The TMSI Board of Directors has selected a successor to Mr. Larry Krupala. Rob Madsen comes to TMSI with over 23-years of experience with the for-profit activities of the Illinois Hospital Association. Rob is also an experienced insurance executive. He is a Licensed Property and Casualty Producer and an Associate in Risk Management (ARM). Rob recently worked as a consultant to the TORCH Insurance Program Manager, HealthSure, Inc., in Temple, Texas.

Rob and his wife, a business executive at Walgreens, are currently residing in the Dallas/Fort Worth area. Rob has a Master of Science in Industry and Technology; Safety, from Northern Illinois University, in De Kalb, Illinois and a Bachelor of Science in Education; Safety, from the University Of Wisconsin in Whitewater, Wisconsin. He is also a big Green Bay Packers fan, but we aren’t going to hold that against him just yet.

Rob is passionate about the benefits that associations provide to their members and he is extremely excited about working with TORCH. He plans to go out and visit with each and every rural and community hospital member in 2008. His knowledge about the opportunities for TMSI to succeed combined with the administrative expertise of Larry and the rest of the staff at TORCH will surely help move the organization forward.

Larry will soon be assuming a part-time role with TMSI as of January, but he plans to continue to assist rural and community hospital boards with their strategic planning and other consultative needs. We want to acknowledge Larry for the tremendous contribution he has made to TMSI and all rural hospitals through his hard work and commitment to the success of each and every hospital that requested assistance during his tenure.

Rob can be reached at 512-873-0045 or you can email him at rob@torchnet.org.
 

The entire Texas Medical Board (TMB) and its officials have been named in a lawsuit filed by the Association of American Physicians and Surgeons (AAPS). The complaint, filed the last week in December in District Court in Texarkana, accuses the board of misconduct while performing its official duties, specifically:

• Manipulation of anonymous complaints;
• Conflicts of interest;
• Violation of due process;
• Breach of privacy; and
• Retaliation against those who speak out.

“The situation has reached the crisis point for patients and doctors,” said Jane M. Orient, M.D, Executive Director of AAPS. “Our members are too afraid of retaliation to sue the Board as individuals.”

The lawsuit specifically points out misconduct by Roberta Kalafut, the Board president. The law suit claims that Kalafut “arranged for her husband to file anonymous complaints again other physicians, including her competitors in Abilene…” She then “…worked inside the TMB, with other defendants, to discipline doctors based on anonymous complaints filed by her physician husband.”

The lawsuit also charges that Kalafut and Donald Patrick, Executive Director, knew about the conflict of interest of Keith Miller while he was Chair of the Disciplinary Process Review Committee. Miller served as plaintiffs’ witness in at least 50 cases brought before the Board without disclosing that to the disciplined doctors or the public.

During a marathon 11-and-a-half hour legislative hearing about the Texas Medical Board on October 23, 2007, Kalafut and Patrick admitted under oath that they were aware of the conflicts of interest.

“It seems clear from the sworn testimony before the legislative committee that they knew about the problems and had done what they could to hide them,” said Dr. Orient. The lawsuit demands that the Court put an immediate stop to abuses by the Board, and that previous disciplinary actions tainted by the Board’s violations be re-opened.

“Doctors in Texas should not be forced to practice in this atmosphere of fear and intimidation,” said Dr. Orient. “Complaints from our members have identified the TMB as probably the worst in the country. It’s bad for patients when their doctors are afraid that doing the right thing could result in licensure action.”

Many hospitals are concerned about the length of time that it currently takes the Texas Medical Board to issue physician licenses. However, you may not be aware that there is a process by which the Office of Rural Community Affairs can help speed the process. The key is ‘Form Y’, the Affidavit for Expedited Handling.

Statute requires that the board expedite applications by persons who submit an affidavit with the application stating that: 1) the applicant intends to practice in a rural community; or, 2) the applicant intends to practice medicine in a medically underserved area or health professional shortage area, designated by the United States Department of Health and Human Services, that has a current shortage of physicians. (Section 155.1025(a), Occupations Code)

Rural communities are designated by the Office of Rural Community Affairs (ORCA). Medically underserved areas (MUAs) and health professional shortage areas (HPSAs) are designated by United States Department of Health and Human Services.

If your practice area qualifies, ORCA and/or DSHS will email verification to you and TMB. If you do not have an intended practice address yet, ORCA and/or DSHS will email an acknowledgment that you intend to either work in a designated area or serve a designated area.

To find out if your intended practice area qualifies as a MUA or HPSA, please email the Texas Department of State Health Services (DSHS) a request to research the address to TexasPCO@dshs.state.tx.us. To find more about this process or to find out if your intended practice area is considered a rural community, please email Rebecca Valenzuela, Program Specialist with ORCA at rvalenzuela@orca.state.tx.us.

Form Y is found at www.tmb.state.tx.us/professionals/physicians/applicants/licforms.php

Mail the form with your signature as soon as possible to the Texas Medical Board (TMB). Both this form and verification from DSHS or ORCA are required before your application will be assigned to a licensure analyst and flagged for expedited handling.
 

President Bush signed H.R. 2764 into law just after Christmas. The bill appropriates over $555 billion dollars worth of new federal spending. However, the President got a parting shot in to Democratic leaders by including an official signing statement that was highly critical of the continued use of earmarks. Commonly referred to as pork-barrel spending, earmarks have historically been used to fund ‘pet projects’ for many members of Congress. This year, over 9,800 earmarks added some $10 billion in additional spending to the federal budget.

The tables have turned however as transparency begins to come full circle. The federal government is now having to live by some of the same standards that healthcare providers have been compelled to meet in recent years. There are two very interesting websites that now give you a more complete picture of how the federal government spends its allowance. Also, federal agencies are subject to an effectiveness rating system similar to Hospital Compare. Here is a quick rundown on both:

The new www.USAspending.gov (a relaunch of an earlier website called FederalSpending.gov) provides citizens with easy access to government contract, grant and other award data. The Federal Funding Accountability and Transparency Act of 2006 (Transparency Act) requires a single searchable website, accessible by the public for free that includes for each award:

1. The name of the entity receiving the award;
2. The amount of the award;
3. Information on the award including transaction type, funding agency, etc;
4. The location of the entity receiving the award;
5. A unique identifier of the entity receiving the award.

Also, www.ExpectMore.gov was developed by the U.S. Office of Management and Budget and Federal agencies. Together, they assess the performance of every Federal program and are accountable for improvement. They use a standard questionnaire called the Program Assessment Rating Tool, or PART. The program rating indicates how well a program is performing, so the public can see how effectively tax dollars are being spent. Unfortunately, this process accounted for the termination of both the State Planning Grant Program and the Healthy Community Access Program.

Of course, we still don’t have a hand on any purse strings at the federal level, but the government does seem to be acknowledging the idea that the public should have the same open access to information about them as they do about us.
 

As members of TORCH, you once again have the opportunity get a free copy of the 2008 TORCH Rural and Community Hospital Annual Salary Survey. Each year, participating hospitals receive a wealth of information about salary levels for staff positions throughout their organizations and best of all, it’s completely free. All you have to do is participate.

The notice of survey was mailed to all TORCH member hospitals in December. 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 have the most complete and accurate analysis possible, it is important that as many hospitals as possible complete the necessary survey. The deadline for information to be submitted to Human Resources Health Care consultants has been extended to February 15th.

For more information or a copy of the survey instrument, contact Joe Rogers at 254-778-9455, crogerjr@hot.rr.com or the TORCH office at 512-873-0045.

The RCH Protect Cooperative the self-funded workers’ compensation program that was created back in 1992 has had a long and successful run. However, the workers’ compensation market in Texas has become increasingly “soft” and highly competitive in the last few years. The soft pricing has driven many of the current members to accept insurance from outside the cooperative.

The RCH Board of Directors has decided not to provide coverage as of January 1, 2008. The pool will continue to pay claims that come in for hospitals that have participated in the pool up to 12/31/07 and for the remaining pool members during the first 60 days of this year to allow time to seek quotes from other carriers. The pool is sufficiently funded to pay off all of its ongoing obligations.

We truly appreciate the many years of dedicated service that both the members and advisors have invested in this effort. RCH Protect provided rural public hospitals in Texas with a competitive insurance option at a time when many hospitals were being challenged with locating adequate coverage for their employees. RCH Protect made a positive impact by increasing the competition in the marketplace and supporting the needs of many TORCH-member hospitals.

The 2008 TORCH Annual Conference and Trade Show is coming and you will soon be receiving the Program Agenda and Registration Materials by mail. In this era of increasing disclosure and transparency, you can either try to hide from the changes or embrace them. This year’s annual meeting will encourage you to use these new responsibilities to your best advantage and make a positive impact on your community at the same time.

Never before has there been a better time to showcase the ability of rural hospitals to provide exceptional services and promote rapid improvement at all levels. Being smaller isn’t a bad thing. Consider the term ‘lean and mean’ and take it to heart. We’ve invited experts on the Studer Principles and Lean Six Sigma to help you employ these models in your own facility. Couple that with the excellent education you’ve come to expect on rural hospital advocacy, finance and operations and it is clear why this is a ‘must see’ event.

Our biggest Trade Show ever means more time to spend with the vendors who are committed to your success and excited to showcase their programs and services to you and your colleagues. The Intercontinental Hotel will be rolling out the red carpet for their 10th opportunity to host the Texas Conference of Rural and Community Hospitals. Make your plans now to come to Addison on March 18, 19 & 20. Come be a part of our biggest event of the year and we’ll have you saying, “Up, up and away!”

This is probably the only time every four years when people in Texas care what anybody in Iowa or New Hampshire is thinking, that’s because it is Presidential primary season once again. And as it has been for many years, in this hyped-up, instant-access world that we now live in, the Texas primaries won’t take place until two full months after Iowans have all returned from their caucuses and gone back into hibernation.

Last legislative session saw repeated efforts by lawmakers to make the Texas primaries more meaningful by moving them up in the year, but to no avail. We still must wait for the month of March to roll around until we can validate what 40 other states have already decided. Some might say that the Republican and Democratic parties have already decided internally who they want their respective candidates to be. However, to not have a meaningful vote on the matter is sort of like not having a date for the prom, but going anyway.

For being one of the most populous states, we are still a month behind our biggest competitors, New York and California, which both hold primaries on the most universal date the first Tuesday in February. It is time for our state legislators to give Texans a voice and to come to some agreement on a new primary date. This is one occasion when it doesn’t pay to be fashionably late. Voter turnout rarely goes up if the electorate feels that their votes don’t make any difference.

By the way, Texas holds an open primary, which means that voters of any affiliation may vote for the slate of any party. The voter registration deadline for the March 4th primary in Texas is February 4th, so you still have a month to see if those who aren’t fortunate enough to live in Texas have decided who’ll be at the top of each party’s ticket.

Sandra Mann of Brownwood Regional Medical Center is the first recipient of the TORCH and the West Central Texas WorkForce Development Board educational scholarship. Ms. Mann is a student in the Radiography Program at Hendrick Medical Center and is a 10 year member of the staff at the hospital. She is a full time employee and supports her family while continuing her education. Matt Maxfield, CEO of Brownwood Regional Medical Center, stated in his recommendation that she is “a strong and valued employee and has the respect of her co-workers as a team player. She is seen as a high performer and would be a worthwhile candidate for any program of her choosing.”

This scholarship program was developed to provide assistance to employees striving for improvement. Ms. Mann’s accomplishments are outstanding and we were pleased to make this award to her. Providing financial assistance for training opportunities to attract and retain productive employees is one of the ways we can support our member hospitals and their mission to provide access to health care in rural Texas. We are pleased to work with the WorkForce Development board in Abilene on this initiative.

The National Rural Health Association (NRHA) recently announced the final selections for the 2008 Rural Health Fellows Program. After the completion of a competitive review process, twelve fellows were selected to participate in this year-long, intensive program aimed at developing leaders who can articulate a clear and compelling vision for rural America.

“We are very pleased to announce this new class of fellows as this program enters its second year. Once again, this class represents various levels of rural healthcare expertise, “With the successes achieved by the 2007 class, we look forward to continuing the tradition of building rural healthcare leaders through this valuable program,” said Alan Morgan, NRHA CEO.

Fellows will gain valuable insights and build critical skills in three primary domains:

• Personal, team, and organizational leadership;
• Health policy analysis and advocacy;
• National Rural Health Association governance and structure.

We are pleased to announce that David R. Pearson, MPA, FACHE, President/CEO Texas Organization of Rural Community Hospitals, has been selected for one of the twelve fellowship positions this year. The start of the program coincides with the NRHA Rural Health Policy Institute in Washington, DC, later this month.

The board discussed a number of important items at their last meeting of 2007. As you know, the primary objectives of the year-end meeting are to approve a budget and strategic plan for the upcoming year. However, there were several other important topics covered also.

The budget that was adopted for 2008 will continue to solidify our financial stability as well as allow for TORCH to invest in initiatives that emerged during the strategic planning process for TORCH, TMSI and the Foundation. A publication that includes the 2008-09 strategic plan and our 2007 Annual Report to the members will be distributed at the upcoming Annual Conference. David Pearson, President/CEO, will be providing an overview of the strategic plan during the conference in March.

As TORCH begins to develop its legislative agenda for 2009, the board has directed the staff to determine the value and level of commitment that members have to increase access to care in rural areas by allowing hospitals to employ physicians. A survey will soon be distributed to test the attitudes of both the hospitals and physicians who are currently in residency training programs. Please complete and return the hospital survey as soon as possible once you receive it.

The Board also supported two leadership changes that were recently approved by our subsidiaries. CHFTX (which will soon be named The TORCH Foundation) approved the appointment of Quang Ngo as their President/CEO. Quang, who is Director of Project and Fund Development for TORCH, assumes this leadership of the foundation from Larry Krupala. Rob Madsen was named the new President/CEO of TMSI as of January 1. Additional details about Mr. Madsen are included in this edition of Frontline.

The Board also agreed to appoint the chairs of TMSI and the Foundation to the TORCH Board, support the Texas A&M School of Rural Public Health administrative residency program, decrease out-of-state hospital member dues by 50%, and a study of the dues structure for TORCH Corporate Members.

The TORCH Board was clear in it’s optimism about a bright future for TORCH and it’s subsidiaries and resolute in their determination to have a strong organization to support and advocate for all rural hospitals.

The Dallas-Fort Worth Hospital Council (DFWHC) announced last year that its Board of Trustees had named W. Stephen (Steve) Love as the organization’s President and Chief Executive Officer. Love succeeded John C. Gavras, who retired from the Council after 31 years of service.
Love, 56, most recently was Senior Vice President and Chief Financial Officer for Triad Hospitals, Inc., in charge of planning and implementing the company’s overall financial strategies including compliance with all Sarbanes Oxley (SOX) regulations, while supervising financial activity of the company and setting accounting policies and procedures.

In his position at Triad, he was also leading a team responsible for developing and implementing the insurance and risk management program for the company including general and professional liability, employee liability and workers compensation.

In late December, representatives of TORCH, TMSI and the TORCH Foundation met with Mr. Love in Austin. The groups discussed several areas of commonality and services that might reasonably be shared back and forth. We look forward to working with Steve and appreciate the support of John Gavras and DFWHC over the years.

The TORCH workers’ compensation group purchasing program available to hospitals through Texas Mutual Insurance Corporation has steadily increased in membership its first full year of operations. This program provides affordable premiums, up-front discounts and dividends to those who purchase coverage through this group which has been formed solely for hospitals. For more information, please call Brant Couch at Healthsure, the TORCH Insurance Program Manager, at 888-665-1539 or pass information and the number on to your local insurance agent.