At the 2007 Annual Membership Meeting, elections were held to determine who will serve in seven of the positions on the TORCH Board of Directors. TORCH is pleased to announce that five incumbent members of the TORCH board were elected to serve another three-year term. They are Joyce Crumpler of Bowie, Thalia Munoz of Rio Grande City, Mike Morris of Bellville, Chuck Norris of Gonzales, and Jan Reed of Electra. In addition we are happy to welcome Grady Hooper, CEO of Smithville Regional Hospital, and John Henderson, CEO of Childress Regional Medical Center, as the two newest members elected to the TORCH Board. Grady and John will be replacing Doug Langley, CEO of Coleman County Medical Center, and Steve Summers, CEO of Wise Regional Medical Center in Decatur. Doug and Steve left the board due to term limits. We heartily appreciate Doug and Steve for their years of dedicated service to the organization. All of the board members elected at the TORCH Annual Meeting will begin their new terms of office on July 1st. Congratulations!

The final rule adopting the NPI as the standard unique health identifier for health care providers was published on January 23, 2004, and became effective on May 23, 2005. All covered entities must be in compliance with the NPI provisions by May 23, 2007. Compliance means in part that the NPI must be used by covered entities to identify providers on all HIPAA covered transactions that call for health care provider identifiers.
       Covered transactions that require a health care provider’s identifier that are transmitted containing only legacy identifiers or containing both legacy identifiers and NPIs would be noncompliant.
      With the May 2007 deadline just ahead, HHS has received a number of inquiries expressing concern over the health care industry’s state of readiness. In response, the Department believes it is particularly important to outline its approach to enforcement of HIPAA’s NPI provisions. The Department will continue to provide technical assistance to the industry and issue guidance on the NPI provisions and compliance requirements.
      The Secretary has delegated to the CMS Administrator authority to enforce the electronic transactions, code set, security, and identifier provisions of HIPAA. CMS will focus on obtaining voluntary compliance and use a complaint-driven approach for enforcement. When CMS receives a complaint about a covered entity that appears to allege a failure to comply with a non-privacy administrative simplification provision of HIPAA, it will notify the entity in writing that a complaint has been filed.
      Following notification from CMS, the entity will have the opportunity to 1) demonstrate compliance, 2) document its good faith efforts to comply with the standards, and/or 3) submit a corrective action plan. HHS may not impose a civil money penalty where the failure to comply is based on reasonable cause and is not due to willful neglect, and the failure to comply is cured within a 30-day period.
For a 12 month period after the compliance date (i.e., through May 23, 2008), CMS will not impose penalties on covered entities that deploy contingency plans (in order to ensure the smooth flow of payments) if they have made reasonable and diligent efforts to become compliant. In determining whether a good faith effort has been made, CMS will place a strong emphasis on sustained actions and demonstrable progress. A covered entity may end its contingency plan at any time prior to May 23, 2008, but not after that date.
      In the remaining time before the May 23, 2007, deadline for all covered entities, HHS encourages those covered entities to intensify their efforts toward achieving compliance with the NPI requirements. Although compliance with the NPI is a huge undertaking, the result will be greatly enhanced electronic communication throughout the health care community. HHS plans to reassess industry readiness on the May 23, 2007, compliance date, and throughout the 12 month contingency plan period. For more information or to apply for your NPI, go to www.cms.hhs.gov/NationalProvIdentStand.

TORCH-endorsed vendor, Optio® Software, has signed a contract with Trinity Medical Center in Brenham, TX with their EHR solution suite -- Optio QuickRecord® Suite. The solution will be integrated with Trinity’s MediTech hospital information system as well as other supporting clinical applications to provide users with a complete automated health record that includes single sign-on access to all current and historical patient information. Trinity’s contract also includes forms automation, electronic signature capture and chart deficiency management technology, which can be easily accessed by authorized users, both inside and outside of the hospital.
      Trinity Medical Center joins Gonzales Healthcare Systems, Matagorda General Hospital and Hamilton General Hospital as the fourth facility since the TORCH endorsement in April 2006 to take a leadership role in deploying an electronic health record for their staff and the communities they serve.
For info, contact Robb Litvak at rlitvak@optiohealthcare.com or 678-458-0050.

The HHSC Office of Inspector General (“OIG”) recently issued Provider Self-Reporting Guidance to encourage providers to voluntarily investigate and report matters involving the possible fraud, waste, abuse, or inappropriate payment of funds under state administered programs. Recipients of funds administered through the state’s health and human services programs, including the Medicaid program, have an ethical and legal duty to insure the integrity of their dealings with such programs (Title 1, Texas Administrative Code (TAC), Chapter 371).
      This duty includes an obligation to take measures to detect and prevent fraudulent, abusive, and wasteful activities, as well as circumstances that result in the incorrect payment of funds, and to report those activities when discovered. It also promotes the OIG’s expectation that providers implement specific procedures and mechanisms to examine and resolve instances of non-compliance with program requirements. It is the OIG’s intention to endeavor to work collaboratively, and not adversarially, with providers who choose to proceed in accordance with the letter and spirit of this Guidance.
      The OIG’s Provider Self-Reporting Guidance is intended to facilitate the resolution only of matters that, in the provider’s reasonable assessment, potentially violate criminal or civil laws and/or material violations of the administrative rules governing the state’s health and human services programs, including Medicaid. Matters involving other overpayments or errors should be brought directly to the attention of the claims administrator that processes claims and issues payments for the particular program.
      The OIG will not make firm commitments as to how a particular self-report will be resolved or the specific benefit to the self-reporting provider, nor is the OIG bound by any findings made by a provider through its compliance program. However, making full disclosure of non-compliance to the OIG at an early stage will generally allow the provider to work with the OIG toward a better result for the provider than if the OIG discovered the matter independently. One potential benefit is the possibility of avoiding or decreasing penalties.
       To read the guidance issued by the OIG on March 19th in its entirety, go to oig.hhsc.state.tx.us/OIG_home.aspx and click Provider Self-Reporting Guidance at the top of the left-hand menu.

The Private hospital Upper Payment Limit program is a brand new UPL program in Texas. CMS approved the program last September, and the Health and Human Services Commission finalized the rules in late March. This program is designed to extend the benefits of other UPL programs to the for-profit and not-for-profit hospitals in Texas.
      The UPL concept is that local tax dollars can be considered a State funding eligible for the Federal matching portion of Medicaid. The Federal portion is about 60% of each Medicaid dollar. This means that $1 of local government money can be transformed into $2.54 of Medicaid funding. This shift of local dollars to the State is called an inter-governmental transfer (IGT).
       There are distinct differences between this program and the public and TORCH rural public hospital UPL programs. The most significant being the source of the State funds used to initiate the Federal matching process. While public programs require that the IGT comes from a governmental entity, the private UPL requires that the IGT comes from an entity with the power of taxation. The other important point is that the UPL payments received by private hospitals cannot be transferred directly to the entity that made the IGT. The final issue is that while most rural providers have a smaller UPL capacity, the larger (often urban) providers may have a very large UPL capacity, where there are significant dollars available.
      The obvious question then is why any governmental entity would want to transfer this money, and can they legally transfer money without a benefit. An example would be an existing County that pays $100,000 of indigent claims, with almost all of it going to one facility. The County could transfer $75,000 of this money to the program, and the private hospital would now receive $190,500 of funding. The private hospital can agree to provide for or pay up to the first $125,000 of indigent care services for the County. In this method both entities are way ahead.
      What if the local government did not have an indigent payment issue? There could be other services that the local community may want or need such as a new physician or other needed services. This same method can be used to help fund these needed services, whereby the local governmental funding goes a little further than it would have otherwise gone. The overall goal is to create a win-win situation for both the public and private hospitals.
      The CMS approval authorized funding back to the State fiscal year ending in 2006, but has implemented a deadline of May 31, 2007, for letters of intent and affiliation. The CMS approval process indicated that the total funding would be approximately $1 billion. During the inaugural funding cycle in April, 64 facilities in Texas participated in the private UPL program.
       As you can see, this program is now up and running and it is already bringing financial benefits to hospitals that heretofore were unable to qualify for UPL. Brandon Durbin is currently working with private and public facilities throughout Texas to maximize participation in this important new program. The legal work is being performed by Fletcher Brown of Davis & Wilkerson. For more information please contact Brandon at 806-791-1591 or Fletcher at 512-482-0614.

The FCC has initiated a pilot funding program to facilitate the creation of a nationwide broadband network dedicated to health care, connecting public and private non-profit health care providers in rural and urban locations. Based on past experience under the current Rural Health Care program, the FCC estimates that approximately $55-60 million will be available for the pilot program in Funding Year 2006, and again in 2007. The pilot program will pay up to 85% of the costs incurred to deploy a dedicated broadband healthcare network.
      A collaborative effort among several institutions and organizations in Texas including TORCH, UTMB, Texas Tech HSC, Texas A&M HSC, and others seeks funding to establish a dedicated network to connect rural communities, increase access to care, and provide support for new technology. To meet this objective, the Texas Health Information Network for Communities (THINC) collaboration plans to extend the state-funded fiber optic network, currently dedicated for research and education (LEARN) for universities and academic health care centers, to rural healthcare providers to increase connectivity and grant access to Internet2, National LambdaRail (NLR) and more.
      Creating a statewide network for health care providers in Texas will improve access to health education for providers and patients and will provide accessibility to healthcare services via the internet (i.e. telemedicine, data sharing, EMR, remote pharmacy). In addition, funding from the FCC’s Rural Pilot Health Care Program will provide support for the highest level of healthcare to every Texan, rural or urban, by using existing and new resources, technology, and organizations.
      In addition, CHFTX is sponsoring a separate, cooperative FCC proposal that would expand the capacity of some Alliance members to allow them to better utilize high bandwidth applications such as PACS. CHFTX is also working with the St. David’s Healthcare Partnership in Austin and a company called Tandberg, a manufacturer of high-end televideo systems, to submit a funding proposal to the USDA under the Rural Utility Services program. Thank you to everyone who has taken the time to provide information and/or letters of support. Grant recipients will be announced in the next couple of months.

For more than five decades leadership training has been a key component of every organization’s developmental plan. And for just as long that leadership improvement has often been not much more than “high-level management” training. There is a difference.
      Too often we do not distinguish between leading and managing. Certainly every leader is called upon quite often to manage. In fact, it is a sure bet that no one operates in “full leader mode” 100% of the time. Part of her work has to be managing, rather than leading.
      The same is true of managers. Every one with management responsibilities must sometimes step up and apply his or her leadership skills, especially in a fast-paced environment like a hospital.
• Knowing when to lead and when to manage is not that difficult. But building equal confidences in both those skill sets—managing and leading—can be difficult. However, you can do it!
• Several factors can expedite one’s knowing when to lead and when to manage and doing either confidently. These factors include:
Knowing the difference between Managing and Leading as well as how (and when) the two actions complement one another.
• Identifying what situations call for one to go into Leader mode...and how it may benefit one’s hospital if he or she leads (rather than manages) more often.
Distinguishing and continuously improving leadership skills and attributes, such as:
+ Communicating at several levels
+ Developing leader’s vision from manager’s observation
+ Stimulating commitment among the people one leads.

TORCH is offering a training workshop to help you explore and develop those factors. On Thursday, May 17th, Tim Wright, MBA and President of Wright Results, will facilitate “Discovering Your Inner Leader.” This hands-on workshop experience will help you become more familiar with your leadership attributes and able to call them out more often.

The meeting will be held on May 17, 2007, at the Crowne Plaza Hotel (formerly the Red Lion) in North Austin. For more information, call 512-873-0045. This workshop is designed for hospital department heads, supervisors, and other key staff members.

Congratulations to the following Administrators on receiving Fellow Status in the American College of Healthcare Executives as of the 2007 ACHE Congress:

Wally Boyd, FACHE, Perryton
Thomas Cammack, FACHE, Jacksonville
Jack Endres, FACHE, Athens
Neal Kelley, FACHE, Luling
Nancy Kinkler, FACHE, Kenedy
Norm Lambert, FACHE, Borger
Michael McAndrew, FACHE, Sulphur Springs
Evan Moore, FACHE, Snyder
Pat Murray, FACHE, Kerrville
Theron Park, FACHE, Dumas
Bob Pascasio, FACHE, Anahuac
Chris Stipe, FACHE, Quitman
Steve Summers, FACHE, Decatur
Daryle Voss, FACHE, Bay City
Jonathon Wade, FACHE, Plainview
Pat Wallace, FACHE, Athens