For the 80+ participants of our first-ever TORCH Leadership & Management Institute, it was a meeting that well exceeded most people’s expectations. If for some reason you were unable to attend, we’re sorry that you missed it, but don’t worry, we’ll definitely be doing it again next year. Also, we plan to add some other educational opportunities throughout the year, in the form of teleconferences, small events and the full-scale development of our TLMI website.
       The meeting got off to a great start with Krish Dhanam, who spoke about Top Performance and setting a new standard for your personal and professional life. He was engaging, light hearted and sincere. His life experience and career advancement had the audience mesmerized. He had us all on the edge of our seats and we appreciate him taking time out of his busy schedule at Zig Ziglar Training to join us in Austin.
      Judy White House and Debbie Leverett added volumes of interesting and useful information to the TLMI program. Judy focused her presentations on the area of human resources and provided participants with some no nonsense information on hiring practices and communications in the workplace. Debbie used her extensive customer service background to get the audience interested in better serving the patients and learning how to manage change.
      Ron Kessler added his valuable insights on Leadership as well. Ron reflected on his own leadership successes and coaching experiences in a series of three presentations that were intended to teach us about leadership style and making a personal commitment. Gary Cooke, writer and communications expert, used his experience in marketing and fundraising to encourage hospitals to tell their story. Gary knows that hospitals must deliver timely and effective communications in order to compete in an information-rich market.
      Mary Rauch is a professor and accomplished speaking coach who excelled at making her points with good humor. She shared some very kind words about TORCH and its accomplishments, and her depictions of the stereotypical male and female presenters will forever be etched in our minds. Thanks to Mary’s rousing presentation and the wonderfully brief closing ceremony, the inaugural TORCH Leadership & Management Institute ended on a particularly high note.
      As it was pointed out during the conference, this truly was a member-driven event. The TORCH Board of Directors felt that developing affordable leadership training that was easy for hospital employees to access was a perfect use of the association’s time and effort. Thanks to a number of top notch trainers who got excited about the project as well, we feel the results speak for themselves.
      All attendees left with a motivational CD to help them remember the experience. Mike Hare, Pam Gonzales, Jeff Huskey, Karen Dearick, Rebecca McCain and Tisha Zalman each won a management book. W.J. Mangold Memorial Hospital won a gift basket for bringing eight people to the conference. Please keep a sharp eye out for more TORCH Leadership & Management events and offerings. Remember, TLMI is here just for you.

We are pleased to announce that Jim Bucker, Chairman of the TORCH Board of Directors, has appointed Teresa Callahan of Iraan General Hospital and Lance Keilers of Ballinger Memorial Hospital to complete the unexpired terms on the Board vacated by Andy Anderson and Ernie Parisi. For those of you who do not know our new board members, we have included a short biographical sketch for each.
      Teresa Callahan, R.N.N.P., joined the healthcare industry in 1984 in rural West Texas as a registered nurse. She received her B.S.N. at Angelo State University in 1994 and her M.S.N.-F.N.P. from Texas Tech University in 2002. Teresa worked as an Assistant Administrator for Iraan General Hospital and then became the Administrator/CEO for the hospital one year later. She is also the Director of Nursing and serves on the Permian Basin Health Education Center Board. Teresa is married and together with her husband Jody has 4 children, ages 9 to 23.
       Lance Keilers, C.A.P.P.M., E.F.P.M., wears two hats. Not only is he the Hospital Administrator for the Ballinger Memorial Hospital, he also serves as the Administrator of the Regional Cancer Treatment Center in San Angelo. Before that Lance served as Director of Behavioral Health, Public Relations and Marketing for several hospitals in San Angelo. In addition to TORCH, Lance serves on numerous other boards including the National Rural Health Association (NRHA), the Technical Assistance and Services Center (TASC) and the Northwest Texas Hospital Association (NWTHA).
      Congratulations to both Lance Keilers and Teresa Callahan.

The Centers for Medicare & Medicaid Services is closely monitoring data on DRGs and DRG payment errors. TMF is now pleased to offer hospitals two new free educational recorded sessions on coding to assist them in avoiding Medicare payment errors. Both programs have been approved for three units (each) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).
       More information is available on the TMF web site at http://hpmp.tmfhqi.net, under “Resources and Training,” click on “Training” or call TMF at 512/329-6610.

After a marathon hearing lasting over 10 hours, the members of the Sunset Advisory Commission elected to defer their adjudication concerning ORCA’s fate until the members meet again in December or January. That decision came after the Commission’s Chairman, Senator Kim Brimer, halted public testimony and told those who were still present in support of the agency that they had ’won’. Apparently, there was enough concern about what the members termed a ‘disconnect’ between ORCA’s mission, the agency’s track record on program administration and the Sunset staff’s initial findings.
      Brimer also announced that he would be appointing a subcommittee to determine if they felt that ORCA was somehow being unduly scrutinized. The Subcommittee will include Rep. Lois Kolkhorst, Rep. Byron Cook, Sen. Craig Estes & Ike Sugg (also on the ORCA Executive Committee). Based on the testimony by Kolkhorst, Sugg and the ORCA Executive Committee, several members of the Commission felt that perhaps ORCA was ‘set up to fail’ since the development of a statewide rural policy is somewhat incongruent with their primary function, which is to collect and distribute federal grant money.
      Brimer did say that he felt that the agency should be more directly involved in setting statewide policy and interacting with the legislature on issues of importance to rural Texas. In most states, the SORH is actively involved in advocacy at both the state and federal level. TORCH will work with the members of the subcommittee and offer guidance about exactly how and what it is that our members think the agency should be focusing on. Namely, improving the funding and staff support for its rural health programs and ensuring that the agency does take full advantage of its status as the designated State Office of Rural Health.

A couple of Tuesdays ago, we witnessed a fairly dramatic shift in the balance of power at our Nation’s Capitol as the Democratic Party took over leadership positions in both the House and the Senate for the first time since 1994. What this means for the healthcare industry or, more specifically, for rural healthcare providers has yet to be seen. However, since healthcare is in itself a somewhat populist issue, the changes may provide us with some additional opportunities to get beyond the appropriations process and to talk about the real healthcare needs of rural citizens and communities.
      However, the Democrats have first inherited all the same headaches that have plagued their GOP counterparts for the last five or six years. These problems have by no means become any easier to resolve since the 7th of November. Democrats must first fix some rather daunting problems before healthcare can be addressed, but at least it’s on the short list. The incoming House Ways and Means Chairman, Charles B. Rangel (D-NY), put it this way, "Nothing could please me more than to be the chairman that had tax reform, Social Security reform and health reform, but I have no clue as to what can really be accomplished until I see how serious people are in being willing to compromise.”
       In Texas, things have stayed pretty much the same. Democrats gained 5 seats in the House, but both houses and all of the statewide offices are still firmly Republican and the only major Congressional change happened to take place down in Tom Delay’s old district. If Tom Craddick manages to retain his current leadership position, it will likely remain business as usual in Austin. You should still expect some sparring between the Governor, Lt. Governor and the Speaker, but without the antics of the outgoing Comptroller, things will be a bit more relaxed. Susan Combs appears to be much more of a team player and who knows; maybe everyone will be singing Kumbaya before the next Session is over.

In January, we will be holding our 3rd Annual Rural Hospital Information Technology Workshop, only this year we’ve paired it with something else great; a one-day workshop on grant writing and funding opportunities:

• On January 9th, RHIT/07 will provide straight-talk and education about rural health I.T. policy and key technological advancements, as well as a place where hospital leaders and staff can feel comfortable asking the questions they have about I.T. planning and implementation. This annual meeting includes a number of I.T. programs that are currently being executed at rural hospitals in Texas and an in depth look at the state and federal policies that will influence our ability to keep pace with this rapidly evolving aspect of the healthcare industry. This is your best chance to network with other rural I.T. professionals, learn about some affordable options for Electronic Health Record implementation and catch a glimpse of the complex state and national planning processes that are helping pave the way for the digitally integrated future of rural health care. We encourage you to come share your questions, your thoughts and your experiences.
   
• Coming to our first Grant Workshop for Rural Hospitals on January 10th is sure to pay your hospital long-term dividends. Finding creative ways to support new, innovative programs or much needed capital improvements sometimes depend on your ability to attract funding from outside the organization. Governmental agencies, private foundations and even corporations can be a lucrative source of additional revenue for those who know the right way to request it. Our Grant Workshop for Rural Hospitals will begin with a session on Grantsmanship. You’ll learn the tricks of the trade from an experienced grant writer and learn how to communicate your needs in a way that yields real results. The rest of the day, we’ve assembled a team of folks whose job it is to give away money. You’ll learn what it takes to be successful when competing for money from HRSA, DSHS, ORCA and more.

With all the great speakers who have agreed to participate and discounted registration fees for attending both days, we promise you can’t miss! So join us at the Radisson Hotel on Town Lake in downtown Austin. For more information look for the bright yellow flyer or go to the events calendar at www.torchnet.org.

TORCH sent out a request for proposals for providing HCAHPS services to rural hospitals in the State of Texas on November 1st. As you know HCAHPS is CMS’ way of tying patient satisfaction directly to the Annual Payment Update starting in FY 2008.
      The RFP included the following information for certified HCAHPS vendors to consider:

• Purpose of the Request
• Scope of Work
• Medicare Admission Volume of Rural Hospitals in Texas
• Response Time Frame
• Proposal Information
• Proposal Content / Work Plan
• Final Report
• Selection Criteria

The two things we are looking for is a discounted rate for the survey completion, follow-up and reporting as well as the ability to get regular updates and benchmarking the survey results. Proposals are due back to TORCH by the end of the month. Texas Medical Foundation and the Rural Community Health Institute at Texas A&M are partners with us on this activity. We will keep you apprised. The results of the RFP process are expected to be announced sometime in December. The next “dry run” begins in March.

HHS Secretary Mike Leavitt recently called on employers throughout the nation to commit to four steps to improve health care quality and reduce health costs by improving information in the health care sector.
      Fundamental information about health care quality and costs of services is largely unavailable today to consumers, to payers, and to providers alike. Without this information, it is difficult to make informed choices and seek out the best quality at the most affordable price. This contributes to higher health care costs overall.
       "If we are going to get a handle on health care costs -- and we must -- we first need to know what our costs are and what we are getting for our money," Secretary Leavitt said. "Our nation's private employers are the major source of health insurance for Americans, and they can help us provide the information consumers need to achieve better value for their health care dollars."
       At a meeting of business leaders representing large and small companies nationwide, Secretary Leavitt said commitment to four “cornerstone” goals would lead to improved quality of care and lower costs:

• Standards for connecting health information technology, making it possible to share patient health information securely and seamlessly among health care providers.;
• Quality of care reporting, so that health care providers as well as the public can learn how well each provider measures up in delivering care.;
• Providing costs of health services in advance, so that when patients choose routine and elective care, they can make comparisons on the basis of both quality and how much of the total cost they will have to pay under their health plan.;
• Providing incentives for quality care at competitive prices, as in payments to providers based on the quality of their services, or insurance options that reward consumers for choosing on the basis of quality and cost.

Last August, President Bush signed an executive order committing federal health care programs to the four “cornerstone” goals. Medicare, the Veterans Affairs health system, the Federal Employees Health Benefit Program and certain other federal health care programs will begin delivering on the four goals in the coming year.
       Private employers are the largest source of health coverage for Americans. If a significant number of employers also commit to the four goals, common standards for health IT, quality measurement and cost reporting would quickly become the standard throughout the health care system.
      Standards to measure quality and cost are to be developed through consensus processes involving stakeholders from throughout the health care sector. In particular, standards for measuring quality of care must be led by the medical community, Secretary Leavitt said.
       By spring of next year, when payers put out their requests for proposals for 2008, the Secretary's goal is to have more than 60 percent of the marketplace include these cornerstones as a significant part of their purchasing criteria.
       An employer committing to the four "cornerstone" goals would collect quality and price information through its health plan or benefit administrator, using the consensus standards. Employers committing to the goals would also be encouraged to share quality and price information with regional collaboratives, where information from many sources could be aggregated, thus producing the most broad-based and reliable information possible. The employer or its health plan would share quality information with enrollees in the plan, and would provide information on costs, including the specific costs the enrollee would expect to pay under the plan.
       In this way, often for the first time, consumers would have the information they need to choose routine and elective care on the basis of quality and cost. Health care providers would likewise be provided quality and aggregated price information that showed how they compare with others. An advantage to providers would be more uniform methods of quality measurement, especially methods where providers play a leading role in the development of the measures.
       "This approach is about providing better information for everyone, up and down the health care system," Secretary Leavitt said. "Consumers and payers need this information, but physicians and hospitals need it just as much. That's where quality and value improvement will really take place."
       States will also be invited to join in the commitment to the four goals, both as employers and in their Medicaid programs. Secretary Leavitt also pledged to work with health care providers and health plans, unions, consumers and others in achieving the four goals. As a start, Secretary Leavitt said he hopes that 100 individual companies or more will sign up by the end of this year.
       More information is available at www.hhs.gov/transparency.

Excerpted from an article by Karen Garloch of the Charlotte Observer

Some seniors enroll in a plan, only to find out later it's not accepted by their doctor. Does that sound like a familiar story to you? If not, then you should definitely read on.
      When she reviewed Medicare prescription drug plans for 2006, former Mecklenburg County Commissioner Liz Hair, like many other seniors, chose Humana.
       Instead of buying a policy for drug coverage only, she took the advice of a Humana representative and bought Humana Gold Choice, a Medicare alternative that covers drugs, doctor visits and hospital stays, all in one.
       Later, when Hair tried to use her insurance card, she found that neither her hospital, Carolinas Medical Center, nor her hospital-owned doctor's office would accept the so-called Medicare Advantage plan.
       "I was just dumbfounded," said Hair, 86. "I didn't ask what hospitals it was good for. I had no inkling at all, or I wouldn't have done it."
       Like Hair, seniors across the country have been confused by the new Medicare Part D prescription plans. But the added option of Medicare Advantage further complicates the choice.
       "There's been misinformation out there," said Carla Obiol, director of the state's Senior Health Insurance Information Program. "It's been a huge problem."
Today, as seniors begin signing up for the second year of the Medicare prescription drug program, they need to research available plans to make sure they get the best, most cost-effective coverage.
      About 23 million elderly and disabled beneficiaries of Medicare enrolled in prescription drug programs in 2006. Of those, about 6 million, or 14 percent, chose Medicare Advantage plans.
       "If they are satisfied, they can stay with the plan (they already have), and they don't have to do anything," Obiol said. "If they have a substantial premium increase or if a drug they are taking is removed from the (list), then they will need to shop around."
       Hair resolved her predicament by sending a letter to Rep. Mel Watt, D-N.C., of Charlotte. A month ago, she got a call from a Medicare representative who said that, because of "special circumstances," Hair would be re-enrolled in standard Medicare without a penalty. She then bought a separate Humana drug plan.
       Obiol and her staff had to work for six months to extricate a Winston-Salem man from a Medicare Advantage plan that wasn't accepted by his doctors.
The disabled man is now back on standard Medicare, which agreed to pay claims retroactively.
       "He's frail, and it's going to take a lot to get those bills resubmitted," Obiol said. "It can be a very exhausting and costly situation if people sign up in error."
John Quinn, an independent insurance agent in Charlotte, said he sells Humana Gold Choice to customers in Gaston and Cabarrus counties, where most doctors and hospitals accept it.
      But he's disturbed by the push he's seen to switch Mecklenburg-area seniors to Medicare Advantage without making clear that Carolinas HealthCare doesn't accept it.
       "It's very misleading," Quinn said. "Agents are out there telling them they can go to any hospital or doctor they want."
       Humana spokesman Dick Brown said the company has tried to educate consumers about plan differences.
       "It is a concern that people are buying something thinking they can use it," he said. "Obviously, that's not something we would want to happen."
       Complaints about aggressive marketing by Medicare Advantage plans prompted the N.C. insurance commissioner to issue a warning last summer. "Some seniors are allegedly being advised to make decisions that may not be in their best financial interest," it said.