The ouster of Massachusetts Hospital Association head Ron Hollander, a long-tenured executive who resigned after a closed-door meeting of independent board members earlier this month, came as a rare public revolt in the image-conscious, cozy world of hospital associations.
The move, which landed one-time Beacon Hill lobbyist Robert Gibbons as interim president and chief executive officer of the Burlington, Mass.-based trade group, is perhaps the starkest example of an increasingly urgent push from association members for greater influence with policymakers as state healthcare reform efforts gain steam. Initiatives to expand access and coverage stand to affect hospitals budgets significantly, and shaping emerging state policies has become a high priority within state hospital associations, said insiders and hospital officials.
The role of the state hospital association is in flux, said Dan Moen, the Massachusetts groups chairman. Moen, who is also president and CEO of 129-bed Heywood Hospital in Gardner, said the states hospital officials lacked confidence in 56-year-old Hollanders clout during recent critical health-policy reform debates. Massachusetts passed a law in April 2006 to cover nearly all residents. Were the incubators, he said. Healthcare is moving toward that tipping point. The confluence of issues and pressures is going to result in change.
For state hospital association leadership, the issue is critical, said newly appointed and outgoing trade group executives, who are often the public face pushing hospitals agendas before state and federal lawmakers.
Including Massachusetts, a half-dozen state hospital association chief executives have announced plans to step down or have done so in recent months. Wayne NeSmith, 65, the Florida Hospital Association president, said last week he will retire when his contract expires in September 2008.
Physician Dan Stultz, 56, succeeded Texas Hospital Association President and CEO Richard Bettis, 62, who retired Jan. 1. Douglas Leonard, 54, was tapped in late December to succeed Kenneth Stella, 64, who is expected to retire as Indiana Hospital & Health Association CEO this summer after 23 years there.
The states are a perfect place for reform, said Steven Summer, 57, who left the top spot at the West Virginia Hospital Association to head the Colorado Hospital Association Sept. 1, succeeding Larry Wall, who retired at 61 to pursue other interests. Delaware Healthcare Association President and CEO Joseph Letnaunchyn, 53, succeeded Summer in West Virginia in early November. Expect at least one more retirement in coming months: Jim Ahrens, 65, said he plans to step down in June as president of the Montana Hospital Association. The search for a successor is under way.
I think health reform is our opportunity, Summer said.
More than two dozen states have started initiatives to expand coverage, most notably California, where Gov. Arnold Schwarzenegger unveiled a $12 billion proposal Jan. 8 to cover the states 6.5 million uninsured (Jan. 15, p. 6). And increasing states leeway to overhaul policies to expand health coverage and access figured into a plan unveiled Jan. 18 to extend coverage to half the nations 46.6 million uninsured (See related story, p. 8).
The solution to the uninsured is going to be field-tested before there is a national solution, Stella said. He also doubted Congress would take action amid presidential campaigns or during a first-term presidency. Hospitals will look closer to home for answers to access and coverage out of necessity, he said. When youre living in Washington, D.C., youre living away from the problem. When youre in Indianapolis youre living the problem.
With so much riding on success, some hospital officials may not be willing to wait for change.
Stella said members expectations for quick communication and ready solutions have increased. Quicker, faster is what you work under, he said.
Its a pressure-cooker job, from my point of view, Moen conceded. Hospitals interests vary based on factors that affect their reimbursement and regulations, such as location, ownership or services. Its not easy to get a consensus, he said. Youre trying to please all the members all of the time. Its a high-pressure situation.
Moen, who praised Hollanders performance as great, said the associations board opted to move in a different direction. We need a higher profile and be better-positioned politically.
Hollanderwho will step down at the end of Januarydeclined an interview request, said the Massachusetts groups spokesman, Paul Wingle. In a statement issued shortly after his resignation, Hollander defended his tenure, citing patient safety, quality improvement and access initiatives among the associations achievements under his leadership. Hollander, who spent 25 years with the MHAincluding nearly 12 as CEOsaid he remains interested in public policy and plans to look for work at a mission-driven enterprise.
Interim CEO Gibbons, who left Boston lobbying firm Delaney Associates to join the MHA in 1996and was most recently senior vice president for government relations thereis not a candidate to succeed Hollander, the association said in a news release on his appointment.
NeSmith also faced dissensionincluding an attempted ousterat the Florida association, but said thats not why he opted to retire. I will be 67 at the end of September 2008, when his contract expires, he said. Its time for me to move on.
NeSmith survived a bid by Floridas largest hospital chain to force him out in early 2006, but not before HCA pulled its 40 hospitals and $750,000 to $1 million in yearly dues from the Florida Hospital Association. The defection, described by an HCA official as a vote of no confidence for NeSmith, cut the associations membership by 20% and slashed its dues revenue, which was $5.14 million in fiscal 2004.
HCAs defection followed the 2004 exit of Tenet Healthcare Corp., Dallas, which left in a dispute over the 2001 merger of two other Florida hospital trade groups with the association (Feb. 27, 2004, p. 10).
Now NeSmiths departure could move HCA to rejoin, though its far from certain, said Bryan Anderson, HCAs vice president for government affairs in Florida. Any reunion would follow NeSmiths retirement and will largely depend on who replaces Wayne, he said.
Thats not the case with Tenet. We are members of another hospital association with more local interests to advance our position, said Mitch Feldman, Tenets Palm Beach Health Networks vice president, in a statement. We anticipate that we will meet with the new FHA leadership to best determine how our interests may be aligned.
NeSmith, who will end his career after
39 years with hospital associations, including 25 as a CEO, said members interest in FHAs lobbying efforts has intensified in recent years. Florida, with an aging population thats burgeoning and its significant 27-member congressional delegation, is a player on Capitol Hill as well as in Tallahassee, he said.
Sue Brody, president and CEO of 400-bed Bayfront Medical Center in St. Petersburg, Fla., and past-chairwoman of the FHA, said the search committee has not yet set criteria for NeSmiths successor, but hopes to recruit an incoming president before Floridas spring legislative session in 2008.
In Texas, hospitals recruited a successor for Bettiswho retired as Texas Hospital Association president and CEO Jan. 1with an eye on the Lone Star States five-month biennial legislative session. You get one chance every two years, said Dan Wolterman, chairman of the Texas Hospital Association. If you miss that, you get two more years of pain. We cant afford that.
Hospitals hope to use the THA to drive healthcare reform, which Wolterman said is urgently needed to address the states high rate of uninsured and Texas stringent Medicaid criteria. One in four Texans was uninsured in 2005, according to U.S. Census Bureau estimates released in August 2006. In Houston, where Wolterman is president and CEO of six-hospital Memorial Hermann Healthcare System, about 33% of residents lack coverage, he said. Thats just unsustainable, Wolterman said. We have to be much more effective in advocating for change.
Wolterman agreed with hospital industry insiders elsewhere who said failed reforms in Congress and the upcoming presidential election have shifted the momentum behind healthcare policy to states. Were evolving into 50 different health systems in our country, he said. Thats fine. If thats how its going to be, then the state hospital associations have to recreate themselves to be effective.
To do so, Texas Hospital Association trustees felt the trade groups next president would need to revamp its strategy. The status quo of how the association operated and conducted its affairs needed to change, Wolterman said.
Trustees aggressively looked outside healthcare for an extroverted, energetic, highly effective communicator, Wolterman said, placing a greater premium on candidates skill negotiating among Texas lawmakers and navigating hospitals occasionally competing interests than their knowledge of healthcare. We didnt want the traditional association executive, he said.
The finalists, however, all had healthcare experience and ultimately trustees selected Stultz, a San Angelo, Texas, hospital executive to succeed Bettisjust in time for the 2007 legislative session. Our time is now, Stultz said.