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

We are approaching crunch time in Olympia. The House Democrats will release their version of the budget on Wednesday, April 6th. That will signal the beginning of the final chapter for this legislative session-and none too soon in most people's judgment. There appears to be broad agreement in the House, Senate and Gregoire Administration about spending priorities and the balance between spending cuts and new taxes. Unless something unexpected occurs, it appears likely that the session will end on time, about three weeks from today.

The end of session will bring us all a bit closer to the impending public battle over medical liability. The legislature may or may not vote to adopt an alternative, but no matter what happens with "Plan B," I expect the summer and fall will be thick with rhetoric designed to promote people's fears and feed their suspicions. It's hard to imagine how we will come out looking better to the public whether we prevail at the polls or not.

That's one reason the AWPHD Board has authorized a special assessment for a public effort of our own. We'll make a significant investment over the next few months to ensure that people hear about more than "greedy lawyers" and "slipshod medicine." Thanks for your support.

Policy makers are beginning to tighten the reins on critical access hospitals (CAHs). From the MedPac Advisory Group to Congress to Governor Gregoire to the Legislature, there appears to be a concerted movement to close as many doors as they can find before any more hospitals can be designated as CAHs. Meanwhile, the designation is proving to be a mixed blessing, at least in some communities where one organization is operating both a CAH and a nursing home. The short story here seems to be that the limits on what a CAH can classify as costs is bringing the inadequacy of the state's nursing home payment system into sharp focus. Some very tough decisions are not far off, at least from what several of you have told me.

Meanwhile-hey, it's light now when I leave work! Make time to get outside and stretch your muscles and your mind. You'll be glad you did!

SNAPSHOTS

As the Legislature moves through its next cut-off dates (April 1st for policy bills and April 4th for fiscal bills to move out of committee), we can't get you a full assessment of where all the legislation impacting AWPHD members currently stands: it will take a few days for the smoke to clear and the results to be posted on the Legislature's website. However, Substitute Senate Bill 5146, AWPHD's quality improvement bill, sits in the House Rules Committee, awaiting a vote on the floor of that chamber. Although valiant and determined efforts were made to move Substitute House Bill 1341 and House Joint Resolution 4202 out of the Senate Government Operations and Elections Committee-bills which would have enabled the larger PHDs to invest in corporate bonds and equities-those actions were ultimately unsuccessful.

The State Auditor's Office (SAO) recently asked AWPHD to review a draft of the SAO's 2005 Annual Financial Reporting Package for Hospital Districts. In turn, we thought it would be helpful to both the SAO and our members if a representative sampling of chief financial officers and outside auditors for the PHDs were able to comment on this document.

"In house" reviewers were Mike Bernstein and Jeannine Grinnell (Valley Medical Center, Renton, King County PHD #1), Doug Bishop (Whidbey General Hospital, Coupeville, Whidbey Island PHD), Annette Edwards (Odessa Memorial Healthcare Center, Lincoln PHD # 1) and Terry Litke (Samaritan Healthcare, Moses Lake, Grant County PHD #1). Don Hansen (Moss Adams LLP, Everett), Tom Dingus (Thomas D. Dingus & Associates PLLC, Spokane) and Mike Sonner (LeMaster & Daniels PLLC, Spokane) were the outside auditors who looked over the package. AWPHD offers its thanks for their efforts on our members' behalf.

The SAO has reviewed their comments, made revisions to the package, and will be mailing it out to PHDs next week. According to Kelly Collins, the SAO's hospital audit manager, the information will clarify current requirements, not impose additional ones.

If you're facing a labor shortage that may require you to look outside the country for health care professionals, Jannell Prentice (Office of Community and Rural Health, Washington State Department of Health) suggests you go to the following websites for information about hiring foreign nationals:

• www.cgfns.org The Commission on Graduates of Foreign Nursing Schools is authorized to do visa credentials assessment certification not only for registered and licensed vocational nurses, but also for physical therapists, speech-language pathologists and audiologists, medical technologists, medical technicians, occupational therapists, and physician assistants.
• www.cgfns.org The Washington State Department of Health has information on hiring J-1 physicians.
• workforcesecurity.doleta.gov/foreign/wages.asp This U.S. Department of Labor website has information on prevailing wages for foreign labor certification.

So far, no one has applied to fill the seat on the PHD Project Review Board set aside for a representative of a PHD that has annual revenues equal to or less than $15 million. (Please see last month's In Focus for details.) The Governor's Office contacted AWPHD and asked that we continue to publicize the vacancy. Applicants, who must be experienced in public works or commercial construction, can obtain an application on-line at www.governor.wa.gov/boards/default.htm and should apply by April 13th. For PHDs looking for ways to build large public works projects without having to resort to the traditional "design-bid-build" method, this board is the body that must give approval to the district to use the General Contractor/Construction Manager procedure, an alternative method of construction contracting.

March election results were mixed for PHDs. Lincoln County PHD #1 (Odessa Memorial Healthcare Center) achieved 78.25 percent approval for a special levy of $147,000 ($1.03/$1,000 of assessed value). Voters in Okanogan County PHD #4 (North Valley Hospital, Tonasket) weren't as supportive of its bond levy to build a new addition to the hospital: only 58.32 percent approved this proposal. (A shift of about 58 votes would have given the district the margin it needed.) However, the district's commissioners just voted unanimously to run the levy again on May 17th.

For those of you who haven't run a "mail-in only" election, Warner Bartleson, North Valley's CEO, has advice that may help you turn out voters: during the voting period, you can get a list from the county auditor of voters who have mailed in their ballots. (In King County, we've heard a printout is available on a daily basis. We suggest that you check with your county auditor about availability and cost.) According to Warner, this ability to track ballots enabled one of the area's school districts to get the votes necessary to pass its levy.

The deadline for "Leading Wisely, Living Well," AWPHD's retreat for CEOs and Administrators only, is fast approaching. Registrations must be faxed by Friday, April 15 to Beionka Moore at (206) 283-6122. If you have questions, please can call her at (206) 216-2530.

PEOPLE AND PLACES

Dr. Michael Luce, chief of staff at Dayton General Hospital (Columbia County PHD) was the recipient of the 2005 "Outstanding Washington Rural Health Physician of the Year" award. Washington State Secretary of Health Mary Selecky bestowed the award on Dr. Luce at the 18th Annual Northwest Regional Rural Health Conference in Spokane. Described as an outstanding diagnostician and gifted teacher, Dr. Luce has practiced medicine in Dayton for more than 25 years and displayed "exceptional professionalism, wisdom, innovation and dedication."

Beth Williams Gieger is the new administrator of Inter-Island Medical Center in Friday Harbor (San Juan County PHD). Beth, who has been in health care for 20 years, may be familiar to PHD members: prior to arriving at Inter-Island, she was the clinical administrator for Orcas Island Medical Center, which is under the fiscal management of Island Hospital (Skagit County PHD #2), and was in administration at United General Hospital in Sedro Woolley (Skagit County PHD #304).

Bill Russell, the administrator at East Adams Rural Hospital in Ritzville (Adams County PHD # 2), will be resigning his position effective May 22.

United General Hospital is expanding its facilities and services: a new on-campus building to house outpatient services and physician offices is being added; MRI services were recently established and a new 16-scan CT is being purchased; its respiratory therapy services were increased with the addition of a new pulmonary function laboratory (the only one of its kind in a three-county region); and its North Puget Oncology clinic is being remodeled to make room for a new linear accelerator and CT simulator.

NETWORK NEWS

The RHQN is ready to start the first of three proposed quality improvement efforts. Over the last two weeks, the RHQN sent its members a letter about its heart failure project, outlining the project's requirements and proposed timeline. Members who didn't receive the letter or have questions should contact Jackie Huck (jackieh@awphd.org, 206-577-1821).

Among the measures identified for targeted intervention are documented discharge instructions (areas to be addressed include activity level, diet, discharge medications, follow-up appointments, weight monitoring, and actions to take if symptoms worsen); documented smoking cessation counseling/advice; and the prescription of Angiotensin converting enzyme inhibitors (ACEIs) and Angiotensin receptor blockers (ARBs) for patients with left ventricular systolic dysfunction.

To reach consensus on the intervention strategies that will be used, the RHQN will convene an advisory committee to examine the intervention tools that are available. Member hospitals that have had success with a particular intervention strategy should submit it to Jackie for inclusion in the committee's review. If a staffer of an RHQN member would like to serve on the advisory committee, he or she should contact Jackie as soon as possible.

To assist those hospitals that have not been collecting any data on heart failure, Jackie can provide an abstraction tool that can be used to do retroactive chart abstractions as well as concurrent abstractions.

UPCOMING EVENTS

AWPHD Finance Committee Meeting
April 5 - 2:00 p.m.• Conference Call
Contact: Wendy Ray (206)216-2516

RHQN Board Meeting
April 8 - 10:00 a.m. • Conference Call
Contact: Brad Vollegraaf (206)216-2550

WSHA Executive Committee Meeting
April 15 - 12:00 noon • WSHA Office, Seattle
Contact: Lisa Rusk (206)577-1852

WWRHCC Member Meeting
April 22 • Enumclaw Community Hospital, Enumclaw
Contact: Elizabeth Floersheim (206)577-1851

WHF Heroes in Health Care Awards
May 5 - 4:30 p.m. • Westin Hotel, Seattle
Contact: Heather Pitre (206)577-1848

WHF Healthy Communities Colloquium
May 6 - 9:30 a.m. • Westin Hotel, Seattle
Contact: Nikki Lac (206)216-2529

AWPHD Administrator Retreat
May 11-12 • Sleeping Lady Resort, Leavenworth
Contact: Beionka Moore (206)216-2530

AWPHD Board Retreat
May 12-13 • Sleeping Lady Resort, Leavenworth
Contact: Beionka Moore (206)216-2530

Wash. State Hospice & Palliative Care Organization Spring Conference
May 12-15 • DoubleTree Hotel, SeaTac
Contact: Christine Grace (425)290-8739

WWRHCC Member Meeting
May 20 • Mason General Hospital, Shelton
Contact: Elizabeth Floersheim (206)577-1851

WSHA Rural Hospital Committee
May 26 - 10:00 a.m. • WSHA Offices, Seattle
Contact: Kristen Michal (206)281-7211

WSHA Board
May 27 - 9:00 a.m. • WSHA Offices, Seattle
Contact: Lisa Rusk (206)577-1852

Want to tell others about a recent event at your PHD but don't have the time or staff to write an item for In Focus? If an article was published in your local paper, just send us the story (noting the paper's name and date of publication) and we'll extract the information for you. The deadline for next month's In Focus is Friday, April 22nd. Send articles or information to Dick Goldsmith (richardg@awphd.org, Fax: (206) 577-1897, 300 Elliott Avenue West, Suite 300, Seattle, WA 98119-4118.

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