THA 2023 YEAR IN REVIEW
A Report to the THA Board of Trustees
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THA 2023 YEAR IN REVIEW
TABLE OF CONTENTS 4
SNAPSHOT OF SUCCESS & A MESSAGE FROM THA’S PRESIDENT/CEO
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PROJECT PUSHBACK
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BENEFITS OF BELONGING
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BUSINESS AFFAIRS
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THA DEI & EQUITY ACCOMPLISHMENTS
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ADVOCACY IN ACTION
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HOSPAC
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EVOLVING THA’S COMMUNICATION STRATEGY
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LEGAL ACTION & EXPERTISE
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QUALITY & PATIENT SAFETY
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INTERACTIVE PROGRAMS & EVENTS
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THE BUSINESS OF THIE
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THA CEO ENGAGEMENT
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THANK YOU
According to Texas Government Code 305.027, this material may be considered “legislative advertising.” Authorization for its publication is made by John Hawkins, Texas Hospital Association. © 2023 Texas Hospital Association. All Rights Reserved. w w w. t ha . o rg
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SNAPSHOT OF SUCCESS A Message From THA’s President/CEO
Thank you for entrusting me to lead the Texas Hospital Association, an organization that continues to grow in strength, numbers and importance as the health care landscape evolves. As THA’s President and Chief Executive Officer, I continue to focus the association’s attention on being a powerful thought leader and vocal advocate for Texas hospitals, both here in Texas and across the nation. This year was particularly notable as we faced a tough 140-day legislative session, where anti-hospital sentiment was at a high and misinformation created barriers to getting things done on behalf of patients and hospitals. Despite the uphill battles, we knocked out many of the items on our priority list and stopped numerous bad bills in their tracks. During the interim months, we are refining and building our work to collectively push back against negative momentum against the industry and pave the way for a more pro-hospital landscape.
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2023 Legislative Success •
Despite the negative forces against hospitals, THA’s advocacy team secured major successes this legislative session. THA short-circuited numerous bad policies that would have hurt access to care and jeopardized many hospitals’ very existence. THA achieved incredible workforce victories plus critical budget wins on behalf of the industry. And, THA stopped a record number of bad bills, including ones that would have banned outpatient hospital payments and capped rates.
2023 Federal Success •
At the federal level, Texas received approval for the state’s five critical directed payment programs for hospitals for 2024. Through a massive federal package, THA also successfully advocated for delaying a deep Medicare cut, extending pandemicera patient care flexibilities and providing struggling rural hospitals with continuing help. These federal successes yielded major benefits for hospitals and their patients.
I couldn’t be prouder of our employees and their diligence over the course of this year. Our track record is to hire the brightest and the best – leaders in their field of focus – people who have an innate sense of urgency and passion for health care. Our team continues to push THA to be one of the most efficient and innovative associations in the country, leading the pack, front and center, as the most credible and vocal advocate for Texas hospitals. It has been an honor to serve alongside our stellar Board of Trustees and our entire membership. The work of our staff, in lockstep with your teams, makes Texas hospitals better, and I thank you for your ongoing partnership.
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PROJECT PUSHBACK Texas hospitals have been under attack like never before, with anti-hospital sentiment at an all-time high. During the 2023 legislative session, THA battled hundreds of bad bills, killing many and fixing others, all while operating in an environment of extreme negativity and misunderstanding about the importance of hospitals and how they operate. Moving forward, THA has launched a strategic pushback to pave the way for a more pro-hospital landscape, using data, grassroots advocacy, messaging and outside organizations. With more than 450 member hospitals in Texas, THA has a foundational powerhouse ready and able to push back against this negative momentum against the industry. Using this untapped secret strength, THA is working to engage hospital CEOs and other C-suite leadership to go on the offensive in their local communities, using THA knowledge and resources to inform their activities. Using advocacy, political strategy, member engagement and communications, THA is working to improve the landscape – for hospitals, patients, workforce and the overall health care infrastructure in Texas.
Areas of focus include: 1. Hospital Leadership Commitment + Engagement 2. Targeted Legislative Package 3. Data Attainment for Advocacy 4. Establish Response Entity 5. Special Interest Group Engagement 6. HOSPAC Political Engagement 7. Communications Push Back + Positive Messaging 8. Hospital Perception
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BENEFITS OF BELONGING Being a member of the Texas Hospital Association gives hospitals more than just strength in numbers. As the only advocate that speaks on behalf of all Texas hospitals, THA works hard to ensure hospitals have the information, resources and education they need to meet and exceed the highest standards of care. THA membership gives hospitals the opportunity to create real change in health care policy. Fast Information. THA pushes out clean, fast information that is essential to the industry. From alerts and newsletters to messaging and guidance, THA stays on top of emerging information and quickly shares clear, concise updates on technical issues to its members.
Engaged Membership. We are on track to once again renew membership at nearly 98%, with additional groundwork occurring to recruit new members. Through its boards, councils and committees, THA ensures that individual hospital voices are heard.
Technical Support. THA staff works around the clock to ensure hospitals have the technical guidance they need to quickly move forward when complex issues strike. This year, this includes guidance related to everything from technical finance pressures, itemized billing laws, end of life care, abortion laws, price transparency regulations, and other critical areas.
Modernized Communications. THA’s visibility continues to grow and modernize, with a digital-first communications approach that has proven to be efficient and effective. Essential Reports. Immediately following the final gavel of regular session, THA released its 20-page end-of-session recap of all health care-related legislative outcomes for Texas hospitals. In August, THA released its 240-page comprehensive 2023 New Health Care Laws manual, summarizing over 120 new laws enacted during the 2023 Texas legislative session.
Strategic Relationships. Over the course of the year, THA staff have met with hundreds of lawmakers, staffers and leaders in Texas and in Washington, D.C., and continue to maintain close, respectful partnerships with local, state and federal decision makers and advocates.
Members receive exclusive benefits including: •
Weekly e-newsletter, the Health Care Advocate, detailing the latest health care policy news.
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Opportunity to participate in THA’s Leadership Fellows program.
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Exclusive, ad-hoc advocacy alerts with the latest breaking information for Texas hospitals and health care providers.
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Discounted pricing for select THA products and services.
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Access to a team of expert health care policy lobbyists.
The opportunity to serve on one of THA’s boards, councils or committees.
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Access to Health Law and Hospital Signage manuals.
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Discounted registration prices on THA educational events.
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Invitations to member-only events such as THA town halls
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BUSINESS AFFAIRS From a business perspective, THA continually reviews its organizational structure, financial position and business/workplace practices to ensure it continues to be one of the most progressive and effective associations in the country. THA remains a strong, stable force for Texas hospitals and is poised to continue to offer top-notch support to its membership base via its services and program offerings. Membership. Membership remained strong with a 98% renewal rate for 2023. THA is pacing ahead for 2024, with renewals issued in August and collection following last year’s trend. Currently, THA has a 72% participation rate among eligible hospitals. THA is working to increase that rate to 80% over the next five years. THA continues to focus on providing a strong value statement for behavioral and psychiatric hospitals to increase their presence with THA. Financial Status/Outlook. THA is on track to meet all strategic board financial goals for 2023. THA has continued to ensure organizational excellence and viability by meeting the Board’s annual financial goals of: (1) a minimum of 12-month operating budget in reserves; (2) a healthy current ratio of 1.5:1 and (3) a projected 3% return on reserves. As THA prepares for fiscal year 2024, staff is budgeting to move forward with several initiatives discussed at the Board’s strategic planning meeting in September. Chiefly, THA has embarked on an aggressive plan to pushback against negative hospital narratives. Also, a greater emphasis will be made to ensure THA members understand the role THA products and services have in providing costeffective solutions to members while contributing revenue to keep membership costs down. Compass Program. The THA Compass program continued to grow in 2023 with nearly 360 THA members participating in the program. The program allows hospitals to manage and have access to the most complete data possible. Based on member feedback, a new outpatient analytics module was launched mid-year to strong member interest. The module is based on professional claims and provides Compass participants with the ability to analyze outpatient volumes and referral patterns within their MSA. Partner Relationships. Multiple new vendor partner relationships were launched in 2023, closely aligned with 8 TH A 2023 YE AR I N REVI EW | T E XAS HOS P ITAL AS S OCIAT ION
member feedback. Revuud, an innovative IT staffing provider, has had rapid adoption across across Texas hospitals that consistently express a need for IT resources for projects and operations. Other innovative partnerships forged in 2023 include payment automation to bring much needed relief to hospital finance departments, a new group purchasing organization agreement, and a cost effective and highly scalable cybersecurity partner for managed services, risk management and security operations. Legacy partners for contract nursing and physician recruitment continue to grow and enjoy strong member support and engagement. Overall, THA added six new strategic partnerships in 2023 contributing an additional $250,000 in non-dues revenue. THA continues to diligently listen to member needs and survey the market to align with member goals. Retirement Program. Interest in the Texas Hospital Association Retirement Plan continues as employee participation and the number of sponsors increased for this year. THARP’s focus on maintaining a low fee structure for its sponsors is evidenced by its ongoing review of its service provider and industry benchmarks. This allows THA to offer a turn-key program for members at a cost that is below most current plans. THA Modernization. Post-pandemic communication and interaction relies on robust video, audio and online capabilities. In advance of the 2023 legislative season, THA embarked on a modernization project to strengthen THA’s video and audio capabilities to support member engagement, legislative activities and governance needs. This new platform has increased communication and collaboration with all aspects of operations and further enables THA to effectively advocate on behalf of THA members. The expanded capabilities, efficiency and satisfaction from meeting participants is evidence of this timely and welcomed improvement.
Cyber Support •
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The Risk. Industry research has identified that over 69% of corporate devices used for remote work are unmanaged and therefore vulnerable. Notably, 52.4% of cyber attacks have “human roots” as employees opening links from malicious emails are the leading cause for cyber attacks on end-users. Security researchers tracked a yearover-year 569% increase in malicious (phishing) emails as threat actors refine and improve deception tactics to successfully exploit users. Education & Solutions. THA is working with members, individually and as a group, to support cyber needs through engagement with member IT teams and by hosting educational events for members. In recognition of cyber security awareness month, THA has partnered with two technology partners to host multiple webinars
focused on cyber preparedness and awareness. THA is developing a comprehensive portfolio of vendor partners to offer members a onestop source for effective security solutions that, in conjunction with educational efforts and effective management, are helping members manage cyber risk. •
THA Security. In response to the rising cyber threats and improvements in technology, THA corporate has adopted a more capable cyber security platform ensuring that employee computers and organizational servers are effectively protected and monitored for compliance with security industry best practices, the very same model that is promoted to member hospitals.
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BUSINESS AFFAIRS CONT.
THA DEI & EQUITY ACCOMPLISHMENTS THA’s staff-led Diversity, Equity & Inclusion Committee continues to work on initiatives to expand its efforts and presence among THA initiatives. Several internal committee members also serve on THA’s member-led Diversity, Equity and Inclusion Committee to report on initiative progress and provide staff support for priorities identified by that committee. THA’s DEI Committee has accomplished the following initiatives over the past year: •
THA has expanded staff education through a DEI spotlight in monthly all-staff meetings.
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Enhanced diversity of speakers and coverage on health equity topics for THA's Annual Conference and Expo and the Healthcare Governance Conference.
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Documented increase in satisfaction with inclusivity and equity efforts among THA and Family of Companies staff based on DEI staff survey.
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Pursued stronger legislation to support more equitable care. Achieved passage of an extension for postpartum Medicaid coverage for new
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Developed DEI book club and discussion group for THA and Family of Company staff.
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mothers from two months to 12 months, pending federal approval.
ADVOCACY IN ACTION Mired in one of the most difficult state legislative sessions for hospitals in recent memory, THA responded with an association-wide advocacy effort that both advanced crucial, forwardfocused legislation for health care and stopped potentially devastating bills from becoming law. Advancements for the hospital workforce, Medicaid, behavioral health and maternal care were highlights among THA’s achievements. But just as important was THA’s successful work to stop various bills that threatened hospitals and access to care across Texas. Baseline Before Session: Going into January’s kickoff of this session, the hospital industry faced a tough 140 days ahead. That’s why THA prepared to stand up for hospitals, working with lawmakers throughout the 2022 interim, collecting and distributing data in two groundbreaking presession reports that helped illuminate the truth. THA also unleashed a hard-hitting news media push before session to blanket the state with information about the ongoing financial plight of Texas hospitals and to remind the general public of hospitals’ critical public health role in emergencies and everyday life.
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Myriad other funding wins in the state budget for 2024-25, including a tripling of the rural Medicaid labor and delivery add-on payment; funding to supply nearly 200 community inpatient psychiatric beds; and full funding for important women’s and maternal health programs.
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Passage of an extension for postpartum Medicaid coverage for new mothers from two months to 12 months, pending federal approval.
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A pathway for Texas hospitals to continue the pandemic-era federal hospital-at-home program, which allows qualifying patients to be treated at home and helps hospitals control surges of outbreaks like COVID-19.
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Improvements and clarifications to the Texas Advance Directives Act, the law that dictates how to resolve disputes over end-of-life care.
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Clarification on the limited, appropriate provision of abortion care in Texas following the 2022 U.S. Supreme Court ruling that a constitutional right to abortion didn’t exist.
The Progress: 2023 Wins THA’s advocacy team entered the 2023 Texas legislative session with an ambitious list of priorities, and managed to guide many of them to the legislative finish line. THA’s biggest wins passed by the Legislature in 2023 included: •
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Extensive new funding to build the health care workforce pipeline, including $25 million for a new nursing scholarship program and a 1,400% increase in budget funding for the Loan Repayment Program for Mental Health Professionals, as well as increased funds for nursing school expansion and physician graduate medical education and loan repayment. Two pieces of key workplace violence-related legislation, which collectively required health care facilities across the state to adopt a plan to deal with workplace violence and maintain a workplace violence committee; prohibited retaliation for reporting a violent incident in good faith; and enhanced the penalty for assaulting a hospital worker to a third-degree felony.
Outside of session, THA’s late-2022 advocacy for a licensure process in the new federal rural emergency hospital (REH) program resulted in the Texas Health and Human Services Commission releasing emergency rules to implement the program in January 2023, ending pins-and-needles uncertainty for many rural hospitals that faced financial difficulties if they couldn’t quickly follow through on plans to become an REH.
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On Defense: Stopping Bad Bills A small but relatively powerful group of state lawmakers was determined to push health insurer-backed legislation that would cripple hospitals across Texas and force many to close. But THA threw its energy into defeating those proposals, galvanizing its membership to make sure hospital voices were heard and ultimately preventing the worst bills from becoming law. Extremely troubling initiatives THA shot down included: •
Several iterations of proposed bans on hospital outpatient payments, defined by the legislation as “facility fees.”
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A bill that would have forced hospitals to accept as payment the lowest contracted rate they had with any health plan for services provided outside insurance, disincentivizing patients from obtaining coverage.
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A government rate-setting proposal to turn payment rates for four state health plan systems over to the unilateral decision of a 10-lawmaker committee.
Next Level Engagement. Engagement with memberhospital government relations experts was key to the industry’s success during 2023. THA’s advocacy team led at least weekly meetings of the Hospital Advocacy Group to
detail the impact of filed and ongoing legislation, and direct strategy about daily, and sometimes hourly, lobby efforts. THA’s councils and committees, routinely convened by the THA policy team, provided key feedback on the impact of proposed budget and statutory changes, and helped THA’s advocacy team craft responsive lobby strategies. Advocacy on Capitol Hill. Coming off a highly positive end-of-year federal omnibus bill to wrap up 2022 – which delayed a deep Medicare funding cut and extended key funding programs for rural hospitals – THA continued seeking gains for Texas hospitals in 2023 through yet more fervent advocacy in Washington, D.C. On multiple trips to Washington to visit with offices of the Texas congressional delegation, THA lobbied vehemently against attempts to expand site-neutral payment policies and the payment cuts those policies would bring with them. THA also strove to keep lawmakers from weakening Texas’ safety net, pushing for delaying or repealing cuts to disproportionate share hospital payments that were scheduled to go into effect for fiscal year 2024. Lawmakers also considered new mandates related to price transparency and increased reporting and oversight of the 340B Drug Pricing Program. THA lauded Texas hospitals’ strong compliance with existing price transparency law, let members of Congress know that the existing transparency laws are working as intended, and also spoke out against any additional burdens being placed on 340B hospitals.
HOSPAC The HOSPAC Board is continuing its priority of re-invigorating the culture of giving among THA members. With help from Sagac, a public affairs firm, the HOSPAC Board adopted a strategic plan and has targeted strategies to accomplish identified goals. •
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Suggested Giving Levels. The HOSPAC Board identified three initial priority areas: suggested giving levels, corporate contributions and an ambassador program. Dedicated subcommittees were named and have been working throughout the year on new, suggested HOSPAC contribution levels, a draft plan for HOSPAC to accept vendor-based, corporate sponsorships and a pilot HOSPAC ambassador program. The ambassador program will help HOSPAC “get local” by identifying a hospital-based individual charged with raising much needed dollars within that system.
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Election Cycle Giving. After the 88th Legislature adjourned, HOSPAC leaned into the election cycle, meeting with, hosting and attending fundraisers for state and congressional candidates running for office.
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Strategic Planning. The HOSPAC Board held its second strategic planning retreat in the fall of 2023, identifying strategies to make HOSPAC endorsements and campaign contributions more meaningful. The group discussed how to make progress towards its strategic goals and how to increase HOSPAC fundraising in 2024.
New Fundraising Goals. The HOSPAC Board retooled its 2023/2024 fundraising goals, giving more clarity to its yearly fundraising efforts by implementing a Threshold/Target/Max approach.
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Refreshed Fundraising. The HOSPAC team and THA communications team are coordinating on the development of a two-year communications plan. The plan includes new fundraising messaging and promotion of regional, get out the vote events in support of candidates facing tight primary races.
EVOLVING THA’S COMMUNICATION STRATEGY In 2023, THA revamped its communications strategy to a digital-first model. By removing antiquated processes and improving existing ones, THA’s Communications team saved time and money by streamlining the way news, stories and information is disseminated to stakeholders. New in 2023: The Scope Blog Launched in January 2023, The Scope blog replaced the bi-monthly Texas Hospitals magazine as THA’s online news hub. Within months, The Scope’s performance quickly exceeded the highest performance projections. By the time the Texas Hospitals magazine completed its circulation in 2022, it amassed 35,000 pageviews throughout the year. By the end of August 2023, pageviews on The Scope amassed 88,733 pageviews, representing 153% growth in traffic before the end of the year. This platform has enabled THA to quickly disseminate content for members and the general public, and quickly gather performance feedback to inform future content pieces. By the end of August 2023, content on The Scope has attained over 2.6 million impressions across social media platforms. The platform’s reach is compounded by the following. 14 TH A 2023 YE AR I N REVI EW | T E XAS HOS P ITAL AS S OCIAT ION
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Targeted Messaging: Instead of a one-size-fitsall approach, The Scope's content is tailored to specific audiences: Health care executives and workers receive more advocacy-specific or industry-related content, while the general public receives more palatable public health-related messaging and content.
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Feedback Mechanisms: By regularly monitoring content performance, THA’s communication strategy is more agile and adaptable to produce organically high-performing content based on historical performance of similar content.
Enhancing Existing Communication Channels Realizing the limitations of traditional communication methods in a rapidly changing landscape, THA sought to enhance its existing channels.
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Revamping Website: In April 2022, THA transitioned its website to WordPress, a popular web content management system. The transition further enabled THA to streamline its communications strategy. YTD, THA has amassed 288,578 pageviews across the THA website, compared to the same time period in 2022, which yielded 237,098 pageviews. This 18% growth over the year represents THA’s ability to remain relevant and produce high-value content that stakeholders want to consume and can easily find. Email Optimization: In May 2022, THA transitioned its email marketing platform to Mailchimp. The transition had immediate, positive impact on email deliverability rates and over the course of the year, we’ve seen further improvement in higher average open rates for both marketing-related emails and advocacyrelated emails. Compared to the same time period in 2022, the average open rate for THA emails has increased by 5% and decreased unsubscribe rates by 50%. Strengthening Social Media Presence: With a more regular publishing cadence, THA is able to reach more people while being cost conscious. We set an aspirational goal of 1 million LinkedIn impressions in 2023, focusing on LinkedIn as it’s a platform where most of THA's members and external stakeholders are active. YTD, THA has amassed 770,000 impressions on LinkedIn, compared to the same time period last year, which was 558,000 impressions, representing 38% growth in impressions. This growth over the year is indicative of THA’s rigorous publishing cadence, coupled with the ability to scale organically high-performing content with a paid social media strategy.
THA’s overall communications shift to a digital-first model was key to these results – by keeping members informed and engaged in the advocacy communications realm: •
VoterVoice: An emphasis on timely VoterVoice campaigns – which gave members an avenue to quickly and easily write a message to lawmakers urging opposition of the worst bills lawmakers had to offer – were paramount. For example, a campaign to stop the Senate version of one
of the proposed bans on hospital outpatient payments generated nearly 2,700 member messages from almost 300 senders. •
Cap Recap: As part of The Scope, THA’s new digital news source, the advocacy communications department launched the Cap Recap, a weekly summary of the most important hospital-related news to emerge from session during the previous week. The Cap Recap morphed into not just a written summary, but a weekly podcast as well, leveraging our internal and external audio capabilities to develop a recording members could listen to anywhere at any time.
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Video & App: The Communications team also leveraged enhanced video capabilities during session, working with two external video vendors – one for longer-form videos, one for “microvideos” – to produce pieces on THA’s behavioral health aims, hospitals’ workforce needs and more. THA’s Advocacy App underwent a refurbishment both aesthetically and in terms of how testimonies and other key content were presented and organized, making it easier for members to keep up with session wherever they were.
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White Papers: White papers and reports were a major facet of THA’s information delivery to members and the public. Before and during session, THA freshly produced or updated 31 white papers relevant to the 2023 session on a wide array of hospital issues. The THAcommissioned Kaufman Hall report set the stage for discussions about financial challenges facing hospitals, and THA’s COVID-19 Impact Report served as a detailed reminder of the role hospitals played throughout the pandemic in every community in the state.
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Advocacy Emails: Advocacy-related emails reached a strong percentage of members during the legislative session and have continued to do so in the aftermath of session. Weekly email open rates for the Health Care Advocate during session reached as high as 36.8%, rarely dipping below 20% in any given week. Post-session, interest in the Advocate has been even greater; several Advocate editions in July and August 2023 have topped or approached the 40% mark. w w w. t ha . o rg
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LEGAL ACTION & EXPERTISE Advocacy Via Legal and Regulatory Guidance. As
coordinated by the THA Legal team, THA has provided guidance to its membership on several complicated legal and regulatory issues requiring intense focus. These reference materials have aided the membership in navigating new requirements imposed by the legislature which often involve novel concepts and murky statutory language, including publications consisting of:
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Guidance on the new requirements for hospitals to provide an itemized bill in connection with collection efforts as imposed by SB 490.
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Guidance on the significant changes to the Texas Advance Directives Act and its effect on care at the end of a patient’s life, as enacted in HB 3162.
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Coordination of THA’s comprehensive 2023 New Health Care Laws manual, summarizing over 120 new laws enacted during the 2023 Texas legislative session.
Advocacy Via the Judiciary. As coordinated by THA Legal, THA has been active in several significant court proceedings to further important interests of the THA membership, including: •
Continued participation in a case challenging the limitation on non-economic damages applicable to medical liability cases under the U.S. Constitution in order to ensure that the hospital perspective was adequately represented through the conclusion of the litigation. The case was tried in February 2022 and a favorable decision was issued in March 2023, upholding the liability limitation for all Texas hospitals.
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Lending support to several amicus curiae briefs in support of causes of major importance to member hospitals, including a case addressing an important question regarding the medical standard of care and the weight that should be given by a court or jury to deviations from clinical protocols; and a case involving significant questions of liability for filing mental health commitment applications.
Advocacy Via Formal Comments. Advocacy Via Formal Comments. The THA Legal team has drafted and/or edited and submitted comment letters to federal and state agencies on proposed rules and policies impacting hospitals on a wide range of subjects. Proposed rules that THA commented on include: •
Neonatal Facility Levels of Care Designation (state);
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Licensing Standards for Limited Services Rural Hospitals (state);
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Rules implementing the Medicaid Outpatient Prospective Payment System (state);
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Standards for reviewing and clearing mergers and other significant transactions under antitrust laws (federal);
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Comments on the impact of the proposed rule for the invalidated 340B Drug Program remedy;
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Comments on Policy and Technical Changes to the Medicare Advantage Program and Medicare and Medicaid Interoperability rule;
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Comments on federal rules on Short Term
Limited Duration Insurance and Fixed Indemnity Products; •
Comments on CMS proposal to exclude Section 1115 Days for UC Pools from Medicare DSH Calculation; and
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Hospital Outpatient Prospective Payment System and price transparency regulations (federal).
Direct Advocacy with Legislative and Regulatory Bodies. The THA attorneys have worked closely with the Government Affairs team to engage with legislators and legislative bodies on issues affecting Texas hospitals during the 2023 legislative session, as well as on engaging with regulatory agencies on ongoing issues. THA attorneys have: •
Testified before legislative committees over 30 times during the session on bills of significance to Texas hospitals.
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With the Government Affairs team, engaged with legislators and stakeholder groups on numerous policy issues that were the subject of legislative efforts.
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Responded to federal and state legislative inquiries and educated legislators and regulators on many policy issues.
Internal Legal Support. THA’s Legal team provides frequent legal advice, counsel and support to various THA programs and services as they seek to strengthen their work on behalf of our membership. Examples over the last year include: •
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Supporting the governance process through the review and provision of recommendations related to corporate governance documents. Ongoing support to all THA departments
and affiliates, including engaging in business development efforts and contract review and negotiation. •
Developing member education and legal sessions, including formal presentations at the THA Annual Conference, the Texas Healthcare Trustees Healthcare Governance Conference and the THA Quality and Behavioral Health Conference.
External Legal Support. Over the last year, THA’s Legal team frequently engaged with THA members on a variety of legal and regulatory issues including hosting the In-House Counsel Group Annual Meeting in August and frequently answering questions from member hospitals on many different legal, operational and regulatory issues. THA organized a half-day, in-person discussion on brain death and end-of-life cases, which was attended by almost 70 individuals and generated positive feedback. Additionally, THA attorneys have engaged with local and national communities by participating in events hosted by groups such as the Austin Bar Association Health Law Section, State Hospital Association Allied Attorneys, the Austin chapter of the American College of Healthcare Executives, The University of Texas (Health Law Conference) and the State Bar of Texas (Health Law Conference). Corporate Compliance. THA’s Legal team continues to manage organizational risk and compliance issues through internal education, training and process improvement, as well as the implementation of THA’s compliance program. Key efforts include: • Education directed at THA’s workforce on mechanisms to report compliance concerns and incorporating THA’s Code of Conduct and Compliance Program into New Employee Orientation sessions. •
Ongoing monitoring and Annual Disclosure Statement related to conflicts of interest.
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QUALITY & PATIENT SAFETY Patient Safety and Quality Improvement. Through a variety of programs and products, THA's Quality & Patient Safety (QPS) team has long worked with both clinical and non-clinical departments and at all levels in Texas hospitals. During 2023 THA’s QPS team has worked directly with 234 facilities from the smallest of Critical Access Hospitals to the large urban-based systems. Patient Safety Organization. THA’s Patient Safety Organization (PSO) was established in 2013 to support Texas hospitals taking advantage of the opportunity for improving patient safety afforded by the Patient Safety Act of 2005. The THA PSO currently has 98 actively participating health care facility members. Quarterly “Safe Tables” provide a secure environment for the review of actual safety events and shared learning. Quarterly “Learning Forums,” held virtually, provide educational opportunities with subject matter experts. New in 2023, was the first annual THA PSO Spring Safety Summit held at the THA office in Austin. Attending members spent two days learning from experts in the field and from each other. Peer Review Network. The Peer Review Network (PRN), developed in response to needs identified by THA members, was developed to provide a high-quality and cost-effective solution for medical peer review. A cloudbased platform allows PRN member hospitals to manage both their internal and external peer review processes. When a PRN member hospital requests an external review, the case is assigned to appropriately credentialed physician in current practice at another PRN member hospital. The PRN went live in January of 2022 and during the first year of the program member facilities conduced 75 external reviews for each other. During 2023, the number of external reviews completed within the network will be more than twice that number.
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Critical Access Quality Improvement Project. The Critical Access Quality Improvement project is funded by the State Office of Rural Health. The QPS department has contracted with SORH since 2014 to provide quality improvement and patient safety training/support to the 88 critical access hospitals across the state. During 2023, in addition to Regional Quality Improvement Boot Camps and numerous virtual trainings/meetings, the QPS team facilitated a full-day workshop for new critical access nurse leaders. Held at the THA office in Austin, this event was well attended and the feedback overwhelmingly positive. Infection Prevention. During 2023 the QPS team was once again able to utilize available ASPR grant funds to provide a free virtual training program for infection prevention personnel to prepare them for the Certified Infection Control examination. Thirty individuals from hospitals around the state participated in the seven-session prep course. Emergency Preparedness & Response. Remaining ASPR Grant funds marked for learning activities in 2023 were utilized to provide an educational series on emergency preparedness and disaster response topics. The series was kicked-off in-person during the THA Quality & Behavioral Health Conference and followed up with three virtual sessions. Hospital Quality Improvement Contractor. The QPS department is engaged in the HQIC program, funded by CMS, to provide education to participating hospitals on their Journey to High Reliability. This program focuses on rural hospitals and those that serve vulnerable populations. There are 104 Texas hospitals enrolled in this project. During 2023 the QPS team developed eight learning modules on a variety of topics, including reducing hospital acquired infections, antibiotic stewardship and the utilization of Z-codes to improve health equity.
INTERACTIVE PROGRAMS & EVENTS Annual Conference. THA held its first full-capacity Annual Conference in February and more than doubled the in-person 2022 attendance numbers with over 300 members convening in Austin. To complement the in-person attendance, the conference continued to bring in a robust online audience, with 200 registrants joining the programming virtually. Additionally, the conference performed very well financially, finishing ahead of budget with a 50% variance. The educational programming was received well, with an attendee satisfaction rating exceeding 90%.
applicants that we have had since 2017. Twenty-three individuals were selected to participate in the 2023 class, and 20 members accepted their spot in this year’s program. For the first time, THA received seven applications for the class of 2024 prior to registration officially launching.
Leadership Fellows Program. For the 2023 application period, THA did a complete overhaul of the Leadership Fellows marketing and branding, including a video testimony from Fellows alumni. This resulted in the largest pool of
Texas Healthcare Trustees Management. THT held its 2023 conference in Austin in July. Between in-person and online channels, THT brought in nearly 400 attendees, exceeding 2023 goal registration numbers.
Online Education. THA continues to offer a multitude of complimentary and at-cost online education offerings, including livestream offerings, bringing in $43,000 in registration revenue to-date.
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THE BUSINESS OF THIE Retention & New Business. THIE has maintained 100% retention across all products from THIE subscribers. THIE also has written 18 new policies – 13 were added in Texas, one in Oklahoma, and four in Arkansas. Hot Topics. THIE’s Hot Topics events continue to grow year-over-year, averaging 130 attendees. In March, THIE saw one of its most successful events, with the addition of a “lunch and learn” focused on human resources. The event had 90 attendees, 26 of whom held human resources roles in their respective facilities. The first Hot Topics of 2024 will be March 6 and 7 in Georgetown. Surplus Refunds. Over the last 12 years, more than $8 million of surplus has been refunded to THIE subscriber owners.
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Risk Education. In March, THIE's Board of Directors approved subscribers to use up to $2,500 from their surplus funds toward Risk Management Development and Infection Control education from THIE through Med-IQ. As of Aug. 1, 33 staff from our subscriber facilities have been enrolled in the first round of the education program. Workers Compensation Coverage. THIE insures 17,314 lives from 82 facilities throughout Texas annually through workers' compensation coverage.
THA CEO ENGAGEMENT While virtual interaction continues to serve a valuable purpose post-pandemic, personal visits and in-person collaboration continue to be markers of engagement and success. During his second year at the THA helm, THA President/CEO John Hawkins continued his dedication to being in the field, hearing firsthand from members and collaborating on solutions for the future. Additionally, ensuring hospital industry presence and perspective at external forums, boards, committees and fundraisers is key to moving the needle on overall sentiment -- and helps ensure hospitals are at the table. THA's regional ambassadors help expand THA's reach and promotes use of THA programs and messaging. The following is a recap of some of Hawkins' major meetings and events from 2023: AHA Related Meetings •
AHA Regional Policy Board Meetings
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AHA Annual Meeting
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AHA State, Regional & Metro Hospital Association Executives Meetings
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AHA State Issues Forums
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AHA Weekly Federal Update Calls
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Capitol Hill visits
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AHA Rural Conference
Collaboration Meetings •
Multi-Association Monthly Luncheons (CHAT, TAVH, TORCH, THOT, DFWHC)
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Regularly scheduled meetings with CEOs of the Texas Medical Association and the Texas Nurses Association
State Meetings •
State Hospital Association Executive Forums (SHAEF)
Board Meetings (Member of) •
THA Board of Trustees
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THA Executive Committee
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THT Board of Directors
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THA Management Corporation Board (chair)
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THA Foundation Board of Directors
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THIE Board of Directors Meetings, Hot Topics and Retreat
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THA Executive Policy Committee Meetings
Other Board/Council Meetings (attends) •
HOSPAC Board of Directors
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THA Governance Committee
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THA Nominating Committee Meeting
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THA Fellows Modules
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THA Emerging Leadership Forum (formerly LDC)
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Council on Policy Development
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THARP Board of Directors
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Rural Hospital Council
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Leadership Development Council Meetings
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Hospital Physician Executives Group and Quality & Patient Safety Council Joint Meetings
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TAVH Board Meetings
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THA Finance Committee
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THA Audit and Compliance Committee
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Taskforce and Other Meetings •
TBR Policy Discussions
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HCA Advocacy Days
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Austin Health Care Council
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Attended the Vistria 2023 Spring Healthcare Advisory Meeting
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Meetings with HHSC
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Attended the NAMIC Boot Camp (for THIE board members)
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Attended the HIIMS Event
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TORCH Spring Conference
Member Visits •
Information Forum for Hill Country Memorial Hospital
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Member Visit – JPS Health Network
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Member Visit – Texas Health Harris Methodist Fort Worth
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THA Membership Tenure Award Presentation – Texas Health Harris Methodist, H-E-B,
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Attended the Limestone Medical center, Groesbeck 50th Anniversary
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Member Visit – St. David’s North Austin Medical Center, Austin
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THA Membership Tenure Award Presentation – Baylor Scott & White, Taylor
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Member Visit with Dell Children’s Medical Center, Austin
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Member Visit – St. David’s North Austin Medical Center, Austin
Presentations •
Joint Presentation with AHA at the Healthcare Landscape Conference
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ACHENTX In Person Meeting
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Presented at the Medical Center Hospital – Permian Basin Board Training, Odessa
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THA Presentation to Laredo Medical Center (virtual)
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Presentation at Hendrick Board Retreat
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Presentation for MBA Class, Baylor University
Interviews •
Multiple interviews throughout the year with TV stations, newspapers and radio stations.
THANK YOU Thank you for entrusting me to lead the Texas Hospital Association. The team and I are grateful for the opportunity to continue to position THA as a thought leader on critical issues and modernize our approaches as we move forward. The strategic input, guidance and leadership of the THA Board of Trustees make our work possible. I am proud to work for THA – and for you – and am excited about the new year.
Visit www.tha.org for additional information |
| 1108 Lavaca, Austin TX, 78701-2180
THA 2023 YEAR IN REVIEW According to Texas Government Code 305.027, this material may be considered “legislative advertising.” Authorization for its publication is made by John Hawkins, Texas Hospital Association. © 2023 Texas Hospital Association. All Rights Reserved.