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

September has always seemed like the beginning of the year to me, and this year is no exception. We are getting ready to elect new leadership at our October membership meeting, our 2006 budget will be proposed to the Board on the night before, and we have new programs taking shape in every corner of the office. Beionka Moore and Dick Goldsmith engineered what sounded like a great educational forum for public hospital district foundations; the evaluations were very good and I expect a follow-on meeting may well occur next year. Thanks, too, to Dave Campbell, Leigh Bacharach, Megan Guido, and Joan Baird Glover for their commitment to developing the agenda and making sure the presentations were on target!

As I write this we are in the middle of a series of media training workshops (if only we were training the media…sigh…) to support the incredible efforts going on around the state to improve quality and increase patient safety. The response to those workshops and to the public campaign you all funded has been really exciting to see. I am looking forward to more good work on that front later this fall.

We have had strong positive reaction already to the two-day seminar on public construction we will host in Ellensburg on November 3rd and 4th. We've put together a great faculty and it looks to me as if they are going to respond to my challenge that we make this a comprehensive learning experience.

The first ads around the medical liability battle are showing up on television here in the Seattle market. It appears that those who are hoping for a real bare knuckle campaign will not be disappointed. On a related note, I was happy to get a message this week describing what seems like a remarkable recovery for Washington Casualty. Congratulations to the staff there, and to all the members who stuck with them over the past few years.

I sat with the rest of the WSHA Policy Team earlier this week and listened to a presentation by Steve Hill, who now heads up the state Health Care Authority. Steve was extremely well prepared and quite cordial. He also has an enormous task ahead of him-find some way to reduce the surge in state health care spending. At the moment he is very focused on the power that lies in promoting "evidence-based medicine." His path into the debate was an interesting one: "We have an access problem because we have a cost problem. Health care is too expensive for many to afford. We have a cost problem because we provide too much care that has unproven benefit. If we can stop paying for care that provides little or no value, the state can save a lot of money and make care more affordable for everyone else." It will be interesting to see where that path leads!

Hope to see all of you next week!

SNAPSHOTS

AWPHD's Annual Membership Meeting takes place at 8 a.m. on Thursday, October 13th, in conjunction with the Washington State Hospital Association's 73rd Annual Meeting at the Bell Harbor International Conference Center in Seattle. AWPHD's meeting will be held in the Conference Center's Sound Room and is scheduled to last until 9:15 a.m.

PHDs with annual revenues of up to $40 million should be especially interested in AWPHD's Small Hospital Construction Workshop, November 3rd-4th in Ellensburg. Thursday's session-under the umbrella of "Strategic Planning to Funding"-addresses such topics as assessing community need and demand, physical plant needs and evaluation issues, architect options, capital/project cost estimating, new revenue assumptions, operating efficiencies, financing, and finalizing the plan. Guiding you through these preliminary construction phases will be Jody Carona (Health Facilities Planning and Development, Seattle), Dave Franklund (KDF Architects, Yakima), Dan Harden (Harden Financial Services Inc., Seattle) and Mike Bell (Michael R. Bell & Company, Spokane).

Friday's session will cover such "after funding" stages as construction team selection, project delivery methods for public entities, contract acquisition, the construction process, and construction close-out. In addition to presentations by Dave Franklund, Dan Chandler and Court Olson (Olympic Associates Company, Seattle), and Ted Coulson and Greg Guedel (Foster Pepper & Shefelman, Seattle), there will be roundtable discussions on equipment planning, moving in, legal pitfalls, and sustainable design.

The workshop brochure was recently mailed out to AWPHD members and is also available online at awphd.org. For more information contact Wendy Ray (206-216-2516, wendyr@awphd.org)

AWPHD is looking for a chief financial officer from a mid-sized PHD (a district with annual revenues in the neighborhood of $30-$90 million) to serve on an association committee to improve state audits of PHDs.

The committee's work will include reviewing proposed changes to the State Auditor's Office (SAO) reporting package; providing assistance in the training of SAO staff who will conduct PHD audits; and helping AWPHD put together a member survey to evaluate how SAO audits are being conducted. The committee also will meet annually with SAO representatives during the WSHA Rural Hospital Summer Workshop in Chelan.

The yet-to-be named committee is currently composed of representatives from CPA firms that work with PHDs; it's important that the perspectives of CFOs from the small, mid-sized, and large PHDs are heard. (Potential committee members from small and large PHDs have already been identified.) Except for the Chelan meeting, the bulk of the committee's work will take place through conference calls and e-mails. If your CFO would be interested in participating in this important activity, please have him or her contact Dick Goldsmith (206-216-2528, richardg@awphd.org) by October 15th.

Your district may be able to reduce its Microsoft software licensing costs if it qualifies to participate in a volume licensing agreement between the State of Washington and Microsoft. To learn about this program for public entities, contact Tara Larson (425-705-5200, tarala@microsoft.com)

AWPHD members' facilities were the highlights of the annual Legislators' Rural Health Care Tour, which traveled by bus from Spokane to Walla Walla and back again September 7th through 9th. Dayton Community Hospital (Columbia County PHD), Garfield Community Hospital in Pomeroy (Garfield County PHD), Pullman Regional Hospital (PHD No. 1-A of Whitman County), and Whitman Hospital and Medical Center in Colfax (Whitman County PHD No. 3) were among the health care facilities (hospitals, clinics, research labs and classrooms) visited.

Many of the legislators, legislative staff, and agency representatives on the tour were visiting these health care facilities-and rural communities-for the first time. The legislators also held meetings with local health care providers to learn more about community health care needs and concerns. Major issues brought to their attention included the lack of access to dental care and mental health services (especially mental health services for children) for the uninsured and low income in these communities; the increase in use of methamphetamine among rural communities and its impact on the delivery of local health care services; inadequate reimbursement for hospitals with nursing homes; and the competition between Washington and Idaho border communities for health care providers and services.

Western Washington Representatives Eileen Cody, Pat Lantz, Dawn Morrell, Judy Clibborn, and Tami Green were on the entire tour; all but Representative Lantz (an attorney and head of the House Judiciary Committee) are nurses. Senator Mike Hewitt and Representatives David Buri, Bill Hinkle, Don Cox, John Serben and Maureen Walsh visited facilities and/or attended meetings when the tour traveled to their districts. Although Secretary of Health Mary Selecky and Health Care Authority Administrator Steve Hill had intended to be on the tour, pressing concerns in Olympia prevented their participation. Charlotte Hardt of the Eastern Washington Area Health Education Center was the tour coordinator.

AWPHD's PHD Foundation Conference-Opportunities and Challenges-was a big hit for the 67 attendees at this first-time event. The crowd was 33 percent more than the Steering Committee had expected and according to the after-conference evaluations, people want another conference next year.

AWPHD's thanks go to the Conference's speakers: Brad Berg (Foster Pepper Shefelman, Seattle), Dixie Coggins (Strategies 360, Seattle), Bev Court (Office of Community and Rural Health, Department of Health), Sarah McKinstry (Seattle Office of U.S. Senator Patty Murray), Katharine Sanders (Washington Health Foundation), John Anderson (HealthCare Fund Development Consultants, Inc., Merrimac, Wisconsin), Erin Tomlinson (Kennewick General Hospital Foundation), Dave Campbell (Samaritan Healthcare Foundation, Moses Lake), Megan Guido (Pullman Regional Hospital Foundation), and Leigh Bacharach (Mason General Hospital Foundation, Shelton).

And the conference wouldn't have been the success it was without the efforts of the Steering Committee: Foundation staffers Dave Campbell, Leigh Bacharach, and Megan Guido; Kittitas County PHD No. 1 Commissioner Joan Baird Glover; and AWPHD staff members Beionka Moore and Dick Goldsmith.

SPOTLIGHT: EMPLOYMENT AND LABOR LAW

Editor's note: Sparked by a comment from Mark Barglof, administrator at Odessa Memorial Healthcare Center (Lincoln County PHD No.1), In Focus asked attorney Julie Kebler, chair of the Employment, Labor and Immigration Practice Group at the Seattle firm of Foster Pepper & Shefelman, if she would periodically write a short piece answering an employment or labor law question posed by one of our members. She graciously agreed and this is her first column. Questions for future issues should be submitted to Dick Goldsmith (richardg@awphd.org) and Julie will respond to those likely to be on the minds of many AWPHD members.

Can an employee take FMLA leave in six minute increments?

The Family and Medical Leave Act (FMLA) allows employees to take FMLA leave on an intermittent or reduced schedule basis, meaning that they can take separate, sporadic blocks of leave. While there is no limit on the size of an increment of leave, the Code of Federal Regulations [Title 29, Section 825.203(d)] states that "an employer may limit leave increments to the shortest period of time that the employer's payroll system uses to account for absences of leave, provided it is one hour or less." So, if your payroll system can track leave in six minute increments, it would be possible for any employee to take FMLA leave for that period of time. Of course the underlying question is why is the employee taking leave in such small increments?

In a May 2004 Opinion Letter, the U.S. Department of Labor (DOL) confirmed that "If the medical certification does not provide a basis for the timing of the intermittent absences the employer may request a recertification…" For example, if a medical certification indicated the need for intermittent leave two or three days a month due to migraine headaches and the employee had a pattern of taking this leave on Mondays and Fridays (the first and last day of his/her work week), the employer could ask for a recertification. DOL went on to counsel that the employer-when "requesting medical certification or recertification"-may inform the health care provider that the employee has a pattern of Friday-Monday or apparent excessive absences, and that the "…employer who has observed such a pattern of potential abuse may ask the health care provider, as part of the certification (or subsequent recertification) process, if this pattern of absence is consistent with the employee's serious health condition."

Remember that the medical certification process can be a key tool in addressing suspected FMLA abuse.

PEOPLE AND PLACES

Larry Hutcheson and Don James, formerly the interim administrators at Adams County PHD No. 2 (East Adams Rural Hospital, Ritzville) and Grant County PHD No. 3 (Columbia Basin Hospital, Ephrata), respectively, are now the administrators of these districts.

The September 20th election both brought joy and sadness to AWPHD members. For Chelan County PHD No. 1, the election resulted in 70.2 percent of the voters approving an $8.8 million bond issue to renovate Cascade Medical Center in Leavenworth. However, voters dealt a disheartening blow to Grays Harbor County PHD No. 1 when they failed to approve a $16.5 million bond issue to build a new hospital to replace Mark Reed Hospital in McCleary. Plaguing the Grays Harbor vote was an error in the County Auditor's Office that initially resulted in Elma area residents getting an incomplete ballot or no ballot at all.

Over 200 people joined in the September 1st groundbreaking ceremony for the $87.8 million addition to Skagit Valley Hospital in Mount Vernon (Skagit County PHD No. 1). Included in the three-story building (220,000 square feet), which will more than double the size of the hospital, are a larger Emergency/Trauma unit, a state-of-the-art Surgical Services Department with six operating rooms, and expanded space for Critical Care. Among the speakers was Congressman Rick Larsen, who along with U.S. Senator Patty Murray, helped the hospital and the City of Mount Vernon obtain $2 million in federal transportation funds for infrastructure around the building. The addition is scheduled to open in Fall 2007.

Three AWPHD members are among the 11 recipients of 2005 Rural Health Leadership Grants from the Washington Health Foundation. Receiving two-year grants each totaling $50,000 are Prosser PHD No. 1 for its Parental and Infant Learning Opportunities and Nurturing (PILON) Program; Skagit County PHD No. 304 for its Chronic Conditions Outreach Program; and Garfield County PHD for its Garfield County Accounting for Health Challenge.

Skagit County PHD No. 304 also has other news to share: the district's hospital-United General Hospital (UGH) in Sedro-Woolley has purchased an Omnicell medication management as part of the its enhanced patient safety initiative. The hospital reports "this new technology dramatically reduces the potential for medication error." UGH also is refurbishing its patient rooms to "combine the warmth of a home bedroom with the efficiencies of a state-of-the art hospital." And UGH will be opening a two-bed sleep lab this fall.

UPCOMING EVENTS

WSHA Rural Hospital Committee
October 12 - 12:00 noon • WSHA Offices
Contact: Melissa Waddell (206)216-2510

PHD & WAH Board Meeting
October 12 - 4:00 pm • Seattle Waterfront Marriott
Contact: Anita Badri (206)216-2553

AWPHD Board Meeting
October 12 - 6:00 pm • Melting Pot
Contact: Beionka Moore (206)216-2530

AWPHD Membership Meeting
October 13 - 8:00 am • Bell Harbor Conference Center
Contact: Beionka Moore (206)216-2530

WSHA Annual Meeting
October 13-14 • Bell Harbor International Conference Center, Seattle
Contact: Danie Wright (206)577-1845

WWRHCC Board Meeting
October 28 • Jefferson General Hospital, Port Townsend
Contact: Elizabeth Floersheim (206)577-1851

Washington End of Life Consensus Coalition Fall Conference
October 28 - 8:00 am • Seattle Marriott SeaTac Airport Hotel
Contact: Graham Short (206)956-3633

Small Hospital Construction Workshop
November 3-4 • Ellensburg Inn, Ellensburg
Contact: Wendy Ray (206)216-2516

RHQN Board Meeting
November 8 - 10:00 am • Conference Call
Contact: Brad Vollegraaf (206)216-2550

Workers' Compensation-Building Bridges for a Culture of Safety
November 15 - 12:00 noon • Webcast
Contact: Anita Badri (206)216-2553

WWRHCC Board Meeting
November 18 • Willapa Harbor Hospital, South Bend
Contact: Elizabeth Floersheim (206)577-1851

The deadline for the next In Focus is: Friday, October 21st. 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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