The Executive Connection of North Texas: Spring 2013

SPRING 2013 

Congratulations to North Texas ACHE Chapter Member

CONTENT

Joan Clark, DNP, FACHE

President’s Remarks Caleb O’Rear, FACHE

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Advancement Promotion

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Health Policy Brief

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ACHE of North Texas Chapter Member and Texas Health Leader Receives National Award

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Welcome New Members

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for receiving a

National Award!

Read the full story on page 8 northtexas.ache.org

Congress Scholarship Recipients

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Five Ways to Foster Innovation

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ACHE of North Texas Members

Preparing for the BOG Examination?

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As we continue to strive to meet our member’s needs, our website subcommittee is conducting a short 5 question survey regarding the quality of our Chapter’s site. We ask that you take a few minutes to answer the questions and provide us with feedback and suggestions so that we are able to enhance the site and ensure that you are able to find the information you are looking for.

News from National

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We appreciate your time and participation, Communication Committee

Calendar

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http://www.surveymonkey.com/s/L9685M5

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 info@northtexas.ache.org. 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.

ACHE of

North Texas

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2013

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2013 Board of Directors Teresa Baker, FACHE VA North Texas Health Care System Beverly Dawson, RN, CCM, FACHE Elder Care Forney Fleming University of Texas at Dallas Editor-In-Chief

Susan Edwards, FACHE

Managing Directors

Matthew van Leeuwe Joan Shinkus Clark, DNP, RN, FACHE

Contributing Editors

Lisa Cox

Production

Kay Daniel

Advertising/ Subscriptions

info@northtexas.ache.org

Questions and Comments:

ACHE of North Texas Editorial Office, c/o Executive Connection 250 Decker Drive | Irving, TX 75062 p: 972.413.8144 e: info@northtexas.ache.org | w: northtexas.ache.org

Dresdene Flynn – White John Peter Smith Health Network Jay Fox Baylor Medical Center - Waxahachie Michael Hicks, MD, FACHE Pinnacle Anesthesia Consultants Janet Holland Rendina Companies Jonni Johnson, CPSM RTKL Ashley McClellan, FACHE Medial Center of Lewisville Kevin Stevenson, FACHE Atrium Medical Center

2013 Chapter Officers

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

President-Elect Winjie Tang Miao Texas Health Harris Methodist Hospital Alliance

Secretary Josh Floren, FACHE Parkland Health & Hospital System

Treasurer Pam Stoyanoff Methodist Health System

Regent Michael D. Murphy, FACHE Abilene Regional Medical Center

Matthew van Leeuwe Lake Granbury Medical Center Demetria Wilhite University of Texas at Arlington Bethany Williams Zirmed Chip Zahn, FACHE Surgical Care Affiliates Lisa Cox Chapter Coordinator

ACHE of

North Texas

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2013

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President’s Remarks

Caleb O’Rear, FACHE Dear Chapter Members, With March behind us and Spring officially here, it is difficult to believe that 2013 is moving so fast. The North Texas Chapter is hoping that you all have had a nice start to the year. I hope that some of you were able to participate in our annual Congress Meeting in Chicago last month. For those of you that have not been in the past, it is a great way to network with your peers from around the country and to take advantage of an assortment of healthcare related education sessions. I know that I have always come back with a renewed sense of energy and a healthy appreciation for not only the innovative healthcare leadership that exists around our country, but also the huge inventory of highly talented leaders – both seasoned and up-andcomers. This year, our North Texas Chapter sponsored and sent 6 chapter members to the event. You can read more about their experience in this issue.

If you are a member who is considering advancement within the College, please do not forget to consider the exam fee waiver that is being offered or our North Texas Chapter’s application fee reimbursement. For more information, please do not hesitate to contact us. I hope that everyone has a great Spring and I look forward to seeing you at some of our upcoming events.

Until next edition, Caleb O’Rear, FACHE

Advancement Promotion Take the next step in in advancing your career and sit for the Board of Governors Exam to earn your FACHE credential. To assist you, ACHE of North Texas is providing financial support. Be one of the first twenty to submit an application and pass the Board of Governor’s Exam before October 31st and we will reimburse the $250 application fee.

National is also offering to waive the $200 exam fee through June 30th.

Why not take advantage of these two offers and have the full cost of the exam covered? What are you waiting for? Maximize your professional potential by earning the premier credential in healthcare management. When you become board certified in healthcare management as an ACHE Fellow (FACHE), you have proven to have the knowledge, skills and confidence to succeed.

Visit our website for the reimbursement application northtexas.ache.org

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2013

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What’s the issue?

A problematic formula for paying physicians under Medicare has been in place for years and, since 2003, has been stipulating that there should be mandatory cuts in payments to doctors as a result of the increasing volume of services provided. However, Congress has consistently postponed those cuts and instead raised Medicare physician fees slightly or held them constant.

In early January 2013, Congress adopted and President Barack Obama signed legislation to postpone a scheduled 26.5 percent reduction in Medicare physician fees and keep rates unchanged until January 1, 2014. In February 2013, the Congressional Budget Office (CBO) issued new estimates of the cost of this “doc fix” that greatly increased the likelihood of congressional action making the change permanent.

This policy brief examines the various proposals and their possible effects on federal spending and on health care providers.

What’s the background?

Medicare pays physicians using a fee schedule, or list of prices. This list sets a fixed maximum price for each of more than 7,000 defined services, such as an office visit, a particular surgical procedure, or a specific diagnostic test. Current law requires the Centers for Medicare and Medicaid Services (CMS) to update these prices each year—using a formula that, in theory, ensures that total per capita spending for physician services does not grow faster than the increase in the gross domestic product (GDP).

Health Policy Brief Medicare Payments to Physicians.

After enacting another short-term ‘doc fix,’ Congress may finally have a permanent solution in its sights.

Reproduced with permission of the Robert Wood Johnson Foundation, Princeton, N.J.

Targeting Spending: The formula has its roots in concerns dating back to the 1980s about the rapid rate of growth in the number of services that physicians were providing to their Medicare patients.

In 1989 Congress put in place a fee schedule system and a method for annually updating fees that was intended to slow growth in volume. In 1997 Congress revisited this approach and put in place a system of spending targets based on a “sustainable growth rate” formula, often referred to as the SGR. Here is how the system works: When computing the annual update, CMS starts with an estimate of inflation in the costs of running a medical practice. It then adjusts this amount upward or downward, depending on how rapidly total Medicare spending for services rendered by physicians (and some related services) has been growing. If spending has stayed within set targets, physicians get a bonus—a payment increase greater than inflation. But if spending has exceeded the targets, the updated prices may rise more slowly than inflation or even be reduced.

The SGR formula is complicated, but its basic goal is to keep spending for each Medicare enrollee from growing faster than the per capita increase in the GDP. Growth of the GDP was included in the formula under the theory that it is not fiscally sustainable for Medicare physician spending to grow faster than growth of the national economy.

Hope Not Realized: The expectation that this payment system would control spending has not been realized. Despite the cont. on p 6

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2013

prospect of a collective penalty for excess spending growth, individual physicians have no incentive to limit the number of services they furnish. During the first few years under the 1997 rules, physician spending stayed within the targets, and physicians were rewarded with price increases greater than inflation. But for 2002 the updated formula required physician fees to be reduced by almost 5 percent. Congress allowed the reduction to take effect.

But when the formula dictated an additional reduction for 2003, Congress overrode the Balanced Budget Act rules and approved a small physician fee increase instead.

That action set a precedent that has continued to this day. In each year since 2003, despite the statutory formula that would have led to a fee cut, Congress has instead either granted an increase or frozen the rates and prevented a decrease. Despite repeated congressional intervention to prevent rate cuts, the formulas that dictate these cuts have not been revisited. Each time Congress has increased fees, it has specified that the updates for later years should be computed as if it had not acted to increase those fees. What’s more, Congress has never modified the SGR targets themselves.

Until lately, the number of services that physicians provided grew steadily, and the services were increasingly costly and complicated.

That means that each year there has been a widening gap between actual spending and the targeted spending amount. Under the law, this ballooning deficit is supposed to be recouped by even steeper automatic rate cuts in the future. But so far, Congress has acted each time to forestall the cuts, and even to grant physicians small Medicare fee increases.

Federal Deficit Challenge: Why has Congress consistently acted in this fashion, overriding automatic cuts—but on a short-term basis—14 times so far? The answer is that a longer-range fix could greatly increase the projected federal deficit. Congress relies on the CBO to measure the impact of proposed legislation.

The CBO establishes a baseline, or projections of future spending and revenues, that assumes all current laws will be enforced.

The baseline includes all of the physician cuts scheduled to take effect in future years, which would produce substantial savings for Medicare.

Any legislation that overrides future cuts is scored by the CBO as increasing the deficit, relative to the current baseline. However, recent changes that have lowered the estimate of the costs of overriding future cuts now makes a permanent legislative doc fix more likely.

The CBO in February 2013 estimated that eliminating the SGR targets and freezing Medicare physician fees at the current level for 10 years would cost about $138 billion between fiscal years 2014 and 2023. This was a sharp reduction from the CBO’s most recent estimate of $245 billion over 10 years. CBO explained that the change was primarily because actual physician payments for the past three years have been less than proejcted and lower than the spending targets inherent in the SGR.

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Many lawmakers might prefer a permanent solution so that they do not have to keep revisiting the issue. However, given the current focus on deficit reduction, Congress is unlikely to enact a costly long-term fix without either finding some way of paying for it or reforming physician payment in a way that justifies accepting a larger deficit.

What are the proposals?

Most current proposals would have Congress set Medicare physician payment rates in advance for some fixed number of years. This approach would reduce uncertainty for physicians and make the federal budgetary process clearer and more predictable.

In theory, a multiyear payment mechanism would allow time to develop and build approval for more fundamental reforms in the way physicians are paid. The following section reviews some recent proposed fixes (Exhibit 1).

MedPAC: The Medicare Payment Advisory Commission (MedPAC), an independent congressional agency, recently proposed a fix with a price tag of about $200 billion over 10 years. The MedPAC plan would repeal the SGR provision and set payment rates for the next 10 years. Rates for patient visits to primary care physicians would be frozen at their current level through 2021. Payments for other services by those physicians, and for all services by nonprimary care specialists, would be reduced by 5.9 percent in each of the three years from 2012 to 2014 and then be frozen through 2021.

Primary care would be exempt from the reductions chiefly because of MedPAC’s concern about access to these services. MedPAC notes that primary care physicians are far less likely than specialists to accept new Medicare patients. Because primary care visits account for only a small fraction of Medicare physician spending, only 8 percent of services would be exempt from the cuts.

The MedPAC plan would also reduce payments for “overvalued” services. These are services for which the Medicare price is deemed excessive, relative to the difficulty of providing the service or the physician’s overhead costs. For example, automation may have reduced the time it takes a physician to read an electrocardiogram, but the current price may not reflect this.

Cutting payments to specialists makes this plan less expensive than an across-the-board freeze: about $200 billion over 10 years.

The MedPAC proposal includes a list of possible Medicare savings to offset this cost, although MedPAC is not formally recommending any specific item. Among the suggested offsets are requiring drug manufacturers to give rebates to Medicare Part D plans for drugs furnished to low-income beneficiaries, making sharp cuts in payments to skilled nursing facilities and clinical labs, and imposing an excise tax on Medicare supplemental (Medigap) plans that provide “first-dollar” coverage of Medicare’s cost sharing. (See the Health Policy Brief published September 21, 2011, for more information on Medigap plans.)

Not surprisingly, each of these changes is being strongly opposed by the providers or other groups affected. Specialty groups oppose the rate reductions, and many primary care physicians reject a 10cont. on p 7

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2013

year freeze. The American Medical Association notes that Medicare fees have risen by less than 5 percent since 2001, although practice costs have grown by nearly 25 percent.

On the other hand, because physicians have been furnishing more services, their Medicare revenues have grown faster than the payment rates. This would continue to be true under the MedPAC proposal. And despite physicians’ concerns about Medicare failing to keep pace with practice costs, Medicare’s payment rates for physician services are well above those paid in other developed nations. (See the September 2011 Health Affairs article by Miriam J. Laugesen and Sherry A. Glied listed in the Resources section below.)

Bowles-Simpson: The National Commission on Fiscal Responsibility and Reform, known as the Bowles-Simpson Commission, included a physician payment reform plan among its broader recommendations on balancing the budget. The commission’s plan, released in December 2010, would freeze physician payment rates through 2013, reduce rates by 1 percent in 2014, and then reinstate the SGR system in 2015 using 2014 spending as the base year. In effect, past overspending would be forgiven, offering physicians a new chance to restrain spending but threatening them with future penalties for failing to do so. The estimated 10year cost of this approach is $261.7 billion, according to the CBO. Obama Administration: The White House’s fiscal year 2013 budget proposal, released in February 2012, offers a “best estimate” of the cost “to achieve permanent, fiscally responsible reform” but provides no details on what specific measures are intended. Its 10year projected cost of the doc fix for fiscal years 2013–22 is $429 billion.

Longer-range Payment Reforms: Many observers argue that Medicare needs to move beyond the traditional method of paying physicians for each service that they provide to each patient. This fee-for-service approach may encourage the fragmentation of care and the delivery of unnecessary services. There are numerous proposals for payment and delivery system changes that would promote integrated care delivery and encourage costeffective medical treatment, and many are already under way. However, it will take time for these to be adopted widely.

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During 2012 lawmakers in the House and Senate held a number of hearings to explore possible alternatives to the SGR. Physician groups expressed support for legislation that would keep payment rates level or increase them slightly for three or more years, during which time Medicare would continue experimenting with payment reform initiatives, such as pay-for-performance, in which payments are tied to quality and other outcomes measures, or bundling, in which a single payment is made to one entity for a combination of services made by several providers.

One such bill, introduced last year by Rep. Allyson Y. Schwartz (DPA) and Rep. Joe Heck (R-NV), would scrap the SGR and set up a fiveyear transition period in which to test new payment models. No hearings on the bill (HR 5707) were held, however. The lawmakers reintroduced a similar bill in February 2013 (HR 574).

Latest Action: Unable to agree on any of these alternatives, Congress has up until now intervened repeatedly with short-term changes to avoid draconian cuts, as noted above. The most recent extension, enacted by Congress on January 1, 2013, and signed into law by President Obama the following day, will keep Medicare physician fees level through the end of 2013. The cost of doing so is to be offset by a variety of Medicare and Medicaid payment cuts to hospitals, including reducing payments for inpatient care, extending the current reduction in rates for uncompensated care, reducing payments and modifying payment rates for blood dialysis services and endstage renal disease treatments, and reducing payments to Medicare Advantage plans.

What’s next?

In January 2013, House lawmakers put forward a proposal similar to MedPAC’s to repeal the SGR, and more such legislative proposals are likely to be forthcoming in the wake of the CBO’s reduced estimates of a permanent doc fix. Any changes may now become part of a broader deal between Congress and the White House to forestall major federal budget cuts, or “sequestration,” necessitated by the Budget Control Act of 2011 that will take effect in March 2013 unless Congress acts.

If there is such a deal on Medicare physician payments, it could put an end to a long decade in which federal policy makers regularly delayed scheduled Medicare physician fee cuts and found money to pay for it, one year at a time.

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2013

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ACHE of North Texas Chapter Member and Texas Health Leader Receives National Award Texas Health Resources’ top nurse executive has received a national award for her leadership in advancing a new nursing role designed to improve patient care.

Joan Shinkus Clark, DNP, RN, NEA-BC, CENP, FACHE, FAAN, senior vice president and chief nurse executive at Texas Health Resources, was presented the 2013 CNL Visionary Leader Award from the American Association of Colleges of Nursing (AACN).

She received the award, one of only two presented, at the Clinical Nurse Leader (CNL) Summit held Jan. 17-19 in New Orleans.

Under Clark’s leadership, Texas Health has been a pioneer in the development and implementation of the CNL nursing model, a fast-emerging R.N. role developed by the AACN to improve the quality of patient care and better prepare nurses to thrive in today’s health care system. These master’s-prepared clinicians put evidence-based practice into action to ensure that patients benefit from the latest innovations in care delivery.

“Introducing a new nursing role into the health care delivery system takes vision, courage and leadership,” said AACN President Jane Kirschling, Ph.D., R.N., F.A.A.N. “And Joan has even gone above and beyond that.”

Breaking new ground Clark helped establish a Nursing Excellence Fund to support advancing nursing excellence at Texas Health, including covering the cost for Texas Health nurses to become clinical nurse leaders. Today, Texas Health has 30 CNLs and patient care facilitators (nurses studying to become CNLs) serving hospitals throughout its system.

“A number of forces — from more complex, high-risk patients to the need for improved continuity — created the need for CNLs,” Clark said. “The CNL brings a dedicated leader with clinical knowledge, depth and expertise as a regular presence back to the bedside.”In practice, clinical nurse leaders oversee the care coordination of a distinct group of patients and actively provide direct patient care in complex situations. The nurse leaders evaluate patient outcomes, assess risks and have the decisionmaking authority to change care plans when necessary. They also serve as a focal point for the patient, family and health care team in coordinating the patient’s plan of care.

Providing a consistent presence, Cory Franks, M.S.N., R.N., C.N.L., Texas Health Harris Methodist Hospital Alliance, was one of the system’s first CNLs. “As a clinical nurse leader, you are in a position to accurately assess what is needed at the bedside, you have the time and expertise to come up with an evidence-based solution, and you are empowered to implement changes,” he said. “Plus, I’m

a consistent presence on the floor for staff, other members of the health care team, and most importantly, for my patients and their loved ones.”

According to Emily Jestes, M.S.N., R.N., C.N.L., Texas Health Presbyterian Hospital Plano, a CNL’s most important responsibility is to look at the whole patient.

“We round on patients five days a week, as well as follow their progress 24/7 as needed; help manage the patient’s expectations throughout their hospital stay; and promote a team-based approach to care by keeping an open line of communication between the care team and the patient,” she said.

Leading at the national level, Clark has served on the AACN CNL Implementation Task Force and the CNL Steering Committee. Her leadership as a member of the American Organization of Nurse Executives has been key to promoting a national dialogue and awareness of the clinical nurse leader, according to the AACN. “AACN commends the ground-breaking work led by Dr. Clark to introduce the CNL into her health system as a mechanism for enhancing care coordination, strengthening outcome-based practice and enhancing patient safety,” Kirschling said.

About Texas Health Resources Texas Health Resources is one of the largest faith-based, nonprofit health systems in the United States. The health system includes 25 acute care and short-stay hospitals that are owned, operated, joint-ventured or affiliated with Texas Health Resources. It includes the Texas Health Presbyterian, Texas Health Arlington Memorial and Texas Health Harris Methodist hospitals, Huguley Memorial Medical Center, Texas Health Physicians Group, outpatient facilities, behavioral health and home health, preventive and fitness services, and an organization for medical research and education.

For more information about Texas Health Resources, call 1-877-THR-WELL, or visit www.texashealth.org.

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2013

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Welcome New Members FEBRUARY

LaToya L. Rivers-Azanga, Dallas

Emad Mikhail, Flower Mound

Rick Bradford, Argyle

Randy Schieberle, Rockwall

Warren Porter, Arlington

Brayson Burchfiel, Dallas

Laura L. Steinkraus, Dallas

Andrew Rhodes, Arlington

Kevin Campbell, Murphy

Jim Waverka, Flower Mound

John Richardson, Carrollton

Crystee Cooper-Walton, Irving

Andre Williams, Fort Worth

Erik Roberson, Arlington Benjamin Stolz, Fort Worth

Dayna Downing, Dallas James Evely, McKinney

MARCH

Heather Tubbs, Dallas

Barrett Freeman, Dallas

Eugene Abraham III, Plano

Oscar Uribe, Dallas

Marva M. Goins, PharmD, Cedar Hill

John M. Baker, Fort Worth

Veronica L. Vega, Dallas

Pablo Guzman, Grapevine

Nikole M. Best, McKinney

Randy Walker, Garland

Laura Hall, Grapevine

Tatyanna Boyer, Fort Worth

Susie White, Dallas

Katrina K. Harper, Rowlett

Cody Campbell, Dallas

Eric Wikoff, Carrollton

Stephen C. Johnson, Dallas

Nicole A. Clarke-Smith, Plano

Kevin Wright, Irving

Lalanii Jones, Dallas

Harrison Ford, Fort Worth

Lisa Knutson, Celina

William A. Garner, DrPH, Fort Worth

Amanda C. Mueller, Dallas

John A. Geesbreght, Fort Worth

Leslie Pierce, Dallas

Elisa Hernandez, Dallas

Erin B. Pike, Fairview

Danielle Johannes, Dallas Darin L. MacCatherine, Little Elm

Congratulations to the following members who advanced to Fellow status Tracye B. Davis, FACHE | Adam L. Myers, MD, FACHE

Recently Passed the Board of Governors Exam Byron J. Serna | Teresa W. Baker | Edward T. Dold | Janice E. Baldwin | Trudy K. Wiig

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2013

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CONGRESS SCHOLARSHIP RECIPIENTS

With the uncertainty surrounding healthcare reform, the recent sequester, and the numerous mergers and internal changes within many organizations, ACHE Congress “Changing Healthcare by Design” was informative, enlightening and refreshing.

My first session “Your Career is a Marathon- Training to Win” was a great start for an early careerist such as myself. The importance of having a mentor, sustaining the drive to learn, maintaining self awareness of your own strengths and weaknesses, and understanding the path to success is different for everyone was reinforced.

During a luncheon, I was able to hear a humorous, but great speech from Dr. Shalala, recounting her thoughts on the transformation of healthcare with an emphasis on using nurses more effectively. Her main points would be echoed in my sessions focusing on the patient and provider relationship and the tools available for measuring performance outcomes.

“The importance of having a mentor... was reinforced”

Megan Clark I made a point to take advantage of session/topics which I currently have minimal knowledge. I was able to learn about the pros and cons of creating simulation centers. Due to the limitation of space at many teaching hospitals, simulation centers can be hard to expand but the skills acquired can have a great impact on patient outcomes. Also, I was able to learn about the importance of creating women’s affinity programs and hope one day to create or be part of a positive, highly effective group of women.

Overall, ACHE was a great experience. Chicago’s cold, but crisp weather, combined with a massive group of healthcare professionals all hoping to learn something that will help improve their own organizations and communities, proved to be not only insightful, but gratifying.

Thank you ACHE for the scholarship - I truly appreciate the opportunity to attend Congress.

First I want to thank the North Texas Chapter of ACHE for subsidizing my attendance to the Congress.

There were several highlights I found to be most outstanding. The hospital acute care tracks and continuum of care were most educational and included usable standards of best practice.

‘Doing the Right Thing: How Evidence-Based Medicine can Help’; presented by Doctors Starmer and Rhew provided the importance and technology available to ensure best practices are utilized in patient care. The ‘team’ provides the best safe care when all entities are onboard culminating in best outcomes. Inputs, implementation, and feedback closes the loop on safe quality care. Clinical and financial outcomes are proven to meet improved outcomes. This includes improvements in mortality, cost, length of stay, admissions/readmissions, and hospital-acquired conditions.

All presentation information provided viable elements in the delivery of quality care.

Another noted presentation attended was the “Proven Approaches for Healthcare Executives to Expand Their Resiliency Range’ given by Robert Wicks. I felt this to reach my intermittent need to gain resilience to provide the leadership and role model characteristics meeting my role responsibilities. I believe this to be a frequent challenge for all leaders.

Catherine Campbell

Resiliency is the ability to overcome challenges of all kinds–trauma, tragedy, personal crises, plain ‘ole’ life problems–and bounce back stronger, wiser, and more personally powerful. There are inevitable difficulties, but meeting the needs and support for others is the role strong servant leader. Knowing how to improve your resiliency deflects the constant feeling being drained.

“All presentation information provided viable elements in the delivery of quality care.”

Other presentations included present day recommendations and usable leadership skills meeting the demands of healthcare today. Continuum of Care is relevant in our quest to decrease readmissions. ‘Patient- Centered Care: A Strategic Imperative,’ ‘Developing a SNF Affiliate Network: Improving Care Across the Continuum,’ and ‘Accountable Continuum Care: A Strategic Approach to Pay-for-Outcomes’ were viable presentations improving the continuum of care, decreasing readmissions, decreasing length of stay, and decreasing cost.

The leadership education provided by the 2013 Congress was priceless, meeting expectations of excellent presentations.

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2013

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CONGRESS SCHOLARSHIP RECIPIENTS

The 2013 Congress on Healthcare Leadership was a privilege to attend March 10-14 via a scholarship from the North Texas Chapter of the ACHE. This Congress marks CEO Thomas C. Dolan’s 27th year of service to ACHE, twenty-two years as CEO and ushers in current COO Debra Bowman this role on 1 May 2013. While filled with exceptional ACHE faceto-face credit offerings the additional activities were an interesting mix of University Alumni gatherings, educating attendees on the use of both Linked-in (a must for job seekers) and Twitter for professional communications, and many networking events; a time to renew past friendships and solidify new acquaintances going forward.

Some session nuggets: In the past mergers generally weaker institutions/companies partnering with stronger institutions/companies, today it’s strong corporations/ institutions partnering with strong(er) (the latter stability has caused private equity firms, who shunned healthcare institutions due to their unpredictability in the past, to take notice of this new merger strength); Pay is now based on the best outcomes for the price; Hospitals have aligned or are preparing to align with physicians (payors Trudy Wiig have less leverage); Payors aligning with physicians yield less leverage for hospitals; Corporations with physician, hospital and payor competencies are in perhaps the best position; In 2014 Merritt Hawkins estimates 75% of physicians will be employed; For physicians, “working harder and smarter,” no longer works; There is no “one method of physician compensation” seen as more or less effective, it’s too early to make that determination but physicians who aren’t engaged in discussion (for the group’s purchase or employment) currently will find that “wait and see” is problematic due to alignment cohesion; If you wonder if social media is effective consider the following link: http://www.youtube.com/ watch?v=QUCfFcchw1w publicized in a conference session with most attendees requesting a copy; Linked-in is the “new resume” so keep it updated and if you’re conducting a job search, it’s imperative that you’re on this site; Business and legal implications of institution/company social media sites are significant - hint: whomever is handling your twitter account, make certain it’s the “company twitter account” and not that individual’s “personal account” - they can and will be within their rights to take their account with them when they go and you’ll be starting your contact list of thousands or more, all over again; Major HIPAA concerns on FDA-regulated medical devices, mobile platform applications, and physician and/or healthcare patient-related care coordination exist and must be mitigated; Facebook marketing is valuable ad real estate; among many other interesting and evidence-based education offerings. A delightful educational, social, and networking event; thank you for the privilege.

“Corporations with physician, hospital and payor competencies are in perhaps the best position”

The thoughtfulness and investment by the North Texas ACHE to provide the 2013 ACHE Congress scholarships to attend an enriching and rewarding event is greatly appreciated. Thank you to the North Texas ACHE selection committee and general membership for providing a great learning and networking experience with healthcare leaders, practitioners and friends from across the globe.

The 2013 Congress was an energizing experience that started with Sunday’s Seventy-Ninth Convocation. My fellow colleagues, their families and I celebrated our journey to become Fellows of the American College of Healthcare Executives (FACHE). Eight hundred plus members were recognized this year for their commitment and dedication to healthcare by completing the requirements to be recognized as a FACHE. As the healthcare industry transforms from a fee-for-service to a value based payment industry, the strategies, stories, commitment, anticipation and successes of making the transformation were evident in the hot sessions, seminars, luncheon presentations and networking dialogue. At the conclusion of the Congress, I was encouraged by the willingness of my colleagues to change their business, care management and cultures to meet the challenges and opportunities of healthcare reform.

“One of the many highlights was a great reinforcement on diversity and individuality”

Monte Parker

One of the many Congress highlights, was a great reinforcement on diversity and individuality that came from Dr. Connie Mariano’s lecture “The Whitehouse Doctor: My Patients Were Presidents” during the Leon I. Gintzig Luncheon, in which she shared her informative and entertaining Whitehouse job interview story that encouraged us to be ourselves and be willing to be different.

Thank you again for the Chapter’s scholarship and commitment to its membership. Best wishes on your individual and organization goals and continued healthcare service.

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A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2013

CONGRESS SCHOLARSHIP RECIPIENTS First and foremost, I would like to sincerely thank the chapter for affording me the opportunity to attend this year’s ACHE Congress. As a first time attendee, I did not really know what to expect and found the overall experience both educational and gratifying. My primary purpose in attending this year’s event was to sit for my FACHE exam. While it certainly was not a “walk in the park” it is something that I believe every aspiring healthcare executive should strive to attain. Unfortunately, when you sit for the test at Congress, it takes approximately six to eight weeks for the results to be tabulated, so I will not know the final outcome for some time.

“...the overall experience was both educational and gratifying”

The local chapter was an invaluable resource for me in my preparation for the exam as I participated in the weekly “lunch and learn” and I was able to network with other members who had already been through the process. I would highly recommend attending Congress to any member of our local chapter and look forward to returning in the future!

Scott Hurst

Five Ways to Foster Innovation Innovation is a hot topic for businesses. Everyone wants it, but how do you know if you have it? How do you know if you are encouraging innovation in your organization? Here are some ways companies can foster innovation: 1. Encourage Experimentation. Companies that make experimentation a priority will see results from those experiments. It’s important to give people time to be innovative. One example is allotting every employee to use a percentage of their time to be creative and explore new ideas.

If your employees spend all of their time in meetings or on phone calls, they don’t have time to actually work on projects and be creative. Encourage experimentation and build time into the day to allow ideas to surface.

2. Recognize innovation. Sometimes this is as simple as acknowledging a contribution, while other organizations offer bonuses or prizes for innovative ideas. If your company prizes innovation, then make sure your employees know innovation is valued.

4. Create Connections. How many times have you heard someone say that they had a great idea and presented it to someone higher up in an organization and it went nowhere?

Companies need outlets for employees to voice their ideas.

Some companies have suggestion boxes and others have formal processes to submit ideas, but what’s most important is to create pathways for ideas to become reality within organizations.

5. Work in Teams. Create innovation teams to source new ideas.

Look for people who are passionate about creating something new and different and allow them to work together to source ideas and processes.

Once you have these new ideas, your organization needs to use them. Put your innovative ideas into practice. If you tell people to be innovative, encourage the process and allow the results to shine. The worst thing you can do is encourage ideas and not implement them.

Adapted from “5 Ways to Foster Innovation” by Lorie Watson, brandon-hall.com

3. Reward Failure. One reason employees often don’t express their ideas is that they don’t want to rock the boat. They don’t want to be a failure if something doesn’t work out. Tolerate mistakes and expect failure, and reward lessons learned.

Ideas don’t always work the first time. Thomas Edison, one of American’s greatest inventors, once said “I have not failed. I’ve just found 10,000 ways that it won’t work.” You’ll never find the ways things do work without finding the ways that won’t work first.

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2013

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Preparing for the Board of Governors Examination?

ACHE chapters offer close-to-home study groups

ACHE Members who are working on their Fellow advancement requirements can begin their preparation for the Board of Governors Examination in Healthcare Management in a variety of ways. One way is to join a close-to-home study group. ACHE chapters are committed to the advancement of their members, and many of them offer study groups that affiliates can join.

San Diego Organization of Healthcare Leaders (SOHL) and South Texas Chapter of the American College of Healthcare Executives are two chapters that have created formal study groups to help their members prepare—with successful results. An overview of how each chapter organizes its study group follows.

For the past three years, the San Diego Organization of Healthcare Leaders has provided an 11-week study group at no charge to review the Exam knowledge areas with a variety of content experts. SOHL’s past president Stonish Pierce, FACHE, director of ambulatory services, Resurrection Health Care, Chicago, and current President-Elect, Jared A. Vogt, system analyst, Rady Children’s Hospital–San Diego, founded the study group program three years ago. SOHL’s Membership Committee Co-chairs Alice Dang, human resources, Scripps Health, San Diego, and Alicia M. Gormican, revenue cycle IT analyst, University of California–San Diego Medical Center, have been responsible for developing the study groups since 2010.

The first session of the 2011 group began in April and continued through June. Members were encouraged to take advantage of ACHE’s $200 Exam fee waiver by submitting a completed Fellow application by June 30. (The Board of Governors Exam fee waiver is offered annually to Members who submit a Fellow application and the $250 application fee between March 1 and June 30.

ACHE waives the $200 Board of Governors Exam fee pending application approval.)

Each knowledge area is covered by a content expert—the majority of whom are ACHE Fellows. They are generally chosen through referrals from SOHL board members or their respective organizations, or they have served as speakers previously. All sessions are held in person, usually at the same facility, from 6:30 p.m. to 8:30 p.m.

After each session is complete, PowerPoint slides are posted on SOHL’s website for members to use. The first session began with a networking event that 30 people attended, which included a presentation from past Regent Michael H. Covert, FACHE, on the benefits of being an ACHE Fellow. Then, attendees got right to work on the first knowledge area, Governance and Organizational Structure. “[All of the first-session] attendees may not end up doing the study group, but they did get a lot of information on the importance of the FACHE credential and guidance on obtaining it,” says Gormican.

Average attendance for this year’s study group was 16 people per session and remained fairly constant as the weeks went by.

The group concluded with a final review session with those who recently passed the Exam from a previous study group.

“We’ve received positive feedback on the programs every year,” says Gormican. “We survey the attendees to make sure the sessions are beneficial to everyone.”

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2013

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NEWS FROM NATIONAL

ACHE Launches Physician Executives and Healthcare Consultants Forums

2013 Fund for Innovation in Healthcare Leadership Education Programs

ACHE recently launched its new Physician Executives Forum and Healthcare Consultants Forum to enhance value to physician executive and healthcare consultant members through a package of benefits tailored to their unique professional development needs.

The 2013 ethics program, “The Ethics of Access to Care and Care Disparities,” will be led by Joseph R. Betancourt, MD, director, The Disparities Solutions Center, Boston, on Aug. 7, and offered in conjunction with ACHE’s New York Cluster. The half-day session will focus on issues of equity of care and disparities in access, treatment and outcomes. A select panel of healthcare leaders will react to Dr. Betancourt’s remarks and share their experiences with the ethical challenges of increasing access to care and care equity.

For those already attending the New York cluster, continue your professional growth with this important session. Or, just participate in the morning workshop and leave with a renewed sense of commitment. Register online at ache.org/NewYork.

The Physician Executives Forum offers education, networking and relevant information that address the top issues physician executives face such as leading quality initiatives and enhancing interdisciplinary communication skills. Physician executive members are encouraged to visit ache.org/PEForum where they can learn more about the Forum’s benefits and join.

The Healthcare Consultants Forum can help healthcare consultants stay ahead of the curve and more effectively meet client needs through targeted resources designed with their needs in mind.

Benefits include a special designation on ACHE’s online Member Directory, e-newsletter and a LinkedIn Group. More information is available on ache.org/HCForum where interested consultant members can also join.

The cost for joining either the Physician Executives or Healthcare Consultants Forum is $100 annually in addition to ACHE annual dues.

The 2013 innovations program, “Healthcare Innovation: Taking Action, Improving Care and Reducing Costs,” will focus on key initiatives introduced by the Center for Medicare and Medicaid Innovation (the Innovation Center). The program will highlight three organizations that received Healthcare Innovations Awards and their experiences in implementing projects to develop better healthcare in communities with the highest care needs and will be offered in conjunction with the San Diego cluster in September.

Full details will be available soon at ache.org/Innovation.

Both programs qualify for ACHE Face-to-Face Education credits.

ACHE Publications App The ACHE Publications App debuted in January with the first 2013 editions of Frontiers of Health Services Management, Healthcare Executive magazine and the Journal of Healthcare Management.

The app is an added benefit for members and does not replace the print editions. It will provide an enhanced experience for readers by delivering interactive digital versions of each ACHE publication. The app can be downloaded at no charge from the App Store and also accessed as a mobile Web app through any browser.

Only members and subscribers can access the digital publications. For more information, visit ache.org/DigitalPublications.

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2013

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NEWS FROM NATIONAL

ACHE Senior Executive Program The Senior Executive Program prepares senior healthcare leaders for complex environments and new challenges. Past participants have been senior directors, vice presidents, COOs, CNOs and CFOs—many of whom aspire to be a CEO and believe the Senior Executive Program has assisted them in that goal. It consists of three sessions, each two-and-a-half days in length. Locations and dates are as follows: Chicago (June 3–5), San Diego (Aug. 12–14) and Orlando, Fla. (Oct. 14–16).

Participants grow professionally in a supportive learning environment over the three sessions. The Senior Executive Program includes such relevant topics as reducing medical error, improving board relationships, increasing personal influence, financial management in the era of payment reform, confronting disruptive behavior and influencing public policy.

Enrollment is limited to 30 healthcare executives. For those individuals whose organization lacks the resources to fully fund their tuition, a limited number of scholarships are available. For more information, contact Darrin Townsend, program specialist, at (312) 424-9362 or visit ache.org/SeniorExecutive.

ACHE Executive Program The ACHE Executive Program is designed to help healthcare middle managers refine their knowledge, competencies and leadership skills. Participants will have the opportunity to learn, share and grow professionally together over the three multi-day sessions. The program will cover such relevant topics as improving patient safety and clinical quality, physician integration strategies, appraising personal leadership, managing disruptive behavior, talent development, understanding hospital governance, conflict management and measuring financial success.

The Executive Program, a three-part series of sessions, will be held at the following locations and dates: Chicago (June 3–4), San Diego (Aug. 12–14) and Orlando, Fla. (Oct. 14–16). Participants will attend all three sessions.

For more information on the Executive Program or the Toshiba America Medical Systems, Inc. scholarships, please contact Darrin Townsend, program specialist, at (312) 424-9362 or go to ache. org/Executive.

Tuition Waiver Assistance Program To reduce the barriers to ACHE educational programming for ACHE members experiencing economic hardship, ACHE has established the Tuition Waiver Assistance Program.

ACHE makes available a limited number of tuition waivers to ACHE Members and Fellows whose organizations lack the resources to fund their tuition for education programs. Members and Fellows in career transition are also encouraged to apply. Tuition waivers are based on financial need and are available for the following ACHE education programs: • Congress on Healthcare Leadership • Cluster Seminars • Self-Study Programs • Online Education Programs • Online Tutorial (Board of Governors Exam preparation) • ACHE Board of Governors Exam Review Course All requests are due no less than eight weeks before the program date, except for ACHE self-study courses; see quarterly application deadlines on the FAQ page of the tuition waiver application.

Incomplete applications and applications received after the deadline will not be considered. Recipients will be notified of the waiver review panel’s decision not less than six weeks before the program date. For ACHE self-study courses, applicants will be notified three weeks after the quarterly application deadline.

If you have questions about the program, please contact Teri Somrak, associate director, Division of Professional Development, at (312) 424-9354 or tsomrak@ache.org. For more information, visit ache.org/Tuitionwaiver.

Board of Governors Exam Fee Waiver Promotion 2013 ACHE is pleased to offer once again the Board of Governors Exam fee waiver promotion to ACHE Members who apply for the FACHE® credential between March 1 and June 30. Members must submit their completed Fellow application and $250 application fee during the promotion period. Pending application approval, ACHE will waive the $200 Board of Governors Exam fee. All followup materials (i.e., references) must be submitted by Aug. 31 to receive the waiver. For more information on the promotion, go to ache.org/FACHE.

2013 CALENDAR

Thursday, April 18th Education Program: A Collaborative Practitioner Model for Efficiency and Safety in Patient Care Featuring: Adam Corley, MD, EmCare

Dr. Cole Edmonson, DNP, RN,

FACHE, NEA - BC, Texas Health

Presbyterian Hospital Dallas

Charles Williams, FACHE, COO,

Doctors Hospital/White Rock Lake Moderated: Michael Hicks, MD, MBA, MHCM,

FACHE, EmCare Time: 5:30 - 7:30 pm Location: Texas Scottish Rite Hospital

for Children Wednesday, April 24th After Hours Event Time: 5:30 - 7:30 pm Location: AT&T Performing Arts Center

Thursday, June 20th Making Sense of Performance Transformation Methodologies Time: 5:30 - 7:30 pm Location: Tarrant County

Wednesday, July 10th After Hours (Early Careerist Focused) Time: 5:30 - 7:30 pm

Thursday, July 18th Rebuilding Public Trust following Hospital Clinical and Managerial Errors Time: 5:30 - 7:30 pm Location: Rangers Ballpark in Arlington

Thursday, May 16th General Membership Dinner and Education Program: Improving the Health Status of Your Community Time: 5:00 - 8:00 pm Location: NYLO Hotel, Las Colinas Thursday, June 13th Community Based Activity or After Hours Time: 5:30 - 7:30 pm

We are currently working on new educational and networking opportunities.  For the latest updates please check our website or watch your inbox for the event guide.

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.