Our 2006 Texas Conference of Rural and Community Hospitals brochure should have made landing at your hospital by now. Therein you will find all the details about our informative speakers, social events and the annual trade show. Take a moment to consider all the changes that rural hospitals are currently embroiled in. Managing day-to-day operations is challenging enough without having to try and make sense of shifting policies and new regulations. The 2006 TORCH Annual Conference is the best place you can go to have your burning questions answered.
       Wednesday’s program will focus on state and federal advocacy initiatives. We reversed the order this year to highlight the importance of being proactive and maintaining a high profile through a strong grassroots advocacy effort. Thursday, the topic is operational issues. As usual, the longest day of the program is also the most diverse. Lastly, rural hospital financial issues will be on Friday. We’ve saved this popular topic for last in order to give rural CFOs the opportunity to attend the last day only.
       For 15 years, TORCH has delivered reputable and cost-effective programs and services to rural and community hospitals. As we launch into our next 15 years, we invite you to come be a part of the biggest gathering of rural hospital administrators, trustees and staff in the Southwest. Don’t miss the 2006 TORCH Annual Conference – The New Frontier: A Rural Hospital Odyssey.

T-Minus 4 Weeks and Counting
A block of rooms is reserved for our Annual Conference participants at the Hotel Inter-Continental Dallas, 15201 Dallas Parkway, Addison, Texas. Call the hotel directly at (972) 386-6000 before March 15, 2006, to make reservations. To receive the special rate of $127.00 (single/double), be sure to tell the hotel that you are attending the Texas Conference of Rural and Community Hospitals. Reservations must be made before the deadline to ensure accommodations and rate.

President Bush proposed almost $36 billion in cuts to Medicare over five years in his fiscal year 2007 Federal Budget. These cuts show that the President is prepared to make major cuts to healthcare for the balance of his second term in office. The chart below shows what some of the key provisions would mean for the state of Texas.
       In addition, the following Medicare cuts were not modeled, but pose a significant risk to hospitals and other healthcare providers:

• A freeze in the payment update for skilled nursing facilities and home health services for 2007 and an update of market basket minus 0.4% in FY2007 and FY2008
• Adjustment in payment for hip and knee replacements in post-acute care settings
• An overall Medicare spending cap which, if exceeded would require automatic across-the-board cuts provider payments.

Cuts to Medicaid payment:

• Limiting payment to public providers through IGT and UPL restrictions
• Reducing the allowable provider tax from 6% to 3% to all

On January 10th and 11th, Nocona General Hospital challenged its employees to begin to make better dietary choices and find ways to become more active. The LoneStart 21-Day Wellness Initiative kicked-off a concerted campaign by administrator Michael R. Graham to increase awareness of personal wellness and reduce employee health care costs. The program also marked the countdown to the opening of the Nocona General Hospital Wellness Center, which will be available to the public and is scheduled to open this spring. Because Nocona General Hospital administration made a strong commitment to participate in the program as a “functional partner with LoneStart,” employees felt the support, excitement and interest of all involved—and in turn became more involved themselves.
       Now, with the first 21-day cycle complete, the Nocona General Hospital culture is changing. Corrie Kirkendall, RN, Wellness Center Director at Nocona General Hospital, says she sees a big change in a broadened concept to “becoming healthier.” She points to snacking as an example and says she sees employees not snacking at all or bringing fresh fruit to work rather than heading to the vending machines for a soft drink and candy bar. “The LoneStart program is important to the hospital because it promotes what we’re all about—taking a proactive approach to health and wellness. It’s more than just losing weight or exercising, it’s making a permanent, and healthy change in lifestyle,” says Kirkendall.
       It is also the first program of its kind that addresses the serious effects of obesity, overweight and lack of physical activity on our society and health care system—and proposes a strategy for real and lasting change based on individual choice and responsibility.
       Graham says, “tying a wellness program to individual responsibility means everyone benefits—employees, families and patients. Our goal is to reduce absenteeism and the hospital’s overall health care costs. Everyone wins.”
Graham says he knew he had to rein-in employee health care costs and researched wellness programs for two years before selecting LoneStart. He says there is no question that a properly designed and administered wellness program will reduce health care costs and help employees feel better about themselves and the organization they work for. An additional program benefit is anticipated as the hospital in turn begins its own community outreach wellness initiative. Interest generated through hospital employees has already spilled out into the community.
       While the LoneStart 21-Day Wellness Initiative is a weight loss program, it is much more. It is a first step to long-term health and wellness. According to Jay Seifert, co-founder of the LoneStart Initiative, the program focuses on how fundamental changes in dietary choices and level of physical activity can produce real improvements in health, energy levels, weight loss, sense of wellness and appearance. It is based on established principles of social psychology and social psychophysiology and shows participants how to develop their personal motivational triggers, build momentum and increase confidence through moment-by-moment, day-to-day choices.
       Kirkendall adds that the hospital’s dietician and dietary manager support the LoneStart initiative and are offering variations in the daily menu. Now, when employees sign up for meals in the cafeteria they have a choice of the regular menu, a reduced calorie meal or salad. Even the sweet tooth is giving it a go. Dessert now includes items such as diabetic ice cream, sherbet, or fruit.
       While Kirkendall doesn’t yet have cost results regarding time lost for illness or insurance cost information, she says she is confident that over time these numbers will decrease due to improved health and wellness.
       Graham points out that administrators have the opportunity to create a work environment that fosters well-being while targeting those lifestyle choices made by employees so that healthier behaviors are learned and adopted. He stresses that once a plan is put in place, it must be supported by the leadership team. By their involvement, the administration can set the stage for a comprehensive plan that will decrease costs and support the mission of the hospital.
       According to Seifert, not only is buy-in from the leadership team a necessity, the comprehensive wellness plan must be presented to employees in a way that they too understand the costs of stress and illness to their own lives and to the hospital, and see how a comprehensive plan will support their choices for a healthier lifestyle. For more information, please contact Jay Seifert at jseifert@lonestartnow.com.

The Center for Healthcare Governance is a dynamic community of board members, executives and thought leaders dedicated to advancing excellence, innovation and accountability in health care governance. The Center can help keep trustees and other leaders up-to-date on the latest governance issues, and lead them to many ways of energizing and strengthening their boards.
       Its mission is to help you in whatever way works for you. There are online resources for in-house education and development, top-quality regional and national education programs, and even retreats that can be customized and delivered for your team. The Center also publishes the nationally acclaimed Trustee magazine a rich source of research and studies on emerging trends in governance all aimed at helping CEOs and trustees stay ahead of the curve.
       Members of the Center have access to the "governance assessment process," a board assessment tool to help CEOs and boards get the most out of the time and talent they give to their organizations. Center members also can tap into the "speakers express," which connects you with expert speakers on any number of related governance topics.
       Each year, the Center conducts an environmental assessment to gauge what issues are important both today and in the future for hospital leaders. The assessment guides the Center in designing programs that have real-world implications. In 2006, the Center will continue to focus on many issues, including quality and patient safety; physician relationships; long-term strategic and financial planning; and new models of governance in an era of reform.
       In addition to your THT membership, you may want to take advantage of what the Center for Healthcare Governance offers. To learn more, visit www.americangovernance.com.

Effective January 1, 2006, elected and appointed officials – including board members of public hospitals – are required by state law to receive training on Texas’ Open Government laws. Officials who are in office before January 1, 2006, have until January 1, 2007, to complete the required training. Officials who are elected or appointed after January 1, 2006, have 90 days in which to complete the training.
       The law requires at least two hours of Open Government training, including one hour on the Open Meetings Act and one hour on the Texas Public Information Act. Once the members of a hospital’s board have completed the training, they must complete a course completion certificate that should be maintained by the hospital and available for public inspection upon request. The certificates can be obtained from the AG’s Office.
       For more information on the training, visit the AG’s Web site at http://www.oag.state.tx.us/and click on “Open Government Training.” Web users can view the videos and fill out the course completion certificate online, or they may choose to order the videos and certificates for delivery by mail. Those without Internet access can call 800/252-8011 to request the materials.

TORCH monitors the rural hospital-related news clips on an almost daily basis. Since the Board of Directors has placed great emphasis on the importance of our members maintaining good communications with the community and the media, we felt we should do more to recognize the hospitals that make the best use of their local media.
       Therefore, in our continuing effort to educate the public on the needs of rural hospitals, we have developed the TORCH Media Success Awards. The awards will be presented at the TORCH Annual Conference to two TORCH member hospitals and their local partners in honor of the positive collaboration that has taken place.
       No nominations or applications are being accepted. Each year, the TORCH staff will select hospitals based on an independent review of the news clips. We think you’ll agree that the hospitals selected for 2006 are very worthy indeed. Please join us in Dallas and find out who they are.

The Texas Board of Legal Specialization has announced that Jennifer Claymon is now Board Certified in Health Law. This announcement is a formal recognition of skill, experience and reputation as a lawyer in the health law field. Jennifer has demonstrated broad experience and knowledge of legal theories and technicalities, and the Board has received letters of recommendation from lawyers and others attesting to her qualifications and expertise. The Supreme Court of Texas will preside over an Induction Ceremony and Reception this month. Jennifer joins in the ranks of other notable Board Certified lawyers at Davis & Wilkerson. Those certified in Health Law now include, Fletcher Brown, Joyce McLaughlin, Kevin Reed, and Jennifer.
       Also, D&W has received recognition as one of the most distinguished law practices in the country according to the 2005 edition of the Martindale-Hubbell Bar Register of Preeminent Lawyers. Davis & Wilkerson achieved the prestigious ‘AV’ rating, with ‘A’ denoting the highest level of legal ability, and ‘V’ signifying ‘very high’ adherence to the Professional Code of Responsibility in ethics, diligence, reliability and conduct.
       Congratulations to Jennifer Claymon and the rest of the Davis & Wilkerson law firm!

FirstChoice Cooperative is a TORCH Endorsed Vendor and a home-grown solution to an age-old idea; group purchasing. FirstChoice currently provides a process second to none for healthcare providers, educational institutions, municipalities and other community businesses. Any TORCH member hospital is eligible to participate in FCC programs.
       FirstChoice Cooperative is a member owned cooperative whose primary goal is to provide a process for all providers, small or large, to reduce supply cost in the communities where they operate while maintaining the highest level of quality. FCC feels that healthcare costs go beyond the walls of the healthcare facility, so they have also incorporated into their mission a process to help reduce the overall cost in each community by asking them to join in the effort to reduce similar costs between industries.
       FirstChoice Cooperative has a network of over 20,000 members nationwide through its affiliations and management agreements with other national cooperatives which include healthcare providers, city and county municipalities, educational institutions, and community businesses that add additional purchasing volume and strength to FirstChoice Cooperative.
       FirstChoice Cooperative feels that their process is the most innovative and cost effective model in the industry and they invite you to discover the FirstChoice Cooperative difference. There are no membership fees and no tiered pricing. To register, please contact Ron Kethan at 800-250-3457 or rkethan@fccoop.org.

Sage Advice From A Fellow CEO >>

Bill Swanson, CEO of aerospace contractor Raytheon, has turned a lifetime's worth of executive wisdom into a handy pocket-size guide called Swanson's Unwritten Rules of Management. Swanson has a knack for making complex ideas easy to grasp. Corporate leaders swear by it -- but it isn’t for sale. We will be printing new rules in future editions of Frontline. You can also request your own copy at wwwxt.raytheon.com/communications/whs_rules/.

Have fun at what you do. It will be reflected in your work. No one likes a grump except another grump!

We all spend plenty of hours at work. It's much more pleasant to spend those hours with people who have a bounce in their step and a smile on their face than with those who mistakenly associate professionalism with a dour disposition. I don't like being around depressing people because they make me depressed. The best managers give of themselves by having fun at what they do -- and I look for that in those around me.