Since Richard Davidson, 61, took over as president in 1991, the AHA has been in a state of almost constant reorganization.
Under Davidson, the AHA shifted its power from Chicago to Washington and slashed its overall size. Now, there are fewer than half the full-time-equivalent employees (about 322) than in 1991.
It's a thinning down that Davidson, former president of the Maryland Hospital Association, says makes the country's largest hospital trade group more effective.
Consolidation in the industry also has meant a decline in membership, which pushed the AHA's annual dues revenues down for the second consecutive year in 1996.
But recognizing an evolution in healthcare, the AHA-under Davidson's tutelage-also shepherded in a dramatic membership change last year, when it voted to allow integrated delivery systems to become full-fledged members beginning in 1999.
Why did you want the job as AHA*top executive?
I truly did not know whether I would be interested in the job. I have always felt the AHA was an enormously important organization, but I always wondered how willing it was to put its chin out and say what it's for. . . . The people on the search committee had a pretty broad and progressive view of what they wanted to happen, and it certainly coincided with my own view. I was honored to be asked to consider taking this job . . . and we immediately started to push an agenda with our chin out pretty far.
What were your major accomplishments at the AHA?
We've tried to reshape the AHA to be more effective for the membership. We've had an agenda to pursue since 1991, and we have strengthened the overall advocacy and representation partnerships by building a stronger relationship with our state and metropolitan hospital associations. . . . We've built a much stronger advocacy team than we've ever had before.
We have been strong advocates that the role of our organizations in the community should be seeking to improve health status and that there should be incentives in the payment system to help that.
We have dramatically reshaped the size and operation of the organization. [In 1991 there were about 670 full-time-equivalent employees. Today there are about 320.] It makes a leaner, more effective organization where our activities are focused on (member hospitals') most important needs.
I have serious regrets over what didn't happen over advancing health insurance coverage for all Americans [in 1994 when the Clinton healthcare reform plan failed to pass Congress]. . . . I think the window for comprehensive insurance to move us toward coverage for all Americans has passed for certainly the next five years, that any changes we'll see will be small pieces, like kid-care coverage, which is a major achievement. [At least 10 states have submitted plans to HCFA to expand coverage for children since the passage of the Balanced Budget Act of 1997.] The encouraging side is that we made a little nudge forward. [Davidson said the AHA is committed to getting access and coverage for all Americans. It's chipping away at that goal through its members.] In the absence of government initiatives, what can we do to make things better for people in our community?
Anything you would have done differently?
I probably would have been more vigorous with the Clinton administration about what was wrong with their healthcare reform proposal to keep it from being defeated. . . . They had created too complex a proposal. . . . We worked on trying to neutralize a lot of that in the back room so that they would be successful.
What role does the AHA play in today's healthcare industry?
It should provide leadership, education, information and protection. Leadership means to lead in the areas of public policy that are consistent with our vision, and our vision is to be a nation of healthy communities where every individual meets their highest potential for health. . . . Protection is a role that's always going to be needed, that's what a trade association is all about . . . because someone is always going to have an idea to propose that could be dangerous for our members. . . . We don't apologize for saying that protection is a very important role.
How has that role changed over time?
I think there's more need for protection today than there has ever been. . . . Just look at the balanced-budget debate last year. . . . From our perspective, we protected at least $2.5 billion that was targeted as additional reductions just for 1998. . . . For our members to translate that into financial terms, that's about $50 returned for every dollar in dues paid to the AHA.
Where does the AHA have the greatest impact?
I think our grass-roots connections give us a strong voice in having public policymakers know what's on our minds. [These connections include state associations and local hospitals and health systems.]
What will that impact be in the future?
I think pressures are going to build on the whole healthcare delivery system as we move to an aging population. When people talk about the finances of healthcare and how to squeeze money out of the system, it's always easier to turn to providers than beneficiaries.
Where do you see the AHA in 10 or 20 years?
I think it will continue to be the voice of what I would call community-based healthcare providers, which means perhaps a little bit different than just hospitals. . . . It will serve in that role providing leadership, public policy and protection, but with a changing kind of membership moving from freestanding hospitals to systems and integrated delivery networks. . . . If we have an expanded membership that includes long-term care . . . and hospital-based PSOs . . . we'll collaborate with organizations that already serve those constituencies.
Any final thoughts?
When you look back on the past 100 years, you get a sense of history. There will be another 100 years. . . . This organization may have a different name and different makeup, but it will be representing people as the healthcare world changes dramatically.