aha chairman on “defining moments,” katrina, and ... final.… · call number on 1-800-843-1329...

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

WINTER 2006 www.arkhospitals.orgWINTER 2006 www.arkhospitals.org

Special Section:Katrina Revisited

AHA Chairman on “Defining

Moments,”Katrina, and

Challenges to Healthcare

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Winter 2006 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 DIRECTORSRobert Atkinson, Pine Bluff / Chairman

Ray Montgomery, Searcy / Chairman-Elect

Luther Lewis, El Dorado / Treasurer

Timothy E. Hill, Harrison / Past-Chairman

Robert R. Bash, Warren / At-Large

David Cicero, Camden

Ann Cloud, Siloam Springs

David Dennis, Berryville

Dan Gathright, Arkadelphia

Michael D. Helm, Fort Smith

Ed Lacy, Heber Springs

James Magee, Piggott

Larry Morse, Clarksville

John Neal, Stuttgart

Richard Pierson, Little Rock

John N. Robbins, Conway

Steve Smart, El Dorado

Russ Sword, Crossett

EXECUTIVE TEAMPhil E. Matthews / President and CEO

Robert “Bo” Ryall / 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.

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Edition 53

Arkansas Hospitals

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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

WINTER 2006 www.arkhospitals.orgWINTER 2006 www.arkhospitals.org

Special Section:Katrina Revisited

AHA Chairman on “Defining

Moments,”Katrina, and

Challenges to Healthcare

Cover Photo Arkansas StateCapitol at Christmas, Little Rock

Photo by ArkansasDepartment of Parks and Tourism

The Uninsured

Katrina Revisited

Departments

Quality/Patient Safety

Hospital Quality Improvement Indicators14

Hospitals’ National Ranking Rises14

Physician Voluntary Reporting Begins15

Two AR Hospitals Earn Quality Awards16

Surgical Care Improvement Project16

CMS Releases HCAHPS Survey17

Cancer Death Rates Continue to Decline17

New Breast Cancer Treatment from UAMS17

Electronic Health Records

Survey: Costs are HIT Barrier31

Health IT Could Save $162 Billion31

Rules Bolster E-prescribing, EHRs31

New AHA Chairman on “Defining Moments,” Katrina, and Challenges to Healthcare 24

AHA Annual Meeting: Awards Presented33

75 Years of AHA History… A Look Back Part 241

AHRQ Releases New Data on Uninsured12

Difficulty Paying Medical Bills Increases12

Medicaid Discussions with State Officials12

ER Visits Up 26% Since 199313

Arkansas Under Emergency Declaration20

Agreement Eases Nurse Licensure Delays19

Katrina Hits Home for Chairman’s Son20

Chef’s New Home at Ouachita Med Center21

Prudhomme Salutes Pine Bluff Connection23

St. Edward Mercy Provides Assistance27

Regional Networks Made a Difference28

Education Calendar6

From the President4

Arkansas Newsmakers and Newcomers7

Charity Care Understated by Hospitals13

PAGE 33

News — STAT!

AHA/JCAHO Resolve Confidentiality Issues10

Hospitals Intervene in JCAHO Recommendation11

2006 AHA Strategies9

Medicare FY 2006 OPPS Final Rule10

Change for Section 1011 Billing Data11

New Report on Critical Access Indicators11

US Philanthropic Giving Back on the Rise11

Records Retention Rules : a Reminder29

Legal Issues in Life-Limiting Conditions46

Report Lists Electronic Record Needs30

4 Winter 2006 I Arkansas Hospitals

Every day, we hop into our cars and speed off downlife’s highways…that is, until the car doesn’t work. All ofa sudden, we’re in a frenzy. Our schedules are shot, our

nerves are frayed, and it feelslike our personal indepen-dence is up for grabs. We getthe car fixed and vow wewill never take our vehiclefor granted again.

Isn’t it true for all of us?We take so many things inlife for granted. Our cars,electrical power, clean water,traffic signals, phone service,our hospitals.

It’s true, some peopleeven take our hospitals forgranted; that is, until theirown health or that of a lovedone makes a hospital visit

necessary. At such a time, the hospital’s caring doctorsand nurses, its many and varied technicians, and its gov-erning board and administrators all become heroes.

But those of us whose lives are entwined with thehealthcare field never take our hospitals for granted. Wework — you work — every day to keep the communityaware of the hospital’s vital presence, the economic back-bone it affords, the further economic development its verypresence can attract. You know how much your commu-nity would suffer if your hospital was not there.

It’s no secret that hospitals across our nation, and cer-tainly here in Arkansas, are facing tough financial times.As someone who believes in and follows Arkansas’ hospi-tals, you know what the cost of continually providingmore and more uncompensated care is doing to the bot-tom line — our hospitals’ ability to keep the doors open.

According to a recent study by the Arkansas Center forHealth Improvement, 17% of Arkansans did not havehealth insurance in 2004. The numbers keep climbing —though most of the uninsured are people working hard ateither full- or multiple part-time jobs.

In Arkansas alone, uninsured patients accounted for$354 million in hospital bills in 2003, the last year forwhich data is available. According to recent comparativestatistics, charity care and bad debt for Arkansas hospitals

totaled $390 million in 2000, and grew to a whopping$475 million by 2003.

The number of patients coming to our hospitals withno way to pay their bill is on a rapid rise, and so is the costof that care. Hospitals can only provide care without pay-ment for a limited time before they can no longer affordto stay open.

What can be done? The answer is good communica-tion. Each of us involved in the healthcare field —trustees, administrators, physicians, nurses, technicians,support staff, auxilians and the AHA alike — all continueto work with our legislators so they understand the direneed for raising Arkansas’ Medicaid per diem reimburse-ment, which has not been raised for nearly ten years.

But grassroots communication is also key. We mustkeep our communities well informed about the many serv-ices our hospitals eagerly provide to hometown folks —services too often taken for granted. And especially inthese tough financial times, Arkansans need to be remind-ed of the financial struggle hospitals face, and the reasonsbehind that struggle.

Informed citizens tend to partner with their hospitals infinding ways to raise funds, to be wiser in the use ofhealthcare, to create solutions so all in the communityreceive the medical care they need. When citizens remem-ber that “the” hospital is “their” hospital, no longer tak-ing it for granted, a very precious partnership forms.

As one who is involved in the healthcare field, your rolein continually carrying the message to the community isvital, especially in tough financial times! I urge you to talkwith your legislators, your local service club members,friends at the grocery store and people at the barber shop.Remind folks of how vital their local hospital is to thecommunity. When you do so, you ensure that your hos-pital will never be taken for granted.

Arkansas’ Hospitals — Never Take Them for Granted!

Phil E. MatthewsPresident and CEO Arkansas Hospital Association

F R O M T H E P R E S I D E N T

The U.S. DEPARTMENTOF HEALTH AND HUMAN

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January 10, BismarckCoding Update 2006 Workshop

January 25, Little RockA Day with the Lawyers Workshop

January 30, Little RockAPC 2006 Coding UpdateWorkshop

February 1-3, Tunica, MSHealthcare Financial ManagementAssociation Tri-State Meeting

March 9, Little RockCompliance Forum

March 27-30, ChicagoAmerican College of Healthcare

Executives Congress onHealthcare Leadership

April 5-7, Hot SpringsHealthcare Financial Management

Association Workshop

April 30-May 3, Washington, D.C.American Hospital Association

Annual Meeting

May 3-5, Hot SpringsSociety for Arkansas Healthcare

Purchasing and MaterialsManagement

June 14-16, Branson, MOArkansas Hospital Administrators

Forum Summer LeadershipConference

August 16, Little RockCompliance Forum

August 16, Little RockContinuous Service ReadinessWorkshop

August 16-18, Hot SpringsHealthcare Financial ManagementAssociation Workshop

October 4-6, Little RockArkansas Hospital Association

76th Annual Meeting and Trade Show

Program information available at www.arkhospitals.org

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ARKANSAS NEWSMAKERSandNEWCOMERS

James R. (Jamie) Carter has been named CEO ofCrittenden Memorial Hospital in West Memphis,effective November 7. He succeeds Ross Hooper, whoretired in September. Before moving to WestMemphis, Carter was administrator of NorthMississippi Medical Center in Iuka. He previouslyheld administrative positions with the NorthMississippi Physicians Association, YalobushaGeneral Hospital and Nursing Home and theQuitman County Hospital.

Governor Mike Huckabee has appointed SteveErixon, CEO of Baxter Regional Medical Center inMountain Home, to the Governor’s Trauma AdvisoryCouncil. His term expires July 1, 2009. TheGovernor also appointed C. C. McAllister to theEmergency Medical Services Advisory Council.McAllister, CEO of Ouachita Valley Health System inCamden, will serve until July 1, 2008.

Herbert K. “Kirk” Reamey, CEO of Ozark HealthMedical Center in Clinton, has been elected to a sec-ond three-year term as a Section for Small or RuralHospitals delegate to the American HospitalAssociation’s Regional Policy Board 7. His termexpires December 31, 2008.

Ben Owens, president and CEO of St. BernardsHealthcare in Jonesboro, was recently selected BusinessExecutive of the Year by the College of BusinessAlumni Chapter of Arkansas State University inJonesboro. Owens served as administrator/president ofSt. Bernards Medical Center for many years, beforemoving to the corporate office of the organization.

Jim Richardson, president and CEO of SalineMemorial Hospital in Benton, has been elected to theArkansas Hospital Association Workers’Compensation Self-Insured Trust board of directors.He succeeds Eugene Zuber of Newport and will serveuntil the 2006 annual meeting.

Stephen Smart, DDS, of El Dorado, has been appoint-ed an at-large member of the American HospitalAssociation’s Committee on Governance. His termwill expire in December 2008. Smart currently serveson the Arkansas Hospital Association board of direc-tors representing the Arkansas Association of HospitalTrustees, for which he is president.

Robert R. Bash was named administrator of BradleyCounty Medical Center in Warren October 27, afterhaving served as assistant administrator sinceDecember 2003. He succeeded long-time administra-tor Harry Stevens. Prior to moving to Warren, Bashwas administrator of Booneville Community Hospitaland was also rural administrator of Sparks HealthSystem in Fort Smith. Bash is a past-chairman of theAHA and currently serves on the AHA board as thedirector at-large.

I N M E M O R I A MThe Arkansas Hospital Association (AHA) losta longtime friend and colleague Saturday,October 15 with the death of Harry H. Stevens,administrator of Bradley County MedicalCenter (BCMC) in Warren. He was 80 yearsold. Stevens, a Korean War veteran, was a 40-year resident of Warren. He owned and operat-ed the Pine Lodge Nursing Home there from1965 until 1975, when he sold the nursing homeand began his career at BCMC. Stevens hadserved as the administrator at BCMC since1986. In June 2004, Harry received the AHA’sChairman’s Award in recognition of his serviceand contributions to BCMC and to the AHA, aswell as to the city of Warren and other parts ofsoutheast Arkansas.

Edward Rensch, Jr., former president and CEOof the Central Arkansas Radiation TherapyInstitute (CARTI) in Little Rock from 1983-1994, died September 2. Rensch’s career inhealthcare spanned almost 40 years. After mov-ing to Little Rock in 1966, Rensch was assistantadministrator for St. Vincent Infirmary beforebeing named by Gov. Winthrop Rockefeller in1967 as director of the ArkansasComprehensive Health Planning Agency. Healso served as associate coordinator of theArkansas Regional Medical Program from1970-1973. In 1973, Rensch became the firstexecutive director of CARTI and served in thatcapacity before being named the organization’spresident/CEO in 1983. •


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 Arkansas Hospital Associa-tion each year sets forth strategiesfor the coming year, focusing onfour major areas: Advocacy,Education, Data Gathering/Moni-toring, and Communication. TheFiscal Year 2005-2006 Strategiesare presented here.

ADVOCATE — ActivelyAdvocate for Arkansas’ Hospitals1) Develop strategies for methods

to increase state Medicaid fund-ing of hospital services.

2) Obtain the assistance ofArkansas legislators and stateDepartment of Health andHuman Services officials toinclude sufficient funding in theFY 2008-2009 budget to coverincreased payments for hospitalinpatient and/or outpatientservices.

3) Communicate on an ongoingbasis with Arkansas’ congres-sional delegation about federalissues impacting hospital opera-tions, costs and revenues.

4) Gain support of members ofArkansas’ congressional delega-tion for legislative and regulato-ry items included on hospitals’advocacy agenda for the 109thCongress.

EDUCATE — Provide EducationOpportunities5) Educate, inform and assist all AHA

member hospitals about/with stateand federal efforts aimed at imple-menting new health informationtechnology — and specificallytoward implementing electronic

health records in hospitals andprovider practices.

6) Provide in-state educational oppor-tunities for member hospitals andtheir employees and trustees cover-ing such issues as quality reporting,medication errors, patient safety,EMTALA, compliance, gover-nance, emergency readiness,HIPAA, reimbursement, codingand other topics.

7) Educate the public on the impor-tance of their local communityhospitals and the medical andsupport staff members who servetheir health needs.

ANTICIPATE DATA NEEDS —Seek, Explain and Provide Data;Address Data Reporting Issues 8) Conduct a follow-up study to

quantify continuing lossesaccruing to Arkansas hospitalsdue to inadequate Medicaidpayments.

9) Monitor, address, and resolveongoing legislative, regulatoryand policy issues concerningrequirements for public report-ing of hospital data.

Communicate results to memberhospitals.

10) Ensure that all Arkansas-basedquality initiative programs utilizeexisting data sources, includemeaningful quality measures andlimit additional hospital data col-lection/submission efforts andcosts related to compliance.

11) Ensure that Arkansas hospitals aredirectly involved with efforts toestablish and implement RegionalHealth Information Organizationsfor the sharing of clinical data fortreatment and quality improvementpurposes, and assisting in publichealth and research activities.

COMMUNICATE — Inform,Communicate, Network12) Inform all AHA member hospitals

on an ongoing basis about issues,concerns, activities and actionsaffecting hospitals and healthcareat the state and federal levels, toensure their knowledge about andinvolvement with those matters.

13) Work in conjunction withgroups such as the ArkansasFoundation for Medical Care,Arkansas Blue Cross and BlueShield, the Arkansas MedicalSociety and other healthcare-related organizations to furtherdevelop specific approaches toreduce medical and medicationerrors in Arkansas hospitals.

14) Provide printed, online, and face-to-face resources for AHA mem-ber hospitals so they may keepabreast of current issues, legisla-tion, and communication needs inthe hospital field. •


2006 Arkansas Hospital Association Strategies


Medicare FY 2006 OPPS Final Rule in Effect as of January 1, 2006

The Centers for Medicare &Medicaid Services (CMS) hasreleased its 2006 OutpatientProspective Payment System (OPPS)final rule, applying a full 3.7% mar-ket basket update.

The update, together with otherchanges in the rule mandated by theMedicare Modernization Act(MMA), will result in average pay-ment increases of about 2% to urbanhospitals and 3.9% to rural hospitals.

As required by the MMA, the ruleends “hold harmless” payments forsmall rural hospitals and rural solecommunity hospitals (SCHs), howev-er it provides an adjustment to ruralSCHs that will increase payments by7.1% in 2006.

The rule continues the decline incoinsurance rates Medicare benefici-aries will pay for many hospital out-patient services. Prior to the imple-mentation of the OPPS in August2000, the beneficiary often paid

more than 50% of the total paymentto the hospital for a service.Coinsurance rates for OPPS servicesare being reduced gradually until thebeneficiary’s share for any outpatientservice will be 20% of the hospital’stotal payment.

Under the final rule, the coinsur-ance rate for 31 additional medicaland surgical Ambulatory PaymentClassifications (APCs) will decline tothe 20% minimum, a 21% increasein the number of APCs at the 20%coinsurance level over calendar year(CY) 2005. It also reduces themaximum coinsurance rate for anyservice to 40% of the total paymentto the hospital for the APCs in 2006,down from 45% in 2005.

Overall, average beneficiary co-payments for all outpatient servicesare expected to fall from 33% oftotal payments in CY 2005 to 29%in CY 2006. This represents a declinein beneficiary liability of more than

$400 million from the CY 2005OPPS to the CY 2006 OPPS.

The final rule sets the outlierthreshold at $1,250 for 2006. Outlierpayments are intended to partiallycompensate hospitals for certain highcost services. To be eligible for anoutlier payment, the estimated costsfor a service must be greater than1.75 times the payment amount forthe APC and greater than the APCpayment amount plus the outlierthreshold.

The changes to the payment ratesand increased volume of services con-tribute to an overall increase in pro-jected payments to over 4,200 hospi-tals for Medicare outpatient services of$27.6 billion in 2006 compared toprojected payments of $26.2 billion in2005, an increase of 5.2%. The finalrule takes effect January 1, 2006.

See http://www.cms.hhs.gov/provi-ders /hopps/2006fc/CMS-1501-FC.pdf for the complete report. •

AHA and JCAHO Resolve ConfidentialityIssues After Intense Discussions

Arkansas Hospital Association(AHA) legal counsel Elisa White noti-fied the AHA October 11 that theJoint Commission on Accreditation ofHealthcare Facilities (JCAHO) agreedto a revision in its accreditation agree-ment that will safeguard Arkansashospitals’ privileged documents fromdisclosure in the accreditation process.

As revised, Section 5 of the agree-ment now says that:

1) JCAHO will conduct all of itsaccreditation activities in accordancewith all applicable privileges of confi-dentiality and immunity under appli-cable state and federal law;

2) If the JCAHO requests privileged

information, the hospital can notifythe JCAHO in writing and theJCAHO will work with the hospital tofind an alternative that will both allowthe JCAHO to obtain the informationit needs for accreditation purposes andmaintain legal protections for therequested item; and

3) If privilege is challenged basedon any accreditation activity, theJCAHO will help the hospital fight tomaintain the privilege.

White noted that the JCAHO con-tinued to refuse to negotiate on theagreement’s indemnity clause, whichfavors the JCAHO, and the limitationof remedy clause. She advised that as

of October 13, Arkansas hospitalswould be able to execute their revisedagreements electronically with theJCAHO.

Arkansas was the only state initial-ly pushing the privilege documentissue with JCAHO; other states even-tually joined the discussion.According to AHA president and CEOPhil Matthews, “The AHA Board ofDirectors provided direction andstrong support of our position.Protecting our privilege issue was ofthe utmost importance, and JCAHOfinally realized that it was a majorissue with us. We are very pleasedwith the outcome.” •


No Name Required: Note This Change for Section 1011 Billing Data

Hospitals that are providing emer-gency care services to undocumentedaliens should be aware that as ofNovember 10, 2005 the patient’s nameand address are no longer required forsubmission of Section 1011 paymentrequests.

TrailBlazer Health Enterprises, theCenters for Medicare & MedicaidServices (CMS) contractor for Section1011 payments, said its Direct Data

Entry system will no longer allow entryin the name, address and zip code fields.CMS last year indicated it would notrequire hospitals and other healthcareproviders to ask “invasive” questionsabout patients’ citizenship status anddisclose personal patient information toreceive funds under Section 1011 of theMedicare Modernization Act.

The Act allocated $250 million inMedicare reimbursements annually

through fiscal year 2008 to help reim-burse hospitals for their cost of provid-ing uncompensated emergency care toundocumented immigrants. However,billing instructions issued earlierrequired providers to submit thepatient’s name and address. CMS tookhospitals’ advice to remove the require-ment on the grounds it was unnecessaryand might discourage undocumentedimmigrants from seeking care. •

Hospitals Intervene in JCAHO Recommendationto Sell Data Analyses to Third Parties

Yielding to pressure put on byAmerica’s hospitals and physiciansthrough the American HospitalAssociation, the American MedicalAssociation, American College ofPhysicians, various state hospital asso-ciations (including the ArkansasHospital Association) and others, theJoint Commission on Accreditation ofHealthcare Organizations (JCAHO)

Board of Commissioners, at itsNovember 18-19 meeting, agreed towithdraw an earlier recommendationto sell analyses of hospital data to thirdparties.

The decision followed six monthsof intense discussion over a “data-min-ing” contract between a JCAHO sub-sidiary and the Blue Cross Blue ShieldAssociation. JCAHO will continue to

seek patient level data from hospitals,once issues involving HIPAA privacyconcerns are addressed.

After considering hospitals’ con-cerns, JCAHO’s commissioners decid-ed to withdraw the original recom-mendation and instead recommend tothe JCAHO board that the JCAHOrefrain from selling analyses of hospi-tal data to third parties. •

Healthcare Philanthropic Giving Back on the Rise in U.S.Donations to U.S. members of the Association for

Healthcare Philanthropy increased 3.5% to $6.1 bil-lion in 2004, up from $5.9 billion in 2003, the associ-ation said in a recent report.

Cash contributions accounted for 67%, or $4.1billion, of the total funds raised by U.S. members of

the group. Pledges, planned gifts and other assetsaccounted for $1.6 billion, or 26.5%.

The number of donors grew 2.7% from 2003 andthe number of gifts received increased 5%. Individualsprovided 60% of all funds raised; businesses, includ-ing corporate foundations, supplied 19.4%.

Meanwhile, in Canada, giving to healthcareorganizations declined 4.8% to $1.07 billion in2004. The report was based on a survey of morethan 300 organizations belonging to the associa-tion. The association said hospitals make up themajority of its membership. •

New Report Compares Critical Access Hospital IndicatorsResearchers for the federal Office of Rural Health Policy have issued a

report on comparative financial indicators for the nation’s Critical AccessHospitals (CAH).

The report, which provides a state-by-state summary of CAH financialindicators, compared with national medians, is available at http://www.flex-monitoring.org/cahlist.

The indicators are grouped in categories for profitability, liquidity, capitalstructure, revenue, cost and utilization.

Further information about the definition and interpretation of the indica-tors can be found in a previous report, “Briefing Paper No. 7: FinancialIndicators for Critical Access Hospitals,” which can be downloaded fromhttp://www.flexmonitoring.org. •

C O S T S U N I N S U R E D


Rising health insurance costs are forc-ing businesses of all sizes to pass a grow-ing portion of premiums, co-payments ordeductibles on to their employees,according to a new poll of business lead-ers, nearly 80% of which said they feartheir employees won’t be able to afford it.

The poll of 600 business ownersand benefit managers, released in thefall of 2005 by the Robert WoodJohnson Foundation, found that com-panies expect health insurance costs to

jump an additional 12% over the nextyear, and that business owners will asktheir employees to pay an average of21% of this increase.

Respondents’ employees currentlypay, on average, 29% of their ownhealth insurance premiums.

More than one-third of businessesthat projected an increase in costs saidit’s likely their employees would dropcoverage as a result of increases. Morethan half of respondents said allowing

the self-employed and small businessesto purchase private health insurance atgroup rates would increase Americans’access to healthcare, and 41% said taxincentives would help.

The poll was released at a CapitolHill panel discussion on healthcare fea-turing federal and state lawmakers andcompany CEOs. For more on the polland its ramifications, go to http://cover-theuninsuredweek.org/media/docs/release091405.pdf. •

Business Leaders Troubled by Health Insurance Costs

The Arkansas Center for HealthImprovement released the results ofits most recent survey on Arkansas’uninsured population in mid-September. The findings showedthat 456,000 people in the statehad no health insurance coveragein 2004, making up 17% of thestate’s population. That’s up from

15% of Arkansans who were unin-sured in 2001.

The report showed that more chil-dren now have coverage, thanks toseveral years of expansion inArkansas Medicaid’s ARKids Firstprogram. But the numbers of unin-sured is growing for all other groups.

Sixty percent of the state’s unin-

sured population work, but most ofArkansas’ employers are small busi-nesses with fewer than 50 employeeseach and only 26% of those employ-ers offer group health benefits.

Demographic breakdowns showthat 39% of Hispanics in Arkansaslack coverage, compared with 17%of blacks and 15% of whites. •

New Survey Shows More Arkansans Uninsured

Members of the Arkansas HospitalAssociation (AHA) executive team metin November and again in Decemberwith top officials from the ArkansasDepartment of Health and HumanServices and its Medicaid programregarding the need for additionalMedicaid funding for hospitals.

The AHA has been working onthe issue with the governor’s officeand members of the state legislaturesince the end of the 2005 legislativesession to secure support for anincrease in the cap on Medicaid hos-

pital per diem rates. The current$675 per day cap has been in placesince 1996. Some hospitals have hadno Medicaid rate increase since thenand as each year goes by, more hos-pitals see their Medicaid inpatientrates limited by the cap, which nowgoverns a vast majority of the state’shospitals.

The AHA worked last spring toget support for a bill that was passedand then signed as Act 2222 of 2005.The law provides the opportunity forhospitals to receive an increase in

their Medicaid per diem rates ifinsurance premium taxes paid to thestate are above forecast levels.

However, since Act 2222 isprospective in nature, exactly howmuch it could yield for hospitalswon’t be known until June 30, 2006.The AHA hopes that an economicupturn in Arkansas, which has led toa surplus in state general revenues,will provide a window of opportuni-ty for the governor and the legisla-ture to designate additional funds forMedicaid hospital payments. •

Medicaid Discussions with Arkansas State Officials Continue

C O S T S U N I N S U R E D


U.S. hospitals provided $26.9billion in uncompensated care in2004, up from $24.9 billion in2003, according to the latestAmerican Hospital Association(AHA) Annual Survey of Hospitals.

The survey measure includescharity care and bad debt, valued atthe cost to the hospital of the servicesprovided. The amount of uncom-pensated care provided by hospitalshas increased by $5.3 billion, ormore than 25% since 2000.

The information on hospitaluncompensated care comes from theAHA’s Annual Survey Data, 1980-2004. For more information, go tothe “What’s New” section athttp://www.aha.org. •

Providence Health System ofPortland, Oregon, agreed in earlyNovember to settle a class action law-suit brought by attorney RichardScruggs. The suit was brought onbehalf of uninsured patients andalleged that not-for-profit Providenceviolated its charitable mission bycharging its highest prices to thoseleast able to pay. The settlement stillmust go before a state Circuit Courtjudge in Portland.

Under the settlement, Providenceadmitted no wrongdoing and said itchose to settle to avoid legal costs.

The settlement allows any uninsuredpatient charged for care at any ofProvidence’s seven hospitals in thepast four years to apply for an esti-mated 30% reduction in their bill,reflecting the average “preferredprovider” private insurance rate.

Additional reductions would beoffered to uninsured patients livingbelow 400% of the federal povertylevel and would waive bills of thoseliving at or below 200% of thepoverty level and having limitedassets. •

Oregon System Agrees to Settle Uninsured-Billing Class Action Lawsuit

Hospitals Spend$5.3 BillionMore on UncompensatedPatient Care


Q U A L I T Y

Arkansas Hospitals’ National Ranking Rises:Care Improving for Pneumonia, Heart Attack, Heart Failure, SurgerySubmitted by the Arkansas Foundation for Medical Care

Arkansas hospitals have dramati-cally improved their national rankingin the care of Medicare patients.According to an analysis by theArkansas Foundation for MedicalCare (AFMC), Arkansas hospitalshave gone from 49th in the countryin 2000-2001 to 35th by the end of2004 on 20 measures focusing onmanagement of pneumonia, heartattacks, heart failure, and surgicalinfection prevention.

AFMC works with hospitalsacross the state to set goals toincrease the number of patients whoreceive important aspects of care.

“One of our goals was to improveour ranking from 49th to 40th by2004, and Arkansas hospitalsexceeded our expectations. Ourranking improved to 35th,” said PamBrown, AFMC’s inpatient projectmanager. “More important, eachpercentage point of improvementrepresents hundreds of patientsreceiving better healthcare and possi-bly better outcomes. We still have alot of work ahead of us, but theseresults are encouraging.”

State ranking is based on data from50 states plus the District of Columbiaand Puerto Rico. The data reflects hos-

pital performance on more than 20quality improvement indicators forMedicare patients. The indicators affectcare for patients who are hospitalizedfor surgery, heart attack, heart failureor community-acquired pneumonia.

Paul Cunningham, senior vice pres-ident of the Arkansas HospitalAssociation, said that the state’s hospi-tals are very pleased to see the dramat-ic improvements. He noted that theAFMC analysis should be encouragingnews for hospitals and people in com-munities throughout Arkansas.

Cunningham said, “The improvedrates reflect that hospital quality

Arkansas Performance on Hospital Quality Improvement Indicators

The state’s overall ranking rose to35th in 2004, up from 49th in 2000-2001. Rankings are based on theArkansas Foundation for MedicalCare’s analysis of the Centers forMedicare & Medicaid Services’ surveil-lance data from 50 states, plus theDistrict of Columbia and Puerto Rico.Data covered hospital performance onmore than 20 quality indicators forMedicare patients, including:

For pneumonia patients

■ Initial antibiotic received withinfour hours of hospital arrival• Baseline rate: 62.7%• Current rate: 76.6%• National current rate: 70.5%

■ Oxygenation assessment• Baseline rate: 91%• Current rate: 98.7%• National current rate: 98.6%

■ Pneumococcal vaccination status• Baseline rate: 5.1%• Current rate: 45.7%• National current rate: 44%

For heart attack patients

■ Aspirin on arrival• Baseline rate: 75.3%• Current rate: 81.2%• National current rate: 88.4%

■ Aspirin prescribed at discharge• Baseline rate: 82.2%• Current rate: 86.1%• National current rate: 91.1%

■ Beta-blocker prescribed at discharge• Baseline rate: 55.4%• Current rate: 86.3%• National current rate: 89.2%

For surgical infection prevention

■ Prophylactic antibiotics receivedwithin one hour prior to surgicalincision• Baseline rate: 40%• Current rate: 67.8%• National current rate: 66.6%

For heart failure patients

■ Comprehensive discharge instructions• Baseline rate: 0.9%• Current rate: 15.5%• National current rate: 17%


Q U A L I T Y

Physician Voluntary Reporting Program Begins in January

The Centers for Medicare & Medicaid Services (CMS)announced on October 31 a voluntary quality reporting initiativefor physicians that could be a first step to a Medicare pay-for-per-formance program for doctors.

The initiative starts in January 2006 with 36 quality meas-ures developed by the American Medical Association, theNational Quality Forum and other groups. More measures willbe phased in during 2006.

The agency said the data will be for both its use and physi-cians’ review, and will not be made available to the public.

Hospitals already receive additional Medicare paymentsfor reporting data to the CMS, and the agency has begun apay-for-performance demonstration project involving largemedical groups.

The CMS announcement did not address additional reim-bursement for physicians who report the data under the latestinitiative. CMS said the initiative is part of its ongoing effortwith Congress to make sure Medicare is paying doctors ade-quately without increasing overall program costs. •

managers, medical staff membersand patient care professionals havebeen working closely together andwith the AFMC to implementchanges that include ‘best practice’processes and policies which can leadto better patient outcomes.”

Arkansas has shown considerableimprovement on most of the measures.The state’s performance improved themost in the topic of community-acquired pneumonia. For instance,ideally all patients with pneumoniashould be assessed to see if they aredue for a flu shot. In late 2000, only 5percent of hospitalized patients wereassessed for flu immunization statusand immunized appropriately. By2004, the rate had risen to more than45 percent — higher than the nationalaverage of 43.4. The percentage ofpneumonia patients who received anantibiotic within four hours of arrivalincreased from 62.7 percent to 76.6percent — compared to the nationalrate of 70.5 percent.

However, there is still room forimprovement, particularly on most

of the indicators related to heartattack (acute myocardial infarction,or AMI). The percentage of patientsreceiving aspirin on arrival — longconsidered standard, life-saving care— rose from 75.3 to 81.2 percent.The national average is 88.4 percent.

“Arkansas hospitals have madeimpressive progress, and I am confi-dent we will see more in the future,”said Dr. William E. Golden, AFMC’svice president for clinical qualityimprovement. “They have embracedquality improvement as fundamentalto modern medical care and, as agroup, have jumped over the perform-ance of peers in other states. AFMCwill continue to work with Arkansashospitals and other health providersto implement systems changes thatmake care safer and consistent withcurrent clinical science.”

Cunningham agreed, saying,“While the information shows defi-nite progress, the AHA and its mem-bers understand that there are moregains to be made in the areas of qual-ity and patient safety.” He said that

Arkansas hospitals are committed tocontinuing their quality improve-ment efforts and that they intend towork along with the AFMC to buildon the recent successes to make surethat hospital patients throughout thestate have access to the highest qual-ity patient care.

As the state’s quality improvementorganization for Medicare andMedicaid, AFMC works with hospi-tals, physician offices, nursing homesand home health agencies to ensurethat Arkansans receive high-quality,cost-effective healthcare. Priorities aredetermined by the Centers forMedicare & Medicaid Services and theArkansas Department of Health andHuman Services, and include care forpeople with medical conditions such asheart attack, heart failure, diabetesand asthma, as well as preventive caresuch as mammography, childhoodimmunization, and flu and pneumoniaimmunization for adults. AFMC isalso working to help healthcareproviders make effective use of healthinformation technology. •

Surgical Care Improvement Project: Has Your Hospital Signed On?

Three months ago a partnership ofleading public and private healthcareorganizations including the AmericanHospital Association (AHA) launcheda project to improve surgical care inhospitals nationwide.

The goal of the project is to reducesurgical complications by 25% by theyear 2010. This Surgical CareImprovement Project (SCIP) targetscomplications related to surgicalwound infections, blood clots, peri-operative heart attack and ventilatorassociated pneumonia.

Since 2003, the SCIP has been lim-ited to a three-state pilot project withthe objective of identifying the most

effective methods for MedicareQuality Improvement Organizations(QIOs) to help hospitals improve theirperformance in surgical care.

Last August, the SCIP became partof the QIOs’ work plan. Now they willwork intensively on reducing surgicalcomplications with hospitals in everystate. The national SCIP partners arefinalizing the process and outcomemeasures hospitals will be asked tocollect as they participate in SCIP, anda data collection tool is being devel-oped by the Centers for Medicare &Medicaid Services (CMS).

In addition, everything is beingcoordinated with the Joint

Commission on Accreditation ofHealthcare Organizations (JCAHO)so that hospitals submitting SCIP datacan use the same vendors they use foraccreditation data collection and forsubmitting data to the HospitalCompare Web site. These tools will beready soon.

Participating hospitals will submitdata to the QIO warehouse, as they donow for public reporting for CMS’Hospital Compare program. Initially,the SCIP data won’t be publicly report-ed, but in the future some of the SCIPmeasures will appear on the HospitalCompare Web site.

Before any hospital-specific dataare made public, hospitals will beinformed about what that informa-tion is and given the choice ofwhether to share their data publicly.Hospitals are being asked to learn asmuch as possible about the SCIP andconsider signing a letter of participa-tion now.

In addition, hospitals that plan toparticipate should begin educatingmedical staff members about the proj-ect and the modules in which the hos-pital will enroll. The participation letterscan be found on the AHA Web site athttp://www.aha.org/aha/key_issues/patient_safety/contents/050923SCIP.pdf.

For more information, go tohttp://www.MedQIC.org/scip. •


Q U A L I T Y

Two Hospitals Earn Arkansas Hospital Quality Awards

Two Arkansas hospitals are amongnine organizations that receivedArkansas Institute for PerformanceExcellence (AIPE) awards October 17at The Peabody Little Rock.

Arkansas Methodist MedicalCenter in Paragould and the Perinatal

Bereavement Program of the St.Vincent Center for Women &Children in Little Rock were selectedas winners of AIPE awards for excel-lence in organizational performanceand strategies.

The AIPE, formerly known as the

Arkansas Quality Awards group, wasdeveloped to provide opportunities fororganizations to measure progress inperformance excellence. Their awardsrecognize groups and institutionsinterested in improving quality, pro-ductivity and financial effectiveness. •


Q U A L I T Y

New Breast Cancer Treatment Shown to Reduce Need for Repeat Surgeriesfrom UAMS Communications

A breast cancer treatment devel-oped by University of Arkansas forMedical Sciences (UAMS) surgeon V.Suzanne Klimberg, M.D., has beenshown in a clinical trial to reduce theneed for repeat surgery followinglumpectomy by 86 percent.

Klimberg, director of the breastcancer program at UAMS’ ArkansasCancer Research Center, is the princi-pal investigator of a multiphase clini-cal trial for the new procedure called

Radiofrequency Ablation (RFA)-Assisted Lumpectomy. The findings ofthe study were presented in lateOctober at the American College ofSurgeons’ 91st Annual ClinicalCongress in San Francisco.

The RFA procedure, which sears aone-centimeter margin, or perimeter,of soft tissue following standardlumpectomy removal of a breasttumor, is intended to give the patient acancer-free area around the site where

the tumor has been removed so that asecond surgery in the area around thelumpectomy and/or radiation therapyare unnecessary. Currently, about 40percent of patients require a secondsurgery to remove additional malig-nant tissue.

UAMS is the first hospital to useRFA-assisted lumpectomy to treatbreast cancer. Klimberg’s recently con-cluded trial involved 25 breast cancerpatients. •

Cancer Death Rates Continue to Decline Americans’ risk of dying from can-

cer continues to decline while the rateof new cancers holds steady, accord-ing to the “Annual Report to theNation” by the National CancerInstitute, Centers for DiseaseControl and Prevention, AmericanCancer Society, and North American

Association of Central CancerRegistries.

The report provides updated infor-mation on U.S. cancer rates andtrends. According to the new report,death rates for all cancers combineddeclined 1.5% per year in men from1993 to 2002, and 0.8% in women

from 1992 to 2002, while overall can-cer incidence rates for both sexes havebeen stable since 1992. Lung cancer isthe leading cause of cancer deaths inboth men and women. For more onthe report, go to http://jncicancerspec-trum.oxfordjournals.org/cgi/content/abstract/jnci;97/19/1407. •

CMS Releases HCAHPS SurveyThe Centers for Medicare &

Medicaid Services (CMS) recentlyreleased its final Hospital CAHPS(HCAHPS) survey instrument, the firstnational survey to collect uniformpatient feedback on hospital care.

The American Hospital Association(AHA)-backed survey will be imple-mented in 2006 as part of the HospitalQuality Alliance (HQA), the public-private collaborative whose membersinclude the AHA, Association ofAmerican Medical Colleges, Federa-tion of American Hospitals, NationalAssociation of Children’s Hospitals

and Related Institutions, AmericanMedical Association, AmericanNurses Association, AARP, AFL-CIO, Consumer-Purchaser Disclosure

Project, Joint Commission onAccreditation of Healthcare Organi-zations, National Quality Forum,U.S. Chamber of Commerce, CMS,and the Agency for HealthcareResearch and Quality.

Participation by hospitals will bevoluntary, and results ultimately willbe publicly reported on the HHSHospital Compare Web site athttp://www.hospitalcompare.hhs.gov/.

More information on the HCAHPSsurvey and on HQA is available athttp://www.cms.hhs.gov/quality/hos-pital. •

In areas ravaged by Hurricane Katrina, the hospital “H” also came to mean

“hope” … and “heroes.”

Thousands of hospital workers held the line, endured the storm and survived

the deluge — to care for their patients.

The stories are just beginning to be told:

At one New Orleans hospital, staff went days without food and water while

evacuating patients — carrying some on stretchers, some on their backs —

through floodwaters and up eight flights of stairs to waiting helicopters.

In Mississippi, a surgeon performed emergency surgery by flashlight, with flood

water rising over his feet and medical equipment failing.

At another hospital, food and supplies ran out, and many of the staff knew

that they had lost their own homes. But they continued to accept new

patients — treating evacuees and rescue workers alike.

The men and women of America’s Hospitals … heroes every day.

America’s Hospitals.First in hope. First in care. Always there.

www.aha.org

This Sign Means HopeHURRICANE KATRINA

Hospital employees in Louisiana,

Mississippi and Alabama suffered

devastating losses from Hurricane

Katrina. Some lost everything,

yet they continued caring for

their patients and neighbors.

See what you can do to help those

who helped so many.

Go to: www.TheCareFund.net

This Is What YouCan Do to Help:

S P E C I A L S E C T I O N K A T R I N A R E V I S I T E D


Editor’s Note: Four short monthsago, on August 29, 2005, our nationand the world watched in horror asthe Gulf states of Mississippi,Louisiana, and southern Alabamawere crushed by Hurricane Katrinaand the unrelenting floods that fol-lowed her landfall.

The following weekend — LaborDay Weekend 2005 — was unlike anyLabor Day healthcare personnel hadpreviously experienced in our state. InHurricane Katrina’s aftermath,Arkansas hospitals immediately mobi-lized, volunteering to do what theycould to help not only the devastatedGulf Coast hospitals, but also the hur-ricane victims who had lost everythingto the storm.

Stories were being told acrossArkansas about the healthcare pro-fessionals and teams who launchedinto action, preparing to go south orto help evacuees as they came north.Hospitals such as North ArkansasRegional Medical Center in Harrisonand Baxter Regional Medical Centerin Mountain Home sent personnel inambulances loaded with food, water,medicines and even boats to navigatethe flooded city streets of NewOrleans.

The Central Arkansas VeteransHealthcare System coordinated citi-zen evacuation efforts while theNational Disaster Medical System(NDMS) emergency manager, Billy

Conner, deployed to Mississippi andLouisiana in order to set up medicalrelief operations.

Many, many others added theirnames to the growing list of volunteerhealth professionals eager to work forseveral weeks to spell workers in hos-pitals spread across the Mississippi andLouisiana Gulf Coast, many of whomhad lost everything and needed time totake care of personal matters. Entirefacilities, including Stuttgart RegionalMedical Center and Crossett’s AshleyCounty Medical Center, coordinatedthe preparation and serving of mealsfor evacuees with local civic organiza-tions and area churches.

HSC Medical Center in Malvern,Washington Regional Medical Centerin Fayetteville, Northwest Health inSpringdale, hospitals in the MercyHealth System, St. Bernards MedicalCenter in Jonesboro and Little Rockarea hospitals rotated shifts of nursesand physicians in camps and sheltersset up throughout the state to houseevacuees.

Arkansas Hospice and several psy-chiatric facilities offered their servicesby providing social workers, griefcounselors, and nurses.

These are a few of the many waysArkansas hospitals and healthcarefacilities assisted with the heartbreak-ing needs of both the evacuees andthose who worked at the damagedhospitals along the Gulf Coast.

Unbelievably, two weeks later,another hurricane by the name of Ritaslashed into the Gulf area once again.This time, Texas and Louisianareceived the brunt of the storm.

Hospitals in Little Rock, NorthLittle Rock, Jacksonville and Bentonand the Metropolitan EmergencyMedical Services involved in theNDMS were called into action follow-ing Hurricane Rita to receive patientsfrom Texas and Louisiana hospitalsevacuating either due to rising wateror to predicted storm damage.

Through it all, the ArkansasHospital Association served as hurri-cane communication headquarters andliaison to our hospitals, the DHHSDivision of Health, Governor MikeHuckabee’s Office, the ArkansasDepartment of Emergency Manage-ment, CMS and the Medicare andMedicaid offices, the AmericanHospital Association, other state hos-pital associations, our congressionaloffices and many, many other entities.

We are proud of our healthcare per-sonnel and the lifesaving comfort theyoffered to hurricane victims. We hopeyou enjoy reading some personalaccounts in the pages that follow andthat you will add these shiningmoments to your memories of the hur-ricanes of 2005.

— Beth Ingram, Vice President,AHA and Editor, Arkansas Hospitals

Temporary Agreement is Easing Nurse Licensure Delays

The Arkansas State Board ofNursing (ASBN) has agreed with anArkansas Hospital Association(AHA) request about issuing tem-porary state licenses to nurses whoare currently licensed in anotherstate and wish to practice inArkansas.

The ASBN notified the AHA of itsdecision in mid-October. Under the

new policy, a temporary license willbe issued immediately upon request,and will be made final upon comple-tion of a criminal background checkby the Arkansas State Police.

This new policy should eliminatethe long wait for Arkansas licensesbeing experienced by many nursesfrom states that are not a part of amulti-state compact, which allows

reciprocal licensing of nurses amongthose states.

Some hospitals lost nurses toother employers because of the earli-er, lengthy delays. With the ASBNpromising immediate temporarylicensure for nurses who submit aphotocopy of their current licensefrom another state, that problemshould be solved. •

Arkansas Included Under Emergency Assistance Declaration



Editor’s Note: Robert Atkinson is thenew Chairman of the Board of theArkansas Hospital Association, andalso serves as president and CEO ofJefferson Regional Medical Center inPine Bluff. His is a very personal storyof dealing with Hurricane Katrina,from helping his son prepare his hometo outrunning the storm to returning todeal with its overwhelming aftermath.

August 28. Brooklyn GraceAtkinson, first grandchild of Bob andBecky Atkinson, was to be baptized inSlidell, Louisiana. The extended fami-ly had gathered, but as the nationwatched, Hurricane Katrinaapproached the Gulf Coast.

“We knew we would need to leavethe Slidell area soon,” Atkinson said.“In preparation for the storm to come,our daughter-in-law, Alison, and ournew granddaughter fled to Alison’sfolks in Baton Rouge. Our son stayedbehind in Slidell. He is one of the sen-ior auxiliary policemen there, and wasneeded by the community.” Afterhelping Chris and Alison prepare theirhome for the storm, Bob and his wife,Becky, joined thousands of others leav-ing the area by car and began theirescape north.

“Our son’s home is near the inter-change of Interstates 10, 12 and 59, sowe were able to get to the highway

fairly easily,” Atkinson recalls. “Wewere in reverse traffic flow conditions(where all lanes of Interstate Highway59 were re-directed northbound) allthe way to Hattiesburg, Mississippi. Ittook us six hours to reach Jackson(Mississippi) — nearly three timeswhat it would normally take.” Fromthere, the Atkinsons made their wayback to south central Arkansas.

As Katrina neared, it became evi-dent that Slidell was directly in herpath. Located northeast of NewOrleans on the north side of LakePontchartrain, Slidell was a quiet com-munity of about 26,000. AfterKatrina, nearly all of its families facedthe fate of the younger Atkinsons.Homes were destroyed; lives had to berebuilt.

“One of the most remarkablethings I can tell you is that the humanspirit is a wonder,” Atkinson says.“People do have the desire and spiritto conquer even the worst of circum-stances. As Becky and I ventured backto Slidell each weekend to help ourkids recover from the storm, we sawthat in the community and in its resi-dents.”

After Katrina struck, communica-tion was, of course, difficult. Therewas no electricity, few ways to let peo-ple know what was happening. ChrisAtkinson and his fellow policemen —

both full-time and auxiliary — shel-tered through the storm in a buildingnear Slidell’s hospital. On Wednesday,two and one-half days after Katrinahad done her worst, the Atkinsonsheard that Chris was all right.

“Of course, there was major dam-age everywhere. Chris told aboutwatching trees snap off in the 120 mphwinds,” Atkinson says. Slidell alsoreceived more than 16 feet of water byway of storm surge. “Nearly everyhome received damage. Those nearestLake Pontchartrain had little to gohome to. Those farther away — likeChris and Alison (three miles from thelake) — had homes still standing butwith significant damage.”

Returning to Slidell the weekendfollowing Katrina, Atkinson, sonsChris and Tim and Alison’s dad andbrother all worked to do what theycould at the home. “When we firstarrived, it was quite a sight to behold,”he says. “It almost looked like a blackand white photograph, because every-thing was caked with grey mud.”

A large tree had blown down,blocking the front walk. The garagedoor was banged up as a result oftrees, furnishings, cars, etc. beingrammed into it as the water surged. Aboat had come to rest between thehouse and the backyard fence. Large,heavy outdoor urns had floated into

Katrina Hits Home, Literally, for AHA Board Chairman’s Son

On September 8, federal Depart-ment of Health and HumanServices (HHS) Secretary MichaelLeavitt issued an 1135(b) waiverdeclaring a Public HealthEmergency for eight states, includingArkansas, retroactive to Hurricane

Katrina’s landfall in late August. The declaration assures that those

states where a great majority ofHurricane Katrina evacuees continueto seek shelter are included in the vari-ous Medicaid flexibility provisions thatSecretary Leavitt announced earlier.

The Arkansas Hospital Associa-tion worked with members ofArkansas’ congressional delegationand state officials to achieve this dec-laration, and appreciates all thosewho were instrumental in obtainingthe waiver for our state. •



the yard up and over a six-foot fence.There was no power, no water.

“The first thing we did was toremove the plywood from the win-dows so we could see what had hap-pened,” Atkinson says. “All of theupholstered furniture was upsidedown, soaked. Furniture had beentipped over, and was covered in mud.As we walked, our feet would stick inthe mud plastered into the carpets.”

Atkinson and his family were someof the first people into the devastatedcity. They brought a U-Haul truckwith them so they could remove any ofChris and Alison’s personal belongingsthat survived above the water line.“We saved between 10 and 20 percentof the kids’ stuff,” he said. “The restof their life’s mementos, and those ofall living on the Gulf Coast, were sim-ply washed away.”

The first weekend was spentremoving all of the home’s cabinets,appliances, bedding and furniture.“We took it to the curbside for eventu-al pickup,” he says. “If you can

believe it, we had a mountain morethan six feet high and many feetwide.”

Keeping ahead of mold was the firstpriority. They sprayed germicideeverywhere in the home. “We knewwe would end up removing all of thewallboard, all of the insulation, all ofthe carpets,” he said.

With water having reached a heightof 3.5 feet in the home, there wasmuch to be removed.

The next weekend, Atkinson head-ed to Hattiesburg, Mississippi andbrought in new insulation to replacewhat had been soaked in the stormand its residual flooding. In subse-quent weekends, sheetrock wasreplaced, new cabinetry and carpetsordered, and painters brought in.

Chris, who serves as HumanResources Manager for OchsnerClinic/Medical Center in NewOrleans, is commuting every dayfrom Alison’s family cabin on theTickfaw River near Hammond.Alison says she is ready for her fami-

ly to be able to return home.“Television just can’t express the

amount of damage the storm and itsaftermath have done in the area,”Atkinson says. “People say it lookslike a war zone, and it does. Allaround you, people’s lives — all theyhave owned and collected, all of theirdreams — are piled at the curbside.When you are there in person, seeingit 360 degrees around you, you real-ize just how powerful Mother Naturecan be.”

But in helping Chris and his neigh-bors, Atkinson says he has seen thebetter side of mankind. “MotherNature is powerful,” he says, “but thehuman spirit is indomitable. We haveseen the positive side of people’s spirit,and truly the milk of human kindnessflowing as people reach out to helpothers. It seems like people are saying,‘we are going to lick this thing.’”

It will take years, but the Gulfwill recover. As Atkinson says,Mother Nature is strong, butHuman Nature perseveres. •

Pat O’Brien’s Loss is Ouachita County Medical Center’s Gain:Chef Finds a New HomeEditor’s Note: The first portion ofthis story originally appeared as anOctober article in the Camden News.We thank Editor Donna Collins forallowing us to reprint it here. Thesecond portion (after the asterisks)was written by Arkansas Hospitalsstaff members.

From the Camden News,by Stephanie Jones

The food in the Ouachita CountyMedical Center dining hall now has aCreole flair.

Richard Smith, 47, formerly achef at a restaurant in New Orleans,moved to Camden recently afterevacuating his Louisiana home fol-

lowing Hurricane Katrina. His fami-ly plans to stay in town permanently.

Smith came to Camden with hiswife and three sons, ages 12, 9 and1, because his mother-in-law liveshere. But he said he is pleased withthe move for more reasons than heexpected.

Smith is impressed with Camden’sfamily atmosphere. The people intown are different from NewOrleans, he said.

“I love Camden. I really do,”Smith said. “When we got here,everybody had smiles for us.”

He said Camden residents had beeneager to reach out to his family and helpthem settle in. His wife quickly found

a job as a certified nurse’s assistant atthe Medical Center of South Arkansasin El Dorado. His two older childrenare in Camden Fairview schools.

“My boys are in school, the schoolsand the people are treating them sokind,” he said. “They’re getting usedto their classes so fast.”

Smith said he plans to return toNew Orleans in the coming weeks tosettle insurance and property matters,but he will return to live in Camdenfor good.

“The bills are still coming in — thewater bill, the electric bill,” and hisfamily is not even there. “I’ve got toclose all of that out,” he said.

He also has to pick up his car,



damaged by the flooding that fol-lowed the hurricane.

Smith has been working at the hos-pital for nearly a month, he said, andofficials there have given him a lot offreedom to make the dining hall menuhis own, he said.

“I love working at the hospital,” hesaid. “The people have been real goodto me. I’ve been able to get into thekitchen and do my own thing, andspice it up, you know. They prettymuch told me, ‘Whatever you want todo in the kitchen, go ahead.’ The spiceand flavors, I’ve gotten a goodresponse; it seems like everybody lovesit,” he added.

He said guests and hospital admin-istrators have complimented his dishes.

Smith’s supervisor, Sarah Silliman,confirmed that everyone is pleasedwith his work. “We’re very fortunateto have him,” she said.

Beef sirloin, roast beef and roastpork, red beans and rice and shrimpetouffée are a few of the dishes Smithhas been serving up.

“I’ve been doing a lot of pasta dish-es; everyone really seems to like

those,” he said. “And right now I’mworking on a béarnaise sauce.”

Cooking has been a part of Smith’slife since his childhood. He said hefirst became interested in it when hespent time in the kitchen with his step-father.

Smith attended JumonvilleCulinary Technical Institute in St.Martinville to get training before hebegan restaurant work. When thefamily was forced to leave (NewOrleans), he was a chef at PatO’Brien’s restaurant.

The Smiths only evacuated afterthey stayed in their home through thestorm itself, Smith said. He said thehome was damaged primarily by theforce of the storm winds and rains, butwasn’t flooded.

“The flood water reached up tothe front steps,” he said. “But whenthe roof caved in, that’s when thingsgot crazy.”

* * *Since this article first appeared in

early October in the Camden News,Richard Smith has made his returnjourney to New Orleans. What he

found was total devastation of hishome and belongings.

“Unfortunately, he returned tofind what was NOT left of hishome,” says Ouachita Valley HealthSystem CEO C.C. “Mac” McAllister.“He had hoped to bring his car andthings from his home in NewOrleans back to Camden, but all hebrought back was bed frames. Eventhe car was totally ruined.”

When speaking of Richard Smithand what he has meant to the healthsystem, McAllister’s voice softens.“He has adopted us, and we haveadopted him. He is a very friendlyguy,” he says.

McAllister also comments on what“great cooking” can do for attendanceat meetings. “I am on the CommunityFoundation Board, and we hold ourmeetings at the hospital,” he says.“All I can tell you is that since Richardhas been providing the food for themeetings, our attendance is up!”

Hurricane Katrina was whatMcAllister calls a “wake-up call” forArkansas hospitals. “Through theArkansas Hospital Association, we allgot involved, doing what we could, inwhatever way we could,” he says.“But what Hurricane Katrina reallydid was show us that as bad as it wasand as real as it was, it was a dressrehearsal for something that could bemuch worse.”

He says the hurricane and handlingits evacuees caused the Sheriff’sDepartment, Office of EmergencyServices and other local groups to worktogether with national agencies (suchas FEMA — the Federal EmergencyManagement Agency) in a way neverbefore possible. “It helped us all thinkagain about what we would do in a dis-aster situation,” he says.

What effect has the hurricane hadon Camden? “Our population isgrowing as people move here tobegin a new life,” he says. And asfor the hospital cuisine? Let’s justsay it’s a new experience to havefolks calling to find out what’s cook-ing, and have them lining up outsidethe doors for a sample of RichardSmith’s daily fare. •

From Pat O’Brien’s restaurant in New Orleans to head chef of his own kitchens atOuachita County Medical Center in Camden, it has been an interesting three months forRichard Smith. After fleeing Hurricane Katrina’s destruction (his family’s home wasdevastated by storm winds), Smith and his family sought refuge at his mother-in-law’shome in Camden. Now, the Smiths and their three children are permanent residents ofthe Camden community, and those who have reason to dine at the Medical Center canfully appreciate his culinary expertise!

Phot

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Jam

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Paul PrudhommeProvides Meals forRelief Workers in New Orleans — Thanks to a Truckload of Ingredients from Pine Bluff’sDoctors and theCommunity

World-renowned chef Paul Prudhomme, his fami-ly and restaurant workers joined the thousands mak-ing a temporary escape from New Orleans during theheight of Hurricane Katrina and its aftermath. Theyfled to the camp-in-the-woods of one of Pine Bluff’sphysicians, a dear friend for many years. There, hespent two weeks waiting for New Orleans to dry outenough for his group to venture back. Upon theirreturn, they immediately began cooking meals for themany relief workers in the New Orleans area. Butgetting fresh food into town was difficult, at best.Four weeks after the storm, Prudhomme’s Pine Blufffriends again came to the rescue, raising more than$15,000 and filling a semi-trailer truck full of freshfood and needed ingredients. This is the “thank you”message Prudhomme and his pals placed in the PineBluff Commercial, thanking the medical communityand the people of the city who sent the personalized“food relief truck.” •

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C E O P R O F I L E

Jefferson RegionalMedical Center (JRMC)in Pine Bluff is but oneof many Arkansashealthcare facilitiesresponding to cries ofdesperation followingthe confusion and dev-astation wreaked byHurricane Katrina.JRMC’s rapid responseto evacuees is testa-ment to one hospital’sdisaster planning andthoughtful considera-tion for humanneed…and in themidst of the hospital’sadministering care andcompassion to thosefleeing Katrina’schaos, one family’sstory was very personally unfoldingfor the medical center’s CEO andPresident Robert Atkinson.

Atkinson’s eldest son, Chris, andhis family from Slidell, Louisianafound themselves in Katrina’s directpath Sunday, August 28. “We were allgathered in Slidell that weekend forour first granddaughter’s baptism,” hesays. “But with Katrina’s approach,we knew that would be postponed.Before we left, we helped Chris andAlison prepare their home for thestorm. We put plywood on all thewindows and did what we could tosecure the house. Then, we began ourdrive home to Pine Bluff, and the workwe knew would await us with incom-ing evacuees.”

The winds and flood waters thatbuffeted Gulf Coast families had per-

sonal impact on somany Americans; theirensuing stories eachcome down to oneperson, one family’saccount of what hap-pened “to them.”JRMC will be a partof many of those sto-ries because of thehelp it provided andthe compassion itoffered with welcom-ing arms.

“Pine Bluff took inbetween 2,000 and3,000 evacuees in thestorm’s aftermath,”Atkinson says. “Atfirst, it was in smallgroups of three andfour cars, families and

friends driving together to escape theimpending storm. Then we receivedmore and more people who had beenevacuated from New Orleans, directlyafter or in the next week after Katrinahit.” Some of those had originallybeen evacuated to Fort Chaffee, nearFort Smith.

Sheltered at the Pine BluffConvention Center, those arriving inthe earliest days had fewer medicalneeds; most required a refill of theirprescription drugs. “We set up abooth at the Convention Centerwhere people could come for medicalhelp,” Atkinson recalls. “At first weserved mostly as a first aid station,administering lots of tetanus shots,refilling prescriptions and assessingpeople for injuries.”

But with the second wave of evac-


New AHA Chairman on“Defining Moments,” Katrina, and Challenges to Healthcare

Bob Atkinson was installed asthe new Chairman of the Boardfor the Arkansas HospitalAssociation at its annual meetingin October. He is a great believerin the importance of hospitalsworking together for the good ofArkansas’ healthcare facilities,their patients and communities.

“I have been involved with theAHA almost since I arrived inArkansas in 1992,” he says. “Ihave long felt that the associa-tion’s leadership is its greateststrength. The Board membersand the AHA staff have workedtogether so well through the yearsand done a great job. They are agood team.”

He sees the main job of theAHA as keeping the state’s hospi-tals and their administrative pro-fessionals well informed. “Thereare so many changes constantlyoccurring in healthcare,” he says.“The AHA tells us what we needto be concerned about, and rep-resents us well both at the stateand the national levels.”

“In every life, there are defin-ing moments...distinct milestonesthat influence our character, illu-minate our dreams and shape thedirection of our lives,” he says.“Several of those definingmoments have taken place in mylife this year. The most meaning-ful was the birth this summer ofmy first grandchild, BrooklynGrace Atkinson. She representsthe very best of our family’s pastand future, and her arrival cer-tainly defined my aspirations asan influence in her life.

“Another defining momentwas being nominated to serve aschairman of the ArkansasHospital Association. I have adeep respect for the AHA and theguidance it provides to health-care professionals throughout thestate. It is a privilege to be anAHA member, and an honor toserve as Chairman. I look for-ward to continuing the standardof excellence that has defined thehealthcare industry for us all.”

Robert Atkinson was installed asthe 2005-2007 Chairman of theBoard of the Arkansas HospitalAssociation in October. Atkinsonis president and CEO ofJefferson Regional MedicalCenter in Pine Bluff, a position he has held since 1992.

by Nancy Robertson Cook

uees — those escaping the floods ofNew Orleans — Atkinson says theneeds rose tremendously.

“Those arriving from NewOrleans had had no way to wash, toeat, to meet their critical medicalneeds,” he says. “These 300-500 peo-ple showed considerably more stressand strain than those who had comebefore them. They needed a place tobathe, and food to eat. They neededmedical assessment, referrals and thecare that those of us in the medicalfield can specifically offer.”

JRMC posted a team of around 30doctors and nurses at the ConventionCenter to begin offering medical hopeas soon as people stepped off the buses.“Essentially, we were putting our dis-aster plan into place,” Atkinson says.“And the evacuees’ reaction — theirthanks — was truly heartwarming.”

As people told their stories, thehuman side of the storm’s aftermathbegan to unfold. “People were soconcerned for those they had leftbehind,” Atkinson says. “So many ofthem lost their homes, their friends,even family members.” Pine Bluffchurches came to the rescue, offeringshelter and food — ”aid and comfortin the finest sense,” Atkinson says.“JRMC’s biggest contribution was inhelping get people back on their med-icines. We estimate that we providedbetween $30,000 and $40,000 in pre-scription medicines. We may or maynot be reimbursed for those medica-

tions, but dispensing them was sim-ply the right thing to do.”

Atkinson says two of the things hewill most remember about Katrinaare the unbelievable power of MotherNature, and the compassion ofhumans, one for the other.

He is no stranger to MotherNature’s power. At the tender age ofsix, he saw first-hand the effects of atsunami while living with his militaryfamily in Hawaii.

“I guess you could call me a Navybrat,” he says. “We moved around agreat deal as I was growing up. I willnever forget standing on the shore inHawaii, a boy of six, and watching theocean literally suck itself outward for amile or more. Fish were floppingeverywhere. We knew it was time tohead home. And soon afterward, atsunami wave crashed in, close towhere we lived. It is something I willnever forget.”

Atkinson spent many of his grow-ing-up years in southern California,eventually attending high school in LaMirada. “Then, we had a big transi-tion,” he recalls. “We moved toJackson, Mississippi, where I wouldfinish high school. That was really aneye-opener!”

With a smile in his eyes, he remem-bers being “a novelty” to the nativeSoutherners. “I was so non-Southern,I didn’t even know that iced tea wassomething ‘everybody’ drank. I sawtea as a drink mostly enjoyed by

adults. And okra, black-eyed peas —all of these were new to me. I am suremy classmates enjoyed a few goodlaughs because of me!”

Atkinson’s chosen career path wasone of science. He earned his bache-lor’s degree from Mississippi StateUniversity in general science, thenwent on to earn his master’s in zoolo-gy and physiology. “I planned topursue my doctorate,” he says, “butit was 1972 and the war in Vietnamwas raging. I had an ROTC commit-ment to fill, and because of my sci-ence degrees was placed in St. Louisas administrative officer of a regionalmedical laboratory.”

He shakes his head as he tells howhis planned career in science shifted,instead, to one in administration.“The Army really threw me a curveball,” he says. “I had no administra-tive experience. I read up on it,learned as much as I could, and withmy science background found it easyto talk with the doctors and nurses atthe lab.”

His new career path became clear.Upon completion of his military com-mitment, Atkinson returned to theSouth and attended the University ofAlabama at Birmingham in pursuit ofa master’s degree in hospital adminis-tration. Graduating in 1976, he spentthe next two years in Birmingham asan assistant administrator at St.Vincent’s Hospital.

In 1978, he accepted an offer from

On Sunday, September 4, 2005, Pine Bluff welcomed 324New Orleans evacuees who had previously been housed atFort Chafee. JRMC employee health nurse Alice Lawson, RN,triaged each survivor as he or she got off the bus.

JRMC responded immediately by setting up a first aid station to offer minoremergency care, physician referral and prescription assistance. JRMC’sRuth Rogers, RN, (center) gave updates on how to run the clinic. Volunteersincluded a number of physicians such as Reid Pierce, MD (left).


Humana, a for-profit hospital chain,and moved his wife, Becky, and sonsChris and Tim to Huntsville, where heserved as associate administrator andCOO of Humana Hospital-Huntsville. His next assignment withHumana was in Muscle Shoals,Alabama, where he served as adminis-trator and was charged with buildinga new hospital from the ground up —

a hospital that would be used as a pro-totype for the Humana system foryears to come.

“That was a particularly interestingproject,” he says. “We helped withdesign of the entire hospital, a veryrewarding experience.”

His next position was withChalmette Medical Center in NewOrleans — a hospital, herecalls, that took on seven feetof floodwater in Katrina’s after-math. He served as administra-tor at Chalmette from 1985-87,then accepted an offer fromSlidell to become administratorof Slidell Memorial Hospital.Slidell is where his two sonsspent their later teen years, andit is ultimately where elder son,Chris, settled.

In 1992, Atkinson becamepresident and CEO of JeffersonRegional Medical Center in PineBluff, Arkansas, a move he says

has been enjoyable in every way.“Becky and I were empty-nesterswhen we moved to Pine Bluff,” hesays. “We have enjoyed becoming apart of the community, and love thepeople here.”

There have been many changes inhospital administration over thecourse of Atkinson’s career. “The roleof the administrator used to be to han-

dle the hospital’s internal affairs,” hesays. “Now, that’s more the role of anassistant administrator or vice presi-dent. The role of the CEO is nowmore external, networking with otherhealthcare providers, working withlegislators, helping with physicians’concerns and issues, fighting the reim-bursement fight, and serving as the

medical center’s liaison with thegreater community.”

The hospital is a central part ofevery community, he says, and is oftenthe center of its economy. JRMC isone of the top employers in Pine Bluff,and indeed in all of Jefferson County.

He cites “the insurance situation”(growing numbers of uninsured andunderinsured) as one of his biggestconcerns as an administrator. “Withthe cost of healthcare on the rise, smallemployers just can’t afford to providehealth insurance for their workersanymore,” he says. “Health crises canput families into bankruptcy, yet toomuch charity care can force a hospitalto close its doors. There is a real bur-den on hospitals to provide care atreasonable costs while still being ableto provide needed services. It is a dif-ficult spiral, and a big challenge forour society.”

He also cites a change in the health-care workforce as challenging.“Many are simply losing heart,” hesays. “They are still extremely dedi-cated, but with fewer workers we areasking more and more of those still onthe job, and that is hard on them. Theaverage age of nurses is 41-42, andmany will retire soon. We must findways of recruiting and training thehealthcare workforce needed with ourgrowing, aging population.”

As both scientist and hospitaladministrator, Atkinson sees the futureof healthcare as exciting and promis-ing, even with its inherent challenges.“There are new medicines, new tech-

nologies that are saving people’slives every day. And new things arebeing discovered all the time — it’salmost like something out of StarWars,” he says.

Serving the healthcare field istruly a calling, Atkinson says. “Wehave come so far; it is hard toimagine the advances that havebeen made in just the past 75years. Knowledge, treatment,technology, all are growing expo-nentially. Collectively, as membersof the field of healthcare, we canall be proud of the job we do andthe service we provide!” •



Hot Showers, Warm Meals, Finding Mama — It’s All in a Day’s Work at St. Edward Mercy Medical Center


Chip Paris, Director of Marketingand Planning for the St. EdwardMercy Health Network in Fort Smith,vividly recalls Labor Day weekend of2005. “Friday, September 2, ouradministrators were notified in the latemorning by people at Fort Chaffeethat our area would be receiving anumber of evacuees from HurricaneKatrina,” he says. “They could give usno definite time or numbers of people,but we knew we had to be ready.”

The first wave of evacuees arrivedby plane at Fort Smith, followed bywhat we all now remember as analmost never-ending line of busesfrom the Gulf. “We received peoplefrom both Louisiana and

Mississippi,” he says. “In all, thou-sands of people passed through theFort Chaffee relief center.”

“By Saturday, we had triagedpatients at the Fort, and broughtbetween 300 and 400 to the hospitalfor further assistance,” he says. “Ofcourse, those people came with theirfamily members. We offered cleanclothing, a hot shower and hot mealsto all who came through our doors,whether patient or relative.” Theevacuees came with needs rangingfrom prescription refills to full-timenursing care. “We also saw peoplewho had ‘normal’ problems, like theflu,” he says.

Shirrell Henry, another member ofthe St. Edward staff, recalls the carefor a man who suffered a fractured legduring the storm. “By the time hereached us, he was in bad shape,” shesays. “We had to amputate his leg. Helost his leg, but we saved his life!”

For 72 hours afterthe first wave of evac-uees began arriving atFort Chaffee, it was aconstant carousel ofpeople in and out of thehospital, Paris says.“We admitted around20 patients, sawbetween 300 and 400,and helped more than1000 families, in all.”

Not only were themedical staff membersneeded beginning thatFriday, but also those on the nutritionstaff, who cooked and provided mealsfor the evacuees. “We heard they werehaving a problem feeding the numbersof people coming into the Fort,” Parissays, “so our nutritional staff immedi-ately went into action. They cooked600 hot meals complete with ice, colddrinks and all the fixings, transportedthem to the Fort, set up a buffet line inthe grass, and began serving. All ofthis while still cooking for the patientsand regular hospital dining rooms.”

He says that a number of the nutri-tional staff, as well as off-duty medicalstaff and administrators went to theFort to serve the meals.

“The whole thing was so amazing,”he says. “The evacuees and the greaterFort Smith community suddenlybecame aware of the level of caring wesee and know at our hospital everyday. I think it showed the community,reminded them, of the great care andcompassion we provide at St. EdwardMercy Medical Center.”

That level of caring was alsoshown by the Mercy hospital net-work, headquartered in St. Louis,Missouri and of which St. Edward isa part. “More than $300,000 wasraised by Mercy employees system-wide,” he says. “Then, the corpora-tion matched it. In all, we raised$600,000 for hurricane relief.”

One of the mosttouching stories tocome out of St. EdwardMercy centers onMonte Wilson, VicePresident of ClinicalOperations (Cardiologyand Surgical Services).Wilson, through hischurch and work atthe hospital, foundhimself in the middleof many stories involv-ing Katrina evacuees.

“On Labor Dayweekend, he met a family — a mom,dad and son — who had with them an11-year-old girl not belonging to theirfamily,” Paris recalls. “This child hadbeen through a nightmare already.She, her mother and baby brotherescaped the hurricane and tried tomake it to one of the New Orleansshelters. They made it to the I-10bridge, which many of us rememberseeing on television. There, few carscame by to help. But eventually, atruck stopped and had room — onlyfor the mother and baby. This girl’smother had to make the heart-wrench-ing decision to take her baby to safety,while leaving her daughter to try tofind them later. This amazing 11-year-old made it on her own for severaldays, then met this family, who tookher in.

“They wound up at Fort Chaffee.Monte Wilson met the family, andbrought the girl and two other kidswho had been separated from theirfamilies, home with him. He shared hiskids’ clothes with them, and gave thembeds to sleep in and plenty to eat.”

Then, a remarkable thing hap-pened. Wilson, through his church,heard that the two siblings’ familyhad been located in Dallas, Texas.“Monte took the two kids, alongwith another church member andthis 11-year-old, to Dallas to try to

Monte Wilson



find their parents,” Paris says. Thesiblings’ family was found, and theywere reunited. But no word on theyoung girl’s mother and brother.

“Then, they heard that the motherand baby might be in Austin,” Parissays. “So even though it was 9:30 atnight, they headed for Austin, arrivingthere between 1 and 2 in the morning.Of course, once they located the shel-ter in Austin, they found most every-one there asleep. And they didn’t even

know if the mom was there. But theybegan to ask a few people in the hall-ways, and when they turned a corner,the mother was simply THERE!Monte said it was an act of God.” Atthe very least, it was a miracle!

Most of the people who camethrough Fort Chaffee quickly movedon. After the experience was over,many on the St. Edward staff continuedto trade anecdotes and stories aboutwhat had happened — and among the

2000 workers at the hospital, therewere many wonderful stories to tell.

“Of course, as a hospital, we drill,drill, drill on disaster preparedness,”Paris says. “Dealing with the after-math of Katrina made us take a longlook at our plans, and we are glad toreport that they were very flexible andworked well.” Though a few adjust-ments have been made, the disasterplan stands ready for the next event.Let’s hope it doesn’t come soon. •

Regional Networks Made All the Difference:An Arkansas Children’s Hospital Retrospective

“As we have thought it through in the time sinceHurricane Katrina, a couple of things have become veryclear,” says Scott Gordon, Executive Vice President andChief Operating Officer for Arkansas Children’s Hospital(ACH) at Little Rock. “One — when things need to move,regional networks get the job done, and two — keeping yourinternal communications strong is vital.”

Gordon says, “We have a particularly strong regional net-work in the area of transporting patients. Regional trans-portation directors know one another, know their hospitals’abilities for transport, their people’s and hospitals’ capaci-ties. Within one hour of identifying New Orleans’ need formoving patients from hospitals, the informal regional net-work mobilized — in most cases before the hospitals thereeven realized they would have to evacuate their patients.”

As became evident in the early days of Katrina’s after-math, the helicopter evacuation of patients became a lifeline.“No one asked, ‘Who is going to pay for this?’ prior to act-

ing,” Gordon says. “We just went into action, matchingresources to needs.”

He credits not only the ACH transport team, but also theentire staff of the medical facility, in helping things to hap-pen quickly. “Our nutritional services group helped bringfood and water that could be transported to New Orleans.And our vendors were outstanding. Alltel provided satellitephones for communication. Sikorsky kept teams availablein Baton Rouge so the helicopters’ engines could be flushedand remain undamaged by the salt air.”

“At the end of the day, all our people were proud to havebeen a part of the effort,” Gordon says. That is where theinternal communication updates helped. “Every person onstaff wanted to know what we were doing, and we keptgood communication with our internal organizationthroughout. 40-50 people received regular updates, andpassed the information on to their own staffs.”

An internal de-briefing took place following the return ofACH employees from the Gulf region. “It helped those whohad been on-site to discuss what they had been through, andit helped those left to work here in Little Rock to be able toask questions, to better understand. It was a very powerfulsession.”

In the end, the informal regional transportation networkwas able to go into action well ahead of the federal emer-gency response. Gordon says this happened because peopleknew each other, they were already organized to make thingshappen, and they knew not to over-commit or to makeunreasonable demands. “They proved that when thingsneed to move, local and regional relationships provide themost effective response in time of crisis,” he says. “We alllearned to recognize the value of informal relationships andwhat they can do.”

He also notes that ACH is uniquely set to respond quick-ly — and that with that ability comes responsibility.“Moving patients, helping to evacuate hospitals, was vitallynecessary after Katrina,” he says. “We responded. This iswhat we’re all about.” •

The Arkansas Children’s Hospital transport team worked close-ly with other regional transport groups to move patients fromhospitals affected by Hurricane Katrina.

Phot

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Kel

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Several recent calls to the ArkansasHospital Association have concernedhospital requirements for recordsretention. According to the 2005 edi-tion of the state’s Rules andRegulations for Hospitals and RelatedInstitutions (Section 14.A.17): “Allmedical records shall be retained ineither the original or microfilm orother acceptable methods for 10 yearsafter the last discharge. After 10 years,a medical record may be destroyedprovided the facility permanentlymaintains the information containedin the Master Patient Index. Completemedical records of minors shall beretained for a period of two years afterthe age of majority.”

In addition, the Arkansas HealthInformation Management Association(AHIMA) recommends the followingpermanent records: • Master patient index • Number index • Admission list or patient register • Death register • Statistical reports

AHIMA also gives these time-frames for retaining records:• Annual statistical reports — 30

years; • Physician indexes, disease and

operation indexes, monthly statisti-cal reports, quality improvement— 10 years;

• Medical audits and correspon-ding retrieval sheets, medicalstaff utilization reports, tissueand transfusion committee work-sheets — 5 years;

• Consent forms for release ofinformation on microfilmedrecords, release of informationlog — 3 years;

• Daily census summary or dischargelist — 1 year;

• Transcription logs — 6 months;

• Surgery schedules, daily census —3 months; and

• Reproduction of microfilm recordssent to the floor — until discharge. •

Arkansas Medical Records Retention Rules : a Reminder

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E L E C T R O N I C H E A LT H R E C O R D S

The federal government shoulddevelop a nationwide patient authen-tication standard that protects indi-viduals’ information and lead aneffort to offer financial incentives toproviders in order to foster the elec-tronic exchange of health informa-tion and to create a system ofinstantly accessible health recordsfor all Americans, according to twokey recommendations releasedOctober 25 by the Commission onSystemic Interoperability (CSI).

In all, the Commission, which for-mulated its recommendationsaround the tenets of adoption, inter-operability and connectivity, pin-points a total of 14 steps for creatinga connected system of instantlyaccessible health records for every

American. Such a system would leadto dramatic improvements in patientsafety, quality of care, convenience,satisfaction and health while helpingto rein in soaring healthcare costs.

In their report, “Ending the

Document Game: Connecting andTransforming Your Healthcarethrough Information Technology”(http://endingthedocumentgame.gov/PDFs/Recommendations.pdf), the 11commissioners focused on givingpeople the information they need tomake wiser decisions about theirhealthcare and helping consumersunderstand how electronic recordsand other technology are critical toachieving that goal.

The CSI also calls on governmentto “act with urgency to revise oreliminate regulations” that impedeimplementation of interoperableelectronic health records, mostnotably the Physician Self-Referral(Stark) law and the Federal Anti-Kickback Law. •

Report Lists Electronic Record Needs


E L E C T R O N I C H E A LT H R E C O R D S

Survey: Costs are HIT Barrier Ninety percent of U.S. hospitals

are using or considering the use ofhealth information technology (HIT)for clinical purposes, according to anew American Hospital Association(AHA) survey, but most cite cost as amajor impediment to broader adop-tion, especially for small or ruralhospitals.

The survey results suggest that theuse of health IT in caring for patientsis evolving as hospitals adopt specifictechnologies based on their needs andpriorities, size and financial resources.

While most are still in the beginningstages, the survey shows hospitals aremaking investments in HIT, in largepart to make gains in the safety and

quality of patient care. Some of thetechnologies and systems hospitals areusing include bar coding devices, com-puterized physician order entry andelectronic medical records. To view thesurvey in its entirety, go to:http://www.ahapolicyforum.org/ahapolicyforum/resources/content/FINALNonEmbITSurvey105.pdf. •

With Government Help, Study ProjectsHealth IT Could Save $162 Billion

Widespread adoption and effec-tive use of electronic medical records(EMR) and other health informationtechnology (HIT) could save the U.S.healthcare system up to $162 billionannually and prevent a third or moreof adverse drug events in outpatientsettings each year, a new study byRAND Corp. projects.

Assuming about 20% of hospitalsand physicians have an EMR system

now, the study estimates it would cost$98 billion for hospitals and $17.2 bil-lion for physicians to adopt a stan-dardized EMR system over the next 15years, much less than the $162 billionper year in possible savings.

“The potential savings from HITis mind-boggling, but it isn’t going tohappen overnight,” the lead authorsaid. “The federal government willneed to step in to speed the diffusion

of HIT and remove some major bar-riers if we are going to reap thetremendous benefits it could have onimproving quality, managing dis-eases, and extending people’s lives.”

Key barriers include the acquisi-tion and implementation costs forhealthcare providers, slow anduncertain financial payoffs, and dis-ruptive effects on practices, theauthors say. •

Proposed Rules Bolster E-prescribing, EHRsThe federal Department of Health

and Human Services (HHS) took astep toward meeting President Bush’sgoal of widespread adoption of addi-tional information technology (IT) inthe healthcare field with an October5 announcement of two new sets ofregulations that support adoption ofelectronic health records (EHRs) ande-prescribing, which enables a physi-cian to transmit a prescription elec-tronically to a patient’s pharmacy ofchoice.

HHS Secretary Mike Leavitt saidthat the proposals should speedadoption of health IT by hospitals,physicians and other healthcareproviders to improve quality and

safety for Medicare beneficiaries andall Americans.

Under the first proposed rule, theCenters for Medicare & MedicaidServices (CMS) would create excep-tions to the “physician self-referral”law by establishing conditions underwhich hospitals and certain other enti-ties can give physicians hardware, soft-ware or information technology, andtraining services for e-prescribing andEHRs, particularly when the supportinvolves systems that are “interopera-ble” and thus can exchange informa-tion effectively and securely amonghealthcare providers.

The second proposal came fromHHS’ Office of Inspector General.

That proposed rule would establish theconditions under which such entitiesmay donate to physician EHR softwareand related training services. This pro-posal would be relatively narrow untilnationwide product certification crite-ria are established and approved by theSecretary. At that point, hospitals andcertain other entities could donate abroader array of technology to physi-cians, if the technology met the productcertification criteria.

CMS is considering imposing a capon the value of the technology thatmay be donated by a single donor toreduce the potential for abusivearrangements designed to pay physi-cians for referrals. •

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Mansfield Named Weintraub Award Recipient

Stephen Mansfield, President andCEO of St. Vincent Health System inLittle Rock received the ArkansasHospital Association’s A. AllenWeintraub Award at the AHA’s AnnualAwards Dinner, Thursday, October 20,at the Peabody Hotel in Little Rock.Mansfield has been President and CEOof St. Vincent Health System (SVHS)for the past five years.

Mansfield is noted for achieving asuccessful turnaround in hospital oper-ations in areas of community percep-tion, patient satisfaction, employeemorale and improved financial per-formance. In 1998 the organizationwas millions of dollars in debt.Mansfield was able to accomplish an$11 million turnaround.

Under his leadership SVHS was

named one of Solucient’s Top 100Performance Improvement Leaders.Solucient is a leading provider ofstrategic business and clinical infor-mation for the health care industry.Mansfield is also responsible forestablishing St. Vincent Centers ofExcellence in cardiac, orthopedic,senior, spine, stroke and women’sservices. •

AHA Chairman Tim Hill presents Stephen Mansfield, President and CEO of St. Vincent Health System, with the Arkansas HospitalAssociation’s 2005 A. Allen Weintraub Award at the AHA’s Annual Awards Dinner.

In addition to the Weintraub Award, the AHA’s highesthonor, additional awards were presented at the ArkansasHospital Association’s Annual Awards Dinner in October.

Distinguished Service Awards W. Turner Harris, M.D., of Little Rock and Linda Feltner,formerly of Fort Smith, were selected by the ArkansasHospital Association’s (AHA) board of directors as recip-

ients of the association’s Distinguished Service Award. Dr. Harris, a radiologist, has been a consultant with St.

Vincent Health System in Little Rock since his retirementfrom more than 30 years with the System. His earlyresearch on bone-scanning methods contributed toNASA’s development of an in-space exercise program forastronauts to offset the negative effects posed by theabsence of gravity. A Fellow in the American College ofRadiology, Dr. Harris also is the founder and medicaldirector of Volunteers in Medicine.

At the time of her death in April, Ms. Feltner was direc-tor of the medical records department at Sparks RegionalMedical Center in Fort Smith. Over her 36-year career, shedistinguished herself professionally at the state andnational levels; served as a mentor to scores of medicalrecords administration students at Arkansas TechUniversity; and provided extraordinary leadership in med-ical records departments at Washington Regional MedicalCenter (Fayetteville), St. Edward Mercy Medical Center(Fort Smith) and Sparks Health System.

Statesmanship Award State senator Tim Wooldridge from Paragould receivedthe Arkansas Hospital Association’s (AHA) StatesmanshipAward for 2005. The AHA Board of Directors selectedWooldridge to receive the award in recognition of his con-tributions to and leadership in Arkansas hospital andhealthcare issues.



AHA Awards Presented

Friends and family of Linda Feltner along with representatives of Sparks Health System in Fort Smith

W. Turner Harris, M.D

Wooldridge, who served four terms in the ArkansasHouse of Representatives before being elected to thestate Senate in 1999, chairs the Revenue and TaxationCommittee.

During the 2005 legislative session, SenatorWooldridge successfully sponsored the MedicaidFairness Act, which was a key component of the AHA’slegislative agenda. He also supported passage ofArkansas Act 134 of 2005 that prohibits smoking onhospital campuses throughout Arkansas.

In addition, Senator Wooldridge was instrumental inhelping pass legislation that provides for an additionalsource of Medicaid funding to help offset some of thelosses that hospitals are experiencing in treatingMedicaid patients, and legislation that restricts theamount of time that insurance carriers can audit andrecoup payments to healthcare providers when serviceswere provided and paid for on the basis of informationprovided by the carriers.

Senator Wooldridge also championed legislationknown as Garrett’s Law designed to provide additionalprotection and services to children born with illegal sub-stances in their blood.

Young Administrator of the Year Jonathan Davis, Administrator/CEO of St. Anthony’sHealthcare Center in Morrilton, was the recipient of theArkansas Health Executives Forum’s C. E. Melville YoungAdministrator of the Year Award, which also was present-ed during the Arkansas Hospital Association’s annualAwards Dinner.

“In such a short time in hospital administration,

Jonathan has already proven himself an effective leader,bringing significant improvements to a small, rural hos-pital. His fiscal responsibility, concern for and value ofhis staff, and insistence of the highest quality care havemade St. Anthony’s an important institution in



State Senator Tim Wooldridge and AHA Chairman Tim Hill Jonathan Davis

Vickey Boozman



Morrilton and Conway County,” said Steve Mansfield,president and CEO of St. Vincent Health System, in hisnomination letter.

During his three-year tenure at St. Anthony’s, Davishas improved the financial growth of the hospital,upgraded and improved technology, made magnetic reso-nance imaging available around the clock to patients andsecured new surgical equipment that has made minimallyinvasive orthopedic procedures possible. In addition, he’sresponsible for opening a same-day surgery center, a newfacility for outpatient specialties, private labor-and-deliv-ery suites and remodeling the emergency room.

Chairman’s Award Chairman Tim Hill presented a Chairman’s Award honor-ing Dr. Fay Boozman, former director of the ArkansasDepartment of Health, who passed away last spring. Theaward recognized Dr. Boozman’s priority for improvinghealthcare services throughout Arkansas; his efforts toadvance quality, effectiveness and efficiencies in the sur-veys and certifications affecting Arkansas hospitals; andhis unwavering pledge and commitment to improve thehealth status of all Arkansans. Mrs. Vickey Boozmanaccepted the award on behalf of the Boozman family.

2005 Diamond Awards The Arkansas Hospital Association’s 2005 DiamondAwards competition was co-sponsored by the ArkansasSociety for Healthcare Marketing and Public Relations.It is designed to recognize excellence in hospital publicrelations and marketing. Diamond, Excellence andJudges’ Merit Awards were possible in three divisions(hospitals with 0-99 beds, hospitals with 100-249 bedsand hospitals with 250 or more beds) in twelve cate-gories. The competition drew 162 entries.

Judging for each entry was based on goals and objec-tives, audience to whom directed, reasons for choosingthe format, frequency and quantity, portions that werecreated internally/externally, results/evaluation andtotal budget.

The award-winning hospitals are: Arkansas Children’s Hospital, Little RockArkansas Hospice, Little Rock Baxter Regional Medical Center, Mountain HomeCARTI, Little RockCentral Arkansas Hospital, SearcyConway Regional Medical Center, ConwayJefferson Regional Medical Center, Pine BluffNational Park Medical Center, Hot SpringsOzark Health Medical Center, Clinton Saint Mary’s Regional Medical Center, RussellvilleSt. Bernards Medical Center, JonesboroSt. Joseph’s Mercy Health Center, Hot SpringsSt. Vincent Health System, Little RockUAMS Medical Center, Little RockWhite County Medical Center, SearcyWhite River Health System, Batesville

Photos by Sarah Bussey



AHAA Awards John Neal, CEO and administrator of Stuttgart RegionalMedical Center, was named Administrator of the Year forhospitals with fewer than 100 beds by the ArkansasHospital Auxiliary Association (AHAA) during theAHAA’s annual meeting October 21. Ray Montgomery,president and CEO of White County Medical Center inSearcy, received the association’s Administrator of theYear Award for hospitals having 100 beds or more.

ACHE Regent’s Awards Phillip Gilmore of Malvern, Arkansas’ ACHE Regent, pre-sented two Regent’s Awards during the American Collegeof Healthcare Executives/Arkansas Health ExecutivesForum breakfast October 20 in Little Rock. Recipientswere Christina P. Hockaday, director of business develop-ment and administrative services for Conway RegionalHealth System, who received the early career healthcareexecutive award; and Chris B. Barber, administrator, St.Bernards Medical Center in Jonesboro, who received thesenior level healthcare executive award.

John Neal and Ray Montgomery Corporate Partners The Arkansas Hospital Association wishes to thank thecompanies and organizations participating in the 75thAnnual Meeting and Trade Show. With their financialsupport of the annual event, high quality educationalprogramming is made possible for the AHA member-ship. Those contributing as major sponsors are indicat-ed by asterisks at the following levels: ****** Diamond, ***** Platinum, **** Gold, *** Silver, ** Bronze and *Host. Thanks to all!

Administrative Consultant Service, LLCAHA Services, Inc. ******AIG VALICAir ProductsAlberici Healthcare ConstructorsAmerican Data NetworkAmerican Pharmaceutical Partners, Inc.American Red Cross Blood ServicesArCom Systems, Inc.ARJO, Inc.Arkansas Association of Hospital Trustees **Arkansas Auxiliary of Gideons InternationalArkansas Blue Cross and Blue Shield *****Arkansas Foundation for Medical Care **Arkansas Health Care Access Foundation,

Inc.Arkansas Health Executives Forum *Arkansas Managed Care Organization

(AMCO)Arkansas Medical ImagingArkansas Medical NewsArkansas Regional Organ Recovery AgencyBenefit Management Systems, Inc.BKD, LLP ***Business World Inc.C2P Group, LLCCarstensCarter & BurgessCommunity Health Centers of Arkansas, Inc.CoreSource, Inc.Correct Care, Inc.Crafton, Tull & Associates, Inc.Data Systems Management, Inc.DCS Global SystemsDD&F Risk Management GroupDisability Determination for Social SecurityDMS ImagingEDS and Arkansas MedicaidEmCareemdeon Business ServicesEmergency Service PartnersEngelkes, Conner & Davis, Ltd. *EZ Way Inc.First Choice CooperativeFirst Uniform, Inc.G2N, Inc.Generation Product CompanyGenworth FinancialGraduate Program in Health Services

Administration-UAMSGuldmann Inc.Hagan Newkirk Financial Services, LLCHammes CompanyHBE CorporationHealthcare Administration Technologies, Inc.Hill-Rom Company, Inc.Hill Wholesale Distributing Co., Inc.Hubble-Mitchell InteriorsHughes, Welch & Milligan, Ltd.IHC/AmerinetInman Construction Corp.Innerface Sign Systems, Inc.

InnerplanIntellamedJackson & Harris, LLCKutak Rock, LLP **Kwalu, Inc.La-Z-Boy ConceptsLHC Group ***Marshall Erdman & AssociatesMDM CommercialMedAssets *MedBill Services, Inc.Medical Management Consultants, Inc.Metropolitan Healthcare ServicesMid-South Marking SystemsMobile Instrument Service & RepairModern Biomedical & Imaging, Inc.Modular Services CompanyMultiPlan, Inc.Nabholz Construction *National HVAC ServiceNC StaffingOptus Inc.Patient Line ProductsPCI (Publishing Concepts)Pinnacle Health GroupPMABPPOplusPress Ganey Associates, Inc.QHR (Quorum Health Resources) **Ramsey, Krug, Farrell & Lensing ***Service Plus Telecommunications Inc.Service Professionals Inc.Sign Systems, Inc.Signet Health CorporationSimplexGrinnellSnell Prosthetic and Orthotic LaboratorySodexho Health Care ServicesSoutheast ImagingSpectron CorporationStephens Inc. *Sterling HealthcareSwisslog TranslogicTandusTeam HealthTelcoe Federal Credit UnionTeletouch PagingTERM Billing, Inc.The Crump Firm, Inc.The Fleming CompaniesThe Lawrence Group ArchitectsThe MHA Group **The SSI Group, Inc.TIAA-CREFTME, Inc.Trane ArkansasTRO/The Ritchie OrganizationUnited ExcelUS FoodserviceVoi Cert, The White Stone GroupWilcox Group ArchitectsWittenberg Delony & Davidson ArchitectsWorkplace Resource of Little RockChristina P. Hockaday Chris B. Barber



The AHA honored longtime board member Frank Wise for his more than 25 years ofservice. Here, board chairman Tim Hill presents Wise with a remembrance plaque.

With more than 100 healthcare vendors and educational groups on hand at thisyear’s Trade Show, visitors had a chance to network, learn and share new ideas.

During the Advocacy Luncheon, former U.S.Senator David Pryor, current Dean of theUniversity of Arkansas Clinton School of PublicService, explained the mission and function ofthe Clinton School, and also shared somethoughts on today’s current political arena.

Three very atypical“waiters” entertainedat the Awards Dinner,

singing well-knownopera arias and a few

favorite pop tunes.

At the ACHE Breakfast, Garrison Wynn helped us understand“The Truth about Success” and gave the top seven characteris-tics top performers have in common. Those characteristicsfocus on growing, building and maintaining strong relationships.

Renowned healthcare consultant and keynote speaker JamieOrlikoff helped us look at today’s almost unwieldy healthcarechallenges and trends. Orlikoff reminded us that hospitals aretoo often the unknown and unappreciated backbone of thecommunity. He encouraged the building of strong hospital-community relationships, where challenges are laid on thetable and dealt with by thinking things through, together.

Recalling the AHA’s rich 75-year history was the idea behind a spe-cial Diamond Anniversary video highlighting the past and presentwork of the hospital association. Current and past AHA boardmembers, presidents and executives detailed the AHA’s ongoingmission of supporting a healthier Arkansas.

This year’s early-bird educational session explored the reasonsbehind and some solutions for the growing physician shortage inAmerica. Our speaker was Kurt Mosley of the MHA Group.





Former AHA president Roger Busfield (right) and his wife, Addie, with (from left) former AHAchairmen Frank Schweitzer and Howard Johnson and their wives, Plesine and Bonnie,respectively, at the reception honoring new AHA board chairman Robert Atkinson.

Incoming board chairman Robert Atkinson, president and CEO ofJefferson Regional Medical Center in Pine Bluff, was honored with acongratulatory reception. Here Atkinson (left) is greeted by ACHERegent Phil Gilmore (center) and C.C. “Mac” McAllister, CEO of theOuachita Valley Health System (right).

Helping us turn life’s challenges intoopportunities was John Cassis’ goal in hisclosing presentation, “Catching a SecondWind.” His humorous anecdotes andgentle, yet pointed, suggestions closedthis year’s annual meeting on a highlypositive note.

Transparency and accountability are absolute necessities in today’s healthcarefield. Helping us understand both challenges and new ideas/programs proven towork were Daniel Landon, Joe Kachelski and David Feinwachs of the Missouri,Wisconsin and Minnesota Hospital Associations. Photos by Sarah Bussey


Editor’s Note: The Arkansas HospitalAssociation recently completed its 75thyear of service to the state’s hospitals,healthcare facilities, patients and fami-lies. For three-quarters of a century, thepeople and organizations that make upthis association have banded togetherfor the common purposes of improvingtheir communities’ healthcare qualityand raising the level of health servicesfor and health status of all Arkansans.

In the Fall issue of ArkansasHospitals, Paul Cunningham detailedthe early years of the AHA’s service, from1929 through the first part of the 1970s.In this article, he concludes the lookback at the association’s first 75 yearsand begins to look toward the future.

The Later ‘70s — Tumultuous Times

Nationally, healthcare issues wereovershadowed by other world eventsduring the final years of the 1970s:Watergate, 12% inflation, the ThreeMile Island nuclear power plant melt-down, U.S. embassy workers takenhostage in Tehran, Iran.

Of course, there were plenty of in-state matters raising concern for thestate’s hospitals. The Arkansas Hos-pital Association took issue throughthose years with every branch of stategovernment — administrative, legisla-tive and judicial. The AHA went toe-to-toe with the state Pharmacy Boardconcerning jurisdiction over the inspec-tion of hospital pharmacies; lockedhorns with legislators over a proposalrequiring some hospitals to publishquarterly audited financial reports; andfought to get Joint Commission inspec-tions to stand in lieu of state surveysfor accredited hospitals. The AHA alsodug in against the state Department of

Labor to defend a court decision thatstruck down several costly Arkansasovertime laws.

There were the perennial manpowerissues, too. The AHA and its membersworked with several Arkansas colleges

and universities to find ways to pro-duce more physical therapists and nurs-es, and wrestled with the need for moreexperienced nurses who were qualifiedto teach in the state’s nursing schools.

At the same time, the associationtended to the daily routine, guidinghospitals through the 1977 and 1979legislative sessions, dealing with con-tinuing Medicare and Medicaid pay-ment problems, and handling theunexpected surprises that cropped up30 years ago, just as they do today.

By the late-1970s, the two wordsmost commonly used in conjunctionwith hospitals were “cost” and “con-tainment.” As you might expect, theconcept wasn’t well received by hospi-tals anywhere.

Beginning in 1977 through the end

of his term, President Jimmy Cartertried to convince Congress to pass leg-islation to force mandatory controls onhospital spending, without controllingprices for the goods and services hospi-tals had to buy. The AHA joined hos-

pital groups across the country in 1978to stave off these forced controls byadopting their own Voluntary Effort(VE) to Control Health Care Costs.

The VE worked for a couple ofyears, setting the stage for a November1979 House vote that killed the Carterbill. Unfortunately, the VE programdied shortly thereafter, a victim of thesame relentless increases in hospitalcosts it was trying to bridle.

In another major battle, the AHAclashed with the state over its “certifi-cate-of-need” (CON) law. Arkansas,which had operated a federal “capitalexpenditure review” program underPublic Law 93-641 since 1972, gainedapproval for a CON law in 1975. Bothprograms were indirect attempts athospital cost control by limiting hospi-

75 Years of AHA History… A Look Back

by Paul Cunningham, Senior Vice President, Arkansas Hospital Association

Sparks Health System, Fort Smith

Part 2


tal capital spending to approved proj-ects only.

The AHA persisted in its demandsthat the federal contract be droppedafter the state passed its law. The twoprograms served the same purpose andthe AHA believed that the state didn’tneed both. Governor Bill Clinton final-ly terminated Arkansas’ contract toperform the federal review.

Blue Cross got into the picture,too. Saying it had a moral corporateobligation to do what it could to con-trol hospital costs, the payer imple-mented its own version of a capitalexpenditure review program, tying itto other local reviews.

All the hubbub over hospital costcontainment eventually led the AHA toexpand its staff to include someone with

a background in health and facilityplanning. By the time the AHA’s neweststaffer arrived in December 1980, thejob emphasis had already changed. Thenew focus centered on a four-letterword that touched on planning andmuch more. That word? Data.

Entering the EightiesComing into the 1980s, a

Hollywood actor became our 40thPresident, surviving an attemptedassassination by the mid-point of thedecade. Pope John Paul II also survivedan assassin’s bullet, although BeatleJohn Lennon and India’s PrimeMinister Indira Gandhi did not.Mount St. Helens blew its top, the fed-eral deficit shot to $180 billion, and welearned a new business jargon — gold-en parachute, poison pill, junk bonds

— plus a new term for the day’s equiv-alent of plague, AIDS.

The AHA had begun building aframework in the 1960s for a strong,durable member organization. Startingas primarily an advocacy and represen-tation group, the AHA became morevaluable during the 1970s with timelycommunications and powerful educa-tional programs. By 1986, the AHAhad added a data component and setup a subsidiary, AHA Services, Inc., tohelp member hospitals link up withneeded products and services.

Hospital issues requiring attentionwere piling up at a frenetic pace, andthe AHA stepped up to help. Thestate’s Medicare claims review contrac-tor wanted to expand into performingmedical review of claims for private

payers, too. Allied health professionalgroups pressed for state licensure.Governor Clinton leaned toward forc-ing hospitals to pay a tax to fund indi-gent care. The state, which alreadymandated that hospitals obtain a cer-tificate-of-need for their capital expan-sion projects, was proposing that theypay a fee for the privilege of doing so.

Payment issues pulled a hat trickduring the early 1980s, as hospitalsdealt with major reimbursementchanges on three fronts almost simulta-neously. In 1983, Medicare was prep-ping its move to a completely new wayof paying hospitals based on somethingcalled “diagnosis-related groups,” orDRGs. Medicaid followed suit a yearlater, opting to pay hospitals prospec-tively set per diem rates, since the statelacked the capabilities for a DRG sys-

tem. The coup de grace was Blue Cross’1985 announcement of its own DRGpayment system. AHA staffers andcommittees worked to overcome prob-lems with each of the changes.

The AHA also brought several“firsts” to Arkansas between 1980 and1986. The most visible, or audible, wasa first-ever statewide radio campaigndesigned to make the general publicmore aware of their community hospi-tals and to better understand factorsbehind high hospital costs. Anotherwas the AHA’s Hospital EquipmentLoan Program, providing low interestfinancing for hospital equipment pur-chases using funds generated frombond issues.

Later, when Arkansas hospitalsencountered problems finding afford-able workers’ compensation coverage,the AHA established the AHAWorkers’ Compensation Self-InsuredTrust, the first program offered underthe umbrella of AHA Services.

One of the AHA’s most significantsteps occurred at the outset of thedecade, in October 1980. That waswhen the board approved the purchaseof land on Natural Resources Drive inWest Little Rock as the site of the asso-ciation’s first headquarters building.The board took a hard stand on thebuilding program, convincing otherAHA members to give their blessing towhat would prove to be an extremelywise decision.

As those building plans graduallycame together over the next eightyears, the world lived through sometough times. Between 1986 and 1990,disasters were the big stories, over-shadowing everything else. It started inJanuary 1986, with the explosion ofthe space shuttle Challenger, 73 shortseconds after liftoff. Before the end ofthe decade, we’d know about theChernobyl nuclear meltdown in theU.S.S.R., the bombing of Pan AMflight 103, the Exxon Valdez, the SanFrancisco earthquake, the bloodshedin Tiananmen Square and BlackMonday on Wall Street, when thestock market crashed.

There were things going on inArkansas hospital circles that somethought disastrous, too. Nationally,they came in the form of the Gramm-Rudman-Hollings Act that provided

UAMS, Little Rock


for automatic federal spending cuts,the 1986 Emergency MedicalTreatment & Active Labor Act(EMTALA) imposing specific emer-gency service obligations on hospitals,and the federal government’s release ofhospital mortality reports.

The major in-state worries involvedBlue Cross, when the companyannounced its intent to develop thestate’s first Health MaintenanceOrganization. Nobody knew how thatmight affect the future of healthcareservices in Arkansas. The more imme-diate concern was Blue Cross’ plan tochange the way it paid hospitals. Out-dated charged-based payments wouldbe dropped in favor of a Blue Crossversion of a DRG system.

Medicare’s DRG system had beenup and running for two years with aquestionable track record. The AHAand its members spent the next 18months trying to assess the Blue Crossplan and help fashion it into somethingmutually agreeable rather than try tostop it. In the end, a new legal empha-sis on sensitive anti-trust concerns lim-ited the AHA’s advice and added tohospitals’ frustration and confusion.The new payment model finally wentinto effect in February 1987.

A challenge of the state law pro-hibiting non-profit hospitals fromoperating retail pharmacies was partof the AHA agenda for an evenlonger time. The AHA believed thelaw to be unconstitutional. The statehad a different opinion. The legalaction, filed in October 1985, navi-gated the state’s winding legal systemfor 40 months before the ArkansasSupreme Court upheld the law inJanuary 1989.

State Medicaid policies constantlykept hospitals flirting with disaster.The program was covering 35 inpa-tient hospital days for its recipients in1985, but was also requiring a priorauthorization for inpatient admissions.Payments routinely fluctuated up anddown, mostly down. During thoseyears Medicaid routinely blendedchanges in its payment methodologywith across-the-board cuts andincreases, depending on the budget sit-uation, along with a few recoveries ofoverpayments and repayments ofmonies erroneously taken away from

hospitals. Changes were sudden andunpredictable.

It was a budget-driven world andbudgets were tight. Most of the timethe state simply didn’t have enoughmoney. Medicaid generally stayed with-in its limits by paying less. The HealthDepartment, on the other hand, begancharging unprecedented fees for anarray of items — like hospital licenses— to get through the lean times.

The state’s hospitals understood thereasons behind the newly levied HealthDepartment fees, but they were moreambivalent about the final resolution in1987 of hospitals’ long running squab-ble with the state about certificate-of-need. It was in that year that GovernorClinton signed a law stating that hospi-tals would no longer have to obtainCONs for capital expansion projects.

Despite the bad news crammed intothose years, things ended on a goodnote. On November 12, 1989, theBerlin Wall, an icon for the Cold War,began tumbling down. Two monthsearlier, on September 13, after plan-ning and saving for it seven years andbuilding it for one more, the AHAmoved into its new headquarters build-ing. Debt free.

The Politics of the ‘90sArkansans as a group probably

remember the early 1990s for the poli-tics more than anything else. After all,it was Arkansas’ time to take centerstage, politically speaking. Bill Clintonwas elected President of the UnitedStates in November 1992. The cadre ofstate leaders who followed theGovernor to Washington would playmajor roles in setting national policyon all fronts, though it would prove tobe a bumpy ride at times.

National healthcare reform was atthe core of some of the most heatedpolitical debates. First Lady HillaryRodham Clinton took charge and facedoff with Harry and Louise and the restof the insurance industry over thePresident’s ill-fated quest for that elusivegrail in 1993. And former ArkansasDepartment of Health director JoycelynElders raised awareness, questions andeyebrows throughout her brief tenure asU.S. Surgeon General.

The politics of healthcare inArkansas stirred some choppy waters

of its own, due mostly to insufficientMedicaid funding. By 1990,Medicaid had pretty much aban-doned its experiment with prospec-tively set rates and agreed with theArkansas Hospital Association toreturn to cost-based reimbursements,at least for all but the largest hospi-tals. The AHA wouldn’t budge andprepared a lawsuit to mandate thatall hospitals be cost-reimbursed.

Having already cut several optionalprograms in 1991, Medicaid pled itscase to the AHA and other groups,which reluctantly accepted a plan for aprovider tax based on Medicaid rev-enues as a way to raise state matchingdollars and increase overall programfunding. The tax went on the books in

July 1991. It brought in more dollarsand allowed Medicaid to pay cost-based per diem rates to all hospitals,up to a point.

The first hitch was the state’s insis-tence on capping the per diems at$584. Eventually, Medicaid again ranshort of money and started tinkeringwith benefit limits. That was justbefore the federal government’s rulingthat the state’s provider tax was illegal.

Knowing that the decision spelledbig trouble if no replacement revenuescould be found, the newly formedCoalition for a Healthier Arkansasspearheaded the task of getting votersto okay a 25-cent per pack cigarettetax in the November 1992 generalelection. The funds would go toMedicaid. The AHA assumed the leadrole, pumping time, energy and money

St. Bernards Medical Center, Jonesboro


into the campaign. All signs pointed tosuccess, until an 11th hour ArkansasSupreme Court ruling kept the initia-tive off the ballot

The problem fell straight into thelap of new Governor Jim GuyTucker, who recoiled and struckback with the idea to restructure theMedicaid tax to meet the federalgovernment’s smell test. In otherwords, he’d ask the providers topony up a larger ante.

Heated meetings followed withmost participants disagreeing andsome being disagreeable. Politicalchips landed on the table from everydirection. In the end, the Medicaidcoalition won over the legislaturewith their idea for an alternativefunding source — a soft-drink tax.

There were other political maneu-verings, too. The AHA got DennisO’Leary, president of the JointCommission on Accreditation ofHealthcare Organizations, intoArkansas not once, but twice toaddress growing JCAHO concerns.The association negotiated for morethan two years with the stateWorkers’ Compensation Commissionand members of the Arkansas StateChamber of Commerce on a fair hos-pital fee schedule. And, it raised$350,000 from the state’s hospitals toestablish a new Physical Therapy pro-gram at Arkansas State University.

Not everything of historic note forthe AHA that occurred between 1990and 1995 was about politics, however.Roger Busfield, who navigated theAHA through political waters for 20

years, retired in June 1994. The boarddidn’t have to look far for its next cap-tain. Jim Teeter, a 26-year veteran ofthe AHA, would take the helm and setthe course for the political storms yetto come.

Fortunately, a short respiteoccurred. The state’s Medicaid pro-gram was in better shape financiallythan it had been in years. The softdrink tax, which was passed two yearsearlier, withstood an assault in 1994and was bringing in almost $140 mil-lion annually, when matched with fed-eral dollars.

The Arkansas Hospital Associationhad been a key to passing the tax in1992 and played a major role in its1994 rescue. The state’s soft drink bot-tlers hoped to dismantle the tax by put-

ting it in the voters’ hands, so the AHAagain took the lead in a campaign tokeep the soft drink tax on the books.Voters were persuaded, backing thetax by a 55%-45% margin inNovember 1994.

The storms returned a mere fourmonths later with Medicaid’s unex-pected announcement predicting a$70 million deficit by July 1997;Governor Tucker proposed to stripthe state’s non-profit hospitals of $35million in sales tax exemptions thatwould be re-routed to the MedicaidTrust Fund. The AHA successfullychanged his mind, but the expectedshortfall grew to $232 million for the1998-1999 biennium.

The association responded to otherflash fires, too. Retail pharmaciststhought hospitals didn’t need to pro-

vide certain drugs and IV solutions topatients being seen by their own homehealth agencies. Respiratory thera-pists wanted additional licensingrequirements. Trial lawyers opposedthe strengthening of laws providingconfidentiality of hospital peer reviewand quality assurance activities. And,business and insurance groups pushedwith all their might against an AnyWilling Provider law, something theAHA supported at the time.

Outside the legislative arena, theAHA defended allegations by thestate’s nursing homes that hospitalswere providing skilled nursing servic-es illegally, worked through competi-tive issues involving the HealthDepartment’s provision of homehealth services, negotiated an agree-ment with the Board of Nursing onrules involving the delegation of nurs-ing tasks, and intervened with theState Auditor on a matter involvinghospitals and their disposition ofunclaimed personal property.

Nationally, the Beltway feud over abalanced budget spanned two yearsand one government shutdown. In theend, President Clinton signed the mas-sive 1,200 page Balanced Budget Actof 1997, which the Republican con-trolled Congress had passed.

Lost amid the hoopla, fanfare andbackslapping over the agreement forbalancing the budget by sucking $116billion from future Medicare spending($44 billion from hospitals) were thewarnings of people who understoodthat the actual cuts would be muchmore severe than projected.

AHA joined with other hospitaladvocates in successfully convincingCongress to restore some of theMedicare and Medicaid cuts throughlaws passed in 1999 and 2000. In themeantime, its Washington focus shift-ed to the Justice Department’s crusadeto apply the federal False Claims Actto hospital Medicare billing errors.

Back at home, the association wonsupport for a law allowing JointCommission accreditation to standfor hospital licensure surveys, too,and helped hospitals better under-stand details related to rising concernsover quality, patient safety, compli-ance plans, and the newest hospitalemergency room requirements.

Southwest Regional Medical Center, Little Rock

Y2K Challenges Usher in New Century

As 1999 came to an end, all eyeswere on the clock and the coming ofthe Year 2000, affectionately known asY2K. Experts predicted massive systemfailures, the technological equivalent ofwar, famine, pestilence and death, forJanuary 1, 2000. The AHA and itshospitals prepared for more than twoyears to avoid any and all calamities.Within minutes of the stroke of mid-night, everyone knew the planning andpreparations had worked.

The association breathed a sigh ofrelief and moved on. The first order ofbusiness was to take up a cause thathad been a core value of the AHA sinceits inception — improving the health ofthe people who live in our small, beau-tiful state. As January 2000 dawned,the AHA began almost immediatelyworking toward the first of two majoraccomplishments that many agree tobe among the AHA’s most importantduring its 75-year history. Bothachievements should positively impactthe health of Arkansans for years tocome.

The first was the association’s rolein getting a spending plan forArkansas’ $1.62 billion share of theNational Tobacco Settlement Fund.The AHA took a lead role, joined bythe original coalition of healthcareproviders who supported the failed1992 attampt to pass a cigarette tax tohelp fund Medicaid, and developed aplan that would earmark Arkansas’full tobacco-settlement amount forhealth-related purposes over the fund’s25-year life. The AHA was activelyinvolved in the election campaign. OnNovember 7, 2000 voters said yes toCHART’s (Coalition for a HealthierArkansas Today) ideas with a solid65%-35% margin.

The second achievement came in2005, when the AHA was responsiblefor a law prohibiting the smoking oftobacco products in hospitals and ontheir grounds. It was a way for theassociation’s board and members toshow that Arkansas hospitals not onlytalk about improving communityhealth, but also are willing to walk thewalk and do something about it.

Sandwiched between those twomilestones are other successes that

have to be considered among theAHA’s most significant. The AHAworked to defeat an effort in 2000 toabolish certain state and local salestaxes that would have sapped $144million from annual state revenues.Then, in 2002 the association helpeddefeat a proposed constitutionalamendment to “ax the sales tax” onfood and medicines. The amendmentwould have taken between $400 mil-lion and $600 million from state cof-fers each year with no suggestions onhow to replace it. Either of the taxreductions most likely would have ledto a state Medicaid crisis.

Passing a state tort reform law in2003 has to make everyone’s top tenlist of significant achievements. TheAHA joined in the fight early as part of

another coalition, the Committee toSave Arkansas Jobs, in the successfulrun at overhauling Arkansas’ civil liti-gation system. The law gave a way tohelp hospitals curb crippling medicalliability costs and thwarted a potentialexodus of healthcare providers fromthe state.

Following the September 11, 2001terrorist attacks in New York andWashington, and again followingHurricane Katrina in August 2005,America became fully aware of hospi-tals’ strategic importance to thenation’s emergency response system.The AHA has had a direct hand inworking through countless emergencyresponse issues aimed at better prepar-ing Arkansas hospitals for these oftenoverlooked essential responsibilities.

Some AHA members might point to

a 2001 move that resulted in anArkansas Medicaid “upper paymentlimit” program as the most importantfinancial achievement. It would behard to argue with a program whichhas netted more than $100 million insupplemental Medicaid hospital pay-ments that otherwise wouldn’t havebeen available.

And Now, to the Future…If we asked ten individuals who were

active with the AHA at different timesover the past 75 years what they wouldchoose as the AHA’s most significantaccomplishment, we’d probably get tendifferent answers. What would youchoose? Whatever the choice, it’ll betrumped in the future by another one,bigger and more outstanding. Maybe it

will have something to do with the cur-rent move to make hospitals moretransparent and accountable to theircommunities. Or, will it be related tofascinating new information technologythat will serve as the basis for the fullimplementation and use of universalelectronic medical records?

Those issues are key issues of today.They won’t go away, and will mostlikely expand. But, that’s okay, as longas the requirements are reasonable, theresults meaningful, and they serve toimprove the state’s healthcare qualityand status.

After all, that’s the very reason asmall group of hospital leaders gottogether 75 years ago and formed theArkansas Hospital Association, and it’sthe reason we’ll keep moving forwardfor the next 75 years and beyond. •


Siloam Springs Memorial Hospital, Siloam Springs


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The American Health LawyersAssociation (AHLA) has released AGuide to Legal Issues in Life-Limiting Conditions. The document

was produced as part of AHLA’spublic interest commitment to serveas a public resource on selectedhealthcare legal issues.

The Guide is the second publicationin a new Public Information Seriesthrough which AHLA shares its

expertise on topics of interest both tohealthcare attorneys and the broaderhealthcare community, includinghealth professionals, healthcare execu-

tives, public health agencies,pro bono attorneys, and con-sumer groups. (You may reador download the first publica-tion from the series —Emergency Preparedness,Response & Recovery Check-list: Beyond the EmergencyManagement Plan by going tohttp://www.healthlawyers.org/Content/NavigationMenu/Public_Interest_and_Affairs/Public_Information_Series/pi_EmergencyPreparedness.pdf)

The new legal guide to life-limiting conditions provides anoverview of the key legal andpractical issues that arise in thecare of individuals who face alife-limiting condition or whocare for a loved one with a life-limiting condition. As an aid tothe planning process, the guideis organized around the contin-uum of care, beginning with

healthy individuals who are able tolive at home and following the contin-uum to independent retirement com-munities, assisted living, long termcare, and an eventual return to thehome with the aid of hospice services.

Dr. Ira Byock, one of the foremost

experts on caring for those at the endof life, endorsed the guide for manydifferent audiences: “This Guidedeserves a place on the desk of anyattorney, physician, nurse, case man-ager, or social worker who helps elder-ly or ill clients think about and planfor the future. It sits on mine.”

Elisabeth Belmont assessed the pub-lication’s importance to the public.“Individuals with life-limiting condi-tions find themselves facing a host ofcomplex decisions, often at a timewhen they are in crisis.

“Making important decisions whena loved one is vulnerable and in need isdifficult at best. This guide provideskey questions to guide families in mak-ing decisions along what might be con-sidered the ‘customary’ chronic carecontinuum. The guide stresses thatindividuals should plan for the futureand make informed choices now toensure that their wishes are known ata future time when their physicaland/or mental functioning may beimpaired. This type of planning is par-ticularly important in view of therecent Terri Schiavo situation,”Belmont said.

To view the guide in its entirety orto download it, go to:http://www.healthlawyers.org/Content/NavigationMenu/Public_Interest_and_Affairs/Public_Information_Series/llc_guide.pdf •

AHLA Issues Complimentary Guide to Legal Issues in Life-Limiting Conditions

Presorted Standard

U.S. Postage PaidLittle Rock, AR

Permit No. 2437

Arkansas Hospital Association419 Natural Resources DriveLittle Rock, AR 72205

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