the executive connection of north texas: fall 2012

FALL 2012

CONTENTPresident’s Remarks 4Caleb O’Rear, FACHE

Navigating the Texas 51115 Medicaid Waiver

Member Spotlight 8

What’s New with 10Community Benefit

How Social Are You? 11

News from National 12

Meaningful Use Stage II: 13Evolution Not Revolution

Fall General 14Membership Meeting

Event Encore 15

Event Encore Extras 16

Calendar 17

ofACHE

North TexasACHE

North Texas

The ACHE of North Texas e-magazine, The Executive Connection, is published quarterly (Spring, Summer, Fall and Winter) and includes information on the latest regulatory and legislative developments, as well as the quality improvement and leadership trends that are shaping and influencing the healthcare industry. Readers get indepth reporting on the issues and challenges facing hospital and health system leaders today. We make it our job to tell you about the great things the organization and Chapter are doing every day to ensure the health of our community. If you have any news and updates that you want to share with other members, please e-mail your items to [email protected]. Microsoft Word or compatible format is preferable. If you have a graphic or picture that you’d like to include, please send it as a separate file. The following are the types of information that our members shared in past ACHE of North Texas magazines: Advocacy Issues, Legislative Issues, Educational Opportunities, Awards / Achievements, Promotions (Members On the Move), Committee Updates, journal submissions, conference submissions, and workshop participations, sharing mentoring experiences, etc.

northtexas.ache.org

It always seems impossibleuntil it’s done.

Peter B. Lewis BuildingCase Western Reserve University

huntconstructiongroup.com | 4099 McEwen, Suite 400 | Dallas, TX 75244 | P: 972.788.1000

Social Media Surveysee page 11 for details

http://www.northtexas.ache.org

http://www.huntconstructiongroup.com


A Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2012 3

Editor-In-Chief Susan Edwards, FACHE

Managing Directors Joan Shinkus Clark, DNP, RN, FACHE Angela CJVincent, MHS

Contributing Editors Felicia McLaren Lisa Cox Forney Fleming Jose Alejandro

Contributing Writers Ashley Wise, MBA David C. Salsberry Mia Johnson

Production Kay Daniel

Advertising/ Subscriptions [email protected]

Questions and Comments: ACHE of North Texas Editorial Office, c/o Executive Connection 511 John Carpenter Frwy, Suite 600, Irving, Texas 75062 p: 972.812.1154 | f: 972.570.8037 e: [email protected] | w: northtexas.ache.org

2012 Chapter Officers

President Caleb F. O’Rear, FACHE Denton Regional Medical Center

Secretary Winjie Tang Miao Texas Health Harris Methodist Hospital Alliance Co-Chair, Sponsorship

Treasurer Pam Stoyanoff Methodist Health System

2012 Board of Directors

Teresa BakerVA North Texas Health Care SystemCo-Chair, Advancement and Mentoring

Britt R. Berrett, PhD, FACHE Texas Health Presbyterian Hospital DallasEx-Officio, Regent

Lisa CoxThe Health Industry CouncilACHE Coordinator

Beverly Dawson, RN, CCM, FACHEElderCareChair, Advancement and Mentoring

Forney FlemingUniversity of Texas at DallasEx-Officio, Faculty

Josh Floren, FACHEParkland Health & Hospital SystemCo-Chair, Membership and Networking

Dresdene Flynn-WhiteJPS Health NetworkChair, Communications

Jay FoxBaylor Medical Center, WaxahachieCo-Chair, Advancement and Mentoring

Jonni Johnson, CPSMRTKL Associates Inc.Chair, Sponsorship

Matt van LeeuweParkland Health & Hospital SystemEx-Officio, Student Council

Ashley McClellan, FACHEMedical Center of LewisvilleCo-Chair, Education

Demetria WilhiteThe University of Texas at ArlingtonEx-Officio, Faculty

Bethany WilliamsZirMedChair, Membership and Networking

Chip Zahn, FACHELas Colinas Medical CenterCo-Chair, SponsorshipNominating Committee Chair


President’s RemarksCaleb O’Rear, FACHE

Dear Chapter Members,

As our days have become shorter and the nip of Fall is in the air, I am certain that everyone is personally preparing for a joyous Holiday Season. Professionally, Fall marks the beginning of what many of us consider our, “busy,” season. Regardless of which sector of Healthcare you’re involved in, these last few months of the year seem to always be especially hectic. Insurance providers are preparing for the enrollment of new members, hospitals and surgery centers are scrambling to accommodate patients eager to schedule procedures, and everyone is busy planning new budgets and projects for the New Year. As a Hospital Administrator, this is personally my favorite time of year. Despite the hectic schedules, it is an ideal time for us all to bring finality to the current year, reflect on the successes of the past, and recharge for the coming year. Most importantly, it is a time for us to all be thankful for the opportunities we’ve been afforded and the people who surround us. I am particularly thankful this year for our North Texas Chapter and for the many professional members in it who surround me. They are people that I interact with everyday and many who have recycled back through this very close-knit healthcare world in which we work. If I could encourage each of you to take advantage of just one thing that membership in this organization provides, it would be the collegial relationships that it helps develop. More often than not, we tend to rely on these relationships in tough times or times of need, rather than the good times or successful times. It is important for us to all realize that our professional network should be utilized routinely in all facets of our work-life. A great place to rekindle those professional relationships, start a new, or strengthen your existing executive connections is during our Fall General Membership Meeting on November 15, 2012. While I am proud of all of our events, I think this one encapsulates the ideas of closing out the year and recharging for the next. During this meeting, I will have the opportunity to share our chapter success,recognize those members who made outstanding contributions and usher in new members of the Board. Hope to see you there! And in the spirit of Thanksgiving, I hope that each you will take a moment to be thankful for the colleagues who surround each of us. Until next edition,Caleb O’Rear, FACHE

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http://www.perkinswill.com


With intense interest and nervous trepidation, leaders of the Texas health care community have watched the rapid development of the 1115 Waiver. But just what is an 1115 Waiver and why is Texas implementing the Waiver?

Let’s start with the “why”. The Waiver was birthed out of the convergence of a national imperative to improve population health outcomes and a state imperative to balance its budget. In the last legislative session, the state of Texas decided to expand Medicaid Managed Care to the entire state to help close the gap created by a budget deficit. Because of federal rules, this change was to result in a loss of $2.8 billion in Upper Payment Limit (UPL) program payments to hospitals for uncompensated care and undercompensated Medicaid services. In response, the Texas Health and Human Services Commission (HHSC) and the Centers for Medicare and Medicaid Services (CMS) teamed up to develop the Waiver.

With the Waiver, Texas was able to secure replacement funding for the lost UPL payments. At the same time the Waiver created Regional Health Partnerships (RHPs) responsible for developing five year plans for transforming health care delivery. The plans will include allocation of a large funding pool to reward providers for improved coordination of care and population health quality improvements. The Waiver is being implemented as a model for other states to consider.

The unique aspect of this initiative is how the RHP structure is leveraged for community benefit. HHSC has divided the state of Texas into 20 RHP regions. Each RHP is led by an “anchor” organization, which is typically but not always a

public hospital. The RHP enjoins healthcare providers of many types including hospitals, physicians and behavioral health centers, with government based organization such as hospital districts, county governments, academic medical centers, and public health departments, among others. In the middle of this partnership sit HHSC and CMS as “investor” and oversight organizations guiding the program.

Participation by providers and government entities is voluntary. However, the “marriage” of public and private sector entities is necessary for development of RHP plan funding. Funding for the waiver must be accomplished through qualifying governmental dollars, in this case intergovernmental transfers (IGT).

Every IGT dollar raised by the public entity results in a drawdown of federal matching dollars. In its simplest form, 42 cents of IGT is matched with 58 cents of federal dollars provided by CMS to fund the Delivery System Reform Incentive Pool (DSRIP). HHSC serves as the conduit entity for managing program requirements and the flow of funds through the pool.

The purpose of the collective family of participants in an RHP is to achieve the CMS triple aim, which focuses on: • Bettercareforindividuals(includingaccesstocare,quality of care, and health outcomes) • Betterhealthforthepopulation • Lowercostthroughimprovement(withoutanyharm whatsoever to individuals, families, or communities)

cont. on p 6

“Every truly great accomplishmentbegins with the impossible”

Navigating theTexas 1115Medicaid Waiverby David C. Salsberry, EVP/CFO, JPS Health Network


Not all hospitals recognized in all specialties. See the August 28, 2012, U.S. News and World Report Best Hospital Guide for complete listings. 2012 Baylor Health Care System BHCS_866_12 TM

Gastroenterology Diabetes & Endocrinology Neurology & Neurosurgery

OrthopedicsUrology

Pulmonology

NephrologyCancer

GeriatricsEar, Nose & ThroatCardiology & Heart Surgery Gynecology

RRECOGNIZED FO EXCELLENCE IN

For a physician referral or for more information,

call 1.800.4BAYLOR or visit us online at BaylorHealth.com.

The most“Best Hospitals”

in Dallas/Fort WorthOnce again, Baylor Health Care System has more “Best Hospitals” on U.S. News & World Report’s 2012 metro ranking than any other health care system in Dallas/Fort Worth. Among Baylor’s top-ranked hospitals, Baylor University Medical Center at Dallas nationally ranked in 6 specialties and rated High Performing in 6 others. Also regionally ranked were Baylor Regional Medical Center at Plano, Baylor All Saints Medical Center at Fort Worth, Baylor Medical Center at Irving and Baylor Medical Center at Garland.

These aims are achieved through implementation of improvement projects pursued by the RHP’s “performing providers”. The RHP proposed planning protocol provided by HHSC suggests that an effective RHP plan could transform the delivery of patient care by focusing on the following:

Source: DSRIP Regional Healthcare Partnership Planning Protocol Category 1, HHSC

Medicaid Transformation Waiver

Successful implementation of the improvement projects, as evidenced by accomplishment of established milestones and metrics, enables performing providers to receive incentive payments from the DSRIP pool.

For those directly involved in the Waiver development, the transformation journey has been a challenge. This challenge has been fueled by four fundamental aspects of the Waiver including: • Tighttimelines • Theenormoustaskofdevelopingprogramrequirementsand funding protocols for assembling complex regional health plans • CultivationofnewandemergingrelationshipsamongRHP participants • Theimperativeforsuccess

TIMELINESHHSC proposed the Waiver to CMS in July, 2011. Through an expedited negotiation process, CMS and HHSC labored diligently to work out basic terms and conditions in less than 6 months from the time of the original submission. On December 12, 2011, CMS approved the Waiver. The Waiver is for a 5 year period from federal fiscal year 2012 through 2016 and provides potential funding of $29 billion. Year one of the Waiver is a transition period during which funding continues that replaces the terminated UPL payments.

cont. on p 8

During the transition year, RHPs are expected to develop DSRIP plans. Submission of plans to HHSC will occur between September 1st and October 31st so they can be reviewed, modified, and submitted to CMS. Professionals versed in development of regional health plans would say that an effort of this magnitude in a time frame of less than one year is, at its worst, an impossible task and, at its best, a daunting task.

RHP PLAN DEVELOPMENTAs approved, the Waiver included only basic terms and conditions and a high level framework of requirements. Unlike other well-developed federal programs, the program and funding mechanics of the Waiver have to be developed from the ground up in the initial transition year. This process of building something new makes the goal of transforming healthcare delivery and outcomes a fascinating journey.

While those of us who have worked in healthcare for some time have longed for the opportunity to build something from scratch that has high patient care impact, actually doing it has proven to be painful and difficult. Since the Waiver was approved, the provider community has struggled to get their arms around setting priorities and determining funds flow, as the rules and mechanics have been slowly developed and negotiated between CMS and HHSC. As of late-July, providers are still waiting for decisions that are crucial to plan development.

http://www.baylorhealth.com


All the while, the timelines for implementation have remained firm. The process has been very transparent and HHSC has been exceptional in allowing and soliciting input and feedback, but they are also struggling to meet the deadlines. So providers are left to build an airplane while it is being flown. During the process, we have had to unlearn many things that no longer apply and take on new perspectives that are unfamiliar. In the end, those who will have the greatest success under the Waiver will be those who can build plans that are both nimble and scalable.

NEW AND EMERGING RELATIONSHIPSTo date, the journey to understand and implement the Waiver requirements has required that stakeholders interact in a way that heretofore has never occurred. The RHP is designed to facilitate collaboration between community representatives, healthcare providers, and governmental stakeholders in the development of strategic priorities and new directions that best serve their communities. New roles and relationships have been identified and are being developed, new partnerships are forming, and organizations that have historically not been financially integrated are learning that the future may require dependence on one another and a joint focus on improving outcomes. Given that this new working relationship is in its early infancy, participants need to remain agile and engaged in order to see that the hoped for transformation is achieved.

NO PLAN “B”In an environment of diminishing revenues, the Waiver provides a unique opportunity for the healthcare community to simultaneously improve both patient care and financial performance. As noted above, the decision to convert all Medicaid beneficiaries to managed care left Texas with no UPL

dollars. The Waiver is the only substitute for this program. As such, there is no plan “B” that avails the state of the resources and reimbursement needed to support the infrastructure that serves the uncompensated care population. Even the Affordable Care Act (ACA) cannot adequately fill this void. It is this reality that requires all those involved to work cooperatively to make the program successful.

The Road AheadThe deadline for RHP submissions of regional health plans to HHSC was September 1, 2012. The pace of work has been feverish, amidst ever changing rules and protocols, and with continuing discovery of new threats and opportunities. Submitted plans will be scrutinized first by HHSC and ultimately by CMS, and RHPs will have opportunities to revise plans during the process. The goal is to have final CMS approval by January, 2013.

At this juncture, the future is in sight and those that have invested so much in seeing the Waiver come together continue to press onward. In this moment, true leaders are being identified in the Texas healthcare community. Many leaders will see the Waiver, like many other aspects of the ever changing healthcare environment, as just another change painting a futuristic picture that looks uncertain and frightening. Alternatively, there are those who understand that every truly great accomplishment begins with the impossible. As these leaders continue to engage the process, they avail themselves of the greatest opportunity of their careers to see their community transformed, to see that their friends and neighbors have access to care not previously available, and to see a healthcare provider community that can continue to provide world class medicine and healthcare solutions.

http://www.letu.edu/health


Blake Allison, FACHEVice PresidentPhysician Strategy GroupUnited Surgical Partners International

What are you doing now?

I currently work for United Surgical Partners International, a national management company focused on short stay surgery. Specifically within USPI, I work for a division called the Physician Strategy Group which is a wholly-owned consulting company focused on being a strategic resource to our physician partners. Our group works at the physician practice level with a focus on helping the private practice physician be successful into the future.

In your opinion, what is the most important issue facing Healthcare today?

The single most important issue we are facing today is transparency amongst providers in the areas of cost and quality and beginning to display the value proposition to the consumer. The ability to prove your value proposition as a provider related to the quality of care that you deliver and the cost associated with delivering it is becoming vitally important. We will need robust information technology systems to assist with this important endeavor moving forward.

How long have you been a member of ACHE?

I have enjoyed the benefits of membership since I became a student member in 2003.

Why is being a member important to you?

In a field of ever changing market dynamics, I feel the need to stay linked to a group focused on ensuring I have visibility on the most pressing issues facing our industry and access to the experts to assist with navigating the strategic execution needed to be successful. Also, it is important to have a strong professional network to consistently rely on to provide mentoring, guidance, coaching and support. I believe ACHE has the infrastructure to assist with all of these elements.

What advice can you give to Early Careerists or those considering membership?

My advice would be to be an active member and have a plan for how ACHE will assist you in reaching your career goals. ACHE has the resources to greatly enhance your career, then makes those resources available, but it is up to the individual to integrate them into their personal growth plan.

Tell us one thing that most people don’t know about you.

I once spent the night in an underwater hotel.

MEMBER SPOTLIGHT

Angel BenschneiderSenior Vice President Caddis Partners, LLC


Currently I am responsible for portfolio asset management and development leasing as well as physician lease representation for Caddis.


There are critical decisions to be made in the future that impact the direction of healthcare for providers and patients. I don’t think one single issue is as important as the impact of a multitude of decisions which will be made and will direct care in the future.


Four years.


The relationships, programs and educational offerings have benefitted me through mentoring others and developing healthcare relationships outside of the real estate industry. I recently completed my HMA in addition to the MBA I currently hold. The educational offerings and assistance by other members will be instrumental to my plans to complete the FACHE designation.


I am involved on multiple boards and in multiple other industry organizations. The execution of the benefits of ACHE is unmatched for the cost of belonging. Lisa does a wonderful job providing information and assisting in furthering my involvement.


I have an identical twin sister in real estate as well. That was fun when I was 20 and dating, today, every other person I meet says to me “you look just like your sister or better yet, call me by her name”. Maybe we should have thought more about having identical careers...


Chris Surley, MBAGlobal Category Manager- Alcon


I am a Procurement and Sourcing Analyst at Alcon Laboratories working in Global Category Management.


Giving people that chance to live their best lives while maintaining a viable cost structure. In business terms, it is a question of productivity: what outcomes are we getting for the resources consumed?


A little less than 2 years.


It is important to understand healthcare industry trends and what others are doing improve healthcare. Ultimately, patients are the consumers of the services and products we provide and, as healthcare professionals, we owe them the very best in healthcare.


Take advantage of the opportunities. Finding a home in healthcare can be challenging and ACHE gives you the chance to learn and develop relationships with the regions healthcare leaders.


Since the age of 16 I have worked in and around the healthcare industry. From a file clerk in a pediatrics clinic in my home town, to electronic components used to build medical devices, and finally to my current position at Alcon.

MEMBER SPOTLIGHT

Sometimes making a community healthier is about building parks. It’s about

supporting local schools and stocking food banks. As the largest not-for-profit,

faith-based health system in North Texas in terms of patients served, we value

our relationships within our communities. We are proud to continue a tradition

of being a responsible, major employer in every city we serve and to building

healthier communities beyond our walls. 1-877-THR-Well • TexasHealth.org

SHOULDN’T A HOSPITAL’S

COMMITMENTTO A HEALTHIER COMMUNITY EXTEND

BEYOND ITS WALLS?

ofACHE

North TexasACHE

North Texas

http://www.texashealth.org


http://www.waltermoore.com


What’s New With Community Benefit?Reproduced with permission of the

Robert Wood Johnson Foundation, Princeton, NJ

OVERVIEW

Non-profit hospitals are required to provide benefits to the communities they serve to keep a tax-exempt status. Nationwide, about 2,900 hospitals (60% of hospitals) are non-profit and the financial benefit to these hospitals from being tax exempt is estimated to be worth $12.6 billion annually.

Historically, much of hospitals’ community benefit activities have been charity care and other forms of uncompensated care. A lack of transparency and wide variations in how, and how much, hospitals spend for community benefits led to increased oversight by the Internal Revenue Service (IRS) and Congress. New community benefit requirements under the Affordable Care Act include community health needs assessments and improvement plans, as well as additional consumer protections on financial assistance, billing, and collections practices.

COMMUNITY HEALTH NEEDS ASSESSMENTS ARE CENTRAL TO COMMUNITY BENEFIT

A community health needs assessment, which must be made widely available to the public, uses local data and community stakeholder input to identify and prioritize a community’s health needs. The law specifically requires coordination with the local community and public health experts. The assessment must lead to the development of strategies to address the identified needs–all of which must be updated every three years. The IRS has issued preliminary guidance about community health needs assessments and will release final regulations at a later date.

Hospitals can look to local and state health departments, the County Health Rankings & Roadmaps, and other data sources to help them identify community health needs. Resources such as the Guide to Community Preventive Services and What Works for Health can be used to help identify evidence-based programs to improve health.

HOW CAN HOSPITALS, LOCAL HEALTH DEPARTMENTS, AND COMMUNITIES WORK TOGETHER TO IMPROVE HEALTH?

The community health needs assessment process offers an opportunity for the entire community to work together to collectively improve health. Participants can include health systems, health departments and other government agencies, community organizations, employers, the faith community, United Ways and other non-profits, local funders, academic institutions, and other community leaders.

In many communities around the country, hospitals, health departments, and community groups are already working together. For example, a collaborative effort is underway in the Portland, Oregon metropolitan area to conduct a community health needs

cont. on p 12


assessment. The partners include all 14 hospitals in the region and four county health departments, and the Multnomah County Health Department is facilitating the process. And in New Jersey, the United Way of Greater Mercer County is leading an effort to conduct a community health assessment, which includes a collaboration with four community hospitals and eight local health departments.

WHAT ARE THE BENEFITS OF THE NEW REQUIREMENTS?

The collaboration on assessments can ensure that public and private resources are being used as efficiently as possible to address a community’s most pressing health needs. In Buncombe County, North Carolina, better utilization of health needs data and collaboration led to health departments and hospitals creating voluntary partnerships with local providers to provide a stronger safety net and reduce costs associated with uncompensated care. There are additional incentives for public health departments to work with hospitals on community health assessments including accreditation. Public health departments are required to have a community health assessment and a community health improvement plan in place in order to become accredited by the Public Health Accreditation Board.

CONCLUSION

Hospitals, health departments, and other community partners should work together to assess community health needs and create a plan for addressing those needs. A successful collaboration will ensure that resources are used efficiently and effectively to improve the health of all members of the community.

TAKEAWAYS:

•Therearelong-standingfederalrequirementsforhospitalstoprovidebenefitstotheircommunitiesinordertomaintaintheirnon-profitstatus–thisnowincludesacommunityhealthneedsassessmentandimprovementplan.

•Assessingcommunityhealthneedsandadoptingastrategytoaddressthoseneedsprovideshospitalswithavaluableopportunitytoworktogetherwithcommunitypartnerstoidentifystrategiesforimprovinghealth,qualityoflife,andthecommunity’svitality.

•Benefitsofthenewrequirementsgobeyondimprovinghealth–theyincludeenhancedaccountabilityforhospitals,moreeffectiveuseofresources,andbuildingcommunitycapacityandengagementinaddressinghealthissues.

How Social Are You?Are you Linked In to Tweeting about Facebook or are these terms foreign to you? The North Texas ACHE Chapter wants to know! By clicking on the link and taking the brief survey on social media habits, you will be assisting the chapter by providing insight into these communication channels and helping us deliver information in the best way possible...YOUR Way!

http://www.surveymonkey.com/s/6ZFJDXB


NEWS FROM NATIONAL

Looking for Information About Health Reform? The ACHE Healthcare Reform Resources section on ache.org is dedicated to helping you find resources to address reform challenges. Exclusively for ACHE members, the guide is intended to provide the knowledge and insight necessary to lead your organization through the challenges leaders face today. It is not intended to be all-inclusive, but rather an ever-evolving tool with regularly-updated resources to address your concerns, develop your skills and meet the demands of the changing environment. To further facilitate browsing, the resources have been organized into 10 topic areas, including delivering accountable care, meeting clinical staffing demands, implementing IT solutions and more. Access the guide today.

Complimentary ResourcesMembers Seeking to Pass Board of Governors Exam

For Members starting on the journey to attain board certification, ACHE offers complimentary resources to help them succeed so they can be formally recognized for their competency, professionalism, ethical decision making and commitment to lifelong learning. These resources, which include the Exam Online Community, the Board of Governors Examination in Healthcare Management Reference Manual and quarterly Advancement Information webinars, are designed to be supplements to other available Board of Governors Exam study resources, such as the Board of Governors Review Course and Online Tutorial.

• The Exam Online Community is an interactive platform tolearn and glean study tips from other Members taking the Exam. It also provides the opportunity to discuss Exam topics with experts and the option to participate in study groups. Interested Members may join the Exam Online Community at http://bogcommunity.ache.org.

• The Reference Manual, found at ache.org/FACHE, includesa practice 230-question exam and answer key; a list of recommended readings; and test-taker comments, study hints and tips.

• FellowAdvancementInformationwebinarsprovideageneraloverview of the advancement to Fellow process, including information about the Board of Governors Exam, and allow participants to ask questions about the advancement process. An upcoming session is scheduled for December 6. Register online at ache.org/FACHE.

Save the Date 2013 Congress on Healthcare Leadership: March 11th–14thChicago Hilton and Palmer House Hilton

ACHE’s Congress on Healthcare Leadership brings you the best in professional development, exceptional opportunities to network with and learn from peers, and the latest information to enhance your career and address your organization’s challenges in innovative ways.

Nearly 4,700 healthcare leaders attended the 2012 Congress on Healthcare Leadership. Join us in 2013 and experience the energy of an event that draws the top healthcare leaders from across the nation and around the world.

This premier healthcare leadership event provides: • Educationoncurrentandemergingissues • Morethan140sessionsofpracticallearningfromhealthcare’s top leaders • Opportunitiestoconnectwithyourpeers • Career-enhancementworkshops

The opening date for Congress registration and to reserve hotel accommodations is Nov. 13, 2012.

http://www.kmdarchitects.com


While the release of the Meaningful Use Stage II regulations has once again stirred debate among many providers and healthcare professionals, the legislation is notably void of significant mandates for change. Rather than focusing on the addition of new objectives, the Stage II rule is decidedly centered on the goal of raising compliance with the existing measures of Stage I. This fact is reflected most pointedly in the legislation’s small list of 6 new objectives, of which 5 are optional Menu Set additions. The hesitant design of this legislation is arguably a reflection of the continuous challenge to inspire change in America’s healthcare industry. Just as ICD-10 utilization has been repeatedly delayed due to provider resistance and lack of preparation, the new Meaningful Use rule represents a reluctance to mandate rapid change in a sector that is so fragmented and deeply rooted in tradition. While many proponents of health information technology and patient empowerment are disappointed at the evolutionary development of the Meaningful Use program, the slow pace of advancement should not be viewed as a failure.

The American healthcare industry is an incredibly complex economic sector with a proliferation of medical specialties, an array of delivery models and an extremely complex billing and insurance system. Creating medical technologies and standards that can cater to the needs of a field this diverse is a substantial undertaking. Additionally, standardized progress is often hard to achieve because of the limited resources of many private practitioners. While hospitals and health systems may have the intellectual, human and financial resources to tackle legislative reforms and technical implementations, many private practitioners are ill equipped to understand and comply with new regulations. These market dynamics force us to consider the rate of change that is achievable and sustainable within the industry. If the program’s aim is to achieve wide adoption of Meaningful EHR use among

providers, then the legislation must have a model and scope that is designed for the abilities and limitations of our system. The Stage I regulations provided us with an opportunity to evaluate both the rate of technology adoption in the industry and the nature of the challenges many providers faced in meeting the requirements of reform. This knowledge served as a basis for the Stage II regulations, and the desire for wider participation in the Meaningful Use program highlighted the need to temper the pace of change.

Understanding the challenges of provider compliance with Meaningful Use regulations also provides us with a roadmap for how to lower these barriers and how to create significant health IT advancement outside of the Meaningful Use program. As technology use spreads, the need to share information across care settings and proprietary software grows at an alarming rate. Providing excellent patient care and eliminating redundant costs are goals that both hinge upon our ability to provide physicians with complete and accurate patient information at the point of care. While Meaningful Use advances these goals, the necessity of building more standardized data sets, replicable interface designs, and evidence based quality measures have all been uncovered as areas of significant opportunity. Although the government may fail to inspire comprehensive and rapid adoption of EHR technology by providers across the medical industry, it can create the impetus for advancement in many of these peripheral regards. Encouraging or requiring cooperation between proprietary software vendors and creating the tools and languages for interoperability will mean that when our providers are ready for true EHR use, there will be a technical structure to collect their information to the broader healthcare community and to ensure that the health of both individuals and populations alike is being monitored and advanced.

cont. on p 14

Meaningful Use Stage II:Evolution Not Revolution Ashley Wise, MBA, EMR/Technical Operations Director,

Physician Strategy Group


Significant Stage II Changes for Eligible Providers

Highlight of New Objectives: New Core Requirement Secure Patient – Provider Messaging: • Patientsgiventheabilitytosecurelyelectronicallycommunicate with providers about their care

New Menu Requirements: Electronic Notes: • Requirementthatprogressnotesbecreatedasstructureddata Imaging Results: • Requiresthatimagingresultsandexplanationsareaccessible through CEHRT Family Health History: • Requiresastructuredentryoffamilyhistoryinformationforat least one immediate family member Cancer Registry: • Requiresthatprovidershavethecapabilitytoreportcancer cases to a public health registry Specialized Registry: • Requiressuccessfulongoingreportingtoaspecializedregistry of the provider’s choice

Stage I Objectives Eliminated in Stage II

Stage II Requirements Now Included in More Comprehensive Stage II Measures: • DrugFormularyChecking • Up-to-DatePatientProblemListasDiscreteData • ListofActiveMedications • ListofActiveMedicationAllergies • AbilitytoExchangeKeyClinicalInformationElectronicallywith Other Providers

Stage I Requirements Eliminated from Stage II: • Timelyelectronicaccesstohealthinformation–objective eliminated in favor of more robust Stage II requirement of Online Patient Access (Core Requirement #10)

Significant Changes to Stage I Objectives

• CPOEexpandedtoincludelaboratoryandradiologyorders • EligibleProvidersrequiredtoimplementatleast5Clinical Decision Support Rules that are targeted at improving the quality of care and improving healthcare efficiency (lowering costs) • Providersmustsendproactivereminderstopatients(e.g.for preventative care) and must send all reminders per patient preference (e.g. via phone, email, text, etc.) • Providersmustprovidepatientswithonlineaccesstoa comprehensive view of their treatment history. Unlike the CCD files, the online access is not a snapshot of a patient’s health at a specific point in time, instead requiring historical diagnostic and treatment data • ClinicalSummaryandSummaryofCaredataelementshave been updated to provide a more comprehensive view of the patient’s care plan

Fall General Membership Meeting Thursday, November 15th Omni Mandalay at Las ColinasNetworking from 5:00 - 6:00 pmDinner Chapter Updates, Awards, and Speaker from6:00 - 8:00 pmFor more details: northtexas.ache.org

• 2012ChapterPerformanceUpdate• StudentCouncilCaseStudyCompetitionAwards• ACHEMembershipRecognitionandAwards• Voteon2013Officers/NewBoardMember Recommendations • KeynoteSpeaker,BerniceWashington,PresidentandCEO, BJW Consulting

Bernice WashingtonPresident & CEO,BJW Consulting Group“Delivering Results in aHigh Performance Environment”

The future of many healthcare organizations will depend on how hospitals and physicians manage their NEW relationship. Hospitals, Boards and Physicians require coaching on how to make the transition from the “I, Me, My” model to the “Us, We, Our” paradigm. As we move from fee-for-service to a performance base model, we must be willing to “Discuss the Undiscussable” and have the courage to raise and tackle key issues that stifle hospital and physician alignment.

Hospital leaders will be motivated and inspired to engage in these necessary discussions and revolutionary thinking in order to forge that NEW relationship. Leaders will gain insight into how great leaders embrace the opportunities and face the challenges to hospitals in the post-reform environment.

Hospital leaders must have the ability to influence, persuade, and motivate while projecting confidence and credibility. The bottom line for any healthcare organization is RESULTS. Our objective is to provide a clear understanding of the skills and tools needed to improve performance and increase PRODUCTIVITY.

Healthcare systems that understand the importance of teamwork are valuable assets to the organization. This powerful presentation explores the self-motivation, strategies and actions required to enhance potential and maximize team performance.

EVENT ENCOREA Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2012 15

Executive Women’s Breakfast- September 18, 2012Submitted by Mia Johnson

Tuesday, September 18, 2012, ACHE of North Texas hosted an Executive Women’s Breakfast at Hotel ZaZa. Ashley McClellan, FACHE, President and CEO of Medical Center at Lewisville moderated. The distinguished panel of four consisted of Audrey Andrews, Senior Vice President and Chief Compliance Officer at Tenet Healthcare Corporation; Patricia Ball, Senior Vice President Strategic Development and Public Affairs at LHP Hospital Group; Jennifer Coleman, Senior Vice President of Consumer Affairs at Baylor Health Care System; and, Patricia Driscoll, President and CEO of Home Health Services of Texas as well as Professor of Health Care Administration at Texas Women’s University. This event marked an extraordinary occasion allowing these knowledgeable health care industry leaders to share both professional and personal experience. After introductions of panelists, much of the responses to questions discussed differentiating career building versus being prepared. Additionally, attendees were interested in how women can “have it all” when balancing work and life activities. While many suggestions were made, the panelists confer remaining serendipitous, continuing education, building relationships as well as both seeking and becoming mentors are important to lay a strong foundation.

ACHE of North Texas expresses gratitude to each host and the 72 members for attending and participating in this event. For more information on future events, please visit us at www.northtexas.ache.org or send us an e-mail at [email protected].

Angel Benschneider and Panelist, Jennifer Coleman

Panelists Audrey Andrews, Tenet Healthcare Corporation; Pat Driscoll, Home Health Services

of Texas; Pat Ball, LHP Hospital Group


Breakfast with the CEO - September 12, 2012

Gant Braley, Rendina Companies;Paul Kappleman, FACHE, LHP;

Jared Shelton, Texas Health Presbyterian Dallas

Lynn Meers, MEDCO Construction; Host,Dan Moen, LHP Hospital Group;

Victoria Dale, Texas Hospital Association

Host, Dan Moen, CEO, LHP Hospital Group

Physician Integration I - September 20, 2012

Organizars AmandaBloom, Texas Health Presbyterian Plano; Kevin Smith, FACHE, Texas Health Presbyterian Kaufman;

Jessica Daw, Hammes Company

Panelists Chuck Peck, MD, Health Inventures; Britt Berrett, PhD, FACHE, Texas Health Presbyterian Dallas; Dave Ashworth, FACHE, Cambridge Healthcare Properties; Ken Larson, PwC

After Hours Eventwith Host

Joseph Casper, CEO,

Sandlot SolutionsOctober 11, 2012

EVENT ENCORE - EXTRAS

2012CALENDAR

ACHE of North Texas thanks the following Corporate Sponsors for assisting the organization’s mission. By sponsoring various events throughout the year, these sponsors are provided local and national exposure with an opportunity to showcase their organization, brand, career opportunities, products and services to the ACHE membership and its affiliates.

We are currently working on new educational and networkingopportunities. For the latest updates please check our website or

watch your inbox for the event guide.

Thursday, November 15thFall General Membership MeetingTime: 5:00 - 8:00 pm Speaker: Bernice Washington, President and CEO, BJW ConsultingLocation: Omni Mandalay at Las Colinas

Thursday, December 6thHoliday After Hours Networking EventTime: 5:30 - 7:00 pm Host: ACHE of North Texas Board of DirectorsLocation: Dallas

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http://www.familysleepdiagnostics.com/

http://www.letu.edu/

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the executive connection of north texas: fall 2012

Documents

health system leaders

legislative issues

caleb orear

advocacy issues

executive connection

promotions members

healthcare industry

fache angela cjvincent