President s Message. The Healthcare Association of Hawaii reached a milestone this year: we turned 75!

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3 President s Message The Healthcare Association of Hawaii reached a milestone this year: we turned 75! This is a special accomplishment. From our beginnings as the Hospital Association of Hawaii in 1940, to our reconciliation with the Hawaii Long Term Care Association in 2015, this Association has worked to represent its members, who now encompass the entire continuum of care. The fiscal year shows why it is important for us to continue working together on important healthcare issues. We are all adapting to challenges in the healthcare landscape brought about by our aging population, our changing economy, and the requirements of the Affordable Care Act. Against the backdrop of these challenges, HAH members continue to improve their quality measures and reach for the highest standards of patient care. And they work to improve access to that care for all residents of Hawaii. I am humbled by their passion, their hard work, and their generosity in sharing their knowledge and expertise. They remain my inspiration every day. Sincerely, GEORGE W. GREENE, Esq. President & CEO Healthcare Association of Hawaii

4 Legislative Action 2015 HAH represents its membership by proposing and supporting legislation at the state and federal levels that is in the collective interest of healthcare providers and patients statewide. HAH works to ensure that laws and regulations furnish a reasonable and equitable environment in which healthcare organizations can provide affordable, safe, high quality healthcare. During the 2015 Legislative Session, HAH was more active than ever. HAH defeated 4 bills that would have hurt best practices for patient care, and overall lobbied and testified on 30 measures during the 2015 legislative session. HAH s anchor sustainability bills passed the legislature again in 2015: Act 70 Hospital Sustainability Program Act 69 Nursing Facility Sustainability Program Both sustainability programs are designed to draw down federal matching Medicaid funds to improve reimbrusements that would maintain access to care for this population. No state funds and no taxpayer dollars were used. Instead, the legislation raised funds from private facilities. HAH also collaborated with stakeholders toward the passage of important healthcare legislation: HHSC Maui Region Partnership Stroke Standards of Care Kupuna Care Funding ACA Waiver Task Force

5 Shaping National Policy During the fiscal year, HAH advocated in Washington, D.C. on a number of issues critical to Hawaii healthcare provider organizations, including: Behavioral Health Electronic Health Records (EHR) COFA Insurance Coverage Critical Access Hospital Relief Act Disproportionate Share Hospital (DSH) Reduction Relief Establishing Beneficiary Equity in the Hospital Readmission Program Face-to-Face Requirement Frontier Status Home Health Care Planning Improvement Home Health Rebasing Relief Hospice Evaluation and Legitimate Payment Improving Access to Medicare Medicare Audit Improvement Medicare Durable Medical Equipment (DME) Medicare Home Infusion Protecting Access to Rural Therapy Services VA Authority for Extended Care 340B Program

6 St. Francis Health System of Hawaii

7 Quality The National Partnership to Improve Dementia Care in Nursing Homes Hawaii ranks #1 in the nation for appropriately low antipsychotic use for long-stay nursing home residents. Hawaii had a 30.1% decrease ( ). Partnership for Patients ( ) 22.7% improvement in obstetric (OB) trauma rate 58.8% reduction in rate of vascular catheterassociated infections 71.7% reduction in pressure ulcer rates 77% reduction in rate of ventilator-associated pneumonia 79.1% reduction in rate of catheterassociated urinary tract infections (CAUTI) Highlights 21 on-site quality coaching visits Advancing Excellence in America s Nursing Homes Campaign INTERACT II training Sharing Best Practices HAH Quality Committee New HAH quality committee dedicated to postacute care members

8 RIMPAC 2014 Castle Medical Center Maui Memorial Medical Center

9 Emergency Services Rapid Response to Ebola Threat HAH Emergency Services developed and implemented an Ebola Virus Disease training, PPE stockpiling and patient transport program Co-Chaired EVD Working Group with the Department of Health Program Highlights Hawaii Incident Management System course offered to Japanese hospitals in collaboration John A. Burns School of Medicine Launched Active Shooter education program Emergency aeromedical missions in Hawaii and into the Pacific Response to two hurricanes in Hawaii Emergency Services Coalition expanded to include dialysis providers Federal Hospital Preparedness Program Site Visit Key Findings: The entire organization and execution of Hawaii s [HAH] healthcare coalition is a best practice. Entire list of medical surge capabilities of the HAH healthcare coalition is a best practice. Strong leadership Well-developed plans, procedures, communications and extensive experience Coalition on-line Learning Management System (LMS) is a best practice Clear, concise and actionable information Strong mass fatality planning and equipment Robust and redundant communications system is a best practice Implementation of HPATS (patient tracking system) is a best practice

10 Events and Education HAH offered 55 free or reduced-rate educational opportunities for members in the fiscal year, along with signature events offering opportunities for networking, sharing best practices and receiving updates from national healthcare leaders. Accountable Care Organizations Annual Meeting Awards & Scholarship Dinner Advocacy Day Dementia for Acute Care DMEPOS Competetive Bidding ICD-10 Coding Education Joint Commission Resources Custom Education Program Long Term Care Trend Trackers On-the-Job Training Quest Integration Forum

11 Community Health Needs Assessment In 2013, Hawaii became one of only two states to conduct a statewide Community Health Needs Assessment (CHNA), through a partnership with Hawaii hospitals and the Hawaii Department of Health. This year, HAH began the CHNA process for plans to be submitted in Healthy Communities Institute (HCI) conducted 75 key informant interviews and utilized the Hawaii Health Matters database for secondary data. HCI s Florence Reinisch, MPH and Jenny Belforte, MPH presented their preliminary findings of public health challenges facing each county in the state to HAH members and HAH s CHNA Advisory Group. Hospitals are embracing this opportunity to make a meaningful impact in addressing public health challenges. George Greene, Esq.

12 INCOME Grants & Contracts 469,000 Other 159,000 Investments 56,000 Emergency Services Contract Support 653,000 Membership Dues 2,100,000 EXPENSES Association Management 852,000 Representation & Advocacy 411,000 Education & Research 519,000 Emergency Services Contract Support 726,000 Communications 703,000

13 CELEBRATING 75 YEARS FROM G.N. Memorial Wilcox Hospital 1938 Leahi Home (now Leahi Hospital) c 1938 Dowsett Hospital (Shriners Hospitals) 1933 First Annual Meeting of the Hospital Association of Hawaii June 1940 The Queen s Hospital c 1939 Home Health Visit 1938

14 Kahuku Medical Center CT Scanner in Radiology Dept. Return on Investment HAH leveraged more than $67 million in direct monetary benefit for members this year: $9,500 in healthcare scholarships. $112,000 million statewide quality improvement - Partnership for Patients. $166,000 saved in travel costs from Joint Commission and other in-state education. $500,000 accrued savings to participating HAH hospitals from statewide Community Health Needs Assesment. $4 million indirect improvement in reimbursement rates through sustainability programs. $7.7 million saved through defeat of bills that would have negatively impacted the healthcare system. $11.3 million in additional federal funds through the nursing facility sustainability program. $43.9 million in additional federal funds through the hospital sustainability program.

15 Hilo Medical Center s Hawaii Pacific Oncology Center Connecting the Continuum of Care HAH Member Committees serve as a springboard for collaboration and sharing of best practices throughout the continuum of care. Regular Member Divisions: Acute Care Leadership Long Term Care Leadership Home Care and Hospice Leadership (home health, hospice, and DME executives) Awards & Scholarship Committee Board of Directors and Executive Committee Chief Financial Officer Roundtable (hospital CFOs) Community Health Needs Assessment Advisory Group Chief Nursing Officers Roundtable (hospital CNOs) Emergency Management Committee Finance Committee Government Relations Committee Hawaii Affinity Team Hawaii Healthcare Heroes Committee Long Term Care Reimbursement Committee Mental Health Task Force Neighbor Island Committee Acute and Post-Acute Quality Committees Public Information Officer Working Group Transitions of Care Committee

16 Public Relations HAH s communications team works to elevate the positive image of Hawaii s healthcare systems, correct media misperceptions, and highlight achievements of member facilities. It was a very favorable media year for HAH, with more than 30 earned media placements for HAH s 75th Anniversary, Hawaii Healthcare Heroes, Ebola preparedness and RIMPAC.

17 Wilson Home Care - Kailua

18 Board of Directors FY Chair: KATHRYN RAETHEL, FACHE, MAHA, MPH, RN, Castle Medical Center Chair-Elect: BETH HOBAN, RN, MAOM, Prime Care Services Hawaii, Inc. Secretary/Treasurer: TIMOTHY ROE, MD, Rehabilitation Hospital of the Pacific Past Chair: EMILIE SMITH, RN, BSN, MBA, Castle Home Care President & CEO: GEORGE W. GREENE, ESQ., Healthcare Association of Hawaii JERRY CORREA, JR., St. Francis Healthcare System of Hawaii COL DAVID DUNNING, (Tripler Liaison), Tripler Army Medical Center ART GLADSTONE, Straub Clinic & Hospital and Pali Momi Medical Center STEVE GOLD, MHA, CFACHCA, FACHE, (AHCA Delegate), Hale Nani Rehabilitation & Nursing Center NICK HUGHEY, (Neighbor Island Committee Chair), Kula Hospital/Lanai Community Hospital GARY K. KAJIWARA, Kuakini Medical Center RICHARD KISHABA, (Long Term Care Division Chair), Ohana Pacific Management Company WAYNE PFEFFER, (VA Liaison), VA Pacific Islands Health Care System CORINNE SUZUKA, RN, BSN, MA, (Home Care & Hospice Division Vice Chair), CareResource Hawaii ARTHUR A. USHIJIMA, The Queen s Health Systems RAYMOND P. VARA, Jr. (AHA RPB 9 Delegate), Hawaii Pacific Health LAURA WESTPHAL, (AONE Liaison), Castle Medical Center JOHN WHITE, Shriners Hospitals for Children - Honolulu KENNETH ZERI, RN, MS, NHA, (Home Care & Hospice Division Chair), Hospice Hawai`i Reimbursement Advocacy Quality Emergency Services Education Unified Voice for Healthcare

19 HAH is the official Hawaii state affiliate for the leading national healthcare associations:

20 Members ACUTE CARE HOSPITALS and HOSPITAL-BASED SKILLED NURSING FACILITIES Castle Medical Center Hale Ho`ola Hamakua Hawaii State Hospital Hilo Medical Center Kahi Mohala Kahuku Medical Center Kaiser Permanente Medical Center Kapiolani Medical Center for Women & Children Kauai Veterans Memorial Hospital Kohala Hospital Kona Community Hospital Kuakini Medical Center Kula Hospital Lanai Community Hospital Leahi Hospital Maui Memorial Medical Center Molokai General Hospital North Hawaii Community Hospital Pali Momi Medical Center Rehabilitation Hospital of the Pacific Samuel Mahelona Memorial Hospital Shriners Hospitals for Children Honolulu Straub Clinic & Hospital The Queen s Medical Center The Queen s Medical Center - West Oahu Wahiawa General Hospital Wilcox Medical Center

21 FREE-STANDING SKILLED NURSING FACILITIES and ASSISTED LIVING FACILITIES & TYPE II ARCHs 15 Craigside Aloha Nursing Rehab Centre Ann Pearl Nursing Home Arcadia Retirement Residence Avalon Care Center - Honolulu Care Center of Honolulu Garden Isle Healthcare Center Hale Anuenue Restorative Care Center Hale Ho Aloha Hale Kupuna Heritage Home Hale Makua - Kahului Hale Makua - Wailuku Hale Malamalama Hale Nani Rehabilitation & Care Center Hale Ola Kino Hi`olani Care Center at Kahala Nui Island Nursing Home Ka Punawai Ola Kauai Care Center Kulana Malama Life Care Center of Hilo Life Care Center of Kona Liliha Healthcare Center Maluhia Maunalani Nursing and Rehabilitation Center Nuuanu Hale Oahu Care Facility Palolo Chinese Home Pearl City Nursing Home Pohai Nani Pu`uwai `O Makaha VA Center for Aging 15 Craigside Aiea Heights Senior Living Arcadia Retirement Residence Hale Ku`ike Hale Ku`ike Bayside Hawaii Kai Assisted Living & Retirement Community Kahala Nui Korean Care Home Kuakini Home Oceanside Hawaii Assisted Living One Kalakaua Senior Living Pohai Nani-Good Samaritan Society Regency at Hualalai Hawaii Island Regency at Puakea Kauai The Plaza at Mililani The Plaza at Moanalua The Plaza at Punchbowl Wilson Senior Living

22 HOME HEALTH AGENCIES, HOSPICES, DURABLE MEDICAL EQUIPMENT SUPPLIERS, HOME INFUSION COMPANIES and PHARMACIES Ace Medical Apria Healthcare Bayada Home Health Care - Maui Bayada Home Health Care - Oahu Bristol Hospice CareResource Hawaii Castle Home Care Hale Nani Rehabilitation & Care Center Hawaii Islands Medical Corporation Hilo Medical Center Home Care Home Health by Hale Makua Hospice Hawaii Hospice Maui, Inc. Hospice of Hilo Hospice of Kona Islands Hospice Kaiser Home Health Agency Maui Kauai Hospice Kohala Home Health Care Kokua Nurses North Hawaii Hospice, Inc. Ohana Home Health, LLC Pharmacare Prime Care Services Hawaii St. Francis Home Care Kauai St. Francis Home Care Oahu St. Francis Hospice Stay at Home Healthcare Services Wahiawa General Hospital Home Health Agency West Hawaii Home Health Services Wilson Homecare

23 ASSOCIATE Airgas Gaspro, Inc. Alston Hunt Floyd & Ing Altres Medical American Organization of Nurse Executives Hawaii Chapter AON Risk Services, Inc. of Hawaii Architects Hawaii Ltd. Atlas Insurance Agency B-Homecare Blood Bank of Hawaii Cardinal Health Comforting Hands Senior Care Convatec CW Associates Diagnostic Laboratory Services, Inc. Ensocare Ernst & Young LLP Goodsill Anderson Quinn & Stifel Hawaii Health Information Corporation Hawaii State Center for Nursing Healthcare Coding Consultants of Hawaii HiHomeCare HiNursing Intellimed International Corp. Johnson Controls Kahu Malama Nurses, Inc. Legacy of Life Hawaii MGA Architecture Meadow Gold Dairies Hawaii MetLife Resources Monarch Insurance Services, Inc. Mountain-Pacific Quality Health Foundation Pharmerica Pu`ulu Lapa`au SH Consulting LLC Sodexo Health Care Division Facility Management Services Standard Parking Team Praxis The Queen s Federal Credit Union Verge Solutions Wealth Strategy Partners, LLC

24 PERSONAL Frances Becker Wendy Gibson Rick Jackson Kaimi Maka John Farias Shelley Hee Pat Lambrecht Barbara Ornellas Frank Vitale EMERITUS Will Henderson Rich Meiers Rose Ann Poyzer Herb Yim AFFILIATE Advantage Health Care Provider, Inc. All Island Case Management Corporation American Medical Response & AMR AIR Hawaii CardonOutreach Case Management University of Honolulu, School of Nursing Chaminade University of Honolulu, School of Nursing Hawaii Life Flight Ho`okele Health Navigators, LLC Tripler Army Medical Center University of Hawaii at Manoa, John A. Burns School of Medicine University of Hawaii at Manoa School of Nursing & Dental Hygiene U.S. Renal Care Veterans Affairs, Spark M. Matsunaga Medical Center

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26 HAH Team FY14-15 Executive Staff George W. Greene, Esq. President & CEO Andrew Garrett, MPA Associate Vice President, Post-Acute Care & Operations STAFF Gail Coleman Office Coordinator Adria Estribou, MA Senior Manager, Public Relations & Communications Gina Gibo Staff Accountant Bess Hayashi Chief Financial Officer Anjanette Hendrix Administrative Assistant Sharie Higashionna-Ibarra, MEd Special Assistant to the President & CEO Katherine Korenaga Executive Coordinator for the Vice President & COO Kathleen Libao-Laygo, RN Director, Quality & Regulatory Affairs

27 Jamie Velasco Communications and Special Events Assistant Paul Young, MBA Senior Director, Reimbursement & Public Policy HAH EMERGENCY SERVICES Toby L. Clairmont, RN, CEM Director William Bill Richter, RN Manager, Clinical Operations Chris Crabtree, DrPH, CEM Manager, Program Development Aiko Holmberg Program Coordinator

28 The leading voice of healthcare since 1939 HAH.org Richards St., PH2, Honolulu, Hawaii