Governing Council Meeting
Section for Health Care Systems
Chicago, IL
February 26-27, 2004
PRESENT ALSO PRESENT
James Brexler, chair Jim Bentley
Glenn Steele, Jr., M.D ., chair-elect Merry Beth Kraus
Lloyd Dean Barbara Lorsbach
Jon Foster Kristen Morris
Robert Lipson, M.D. Eileen O’Keefe
Susan Smith Makos Ellen Pryga
Michael Murphy
Larry Mullins GUEST
Michael Rock, M.D. William Dwyer
Samuel Wallace
Paul Wiles
Sister Laura J. Wolf
Welcome and Open Forum
Jim Brexler, president, Erlanger Health System and 2004 Health Care Systems governing council chair, called the meeting to order. New council members were welcomed and introduced—Jon Foster, Dr. Robert Lipson, Susan Smith Makos, Sister Laura Wolf, and Samuel Wallace. Dr. Michael Rock was welcomed back as a re-appointment. Mr. Brexler provided a brief overview of the meeting agenda and council members voted to approve the June 2, 2003, governing council meeting minutes.
Governing council members and staff introduced themselves and identified their greatest leadership challenges and management issues in the coming year or two. Common themes revolved around ongoing workforce challenges such as recruitment, retention and staff development, labor relations matters, and the continuing challenge of creating effective hospital-physician relationships. The ability to maintain earnings and revenue streams in an under-financed system and lack of good quality improvement methodologies were also mentioned often. Members suggested AHA could assist members with new models for relating to physicians that include economic alignment, care models for the future, processes to improve quality and safety, and use of technology across the continuum. Assistance with nurse staffing issues at state levels and models to simulate a care delivery infrastructure would also be helpful.
AHA Board of Trustees Update
Frank Perez, AHA Board of Trustees member and liaison to the Section for Health Care Systems, shared highlights of the February 2004 AHA Board retreat, Road Map to Reform. Council members were interested to hear discussion about creating political will for health care reform and progress by AHA’s Ad Hoc Committee on Paying for Health Services. Members inquired about board discussion on pay for performance and if an industry definition of affordable care exists. Members stressed the importance of physician participation as a key to success and suggested AHA might champion demonstration projects to test some approaches based on a standardized set of measures to improve quality and not merely costs.
Washington Update
Kristen Morris, Vice President, Legislative Affairs, provided a brief wrap-up on accomplishments of AHA’s 2003 advocacy activities and sought council input on 2004 and beyond advocacy priorities. Members were appreciative of AHA’s 2003 accomplishments in securing hospital provisions as part of the Medicare Prescription Drug Package.
AHA’s 2004 and Beyond Advocacy Agenda Framework consists of four focused strategies to advance health care in America: expand the debate on a new course for care; reduce vulnerabilities by enhancing public trust; change the mindset by demonstrating the value of health care; and broaden the base by reconnecting with our communities. The strategy related to broadening our base by reconnecting with our communities drew out many comments as it was viewed as vital for members to reach out more effectively to local employers, consumers and media.
Members discussed AHA’s activities related to the niche issue and again stressed the need to find ways to better partner with physicians, both primary care and specialists. Intertwining economics, information technology, and capital is paramount in these relationships.
Unified Health Care Policy: Campaign 2004
Kristen Morris provided an update to members on the AHA’s Unified Health Care Policy agenda and Campaign 2004. Members were briefed on AHA’s efforts to engage political leaders in the health care reform debate Campaign 2004 initiative “Seven Steps to a Healthier America” and asked for input on how best to engage the field in this effort.
Members also viewed a short video by Public Opinion Strategies that explained results of important public opinion polls on health care and emerging concerns to voters.
Regarding AHA’s Seven Steps, members suggested again that health care providers improve alliances with local businesses to foster positive attitudes towards hospitals that will transfer to Congress. One tool to assist in galvanizing this effort would be to develop local powerful anecdotes. Members also suggested translating data to the local community level from the publication Health Care as an Investment. By working with Chambers of Commerce, small businesses, etc. on the local economic issues, members felt we would be better able to demonstrate the value of health care in the community (in terms of jobs, returning people to work, etc.)
Members felt strongly the underlying public issues in the 2004 election are jobs and the economy. Therefore, we need to simplify our message (e.g., access, security) and tie health
care coverage more specifically into jobs and as an economic good that directly impacts the local community and economy.
Improving Hospitals’ Access to Capital
Jim Bentley, Ph.D., AHA Senior Vice President for Strategic Policy Planning, summarized findings from the new HFMA/GE report How Are Hospitals Financing the Future? Access to Capital in Health Care Today. Members were asked to identify the types of projects requiring capital financing, the barriers to accessing capital and options that would be most helpful in better accessing capital.
Council members, once again, suggested that the real issues are hospital operating performance (lack of discipline) and adequacy of reimbursement, not access to capital. They also suggested that the push may be coming from technology companies and recommended that, like Ford Company, technology companies should consider taking on the risk. Members felt capital markets come close to working efficiently now and that having earnings to service the capital is key.
Members were empathetic in wanting to understand from other members (via summary reports of upcoming RPBs and other council meetings) what their capital needs are and the barriers they are encountering. They recommended the AHA assist members by providing them with models that illustrate good operating principles to access capital and by continuing to work on reimbursement issues to ease operating performance problems.
Hospital of the Future
Members received a presentation from Bill Dwyer, Divisional Vice President Strategic Marketing at Abbott Health Systems, on a 12-month study of the nation’s hospitals and health systems that proposed a sustainable business model for hospitals a decade from now and identified attributes of strong leadership.
Health Care as an Investment
Jim Bentley discussed findings of a new publication The Value of Investment in Health Care. Members viewed the publication positively but felt the message needed to be short term and locally directed. It was suggested that no additional studies/data were needed but a more simplified, positive, proactive communications plan.
Members felt the public does not understand the pricing structure of health care, the idea of cost shifting, the impact of federal/state requirements, etc. More importantly, they felt we in health care never propose the answer, even a consensus solution, which is frustrating for those who are sensitive to our problems.
Again, it was suggested during this discussion that economic modeling on productivity enhancement to US businesses resulting from health care be attempted, from a societal level down to a productivity level. Possible data sources might include the Employee Benefit Research Institute, state Workers Compensation agencies, and Veterans Administration/Return to Work data.
Hospital Billing and Collection Practices
Joe diGenova, a partner of diGenova & Toensing, provided members with an update on federal level activities regarding hospital billing and collection, particularly the upcoming
HHS Office of Inspector General and CMS hearings. He cited available guidelines and principles and emphasized the need for clarity. Barbara Lorsbach followed with a discussion on AHA resources and services that members would find beneficial to them and their boards of trustees on this issue, stressing the importance of internal hospital review of policies, enforcement, communication and consistency.
Business Report
Jim Brexler informed the council that John Kenagy, M.D., vascular surgeon, health care executive and patient, would deliver this year’s Roger G. Larson Luncheon Lecture entitled “Fixing a Broken Health Care System” on Monday, May 3rd at AHA’s Annual Meeting. He also invited members to participate in the Special Briefing for Systems Executives immediately preceding the Larson Luncheon and Lecture.
Jim referenced current exploration of the agenda for the 21st Annual Health Care Systems Leadership Retreat and asked for council input on discussion topics and recommended presenters around the theme of aligning integrity, governance and physician-relations. The retreat, hosted by the governing council, will be at the Hyatt Regency Scottsdale Resort at Gainey Ranch in Scottsdale, Arizona, on October 14th-15th.
Adjournment
Jim thanked council members for their comments and participation throughout the meeting. The meeting was adjourned at 11:00 a.m.
Next Meeting
The governing council will serve as hosts for the 21st Annual Health Care Systems Leadership Retreat, October 14th-15th, 2004, at the Hyatt Regency Scottsdale Resort at Gainey Ranch. No separate governing council meeting will be held.
05/04