,158Inpatient Days .................................................................... 1,989,969outpatient Visits ..................................................................4,972,752Births....................................................................................... 39,013Total employees ...................................................................... 43,727Payroll ........................................................................$1,956,438,189Billed charges .......................................................... $13,818,991,625Total Amount collected ..............................................$4,807,626,026operating costs ........................................................ $4,921,858,438cost of charity care Provided ...................................... $185,069,581Patient service margin ........................................................... -2.38%other operating revenues ............................................$169,341,834operating margin ..................................................................... 1.15%

*Cardiac, Pediatric, Surgical, Women’s, VA

A snapshot of Arkansas hospital Association members

97

3

2

102

8

100

105


statistics

Payer Categories # Discharges % Discharges Total Charges

Average Charges per

Stay% TotalCharges

Average Lengthof Stay

Average Chargeper day

1 - Medicare 186,149 43.77% $4,602,073,788 $24,723 52.14% 6.17 $4,007

2 - HMO/Comm. Ins. 100,059 23.53% $2,018,944,692 $20,178 22.87% 4.16 $4,850

3 - Medicaid 87,807 20.65% $1,256,115,195 $14,305 14.23% 4.76 $3,005

4 - Self Pay 30,121 7.08% $517,610,127 $17,184 5.86% 4.88 $3,521

5 - Other/Unknown 15,099 3.55% $343,116,775 $22,724 3.89% 4.48 $5,072

6 - Other Gov. Programs 6,071 1.43% $88,747,549 $14,618 1.01% 4.09 $3,574

ALL CAtegories 425,306 100% $8,826,608,126 $20,754 100% 5.23 $3,968

Source: Arkansas Department of Health Hospital Discharge Data System

ChArges stAy dAiLy rAte

ArkAnsAs HospitAl CHArgesby Payer Category - 2008


statistics

1 Washington 1.7 Vermont 82.6 Utah 371.3 Nevada 1,121.702 Utah 1.8 Utah 82.7 Washington 406.7 Arizona 1,186.803 Oregon 1.8 Alaska 84.8 New Mexico 408.2 South Carolina 1,322.404 California 1.9 Hawaii 86.4 Oregon 409.5 California 1,329.705 Nevada 2.0 New Mexico 87.8 Idaho 421.9 Florida 1,332.906 New Mexico 2.0 Washington 88.4 Colorado 447.5 Texas 1,431.307 Arizona 2.0 Idaho 89.0 California 490.9 Maryland 1,434.708 Colorado 2.0 Colorado 89.5 Arizona 497.7 Georgia 1,464.409 Vermont 2.1 Oregon 92.0 Nevada 500.2 Oklahoma 1,491.40

10 Maryland 2.1 California 94.2 New Hampshire 505.1 Hawaii 1,567.6011 New Hampshire 2.2 New Hampshire 94.4 Alaska 505.6 WSC Region 1,600.2012 Idaho 2.2 Nevada 95.1 Vermont 529.0 Colorado 1,702.4013 Connecticut 2.3 Wyoming 98.7 Texas 552.1 Mississippi 1,706.6014 Alaska 2.3 Georgia 99.0 Wisconsin 563.7 Virginia 1,713.8015 Virginia 2.3 Virginia 102.4 Virginia 573.1 Washington 1,737.4016 Rhode Island 2.3 Texas 106.3 Maryland 585.5 Arkansas 1,741.8017 Delaware 2.4 Montana 107.4 Indiana 600.6 Tennessee 1,809.7018 Hawaii 2.4 Wisconsin 109.7 WSC Region 602.6 Wyoming 1,893.0019 New Jersey 2.4 Arizona 110.2 Illinois 625.4 Minnesota 1,916.9020 Massachusetts 2.4 Maine 112.9 Rhode Island 634.4 North Carolina 1,922.9021 Wisconsin 2.4 North Carolina 113.0 Michigan 634.8 Delaware 1,925.6022 Texas 2.5 Connecticut 114.4 Georgia 637.3 Idaho 1,929.4023 North Carolina 2.5 Indiana 114.9 Maine 642.4 Alabama 1,934.5024 Michigan 2.5 WSC Region 115.3 New Jersey 644.5 Utah 1,939.1025 Georgia 2.6 Kansas 117.2 U.S. 644.9 U.S. 2,052.5026 U.S. 2.7 U.S. 117.6 Massachusetts 644.9 New Jersey 2,089.1027 Maine 2.7 South Carolina 118.1 North Carolina 652.7 New Mexico 2,142.9028 Illinois 2.7 Delaware 118.8 Connecticut 656.0 Oregon 2,258.1029 Indiana 2.8 Nebraska 120.5 Hawaii 657.4 Kentucky 2,262.5030 WSC Region 2.8 Rhode Island 121.2 South Carolina 661.3 Connecticut 2,306.4031 South Carolina 2.8 Michigan 122.2 Florida 665.2 South Dakota 2,310.9032 Florida 2.9 Minnesota 122.8 Oklahoma 668.9 Kansas 2,329.1033 Ohio 2.9 Iowa 124.3 Ohio 680.4 Illinois 2,401.5034 Minnesota 3.0 Massachusetts 124.4 Arkansas 697.0 Alaska 2,468.4035 Oklahoma 3.0 Illinois 124.8 Delaware 702.2 Rhode Island 2,506.4036 New York 3.1 New Jersey 125.1 Minnesota 742.1 Wisconsin 2,523.7037 Missouri 3.2 Maryland 126.2 Kansas 742.2 Louisiana 2,530.3038 Pennsylvania 3.2 South Dakota 127.0 Missouri 743.7 Nebraska 2,595.1039 Alabama 3.3 Oklahoma 127.1 Iowa 748.9 North Dakota 2,645.2040 Kentucky 3.3 New York 129.7 Kentucky 753.4 Indiana 2,669.3041 Arkansas 3.4 Florida 130.8 Alabama 756.0 New York 2,697.1042 Tennessee 3.4 Arkansas 131.8 Louisiana 765.9 Michigan 2,799.0043 Iowa 3.5 Ohio 134.7 Wyoming 777.6 Ohio 2,863.6044 Louisiana 3.6 Tennessee 138.3 Tennessee 790.2 Pennsylvania 3,089.4045 Kansas 3.7 North Dakota 139.2 Pennsylvania 831.8 Massachusetts 3,148.6046 Wyoming 3.9 Missouri 142.3 Nebraska 876.6 Missouri 3,184.8047 Montana 3.9 Kentucky 143.0 West Virginia 917.4 Montana 3,261.9048 Nebraska 4.1 Louisiana 144.4 New York 922.1 New Hampshire 3,395.5049 West Virginia 4.1 Mississippi 146.5 Montana 934.8 Iowa 3,456.8050 Mississippi 4.5 Alabama 147.5 Mississippi 955.4 West Virginia 3,644.7051 South Dakota 5.1 Pennsylvania 152.7 North Dakota 1,162.10 Maine 3,870.3052 North Dakota 5.4 West Virginia 156.3 South Dakota 1,251.00 District of Columbia 3,979.8053 District of Columbia 5.7 District of Columbia 231.9 District of Columbia 1,612.20 Vermont 5,323.80

rank hospital Beds Admissions inpatient days outpatient Visits

Comparative Utilization Indicators Per 1,000 PopulationU.S. CommUnity HoSPitalS, 2008

West South Central (WSC) Region: Arkansas, Lousiana, New Mexico, Oklahoma, TexasSource: American Hospital Association, Hospital Statistics, 2010


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871

3,17

4,93

5 3,

153,

839

3,33

2,94

5 -4

.86%

OCCU

PAN

CY R

ATE

58.1

%58

.6%

58.4

%57

.2%

55.0

%56

.3%

-5.2

7%IN

PATI

ENT

SURG

ERIE

S11

7,18

1 11

5,51

2 12

6,37

4 10

8,65

1 11

6,01

9 10

2,68

1 -0

.99%

OUT

PATI

ENT

SURG

ERIE

S15

1,65

3 14

6,07

4 14

1,10

4 14

4,61

9 14

7,22

2 13

6,56

5 -2

.92%

TOTA

L SU

RGER

IES

268,

834

261,

586

267,

478

253,

270

263,

241

239,

246

-2.0

8%O

UTPA

TIEN

T AS

% O

F TO

TAL

SURG

ERIE

S56

.41%

55.8

4%52

.75%

57.1

0%55

.93%

57.0

8%-0

.86%

TOTA

L FT

E EM

PLOY

EES

43,4

92

42,6

29

42,8

02

43,0

74

42,5

40

43,7

27

-2.1

9%FT

Es P

ER A

DJU

STED

OCC

UPIE

D BE

D4.

794.

764.

784.

954.

924.

792.

81%

GRO

SS R

EVEN

UE, I

NPA

TIEN

T$6

,115

,623

,287

$6

,513

,778

,911

$6

,962

,421

,549

$7

,346

,539

,305

$7

,750

,748

,662

$8

,250

,771

,568

26

.74%

GRO

SS R

EVEN

UE, O

UTPA

TIEN

T$3

,592

,960

,043

$3

,861

,410

,128

$4

,238

,194

,924

$4

,655

,737

,561

$5

,054

,791

,861

$5

,568

,220

,057

40

.69%

GRO

SS P

ATIE

NT

REVE

NUE

$9,7

08,5

83,3

30

$10,

375,

189,

039

$11,

200,

616,

473

$12,

002,

276,

866

$12,

805,

540,

523

$13,

818,

991,

625

31.9

0%BA

D DE

BTS

$531

,161

,829

$5

65,2

20,3

66

$566

,152

,497

$5

96,8

42,3

33

$628

,063

,918

$6

81,2

59,9

86

18.2

4%CH

ARIT

Y$2

06,9

95,0

46

$239

,575

,478

$2

93,5

04,0

71

$309

,914

,742

$3

26,1

26,8

35

$360

,456

,189

57

.55%

TOTA

L DE

DUC

TIO

NS

$5,7

90,6

02,6

43

$6,3

60,7

83,0

14

$6,9

45,0

17,0

78

$7,5

72,6

65,7

42

$8,2

20,6

32,3

92

$9,0

11,3

85,5

99

41.9

7%M

EDIC

ARE,

MED

ICAI

D &

OTHE

R PA

YER

WRI

TEO

FFS

$5,0

52,4

45,7

68

$5,5

55,9

87,1

70

$6,0

85,3

60,5

10

$6,6

65,9

08,6

67

$7,2

66,4

41,6

39

$7,9

69,6

69,4

24

43.8

2%N

ET P

ATIE

NT

REVE

NUE

$3,9

17,9

80,6

87

$4,0

14,4

06,0

25

$4,2

55,5

99,3

95

$4,4

29,6

11,1

24

$4,5

84,9

08,1

31

$4,8

07,6

06,0

26

17.0

2%OT

HER

OPE

RAT

ING

REVE

NUE

$127

,642

,206

$1

34,7

80,8

57

$153

,253

,789

$1

54,7

44,4

39

$162

,135

,731

$1

69,3

41,8

34

27.0

2%N

ON

OPE

RAT

ING

REVE

NUE

$49,

276,

715

$57,

186,

707

$51,

496,

442

$74,

174,

385

$56,

666,

788

$31,

674,

701

15.0

0%TO

TAL

NET

REV

ENUE

$4,0

94,8

99,6

08

$4,2

06,3

73,5

89

$4,4

60,3

49,6

26

$4,6

58,5

29,9

48

$4,8

03,7

10,6

50

$5,0

08,6

22,5

61

17.3

1%PA

YRO

LL E

XPEN

SE$1

,510

,600

,000

$1

,528

,324

,259

$1

,608

,181

,270

$1

,688

,987

,123

$1

,825

,435

,512

$1

,956

,438

,729

20

.84%

TOTA

L EX

PEN

SE$3

,947

,107

,676

$4

,015

,475

,758

$4

,225

,289

,800

$4

,437

,596

,804

$4

,585

,732

,810

$4

,921

,858

,438

16

.18%

PATI

ENT

REVE

NUE

MAR

GIN

-0.7

4%-0

.03%

0.71

%-0

.18%

-0.0

2%-2

.38%

-97.

58%

TOTA

L M

ARGI

N3.

61%

4.54

%5.

27%

4.74

%4.

54%

1.73

%25

.73%

CHAR

GE P

ER A

DJU

STED

INPA

TIEN

T DA

Y$2

,928

.61

$3,1

76.2

7 $3

,425

.40

$3,7

80.3

2 $4

,060

.30

$4,1

46.1

8 38

.64%

RECE

IPTS

PER

AD

JUST

ED IN

PATI

ENT

DAY

$1,1

81.8

6 $1

,228

.97

$1,3

01.4

6 $1

,395

.18

$1,4

53.7

5 $1

,442

.45

23.0

1%EX

PEN

SE P

ER A

DJU

STED

INPA

TIEN

T DA

Y$1

,190

.65

$1,2

29.3

0 $1

,292

.19

$1,3

97.7

0 $1

,454

.02

$1,4

76.7

3 22

.12%

PAYR

OLL

PER

AD

JUST

ED IN

PATI

ENT

DAY

$455

.67

$467

.88

$491

.82

$531

.98

$578

.80

$587

.00

27.0

2%PA

YRO

LL A

S %

OF

TOTA

L EX

PEN

SE38

.3%

38.1

%38

.1%

38.1

%39

.8%

39.8

%4.

01%

BAD

DEBT

AN

D CH

ARIT

Y AS

% O

F TO

TAL

CHAR

GE7.

6%7.

8%7.

7%7.

6%7.

5%7.

5%-2

.00%

TOTA

L DE

DUC

TIO

NS

AS %

OF

TOTA

L CH

ARGE

59.6

%61

.3%

62.0

%63

.1%

64.2

%65

.2%

7.63

%O

UTPT

. REV

ENUE

AS

% T

OTAL

PAT

IEN

T RE

VEN

UE37

.0%

37.2

%37

.8%

38.8

%39

.5%

40.3

%6.

66%

ADM

ISSI

ON

S PE

R BE

D39

.240

.040

.540

.138

.638

.8-1

.52%

PATI

ENT

DAYS

PER

1,0

00 P

OPU

LATI

ON

766.

174

4.9

720.

769

1.3

679.

169

7.0

-11.

36%

ADM

ISSI

ON

S PE

R 1,

000

POPU

LATI

ON

142.

313

9.1

136.

813

2.7

130.

413

1.8

-8.4

2%PO

PULA

TIO

N (0

00's

)2,

726

2,75

3 2,

779

2,81

1 2,

811

2,85

5 3.

12%

Sour

ce: A

mer

ican

Hos

pita

l Ass

ocia

tion,

Hos

pita

l Sta

tistic

s, 2

010

Ar

kA

ns

As

Ho

sp

itA

ls

:Co

mm

unit

y Ho

spit

al F

inan

cial

and

Uti

lizat

ion

Indi

cato

rs, 2

003-

2008

PERC

ENT

CHAN

GE


statistics

Arka

nsas

Loui

sian

am

issi

ssip

pim

isso

uri

okla

hom

ate

nnes

see

texa

sUn

ited

stat

es

Hosp

itals

char

ged

this

amou

nt fo

r th

e in

patie

nt a

nd o

utpa

tient

car

e th

ey

prov

ided

in 2

008:

$13,

818,

991,

625

$26,

052,

700,

386

$18,

556,

618,

273

$40,

129,

059,

468

$19,

181,

795,

806

$39,

744,

329,

666

$136

,968

,066

,154

$1,8

02,5

16,7

74,6

32

But,

patie

nts

and

paye

r gro

ups

didn

’t pa

y th

e fu

ll am

ount

of b

illed

char

ges

for

vario

us re

ason

s. G

over

nmen

t pro

gram

s lik

e M

edic

are

and

Med

icai

d, w

orke

rs’

com

p pr

ogra

ms

and

othe

rs n

ever

pay

th

e fu

ll ho

spita

l bill.

Man

aged

car

e pl

ans

and

othe

r ins

urer

s ty

pica

lly p

ay

disc

ount

ed a

mou

nts

only

and

indi

vidua

l pa

tient

s of

ten

can’

t affo

rd to

pay

som

e or

any

of t

he o

ut-o

f-poc

ket c

osts

rela

ted

to th

eir h

ospi

tal b

ills. F

or th

ose

reas

ons,

ho

spita

ls ha

d to

forfe

it th

is m

uch

of th

eir

bille

d ch

arge

s:9,

011,

385,

599

17,4

11,14

2,73

2 12

,632

,981

,913

24

,102

,018

,264

12

,656

,733

,800

27

,469

,500

,901

97

,866

,719

,468

1,1

91,6

15,8

89,3

65

As a

resu

lt, a

ctua

l pay

men

ts to

ho

spita

ls w

ere:

4,80

7,60

6,02

6 8,

641,

557,

654

5,92

3,63

6,36

0 16

,027

,041

,204

6,

525,

062,

006

12,2

74,8

28,7

65

39,1

01,3

46,6

86

610,

900,

885,

267

At th

e sa

me

time,

hos

pita

ls s

pent

this

m

uch

prov

idin

g pa

tient

car

e se

rvic

es4,

921,

858,

438

9,01

4,21

2,75

5 5,

817,

368,

267

15,8

24,1

62,5

45

6,36

1,69

0,04

0 11

,996

,245

,958

40

,396

,037

,477

62

6,57

6,95

7,91

2

So, t

he re

venu

e ex

cess

(los

s) w

as:

($11

4,25

2,41

2)($

372,

655,

101)

$106

,268

,093

$2

02,8

78,6

59

$163

,371

,966

$2

78,5

82,8

07

($1,

294,

690,

791)

($15

,676

,072

,645

)

In o

ther

wor

ds, h

ospi

tals

mad

e (o

r lo

st) t

his

muc

h on

eac

h of

the

equi

va-

lent

day

s of

car

e th

ey p

rovid

ed to

in

patie

nts

and

outp

atie

nts:

($34

.28)

($66

.09)

$22.

51

$26.

12

$41.1

1 $3

4.27

($

61.3

3)($

48.3

7)

Yiel

ding

a “

patie

nt s

ervi

ce”

mar

gin

of:

-2.3

8%-4

.31%

1.79

%1.

27%

2.50

%2.

27%

-3.3

1%-2

.57%

In a

dditi

on, h

ospi

tals

also

rece

ived

reve

nues

from

oth

er o

pera

ting

sour

ces,

su

ch a

s ca

fete

ria a

nd g

ift s

hop

sale

s,

addi

ng th

is m

uch

to th

eir r

even

ues:

$169

,341

,834

$5

21,4

25,5

42

$319

,430

,782

$9

85,1

55,8

09

$211

,578

,156

$4

96,2

58,7

79

$4,0

40,6

12,3

62

$37,1

36,5

77,11

4

Whi

ch ra

ised

tota

l ope

ratin

g in

com

e to

:$5

5,08

9,42

2 $1

48,7

70,4

41

$425

,698

,875

$1

,188

,034

,468

$3

74,9

50,12

2 $7

74,8

41,5

86

$2,7

45,9

21,5

71

$21,

460,

504,

469

As a

resu

lt, t

he “

oper

atin

g m

argi

n”

rose

to:

1.15%

1.72

%7.1

9%7.

41%

5.75

%6.

31%

7.02

%3.

51%

Hosp

itals

als

o co

llect

ed o

ther

type

s of

re

venu

e fro

m s

ourc

es in

clud

ing

con-

tribu

tions

, tax

app

ropr

iatio

ns, i

nves

t-m

ents

and

the

rent

al o

f offi

ce s

pace

. Th

ose

amou

nted

to:

$31,

674,

701

$33,

327,

586

$36,

224,

687

($36

0,47

7,38

6)$3

7,21

3,78

5 $8

1,61

4,39

7 $3

10,5

46,1

08

($4,

453,

107,

631)

That

resu

lted

in to

tal f

unds

ava

ilabl

e to

rein

vest

in n

ew e

quip

men

t, up

date

fa

cilit

ies,

exp

and

prog

ram

s an

d re

pay

debt

equ

alin

g:$8

6,76

4,12

3 $1

82,0

98,0

27

$461

,923

,562

$8

27,5

57,0

82

$412

,163

,907

$8

56,4

55,9

83

$3,0

56,4

67,6

79

$17,

007,

396,

838

For a

retu

rn o

n in

vest

men

t tot

alin

g:1.

80%

2.11

%7.

80%

5.16

%6.

32%

6.98

%7.

82%

2.78

%

Sour

ce: A

mer

ican

Hos

pita

l Ass

ocia

tion,

Hos

pita

l Sta

tistic

s, 2

010

Com

mun

ity H

ospi

tal S

umm

ary

Fina

ncia

l Dat

a ar

kans

as a

nd S

urro

undi

ng S

tate

s, 2

008


statistics

Ashdown Little River Memorial Hospital Critical Access 25 x x CountyBatesville White River Medical Center Rural, SCH/RRC 200 14 12 15 x PNPBenton Rivendell Behavioral Health Services Psychiatric 77 77 CorporateBenton Saline Memorial Hospital Urban 167 19 12 x PNPBentonville Northwest Medical Center, Bentonville Urban 128 x CorporateBerryville St. John's Hospital - Berryville Critical Access 25 x x PNPBlytheville Great River Medical Center Rural 168 20 CorporateBooneville Booneville Community Hospital Critical Access 25 x x CityCalico Rock Community Medical Center of Izard County Critical Access 25 x x PNPCamden Ouachita County Medical Center Rural 98 x 12 10 x PNPClarksville Johnson Regional Medical Center Rural 80 x 10 12 x PNPClinton Ozark Health Medical Center Critical Access 25 x x PNPConway Conway Regional Health System Urban 146 11 x PNPConway Conway Regional Rehabilitation Hospital Rehabilitation 26 26 PNPCrossett Ashley County Medical Center Critical Access 25 x 8 x PNPDanville Chambers Memorial Hospital Rural 41 x x PNPDardanelle River Valley Medical Center Critical Access 25 x CorporateDeQueen DeQueen Medical Center, Inc. Critical Access 25 x 10 CorporateDeWitt DeWitt Hospital Critical Access 25 x x PNPDumas Delta Memorial Hospital Critical Access 25 x PNPEl Dorado Medical Center of South Arkansas Rural 166 20 PNPEureka Springs Eureka Springs Hospital Critical Access 22 x x CorporateFayetteville HEALTHSOUTH Rehab. Hospital of Fayetteville Rehabilitation 60 CorporateFayetteville Springwoods Behavioral Health Hospital Psychiatric 80 CorporateFayetteville Veterans Healthcare System of the Ozarks Veterans Admin. 51 FederalFayetteville Vista Health Fayetteville Psychiatric 92 CorporateFayetteville Washington Regional Medical Center Urban 366 19 x PNPFordyce Dallas County Medical Center Critical Access 25 x x CountyForrest City Forrest City Medical Center Rural 118 x 18 x CorporateFort Smith Advance Care Hospital of Ft. Smith Long Term Care 25 PNPFort Smith Sparks Health System Urban 492 30 x PNPFort Smith St. Edward Mercy Medical Center Urban 352 21 22 x PNPFort Smith Vista Health Fort Smith Psychiatric 57 CorporateGravette Ozarks Community Hospital Critical Access 25 CorporateHarrison North Arkansas Regional Medical Center Rural, SCH 174 14 x PNPHeber Springs Baptist Health Medical Center-Heber Springs Critical Access 25 x x PNPHelena Helena Regional Medical Center Rural 155 x 18 x CorporateHope Medical Park Hospital Urban 79 x 12 CorporateHot Springs Advance Care Hospital of Hot Springs Long Term Care 27 PNPHot Springs HealthPark Hospital Urban (Surgical) 20 CorporateHot Springs Levi Hospital Urban 81 37 27 PNPHot Springs National Park Medical Center Urban 166 10 20 x CorporateHot Springs St. Joseph's Mercy Health Center Urban 282 21 20 x PNPJacksonville 19th Medical Group, LRAFB Dept. of Defense 0 DoDJacksonville North Metro Medical Center Urban 113 18 21 x PNPJohnson Willow Creek Women's Hospital Urban (Women's) 64 CorporateJonesboro NEA Baptist Memorial Hospital Rural-MDH 88 x CorporateJonesboro St. Bernards Medical Center Urban 438 27 60 x PNPLake Village Chicot Memorial Hospital Critical Access 25 x x PNPLittle Rock Allegiance Specialty Hospital of Little Rock Long Term Care 40 CorporateLittle Rock Arkansas Children's Hospital Urban (Pediatric) 280 14 PNPLittle Rock Arkansas Heart Hospital Urban 112 Corporate

City Hospital Medicare ClassificationLicensed

BedsSwing

Bed UnitRecup.

Care UnitA&D Unit# Beds

Psych.Unit # Beds

Rehab. Unit# Beds

Home Health Agency Control

AHA memBer orgAnizAtions 2010:


statistics

Little Rock Arkansas Hospice Inpatient Hospice 40 PNPLittle Rock Arkansas State Hospital Psychiatric 345 StateLittle Rock Baptist Health Extended Care Hospital Long Term Care 37 PNPLittle Rock Baptist Health Medical Center-Little Rock Urban 827 35 20 50 x PNPLittle Rock Baptist Health Rehabilitation Institute Rehabilitation 120 120 PNPLittle Rock CARTI OP Cancer Center 0 PNPLittle Rock Central Arkansas Veterans Healthcare System Veterans Affairs 549 80 25 FederalLittle Rock Pinnacle Pointe Behavioral HealthCare System Psychiatric 124 124 CorporateLittle Rock St. Vincent Infirmary Medical Center Urban 615 49 x PNPLittle Rock UAMS Medical Center Urban 400 StateMagnolia Magnolia Regional Medical Center Rural 49 x x CityMalvern HSC Medical Center Rural 72 18 15 x PNPMaumelle Methodist Behavioral Hospital Psychiatric 60 60 PNPMcGehee McGehee-Desha County Hospital Critical Access 25 x x PNPMemphis, TN Regional Medical Center at Memphis Urban 620 PNPMena Mena Regional Health System Rural 65 x 12 12 CityMonticello Drew Memorial Hospital Rural 49 x x CountyMorrilton St. Anthony's Medical Center Critical Access 25 x x PNPMountain Home Baxter Regional Medical Center Rural, RRC/SCH 268 0 19 19 x PNPMountain View Stone County Medical Center Critical Access 25 x PNPNashville Howard Memorial Hospital Critical Access 20 x x PNPNewport Harris Hospital Rural 133 x 12 CorporateNorth Little Rock Arkansas Surgical Hospital, LLC Urban (Surgical) 51 CorporateNorth Little Rock Baptist Health Medical Center-North Little Rock Urban 220 30 x PNPNorth Little Rock The BridgeWay Psychiatric 103 14 89 CorporateOsceola SMC Regional Medical Center Critical Access 25 x 10 CorporateOzark Mercy Hospital/Turner Memorial Critical Access 25 x CountyParagould Arkansas Methodist Medical Center Rural 129 x 15 x PNPParis North Logan Mercy Hospital Critical Access 16 x PNPPiggott Piggott Community Hospital Critical Access 25 x x CityPine Bluff Jefferson Regional Medical Center Urban 471 25 20 27 x PNPPocahontas Five Rivers Medical Center Rural 50 14 x CityRogers Mercy Health System of Northwest Arkansas Urban 165 x PNPRussellville Saint Mary's Regional Medical Center Rural, RRC 170 15 20 x CorporateSalem Fulton County Hospital Critical Access 25 x CountySearcy Advanced Care Hospital of White County Long Term Care 27 PNPSearcy White County Medical Center Rural, RRC 438 27 36 31 x PNPSherwood St. Vincent Medical Center/North Urban 69 x PNPSherwood St. Vincent Rehabilitation Hospital Rehabilitation 93 60 CorporateSiloam Springs Siloam Springs Memorial Hospital Urban 73 x CorporateSpringdale Northwest Medical Center, Springdale Urban 222 31 x CorporateStuttgart Baptist Health Medical Center-Stuttgart Rural 49 x PNPTexarkana, TX CHRISTUS St. Michael Health System Urban 312 PNPVan Buren Summit Medical Center Urban 103 CorporateWaldron Mercy Hospital of Scott County Critical Access 24 x PNPWalnut Ridge Lawrence Memorial Hospital Critical Access 25 x CountyWarren Bradley County Medical Center Critical Access 35 x 10 x PNPWest Memphis Crittenden Regional Hospital Urban 152 20 x PNPWynne CrossRidge Community Hospital Critical Access 25 x x PNP

PNP = Private Not-for-Profit RRC = Rural Referral CenterDoD = Department of Defense SCH = Sole Community Hospital

City Hospital Medicare ClassificationLicensed

BedsSwing

Bed UnitRecup.

Care UnitA&D Unit# Beds

Psych.Unit # Beds

Rehab. Unit# Beds

Home Health Agency Control

Location, Medicare Classification, Facilities and Services


statistics

1 New Jersey $50,628 District of Columbia $16,493 District of Columbia $15,658 Utah 8.04%2 California 43,441 Alaska 15,048 Alaska 15,463 Idaho 4.80%3 District of Columbia 41,426 New York 13,358 New Hampshire 12,299 New Hampshire 4.61%4 Nevada 40,975 Massachusetts 12,702 Washington 12,250 New Mexico 3.49%5 Pennsylvania 38,365 California 12,459 Delaware 12,156 South Dakota 3.11%6 Colorado 36,856 Delaware 12,328 Nebraska 12,030 Alaska 2.69%7 Alaska 35,142 Washington 12,074 New York 12,015 Oklahoma 2.50%8 Texas 33,701 Colorado 11,854 California 11,936 Virginia 2.35%9 Florida 33,450 Nebraska 11,817 Colorado 11,812 Tennessee 2.27%

10 Arizona 33,068 Hawaii 11,755 Massachusetts 11,364 Mississippi 1.79%11 South Carolina 31,659 New Hampshire 11,733 Oregon 11,270 Nebraska 1.76%12 Washington 30,892 Oregon 11,715 Minnesota 11,223 Washington 1.44%13 U.S. 30,497 Connecticut 11,397 Hawaii 11,191 Missouri 1.27%14 WSC Region 30,225 New Jersey 11,354 Utah 11,106 Kentucky 1.23%15 New York 30,122 Minnesota 11,342 Maine 11,048 Wisconsin 1.08%16 Hawaii 28,834 Maine 11,095 Connecticut 11,030 Florida 0.57%17 Connecticut 28,666 Rhode Island 10,906 Missouri 10,785 Pennsylvania 0.41%18 New Mexico 28,452 Nevada 10,845 Wisconsin 10,760 South Carolina 0.40%19 Virginia 28,351 Indiana 10,718 Nevada 10,687 Wyoming 0.19%20 Illinois 28,300 Missouri 10,649 South Dakota 10,674 Montana 0.00%21 Tennessee 27,942 Wisconsin 10,644 New Jersey 10,665 Kansas -0.15%22 Nebraska 27,907 U.S. 10,601 Indiana 10,464 Colorado -0.35%23 New Hampshire 27,848 South Carolina 10,421 South Carolina 10,463 Maine -0.43%24 Ohio 27,068 South Dakota 10,342 U.S. 10,336 Arizona -0.45%25 Missouri 27,004 Maryland 10,335 Pennsylvania 10,322 West Virginia -0.69%26 Massachusetts 26,925 Pennsylvania 10,280 Maryland 10,234 North Carolina -0.96%27 Alabama 26,819 Ohio 10,220 Virginia 10,119 Maryland -0.98%28 Rhode Island 26,553 Utah 10,213 New Mexico 10,024 Minnesota -1.06%29 Minnesota 26,535 Michigan 10,146 Rhode Island 10,014 Georgia -1.13%30 Georgia 26,204 Montana 9,974 Ohio 9,991 Vermont -1.40%31 Mississippi 25,626 Texas 9,940 Montana 9,974 Delaware -1.41%32 Indiana 25,573 Virginia 9,881 Michigan 9,867 Nevada -1.49%33 Kansas 25,427 Illinois 9,879 Wyoming 9,813 Ohio -2.29%34 Oklahoma 25,399 Wyoming 9,794 Arizona 9,626 Arkansas -2.38%35 Louisiana 24,514 New Mexico 9,675 Texas 9,621 Indiana -2.43%36 Michigan 24,444 Arizona 9,669 Idaho 9,518 U.S. -2.57%37 Utah 23,979 Vermont 9,396 Illinois 9,475 WSC Region -2.74%38 Delaware 23,003 WSC Region 9,358 Vermont 9,266 Michigan -2.83%39 Kentucky 22,842 North Carolina 9,233 Kansas 9,213 Texas -3.31%40 Oregon 22,783 Kansas 9,227 North Carolina 9,145 Connecticut -3.33%41 North Carolina 22,741 Georgia 9,089 WSC Region 9,109 Oregon -3.94%42 South Dakota 22,456 Idaho 9,061 Georgia 8,987 Iowa -4.09%43 Wisconsin 22,051 North Dakota 8,966 Florida 8,957 Illinois -4.27%44 Arkansas 21,934 Florida 8,905 Oklahoma 8,640 Louisiana -4.31%45 Maine 20,479 Iowa 8,831 Tennessee 8,630 California -4.38%46 Iowa 19,214 Louisiana 8,482 North Dakota 8,493 Hawaii -5.04%47 Idaho 18,875 Tennessee 8,434 Iowa 8,484 District of Columbia -5.33%48 Wyoming 18,088 Oklahoma 8,424 Mississippi 8,180 North Dakota -5.57%49 Montana 17,991 Mississippi 8,033 Louisiana 8,131 Alabama -5.77%50 Vermont 17,607 Kentucky 7,941 Kentucky 8,039 New Jersey -6.47%51 West Virginia 17,369 West Virginia 7,877 West Virginia 7,823 Rhode Island -8.90%52 North Dakota 16,623 Arkansas 7,812 Arkansas 7,631 New York -11.18%53 Maryland 12,590 Alabama 7,316 Alabama 6,916 Massachusetts -11.78%

rank Average ChargePer hospital stay

Average operating CostPer hospital stay

Average PaymentPer hospital stay

margin onPatient Care services

West South Central (WSC) Region: Arkansas, Louisiana, New Mexico, Oklahoma, TexasSource: American Hospital Association, Hospital Statistics, 2010

Comparative Financial IndicatorsU.S. CommUnity HoSPitalS, 2008


1-800-540-7566 ARHealthNetworks.com TDD 1-800-285-1131

In 2007 Arkansas Hospitals

Help reduce your bad debt by suggesting ARHealthNetworksto your patients who have no other way to pay!

provided over $485 million dollars in services to self pay Arkansas patients. Most of it was uncompensated.

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In 2007 self pay Arkansans:

• Accounted for 30,000 hospital admissions annually.

• Cost $15,994 for the average hospital stay.

• Averaged 5.29 days length of stay.

ARHealthNetworks is a Department of Human Services program that can help your hospital get paid for the services it performs for hard-working Arkansans who don't have medical coverage.


statistics

investor owner/manager hospital City

Allegiance Health Management Allegiance Specialty Hospital of Little RockDelta Memorial HospitalEureka Springs HospitalNorth Metro Medical CenterRiver Valley Medical Center

Little RockDumasEureka SpringsJacksonvilleDardanelle

Arkansas Surgical Hospital, LLC Arkansas Surgical Hospital North Little Rock

Capella Healthcare National Park Medical CenterSaint Mary’s Regional Medical Center

Hot SpringsRussellville

Community Health Systems Inc. Forrest City Medical CenterHarris HospitalHelena Regional Medical CenterMedical Center of South ArkansasNorthwest Medical Center BentonvilleNorthwest Medical Center SpringdaleSiloam Springs Memorial HospitalWillow Creek Women’s Hospital

Forrest CityNewportHelenaEl DoradoBentonvilleSpringdaleSiloam SpringsJohnson

QHR (Managed Only) Great River Medical CenterSouth Mississippi Regional Medical Center

BlythevilleOsceola

Health Management Associates Summit Medical CenterSparks Health System

Van BurenFort Smith

HealthSouth Corporation HealthSouth Rehab. Hospital of Fort Smith #HealthSouth Rehab. Hospital of Jonesboro #HealthSouth Rehab. Hospital of Fayetteville **St. Vincent Rehabilitation Hospital *

Fort SmithJonesboroFayettevilleSherwood

Hospital Management Consultants Booneville Community Hospital Booneville

JCE Healthcare Group DeQueen Regional Medical Center, Inc. DeQueen

MedCath Arkansas Heart Hospital Little Rock

Physicians’ Specialty Hospital Physicians’ Specialty Hospital # Fayetteville

Psychiatric Solutions Pinnacle Pointe Behavioral HealthCare System Little Rock

Ouachita Diagnostic and Surgical Center, Inc. HealthPark Hospital Hot Springs

Regency Hospital Company Regency Hospital of Northwest Arkansas #Regency Hospital of Springdale #

FayettevilleSpringdale

Select Medical Corporation Select Specialty Hospital - Fort Smith #Select Specialty Hospital - Little Rock #

Fort SmithLittle Rock

Shiloh Health Services Medical Park Hospital Hope

Texarkana Behavioral Health Services Vista Health FayettevilleVista Health Fort Smith

FayettevilleFort Smith

Universal Health Services The BridgeWayRivendell Behavioral Health ServicesSpringwoods Behavioral Health Hospital

North Little RockBentonFayetteville

# Not an AHA-member hospital * Partnership with St. Vincent Health System ** Partnership with Washington Regional Medical System

ARKANSAS HOSPITALS:Investor Owned, Operated and/or Managed Hospitals


statistics

not-for-Profit system hospital City

Baptist Health Baptist Health Extended Care Hospital Baptist Health Medical Center - Little RockBaptist Health Medical Center - ArkadelphiaBaptist Health Medical Center - Heber SpringsBaptist Health Medical Center - North Little RockBaptist Health Rehabilitation Institute Baptist Health Medical Center - Stuttgart

Little RockLittle RockArkadelphiaHeber SpringsNorth Little RockLittle RockStuttgart

Baptist Memorial Healthcare Corp. NEA Baptist Memorial Hospital Jonesboro

Catholic Health Initiatives St. Anthony's Medical CenterSt. Vincent Infirmary Medical CenterSt. Vincent Rehabilitation Hospital *St. Vincent Medical Center North

MorriltonLittle RockSherwoodSherwood

Conway Regional Health System Conway Regional Medical CenterConway Regional Rehabilitation Hospital

ConwayConway

Dubuis Health System Advance Care Hospital of Hot SpringsAdvance Care Hospital Fort Smith

Hot SpringsFort Smith

Olivetan Benedictine Sisters St. Bernards Medical CenterLawrence Memorial HospitalCrossRidge Community Hospital

JonesboroWalnut RidgeWynne

Sisters of Mercy Health System St. Edward Mercy Medical CenterSt. Joseph’s Mercy Health SystemMercy Health System of NW ArkansasSt. John’s Hospital North Logan Mercy HospitalMercy Hospital of Scott CountyMercy Hospital/Turner Memorial

Fort SmithHot SpringsRogersBerryvilleParisWaldronOzark

White County Medical Center Advanced Care Hospital of White CountyWhite County Medical Center

SearcySearcy

White River Health System White River Medical CenterStone County Medical Center

BatesvilleMountain View

ARKANSAS HOSPITALS:Members/Affiliates of Not-For-Profit Multi-Hospital Systems

indiCAtor 2000 2001 2002 2003 2004 2005 2006 2007 2008 Percent increase

Number Self-Pay Patients Admitted 20,545 26,843 28,899 30,063 29,364 27,638 27,963 30,296 30,121 46.61%

Self-Pay As Percent of All Patients Admitted 5.50% 6.80% 7.30% 7.01% 6.82% 6.44% 6.50% 7.08% 7.08% 28.73%

Total Uncovered Charges ($ Millions) $168 $248 $307 $354 $398 $419 $439 $485 $518 208.33%

Total UncoveredCosts ($ Millions)* $78 $108 $129 $144 $154 $158 $162 $174 $185 123.08%

* A joint venture between St. Vincent Health System and HealthSouth

Source: Arkansas Department of Health, Hospital Discharge Data Program 2008* Estimate based on statewide cost-to-charge ratio

Impact of Self-Pay (Uninsured) Inpatients On Arkansas Hospitals, 2000-2008


statisticsAHA-Member organizations: public Hospitalshospital governmental entity

Arkansas State Hospital State of Arkansas

Dallas County Medical Center Dallas County

Drew Memorial Hospital Drew County

Five Rivers Medical Center City of Pocahontas, AR

Fulton County Hospital Fulton County

Lawrence Memorial Hospital Lawrence County

hospital governmental entity

Little River Memorial Hospital Little River County

Magnolia Regional Medical Center City of Magnolia, AR

Mena Regional Health System City of Mena, AR

Piggott Community Hospital City of Piggott, AR

UAMS Medical Center State of Arkansas

AHA Member organizations by Hospital typegeneral Acute Care hospitals (44)Arkansas Methodist Medical CenterBaptist Health Medical Center - Little RockBaptist Health Medical Center - North Little RockBaptist Health Medical Center - StuttgartBaxter Regional Medical CenterChambers Memorial HospitalConway Regional Health SystemCrittenden Regional HospitalDrew Memorial HospitalFive Rivers Medical CenterForrest City Medical CenterGreat River Medical CenterHarris HospitalHelena Regional Medical CenterHSC Medical CenterJefferson Regional Medical CenterJohnson Regional Medical CenterLevi HospitalMagnolia Regional Medical CenterMedical Center of South ArkansasMedical Park HospitalMena Regional Health SystemMercy Health System of NW ArkansasNational Park Medical CenterNEA Baptist Memorial HospitalNorth Arkansas Regional Medical CenterNorth Metro Medical CenterNorthwest Medical Center - BentonvilleNorthwest Medical Center - SpringdaleOuachita County Medical CenterSaint Mary’s Regional Medical CenterSaline Memorial HospitalSiloam Springs Memorial Hospital Sparks Health SystemSt. Bernards Medical CenterSt. Edward Mercy Medical CenterSt. Joseph’s Mercy Health CenterSt. Vincent Infirmary Medical Center

St. Vincent Medical Center/NorthSummit Medical CenterUAMS Medical CenterWashington Regional Medical SystemWhite County Medical CenterWhite River Health System

Critical Access hospitals (29)Ashley County Medical CenterBaptist Health Med. Center - ArkadelphiaBaptist Health Med. Cntr. - Heber SpringsBooneville Community HospitalBradley County Medical CenterChicot Memorial HospitalCommunity Medical Center of Izard Co.CrossRidge Community HospitalDallas County Medical CenterDelta Medical CenterDeQueen Medical CenterDeWitt HospitalEureka Springs HospitalFulton County HospitalHoward Memorial HospitalLawrence Memorial HospitalLittle River Memorial HospitalMcGehee/Desha County HospitalMercy/Turner Memorial HospitalMercy Hospital of Scott CountyNorth Logan Mercy HospitalOzarks Community HospitalOzark Health Medical CenterPiggott Community HospitalRiver Valley Medical CenterSMC Medical CenterSt. Anthony’s Medical CenterSt. John’s HospitalStone County Medical Center

Psychiatric hospitals (8)Arkansas State HospitalThe BridgeWayMethodist Behavioral HospitalPinnacle Pointe Behavioral HealthCare SystemRivendell Behavioral Health ServicesSpringwoods Behavioral Health HospitalVista Health - FayettevilleVista Health - Fort Smith

Long term Acute Care hospitals (5) Advance Care Hospital - Hot SpringsAdvance Care Hospital - Fort SmithAdvanced Care Hospital of White CountyAllegiance Specialty Care Hospital of LRBaptist Health Extended Care Hospital

specialty service hospitals (5) Arkansas Children’s HospitalArkansas Heart HospitalArkansas Surgical Hospital, LLPHealthPark HospitalWillow Creek Women’s Hospital

rehabilitation hospitals (4) Baptist Health Rehabilitation InstituteHEALTHSOUTH Rehab. Hospital of FayettevilleConway Regional Rehabilitation HospitalSt. Vincent Rehabilitation Hospital

non-hospitals (3) 19th Medical Group, LRAFBArkansas HospiceCARTI

VA hospitals (2) Central Arkansas Veterans HC SystemVeterans HC System of the Ozarks


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More than 500,000 Arkansans wake up each morning with an uneasy feeling that they or members of their families could need some kind of healthcare service before the day is done. Their concerns are well founded. Illness and injury are largely unpredictable, and the plain and simple truth is they can’t afford either one. For them and another 46 million uninsured Americans, healthcare coverage is provided by a frayed patchwork quilt of “safety net” providers that is becoming more worn and threadbare by the year.

Community health centers, a shrinking number of private physi-cians willing to offer some care for little or no pay, free clinics, primary care centers and rural health clin-

ics all shoulder part of the burden of providing uncompensated care to those who can’t pay. But none plays a greater role in providing healthcare to self-pay patients than local hospitals, which, because of the 24/7 nature of their operations, tend to be the unin-sured’s most accessible and traversed gateway to the healthcare system. The cost of uncompensated care in Arkansas hospitals alone exceeded $382 million in 2008 (the charges were close to $1 billion). That was up by more than 27 percent over the previous five years.

The real impact of uncompensated care affects not just the poor and uninsured, but also everyone else in the community. To fully understand requires a general agreement on what

uncompensated care is; or, rather, what it is not. Uncompensated care doesn’t necessarily refer to care that nobody pays for. In fact, much of the uncompensated care tally is paid for; but usually it’s paid by someone the patient who actually receives the care does not know. A sizeable portion of the costs related to “uncompensated” bills are shifted to individuals and businesses in the form of higher health plan premiums, which are nothing more than hidden taxes.

Generally, uncompensated hospi-tal costs are classified as charity care and bad debt, depending on the hospital’s policies for determining whether a patient is deemed able to pay for services. Charity care is the cost of services (net of any contrac-

hospital Uncompensated Care Costs


statistics

Source: American Hospital Association, Hospital Statistics, 2010

ArkAnSAS CoMMunity HoSpitALSUncompensated Care Costs, 1998-2008

tual allowances) that patients have been deemed unable to pay prior to receiving care. Bad debt constitutes all other unpaid services for which a hospital expected but did not receive payment. It excludes Medicare bad debt, but deductible and co-pay amounts left unpaid by patients who have coverage are part of the total.

In 2008, more than 30,000 patients who had no insurance coverage were admitted to Arkansas hospitals. That represented about 7.1 percent of all inpatients (up 29 percent since 2000).

Those patients rang up $518 million in charges, an average of $17,200 per patient. Needless to say, few could afford to pay those bills or even a very small percentage.

Thousands more uninsured came or were brought to hospital emergency rooms seeking treatment for conditions ranging from major trauma to fevers and ear infections. Some required immediate attention, while others came simply to see a doctor, because they don’t have a family physician to take care of less

urgent medical needs. All received the needed care, accounting for millions of dollars more in care.

That’s a stunning total, but the story doesn’t end there. Counting all the insured patients who received care but could not cover all their deductibles or co-pays, Arkansas hospitals, which are consistently among those with the highest uncompensated care costs, provided more than $1 billion in uncompensated care in 2008. That converts to roughly $382 million in uncovered costs which had to be picked up by other patients.

Those amounts reflect just 2008 numbers. The cumulative amounts are staggering. Charity care and bad debt amounts share common ground when it comes to their astounding growth. Between 1998 and 2008, hospital charity care and bad debt costs in Arkansas hospitals jumped 68 percent and are a root cause of the overall hospital cost increase of 75 percent for the same period.

Things are poised to get better, with the recent passage of health reform legislation designed to cover another 30 million people. But that’s still a few years away, and at best there will still be 15 million to 25 million uninsured who will continue to need care that they can’t afford. •

YearTotal Billed

ChargesNet Charges

Collected

Other Operating Revenue

Total Operating Revenue Operating Costs

Cost/Charge Ratio

TotalUncollected

Bills Bad Debt Charity

Uncom-pensated

Care Charges

Uncom-pensated

Care Costs

Percent of Total Costs

1998 5,581,832,069 2,859,625,078 83,252,406 5,665,084,475 2,802,389,937 50.21% 2,722,206,991 305,070,830 147,302,300 452,373,130 227,116,454 8.10%

1999 6,096,135,975 2,933,364,021 95,687,603 6,191,823,578 2,972,492,256 48.76% 3,162,771,954 349,960,717 157,664,182 507,624,899 247,519,263 8.33%

2000 6,840,121,635 3,117,677,033 95,650,547 6,935,772,182 3,176,562,841 46.44% 3,722,444,602 400,358,728 139,956,601 540,315,329 250,923,257 7.90%

2001 7,445,452,895 3,300,453,542 103,461,117 7,548,914,012 3,249,943,830 43.65% 4,144,999,443 438,812,612 140,217,960 579,030,572 252,747,128 7.78%

2002 8,623,946,905 3,703,886,971 134,677,549 8,758,624,454 3,612,279,530 41.89% 4,920,059,934 481,582,688 193,429,493 675,012,181 282,739,761 7.83%

2003 9,708,583,330 3,917,980,687 127,642,206 9,836,225,536 3,947,107,676 40.66% 5,790,602,643 531,161,829 206,995,046 738,156,875 300,103,998 7.60%

2004 10,375,189,439 4,014,406,025 134,780,857 10,509,970,296 4,015,475,758 38.70% 6,360,783,014 565,220,366 239,575,478 804,795,844 311,477,513 7.76%

2005 11,200,616,473 4,255,599,395 153,253,789 11,353,870,262 4,225,289,800 37.72% 6,945,017,078 566,192,497 293,504,471 859,696,968 324,309,723 7.68%

2006 12,002,276,866 4,429,611,124 154,744,439 12,157,021,305 4,437,596,804 36.97% 7,572,665,742 596,842,333 309,914,742 906,757,075 335,254,914 7.55%

2007 12,805,540,523 4,584,908,131 162,165,731 12,967,706,254 4,585,732,810 35.81% 8,220,632,392 628,063,918 326,126,835 954,190,753 341,700,831 7.45%

2008 13,818,991,625 4,807,626,026 169,341,834 13,988,333,459 4,921,858,438 35.62% 9,011,385,599 694,032,836 379,231,835 1,073,264,671 382,260,654 7.77%

increase 147.57% 68.12% 103.41% 146.92% 75.63% 231.03% 127.50% 157.45% 137.25% 68.31%


On Behalf Of Our MeMBers: Arkansas Hospital Association Accomplishments 2009-2010

1) Led the successful implementa-tion of Arkansas’ new Medicaid Hospital Assessment program and the $125 million in supplemental quarterly hospital access payments now available to be shared among most acute care and inpatient psy-chiatric hospitals.

2) Coordinated hospitals’ participa-tion with the newly established statewide trauma care network. 72 hospitals have expressed intent to be a part of the system.

3) Implemented an Arkansas-specific “Stop BSI” project in conjunction with Johns Hopkins that focuses on reducing central line-associat-ed bloodstream infections. The project, in which 27 Arkansas hospitals are participating, has a goal of adopting evidence-based “best practice” interventions aimed at reducing or eliminating blood stream infections.

4) Actively pursued changes in National Disaster Medical System (NDMS) policies affecting logis-tical and reimbursement issues impacting patient evacuations and definitive medical (inpatient) care provided by host state hos-pitals during times of national emergencies.

5) Worked with the Arkansas Department of Health to coordi-nate a statewide effort to ensure the availability of sufficient hos-pital resources to prepare for an expected significant H1N1 swine flu outbreak within the state. This included a pandemic preparedness communications kit for hospital public information officers, in addition to providing daily/weekly electronic updates regarding the pandemic.

6) Conducted a series of workshops and teleconferences to inform and educate Arkansas hospitals about

the implementation issues relat-ed to Medicare Recovery Audit Contractor (RAC) and Medicaid Integrity Program (MIP) reviews in the state.

7) Ensured that Arkansas hospi-tals were directly represented on the Executive Committee of the Statewide Health Information Technology Task Force, which will spearhead the development of a health information exchange for the state.

8) Conducted a membership sat-isfaction survey, with results showing the following member perceptions of the AHA:• 93 percent said the Board of

Directors represented their best interests in developing policy

• 92 percent reported the AHA’s effectiveness as advocate

• 91 percent preferred the AHA’s educational program over other organizations

• 92 percent reported the AHA staff’s responsiveness above average

• 95 percent agreed that the AHA publications met or exceeded their needs

• 93 percent indicated the AHA’s educational programs provided opportunities for respondents’ improvement in their particu-lar field

• 85 percent indicated AHA would meet their needs and be relevant into the foreseeable future

9) Provided legal guidance for members in complying with a host of statutory, regulatory, and accreditation requirements, which included adapting to the new Joint Commission stan-dards and survey process, and providing support with scope of practice, regulatory compli-ance, emergency preparedness,

emergency medical services, and Medicare Conditions of Participation issues.

10) Provided in-state education for more than 4,000 hospital employees through workshops and Web-based instruction on subjects including compliance, revenue cycle improvement, CPT and ICD-9 coding, super-visory skills, case management, chargemaster maintenance, ambulatory payment classi-fications, quality and patient safety, legal issues, emergency readiness, governance matters, information technology and Medicare updates.

11) Conducted a comprehensive wage and salary survey covering more than 115 jobs/positions typically found in hospitals and made the report available at no charge as a member service to participating hospitals.

12) Communicated on an ongoing basis with the AHA member-ship, trustees, state legislators and government leaders, and the Arkansas congressional del-egation on issues impacting the state’s hospitals and healthcare systems through the weekly newsletter, The Notebook, the quarterly Arkansas Hospitals magazine, and the quarterly The Arkansas Trustee.

13) Offered a summer leadership conference and annual mem-bership meeting to educate hospital CEOs and management teams about federal issues, pri-mary care physician shortag-es, leadership, evidence-based medicine, quality and patient safety, social networking, local politics, decision making and healthcare reform.

14) Conducted a series of regional


On a recent CBS News report, a story was aired about digital copy machines that are leased and returned, or sold outright. What many of us don’t realize is that a copy machine contains an internal hard drive which stores an image of every copy it makes.

So the next time you return a copy machine that you have leased, or sell your copy machine to a third

party, make sure the hard drive is scrubbed to get rid of all the data that it has stored. Personal health information, social security numbers and other sensitive data in the wrong hands can put your facility in a legal and compliance world of hurt. Consider options like getting an encryption feature on your copiers, adding a section to your copier contract mandating your vendor to

scrub the copier hard drive before it is reused, or obtaining software that totally scrubs hard drives such as CyberScrub, Active@Killdisk, InfoSweep, Comodo or WipeDrive.

The CBS News story, “Digital Photocopiers Loaded With Secrets,” and a video are available at: http://www.cbsnews.com/stories/2010/04/19/eveningnews/main6412439.shtml?tag=currentVideoInfo;videoMetaInfo. •

Scrub Those Copier Hard Drives!

meetings for hospital trustees to discuss state and federal regula-tions and health reform issues.

15) Strengthened relationships between the AHA and offices of mem-bers of the state’s congressional delegation and their chief health aides, ensuring that they were con-tinually updated and briefed on hospitals’ issues and concerns.

16) Convened a special ad hoc com-mittee composed to explore a suspected $400 million Medicaid shortfall and recommend options for an AHA response to Medicaid’s request for input on the budget issue.

17) Initiated communications with

the new director of the Arkansas Medicaid program to establish the framework for a strong work-ing relationship.

18) Worked with Arkansas Medicaid program representatives to resolve concerns raised by the state’s hospitals relating to inequities in Medicaid’s SFY 2010 Inpatient Quality Initiative.

19) Coordinated efforts between the state’s freestanding inpatient psych hospitals and DHS to make community mental health centers (CMHCs) more accountable for covering payments for adult inpatient psychiatric care provided to their clients.

20) Worked in conjunction with AHA Services, Inc. to obtain an agreement with a California-based company on details for a product designed to assist hospi-tals in negotiating contracts with third-party payers.

21) Gained cooperation from Arkan-sas Insurance Commissioner Jay Bradford to review a worsening set of complaints regarding pay-ment practices of some Medicare Advantage plans operating in the state.

22) Conducted an in-state Mid-Management Hospital Leadership Series of eight workshops conduct-ed throughout the year to help groom hospitals’ employees for advancement into mid-level man-agement positions and awarded certificates to 30 individuals who participated in at least five courses in the eight-course series.

23) Sponsored a program recogniz-ing hospitals for their excellence in marketing.

24) Provided up to $1,000 to help cover the costs for any hospital CEO who attended the American Hospital Association’s 2010 Annual Membership Meeting.

25) Distributed an orientation manual for hospital governance leaders.

26) Approved a partnership with Best on Board to offer gover-nance education, testing and cer-tification. •


Arkansas hospital Association80th Annual Meeting and Trade Show

October 6-8, 2010Peabody Hotel and Statehouse Convention Center, Little Rock

Mark your calendar now for these exciting events!

“hCAhPs Booster: What Leaders need to do now” Leadership Workshop, Wednesday, October 6

“the Florence Prescription: Building a Culture of ownership”Keynote Address by Joe Tye, CEO and Head Coach, Values Coach, Inc.

“the Future of the healthcare marketplace: Life in the gap and Life in the game”Keynote Address by Ian Morrison, Healthcare Futurist

“executive Leadership Luncheon: Point/Counterpoint – elections 2010”“readmissions…What Can and Cannot Be Prevented?”“Who Cares? how to get your Community engaged and supportive”“Leadership Lessons from Around the World”ACHe Breakfast by Charles Evans

“Are medical groups in your Portfolio? Critical Factors to manageyour investment”ACHe Category i Workshop, Friday, October 8

And, don’t forget theAnnual trade show with more than 100 exhibiting companies and many fabulous door prizes!

Printed brochures will be mailed August 2; program and registration information will soonbe available online at http://www.arkhospitals.org/events/annual-meeting

We hope to see you october 6-8!

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2010 AHA Award NominationsAccepted through August 6

Nominations are open for the 2010 Arkansas Hospital Association (AHA) awards program. Awards will honor distinguished service by hospi-tal chief executives, elected officials, healthcare-related professionals and hospital marketing and public infor-mation programs.

The A. Allen Weintraub Memo-rial Award and Distinguished Service Award will be presented during the Association’s 80th Annual Meeting Awards Dinner Thursday, Oct. 7, at the Peabody Hotel in Little Rock.

Arkansas’ C. E. Melville Young Administrator of the Year will be recognized by the Arkansas Health Executives Forum (AHEF). The Diamond Awards, cosponsored by the Arkansas Society for Healthcare Marketing and Public Relations, also will be presented at the 80th annual Awards Dinner.

In addition, the ACHE Regent’s Awards will be presented at the ACHE Breakfast meeting that same morning. Criteria for each award follow:

• The A. Allen Weintraub memorial Award, named for Allen Wein-traub, long-time administra-tor of St. Vincent Infirmary Medical Center in Little Rock, is the highest honor bestowed upon an individual by the AHA. Those nominated for this honor should be hospital chief execu-tive officers who are contrib-uting to their hospitals and communities in much the same manner as did Allen. Those who remember him always mention his care and concern, not only for hospital patients, but also for his employees, his passion for quality healthcare for Arkansans, his recognition

of duty to the community, and his visionary influence.

• The AhA’s distinguished service Award is presented to individu-als who, while not necessarily AHA members, have promoted a cause of the healthcare indus-try, thereby becoming entitled to special recognition. Examples of those eligible for this award are physicians, nurses, trustees, auxilians, community leaders and other deserving individuals.

The 2010 recipients of the Weintraub and Distinguished Service Awards will be chosen by the AHA Board of Directors from those nominated.

• The C. e. melville young Admin-istrator of the year Award is named for the late C. E. Melville, administrator of Jefferson Regional Medical Center in Pine Bluff. The award recipient is selected by AHEF’s Awards Committee. The award recipient must be under the age of 40, a resident of Arkansas for at least two years, employed by an Arkansas healthcare institution and meet requirements for active membership in AHEF.

• The 2010 diamond Awards hon-oring excellence in hospital

marketing and public relations will be presented in several cat-egories, including advertising, annual report, Internet Web site, publications, special video pro-duction, and writing. Diamond Awards (for hospitals with 0-99 beds, 100-249 beds, and 250 or more beds) will be presented in each category. Entries were accepted in April and will be judged individually by a panel of judges not affiliated with any Arkansas hospital.

• The 2010 AChe regent’s Awards will honor outstanding health-care executive leadership in two areas – early career and senior level. The two recipients, selected by AHEF’s Awards Committee, will be presented their awards at the ACHE Breakfast during the AHA Annual Meeting.

Nominations and entries, accompanied by appropriate doc-umentation, must arrive at AHA headquarters no later than August 6, 2010. Informational brochures providing details of all awards have been mailed to each hospital CEO and public relations/market-ing officer.

Please call Beth Ingram or Lyndsey Dumas at (501) 224-7878 with questions about the awards or the award process. •

Awards will honor distinguished service by hospital administrators, elected officials, healthcare-related professionals and hospital marketing and public information programs.


Plan now to attend the fall series of workshops in the AHA’s Mid-Management Series, designed for individuals new to hospital super-visory or mid-level management positions, those being groomed for possible movement into mid-dle-management positions, and experienced managers seeking a “refresher course” in the latest trends and topics. Class sizes are limited to 40 individuals to ensure effective interaction and learning.

Sept. 16’s workshop is titled “The Legal Aspects of Management.” Course leaders Guy Wade and Dan Herrington, partners in the Little Rock law firm Friday, Eldredge and Clark, are experts in labor and employment law, regulation and commercial litigation, and workers’ compensation. The course is designed to help managers know the laws and regulations affected by each decision made. Many new managers are unfamiliar with the guidelines for the Family Medical Leave Act (FMLA) and what action needs to be taken in the case that they must discipline or dismiss an employee. This program will provide valuable information for new managers on the legal aspects of their jobs. In addition to FMLA, topics covered will include disciplinary action, interviewing questions, workers’ compensation, and legal strategies pertinent to day-to-day work force issues, including ADA.

Susan Keane Baker, MHA, a nationally recognized healthcare professional with more than 30 years experience as a hospital administra-tor, director of a quality initia-tives program for a national PPO with 19 million members, author of “Managing Patient Expectations: The Art of Finding & Keeping

Loyal Patients,” and owner of her own company, will lead the October 6 Executive Leadership Workshop. This program is the pre-conference program associated with the AHA’s annual meeting. (Participants may register to attend the entire three-day meeting, or simply the one-day Executive Leadership Workshop.)

The one-day program will offer four separate leadership topics: “Getting to 99 - Achieving a Culture of Service Excellence” (inspiring your staff to interact with others in a positive manner), “Listening Boot Camp” (practical applica-tions for effective listening), “The Credibility/Likeability Makeover” (developing the social skills and credibility needed to lead effective-ly), and “I’m Sorry to Hear That - Service Recovery Skills to Restore Patient Satisfaction” (learning to resolve complaints with service recovery skills that help preserve the patient/hospital relationship).

The final workshop of the year will be held October 21. John Baird, PhD, and Marsha Borling, RN, MA, will coach participants in “Leading through Reform Without

Losing Your Workforce.” The course focuses on factors known to thwart meaningful change in the workplace and illustrates such unintended consequences as mid-level leader disengagement, union organizing activity and employ-ee turnover. Participants will be encouraged to share their own experiences regarding the unique challenges they face in their efforts to enact organizational and cul-tural reform in the workplace. Baird and Borling are partners in Baird/Borling Associates, a group of experienced labor relations and human resources consultants.

Those interested in the series may attend one or any number of programs. Individuals seeking an AHA Mid-Management certificate must attend and complete at least five of the seven programs offered during 2010, and also must complete one of two online courses.

For more information or to reg-ister for these workshops, please contact Beth Ingram or Anna Sroczynski at 501-224-7878, or e-mail Anna at [email protected]. •

Mid-Management Series Resumes in September;Only Three Courses Remain in 2010


growth of AhA services means more savings optionsfor Arkansas hospitals

Celebrating its 25th year, AHA Services, Inc. (AHASI) was organized in 1985 primarily to help member hospitals with group-purchasing discounts on insurance products.

Since that time, AHA Services has expanded, at member hospitals’ requests, to span a number of services including management, purchasing, insurance, human resources and education resources.

As a wholly owned subsidiary of the Arkansas Hospital Association, AHA Services negotiates group discounts across many areas for its member hospitals, saving hospitals thousands of dollars every year.

If you have not recently examined the wide range of discounted services available to AHA member hospitals through AHASI, you may be pleasant-ly surprised at the many money-saving options available to your facility.

“We are often asked how we select the vendors AHASI chooses to endorse,” says Tina Creel, Vice President of AHA Services, Inc. “Often, AHA member hospitals come to us with a need, or we know of a need arising within several of our member hospitals. When this happens, we seek vendors that are willing to offer deep discounts to those hospitals wishing to participate in AHASI’s group purchasing advantages.”

In other situations, vendors themselves present ideas to the AHASI board for its consideration. “These are vendors that want to offer deeper discounts than they can offer to single hospitals alone,” Creel says. “They seek our endorsement so that they may offer their services to all Arkansas Hospital Association member hospitals, making these discounts available.”

AHASI exists to save member hospitals money. Through AHA, the member hospitals own AHASI,

and there is no cost to AHA-member hospitals for participation in these programs for discounted services.

“If there is a service you have seen offered and you feel it would help your hospital, let us know,” Creel says. “We will examine it, work with vendor(s) to seek benefi-cial group purchasing discounts, and when value-added services are nego-tiated we will add the vendor to our list of endorsed companies.”

Profits earned by AHASI are returned to the AHA; since its inception in 1985, AHASI has returned more than $2 million to the AHA for assistance in its operations, in turn lowering member hospital dues. AHASI also helps sponsor educational meetings including the AHA Annual Meeting, the Summer Leadership Conference, and Affiliated Group sponsorships.

New companies recently endorsed by AHASI and highly utilized by member hospitals include: • Audit-Trax (RAC and MIC audit

management), • Background Information Systems

of America (pre-employment back-ground checks),

• ControlPay® Advanced (automat-ed accounts payable solutions),

• Denial Management Services (review and appeal of QIO, MAC, CERT, RAC and commercial insur-ance denials as well as DRG/coding changes),

• HealtheCAREERS Network (online recruitment, advertising and career solutions utilizing hundreds of healthcare recruit-ment sites), and

• Professional Data Services (revenue cycle management tools).Also highly utilized is careLearning,

an education management solution offering Webinars, re-credentialing courses, nursing education courses,

hospital-specific private courses, reporting and documentation, as well as mandatory education required by the Joint Commission and OSHA. Related to careLearning is careSkills, a competency management system.

Member hospitals also continue to utilize these endorsed vendors:• AHA Workers’ Compensation

Self-Insured Trust (Workers’ Compensation)

• Amerinet (Group Purchasing)• BancorpSouth Insurance Services,

Inc. (Liability Insurance Products and Services)

• Credit Guard (Protection Against Identity Theft)

• DocuVoice, LLC (Coding and Transcription)

• Guldmann, Inc. (Safe Patient Handling and Movement)

• Hagan Newkirk Financial Services, Inc. (Employee Benefit Programs)

• Harbour Resources (Leadership Recruiting Services)

• Life Insurance Company of North America (Volunteer Insurance Plan)

• Med Travelers (Temporary Allied Health Professional Staffing)

• MediTract (Contract Compliance Monitoring)

• Merritt Hawkins (Permanent Physician and Allied Health Professional Placement)

• Press Ganey (Satisfaction Mea-surement Services)

• Staff Care, Inc. (Locum Tenens)• Utility Management Corporation

(Gas and Power Management)• Vision Service Plan (Vision Care)

The Arkansas Hospital Asso-ciation encourages its member hos-pitals to take advantage, wherever practical, of the lower prices and valuable benefits offered by AHA Services, Inc. and its service providers.

“As AHA member hospitals, you own AHASI,” Creel says. “Please remember to use it!” •


L E g A L N o T E S

Because Connolly Healthcare, the Recovery Audit Contractor (RAC) for Region C, has begun sending Additional Documentation Requests for medical records in Arkansas, hospitals will want to review the maximum number of medical records that the RAC is allowed to request from institutional providers during 2010.

Each fiscal year, CMS will establish a “per campus” maximum number of medical records that may be requested within a 45-day period. The record limitations for fiscal year (FY) 2010 are set out in the CMS publication entitled, “Additional Documentation Limits for FY 2010 for Institutional Providers (as of Jan. 28, 2010).” [In that publication, CMS notes that the definition of a campus for RAC documentation request limits differs significantly from the definition in 42 CFR 413.65(a)(2) used to determine eligibility for provider-based billing.]

For RAC medical record request limit purposes, a “campus” is estab-lished based upon the healthcare pro-vider’s Tax Identification Number (TIN) and the first three positions of the ZIP code where they are physi-cally located. Healthcare providers with different TINs will be treated as distinct entities and each will have its own medical record limit. However, if several different types of providers operate under one TIN, they may be grouped together as

one “campus” if they share the same first three zip code digits. All Medicare providers that fall within this definition of hospital campus, including non-inpatient providers and units, will be subject to one RAC medical record request limit. Here are a couple of examples from the CMS publication that may help clarify this definition:• ProviderAhasaTIN123456789

and two physical locations in ZIP codes 12345 and 12356. The two locations would qualify as a single campus for purposes of the medical record request limit.

• ProviderBhasaTIN123456780and is physically located in 12345 as well as 21345.This provider would be treated as two distinct entities for purposes of the medical record request limit, and each location would have its own limit.The medical record limit for a

campus is equal to 1 percent of all claims submitted for the previous calendar year (2008) divided by eight. So, for a provider that filed 50,000 inpatient claims and 70,000 outpatient claims, the limit would be (120,000 x .01) ÷ 8 or 150 medical records per 45 days.

CMS has stated that a provider’s limit will be applied across all claim types, including professional services. The medical record limit also is subject to an overall cap of 200 records per 45 days, subject to two exceptions. For providers

that bill in excess of 100,000 claims (per TIN), the cap is 300 medical records per 45 days. Under the second exception, after the first six months of the fiscal year, the RACs may request to exceed the cap, but CMS must approve this request on a case-by-case basis.

In addition, hospitals may want to consider the following pointers for submitting documents to the RACs:1. Send the records, on a timely basis

to avoid denials, by certified mail so that you can confirm that the RAC has received your response in case the records are misplaced after they are delivered.

2. Group the records by patient in chronological order so that they will make sense when reviewed. Do this regardless of whether you are sending the records on paper or on CD/DVD.

3. Clearly separate the records for each patient. One way you might do this is to put a colored sheet of paper at the beginning of each patient’s record. It is recommend-ed that you not rely only on rub-ber bands or paper clips to sepa-rate the records of each patient. We have been informed that the RACs scan the records when they are received, so the rubber bands and clips are removed immedi-ately. Having a different colored cover sheet may help safeguard against pages of one patient’s record being scanned as part of another patient’s record. •

RAC Medical Record Requests

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

A member hospital recently contact-ed the AHA to ask about EMTALA issues that may arise when physicians who are not on-call come to the emer-gency room to see their own patients.

Importantly, in this case, the physician regularly took call at the hospital, but on the night in question, neither that physician nor any other physician of her specialty was on-call.

EMTALA requires that each hospital maintain a list of physicians who are on-call to provide stabilizing treatment (or further evaluation) after the initial medical screening

EMTALA and Selective Call


examination has been completed. See 42 C.F.R. § 489.20(r)(2).

CMS has no requirements regarding how frequently on-call physicians are expected to be available to provide on-call coverage. For example, “CMS has no rule stating that whenever there are at least three physicians in a specialty, the hospital must provide 24-hour/seven-day coverage in that specialty.” See CMS Survey & Certification Letter 09-26 on pg. 1.

Each hospital has the discretion to maintain the on-call list in order

to best meet the needs of its patients according to the resources available to the hospital. 42 C.F.R. §489.24(j)(1). However, CMS has indicated that hospitals should ensure that any services it offers to the general public during regular working hours are available through on-call coverage of the emergency department. See CMS Survey & Certification Letter 09-26 at Tag A-2404/C-2404.

Despite the flexibility offered by CMS with regard to on-call requirements, EMTALA issues may

arise when a physician engages in “selective call” by refusing to participate in the call list at all and coming into the hospital to see her own patients. In that case, an EMTALA violation may occur.

CMS has informed the AHA, however, that an EMTALA violation does not occur when the physician (1) regularly takes call but also (2) comes into the emergency depart-ment when she is not on-call to see a patient with whom she has an estab-lished doctor-patient relationship. •

On April 15, the White House issued a Presidential Memorandum to the Secretary of Health and Human Services (the secretary) on hospital visitation.

In recognition of patients’ need for “compassion and companionship” when they are admitted to the hospital, President Obama’s memorandum calls for rulemaking by the secretary to ensure that patients’ wishes about who may visit and make medical decisions for them be respected.

In contrast to the standard bureaucratic legalese typically con-tained in these types of statements, this Memorandum contained plain language explaining the president’s reasoning: [E]very day, all across America, patients are denied the kindnesses and caring of a loved one at their sides – whether in a sudden medical emergency or a prolonged hospital stay. Often, a widow or widower with no children is denied the support and comfort of a good friend. Members of religious orders are sometimes unable to choose someone other than an immediate family member to visit them and make medical decisions on their behalf. Also uniquely affected are

gay and lesbian Americans who are often barred from the bedsides of the partners with whom they may have spent decades of their lives – unable to be there for the person they love, and unable to act as a legal surrogate if their partner is incapacitated. For all of these Americans, the failure to have their wishes respected concern-ing who may visit them or make medical decisions on their behalf has real consequences.

Accordingly, the president directed the secretary to issue regulations to ensure that hospitals participating in Medicare or Medicaid respect the rights of patients to designate visitors, including those identified in advance directives, and that visitors designated by the patient have the same visita-tion privileges as immediate family members. The regulations also must ensure that hospitals cannot deny visitation privileges based upon “race, color, national origin, religion, sex, sexual orientation, gender identity, or disability.” However, the regulations must take into account the need for hospitals to restrict visitation in medi-cally appropriate circumstances.

The Memorandum also instructed the secretary to take steps to ensure

that hospitals are in compliance with existing regulations guaranteeing that patients have the right to designate an individual to make healthcare decisions on his or her behalf and ensuring that advance directives (such as durable powers of attorney for healthcare and healthcare proxies) are respected.

The president also requested the secretary to issue guidelines and tech-nical assistance on how hospitals can best comply with these regulations. The Memorandum concluded with a request for additional recommenda-tions from the secretary within 180 days of addressing these issues.

It is important to note that this Memorandum, standing alone, does not change existing laws or regulations. The secretary must issue regulations to implement the directives contained in the Memorandum.

In the meantime, hospitals should take steps to ensure that their policies and procedures comply with the existing rules found at 42 C.F.R. § 482.13 and 42 C.F.R. § 489.102(a).

As always, the AHA will keep its members posted as additional regulations are published and imple-mented. •

Presidential Memorandum on Hospital Visits

Suggested topics for the Legal Note may be submitted to [email protected]. The Legal Note is provided solely for informational purposes and does not constitute legal advice. Readers are encouraged to consult with their own attorneys about any legal issues, including those discussed in these articles.

L E g A L N o T E S


Arkansas’ statewide trauma sys-tem is moving forward at a rapid pace. By June 30, more than 66 hospitals had received their start-up grants to go toward the establish-ment of a trauma center.

In the fall, the survey and desig-nation process begins for level 1, 2 and 3 hospitals. These surveys will ensure that those hospitals have the capabilities and services needed to be assigned their designated level.

The Arkansas Department of Health will establish a trauma call center in the next year that will provide direction to hospitals and ambulances on transfers. The call center will be able to direct patients to the nearest hospitals with the most appropriate physician available.

While the statewide trauma sys-tem is a work in progress, vast improvements are being made in Arkansas’ trauma patient care. •

Bob Langston, Director, Emergency Services; Dr. Bryan Clardy, Sebastian County Health Officer; Jo Wester, Administrator, Sebastian County Health Unit; and Jeff Johnston, CEO of St. Edward Mercy Health System in Fort Smith, accept a check from the Arkansas Department of Health for start-up funds of St. Edward’s trauma center.

30+ Hospitals Complete TraumaSystem Application Process

Join us Aug. 26-27, 2010, at the Arkansas Hospital Association in Little Rock as we host an important and innovative course designed to help hospitals lift their performance across the board.

Organizations mired in mediocre results (or perhaps not achieving the heights leaders had hoped for) can generally count on a predictable and correctable root cause: their employees are either not willing or not able to bring up touchy, controversial or high-stakes issues and handle these discussions well.

Based on more than 25 years of research, Crucial Conversations training asserts one thing: If you can transfer skills that top performers routinely use to effectively handle crucial conversations – particularly in the presence of authority – then you can create more positive results across an entire organization (everything from quality to customer satisfaction to morale).

The Arkansas Hospital Associa-tion will offer Crucial Conversations training, a two-day, 14-hour work-shop that will include original video clips of “before and after” situations, in-class practice, group

participation and personal reflec-tion designed to explore and master these crucial skills.

Crucial Conversations training teaches individuals and teams from different backgrounds, depart-ments and specialties how to will-ingly and effectively surface and discuss ideas in a way that leads to virtually everyone buying into the decisions – creating broad align-ment, maximizing synergy and ensuring commitment to the best ideas. When taught, these skills inevitably result in rapid, sustain-able and wide-reaching positive changes in the results that you care about most.

During the workshop, participants will learn the following lessons: get

unstuck, start with heart, learn to look, make it safe, master stories, state your path, explore others’ paths and move to action. Each attendee will receive a valuable toolkit including a 224-page training workbook; action planner; contact cards; Crucial Conversations: Tools for Talking When Stakes are High, the New York Times bestseller based upon this training course; an audio CD companion course; subscription to the Crucial Skills Reminder, a weekly e-mail service; Web resources; and more.

Program and registration infor-mation is available at www.arkhos-pitals.org/events. For more informa-tion, please contact Beth Ingram at the AHA, 501-224-7878, or e-mail her at [email protected]. •

Crucial Conversations® Training:Get Unstuck … and Rapidly Improve the Results You Care About Most

Based on more than 25 years of research, Crucial Conversations training asserts one thing: If you can transfer skills that top performers routinely use to effectively handle crucial conversations – particularly in the presence of authority – then you can create more positive results across an entire organization (everything from quality to customer satisfaction to morale).

The Financial Accounting Standards Board accepted comments through May 17 on a proposed accounting standard for disclosing mea-sures of charity care in finan-cial statements.

Proposed by the Board’s task force on emerging issues, the standard would measure charity care based on the direct and indirect costs of providing charity care services.

The Board said the standard would enhance comparability, because some healthcare providers currently use a cost-based measure while others use a revenue-based measure. It said many healthcare entities already track the costs of providing charity care for regulatory or management purposes.

“For example, entities that file a Form 990 with the [Internal Revenue Service] are required to report a measure of charity care that is based on the entity’s direct and indirect costs to provide those services,” the proposal notes.

See http://www.fasb.org/cs/ContentServer?c=Page&pagename=FASB%2FPage%2FSectionPage&cid=1175801893139 to find the proposal. •

Proposal Being Considered for Charity Care Disclosure Standards

It said many healthcare entities already track the costs of providing charity care for regulatory or management purposes.

P.O. Box 251510 • Little Rock, Arkansas 72225 • (501) 664-7705

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The American Health Lawyers Association’s (AHLA) Executive Summary of the report Protecting Patient Data – New Rules, New Headaches; Risk Management: What Board Members and Senior Managers Need to Know has been made available to the Arkansas Hospital Association to share with its member hospitals.

The 17-page summary, writ-ten by Steven J. Fox, Peter D. Hardy and Vadim M. Schick of the AHLA’s Health Information and Technology and Business Law and Governance Practice Groups, discusses the Red Flags Act, HIPAA and the HITECH Act, steps to minimize exposure to a data breach, and responses to a

detected Red Flag or to an inten-tional data breach.

Also included is an appendix out-lining the HITECH Act’s breach noti-fication requirements.

If any AHA-member hospital would like a copy of the executive summary, you may contact AHA Vice President and General Counsel Elisa M. White at 501-224-7878. •

Healthcare providers should be aware of signs and symptoms reported among some users of “K2,” a synthetic marijuana product that is legal and readily obtainable in Arkansas.

Providers should note that use of this substance, alone or in combi-nation with other substances, may cause symptoms including anxiety coupled with agitation, tachycardia, elevated blood pressure, pallor, vom-iting, tremors, hallucinations, and possibly seizures.

The Arkansas Department of Health asks healthcare providers to report to the Arkansas Poison and Drug Control Information Center at 1-800-376-4766 any patient with compatible signs and symptoms that are thought to result from “K2” use.

“K2” – also known as “K2 Spice,” “Spice,” “K2 Summit,” “Genie,” “Zohai” and various other names – is an unregulated mixture of dried herbs that are sprayed with a synthetic cannabinoid-like substance and sold as incense. The product is typically burned, and the smoke is inhaled for effect.

The cannabinoid-like substance

in this product acts on the same brain receptors as does marijuana.

A great many of these substances have been synthesized, and it would not be possible to know how much or which, if any, of these many synthetics are present in “K2” without doing an extensive chemical analysis. “K2” and similar products do not test positive as marijuana or as any other illicit substance when subjected to urine drug testing.

“K2” is sold legally in Arkansas and it is available for purchase from retailers in many parts of the state. The product is also widely available on the Internet.

Since early February 2010, poi-son control centers in other states have received questions from emer-gency department (ED) physicians regarding management of patients who have had adverse reactions after smoking “K2.”

The Arkansas Poison and Drug Control Information Center has received calls about “K2.”

Signs and symptoms associated with smoking “K2” as reported from other states are: tachycardia, elevated blood pressure, anxiety, pallor, numbness and tingling,

vomiting, agitation, hallucinations, and, less commonly in some cases, tremors and seizures.

Although these are not the usual responses associated with marijuana use, most have been reported with some frequency as adverse effects in naive marijuana users or in some cases when highly potent marijuana products are used. It is also possible that some of these reactions are a result of the other unrecognized chemicals present in the smoked “K2” that are not related to the cannabinoid receptor system.

The Arkansas Department of Health recommends the following: Ask about “K2” use in patients who present for care with com-patible symptoms (anxiety coupled with agitation, tachycardia, elevated blood pressure, pallor, vomiting, tremors, hallucinations, and pos-sibly seizures) and when substance use is suspected.

Be aware that these chemical-ly-related cannabinoids do NOT cross-react with delta-9-tetrahydro-cannabinol (THC) on the standard urine immunoassay (UDS) tests that reference laboratories use for com-prehensive drug screens. •

Arkansas Department of Health Issues Advisory on K2 Synthetic Marijuana Use

From the Arkansas Department of Health

Executive Summary of “Protecting Patient Data” Report Available from AHA


A D V o C A C Y / L E g I S L A T I o N

The American Hospital Asso-ciation (AHA), in partnership with state hospital associations, in April awarded 52 individu-als with the American Hospital Association Grassroots Champion Award. The Arkansas award went to James David Cicero, pres-ident of Ouachita Medical Center in Camden.

As a 2010 Grassroots Cham-pion, Cicero is recognized for exceptional leadership in gener-ating grassroots and community activity in support of a hospital’s mission.

The American Hospital Asso-ciation Grassroots Champion Award was created to recognize

those hospital leaders who most effectively educate elected officials on how major issues affect the hospital’s vital role in the commu-nity, who have done an exemplary job in broadening the base of com-munity support for the hospital, and who are tireless advocates for hospitals and their patients.

“We depend upon strong local voices to help tell the story of hos-pitals as cornerstones of the com-munities they serve,” said Rich Umbdenstock, AHA president and CEO. “This award is a small token of our appreciation for the hard work and dedication of these individuals to improving health and healthcare in America.” •

Grassroots Champion Award Presented to Camden’s James David Cicero

David Cicero (left), President of Ouachita County Medical Center in Camden, received the American Hospital Association’s “Grassroots Champion Award” during the association’s annual meeting in Washington, D.C. With Cicero is Robert “Bo” Ryall, Executive Vice President and Chief Lobbyist for the Arkansas Hospital Association.



The 2010 Annual Membership Meeting of the American Hospital Association (AHA) April 25-28 brought together hospital lead-ers from across the country to Washington, D.C., to hear from key policy-makers and experts and to advocate for patients and com-munities.

General sessions included a Federal Forum, where lawmakers from both sides of the aisle discussed healthcare reform and revising the Health IT rule. Though there was disagreement between the party representatives over the recently enacted healthcare reform legislation, bipartisan support was voiced for revision of the Centers for Medicare & Medicaid Services’ (CMS) proposed rule on “meaningful use” of electronic health records (EHR).

House Speaker Nancy Pelosi (D-CA) thanked the AHA for its leadership and support in enacting the recent health reform legislation, saying, “In backing reform, you stood up for the well-being of all Americans.” She told AHA mem-bers, “You gave us the confidence that this could be done. Thank you for the role you played in passing this historic legislation.”

Senator John Cornyn (R-TX) told AHA members that congressional Republicans will seek to repeal and replace the healthcare law. The Senate Finance Committee member said Republicans will advocate for changes to the current legislation.

Representatives Chris Van Hollen (D-MD) and Michael Burgess (R-TX) both strongly criticized CMS’s proposed rule on “meaningful use” of EHR and the proposed penalties for hospitals failing to meet the final requirements drafted by CMS. Burgess urged

hospital leaders to “stay involved” in the rulemaking process, saying hospital advocacy can “affect the course” of future regulatory policy. He co-sponsored a bipartisan letter signed by 249 U.S. representatives, including Van Hollen, who urged CMS to revise its proposal that hospitals meet 23 requirements to qualify as “meaningful users” of EHR systems.

Speaking on healthcare reform, Health and Human Services Secretary Kathleen Sebelius said passage was the “first step, but now the real work begins at transform-ing our healthcare delivery system.” She stressed the need to “change the incentives in our healthcare system so doctors and hospitals get reward-ed for providing high-quality care,” saying that too often, payments are made based on quantity, not qual-ity ... volume, not value. She said the new law’s Medicare demonstra-tion projects are intended to spur more coordinated care, and said it’s never been more important for HHS and hospitals to work together to improve the quality of care for all Americans.

Speaking specifically to those demonstration programs, for-mer Senate Majority Leaders Tom Daschle (D-SD) and Bill Frist (R-TN)

told hospital leaders that demonstra-tion programs could urge delivery system and payment reforms that control health spending far more effectively than cutting provider payments. Both said success of cost containment efforts may largely depend on CMS’s commitment to experimentation in Medicare.

AHA President and CEO Rich Umbdenstock told AHA members that the hospital field must make sure healthcare reform’s foundation supports and advances what hospitals are doing across the country to make care safer and more efficient, effective and transparent. He observed that the recently enacted healthcare legislation contains key principles from the AHA’s Health for Life reform framework. The healthcare “mantra used to be to do more with less,” he said. “That’s changing to do better with less.” He said many hospitals are “jumping ahead of this wave of change ... delivering higher quality more efficiently and lowering costs to improve value.”

Speakers at the meeting also issued a call for CMS to reverse course on PPS cuts. In his remarks at the meeting, AHA Executive Vice President Rick Pollack urged hospital leaders to let lawmakers know that the cuts in the proposed inpatient prospective payment sys-tem (PPS) rule for fiscal year (FY) 2011 are “unacceptable.” He said the proposal ignores the reality that hospital patients are getting sicker and would undermine care in communities across the country.

Hospital leaders, including the Arkansas delegation to the annual meeting, delivered that “stop-the-cuts” message in meetings with their legislators and staff on Capitol Hill. •

reform, health it, Cost Containment major topicsat American hospital Association Annual meeting

Hospital leaders, including the Arkansas delegation to the annual meeting, delivered that “stop-the-cuts” message in meetings with their legislators and staff on Capitol Hill.



A group of 27 hospital CEOs, admin-istrative team members, medical staff, trustees, auxilians and Arkansas Hospital Association (AHA) staff members made the trip to Washington, DC in April for the annual membership meeting of the American Hospital Association, and more importantly, took part in individual meetings with mem-bers of Arkansas’ congressional delegation.

Two main concerns discussed with Senators Blanche Lincoln and Mark Pryor and Representatives Marion Berry, Vic Snyder, Mike Ross and John Boozman were the need to guard against widespread unionization among hospital employees and securing an extension of the increased FMAP rate allowed for states under the American Recovery and Reinvestment Act of 2009 (ARRA).

Other major points were addressed as well, including support for changes in Medicare policy regarding reimbursement for hospitals that accept patients evacu-ated from other states’ hospitals during a time of national emergency and reducing burdensome reporting requirements of the current “Meaningful Use” rule pertaining to Electronic Health Records.

The Arkansas group also met with aides and staff members from the offices of the state’s senators and representatives regard-ing the issues. “These meetings help solid-ify our ongoing positive relationships with our congressional delegation,” says Phil Matthews, president and CEO of the AHA. “It is vital that we keep in close communica-tion with these aides and staff members, as they are key in relaying the local message to our elected officials.”

Arkansans visit with U.S. Senator Blanche Lincoln while in Washington for the American Hospital Association Annual Meeting April 25-28.

The approval and signing of the Patient Protection and Affordable Care Act of 2010 and its companion, the Reconciliation Act of 2010 addressed many concerns of Arkansas’ hospitals involving healthcare access and payment issues. However, reforming healthcare insurance, financing and delivery systems was not the cure-all for hospitals. Other items requiring attention are:1) THe empLoyee FRee CHoiCe ACT (H.R. 1409/S. 560)

These companion bills are still in the legislative queue. While we do not know when, or if, they will be further considered, the Arkansas Hospital Association remains firmly opposed to both. We asked that our delegation preserve secret ballot union elections, as the AHA believes this to be in the best interest of Arkansas’ hospitals and our state. We asked that members oppose efforts to pass the bills.

2) exTenDing THe ARRA’S enHAnCeD FmAp peRCenTAgeSThe length and depth of the recession means that states

will continue to face significant budget shortfalls long after the enhanced FMAP provisions expire on Dec. 31, 2010. Governor Mike Beebe has already called for state Medicaid reductions during SFY 2011. Extending the FMAP boost, even for another six months, would limit those cuts and assist hospitals in maintaining services and further stabilizing the economy. We asked that our delegation vote in favor of extending the enhanced FMAP provision before it expires.

3) nDmS CHAngeSSeveral hospitals in the Metropolitan Little Rock area

participated as part of the National Disaster Medical System (NDMS) following Hurricane Katrina in August-September 2005 and again during and after Hurricanes Gustav and Ike in September-October 2008. On both occasions, they received many patients evacuated from Louisiana hospitals in the storms’ paths. Reimbursement problems have not been resolved. Hospitals have, in many cases, been left to absorb the costs of caring for these patients.

We asked our delegation’s support for changing Medicare policies to recognize that during disaster-related evacuations when the NDMS is activated, NDMS can be the primary payer for all evacuated patients, in essence suspending Medicare’s coverage for those patients during the evacuation period until the patient is returned to the hospital from which he/she came.

27 Represent Arkansas Hospitalsin Meetings with Congressional Delegation

ArKAnSAS ISSUeS DIScUSSeD wItH congreSSIonAl DelegAtIon

continued on page 40



4) ACCeSS To CApiTALAn increased difficulty in secur-

ing debt financing from banks and other financial institutions and other payment pressures are lead-ing to a decline in hospitals’ finan-cial health at a time when demand for healthcare services is growing.

We asked our delegation to help by supporting various steps to improve hospitals’ access to capital.

5) “meAningFuL uSe” AnD eHR inCenTiveS

CMS’ proposed rule on the Medicare and Medicaid electron-ic health record (EHR) incentive programs lays out the expecta-tions for healthcare providers who will qualify for Medicare and Medicaid payments estab-lished under the American Recovery and Reinvestment

Act of 2009 (ARRA). If suc-cessfully implemented, the law should improve EHR capabili-ties, leading to better clinical care, improved coordination of care, fully informed and engaged patients, and improved public health.

The proposed rule overlooks the fact that constructing a nation-wide health information network interconnecting multiple health-care providers across a region, state or country and equipping them with the capability to exchange key clinical information to improve patient care will require buy-in and cooperation from all parties. For that reason, the AHA is very concerned about the definition of “meaningful use,” the short transition times and other conditions for accessing

the HIT funds as outlined in the proposed rule.

We asked our delegation to press for changes in the proposed rule to:• Lengthen the timeframe for

achieving meaningful use. • Limit applicable objectives to

ensure that CMS takes a phased approach, allowing hospitals to be considered meaningful users while meeting fewer requirements in the earlier years and gradually complying with the more stringent requirements.

• Reduce burdensome report-ing requirements on 23 HIT functionality measures, at the same time that reporting on an additional 35 Medicare quality measures is being mandated. •

Q U A L I T Y / P A T I E N T S A F E T Y

In this time of economic upheav-al, pressure remains strong in the healthcare industry to increase effi-ciency and keep quality high. The responsibility for quality spans all levels of the hierarchy of healthcare: physicians, nurses, technicians, lab techs, housekeeping, administra-tion, etc. All have a role in the care of the patient.

The Arkansas Foundation for Medical Care has recently become a part of a unique national effort to improve quality and reduce medi-cal errors. TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) was developed by the U.S. Department of Defense in collaboration with the Agency for Healthcare Research and Quality. The program, which is part of the National Patient Safety Initiative, focuses on improv-ing patient safety. Since before the Institute of Medicine issued its land-

mark report on medical errors 10 years ago, there has been much study regarding the cause of errors in hos-pitals. Many of the quality experts who conducted these studies con-cluded that the systems and organi-zations themselves are the cause, not individual persons. Communication and care team dysfunction seem to be the root cause of many medical errors. The TeamSTEPPS program is designed to improve patient safety by teaching healthcare professionals key communication strategies and specific teamwork skills.

As part of the Centers for Medicare & Medicaid Services’ (CMS) 9th Scope of Work for Quality Improvement Organizations, AFMC is providing TeamSTEPPS training for hospitals participating in the methicillin-resistant Staphylococcus aureus (MRSA) quality improve-ment project. CMS has funded QIOs across the country to provide

this training to hospitals partici-pating in this project as a strategy to reduce MRSA in their organi-zations. During a two-and-a-half-day master trainer seminar, hospital staff members receive comprehensive training that allows them to return to their organization and train oth-ers. The program in Arkansas has been very well received thus far, with 83 individuals from 11 hospi-tals participating.

The core curriculum includes strategies to optimize the use of information, people, and resources to achieve the best clinical outcomes for patients, increase team aware-ness, and clarify team roles and responsibilities. The training uses a team competency model, which focuses on the skills required to create a high-performing team and is centered on team knowledge, atti-tudes and performance. Participants develop skills in the areas of lead-

teamStePPS in Arkansas:changing Attitudes toward Healthcare

by Pamela Brown, RN, BSN, CPHQ



ership, mutual support, communi-cation and situation monitoring. They learn tools to resolve conflict, improve information sharing, and eliminate barriers to quality and safety. One such tool is a huddle, which is used for reinforcing the plans already in place for treatment of a patient in response to changes in the environment of care so that all team members can adapt appro-priately. A physician, for example, might call a huddle before perform-ing a bedside procedure. It helps all team members develop a shared understanding of the plan of care.

TeamSTEPPS training is divided into three phases: a pre-training assessment for site readiness, training for onsite trainers and healthcare staff, and a plan for implementation and “sustainment,” the TeamSTEPPS term for ongoing use of the program.

pRe-TRAining ASSeSSmenTBefore an organization takes on

any initiative that involves a change in culture, it must determine its readiness. The pre-training assess-

ment is sometimes referred to as a training needs analysis, and can be done through a site assessment. This process helps to identify the focus of the training and to address any teamwork gaps. The informa-tion from the assessment is then used to identify critical training needs and develop training objec-tives. It is also used to determine the organization’s patient safety culture – imperative in implement-ing TeamSTEPPS – key staff to be involved (the ChangeTeam) and resources. During this phase, some organizations determine that they must focus on creating a culture conducive to patient safety before implementing TeamSTEPPS.

TRAining FoR onSiTe TRAineRS AnD HeALTHCARe STAFF

TeamSTEPPS training should include all members of the health-care team: doctors, nurses, unit clerks, LPNs, aides, pharmacy and administration. Some organizations choose to implement the program gradually, starting with the surgi-cal department or the emergency

department, for example, before broadening it to the whole organi-zation.

TeamSTEPPS training involves both a train-the-trainer course and a train-the-participant course. The train-the-trainer (Master TeamSTEPPS Course) seminar teaches the fundamental concepts of the program and how participants can successfully implement it in their own organizations. It also focuses on providing them with the skills for training others and requires a “teach back” of material during the training.

The train-the-participant training (referred to as the Fundamental Course), which lasts four to six hours, teaches staff the basic fundamentals and how to implement TeamSTEPPS within their organization.

impLemenTATion AnD SuSTAinmenTAs part of this phase, AFMC

offers support and technical assis-tance to participants during the initial training at their organization. Providers are charged with develop-ing a plan for implementation that allows testing of actual strategy implementation, assessing whether the aim of the implementation is being achieved and providing orga-nizational progress updates.

To create sustainment of these strategies within the organiza-tion, progress must be monitored. Ongoing involvement by both administrative and clinical leader-ship is key. Organizations that have successfully implemented and sus-tained the TeamSTEPPS program have used continued training of new staff and periodic in-services to refresh existing staff. According to the official TeamSTEPPS Web site (http://teamstepps.ahrq.gov):

The designated change team manages sustaining interventions through coaching and observing team performance. An effective sustainment plan should account for ongoing assessment of the effectiveness of the intervention,

This diagram illustrates the fundamental concepts and processes of the TeamSTEPPS program.




A total of 43 hospitals, nursing homes, doctor’s offices and home health agencies earned recognition recently in the Arkansas Foundation for Medical Care’s annual Quality Awards program.

The awards are designed to recognize individual performance improvement in AFMC’s qual-ity improvement projects. They spotlight several facets of quality healthcare, from creating innova-tive community projects to using electronic health records to identify and close gaps in the quality and

amount of healthcare received by various ethnic and socioeconomic groups.

Barry M. Straube, MD, director of the Office of Clinical Standards and Quality (OCSQ) and the chief medical officer at the Centers for Medicare & Medicaid Services (CMS), presented the awards at a luncheon Friday, May 21, as part of AFMC’s annual Quality Conference in Little Rock.

A complete list of award winners and award criteria is available at www.qualityconference.org. •

2010 Quality Awards Go to 43 Facilities

Representatives of Saline Memorial Hospital accept their quality award.

John N. Robbins, FACHE, has been named the Arkansas Foundation for Medical Care’s interim president

and chief executive officer. Robbins replaces Dr. Nick Paslidis, who recently resigned to pursue other career interests.

Robbins is currently president of Robbins and Associates Consulting of Germantown, Tennessee, and is past president and CEO of Conway Regional Health System. He previ-ously served as executive vice presi-dent of the Baptist Memorial Health Care Corporation, Inc., in Memphis. He has more than 40 years of expe-rience in healthcare administration in Arkansas, Tennessee, Florida and Mississippi, and is board-certified in healthcare management as a fellow in the American College of Healthcare Executives.

He has also served on a number of boards, including the Arkansas Foundation for Medical Care and Arkansas Hospital Association. Robbins has also been a Regent for Arkansas to the American College of Healthcare Executives. He holds a master’s degree in healthcare administration.

“With the recent passage of healthcare reform legislation, this is an exciting time to lead an organi-zation like AFMC,” Robbins said. “I look forward to meeting the challenges of our industry’s chang-ing landscape while we continue to provide healthcare improve-ment services to the citizens of Arkansas.” •

AFMc leadership changes:John Robbins named interim president and Ceo

John Robbins

sustainment of positive changes, and identification of opportunities for further improvements. Other key sustainable features include: • Provide a supportive practice

environment • Ensure leaders emphasize new

skills • Provide regular feedback and

coaching • Celebratewins

• Measuresuccess• Updatetheplan

While the future of healthcare may seem to be in turmoil, TeamSTEPPS serves as a great base on which to build and maintain an environment that promotes good practice as well as sustainability. Whether your institution has a huddle before a procedure, or a nurse uses a communication tool

when calling a physician, Arkansas patients can truly benefit when an organization implements a program such as TeamSTEPPS. For more information, contact AFMC at 501-375-5700 or 877-375-5700.

Pamela Brown, RN, BSN, CPHQ, is the Arkansas Foundation for Medical Care’s assistant vice president for the Health Care Quality Improvement Program. •


The presentations, though sepa-rate, brought to mind the old point/counterpoint segments which occu-pied the closing slot on CBS’s 60 Minutes for a few years during the 1970s. Daschle aptly filled the role of Newsweek columnist (no, not communist) Shana Alexander, who always expressed a more lib-eral voice, and Romney did a fine job of channeling the conservative viewpoint of James J. Kilpatrick, a columnist at the time for the now-defunct Washington Star.

Daschle and Romney weren’t on stage together, so there was none of the catty back-and-forth that char-acterized the on-tube relationship between Alexander and Kilpatrick (“Oh, come on, Jack!” “Now, see here, Shana!”). But, like the two writers on so many issues, and par-ticularly like the American people on the subject of health reform, their views of the law were so dia-metrically opposed that you had to wonder if the pols were both talking about the same thing.

Knowing the divisive nature of the debate over reform during the past year, it’s more than likely that, had the barbs been thrown, they might have taken on an air of those exaggerated Saturday Night Live point/counterpoint parodies where Jane Curtain first presented the lib-eral side of an issue before Dan Aykroyd began his response saying,

“Jane, you ignorant slut.” Curtain’s lead-in to a defense of her posi-tion would be, “Dan, you pompous ass.” It would have been like a mini health reform town hall meeting.

One thing which both men agreed on is that in spite of the legislation, health reform is a work in prog-ress. Success or failure, security or intrusion, balance or disproportion: those things lay in the hands of the secretary of HHS, who eventu-ally will attach many working parts onto the legislative framework. The phrase “the secretary shall” appears regularly throughout the law – more than 1,000 times by some counts – often followed by a directive to develop regulations for everything from coverage and affordability to delivery system changes, quality and transparency. That translates into a lot of new rules and regulations. The devil really is in the details.

It remains to be seen whether the general public will eventually warm to the idea of health reform in the years ahead, but the fact is that the status quo – 46 million uninsured, arbitrary coverage denials and the prospects that health costs could surpass 34 percent of GDP in a mat-ter of years – is clearly unacceptable. There’s an odds-on chance that even folks most adamantly opposed to the law today would never let go of their coverage benefits down the road. If the reform measures prove

to reduce the deficit significantly over the next 20 years, as predicted, then all the better.

During the symposium, Sen. Daschle told a story about the 1908 Democratic National Convention in Denver where William Jennings Bryan received his third and final presidential nomination. At the time, the U.S. was bogged down fighting an insurgency in a distant land (the Philippines), Americans were worried about the flood of immi-grants (from Europe), and greedy Wall Street bankers were getting the blame for a tanking economy.

Bryan supposedly commented dur-ing the gathering that he wished he could return in 100 years to see how the nation survived. Had he been able to attend the 2008 convention in Denver 100 years later, he would have found the U.S. bogged down fighting insurgencies in two distant lands, Americans worried about the flood of immigrants and a tanking economy, with greedy Wall Street bankers still footing the blame.

But, he also would have found an America strengthened through fights to preserve freedom in two World Wars, Korea, Vietnam, Iraq and Afghanistan, the Great Depression, a battle over civil rights, the assassination of one president, the resignation of another and the impeachment of yet another, and too many political scandals to count.

And, Bryan may have been sur-prised at current day programs like the Federal Reserve, Social Security, Medicare and Medicaid. All were controversial in the beginning for their perceived insidious nature. But, they were later not only accepted, but embraced by the same people who once fought them tooth and nail. Don’t be surprised if a similar fate awaits healthcare reform. •

The Real Measure of Health Reform Success?cHAngIng oPPoSItIon to APProvAl

by Paul Cunningham, Senior Vice President, Arkansas Hospital Association

HP Enterprise Services, an arm of Hewlett-Packard, the American multi-national information technology corporation that contracts to operate Medicaid Management Information Systems in Arkansas and several other states, hosted a one-day healthcare symposium in May for its clients and a few other invited guests. The highlight of the day was back-to-back appearances by former Senate Majority Leader Tom Daschle and former Massachusetts Governor Mitt Romney, both of whom offered their takes on the recent health reform legislation.

H E A L T H C A R E R E F o R M



The year-long national debate over health reform ended in March, when President Obama separately signed into law the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA), which made modifications to the PPACA. Together, this historic legislation constitutes the largest change to America’s healthcare system since the creation of Medicare and Medicaid.

The law addresses changes to be made over the next decade in the following areas;

Consumers and Purchasers: The PPACA expands cover-age to 32 million people through a combination of public program and private-sector health insurance expansions. Key insurance reforms include a mandate for individuals to have insurance; employer responsibility to provide or con-tribute to health insurance; low-income subsidies to help individuals purchase insurance; an expansion of Medicaid eligibility; and the creation of state-based health insurance “exchanges.”

Payment and Revenue: A number of steps will be taken to reduce the rate of increase in Medicare and Medicaid spending through reduced payment updates, decreases in disproportionate share hospital payments, and financial penalties. Additional financing is provided through a combination of taxing high-premium health insurance plans, raising the Medicare tax for high-income indi-viduals and imposing annual fees on the pharmaceutical, medical device, clinical laboratory and health insurance industries.

Delivery System Reform and Quality: Key delivery system reforms are employed to better align provider incentives to improve care coordination and quality and reduce costs. These reforms include value-based purchasing; pilot projects to test bundled Medicare payments; voluntary pilot programs where qualifying providers - including hospitals - can form Accountable Care Organizations and share in Medicare cost savings; and financial penalties for hospitals with “excessive” readmissions.

Wellness and Work Force: Grants and loans will enhance work force education and training to support and strengthen the existing work force and to help ease healthcare work force shortages. Public and private insurers to cover recommended preventive services, immunizations and other screenings with zero enrollee cost sharing (no co-payment or deductible). It also initiates policies to encourage wellness in schools, workplaces and communities, and takes steps to modernize the public healthcare system.

Other: The law includes provisions to reduce waste, fraud and abuse in the Medicare and Medicaid programs, and new reporting requirements are imposed on tax-exempt hospitals. In addition, the law also incorporates several oversight programs including new requirements for physician-owned hospitals. •

Health Reform Highlights Historic Health Reform Law:What it Means to Local Hospitals

On March 23, President Obama signed into law H.R. 3590, The Patient Protection and Affordable Care Act. A companion bill, H.R. 4872, The Health Care and Education Affordability Reconciliation Act of 2010, passed both chambers of Congress on March 25. Together, the two pieces of legislation combine to form the Affordable Care Act of 2010.

The historic legislation contains an individual coverage mandate, low-income subsidies, an expansion of Medicaid, insurance reforms and the creation of state-based health insurance exchanges.

The law also calls for new, non-profit, con-sumer-operated and -oriented plans (or co-ops), as well as multi-state health plans overseen by the federal Office of Personnel Management, to compete with other private health plans in the insurance exchanges.

Financing includes taxing high-premium health insurance plans, raising the Medicare tax for high-income individuals and imposing annual fees on the pharmaceutical, medical device, clinical laboratory and health insurance industries, as well as reducing Medicare and Medicaid provider payments.

Among its many provisions, the healthcare reform package:• Expands access to coverage to 32 million

individuals by 2019 through a combination of Medicaid expansions and private section health insurance reforms. That means many patients who currently have no health insurance will have a source of payment for care they receive.

• Decreases Medicaid DSH payments by $14billion and Medicare DSH payments by $22.1 billion, with reductions beginning in fiscal year (FY) 2014.

• Reduces hospital Medicare PPS paymentupdates by approximately $112.6 billion over 10 years. For 2010 (effective April 1) and 2011, the hospital payment update would be reduced by 0.25 percentage point. Beginning in 2012, the market basket would be reduced by an estimate of productivity, with added reductions of 0.1 percentage point in 2012 and 2013, 0.3 percentage point in 2014, 0.2 percentage point in 2015 and 2016, and 0.75 percentage point in 2017, 2018 and 2019. In 2020 and beyond, hospital payment updates would be reduced by productivity. The final bill eliminates a provision in the Senate bill



calling for the reductions not to occur if certain coverage targets are not met in 2014-2019.

• Establishes the following programs tied to hospitalpayments:1. A national, voluntary, five-year pilot program

on bundling payments to providers around 10 conditions. If successful, the Secretary of Health and Human Services (HHS) may expand the pilots after 2015;

2. Financial penalties on hospitals for “excess” readmissions when compared to “expected” levels of readmissions based on the 30-day readmission measures for heart attack, heart failure and pneumonia that are currently part of the Medicare pay for reporting program (excluding critical access hospitals [CAH] and post-acute care providers);

3. A Value-Based Purchasing (VBP) program for hospital payments beginning in FY 2013 based on hospitals’ performance in 2012 on measures that are part of the hospital quality reporting program. The program is budget neutral, with 1 percent of payments allocated to the program in FY 2013, growing over time to 2 percent in 2017 and beyond; and,

4. An additional 1 percent penalty for hospitals in the top quartile of rates for hospital acquired conditions.

• Includes$400millionforpaymentsforFYs2011and2012 to section 1886(d) hospitals located in counties that rank in the lowest quartile for age, sex and race adjusted per enrollee spending for Medicare Parts A and B. The payments would be proportional to each hospital’s share of the sum of Medicare inpatient PPS payments for all qualifying hospitals.

• Eliminatestheexceptionforphysician-ownedhospitalsunder the Stark Law and grandfathered existing hospitals with a Medicare provider number as of Dec. 31, 2010. But, it provides limited exceptions to the growth restrictions for grandfathered physician-owned hospitals, including a new exception for hospitals that treat the highest percentage of Medicaid patients in their county (and are not the sole hospital in a county).

• Creates a new, independent board that would makebinding recommendations on Medicare payment policy and non-binding recommendations for changes in private payer payments to providers. It excludes Medicare PPS hospitals (but not CAHs) through 2019.

• Extends eligibility for the 340B drug discountoutpatient program to children’s, cancer and CAHs, as well as certain sole community hospitals and rural referral centers. It does not expand the program for existing 340B hospitals to cover inpatient drugs, and it exempts orphan drugs from required discounts for new 340B entities.

• Sustains and improves access to care in rural areasthrough these various improvements:1. Extending the outpatient hold-harmless payments

for certain hospitals in rural areas2. Improving payments for low-volume hospitals3. Ensuring that CAHs are paid 101 percent of costs

for all outpatient services regardless of the billing methods elected

4. Extending and expanding the Rural Community Hospital Demonstration Program

5. Extending the Medicare Dependent Hospital program for one year

6. Extending the Medicare Rural Hospital Flexibility Program through 2012

7. Extending reasonable cost reimbursement for laboratory services in small rural hospitals

• Includes one-year extensions of certain Medicareprovisions, including Section 508 wage index reclas-sifications; increasing the work geographic index to 1.0; grandfathering direct billing for anatomic pathol-ogy technical component services; add-on payments for ground ambulance; and a 5 percent increase in physician payment for certain psychiatric therapeutic procedures.

• Extends for two years selected long-term acute carehospital (LTCH) provisions in the Medicare, Medicaid and SCHIP Extension Act of 2008. It further delays full implementation of the 25 percent Rule, the short-stay outlier cuts, and the one-time budget-neutrality adjustments planned by CMS. Extends current moratorium on new LTCH beds and facilities, with exceptions.

• Creates a 3 percent add-on to payments made forhome health services to patients in rural areas. The add-on applies to episodes ending on or after April 1, 2010, through Dec. 31, 2016.

• Extends the exceptions process for outpatient therapycaps (see Section 3103). Outpatient therapy service providers may continue to submit claims with the KX modifier, when an exception is appropriate, for services furnished on or after Jan. 1, 2010, through Dec. 31, 2010. The therapy caps are determined on a calendar year basis, so all patients began a new cap year on Jan. 1, 2010. •


The Department of Health and Human Services (HHS) plans to unveil by July 1 the first version of a Web site designed to help individuals and small businesses get infor-mation about health insurance options in their state.

HHS’ Office of Consumer Information and Insurance Oversight will oversee the Web portal (HealthCare.gov) that will provide consum-ers with information about private insurance, high-risk pools, Medicaid and the Children’s Health Insurance Program. The site will not have pricing information, which is often based on insur-ers’ proprietary algorithms that factor in numerous health-related characteristics of the potential subscriber. A second launch of the site on October 1 is expected to include price estimates.

HHS hopes the new portal will influence states’ creation of health insurance exchang-es; increase enrollment in Medicaid, CHIP and high-risk pools; and boost the sale of private policies to the unin-sured.

Details are included in an interim final rule at http://www.hhs.gov/ociio/gather-inginfo/index.html. •

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M E D I C A R E / M E D I C A I D

The American Hospital Asso-ciation (AHA) has expressed strong support for President Obama’s recent nomination of Donald Berwick, MD, as administrator of the Centers for Medicare & Medicaid Services (CMS). Berwick is president and CEO of the Institute for Healthcare Improvement (IHI),

and served as an independent member of the AHA Board from 1996 to 1999.

Berwick co-founded IHI, a non-profit Boston area consulting and research group, in 1991.

“The tools and advice made available through IHI under his leadership have been used by hospitals and healthcare-givers around the world, and as a result, have touched the lives of thousands of patients,” said AHA President and CEO Rich Umbdenstock. “As the changes made by healthcare reform are put in place, we look forward to working with Don (Berwick) and the administration to continue finding new ways that hospitals can improve care for the patients and the communities they serve.”

Berwick, a pediatrician, is an

adjunct staff member in the Depar-tment of Medicine at Boston’s Children’s Hospital and a consul-tant in pediatrics at Massachusetts General Hospital. He also serves as a professor at Harvard Medical School and its School of Public Health. Berwick would carry out major provisions of the new health-care reform legislation – the largest rollout of a social program since the 1960s.

As administrator, Berwick would manage a bureaucracy of 4,500 that serves nearly one in three Americans and has an annual budget of about $780 billion.

The Senate must confirm his nomination as CMS administrator, a position that has been filled through temporary appointments since 2006. •

Berwick’s Innovative Approach Seen as an Asset for CMS Head

Donald Berwick

The Centers for Medicare & Medicaid (CMS) on May 28 direct-ed Pinnacle Business Solutions, Inc. (PBSI) to merge the Fiscal Intermediary Shared System (FISS) into one system in preparation for the Jurisdiction 7 (J-7) A/B Medicare Administrative Contractor (MAC) implementation. The merge will move existing Part A workloads for the states of Arkansas, Mississippi and Louisiana into a sin-gle Customer Information Control System (CICS) region. Providers will need to be aware of several significant changes with this merger.

According to the CMS directive, providers will be impacted in the following ways:• The payment cyclewill change

from a weekly payment to a daily payment.

• The Local Coverage Determi-nations (LCDs) will merge into a common set for all three states. Some LCDs will be new, some revised and some will be retired.

• The claims processing systemedits will merge into a common set for all three states.

• TheDirectDataEntry(DDE)sys-tem will have some screen changes.

• Monday, Aug. 2, 2010, willbe a “dark day” in which the FISS, DDE and Interactive Voice Response System (IVRS) will not be available.

• There will be consolidation ofinformation on the PBSI Web site.

The cutover date will be Monday, Aug. 2, 2010. PBSI staff is working closely with all stake-holders including the FISS, the Enterprise Data Center (EDC), Palmetto GBA, and CMS regional and central offices to ensure a successful changeover. Additional information will be published as it becomes available. There also will be special teleconferences sched-uled for providers to learn more about these changes. The most current information concerning these changes can be found on the PBSI Web sites, www.arkmedi-care.com and www.lamsmedicare.com. Questions may be submitted via e-mail through the Web site’s “Contact Us” feature or by calling Greg Hart, Senior Coordinator of Professional Relations, at (501) 210-0740.

Read CMS’ Change Request 6919 at http://www.cms.gov/trans-mittals/downloads/R675OTN.pdf. •

cMS Preparing For J-7 MAc Implementation

The merge will move existing Part A workloads for the states of Arkansas, Mississippi and Louisiana into a single CICS region. Providers will need to be aware of several significant changes with this merger.


New legislation signed June 25 by President Obama spares physicians from a 21.29 percent cut in Medicare payments for another six months, but will cost the nation’s hospitals about $4 billion in coming years. In passing H.R. 3962, the U.S. House of Representatives agreed with the Senate to delay for six months the

Medicare pay cut for physicians and replace it with 2.2 percent increase in the Medicare physician fee schedule through November 30. It marks the 10th time a cut in the fee schedule has been blocked in the last 8 years, including four times this year.

The bill, approved by a 417 to 1 vote, also will reduce hospital

payments by prohibiting them from retrospectively billing to unbundle payments for outpatient therapeutic services provided prior to date of enactment of the legislation if they were performed within 72 hours of a hospital admission and were unrelated to that admission. The provision was opposed by the

law changes “3-Day window” Bundling


Hospitals stand to lose ground in their pursuit of fair payments under CMS’s proposed rule for the fiscal year (FY) 2011 Medicare Inpatient Prospective Payment System (IPPS).

While CMS proposes a full market-basket update (2.4 percent) for the Medicare base rate, there is also a 2.9 percent behavioral offset reduction to the update factor, pushing the overall rate update into negative territory.

CMS says the offset is designed to recoup half of what the agency believes are excess payments that relate to improvements in the coding and classification of patients brought about by the switch in FYs 2008 and 2009 to a Medicare Severity Diagnosis Related Group (MS-DRG) system.

Hospitals argue that any addi-tional payments were warranted due to real case-mix changes reflecting actual patient characteristics and treatment patterns.

Not included in the proposed rule is recognition that the FY 2011 update factor must be reduced by an additional 0.25 percentage points as mandated by the new healthcare reform legislation (the market-basket update provided in FY 2010 must also be reduced by 0.25 percentage points retroactive to April 1, 2010).

The net impact of these adjust-ments yields a FY 2011 Medicare IPPS standard payment amount that will be about 0.8 percent lower than the FY 2010 version.

Due to timing of the recent legislation, the proposed rule does not include any regulatory language regarding implementation of related reform provisions contained in the law affecting FY 2011 Medicare IPPS payment rates. Those will be handled via separate rules.

In addition to the coding adjustment, highlights of the proposed IPPS rule include:• Quality Measures Used for the

Hospital Pay-for-Reporting Program: To receive a full market-basket update in FY 2011, hospitals will be required to successfully report data on 45 quality measures. Hospitals that don’t successfully submit their quality data will be subject to a 2.0 percentage point reduction to their IPPS update.

• OutlierThreshold: CMSispro-posing to increase the outlier threshold by 3.6 percent, from $23,140 in FY 2010 to $23,970 in FY 2011, in order to maintain estimated outlier payments at 5.1 percent of total payments under the IPPS.

• ConsiderationofCostsofProviderTaxes as Allowable Costs for CAHs: CMS wants to clarify which provider taxes assessed by states may be considered allowable reasonable costs and paid under Medicare to address concerns that some provider taxes may not be “related to the care of beneficia-

ries” and that some, if not all, of the costs of these taxes might not be actually incurred by provid-ers. The clarification, which could affect Medicare reimbursement to CAHs, will require Medicare fis-cal intermediaries to determine if the provider taxes are allowable on a case-by-case basis, based on reasonable cost principles.

• Medicare-Dependent Hospital(MDH) Qualification Criteria: CMS is proposing to modify the MDH qualification criterion that requires 60 percent of a hos-pital’s inpatient days/discharges to be attributable to individu-als receiving Medicare Part A benefits during the hospital’s cost report period by replacing the word “receiving” with the phrase “entitled to.” It would allow hospitals seeking MDH status to include all days or dis-charges attributable to individu-als entitled to the Medicare Part A insurance benefit.A display copy of the proposed rule

is available on the CMS Web site at: http://www.cms.gov/AcuteInpatientPPS/IPPS/list.asp#TopOfPage. Click on “Show only items whose Year is 2011” and refer to CMS-1498-P. Please note that the display copy is double-spaced and more than 1,000 pages long. CMS has also posted a fact sheet on the proposed rule at: http://www.cms.hhs.gov/apps/media/fact_sheets.asp. •

CMS Proposes FY 2011 IPPS Reductions


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American Hospital Association (AHA) due to concerns that the secretary could broaden the definition, forcing hospitals to bundle even more services than currently required.

The American Medical Asso-ciation (AMA) had hoped that Congress would permanently fix the Medicare payment system for physicians by doing something to address the related solvency issues. The law only pushes the problem a few years down the road. AMA has argued that the failure for a permanent fix to the issue by repealing the Sustainable Growth Rate (SGR), which governs physicians’ fees, is shortsighted. •

The American Medical Association (AMA) came out against the bill’s attempt to address the chronic uncertainty surrounding Medicare physician fees. AMA wants Congress to permanently fix the Medicare payment system for physicians by doing something to address the related solvency issues.

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Aetna Medicare Advantage/Drug Plans Earn Sanction On April 5, 2010, CMS issued a

notice to Aetna Insurance Company of its intent to impose an inter-mediate sanction to ensure that Medicare beneficiaries continue to have access to prescription drugs under Medicare’s requirements.

Aetna was served with the inter-mediate sanction notice because it has continued to improperly admin-ister the Medicare drug benefit in the plan’s national stand-alone pre-scription drug plan (PDP) and its 25 Medicare Advantage prescrip-tion drug (MAPD) contracts.

Approximately 400,000 Medi-

care beneficiaries are enrolled in the organization’s MAPD plans and another 600,000 are enrolled in the Aetna PDP.

The intermediate sanction, which will prevent Aetna from marketing to and enrolling new beneficiaries, was effective April 21 and will remain in effect until Aetna demonstrates to CMS that it has corrected its deficiencies and they are not likely to recur.

To read the entire CMS press release on the action, go to http://www.cms.gov/apps/media/press_releases.asp. •

Arkansas hospitals participat-ing in the new Medicaid hospital assessment program received their initial quarterly supplemental hos-pital access payments on April 16, along with an invoice from the Medicaid program for the assess-ment fee. The second quarterly payments were made on June 4.

Invoiced amounts are payable to Medicaid within 10 days of receipt.

Under the assessment program, which the Legislature enacted dur-ing its 2009 session, hospitals will pay assessment fees to the state totaling about $34 million. Those revenues will be used to support new federal Medicaid dollars that will add to Medicaid payments for inpatient and outpatient care

and will help to offset more than $100 million annually in losses that accrue to the state’s hospitals due to Medicaid underpayments.

The assessments and access payments will be made quarterly. The April batch covered the first quarter of State Fiscal Year (SFY) 2010 (July-September 2009). Separate payments and the associ-ated assessments covering the sec-ond and third quarters of that fis-cal year (October-December 2009 and January-March 2010) were to be made before the June 30 fiscal year end.

Beginning with the final quarter of SFY 2010 (April-June), future payments will be paid closely fol-lowing the end of each quarter. •

Medicaid Hospital Access Payments Begin



The Centers for Medicare & Medicaid Services (CMS) has instructed its Medicare contractors not to evaluate or enforce the “direct supervision” requirement for thera-peutic services furnished in calendar year 2010 to outpatients in critical access hospitals (CAH).

In a March 15 notice to congres-sional committees, the agency said, “CMS believed this requirement to be a clarification of longstanding policy, but the rule has generated concern among some rural providers who had previously interpreted the CMS policy to require only ‘general supervision’ and who believe that it may be difficult to meet this require-ment. CMS plans to revisit the issue of supervision for therapeutic servic-

es provided to hospital outpatients in CAHs through the annual rulemak-ing cycle for CY 2011.”

The final 2010 hospital outpatient prospective payment system rule included a “direct supervision” policy that requires a supervisory physician or non-physician practitioner to be present on a hospital or CAH campus when outpatient therapeutic services are performed and that they be immediately available to provide assistance and direction throughout the duration of procedures. •

CAh “direct supervision” Policy Clarification

The U.S. Food and Drug Admin-istration recently announced an initiative to reduce unnecessary radiation exposure from three types of medical imaging procedures: computed tomography (CT), nuclear medicine studies, and fluoroscopy. These procedures are the greatest contributors to total radiation exposure within the U.S. population and use much higher radiation doses than other radiographic procedures, such as standard X-rays, dental X-rays, and mammography.

“The amount of radiation Americans are exposed to from medical imaging has dramatically increased over the past 20 years,” said Jeffrey Shuren, MD, JD, direc-tor of the FDA’s Center for Devices and Radiological Health. “The goal of FDA’s initiative is to sup-port the benefits associated with medical imaging while minimizing the risks.”

The three-pronged initiative the FDA is announcing will promote

the safe use of medical imaging devices, support informed clini-cal decision-making, and increase patient awareness of their own exposure.

In addition, the FDA and the Centers for Medicare & Medicaid Services are collaborating to incorporate key quality assur-ance practices into the mandatory accreditation and conditions of participation survey processes for imaging facilities and hospitals. These quality assurance practices will improve the quality of over-sight and promote the safe use of advanced imaging technologies in those facilities.

The FDA recommends that healthcare professional organi-zations continue to develop, in collaboration with the agency, diag-nostic radiation reference levels for medical imaging procedures, and increase efforts to develop one or more national registries for radia-tion doses. •

new Initiative Seeks to reduce Unnecessary radiation from Medical Imaging

The new Patient Protection and Affordable Care Act (PPACA) includes an amended time period for filing Medicare fee-for-service (FFS) claims as one of many provisions aimed at curbing fraud, waste and abuse in the Medicare program.

The time period is specified in Sections 1814(a), 1835(a)(1), and 1842(b)(3) of the Social Security Act and in the Code of Federal Regulations (CFR), 42 CFR Section 424.44.

Section 6404 of the PPACA changes the requirements by reducing the maximum time period for submission of all Medicare FFS claims to one calendar year after the date of service.

Under the new law, claims for services furnished on or after Jan. 1, 2010, must be filed within one calendar year after the date of service. In addition, Section 6404 man-dates that Medicare claims for services furnished before Jan. 1, 2010, must be filed no later than Dec. 31, 2010.

For claims with dates of service before Oct. 1, 2009, Medicare providers must follow the pre-PPACA timely filing rules. Claims with dates of service Oct. 1, 2009, through Dec. 31, 2009, must be submitted by Dec. 31, 2010.

Section 6404 of the PPACA also permits the secretary of Health and Human Services to make certain exceptions to the one-year filing deadline.

At this time, no excep-tions have been established. However, proposals for excep-tions will be specified in future proposed rulemaking. •

Medicare FFS Filing time Period is Amended

CMS plans to revisit the issue of supervision for therapeutic services provided to hospital outpatients in CAHs through the annual rulemaking cycle for CY 2011.


Since the February 3, 2010, meet-ing when Arkansas Department of Human Services’ (DHS) officials informed a room full of Medicaid provider groups of an immediate need to cut $400 million from the program for State Fiscal Year (SFY) 2011, the outlook has improved, at least to a degree.

In mid-April, the same groups gathered again to hear the latest on DHS’s budgeting plans for SFY 2011 and beyond. They learned that a combination of favorable developments had provided relief that will allow DHS’s primary focus to turn toward exploring and implementing long-term Medicaid program reforms, rather than relying on expedient short-term cuts.

Medicaid Director Eugene Gessow on April 14 reviewed a list of 27 potential reforms that he and his staff will explore. Several are related to provisions found in the recently enacted Patient Protection and Affordable Care Act, the new

healthcare reform law. Five items affecting acute care hospital ser-vices included on the menu are:• A demonstration project that

would evaluate an “episodes of care” approach for provision of Medicaid services. The episodes would group a hospitalization along with concurrent physician services provided during the hos-pital stay;

• A demonstration project for aglobal payment system;

• Thedevelopment of aDRGhos-pital inpatient payment system and an Ambulatory Patient Group (APG) system for outpatient care;

• Health homes for Medicaidenrollees with chronic condi-tions; and

• Paymentadjustmentsforcarepro-vided to Medicaid patients with healthcare acquired conditions.To address behavioral health

issues which impact psychiatric hos-pitals, Gessow said that the Medicaid office would pursue a state waiver to

provide support services to individu-als with chronic health conditions, implement new licensing and train-ing requirements for mental health paraprofessionals and seek to obtain a Medicaid emergency psychiatric demonstration grant.

Other steps involve changes in the Medicaid long term care program, more intense fraud and abuse pro-tections, implementing a Web-based electronic medical record system that will allow Medicaid providers to see and review claims for their Medicaid patients, and working to improve the current primary care case management program.

DHS Director John Selig cau-tioned that while the improved out-look buys additional time for the state to address Medicaid’s chronic funding issues, it does not resolve the underlying systemic problems. He and Gessow said that they will enlist the assistance and input from specific provider groups as they work on the individual reforms. •

MARCH: The Region C Reco-very Audit Contractor (RAC), Connolly Healthcare, posted 25 new DRG Validation Issues to their list of CMS-approved audit issues on March 16, plus another five on Friday, March 19.

Once again, Connolly has been approved for even more MS-DRGs with high Relative Weights (which equates to high dollar reimburse-ments) and high discharge volumes (which equates to large number of claims to potentially audit).

The 13 states affected by the new approved issues are: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee and Texas.

To see the complete set of Connolly Healthcare’s “New Issues” listings,

click on http://www.myedutrax.com/rac-new-issues-pages/49253.

APRIL: Connolly Healthcare, CMS’ Recovery Audit Contractor (RAC) for Region C, which includes Arkansas, posted 20 new

DRG Validation Issues to the com-pany’s list of CMS-approved audit issues on Friday, April 16. The new issues include eight MS-DRGs with very high Relative Weights (RW), which equate to high dol-lar reimbursements and thereby potentially high RAC fees, should the payments be denied.

Six of the new issues have claim volumes in the top 25 percent of all DRGs (a high volume of dis-charges provides a corresponding large number of claims for the RAC to potentially audit), and four are for MS-DRGs with RWs in excess of 10.0 (one of them – MS-DRGs 001, Heart Transplant – has one of the highest weights: 24.85), which pro-duces a high dollar reimbursement, since the RW of a DRG is used to calculate a facility’s payment. •

State Medicaid Reforms Under Exploration

RAC Posts New Validation Issues



Frustration over fruitless efforts to get officials to effectively address concerns identified during activations related to hurricanes that hit the Louisiana Gulf Coast in 2005 and 2008 has prompted Little Rock area hospitals to withdraw their volun-tary participation from the National Disaster Medical System (NDMS), effective June 1.

The withdrawal does not apply to Arkansas Children’s Hospital, which participates in a network that serves children.

At issue is the failure to act in a timely manner on revisions to the Memorandum of Agreement (MOA) between hospitals and the NDMS aimed at improving logisti-cal and reimbursement components of the agreement.

The suggested revisions were submitted to NDMS leaders by the Arkansas Hospital Association (AHA) on behalf of the Metropolitan area NDMS hospitals in June 2009 with hope that at least some of the changes could be incorporated before the 2010 hurricane season began June 1.

Throughout its history, NDMS, which was established in 1984 as backup medical support for the Department of Defense (DoD) and the Veterans Administration during

conventional overseas conflicts and to supplement state and local emergen-cy resources during disasters, has had only three significant activations for definitive care of hospital inpatients. All were non-DoD activations.

They were related to Hurricanes Katrina/Rita (2005), Hurricanes Gustav/Ike (2008) and following the earthquake in Haiti earlier this year. The Metropolitan Little Rock area hospitals were actively involved with the 2008 deployment.

During the activation, those hos-pitals encountered situations where capacity limits created a need to postpone local patients’ elective admissions and procedures for days and weeks while trying to accommo-date NDMS patients from Louisiana who experienced extended stays beyond their control.

The hospitals also found them-selves battling with NDMS, FEMA and CMS for more than a year to recoup even a portion of the costs associated with their good faith efforts.

In an April 15 letter to Dr. Nicole Lurie, the Department of Health and Human Services’ assistant sec-retary for preparedness and response (ASPR) who has NDMS oversight, AHA President Phil Matthews wrote, “While Little Rock area hospitals

want to do the right thing in assist-ing with care for inpatients subject to unexpected emergency evacuations from other states, they can’t place patients in their own community, or themselves, at risk when doing so.

“The MOA must get closer atten-tion, because the success of NDMS’s federal/state partnership hinges on an agreement which creates no obstacles to hospitals’ voluntary participation. The array of prob-lems incurred by Arkansas hospitals during NDMS patient evacuations in 2008 should be sufficient grounds to conclude that the current MOA fails to meet that standard.”

At press time, the Arkansas Hospital Association and Metro members were working through Dr. Kevin Yeskey, deputy assistant secre-tary of ASPR, toward improvements in the MOA. Dr. Yeskey continues to provide Arkansas hospitals with updates on changes being implement-ed for the movement of patients dur-ing disasters. Those updates included transportation contracts, provisions for alternate care sites, patient track-ing and service access teams.

It is the hope of the AHA and the Metropolitan Hospital Association that Arkansas hospitals will once again be able to participate in NDMS patient movement. •

E M E R g E N C Y P R E P A R E D N E S S

Because of Continued inaction on major Concerns,Arkansas Withdraws from ndms

The May 20 episode of the ABC TV series “Grey’s Anatomy” dealt with an active shooter situation in the hospital as the theme of its season finale. With the April 19 hospital shooting incident that occurred in Knoxville, Tennessee, and previous incidents that have occurred in and around Arkansas, the show spawned questions and inquiries within the healthcare community about pre-paredness for a similar situation. The

following information may be helpful for hospitals seeking improvement in their response to such situations:1. Hospital Active Shooter Guid-

ance: Several years ago, after the Virginia Tech shooting, Dr. Earl Motzer, chair of the Kentucky Hospital Association’s Emergency Preparedness Committee, created some general guidance for hos-pitals to consider if reviewing or developing their own internal pol-

icies and procedures. That guid-ance is posted on the Arkansas Hospital Association’s Web site under disaster resources.

2. U.S. DHS Guidance: The U.S. Department of Homeland Security’s National Protection and Programs has developed a new resource package called “Active Shooter: How to Respond.” A pocket printable version, along

“Active Shooter” In-Hospital Guidance



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3. Employee Handout: An “Active Shooter: How to Respond” information brochure also is available on the AHA Web site. It is in PDF format, and creates a double-sided color flyer on standard paper.

4. Training Video: The Center for Personal Protection and Safety (CPPS) has a good training video entitled, “Shots Fired: When Lightning Strikes” that in less than 20 minutes uses a typical office scenario to pres-ent clear guidance for surviving an active shooter situation. To learn more about the video and training materials, go to: http://www.crmlearning.com/shots-fired-when-lightning-strikes. More on CPPS: http://www.cppssite.com/2,aboutcpps.All of the above information

was e-mailed to Arkansas hospital preparedness coordinators on May 19. While this information is not intended to be alarmist, sometimes TV reflects real-life and can be a catalyst for change. We would like to make sure that as a preparedness community our members have some tools and materials available to handle questions that could surface as the result of this program from leadership or members of a healthcare facility’s staff.

Our thanks to Richard Bartlett at the Kentucky Hospital Association for major portions of this article. •

hit “meAningFUL Use” And hoW it AFFeCts hosPitALs

The Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC) has issued a proposed rule to establish a temporary and permanent certifica-tion program for electronic health record (EHR) systems. See 75 Fed. Reg. 11378 (March 10, 2010).

EHR technology must be certi-fied for providers to receive incen-tive payments under Medicare and Medicaid for the adoption and meaningful use of EHRs under the-Health Information Technology for Economic and Clinical Health Act (HITECH), which was enacted as part of the American Recovery and Reinvestment Act of 2009.

The proposed rule covers both the temporary and permanent certifica-tion programs, but ONC anticipates

issuing separate final rules for each of the programs. The temporary certification program would allow organizations to test and certify complete EHRs or EHR modules so that they can begin demonstrating meaningful use and receive incentive payments.

The second proposed rule would establish a permanent certification program to replace the temporary program.

ONC expects to issue separate final rules for each program. ONC plans to issue the final rule for the temporary certification program around the same time as HHS issues final rules for meaningful use stage 1 and standards and certification crite-ria. The final rule for the permanent certification program is expected by the fall of this year. •

Proposed Rule for EHR Certification

In case you didn’t know it, your hospital is planning a major uptick in hiring IT staff, and you can thank the seemingly ubiquitous ARRA (American Recovery and Reinvestment Act). That’s one of the findings from the Healthcare Information and Management Systems Society (HIMSS) annual survey, officially released March 1.

According to the survey, nearly 70 percent of respondents said they planned to increase hiring in 2010, compared with 42 percent last year.

Survey respondents also predicted

a major boost to IT operating bud-gets – with 72 percent projecting an influx of capital. Of that, 49 percent said meaningful use is the driver. Here are some other notable results:• 41%saidmeetingmeaningfuluse

criteria is their top IT priority. • 38% said governmental issues

will have the most impact on healthcare, followed by financial considerationsat23%.

• 41% said they have no plans toparticipate in a health informa-tion exchange, down from52%last year. •

Excerpted from an article by Matthew Weinstock, H&HN (Hospitals & Health Networks) Online

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