SPRING ISSUE OF GREAT BOARDS is now available, with articles on governance of joint ventures and proper use of board executive sessions. See it now at www.GreatBoards.org.
SUMMER ISSUE OF GREAT BOARDS will feature articles on aligning hospitals and physicians around common quality goals (by strategy consultant Don Seymour), and following "red rules" for board conduct (by Barry Bader). Look for it in June.
The Governance Institute's Leadership in Asheville, NC, on May 20-23, 2007 has a few spaces left. Barry Bader will speak on institutional integrity and lead a new trustee orientation. Other speakers include Gary Yates of Sentara, plus consultants Don Seymour and Marian Jennings, and author Emily Friedman. For information go to http://www.governanceinstitute.com/default.aspx or call (877) 712-8778.
The Governance Institute also sponsors a first-ever conference for board support staff, on August 12-14, 2007, in San Diego, CA. Speakers include Chris Van Gorder, CEO of Scripps Health and consultants Linda Galindo and Nate Kaufman. Topics include legal issues in minute taking, governance resources, preparing board packets, and board roles & responsibilities -- plus a chance to network with peers who provide administrative support to their boards. For information go to http://www.governanceinstitute.com/default.aspx or call (877) 712-8778.
Grassley asks GAO to examine nonprofit hospitals
So, the Democrats won and you thought it was safe again for socially-minded not-for-profits. Don't be naïve. Sen. Charles Grassley on April 5 asked the Government Accountability Office to study community benefit and executive/board compensation at nonprofit hospitals as part of his ongoing review of nonprofit practices. In a letter to the GAO, the ranking member of the Senate Finance Committee asked that GAO examine the "standards and policies nonprofit hospitals use to define the components of uncompensated care, charity care and bad debt, and how nonprofit hospitals interpret and report them in practice." In addition, he sought information on the extent to which executives and board members "are involved in for-profit business ventures with the nonprofit hospital." For more information go to http://www.senate.gov/~finance/press/Gpress/
2007/prg040507b.pdf.
IRS clarifies Form 990 disclosures
In April 26 the IRS released new "FAQs" for the Form 990 clarifying controversial new questions relating to board structure, when to report compensation for directors and officers who have relationships with other organizations, how to report compensation for all "disqualified persons," and relationships between directors, officers and other insiders (the so-called "notorious line 75b"). Michael Peregrine and his colleagues at McDermott Will & Emery say the clarifications are helpful but "the IRS is actively interested in learning much more about the interests and relationships of organization insiders, particularly board members." Peregrine recommends briefing the board on the disclosure requirements and working with the Governance Committee to develop a simplified method of reporting the information. For more information go to the MWE website, http://www.mwe.com/index.cfm/fuseaction/
publications.nldetail/object_id/
40b59eb1-c2c8-4bbc-86f4-eff32e807fc1.cfm, and to the IRS website: http://www.irs.gov/pub/irs-tege/2006_form_990_qas_final.pdf.
Commonwealth Fund releases report
Quality efforts are paying off, the study says, in improved quality and efficiency over time. Results indicate significant improvements across hospitals in reducing mortality and increasing efficiency over 2001--2005, although results are mixed for reducing complication and morbidity rates. Reduced mortality is likely due to improvements in care, such as better diagnostic techniques and earlier interventions, as well as more conscientious record coding and changing discharge practices. Consistent reductions in length of stay underscore the financial pressures on hospitals, perhaps combined with improved ability to stabilize, treat, and discharge patients.
A companion report focuses on how hospitals achieve and sustain improvements over time. Case studies of four hospitals that made substantial improvements reveal a pattern: 1) a trigger such as a crisis or new leader serves as a "wake-up call" that prompts the hospital to make 2) organizational and structural changes such as multidisciplinary teams, quality-related committees, and technology investments, which in turn facilitate 3) a systematic problem-identification and problem-solving process, resulting in 4) new treatment protocols and practices, which in turn result in 5) improved outcomes. Success strengthens commitment and turns this "temporal pattern" into an ongoing cycle and reinforces "a culture of quality." Go to http://www.cmwf.org/publications/
publications_show.htm?doc_id=471265&#doc471265.
Hospitals go public with JCAHO survey results
Five large Boston teaching hospitals have released the results of their usually confidential results JCAHO inspections, including safety concerns found. One most common problem -- found at three of the hospitals and about 1 in 3 nationwide -- is failing to ask some patients being admitted to list their medications. At Mass General, in nine instances inspectors found that doctors and nurses inserting intravenous tubing or performing other procedures either did not take a "time out" to verify a patient's identity and procedure, or did not document that they had. The Brigham and Boston Medical Center said they need to improve the way nurses and doctors handle "critical test results," such as low red blood cell counts, that indicate a patient needs an immediate intervention. All the hospitals have been or will be reaccredited and have made improvements. To see the story go to the Boston Globe at http://www.boston.com/news/local/articles/2007/04/21/
five_hospitals_release_data_on_inspections/.
Quality-based buying slow to catch on
The future's not here yet. Some health plans have introduced "high-performance networks" to encourage use of providers--predominantly physician specialists--deemed "high performing" on efficiency and quality measures -- but early adopters are few and most are large national employers. Smaller employers are interested but actual adoption has lagged, according to a new study by the Center for Studying Health System Change (HSC). "High-performance networks have gained a toehold in such markets as Boston, Milwaukee and Seattle only when large employers have been aggressive in pushing them," said Paul Ginsburg, HSC president and co-author of the study. For more information, go to http://www.hschange.org/CONTENT/929/.
With government health spending increases unchecked, look for renewed efforts to trim the federal payments -- and Congressional battles to "save" patients and their benefits. AHA's latest focus is stopping nearly $4 billion in cuts to Medicaid payments. An amendment to the Iraq-Afghanistan funding bill offered by Sen. Dick Durbin (D-IL) places a two-year moratorium on the CMS Medicaid rule on intergovernmental transfers and certified public expenditures, and prevents CMS from working on any rules related to eliminating payments for graduate medical education under Medicaid. Trustees should make their views. For information go to http://www.aha.org/aha_app/secureMember
?page=/aha/action-alert/2007/070405-aa.html.
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Barry S. Bader, Bader & Associates
12225 Seline Way, Potomac MD 20854, 301-340-0903
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