The Health of Arkansas’ Hospitals Hospitals Spr… · It’s the fast way to check: • Eligibility • Benefits • Claims status Call number on 1-800-843-1329 1-800-827-4814 the

The Health ofArkansas’ Hospitals

What to Expect fromCongress This Year

A M A G A Z I N E F O R A R K A N S A S H E A LT H C A R E P R O F E S S I O N A L 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

SPRING 2005 www.arkhospitals.orgSPRING 2005 www.arkhospitals.org

The Health ofArkansas’ Hospitals

What to Expect fromCongress This Year

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Spring 2005 I Arkansas Hospitals 3

is 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

BOARD OF DIRECTORSTim Hill, Harrison / Chairman

Robert Atkinson, Pine Bluff / Chairman-Elect

Eugene Zuber, Newport / Treasurer

Robert Bash, Warren / Past-Chairman

Frank Wise, Salem / At-Large

David Cicero, Camden

David Dennis, Berryville

Randall Fale, Hot Springs

Dan Gathright, Arkadelphia

Michael D. Helm, Fort Smith

Louetta Jorgenson, Springdale

James Magee, Piggott

Ray Montgomery, Searcy

Larry Morse, Clarksville

John Neal, Stuttgart

Richard Pierson, Little Rock

Steve Smart, El Dorado

Russ Sword, Crossett

EXECUTIVE TEAMJames R. Teeter / President and CEO

Phil E. Matthews / Executive Vice President

W. Paul Cunningham / Senior Vice President

Beth H. Ingram / Vice President

Don Adams / Vice President

DISTRIBUTIONArkansas Hospitals is distributed quarterly to hospital executives, managers, and trusteesthroughout the United States; to physicians,

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

To advertise contactAdrienne Freeman

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Edition 50

Arkansas Hospitals

PAGE 22PAGE 19

PAGE 33PAGE 28

Cover Photo Little Rock Skyline

Photo by ArkansasDepartment of Parksand Tourism

Disaster Readiness

Quality/Patient Safety

CEO Profile

Departments

News—STAT!

Features

Advocacy

AAHT Spring Conference is April 209

Dr. Fay Boozman: Friend of Hospitals12

JCAHO Joins Those Calling for Medical Liability Reform

29

How to Handle the Media33

AHA Summer Leadership Conference,June 15-17

34

Hospital Compare: Web Site Goes Online35

Americans Say, “Lower Healthcare Costs!”13

Leavitt is New HHS Secretary14

Nursing Enrollments Improve14

CMS Expands Patient Discount Guidance14

FCC Decision Reflects AHA Concerns15

HIPAA Security Rule Guidance Issued 16

Uninsured Policy Manual Available17

Medicare Contractor Survey17

Hospital Staff Privileging Requirements17

Improving Communication in Healthcare 31

Disruptive Acts Common, Study Shows31

HIPAA Deadline Nears37

Med Center, Ouachita County Settle38

AHA Meets With Governor Huckabee19

Any Willing Provider LawNow Act 490

19

The Health of Arkansas’ Hospitals22

AHA Advocacy Agenda—200524

AHA Meeting in Washington, D.C.24

Act Makes Hospitals Smoke-Free26

PAC Contributions Recognized27

Your Leadership Contributions Count28

AHA Protests Medicaid Cuts28

Jim Maddox—three St. Edward MercyHealth satellite hospitals keep him “running”

20

Progress Report: Hospital Preparedness10

Bioterrorism Awareness Campaign 10

Leapfrog Group’s Patient Safety Survey11

Proposed 2006 Patient Safety Goals11

Computers and Medication Dispensing11

Infection Control Efforts, Lacking12

HHS Medicare E-Prescribing Rules18

Jim Teeter—The Ultimate Gift4

Education Calendar6

Arkansas Newsmakers and Newcomers7

From the Field8

Could Arkansas Land Six Super Projectsa Year?

30

Changes in Surgical Procedures Needed37

New Gainsharing Ventures18

4 Spring 2005 I Arkansas Hospitals

The Ultimate GiftToday, tomorrow, and every day, 18 Americans will die

before getting a life-saving organ transplant. That’s almost6,600 people who, in the next twelve months, will breathetheir last breath waiting for a lung, liver, kidney, pancreas, orheart that will never come. More than 87,000 are on the

transplant waiting list, a listthat grows daily. That’s whyI’m eager to tell you about aman that meets my definitionof a real American hero.

A Hero’s StoryA young Oklahoma

physical therapist was ridinghis motorcycle recently whenhe had an accident that lefthim paralyzed from the neckdown. He was unable tospeak, but could communicatewith his family and with histrauma center medical teamby blinking, smiling, andmoving his eyes to spell out

words on a letter board. Using this means, he “discussed” hiscase with his physicians and came to clearly understand thathe had no chance of a full recovery.

An energetic and adventurous health professional, theman found life under these circumstances to be unacceptable.After consulting with his family, he signaled that he wantedto end his active care. Wanting his death to count forsomething, he requested that his family broach the subject oforgan donation with the medical team. Options wereexplained, including “donation after cardiac death” (DCD),which had never been performed in Oklahoma. The youngman smiled and blinked, “Yes, DCD is what I want.” Therewas absolutely no question that both he and his familyunderstood the consequences of his decision.

With his family, this courageous, generous young healthprofessional planned his own funeral, including a “party” incelebration of his life. After making these preparations, hetold his family goodbye and was taken to the operating roomaccompanied by a chaplain, nurse, and physician who stayedwith him from the time life support was withdrawn to themoment death was pronounced. The organ recovery teamthen entered and salvaged the young man’s organs and tissue.Two kidneys and his liver were soon transplanted, giving newlife to three people he had never met.

The Most Personal DecisionWhat is so different and, in my opinion, heroic, is that this

health professional made a conscious decision as to how he

would live and die, and in dying, improve and extend thelives of others. In the vast majority of cases, it is the familythat grants permission to take organs at death, a decisionusually based upon what they think their loved one wouldhave wanted, or upon the patient’s having previouslycommunicated his wishes, perhaps on his driver’s license.

Organ donation after cardiac death, or DCD, as occurredwith our Oklahoma hero, is relatively rare, but becomingmore common. Before the introduction of brain death laws inthe 1980s, all organs for transplant were recovered aftercardiac death. It is important to understand that now, as in the1960s and 1970s — the early days of transplantation — DCDis considered only after the family has decided to withdrawlife support. Like donations after brain death, the DCD optioncan bring comfort during a time of grief and allow a family tobegin the healing process, knowing that their loved one’sorgans can live on in as many as four or five people.*

Of the estimated 25,000 Americans who will die this yearunder circumstances conducive to organ donation, only5,000 will actually donate. Lack of education about thesubject and a hesitancy to approach potential donors andtheir families too often stand in the way of the program’sgrowth. That’s why Congress passed the Required RequestAct of 1987 which calls for hospital staff to discuss theconcepts of organ and tissue donation with the family of anypatient that could be considered a potential donor.

Many Arkansas hospitals, physicians, and nurses workclosely with the Arkansas Regional Organ Recovery Agency(ARORA), an organization that provides organs and tissuesfor life-saving and life-enhancing transplantation. Medicalteams assist ARORA by identifying potential organ donorsand then gently, sensitively approaching their families tomake them aware of organ donation options.

Your hospital’s medical team, and you, personally, can helpspread the word about the life-giving gift of organ donation. Asyou do, many more potential heroes like the young physicaltherapist from Oklahoma may decide to offer life to many afterone life has ended. By spreading the word, you are facilitatingmiracles. You become a partner in offering the ultimate gift. •

*The first DCD transplant to be performed in Arkansas was atUAMS in December 2004. There are three organ transplantcenters in Arkansas – Arkansas Children’s Hospital, Baptist HealthMedical Center, and UAMS Medical Center, all located in LittleRock. All three centers perform heart and kidney transplants.UAMS also performs pancreas transplants and has applied forapproval to perform liver procedures. Medical centers throughoutthe state perform tissue transplants, including bone and cornea.

James R. TeeterPresident and CEO Arkansas Hospital Association



April 7, Little RockArkansas Association for MedicalStaff Services (AAMSS)Spring Conference

April 8, Little RockArkansas Organization for NurseExecutives (AONE)Spring Conference

April 20, Little RockArkansas Association of HospitalTrustees (AAHT) ConferenceHoliday Inn Presidential Center,Little Rock

April 27-29, Hot SpringsHealthcare Financial ManagementAssociation (HFMA) Workshop

April 29, Little RockArkansas Healthcare HumanResources Association (AHHRA)Spring Conference

May 5-6, Hot SpringsArkansas Association forHealthcare Engineering (AAHE) Annual Meeting and Trade Show

May 6, Little RockArkansas Health Executives Forum

May 11-13, Hot SpringsSociety for Arkansas HealthcarePurchasing and MaterialsManagers (SAHPMM)Annual Meeting and Trade Show

May 20, North Little RockHospital Emergency PreparednessVendor Fair

June 3, Little RockFred Lee’s “If Disney Ran YourHospital—Some Things You’d DoDifferently”

June 9, Little RockCompliance Forum

June 15-17, Orange Beach,AlabamaAdministrators Forum SummerLeadership Conference

July 15, Little RockArkansas Organization for NurseExecutives (AONE)Summer Conference

July 28, Little RockArkansas Society for Directors ofVolunteers (ASDVS) SummerWorkshop

Program information available at www.arkhospitals.org

EducationCALENDAR


ARKANSAS NEWSMAKERSandNEWCOMERS

John A. Guest has been named CEO of Sparks HealthSystem in Fort Smith, following the System’s engage-ment of QHR for hospital advisory services. Guest hasmore than 20 years of healthcare leadership experience,having served as president/CEO of Harris CountyHospital District in Houston, TX and as president/CEOof University Health System in San Antonio. He is apast-chairman of the Texas Hospital Association.

Governor Mike Huckabee has named AngelicoCabantac, administrator of St. Vincent Doctor’sHospital in Little Rock, to the Advisory Board forPerinatal Health Services. His term will expireNovember 15, 2006. Cabantac replaces Susan Barrett,president and CEO of St. Mary’s Hospital in Rogers.

Tim Shea has been named Medical Center Director ofthe Central Arkansas Veterans Healthcare System inLittle Rock. He succeeds George “Buzz” Gray who leftin August to direct the Veterans Integrated ServiceNetwork 8 in Florida and south Georgia. Dr. NickLang has been acting director since Gray’s departure.Shea previously was Medical Center Director of theLouisville (Kentucky) VA Medical Center.

David A. Dennis, president of St. John’s Hospital inBerryville, has been elected to the AHA board of direc-tors representing the Northwest Hospital District.Dennis succeeds Donnie Frederic who resigned his posi-tion on the board. Frederic has been named CEO ofGulf Coast Medical Center in Wharton, Texas.

Ian Watson has been named CEO of Great RiverMedical Center (formerly Baptist Memorial Hospital –Blytheville) following the purchase of the hospital byAmeris Health Systems of Tennessee. Watson has morethan 11 years of experience in hospital administration,having recently served as COO of Smith NorthviewHospital in Valdosta, Georgia.

DeWitt voters overwhelmingly passed a 1.5% sales taxreferendum recently that is expected to keep DeWittHospital open for at least another decade. The addi-tional 1.5% tax, which brings the local sales tax up to10.5%, was approved by 80% of voters. Revenue gen-erated by the tax increase will be used to purchase $5.7million in bonds which will pay off $2.7 million in hos-pital debt and provide subsidies for daily operations forseveral years. Darren Caldwell, CEO, told the AHAthat the vote “will make a big difference in the solven-cy of the hospital and the sanity of the CEO.”

Herbert K. “Kirk” Reamey III, administrator/CEO ofMagnolia Hospital, was recently elected to fill a termas a Section for Small or Rural Hospitals delegate tothe American Hospital Association Regional PolicyBoard 7. Reamey’s term expires December 31, 2005.

Thomas Kinnebrew has been appointed chief execu-tive officer of Helena Regional Medical Center, afterhaving served in an interim capacity for severalmonths. He succeeded Guy Hazlett. Kinnebrew hasmore than 25 years of healthcare experience, havingpreviously served as assistant chief executive officer atFannin Regional Hospital in Blue Ridge, Georgia, andchief operating officer at Delta Regional MedicalCenter in Greenville, Mississippi.

Jennifer Lang, Ph.D., has been named administratorof Methodist Behavioral Hospital in Maumelle. She isone of the founding directors of the hospital and waspreviously employed as the clinical operations officerprior to being named administrator. Dr. Lang receivedher Ph.D. in clinical psychology from the University ofTulsa. Previous positions included Assistant Professorof Psychiatry and Neurology at Tulane UniversitySchool of Medicine and psychologist for the eatingdisorder inpatient program at DePaul-TulaneHospital.

Ronny McMahan, chairman of the board of directorsfor Saline Memorial Hospital (SMH) in Benton, hasannounced the resignation of president and CEO JackC. Mitchell. “Jack has made significant contributionsin advancing the mission of SMH, highlighted by theopening of the new $9 million Saline Surgery Center,”said McMahan. Jim Richardson has been named inter-im administrator while a search is conducted for anew administrator. “Our patients can anticipate thesame level of quality and dedication they have come toexpect from our physicians and hospital staff as SMHcontinues to improve the health of our community,”said Dan Cartaya, M.D., SMH chief of staff.

David Chumley, CEO of the American Red CrossBlood Services Greater Ozarks – Arkansas Region, hasbeen named CEO of the American Red Cross Missouri– Illinois Blood Service Region in St. Louis. Glen Baker,M.D., the organization’s medical director, has beennamed interim CEO of the Arkansas Region until a per-manent replacement is found.

It’s a new season and a new approach to thinking aboutwhat the Arkansas Hospital Association means to itsmembers. In each issue of Arkansas Hospitals, you’ll findCEOs, other administrators and people associated with thehospital field commenting on what their AHA membershipbenefits have brought to their hospitals and communities.You can add to the discussion by emailing AHA VicePresident Beth Ingram at [email protected].

Darren Caldwell, CEODeWitt Hospital, DeWitt

“The AHA gives me, the chiefexecutive of a small hospital withlimited resources, the timelyinformation that I need to makedecisions on a strategic basis,rather than on a reactive basis.Whether the information dealswith changes in the CMS,Medicare, Medicaid, and otherregulatory agencies, the advan-tage I gain from qualified input

on difficult topics is fantastic. The AHA staff is alwayshelpful with ideas on issues to address, oftentimes usingexamples of other member’s experiences. This networkingcould not be possible without an organization whose solepurpose is to promote an industry whose foundation is tak-ing care of people who cannot take care of themselves.

I have no idea what DeWitt Hospital and NursingHome would be without the AHA, but I do know it isbetter because of the AHA.”

Gary R. Sparks, AdministratorCrossRidge Community Hospital, Wynne

“The Arkansas HospitalAssociation is a criticalresource to hospitals acrossthe state and is especially ben-eficial to the small, rural facil-ities that do not have the staffor resources of the larger,urban facilities. The AHA pro-vides essential education,advocacy, and networkingbenefits to its members, which

is key to the enhancement of healthcare services to

the citizens of our state. Both the staff and leadershipare always personable, professional, and most impor-tantly, effective. Needless to say, I believe AHA mem-bership is a bargain!”

John N. Robbins, FACHE, President and CEOConway Regional Medical Center, Conway

“I have had the opportunity towork with several state hospitalassociations and I believe theArkansas Hospital Associationis the best. In today’s challenginghealthcare environment, theimportance of having a strongassociation is even greater. TheAHA is a very effective advocatefor our hospitals. Additionalmembership benefits include the

educational programs and networking opportunitiesafforded us. Thank you, AHA, for your great support!”

Vince DiFranco, CEOMena Medical Center, Mena

“The Arkansas HospitalAssociation is an excellentresource for my hospital staffand for me. I feel this is espe-cially true in a rural, remote areaof the state. Having access totimely information through the‘Hotline’ and legislative updatesis invaluable to keep abreast ofthe latest news with which toeducate our medical staff and

board. The strength of the hospital voice through thestrong and persistent advocacy efforts of the AHA hasbeen very apparent over the past few years as hospitalshave had an effective influence on statewide legislation.In addition, the AHA is responsive to serving the educa-tional needs of hospitals by organizing meetings and secur-ing speakers to address the hot topics of the day. Finally,after being in the state for less than four years, it is com-forting and reassuring to have such an experienced andcohesive staff as we do at the AHA. The teamwork andmission demonstrated by the Arkansas Hospital Associa-tion staff is very much appreciated in the field.” •


Field!from the


Healthcare accounting consult-ant Jeff Johnson and former feder-al law enforcement officer JimKopf will be the featured presentersat the Arkansas Association forHospital Trustees’ (AAHT) springconference Wednesday, April 20 atthe Holiday Inn PresidentialConference Center in downtownLittle Rock. The half-day program,which will begin at 9:00 a.m., isaimed at helping trustees betterunderstand hospital financial state-ments and the need for implement-ing effective programs to complywith fraud and abuse guidelines.

Johnson will “demystify” hos-pital financial statements fortrustees by explaining the funda-mentals of finance and how tointerpret financial information.

Both have become key elements tosuccessful management and gover-nance of hospital operations at atime when legal and public impactsof the Enron, MCI, and Tyco finan-cial scandals have had a trickle-down effect on hospitals and othernonprofit organizations. Thosecases make it even more importantthat the boards of nonprofitorganizations fully understand thefinancial information of theirorganizations in order to carry outtheir fiduciary responsibilities.

Kopf will take a look at federalenforcement initiatives, whichrequire that “the organization’sgoverning authority must beknowledgeable about the contentand operations of the complianceprogram and exercise reasonable

oversight over it.” Attendance willalso help to assure the Office ofInspector General when it asks,“Has the hospital’s governingbody been provided with appro-priate training in fraud and abuselaws?” In addition, Kopf also willdiscuss pressure by Congress forthe Department of Justice to pur-sue more criminal and civil health-care cases.

A workshop brochure with reg-istration information was mailed inmid-February. Because the meetingis targeted to both new and veterantrustees, a registration discountwill be provided for hospitalsbringing three or more individuals.Call Beth Ingram at (501) 224-7878 with any questions about theworkshop. •

AAHT Spring Conference is April 20


Arkansas Bioterrorism Public Awareness Campaign Unveiled

The Arkansas Department of Health has initiated a new public edu-cation campaign designed to make Arkansans more aware of the threatof bioterrorism and what to do to prepare for an attack. The campaign,named “Arkansas BioPrepared,” includes a print advertisement, a Website and a brochure. A video spot will soon be part of the campaign.

The campaign addresses issues such as the importance of making afamily response plan and offers instructions about how to put togetheran emergency response kit. It also directs readers to the agency’s Website, where they can find fact sheets on the six “bioagents” that the fed-eral Centers for Disease Control and Prevention have identified as hav-ing the most potential to do large-scale damage. These bioagents areanthrax, botulism, plague, smallpox, tularemia and viral hemorrhagicfever. The information contained in the “Resources for Families” sectionof the site comes from the American Red Cross and the FederalEmergency Management Agency.

Funding for the $453,000 campaign came from the state’s federalbioterrorism grants. Arkansas received $9.3 million in bioterrorism pre-paredness funding from the Centers for Disease Control and Preventionand $5 million from the federal Health Resources and ServicesAdministration for fiscal year 2004. The Arkansas Hospital Associationis actively involved with the Health Department on a number ofstatewide bioterrorism preparedness activities.

Go to http://www.HealthyArkansas.com/services/bioterrorism/prepared-ness_program.html to view the information posted on the Web site. •

Progress Report: Arkansas Hospital PreparednessArkansas hospitals

continue to workthrough the ArkansasDepartment of Health(ADH) on emergencyreadiness projects relat-ed to federal grantfunding from theHealth Resources andServices Administration(HRSA) and the Center for DiseaseControl and Prevention.

Work is progressing on astatewide, secure computer networkfor hospitals to develop reporting sys-tems, email connectivity, video con-ferencing, distance learning andtelemedicine. The network will bene-

fit disease surveillanceamong hospitals, helphospitals communicatewith others in theirregions, and improveoverall communica-tions with the ADH.

Hospital employeesare beginning to receiveemail addresses and

hospital bioterrorism coordinators arebeing asked to determine which pieceof the Tandberg equipment (video-conferencing or telemedicine) the hos-pital would like to order. Most of theequipment should be in place by latesummer, with the network fully func-tional by October.

The Arkansas Hospital Associationis working with the ArkansasDepartment of Emergency Manage-ment to offer regional “train-the-train-er” workshops on incident command.Expenses for the workshops will bepaid through regional training dollarsprovided through the HRSA grant.

President Bush’s new budget callsfor an expected decrease in federalemergency preparedness funds. In thenext few years, Arkansas will be in the“fine-tuning” phase of its preparednessefforts which began three years ago.While there remains much work to bedone, Arkansas hospitals are much bet-ter prepared for emergencies and actsof terrorism than ever before. •

D I S A S T E R P R E P A R E D N E S S


The Leapfrog Group has releasedthe results of its latest annual surveymeasuring hospitals’ progresstoward reaching the group’s patientsafety goals. Of 1,019 hospitalsresponding to the survey, 80% haveimplemented procedures to avoidwrong-site surgeries, and 70%

require a pharmacist to review allmedication orders before medicationis given to patients. Roughly 20% ofrespondents have fully implementedcomputerized physician order entry(CPOE) or plan to do so by 2006.

The survey measures hospitals’use of CPOE, referral of patients for

certain high-risk procedures basedon volume, staffing of intensive careunits with specially trained physi-cians, and implementation of theNational Quality Forum’s patientsafety practices.

See the survey results athttp://www.leapfroggroup.org. •

Leapfrog Group’s Latest Patient Safety Survey Results

Proposed 2006 Patient Safety GoalsAccredited organizations have

recently submitted electronic evalua-tions of the Joint Commission on theAccreditation of HealthcareOrganizations’ (JCAHO) proposed2006 National Patient Safety Goals(NPSGs) and requirements. TheJCAHO posted the proposed goals onits Web site January 27, and plans toreview the evaluations before finaliz-ing the goals for release this summer.

The field review for hospitalsincludes 16 proposed requirementsor language updates to existing goals,six proposed new goals with 20 pro-

posed requirements, and “retire-ment” of several goals. Missing fromthe list is bar coding, a goal that wasproposed last year for implementa-tion in 2007 but didn’t make the cutfor the 2005 goals.

Two goals in place for otheraccreditation programs are proposedfor inclusion in the hospital goals.They include: Reduce risk of influen-za and pneumococcal disease in olderadults and reduce surgical fire risk.

The six proposed new goals are: • Create and sustain a patient safe-

ty culture.

• Empower patients to becomeinvolved in their care.

• Avoid patient harm caused byhealthcare worker fatigue.

• Avoid healthcare-associated decubitus ulcers.

• Prevent patient harm from antico-agulants, insulin, and narcoticanalgesics.

• Reduce risk of harm due to emo-tional and behavioral crisis. Go to http://www.jcaho.org/ac-

credited+organizations/field_reviews.htm to view the complete list. •

Computer technologies used toorder and dispense medications wereinvolved in nearly 20% of the hospitaland health system medication errorsreported to U.S. Pharmacopeia’snational voluntary database last year.

Computer entry errors, in whichincorrect or incomplete informationwas entered into a computer system,accounted for more than 27,000errors, with distractions (56.5%),increased workloads (20.4%) andinexperienced staff (17.9%) cited ascontributing factors.

Computerized Physician Order

Entry (CPOE), one of the initial threehospital patient safety steps (along withIntensive Care Unit Physician Staffingand Evidence-Based Hospital Referral)recommended by The Leapfrog Groupfor Patient Safety, was associated withmore than 7,000 errors.

However, 99% of errors associatedwith CPOE did not reach or harmpatients, suggesting the technologycan reduce the risk of harmful errors,USP concluded.

Automated dispensing devices,computer systems used to store anddispense drugs, were implicated in

almost 9,000 errors, most of theminvolving the wrong dose or drug.

Research by The Leapfrog Groupshows that implementing CPOE in allurban hospitals in the US could pre-vent as many as 907,600 serious med-ication errors each year. Studies havealso shown that CPOE reduces lengthof stay; reduces repeat tests; reducesturnaround times for laboratory, phar-macy and radiology requests; anddelivers cost savings.

To read the entire report online,go to http://www.onlinepress-room.net/uspharm/. •

Reviews on Computer Technologies Used for Medication Dispensing Are Mixed

Q U A L I T Y

Arkansas hospitals lost a friendMarch 19 when state Department ofHealth director Dr. Fay Boozman diedas a result of injuries at his farm inCave Springs. Dr. Boozman wasworking to remove stalls in a newbarn when part of the structure col-lapsed on him.

Dr. Boozman, who was nameddirector of the Arkansas Departmentof Health in 1999, was an outspokenadvocate for programs aimed atimproving the health status ofArkansans statewide. Under his direc-tion, the Health Department becamesynonymous with the familiar HealthyArkansas nickname now attached to it.

He dedicated himself and theHealth Department to doing whatev-er possible to change unhealthybehaviors that plague the state’s pop-ulation, including smoking, baddietary habits and the lack of exercise.In addition, Dr. Boozman was an earlyand instrumental supporter of ensur-ing that monies Arkansas receivedfrom the national tobacco settlementfund were used strictly for health-related programs.

During his tenure, Dr. Boozmanworked closely with the ArkansasHospital Association (AHA) and itsmember hospitals to resolve concernsabout numerous licensure and regula-tory issues. He was particularly inter-ested in rural hospitals, helping fosterthe move by 23 Arkansas facilities to

seek and achieve designation asMedicare Critical Access Hospitals.

He also strived to make sureArkansas hospitals are as wellequipped and prepared as possible torespond to emergency situations,whether caused by natural events orrelated to nuclear, biological or chemi-cal terrorist attacks.

Dr. Boozman earned his medicaldegree from the University ofArkansas for Medical Sciences, grad-uating first in his class. He complet-ed residencies in both Pediatrics andOphthalmology, and worked formany years as an ophthalmologist inthe Rogers, Arkansas area. In addi-tion, he earned his masters degree in

Public Health through TulaneUniversity in 2001.

He served the state as a state sena-tor from 1995-1998, and the nation asa flight surgeon in the Arkansas AirNational Guard from 1971-1979.

At the time of his death he servedas president-elect of the Associationof State and Territorial HealthOfficials (ASTHO), and served onthe faculty of the University ofArkansas for Medical SciencesCollege of Public Health. He was amember of the Arkansas TobaccoSettlement Commission, the ChildHealth Advisory Committee and thePine Bluff Arsenal Citizen’s AdvisoryCommittee.

Since being named director of thestate Department of Health, Dr.Boozman received many awards forhis dedication to public health.Included in those awards are theNational Public Health LeadershipInstitute’s 2004 Martha Katz Award,the National Governors AssociationAward for Distinguished Service toState Government, the ArkansasPublic Health Association’s Tom T.Ross Award for Outstanding Serviceto Public Health, the AIDSFoundation Compassion Award andthe Southern Health Association’sCharles Jordan Memorial Award forOutstanding Service to Public Health.

Dr. Boozman will be greatly missedby the Arkansas hospital community. •


Dr. Fay Boozman: Friend of Arkansas Hospitals

About-one third of hospitals sur-veyed had less than the recom-mended ratio of one infection-con-trol staffer per 100 patient beds,and the two largest impediments tobetter performance in infection

control were insufficient resourcesand a lack of physician support,hospital cooperative VHA saidrecently.

John Hitt, vice president of clin-ical improvement at VHA, said the

cost of a single hospital-acquiredinfection can range from severalthousand dollars to more than$50,000. Hospital-acquired infec-tions add an estimated $7 billion tothe national healthcare bill.

Infection Control Efforts Lack Staff,Money, According to Study


The Kaiser Family Foundation andHarvard School of Public Healthrecently released the results of a pollshowing that Americans rank health-care as the third most pressing priori-ty for Congress and the president in2005, behind the war in Iraq and theeconomy, and on a par with terrorismand national security.

Among respondents’ greatesthealth-related concerns, 63% saidlowering the cost of healthcare andinsurance should be a top healthcarepriority for their national elected offi-cials, while similar numbers citedmaking Medicare financially sound

for the future (58%) and increasingthe number of Americans with healthinsurance (57%) as top priorities.

The survey found that 60% ofAmericans think the number of mal-practice lawsuits is a “very impor-tant” factor in rising healthcare costs.Almost a third (32%) say that themost important factor causing risingmalpractice insurance rates is toomany lawyers filing unwarrantedlawsuits, while 15% say it is the highprofits of malpractice insurers; 14%say it is too many patients makingunwarranted claims against doctors;and 11% say it is too many doctorsmaking mistakes.

While most of the policy debatehas focused on putting caps on juryawards, 9% cite “too many juriesmaking excessive awards” as the

most important reason malpracticecosts are on the rise. Nearly seven inten say a law to cap pain and suffer-ing awards would help reduce overallhealthcare costs. Just over a quarterof the respondents indicated thatreducing malpractice jury awardsshould be a top priority for the presi-dent and Congress. That ranks 11th

on the list of healthcare concerns, justahead of increasing federal fundingfor stem cell research (21%). Thirty-one percent said they want Congressto allow drugs to be imported fromCanada as a top priority, rankingeighth on the priority list. The surveyof 1,396 adults was conducted fromNovember 4-28, 2004. •

Americans Say, “Lower Healthcare Costs!”

Harvard School ofPublic Health recentlyreleased the results of a poll showing that Americans rankhealthcare as the thirdmost pressing priorityfor Congress and thepresident in 2005.


The Centers for Medicare &Medicaid Services (CMS) has issuedadditional guidance confirmingthat hospitals can offer discountsto any uninsured patients, withoutputting the hospital’s Medicarepayments at risk. The agency issuedits first set of guidance in February,

2004 and responses from adminis-tration officials during a June CMSopen door forum led hospitals tobelieve that offering discounts toany uninsured patient would bepermitted and would not imperilMedicare payments.

The new guidance, released in the

form of a “Frequently AskedQuestion,” appears to confirm theinformation provided to hospitals lastJune that “individualized determina-tions of need” are not required to offerdiscounts to uninsured patients. Go tohttp://www.cms.hhs.gov/providers/FAQ_Uninsured_Additional.pdf. •

CMS Expands Patient Discount Guidance

The U.S. Senate on January 26 con-firmed former Utah Governor MikeLeavitt as Health and Human Services(HHS) Secretary. Leavitt replaces for-mer HHS Secretary TommyThompson, who in Decemberannounced that he would resign afterspending four years at the helm of theagency. American Hospital Association(AHA) president Dick Davidson said,

“Mr. Leavitt’s leadership, managementskills and record of public service makehim an excellent choice to lead anagency that touches the lives of nearlyall Americans.”

Davidson added that the AHAstands ready to work with Leavitt onthe many critical issues facing ourhealthcare system, such as approvingprofessional liability reforms, ensuring

adequate funding for Medicare andMedicaid, and adopting informationtechnologies to further enhance quali-ty of care for all patients. Leavitt, whountil recently served as EnvironmentalProtection Agency administrator, saidhis priorities at HHS will includeMedicaid reform, healthcare informa-tion technology and medical liabilityreform. •

Leavitt is New HHS Secretary

Despite a recent report from theAmerican Association of Colleges ofNursing (AACN) that enrollment inU.S. baccalaureate nursing programsincreased for the fourth consecutiveyear in 2004, the nursing shortage inthe U.S. is likely to get worse beforeit gets better. One reason: schoolshad to turn away more than 26,000qualified applicants, primarily due toa shortage of faculty.

Enrollment in nursing schoolsincreased by 10.6% in 2004, downfrom a 16.6% increase for the previ-ous year, suggesting some nursingschools may have reached the limit inhow far they can expand, accordingto the AACN. The organizationexpressed concern that growing com-petition for limited courses couldencourage nursing students to changemajors as they near graduation.

The situation is further complicat-ed by a recent action of the StateDepartment. As of January 1, the

federal government stopped issuingemployment-based visas for workersin countries that have exceeded theirannual quota for green cards, such asthe Philippines, India and China. Thenew policy will hurt the nurse supplyin Arkansas hospitals where there is a12% vacancy rate in hospital-based

nursing positions, according to areport by the Arkansas LegislativeCommission on Nursing. That reportsays that Arkansas needs 1,925 newnurse graduates each year to keep upwith demand. In 2004, there were 793nurse graduates who were licensed.

In a recent letter to members ofCongress, American HospitalAssociation executive vice presidentRick Pollack said the move will dra-matically curtail the recruitment offoreign nurses and aggravate the seri-ous shortage of caregivers. Pollackencouraged the congressmen andsenators to act swiftly to address thisimminent change in immigrationprocessing. He wrote, “We urge youto take action now to address anemergency situation that will limithospitals’ ability to address theirworkforce challenges and respond tothe needs of their patients and com-munities, and that only legislationcan correct.” •

Nursing Enrollments Improve; Shortage Continues


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C O N C E P T S

The Federal CommunicationsCommission (FCC) announcedJanuary 26 that it will delay plans tolift power restrictions on AirportTerminal Use (ATU) frequenciesoperating in the 460-470 MHz bandof Private Land Mobile RadioServices. The decision is based onAmerican Hospital Association(AHA) concerns that relaxing currentpower limits could lead to harmfulinterference with wireless medicaltelemetry equipment. The agency saidthat it will continue to take steps toprotect medical telemetry from inter-

ference because the equipment is usedto protect safety of life. The FCC inOctober 2002 proposed lifting therestrictions to improve communica-tions at large airports.

In its report, the agency said itagreed with the AHA Task Force onMedical Telemetry’s contention thatallowing higher-powered ATU fre-quencies into the 460-470 MHz bandwould have a “negative impact” onwireless medical equipment operatingin the band. It said it will delay liftingthe restrictions until January 30,2006, 30 days after an FCC freeze onhigh-powered users in the 460-470MHz band expires. The FCC last yearextended the freeze on high-poweredusers in the 460-470 MHz band, asrequested by AHA and its AmericanSociety for Healthcare Engineering, toallow hospitals sufficient time tomigrate into the Wireless MedicalTelemetry Service bands set aside formedical telemetry equipment. •

FCC DecisionReflects AHAConcerns


AHA Services is committed to providing

AHA member hospitals with access to

quality products and programs.

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

A wholly owned subsidiary of the Arkansas Hospital Association.

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

The Centers for Medicare & Medicaid Services (CMS) has releasedone of seven guidance papers on the Health Insurance Portability andAccountability Act (HIPAA) security rule. This paper, “Security 101for Covered Entities,” offers a basic overview of the security rule, cov-ering topics such as what administrative simplification means, whothe rule covers, and who must comply.

The papers are meant to assist providers in understanding theHIPAA security rule — not provide sure-fire compliance methods.“While there is no one approach that will guarantee successfulimplementation of all the security standards, this series aims toexplain specific requirements, the thought process behind thoserequirements, and possible ways to approach the provisions,”according to the first paper.

Topics for future guidance include: • Administrative, physical and technical safeguards • Policies and procedures, and documentation requirements • Basics of risk analysis and risk management • Implementation for the small provider

Go to http://www.cms.hhs.gov/hipaa/hipaa2/education/de-fault.asp#securityed to download the first paper and for more information. •

HIPAA Security Rule Guidance Paper Issued


One of the hottest issues today ishow hospitals bill and collect fromlow-income, uninsured patients.Intense public and legislative scrutinyhas brought the issue to a boilingpoint. It is critical that all hospitalshave written charity care policies andclearly communicate them to low-income patients. Equally important,hospitals must report their charity careaccurately and consistently.

The California HealthcareAssociation has published Assisting

Low-Income, Uninsured Patients, aguidebook that details a step-by-stepprocess for developing and imple-menting a charity care policy. Itincludes relevant state and federalguidance, details charity-care policycomponents and outlines collectionprocesses, record keeping and docu-mentation requirements for assistinglow-income, uninsured patients.Sample policies and a process check-list are also included.

The Arkansas Hospital Association

has purchased two copies of the guide-book and is making them available forloan to member institutions. If youwould like to borrow a copy for a one-week period, please call Sandra Minorat (501) 224-7878 or email her at [email protected]. To purchasea copy of Assisting Low-Income,Uninsured Patients for $190, call theCalifornia Healthcare Association at(800) 494-2001 or obtain the orderform at http://www.calhealth.org/pub-lic/pubs/gms/assisting.html. •

Uninsured Policy Manual Available

A recent memo to state surveyagency directors from the Centers forMedicare & Medicaid Services(CMS) clarifies that a hospital’s gov-erning body is responsible for ensur-ing that all practitioners who providecare in the hospital are individuallyevaluated by the hospital’s medicalstaff and that they have the appropri-ate qualifications and competencies.The memo says that a hospital’s gov-erning body must determine whichcategories of practitioners are eligi-ble to be on its medical staff or to

have hospital privileges, and to clear-ly delineate the scope of privilegesfor each category of practitioners.

The memo further specifies thathospital medical staff must conductindividual reviews of practitioners atleast once every two years to ensurethey have the necessary qualifica-tions and demonstrated competen-cies for the privileges granted –including education, licensure, andcurrent work practice and patientoutcomes. Based on medical staffrecommendations, the governing

body must decide whether to grant,deny, continue, limit or revoke apractitioner’s privileges, and mustnotify the appropriate state and fed-eral authorities and registries if it hasrevoked or constrained a practition-er’s privileges.

The memo, effective immediately,instructs state survey agency surveyorsto assess whether a hospital’s privileg-ing process complies with CMSrequirements. The memo is available athttp://www.cms.hhs.gov/medicaid/survey-cert/sc0504.pdf. •

Hospital Staff Privileging RequirementsShould Be Regular, Complete

The Centers for Medicare &Medicaid Services (CMS) has initi-ated a pilot test of a new survey toassess providers’ satisfaction withthe services provided by fiscalintermediaries and other Medicarefee-for-service contractors. CMSplans to send the draft survey toroughly 7,400 Medicare providers,

including hospitals, in multiplestates. The 76-question survey,which CMS estimates will take 22minutes to complete, asksproviders to rate contractors onadministrative functions such asprovider inquiries, claims process-ing, appeals, medical review, reim-bursement and other areas.

The findings will be used to fine-tune the survey instrument before aplanned roll out to all Medicareproviders in 2006. CMS intends touse the final survey instrument tohelp contractors improve the quali-ty of their services, and create a per-formance-measurement standardfor contracting purposes. •

Medicare Contractor Survey Will Assess Satisfaction


Health and Human Services(HHS) Secretary Mike Leavittannounced January 27 new pro-posed regulations that will supportelectronic prescriptions for Medicarewhen the prescription drug benefittakes effect in January 2006. In hisannouncement, Leavitt said that theproposed e-prescription rules wouldset standards to help Medicare,physicians and pharmacies takeadvantage of new technology thatcan improve the healthcare of seniorsand persons with disabilities.

The proposed e-prescribing regula-tions would adopt standards for:• Transactions between prescribers

and dispensers for new prescrip-tions, prescription refill requestsand responses, prescription changerequests and responses, prescrip-tion cancellation requests andresponses, and related messagingand administrative transactions.

• Eligibility and benefits inquiries andresponses between drug prescribersand prescription drug plans.

• Eligibility and benefits inquiriesand responses between dispensersand Part D sponsors.

• Formulary and benefit coverageinformation, including informationon the availability of lower-cost,therapeutically appropriate alterna-tive drugs, if certain characteristics

are met. Electronic prescribing, or “e-pre-

scribing,” enables a physician to trans-mit a prescription electronically to thepatient’s choice of pharmacy. It alsoenables physicians and pharmacies to

obtain from drug plans informationabout the patient’s eligibility and med-ication history. It offers a way toimprove patient safety and reduceavoidable healthcare costs by decreas-ing prescription errors due to hard-to-read physician handwriting and by

automating the process of checkingfor drug interactions and allergies.

Participation by physicians in e-prescribing will be optional, but theestablishment of standards and stepsto encourage the adoption of effec-

tive e-prescribing programs willmake e-prescribing more attractive.

The proposed rule was published inthe February 4 Federal Register. Formore information, visit the Centers forMedicare & Medicaid Services Website at: http://www.cms.hhs.gov. •

HHS Proposes Medicare E-Prescribing Rules

The inspector general’s office of theU.S. Department of Health andHuman Services (HHS) released advi-sory opinions in early February thatopen the door to the possibility of hos-pitals and physician groups sharing infinancial gains resulting from cost-sav-ing measures.

In the opinions, hospitals inGeorgia, Pennsylvania and SouthCarolina were given permission to

share with their cardiology groupssavings accrued from a new programto use specific supplies during speci-fied cardiac surgery and heartcatheterization procedures.

Cost savings projected through useof the specific supplies are $600,000 to$4 million a year, and physicians agree-ing to use of the specified supplies willshare in up to half of the savings.

In each of the cases examined by

HHS, the inspector general’s officesaid the proposed arrangement wouldconstitute an improper payment tophysicians under federal antikickbacklaw, but the office said it would notimpose sanctions because of safe-guards – such as the transparency ofthe arrangement and credible medicalsupport – in place for each proposal,according to a February 16 ModernHealthcare Alert. •

HHS Signals “Go” on Several New Gainsharing Ventures

A D V O C A C Y

Arkansas Governor Mike Huckabeesigned the state’s second Any WillingProvider legislation (the first being enact-ed in 1995) on March 2. The governoractually signed two bills that wouldopen up health plan networks to moreproviders, assuming they will accept theplan’s payment rates.

Act 490 of 2005, which allowshealthcare providers’ participation ininsurance companies’ networks, is thelatest round in the state’s decade oldfight over “any willing provider” laws.The Act will go into effect only if the 8thCircuit Court of Appeals in St. Louisoverturns a current decision upholding

the previous 1995 Arkansas AWP law. The legislature first passed an any willing

provider law in 1995. A state court lateroverturned that law, saying the federalEmployee Retirement Income Security Act(ERISA), made it unenforceable. A federaldistrict court judge and the 8th Circuit agreedwith the ruling.

Then, in April 2003, the U.S. SupremeCourt upheld a similar law in Kentucky, say-ing it was not contrary to ERISA. That deci-sion led supporters of Arkansas’ 1995 law toreopen their case. A federal judge lifted theinjunction against the law last year. The caseis now again before the 8th Circuit, whichhas yet to rule. •

Any Willing Provider Law Now Act 490


AHA Meets With Governor HuckabeeMembers of the Arkansas Hospital

Association (AHA) executive team metin December with Arkansas GovernorMike Huckabee to discuss hospitals’need for more Medicaid funding. TheAHA reviewed with the governor itsstudy conducted by the accountingfirm BKD showing that hospitals lost$33 million in 2002 providing inpa-tient and outpatient services toMedicaid patients.

Based on those findings, the AHAhas been seeking support of lawmak-ers and the administration to add

$6.5 million per year to the Medicaidbudget. That would generate around$26 million annually, when coupledwith federal matching funds, enoughto increase the current Medicaid hos-pital per diem cap from $675 per dayto $850 per day. The money is not apart of the current Medicaid budgetrequest, which is now under review.

Huckabee said that he understoodthe need for the additional funds, not-ing that local hospitals provide notonly vital healthcare services, but alsothat they are necessary for future eco-

nomic development across the state.He indicated that competition for statedollars is intense, in light of continuingissues about the funding for publiceducation and school facilities.

While the governor was support-ive of the AHA’s request, he said hisfirst priority for Medicaid would beto get the additional $200 million theprogram had requested to keep serv-ices at current levels. However, if thedollars can be found, he said that hewould do what he could to supportthe added funding. •

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A H A M E M B E R P R O F I L E

Even the fastest sprint runner wouldneed to stop for a breather trying tokeep up with Jim Maddox. Beingregional administrator of not one, butthree St. Edward Mercy Health satellitehospitals keeps him running betweenthe three small western Arkansas townsof Paris, Ozark and Waldron.

Maddox is familiar with the manycomplexities of these St. Edward satel-lites, having been with the hospital sys-tem for 25 years. In 1999, he wasnamed regional administrator of MercyHospital of Scott County in Waldron,North Logan Mercy Hospital in Paris,and Mercy Hospital/Turner Memorial

in Ozark. “On an average day, I startat Paris in the morning, then go toOzark, then back to Paris in the after-noon. I spend one day each week atWaldron,” says Maddox

The three hospitals are each a part ofthe rural satellite healthcare network ofSt. Edward Mercy Medical Center,located in Fort Smith. “When I becameregional administrator in 1999, we dida reorganization of the facilities, andthe Directors of Nursing took on therole of assistant administrators,” saidMaddox. “They are the operationalcomponent.”

Also, the hospitals became licensedas Critical Access Hospitals, a new des-ignation. “This changed reimburse-ment from the prospective payment sys-tem to a cost-based reimbursementwhich offered opportunities for bettersurvivability for the rural facilities,” hesaid. “We were also fortunate to passsales tax initiatives in Paris and Ozarkto help fund operational costs to main-tain the facilities.”

Maddox’s degree in medical technol-ogy first led him to St. Edward as a staffmedical technologist in Fort Smith. “Atthat time, I was trying to decidebetween management and equipmentsales. Hospital administration justseemed like a better fit,” he said. Aftertwo years of lab and another two yearsserving as managerial director of

Nursing Services, Maddox was namedChief Administrative Officer for NorthLogan Mercy Hospital in Paris. “I wasborn and raised in Paris, so working inmy hometown was a real joy for me,”he says.

North Logan Mercy Hospital is a16-bed acute care rural facility employ-ing 35 professional staff members. Itwas the first satellite facility to be estab-lished in the St. Edward system. “Itwas like starting up a new business, andI was proud to be a part of that uniquesituation,” he says. North LoganMercy was also the first hospital in thestate to be designated as a CriticalAccess facility; Maddox was on thesteering committee that helped establishthe Critical Access Hospital licensuredesignations.

Several criteria must be met before afacility can achieve Critical Access sta-tus. “To begin with, the hospital mustbe a nonprofit or public hospital locat-ed in a rural area, must be at least 35miles from another hospital, must pro-vide 24-hour emergency care and musthave a maximum of 25 total beds,”Maddox explains. “The rural areamust also be located in a county withan unemployment rate that exceeds thestate’s overall unemployment rate andcontains a percentage of population age65 or older exceeding the state’s aver-age.” In order to be named a Critical

JIM MADDOX— three St. Edward Mercy

Jim Maddox


Plant Operations Managers Randy Dickerson of Ozark, Butch Barnhill of Paris, and Ken Coxof Waldron, meet with Maddox (right) to discuss new bioterrorism measures that have beenestablished by the Arkansas Department of Health. The plant operations managers are incharge of setting up special equipment that will be used in case of a bioterrorism attack.

Consulting with senior executive assistant Freda Diffee on schedulingvarious meetings for the week, Maddox relies on Diffee and otheradministrative staff to keep the operations at Mercy Hospital/TurnerMemorial in Ozark running smoothly.


Access facility, a hospital must meettwo out of five criteria, go through acomprehensive application process andperform several studies regarding eco-nomic and community involvementwith the hospital, he explains.

Maddox says small rural facilities dohave obstacles to overcome. “Over theyears, many changes have hurt ruralhealthcare. Medicine has become sospecialized and technology has becomeso expensive that it is difficult to keepup with the changes,” he explains.

“Also, there has been a shift frominpatient to outpatient services. In thepast, most of a hospital’s revenue camefrom inpatient services, but since newtechnology has come along, most of theprocedures can be done in a day, soinpatient stays are reduced. And, ofcourse, to provide the new technologiesthe hospital must have money to buy theequipment that the medical staff needs.”

That’s where the satellite network’sbenefits really shine. “Though a ruralhospital will never be a (fully outfitted)medical center, we can provide qualityservices in certain niches,” he says.“The goal is to provide excellent care,personalizing it for our patients.”

St. Edward Mercy Health provideseach facility with necessary servicesincluding accounting, dietary servicesand laundry, to name a few. “Becausewe’re a part of St. Edward, we have allthe backing we need,” says Maddox.“Three times each week, a shuttle comesfrom Fort Smith bringing supplies, med-icine and food that we have ordered. Itwill drop off new inventory, collect dirtylaundry and other items that need to goback to our main facility, and then trav-el to the next hospital. This shuttleapproach has quite a positive effect onthe economics of each hospital. It’s avery sophisticated system that has beenworked out over the years.”

Upon establishment of the satellitesby St. Edward, a regional board ofhospital and community leaders fromeach town was created. “They meetquarterly, and this is where we start tosee the whole picture come together,”says Maddox. “Within the board,

there are committees overseeing dif-ferent areas. They compare best prac-tices between the members. Thisallows for the best practices to beimplemented at other facilities.”

He is a past president of theArkansas Hospital Association’sArkansas Valley District and is a truebeliever in the AHA’s benefits. “TheAHA is very supportive of rural health-care,” he says. “AHA representativeshave attended all of our quarterlyCritical Access meetings.”

He is also a charter member and for-mer chairman of the board for theArkansas River Valley HealthCooperative, a non-profit organizationformed in 1999 to help improve health-care access to residents in Franklin,Logan and Scott counties. Maddox,along with executive director BobRedford, developed CommunityHealthlink with the Office of RuralHealth. Local and regional health-care providers, who were giving alarge volume of uncompensated carein the network area, also voiced inter-est in this program.

With the help of the Arkansaslegislature, the Health Care AccessProgram, or HCAP, encompassesthree areas: a low-cost insuranceplan to help those who cannotafford coverage on their own but donot qualify for Medicare orMedicaid; health education andchronic disease education; and aninformation and assistance programthat helps individuals gain access toprograms such as the PrescriptionDrug Assistance Program.

Maddox has served on the ParisSchool Board and is a member andpast president of the Paris Chamberof Commerce. Other professionalmemberships include the AmericanSociety of Clinical Pathologists,American College of HealthcareExecutives, Paris Kiwanis Club andthe Paris Knights of Columbus.

Maddox assures us that he doesfind time for a little rest and relaxation.“Whatever one administrator at onehospital does, I do that job times three,

so I always take advantage of my downtime,” said Maddox. An avid photogra-pher, Maddox will capture on film sub-jects ranging from old barns to insects.Friends say he also loves losing golf ballson the local golf course.

His wife, Elizabeth, has been a nursewith St. Edward Mercy Health in FortSmith for 33 years, and together theyhave three children, Austin, 30; Leslie,25; and Sabra, 23.

Keeping up with the intricacies ofthree hospitals definitely isn’t an easytask, but Jim Maddox has stepped upand keeps the system running smoothly.“Without our dedicated staffs and com-munities, we wouldn’t be able to oper-ate as well as we do,” he says. Becauseof his expertise, the people in andaround Paris, Ozark and Waldron areprovided with quality healthcare servic-es and will have those opportunities formany years to come. •

This is the ninth in a series profiling Arkansas hospital executives.

Health satellite hospitals keep him “running”Story and photos by Laura Norris

Special cabinets built into the walls of Mercy Hospital ofScott County in Waldron help the staff stay organizedwith inventory for the hospital. Each hospital underMaddox's supervision receives supplies from St. EdwardMercy Health in Fort Smith on a weekly basis.

Mercy Hospital/Turner Memorial in Ozark overlooks thescenic Arkansas River. Maddox divides his time betweeneach hospital and other organizations such as theArkansas River Valley Health Cooperative in Ratcliff.

A D V O C A C Y

Every week we get calls fromhospital executives, the news media,and others who ask basically twoquestions: (1) How are Arkansas’hospitals doing, financially? and (2)What’s the story with Medicare andMedicaid, and what should weexpect from Congress this year withregard to these programs? They’regood questions, and it occurs to usthat it might serve a purpose toshare our answers with you, ourtreasured readers of ArkansasHospitals.

How are Arkansas’ hospitalsdoing financially? The year2003 is the most recentyear for which we havecomplete statistics. Thatyear, we had 33 feweracute-care beds than theyear before, yet admissionswere up by 4,500. Even so,there were almost 22,000fewer inpatient days in2003 than the year before.

Although “the busi-ness” seems to have shiftedmore to the outpatient sidein recent years, there were256,000 fewer outpatientvisits in 2003 than the yearbefore. While inpatientsurgical procedures weredown by 2,300, there weremore than 7,600 fewerhospital outpatient surgi-cal procedures performed.We suspect the troublinggrowth of physician-

owned and other freestanding surgi-cal centers are responsible for someof the decline in hospital-based sur-gical procedures.

Of great concern to us is the factthat Arkansas hospital write-offs tobad debts and charity soared by9.3% in 2003, reaching $738 mil-lion. Total write-offs, includingbilled charges not paid by Medicare,Medicaid and third-party payersreached $5.8 billion (yes, billionwith a “B”) meaning that Arkansas’hospitals were unable to collect anymore than 59% of billings.

Across the state, total hospitaloperating costs, in the aggregate,exceeded net patient revenue by $29million for the year, knocking theaggregate patient revenue margin inArkansas down to minus 0.73% asopposed to 2.47% in 2002.

Twice a year, Arkansas Businessreports hospital profits and losses.While we might dispute some oftheir numbers, we do pay attentionto the AB reports, the most recent ofwhich was published in October2004. According to that report, 42of our acute-care hospitals posted a

net income while 36 hadnet losses ranging from$40,000 to $15 million.We can only imagine howdire the circumstances ofthose hospitals would behad the AHA not beenable to get the Medicaidsupplemental UPL pay-ments established inArkansas. While severerestrictions have beenimposed on these pay-ments recently, they haveyielded $150 million inbadly needed additionalrevenue for our hospitals.

What is the status ofMedicare and Medicaid,and what will the Congressdo this year? Medicare, ofcourse, is a big, big prob-lem — much bigger thanSocial Security on whichPresident Bush seems to be


The Health of Arkansas’ Hospitals and the Year Ahead:

What’s The Story?

by James R. Teeter, President and CEO, Arkansas Hospital Association

obsessing. The Medicare “TrustFund” is projected to be depleted 14years from now. You know howquickly the years pass, so we’re talk-ing a few blinks of the eye, really.

Every year, Medicare costs contin-ue to escalate. The Medicare Rx bill,alone, will cost at least $500 billionover the next 10 years, and with77,000,000 baby boomers to beadded to the rolls in the years imme-diately ahead, it’s no wonder that the75-year deficit projection forMedicare is almost $28 trillion (yes,trillion with a “T”).

All of this at a time when the fed-eral deficit is projected at $367 billionfor FY 2005, on top of a $416 billionbudget shortfall last year. And thesenumbers do not include PresidentBush’s call for another $80 billion forthe war in Iraq and Afghanistan.

Obviously, Medicare costs are outof control. And if President Bush car-ries out his campaign promise to cutthe deficit in half, all programs will bescrutinized, most certainly Medicareand Medicaid because of their sizeand their growth rates.

So, does this portend BBA II orother big Medicare cuts this year?While many in both the lay and tradepress and many of our own colleaguespredict a BBA II or other big cuts thisyear, we’re inclined to think other-wise. While obviously something hasto be done about Medicare, ourhunch is that it won’t happen this yeardue to, in part, the following reasons:

A. The president’s agenda seems tobe focusing on Social Securityreform and tort reform. There’snothing on the White House radarright now that seems threateningto Medicare. There’s optimism onthe part of President Bush thattax-exempt health savingsaccounts could take some of theheat off Medicare.

B. There are many new faces inCongress this year. Committeeswith jurisdiction over Medicarehave changed in membershipcomposition and many of themembers’ records on healthcare

are unclear. Even HHS has a newdirector, Michael Leavitt, formerGovernor of Utah.

C. We’re told by Arkansas congres-sional staffers in Washingtonthat the 2005 congressionalagenda seems to be less certainthis year than in any year theycan remember.

D. Congress learned in the BBA ’97fiasco that there are many unin-tended consequences of legislationof that kind and that cuttingMedicare hospital payments is notgood public policy. Twice sincethe passage of BBA ’97, Congresshas had to pass legislation to helpmitigate the damage it caused.

E. The Medicare outpatient Rx bill,which included a $25 billion infu-sion for hospitals, kicks in nextyear. We think the Congress mightbe loathe to further Medicare“reform” right now.

F. And finally, MedPAC has toldCongress that Medicare marginsdipped to minus 1.9% in 2003, asignal that now is not a good timeto impose more cuts.

But again, if not this year thensurely the one following, somethingwill simply have to be done aboutMedicare. While we cannot imagine itever happening, there is talk of cuttingMedicare beneficiaries’ hospitaliza-tion benefits by 50%. There’s alsotalk of increasing the wage tax thatfunds Medicare Part A from the cur-rent 2.9% to 6%.

While we think Medicare mightescape scrutiny this year, Medicaidcould be another story. Medicaidcosts are escalating wildly, shootingup 63% since 2000. With more than50,000,000 beneficiaries and morethan $300 billion in federal and stateoutlays, Medicaid is bigger thanMedicare.

With this in mind, President Bushhas asked for significant reductions inMedicaid spending and may try theblock grant approach he first pro-posed in 2003. There would be muchopposition to this — beginning withthe governors who have told theWhite House not to reduce federalMedicaid spending since the statessimply don’t have the money to pickup the slack. But remember that newHHS Director Leavitt reformedMedicaid when he was Governor ofUtah. He got a controversial waiverthat allowed the state to expand itsMedicaid program. However, it cutbenefits and forced some beneficiariesto pay for inpatient hospital servicesin order to pay for the expansion.What other “reform ideas” mightLeavitt have?

No matter what, it promises to bean interesting and, as always, a sus-penseful year in Washington.Medicare and Medicaid accounts fora large portion of your hospital’s rev-enue, and that’s why it’s incumbentupon you and other advocates of yourhospital to work closely with us as wetry to meet the Medicare andMedicaid challenges that surely willsurface in the future. •

On the Home FrontAs we went to press, the Arkansas Hospital Association had

asked the 85th Arkansas General Assembly for an additional $6.5million a year in state dollars, earmarked for hospital services toMedicaid patients. Hospitals are now being paid $33 million ayear less than what it costs them to care for these patients.Should the legislature appropriate the requested $6.5 million foreach year of the current biennium, about $26 million would begained, including federal Medicaid matching funds.


A D V O C A C Y


Protecting the healthcare safety net,increasing affordability and improvingcare are the three major areas of focusin the American Hospital Association’s2005 advocacy plan.

In early February the AmericanHospital Association (AHA) distrib-uted its final 2005 Advocacy Agenda,which will serve to guide the organiza-tion’s advocacy activities throughout2005. In brief, the AHA’s 2005 advo-cacy plan includes: • Legislative and regula-

tory strategies to ensureadequate Medicare andMedicaid funding forhospitals and the peo-ple and communitiesthey serve.

• An effort to permanent-ly extend the moratori-um on physician self-referral to new limited-service hos-pitals, and to examine new modelsfor working with physicians in amore constructive manner.

• Work with other national organi-zations to develop solutions tothe uninsured crisis and to make

care more affordable. • Strategies for improving coordina-

tion of care for all Americans (espe-cially the chronically ill).

• Ongoing advocacy to pass federallegislation that solves the crisisbeing caused by skyrocketing med-ical liability insurance costs.

• Ongoing strategies to strengthen thedelivery of care, while also strength-ening the bond between hospitalsand those we serve.

At the same time, theAHA will also work toachieve several long-termgoals in partnership withgovernment by the end ofthe decade, with the intentof moving America to aunified health policy.These long-term goalsfocus on:

• Quality: Public quality reportingby every hospital, to promotetrust, choice, competition andaffordability.

• Information Technology (IT):National IT standards should bedeveloped to achieve interoperabili-

ty among hospitals and otherhealthcare settings, and every hospi-tal should be on the road to meetingthem to promote safety, quality,choice and affordability.

• Workforce: 300,000 new health-care professionals on the job inAmerica’s hospitals.

• Emergency Readiness: Every hos-pital with staff, equipment andtraining should be self-sufficientfor 48 hours following a masscasualty incident.

• Affordability: Maintain afford-able coverage for all Americanswho have it today. Increase by 25million the number of Americanswith access to affordable cover-age. No public policy changesthat will cause any citizen to losecoverage.

• Care Management: Every hospitalshould be a key partner in manag-ing services in their community toimprove the quality, coordinationand efficiency of care to the 20%of our patients who are chronical-ly ill and on whom 80% ofresources are spent today. •

American Hospital Association Advocacy Agenda—2005

“America’s Hospitals: Corner-stones of Community Care” is thetheme for the American HospitalAssociation’s annual membershipmeeting May 1-4 in Washington, DC.During the event, Arkansas hospitalexecutives and trustees will visit withthe state’s congressional delegation onWednesday, May 4, and honor thecongressional aides with an apprecia-tion/get-acquainted dinner Monday,May 2.

The annual meeting format hasmuch to offer. Attendees will hearkeynote speaker Karen Hughes, for-mer advisor to President Bush, in oneof her last speaking engagementsbefore she returns to theAdministration as under secretary for

public diplomacy at the Department ofState. Other keynote speakers includeHHS Secretary Mike Leavitt andNational Coordinator for HealthInformation Technology David Brailer.

Participants have the opportunityto attain American College ofHealthcare Executives Category Icredit through a workshop on Sunday,May 1. “The Challenge of ManagingPhysician-Hospital Relations” featuresan interactive session led by KenMack, FACHE, president of DMITransitions.

Hospital trustees will have severaleducational opportunities to discussissues such as financial fitness, thetrustee’s role in quality and patientsafety, and future trends in healthcare

and governance. Several executivebriefings will be held on topics such asthe rising cost of healthcare, position-ing the hospital as a communityresource, retaining tax-exempt status,the Baldrige Award process, healthcareinformation technology, and patientsafety improvement strategies.

Meeting and registration informa-tion has been mailed to AmericanHospital Association members or youmay register online athttp://www.aha.org. Please fax a copyof your meeting registration form toBeth Ingram at the Arkansas HospitalAssociation (501-224-0519) to receivespecial mailings detailing Arkansasevents. You may also email attendanceplans to [email protected]. •

Join Us for the AHA Annual Meeting in Washington, D.C.


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A D V O C A C Y


Hospital campuses acrossArkansas will become smoke-free environments as ofOctober 1, 2005 under provi-sions of new legislation passedby the Arkansas Legislature.Act 134 of 2005 prohibitssmoking in and on thegrounds of all medical facili-ties in Arkansas, includinghospitals as well as hospital-owned and operated ambulatory sur-gery centers and hospital-owned andoperated free-standing medical clinics.

The law exempts psychiatricfacilities as defined by Departmentof Health rules for hospitals andrelated institutions, and does notcover the use of smokeless tobaccoproducts. It also provides that physi-cians may write orders for patientswho need to use tobacco, as long asthe orders are consistent with the

hospital’s bylaws, state hospital reg-ulations and local ordinances.

The Arkansas Hospital Associa-tion (AHA) backed the bill as a wayto improve overall community healthfor smokers and non-smokers alike.Several hospitals in the state that hadpreviously made their own decision to

move to smoke-free campuseshave weathered the transitionwith few complaints.

The October 1 effectivedate was included to giveample time for all other hos-pitals to educate their medicalstaff members, employees andthe public about the new lawand to move toward fullimplementation.

What happens if some individualschoose not to comply? The Act saysthe first step would be for a represen-tative of the facility to request theperson to stop smoking. If that fails,then the medical facility may reportthe violation to the appropriate lawenforcement agency.

The AHA has encouraged all itsmember hospitals to review Act 134and to begin making preparations forthe October 1 implementation date. •

Act Makes Arkansas Hospitals Smoke-Free

AHA Executive Vice President PhilMatthews and Diane Mackey, legal counsel, testify before a committee to discuss smoke-free hospitals.

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During 2004, the Arkansas HospitalAssociation Political Action Committee(AHAPAC) received $30,553 in contribu-tions, primarily from hospital executivesand employees throughout the state.These donations, which are sharedbetween the Arkansas HospitalAssociation and the American HospitalAssociation, make possible the financialsupport those organizations are able toprovide to political candidates seekingstate or federal elective offices.

Contributions of any amount from allcontributors to the AHAPAC are seriously

needed and deeply appreciated. Specialacknowledgement is given individuals whocontribute at certain threshold levels.Those individuals qualify for recognitionas members of the American HospitalAssociation’s Capitol Club or itsChairman’s Circle.

Capitol Club membership is awarded forindividuals who contributed $250 or more toAHAPAC during the year, while theChairman’s Circle membership is earned witha $500 donation. Individuals from Arkansaswho qualified for membership in each ofthese clubs in 2004 are shown below. •

Arkansas PAC Contributions Recognized

Arkansans who contributed at least $500,becoming members of the AHAPAC’s 2004Chairman’s Circle are:Don Adams, Arkansas Hospital Association (AHA)Robert Bash, Bradley County Medical CenterRoger Busfield, AHA, RetiredPaul Cunningham, AHADean Davenport, BKD, LLPStephen Erixon, Baxter Regional Medical CenterDan Gathright, Baptist Health Medical Center-ArkadelphiaRussell Harrington, Baptist HealthMichael Helm, Sparks Health SystemTim Hill, North Arkansas Regional Medical CenterBeth Ingram, AHALuther Lewis, Medical Center of South ArkansasPhil Matthews, AHAC.C. “Mac” McAllister, Ouachita County Medical CenterRay Montgomery, White County Medical CenterJohn Neal, Stuttgart Regional Medical CenterScott Peek, Chambers Memorial HospitalBarry Pipkin, Universal Health ServicesRon Rooney, Arkansas Methodist Medical CenterJim Teeter, AHAJohn Tompkins, Baptist Memorial Hospital-BlythevilleDoug Weeks, Baptist Health Medical Center-Little Rock

Members with minimum contributions of$250 who qualify for membership in the2004 Capitol Club are:Robert P. Atkinson, Jefferson Regional Medical CenterGary Bebow, White River Health SystemJoAnn Butler, AHADavid Cicero, Ouachita County Medical CenterKevin Clement, Crawford Memorial HospitalTina Creel, AHADavid Dennis, St. John’s HospitalRandall Fale, St. Joseph’s Mercy Health CenterNancy Fodi, Southwest Regional Medical CenterDonnie Frederic, NW Med. Ctr. of Washington CountyJohn Hoffman, M.D., St. Edward Mercy Med. CenterRoss Hooper, Crittenden Memorial HospitalEdward Lacy, Baptist Health Medical Center-Heber SpringsPeter Leer, UAMSJimmy Leopard, Medical Park HospitalMark Lowman, Baptist HealthMike McCoy, Saint Mary’s Regional Medical CenterLarry Morse, Johnson Regional Medical CenterDavid Morton, American Hospital AssociationJames Newman, St. Edward Mercy Medical CenterKristy Noble, St. John’s HospitalCraig Ortego, Dallas County Medical CenterBen Owens, St. Bernards HealthcareKirk Reamey, Magnolia City HospitalJohn Robbins, Conway Regional Medical CenterAllen Smith, Baptist HealthJason Spring, HealthPark HospitalSandy Sullins, Lawrence Memorial HospitalRuss Sword, Ashley County Medical Center

A D V O C A C Y


The meetings of the AmericanHospital Association’s (AHA)Committee on Governance (COG)frequently include an open forum inwhich members discuss a timely andprovocative topic or question – usual-ly one posed by AHA staff. At its fallmeeting, the COG was asked to iden-tify the key areas where they thoughtboard members could make the great-est leadership contributions – bothwithin the organization and in thecommunity or political arena.

Within the hospital, committeemembers felt that internal leadershipcould be implemented throughtrustees working with senior execu-tives to improve and communicate adesirable organizational culture,working to make the organization anattractive one for patients, staff andstakeholders. Trustees are also highly

effective liaisons between the adminis-tration and the medical staff, helpingto build and clarify their relationship.

Outside the boardroom, trustees canbe ambassadors for the hospital whenwe speak with our friends, neighborsand colleagues. As hospital trustees, weare respected members of our commu-nities and when we talk about our hos-pital’s community benefits, our wordshave the integrity of volunteers com-mitted to our organization – we do notspeak as paid lobbyists or employeesdependent on a salary or bonus. And,board members are invaluable for edu-cating the community on billing prac-tices by explaining, in layman’s terms,how money is spent by the hospital.

Finally, trustees can provide leader-ship by participating in the politicaladvocacy process. This can be doneboth when legislators visit the commu-

nity and when trustees take the hospi-tal’s message to their state and federallegislators. As we have often noted,legislators need to have issues broughtbefore them often in order to appreci-ate hospitals’ problems and needs. Andthen, when a relationship does devel-op, your message cannot be passedover as easily as one from a profession-al lobbyist.

I hope you are already making aleadership contribution both inside andoutside your hospital. If not, please usethe post-election period as a time toestablish some new patterns of leader-ship as a member of the board. •Robert J. Parsons, Ph.D., is COGchair and chair of IntermountainHealth Care-Urban South Region,Provo, Utah. He can be reached [email protected]. This articleoriginally appeared in the November2004 edition of Trustee Magazine.

Your Leadership Contributions Count

This letter was sent to ArkansasSenator Blanche Lincoln February 9 byJim Teeter, Arkansas Hospital Associa-tion president and CEO, on behalf ofthe association. Similar letters weresent to Senator Mark Pryor andRepresentatives Marion Berry, JohnBoozman, Vic Snyder and Mike Ross.

February 9, 2005

The Honorable Blanche LincolnThe United States SenateWashington, D.C. 20510

Dear Sen. Lincoln:With both state and federal Medicaid

costs escalating wildly, we were not sur-prised when President Bush proposed in hisFY 2006 budget to reduce federal Medicaidspending. However, we were astounded bythe magnitude of his proposed reductions —$60 billion over the next 10 years!

Undoubtedly there are ways to reformand improve Medicaid — the only healthcaresafety net for the most vulnerable Americans— but this is not the way to do it. The truetest of any reform is not how many dollars

can be saved but whether it improves thelives of those who depend upon the program— children, the blind and disabled, and oth-ers who simply don’t have the means to payfor health services.

The president’s proposed cuts are stag-gering and would shift enormous costs toArkansas and other states, an ill-conceivedmove that would add to the financial burdenthe states are already experiencing.Arkansas would lose at least $561 million inMedicaid funding under the president’s pro-posal, according to projections issued byFamilies USA.We fear the actual losses couldeasily exceed those projections.

The president’s draconian Medicaidspending reductions are proposed at a timewhen the Arkansas Department of HumanServices is already struggling to meet theneeds of 664,000 Arkansans who receiveMedicaid services (27% of the state’s entirepopulation). These beneficiaries include atleast 280,000 children and 90,000 personswho are blind and disabled. The president’sproposed cuts in Medicaid also come at atime when Governor Huckabee and mem-

bers of the Arkansas Legislature are trying tofind $200 million in state funds just to pre-serve our state’s Medicaid status quo.

Not only would President Bush’s slashesin Medicaid spending jeopardize services tobeneficiaries, but they would also furtherharm the healthcare providers who servethose beneficiaries, including Arkansas hos-pitals that are already being paid $33 milliona year less than the cost of providing serv-ices to the beneficiaries.

This payment deficit would be exacerbat-ed by another $30 million a year were it notfor Medicaid supplementary UPL paymentsthat the governor, you, and other members ofthe Arkansas delegation helped us achievefour years ago. Unfortunately, even thesepayments will soon be severely reduced dueto a recent amendment to the State MedicaidPlan forced upon us by the Centers forMedicare & Medicaid Services.

Given these facts, we urge you to vigor-ously oppose cuts in federal Medicaid spend-ing to the degree the president has proposed.

Sincerely,James R. Teeter •

AHA Protests President’s Proposed Medicaid Cuts

by Robert J. Parsons


The Joint Commission on Accred-itation of Healthcare Organizations(JCAHO) has issued a call to actionto reform the nation’s medical liabil-ity system, urging that the current pro-posal for caps on non-eco-nomic damages be expand-ed to pursue intermediateand long-term systemchanges that truly facil-itate improvements inpatient safety.

According to theJoint Commission, byits basic design, the cur-rent medical liability sys-tem chills the identification andreporting of adverse events in health-care and thus undermines opportuni-ties for learning that could providethe basis for significant safetyimprovements.

The call to action is set forth in theJoint Commission’s newest public pol-icy white paper, “Health Care at theCrossroads: Strategies for Improvingthe Medical Liability System andPreventing Patient Injury.” The JointCommission’s report urges intensifiedattention to patient safety and medicalinjury prevention by healthcareproviders and practitioners; empha-sizes the critical importance of opencommunication between patients andpractitioners; and urges the creation ofan injury compensation system that ispatient-centered and serves the com-mon good.

Any redesign of the medical liabil-ity system, the report suggests, shouldassure appropriate compensation forall injured patients, while also encour-aging healthcare providers and practi-tioners to surface errors, learn frommistakes in the design and perform-ance of care processes, and takeaction to ensure that adverse eventsdo not recur.

The Joint Commission’s whitepaper was developed in collaborationwith an Expert Roundtable whose 29members represent a wide diversity ofinterests relevant to medical liability.

The report contains 19 specific recom-mendations and identifies accountabil-ities for each of those. As with its otherpublic policy initiatives, the JointCommission intends to work in collab-

oration with other parties atinterest to see that each of

those recommendations iseventually met.

The current medicalliability system, theJoint Commission sug-gests, fails patients

because it does not effec-tively deter negligence,

truly offer corrective justice,or provide fair compensation to

those who have been injured throughthe care process. The Joint Com-mission also says it’s accurate to saythat too little progress has been made inimproving patient safety since therelease of the Institute of Medicine’sgroundbreaking report on medical errorfive years ago. The Joint Commissionalso notes that a very small proportion– two to three percent – of injuredpatients receive compensation throughthe medical liability system, and thosewho do receive highly variable recom-pense for similar injuries.

The Expert Roundtable identifiedthree strategies for achieving its over-all goal:• Actively pursue patient safety initia-

tives that prevent medical injury.Specific recommendations addressthe need to encourage the creation ofcultures of safety in healthcareorganizations; to strengthen over-sight and accountability mechanismsfor ensuring the competency of doc-tors and nurses; and to providehealthcare researchers access toopen liability claims to permit time-ly identification of problematictrends in care. “Pay-for-perform-ance” programs that provide incen-tives for improving patient safetyand healthcare quality must also bepart of the solution.

• Promote open communicationbetween patients and practitioners.

Emphasize that patients mustbecome members of the healthcareteam. Ineffective communicationand lack of disclosure are the mostprominent complaints of patients,and their families, who are victims ofmedical error or negligence. As oneof its recommendations, the reporturges pursuit of legislation thatwould protect disclosure of mistakesand the associated apologies frombeing used against practitioners inlitigation. Other recommendationsencourage the non-punitive report-ing of errors to third parties to sup-port the development of patient safe-ty solutions, and enactment of pend-ing federal patient safety legislationthat would provide legal protectionfor medical errors and adverseevents reported to designated patientsafety organizations, such as theJoint Commission.

• Create a patient-centered injurycompensation system. Specific rec-ommendations emphasize the needto conduct demonstration projectsof alternatives to the current medicalliability system that promote patientsafety and provide swift compensa-tion to injured patients. While theseefforts are underway, the report alsoadvocates for prohibition of confi-dential settlements known as “gagclauses” that prevent learning fromevents that lead to litigation; use ofcourt-appointed, independent expertwitnesses; and the redesign orreplacement of the NationalPractitioner Data Bank which hasnever fulfilled its promise to be thepremier resource for meaningful,valid and reliable information aboutphysician performance.A complete copy of the Joint Com-

mission white paper, “Health Care atthe Crossroads: Strategies for Improv-ing the Medical Liability System andPreventing Patient Injury” is availableon the Joint Commission Web site, athttp://www.jcaho.org/about+us/pub-lic+policy+initiatives/medical_liabili-ty.pdf. •

JCAHO Joins Those Calling for Medical Liability Reform


Could Arkansas land six superprojects a year? Yes. (If you like thepremise of this column title, thenread on.)

Last July, I had the “fortunate” and“unfortunate” experience of a lengthystay in the hospital, followed by aneven longer homebound recovery. Theexperience was “unfortunate” in that amajor health setback forced the hospi-tal stay. However, it was “fortunate” inthat I received excellentin-hospital and homehealthcare during my sur-gery and recovery. I praisemy doctor for saving mylife, but I praise my nurs-es for saving my sanity.

For ten days follow-ing surgery (and severalweeks after my hospitaldischarge at home),nurses helped me findcomfort in my most painful andpride-less moments. When you aresick, injured, and compromised bypain or grueling discomfort, you justwant to feel better. You are miser-able. You are restless. You arescared. My nurses came to my aiddaily and nightly and I can honestlysay that I would have never made itthrough my hardship without theirskills, their attention, and mostimportantly, their caring.

I’m lucky. They were there for me. But will they be there next time and

will they be there for you? A legislative commission has been

studying a crisis in our state’s nursingprofession for four years. A lot ofgood people deserve credit for plow-ing through this tough issue. The com-mission presented its findings recentlyand here are some incredible facts:

• Arkansas needs 1,925 new regis-tered nurses (RNs) and 959 newlicensed practical nurses (LPNs)each year to meet current workforce needs. That’s 2,884 new nurs-es per year.

• On average, Arkansas graduates

fewer than 700 new RNs andaround 500 LPNs each year.

• By 2010, the state must have at aminimum 27,000 RNs and 16,000LPNs compared to the 18,750 RNsand 10,975 LPNs we had in 2000.

• If this number of new nurses wereadded to the state each year, itwould yield on a per year basis:$69,744,500 in new salaries;

$3,398,360 in new statetax revenues; and pro-duce a $174,361,250economic benefit toArkansas communities.

There are nearly 2,900nursing jobs in this statewaiting to be filled. Thesejobs already exist. Wedon’t have to create them.We don’t have to recruitthem to Arkansas. We

don’t have to wait for “market forces”to produce them. We don’t have tocome up with an incentive package thatwould “give away the state” to getthose jobs to come here.

We have the potential to createnearly six super projects in Arkansasper year without turning a spade ofdirt, without making a phone call toJapan, without seeking the help of anout-of-state recruiter, and withoutcommissioning another study.

A super project has typically beendefined as any business enterprise thatwould create 500 new jobs or result in$500 million in new infrastructureinvestment. Doesn’t solving our nurs-ing crisis qualify?

In talking to a two-year collegepresident at the Capitol recently, I wastold that a nursing program can be amoney loser for the college. So whydoesn’t the state chip in like we wouldif Toyota wanted to come toArkansas? Why not commit a fractionof the money necessary to fund oureducation institutions adequately toaddress this need? Why not find a wayto make nursing school available tothe thousands of Arkansas high school

graduates not attending college? Some private institutions are

already stepping up. Private hospitalsare paying for nursing school for stu-dents on the promise that they willwork for their hospitals for two years.Wait! We’ll pay for your schooling andprovide you with a job upon gradua-tion! That’s a bargain. But it’s notenough and we can do more.

If the political will is there to dowhat it takes to land one super projectin Arkansas, then surely the politicalwill is there to create six super projectsa year.

I am optimistic that the Legislaturewill look at this potential and do some-thing about it this session. I think pri-vate industry, i.e. the healthcare indus-try in Arkansas, would step up to theplate and do whatever is asked to meetthis critical challenge. More so than acar maker, which can locate anywhereand expect red carpet treatment.

Bluntly put, people will continue toage and be sick. With a larger, agingpopulation, the need for these jobs isnever going away.

Nursing also allows great flexibilityin terms of career changes. A nurse canutilize technology in a high-tech ER set-ting. A nurse can work with theyoungest and most fragile children withhealth needs. A nurse can work withour aged seniors whose health needsknow no boundaries. Nurses are facili-tating breakthrough research atUAMS. Career options and new needsare endless in this profession, muchmore so than working at an auto plant.

I think we are missing a majoropportunity by continuing to just ana-lyze and discuss this problem. Whilethere are public and private institu-tions out there doing what they can,frankly more can be done.

And it should be. Your life coulddepend on it. •Roby Brock is the host of “TalkBusiness,” a weekly television pro-gram that focuses on business and pol-itics in Arkansas. His email address [email protected].

Could Arkansas Land Six Super Projects a Year?

by Roby Brock

Roby Brock


Poor communication and collabo-ration among healthcare professionalsleads to continued medical errors andstaff turnover, according to SilenceKills: The Seven Crucial Conversationsfor Healthcare, a study of more than1,700 nurses, physicians, clinical carestaff, and administrators.

Released January 26, the study wasco-sponsored by the AmericanAssociation of Critical-Care Nurses(AACN) and VitalSmarts, a Utah-based company that specializes inleadership training and organizationalperformance, according to a U.S.Newswire article.

The findings include:• 84% of physicians and 62% of

nurses and other clinical careproviders have seen coworkers takeshortcuts that could endangerpatients

• 88% of physicians and 48% ofnurses and other providers work

with people who display poor clin-ical judgment

• Fewer than 10% of physicians,nurses, and other clinical staffdirectly confront their colleaguesabout concerns, and one in fivephysicians said they have seenharm come to patients as a result

• Those healthcare workers whoraise these concerns observe betterpatient outcomes, work harder, aremore satisfied, and more commit-ted to staying in their jobs“Too often, improving workplace

communication is seen as a ‘soft’issue. The truth is we must buildenvironments that support anddemand greater candor among staffif we are to make a demonstrableimpact on patient safety,” said KathyMcCauley, RN, PhD, BC, FAAN,FAHA, president of the AACN.

Hospital leaders must make improv-ing crucial conversations a priority,

according to the study. As a solution tothe communication problems, theAACN developed a set of recommen-dations to promote communicationand collaboration among caregivers.

The four recommended steps tothis end are:• Establish a baseline and target for

improvement• Conduct focus-group interviews• Focus on problem areas• Implement training

Dennis O’Leary, MD, president ofthe Joint Commission on Accredi-tation of Healthcare Organizations,said that communication is a majorcontributor to medical errors. “Thestandards and recommendations putforth today make an important con-tribution to beginning to solve theidentified communication prob-lems,” he said.

To read the study, visit www.rxfor-bettercare.org. •

Study Recommends Improved CommunicationAmong Healthcare Workers

About 86% of nurses and 49% ofphysicians recently surveyed saidthey had witnessed disruptive behav-ior among healthcare professionals,according to a VHA study.

Most respondents said theybelieved such behavior had animpact on adverse events, medicalerrors, patient safety, patient mortal-ity, quality of care and patient satis-faction.

VHA defined “disruptive behav-ior” as any inappropriate behavior,confrontation or conflict, rangingfrom verbal abuse to physical andsexual harassment. It drew responsesfrom a total of 1,500 nurses andphysicians in 12 states. About 60%of respondents said they were awareof potential adverse events that may

have occurred as a result of disrup-tive behavior.

Disruptive behavior among nurseswas commonplace. Some 68% ofnurses and 47% of physicians saidthey had witnessed disruptive behav-ior among nurses and by nursesdirected at other hospital staff.

The report did not provide dataspecific to disruptive behavior byphysicians.

“The survey suggests a seriousproblem within and across disci-plines,” said Alan Rosenstein, co-author of the study. “Disruptivebehavior needs to be addressed at theorganizational level. Hospitals needto invest time and resources into per-forming self-assessments, increasingstaff awareness of the issue, openinglines of communication and creatinggreat collaboration among peers. Ifhospitals don’t do this, the problemwill continue to grow and patientswill continue to needlessly suffer.”The full survey results can be foundin the January American Journal ofNursing. •

Disruptive Acts Common Among Hospital Staff, Study Shows


Arkansas Medical imaging was founded with a vision.....that radiology departments in small, rural facilities couldbecome clinical centers of excellence. Through a unique blendof technology, professional, and marketing service, AMI isbringing that vision to reality every day—to the benefit of ruralArkansas Hospitals, to their communities,and to rural Arkansans across the state.

Fueled by rapid advances in digital tech-nology, Radiology is changing more rapidlythan any medical specialty. Every day, tech-nology driven advances lead to new imagingstrategies, protocols and algorithms that dra-matically improve the ability to diagnose,stage and evaluate disease. While radiologythroughout much of the country moves for-ward, it has historically lagged behind inmany rural community hospitals.

AMI empowers small, rural facilities toprovide the same quality of care that is avail-able in tertiary care radiology facilities. Evenin cases where definitive care cannot be pro-vided locally, complex imaging evaluationscan be performed locally. Capture of theseimaging evaluations strengthens the localhospital, and builds a resource vital to theresidents of the community both economically and practically.AMI accomplishes its mission through a blend of the follow-ing services:

eRadiology: The first step in achieving local excellence isto convert inefficient film-based opera-tions to filmless, even paperless radiolo-gy departments. The benefits are myriad:• No lost films• No lost reports• No waiting for images or reports• Report-image integration for you

clinical staff• Improved workflow and efficiency• Higher patient throughput• Improved patient, clinician, and

radiologist satisfactionAccess to subspecialty trained

radiology: In addition to the practicalefficiencies of filmless/paperless imaging,eRadiology provides much needed sup-port to the hometown radiologist. Oftenin solo practice, or covering a “circuit” of hospitals, rural radiol-ogists are often overworked. That’s where AMI’s network of fel-

lowship trained specialists can help by providing night-time cov-erage, weekend coverage, and access to over-read and consulta-tive services. Never in competition with local resources, AMIstands ready to help build volumes by supporting, and backinglocal radiologists and making sure that local hospital always hasthe coverage is deserves.

MARKETING: A unique, but highly effective market-ing campaign constitutes the third leg of the AMI solution. Asquickly as the state of the art changes, it can be challenging forthe most highly trained radiologist to keep up with the latest

imaging protocols. AMI marketing teachesreferring physicians how to use technology towork-up and effectively diagnose theirpatients. Evidence-based imaging protocolscoupled with local hospital branding ensurethat rural Arkansas physicians what is avail-able at home....and that they order the appro-priate examinations from their local hospital.

These turnkey programs, offered withinthe institution’s operational budget allow thesmallest rural hospitals to compete on evenfooting with the centers that have been draw-ing their patients away for years.

According to AMI founder and PresidentMichael V Beheshti MD, a practicing radiolo-gist in Little Rock, “Too many Arkansans aredriving too many hours to obtain imagingexaminations. In today’s world, local patientscan be imaged locally. It is better for them,better for their hospital and better for their

community.” “We have been deeply gratified by the success ofthis model in the state,” continued Dr. Beheshti. “We have seenone institution’s CT volume increase over 40% in one year—atestament to the quality and value of the AMI solution.”

Backed by a team with hundreds ofman-years of experience in radiology andin information technology, AMI isquickly becoming known to ruralArkansas hospital executives. “Every dayour vision is becoming reality”, com-mented Dr. Beheshti. “Our solutionworks. It improves quality of care, itbuilds local excellence in radiology, andit strengthens the facilities with whomwe work.”

Anyone seeking additional informa-tion regarding AMI services may call Mr.Charles Socia at (501) 223-3392, or mayemail Arkansas Medical Imaging atinfo@arkansasmedical imaging.com .Further information is available on the

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Arkansas Medical ImagingEmpowering Radiology in Rural Arkansas

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Editor’s Note: Steve Rivkin will be thekeynote speaker at this year’s SummerLeadership Conference. His topic willbe “How to Overcome NegativePublicity.” For more information, seerelated article on page 34.

“What we have here is a failure tocommunicate.”

How often have you heard that oldsaying? A “failure to communicate” isan underlying aspect of every hospitalcrisis, adverse development or challeng-ing situation.

Dealing with the media is an oppor-tunity for you to get across the pointsyou want to help achieve the objectivesof your organization. Standing in yourway is a journalist, whose only job is toextract from you the most interestingstory he or she can.

Contrary to what you may think,most journalists are neither overly hos-tile nor overly friendly. In fact, theydon’t care much what you say, as longas it’s interesting to their readers, listen-ers or viewers.

Your job is to be available, to becandid, and to be interesting—whilealways keeping your organization’sgoals in mind.

STICK TO THE SCRIPT

To succeed with the media, you haveto know your M.A.P.s—your Must AirPoints.

These are the three or four — nomore — messages that you must getacross on the air or in print.

These are the key messages thatwill help your organization respondto a crisis or deal with a difficult situation.

Good M.A.P.s have these character-istics: • They go right to the heart of

the matter. • They are direct and truthful. • They are strong, positive,

committed. • They cite evidence, facts, proof.

10 INTERVIEW DO’S

1. Do prepare. Before an interviewor meeting with the media, you shouldknow how the interviewer reports, forwhom he reports, and what his point ofview is. Know the main points youwant to make before the interviewbegins.

2. Do relax. Most reporters are peo-ple just like you, trying to do a job.Sure, some reporters are jerks. Even so,building rapport will help.

3. Do be open and honest. TV, inparticular, magnifies phoniness. A half-truth can quickly become a half-lie.

4. Do speak in personal terms. Mostpeople distrust large organizations. Toomany references to “the institution”and “we believe” are ominous. Don’thesitate to use “I.”

5. Do welcome a naive question.The question may sound simple, butanswer it anyway -with enthusiasm. Itmay be helpful to someone who doesn’tknow much about you.

6. Do answer briefly and directly.Don’t ramble. Get to the point. Avoidjargon.

7. Do play it straight. Be careful

with humor. If humor doesn’t comenaturally, play it straight. Reaching fora joke or an irreverent comment maybe interpreted as being foolish or frivo-lous.

8. Do state facts and back up gener-alities. Examples bolster an interview.Be armed with specific data to supportgeneral statements.

9. Do radiate some energy. Youshould be enthusiastic about yourtopic. True, you may have been askedthe same question many times before.But it’s fresh for this audience.

10. Do tell the truth. It’s the cardinalrule. Journalists are generally percep-tive; they can sniff out a fraud. So don’tbe evasive, don’t cover up, and don’tlie. If you have to decline to answer aspecific question, explain why you’redoing so.

10 INTERVIEW DON’TS

1. Don’t let the interviewer domi-nate. You can control the interview byvarying the length and content ofresponses. If a question requires a com-plicated answer, say so before you gettrapped in an incomplete and mislead-ing response. If you make a mistake,correct it and go on. If you don’t under-stand a question, ask for clarification.

2. Don’t assume everything you saywill be used. Print interviewees pickand choose what they need to fill thespace they are given. TV is a quick,imperfect and heavily-edited medium.To make a point on TV, you need to bebrief and direct.

3. Don’t say, “no comment.” Itsounds evasive. If you can’t answer aquestion, explain why. Begging off forcompetitive or proprietary reasons isperfectly acceptable as long as you offersome explanation.

4. Don’t take the skepticism person-ally. A journalist’s job is to be skepticalof everything.

5. Don’t patronize. Journalists aren’tterribly impressed by titles. Many hold

Contrary to what you maythink, most journalists areneither overly hostile noroverly friendly. In fact,they don’t care much what you say, as long as it’s interesting.

How To Handle The Media

by Steve Rivkin


the heretical view that there are a lot ofdumb politicians and business execu-tives running around. (For shame!)

6. Don’t take offense. Some reportersaren’t mannerly, polite or deferential. Aslong as they’re honest, who cares?

7. Don’t get confrontational. Mostreporters know very little about health-care issues. Sure, it would be better ifthey were better briefed. Just be patientand keep cool.

8. Don’t tell them how to do theirjobs. No, you can’t see the story inadvance. No, they won’t agree withyour definition of “news.”

9. Don’t get chummy. Reporters arenever off-duty. So keep your guard up— all the time.

10. Don’t lie. Never, never.

SOME IMPORTANT DEFINITIONS On the Record. Means the comment

is for quotation by a source whosename will be used.

Background. Implies that while thematerial can be quoted, it will not beapplied directly to you. A term suchas “an industry observer” is oftenused to muddle the identity of a back-ground source.

Deep Background. A synonym for“not for attribution,” which means thereporter should not attach the com-ment to anyone. (Instead, the journalistparaphrases you and attributes theideas to his or her own intuition.)

Off The Record. Strictly defined,means not for publication or use on theair. (In other words: “Don’t use this!”)Over the years, this term has frayed atthe edges and may instead mean “just

between us” or “use with discretion.”Your best bet is to proceed by

assuming that there is no such thing as“off the record.” If you don’t want tosee something in print, or on the air,don’t say it.

PRINT VS. BROADCAST—A QUIZ1. Who gives you more time to

express yourself? Print. You’ll normally spend more

time talking with the writer of an arti-cle than you would with a broadcasthost or newsperson. Often, you’ll meetthe broadcaster right before they turnthe camera on. So be prepared to hit theair running!

2. Where are you most likely to becaught off guard?

Print. The extended time spent withprint journalists tends to lull some intoa relaxed, informal state. Dangerous.Keep alert at all times, or you’ll bequoted saying things you won’t beproud to see in the cold light of print.

3. Where can you make the greatestimpact?

TV. The viewer sees you and hearsyour words. The impact is immediate,emotional and lasting.

4. Where are you at most risk to beperceived inaccurately?

Print. Readers can neither see norhear you. They absorb the writer’simpressions. This “filter” can altermarkedly how you and your organiza-tion come across.

5. Where are you safest? Radio. You can use as many notes

and references as you like. Listenerswon’t know and hosts won’t care. So

your facts (and your cleverest com-ments) are literally at your fingertipsfor easy reference.

6. Where will your radiant personal-ity most readily be revealed?

TV. Live television is the best medi-um to convey to viewers who you areand what you stand for. There is nointermediating device between you andthe viewer to filter your words anddeeds.

7. Which is the most difficult chal-lenge?

TV. Particularly live television. Yourwords, actions and appearance must all“click” at once, or else the viewer will“click” you – off, that is. You get nosecond chance.

8. Where will you be most pressedfor time?

Broadcast news interviews. Thesedepend on brevity and immediacy. Soyour answers must be short and pithy.Remember your M.A.P.s.

9. Where is rapport with the inter-viewer most important?

Print. In broadcast, you speakdirectly to the listener or viewer. But inprint, you must depend on the inter-viewer to interpret your views accurate-ly. This, in turn, is often dependent onwhat the interviewer thinks of you. Sobe gentle and don’t alienate.

10. Which is most likely to conveyyour message accurately?

Radio. TV conveys more of you andyour personality than your message.Print depends on a reporter’s interpre-tation to convey your message. Butradio carries only your message.Unless, of course, it’s edited severely. •

The Arkansas Hospital AdministratorsForum/Arkansas Health Executives Forumsummer leadership conference will be heldJune 15-17 at the Perdido Beach Resort inOrange Beach, Alabama. As expected, thearea is re-building and renovating after hurri-canes repeatedly slammed the Gulf Coast latelast year.

Educational topics and speakers for thetwo-day conference include healthcarestrategist Nate Kaufman and his ideas toimprove hospital performance, and marketing

and communications consultant Steve Rivkin,who will discuss ways to change negativepublic perception and how to cope in a crisissituation. Diane Mackey, AHA legal counsel,will present a healthcare update.

Along with the planned educational activi-ties, Perdido Beach Resort and the Gulf Coastarea offer many opportunities for family enter-tainment—beautiful beaches, golfing, shopping,fishing, boating, swimming, tennis, a full range ofactivities for children, and much, much more—which make the trip to the coast memorable.

Because the Gulf Coast area remains apopular summer vacation spot, we encourageyou to make reservations now. You may callthe hotel direct at 1-800-634-8001, men-tioning the Arkansas Hospital AdministratorsForum (or the Arkansas Hospital Association)to obtain the special convention rate. Or, youmay make reservations online at www.perdi-dobeachresort.com, clicking on “reserva-tions,” and entering the Group Code AHA605.Contact Beth Ingram at (501) 224-7878 foradditional information. •

AHA Summer Leadership Conference, June 15-17


In early April, helpful consumerinformation on hospital qualitybecame available to the general pub-lic for the first timethrough the new con-sumer Web sitewww.hospitalcom-pare.hhs.gov. Thissite marks a milestonein public accountabili-ty and is the outcomeof a landmark public-private partnershipbetween hospitals,government and otherhealthcare organiza-tions, known as theHospital QualityAlliance.

Patients, familiesand communities will,through the HospitalCompare Web infor-mation, be able toexamine quality sta-tistics and make anapples-to-apples com-parison of hospitals.By using a commonset of measures, thepublic will be able toaccess relevant data,presented in laymen’sterms, to help makeimportant healthcare decisions. (Inthe past, comparative informationwas available, but because no stan-dard set of measurements existed,there was no accurate way to evaluatethe comparative data.)

The launch of the HospitalCompare Web site is an important firststep in hospitals’ efforts to publiclyreport quality information, and the sitewill continue to evolve as new condi-tions and measures are added.

Consumers will first be able to

research and compare hospital qualitydata for three common medical condi-tions – heart attack, heart failure and

pneumonia. More quality-relatedinformation will be added over time,with new information on surgicalinfection prevention scheduled to beadded as early as this summer, andpatient satisfaction comparisonsscheduled in 2006.

It is very difficult to measure thequality of healthcare, but one methodis to measure how often healthcareproviders make use of treatments thathave been shown to be most effective.The 17 measures being reported

through Hospital Compare helppatients understand the effectivenessof the care they receive compared with

care that research indicates will lead tothe best outcome. The new qualitymeasures are one important source ofinformation about a facility, but theyshould not be the only source.

Most Arkansas hospitals, workingin conjunction with the ArkansasFoundation for Medical Care (AFMC),Arkansas’ medical quality improve-ment organization, have submitteddata as part of this voluntary initiativeto better equip their communities withcredible quality information. The

Hospital CompareWeb Site Goes Online

Arkansas Hospital Association (AHA),which endorses the national HospitalQuality Alliance, notes that HospitalCompare is an important tool forimproving patient safety and quality ofcare. The AHA agrees that it should beviewed as just one of the many sourcesthat patients and families can use tochoose a hospital.

Paul Cunningham, AHA seniorvice president, said, “HospitalCompare is a starting point in aprocess of collecting and sharinginformation on quality of care thatwill continually expand and evolve.This initial report provides consumersa brief snapshot of current practicesthat individual hospitals use in caringfor patients admitted to those facilitiesfor three specific conditions.”

Cunningham added, “Futurereports will not only include addition-al quality measures and patient satis-faction information but also will allowconsumers to track hospital progressover longer periods of time towardimproving their quality measuresthrough adopting proven ‘best prac-tices’ of care.”

The initial three “starter” measuresare further broken into sub-areas rep-resenting the best standard of care fortreatment of the conditions. To begin,consumers will be able to comparehospitals based on:

Treatment of Heart Attack• Aspirin given at arrival• Aspirin given at discharge• Beta-blocker at arrival• Beta-blocker at discharge• ACE inhibitor for left ventricular

systolic dysfunction (LVSD)• Percutaneous coronary intervention

within 120 minutes of arrival• Thrombolytic agent received within

30 minutes of arrival• Smoking cessation counseling

Treatment of Congestive Heart Failure• Left ventricular function (LVF)

assessment• ACE inhibitor for left ventricular

systolic dysfunction (LVSD)• Smoking cessation counseling• Discharge instructions

Treatment of Pneumonia• Mean time to first antibiotic dose

• Pneumococcal screening and/or vac-cination

• Oxygen assessment• Smoking cessation counseling• Blood culture before antibiotic

AFMC plays a pivotal role inimproving Arkansas hospital qualityby offering hands-on resources, one-on-one training and staff education.“As the Medicare contractor inArkansas charged with working withhospitals to improve their quality ofcare, we have seen first hand howhospitals are making changes andimproving,” said Pam Brown,AFMC’s inpatient project manager.“We commend our state’s hospitalsfor making quality a top priorityevery day.”

Hospitals across the country choseto participate in this voluntary part-nership as a part of their ongoingeffort to improve patient safety andquality of care within their facilities.The hospital field has taken the leadin making more and better informa-tion available to patients and con-sumers about the quality of hospitalcare. The Web site is one importanttool for improving the quality of careand empowering patients with credi-ble quality information.

In 2002, the American HospitalAssociation, Federation of AmericanHospitals (FAH) and Association ofAmerican Medical Colleges (AAMC)worked together to develop a nationalstrategy to provide relevant informa-tion on hospital performance to thepublic. The goal was to share hospitalquality information with patients, fam-ilies and communities in a unified, con-sistent manner. Joining the hospitalsand hospital organizations in thisambitious effort were the Centers forMedicare & Medicaid Services (CMS),consumer and employer groups,national healthcare accreditors (includ-ing JCAHO, the Joint Commission onAccreditation of HospitalOrganizations), and others. HospitalCompare is truly a team effort, and isone important tool in improvingpatient safety and quality of care.

For more information, visitwww.hospitalcompare.hhs.gov orwww.medicare.gov and select“Compare Hospitals in Your Area,”or call 1-800-MEDICARE (1-800-633-4227). •


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Arkansas Foundation forMedical Care (AFMC) in lateFebruary announced progress insurgical infection prevention afterthe Archives of Surgery published astudy highlighting the need for bet-ter, more consistent practices toaddress infection risk factors.

The precise timing of adminis-tering antibiotics to prevent surgi-cal infections is critical, but oftennot strictly regulated. AFMC saysit plans to intensify its work withlocal hospitals to redesign proce-dures and protocols so that surgicalpatients are given antibiotics withinsixty minutes before surgery begins,the timeframe most effective for pre-venting infections.

In the Archives of Surgery study,titled “Use of AntimicrobialProphylaxis for Major Surgery:Baseline Results From the NationalSurgical Infection Prevention Project,”researchers found that only a littlemore than half of Medicare beneficiar-ies undergoing major surgery receivedantibiotics in the optimal timeframe.

In the article, researchers report the

results of their analysis of medicalrecords from 2,965 acute care hospi-tals throughout the United States,involving a random sample of 34,133Medicare inpatients undergoing majorsurgeries during 2001, including opencardiac, vascular, colorectal, total hip,total knee, and hysterectomy. Datawas collected in conjunction with the2002 launch of a surgical infectionprevention project jointly sponsoredby the Centers for Medicare &Medicaid Services (CMS) and theCenters for Disease Control andPrevention (CDC).

“AFMC recognizes the impor-tance of this research and, seeingthe opportunity for significantimprovement, already has effortsunderway to address the problemof surgical infection prevention,”said Pamela Brown, inpatientproject manager for AFMC’sHealth Care QualityImprovement Program.

As AFMC works with localhospitals to improve delivery andadministration of preventativeantibiotics, it is reporting wide-

spread successes across the state aswell as plans for an expanded focus onsurgical infection prevention in thenear future.

As part of Medicare’s HospitalQuality Initiative, Quality Improve-ment Organizations (QIOs) likeAFMC promote rapid resolution ofhospital quality issues and sharing of“best practices” to assist hospitals inimproving their quality of care inseveral areas. In addition to surgicalinfection prevention, focus areasinclude heart attack, heart failureand pneumonia. •

Changes in Surgical Procedures NeededAFMC Works with Arkansas Hospitals to Lower Surgical Infection Rates


Eighteen percent of healthcareproviders and 30% of payers report-ed being in compliance with infor-mation-security rules that take effectApril 20 as part of the HealthInsurance Portability andAccountability Act of 1996, accord-ing to a January survey of 400providers and payers.

Fewer organizations said theyexpected to meet the security

requirements by deadline — 74% ofproviders and 80% of payers, downfrom 87% and 91%, respectively, inJune 2004. The results were “sur-prising and worrisome,” saidD’Arcy Guerin Gue, executive vicepresident at information systemsconsultant Phoenix Health Systems,Montgomery Village, Maryland,which conducted the survey withthe Healthcare Information and

Management Systems Society. Providers made no appreciable

progress in recent months, with thesame percentage reporting compliancein January 2005 as in June 2004. Bycontrast, the percentage of payers thatsaid they met security requirementsjumped to 30% in January from 13%last June. Read the survey report atwww.himss.org/content/files/WinterSurvey2005.pdf. •

Most Providers, Payers Not Yet in Compliance as HIPAA Deadline Nears


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A long-lingering $326,000 lawsuitfiled against Ouachita County by theMedical Center of South Arkansas inEl Dorado has been settled to the sat-isfaction of the medical center.

The suit was filed after OuachitaCounty officials refused to pay formedical services provided in 2001 toa Ouachita County woman who,while incarcerated in the UnionCounty Jail on a murder charge,became gravely ill.

The woman was being housed inthe Union County Jail becauseOuachita County does not have facil-ities for female inmates. She received76 days of care at the El Dorado med-ical center, including six or seven sur-geries. She has since died.

Under terms of the settlement,Ouachita County has agreed to paythe medical center $675 for each day

the inmate received care there. Thisamount equates to the medical cen-ter’s Medicaid per diem rate.

In action related to the case, theMedical Center of South Arkansashad also sued Union County.However, Union County wasreleased from the suit after it agreedto pay the medical center $675 aday for the care of its own inmatesin the future.

In 1989, the Arkansas SupremeCourt ruled in yet another ElDorado case that law enforcementagencies are responsible for pay-ment for hospital services providedto inmates.

Yet the Arkansas HospitalAssociation is still getting calls fromhospitals reporting cases in whichcities and counties have “dumped”inmates at hospital doors with

absolutely no intention of paying forservices provided to the inmates.

Acting on a series of unsolicited“advisories” from a Little Rocklawyer—“advisories” that have beenwidely circulated in recent years—there are prosecutors, sheriffs, andothers in the law enforcement com-munity who believe they can “out-smart the system” by taking prison-ers to the hospital, releasing themfrom custody, thereby being releasedfrom liability for medical bills, thentaking these people back into cus-tody after they have been treated.

The Arkansas Hospital Associationhas, on a number of occasions, point-ed out—both to hospital executivesand law enforcement officials—thepotential pitfalls of this practice,including the tragedies and public rela-tions nightmares that could ensue. •

Medical Center, Ouachita County Reach Settlement

Presorted Standard

U.S. Postage PaidLittle Rock, AR

Permit No. 2437

Arkansas Hospital Association419 Natural Resources DriveLittle Rock, AR 72205

Documents

The Health of Arkansas’ Hospitals Hospitals Spr… · It’s the fast way to check: • Eligibility • Benefits • Claims status Call number on 1-800-843-1329 1-800-827-4814 the