Good Life Birth Place

WINTER 2017 • VOLUME 20 NUMBER 4

CHI Health's Good Life Birth Place

Laura J. Redoutey, FACHE President Congratulations to the NHA! from one 90 year old company to another.

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Birthday Ad.indd 1 3/10/17 3:29 PM Healthier Nebraska A magazine for and about Nebraska community hospitals and health systems CHAIRMAN, 2017 NHA BOARD OF DIRECTORS James P. Ulrich, Jr., MHA, FHFMA York General, York 2017 NHA BOARD OF DIRECTORS Mike Hansen, FACHE Columbus Community Hospital, Columbus Winter 2017 • Edition 83 Marty Fattig, ACHE Nemaha County Hospital, Auburn Kevin Nokels, FACHE CHI Health Creighton University Medical Center-Bergan Mercy, Omaha Russ Gronewold Bryan Health, Lincoln in this issue John Mentgen, MHA, FACHE Regional West Health Services, Scottsbluff Jason Petik, ACHE Sidney Regional Medical Center, Sidney Luke Poore CHI Health's Good Life Birth Place Kearney County Health Services, Minden 4 Michael Schnieders, MBA, FACHE CHI Health Good Samaritan, Kearney John Trapp, MD Bryan Health, Lincoln Galen Wiser 6 Nebraska health care professionals recognized with top honors at Annual Convention Providence Medical Center, Wayne Daniel DeBehnke, MD Nebraska Medicine, Omaha Ryan Larsen, FACHE Community Medical Center, Falls City Pediatric Cancer Action Network John Arch, FACHE 14 Boys Town National Research Hospital, Omaha Kelly Driscoll, RN, MHA, FACHE Faith Regional Health Services, Norfolk Mel McNea Great Plains Health, North Platte 16 NHA Services adds variety of service lines to preferred business partners Manuela Wolf, RN, MHA Harlan County Health System, Alma Donald Naiberk Butler County Health Care Center, David City Laura J. Redoutey, FACHE - Ex-Officio NHA opposes provision to Tax Cuts & Jobs Act related to Nebraska Hospital Association, Lincoln 18 NHA STAFF tax-exemption for private-activity bonds Laura J. Redoutey, FACHE, president Jon Borton, vice president, NHA Services Inc. Heather Bullock, member services & events manager Kevin Conway, vice president, health information Michael Feagler, vice president, finance Ransomware + Healthcare = Wannacry Julie Fletcher, executive assistant /office manager 19 Andy Hale, vice president, advocacy Elisabeth Hurst, director of advocacy Barbara Jablonski, director of accounting Kim Larson, director of marketing Monica Seeland, vice president, quality initiatives 20 Nebraska Hospital Association celebrates 90 years Cindy Vossler, director of health data Editor Kim Larson, director of marketing [email protected] 22 Quest for Excellence Award: Honoring hospitals that improve health care in Nebraska Healthier Nebraska is published quarterly by the Nebraska Hospital Association, 3255 Salt Creek Circle, Ste. 100, Lincoln, NE 68504, (402) 742-8140, www.NebraskaHospitals.org. All rights reserved. DISTRIBUTION 26 Developing leaders for a world where the stakes are higher Healthier Nebraska is distributed quarterly throughout hospitals in Nebraska. It reaches all hospital department heads including administrators, hospital physicians, managers, trustees, state legislators, the Congressional delegation and other friends of Nebraska hospitals. 28 State hospital association representatives meet with CMS Administrator Verma

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CHI Health's The 5,150-square-foot facility at 8020 O Street features Good Life Birth Place three birthing suites, each individually and stylishly decorated, a large waiting room, three exam rooms, an education room, a kitchen and a family room which walks out Most babies take nine months. This one was in the works to a city park. for nearly three years. The ambiance? Somewhere between hospital and home. When the Good Life Birth Place opened in July, it was the The plush birthing suites put the emphasis on suite, with culmination of a long, concerted push to create a unique full or queen beds, in-room tubs and labor-friendly showers. environment where certified nurse midwives deliver babies Medical equipment is stored out of view, but easily accessible and provide well-woman care. if needed. There’s reclaimed barn wood and heirloom Now the first and only free-standing birthing center in furniture in the lobby, where essential oils can be found Nebraska, the Good Life Birth Place opened its doors in defusing in the corner. Lincoln. “This environment is intended to be different. Quiet and “We’re excited to introduce our new midwifery model homelike,” said Karen McGivney-Liechti, CNM, a certified of care – a holistic approach for women who wish a more nurse midwife who led the planning and picked out many of natural and personal approach to the birthing process – the finishing touches. to the Lincoln community,” said Barbara Brower, Division The care is different, too. Director – Practice Operations. The midwifery care ideal is designed for non-complicated

4 A magazine for and about Nebraska hospitals and health systems. pregnancies, when the mom-to-be desires childbirth that is as more home-like environment for our expecting mothers. This natural as possible with no pain medication and little medical is about creating a unique and comfortable environment not intervention such as labor induction, fetal monitoring and seen anywhere else in Nebraska.” episiotomy. This birth center is actually a more labor-intensive approach Instead, expectant mothers choose from a wide range of for expectant moms. services, including hydrotherapy, water births, aromatherapy, “In order to deliver here, the mother has to be highly nitrous relaxation and massage therapy – as well as motivated,” McGivney-Liechti said. preconception counseling and newborn screenings. Requirements include completing several education “Birthing at the Good Life Birth Place is an option for classes. A monthly Centering Pregnancy program is an option women who meet specific criteria. Protocols clearly delineate for all moms, and has been shown to decrease the incidence who can labor here, and we have protocols and processes to premature birth and low birth weight, and increase breast ensure this is a safe way to deliver,” Brower said. feeding satisfaction. In fact, it’s anticipated that 50 percent of pregnant women It’s thorough, as is the midwifery approach to well-woman receiving prenatal care at the Good Life Birth Place will give care. birth here. The other half deliver a few blocks away at the At the Good Life Birth Place, a well-woman visit is longer Advanced Baby Center at CHI Health St. Elizabeth due to than a typical doctor visit and care addresses health needs at personal preferences or medical issues that develop during the every stage of life. Here, young women can get Pap smears pregnancy. and breast exams, and a menopausal woman experiencing Either way, the certified nurse midwife is right there with occasional incontinence can learn how physical therapy can get her mom-to-be. her back on a trampoline with her grandkids. “We have hospital privileges, and we stay on the woman’s “Midwife literally means ‘with women,’” McGivney-Liechti team through the whole process,” McGivney-Liechti said. said. “We journey with women for a lifetime.” “To be a good midwife, you need a great obstetrician. We co-manage. We work together.” Despite being a stand-alone facility, the Good Life Birth Place is tightly connected to CHI Health St. Elizabeth and the medical community. “We are very collaborative with our physicians, because this model is part of a continuum of care,” Brower said. Many of those physicians – obstetricians, neonatologists and pediatricians – were instrumental in the planning process for the Good Life Birth Place. “It’s been a beautiful marriage of the hospital saying ‘This is good for women and babies,’ and a group of physicians saying ‘Yes, this is an option we should have’,’’ said McGivney-Liechti. One reason? The midwifery model has been found to deliver on the triple aim of most health systems: it lowers expenses, improves outcomes and increases patient satisfaction. “It can be a 50% reduction of the cost of an average hospital birth,” Brower said. “While the cost of delivering at the Good Life Birth Place is less, its purpose is to provide a

A magazine for and about Nebraska hospitals and health systems. 5 Nebraska health care professionals recognized with top honors at Annual Convention

For more than three decades, the Nebraska Hospital Association has been honored to bestow awards to hundreds of Nebraska health care leaders, employees and trustees that have risen to the top by providing service excellence and dedication to their profession. These award recipients commit themselves to the betterment of their hospitals and health systems, their customers, their co-workers and their communities. This is a great way to let these exceptional people know how much they are appreciated and valued in Nebraska’s health care organizations. The NHA is proud to recognize these individuals with our highest honors during our Annual Convention. This year’s convention was held October 25-27, 2017, at Embassy Suites in La Vista, Nebr. The Excellence in Service award is the NHA’s highest honor. There are many hospital executives who benefit their communities through their commitment to health care excellence. This award is presented to a hospital/health system administrator or senior executive who has demonstrated outstanding administrative skills, professional performance, health care organization involvement and significant leadership. The Meritorious Service award recognizes the long-term contributions of members to the Association and their individual hospitals. This award recognizes longevity and breadth of service of an individual, not only to their facility, but to health care in the state. Nominees must be currently employed by a NHA member hospital or have retired from a NHA member hospital within one calendar year or less. The Trustee of the Year award recognizes outstanding leadership and hospital governance by a trustee. The recipient encourages commitment to excellence in health care and collaborates with community leaders to build support for their hospital.

The NHA is proud to announce these award recipients for 2017.

Meritorious Service Award once. You can be sure that hospital nursing departments have always Peggy S. Kennedy, RN, MSA, NE-BC, been among her most important FACHE departments—Emergency and Vice President/Chief Nurse Executive Outpatient Services, Acute Nursing Fremont Health, Fremont and Surgical Services. At Fremont Health, we offer seven distinct Following her graduation from inpatient care programs that share the Methodist School of Nursing, a combined total of 70 licensed Peg Kennedy began her illustrious beds-—that is no small feat, career in 1975 at Memorial Hospital especially with combined census of Dodge County, now known as levels that range from 20 to 55! Fremont Health. Peg started as These inpatient services include a staff nurse just before the new modern, private patient suites as nursing tower opened (1976), and follows: Medical and ICU, Surgical her career here is a testament to and Joint Replacement, Obstetrics her love for the nursing profession and Pediatrics, and as of 2015, and to this organization. She began Behavioral Health. As you might assuming more responsibility on have guessed, Peg Kennedy was the a regular basis, every few years, driving force behind designing our moving to Charge Nurse of Critical new acute nursing tower (2015) and Care, House Supervisor, Patient the new Behavioral Health Program. Area Manager, Assistant Director As mentioned, Ms. Kennedy’s of Nursing, and Director of Acute executive nursing leader over the role has not been limited to hospital Nursing. Ms. Kennedy became Vice course of these past two decades. nursing. Instead, at various stages of President and Chief Nurse Executive Peg Kennedy has led virtually her executive career she has been in 1998, and has continued to make every clinical department in the responsible for our nursing home, many valuable contributions as an Fremont Health system, at least home health and hospice, palliative

6 A magazine for and about Nebraska hospitals and health systems. care, pharmacy, cardiopulmonary, change. She has been inspired by oncology, women’s and children’s Ms. Kennedy’s commitment to the services, imaging, laboratory, health nursing profession, to the mentorship information management and of others, and her superior work informatics, and nutrition services. ethic and performance. Patrick Booth Peg has also served as the executive has had an opportunity to work with leader most responsible for our seven nursing executives over the quality and safety initiatives, as course of his career, both as a peer she helps to oversee the Clinical and as a supervisor, in various settings Effectiveness department while small and large. working closely with our medical Mr. Booth has been impressed by director, medical staff, and the board Peg’s dedication to the mission of of trustees. Fremont Health, her wide range She is one of those people you of experience with programs and can count on to make things happen, services, and her willingness to accept to solve complex problems, and to new challenges. move toward best practices. She Finally, just a few short weeks ago, has often been the key leader to after more than 42 wonderful years take on new projects; working with of service to this organization, our architects to design a state-of-the- patients and residents, and to this art Imaging Center in 2006, leading community, Peg Kennedy announced our Clinical Information Technology that she would be retiring at the end team as they implemented CPOE in of 2017. We believe that Ms. Kennedy for the Western Regional Trustee 2011, researching and establishing a would be an especially deserving Symposium, which has provided successful Behavioral Health program nominee for the NHA’s Meritorious annual trustee education for 21 years. in 2015, and working with VNA to Service Award of 2017, even if she In addition to his service on the build a model home health and had not announced her upcoming PMC board, Mr. Wiser recently served hospice program in our region. retirement. Now that she has, we are as campaign chairman for Providence Ms. Kennedy has also been quite honored to recommend her for this Medical Center’s “Quality Care, active in the community and working “career accomplishment.” Close to Home” capital campaign. with a number of professional His leadership helped to successfully organizations. She became Board complete a $2.5 million fundraiser for Certified in Nursing Administration Trustee of the Year Award the benefit of the Providence Medical (ANA) in 1992 and a Fellow in the Center renovation/expansion project. American College of Healthcare Galen Wiser Mr. Wiser is completing his Executives in 2007. She has been a Board Trustee first two-year term on the NHA member of the Nebraska Association Providence Medical Center, Wayne board of directors and has been of Nurse Leaders and the American re-nominated for a second term. In Organization of Nurse Executives, Galen Wiser is completing addition to his service to NHA, he has and she has served on the Boards of his seventh year as a trustee for previously served on the American the Nebraska Center for Nursing, the Providence Medical Center and has Hospital Association Committee on Visiting Nurse Association, and the served in many capacities during his Governance. Nebraska Arthritis Foundation. tenure, including board chair in 2015. Galen Wiser has truly lived a life of On a more personal level from He has received education service as demonstrated by a sample the two individuals making this certification through the NHA Hospital of the multiple organizations, and nomination, Melinda Kentfield would Trustee Education Certification national and community events in like to offer her observations as a Program and is an advocate of which he has served. Mr. Wiser has nurse who has worked in a variety of continued trustee education for a passion for improving health care hospitals and positions in Nebraska the members of the Providence in rural Nebraska and is a tireless and Iowa over the course of the last Medical Center board with the goal of advocate for Providence Medical 20 years. She has been impressed increasing the overall performance of Center. by Peg Kennedy’s ability to lead, to our organization. Mr. Wiser currently motivate others and to influence serves on the Planning Committee continued on page 8

A magazine for and about Nebraska hospitals and health systems. 7 continued from page 7 medicine offerings as well. She recently recruited a Urologist and Spine Surgeon and is adding specialty services as community needs warrant. Excellence in Service Award Ms. Marsh’s vision remains consistent with the transitional health care model Leslie Marsh, MHA of the future, as LRHC continues to make Chief Executive Officer great strides to remain competitive in Lexington Regional Health Center, Lexington an ever-changing health care system. LRHC recently completed a $25 million Lexington Regional Health Center’s construction project. This project CEO, Leslie Marsh, demonstrates many included a 31,000 square feet addition attributes that exemplary leaders apply of an Outpatient Services Center. in creating a pathway of excellence in Located in this center are 16 exam service. Her great passion for providing rooms for visiting specialists, three new high- quality health care and her mission operating rooms with state-of-the-art for optimizing access to health care in technology, two endoscopy procedure rural areas are part of her commitment rooms, nine pre and post operation to the local communities, region, state recovery rooms, four PACU rooms, and and national levels. Through her vision telemedicine capabilities. In addition, and optimism, Lexington Regional Health there has been a renovation of 23,729 Center (LRHC) has transformed not only square feet to include privatizing patient physically, with its recent renovations and to quality care continued. In May 2013, rooms, redesigning the main entrance expansions, but also through its transition LRHC contracted to provide 24/7 on-site for more convenient patient and visitor in vision, mission, values and strategic emergency room coverage. This positive accessibility, updated mechanical and planning. impact has been seen in LRHC’s overall electrical systems, redesigned kitchen Ms. Marsh was actively involved in the rating of the Emergency Department and dining room and fully accessible strategic planning and implementation of and increased patient satisfaction with ADA public restrooms. She has led the the Urgent Care in 2011, which has shown decreased wait times. construction project as well as been great success in providing accessible Across the nation, health care actively involved in the coordination health care at an affordable cost; not providers, private clinics, and hospitals of funding for the project through a only to the community of Lexington, but are working closely with one another local commercial bank as well as the also to surrounding communities. She to coordinate care. The shortage of US Department of Agriculture’s Rural was successful in recruiting three nurse health care providers in the rural Development Direct Loan Program; practitioners and two physician assistants areas is evident. Through Ms. Marsh’s her team also used New Market Tax to staff this clinic. In 2013, the Urgent/ strategic and progressive planning, in Credit Program to leverage their debt Primary Care received an Excellence July 2014, the Lexington community was and decrease costs. While the hospital Through Insight award for overall patient able to access health care through the district has a statutory taxing authority, satisfaction from HealthStream, Inc., as new Family Medicine Specialists (Rural it remains committed to not levying any well as being the only recipient that was Health Clinic). Recruiting providers taxes for this project. recognized in the Emergency Department to rural, culturally-diverse areas can Great leaders inspire their teams. Fast Track category. The LRHC Urgent prove challenging. She was successful Ms. Marsh not only leads by example, Care clinic received the highest rating in recruiting four nurse practitioners but provides the tools for her team to from HealthStream’s patient satisfaction and three physicians to this clinic strive for excellence. She introduced survey, exceeding industry standards in and is continuing to actively recruit the Studer Group to LRHC in 2010. overall rating of the urgent care staffs’ additional physicians. In March 2016, The facility continues to implement sensitivity to patients’ problems and LRHC expanded services to the Elwood evidence-based Studer tools including concerns, and in providers caring about community and opened a Rural Health bed-side shift report and rounding. LRHC the patient as a person. In 2014, LRHC’s Clinic. Ms. Marsh has diligently worked was recognized for reducing patient Urgent Care won the Excellence Through to expand the orthopedic service line, readmissions and harm in February Insight Award for “Overall Urgent which includes the prestigious Rural 2014, and was one of 11 hospitals in the Care Unit Patient Satisfaction” from Partners of Medicine (RPM). She recruited nation asked to present at the American HealthStream. two orthopedic surgeons, began an Ms. Marsh’s commitment to access orthopedic clinic and is expanding sports continued on page 10

8 A magazine for and about Nebraska hospitals and health systems. Working with you for a healthy Nebraska

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Blue Cross and Blue Shield of Nebraska is an Independent Licensee of the Blue Cross and Blue Shield Association. A magazine for and about Nebraska hospitals and health systems. 9 continued from page 8 (CFI) in 2006. This initiative focused on also participates in the National Rural encouraging fitness in youth to prevent Accountable Care Consortium’s Practice Hospital Association/Health Forum Rural childhood obesity. Partners include the Transformation Network and has recently Health Care Leadership Conference (only city and the Lexington Public School received Patient-Centered Medical Home 11 rural hospitals in the nation were Systems; together they host the following certifications through ‘The Compliance selected to share their story). LRHC was activities: wrestling, football, dance and Team’ and is in a PCMH BCBS program. also chosen as a Mentor Hospital in 2014 volleyball camps along with an annual These unique evidence and medical based for strides in reducing readmissions and dash and splash (run/walk followed by programs will address chronic disease harm to patients. In 2015, Ms. Marsh swimming at the aquatic center). CFI also management by incorporating structured and team led the effort to attain DNV hosts ‘Catch Kids’, an evidence-based exercise and one-on-one education certification for LRHC; this accreditation after school program that teaches kids sessions provided by over a dozen confers deemed status and ensures about nutrition, helping them learn to medical professionals. compliance with rules and regulations. prepare healthy snacks and meal options. Her involvement outside the walls She implemented a Patient and Family Finally, through continued efforts to of LRHC is numerous and expansive to Advisory Council that works together to provide affordable, nutritious food the region. Ms. Marsh has served on improve the quality of care LRHC offers Leslie supported the team in developing, the Nebraska Statewide Trauma Region and improves the patient and family through its Community Fitness Initiative III (Board Member/Designation Board/ experience while receiving care at LRHC. aimed at reducing childhood obesity, a Data and PI Board), Central Community She has helped LRHC achieve a ‘next community garden. All departments are College (Nursing Advisory Board Member/ level’ of superior quality. responsible for planting, maintaining and Synergy Healthcare Advisory and Planning In 2010, Ms. Marsh initiated the harvesting the fresh produce so that it Board Member/Community Foundation corporate wellness programs for LRHC can be taken to the local food pantry. Board), the Department of Health and to provide to area businesses. These It’s not all about the hospital and Human Services (Cast V Maternal Child employment screenings allow businesses exercise though – LRHC has worked with Health Committee Board Member/ to offer preventative measures to their area stakeholders to help the Lexington Genetics and Model Informed Consent employees in an effort to improve High School engage in fundraising efforts Screening Committee/Office of Minority the overall health of their staff. The to restore the community’s movie Health Council), Central Nebraska screenings also allow the employees to theater, the Majestic, which recently Advisory Health Education Council Board receive education about any potential opened. Lexington Regional team Member), Nebraska Hospital Association health concerns. LRHC has offered members volunteer throughout the year (District IV Medicaid Reform Issue numerous community wellness screenings at the community-run theatre helping to Strategy Group Chair/Policy Development in its commitment to overall health for bring new and fun movies to Lexington. Committee Member/Board Member/ its community such as free colorectal kits In another school-based outreach, LRHC Critical Access Hospital Advisory Council, and $20 blood draws. With this free and recently partnered with the American Quality Advisory Council), University of reduced pricing, the community is able Hospital Association to provide CPR Nebraska Medical Center (College of to become more educated and proactive kits to the Overton and Elwood school Public Health Advisory Council), Dawson regarding their health. systems in 2016; LRHC provided these County Council of Economic Development She is a firm believer in giving back to same kits to the Lexington school system (Past President/Past Board Member), the community. Through the recruitment in 2015. Governor’s Infant Mortality Blue Ribbon of a physician with a fellowship in sports Leslie Marsh is very knowledgeable Panel Member. Ms. Marsh continues medicine, LRHC has helped expand the and committed to preparing Lexington to serve on the Nebraska Rural Health sports outreach to local communities. Regional Health Center for the many Association (Board Member), National LRHC will be partnering with area changes that rural health care will Rural Health Association (Critical Access schools to hold sports clinics and be face in the future. The traditional Hospital Leadership Team), Office of on-site during athletic events to more health care hospital setting is shifting Rural Health Resource Center (Technical immediately and effectively provide care. to a population health model. She Advisory and Service Committee LRHC sponsored Lexington High School’s has already anticipated this shift and Member), American Hospital Association’s “Impact Program” by paying for the LRHC has strategically implemented Region 6 Policy Board Alternate Delegate program; this was done to ensure the new medically managed programs. The for Small and Rural Hospitals, University safety of athletes and the prevention of creation of a Transition Care Team, of Nebraska Medical Center Community concussions. which is focused on identifying patients Advisory Board, President of Nebraska With the help of LRHC leadership and facing barriers to healthy outcomes Rural Health Association, President – community stakeholders, Ms. Marsh post-discharge has helped to reduce started the Community Fitness Initiative harm and readmissions. LRHC’s FMS continued on page 12

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800.282.6242 • ProAssurance.com When you are treated fairly you are confident in your coverage. A magazine for and about Nebraska hospitals and health systems. 11 continued from page 10 of the prestigious Grassroots Champion and vision. “We will continue our journey Award, which is given to one leader to excellence; supporting one another, in each state. She was honored for providing excellent, compassionate elect for the Office of Minority Health her work over the previous year in care and creating a warm, inviting and Advisory Board and the Regional helping elected officials understand progressive place for people to receive Health Equity Council’s Co-Chair Data how legislations and regulations affect care. A place where friends, family and Committee Co-Chair for Region VII. She hospitals. Ms. Marsh was recently named faith are a part of everyone’s health care was most recently asked to serve as the in the Becker’s Hospital Review (2016 experience,” said Marsh. NRHA’s Constituency Group Chair and to and 2015) as one of the top 130 women Douglas McArthur states, “A true serve on the Board of Trustees. to know in health care. Each year, leader has the confidence to stand Because of her tremendous Becker’s selects women leaders based on alone, the courage to make tough experience and commitment to rural their management and leadership skills, decisions, and the compassion to listen health care, it is no surprise that Ms. along with career accomplishments. to the needs of others. He does not set Marsh’s opinion and expertise is highly She was also honored by the Nebraska out to be a leader, but becomes one regarded by her colleagues. In addition Rural Health Association (NeRHA) with by the equality of his actions and the to having her work accepted for the Achievement Excellence Award. This integrity of his intent.” Leslie Marsh is a publication as a coauthor, she has been award recognizes an individual in the true leader. She is a valiant leader who asked to speak at over a dozen events at health care industry for promoting the is passionate to serve her mission and is local, state and national events. development of community oriented committed to her vision to succeed and Leslie Marsh’s passion and rural health care delivery. survive the many challenges of health commitment as a leader is evident and The entire team at LRHC is committed care. Most importantly, she strives daily was recognized at the American Hospital to building a brighter future for the to provide accessible, excellent, high- Association’s Annual membership Lexington community and surrounding quality, cost-effective health care to her meeting in 2013. She was the recipient area, thanks to Ms. Marsh’s leadership community.

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Talk to BD 308.234.1836 A magazine for and about Nebraska hospitals and health systems. 13 By Gary Peters, Vice President Affiliate Member Spotlight Pediatric Cancer Action Network

of those afflicted. Shortly thereafter the even more Pediatric Cancer Action Network (PCAN) alarming is was formed to offer assistance and reduce that we have the financial burden placed on families the highest of pediatric cancer patients in Nebraska. mortality This year alone there are projected to rate in the be over 80 new diagnoses in our state. United States. Most, if not all of these families will need It is a major health issue in our State In January 2014 a small group of some sort of financial assistance along and shockingly few are aware of the family members who had been affected their journey and there are precious few magnitude. by pediatric cancer gathered at the State resources available for them. PCAN’s focus is to help families. The Capitol to lobby the Appropriations Pediatric cancer kills more Nebraska only way that we can help is if they are Committee for funds to start a pediatric children than any other disease. Overall aware of our existence. We need the cancer research program in Nebraska. it ranks second only to accidents as the healthcare community to help spread the That effort was so successful that some leading cause of death for children in word to their own local families at the of the parties involved decided that they Nebraska. Nationally, Nebraska ranks earliest point possible in the process. I needed to do more to help the families 5th for incidence rate per capita and have lived through this nightmare myself

14 A magazine for and about Nebraska hospitals and health systems. and know first-hand how overloaded family that could not afford their child’s Sources: a family is upon diagnosis. The sheer medication. The child had fallen weeks 1. Nebraska Dept. of Health and volume of critical medical information behind schedule and that lapse can have Human Services / Public Health / is overwhelming, not to mention caring fatal consequences. Recently, we have Health Statistics / Pediatric Cancer for other family members, monthly bills, even been able to assist with some final in Nebraska Fact Sheet managing time away from work and the expenses to help lay their child to rest. http://dhhs.ne.gov/publichealth/ list goes on. Searching for places to find No other organization that I know of Cancer%20Registry/Cancer%20 financial assistance is the last item on does that. The bottom line is that PCAN Fact%20Sheet%20Pediatric%20 anyone’s priority list. If we could get the is helping families in Nebraska. NHA 2017.pdf patient’s local social workers to provide member organizations can do their part this information to the family, we could by spreading the word and giving us the 2. National Cancer Institute, Centers offer our assistance before they get into a opportunity to help more. for Disease Control, US Dept. bind. We are building momentum on several of Health and Human Services, PCAN has helped pay utility bills, car fronts in the fight against pediatric cancer, National Institutes of Health and payments, rent/house payments, etc., but and with your help, we will gain more. the National Cancer Institute. one of the things that I am most proud For more information please visit our https://statecancerprofiles.cancer. of was when we were able to help a website: www.pcanaction.org gov/index.html

A magazine for and about Nebraska hospitals and health systems. 15 Preferred Spotlight

B r u e si n ness Part NHA Services adds variety of service lines to preferred business partners

NHA Services, Inc. is a subsidiary organization of the Nebraska Hospital Association. Designed to reduce health care expenses, NHA Services is collaboration among the NHA, NHA member hospitals, and other Nebraska health care organizations and providers. NHA Services helps providers find cost-effective, appropriate solutions to their operational challenges. We are pleased to have signed new preferred business partners, each with a unique service line.

healthcare providers. In addition to providing significant payments to NHA members, MCAG’s revenue share model creates funding for our partners. MCAG is partnered with more than a dozen state Accumen provides hospital hospital associations including New laboratory and patient blood York, California, Indiana, Missouri, management performance Minnesota, Massachusetts and improvement and execution many others. This service will bring management and consulting services. significant additional revenue to help hospitals and health systems member hospitals without any retain, optimize and grow their upfront cost. Very little time and labs. They will see improvement effort is required from clients to in cost, quality and service within file a claim. The ROI is enormous their labs, and we can create a new since there is virtually no risk or cost revenue stream for hospitals through associated with the recoveries. provider data. Combining a URAC the development of lab outreach and NCQA accredited and certified programs. 3WON, LLC provides credentialing CVO (credentials verification for hospital privileging and organization) with new technology, primary source verification of offers provider data management provider data (CVO) Credentialing for hospitals, physicians and health and enrollment for health plans, plans, ultimately with consumer provider directory management, connectivity. continuous provider data updating, client dashboards and reporting For more information regarding and indemnification from negligent the services lines available to NHA TM mcagUnique Opportunities • Optimal Returns credentialing risk. They offer a member hospitals through the Saas-based technology platform for preferred business partners of NHA MCAG provides a cost-effective centralized collection, near real- Services, Inc., contact Jon Borton, solution that will provide additional time updating and distribution of vice president, NHA Services, Inc. revenue to NHA members. MCAG provider data management, rather at (402) 742-8147 or jborton@ is the nation’s leading provider of than an off-the-shelf hard-coded nebraskahospitals.org. Settlement Recovery Services among software product that stores static

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A magazine for and about Nebraska hospitals and health systems. 17 By Michael Feagler, Vice President, Finance

NHA opposes provision to Tax Cuts & Jobs Act related to tax-exemption for private-activity bonds

Currently in the House Ways 1.5 to 2.5% for bond transactions With the proposed legislation, any and Means committee is tax of varying levels of credit quality. funds disbursed after enactment reform legislation, the Tax Cuts Conservatively, this could increase would no longer be tax-exempt. & Jobs Act, that was introduced the cost of borrowing by as much This provision has far reaching by Congressman Kevin Brady as 25 to 35%. This provision would impact on our communities, as of Texas, the chair of Ways and not only impact new PABs, but well. Not only does it impact Means. Included in this legislation could impact any existing PABs that nonprofit hospitals, but it would are provisions related to tax- were privately placed. Generally, impact economic development exempt bond financing that will with private placement, the funds projects such as housing have significant impact on the from the PAB are not escrowed development and infrastructure ability of 501(c)3 hospitals and as they would be with public sale. projects. health systems access to low cost The bank funds disbursements The big question of why this capital. The legislation includes as requested from the borrower. provision exists is that, according two provisions that impact to AHA Executive Vice President bond financing for nonprofit Tom Nickels, they need to pay hospitals. for the tax reduction provisions The first provision would We encourage our of the bill. repeal the ability to advance In the Senate, we are waiting refund bonds. Under current members to contact to see the proposed tax reform law, 501(c)3 bonds are their representative in legislation that will be introduced permitted one advanced to the Senate Finance Committee refunding to take advantage the House to remove by Senator Orin Hatch of of changes in interest rates. this provision from the Utah. According to the AHA, Advanced refunding allows the expectation is that similar hospitals to reduce debt Tax Cuts & Jobs Act language may be included in the service and ultimately reduce Senate version of tax reform. costs of providing services to and to contact their The NHA has sent letters to our communities. Senators to oppose our congressional delegation The second provision is the sharing our opposition to the most far-reaching and the most any similar provisions provisions in the House bill, as impactful on 501(c)3 hospitals in the forthcoming well as asking our senators to and health systems. The oppose any like provisions that provision eliminates the tax- Senate proposal. may come forward to the Senate exemption for private-activity Finance Committee. The AHA is bonds (PABs). This provision working hard to prevent any such would effectively eliminate provisions in the Senate bill. the tax-exempt bond market We encourage our members outside of government issued to contact their representative bonds. According to the AHA, in the House to remove this in 2016, over $72 billion in provision from the Tax Cuts & PABs were issued by nonprofit Jobs Act and to contact their hospitals and universities. Senators to oppose any similar The Council of Development provisions in the forthcoming Finance Agencies estimates Senate proposal. that interest rates for For more information, contact borrowers would increase by [email protected].

18 A magazine for and about Nebraska hospitals and health systems. By Meagan Morris, Five Nines

Ransomware + Healthcare = Wannacry

Global Drug Trade makes around again… some of the biggest culprits when it comes to $435 billion dollars a year. What about Unfortunately, the cost of a ransomware clicking on phishing links and opening malicious Cybercrime? $450 billion dollars a year. In attack goes beyond paying the ransom. email attachments. The most effective strategy recent years, hackers have begun targeting Following an attack, healthcare providers must in combating ransomware attacks is to hospitals, clinics and outpatient facilities. It conduct an audit to determine how much implement security awareness training. shouldn’t come as a shock that healthcare information was compromised. For health care At Five Nines, we offer a security organizations are considered the “perfect organizations, studies show that data breaches awareness training program to our staff mark” for ransomware attacks because of cost $402 per compromised record. If there and clients. Through simulated phishing the valuable information that can be taken is even the slightest chance that PHI has been attempts, we educate and raise awareness of in addition to the stiff penalties for a breach. compromised, the attack is considered a HIPAA ransomware attacks, fraud and other social Hackers know that patient health information breach, which carries a hefty penalty ranging engineering tactics that hackers use to bait is essential for providing care and organizations from $100 - $50,000 per violation. organizations. may be willing to pay up to get their systems When it comes to cybercrime, it isn’t a

Devices affected after 24 hours of Wannacry outbreak, source: citrix.com running quickly. Unlike credit card information, The key to preventing an attack is being matter of if you will be targeted for an attack essential patient health information can’t prepared but when. The most reliable solution is to easily be replaced or changed in the event Even the largest healthcare organizations, train your employees to spot an attempt and of an attack. PHI, such as date of birth, social with the most up-to-date software and know what to do in the event of an attack. security numbers, and medical history are equipment can fall victim to cybercrime. Even if you’re prepared, is the entire staff? unique and give hackers greater opportunity The most common source of ransomware is Any employee with access to the internet or for sale in the underground market. a malicious email attachment that hackers email could potentially infect the network and Earlier this year, nearly 200,000 systems disguise as legitimate documents, links, or compromise the data security. were hit by the malware Wannacry. Although spreadsheets that will automatically infect your the damage could have been much worse, device. When it comes to stopping a potential healthcare organizations that run outdated threat, what’s the best resource to safe guard equipment and software can expect this type against attacks? That’s right, it’s you. of attack to happen again. And again. And Recent studies show that executives can be

A magazine for and about Nebraska hospitals and health systems. 19 Nebraska Hospital Association celebrates 90 years at Annual Convention

LA VISTA, NEB. — The Nebraska Hospital Association (NHA) celebrated its 90th Anniversary as the influential

voice of Nebraska’s hospitals during ye the NHA 2017 Annual Convention, held ars Oct. 25-27, 2017, at the Embassy Suites Omaha-La Vista Hotel & Conference Center in La Vista. More than 1,000 participants 017 1927 - 2 attended three days of networking, professional education and sharing with peers and the industry’s leading experts. Throughout the three days, products and services that hospitals her keynote, Ms. Holliday attended national and local speakers took rely on. the breakout session entitled the stage to share their insight and The opening keynote was Dr. Marty “Reversing the Downward Spiral” by expertise on a variety of important Makary, New York Times best-selling presenter Dr. Laurie Drill-Mellum, topics. The NHA Annual Convention author of Unaccountable, a 2012 that addressed health care provider is also host to the largest health Library Journal “Book of the Year” burnout. During the session, Holliday care trade show in the state with – a book about how transparency created a painting that expressed her 100 exhibitors that provide the vital is revolutionizing medicine and interpretation of what she heard. empowering patients. Dr. Makary described how a new movement in American health care seeks to make medical care safer, more transparent and more honest. He detailed how physicians are at the helm of a national effort to fully disclose everything from bedside options to hospital performance. He is a leading health care expert and was the lead author of the original publications on the surgery checklist. He led the World Health Organization technical work group on developing metrics to measure surgical quality worldwide. Our Thursday keynote was Regina Holliday. She is a Maryland-based patient advocate and artist known for painting a series of murals depicting the need for clarity and transparency in medical records. This advocacy mission was inspired by her husband Frederick Allen Holliday II and his Dr. Marty Makary struggle to get appropriate care. After Regina Holliday

20 A magazine for and about Nebraska hospitals and health systems. millions. By encouraging and facilitating Francis Memorial Hospital in West Point employee dream realization, Nemtin received the award for their outstanding showed attendees how to create a work in improving lives through the healthy work-life balance. Employee development of a Parkinson’s Exercise dream realization increases retention, and Support Group. aids recruitment and aligns work-life The Meritorious Service award balance, which leads to happiness. recognizes the long-term contributions Along with the keynote sessions, of members to the association and the NHA 90th Annual Convention their individual hospitals. This award gave attendees access to nearly 50 recognizes longevity and breadth of educational sessions, providing the service of an individual, not only to their latest trends, updates, innovations and facility, but to health care in the state. best practices in health care. The NHA This year’s recipient is Peggy S. Kennedy, Annual Convention also hosts several VP & Chief Nurse Executive at Fremont allied health care organizations who Health in Fremont, who has provided 42 have their membership meetings in years of service excellence. Pete Smith conjunction with the event. The Trustee of the Year Award was The Nebraska Hospital Association presented to Galen Wiser, member of General session speaker, Pete Smith, hosts an awards banquet that the Board of Trustees for Providence spoke about the foundation of choice honors excellence in personal and/or Medical Center in Wayne, who has and the focus on impacting others, organizational accomplishments within provided governance excellence and has and how each phase is designed to Nebraska hospitals. Several awards been a tireless advocate for the hospital shift the way health care professionals are presented to recognize outgoing and the community for many years. think, expand their vision, and uncover board members, American College The NHA also recognized 39 their deepest desires and perceived of Healthcare Executives Nebraska- graduates from Class XIV of the NHA limitations. Western Iowa Chapter awards and the Leadership Institute program. The NHA The closing keynote speaker was NHA PAC awards. The American Hospital Leadership Institute is an intensive Ben Nemtin, a young man who started Association presented Mary Lanning 10-month leadership development with 100 impossible dreams scribbled Healthcare in Hastings with their 75-Year program designed specifically for on a piece of paper in a dorm room and Membership award. hospital middle managers and health quickly grew into a global movement of The NHA’s highest honor is the care leaders who want to update their Excellence in Service award. This award leadership skills. is presented to a hospital/health system On October 27, the Convention administrator or senior executive concluded with the 38th Annual The who has demonstrated outstanding Caring Kind Awards Luncheon. Each year, administrative skills, professional NHA member hospitals from across the performance, health care organization state select one employee to receive The involvement and significant leadership. Caring Kind award. Sixty-six health care This year’s recipient is Leslie Marsh, CEO professionals from Nebraska’s hospitals of Lexington Regional Health Center in were honored at this celebration of Lexington. caring and outstanding health care Two Nebraska hospitals are service excellence. honored with the Quest for Excellence The Nebraska Hospital Association is award for their impressive results for the unified voice for Nebraska’s hospitals implementing initiatives to improve and health systems. The Association quality of care for patients. In the Non- offers collaborative leadership, assisting Critical Access Hospital category, Great its members to provide comprehensive Plains Health in North Platte was the care to their communities, improving the award recipient for their work to reduce health status of those communities. For antibiotic overuse and misuse. In the more information, visit the NHA website Ben Nemtin Critical Access Hospital category, St. at www.NebraskaHospitals.org.

A magazine for and about Nebraska hospitals and health systems. 21

By Kim Larson, Director of Marketing

Quest for Excellence Award: Honoring hospitals that improve health care in Nebraska

The Nebraska Hospital Association’s Quest for Excellence award is given to one Critical Access Hospital and one non-Critical Access Hospital to recognize them for their efforts in improving the quality of care provided at their facilities. Nebraska hospitals are invited to submit applications, which are judged by a panel of health care professionals.

The recipients of the Quest for Excellence Award were honored at the NHA’s 90th Anniversary Annual Convention on October 25, 2017, during their Awards Banquet.

St. Francis Memorial Hospital, West Point “Improving Lives through the Development of a Parkinson’s Exercise and Support Group” The driving factor behind the development of the Parkinson’s Exercise and Support Group was the increasing prevalence of patients with Parkinson’s Disease in the West Point community. The medical and rehab staff at St. Francis Memorial Hospital noted increasing numbers of patients with Parkinson’s and the “revolving door” phenomenon, indicating that this population was missing a critical component in their care. It was not uncommon for a patient with PD to attend therapy for 6-8 weeks, make tremendous functional gains, discharge to a home program, and then return 3-6 months later having lost the gains previously made. and the community in several ways. or requiring placement at a nursing While these individuals’ motivation The program could improve the facility. may have been high at time of participants overall quality of life At the conclusion of the first discharge, the tools, resources, and and well-being, and provide a sense phase, results indicated that all support need to sustain functional of belonging. Patients are provided standardized measures had improved. levels independently or even with a with a cost-efficient way to access Spouses/caregivers were encouraged caregiver were not adequate. healthcare professionals who could to participate in the program and A Parkinson’s Exercise Group was monitor their overall condition and it quickly became evident that a formed led by a Physical Therapist and make appropriate referrals as needed. different type of support group was PT Assistant, and pre- and post-testing The program also would promote the needed for these individuals. In of key indicators were done. The idea of “aging in place” which aims addition to group members meeting rehabilitation staff at SFMH had high to keep people living independently to exercise, spouses and caregivers hopes this program could improve the and safely at home vs. being began meeting as a support group. quality of care provided to patients frequently readmitted to the hospital As this program evolved, we

22 A magazine for and about Nebraska hospitals and health systems. began to provide participants and and resources. Education regarding their spouses/caregivers with up home safety, adaptive equipment to date information and education options, fall prevention, mobility, surrounding PD. Members of St. Francis Memorial and activity levels were frequently our medical staff met with the Hospital, West Point reviewed with the participants by exercise and support groups to SFMH therapy staff. inform them of services offered, Now two years into the program, medications, and other resources the decision was made to split the available. A local pastor and “Improving Lives exercise groups into two sections inspirational speaker, recently through the based on the overall functional diagnosed with PD, came and abilities of the patient. This change shared his story to a full house Development of a necessitated the need for the rehab consisting of the members and Parkinson’s Exercise staff to reach out to all staff of the spouses of the Parkinson’s Exercise hospital to assist during exercise and Support Group, hospital staff, and Support Group” group sessions, allowing for a true and community members. Another multidisciplinary team. As a result, invaluable service to the group was a lower patient-to-staff ratio was the inclusion of the Social Worker created, enhancing patient safety, at SFMH, who began meeting with care and overall experience. the caregiver/spouse group on a regular basis to provide education continued on page 24

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A magazine for and about Nebraska hospitals and health systems. 23 continued from page 23

Great Plains Health, North Platte “Antibiotic Stewardship Implementation Journey” Like all medications, antibiotics have serious side effects such as adverse drug reactions and can lead to serious infections. The CDC has identified inappropriate use of antibiotics as one of the most serious and growing threats to public health. Data review at Great Plains Health demonstrated an opportunity for better antibiotic stewardship. C. Diff infections are directly correlated with antibiotic overuse or misuse. Annually, Great Plains Health (GPH) creates an antibiogram, or breakdown of local trends for antibiotic susceptibility with systemic and urine isolates and is compared to GPH inpatient facility based infection trends. This data

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24 A magazine for and about Nebraska hospitals and health systems. assist in identifying local infection/ to classify antibiotic days based on susceptibility trends and prescribing patient-level exposure, days of therapy habits for the community. Additionally, Great Plains Health, (DOTs) were defined. DOTS are simply a subjective trend was noted in the the number of days that a patient is daily Interdisciplinary Team Meeting North Platte on an antibiotic, regardless of dose. (IDT) as staff began to recognize trends (Griffin et all, 2012). The DOT metric is in increased IV antibiotic usage among also correlated with number of orders providers and patients placed on “Antibiotic Stewardship initiated. In January 2017, the most multiple antibiotics at admission with prescribed IV antibiotic, Vancomycin failure to narrow even when culture Implementation had 183 unique orders with 105.01 DOT results became available. Journey” compared to July 2017 with 204 unique The team at Great Plains Health orders and 20.32 DOT. Levofloxacin had utilized PDSA, small tests of change, and 114 unique orders in January 2017 and LEAN to identify issues, make changes, 87.62 DOT compared to July at 80 unique and achieve improvements. Monday orders and 12.68 DOT. Similar trends through Friday review of antibiotic were seen with multiple frequently used usage within 48 hours was begun in compared to culture results obtained, antibiotics This reduction indicates that 2016. Members of the team include the an IV-to-oral review to determine prescribers are narrowing their antibiotic infectious disease provider, infection which patients can be transitioned to therapies by decreasing the number control, pharmacists, lab and quality. oral administration, a “drug-to-bug” of antibiotics prescribed and length of Others are utilized on an ad hoc basis mismatch and therapeutic duplication. time the patient is given the antibiotic, as needed. Areas of review include a Results to date demonstrate a achieving a more appropriate utilization 48-hour review of antibiotics ordered decrease in days of therapy. In order of antibiotics.

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A magazine for and about Nebraska hospitals and health systems. 25 By Cris Hay-Merchant, Bellevue University

Developing leaders for a world where the stakes are higher

In other industries, operational or customer From five participants in its first year to service issues can cause the company stock 39 participants in 2017, the NHA Leadership price to rise or fall. In the healthcare industry, Institute has grown and evolved, but its original similar issues can result in actual life or death mission remains the same. “The Institute is outcomes. Those higher stakes come with a geared toward providing middle management territory that Hospitals and Health Networks and up-and-coming leaders within hospitals described as “arguably the most complex with the necessary skills to become exceptional industry in existence.”1 is an alumnus of the 2011 program, agreed leaders,” explained Kim Larson, Director of Understanding and aligning patient care, about the foundational value of the institute. Marketing for the NHA and herself a 2009 administration, technology, operations, “At first I was hesitant to enroll. I had been a alumna of the program. strategy and more takes a very particular type department leader for over 10 years. What’s Participants come together throughout the of leadership – a combination of skills and to learn?” he said, admitting that he changed year for intense, day-long sessions designed to experience that aren’t learned overnight, or his tune after the first session. “The Institute’s help them learn new skills, find inspiration in by osmosis. Those challenges are exactly why coursework focused on many of the challenges their roles, and invigorate their performance the Nebraska Hospital Association partnered that we faced at the hospital at the time and it in the hospitals where they work. Some of with Bellevue University to establish its was rewarding to be able to apply the skills (I the specific topics included in the institute’s own Leadership Institute back in 2004. Five learned) immediately.” agenda are 360-degree assessments, working professionals working in organizations ranging with conflict, workplace diversity and leading from an urban tertiary care center to rural across generations. “It’s a very unique program community hospitals made up the first class. “It is important that is constantly evolving thanks to input Dr. Mike Freel, Associate Professor and from our participants and changes in the Healthcare Administration Program Director, for current CEOs industry,” said Dr. Michelle Eppler, Dean of has served as an Institute facilitator and to develop the Bellevue University’s College of Continuing instructor since 2012 and has seen the and Professional Education. She added that industry undergo significant change in areas. leadership pipeline participants are coached by University faculty “Healthcare leaders need a foundation of who are experts in management, business solid leadership skills in order to be effective to ensure effective administration, healthcare administration and, in today’s ever-changing, dynamic healthcare succession planning.” of course, leadership development. environment,” he said. Jim Hain, who According to Jonathan Titus, Director of currently serves as Chief Operating Officer Continuing Education at Bellevue University, for Lexington Regional Health Center and the NHA Leadership Institute stands out

26 A magazine for and about Nebraska hospitals and health systems. through the rich and personalized “This venue is a the course with assisting her during her experience that it offers to participants transition in 2013 to Chief Operating and through its singular focus on serving great way to learn Officer, and then in 2016 to Chief Executive healthcare professionals in Nebraska. leadership skills and Officer of the 25-bed Critical Access Hospital “Participants don’t just hear different (CAH) and its outpatient services and clinics. speakers talking about leadership, they to bring out ones you Larson noted that in addition to start, or continue to build on, their own didn’t know you had.” Mazanec, “Many Leadership Institute leadership development journey,” he said. alumni have risen in the ranks of their Key to that development process is the hospital to even more elevated leadership 360-degree assessment that all participants roles.” However, in a healthcare industry undergo at the outset of the program. that is complex today and will be tomorrow, “Whether you’re a nursing manager in Perhaps the most critical component Larson added, “great leaders will inspire and a hospital that serves patients from a of the Leadership Institute is the bonds elevate people to accomplish great things.” geographic area that is hundreds of miles that are formed among current institute wide or you’re a radiology supervisor, members, as well as the 357 alumni to For more information, visit www. you’re able to get some much-needed date. Lori Mazanec, ACHE, who participated NebraskaHospitals.org/education/ perspective on your strengths and areas in the Leadership Institute in 2011, at the leadership_institute where you need to shore up your skills,” same time she was working as Controller 1 Glaser, John, “Managing Complexity Titus explained. “Two executive coaching at Box Butte General Hospital in Alliance, with Health Care Information Technology,” sessions are provided for every participant, said “The class presented me with Hospitals and Health Networks, Oct. said Jon Borton, Vice President, NHA networking opportunities with hospitals 8, 2013. https://www.hhnmag.com/ Services, “and from the feedback we across the state, which is important articles/6094-managing-complexity-with- get, those sessions are always really to build collaborative efforts between health-care-information-technology meaningful.” organizations.” Mazanec also credited

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A magazine for and about Nebraska hospitals and health systems. 27 By Michael Feagler, Vice President, Finance

State hospital association representatives meet with CMS Administrator Verma

On November 6, 2017, along with consolidations may impact access to care in Several of the points we brought forward representatives of the Iowa, Kansas and both rural and urban areas. were areas of focus for her. However, there Missouri hospital associations, the Nebraska were a few points of contention that will Hospital Association met with Seema Verma, Meaningful Quality Measures require close attention. One area of concern CMS Administrator, at the CMS Regional Office She has heard the criticisms about the is meaningful use. The impression given was in Kansas City. The meeting was an opportunity usefulness of the quality information being she feels the program has not moved us to to hear Ms. Verma’s priorities for the agency, collected. As part of the “Patients Over where we need to be. She was clear that as well as an opportunity for the associations Paperwork” initiative she intends to review Meaningful Use will move forward and that to share their issues and concerns facing their the quality data being collected to ensure her goal is to get to full interoperability. She respective memberships. that what is collected is being used in some didn’t allow for much debate on this topic. Ms. Verma’s priorities that she shared with meaningful manner. If the utility of the data Another area is the 340B Drug Pricing us focused on four areas: isn’t there she intends to eliminate the need to Program. CMS doesn’t have oversight of the report it. program; however, I think that if it was up Maintaining access to care in rural areas When Ms. Verma was done talking about to her that would change. She is concerned Ms. Verma expressed her concerns about her priorities, the association representatives about the perceived lack of oversight of the how we can maintain access to healthcare had the opportunity to discuss the program, as many do on Capitol Hill. We services in rural America. Hospital closures are memberships’ issues and concerns with her. brought up the concerns over the 28.5% inevitable, so we need to find ways to keep Most of the issues facing Nebraska are the reduction in OPPS payments, but there was basic healthcare services available in these same issues that hospitals in Iowa, Kansas little sympathy for providers on this matter. communities. She sees an opportunity for and Missouri are facing. Prior to the meeting The final area that I came away with CMS, the AHA and state hospital associations with Ms. Verma, the four state associations concerns about was the CAH 96-hour Rule to work together to develop solutions. participated in a conference call together to issue. The crux of the issue is the discrepancy compile a list of priorities to discuss. With the between the Conditions of Participation and Administrative Simplification limited amount of time, we wanted to make the Conditions of Payment. CMS has made She shared information regarding her sure we were focused on what CMS could it known that this is a low-priority issue “Patients Over Paperwork” initiative that she impact. for compliance. The fix for this issue lies in rolled out the end of October. The primary Here is a list of the issues we were able to legislation. The concern comes from some focus is to reduce or eliminate regulatory discuss with Ms. Verma. comments made by some of Ms. Verma’s requirements that interfere with healthcare 1. Permanent moratorium on direct staff. There may be some belief within provider’s ability to focus on the patient. This supervision requirements. CMS that some CAHs have over stepped includes ensuring that any regulatory changes their scope by offering services that are not are in sync across the board. 2. Administrative burden (we provided considered “critical” to the care provided in As part of this initiative, she has directed a copy of the AHA regulatory burden their communities. Seema Verma, herself, CMS officials to get out into the field and meet letter). did not comment on the issue. with providers. The Kansas City Regional Office As with any meeting of this nature, has been provided additional funds for what 3. Opioid Crisis. most of the discussion was at a high level. they term “rural roadshows” to get out and However, she was quite clear on what CMS’ meet with rural providers. 4. Access to behavioral health and direction would be on these issues. There substance abuse services. are several issues that we as healthcare Center for Medicare and Medicaid providers can agree on with Ms. Verma, but Innovation (CMMI) 5. CAH 96-hour rule enforcement. there are an equal number of issues with She would like to see CMMI expand and which we are going to be at odds. The NHA provide more leadership in areas such as 6. Cancelling stage 3 of the Meaningful will continue to advocate on behalf of it’s access to care. She sees CMMI partnering Use Program. members to CMS to ensure that your voices with stakeholders to study different models of are being heard. care to maintain services in rural areas. She 7. Access to care in rural areas. If you have any questions, please contact also wants the agency to look at the impact Mike Feagler, VP, Finance at the Nebraska of market consolidation. She has concerns 8. Preserving the 340b drug pricing Hospital Association, at 402-742-8144 or about the consolidation of hospitals and program. email [email protected]. other healthcare providers and how these

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