They're not listed in telephone directories or the American Hospital Association Guide. You won't find minutes of their meetings anywhere; their meetings aren't even publicized. But an elite group of hospital association heads may exert an influence far greater than the number of its members.
The 15-member group is Caribou, founded in 1965 and composed of veteran, top-ranking state hospital association presidents--mostly from larger states--who meet annually in posh hotels and resort communities ranging from Cape Cod, Mass., to Bermuda and from Marco Island, Fla., to Phoenix.
Caribou members discuss healthcare trends and policies and common challenges in running state associations. Members and guest speakers who appear periodically have addressed topics such as
e-commerce, fraud and abuse, state legislation and retirement planning.
The group's exclusivity--it remains largely unknown throughout the healthcare industry and has no headquarters, phone number or address--and the clout of its members gives it the potential to develop industry policy and lobbying strategies. Its two-anda-half-day annual meeting is held the first week of May. Members pay their own way. No dues are taken. Spouses attend dinners and social functions but not meetings.
Secrecy is important to Caribou. Several current and former Caribou members contacted refused to discuss the organization, with current members fearing expulsion if they spoke publicly. Other Caribou members talked more openly about the group, while acknowledging the perception that it's an exclusive organization.
Exclusivity is something some of those familiar with the group deny.
"It's a study group," says Richard Wade, American Hospital Association senior vice president for communications. Wade says he first heard about Caribou in the late 1970s when AHA President Richard Davidson, once an active Caribou member, was the president of the Maryland Hospital Association and Wade was his spokesman.
Wade denies that the group is an elitist organization setting policy behind the scenes. "Caribou does not have an agenda. Its existence is not a secret. It's just an informal group that grew out of a common set of interests."
Davidson did not return phone calls seeking comment about Caribou.
In fact, criticism of Caribou's exclusionary policy has been sparse. That may be because many prominent state hospital association chief executive officers weren't even aware it existed, they say.
With the CEOs of the biggest state hospital associations in attendance, Caribou held its first meeting at Duke University, Durham, N.C., in 1965. It soon opened its membership to a few more experienced association presidents who demonstrated unusual skills, says William Robinson, former president and CEO of the Massachusetts Hospital Association and a former AHA official who was also a Caribou co-founder. The other co-founder, Don Newkirk, 73, formerly headed the Ohio Hospital Association.
The group had no name in the early years, Robinson says. James Neeley, former president of the Pennsylvania Hospital Association, bestowed the name several years after the group's founding when Robinson left the Massachusetts association to assume a leadership role in the AHA, where he kept peace among warring hospital associations.
"Neeley told a story about how the herd of caribou slowly bump an old buck far out onto the tundra until he starves and dies," Robinson remembers. "Then he gave each one of us a tie tack with a head of a caribou with big antlers. And the one he gave me had the antlers cut off, because I'd left the Massachusetts association for the AHA."
Robinson, who lives on Fripp Island, S.C., characterizes Caribou in the early years as a "chatter group that never attempted to do or decide anything. We played golf and bridge and learned a lot about healthcare. Our wives got to know each other pretty well. I desperately miss those meetings."
Newkirk says the original concept was to keep things simple.
"As hospital association executives, we were overorganized. The AHA meetings were consumed by committees and meetings. We wanted to go off somewhere and hash out problems facing us all and talk about how we're doing."
John Russell, past president of Pennsylvania's hospital association, says that early on fellow Caribous recognized that somebody had to run the meetings.
"The comical thing is that all association executives live and work in a democracy and operate by consensus," Russell says. "But members wanted to have an organization in which one person was in charge."
Hence the "Autocrat."
Caribou's leader is known as the Autocrat, and the first rule of the group is that members cannot question the Autocrat's decisions. The Autocrat runs the meetings, sets the agenda and selects the location for the annual meeting. "The Autocrat can decide anything that he wants," Russell says.
This year's Autocrat is Daniel Sisto, president and CEO of the Healthcare Association of New York.
Sisto says he wasn't asked to join Caribou until five years after assuming the state post in 1986.
"I think they made me wait to see what I had," he says. He admits he was ambivalent when he was first asked to join.
"I didn't want to appear that I was a part of something that was elite, exclusive and separate. But those who were in it (convinced) me it was an intense sharing group and I'd get a lot out of it. They were right," Sisto says.
Still, he recognizes that the exclusivity could cause concern.
"This group created some unnecessary consternation among medium and small state associations because they thought Caribou was a lobbying organization. That couldn't be further from the truth. It's an educational group that seeks out and follows the best-practices concept," he says.
Caribou would lose its organizational purpose and effectiveness if it became a policy group, he says. "It would be self-defeating to take it in that direction."
When the AHA's Davidson was appointed Autocrat about 10 years ago, his first action was to name another Autocrat, as he knew he soon would assume the AHA presidency.
Russell says Caribou membership is limited to 15 because "that's about as big as you can get and still remain a small, effective group."
The group's secrecy provisions, far from the Mafia's call for omerta, were never formalized, he says.
"But there was an understanding that it was a place where you could come and say what you needed to say in private without leaving angry," he says. "It's a chance to be candid with one another, and it was understood that you didn't come home and spread it around. I found the group to be very helpful. For some of us, it was the best meeting of the year, something you made time for." Russell is no longer in the group.
Seats are vacated only when someone retires, he says.
The group extends a "courtesy invitation" to each president of the AHA. That might preclude it from being characterized as an "old boys' network." AHA spokesman Wade points out that former AHA President Carol McCarthy, now a healthcare lawyer with the Baltimore firm Ober, Kaler, Grimes & Shriver, attended the Caribou meetings as an "invited guest," although she was not asked to join the group in her earlier capacity as president of the Massachusetts Hospital Association.
Wade says Carolyn Scanlan, president of the Association of Hospitals and Health Systems of Pennsylvania and an active Caribou member, is the first female member.
Neither woman would comment on the organization or her role in it.
Leo Greenawalt, president and CEO of the Washington State Hospital Association, says the Caribou meeting is one of the best meetings he attends in a year crammed with conferences, seminars and meetings.
"We talk about things we tried that didn't work, so others can learn from our mistakes," says Greenawalt, who was asked to join Caribou in the early 1990s. "I'd heard very little about Caribou before being asked to join, but I knew it existed," he says.
Caribou lore includes the true story of an enthusiastic new member, fresh from what he characterized as the best meeting he'd ever attended, who instructed his secretary to send thank-you notes to all the members for inviting him. She inadvertently sent them to the presidents of every state hospital association.
If there was ever a doubt about the organization's existence, that squelched it, members say.
"There's no drugs, or horns or uniforms or secret handshakes, and everyone keeps their clothes on," a Caribou member says. "We're just angry that some coffee company stole our name."