The American Hospital Association-a tireless proponent of collaborative ventures among hospitals-has fallen victim to the success of its own mission.
Largely because of hospital industry consolidation, the AHA has lost more than 250 individual hospitals and 10 hospital systems as members since 1993, according to AHA figures.
Consequently, the association is taking a number of steps to expand its membership base as well as keep current members happy and in the fold.
The AHA's experience mirrors that of other healthcare trade associations, which must deal with the side effects of marketplace changes affecting their members. For example, facing stagnant membership growth, the American Medical Association unveiled an all-out membership drive in July (See related story, p. 52).
The release of the AHA's membership figures follows the disclosure earlier this month that the association's revenues from membership dues dropped in 1995 for the first time in at least a decade (Sept. 9, p. 2).
In the AHA's annual tax filing with the Internal Revenue Service, the AHA reported $57.9 million in dues revenues last year. That's down nearly 6% from 1994 and the lowest dues total recorded by the association since 1992, when it was $52.8 million (See chart, below).
The dues drop-off corresponds to a drop in actual AHA member hospitals and hospital systems, said Richard Wade, the AHA's senior vice president for communications.
As of July 31, the AHA had 4,433 individual hospitals as members. That's down 261 hospitals, or nearly 6%, from the same period three years ago.
During those years, the number of hospital system members of the AHA also dropped by about 6% to 157 systems from 167.
The loss of 10 systems actually is a net loss, according to an analysis of the figures conducted by the AHA.
Wade said 27 hospital systems discontinued their membership, while 17 became AHA members. Of the 27 that left, 11 were the result of two or more hospital systems merging into one, he said. Four of the 27 became ineligible for system membership because they consolidated their acute-care facilities into one hospital, he said.
The balance-12 systems-simply dropped their membership, Wade said. Most of those were small systems, and they let their AHA membership lapse, largely for economic reasons, he said.
"But there were a few high-profile systems that dropped their membership, like (Sharp HealthCare and Allegheny Health, Education and Research Foundation). They left about the same time," Wade said.
Sharp, a San Diego-based not-for-profit system, pulled out of the AHA in January 1995. Sharp executives at the time said the decision primarily was financial (April 3, p. 2). A month after Sharp notified the AHA of its decision, it was disclosed that the system was discussing a joint venture deal with Columbia/HCA Healthcare Corp. That deal is pending.
But Sharp's decision was a black eye for the AHA because it is considered a pioneer in the development of integrated delivery systems. Sharp executives said their decision to drop the association was partly because of their view that the AHA wasn't doing enough for integrated delivery systems.
Equally significant but receiving less attention was the pullout of Allegheny, the Pittsburgh, Pa.-based parent of Allegheny General Hospital in Pittsburgh and Hahnemann University Hospital in Philadelphia. Hahnemann is now known as Allegheny University Hospitals-Center City. Allegheny owns or manages six other hospitals and recently announced plans to merge with Forbes Health System of Pittsburgh (Sept. 23, p. 17).
Thomas Chakurda, a spokesman for Allegheny, wouldn't comment on the system's relationship with the AHA. He also wouldn't comment on whether new hospitals that come into the Allegheny system as it expands have to drop their AHA membership. Hahnemann executives didn't respond to an interview request by deadline.
The AHA, for its part, is taking a number of actions to plug its draining membership ranks as well as open itself up to new types of members:
In January 1995, it created and filled a new senior vice president position for member relations.
In May 1995, it unveiled a plan to replace its nine regional offices with field executives in every state.
In March, it began publishing a weekly feature, dubbed "AHA Today," to remind its members of the association's advocacy successes in Washington and tell them of the availability of products and services to address specific member educational needs.
And the AHA is working on a plan to open its membership to integrated delivery systems and other provider networks. That would allow physicians, insurers and other providers to be AHA members. Wade said the AHA hopes to have the new membership plan in place by 1998.