Annual Report 2014Agenda 2015-2016

Honoring Our Hospitals’ Heritage in Serving the Nation’s Capital for Over 150 Years

Kurt Newman, MDChairPresident/Chief Executive OfficerChildren’s National Health System

Richard O. Davis, PhDChair-ElectPresidentSibley Memorial Hospital

Barry WolfmanSecretaryChief Executive Officer/Managing DirectorGeorge Washington University Hospital

Charles J. BaumgardnerTreasurerChief Executive Officer/Managing DirectorPsychiatric Institute of Washington

Richard Goldberg, MDImmediate Past ChairPresidentMedStar Georgetown University Hospital

Robert A. Malson, Esq.PresidentDistrict of Columbia Hospital Association

Jim LinharesChief Executive OfficerBridgePoint Hospital Capitol Hill

Kevin ChavezChief Executive OfficerBridgePoint Hospital Hadley

James EdwardsChief Executive OfficerHoward University Hospital

John RockwoodPresidentMedStar National Rehabilitation Hospital

John SullivanPresidentMedStar Washington Hospital Center

Amy Freeman, RNPresident/Chief Executive OfficerProvidence Hospital

Beth Gouse, PhDInterim Chief Executive Officer Saint Elizabeths Hospital

Brian HawkinsMedical Center DirectorVeterans Affairs Medical Center

Andrew L. DavisInterim Chief Executive OfficerUnited Medical Center

At-Large Board Members

Julius Hobson, Jr.Senior Policy AdvisorPolsinelli

John Lynch, MDPhysician

Roderic Woodson, Esq.Partner and Co-Chair, DC PracticeHolland & Knight, LLP

The District of Columbia houses some of the most prominent hospitals and health care systems in the nation, and they were indelibly shaped by the U.S. Civil War. 2015 marks the 150th anniversary of the end of the Civil War with General Lee’s surrender at Appomattox.

Prior to the War, there were five hospitals in existence in the District and they were vastly different than the hospitals of today. At that time, hospitals were for those without family to care for them or the means to pay for in-home visits from physicians. Hospitals frequently included jails and workhouses.

Initially, many assumed the war would be easily won by the Union Army. But in 1861, the Battle of Bull Run showed the Civil War would not end quickly. To care for the overwhelming number of wounded soldiers and civilians, the government turned churches, businesses and houses in Washington into hospitals. During the War, the District housed 53 hospitals, including two thousand cots on the floor of the Capitol Building.

Following the War, hospitals as we know them began to emerge. This Annual Report celebrates the heritage of the District’s hospitals’ evolution from the Civil War, and continued service to the patients in our Nation’s Capital.

Since its inception in 1978, the District of Columbia Hospital Association (DCHA) has advocated on behalf of the District’s hospitals to ensure they are able to thrive and provide residents and visitors of the District of Columbia with the world-class care they deserve. We partner with agencies and legislators to develop policies that have a positive impact on our patients and our hospitals.With the continued changes in health care nationally, DCHA’s member hospitals are collaborating with each other and key stakeholders across the District to

Letter fromBoard Chair and President

“All the District’s hospitals were created to meet the changing needs of the city’s varied citizens…”

raise quality and safety for all patients and their workforces. DCHA member hospitals will achieve this goal through a commitment to innovation, collaboration and a focus on District-specific issues and challenges.

Kurt Newman, MDChair

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Robert A. Malson, Esq.President and CEO

DCHA Board of Directors

DCHA Staff

Robert A. Malson, Esq.President

Dr. Jo Anne NelsonExecutive Vice President and Chief Quality Officer

Valerie A. ParkerChief Administrative Officer

Justin J. Palmer, MPAChief Government Relations and Health Policy Officer

Jacqueline Reuben, MPHChief Epidemiology Officer

Brendan Sinatro, MPHChief Patient Safety Officer

NaTasha WilliamsProfessional Staff Member

JR Meyers, JDChief Government Relations Consultant

Renee DuBiel, CPAChief Financial Consultant

• AmeriHealth Caritas District of Columbia• Aquilla Recovery• Bank of Georgetown• CareFirst BlueCross BlueShield• D.C. Primary Care Association• DECO, LLC• Delmarva Foundation of the District of Columbia• Dixon Hughes Goodman• Epstein Becker & Green, PC• Jackson & Campbell, PC• LifeStar Response• Medical Society of the District of Columbia• MedStar Health• Ober, Kaler, Grimes & Shriver• Perkins+Will• Polsinelli• Powers, Pyles, Sutter & Verville, PC

Associate MembersFounded in 1978, the District of Columbia Hospital Association (DCHA) is a non-profit organization whose mission is to provide leadership in improving the health care system in the District of Columbia, advocating for the interests of member hospitals as they support the interests of the community.

William P. Powell, Jr. was one of the first of only thirteen African American doctors to contract with the Union Army as a surgeon. Of the thirteen, only two received military commissions. The balance were private physicians hired as contract surgeons.

Dr. Powell was assigned to the Contraband Hospital under the leadership of Major Alexander Augusta in May 1863, who later became the Chief Executive Officer of Freedman’s Hospital.

Mission

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• Qualis Health• Southeastrans, Inc• Stericycle• The Chappelle Group• The Meyers Group LLC• Trusted Health Plan• Turner Construction Company• Unity Health Care, Inc.• Washington Regional Transplant Community• WasteStrategies LLC• Wingate, Carpenter & Associates, P.C.

Contraband Hospital, c. 1862

Originally called Camp Barker, a swampy plot of land located at 12th, 13th, R and S Streets N.W. became known as Contraband Camp. The Union Army constructed one-story frame buildings and tents to house and provide care for escaped slaves and black soldiers.

In May 1863, the appointments of Major Alexander Augusta as surgeon-in-charge and Dr. William Powell as assistant surgeon marked the first time African Americans served in leadership positions in a hospital in the United States.

The hospital moved several times, eventually establishing itself at Campbell Hospital and becoming Freedmen’s Hospital.

To this end DCHA will:

• Represent and advocate for its member hospitals;• Provide a forum to solve common problems and achieve common goals;• Assist its members to meet community health care needs; and• Encourage health services research and education.

The Association has been in the forefront of the debate on a wide range of national health issues, and locally, DCHA works closely with government and non-government officials to meet community health needs.

Fighting Harmful Nurse Quota LegislationOn March 3, 2015, five members of the Council of the District of Columbia introduced legislation that, if passed, would cause great harm to hospital operations by imposing strict nursing quotas on hospitals. Since 2013, when ten councilmembers introduced similar legislation, DCHA has worked to educate policy makers about the legislation’s potential for adverse impacts on hospital operations and flexible staffing. All District hospitals currently have staffing models in place, carefully crafted to ensure safe, high-quality

care. These models continuously adjust staffing based on patient need and the experienced judgment of nurses at the bedsides of patients.

Storehouse, U.S. Sanitary Commission, 15th and F Streets NW, April 1865

F Street NW became a center for medicine, during and following the war. Georgetown University founded the School of Medicine in 1851, which was housed in a building on F and 12th Streets NW from 1851 to 1868. President Abraham

AdvocacyUnder current models, staffing is a collaborative process, providing a care team with critical flexibility and opportunity for innovation. The mandated, fixed ratio outlined in the proposed legislation prohibits that flexibility and innovation. Furthermore, there is no evidence supporting the assumption that mandated staffing ratios improve quality of care. The District must stay focused on implementing thoughtful, sustainable and proven solutions if we are to continue to make significant improvements in health care. DCHA will collaborate with legislators and our regulatory partners to oppose mandated ratios and ensure hospitals continue providing safe, high-quality care.

Medicaid Hospital Reimbursement MethodologiesIn 2014, the DC Department of Health Care Finance (DHCF) sought and implemented new Medicaid reimbursement methodologies for acute care and non-acute care hospitals. As part of this methodology update, DHCF is transitioning hospital inpatient reimbursements to an All Patient Refined Diagnosis-Related Group system, a comprehensive system that was designed to account for all payers, patients and ages. Additionally, the Department is implementing the Enhanced Ambulatory Patient Grouping system from 3M for outpatient services.

DCHA will ensure that the implementation of these methodologies is consistent with the modeling produced during consideration

of the proposed methodologies, and that they do not yield unexpected, adverse effects on hospital payments or the District’s budgets.

Eliminating the Bed TaxIn 2010, as a result of budget shortfalls, Mayor Adrian Fenty began imposing an ever-increasing bed tax on hospitals to preserve the District’s Medicaid program and prevent sharp reimbursement reductions. DCHA fought to ensure an end to the bed tax, and successfully worked with District leaders to ensure the sunset of the bed tax at midnight on September 30, 2014. By the end of the tax period, hospitals in the District paid $55.4 million in bed taxes.

Increasing Reimbursement Rates Working with the Department of Health Care Finance and the Mayor’s office, DCHA was able to secure the first increase in outpatient reimbursement rates in more than a decade. In FY13, the outpatient reimbursement rate was 49% and was raised for FY15 to 77%. With the 28% increase, the District’s hospitals still lose, on average, $0.23 of every $1 spent on delivering outpatient care.

In order to increase reimbursement rates to near cost, DCHA, in cooperation with the executive and legislative branches of the District Government, is seeking a provider fee mechanism. Through this mechanism (which is already in effect in 38 states), the District’s hospitals contribute to the District’s Medicaid budget, which increases the amount of matching Federal Medicaid funds that the District receives. This, in turn, enables the District to strengthen the Medicaid program for its beneficiaries and supplement insufficient hospital outpatient reimbursements.

Facilitating the ICD-9/ICD-10 TransitionHospital billing begins with proper coding of procedures or services performed. That coding is changing due to a federally mandated transition to a new, more detailed set of billing codes. Given the October 2015 transition deadline, DCHA maintains a sense of urgency to support hospitals in managing this transition.

DCHA has worked with the hospitals and our associate members to identify various vendors who may be able to make the process easier and less expensive for our members. DCHA has partnered with the Medical Society of the District of Columbia and the New Jersey Hospital Association to offer ICD-10 coding workshops for specialty specific practices throughout 2015 to assist District providers though this complex transition, and we will work with the Department of Health Care Finance

and the Medicaid Managed Care Organizations to facilitate a smooth transition to ICD-10.

Protecting Access to Care at the United Medical Center (UMC)UMC is the only acute care hospital east of the Anacostia River and serves the residents of wards 7 & 8 along with their neighbors in Maryland. The District has invested heavily in the facility both before and after the city purchased the hospital July 2010. The President of DCHA holds a seat on the hospital’s Board and has collaborated with the hospital’s CEO, other Board members and various public officials to successfully stabilize the hospital’s operations and finances.

The District government is currently in the process of deciding the future of the hospital. To this end, the District engaged a consulting firm to develop and implement a plan to turnaround the hospital’s finances. DCHA will remain involved in the citywide conversation regarding the future of the hospital.

Fair Criminal Record Screenings ActThe Council of the District of Columbia explored ways to address the reintegration of the growing number of ex-offenders returning to the city. On January 7, 2014, Councilmember Tommy Wells introduced the Fair Criminal Record Screening Act of 2014. The bill prohibited employers from asking about criminal history on an employment application, and only permit criminal history questions after a conditional offer is extended.

During the bill’s consideration, the District’s hospitals emphasized their responsibility to provide care for countless District residents from all walks of life with two things in common: they are sick and they are in need. Working with the Council,

DCHA successfully spearheaded efforts to exempt facilities providing direct care to minors and vulnerable adults from this legislation in recognition of the especially vulnerable populations they serve.

Minimizing Medicare & Medicaid Disproportionate Share Hospital (DSH) Funding Reductions The Medicare and Medicaid DSH programs were designed to provide vital financial support to hospitals that serve high volumes of poor patients. Under the assumption that expanding Medicaid and access to affordable insurance would reduce the number of uninsured individuals accessing hospital care, the Patient Protection and Affordable Care Act (ACA) called for reductions in DSH payments. Unfortunately, the ACA also allows states to expand Medicaid at their discretion, which jeopardizes the ability of the law to reduce the number of uninsured.

DCHA successfully advocated for Department of Health Care Finance to fully fund the DSH program in 2014 and 2015, and is committed to do so in the future.

Preserving Access to Institutions for Mental DiseaseFor the past three years, DCHA member hospitals have been able to transfer Medicaid Fee-for-Service patients who present in their emergency departments (ED) and who need to be hospitalized with a psychiatric disorder to Institutions for Mental Disease (IMD) under a Federal Demonstration Program. Unfortunately, this federal program ended on April 30, 2015.

The program was created to enable health care facilities to refer patients in the age group 21-64 with Fee-for-Service Medicaid to free-standing psychiatric hospitals. Prior to this program, free-standing psychiatric facilities were not reimbursed due to a law created in the 1960s. As a result of the completion of the program, our member hospitals are no longer able to use IMDs as a resource to reduce the burden on their EDs.

Even with this program, District hospitals have experienced a significant increase in ED visits involving psychiatric conditions creating significant placement delays and overcrowding. DCHA and its members are concerned that without the ability to refer these patients to IMDs our hospitals will experience further over-crowding in their emergency departments and lengthy delays for placements. Deputy Mayor for Health and Human Services, Brenda Donald, is working with our member hospitals to quantify the impact, laying the groundwork for requesting a waiver from the Centers for Medicare and Medicaid Services in the future.

Lincoln’s doctor, Robert King, lived and housed his medical office at the corner of F and 14th Streets NW, the headquarters for the Medical Society of the District of Columbia was built on F Street near the corner of 10th Street NW in 1868, and Children’s Hospital opened in a twelve-bed facility on F at 13th Street NW in 1870.

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U.S. Sanitary Commission Group, c. 1865

A non-profit, volunteer organization, the U.S. Sanitary Commission provided support to the military and built hospitals during the Civil War.

Fighting Harmful Nurse Quota LegislationOn March 3, 2015, five members of the Council of the District of Columbia introduced legislation that, if passed, would cause great harm to hospital operations by imposing strict nursing quotas on hospitals. Since 2013, when ten councilmembers introduced similar legislation, DCHA has worked to educate policy makers about the legislation’s potential for adverse impacts on hospital operations and flexible staffing. All District hospitals currently have staffing models in place, carefully crafted to ensure safe, high-quality

care. These models continuously adjust staffing based on patient need and the experienced judgment of nurses at the bedsides of patients.

Dr. Charles Leale, c. 1865

Dr. Leale was the first surgeon to arrive at Lincoln’s box in Ford’s Theater following the shooting by John Wilkes Booth. A 23-year-old surgeon, he was in charge of the Wounded Commissioned Officers' Ward at the United States Army General Hospital in Armory Square and had graduated medical school just six weeks earlier.

Dr. Carlos Carvallos, c. 1862

Carlos Carvallo, MD was the head of Douglas Hospital and later appointed U.S. Assistant Surgeon in 1867. He wrote an account of his service called Ten Days in the Army of the Potomac. Researchers from the Smithsonian Institution discovered around 2010 that he is buried in the Causten Vault in the Congressional Cemetery on Capitol Hill.

Douglas & Stanton Hospitals, c. 1864

Under current models, staffing is a collaborative process, providing a care team with critical flexibility and opportunity for innovation. The mandated, fixed ratio outlined in the proposed legislation prohibits that flexibility and innovation. Furthermore, there is no evidence supporting the assumption that mandated staffing ratios improve quality of care. The District must stay focused on implementing thoughtful, sustainable and proven solutions if we are to continue to make significant improvements in health care. DCHA will collaborate with legislators and our regulatory partners to oppose mandated ratios and ensure hospitals continue providing safe, high-quality care.

Medicaid Hospital Reimbursement MethodologiesIn 2014, the DC Department of Health Care Finance (DHCF) sought and implemented new Medicaid reimbursement methodologies for acute care and non-acute care hospitals. As part of this methodology update, DHCF is transitioning hospital inpatient reimbursements to an All Patient Refined Diagnosis-Related Group system, a comprehensive system that was designed to account for all payers, patients and ages. Additionally, the Department is implementing the Enhanced Ambulatory Patient Grouping system from 3M for outpatient services.

DCHA will ensure that the implementation of these methodologies is consistent with the modeling produced during consideration

of the proposed methodologies, and that they do not yield unexpected, adverse effects on hospital payments or the District’s budgets.

Eliminating the Bed TaxIn 2010, as a result of budget shortfalls, Mayor Adrian Fenty began imposing an ever-increasing bed tax on hospitals to preserve the District’s Medicaid program and prevent sharp reimbursement reductions. DCHA fought to ensure an end to the bed tax, and successfully worked with District leaders to ensure the sunset of the bed tax at midnight on September 30, 2014. By the end of the tax period, hospitals in the District paid $55.4 million in bed taxes.

Increasing Reimbursement Rates Working with the Department of Health Care Finance and the Mayor’s office, DCHA was able to secure the first increase in outpatient reimbursement rates in more than a decade. In FY13, the outpatient reimbursement rate was 49% and was raised for FY15 to 77%. With the 28% increase, the District’s hospitals still lose, on average, $0.23 of every $1 spent on delivering outpatient care.

In order to increase reimbursement rates to near cost, DCHA, in cooperation with the executive and legislative branches of the District Government, is seeking a provider fee mechanism. Through this mechanism (which is already in effect in 38 states), the District’s hospitals contribute to the District’s Medicaid budget, which increases the amount of matching Federal Medicaid funds that the District receives. This, in turn, enables the District to strengthen the Medicaid program for its beneficiaries and supplement insufficient hospital outpatient reimbursements.

Facilitating the ICD-9/ICD-10 TransitionHospital billing begins with proper coding of procedures or services performed. That coding is changing due to a federally mandated transition to a new, more detailed set of billing codes. Given the October 2015 transition deadline, DCHA maintains a sense of urgency to support hospitals in managing this transition.

DCHA has worked with the hospitals and our associate members to identify various vendors who may be able to make the process easier and less expensive for our members. DCHA has partnered with the Medical Society of the District of Columbia and the New Jersey Hospital Association to offer ICD-10 coding workshops for specialty specific practices throughout 2015 to assist District providers though this complex transition, and we will work with the Department of Health Care Finance

and the Medicaid Managed Care Organizations to facilitate a smooth transition to ICD-10.

Protecting Access to Care at the United Medical Center (UMC)UMC is the only acute care hospital east of the Anacostia River and serves the residents of wards 7 & 8 along with their neighbors in Maryland. The District has invested heavily in the facility both before and after the city purchased the hospital July 2010. The President of DCHA holds a seat on the hospital’s Board and has collaborated with the hospital’s CEO, other Board members and various public officials to successfully stabilize the hospital’s operations and finances.

The District government is currently in the process of deciding the future of the hospital. To this end, the District engaged a consulting firm to develop and implement a plan to turnaround the hospital’s finances. DCHA will remain involved in the citywide conversation regarding the future of the hospital.

Fair Criminal Record Screenings ActThe Council of the District of Columbia explored ways to address the reintegration of the growing number of ex-offenders returning to the city. On January 7, 2014, Councilmember Tommy Wells introduced the Fair Criminal Record Screening Act of 2014. The bill prohibited employers from asking about criminal history on an employment application, and only permit criminal history questions after a conditional offer is extended.

During the bill’s consideration, the District’s hospitals emphasized their responsibility to provide care for countless District residents from all walks of life with two things in common: they are sick and they are in need. Working with the Council,

DCHA successfully spearheaded efforts to exempt facilities providing direct care to minors and vulnerable adults from this legislation in recognition of the especially vulnerable populations they serve.

Minimizing Medicare & Medicaid Disproportionate Share Hospital (DSH) Funding Reductions The Medicare and Medicaid DSH programs were designed to provide vital financial support to hospitals that serve high volumes of poor patients. Under the assumption that expanding Medicaid and access to affordable insurance would reduce the number of uninsured individuals accessing hospital care, the Patient Protection and Affordable Care Act (ACA) called for reductions in DSH payments. Unfortunately, the ACA also allows states to expand Medicaid at their discretion, which jeopardizes the ability of the law to reduce the number of uninsured.

DCHA successfully advocated for Department of Health Care Finance to fully fund the DSH program in 2014 and 2015, and is committed to do so in the future.

Preserving Access to Institutions for Mental DiseaseFor the past three years, DCHA member hospitals have been able to transfer Medicaid Fee-for-Service patients who present in their emergency departments (ED) and who need to be hospitalized with a psychiatric disorder to Institutions for Mental Disease (IMD) under a Federal Demonstration Program. Unfortunately, this federal program ended on April 30, 2015.

The program was created to enable health care facilities to refer patients in the age group 21-64 with Fee-for-Service Medicaid to free-standing psychiatric hospitals. Prior to this program, free-standing psychiatric facilities were not reimbursed due to a law created in the 1960s. As a result of the completion of the program, our member hospitals are no longer able to use IMDs as a resource to reduce the burden on their EDs.

Even with this program, District hospitals have experienced a significant increase in ED visits involving psychiatric conditions creating significant placement delays and overcrowding. DCHA and its members are concerned that without the ability to refer these patients to IMDs our hospitals will experience further over-crowding in their emergency departments and lengthy delays for placements. Deputy Mayor for Health and Human Services, Brenda Donald, is working with our member hospitals to quantify the impact, laying the groundwork for requesting a waiver from the Centers for Medicare and Medicaid Services in the future.

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Prior to the Civil War, there were no trained female nurses in the United States. Military and societal protocols prohibited women from field hospitals, though the increasing number of casualties created a demand that required change. It is estimated that between 2,000-5,000 women volunteered.

Nursing was a gruesome job during the War, between a lack of medical professionalism and primitive facilities. Early in the War, women showed up at field hospitals to help. Following the Battle of Bull Run in July 1861, Clara Barton and Dorothea Dix organized a nursing corps.

Dorothea Dix, c. 1853

Dorothea Dix, a pioneer in reforming treatment for mental illness, staged a march on Washington in April 1861 to demand the government allow women to help Union soldiers. Soon after, she was named Superintendent of Female Nurses for the U.S. Army by Secretary of War Simon Cameron. Known for her exacting standards, she was also compassionate and giving. Dix and her nurses cared for Union and Confederate soldiers alike.

Clara Barton, c. 1863

Clara Barton worked at the U.S. Patent Office when the war broke out. Acting on her own, she began to appear on battlefields with clothing, medicine and supplies to nurse the sick and wounded soldiers. She was nicknamed ‘Angel of the Battlefield’, and in 1881 she founded the American Red Cross.

Hannah Ropes, Louisa May Alcott and the Union Hotel Hospital, M and 30th Streets NW

A native of Maine, Hannah Ropes became Matron of the Union Hotel Hospital in Georgetown in 1862. Known as a reformer and abolitionist before the war, she used her social standing and connections to procure supplies and necessities for the wounded soldiers. The Hotel, a tavern hastily converted to a hospital like many of the buildings in the city, had appalling conditions and she frequently butted heads with the military and the hospital’s physicians.

Louisa May Alcott worked briefly at the hospital, and achieved literary success with Hospital Sketches, a collection of letters she sent home where she described her experience, including the mismanagement of the hospital and the callousness of some of the surgeons. She described Matron Ropes as bringing “… more comfort to many a poor soul, than the cordial draughts she administered, or the cheery words that welcomed all, making of the hospital a home.”

In January 1863, both women contracted typhoid pneumonia. Following Matron Ropes’ death on January 20, Ms. Alcott returned home to Boston and a lengthy recovery.

The Inestimable Contribution of Nurses

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The Board Quality Initiative capitalizes on hospital-specific efforts to raise quality while building collaborative networks among the city’s key stakeholders that serve our patient populations. The primary goal is to improve outcomes while lowering costs.

The Board Quality Initiative starts with identifying and addressing specific issues unique to the region – while the District of Columbia is compared to other states, we are a city with a broad diversity and disparity in both our hospitals and patient populations. Unlike other states, all of our member hospitals are surrounded by hospitals located in two other states only a few miles, if not blocks, away.

DCHA hospitals chose two areas of focus for working collaboratively to raise quality – behavioral health and heathcare-associated infections.

Behavioral Health Nationally, years of cuts to funds for behavioral health care have created a system in which patients fill emergency departments (ED), rather than a medically appropriate facility. According to the American Hospital Association, mental health and substance abuse account for 4% of ED visits, with almost 5.5 million visits per year.

In the District, the increase of ED patients seeking narcotic medications and those with complex psychosocial issues, e.g. homelessness coupled with medical, psychiatric and substance abuse disorders, is creating a strain on member hospitals, their medical teams, and patients. The results include repeated inpatient readmissions, disruption of care delivery, delayed patient discharge processes, as well as the negative impacts on the patients, their families and the community.

DCHA and hospital members have created a cross-functional workgroup with medical directors, psychiatrists, psychologists, nursing staff, case managers, social workers, and key stakeholders in the community. The workgroup is focused on solving District-specific issues to reduce mental health readmissions and improving clinical outcomes.

Board of Directors’ Quality Initiative

Healthcare-Associated InfectionsHealthcare-associated infections (HAIs), those acquired during treatment in a health care setting for a different condition, result in increased costs and risks for patients and health care providers. Nationally, organizations like the Centers for Disease Control are increasing their focus on multi-drug resistant organisms (MDRO).

Each year, over 2,000,000 infections occur from MDROs with over 23,000 deaths. Carbapenem-resistant Enterobacteriaceae (CRE), kills up to half of the people with bloodstream infections.

District hospitals are committed to improving and optimizing infection control and strategies for surveillance, prevention, and control of healthcare-associated infections and multi-drug resistant organisms. They are working together and with multiple stakeholders to focus efforts and leverage best practices to improve outcomes.

A collaborative hospital-wide Hand Hygiene Initiative has been implemented to improve existing hospital efforts in promoting and monitoring hand hygiene with the intended outcome of reducing HAIs. DCHA, Delmarva Foundation Washington, D.C., the Association for Professionals in Infection Control and Epidemiology and the Department of Health have formed a HAI Collaborative with the intention of focusing efforts to design and implement initiatives and improve infection control.

In 2015, member hospitals, District nursing facilities, the DC Public Health Laboratory and the Department of Health agreed to implement a point prevalence study to learn more about CRE in our local population and patients. With this study, and future efforts, these healthcare teams hope to learn more about the scope of the challenge CRE presents locally, the type of strains present, best treatments available for those strains, and more about the transmission and prevention of transmission and eradication of the organisms within our healthcare facilities.

Ambulance Shop, Harewood Hospital, 1863

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Testimony in support of PR20-0523, the “Director of the Department of Health Joxel Garcia Confirmation Resolution of 2013” – The Committee on Health, Councilmember Yvette M. Alexander, January 8, 2014

Letter providing comments on the “Fair Criminal Record Screening Act of 2014” – The Committee on the Judiciary and Public Safety, Councilmember Tommy Wells, February 17, 2014

Letter providing comments on the performance of the Department of Health Care Finance in FY14 – The Committee on Health, Councilmember Yvette M. Alexander, March 8, 2014

Testimony for the Department of Health Care Finance’s FY15 Budget as submitted by the Mayor – The Committee on Health, Councilmember Yvette M. Alexander, April 29, 2014

Letter providing comments on the Board of Pharmacy’s draft proposed regulations concerning pharmacy technicians – Daphne Bernard, PharmD, Rph, Chairperson, Board of Pharmacy, May 29, 2014

Plan of the City of Washington,Pierre Charles L’Enfant, 1792

View from U.S. Capitol, Armory Square Hospital (center) and Tiber Creek (Washington City Canal), 1863

Originally conceived as part of the L’Enfant Plan for the city of Washington, the canal was intended to be a key artery connecting the Potomac and the Eastern Branch of the Potomac (Anacostia River) to the city center. The canal started at 17th Street NW and traveled along the Mall in front of the White House, to the front of the Capitol Building, and turned south at 3rd Street toward the Anacostia. By the Civil War, the canal had become a health hazard, with public buildings, including the White House and the Capitol, dumping its waste into it. The poet, Walt Whitman, called the canal a ‘fetid bayou…reeking with pestilential odors.’

Typhoid, malaria and dysentery were the leading diseases of the war, due to both the lack of sanitation inside the hospitals and the surrounding areas. By 1880, much of the canal had been covered. A stone lockkeeper’s house still stands at 17th Street and Constitution NW where a branch of the C & O Canal connected to the Washington City Canal.

Testimonies and CommentsTestimony on B20-0289, the “Clinical Laboratory Practitioners Amendment Act of 2013” – The Committee on Health, Councilmember Yvette M. Alexander, July 2, 2014

Letter providing comments on B20-0757, the “Wage Transparency Amendment Act of 2014” – The Committee on the Judiciary and Public Safety, Councilmember Tommy Wells, July 8, 2014

Letter commenting on B20-0573, the Sustainable DC Omnibus Act of 2013 – The Committee on Transportation and the Environment, Councilmember Mary M. Cheh, July 10, 2014

Testimony on B20-646, the “Medical Imaging Assistants Amendment Act of 2014” – The Committee on Health, Councilmember Yvette M. Alexander, October 9, 2014

Letter committing the Association’s support to Mayor-Elect Muriel Bowser’s mayoral transition – The Health, Human Services & Homelessness Committee, Transition Office of Mayor-Elect Muriel Bowser, Laura Meyers & Louvenia Williams, Co-Chairs, December 2, 2014

Testimony on the Proposed Merger of Pepco Holdings, Inc. and Exelon – Public Service Commission of the District of Columbia, December 17, 2014

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Government Relations/Financial PolicyThe Government Relations/Financial Policy Committee develops DCHA’s positions on legislative and financial policy matters before the legislative or executive branches of the District government, advises on federal issues of interest, and monitors financial issues that affect hospitals.

DCHA Staff: Justin Palmer, Chief Government Relations and Health Policy OfficerCo-Chair: Ruth Pollard, AVP Community Network and Government Relations, Providence HospitalCo-Chair: Aarti Subramanian, Director of Government Affairs and Business Development, Psychiatric Institute of Washington

Human Resources The Human Resources Committee looks at hospital employment issues, with special attention to health professional shortage concerns, as well as licensure and regulatory difficulties.

DCHA Staff: Justin Palmer, Chief Government Relations and Health Policy OfficerCo-Chair: Matthew Lasecki, Vice President, Human Resources, Providence HospitalCo-Chair: Queenie Plater, Vice President, Human Resources for the Johns Hopkins Medicine Community Division

Infectious Disease/Infection Control The Infectious Disease/Infection Control Committee evaluates the latest scientific and medical positions on viral and biologic threats and diseases, and develops response recommendations and protocols for the region.

DCHA Staff: Dr. Jo Anne Nelson, Executive Vice President and Chief Quality OfficerCo-Chair: Angella Browne, Infection Control Specialist, Howard University HospitalCo-Chair: Mary McFadden, Director, Infection Control, MedStar Georgetown University Hospital

Committees

Harewood Hospital, c. 1862, was located on 7th Street NE on the farm of W.W. Corcoran, founder of the Corcoran Gallery of Art.

Information Resources and Planning

The Information Resources and Planning Committee sets the policies for the DCHA Patient Data Program and data releases to government and other entities.

DCHA Staff: Dr. Jo Anne Nelson, Executive Vice President and Chief Quality OfficerCo-Chair: Paul Shapin, Assistant Vice President, Information Services MedStar HealthCo-Chair: Christine Stuppy, Vice President, Strategic Planning, Community Division, National Capital Region, Johns Hopkins Medicine

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Medical DirectorsThe Medical Directors Committee oversees clinical policy concerns, patient safety efforts, physician licensure and other related issues.

DCHA Staff: Dr. Jo Anne Nelson, Executive Vice President and Chief Quality OfficerCo-Chair: Gary Little, MD, Medical Director, George Washington University HospitalCo-Chair: Lawrence Ramunno, MD, Vice President of Medical Affairs and Chief Medical Officer, Sibley Memorial Hospital

Quality and Patient SafetyThe Quality and Patient Safety Committee focuses on a broad range of issues—including health care quality, patient safety, measuring outcomes and public reporting of results—to elevate the quality, safety, efficiency and effectiveness of patient care.

DCHA Staff: Dr. Jo Anne Nelson, Executive Vice President and Chief Quality OfficerCo-Chair: Lisbeth Fahey, RN, MSN, Executive Director, Performance Improvement, Children’s National Health SystemCo-Chair: Judith Zdobysz, Quality Manager, MedStar National Rehabilitation Hospital

U.S. Capitol Under Construction, 1860

The U.S. Capitol was turned into a hospital in 1862 from September to November with over two thousand cots in the Rotunda and the House and Senate chambers. A section of the U.S. Patent Office was used as a hospital from October 1861 to March 1863, and a hospital,

set up on the grounds of the White House south of the Mansion, was called the Reynolds Barracks Hospital.

AcknowledgementsAngel Price • BlackPast.org • Carlton Fletcher • Civil War Saga • Civil War Washington • Civil War Women

History Net • Library of Congress • National Archives • U.S. National Library of Medicine

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DCHA Financials

Notes:

1. The audited financial statements "fairly represent, in all material respects, the operations and financial condition of the District of Columbia Hospital Association."2. The District of Columbia Hospital Association maintains a system of internal accounting controls and procedures to provide reasonable assurance that assets are safeguarded and that transactions are authorized, recorded and reported properly. The system of internal safeguards is characterized by a control-oriented environment that includes written policies and procedures, careful selection and training of personnel, and audits by a professional accounting firm.3. The 2014 audited financial statements were accepted by the DCHA Board of Directors on July 23, 2015.

2010$3.16M

2011$4.17M

2012$2.17M

2013$2.50M

2014$2.88M

0

$0.5M

$1M

$1.5M

$2M

$1.3

3M

$1.0

9M

$1.7

4M$1

.09M

$0.3

3M

$0.0

1M$0

.83M $0

.95M

$0.7

2M $0.8

3M

$0.7

2M

$0.8

3M

$1.7

0M$0

.95M

$1.5

2M

Member ServicesGeneral and AdministrativeSpecial Programs

OperatingExpenses

Hospital DuesAssociate Member DuesSpecial Programs and GrantsInterest Income

Revenue

2010$2.96M

2011$3.89M

2012$2.25M

2013$2.53M

2014$2.94M

0

$0.5M

$1M

$1.5M

$2M

$2.5M

$1.7

4M

$1.2

4M$0

.06M

$1.6

4M

$0.0

3M

$0.0

5M

$0.6

8M

$1.7

9M$0

.053

M

$1.6

9M$0

.05M

$2.1

4M

$0.0

47M

$0.4

9M

$2.4

0M

$0.0

1M

$0.0

1M

$0.0

1M

$0.0

1M

$0.4

5M

1152 15th Street NWSuite 900Washington, DC 20005Phone: 202.682.1581 Fax: 202.371.8151

www.dcha.org