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winter 2013 wi/13

a publication of Texas Organization of Rural & Community Hospitals

KEEPING RURAL HEALTH ON TOP! h t l a e H l Hospitals a r Ru s

Lia

bili

ty

n e a c i r c r e i iv a o W f s k y L e r h ed gislati o P W on Privacy Uninsur ing d i a n c i i d e M a y t i Tr l a u Q g Fundin rting DSH o p e R s t a s t o Da alth C are He ing d C in age a r T n a M


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Texas Organization of Rural & Community Hospitals

winter 2013

Volume 1, Number 4

O N T E N T S

Sections

Feature Story

3 Judey Dozeto, AIGA PUBLISHER

David Pearson, MPA, FACHE, PMP Quang Ngo, MPH, PMP e d i to r s

13 16

Editorial

17

News

18

Dawn Haberkorn a s s i s ta n t

T O R C H E D U C AT I O N C O M M I T T E E

Keeping Rural Health On Top!

Compliance

6

Legal

8-9

ADVERTISING REPRESENTATIVE

14-15

Technology

4

Dave Streilein

e d i to r i a l

President’s Message Sound Off

Hospital Profile

Finance

19

Workforce

20

11

Advertiser Index

12

End Note

Policy

Ruth Cook, Fairfield (Chair) Keith Butler, Sonora and Dennis Jack, FACHE, Borger

T O R C H B OA R D O F F I C E R S Chuck Norris, Chairman Gonzales Healthcare Systems Gonzales Linda Rasor, Vice Chairman Plains Memorial Hospital Dimmitt David Byrom, Secretary/Treasurer Coreyell Memorial Healthcare System Gatesville

TORCH B O A R D O F D I R E C T O R S Frank Beaman, Jacksboro; Donna Boatright, Sweetwater; Harris W. Brooks, Mineral Wells; Teresa Callahan, Iraan; Chris Ekrem , Denver City; Jack Endres, TMSI Vice Chair, Jacksonville; Ernest Flores, Jr., Carrizo Springs; John Hart, Clarksville; John Henderson, Childress; Grady Hooper, Smithville; Letha Hughes, Lamesa; T. Kim Lee, Bowie; Ted Matthews, Eastland; Thalia Muñoz, Rio Grande City; Jan Reed, CPA, Electra; Jeff Turner, Dumas; James Vanek, Foundation President, Hallettsville Rural Matters is published four times per year by the Texas Organization of Rural & Community Hospitals (TORCH), 11675 Jollyville Rd., Suite 300, Austin, Texas 78759, PHONE: (512) 873-0045, FAX (512) 873-0046. Copyright © 2013 by the Texas Organization of Rural & Community Hospitals. Inquiries should be sent to Rural Matters, P.O. Box 203878, Austin, TX 78720-3878. POSTMASTER: Send address changes to Rural Matters, P.O. Box 203878, Austin, TX 78720-3878. Phone: (512) 873-0045. Printed in the U.S.A. No part of this publication may be reproduced in any form without written permission of the Publisher. Opinions expressed in this publication do not necessarily reflect official policy of TORCH. According to Texas Government Code 305.027, portions of this material may be considered “legislative advertising.” Authorization for its publication is made by David Pearson, President/Chief Executive Officer, Texas Organization of Rural & Community Hospitals, P.O. Box 203878, Austin, TX 78720-3878.

/torchnet @torchnet /linkd.in/x2ioqF

Upcoming Events

FEBRUARY 2013 S M T W 3 10 17 24

4 11 18 25

FEBRUARY 18 T

5 6 7 12 13 14 19 20 21 26 27 28

F 1 8 15 22

S 2 9 16 23

President’s Day

MARCH 4-5 TORCH/TRHA Rural Health Advocacy Day Austin

MARCH 10 MARCH 2013 S M T 31 3 4 5 10 11 12 17 18 19 24 25 26

COVER DESIGN BY JUDEY DOZETO

APRIL 2013 S M T 2 1 7 8 9 14 15 16 21 22 23 28 29 30

Daylight Savings Time Begins W

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F S 1 2 6 7 8 9 13 14 15 16 20 21 22 23 27 28 29 30

MARCH 29 Good Friday

MARCH 31 Easter

APRIL 17-19 W 3 10 17 24

T 4 11 18 25

F S 5 6 12 13 19 20 26 27

TORCH Annual Conference & Trade Show Dallas


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R E S I D E N T ’ S

M E S S A G E

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This edition of Rural Matters is dedicated primarily to our advocacy

present to you several articles that will detail a number of different

activities at the State and Federal level. Advocacy is probably one of

policy issues facing rural and community hospitals, as well as the

the primary functions of any trade association and certainly a high

positions that TORCH has adopted. I think you will find that we are

priority for TORCH. I am proud of the accomplishments we can point

facing a bit of an uphill climb once again and that it is imperative that

to from the session in 2011, but we are always being challenged to

we communicate our passion and dedication to serve our communities.

create and respond to legislation that impacts our members and could

For if we don’t rise to the occasion, then who will? Please enjoy this

affect their success in the months and years ahead. We work closely

edition of Rural Matters and take a moment to let us know how we

with the Board of Directors and our Advocacy Committee to craft an

are doing, now that our first year has come to a close.

agenda that reflects the true needs and ambitions of our members. What is vitally important however, is that you take an active role in

David Pearson, MPA, FACHE, is President/Chief Executive Officer of TORCH and a contributing editor of Rural Matters.

delivering that message in Austin and in Washington. As luck would have it, you have a couple opportunities to join us in February and March as we do just that. I hope that you’ll join us and meantime, we

Sound Off: If you had to pick one State and one Federal issue for a TORCH Advocacy priority in the next session, which ones would you choose?

“This summer I traveled to Washington D.C. with David Pearson, Don McBeath and three fellow hospital CEOs. With so much at stake regarding rural hospital provisions, it didn’t take long for me to become concerned that some members of our Texas congressional delegation may not be overly supportive to the needs and issues of our rural hospitals. That threat, coupled with the pressure of the increasing strain on our health care system due to our state’s growing population and poverty levels, while facing a Medicaid shortfall is concerning. Our advocacy must remain strong at the state and federal level. TORCH represents rural hospitals well. I

“I think the top priority in the legislative session is to try to create an acceptable way to get the maximum number of uninsured Texans access to affordable health insurance. This could take the form of a ‘Medicaid expansion’ as many have suggested. If not, then we must find some other innovative way to do the same thing. On the federal level, we need to fight to renew the rural extenders past the end of this year, particularly the low volume adjustment. Making these adjustments permanent would be the preferred solution. Otherwise, we seem to have to revisit this issue every few months, which takes time

“In Austin, we must continue to protect the reimbursement for rural facilities, particularly through the state Medicaid program. HHSC is looking at a new methodology for rural areas and we need to ensure that rural hospitals are treated fairly and don’t backslide financially during that process. In addition, the 1115 Waiver program has put more of our funding at risk and we’ll all have to wait to see the outcome of a very rapid planning and implementation t i m e l i n e . I n Wa s h i n g t o n , M e d i c a r e designations like CAH and SCH must also be allowed to continue to exist. Without them, it would be very difficult to maintain

had the opportunity to personally witness this. But in my opinion, we can’t just sit back and watch. It is critical that we are all actively involved.” Jeff Barnhart, CEO Ochiltree General Hospital

and attention away from caring for our patients.” Jerry Massey, MPA, FACHE, SVP, ETMC Regional Healthcare System

access to life-saving services in many of our rural communities. What happens today with Medicaid and Medicare, will ultimately determine our future viability.” Grady Hooper, CEO Seton Smithville Regional Hospital

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We’re Taking our Voices to the State Capitol for the Advocacy Day!

N

Now that the State Legislature is back in

from across Texas will be converging on the

in helping us to

session and President Obama has been

State Capitol this session.

determine which

sworn into office, it is time to fully engage

TORCH represents more than 3.1 million

messages and

in TORCH’s advocacy program for 2013.

rural citizens throughout the State of

strategies may

Join us as we head to the Capitol to urge

Texas. We firmly believe that building and

work best.

our State Representatives and Senators

sustaining relationships with our policy

to establish laws and policies that are in

makers is critical to stabilizing our already

can see, this

the best interest of rural and community

fragile health care system. The life-saving

process is most

hospitals. The Texas Legislature only meets

services that are provided by TORCH

successful when

for 140 days every other year, so please plan

Member Hospitals are essential for the

we maximize

to make the trip a priority once again for

continued availability of cost-effective,

participation and send a clear message to

yourself, your staff and your trustees.

high-quality health care. We invite you to

our elected representatives about what the

When it comes to advocacy, it is very

come share your story and to contribute to

needs are in rural Texas. So take action now

much a team sport. Therefore, Rural Health

the narrative on the most important policy

and commit to protecting your community

Advocacy Days is once again a joint activity

issues that are facing your community.

by attending Rural Health Advocacy Days.

A s

y o u

of TORCH and the Texas Rural Health

Also, this is an excellent opportunity to

As always, we thank you for your support

Association. The event takes place on

network with fellow TORCH Members and

and hope you will be able to help make this

Monday, March 4 and 5 at the Omni Hotel

to hear from key legislators, their staff and

year’s event our strongest one.

in downtown Austin. Day one will include

those who work most closely on the health

education and training on the legislative

care issues that affect our hospitals. As you

priorities for rural health care. Day two is

visit with your respective legislators and

when we ask all our members to visit with

discuss the policies impacting your facility,

their elected officials in Austin and to share

please remember to share your findings with

the rural message. This is the only time

the TORCH Advocacy Committee and staff.

when rural health provider representatives

The insights you gain can be instrumental

2013 Texas Rural Health Advocacy Days March 4-5, 2013 Omni Downtown Austin

Jack Endres, JD, FACHE, is the CEO at East Texas Medical Center in Jacksonville.

Register online: http://bit.ly/advocacyday13


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A New Session of Congress and the Legislature is Sworn in. So What Next?

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A big question mark surrounding the most

the reality is setting in that federal budget

change in Lt. Governor Dewhurst’s positions

recent state and national elections is how

cuts will be an issue for a long time in this

following his defeat in the U.S. Senate race

these results will impact rural health policy.

country. Entitlement reform will also be on

to Ted Cruz, an ultra-conservative Tea Party

At the federal level, a general consensus

the table and big changes in Medicare may

movement candidate. Dewhurst, obviously

is that things will not change much. The

still be in store. Historically that has spelled

hoping to remain Lt. Governor for now, has

players are pretty much the same. Barrack

payment reductions for providers but there is

a primary election in fourteen months with

Obama (D) is still President of the United

a growing drumbeat of higher age eligibility.

conservative candidates already lining up

States, John Boehner (R) is still Speaker

Without any changes, Medicare will be

against him. Consequently, Dewhurst is

of the U.S. House of Representatives, and

insolvent within 10 years and the SGR cut

now exhibiting more conservative behavior

Harry Reid (D) is still the majority leader

that physicians face is a huge barrier as well.

with the appointment of new and more

and controls the U.S. Senate. Republicans

The budget dynamics, coupled with the

conservative chairs of Senate Committees

continue to have a strong hold on the

fact that Congress has become more urban,

and other stances he has announced in the

House (234 R-to-200 D with one open

leads to a lessening sympathy factor for rural

past month. This could spell a much leaner

seat, as compared to 242 R-to-192 D

health issues and rural hospital problems.

Senate version of the state budget ultimately

before the election) and the Democrats

Many members of Congress (and certainly

leading to a much leaner final budget. That

still rule the Senate (54-to-45 with one

their staff) were not there when Congress

could, in turn, spell trouble for rural hospitals

Independent, compared to 51-to-47 and two

dealt with the rural hospital closures of the

hoping to see some positive adjustments in

Independents before the election). This will

late 1980s and early 1990s. They don’t

what they are paid for Medicaid services,

also mean continued gridlock as the Senate

really understand rural health policy, which

and a reversal of last session cuts such as

can stop the House and vice versa. The

makes special rural considerations a more

Medicaid outpatient and emergency room

House Republicans can yield some power by

likely target for the budget axe. Congress

use for non-urgent care.

not starting or by stopping things the Senate

also seems to continue to push for more

and President want done (like the fiscal cliff

standardized, urban tested “one size fits

more money to plug into the budget driven by

or debt ceiling increases).

all” policies, which seldom work in the

increased sales tax and the oil/gas boom. What

Rest assured that federal health reform

altered dynamics of rural areas. While a

is not clear is how the changing dynamics of

under the Affordable Care Act will continue

mostly Democratic dominated Washington

the Texas Senate and the wave of new faces

to advance, but not equally as a result of

is traditionally a more favorable environment

in the House will want to spend that money.

the early summer U.S. Supreme Court ruling

for health care providers and rural issues,

Most of the new revenue is sure to go toward

giving states an option on participation in

the budget crunch will continue to remove

cuts from last session and the schools are the

Medicaid expansion. Republican controlled

some of that bias and rural advocates will

first in line, but there are many reasons why

states will continue with the banter of

have to maintain a vigil.

hospitals should also be at the top of the list.

not expanding Medicaid, like Texas has

You can help by playing an active role in our

promised. But, over time some of those

unchanged, Texas politics is primed for

states could soften their position, like

more substantial changes, even though

Arizona. The same Supreme Court ruling

the players are the same in Austin. Rick

upheld that federal health care reform is the

Perry is still our Governor, David Dewhurst

law of the land so the talk in the U.S. House

is still Lieutenant Governor, and Joe Straus

of Representatives of abolishing health care

is still Speaker of the House. The big

reform will slowly fade away as any bill they

change appears to be coming from the

might pass would die.

Texas Senate, which has long been more

A big concern for rural health providers

moderate than the House on many issues,

is that no matter who won the election,

including the budget. However, noticeable

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While DC politics remain mostly

What is clear is that the state now has

advocacy activities in 2013.

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Rurals Pulled Backs from the Fiscal Cliff, for now

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This country recently avoided going over the

financially protect many rural hospitals from

1, 2013 effective date to March 1. So,

fiscal cliff and the potential for economic

steep Medicare payment reductions when

Congress must act again by March 1 or these

upheaval was stalled as Congress voted to

the outpatient prospective payment system

sweeping cuts will hit the federal budget

extend a number of tax breaks and various

(PPS) took effect in 2000. The loss of OPHH

hard. These include a two percent automatic

programs. At the same time, Congress

will collectively cost an estimated 50 rural

cut to all Medicare providers. Since passage

generated some new revenue for the federal

Texas hospitals $10 million a year.

of sequestration, Congress has concluded

budget by not extending tax breaks to those

Also of concern is an extension in the

that the cuts probably go too deep, too

with much higher incomes, but they failed to

audit period in Medicare from three to

fast and are too random. The problem for

take any steps to balance the budget leaving

five years. While hospitals support any

rural hospitals is that in the weeks ahead

the door open for more intense budget

reasonable steps the government takes to

as Congress searches for alternative cuts;

battles over the next few months. While

stop fraud and abuse, the extra two years

rural hospitals could become a target again.

the news headlines have focused on the tax

could subject small rural hospitals to

During previous budget cutting dialogue

cuts and lingering deficit, buried within the

shifting limited resources from patient care

there has been mention of elimination or

last minute bill was new life for a number

to audit preparation long after any possible

revisions in the Critical Access Hospital and

of extremely important rural hospital and

billing mistakes should have been caught

Sole Community Hospital programs. While

Medicare provisions.

by the government. Some hospitals also

these two programs are almost financially

Most notable was an extension of

may be denied future Medicare inpatient

irrelevant in the federal budget, one must

the Medicare Dependent Hospital and

payment increases as the bill removes

remember that Congress is mostly urban

Low Volume Adjustment, which provide

an estimated $10.5 billion through a

and they are looking desperately for cuts –

critical Medicare payment adjustments

downward adjustment in annual base

no matter how small – that cause them the

for many rural hospitals that have low

payment increases. Rural Critical Access

least amount of political flak. Rural hospitals

patient volumes, but are the only hospital

Hospitals, who are paid based on cost

and rural providers will need to stay focused

in town. These same hospitals do not

rather than standardized rates, should not

in the actions in Congress over the months

qualify as a Critical Access Hospitals,

be impacted. However, the effect on other

ahead.

furthering intensifying the need for these

hospitals is not year clear.

two programs to continue. Both programs

Another potential exposure is that

expired at the end of September and are

Medicaid disproportionate share hospital

now continued until October 1, 2013. The

(DSH) payments nationally will be reduced

bill also continued a number of Medicare

by $4.2 billion. This will be achieved

provisions that have been a safety net to

by re-basing DSH payments among the

keep health care services for the elderly,

states. The impact on Texas, if any, is not

such as a payment bump for ambulance

known yet. The fiscal cliff bill also held a

services (especially in rural areas) and

hodge-podge of other pending business for

stopping what would have been a 26.5

Congress and extended many other subjects

percent payment reduction to physicians

from agriculture programs to tax credits for

that treat Medicare patients.

wind and other renewal energy.

The last minute legislation did contain

On the budget deficit front, the bill did

some negatives for hospitals. At the top

not contain any substantial cuts, which

of that list, the Outpatient Hold Harmless

is why some Republicans voted against

(OPHH) or TOPS payment were not renewed

it. It did push the automatic cuts held

and consequently died on December 31.

in the “sequestration” legislation passed

OPHH was designed by Congress to help

more than last year from the January

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Fiscal Cliff Bill Provisions Medicare Related Extensions • Extension of Medicare inpatient hospital payment adjustment for low-volume hospitals Low-volume hospitals (less than 1,600 Medicare discharges and be 15 miles or greater from the nearest like hospital) receive add-on payments based on the number of Medicare discharges. This is extended until October 1, 2013. • Extension of the Medicare/Dependent hospital (MDH) program Enhanced Medicare payments to rural hospitals under 100 beds with at least 60 percent of its days or discharges covered by Medicare Part A and not designated as a Sole Community Hospital. This is extended until October 1, 2013. • Medicare Physician Payment Update Medicare physician payment rates were reduced by 26.5 percent on December 31, 2012. This provision avoids that reduction and extends current Medicare payment rates through December 31, 2013. • Work Geographic Adjustment The Medicare fee schedule is adjusted geographically for three factors to reflect differences in the cost of resources needed to produce physician services: physician work, practice expense, and medical malpractice insurance. This tends to financially assist many rural physicians. This is extended through December 31, 2013. • Payment for Outpatient Therapy Services The annual per beneficiary payment limits is $1,880 for all outpatient therapy services provided by non-hospital providers, but there is an exception when additional therapy is determined to be medically necessary. This provision extends the exception process through December 31, 2013. The provision also extends the override of the cap to services received in hospital outpatient departments only through December 31, 2013. • Ambulance Add-On Payments Ground ambulance transports receive an add-on to their base rate payments of two percent for urban providers, three percent for rural providers, and 22.6 percent for super-rural providers. The air ambulance temporary payment policy maintains rural designation for application of rural air ambulance add-on for areas reclassified as urban by OMB in 2006. This provision extends the add-on payment for ground including in super rural areas, through December 31, 2013, and the air ambulance add-on until June 30, 2013. • Performance Improvement Extends program relating to health care performance. Funding continued through 2013. • Extension of funding outreach and assistance for lowincome programs Extends the funding for one year for State Health Insurance Counseling Programs (SHIPs), Area Agencies on Aging (AAAs), Aging and Disability Resource Centers (ADRCs), and The National Center for Benefits Outreach and Enrollment. Other Health Provisions • Extension of the Qualifying Individual Program Allows Medicaid to pay the Medicare Part B premiums for low-income Medicare beneficiaries with incomes between 120 percent and 135 percent of poverty. Extended until December 31, 2013. • Extension of Transitional Medical Assistance Allows lowincome families to maintain their Medicaid coverage as they transition into employment and increase their earnings. Extended until December 31, 2013. • Extension of Medicaid and CHIP Express Lane option Continues option that allows state Medicaid and CHIP offices to rely on data from other state offices, like SNAP and school lunch programs, in w i n t e r

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making income eligibility determinations for children, called Express Lane Eligibility (ELE). Extended through September 30, 2014. Health Provisions Payment Methodology • Documentation and Coding (DCI) adjustment Phase in the recoupment of past overpayments to hospitals made as a result of the transition to Medicare Severity Diagnosis Related Groups (MS-DRGs). Savings: $10.5 billion. • Rebase End Stage Renal Disease (ESRD) payments Re-price the bundled payments to take into account changes in behavior and utilization of drugs for dialysis. Savings: $4.9 billion. • Therapy Multiple Procedure Payment reduction Reduces payment for subsequent therapies when therapies are provided on the same day. Savings: $1.8 billion. • Payment for Certain Radiology Services Equalizes payments for stereotactic radiosurgery services provided under Medicare hospital outpatient payment system. Savings: $0.3 billion. • Adjustment of Equipment Utilization Rate for Advance Imaging Services Increases the utilization factor used in the setting of payment for imaging services in Medicare from 75 percent to 90 percent. Savings: $0.8 billion. • Competitive Prices for Diabetic Supplies Applies competitive bidding to diabetic test strips purchased at retail pharmacies. Savings: $0.6 billion. • Adjust Payment Adjustment for Non-Emergency Ambulance Transports for ESRD Beneficiaries Reduces the payment rates for ambulance services by 10 percent for individuals with ESRD obtaining non-emergency basic life support services involving transport, based on a recent General Accountability Office report. Savings: $0.3 billion • Increase statute of limitations for recovering overpayments Increases the statute of limitations to recover overpayments from three to five years, based on recommendations from the Office of Inspector General at the Department of Health and Human Services. Savings: $0.5 billion. • Medicare Improvement Fund Eliminates funding for the Medicare Improvement Fund. Savings: $1.7 billion. • Rebase Medicaid Disproportionate Share Hospital (DSH) payments to extend the changes from the Affordable Care Act (ACA) for an additional year Rebases DSH allotments to maintain the level of changes achieved in the ACA, and determine future allotments off of the rebased level using current law methodology. Savings: $4.2 billion. • Commission on Long Term Care Establishes Commission on Long Term Care to develop a plan for the establishment, implementation, and financing of a high quality system that ensures the availability of long-term services and supports for individuals. This provision has no scoring implications. • Coding Intensity Adjustment Increases this coding intensity adjustment for Medicare Advantage plans. Savings: $2 billion. • Consumer Operated and Oriented Plan (CO-OP) Rescinds all unobligated CO-OP funds under section 1332(g) of the Affordable Care Act. This provision also creates a contingency fund of 10 percent of the current unobligated funds to be used to further assist currently approved co-ops that have already been created. The provision does not take away any obligated CO-OP funds. Savings: $2.3 billion.

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O R K F O R C E

State Leaders Must Invest in Texas’ Primary Care Workforce

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There is not a self-respecting health policy analyst here or anywhere

Office at the Department of State Health Services, this reduction

in the country that will say otherwise — we need to invest in and

could affect health care access for 1.1 million Texans in underserved

produce more primary care physicians.

areas. Altogether, the budget decisions for these programs constitute

The conventional economic wisdom, backed by common sense and

a withdrawal of $39.8 million, or 80 percent, in the state’s

an abundance of evidence drawn from the real world, is that patients

investment in the production of its primary care workforce.

with ready access to primary care receive more timely and optimal

That was then, this is now.

health care services with better outcomes. Primary care physicians

Buoyed by an improved state fiscal outlook and other demographic

provide preventive, coordinated and continuous care, which results

imperatives – Texas will soon be graduating more medical students

in less invasive and costly medical intervention and reduces the

that we have first-year residency training slots – the Legislature is

probability of redundant or unnecessary services.

poised to renew and strengthen its investment in the recruitment,

Perhaps more important for rural Texas, according to the Agency

training and development of Texas’ primary care workforce.

for Healthcare Research and Quality, family physicians are the most

In its 2014-2015 base budget the Legislative Budget Board

likely of any physician specialty or subspecialty to practice in rural

increased funding for the Physician Education Loan Repayment

areas and the most likely to be geographically distributed in the

Program by $28.2 million. Additionally, state Senator Jane Nelson

same proportion as the U.S. population.

(R – Flower Mound), chairwoman of the Senate Health and Human

Yet flaws in the way Americans pay for health care services and

Services Committee has filed SB 143, which:

in the way we recruit, educate and train physicians have led to

Establishes the Primary Care Graduate Medical

an inexorable problem: fewer and fewer medical school graduates

Education Expansion Program with the goal of

choose careers in primary care medicine. Approximately 18,000

increasing residency slots for primary care;

primary care physicians practice in Texas, serving a population that

will soon exceed 26 million. This ratio falls far below the national

graduation rates and develop innovative programs to

average and will worsen as the population continues to balloon at both ends of the age spectrum.

Establishes incentives for medical schools to improve increase the supply of primary care physicians, and;

Allows physicians who agree to treat Medicaid or Texas

For decades, the Texas Legislature has recognized the importance

Women’s Health Program patients to participate in the

of increasing and supporting our state’s primary care workforce, and

Physician Education Loan Repayment Program.

has invested in medical schools, programs to help fund primary care

Together, these initiatives constitute a bold set of strategies to

residency training, physician education loan repayment programs

grow and improve Texas’ primary care physician workforce and to

and other initiatives.

increase access to primary care services for Texans across the state.

But last session, facing a severe budget shortfall, the 82nd Texas

With a robust primary care physician workforce, we can ensure

Legislature cut the state’s investment in graduate medical education

Texas patients will receive the right care at the right time for the

by almost 40 percent. The most drastic cuts were reserved for a set of

right price.

programs administered by the Texas Higher Education Coordinating Board specifically designed to support the recruitment and residency

Tom Banning is the chief executive officer

training of family physicians and other primary care physicians.

of the Texas Academy of Family Physicians.

The Legislature cut line item funding for family medicine residency programs by almost 75 percent. Two other line items for residency training were eliminated, as was all funding for Texas’ Statewide Primary Care Preceptorship Program. In addition, the state’s new Physician Education Loan Repayment Program was cut from $23.2 million in 2010-2011 to $5.6 million in 2012-2013. According to analysis by the Texas Primary Care

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Texas Medicaid: To Expand or Not To Expand

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Whether to expand Texas Medicaid under the Affordable Care Act

health care in Texas is property tax payers at the local level. Under

(ACA) has become politically explosive in this historically conservative

Texas law, counties and hospital districts are financially responsible

state since last summer’s Supreme Court decision making expansion

for the health care of the poor. If most persons currently covered

a state option.

by the counties and hospitals districts were covered by Medicaid

The ACA first mandated, but now only encourages states to expand

expansion, much of the cost would shift from the local property

their Medicaid programs to cover all adults up to 133 percent of

taxpayers to mostly federal dollars generated from a wide variety of

the federal poverty level. Texas has long operated a limited program

sources and other states.

only covering pregnant women, children, and the disabled with

Other “NO” states are changing their mind – A number of states

varying poverty level qualifications. Expansion would add low-income

beside Texas that initially said no to the Medicaid expansion have further

men and non-pregnant women who are not on Medicare, covering

analyzed the benefit to their state and have reversed their decision.

a substantial portion of those currently uninsured. The federal

It makes economic and business sense – several studies say

government could fund the cost 100 percent for 2014-16, and then

Medicaid expansion in Texas is good for business and could

phase down to 90 percent in 2017.

strengthen the business climate. Former deputy state comptroller

This compares to the current Medicaid system in Texas, which

and the state’s chief revenue estimator Billy Hamilton states that

was remain the same, where the state funds 41 percent and the

Medicaid expansion is a “smart, affordable and fair” decision for

feds cover 59 percent. Here are a few of the pros and cons about

Texas. He claims that with an investment of $15 billion, Texas

this complex policy issue:

could draw down $100 billion in federal dollars. Economic guru

Pros:

Ray Perryman believes “every $1 spent by Texas to expand Medicaid

Dramatic drop in uninsured - The level of uninsured in Texas could

coverage returns $1.29 in dynamic State government revenue

drop from the current 26 percent (as high as 50 percent in some

over the first 10 years of the expansion.” He maintains Medicaid

rural and border counties) to as low as eight percent to 10 percent

expenditures will lead to substantial economic activity, federal funds

with full implementation of ACA. Half or more of the reduction could

inflow, reduction in costs for uncompensated care and insurance,

be from Medicaid expansion.

and enhanced productivity from a healthier population.

Texas benefits the most – because of the high percentage in

The current Texas Medicaid system will grow costing the state

Medicaid program, Texas is projected to receive more new Medicaid

more money – some people advocate that as more people are deemed

dollars and newly insures more population than any other state.

eligible for the new expanded portion of Medicaid, some current

Texas is a receiving state and not a donor state – as with all federal

Medicaid eligible persons not currently enrolled will sign up costing

programs, some states receive more benefits than the dollars they

the state 41 cents of every dollar spent. This may be true many

put in, while other states receive a lesser benefit than they fund.

knowledgeable of Medicaid say this will be almost insignificant.

Texas has long been a donor state. Under Medicaid expansion, Texas

It must be noted that the state has long offered these persons

would gain more benefit than it pays for. If Texas declines Medicaid

Medicaid and already has an obligation to cover them regardless of

expansion, Texans will still pay federal taxes but other states will

what happens with Medicaid expansion.

get the benefit.

The Feds could cut off the higher funding match rate in expanded

Hospitals and other providers in rural areas gain financial stability –

Medicaid and revert it to the existing state/fed match rate – The

high levels of uninsured in rural areas can be a deterrent to new

federal government could cease funding at the higher level for new

physicians moving to rural Texas. Expansion would reduce the

Medicaid or funding for current Medicaid at any time by an act of

number of uninsured meaning providers would take less financial

Congress. They never had and Texas could always pull out.

risk. Not expanding Medicaid in Texas will cost the state’s hospitals nearly $25 billion between 2013 and 2022. Property taxpayers could benefit – the “payer of last resort” for

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Cons:

uninsured, the large population, and a very restrictive existing

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Too many rules and strings attached – The Medicaid program is extremely confusing and complicated. Yet, while there are strings continued on page 17

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T

E C H N O L O G Y

Rural America and Health Information Exchange Opportunity

I

I watched Ken Burn’s special called “The

experience one that will bring them back

Dust Bowl” the other night. I was struck

when the need arises again? It is clear that

by the magnitude of what’s being called

one must put technologies in place that are

the largest man-made ecological disaster

affordable and accessible to rural providers

in history. I was also struck by the people,

if one wants to succeed in the future.

their stories of triumph and tragedy, of

As we were designing CollaborNet, we went

hope and despair but I was struck most by

to discuss a potential partnership with the

was the resilience with which they carried

good folks at TORCH. I’ve had the privilege

on. While I was born well after the 1935

of knowing both David Pearson and Quang

Black Sunday dust storm, I do remember

Ngo for a number of years. I have always

both my grandparents and parents talk

been impressed with not only their mission

about the “Pioneer Spirit” that it took to

but also their steadfast belief that the Rural

live through the great depression as well as

Communities of Texas are underserved

the dust bowl. The best of America is found

especially in information technology. It is

in these rural communities even today. It’s

our combined belief that successful health

my contention that Health Information

information exchanges will be built from

Exchange will be pioneered in rural areas

the community up and not from either the

first for the very simple reason that they are

Federal or State government level down.

truly community-minded already. Unlike

We’ve seen many examples both here in the

major urban areas with many constituencies,

United States and in other countries where

rural communities serve their families,

highly centralized attempts to force data

friends, neighbors, and co-workers. There

exchange have failed. The only way to serve

is a fabric to these communities, a sense of

these communities is to keep the costs down

belonging, pride and responsibility to help

up front and to have a support model where

each other and share that you do not find in

the vendor stays directly involved mitigating

major urban areas.

the technical issues we know will happen.

We are entering a period of information

Technology is only as good as the support

explosion as technology continues to get

you receive in a timely and personable

cheaper and access to data becomes more

manner. We have just deployed Version I of

readily available. In the business world, the

CollaborNet at Willbarger General Hospital

more connected you are, the more efficient

and 6 clinics in Vernon, Texas. The good

you can become, the more time you have

folks in Vernon are continuing to help us

to do the things that really matter and

improve the application for future releases.

make one more productive. Eliminating

Their enthusiasm for both the product

unnecessary steps in daily activities saves

and the project bodes well for all TORCH

time and money, which are scarce resources.

Members and we look forward to continued

As we develop information exchanges, we

success. For more information, contact

do so with these same thoughts in mind.

Holon Solutions at (817) 788-4596.

How can one save time? How can one eliminate steps or unnecessary costs to one’s

Mike McGuire is CEO at Holon Solutions.

operations? How can one make the patient

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L A R U R G EE PIN

K

! P O T N O H T L HEA

A

As another session of the Texas Legislature gets underway, Texas rural

its share of Medicaid costs to help balance the budget – each time

hospitals hope to avoid any further payment cuts a result of overall

dealing with the settlement in the following budget cycle. They

state budget process. Most rural hospitals are already operating in

must also look at the fact that they froze another $5 billion in state

a financial vise and cannot afford any more payment reductions at

appropriations so they could get the current budget certified by the

the state or federal level without reducing services. During the last

State Comptroller. To start flowing those dollars to the programs they

session of the Legislature, all hospitals in Texas suffered serious

were intended for, like the physician loan repayment program, puts

cuts, including an eight percent rate decline for Medicaid outpatient

them in an instant $5 billion hole.

services, as well as a 40 percent payment cut when Medicaid

So, while the state may have seen a slight increase in revenue,

patients use a hospital emergency room, but the services are later

the fight over these dollars will assuredly begin with education and

deemed to be non-urgent.

schools will be first in line as they took the lion share of the cuts

Urban hospitals also were hit with an eight percent payment

last session. One other wild card in the budget game is water. The

decrease for Medicaid inpatient hospitals, while rural hospitals

state is facing a serious water shortfall in the future driven by huge

dodged a bullet when the state maintained its long-standing practice

population growth and the lingering drought. A safe bet is the state

of paying rural hospital rates close to the actual cost of inpatient

will be spending some substantial money this session to attack the

care. Rural hospitals were indirectly impacted by actions placing the

impending water crisis. One bill has already been filed to transfer

new physician loan repayment program on hold, which has limited

$1 billion from the state’s rainy day fund for water issues. However,

the ability of many rural communities to recruit new physicians. All

Governor Rick Perry is again vowing to not use any part of the rainy

of the cuts were part of a larger, cost-cutting approach to the state

day fund for the regular budget. For that matter, Perry immediately

budget when the Legislature found itself with a $20 billion plus

began vowing that with extra money on the table, the Legislature

budget deficit two years ago.

should begin considering tax relief. It seems far-fetched, but the

This session, the state has a greater than expected amount of revenue to work with. There seems to be a session entry attitude

14

battle for the budget has only just begun. Top priorities during the session for the 180 Texas rural

from some members of the need for the Legislature to partially

hospitals will be:

restore some of the prior cuts. However, it is clear there will not be

MAINTAINING COST BASED MEDICAID INPATIENT PAYMENTS

enough money to fully fill all of the gaps. Before seriously looking

The Texas Health and Human Services Commission is proposing

at restoration of some of these cut programs, the Legislature must

to move away from the cost-based impatient Medicaid payment

first address a projected $5 billion dollar hole for Medicaid in the

system for rural hospitals and convert to more standardized

current two-year budget.

statewide payments. Although also proposing to add some payment

This hole is attributed mostly to intentional under funding rather

adjustments, this concept does not address the unique operating

than increased utilization. The Legislature has long underfunded

dynamics of rural hospitals such as narrower operating margins, low

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patient volume, wide swings in the number of patients, challenges

from Governor Rick Perry that Texas will not participate. The original

matching staffing ratios to patients, smaller purchasing power and

health reform federal law mandated the states to expand Medicaid

the inability to provide more complex and profitable services to offset

to all persons up to 133 percent of the federal poverty level. As

cost drivers like a trauma center and obstetrics, plus deal with the

Texas historically only covers pregnant women, children and the

higher levels of uninsured in rural areas. Historically, Texas has

disabled for health services, the law would have forced Texas to

attempted to reimburse rural hospitals at their individual cost of

expand Medicaid services to all adults qualifying under the income

providing services rather than standardized or negotiated Medicaid

limits. This would have significantly reduced the Texas uninsured rate

inpatient rates. The impact of paying some rural hospitals slightly

from 26 percent-to-less than 10 percent as estimated by the Texas

higher rates in the past has been negligible in the cost of Medicaid

Health and Human Services Commission. As to funding to expand

for Texas but has allowed the hospitals to provide the services

Medicaid, the federal government will pay 100 percent of the new

without losing money and to keep their doors open. Without a

cost to states for 2014 through 2016. In 2017, the federal portion

payment system to cover their cost, many rural hospitals may not

begins decreasing its share but never falls below 90 percent. More

be in a financial position to treat Medicaid patients at a loss. Under

than $112 billion in federal funds could be available to Texas over

previous payment systems based on more standardized rates at the

the next 10 years for the newly eligible.

state and federal level, rural hospitals have struggled and many

With the Supreme Court now giving states the ability to not expand

closed. Continuation of a payment methodology for rural hospitals

Medicaid without penalty; Governor Perry has already denounced

that accounts for their operating environment is critical to maintain

any expansion. A scenario now exists where Texas could decline

access to care for Medicaid recipients in rural Texas.

the expansion and the level of uninsured in Texas remains near 26

RECOVER

CUTS

percent (up to 50 percent in some Texas rural and border counties),

The 82nd session of the Legislature (2011) ordered payment cuts

FROM

MEDICAID

PAYMENT

meaning at least one out of every four persons entering a hospital

to various Medicaid providers. This included an eight percent cut in

is not covered by a health plan. And, the financial burden of the

payment to all hospitals (rural and urban) for Medicaid outpatient

uninsured would continue to be shifted to local property payers

services. This forces many rural hospitals to provide services at a loss.

through county and hospital district taxes.

The Legislature also called for the Medicaid program to reduce

Hospitals are hoping the Governor might reconsider his decision,

unnecessary emergency room utilization by Medicaid recipients,

especially if the federal government were to give Texas a little more

which resulted in a reduction of payments to all hospitals by

freedom in how it operates its Medicaid program.

40 percent when an ER visits is non-emergency care. This new

Don’t forget that a very important hands-on advocacy opportunity

policy disproportionately harms hospitals in rural areas where

is coming up for you to help in our battles at the federal and state

there is a much lower availability of primary care, especially

level to survive! TORCH and the Texas Rural Health Association

at night and on weekends. Many sick patients turn to the rural

will hold their joint Advocacy Day in Austin on March 4-5. The

hospital ER because they have no other option. Hospitals costs

afternoon of March 4 will be briefings on the Texas Legislature and

are understandably higher in an ER so the hospital is penalized

hospital/rural health issues with visits to the state Capitol offices on

under the new policy having no option but to treat such patients

March 5. It is critical for all hospitals and others interested in rural

because of federal law and protecting themselves from possible

health issues to attend this event. Urban issues are drowning rural

litigation. This policy should be reconsidered for rural areas.

providers’ voices out! Please make it a priority to attend this events.

EXPANSION OF MEDICAID UNDER THE AFFORDABLE CARE ACT

YOUR FUTURE DEPENDS ON IT. More information can be found on the

All Texas hospitals are very interested in seeing the expansion of

TORCH Web site.

Medicaid under the Affordable Care Act, despite outcries

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C

O M P L I A N C E

The 1115 Waiver and Provider-Related Donations

I

In December 2011, the State of Texas received federal approval for a

Federal regulations prohibit private health care providers from

five-year 1115 waiver, referred to as the Texas Healthcare Transformation

making donations directly to the governmental entity making the

and Quality Improvement Program 1115 Waiver. Replacing the Upper

IGT. Before a governmental entity may participate in the 1115

Payment Limit (UPL) payment methodology, there are now two types

Waiver, it must certify that it will not enter into any agreement to

of payments available to Texas hospitals: payments for uncompensated

condition either the amount of the IGT by the governmental entity

care to Medicaid eligible patients and uninsured patients (commonly

on the amount of indigent care the private hospital will provide. The

referred to as Uncompensated Care or UC) and incentive payments for

governmental entity must also certify that it will not receive refunds

health care delivery system reforms (commonly referred to as a Delivery

of payments the governmental entity makes to a private hospital

System Reform Incentive Payment or DSRIP).

in consideration for making an IGT. Further, any cash transfers

The Texas Health and Human Services Commission (HHSC)

from a private hospital affiliated with a governmental entity must

anticipates that the intergovernmental transfer (IGT) of public funds

be unrelated to the 1115 Waiver, constitute fair market value or

for the final transition payment for 2012 will likely take place in

represent an independent, bona fide transaction negotiated at arms-

either late February or early March of 2013. Only a state agency or

length and in the ordinary course of business.

a unit of local government, such as a county, city, hospital district or

However, federal law recognizes that private health care providers

hospital authority, can make an IGT. Before making an IGT, hospitals

can undertake to support community activities. A governmental entity

and governmental entities should ensure that their IGT arrangements

may take that support into account when determining to make an

comply with both state and federal law.

IGT that will be used to fund Medicaid payments to those providers.

There are state and federal restrictions on the types of funds that qualify as IGT. Generally, a governmental entity may only transfer

However, the existence or amount of an IGT may not contingent upon the existence or amount of the community support.

funds if: (i) the funds are in the governmental entity’s control; (ii)

Hospitals and governmental entities that plan to make an IGT

the funds are not federal funds; (iii) the funds are public funds, not

of public funds or receive the supplemental payment must ensure

private funds; (iv) there is no statutory or constitutional provision that

that the arrangement fully complies with state and federal law. If a

requires the funds to be used solely for another purpose or prohibits

hospital or governmental entity has questions, it would be prudent for

the transfer; (v) the transfer satisfies a statutory or constitutional

the entity to discuss its IGT arrangements with HHSC, a consultant

requirement that relates to the funds; and (vi) the funds are not

or their attorney. The provider-related donation rules applied in the

impermissible provider-related donations.

UPL program and continue to apply under the 1115 Waiver. The key

Public funds are funds derived from taxes, assessments, levies, investments and other public revenues within the sole and unrestricted

factor is that the governmental entity cannot receive consideration from a private entity in return for making an IGT.

control of a governmental entity. Public funds do not include gifts, grants, trusts or donations, the use of which is conditioned on supplying a benefit solely to the donor or grantor of the funds. If a governmental entity designates that the IGT be sent to a

Kevin Reed, J.D. is one of Texas’ leading health care lawyers. He focuses his practice primarily on hospitals and hospital districts. Trent B. Krienke represents clients in the health care, long term care and retirement housing fields at Davis & Wright, P.C.

Medicaid provider other that the governmental entity itself, such as a private hospital, the governmental entity must ensure that its relationship with private hospital does not violate the 1115 Waiver’s provider-related donation regulations. A provider-related donation is a voluntary donation from a non-governmentally operated health care provider or entity related to a private health care provider, in cash or in kind, made to a governmental entity, whether or not that entity provides for an IGT, and is directly or indirectly related to a Medicaid payment or other payment to providers.

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L

E G A L

SCOTUS Reviews Rural Hospital Mergers

A

Antitrust challenges to hospital mergers and acquisitions are relatively

The Supreme Court is expected to issue a decision next spring.

rare. Even rarer are antitrust challenges to a merger involving a rural,

The ruling could affect future merger and acquisition activities by

public hospital. However, an upcoming decision from the Supreme

governmental-owed hospitals, which is important as the number of

Court of the United States could affect the way all public hospitals,

merger and acquisition activities by healthcare increase. According to

including those owned by hospital authorities and hospital districts,

an Irving Levin Associates report, healthcare mergers and acquisitions

participate in mergers and acquisitions.

in 2011 were up 11 percent from 2010. The number of recorded

On November 26, 2012, the Supreme Court heard oral arguments

transactions is expected to be even greater in 2012 as healthcare

on the Federal Trade Commission’s objection to the acquisition of a

providers attempt to address challenges related to healthcare reform

for-profit hospital by a rural, county hospital authority. The issue is

and the economy. However the Supreme Court rules, its decision will

whether the county hospital authority, as a governmental entity, is

give hospital authorities and hospital districts more guidance on the

immune from antitrust scrutiny.

applicability of the state action doctrine and the antitrust immunity

The Hospital Authority of Albany-Dougherty County owns Phoebe

it provides.

Putney Memorial Hospital in rural Albany, Georgia. The

Trent B. Krienke represents clients in the health care, long term care and retirement housing fields at Davis & Wright, P.C.

Hospital Authority of AlbanyDougherty County leases the hospital to a non-profit corporation,

“Medicaid” continued from page 12

Phoebe Putney Health System, which operates the hospital. In 2010, the Authority approved the purchase

attached, the expanded Medicaid is not any more complicated

the only other hospital in the county, Palmyra Park Hospital. The

than current Medicaid. Texas can take the money and follow the

Authority planned to also lease Palmyra Park Hospital to Phoebe

rules like it has since 1967 with Medicaid or the state opt out.

Putney Health System.

The federal budget is almost bankrupt and we can’t keep adding

Following the announcement of the acquisition, the FTC attempted

to it – With a deficit, there is no question the country must reel

to obtain a preliminary injunction from the federal district court. The

in spending. However, the Medicaid program is considered an

FTC alleged that Phoebe Putney Health System, as the operator of

entitlement and will continue. There is no known scenario where

the facility, was the effective acquirer and that the Authority was

non-participation by Texas will reduce overall Medicaid spending

being used to give Phoebe Putney Health System control over other

to any degree nor reduce the federal budget.

competitors. The FTC alleged that as a result the transaction was

Whatever the outcome, it is imperative that Texas leadership

unlawful. However, the federal district court dismissed the case, and

move away from political bantering and perform a detailed analysis

the U.S. Court of Appeals for the 11th Circuit affirmed the dismissal.

of the benefits to Texas by Medicaid expansion and take into

Both courts found that the transaction was immune from antitrust

account all levels of impact from the state budget, to local property

scrutiny under the state action doctrine, which exempts government

taxpayers, to the overall health and well-being of all Texans. Most

entities, such as hospital authorities and hospital districts, from

health care providers see the issue as the pros far outweighing the

federal antitrust laws in certain circumstances. In response, the

cons and they hope wise judgment will prevail.

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P

R O F I L E :

G O O D A L L- W I T C H E R

H O S P I T A L

PHOTOS COURTESY GOODALL-WITCHER HOSPITAL AUTHORITY, MARY MARTHA HALL AND CAROL SPICER.

Clifton: Norwegian Capital of Texas Goodall-Witcher Hospital Authority is a 33-bed acute care hospital located in Clifton, a small rural town in Bosque County. It is the only hospital with inpatient, outpatient and at-home health care service within 35 miles. Goodall-Witcher Hospital services include surgery, obstetrics and nursery, skilled nursing, physical, speech and occupational therapy, lab and radiology services including one of the first digital mammography machines in the area, respiratory therapy, emergency medicine and cardiac rehab. Clifton Medical Clinic is a certified Rural Health Clinic, providing primary care and specialty care in internal medicine and general surgery. Physicians specializing in cardiology, oncology, optometry and orthopedics also hold clinics at various times to provide services to our patients. Goodall-Witcher Hospital Authority was founded in the late 1930s, when two Bosque County physicians—Drs. Van Goodall and Seth Witcher­—had a dream to provide the citizens of the area with the best health care in the most modern facilities available. That dream became a reality in 1939 with the formation of a medical clinic and a 10-bed hospital. Through the years the dream and the facility grew. The hospital was updated with the latest medical technology, and more doctors and staff were added to the expanded services. In 1966, the privately owned hospital was turned over to a governing board of trustees forming a private, not-for-profit Foundation. In 2012, Goodall-Witcher Hospital Authority was created by the Clifton City Council and took over the

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day-to-day operations of Goodall-Witcher Hospital, Clifton Medical Clinic, Goodall-Witcher Home Health Agency, Goodall-Witcher Nursing Facility, and Goodall-Witcher Fitness and Wellness Center. Throughout the years Goodall-Witcher has been recognized as a leading provider of outstanding health care. The Clifton Medical Clinic was recently recognized by the Centers for Disease Control and Prevention (CDC), for its voluntary participation in monitoring the influenza virus in and around Bosque County. Goodall-Witcher Healthcare Foundation was voted “Best Employer” in Bosque County in 2011 and 2012, and the Goodall-Witcher Nursing Facility has again been rated a five-star Nursing Facility” by Medicare. The “U.S. News and World Report” also recognized the nursing facility as one of “America’s Best” nursing facilities in the nation. The hospital has received the Thomson Top 100 Hospitals award two years in a row for excellence in delivery of patient care, and has been recognized for giving back to the community (city, county, region) with a five-star designation in the Cleverley and Associates’ Community Value Index. Goodall-Witcher Hospital Authority prides itself on offering access to high quality medical care locally. Utilizing five medical providers, one surgeon, and four nurse practitioners, the residents of Bosque County can be assured that they are being provided with the best healthcare available while enjoying the many benefits of rural living.

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A

D V E R T I S E R

I N D E X

AIM Radiology...................................................................................................................7 832-296-9361 www.aimradiology.net

O N Alliant-HAS.....................................................................................................................IFC 325-668-8254 www.alliant-has.com

T H E

M O V E

Ryan Barnard, PharmD, FACHE is the new CEO and Pam Clark is the Interim CNO at Swisher Memorial Hospital in Tulia. Adam

Aris Teleradiology............................................................................................................. 2 817-703-4040 www.aristeleradiology.com

Willmann is the new CEO at Goodall-Witcher in Clifton. David Lee is Interim CEO at Otto Kaiser Hospital in Kennedy. Larry Price is the new CEO at Limestone Hospital in Groesbeck. Michael Zilm, FACHE is the

Discovery Healthcare Consulting Grp............................................................................ IBC 888-776-0620 www.dhcg.com

Interim CEO at Bellville General Hospital in Bellville. Jane Bridges is the acting Administrator at Nacogdoches Memorial Hospital in Nacogdoches. Matthew Wiley

Government Capital...........................................................................................................7 817-722-0217 www.govcap.com

is the Administrator at ETMC in Clarksville.

F O U N D AT I O N S I L E N T A U C T I O N We are accepting donations for the

HealthSure....................................................................................................................... 2 512-292-3315 www.healthsure.com

5th

Annual

TORCH

Foundation

Silent Auction, scheduled to take place during the TORCH Annual Conference & Trade Show at the Omni

Prognosis..........................................................................................................................5 281-822-2378 www.prognosishis.com

Dallas Hotel on Thursday, April 18. Proceeds will be used to support education stipends and scholarships for rural hospital staff and health care

Southwest Medical Associates, Inc.................................................................................. 10 800-929-4854 www.swmed.com

SPBS, Inc........................................................................................................................ BC 806-792-2696 www.spbs.com

students. We were able to provide 35 scholarships/stipends from last year’s event. Donations for this event are a great way to show your support for this worthy cause and receive recognition at the same time. We welcome everything from electronics

Texas Mutual................................................................................................................... 10 800-859-5995 www.hotcomp.net

to artwork to gift certificates. To make a donation, please download the Silent Auction Form, on the TORCH Web site, for detailed information

Texas Hospital Insurance Exchange...................................................................................7 512-451-5775 thie.com

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and either fax the completed form to (512) 873-0046 or email directly to dhaberkorn@torchnet.org. R U R A L

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E

N D

N O T E

Better Communication in the New Year

M

Many of us begin a new year with a burst of optimism and a renewed commitment to make positive change. And yet, that enthusiasm often isn’t enough to make our New Year’s resolutions succeed. Consider making 2013 the year that you focus on improving your communication skills. Here are four tips to help you take advantage of the New Year’s positive momentum, while avoiding the pitfalls that often derail our well-intentioned personal change efforts. Find something to quit. It’s often easier to stop something than it is to learn a new habit. And quitting a bad communication habit can be enormously effective since a single habit can repeat frequently and cause numerous problems. Before adding a new communication skill to your toolkit in 2013, see if there’s a bad communication habit you can eliminate first. Resolve to stop (or start) one habit at a time. Our previous discussion about the finite nature of willpower gives a clue why trying to change too many things at once is likely to fail. It’s advisable to concentrate on only one communication behavior at a time, such as not interrupting as much, not asking as many faulty questions, or not raising your voice at Jim from the marketing department. Scattering your focus across multiple changes dilutes the determination you need to make any single behavioral change stick. Break your goal down into milestones. A good goal is meaningful, but achievable, and can usually be split into several interim steps. For example, instead of

Year. The Power of Habit by Charles Duhigg can help you break a

a blanket commitment not to interrupt anyone in 2013, commit to

bad habit or form a new one. And Willpower by Roy Baumeister and

not interrupting your coworkers during staff meetings in January. And

John Tierney will show you ways to more effectively channel your

instead of saying that you’ll never raise your voice again, see if you

determination in support of your change effort.

can go ten days without yelling at Jim. Early successes can make

If you’ve been thinking about improving your communication, the

reaching your communication goal easier because quick victories

New Year is a great time to do it. Use the four ideas above to increase

will increase your confidence to pursue each successive milestone

your chances of success.

until you have actually changed the desired behavior. Reinforce and support your change initiative. Two books are worth reading if you are serious about making positive change in the New

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Geoffrey Tumlin is the President of On-Demand Leadership and the Founder and Board Chair of Critical Skills Nonprofit.

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SPBS, Inc. Biomedical Services

www.spbs.com SPBS provides asset management for all your Clinical & Diagnostic Equipment needs We provide quality service of the entire equipment lifecycle - from acquisition, to service and maintenance, to disposition. SPBS has provided professional, effective, quality maintenance and management of clinical and diagnostic equipment for hospitals and clinics since 1979. We offer customized solutions for all equipment maintenance needs, providing exceptional quality and service at cost effective rates. We offer hospitals several levels of service from electrical safety checks to providing a full complement of onsite technical staff. You can pick a level of service that’s right for you or customize a program to meet your needs. a In-house contract: SPBS call place a fully qualified biomedical team in your facility to manage the entire complement of your equipment assets a Complement to your existing in-house staff: Call us to work hand-in-hand with your staff to supplement their capabilities with our special know-how a Full service contracts focusing on specific departments within your facility: Customize a program to fit your needs by focusing on departments or even equipment a Periodic preventive maitenance, performance testing and electrical safety inspections a Customers have the ability to request services via our website: repairs, quotes, contract information, etc. Using the “Customer Login” tab, you can request a real time equipment inventory, historical service on any or all instruments included in the program, plus compliance data to satisfy inspecting agencies a Please call for a no cost quote or program evaluation – Richard Fischenich, CEO, BSEET, CBET

(806) 771-1381

Biomedical Equipment Service


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