SPRING 2012

CONTENTPresident’s Remarks 4Scott Schmidly, FACHE

Welcome New Members 5and New Fellows

Mission Possible: 6Finding Capital for Stand-Alone Hospitals

2012 Congress on 8Healthcare ScholarshipRecipients

Mentoring Program 8

Will the Affordable 10Care Act MovePatient-Centerednessto Center Stage?

News from National 12

Leverage Your Marketing 13Success to Shore UpPhysician Perception

Calendar 14

ofACHE

North TexasACHE

North Texas

The ACHE of North Texas e-magazine, The Executive Connection, is published quarterly (Spring, Summer, Fall and Winter) and includes information on the latest regulatory and legislative developments, as well as the quality improvement and leadership trends that are shaping and influencing the healthcare industry. Readers get indepth reporting on the issues and challenges facing hospital and health system leaders today. We make it our job to tell you about the great things the organization and Chapter are doing every day to ensure the health of our community. If you have any news and updates that you want to share with other members, please e-mail your items to info@northtexas.ache.org. Microsoft Word or compatible format is preferable. If you have a graphic or picture that you’d like to include, please send it as a separate file. The following are the types of information that our members shared in past ACHE of North Texas magazines: Advocacy Issues, Legislative Issues, Educational Opportunities, Awards / Achievements, Promotions (Members On the Move), Committee Updates, journal submissions, conference submissions, and workshop participations, sharing mentoring experiences, etc.

northtexas.ache.org

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2012 3

Editor-In-Chief Susan Edwards, FACHE

Managing Directors Joan Clark, DNP, RN, FACHE Angela CJVincent, MHS

Contributing Editors Felicia McLaren Lisa Cox Forney Fleming Jania Villarroel Scott Schmidly

Contributing Writers Anthony J. Taddy Jason Beakas Michael L. Millenson Juliana Macri Ann Maloley, MBA

Production Kay Daniel

Advertising/ Subscriptions info@northtexas.ache.org

Questions and Comments: ACHE of North Texas Editorial Office, c/o Executive Connection 511 John Carpenter Frwy, Suite 600, Irving, Texas 75062 p: 972.812.1154 | f: 972.570.8037 e: info@northtexas.ache.org | w: northtexas.ache.org

2012 Chapter Officers

President Scott Schmidly, FACHE Medical City and Medical City Children’s Hospital Co-Chair, Membership and Networking

President-Elect Caleb F. O’Rear, FACHE Denton Regional Medical Center Co-Chair, Communications Committee

Past President Brad Simmons, FACHE Parkland Health & Hospital System Chair, Nominating Co-Chair, Education

Secretary Winjie Tang Miao Texas Health Harris Methodist Hospital Alliance Co-Chair, Sponsorship

Treasurer Pam Stoyanoff Methodist Health System

2012 Board of Directors

Britt R. Berrett, PhD, FACHE Texas Health Presbyterian Hospital DallasEx-Officio, Regent

Beverly Dawson, RN, CCM, FACHEElderCareChair, Advancement and Mentoring

J. Eric Evans, FACHELake Pointe Medical CenterChair, Education

Forney FlemingUniversity of Texas at DallasEx-Officio, Faculty

Josh Floren, FACHEParkland Health & Hospital SystemCo-Chair, Membership and Networking

Dresdene Flynn-WhiteJPS Health NetworkCo-Chair, Communications

Jay FoxBaylor Medical Center, WaxahachieCo-Chair, Advancement and Mentoring

Jonni Johnson, CPSMRTKL Associates Inc.Chair, Sponsorship

Ashley McClellan, FACHEMedical Center of LewisvilleCo-Chair, Education

Rick StevensCo-Chair, Sponsorship

Matt van LeeuweParkland Health & Hospital SystemEx-Officio, Student Council

Jania Villarroel, MHACandor HealthcareCo-Chair, Communications

Demetria WilhiteThe University of Texas at ArlingtonEx-Officio, Faculty

Teresa BakerVA North Texas Health Care SystemCo-Chair, Advancement and Mentoring

Bethany WilliamsZirMedChair, Membership and Networking

Chip Zahn, FACHELas Colinas Medical CenterCo-Chair, Sponsorship

Lisa CoxThe Health Industry CouncilACHE Coordinator

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2012 4

President’s Remarks

Scott Schmidly, FACHEDear Members,

Well, the first three months of 2012 have come and gone. And before it is all said and done, the likely conclusion of the constitutionality of the Patient Protection and Affordable Care Act (PPACA), perhaps one of the most sweeping reform bills ever passed, will have been decided (even if not made public for several more months). Regardless of your own personal position on the PPACA, the three days over which the Supreme Court heard oral arguments from dissenters and sponsors has certainly stirred a nation and reignited controversial topics – well beyond accessibility to health care or even a more affordable approach to health care – like individual rights and the dividing line of authority between states and the federal government.

A thematic question becomes “what effect will the Court’s decision have on the reformation agenda underway in healthcare?” Truthfully, it is unclear and still hotly debated what the short-term or long-term effects will be as a result of the Court’s decision. It is apparent, though, that healthcare providers and healthcare policy will continue to be the subject of sizable scrutiny. Those quick to criticize need to realize this stark reality; more than 49 million Americans are without health insurance. Another 60 million are enrolled in Medicaid (our means-testing program for the poor) and another 48 million are enrolled in Medicare (the entitlement program for our elderly and disabled). In toll, more than 157 million of the 313 million Americans are either uninsured or enrolled in a program that, arguably, does not cover the cost for their care. Medicare and Medicaid are critically important social programs. Their creation and existence supports a dignified societal philosophy rooted in ethical, compassionate responsibility. In turn, as an industry, healthcare needs to remain steadfast in its pursuits to deliver exceptional quality and care in a more efficient manner. There are numerous examples of health care organizations across this nation that have taken the lead on trying to resolve a multitude of issues whether its evidence-based medicine, billing reform and transparency, integrated information and technology systems, individual responsibility for personal well being, and a well-defined patient quality improvement agenda. These topics are involved, with few easy, recuperative paths. But more and more there is a true indication that reform is being led, not by government or cynic, but by capable men and women dedicated to leading their organizations positively and resourcefully.

The North Texas Chapter is honored to aid in this pursuit by serving our membership as the foremost professional organization for continuing education and B2B networking. I hope that in that past three months you have made it a point to attend or get involved in our Chapter. If not, I encourage you to take a moment, visit our

web site northtexas.ache.org and find out more about the upcoming events on the calendar. Also, please stay alert to the weekly e-mail updates provided through info@northtexas.ache.org.

Once again, let me say thank you to our sponsors and volunteers – without you none of this would be possible. Finally, on behalf of our Board, it is a privilege to continue to find ways to serve you better.

Sincerely,Scott Schmidly, FACHE

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2012 5

JANUARYRami Almuhtadi, Fort Worth

Brenda Berry, Addison Mary C. Black, Dallas

Greg Bryan, Dallas Kelli A. Bural, RN, Garland Julie Butner, Fort Worth

Nicholas Carroll, Lutherville Timonium Sanjeev Chhabra, Irving

Brian Craft, Plano Abigail R. Edmister, Bedford

Kent Ellis, Plano Kathryn A. Flores, Carrollton

Kristen M. Georgia, Dallas Qiana M. Johnson, Frisco Shanda Johnson, Wylie

Linda Kurland, Fort Worth Mike LaHaie, Dallas

Don Mang, Newport Jeff Maxwell, West Linn Judith Messer, Murphy

Vishwanath Mysore, Fort Worth Tam Nguyen, Richardson

Sonya B. Odell, Dallas Russ E. Peal, Lantana

Turabia Sajid, Carrollton Brianna R. San Miguel, Flower Mound

Congratulations to the following members who advanced to Fellow status

Welcome New MembersThomas J. Tierney, Grand Prairie

Derek Townsend, Arlington Melanie A. Tsakonas, Lewisville

Brian Villegas, Fort Worth Troy Zupancic, Dallas

FEBRUARYWilliam G. Buck, Mckinney

Carolyn Carlson, Dallas Allen Dye, Dallas

Sally Dyess, Carrollton David Fontenot, Grapevine

Bryan Hill, Arlington John F. Holland, Dallas

James A. Horton, Weatherford Matthew R. Malinak, Strongsville

Stephanie V. Mask, Dallas Michelle Mirkovic, Dallas

Syed Nabeel, Plano David W. Nunez, DDS, Dallas

Judson Orlando, Dallas Charles Oswalt, Dallas

Joseph Palmore, Fort Worth Radhika D. Patel, Dallas

SFC Leslie D. Patterson, Grand Prairie Sandra Routly, Fort Worth

Pamela Sanders, Grand Prairie Matthew Schneider, Dallas

Michael W. Seiler, Mansfield Prashant Shinde, Fort Worth

John P. Taylor, Mckinney Cindy Tucker, Plano Tracy P. Walls, Dallas

Stanley Williams, Fort Worth

MARCHJoseph Brunson, Arlington Craig M. Drayden, Dallas

Patrick S. Finch Jr., Highland Village James R. Garner, Fort Worth

Tanima Hoque, mckinney Trevor Jares, Irving

Donald E. Katz, Dallas Cheryl P. Koch, Rowlett Gerri J. Lindsay, Plano

Andrew Montgomery, Dallas Greg Pipes, Garland Pamela Scott, Dallas

Travis Singleton, Irving Babalola Solomi, Arlington

Randolph S. Swanson, Frisco Jeffrey L. Tobias II, Dallas

FEBRUARYJohn L. Schinske, FACHE, Argyle Patsy L. Youngs, RN, FACHE, Kaufman

MARCH

Carla J. Degges, FACHE, Carrollton

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2012 6

Your mission, should you choose to accept it, is to find capital to renovate or replace your aging hospital at an affordable cost. As a stand-alone hospital that doesn’t rely on taxes, how hard can it be in 2012?

Let’s find out. Median-ratios reports issued at the end of 2011 for nonprofit hospitals and health systems by the “Big Three” credit rating agencies-Standard & Poor’s, Fitch Ratings and Moody’s Investor Service-indicate how industry and economic pressures are affecting the credit ratings of hospitals. These median ratios, by offering a snapshot of the finances of all rated hospitals in their individual portfolios, help in the comparison of credits across rating categories and are used to predict future sector performance.

What Lies Ahead?Year-end median reports pointed to an overall improvement in performance for hospitals and health systems, but predicted challenging conditions for 2012. The Big Three warned of the growing pressures on the nonprofit health-care sector with a still weak economy, selective credit markets, health-care reform uncertainties, low patient volumes and the increasing number of uninsured/underinsured patients along with decreased reimbursement rates. These serious external threats continue to apply pressure on a hospital’s bottom line while patients increasingly expect state-of-the-art facilities and services that provide quality and value.

On the positive side, due to a waning supply of higher rated, investment-grade debt over the past three years, health-care investors have moved down the credit spectrum in search of higher yields. Health-care investors’ increased risk tolerance is evident by the narrowing spread between BBB and A-rated 30-year bonds as investors search for higher returns. For example, the spread between Healthcare Baa/BBB and A/A 30-year offerings was 151 basis points in January 2009. However, as of January 2012, that spread has dropped by 53.6% to just 70 basis points. This has created an opportunity for lower rated, stand-alone hospitals to reduce their cost of capital to levels that more closely match their higher rated brethren. This landscape also requires a growing list of alternative capital-funding options, which low- to noninvestment-grade, stand-alone hospitals can use to revamp their aging plants or refinance existing higher cost debt.

Mission Possible for BBB or BelowHospital leaders—particularly those of stand-alone, investment and noninvestment-grade facilities-need to be aware of what financing

Mission Possible: Finding Capital for Stand-Alone Hospitals

By Anthony J. Taddeyand Jason Beakas

Reprinted with permission from The Capital Issue atwww.lancasterpollard.com.

continued on page 7

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2012 7

options are available to them in order to choose the best way to fund construction, renovations and new technologies and care-delivery methods. In addition to obtaining a debt rating, hospitals can consider the following routes to access long-term, fixed-rate capital:

Government-Sponsored Options• The U.S. Department of Housing and Urban Development’s FHA Sec. 242 Mortgage Insurance offers 100% nonrecourse debt at fixed-interest rates. The maximum term is 25 years after construction completion and loan-to-value is capped at 90%, which in some cases allows the loan to cover the entire actual project cost. Average operating margins must be positive and the average debt-service-coverage ratio must be equal to or greater than 1.25 for the previous three years.

• The U.S. Department of Agriculture offers two programs for rural hospitals – the Business & Industry Program (B&I) for communities of 50,000 or less and the Community and Facilities Program (CF) for communities of 20,000 or less. The B&I program offers a maximum term of 25 years and is best suited for projects of $10 million or less with the size of the loan guarantee varying between 60% - 80% depending on the loan size. The CF program provides direct and guaranteed loans (up to 90%) with a maximum term of 40 years. For both programs, the guarantee is generally issued upon construction completion.

• The New Markets Tax Credit Program (NMTCP) through the U.S. Department of the Treasury may be used to finance capital projects for the health-care sector. NMTCP attracts investment capital to eligible low-income communities-rural or urban-by providing investors with a tax credit against their federal income tax return in exchange for making equity payments in Community Development Entities (CDEs). The tax credit, which totals 39% of the original investment amount, is claimed over a period of seven years. The CDE will then make two loans to the borrower at below market rates, which require interest-only payments for the first seven years. Amortization on the loans begins after that initial period. The borrower pays no fees and most banks will treat investor-provided equity as project equity, reducing the amount of equity a non-profit borrower needs to contribute to finance the project. Additionally, many states offer state tax credits in conjunction with the federal program.

FHA Sec. 242 in ActionElectra Memorial Hospital is a critical access hospital in northwest Texas. Challenged by a tight credit market and rural location Electra and its lender turned to the FHA Sec. 242 program to significantly renovate its 45-year-old facility and build a new wing of private rooms. As a result of the FHA mortgage insurance credit enhancement, Electra is expected to increase patient volume revenues through enhanced patient care and added services at AA-rated equivalent cost of capital.

Commercial OptionsAll nonprofit hospitals and governmentally owned hospitals can

issue revenue (or cash-flow supported) bonds, which are generally ratable depending on their underlying credit characteristics. Additionally, many governmentally owned hospitals can issue general-obligation (or tax-supported) bonds, which also may be rated. These long-term, fixed-rate bonds are underwritten by a broker/dealer in a primary offering. Depending on market conditions and other available financing options, the hospital has the ability to use additional credit enhancement to further reduce its borrowing.

• A floating-rate index note may be a more preferable option than a fixed-rate bond. Basically, the index floater is a variable-rate bond with an initial index-floater mode or period (typically three to seven years) during which the bond pays an interest rate equal to a short-term index plus a fixed-credit spread. The bond can be a public offering or privately placed directly with a bank and is subject to renewal risk at the expiration of its initial term.

• Private placement, a common alternative today, is when tax-exempt bonds are privately placed with a bank or multiple banks or with a large bond fund. These bonds are negotiated with a select group of investors and disclosure requirements can sometimes be minimized and covenants made more flexible. If the private placements are deemed “bank qualified,” banks can deduct 80% of their costs and can pass along the savings to borrowers by means of a reduced interest rate. However, only $10 million in tax-exempt bonds can be designated as bank-qualified by a debt issuer in a year.

• The Federal Home Loan Bank (FHLB) letter-of-credit wrap gives a borrower the means to enhance taxable-debt issuances with a FHLB’s AA+ rating when an FHLB member bank provides the underlying LOC. This means smaller local banks could provide organizations access to investment-grade credit enhancement usually available only from larger banks. Nonprofits should still investigate FHLB LOCs because tax-exempt debt is not providing the cost break it has in the past. Also, taxable bonds require fewer upfront closing costs and fewer restrictions on the use of bond proceeds.

Private Placement in ActionFulton County Health Center, a small hospital in northwest Ohio, has grown to include several specialty units, several medical clinics and a senior-living facility. FCHC, in good financial standing, faced an expiring LOC with a bank. A 5-year variable-rate direct purchase structure was selected. The new issue was a refunding of the earlier bonds plus cost of issuance. The transaction addressed the upcoming LOC expiration and removed the credit renewal risk during the 5-year term.

Despite mixed reviews from the Big Three for the health-care sector in 2012, credit spreads have narrowed and options exist for stand-alone hospitals, such as Electra Memorial and Fulton County, to continue to finance their growth. A good understanding of all the options will help you obtain the required financing at reasonable terms to complete your mission.

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2012 8

2012 Congress on Healthcare Scholarship RecipientsEvery year, the North Texas Chapter for ACHE is proud to o�er limited scholarships to the always exciting and innovative Congress on Healthcare event in Chicago. Sponsored by National ACHE, Congress is the place to network, learn and have fun. See what a few of our local recipients had to say...

“I am grateful for the opportunity the scholarship from the ACHE of North Texas Chapter a�orded me in allowing me to attend the 2012 ACHE congress. My previous experience at ACHE congress was as a student and a new graduate, so this year’s ACHE experience was really meaningful. The sessions were really interesting, informative and provided very useful tools that I can apply at my job.

Studer’s session was one that left a very profound impression. He is certainly known in the healthcare industry and his concepts are being embraced by many healthcare organizations as the standards for day to day operations made the session even more signi�cant. The career development and networking opportunities that ACHE presents are immeasurable. The sessions were very meaningful and provided me the face to face credits I need in obtaining fellow status as I hope to take the exam later this year. Thank you again to ACHE Of North Texas Chapter.”

Sejal Patel, Director of Operations, Critical Care Services and Trauma Services, Children’s Medical Center Dallas

“I would like to take a moment to thank you for the scholarship that you provided enabling me to attend the 2012 Congress on Healthcare Leadership, in Chicago. I know now that this was the �rst Congress of many that I will attend. I think the �rst time I felt a little overwhelmed was when I started the process of deciding which lectures I was going to attend. The topics were incredibly diverse and numerous! It took me a while, but I was able to select a wide variety of topics that were of interest to me on several di�erent levels.

As I look back on the lectures, events and networking Congress facilitated I am still a little overwhelmed. The information was endless. I especially enjoyed the Hot Topics every morning. They were informational, motivating and relevant. The entire experience reinforced my desire to deliver superior healthcare to patients in the current role that have at Dallas Methodist Medical Center and other roles I will have in the future.”

Kena Johnson, Pathology Technical Coordinator Methodist Dallas Medical Center

Kimberly Anderson, Senior Planning Analyst - Children’s Medical Center of Dallas, and Pranshu Narwal, Grad Student - UNTHSC were also awarded scholarships to the event.

2012 Mentoring ProgramACHE of North Texas recently matched 51 mentees and mentors for the 2012 Mentorship Program. The chapter matches experienced healthcare professionals with early careerists that will complete their Master’s program within the year or who have graduated in the last 5 years. Requirements for the program included 16 contact hours within a 6 month period. Mentee’s gain insight into various segments of the health industry including general management; consulting; real estate; �nance; IT; and operations.

2011 Mentee Reactions “I found [my mentor] to be an able and enthusiastic listener; our one-on-one meetings were opportunities to talk about the industry, the challenges she has faced, and the ways in which she overcame them. Her wisdom and insight were invaluable, and I will take her lessons with me as I begin my professional career. In retrospect, there was nothing that could have made my experience more enjoyable. Not only did I get a once-in-a-lifetime opportunity to explore the far corners of hospital activity, but I also got to exchange war stories with a noted leader in the health care community.“

- Virginia Traweek continued on page 9

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2012 9

2011 Mentee Reactions cont.

“The mentor/mentee program provided a bridge from the academic to the administrative world. Mr. William Rathke, director of emergency department operations at Children’s Medical Center, gave professional guidance and understanding to the complex world of modern healthcare. He modeled a genuine interest in helping students, a commitment to his profession through continuing education and personal insight in career development. I spent considerable time learning about the mentor’s organization and professional responsibilities within Children’s Medical Center. The value of this experience provided by ACHE of North Texas exemplifies their long-term commitment to producing leaders in the healthcare industry.”

- Justin Smith

“I would say that my experience in the mentoring program was not only a good one but a great one. I enjoyed talking with John about topics that were specific to the hospital, as well as, the healthcare industry as a whole. This exposure to a real world setting was invaluable to me. I would recommend the mentoring program to all pursuing a path in Healthcare Management either at the undergraduate or graduate level.”

- James Scott

“I have been in several mentor programs and I have to say never have I learned as much as I have through this program.”

- Kim Hightower

“ACHE and the healthcare industry are unique in that there is a community so willing to share with others. I believe in the importance of this effort, and I believe that we have a responsibility to build up those around us through their professional development.”

- Paul Aslin

Baylor University Hosts - Tom Haines, FACHE and JL Radford-Williard; Committee Co-Chair, Jay Fox

Mentee, Leon Nguyen - Mentor, Amy Assenmacher, FACHE

Patty McCoy and Mentee Kim HightowerMentor, Vivian Leopold; Committee Co-Chair, Jay Fox Mentors Ron Coulter and Stephan Moore

Mentor, John O’Neill, FACHE; Mentee, James Scott

Mentor - William Rathke, FACHE; Mentee - Chris Surley; Mentor - Pam Stoyanoff

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2012 10

Summary

Will the Affordable Care Act Move Patient-Centeredness to Center Stage?

Timely Analysis of Immediate Health Policy Issues March 2012

Michael L. Millenson and Juliana Macri

Nearly a decade after the Institute of Medicine designated “patient-centeredness” as one of six goals for a 21st century health care system, the Patient Protection and Affordable Care Act (ACA) has mandated the use of measures of the quality of care, public reporting, and performance payments that reflect this ambitious aim. The law repeatedly refers to patient-centeredness, patient satisfaction, patient experience of care, patient engagement, and shared decision-making in its provisions. Even when the law only uses the more general term “quality measures,” patient-centered assessments are being required when these provisions are turned into regulations for specific programs.

Although questionnaires asking patients about emotional support, communication, and “maintenance of [a hospital] patient’s self-esteem” go back at least to the late 1950s, the context has changed radically. The ACA requirements and similar efforts taking hold in the private sector represent an unsung transformation in the patient’s role based on three separate ideas.

The first is ethical, building on the concept of patient autonomy as a human right that supersedes physician beneficence. The second idea is the economic one of health care as a marketplace filled with consumers and providers weighing costs and benefits. The third idea is for an explicit

clinical role for patient-reported information, where it begins to be collected in standardized formats to provide feedback about ongoing treatment decisions. These separate threads are intertwined in the ACA. Translating them into implementable change is a critical challenge providers face in meeting ACA mandates.

In patient satisfaction surveys, patients rate care. In patient experience of care surveys, on the other hand, patients report what they objectively observed about their care in an attempt to obviate the influence of prior expectations that are a function of age, socioeconomic status or other factors. The family of surveys known as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) has emerged as a common thread connecting disparate parts of the health care system and will play a critical role in assessing the patient experience of care. CAHPS instruments are divided into ambulatory surveys (including health plans) and facilities surveys (for institutions such as hospitals). Supplemental items, related to specific conditions or aspects of care, can be integrated into the “core” instruments, and questions are under development for specific areas of policy interest, such as patients’ experiences with non-physician providers at medical groups.

The ACA also refers to patient engagement and shared decision-making. Consumer advocacy groups talk about patient activation. However, distinctions among terms and their relationships to one another are often unclear in common usage.

Although there are worries about the growth of patient-centered measurement and its costs as a result of the ACA, the law explicitly seeks integration and alignment of measures with other programs. In addition, there is growing evidence pointing to clinical and cost benefits from these measures, including greater patient adherence to medical advice, fewer complaints and grievances, fewer and less serious malpractice claims, and improvement in patient health and functional status outcomes. Equally important, patients’ satisfaction with their care is a valuable outcome in and of itself.

The ACA requires a “consensus-based entity” to provide input to the Department of Health and Human Services (HHS) on the measures to be used, and the National Quality Forum has created a special Measure Applications Partnership to do so. This private-public partnership has proposed 366 possible measures for HHS to use in its 2012 rulemaking.

Nearly a decade after the Institute of Medicine designated “patient-centeredness” as one of six goals for a 21st century health care system, the Patient Protection and Affordable Care Act (ACA) has mandated the use of measures of the quality of care, public reporting, and performance payments that reflect this ambitious aim. The law repeatedly refers to patient-centeredness, patient satisfaction, patient experience of care, patient engagement, and shared decision-making in its provisions. Even when the law only uses the more general term “quality measures,” patient-centered assessments are being required when these provisions are turned into regulations for specific programs.

Although questionnaires asking patients about emotional support, communication, and “maintenance of [a hospital] patient’s self-esteem” go back at least to the late 1950s, the context has changed radically. The ACA requirements and similar efforts taking hold in the private sector represent an unsung transformation in the patient’s role based on three separate ideas.

The first is ethical, building on the concept of patient autonomy as a human right that supersedes physician beneficence. The second idea is the economic one of health care as a marketplace filled with consumers and providers weighing costs and benefits. The third idea is for an explicit clinical role for patient-reported information, where it begins to be collected in standardized formats to provide feedback about ongoing treatment decisions. These separate threads are intertwined in the ACA. Translating them into implementable change is a critical challenge providers face in meeting ACA mandates.

In patient satisfaction surveys, patients rate care. In patient experience of care surveys, on the other hand, patients report what they objectively observed about their care in an attempt to obviate the influence of prior expectations that are a function of age, socioeconomic status or other factors. The family of surveys known as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) has emerged as a common thread connecting disparate parts of the health care system and will play a critical role in assessing the patient experience of care. CAHPS instruments are divided into ambulatory surveys (including health plans) and facilities surveys (for institutions such as hospitals). Supplemental items, related to specific conditions or aspects of care, can be

integrated into the “core” instruments, and questions are under development for specific areas of policy interest, such as patients’ experiences with non-physician providers at medical groups.

The ACA also refers to patient engagement and shared decision-making. Consumer advocacy groups talk about patient activation. However, distinctions among terms and their relationships to one another are often unclear in common usage.

Although there are worries about the growth of patient-centered measurement and its costs as a result of the ACA, the law explicitly seeks integration and alignment of measures with other programs. In addition, there is growing evidence pointing to clinical and cost benefits from these measures, including greater patient adherence to medical advice, fewer complaints and grievances, fewer and less serious malpractice claims, and improvement in patient health and functional status outcomes. Equally important, patients’ satisfaction with their care is a valuable outcome in and of itself.

The ACA requires a “consensus-based entity” to provide input to the Department of Health and Human Services (HHS) on the measures to be used, and the National Quality Forum has created a special Measure Applications Partnership to do so. This private-public partnership has proposed 366 possible measures for HHS to use in its 2012 rulemaking.

Timely Analysis of Immediate Health Policy Issues 2Despite government-led standardization, private firms continue to offer surveys and consulting services. At the same time, web-based entrepreneurs are bypassing traditional methods of collecting patient experience data and could one day exert a powerful influence on consumers’ choice of providers.

The increased emphasis on a patient-centered care system resonates on many levels. For example, a new definition of physician professionalism proposed by the American Board of Internal Medicine included patient autonomy as one of three fundamental principles. There is also increasing acceptance of previously foreign business concepts such as value-based competition based on customer needs.

continued on page 12

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2012 11

More broadly, chronic disease cannot be treated effectively without patient participation and cooperation. In a 2011 survey of nearly 800 hospitals, improving patient experience and patient satisfaction was picked as the second-highest priority (behind quality and safety) for the next year and the highest priority in the two years after that.

A serious and sustained effort to build a patient-centered health care system is starting to gain momentum. Still, while the ACA may signal a turning point, national health reform is an opportunity, not a guarantee. Rhetoric will need to be matched with funding for data collection, consensus building on measure use, and the integration, alignment, and harmonization of measures in different programs. And, of course, declarations of cultural change in hotel meeting rooms will have to be reflected in real changes in hospital and exam rooms.

The journey from aspirational to operational for patient-derived measures will not be a smooth road, but it is one that promises unique clinical, economic, and ethical gains. The rallying cry of the disability rights movement, “Nothing about us without us,” can be the model for a new paradigm of care delivery and continuous improvement. Though the process is still unfolding, providers and others are finally beginning to understand the profound impact of seeing health care “through the patient’s eyes.”

Timely Analysis of Immediate Health Policy Issues 3The views expressed are those of the author and should not be attributed to any campaign or to the Robert Wood Johnson Foundation, or the Urban Institute, its trustees, or its funders.

About the Author and Acknowledgements

Michael L. Millenson is the president of Health Quality Advisors LLC, the Mervin Shalowitz, MD, Visiting Scholar at Northwestern University’s Kellogg School of Management, and a senior policy consultant to the Urban Institute. Juliana Macri is a research assistant at the Urban Institute. The authors thank colleagues Robert Berenson, Kelly Devers, and Ellen Kurtzman at the Urban Institute and peer reviewers Susan Edgman-Levitan of the John D. Stoeckle Center for Primary Care Innovation, and Thomas Valuck of the National Quality Forum, for their many helpful comments and suggestions. This research was funded by the Robert Wood Johnson Foundation.

About the Urban InstituteThe Urban Institute is a nonprofit, nonpartisan policy research, and educational organization that examines the social, economic, and governance problems facing the nation.

About the Robert Wood Johnson FoundationThe Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable and timely change. For 40 years the Foundation has brought experience, commitment and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.

Reproduced with permission of the Robert Wood Johnson Foundation, Princeton, NJ.

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2012 12

NEWS FROM NATIONAL

Board of Governors Exam Fee Waiver Promotion 2012 ACHE is pleased to offer once again the Board of Governors Exam fee waiver promotion to ACHE Members who apply for the FACHE® credential between March 1 and June 30. Members must submit their completed Fellow application and $250 application fee during the promotion period. Pending application approval, ACHE will waive the $200 Board of Governors Exam fee. All follow-up materials (i.e., references) must be submitted by Aug. 31, 2012, to receive the waiver. For more information on the promotion, go to ache.org/FACHE.

Foreign Hospital Partnership Directory LaunchedCreated as the result of a 2011 joint study by ACHE and the American Hospital Association, the Directory of U.S. Hospital Partnerships With Foreign Hospitals is composed of U.S. hospitals nationwide with a foreign hospital partnership. The purpose is to provide a key resource for U.S. hospitals seeking to initiate partnerships with foreign hospitals; hospitals listed in the directory have agreed to be contacted by those seeking more information about their partnership. Hospitals that have a foreign partnership and are not currently listed in the directory are encouraged to submit their partnership information on the page to be considered for inclusion.

The directory can be viewed under ACHE Resources on the homepage ofache.org.

2012 Fund for Innovation in Healthcare Leadership Education ProgramsThe Fund’s 2012 ethics program, “The Ethics of Mission and Margin,” will be led by Richard A. Culbertson, PhD, professor of global health systems and development and of family medicine, Tulane University, New Orleans, and offered on May 23 in conjunction with ACHE’s San Antonio Cluster. The half-day session will address the universal ethical and political challenges of balancing mission and margin, focusing on the interests of patients benefiting from services potentially detrimental to the organization’s fiscal performance; impact on the organization delivering primary and preventive care versus more lucrative specialty services; financial concerns of employers; and welfare of the community. In development is the 2012 innovation program to be offered on Oct. 12 at ACHE’s Atlanta Cluster. Full details will be available soon at ache.org/Innovation.

Both programs qualify for ACHE Face-to-Face Education credits.

C

M

Y

CM

MY

CY

CMY

K

A Publication of the American College of Healthcare Executives of North Texas Chapter | SPRING 2012 13

According to a 2010 industry study conducted by HealthLeaders, nearly 47% of physicians rated marketing within their organization as “very strong” or “slightly strong.” No question that your physicians are in tune to your marketing efforts, especially as it relates to the competitors’ marketing activity.

While there are always physicians that have their own ideas of advertising headlines or suggestions for your logo, strategically, what the physicians really want is for their hospital partner to have a strong brand and effectively compete for share-of-voice in the market. I hope you’re finding physician support for your organization’s marketing efforts today. I believe that to gain this support physicians first have to believe in what you’re doing; and fundamentally they have to perceive that your efforts are indeed building a stronger, more competitive brand.

So, how can you trigger that positive perception? Consider looking at your marketing activities through their eyes and leveraging the good work you’re already doing:

First, define the brand for them. What does the logo signify? And the color theme? What’s the strategic rationale behind the tag line or service line messages? If they understand the back story to the marketing approach the perception can grow from a solid strategic base. No different than your Board members or employees, physicians like to see their hospital partner in the news, for good things. If your marketing department is dealing with budget constraints, likely they’re pushing for – and hopefully landing more – “earned” media opportunities. Physicians will applaud any print or broadcast story you get. Be sure they know about it. Show them clips. Participating in high profile community events that support important causes brings great exposure to your facility. Internal stakeholders view it as an important contribution to the community as well as the hospital’s obligation. Be sure your physicians know about the event sponsorships, food drives, community events, etc. that your organization supports. And invite them to join in. Physicians love a good patient story! One of the best things you can do for a physician is ensure that their patients have a positive experience, and then talk about it. Share positive patient satisfaction scores and heartwarming letters sent by patients with your physicians. The same goes for clinical outcomes. Physicians want to know that they’re associated with a facility that matches their level of clinical expertise. Be sure you don’t overlook physicians when you’re promoting good outcomes and other clinical data. The work we put into reinforcing physicians’ positive perceptions of our organization is a good start to the process of earning more referrals. Aligning with the ‘right’ organization is important to them.

One final thought to consider, look for opportunities to remind them of the residual benefits they gain from the hospital’s marketing efforts. Talk in terms of how your efforts to market the hospital can raise awareness and drive business to their practices as well. Having this conversation will make it easier for you next time you ask them to participate in a media interview or participate in a physician educational event.

When they’re involved and experience the positive impact directly they’ll feel a sense of ownership of the brand.

Leverage YourMarketingSuccess ToShore UpPhysicianPerceptionBy Ann Maloley, MBA, Lead ConsultantBarlow/McCarthy A consulting firm specializing in hospital-physicianrelationship strategy

She can be reached at 402-301-3023or amaloley@barlowmccarthy.com

2012CALENDAR

ACHE of North Texas thanks the following Corporate Sponsors for assisting the organization’s mission. By sponsoring various events throughout the year, these sponsors are provided local and national exposure with an opportunity to showcase their organization, brand, career opportunities, products and services to the ACHE membership and its affiliates.

We are currently working on new educational and networking opportunities for 2012. For the latest updates please check our website or watch your inbox for the event guide.

Wednesday, May 9thBreakfast with the CEOTime: 7:30 - 9:00am Location: Parkland Host: Tom Royer

Thursday, May 24th Spring General Membership Meeting and Education Panel: Building the Hospital of Tomorrow Time: 5:30 - 8:00pm Location: NYLO Hotel | IrvingPanelists: Kevin Stevenson, Grand Prairie Healthcare Center Winjie Tang Miao, Texas Health Alliance Walter Jones, Parkland J. Exley Hill, AHFD

Wednesday, June13thBreakfast with the CEOTime: 7:30 - 9:00 AM

Thursday, June 21stEducation: Using the Baldrige Criteria to Improve Your Organizations Performance and Quality Time: 5:30 - 7:30pmLocation: Texas Health Fort Worth

Thursday, July 19thEducation: Patient Centered Medical Home

Time: 5:30 - 9:00pm

Location: Children’s Medical Center

Panelists: Lister Robinson, MCNT

Peter Roberts, Children’s

Cheryl Camin, Winstead

Nora Esther Gimpel,

UT Southwestern