No matter what the future holds for the American Hospital Association, it's likely the letters A-H-A will be part of it.
Although the group is flirting with a name change to be more inclusive of its evolving membership, it's unlikely any new moniker will stray too far from the mark.
"It's important that we recognize the letters A-H-A are trademarks in the healthcare industry and you don't discard that precipitously," says AHA President Richard Davidson. "You look at the value in terms of name recognition."
What to call itself is something the nation's largest hospital trade association will have to tackle as it embarks on its second 100 years.
"The decision could be to stay the same; the decision could be to change it dramatically or modify it," Davidson says. "My guess is that we will probably modify it in some way."
Any change in the name would be a case of history repeating itself.
When the group first started, it called itself the Association of Hospital Superintendents. That name stuck until 1906 when it was changed to the American Hospital Association of the United States and Canada.
On the eve of its centennial, the AHA's uncertainty over a name is a telling sign.
What it reveals is an organization struggling to chart a course for the future, without losing touch with the past. For the AHA to thrive, it will have to be like a chameleon on the healthcare landscape, adapting to keep pace with a constantly evolving industry.
"Clearly, organizations that don't adapt collapse," says C. Thomas Smith, president of the Irving, Texas-based VHA hospital alliance and a former AHA board member. "(The AHA) has demonstrated a capacity to adapt."
The AHA signaled that willingness last month when its board approved a plan allowing integrated delivery systems to join as full-fledged association members for the first time (Dec. 15, 1997, p. 2).
Effective in 1999, the change recognizes the movement of hospitals from freestanding facilities to complex integrated delivery systems. It also could boost revenues for the Chicago-based trade group, which has seen its membership and finances sag with consolidation in the industry.
For example, in 1996, individual hospital membership decreased by 150 facilities to 4,433, and hospital system membership also dropped by four to 157 (Aug. 25, 1997, p. 2).
That drop in membership translated to a drop in annual dues revenues (See chart). In 1996 the annual dues revenues fell 3% to about $56.4 million. It was the second consecutive year the AHA's dues revenues dropped, after peaking at $61.3 million in 1994.
As can often be the case at the AHA, the change to allow in integrated delivery systems didn't come easily or suddenly. The AHA had been working toward revamping its membership since 1994, when the board adopted a plan to move in that direction.
The AHA's personal membership groups, commonly known as PMGs, face a future of tougher financial standards. The AHA established them as a way for people with special interests, such as food service or risk management, to join the association.
But late last year, the AHA drafted new guidelines for PMGs, making it clear it would no longer subsidize money-losers. The AHA has 15 PMGs, and the new guidelines require them to keep six months' worth of an operating budget as a reserve.
Further evolution of the AHA's membership ranks likely will have to occur as the industry consolidates into large delivery systems where physicians have a dominant role.
"There's been a dichotomy between the AHA and the (American Medical Association), with the AHA representing the institution and the AMA representing the professional side," VHA's Smith says. "There's going to be more of a blurring of the lines between those two organizations."
While Smith believes both trade organizations ultimately will survive, he says the AHA has to make a home in its ranks for doctors, especially those not affiliated with the AMA.
Such a move could be challenging.
"There are still its members who are hospitals who view the world through those sets of eyes," Smith says. "(The AHA) has to be careful that it pays attention to a large bulk of its constituency."
Like Smith, Davidson doesn't see the AHA or AMA supplanting each other. "I think it's possible that we could do a whole series of things that are more collaborative than we've done in the past," Davidson says.
But that diversification in membership also will pose the AHA's biggest challenge.
"The more that (membership) diversifies, the more difficult it is to weigh and balance their interest among the other people's interest and really make sure you're representing them all equally well," says Laura Thevenot, executive vice president and chief operating officer of the Federation of American Health Systems, a for-profit hospital trade association. "It's always a challenge when you have a diverse membership to represent them all fairly."
No matter what new shape the membership ranks might take, advocacy and representation of the members will remain the AHA's chief goal.
Much of that advocacy may center around the economics of medicine.
"We can't keep balancing our national budget just by taking it out of the hides of basically healthcare and basically the provider side of healthcare," says AHA board member John McMeekin, chief executive officer of Crozer-Keystone Health System, an integrated delivery system in Springfield, Pa.
McMeekin says the AHA's advocacy also must wrestle broader issues, such as the lack of a national healthcare policy.
"We are in a country that gives people the legal right to carry a gun but gives them no right to healthcare," McMeekin says. "That's a funny policy for a country like ours."