Announcement

President's Report
by: Rod Betit (November 17, 2006)

Summary: Pennsylvania recently became the first state to publicly report the number of patients who acquired infections. This is a hot topic for legislative discussion in many states, including Alaska for 2005.

Full Story: el PRESIDENT’S REPORT November 17, 2006 Pennsylvania recently became the first state to publicly report the number of patients who acquired infections. This is a hot topic for legislative discussion in many states, including Alaska for 2005. The report, examined 1.6 million patients in 168 hospitals in the state in 2005 taking into consideraton differences in the severity and complexity of their cases and excluded certain patients with conditions that placed them at high risk for infection. According to the report, 19,154 patients acquired infections in 2005. An average of 12.2 per 1,000 patients acquired infections, and those who acquired infections cost private heath insurers an average of $59,915 for hospital care, compared with $8,311 for those who did not acquire infections, according to the report (USA Today, 11/15). The report also found that:  The average cost of hospital care for patients who acquired infections was $185,260, compared with $31,389 for those who did not acquire infections;  The average length of hospital stays for patients who acquired infections was about 23 days, compared with about five days for those who did not acquire infections;  The mortality rate for patients who acquired infections was 12.9%, compared with 2.3% for those who did not acquire infections. SPECIAL FOOTNOTE: The Alaska Legislature created a special Task Force to examine this issue and to make recommendations as to whether mandatory reporting of hospital acquired infections should be required. ASHNHA has a seat on this Task Force. The Task Force will hold its first meeting on November 27, 2006. The Task Force is expected to complete its work and forward recommendations to the Legislature by January 31, 2007. ________________________________________ The ASHNHA Executive Committee met on November 9, 2006 to conduct a strategic planning session for 2007 ASHNHA organization activities. The Committee set forth a series of priority issues for staff and ASHNHA Standing Committees to pursue during the coming year. ASHNHA Board Chairman John Bringhurst sought a “challenging but doable” balance of key issues to put forth to the membership. Pages 2 through 5 set forth those issues. ________________________________________ Issue Title ASHNHA 2007 PRIORITY ISSUES Committee Assigned To ASHPIN Teleradiology Network Project $4.0 of $5.3 million has been raised to build the Alaska Rural Teleradiology Network (ARTN) system. The remaining $1.3 million is under review by 2 key grant partners. Equipment has been purchased to operationalize the host site in Anchorage, and for some of the remote sites. Committees have been formed to guide development and deployment of the network. Networking details are being worked out to bring all sites on line by early 2007. Rural/ASHPIN CON - Protect New Law and Regulations ASHNHA worked successfully to stop legislation during the 2006 Session that would have gutted existing CON laws. In addition ASHNHA filed an Amicus Brief to help Fairbanks Memorial Hospital in their successful challenge of an Imaging Center decision by the State. While 2006 goals were met, protecting current CON laws remains a top priority for 2007. The Executive Committee and ASHNHA staff will develop strategies to accomplish this. Executive Denali Commission - ‘Other than Primary Care’ The ASHNHA/ASHPIN process for prioritizing Denali Commission grant funding for rural hospital/NF projects was successfully implemented in 2006. Several projects were funded in 2006 including ARTN for $2 million. The process was considered a ‘success’ by the Denali Commission and will be used again in 2007 to prioritize the next round of applications. The EC enthusiastically endorsed the program as a major success. Rural Electronic Health Record Project The Executive Committee directed that ASHNHA work with the Acute Care Committee during 2007 to advance adoption of electronic health records and to provide input into a statewide system capable of collecting and disseminating vital health information specifically for patient care purposes. Acute Care Outpatient /ED Data Collection Project ASHNHA has worked with the two facilities (Bartlett and PAMC), & HIDI to develop a report layout for the new OP/ED data set. Bartlett has successfully completed their layout phase. PAMC is still working through theirs. The current plan is to send the record layout with instructions to each facility during November and request they interface with HIDI to test their ability to transmit this data for calendar year 2006. This project should be completed 12/31/2006. ASHNHA staff will proceed to work with the Acute Care to define the reports that will become available in 2007 to ASHNHA facilities. Acute Care Alaska FMAP ASHNHA worked with DHSS and the Alaska Congressional Delegation to extend the life of the special Federal Medical Assistance Percentage (FMAP) rate for Alaska. This special FMAP rate entitles Alaska to receive 57% federal funding for Medicaid rather than 50%. Loss of this special adjustment would reduce Alaska’s federal contribution for Medicaid expenses by $90 million each year. This would have to be made up additional state funding or reduction in services and people eligible. The extension expires in 2008. Work must begin in 2007 to extend the FMAP provision indefinitely. Executive Nursing & Allied Health Shortages This initiative moved forward substantially during 2006. An ASHNHA-wide education plan has been developed. ASHNHA is partnering with Rasmuson to obtain a RWJ grant for a rural nurse preceptor program. Other training strategies are being developed to address the planning priorities identified by the Work Group, and funding sources pursued to help pay for that. This will continue to be a major emphasis in 2007. Workforce Pandemic & Hospital Preparedness ASHNHA’s 2006 objective to include hospital/NH CEOs more directly into State planning and response to a large local or statewide event, be it a pandemic or other emergency, was accomplished with the creation of the new Hospital Preparedness Leadership Committee in October 2006. The Committee will be co-chaired by ASHNHA’s President/CEO. A 2007 work plan will be developed to help the Department decide how to best allocate limited preparedness funding. Acute Care Physician Shortages/ WWHAMI Expansion ASHNHA helped secure start up funding for expansion of the WWHAMI class size from 10 to 20 slots, and to win legislative support for WWHAMI expansion. In addition ASHNHA was instrumental in bringing this issue to the fore front during the Governor and Legislative debates. ASHNHA’s President/CEO participated as a member of the Physician Supply Task Force which released its finding and recommendations on September 20, 2006. Further work needs to be done in 2007 to advance these recommendations and to secure funding for their implementation. Workforce Occupation Licensing & DHSS BCI/FBI Process Currently nurses and CNAs must comply with 2 separate processes to complete BCI/FBI requirements. One process is mandated as part of the Alaska licensure process and one for DHSS purposes related to employment in health care facilities under their oversight. This dual process creates an unnecessary lag in hire and potentially 2 different findings as DHSS’s system has a wider/deeper criminal history file to access. In discussions with Licensing & DHSS there is interest in reaching agreement to use the DHSS process for both agencies. It is unclear at this time whether this would be an administrative policy decision or a statute change. At the direction of the Executive Committee, ASHNHA will initiate bringing the parties together to try and forge a single BCI/FBI process. LTC & Acute Care Interstate Nursing Compact At least 20 states have enacted the RN and LPN/VN Nurse Licensure Compact that allows nurses licensed in one state to practice under a reciprocity agreement in another state. Those states that have adopted the Compact report it is working well and has been immensely helpful in natural disasters to augment nursing personnel. Generally states that have adopted the Compact have done so with the support of their Board of Nursing. ASHNHA will take the initiative to begin discussions with key partners to explore the feasibility of adopting this Compact approach in Alaska. The Executive Committee strongly supported ASHNHA staff evaluating the feasibility of ASHNHA joining this compact, and identifying the steps necessary to do. One key step is the passage of legislation accepting the compact terms. This could not be done before the 2008 Session. Workforce Community Benefit Reporting Standards The status of non-profit hospitals continues to be called into question by Congress with particular emphasis on the question ‘what do these hospitals give back to their community?’ Some states have moved forward to adopt uniform reporting of ‘community benefits’ to enable the public and political leaders to readily see how much is reinvested by non-profits in their communities. Two reporting standards have evolved, one developed by AHA and one by CHA. The CHA standard seems to be most prevalent and is the most conservative of the two. The CHA standard does not include Medicare losses or bad debt. This exclusion can reduce reportable ‘community benefits’ by 50%. The Executive Committee directed that ASHNHA staff should move forward to address the feasibility of adopting a reporting standard based on the AHA methodology rather than CHA. Executive Public Access to Billing /Collection Policies All ASHNHA members have embraced AHA’s Confirmation of Commitment principles that call for adoption of more open policies for billing self insured patients and for providing charity care. ASHNHA does not collect these policies on a facility specific basis and make them available for public review. Recently some concern has been expressed that individual facilities also do not do enough to make these policies know broadly in their community or to patients at time of admission. The Executive Committee directed ASHNHA staff to identify an approach for make it a priority in 2007 to document all hospitals billing/collections and charity policies more widely known in each community, including a link posted on the ASHNHA web site. Acute Care Coordination with Tribal Health The tribal health system is a key partner in delivering health care throughout the State. Have we explored all possible partnerships for maximizing collaboration between the tribal and non-tribal providers in Alaska? Should these be seen as separate, overlapping systems with some areas of collaboration or more like a ‘family of programs’ packaged in the most effective manner to give patients more options for obtaining needed care? The Executive Committee set forth a general strategy for strengthening this important partnership during 2007. Executive Reporting of Hospital Acquired Infections (HAI) The incidence of HAI in a hospital has become a bellwether measure in many states for the overall quality of health care that a facility provides. HAI incidence has been shown to be dramatically reduced by introduction of ‘best practices’ in a hospital care setting. This issue came before the Alaska Legislature in 2006 in the form of a bill requiring the reporting of hospital infections to the State. ASHNHA was successful in converting the bill to a study that will look at this issue over the next year to produce recommendations for the Legislature to consider by January 31, 2007. The Executive Committee outlined a general strategy for addressing this issue. Acute Care ________________________________________ Other Patient Safety Initiatives CMS Quality Initiatives and the 100,000 Lives Campaign are seen as just two important programs for improving patient safety in Alaska facilities. It is clear that implementing strong process improvement changes based on ‘best practice’ produces good results. The Executive Committee directed ASHNHA staff to look for ways to assist facilities to implement these and other programs during 2007. Acute Care LTC LTC Study The Executive Committee considered and approved a proposal to examine the future needs for long term care (home supported care through nursing home level of care) in Alaska. This study would look ahead 10 years with the goal of developing recommendations for the new Administration to consider in advancing future budgets, rate setting policy and alternatives to nursing home care policy? ASHNHA staff was directed to move forward with this study. LTC Worker Compensation Reform During 2006 ASHNHA was successful in convincing the Legislature to extend the life of 2 committees that are addressing reform in this area. A major barrier to moving forward has been obtaining hard data from which to analyze why premiums and costs have been increasing. A key incentive for ASHNHA to see recommendations developed and moved forward during the 2007 Legislative Session is that hospital payments for worker compensated services are frozen at 2004 levels until August 2007. If solutions are not identified by then, it is likely the Legislature will simply extend the freeze rather than letting it expire. Legislative ________________________________________ Upcoming Meetings of Interest: • ASHNHA 2007 Winter Meeting (Juneau) - March 8 & 9, 2007. A room block has been reserved at the Gold Belt Hotel for the nights of March 7 and 8. Rates are $104.00 Mountain View (weather permitting) and $109.00 Water view (there is always water). The phone numbers are - toll-free: 888-478-6909 or 907-586-6900. Meetings will be held at the Centennial Hall adjacent to the Hotel. The ASHNHA Board meeting will occur on March 9. • AHA Annual Meeting (D.C.) - May 5 through 9, 2007 in Washington, D.C. • National Rural Health Association Meeting (Anchorage) - May 14 through 17, 2007 in Anchorage, Alaska. • ASHNHA 2007 Annual Meeting (Petersburg) – to be held in conjunction with education sessions August 6 through August 9, 2007 in Petersburg. The ASHNHA meeting will take place on August 8 & 9. If there are other meetings you would like posted please let Rod know at rbetit@ashnha.com

Downloads
November 17 2006.pdf