FROM WHERE I'M SITTING...By jeff mero, executive director

I took the opportunity last week to go to Chicago for the 2004 National FLEX Conference. It's the first national meeting I have attended that focused on "critical issues" for Critical Access Hospitals. I learned a lot in two days, watching and listening as hospital executives, board members and a huge array of academic and consulting folks shared their wisdom about the new model. With about 200 people in attendance, there were voices from all over the country discussing emerging issues around network development, benchmarking and clinical outcome improvement.

Among the most informative sessions for me was one led by Mary Malone, MS, JD, Executive Director, Consulting Services, Press Gainey Associates. Ms. Malone concentrated on the future of customer service, and offered advice as we watch the Baby Boomers move into the health care system in a serious way. (Note to would-be rockers--Mick Jagger turns 61 on July 26.) Critical Access Hospitals start with a substantial advantage in customer satisfaction compared to hospitals as a whole. Malone's main message was best captured by Will Rogers: "Even if you are on the right track, you'll get run over if you just sit there."

Rogers' advice seems especially important as this Boomer--more precisely, this Boomer's spouse--faces the reality of an up close, prolonged and personal adventure in professional caring. Even in the most integrated of systems, it is difficult for anyone (inside the system or out) to coordinate visits to two specialists. The care we get is top flight (so far as we can tell), but the people caring for us are clearly stretched. Maybe that's as it should be (efficiency is a great goal, after all), but it is not reassuring. Individually and as a group, it is clear that our caregivers want to be "patient-centered." It is also clear, though, that their best intentions, while crucial, won't carry the day.

I left the meeting feeling very good about where AWPHD, WSHA, WHF and, most importantly, all of you stand as we look forward. Public hospital districts are uniquely positioned to organize and deliver safe, effective, patient-centered, timely, efficient and equitable care to their residents. We have the great luck to be part of the most important industry in the world. You save and restore the lives of families that have been torn apart by disease and injury. There is nothing more important. Nothing. As Yoda told Luke: "Try? There is no try. There is only do, or not do."

Financial Benchmarking Project for Critical Access Hospitals (CAHs) -- Jeff Uyyek

With 30 CAHs in Washington and more on the way, there is considerable interest in establishing financial performance benchmarks for them. While national efforts are largely focused on monitoring the effectiveness of the CAH program in maintaining access to care, Washington administrators and CFOs have expressed a need for more operational information-not only to illustrate differences in financial position, but also to identify operational differences that drive financial performance and to share best practices to the benefit of all CAHs in the state.

To that end AWPHD and the Office of Community and Rural Health in the state Department of Health (DOH) are funding a project that will begin capturing data and establishing benchmarks. The goals are to define a set of measures and establish a baseline for ongoing (annual) monitoring of CAH financial health and practices.

Larry Thompson from East West Consulting has been hired to perform the initial study, which is comprised of two phases. Phase I will compile 2002 DOH year-end financial data for CAHs and calculate financial indicators at the organizational and departmental levels. From this data-and with input from a group of CAH CFOs-variations in performance will be identified and two departments will be selected for more detailed analysis. Also during this phase, Larry will continue the work he did for DOH reviewing financial performance of Rural Health Clinics owned by CAHs and PHDs. Phase II will include a survey of CAHs for more detailed and current (2003) data so that an analysis of the drivers of financial performance variation can be performed and best practices identified.

We hope to have results to share by year's end. The idea is to start small, with a few departments, then build on the initial work over the next several years to where we have an annual review of overall organizational performance.

Larry will be in Chelan to provide an update on the project and get input from attendees to further refine the final product.

SNAPSHOTS

Unfortunately, Valley Medical Center (King County PHD No. 1) recently failed to gain the approval of the PHD Project Review Board (PHD Review Board) to use the General Contractor/Construction Manager (GC/CM) procedure for a public works project budgeted at nearly $75 million. But in acting as a "trailblazer," Valley's efforts should be instructive to other PHDs considering this alternative method of contracting.

In coming to the PHD Review Board, Valley was in a unique position-it had already completed its design and specifications work for a major remodel and an addition to its existing main hospital, a project to be completed in three phases.

The statute authorizing the GC/CM procedure states "Public bodies should select general contractor/construction managers early in the life of public works projects, and in most situations no later than the completion of schematic design." With this in mind, the PHD Review Board had discussed at a previous meeting-but had not yet formally adopted-a guideline that if more than 30 percent of the schematic design has already been completed, an applicant must justify why GC/CM involvement is still critical to the project's success.

Although it seemed that Valley made a strong case for bringing in a GC/CM, the PHD Board disagreed. While the PHD Review Board's decision was disappointing, there were indications during its deliberations that phases 2 and 3 of Valley's project-pertaining to surgery construction and remodeling-might be suitable "candidates" for a GC/CM. And the door was left open for Valley to resubmit an application if it so chooses.

The lesson learned: the earlier the GC/CM is brought into the project, the greater the value of the GC/CM. And the later you involve the GC/CM, the stronger must be your justifications that having a GC/CM is in the public interest.

The Joint Legislative and Audit Review Committee (JLARC) has begun its study of the advantages and disadvantages of the GC/CM procedure for the public sector in Washington State. With the ability to use this alternative contracting method set to end on June 30, 2007, the Legislature has asked JLARC-its research and analysis arm-to report its findings by January 2005. As part of its study, JLARC staff and consultants will be conducting interviews with public bodies that have used this procedure, as well as other public works "stakeholders." Although PHDs are newcomers to the GC/CM methodology, AWPHD will be closely monitoring the progress of this study and will update you as information becomes available.

Whether Initiative 864 (I-864)-Tim Eyman's move to cut regular local government property taxes by 25 percent-makes it on the November ballot will be known shortly; the deadline for submitting signatures is 5 p.m. on July 2nd. Given Eyman's earlier initiative successes, some city and county association officials initially were fatalistic-they were certain the initiative would obtain the required number of signatures. But with Eyman's attention focused on non-tribal gambling activities (Initiative 885), they're feeling somewhat hopeful that his signature-gathering efforts will fall short. (We're assuming that information about I-864 and other 2004 initiatives will be on the Secretary of State's web site days after the deadline passes. Everything you wanted to know about this initiative-and others, both past and present-can be found at http://www.secstate.wa.gov/elections/initiatives/statistics.aspx)

AWPHD's Legal Manual is being revised to reflect the passage of bills during the 2003 and 2004 legislative sessions. It's anticipated that the revisions will be available on-line sometime in August. The major changes you'll see pertain to the inclusion of information about alternative contracting processes for large public works projects-the GC/CM and design-build procedures.

The fall lineup of AWPHD educational programs will kick-off with a presentation on Conflicts of Interest--a major topic of discussion around the state. The program, which is under development, will be aimed at both commissioners and administrators.

Other subjects that are being considered include the impacts of anti-trust laws on PHD activities and an immigration law primer for recruiting foreign nurses. If you have topics that you think would be of interest to other PHDs, please e-mail your suggestions to Dick Goldsmith (richardg@awphd.org).

Between July 6th and July 22nd, Dick Goldsmith, AWPHD's director of legal services and health policy, will be visiting about 30 PHDs around the state. It's an opportunity for him to tour facilities and learn first-hand about your achievements and challenges, as well as how AWPHD can better meet your needs.

We look forward to seeing you at AWPHD's Mid-Year meeting in Chelan. This June 28th gathering starts promptly at 9 a.m. and is scheduled to end at 11:30 a.m.

PEOPLE AND PLACES

Snohomish County PHD No. 2's commissioners have appointed Dr. John Todd MD as Stevens Healthcare's president and CEO for a two-year period. Before taking over this post, he was the Senior Executive Director/Medical Director at Stevens.

The new COO at Valley Hospital and Medical Center in Spokane is Keith Baldwin. Previously, Keith was the CEO/Administrator at Samaritan Healthcare in Moses Lake (Grant County PHD No.1).

UPCOMING EVENTS

AWPHD Finance Committee Conference Call
July 15 • 2:00-3:00 p.m.
Contact: Wendy Ray (206)216-2516

WSHA Summer Board Retreat
July 15-17 • Sun Mountain Resort, Winthrop
Contact: Lisa Rusk (206)577-1852

WSHA Rural Hospital Committee Retreat
August 5-7 • Alderbrook Resort, Union
Contact: Johanna Bradford (206)216-2510

AWPHD Board Retreat
August 11-13 • Sleeping Lady Resort, Leavenworth
Contact: Wendy Ray (206)216-2516

UW Health Services Administration Finance Boot Camp for Board Members
August 14 • University of Washington, Seattle
Contact: Lori Jacobs (206)543-8778

RHQN Conference
August 18 • Davenport Hotel, Spokane
Contact: Barbara Hitzl (206)216-2512

PHD & WA Workers' Compensation Board Retreat
August 30-31 • Sleeping Lady Resort, Leavenworth
Contact: Anita Badri (206)216-2553

In Focus is a good way to showcase your PHD's achievements and announce major administrative changes. Just e-mail a brief article to Dick Goldsmith (richardg@awphd.org).

The deadline for the next issue of In Focus is Friday, July 23rd.