July 30, 2007 Volume 14, Number 29

HQA America’s hospitals, which have been reporting quality of care indicators for inpatient
Adopts services since 2003, are on the verge of adding outpatient quality measures to their reports.
The Hospital Quality Alliance (HQA) on July 11 adopted 10 performance measures of
Outpatient
hospital outpatient quality, which will join the 32 inpatient clinical process and outcome
Quality measures, as well as other patient experiences of care measures, that already are reported and
Indicators displayed on the Hospital Compare Web site. Although several of the new measures are
similar to existing inpatient care measures, implementing them for patients who are not
admitted to the reporting hospital will provide a broader view of care, particularly in smaller,
often rural, hospitals.

Many U.S. hospitals have been providing information on inpatient quality measures through
the HQA initiative since October 2003. Last year, Congress mandated that the Centers for
Medicare & Medicaid Services establish a program for reporting quality of hospital
outpatient care, as well. Under the program, hospitals must report the outpatient data to
receive the full annual update to the hospital outpatient prospective payment system payment
rate beginning in January 2009. Hospitals that fail to report the outpatient quality data will
incur a reduction in their annual payment update factor of 2.0 percentage points.

The new measures are considered preliminary, pending further work to complete definitions
and specifications, and to finalize the National Quality Forum’s endorsement. As a result, the
HQA may refine its recommended list as further information becomes available. For now, the
new outpatient measures and the type of care they relate to are:
 Heart Attack: (1) Aspirin at arrival for patients treated in the emergency department
and then transferred; (2) Median time from emergency department arrival to
fibrinolysis for patients treated in the emergency department and then transferred;
(3) Fibrinolytic therapy received within 30 minutes of arrival for patients treated in
the emergency department and then transferred; (4) Median time from emergency
department arrival to electrocardiogram (ECG) for patients treated in the emergency
department and then transferred; (5) Median time from emergency department
arrival to transfer for primary percutaneous coronary intervention (PCI)
 Heart Failure: (6) Angiotensin converting enzyme (ACE) inhibitor or angiotensin
receptor blocker (ARB) for left ventricular systolic dysfunction (LVSD)
 Surgical Care Improvement: (7) Timing of antibiotic prophylaxis; (8) Selection of
prophylactic antibiotic — first or second generation cephalosporin
 Pneumonia: (9) Appropriate empiric antibiotic prescribed for community-acquired
bacterial pneumonia
 Diabetes Mellitus: (10) Appropriate empiric antibiotic prescribed for community-
acquired bacterial pneumonia

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Paul Cunningham, Editor

Phil E. Matthews, President/CEO; 419 Natural Resources Drive; Little Rock, Arkansas 72205; 501-224-7878; facsimile 501-224-0519
AHA Notebook 2 July 30, 2007

ACHE ACHE members will have an opportunity to earn 1.5 Category I (ACHE education) hours by
participating in the September 13 Arkansas Health Executives Forum quarterly meeting.
Meeting Today’s workplace calls for the development of high performance work teams to manage
September 13 dynamic healthcare environments. Healthcare consultant Tom Atchison will lead discussion
of “Developing High Performance Teams,” where he will provide an overview of the
importance of collaboration in the workplace and identify strategies used by best practice
organizations.

Joining Atkinson as panelists focusing on the development of clinical and operational teams,
as well as departmental teams to monitor financial performance, will be Peter Banko,
president and CEO, St. Vincent Health System, Little Rock; Brenda Million, chief nursing
officer, St. Bernards Medical Center, Jonesboro; and Jim Lambert, chief operations officer,
Conway Regional Health System.

The luncheon meeting begins at 10:30 a.m. in Room 22 of the Gilbreath Conference Center at
Baptist Health Medical Center in Little Rock. Program and registration information soon will
be available at http://arkhospitals.org/ahef/events.htm.

The Arkansas Health Executives Forum is an independent chapter of the American College of
Healthcare Executives (ACHE).

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Legal Under certain, limited circumstances, a minor may consent to his or her own treatment
without the need for an adult’s consent. These circumstances include marriage, court-ordered
Note: emancipation, incarceration and treatment for certain conditions. Otherwise, non-emergency
Consent treatment of a minor requires the consent of an adult. According to Ark. Code Ann. § 20-9-
For 602, any guardian or parent may consent to treatment of a minor child. A “parent” includes
an adoptive parent, stepparent and/or foster parent.
Minors
Although no distinction is made between a custodial and non-custodial parent, the statute
states that the father of an illegitimate child cannot consent for the child based solely on his
status as a parent. As long as the mother is authorized to consent to treatment, the child’s
maternal grandparent(s) may consent in the parents’ absence. The same is true of the child’s
paternal grandparent(s) if the father is authorized to consent.

Finally, in cases where someone other than a parent is standing in loco parentis, that person
may consent to treatment. The Arkansas Supreme Court has defined a person standing in loco
parentis as someone who “puts himself or herself in the situation of a legal parent by
assuming the obligations incident to the parental relation without going through the
formalities of adoption.” See, e.g., Babb v. Matlock, 340 Ark. 263 (2000). Whether someone
is standing in loco parentis depends upon the facts of the situation.

Suggested topics for the Legal Note may be submitted to elisawhite@arkhospitals.org. The
Legal Note is provided solely for informational purpose and does not constitute legal advice.
Readers are encouraged to consult with their own attorneys about any legal issues,
including those discussed in this article.

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AHA The Arkansas Hospital Association (AHA) has offered its member hospitals access to a one-
of-a-kind online database of timely hospital utilization and financial performance indicators
DATABANK since 2002. The AHA is one of more than 30 state hospital associations which offer this
Program program through the Colorado Hospital Association (CHA), which developed the
AHA Notebook 3 July 30, 2007

DATABANK program more than 20 years ago. Yet, despite this free member service, many
of the state’s hospitals do not participate. So, AHA, in conjunction with CHA is making a
renewed effort to expand participation to make DATABANK a more valuable tool.

Beginning this summer, CHA will assume full operation of the Arkansas DATABANK
program, including an increase in the number of educational opportunities related to the
program, which is a Web-based benchmarking database which provides users information on
management indicators like average length of stay, outpatient statistics, charges and expenses
per day and per stay, uncollected charges, number of days in accounts receivable gross,
profitability and a number of personnel statistics.

Hospitals that choose to participate, submit specific data on a monthly basis and, in return,
are able to receive a series of reports about their own operations immediately. Reports
containing peer group comparisons can be viewed and printed online once certain peer group
thresholds have been met. The data contained on the DATABANK reports can be used for
budgeting, marketing and internal management purposes within the hospital. More
information about the Arkansas DATABANK program changes will be distributed soon.

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Model The American Hospital Association (AHA) has posted to a “Members Only” page on its Web
site, http://www.aha.org, a model letter that hospital leaders can use to help draft their own
Letter: comments on the Internal Revenue Service’s (IRS) new Schedule H for hospitals. Last
IRS month, the IRS released for public comment a completely redesigned Form 990, a 10-page
Form “core” form for tax-exempt organizations and 15 new schedules that tax-exempt
organizations are required to complete, as applicable. The schedules include a new Schedule
990 H to be completed by all tax-exempt hospitals that are required to file a Form 990.

The AHA model letter, which may be customized to meet individual hospital needs, focuses
on the new Schedule H and the three most critical concerns hospitals should raise with the
IRS early in the comment process. Those include:
 The filing deadline for use of Schedule H is far too short, and the implementation
date should be extended;
 The full value of hospital community benefit or tax compliance is not included in
Schedule H and should be; and,
 Information unrelated to community benefit is requested that will not be meaningful
to the public and should be removed from the form.
While comments will be accepted by the IRS until September 14, the IRS has asked that
comments be submitted early. Because the IRS plans to make changes to the forms as they
receive comments, it is important for hospitals to comment as soon as possible.

Visit http://www.irs.gov/charities/article/0,,id=171216,00.html to access the draft forms and

background materials. Comments can be submitted to: Internal Revenue Service, Form 990
Redesign, SE:T:EO, 1111 Constitution Avenue NW, Washington, DC 20224; or email your
comments to Form990Revision@irs.gov.

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AHA During the annual American Hospital Association (AHA) Health Forum Leadership Summit
in San Diego last week, AHA President and CEO Rich Umbdenstock unveiled the
Unveils association’s much anticipated framework for improving health and healthcare in America.
Framework The framework, Health for Life: Better Health, Better Health Care, was approved for
AHA Notebook 4 July 30, 2007

dissemination by the AHA Board on July 21. It focuses on five goals: wellness; most
efficient, affordable care; highest quality care; best information; and health coverage for all,
paid for by all.

Umbdenstock noted that, because “the issues facing healthcare concern everyone, not just
hospitals,” the framework should not be thought of as the hospitals’ plan for change, but
rather “a framework that hospitals, physicians, patients, businesses, civic and community
leaders can rally around.” AHA hopes to use the framework to engage the public and elected
officials in a debate about health reform as the 2008 elections near.

A video of Umbdenstock’s remarks, along with a copy of the framework, is available at

http://www.aha.org by clicking on the “Health for Life” icon.

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Committee The House Ways and Means Subcommittee on Oversight held the first in a series of hearings
last week on tax-exempt charitable organizations. The subcommittee is interested in looking
Hearing broadly at how to strengthen the sector while ensuring public accountability. Witnesses at the
Concerns hearing included representatives from the Internal Revenue Service (IRS), Government
Tax-Exempt Accountability Office, Independent Sector and Council on Foundations.
Organizations Steven Miller, commissioner of the IRS’ tax exempt and government entities division, said
the agency has increased compliance examinations and communications with the not-for-
profit sector, examining more than 7,000 returns and communicating with more than 5,200
organizations last year. He concluded, “On the whole, the charitable sector is very compliant
with the tax code.”

The hearing comes on the heels of a recent report released by Sen. Charles Grassley (R-IA),
ranking member of the Senate Finance Committee and a leading critic of the performance of
nonprofit hospitals, which proposed that those hospitals should allocate at least 5% of
their operating expenses or revenues — whichever is larger — for charity care or lose their
tax-exempt status. Grassley’s report was released on the same day that the IRS issued the
preliminary results of a survey of nearly 500 nonprofit hospitals which found that the median
hospital spent less than 4% of its annual revenue on free care, and that more than one in five
hospitals — 22% — reported spending less than 1% of their revenue on such care.

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New Hospitals have until August 14 to preview their latest quality data before it’s posted to the
Hospital Compare Web site September 20. If any problems are detected, they should contact
Quality their Quality Improvement Organization. They also should review the demographic
Data information displayed for their hospital on Hospital Compare and submit any changes to their
Available state survey agency’s coordinator by August 17.

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The August 2007

2 Emergency Department (ED): Aversion to Diversion – Webinar #T2323
AHA 7 Finding Our Voice: Speaking Up, Speaking Out, Getting Heard? TELNET/Webinar
Calendar Course #2324 (Healthful Work Environment)
7 Joint Commission Update: Life Safety Codes – Part 1 – Webinar
7 Updates to the Hospital Medicare Discharge Appeal Rights: The Final Two New
Forms and New Billing Manual: Do You Have This Right? – Webinar #T2330