May 24, 2005
Forrest City
Hospital
Future
Uncertain
Volume 12, Number 20
Another Arkansas community faces a possible future without a hospital. Baptist Memorial
Health Care Corporation (BMHCC) of Memphis, which owns and operates Baptist
Memorial Hospital-Forrest City (BMHFC) has indicated that it may be forced to close the
hospital as of September 30 due to continued financial losses at that facility. The Memphis
non-profit corporation bought the hospital from St. Francis County in 2003, after holding a
lease to operate it for about 20 years. Over the last two years, BMHFC has accrued losses of
about $6.2 million.
Almost a year ago, BMHCC decided to pull out of the hospitals it leased in two other
Northeast Arkansas communities, Blytheville and Osceola. The leases for those hospitals,
both in Mississippi County, were later transferred to Ameris Health System of Nashville,
TN. More recently, Eastern Ozarks Regional Health System, located in Cherokee Village
(Sharp County) in North Central Arkansas, closed its doors when the state Health
Department suspended its license. That hospital remains closed.
The financial problems at BMHFC stem from a combination of two prevalent payment
issues that threaten many of the state’s hospitals: a growing number of uninsured patients
and inadequate Medicaid payments. Between 2001 and 2005, the number of uninsured
people in the hospital’s service area fell from 20% to 14%. The hospital also serves a high
number of patients covered by Arkansas Medicaid, which typically pays hospitals about 30%
less than their cost of providing care.
Today, 21 of Arkansas’ 75 counties don’t have a local community hospital. If St. Francis
County officials can’t find another group to buy, lease or otherwise operate the Forrest City
hospital, not only will that number increase, but it will mean that there would be no full
service hospital located along the heavily-traveled Interstate 40 route between Little Rock
and West Memphis.
•
Bill
Needs
Arkansas
Support
•
•
•
Sens. Charles Grassley (R-IA) and Max Baucus (D-MT) introduced the Hospital Fair
Competition Act of 2005 (S. 1002) on May 13. The bill is bipartisan legislation backed by
the American Hospital Association that would permanently extend the moratorium on
physician-owned limited-service hospitals currently set to expire June 8.
Congress has historically been concerned about physicians referring patients to facilities they
own and has weighed in several times to halt the practice. But some physicians have been
exploiting a loophole in current law, which exempts “whole hospitals” from that list of
physician-owned facilities. The practice prompted Congress 18 months ago to place a
moratorium on physician self-referral to new limited-service hospitals until June 8, 2005.
The bill, S. 1002, would restore fair competition and ensure that the best interests of patients
always comes first by closing the loophole permanently. More Senate co-sponsors are
needed. Arkansas hospital officials should contact Sens. Blanche Lincoln and Mark Pryor,
asking that they sign on as co-sponsors for the Grassley-Baucus bill.
Paul Cunningham, Editor
James R. Teeter, President; 419 Natural Resources Drive; Little Rock, Arkansas 72205; 501-224-7878; facsimile 501-224-0519
AHA Notebook
IOM
Follow-Up
Notes
Slow
Progress
2
May 24, 2005
An article in the May 18, 2005 issue of the Journal of the American Medical Association,
updates findings in the landmark 1999 report by the Institute of Medicine, “To Err Is
Human,” which said that up to 98,000 hospital patients die each year due to hospital medical
errors. According to a recent follow-up, that number of unnecessary hospital deaths remains
unchanged, despite the fact that significant improvements, such as reductions of up to 93%
in certain kinds of error-related illnesses and deaths, have occurred over the past five years.
In their study, patient safety experts Donald Berwick and Lucian Leape, both physicians, call
for public and private stakeholders to adopt a set of national goals to spur continued progress
in patient safety over the next five years. They say the 1999 IOM report spurred change that
has set the stage for dramatic advances in the next five years, particularly in the area of
implementing electronic health records. In addition to setting new goals for 2010, they
recommend more research to develop effective patient safety practices and financial
incentives to reward healthcare quality.
•
Web Site
Covers
Advance
Directives
•
•
•
The American Hospital Association launched a new Internet Web site on May 2 designed to
inform the public about the need for advance directives. The new site,
http://www.putitinwriting.org, provides hospitals and consumers with easy-to-use, helpful
information on advance directives in Spanish and English. It builds on an AHA brochure,
Put It In Writing, which was first made available more than 10 years ago. The brochure is
regularly updated and is one of the most requested documents ever published by the
association.
The Web site includes a glossary of terms, a downloadable version of the Put It In Writing
brochure, and a wallet card that people can print and fill out. This card will alert healthcare
workers that the card-carrying patient has filled out an advance directive. It also will provide
emergency contact names and numbers.
The site also highlights the work of the National Palliative and Hospice Care Organization’s
free, state-specific advance directives list as well as tips for communicating wishes to family
and close friends. And, visitors can link to the American Bar Association’s Web guide, 10
Legal Myths About Advance Medical Directives, and a toolkit that contains a variety of selfhelp worksheets, suggestions, and resources that prompt a continuing conversation about
values, priorities, and the meaning and quality of life.
To help spread the word about the importance of advance directives, hospitals are
encouraged to review their current education and information process around patient selfdetermination; know what materials are used and what resources are available to patients and
families; and take steps to further educate and encourage discussions about advance
directives among staff and community.
•
National
Provider
Identifiers
Readied
•
•
•
Centers for Medicare & Medicaid Services (CMS) Administrator Mark McClellan
announced last week that his agency is set to begin the enumeration for the National
Provider Identifier (NPI) on May 23. The NPI is the standard unique health identifier for
healthcare providers that was adopted by the Secretary of Health and Human Services under
the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
The NPI must be used by covered entities under HIPAA (generally, health plans, healthcare
clearinghouses, and healthcare providers that conduct standard transactions). It will identify
healthcare providers in the electronic transactions for which the Secretary has adopted
AHA Notebook
3
May 24, 2005
standards (the standard transactions) after the compliance dates. These transactions include
claims, eligibility inquiries and responses, claim status inquiries and responses, referrals, and
remittance advices.
The NPI will replace healthcare provider identifiers that are in use today in standard
transactions. Implementation of the NPI will eliminate the need for providers to use different
identification numbers to identify themselves when conducting HIPAA standard transactions
with multiple health plans.
All healthcare providers including individuals and organizations are eligible to apply for and
receive an NPI. Healthcare providers who transmit health information electronically in
connection with any of the HIPAA standard transactions are required by the NPI Final Rule
to obtain an identifier. This is true even if they use business associates such as billing
agencies to prepare the transactions.
McClellan’s announcement letter informs healthcare providers about the NPI, describes
three ways to obtain an NPI, and gives them guidance as to what they should do once they
have obtained their NPI. The letter, which also provides contacts and resources should
healthcare providers have questions about the NPI, can be viewed on the CMS Web site at
http://www.cms.hhs.gov/hipaa/hipaa2/npi_provider.asp.
For more, see http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0528.pdf.
•
NQF
Endorses
HCAHPS
Survey
•
•
•
The National Quality Forum (NQF) has endorsed a 27-question survey assessing how
patients view their hospital care as an NQF voluntary consensus standard. Known as
HCAHPS, the survey is intended to allow an “apples to apples” comparison of patients’
perceptions of their hospital stay and is expected to become a key component of the Hospital
Quality Alliance public reporting initiative.
The survey was recommended by a special NQF review panel convened last December and
then submitted to NQF members and the NQF board of directors for their approval as part of
the organization’s consensus process. The American Hospital Association (AHA) voted in
support of the survey, but urged ongoing research on how to minimize the time and costs for
hospitals to administer the survey while ensuring accurate results. The NQF adopted the
AHA’s recommendation.
•
The
AHA
Calendar
•
•
•
June 2005
3
If Disney Ran Your Hospital - Some Things You’d Do Differently, Embassy Suites,
Little Rock
15
AHA Board of Directors Meeting, Perdido Beach Resort, Orange Beach, AL
15-17
Administrators Forum Summer Leadership Conference, Perdido Beach Resort,
Orange Beach, AL
17
AAHQ (Healthcare Quality) Spring Conference “Tools for Cultivating Quality and
Safety,” Baptist Health Medical Center-North Little Rock
•
•
•
•
AHA Notebook
Final
Thoughts
4
May 24, 2005
It’s an easily overlooked fact that Benjamin Franklin established the first U.S. hospital.
Franklin is much more famous for his role as one of America’s founding fathers. He’s also
noted for his wise observations and his legacies as an inventor, statesman, printer,
philosopher, musician and, especially, as a scientist. We learned by the third grade of his
experiments with electrical currents and the story of his famous stormy kite flight in 1752,
when he made his shocking discovery that the atmosphere is brimming with electricity.
It’s safe to say that Ben didn’t realize the historic step he took establishing that Philadelphia
hospital more than 250 years ago. And it’s doubtful he would ever have guessed that same
hospital would still be operating today, or that it, along with about 5,000 others, would form
the backbone of the world’s finest healthcare delivery system in 2005.
It’s a sure bet he would never have suspected that today’s hospitals would be standing
smack-dab in the middle of their own electrically-saturated environment. Or, that they would
be attracting more charges than the metal key tied to the end of his kite string during that
New England thunderstorm.
The latest tempest hovering over the hospital field is filled with literal flashes and
downpours of ideas for forcing hospitals to publicly report a new stream of data that will
lead to a brave new world of “hospital transparency.” That’s the fashionable new term in
healthcare. Federal and state governments, businesses, payer organizations, public consumer
groups and others are on individual crusades to make all aspects of the nation’s hospitals
“transparent,” and they want hospitals to offer up vast amounts of data to make that possible.
Mostly, the underlying intent of the ideas is good. But, there are legitimate questions from
hospitals. Do the data and the statistics they yield truly lead to meaningful consumer
information? Is there anyone willing to pay for the new reporting requirements, since, by the
way, there will be added costs for time and resources? Is the ultimate objective of all this
new reporting a hospital-profiling tool that can be used as the foundation of a pay-forperformance system and a way to limit payments?
As much as we’d like to think it’s true, these ideas aren’t half-baked. No, they are
completely baked. And they’re on the way to the table in many states. The number of
hospitals reporting all or part of these data, either voluntarily or by law, is growing steadily.
At the same time, more hospitals are voluntarily choosing to report a completely different
type of transparency information. They are purposely revealing more details about the broad
range of services and programs they provide for their communities with little fanfare. Those
hospitals, including some in Arkansas, are doing this by issuing community benefit reports.
More should consider it.
Community benefit reports don’t reveal a hospital’s core measures. Instead, they show core
values. They detail how hospitals reach outside their walls and go to the people who can’t
come to them. They are about the mobile units that carry diagnostic equipment to patients
throughout the area, the local clinics that take the hospital into neighborhoods, healthcare
services for low-income families, health fairs, immunizations, screening exams, parenting
classes, counseling, collaborations with local public health and safety organizations,
domestic violence, smoking cessation, exercise, nutrition, and weight control.
The bond between hospitals and their communities is typically strong, but, like any
relationship, it takes some effort to keep it that way. Neither wants nor can afford to be
overlooked. Issuing a community benefits report is something that a hospital can do to
occasionally remind the community of how it adds to the quality of life in those places,
rather than simply assume everyone there automatically remembers from year to year.
Ben Franklin said as much when he quipped, “A little neglect may breed great mischief.” As
for the need to take the initiative and point out the good that hospitals do, even if it means
tooting their own horn once in a while? He was on target there, too: “He that lives upon hope
will die fasting.”