Washington State Healthcare Executives Forum
by Martin Benning, MHA, FACHE
As healthcare leaders in Washington, we are privileged to serve over 7 million residents across the state. Nearly 10% of those residents will end up in one of our hospitals. Millions will see our providers in our clinics and outpatient settings. However, healthcare is changing and as leaders we need to respond. Margins are tight and our traditional way of doing business is changing. Innovations in care delivery models and more robust data systems are helping the healthcare community respond to our changing needs, but is it fast enough? Payment reform under MACRA continues to be a hot topic across our communities and may lead to continued consolidation of physician practices. The upcoming presidential election will also potentially change the trajectory of how patients access care and our reimbursed model.
This is certainly an interesting time to be a leader in healthcare. At WSHEF we represent nearly 1000 healthcare leaders across the state that are working through these opportunities and challenges on a daily basis. Each one of us is committed to serving our communities in one way or another. Your WSHEF board and dedicated committee members have continued to offer networking, education and advancement resources, all in an interest to add value to our membership. As we move into the fall, I look forward to our annual breakfast meeting held on October 14th in conjunction with the WSHA annual conference. You can register by clicking https://wshaconnect.wsha.org/annualmeeting2016/Pages/default.aspx and selecting the ACHE Breakfast. Additionally our Meet-n-Mingle events have restarted and always offer a unique opportunity to connect with colleagues and discuss hot topics in healthcare. Many of you are working towards board certification and I encourage all of you to access the resources that ACHE and the chapter have for you. Please stay connected as we are working to revamp our website and social media channels in the coming months with new content and resources and let a chapter leader know if you have questions or feedback.
On behalf of the board, I’d like to extend our gratitude to have the opportunity to serve and represent you for ACHE and please let us know how we can add value to your career as healthcare leaders in 2016.
Martin Benning, MHA, FACHE
Washington State Healthcare Executives Forum
Message from Your ACHE Regent
For those of us in the Northwest, we live for this time of year. Long days, generally sunny skies, the beginning of crabbing season, the end of hectic school schedules, and hopefully a well-earned break.
I had the honor and pleasure to visit with a number of students this past spring. I visited the University of Washington Masters in Health Administration day program. This group of over 20 students is in a full time program over the next two years. Most of the students I met are just ending their first year, heading to internships here and across the country for the summer, before returning in September. Many are student members of ACHE and we talked about how for me (and I am sure for most of you), ACHE is my professional “home”. We have committed to ACHE, invested in advancement, donated our time to chapters and colleagues, and attended events. I encouraged them to remain committed and to think about what they want to both give and receive from their membership.
The UW completed its Capstone projects for the second year students. In this process, student teams present their work to a panel of evaluators and to their peers. Projects were wide ranging and covered many of your organizations across the state. I participated as a reviewer, and had the opportunity to hear the presentations and to ask questions of the teams. I was really impressed by the quality of the work, the preparation of the teams, and their ability to field some tough questions from the panel.
This year, I also asked the UW if I could talk to the Executive MHA cohorts – both the first and second year groups. These are many mid-career professionals who are blending full time work with hard studies over weekends and nights. Often, this program is overlooked since it is not a traditional day program. Yet, it is a key group of people who can benefit from and contribute to the Chapter and the larger ACHE. Again, I encouraged them to consider membership and asked that they think about what they can get and give from membership. It was nice to see several existing student and regular members.
The Washington Chapter wrapped up its social gatherings – what are termed Meet and Mingles – for the summer. These are no agenda gatherings over food and drink, with the intent to connect colleagues and make the Chapter and ACHE a bit more personal. I encourage you to try to make at least one if it is close by. If you would like to host one anywhere around the state, I am happy to help get it organized, connect you with resources that can help, and attend.
Finally, we had a successful ACHE Cluster here in Seattle in June. These are well organized events that bring ACHE faculty and face to face credits to our state. We are working on ways to bring more face to face credit educational events to the state at an affordable price – so stay tuned.
In all the conversations with students and in talking with people at Chapter events and at the Cluster, it reminds me that in this profession, everyone has a story – a story of why they are in this field and how they got to where they are today. Seldom is it a linear path through one’s career, despite all the best laid plans. I reminded students of this fact. When I work with students as a mentor, I ask my protégés at the first meeting to come back next time with a simple page telling me their story – how did they get here, what path did they take and what direction do they think they want to head in the future. What I learn each time is amazing. Try it yourself. Write your story on a page and share it with a colleague or a family member.
I also am struck that there is also a deeper story that we each have about what drew us to healthcare and what keeps us here. These are often personal and very emotional stories, sometimes tinged with tragedy or driven by hope for change. When I am struggling with a task at hand, I know that I often just need to reflect on a few of my stories to remind myself of the larger narrative of what we are all trying to do.
So, enjoy the summer, tell stories to each other, and come back ready to continue improving healthcare.
Bill Reid, FACHE
Regent for Washington
Ross Hopkins relocated to Salem, Oregon, from Atlanta, Georgia four years ago. He is currently the Director of Physician Practice Operations for Salem Health Medical Group. During his time as a director, he has seen the group grow from two dozen providers to 150 providers. There are many reasons to enjoy working at Salem Health but Ross is most proud of the performance improvement (LEAN) work within the health system, their Magnet status, and the strong supportive relationships between colleagues. Ross’s decision to move to the Pacific Northwest was due in part to the network of members at ACHE who have supported each other during times of transition and professional development.
Ross began his career in a small rural community in western North Carolina. It was by chance that he entered the healthcare field after beginning a career in real estate and banking. His luck began while working for a company that provided physical therapy, occupational therapy, and speech therapy, primarily in the SNF environment. The desire to care for patients was evident within the organization and he felt that it was the best career path for him. After three years with the company, he joined Watauga Medical Center as Executive Director of their newly-formed PHO. It was in this role the he developed his love for physician practice. At this time Ross was introduced to one of his mentors who encouraged Ross to join ACHE and foster relationships with other members. After ten years at Watauga Medical Center, a network of ACHE members reached out to Ross and aided him in finding his next position at Emory Healthcare. He became an Administrator for the Department of Surgery at The Emory Clinic. He remained at Emory for twelve years. After many years in Atlanta, Ross found new opportunities and challenges at Salem Health. His daily task list is robust, as one might imagine for a director, but Ross remains focused on the care of patients. He supports his staff and finds ways to highlight exceptional patient care within the organization. He motivates others to grow and develop their skills while also taking pride in their work.
Outside of work, Ross enjoys the outdoors. He has hiked every section of the Appalachian Trail and covered 900 miles of the 1,200 mile Great Smokey Mountain National Park trail system. More recently, Ross has found time to enjoy motorcycling and 4-wheeling. He also devotes time to a local charity. He has adopted the motto “devote charitable activities to a single purpose that resonates with yourself”. While still living in Atlanta, he began volunteering at the Atlanta Food Bank and now spends time with the Cascades AIDS Project. These organizations give food to those in need, especially those individuals living with HIV.
Proposed Rule on Site Neutral Payments for Off-Campus Hospital Outpatient Departments
The Centers for Medicare and Medicaid Services (“CMS”) released its proposed rule on payments for services provided in off-campus hospital outpatient departments as part of the CY 2017 Outpatient Prospective Payment System Proposed Rule published on July 6, 2016. The proposed rule implements Section 603 of the Bipartisan Budget Act of 2015 (“Section 603”), which applies new payment rules to most items and services provided in an off-campus hospital outpatient department that was not billing for such services before November 2, 2015.
Beginning January 1, 2017, Medicare will pay for items and services provided in an off-campus hospital outpatient department under the applicable fee schedule, rather than under the outpatient prospective payment system (“OPPS”), except for items and services furnished: (1) in a dedicated emergency department; (2) at a location that was billing as a hospital outpatient department before November 2, 2015 (“Grandfathered Facility”); or (3) on the campus of a remote location of a hospital (collectively, “Excepted Services”). A remote location of a hospital is a separate location where inpatient services are provided. “Campus” is defined under the existing provider-based rules to include the physical area within 250 yards of the provider’s main buildings and other areas as determined by the CMS regional offices.
Under the proposed rule, hospitals will have very limited ability to replace or expand their existing off-campus hospital outpatient departments or to expand the scope of services provided in such facilities. It is also unclear how hospitals will bill and receive payment for non-excepted services after January 1, 2017, and in certain cases, whether some services such as certain surgical services that are covered under OPPS but not under the ASC fee schedule, will be paid.
Material Elements of the Proposed Rule and Open Questions:
1. No Relocation or Expansion of Grandfathered Facilities. CMS proposes that any Grandfathered Facility will lose its “excepted” status if it moves or relocates from the physical address listed on the provider’s enrollment form as of November 1, 2015. The proposed rule also makes clear that Grandfathered Facilities may not expand without losing excepted status. “In the case of addresses with multiple units, such as a multi-office building, the unit number is considered part of the address; in other words, an excepted hospital PBD could not purchase and expand into other units in its building, and remain excepted.” 81 FR 45684.
2. No Expansion of Services at Grandfathered Facilities. In the proposed rule, CMS explains that it interprets Section 603 to apply to Grandfathered Facilities as they existed at the time the law was enacted and that those facilities may be paid under OPPS for services within the “clinical family of services” that they furnished at that time. The proposed rule contains a list of 19 such clinical families that are defined by APC and HCPCS codes. If a Grandfathered Facility adds a service from a clinical family that it did not provide before November 2, 2015, that service would be paid under the Medicare Physician Fee Schedule (“MPFS”) or other applicable payment rate and not OPPS.
3. Certain CHOWs Retain Excepted Status. CMS proposes that if a hospital undergoes a change of ownership (“CHOW”) and the new owner assumes the existing provider agreement, Grandfathered Facilities included in the CHOW may retain their excepted status. A single Grandfathered Facility may not, however, be transferred from one provider to another and retain its excepted status.
4. Payment for Services at Non-excepted Facilities. The proposed rule indicates that for most items and services provided at a non-excepted facility, Medicare would pay the physicians who provided the items or services through a bill submitted on a professional claim form (CMS 1500) at the MPFS rate. CMS acknowledged that this would require some hospitals to establish business arrangements with physicians for the bill to be submitted under the physician’s Medicare number and to share the reimbursement for these items and services and that such arrangement could implicate the fraud and abuse and other rules. CMS stated that it is actively exploring options that would allow non-excepted facilities to bill under an applicable payment system, other than OPPS, and that the proposed policy is intended to be a temporary solution.
5. Potential 340B Impact. Hospitals that participate in the 340B program should consider the potential implications of the proposed rule on drugs dispensed in off-campus outpatient departments. Currently, off-campus departments are permitted to dispense 340B discounted drugs if the hospital’s Medicare cost report includes covered outpatient costs and charges at that location. If the proposed rule eliminates those costs from the cost report, hospitals may lose the ability to dispense 340B discounted drugs from those off-campus locations.
Next Steps: While we are all hopeful that CMS, in response to the public outcry about the overly restrictive proposed rule, will soften its position in the final rule, hospitals should take several proactive steps now to secure their ability to continue to receive OPPS payment for Excepted Services.
A. Keep a Record of Existing Off-Campus Facilities and Services. Take an accounting of off-campus outpatient departments that were operating as of November 1, 2015, including their location, the physical structure and scope of services provided. Obtain and retain copies of the hospital’s CMS 855A and hospital license application form in place at that time. If any of the hospital’s off-site outpatient departments were inadvertently left off either form, consider whether additional documentation could be submitted to correct the error.
B. Provide Accurate and Complete Information Going Forward. Inform staff of the importance of submitting complete and accurate information on hospital enrollment and licensing forms going forward to ensure that the addresses of any Grandfathered Facilities are correct and not inadvertently left off such forms.
C. Instruct Staff Against Making Changes to Off-Campus Departments. Instruct staff not to relocate, reduce or expand any off-campus hospital outpatient department without analysis of the impact of Section 603. Similar analysis should be done for any changes in service mix at off-campus outpatient departments.
D. Billing for Non-excepted Services after January 1, 2017. Determine how the hospital will bill for non-excepted services after January 1, 2017. If the hospital does not employ the physicians who provide services at such locations, that may entail entering into agreements with physicians to accommodate billing under the physicians’ Medicare numbers. It may also require the hospital to enroll as a new provider or supplier type such as a group practice or ASC. Consideration should also be given to the fact that the proposed payment policy is intended by CMS to be a temporary solution until CMS can adapt its systems to accommodate payment for non-excepted items and services under the applicable payment system.
Lori K. Nomura
Philip E. Paine
This publication is for informational purposes only and does not contain or convey legal advice.
DEVELOPMENT AND CAREER
Welcome New WSHEF Members:
HM1 Kevin Blake, Wenatchee
JoEllen Colson, Wenatchee
Andrew G. Erickson, Seattle
Christy C. Gallegos, Spokane
Randy Hartman, Richland
Brenda Lawing, Auburn
Timothy McGuire, Mercer Island
Abigail Osborne-Elmer, Colbert
Barbara Pullar, Seattle
Bronwen Raymer, Seattle
Kyle E. Reader, Tacoma
Monica J. Salgaonkar, Seattle
Stacy L. Smith, Seattle
Katlyn Van Curler, Spokane
Laurie Zelaya, Issaquah
Brianna L. Bobiak, Seattle
Tara L. Cannava, Seattle
Tessa Chu, Seattle
Kyle P. Fisher, Seattle
SSgt Abraham I. Garduza,
Ben Landsman, Seattle
HMC Johnnie Taylor Jr., Tacoma
1LT Heidi L. Tittle, Tumwater
Alice Toy, Chicago
Mark Williams, Sammamish
Craig Bakker, Spokane
Kirsten B. Carlile, Spokane
Christopher M. Kramer, Vancouver
Ray Manahan, Seattle
Kimberly McHugh, Seattle
Thomas A. Miller, Camano Island
SGM Michael Mullen, DuPont
Maureen O'Brien, RN, Lake Forest Park
Anita Wharton, Seattle
Congratulations to Members who Advanced to Fellows or Recently Recertified:
Siew-Yong S. Ho, FACHE, Bonney Lake
Kelly J. Malone, FACHE, Seattle
LT Kristoffer Reyes, FACHE, Burke
Rachanee A. Curry, FACHE, Steilacoom
Michele A. Forgues-Fisher, FACHE, Renton
Renee K. Jensen, FACHE, Elma
Thomas A. Moser, FACHE, Spokane
Jaime Nephew, FACHE, Renton
Kenneth G. Overbey, FACHE, Greensboro
Mary Eva Rose, PhD, FACHE, Seattle
Tim M. Strickland, FACHE, Vancouver
Andrea Z. Turner, FACHE, Bellevue
Janice J. Jones, FACHE, Sammamish
CDR Robert T. McMahon III, FACHE, Port Orchard
Theresa Sullivan, FACHE, Moses Lake
Congratulations to Members who recently passed the Board of Governors Exam
Shari L. McClure, Seattle
UW Executive MHA and Medical Management Programs
For your professional development!
The University of Washington's Graduate Programs in Health Services Administration offers healthcare professionals two options for increasing their management and leadership skills: the Executive Master of Health Administration Program (MHA), and the Certificate Program in Medical Management (CPMM).
Both programs are designed for those who want to meet the need for skilled leaders in the ever-changing healthcare delivery system. Physicians, nurses, other experienced clinical practitioners, and health service managers enter these programs to become more effective leaders and meet the increasingly challenging expectations of the patients and families, stakeholders, and communities they serve.
The Executive MHA Program has a 24-month format that combines three-day intensive on-site meetings with teleconferencing, independent assignments and team projects. Applications for admission have an annual deadline of April 30. For details, visit: http://www.uwexecutivemha.org.
For details on the Medical Management Program, visit: http://www.pce.uw.edu/certificates/medical-management.html
To ask questions about either program, contact Maggie Helsel, the program coordinator, at firstname.lastname@example.org or 206-616-2947.
If it is time to futher your education and earn a master's degree in health policy and administration, WSU offers an exciting program designed around a working professional's schedule.
WSU SPOKANE MASTER OF
HEALTH POLICY AND ADMINISTRATION
The Master of Health Policy and Administration (MHPA) degree is a vigorous, CAHME accredited, and personalized program that prepares future leaders in the dynamic and growing field of healthcare management. WSU HPA students enjoy small class sizes (12-20 students), which facilitate opportunities for strong and lasting relationships with both peers and professors. Students are required to participate in individual and group based projects and be actively engaged in class discussions. Additionally, students are provided valuable professional connections by networking with local healthcare professionals through site visits, guest lectures, student body events, and alumni events.
A hallmark of the MHPA program is the completion of an internship. The required internship allows the student to gain leadership experience in the health care environment, explore the field, develop professional contacts, and contribute to career planning. The Department of Health Policy & Administration will help the student find an internship that meets your needs, or the student may arrange their own internship.
Graduates of the program work in a wide range of career fields including hospital management, public health, managed care, group practice management, and financial management. Since 2013, 90% of WSU MHPA graduates secured employment within 3 months of graduation!
The program is ideal for working health care professionals who want to enhance their management skills or advance to management positions. To attract and accommodate our working professional students, our classes are offered from 4:00 p.m. to 6:30 p.m., four days a week. Additionally, the program accommodates both full-time and part-time students.
WSU Spokane’s Department of Health Policy and Administration is a proud member of the Western Interstate Commission for Higher Education (WICHE) which provides waivers for out-of-state tuition in 16 states. For more information regarding WICHE, please visit www.wiche.edu.
To learn more about the MHPA program, visit: http://spokane.wsu.edu/admissions/HPA/ or contact the Academic Coordinator, Robin Durfee, at email@example.com or 509.358.7987.
ACHE: Become Board Certified in Healthcare Management
Ready to Advance to Fellow?
Why Board Certification - You want to go to board certified physicians for your care, so why not go to an organization with board certified healthcare executives. Earning the distinction of board certification as a Fellow of the American College of Healthcare Executives demonstrates your competence, dedication and commitment to lifelong learning. To learn more, visit ache.org and then go to the credentialing page.
Advancement Information Session - Do you want to learn more about the value of board certification and the steps to completion? Then come to the Advancement Information Session sponsored by the Washington State Healthcare Executives Forum. There are two ways to participate. In-person or at your desk through a webinar. These sessions will be held twice annually. For more information about future information sessions you can contact Steve Saxe at firstname.lastname@example.org.
ACHE Tuition Waiver Assistance Program
To reduce the barriers to ACHE educational programming for ACHE members experiencing economic hardship, ACHE has established the Tuition Waiver Assistance Program.
ACHE makes available a limited number of tuition waivers to ACHE Members and Fellows whose organizations lack the resources to fund their tuition for education programs. Members and Fellows in career transition are also encouraged to apply. Tuition waivers are based on financial need and are available for the following ACHE education programs:
- Congress on Healthcare Leadership
- Cluster Seminars
- Self-Study Programs
- Online Education Programs
- Online Tutorial (Board of Governors Exam preparation)
- ACHE Board of Governors Exam Review Course
All requests are due no less than eight weeks before the program date, except for ACHE self-study courses; see quarterly application deadlines on the FAQ page of the tuition waiver application. Incomplete applications and applications received after the deadline will not be considered. Recipients will be notified of the waiver review panel's decision not less than six weeks before the program date. For ACHE self-study courses, applicants will be notified three weeks after the quarterly application deadline.
If you have questions about the program, please contact Teri Somrak, associate director, Division of Professional Development, at (312) 424-9354 or email@example.com. For more information, visit ache.org/TuitionWaiver.
Your Career & Development - JOB BANKS
If you are a member of ACHE you have access to a robust, national job bank. It can be found at:
ACHE Job Bank
We are pleased to provide a link to the WA Healthcare News Job Bank. This is an excellent source of information about positions in our local geographic area. The available position list has also been extended recently to contain some positions in other parts of the country.
WA Healthcare News Job Bank
DELIVERY of WSHEF Newsletter (Disclaimer)
To ensure delivery of your chapter newsletter, please add firstname.lastname@example.org to your email address book or Safe Sender List. If you are still having problems receiving our communications, see our white-listing page for more details:
CHAPTER AND RESOURCES
2016 Officers and Board Members
- Martin Benning, FACHE, President
- Dina O'Leary, FACHE, President-Elect
- Karin Larson-Pollock, MD, FACHE, Immediate Past President
- Lori Nomura, JD, Secretary
- Jim Cannon, MHA, FACHE, Treasurer
WSHEF Board Members:
- Scott Bond
- Bill Reid, FACHE
- Pam Rock, FACHE
- Carol N. Velasquez, FACHE
- Gregg Davidson, FACHE
- Ryan Sundquist
- Jacqui Sinatra, FACHE
- Andrea Turner, FACHE
ACHE Regent, Interim (District 5)
STUDENT AFFILIATE Board Members
University of Washington
- John Heyde, MHA Candidate
Term ends April 2017
Washington State University
- Randolf Briggs, MHPA Candidate
Term ends April 2017
Thank you to our Meet & Mingle Sponsor!
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WSHEF Vision & Values
To be the premier professional society connecting leaders in Washington State to learn, share, and transform health care.
To advance Washington state ACHE members' healthcare professional excellence through interaction and communication and fostering professional development.
As members of our Chapter, we are committed to:
We advocate and emulate high ethical conduct in all we do.
We recognize lifelong learning is essential to our ability to innovate and continually improve ourselves, our organizations and our profession.
We lead through example and mentoring, and recognize caring must be a
cornerstone of our professional interactions.
We advocate inclusion and embrace the differences of those with whom we work
and the communities we serve.
We recognize service to our communities is an integral part of who we are as
We take initiative to build partnerships in advancing professional
development within and outside of our healthcare community.
Looking for ways to connect with more healthcare leaders? Volunteer for a WSHEF committee!
As a volunteer organization committed to being the premier professional society connecting healthcare leaders in Washington State, WSHEF depends on volunteers to run its programs and provide service to its members. Opportunities abound for individuals looking to connect with other healthcare professionals, learn more about WSHEF programs and services or give back to the healthcare professional community. WSHEF has volunteer opportunities for the following committees:
If you are passionate about continuing education and professional
development, consider volunteering for WSHEF’s Programs Committee.
Programs Committee participation can include annual committee
membership, where you participate in setting the vision and long-term
strategies for WSHEF sponsored events. Volunteering can also be event
specific, allowing you to volunteer for the amount of time you are able
to commit. Event specific volunteering is a great way to meet your local
colleagues and support your local ACHE chapter. Time commitment for
events is typically 3 months and totals less than 10 hours, serving in
ways such as:
• Event Planning (Location, Speaker, Topic, etc…)
• Event Materials & Promotion
• Day of Event Support (Check-in/Greeters, Setup, etc…)
you’re interested in volunteering with the Programs Committee, please reach out to Joel Flugstad
& Jacqui Sinatra (Programs Committee Co-Chairs) email@example.com.
Beyond joining a committee, there are other ways to get involved. Write an article for the newsletter, attend an educational session and bring a colleague, provide a venue for an event or serve as a mentor for an MHA student. Just email one of the contacts above to get connected.
Host a Meet N Mingle in Your Area
Get to know your colleagues! Watch for Upcoming Meet-n-Mingle Events in your Neighborhood
• Have you wondered if there are ways you can meet more of your
local healthcare colleagues – that mysterious thing called
• Are you looking to find a next role? You looking for the right candidate?
• Is there a problem you are tackling at work and wonder if
others are working on a similar issue? Or are you just looking for
others who will understand what the heck you are talking about?
• Know where all the local healthcare execs hang out after work?
The highly popular Meet-N-Mingle events are happening at different
venues across our state. As future dates and locations are finalized,
an invitation will be sent out.
Meet-n-Mingles are informal gatherings of area WSHEF members at a local
restaurant or pub. There is typically a small fee to cover appetizers. While this is not a formal education program, someone will be there to
share upcoming WSHEF and ACHE events and activities.
So, rather than heading out into the usual rush-hour, head over to a
local Meet-n-Mingle for a nosh and a drink and get to know your fellow
executives. We want to put A U in COLLEGE! (hint: colleAgUe)
By the way, we are always looking for local hosts around the state and
we will help you do all the planning. If you have an interest in
holding a future Meet-N-Mingle in your area let the membership committee
know at firstname.lastname@example.org.
Thanks, and get networking people!
WSHEF - MEMBERSHIP
Effective January 1, 2008, all ACHE members located within the chapter's assigned geographic territory are automatically members of the chapter as a benefit of being an ACHE member. Only ACHE members are eligible to hold membership in the chapter.
If you are not a current ACHE member, we encourage you to join by visiting the ACHE website. Nonmembers are welcome to attend chapter events. If you would like to be added to the chapter's nonmember mailing list to be notified of future programs and events, please send an email to email@example.com.