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

I remember when summer at the Washington State Hospital Association (WSHA) was a time for long, careful conversations with policy staff colleagues about the "Big Questions": Is there a better-not fairer, but better-way to take care of the uninsured? Is the system really as close to melting down as it seems to be? Are we better off with Democrat or Republican champions? (In those days we had plenty of both.) Would things be better for doctors or patients if we had more regional planning? Who can be trusted to assess and report on the value of new technology?

In those days, it often seemed like we could all be gone for a few days before any of you noticed…the phones almost never rang. Staff would clean their offices, dump material from the most recent legislative battles, reorganize their files, think, and listen.

No more. Maybe it's because my position has changed, but I think not. Yesterday I came back from Chelan to find a half-dozen e-mails from district folks who are on vacation (three of them overseas)-all looking for information they can send back to the hospital so the people there can answer other e-mails. Vacationing sure seems different now!

Here, several major pieces of work are underway. We are working with the Image Campaign's Steering Committee to determine the best next move. We have collected about three-quarters of the special assessment, meaning that we have a bit less than $750,000 in hand. A seizable chunk of this was going to be used for TV time-building a 30-second spot that could be shown primarily on cable, with some limited exposure on network broadcasts.

But as many of you heard in Chelan, our polling shows little room for improvement when it comes to public perception/opinion of hospital care in our state. That creates a bit of a dilemma for the campaign, but it seems-right now at least-to be a nice problem: you spend on TV to move opinion, but our numbers are so high it is not clear we can move them much no matter what we spend. And it seems very unlikely we'd move them with the budget we have.

The poll, however, suggests some areas for investment: the public wants to know more about what is being done to make hospital care better and our facilities safer. What seems most likely at this point will be a recommendation to the Steering Committee to use campaign funds for promoting the safety and quality improvement work being done in Washington's hospitals. If any of you have questions or concerns about this approach, please let me know right away.

We continue to monitor and advise you on the state's actions to implement the Certified Public Expenditure program that will replace several of the Disproportionate Share programs. The Medicaid folks are rushing to meet deadlines associated with the start of the new biennium-it all has a sort of "running with scissors" feel to me.

The Rural Healthcare Quality Network (RHQN) membership stepped up nicely to the network's need for a cash infusion. Now comes a new challenge-to ensure that the RHQN's work is coordinated with the demands from WSHA, the Centers for Medicare and Medicaid Services, and others for engagement and data on safety and quality performance efforts. I heard from many of you that your internal quality assurance and medical staff management resources are being stretched past capacity by all the demands. We will be working here to ensure that we identify and act in a coordinated fashion whenever that makes sense to our staff and to our contributors. Hang tight-I think this is only the crest of this wave!

Finally, I am happy to report that we have had several good conversations with our colleagues at the ports, utilities, cities and counties about the latest curve thrown our way by the state Attorney General. (See the lead item in "Snapshots" below.) We will be joining other local governments to seek a review of this unexpected new advisory and Dick Goldsmith will be leading this charge for us.

SNAPSHOTS

AWPHD sent a letter to Robb McKenna, the state Attorney General, expressing concern over 2005 Attorney General Opinion No. 4 (AGO No. 4). In this opinion, the Attorney General's Office takes the position that special districts are not legislative bodies and consequently don't qualify for the exemption under Section 42.17.130(1) of the Revised Code of Washington (RCW) to take a collective position on ballot measures. (See the May 2005 In Focus for more details.)

Jeff Mero, AWPHD's executive director, wrote to the Attorney General that AWPHD "is very concerned that [this opinion] will have a chilling effect on the ability of our commissioners to carry out their statutory and fiduciary responsibilities." He also pointed out that "AGO No. 4 fails to acknowledge that for more than a quarter-century, a large number of legal counsel to special districts around the state have interpreted the term 'legislative body' more expansively than this AGO and have advised their commissioners accordingly."

The next step: AWPHD will be commenting on AGO No.4 at a July 7th stakeholders' meeting convened by the Public Disclosure Commission (PDC). The PDC wants to discuss its recently-issued guidelines, which are based on this opinion, and we'll let you know the outcome.

Representatives from the State Auditor's Office (SAO) and the major CPA firms working with PHDs recently met to discuss how the PHD audit process could be more efficient and cost-effective for everyone involved. The meeting-organized and facilitated by AWPHD-took place immediately after the AWPHD Mid-Year Meeting in Chelan.

Among the topics addressed at this low-keyed but candid dialogue were auditing consistency between SAO regions, educating new SAO staff about auditing issues unique to hospitals, and improving communications between the SAO, PHDs, and the CPA firms assisting the districts. As a result of this meeting, AWPHD will act as a conduit for the flow of information between the SAO, the CPA firms, and the districts; the CPA firms have offered to help in the training of SAO personnel who will be auditing PHDs; and AWPHD will consider the introduction of legislation that would enable PHDs to submit financial information later than currently allowed. We'll keep you informed as these and other proposals from this meeting are implemented.

Participants were Kelly Collins, Alexa Johnson, Nestor Newman (SAO); Dave Sherwood (LeMaster and Daniels PLLC); Mike Bell, Konrad Capellar (Michael R. Bell and Company); Don Hansen, Eric Nicholson (Moss Adams LLP); Tom Dingus and Luke Zarecor (Thomas D. Dingus and Associates PLLC); and Dick Goldsmith, Jeff Uyyek (AWPHD).

When tragedy unexpectedly strikes a hospital, Mason General Hospital (Mason County PHD No. 1, Shelton) has found that group debriefings can help employees cope. The same day employees learned that a long-time colleague was murdered in a domestic violence incident, Mason General Hospital (MGH)'s administration, as well as its Nursing Education and Social Services Departments, brought in personnel from the hospital's Employee Assistance Service to talk with staff about the incident. Over 30 employees attended the successful debriefing.

Cindy Mortensen, MGH's Patient Resources Manager, also noted the hospital has held joint debriefings with other agencies when their staffs responded to the same traumatic event. She pointed out that organizations such as the Fire Marshal's Office often have a critical incident counselor who is experienced in conducting this type of debriefing.

If you'd like more information about MGH's debriefings, contact Cindy (cmortensen@masongeneral.com, (360) 427-9544).

A PHD's ability to offer tax credits to district taxpayers recently came under review by the SAO during its yearly audit of a Western Washington district. With information provided by AWPHD and a 1986 opinion letter from an Assistant Attorney General to one of the PHDs, the SAO agreed in principle that PHDs can offer tax credits to taxpayers who obtain services from the district; however, the district, among other things, must be able to demonstrate the program has a reasonable public purpose. So the SAO may be asking PHDs who have established a tax credit program to substantiate their decision. For example, an evaluation that the program would give "rate relief to taxpayers, as a relatively short program and for the purpose of inducing greater use of the hospital." As we learn more about the SAO review, we'll keep you posted.

In the last issue of In Focus, we briefly noted that North Valley Hospital's second attempt to pass a construction bond levy failed by the slimmest of margins: 1.61%. This election result-which would have been avoided had just 56 more "yes" votes been cast-is already having negative effects on Okanogan County PHD No. 4 beyond its hospital expansion and modernization efforts. On May 26th, the district's commissioners directed the administration to look at options for divesting the district of its nursing home and assisted living unit. (One option is to turn these facilities over to a 501(c)(3) organization.) Even though the hospital's "Critical Access" designation has improved its finances, those gains have not been enough to offset the considerable losses attributable to the 1997 Balanced Budget Act's poor reimbursement rates for long-term care.

Mark down Monday, August 15th as the date for AWPHD's web cast on the state's Public Records Act. Attorneys Angela Belbeck and Don Black of the Seattle firm of Ogden Murphy Wallace, PLLC will be the presenters. We'll send out more information about this web cast around the middle of July.

PEOPLE AND PLACES

Governor Christine Gregoire has appointed Sharon Cox, the Chief Executive Officer at Klickitat Valley Health Services in Goldendale (Klickitat County PHD No. 1), to the PHD Project Review Board. Sharon fills the seat set aside for a representative of PHDs with total annual revenues of $15 million or less.

Kittitas Valley Community Hospital (KVCH) in Ellensburg (Kittitas County PHD No. 1) was one of four hospitals in the nation to receive a 2005 Hospital Award for Volunteer Excellence from the American Hospital Association. KVCH was the winner in the Community Service Program category for its Patient Assistance Program, which helps low-income citizens with no prescription coverage obtain the medicine they need at no cost. This program, which began in 2001, is staffed by five volunteers who serve 175 patients at two locations.

Through "Creating Home and Building Community," Garfield County Hospital District has been developing a resident-and patient-centered approach to care in Pomeroy. The next phase in this program is "Extreme Makeover," a community forum in early July where patients and long-term care residents, their families, staff, regulators, vendors and other community members will consider design elements for improving the hospital's layout and design.

Olympic Medical Center in Port Angeles (Clallam County PHD No. 2) is starting the process to obtain a contractor for a $7.9 million hospital addition. The 32,322 square-foot addition, to be built in two phases over 15 months, will house administrative offices, resonance imaging, dietary services and cardiac services on its first floor. Part of the basement will be used for records storage and the remainder will be available for future expansion. (Peninsula Daily News, June 16, 2005)

NETWORK NEWS

Heart Failure Project

Thanks to the efforts of all the members' Quality Improvement (QI) personnel, the RHQN was able to shared aggregated 2004 baseline data at its member meeting in Chelan on June 27th. Each member also received a "dashboard report" on its individual activities, which the RHQN also will distribute to QI personnel at each hospital.

RHQN members should now begin sending in data for the 1st quarter of 2005.

Presentations

"Effective Smoking Cessation Counseling Strategies" will be the subject of a one-hour RHQN web cast on July 14th. The web cast will begin at 11:30 a.m. Because of the great interest in this topic, the RHQN is inviting all hospitals in Washington State to participate.

The RHQN-sponsored June 17th videoconference on "Meeting Minimum Standards for State Survey" was well attended. As soon as the RHQN receives a recording of the proceedings from Inland Northwest Health Services, the RHQN will make free DVDs available to members for showing at their facilities. (Members should contact Brad Vollegraaf at bradv@awphd.org to request a copy.)

Workshops

The RHQN will be holding Plan-Do-Study-Act (PDSA) workshops on August 19th and September 30th in eastern Washington. Details will be sent to members in the next few weeks.

RHQN Membership Brings Extra Value

RHQN members can get a 50% discount on an annual membership for the Washington Patient Safety Coalition. And there's an even better deal: join now and the $750 RHQN annual rate will buy 18 months of membership-through Calendar Year 2006. Information about the Coalition is available at www.wapatientsafety.org.

UPCOMING EVENTS

WSHA Annual Board Retreat
July 13-15 • Sun Mountain Resort, Winthrop
Contact: Lisa Rusk (206)577-1852

RHQN Smoking Cessation Web Conference
July 14 - 11:30 • Web Conference
Contact: Brad Vollegraaf (206)216-2550

Ventilator-Associated Pneumonia (VAP) and Central Line Infection Web Conference
July 18 - 12:00 • Web Conference
Contact: Carol Wagner (206)577-1831

PHD & WAH Workers' Compensation Trust Board Retreat
July 21-22 • Sleeping Lady Mountain Retreat, Leavenworth
Contact: Anita Badri (206)216-2553

WWRHCC Board Meeting
July 28-29 • Mason General Hospital, Shelton
Contact: Elizabeth Floersheim (206)577-1851

Rural Hospital Committee Retreat
August 11-13 • Davenport Hotel, Spokane
Contact: Melissa Waddell (206)216-2510

AWPHD Public Records Act Web Conference
August 15 - 12:00 • Web Conference
Contact: Wendy Ray (206)216-2516

AWPHD Board Meeting
August 17 - 10:00 • AWPHD Offices
Contact: Beionka Moore (206)216-2530

Workers' Compensation Regional Claims Meeting
August 19 - 9:00 • Radisson Hotel Gateway, Seattle
Contact: Anita Badri (206)216-2553

Workers' Compensation Regional Claims Meeting
August 20- 9:00 • Hallmark Hotel, Moses Lake
Contact: Anita Badri (206)216-2553

WWRHCC Board Retreat
August 25-26 • La Push
Contact: Elizabeth Floersheim (206)577-1851

The deadline for the next In Focus is: Friday, July 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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