Alaska Native Tribal Health Consortium wins major honor

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1 DECEMBER 2011 / JANU ARY 2012 PRESIDENT S REPORT / KAREN PERDUE Alaska Native Tribal Health Consortium wins major honor AHA President Rich Umbdenstock called ANTHC Board Chair Andy Teuber last week with some unexpected news- the national American Hospital Association Board had just bestowed one of their most prestigious awards to the Alaska Native Tribal Health Consortium. Umbdenstock was calling to highlight what he called a dynamic program to bring better health and better health care to Alaska communities. Its scope and commitment to community health status are models for other hospitals and health systems across the nation. And he wanted to come to tell Teuber he would like to come to Alaska in the near future to present the award and learn more about their work. The American Hospital Association (AHA) named the Alaska Native Tribal Health Consortium (ANTHC) a Carolyn Boone Lewis Living the Vision Award winner. The awards are presented to organizations living AHA s vision of a society of healthy communities where all individuals reach their highest potential for health. The Carolyn Boone Lewis Living the Vision awards recognizes the commitment of individuals and organizations to the vision of the AHA and their contributions to making the vision a reality. This includes a focus on wellness, efficient affordable care, highest quality care and eliminating disparities in health care. The ANTHC Board of Directors stand outside the Consortium corporate office in a photo from From left to right: Chief Gary Harrison, Unaffiliated Tribes, Chickaloon Native Village; Robert Henrichs, Chugachmiut, native Village of Eyak; Bernice Kaigelak, Arctic Slope Native Association; Andrew Jimmie, Tanana Chiefs Conference; Louie Comack, Maniilaq Association; Eveylyn Beeter, Unaffiliated Tribes, Mount Sanford Tribal Consortium; Andy Teuber, Kodiak Area Native Association; Charles Clement, Southcentral Foundation; H. Sally Smith, Bristol Bay Area Health Corporation; Paul Brendible, Metlakatla; Emily Hughes, Norton Sound Health Corporation; Lincoln Bean Sr.; Southeast Alaska Regional Health Consortium; Charlene Nollner, Copper River Native Association; Mike Zacharof, Aleutian/Pribilof Islands Association; Ray Alstrom, Yukon Kuskokwim Health Corporation. Not pictured, new board members, Linda Clement, Metlakatla Indian Community and Robert Sampson, Maniilaq Association. Eleven hospitals and health systems have earned the Carolyn Boone Lewis Living the Vision Award since its inception in ANTHC is the nation s first Indian Health Service (IHS) hospital and Alaska s second company to receive the award: Fairbanks Memorial Hospital also holds the distinction. In bestowing the award, AHA officials said The AHA is proud to recognize ANTHC for its work in providing community, medical, and health-related services to IHS beneficiaries residing in Alaska and for providing services that go beyond traditional hospital care. ANTHC operates on a philosophy of lifelong commitment to its beneficiaries. Because of this, ANTHC takes a preventive view of the provision of health and health care to its people. There is a strong focus on wellness, community-based provision of care, and public health status and improvement. "The Consortium came into existence to exemplify the approach of Alaska Native people taking ownership of our own challenges and responsibilities not only related to personal health, but the wellness of our communities as a

2 whole," said Andy Teuber, ANTHC Chairman and President. "Though care is provided in the most visible manner at ANMC, without staff from all our divisions, as well as our numerous partners across the State, we wouldn't be the recipient of such a tremendous honor." The Executive Vice President of the AHA, Rick Pollack, visited the ANTHC campus this summer to learn about the challenges of Alaska s health care system and was impressed by what he saw and learned. Pollack, along with Bob David, Region 9 representative was in Alaska attending a regional policy board meeting of the AHA. Pollack was so impressed with his visit he went back to Washington DC armed with information to spread the word about the accomplishments of ANMC and the ANTHC health system. Over several months follow up information was gathered from Chris Mandregan Director of the Alaska Area Indian Health Service Office, and Karen Perdue CEO of the Alaska State Hospital and Nursing Home Association, to prepare a package of information for the AHA Board. An important element of the award is that a hospital or organization must be recognized as a leader and nominated by others in the health care field. ASHNHA Board Chair Bruce Lamoureux was pleased but not surprised by the award. Im happy the leadership of AHA has had the opportunity to learn more about a remarkable system that we in Alaska get an opportunity to work with on a daily basis. ANTHC richly deserves this award. Wrangell Votes Yes! Hospital Project Moves Ahead Wrangell residents resoundingly passed a ballot proposition in mid-november which cleared the way for the construction of a new Hospital and Long Term Care Facility for the community. The proposition gave permission for the city to pledge the real property (land and new medical center campus) as a first lien to the United States Department of Agriculture (USDA) Rural Development in order for the community to obtain the loan of $24.7 million dollars from the USDA. The project was brought to Wrangell voters with 100% of the funding in place; in addition to the USDA loan, funding sources includes grants from the State of Alaska, the Rasmuson Foundation, and community contributions. It has been gratifying that Wrangell came out so strongly in support of the new Medical Center and Long Term Care facility, said Noel Rea, Rendering of Wrangell s new Hospital and Long Term Care Facility Wrangell Medical Center CEO, It shows that people are ready to move forward and they understand that we have been fighting a battle in keeping the current facility up to code. The measure passed with 71% of the voters in favor, despite the fact that it was the only item on the ballot. A higher percentage of votes were cast in this election (37% of the registered voters) according to City Clerk, Christy Jamieson, compared to the election on October 4 th which saw a 24% voter turnout. The difference was likely due to the intense effort made by a variety of groups to educate the community on the importance of this vote. Community contributions total nearly $200,000. The only financial support by the Wrangell Borough will be obligated for is their donation of property for the project. I m paying more in taxes for the new playground than I will for the new hospital, noted voter LeAnn Rinehart, It s wonderful that this could be done without the City having to raise sales or property taxes. 2

3 Another question which frequently came up in discussions about the vote was why the current facility couldn t just be remodeled or additions built. The answer came from a study of the current facility which concluded that the cost of upgrading the facility (in order to meet new regulations) would be over $40 million, making it much more economical to start fresh. I have learned a lot since coming to work at the Medical Center, notes WMC employee Kris Reed, but most importantly, I have come to appreciate how critical this new building will be to improving living conditions for our elders. Staff are doing all they can to make Long Term Care residents comfortable and see that they are treated with dignity, the new facility will support Noel Rea, CEO of Wrangell Medical Center listens intently at the ASHNHA meeting in Ketchikan. To his left is Wrangell Medical Center CIO Bob Shymanski. Way to go Wrangell! that high standard of care by providing a homelike environment for residents with a beautiful living space which isn t a pass through area to the rest of the building. SCOTUS takes up POTUS Health Care Law The Supreme Court of the United States (SCOTUS) has agreed to review the President of the United States(POTUS) signature legislation in the next several months. The Supreme Court s case is brought by Florida and 25 other states, including Alaska, challenging the Patient Protections and Affordable Care Act (PPACA). In the case, the 11th Circuit Court of Appeals ruled PPACA s individual mandate unconstitutional, but said the provision could be severed from the rest of the law, which should be left intact. The lawsuit has four major parts and the court devote 5 1/2 hour hearing to each of these issues. (see chart.) The Supreme Court will review the individual mandate and its severability, PPACA s Medicaid expansion, and whether the Anti-Injunction Act bars federal lawsuits against the individual mandate before the provision takes effect. The Court scheduled oral arguments for March The arguments will include two hours on the constitutionality of the individual mandate, 90 minutes on the issue of severability, one hour on the Anti-Injunction Act, and one hour on the constitutionality of the Medicaid expansion. The case briefs are available on the Court s website at: According to the Washington Post November 17 article Court Review Shocks Medicaid Advocates, the most surprising part of the Court s acceptance was the justices announcement that they will consider a one hour hearing on the question of wither the reform law unconstitutionally coerces states into expanding their Medicaid programs. The Post quotes Ron Pollack, executive director of Families USA on the Medicaid inclusion the decision on this issue is probably the most important the Supreme Court will be making on the Affordable Care Act. Modern Health Care quoted Pollack as being flabbergasted that the court opted to review the state s coercion argument. How do you talk about an unfunded mandate when the first three years 100% is being paid by the federal government? The ACA expands the minimum eligibility requirements for Medicaid dramatically, mostly to childless low income adults. Beginning in 2014, under the new law, the states will be required to cover all residents with incomes up to 133 percent of poverty, an estimated 30,000 individuals in Alaska alone. Initially, the feds will cover the whole bill. Its share will gradually drop to 90% by 2020 and beyond. The law also requires each state to chose a set of minimum essential services to be covered in the state. 3

4 Any state that doesn t agree to those terms will, under the federal reform law, lose all of its federal Medicaid funding which the 26 states in the lawsuit assert is tantamount to coercion. Florida and the other 25 states like Alaska sued HHS to stop the Medicaid expansion, and the Supreme Court granted the hearing even though neither the district court judge in Florida nor the appeals court sided with the states so far on the argument. In a Modern Healthcare article, Vanderbilt Law Professor James Blumstein indicates the Supreme Court action is very significant- I think it s the most important issue in the case and it s a sleeper issue. It gets no attention in the media. And Blumstein thinks it likely to be the most successful for the states. He argues the federal government has canceled the traditional Medicaid program starting in 2014 and now states must decide whether to join a new Medicaid program in which the feds dictate the terms of eligibility. The Court will likely make its decision at the end of June The U.S. Supreme Court will hear 5 ½ hours of oral arguments on four questions raised in petitions to review an August 12 decision from the 11 th U.S. Circuit Court of Appeals in Atlanta, which struck down the healthcare reform law s individual insurance mandate. QUESTIONS 11 TH CIRCUIT OTHER RULINGS Does Congress have the constitutional authority to require individuals to buy health insurance? Two hours If the individual mandate is unconstitutional, is the rest of the reform law invalid? 90 minutes Is the mandate actually a tax, and does that mean it can t be challenged until after it becomes effective in 2014? One hour Does Congress have the power to coerce states to expand Medicaid by withholding federal matching funds? One hour HEALTH CARE REFORM AND THE CONSTITUTION Source: November 21, 2011 Modern Healthcare The economic mandate for Americans to purchase insurance from a private company for the entire duration of their lives is unprecedented, lacks cognizable limits, and imperils our federalist structure. Where it is not evident Congress would not have enacted a constitutional provision without one that is unconstitutional, we must allow any further and perhaps even necessary alterations of the act to be rendered by Congress. Not specifically addressed, but the opinion concludes that the mandate is a civil regulatory penalty and not a tax for the purpose of evaluating its constitutionality There is no coercion because Medicaid-participating states have a real choice not just in theory but in fact to participate in the act s Medicaid expansion. The 6 th U.S. Circuit Court of Appeals in Cincinnati ruled the mandate is within Congress power because uninsured Americans shift $43 billion in costs to other payers. The District of Columbia U.S. Circuit Court of Appeals also upheld it, ruling that congressional power reaches individual behavior that would affect a broader economic regulation if left unregulated. A U.S. District Court judge in Pensacola, FL, ruled the entire law void because the law omitted an explicit severability clause and the individual mandate and the remaining provisions are all inextricably bound together in purpose and must stand or fall as a single unit. The 4 th U.S. Circuit Court of Appeals in Richmond, VA, ruled that the mandate is a tax, and therefore pre-enforcement challenges are barred by the Anti- Injunction Act. The 6 th Circuit came to the opposite conclusion. The U.S. District Court judge in Pensacola also rejected this argument. It was raised only in the Florida-based lawsuit, which included officials representing 26 states. 4

5 Marilyn Tavenner on deck to replace Berwick as CMS chief; She s no stranger to Alaska and our unique challenges Marilyn Tavenner, who has an extensive health background as a nurse, a health care official at both the state and federal level and a hospital chain executive, was tapped by President Barack Obama this month to succeed Dr. Don Berwick as administrator the Centers for Medicare and Medicaid Services. Tavenner,who is the agency s principal deputy administrator, will serve on an acting basis as administrator during the confirmation process. Berwick was not confirmed by the Senate and instead got a recess appointment from Obama. His appointment expires Dec. 31 and he will be stepping down Dec. 2. Tavenner is no stranger to Alaska. She led a team of interagency officials in a visit to Alaska in the summer of The study team s job was to perform a congressionally mandated study of access to care for federal beneficaries. The language was inserted in the ACA law by Senator Mark Begich. Alex Spector, head of the VA in Alaska worked closely with Tavenner during the visit Marilyn Tavenner and the subsequent assignment of drafting the report. The Task Force visited Kenai, Fairbanks, some rural Alaska sites and Anchorage. Alex said of Tavenner she provided strong leadership for the group and returned to Washington DC with a new understanding and appreciation for the challenges of delivery of health care in Alaska. I think her visit here will be an asset in working together with her in her new position., said Spector. Another Alaska acquaintance of Tavenner s is Annie Holt. They served together in HCA management positions when Marilyn was HCA Division President in the Richmond Virginia market. Holt says, while she is not a close acquaintance, the two would check in and chat at HCA events and worked on some projects together. I noticed immediately when she was promoted to a CEO position in HCA that she was an RN which of course I like. She has extensive knowledge of health care from clinical to the acute care business to state government leadership. Tavenner has played a key role in overseeing Medicare, Medicaid and the Children's Health Insurance Program. In remarks to the National Association of Medicaid Directors earlier this month, Tavenner shared her thoughts on how to control health care costs, themes that are very similar to ideas Berwick has expressed repeatedly throughout his tenure. The only way to stabilize costs without cutting benefits or provider fees is to improve care to those with the highest health care costs, she said. Tavenner also said she opposed Republican efforts to turn Medicaid into a block grant that would limit the amount of federal funding states can receive for the program. "That approach would simply dump the problem on states and force them to dump patients, benefits or make provider cuts or all the above, she said. Watch for an interactive AHA webcast with Marilynn Tavenner on December 13. Happy Holidays from The Staff at ASHNHA To you and yours December

6 2011 March of Dimes Nurse of the Year Winners The 8 th Annual March of Dimes Nurse of the Year recognizes Alaskan nurses from across the state in 22 different categories. This year March of Dimes received 119 nominations, and chose 24 winners. Three hundred people attended the banquet. Congratulations to the 2011 March of Dimes Alaska Chapter Nurse of the Year Award Winners. Award Winners Emergency/Flight: Richard Janik, Airlift Northwest Juneau Critical Care Adults: Jacqueline Quantrille, ANMC Pediatrics: Charlot Main, Alaska Native Medical Center Friend of Nursing Ancillary: Mike Lopez, Bartlett Regional Hospital Legend in Nursing: James Steven Reese, Bartlett Regional Hospital Maternal/Newborn: Joan Harvey, Bartlett Regional Hospital Military Nursing Administration: Caroline Broden, Bassett Army Hosp. Friend of Nursing Professional: Leilani Sauer, Fairbanks Memorial Hospital Hospital Case Mgmt. Care Coordinating: Hannah Brice Smith, Fairbanks Memorial Hospital LPN: Eugeina Erickson, Fairbanks Memorial Hospital Nursing Administration: Gena Edmiston, Fairbanks Memorial Hospital Rising Star: Heather Cunningham, Fairbanks Memorial Hospital Military Advanced Practice: Valerie Trump, Joint Base Elmendorf-Richardson (JBER) Military Nursing Management: Tambra Yates, Joint Base Elmendorf-Richardson (JBER) Ambulatory Nursing: Lorrie Dreese, Mat Su Regional Medical Center Advanced Practice: Danette Schloeder, Providence AK Medical Center Behavioral Health: Ronald Strandberg, Providence AK Medical Center General Medical/Surgical: Angel Wallis, Providence AK Medical Center Legend in Nursing: Elizabeth Friesen, Providence AK Medical Center NICU: Lindsey Piatt, Providence AK Medical Center Nursing Management: Eva Berthiaume, Providence AK Medical Center Rehabilitation: Judy Elaine Fine, Providence Kodiak Island Medical Center Community Case Management Care Coordinator: Nora Herrera, Southcentral Foundation Friend of Nursing Ancillary: Jasmine Polk, Yukon Kuskokwim Health Corporation Mike Haugen Mike Haugen New Head of the Alaska State Medical Association The Alaska State Medical Association has chosen Mike Haugen to replace outgoing Executive Director Jim Jordan. Haugen will start work at ASMA on the first of May and work with Jordan for two months. Jordan s last day with ASMA will be July 1, Prior to becoming Executive Director at ASMA, Haugen was and still is the Executive Director for Alaska Physicians and Surgeons (APS) in Anchorage. APS is a group comprised of over 160 private physicians who joined together 11 years ago to provide responsible and accountable patient care. 6

7 While at APS Haugen teamed with other medical associations including ASHNHA, ASMA and Providence to form a group called ACCESS. ACCESS lead the legislative effort in 2006 to re-write Alaska s Tort reform law and later to expand the WWAMI program and address the lack of availability of primary care physicians to meet the needs of the Medicare population. Haugen said he is excited to take on his new position at ASMA but at the same time will miss the challenges he faced while running a smaller association at APS. In running ASMA Haugen takes over a nonprofit organization that advocates on behalf of physicians and for the health and wellbeing of all Alaskans. The governance of ASMA includes a House of Delegates and a Board of Trustees while the Executive Director manages the day-to-day operations of the Association. ASMA s Board of Trustees is similar to ASHNHA s Executive Committee and ASMA s House of Delegates is similar to ASHNHA s Board. In addition to his work at APS, Haugen serves as President of the Alaska Medicare Clinic and is the President of the Alaska Heart Institute s Foundation. We have enjoyed working with Mike in his current role and look forward to continuing that relationship at ASMA. ASHNHA Launches Health Information Technology Network On November 14 th, CEOs and IT Directors from five small hospitals in Alaska gathered in Anchorage to launch a new Health Information Technology (HIT) Network project. ASHNHA has received a new grant from HRSA to support small hospitals to work together as a network to implement electronic health records (EHR) and achieve meaningful use. The hospitals that have signed a memorandum of agreement to begin to working together include: Cordova Medical Center Petersburg Medical Center Sitka Community Hospital South Peninsula Hospital - Homer Wrangell Medical Center Those attending the meeting included: Noel Rea, Bob Shymanski, Stephen Sundby, Zhiyong Li, Jim Landon, Liz Woodyard, Don Bieber, Robert Letson, Jim Bartilson. The network provides an opportunity for the small hospitals to explore how to work together and share resources in ways that increase their financial and operational efficiency and quality of care. This is especially important for hospitals not part of a larger health system. As a first step, ASHNHA has contracted with Joe Wivoda of Rural Health Innovations, a subsidiary of The National Rural Health Resource Center. Wivoda is conducting an HIT readiness and meaningful use assessment at the five hospitals initially participating. The information will be used to determine how to best support the hospitals and allocate grant resources. The group has identified some initial areas to focus attention on including: meanin gful use training, calculating incentives, risk and security assessment, project management, and securing resources to support the cost of implementation. 7

8 Nurse Educators Gather to chart the course for the APNC Progress continues on Alaska Perioperative Nursing Consortium (APNC). The consortium pleans to train perioperative nursing in 2012 using the model developed in Seattle, Washington by the NorthWest Perioperative Consortium. The 17 week training for students is planned to begin February 13, As part of this effort, several nurse educators came together on Friday, November 18, to finalize Alaska s curriculum, to assign instructors for the various modules and to determine the best strategies to provide the training. Pictured above from left to right are, Jim Jurrens (ANMC), Merisue Bowerfind (ANMC), Denise Davis (PAMC), Amber Nakazawa (ANMC), Barbara Welte (PAMC), Jamie Britton (FMH/DC), Rosemary Bertok (Ak. Regional) and Vanessa San Pedro, support staff (FMH/DC). Vanessa recently joined the group to help support the effort on the administrative side of the project. Not pictured are: Diane Bigge (Bartlett), Kim Swartz (PeaceHealth Ketchikan), Gail Augdahl (Ak. Regional), Peggy Robinson (Ak. Regional) and Laura Mullin (ANMC). ASHNHA s Dennis Murray Receives AACTE Award ASHNHA s members in Anchorage have been working with the Anchorage School District in the founding and development of the Anchorage Health Career Academy. Recently, Dennis Murray joined other representatives in accepting the Promising Practices Award by the Alaska Association of Career and Technical Education (AACTE) at their awards luncheon. The Promising Practices Award is given based on strong partnerships, vision, longevity, professionalism and evidence of the use of best practices. The Health Career Academy, which began with two teachers, four courses and 100 students in 2009, now has 19 teachers with 24 classes in 11 courses with over 400 students. The number this year is likely to top 600 students. One person who nominated the Health Career Academy for the award had this to say: With the health care industry and its workforce in Alaska continuing to grow into the future, attention to filling the pipeline leading to jobs and post-secondary education with engaged, prepared and skilled students is essential to meeting the health care needs of Alaska residents. This Academy has exceeded our expectations in this regard in a very short time, involving many students, teachers, and schools in creative and strong programs and activities. We are Moving. ASHNHA will relocate its Anchorage office on January 3, Expect a day or two of down time as we reorganize phones, files and computers. We are moving a block away to an office with a conference room and a few other amenities. Our new space is downtown, convenient to several hotels and parking lots. We hope it will be convenient to our members from out of town who may attend meetings and trainings at our office. The office is on the corner of 5th and L: 1049 W 5th Avenue, Suite 100, Anchorage, AK Watch for a change of address notice in the mail. Our phone number will remain the same. 8

9 Events Around the State The Alaska Health Career Academy, a 7-12 career pathway initiative established during the 2009 school year now offers 11 courses to high school students with 4 exploratory activities for middle school students. Specific high school courses in the pathway are: Health Occupations Essentials, Advanced Health Care Professional, Medical Terminology, Intro to Pharmacy, Intro to Veterinary Science, Emergency Trauma Technician, Emergency Medical Technician, Personal Care Assistant, and Certified Nurse Aide. Industry standards for employability including confidentiality agreements, blood-borne pathogen precautions, and barrier crimes are embedded in the coursework to best prepare students for the workforce. Partners currently providing job shadow and other entry level opportunities for ASD Health Career Academy students are the VA, Providence, Prestige Care, the Pioneer Home. With over 400 students currently enrolled in this pathway there is a critical need for additional industry leaders in all areas of health care and support to partner with the ASD to provide summer and part-time employment as well as practicum and job shadow opportunities throughout the year. To join forces in the development and retention of a home-grown health workforce please contact Tammy Williamson at for information about how to become involved. 9