AWPHD Commissioner Candidate Governance Education Webcast. June 8, 2017

Transcription

1 AWPHD Commissioner Candidate Governance Education Webcast June 8, 2017

2 Questions? Please submit your questions via the GoTo Training Chat box for this session. If you have difficulty, Katie Lopez at Questions will be read in the order they are received If we do not have time to address your question during the live session, we will be happy to you after the session concludes. If you would like us to get in touch with you afterwards, please include your address with your question

3 Session Presenters: Cassie Sauer, Chief Executive Officer Washington State Hospital Association Robert Sepler, Legal Consultant Municipal Research and Services Center (MRSC) Nancy Gorshe, Chairperson of the Board Erica Osbourne, Principal Via Healthcare Consulting Ocean Beach Hospital Ocean Beach PHD #3 of Pacific County

4 Governance: A Commissioner s Perspective

5 Agenda The Healthcare Market: An Overview of Health Care Policy and Finance Presented by, Cassie Sauer Powers and Responsibilities of Hospital District Commissioners Presented by, Robert Sepler Working As A Team: How To Be Most Effective In Working With Your Colleagues Presented by, Erica Osbourne

6 The Healthcare Market: An Overview of Health Care Policy and Finance Cassie Sauer, WSHA President and CEO

7 Key Points Maintaining financial viability is Job One. Financial viability depends on mastering new payment models. Hospitals are moving away from in-patient care.

8 Financial Viability is Job One A King County Hospital A Washington Rural Hospital Medicaid, in pink, pays about 70 cents on the dollar for hospital costs Medicare, in green, pays about 80 cents on the dollar Private insurance pays about 121 cents on the dollar

9 Financial Viability: Payment-to-Cost Ratios 150% Private Payer 140% 130% 120% 110% 100% 90% 80% 70% Medicaid (1) Medicare (2) Source: Analysis of American Hospital Association Annual Survey data, 2014, for community hospitals. (1) Includes Medicaid Disproportionate Share payments. (2) Includes Medicare Disproportionate Share payments.

10 Financial Viability: Medicaid is Growing Jan 2017 enrollment report In almost every county in the state, thousands of people receive AppleHealth/Medicaid coverage. Many more buy individual insurance on the Exchange.

11 Payment for Quality and Value is Increasing

12 Percentage of Revenue Hospitals Are Outpatient Care Too! 100% 90% 80% 70% 60% Gross Inpatient Revenue 50% 40% 30% 20% 10% 0% Gross Outpatient Revenue Source: Analysis of American Hospital Association Annual Survey data, 2014, for community hospitals. National Distribution of Outpatient vs. Inpatient Revenues,

13 Questions?

14 Questions? Please submit your questions via the GoTo Training Chat box for this session. If you have difficulty, Katie Lopez at Questions will be read in the order they are received If we do not have time to address your question during the live session, we will be happy to you after the session concludes. If you would like us to get in touch with you afterwards, please include your address with your question

15 Powers and Responsibilities of Hospital District Commissioners By Robert Sepler MRSC Legal Consultant June 8, 2017

16 Visit MRSC.org to learn more about local governments in Washington State Robert Sepler

17 What are the Legal Parameters Within Which Hospital District Commissioners Must Work? I. Purpose of Hospital Districts and the Hospital District Board of Commissioners II. Powers to Achieve Purpose III. Limitations on Powers

18 Purpose of Hospital Districts Deliver health services to folks within the district. Health services include, but are not limited to: nursing homes, extended care, long-term care, outpatient, rehabilitative, health maintenance, and ambulance services

19 Purpose of the Hospital District Board of Commissioners Acts as the governing body of the district Sets policy for the district Day-to-day operations should be delegated to the superintendent (i.e., CEO)

20 Powers to Achieve Purpose I. Powers granted by the legislature II. How does a district exercise its powers?

21 Powers Granted by the Legislature Chapter RCW Power to construct, condemn, purchase, acquire, lease, add to, maintain, operate, develop, sell, and convey property Power to assess a property tax Power to contract with any entity and individuals Power to solicit and accept gifts

22 Powers Granted by the Legislature Flexibility Can do work themselves, contract with a private entity to do it, or contract with another government agency.

23 How Does a District Exercise Its Powers? Board of Commissioners Superintendent (CEO) District Staff

24 How does the Board Exercise its Powers? I. Commissioners only have authority when meeting as a board II. Generally, it takes at least a majority of commissioners to take action. III. The board s primary contact and only employee is the superintendent (CEO)

25 Limitations on Powers I. Nature of Special Purpose Districts II. Open Government Laws III.Limitations on Use of Public Resources IV.Ethics and Conflicts of Interest

26 Nature of Special Purpose Districts I. Public hospital districts are a type of special purpose districts II. Special purpose districts are created to carry out a specific (special) purpose III.Limited to powers expressly granted by the legislature

27 Open Government Laws I. Public Records Act (PRA) II. Records Retention Requirements III.Open Public Meetings Act (OPMA)

28 Open Public Meetings Act (OPMA) Key question: Is there a majority or more of the governing body conducting agency business? When does a governing body conduct agency business? Statutory examples: receipt of public testimony, deliberations, discussions, considerations, reviews, evaluations. Example:

29 Limitations on the Use of Public Resources I. Gifts of Public Funds II. Use of Public Resources to Support or Oppose Campaigns

30 Ethics and Conflicts of Interest I. State Code of Ethics for Municipal Officer II. Local Ethics Codes III.Doctrine of Incompatible Offices

31 Thank You

32 Questions? Please submit your questions via the GoTo Training Chat box for this session. If you have difficulty, Katie Lopez at Questions will be read in the order they are received If we do not have time to address your question during the live session, we will be happy to you after the session concludes. If you would like us to get in touch with you afterwards, please include your address with your question

33 Working As A Team: How To Be Most Effective In Working With Your Colleagues Erica M. Osborne, MPH Via Healthcare Consulting eosborne@viahcc.com June 8, 2017

34 Best Practices: Governance Effectiveness 1. Focus on Governing 2. Foster Healthy Board Culture 3. Develop Strong Board-CEO Relations 2

35 Focus on Governing Respect the distinction between governance and management Understand the unique pressures of being a healthcare district board Bring discussion and issues back to the mission and vision 3

36 Notes on Board Authority 1. Boards only have authority when meeting as a board 2. Boards must speak with one voice 3. The Board s primary contact and only employee is the CEO 4

37 Establishing a Healthy Board Culture Open, facilitated conversations Candid, respectful debate/dissent encouraged Hidden agendas discouraged Hold each other accountable for agreedupon behaviors Work as an interdependent team 37

38 Team Characteristics 1. Common purpose shaped by the team 2. Specific performance goals that flow from the common purpose 3. A strong commitment to how the work gets done 4. Mutual accountability Excerpted from article by Jon R. Katzenbach and Douglas K. Smith The Discipline of Teams Harvard Business Review 6

39 Work Group Functioning Content Meeting Purpose Agenda Topics Process Group Dynamics Decision Making Involvement Interpersonal Communications Courtesy of ACCORD LIMITED 7 3

40 Strong Board-CEO Relationship The most important relationship you have CEO s success (or failure) is yours also Let the full-time people run the show Don t be the police: trust, but verify Show respect in public forums 8

41 Keys to a Successful Partnership 1. Agree on Board s role and responsibilities 2. Agree on a governance philosophy 3. Memorialize agreements in formal Board policies 4. Develop written job descriptions 5. Regularly evaluate CEO performance, set performance goals 9

42 Questions? Please submit your questions via the GoTo Training Chat box for this session. If you have difficulty, Katie Lopez at Questions will be read in the order they are received If we do not have time to address your question during the live session, we will be happy to you after the session concludes. If you would like us to get in touch with you afterwards, please include your address with your question

43 Need more information? Contact us! Ben Lindekugel, Executive Director