The word Transparency conjures up multiple images and concepts, but its application to the healthcare industry is still somewhat unclear. Hospitals, physicians and other providers are being asked to supply more and more information about outcomes, quality and prices to consumers and payors. Your ability to analyze the results and then to improve your resulting performance will not only determine the future success of your hospital, but also the industry as a whole. Our willingness to participate and communicate our active involvement in these efforts is rapidly becoming the new standard by which we are being judged.
      Rural and community hospitals have always been uniquely positioned to make quick and meaningful changes when state and federal regulators alter the rules in the middle of the game. This year’s TORCH Annual Conference will bring together experts in the field who can help you plan for a more transparent future and bring clarity to your board members and staff on exactly what adjustments this ever expanding concept will soon require. Only then can you be sure that you have adequately prepared your hospital for the openness that is destined to arrive.
      Be sure to make yourself visible by attending this year’s TORCH Annual Conference and Trade Show. This conference is your best opportunity to learn the critical information you need to be an effective rural hospital administrator and community leader. As always, our agenda was developed based on the input that the association staff receives from our rural hospital members. Therefore, you can be sure that the topics will be timely and relevant. Make your plans now to be in Dallas from April 3rd through the 5th at the Hotel Inter-Continental Dallas, 15201 Dallas Parkway, Addison, Texas 75001. The phone number to the hotel is 972/386-6000. Please keep in mind that this year’s conference will run Tuesday through Thursday. Call and make your reservations today.

The Board of Directors for the Texas Organization of Rural & Community Hospitals is proud to announce that David Pearson, CHE, MPA, was selected to be the new President/CEO of TORCH. The Board of Directors is the official governing body for TORCH and consists of 21 hospital administrators from across the State of Texas.
      David Pearson was previously the Vice President of Advocacy and Communications and has been with the organization for the past five years. David will continue to remain very involved in TORCH’s state and federal advocacy initiatives.
      James Buckner, the current TORCH Board Chairman, said, “Our future depends on strong leadership and enhancing our efforts to work collaboratively with other healthcare-related associations and providers. David will do just that.”
Pearson assumed his new responsibilities on December 4th and he stated, “I am proud to follow in the footsteps of our esteemed founder, John Boff. I look forward to working with our talented staff and all of our members to improve the position of the rural and community hospitals throughout Texas.”

As usual, the list of issues facing the Texas legislature, advocates and the citizens of Texas is very long. There are more than a few new faces this year and with changes at both TORCH and THA, we are optimistic about the possibilities. Hospitals have grand ambitions to talk about the need to increase healthcare coverage and reform Medicaid at a time when the state has some real money to play with. However, we must not get sidetracked by the myriad smaller changes that will happen along the way.
      On a phone call recently some rural advocates were quick to point out the difference between little ‘a’ advocacy and big ‘A’ Advocacy. Being an advocate does mean making contact with your elected officials when you receive an alert, but it also means taking every opportunity to Address All of the rural issues that Affect your community. Both are useful, but Advocacy in the larger sense is what TORCH and its members need to be striving for.
      We would like to invite you to the TORCH Rural Hospital Advocacy Day on February 13 & 14. Come help us to make a good impression and begin your journey to becoming a true Advocate. Show your love for your local community by spending Valentine’s Day at the Texas Capitol. Call the Radisson Hotel and Suites in Austin to make your reservations 512/478-9611. We’ll handle all the details, all you have to do is get here and Advocate.

As members of TORCH, you once again have the opportunity get a free copy of the 2007 TORCH Rural and Community Hospital Annual Salary Survey. All you have to do is participate. If you haven’t already done so, you’ve just received the gift of time. The deadline for information to be submitted to Human Resources Healthcare Consultants has been extended to January 31st.
      The notice of survey was mailed to all TORCH member hospitals on December 5th. In keeping with the past, data on the wage and salary levels for 81 different employment positions will be collected and analyzed as well as salary and other information on the CEO/Administrator position. All of the information collected is treated as highly confidential.
      In order to create the most complete and accurate analysis we can, it is important that as many hospitals as possible complete the necessary survey. For more information or a copy of the survey instrument, contact Joe Rogers at 254-778-9455 or contact the TORCH office. Please help us to exceed last year’s record breaking participation. Submit your information ASAP.

There are 180 hospitals participating in the program this year, 120 urban and 60 rural. With the last reporting quarter (discharges/data from 2Q 2006) the overall Appropriate Care Measure (ACM) score is 82.5% for hospitals in the award program. This is an increase from 80.0% reported in 1Q 2006. The rural hospital ACM has increased 5 percentage points from a year ago.
      With the 2Q 2006 data, there are 63 hospitals (51 urban and 12 rural) who have attained the level of improvement to win an award. 36 of these 63 hospitals have maintained their goal for 2 consecutive quarters. 4Q 2006 data is the award determination data/period. This data is not due to QNet until May 15, 2007, so the official announcement of winners, including medial tool kits and ceremony, is tentatively scheduled for July 2007.
      You can visit the award website at http://award.tmfhqi.net/ to obtain basic info about the program (criteria, timeline, etc). As always, you can contact Lori Brandes, RHIA, CPQH, with your questions about the Texas Health Care Quality Improvement Award Program. Her telephone number is 512.334.1699, email lbrandes@txqio.sdps.org.
      The Texas Health Care Quality Improvement Award program for Texas hospitals is being sponsored again by TMF Health Quality Institute (TMF). TMF, the Medicare quality improvement organization for Texas, established the awards program in partnership with the Texas Organization of Rural & Community Hospitals, Texas Hospital Association, Texas Medical Association, and Texas Osteopathic Medical Association.

The Texas Health and Human Services Commission (HHSC) is launching an effort to take a strategic look at ways to improve Medicaid.
      “When we step back and look at where we are in Texas, we see a great deal of interest in this issue and many common goals ― providing more options for covering the uninsured, improving the quality of services, and strengthening support for health care providers,” said Health and Human Services Executive Commissioner Albert Hawkins. “I believe we have a great opportunity to transform and improve the way health care services are delivered in this state.”
      The effort will involve multiple health and human services agencies. Several HHSC staff members will support the Medicaid reform effort and direction will be provided by an executive steering committee. Besides identifying and analyzing reform options available to Texas, the reform team will provide support for Medicaid-related issues during the 80th Texas Legislature.
      Up to this point, Texas has been a trailblazer in stretching the boundaries of Medicaid, leading the way by incorporating many of the elements other states are now developing and implementing. Among those is the expansion of STAR, the managed care service now available in almost three quarters of Texas. Similarly, STAR+PLUS is also expanding to more markets in Texas. Other notable improvements include preferred drug lists and expanded community-based long-term care options that promote independence for older Texans and those with disabilities.
       HHSC has created a new website to track the progress of the Medicaid reform effort. The site includes a link where those who are interested can sign up for e-mail updates. Go to www.hhs.state.tx.us/medicaid/reform.shtml.

After a thorough review of over 20 different HCAHPS vendor proposals, TORCH is pleased to recommend two different options for our members to choose from. Our lowest-cost option is offered by a company called J.L. Morgan and Associates. The other TORCH recommended vendor based on the proposals that were submitted is Press Ganey Associates. These results were corroborated by the Rural Community Health Institute at the Texas A&M University Health Science Center who assisted in both the development of the initial RFP and the final selection process. Together, we feel that TORCH members will benefit from both the quality and value of the services that these two experienced vendors can provide.
       J.L. Morgan is based in Birmingham, AL, and is currently providing HCAHPS and real-time patient satisfaction information to rural hospital clients in Texas as well as Georgia, Louisiana, Arkansas, Tennessee, Oklahoma and South Carolina. J.L. Morgan utilizes the ‘telephone only’ survey methodology and they will offer their ‘real time’ patient satisfaction program to TORCH member hospitals at no extra charge. J.L. Morgan has offered coordinated assistance to hospitals wishing to take place in the next ‘dry run’ and be a liaison for the hospitals in dealing with CMS throughout the reporting process. Discounted fees include a one-time database set-up fee of $125 (discount of 37.5%) and a monthly service fee of $213.15 (discount of 13% off) for a total annual amount of $2,682.80 regardless of size. If interested, please contact Jeff Morgan at 205-408-8774 or jefflmorgan@aol.com.
      Press Ganey is a well regarded company which has been providing patient satisfaction measurement services to hospital clients since 1985. The company recently became certified to assist hospitals in collecting, reporting and analyzing data from the HCAHPS survey process. Press Ganey has already assisted over 1,200 hospitals meet the HCAHPS requirements and has a good track record with all types of hospitals which have participated in their more well-established measurement programs. Their annual Compass Awards recognize hospitals nationwide for the most significant and sustained improvement in overall patient satisfaction. Press Ganey has offered a tiered discount price based on bed size: CAH $2,550 per year; 1-50 beds $3,555; 51-100 beds $4,950; and $6,750 for 101 beds or greater. If interested, please contact Tracy Wilson at 800-816-9504 or twilson@pressganey.com.
      Both companies have pledged to offer staff support and training to help TORCH hospitals fully implement HCAHPS and analyze their results so that they may use the data to improve future outcomes with their customers’ inpatient hospital experience. Based on price and value you should consider using either J.L. Morgan or Press Ganey for the upcoming year.
Don’t miss the ‘Introductory Sessions’ with each of our recommended vendors planned for this week via teleconference:

• J.L. Morgan and Associates, January 24th at 1:00pm. Call 866-409-4300, 8730045#. Please follow these directions to join the session and see the online demo by J.L. Morgan:

Browse to www.meetingbridge.com/guest from any web-connected computer and enter your Participant Code (8730045).
Enter your contact information and click 'Login' to connect to the web conference.

• Press Ganey Associates – January 26th at 1:00pm. Call 866-803-5712, 3464641031#. Please follow these directions to join the session and see the online demo by Press Ganey:

Click the following link to see more information about the training session, including its agenda, or to join the session. Join the session. Click here...

Remember to check out the brand new Marketplace Newsletter. This new TORCH sponsored publication is a better way for you to stay abreast of the latest product offerings and new services that TORCH Corporate Members and Endorsed Vendors have to offer. This focused newsletter will highlight some of the unique arrangements and fruitful partnerships that vendors have formed with rural and community hospitals.
      We hope that you will enjoy this new effort to keep you informed about the many money-saving programs that are out there just waiting to be discovered. We will print the next edition as soon as we have enough information to warrant a new issue. Please let us know what your think of the newsletter’s format and content. If you have an idea for a new member service, please contact the TORCH office at 512-873-0045.
      Look for the Marketplace in your inbox soon. We’re officially open for business!

For those who got their kids back in school in time to attend TORCH’s first educational opportunities of the year, they got way more than they bargained for. TORCH had attendees from all over the country, due to the quality of the speakers who agreed to assist our member hospitals in better understanding the world of technology and then giving them the knowledge to go after the dollars to pay for it.
      We want to thank everyone who came and made these events a success. Information Technology and Grant Writing are very technical topics, and we appreciate our many talented speakers for making their presentation both instructive and useful for the busy CEOs, CFOs, I.T. professionals and grant writers who were in the audience. Be sure to continue to refer to our Grant Line newsletter for the latest in funding opportunities and technical writing tips available free to TORCH member hospitals. Also, TORCH, the Community Hospital Foundation of Texas (CHFTX) and the Alliance will continue to work to make technological improvement projects affordable and accessible to the rural and community hospitals in Texas.

The Dean of the School of Rural Public Health (SRPH) at the Texas A&M University Health Science Center, Ciro V. Sumaya, M.D., recently announced that Kevin Reed, TORCH General Counsel, and David Pearson, TORCH President/CEO, have been added to the school’s External Advisory Board. John Boff was one of the board’s original appointees and a long-time member.
      The SRPH faculty and administration relies on the External Advisory Board and its members to provide background and leadership in public health. The membership is composed of strong, influential public health leaders that bring a wealth of knowledge and guidance to the school. Kevin and David were selected based on their focus and experience in issues dealing with the health of rural communities. Members are asked to help the SRPH identify individuals and organizations that can partner with the school through its students, faculty and programs.
      Contributions to the John F. Boff Endowed Fellowship Fund at the SRPH are still gladly being accepted. Please make your donation payable to the HSC Foundation, and send it to the Texas A&M University Health Science Center, School of Rural Public Health, 1266 TAMU, College Station, TX, 77843. More information on the School of Rural Public Health can be found at http://www.srph.tamhsc.edu/.

The 110th Congress convened on Thursday, January 4, 2007. The House of Representatives spent the first few days passing a series of rule changes including ethics reform, the requirement to disclose the sponsor of an earmark (or members' pet projects), and the addition of a spending restraint measure known as PAYGO, or pay-as-you-go. Under PAYGO, any new spending for mandatory programs such as Medicare or Medicaid must be offset by spending cuts elsewhere, or tax increases. This change imposes new fiscal restraints. The Senate Democratic leadership has proposed a similar requirement via legislation, and will likely implement PAYGO as a change to the Senate rules later this spring.
      Meanwhile, Democratic leaders are finishing up what they are calling their first "100 hours," dedicated to six legislative priorities. Two priorities of interest to health providers and the research community are: expanding stem cell research and negotiating lower prescription drug prices in the Medicare program:

• The House passed legislation on Thursday, January 11th, that would allow federal funding for stem cell research involving embryos under certain conditions. The Senate is expected to pass a similar bill. The President has vowed to repeat his veto of a similar measure that passed the House and Senate last year.
   
• The House passed legislation on Friday, January 12th, that would require government negotiation of Medicare drug prices. The Senate is expected to give the administration more flexibility and simply allow the government to negotiate prices. The 2003 Medicare overhaul law that created the drug plans did not allow any government negotiations.

The Dems have also vowed to try and fill the ‘donut hole’ in the Medicare Part D Drug Benefit Program. However, that change would require a substantial amount of new funding and it is highly unlikely that there will be enough PAYGO laying around to make it happen.
      Meanwhile, CMS has decided to go ahead with planned administrative cuts to the Medicaid program totaling nearly $4 billion. The change would have "a significant economic impact on a substantial number" of health care providers, the Bush administration acknowledges. At issue are financing arrangements between states and local governments or IGT’s. These deals tend to increase Washington's share of spending in Medicaid, the joint state-federal program covering 55 million poor and disabled people, even when a state's share is unchanged or drops.
      Lastly, it has been suggested that Congress may opt to fund the entire FY 2007 federal budget with a continuing resolution. This would allow the Democrats to avoid the highly partisan process of trying to pass the 12 remaining spending bills. The good news is that funding levels for many rural health programs would remain at the fairly decent FY 2006 levels, but this rather unorthodox manner of dealing with the appropriations process will only delay the inevitable.