Special Bulletins
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A Message from Imperial Sir Doug Maxwell on the events from this years Imperial
Pediatric Specialty Care
Douglas E. Maxwell, President and CEO
dmaxwell@shrinenet.org (If you desire to respond to this message, please use dmaxwell@shrinenet.org)
My Dear Fellow Representatives,
I would like to begin by thanking each of you for helping move our 135th Imperial Council Session in San Antonio, Texas, to a most “Productive Conclusion”. The “Body”, gave to the “Joint Boards”, some new tools, to allow us to continue to treat children, far into the future.
As was stated a few times, this was the most legislation that has ever come before this group, and many of the items had some very major implications on how we operate our beloved Philanthropy.
I am including, at the end of this communication, a message that was sent this past week from our Vice-President of Hospital Operations, Joe Melchiorre, to all of our 22 Hospital Administrators. Joe does a very good recap of what took place, and how we began moving forward on these new directions last week in Tampa.
Joe’s message is indeed lengthy…but it is a must read… as it is the “Footprint” of where we are going in the Future….I hope you have the time to read and absorb the thoughts.
On a personal note, a most heart felt “Thank you” for the trust you bestowed upon me, by electing me your new “Chairman of the Board of Trustees” for the coming year. I will do everything I can to uphold your expectations of where we go from here… during these “Challenging Times”.
I also want to thank my good friend… Imperial Sir Ralph Semb… “Ralphie”… as he has lovingly had us refer to him…for all of his years of excellent leadership to this Shrine Fraternity and our Philanthropy. As anyone who has ever been installed into office by Ralph, you readily see the love and passion he has for this organization. We are all very fortunate to have Ralph still have two years remaining in his service to us as a trustee… and I fully intend to use his multiple talents to the continued benefit of SHC.
Ralph and I continue to communicate on a daily basis, as he helps me transition into the role of President and CEO, that he served so well for the last six years. Again…Thank You Ralph, our dear brother…for all you have done for the Shrine. And now on to the “Future”….
Last week, I traveled to Tampa to speak with SHC’s senior staff about what we all “perceived”… as the direction given to us at the “Session”.
My first action was to call the Chairman of the Board of Governors of the Galveston Hospital, Jim Denson, and let him know that I’m entrusting to he and his Galveston Board of Governors… the authority to put all of the pieces back together… to enable us to move back to taking care of “Acutely Burned Children” in the South Central United States… as safely and quickly as possible. They have all accepted the task and are successfully moving forward. I also instructed our staff in Tampa, to give them all the assistance necessary, to make this path safe and good for the children we will again serve in Galveston.
The next item, in Tampa, we moved onto was the new path… for us… of “3rd Party Pay”. I stated that the direction… as overwhelming stated by the floor… was to move forward on this…“now”.
After some conversation about “low hanging fruit”… as reference in Joe’s following message, we determined that we will not try to… “re-invent the wheel”… but instead… send out some RFP’s immediately…. to locate a firm to… “Hold our Hand”… and to take us to where we need to be for a successful implementation of this new “Revenue Source” for Shriners Hospitals.
My next conversation with our staff… related to the proposed “Affiliation” deals that we were told about in San Antonio… from the five orthopedic hospitals that were selected for closure.
My question to staff was…with the new direction and changes to the By-Laws that were given to us at the session…do these “Pre-San Antonio” paths make good “Business Sense”?
My conversation with our staff last week… related to…
“Perhaps we don’t want to give our surgeries to an “affiliated partner” for them to “Bill” and “receive the revenue”… to help the “Affiliated Partners” bottom line…
If we… “Shriners”… can do the operation (as we have for the past 87 years) and “now the billing”… to help “Shriners” bottom line?
Again, please read Joe’s statement relating to these thoughts (just before his “Epilogue”).
As we continue to progress… I will keep you informed on all these thoughts….
Also included at the end of this e-mail are the words I spoke during the Award of Merit presentaiton during the PR Presentation on Wednesday afternoon in San Antonio, relating to the "Unknown Shriner," which many of you asked for.
Please feel free to use it with your Nobility to say… “Thank You for all you do”…
Fraternally yours,
Doug Maxwell
Joe Melchiorre’s (Vice-President of Hospital Operations)“Post Imperial Session Epistle”
Ladies and Gentlemen:
The dust is about settled on the outcome of the 135th Imperial Session of Shriners International (note the name change). Our new Imperial Potentate is Jack Jones of Egypt Shriners and the new Outer Guard is Jeff Sowder of Midian Shriners. The new Imperial Recorder is Past Imperial Potentate, Nick Thomas of Al Malaikah Shriners. At the Imperial Council Session the representatives voted to create two new temples under dispensation in the Philippines and in Puerto Rico. This action for the Philippines could have enormous impact for health care services being provided by Shriners Hospitals for Children - Honolulu.
Within the Colorado Corporation (the governing entity for the hospital system), the following election results should already be familiar to you. The Junior Past Imperial Potentate, Imperial Sir Douglas C. Maxwell was elected President and CEO of Shriners Hospitals for Children over Ralph Semb and Gary Dunwoody. Imperial Sir Raoul Frevel was re-elected for a second three year term as Trustee and Noble Bobby Simmons, Al Sihah Shriners, Macon Georgia was elected to his first three year term as Trustee. Trustee Frank Roth was made an emeritus Trustee and will continue to serve on the Investment Committee. In a surprise move, Trustee Bob Smith announced to the Representatives that he would not be a candidate next year in seeking his third three year term as Trustee in 2010.
The Session:
This was an historic event for several reasons. First, this session had the most pieces of legislation presented for deliberation by the Representatives. On the SHC side, many were similar or some were withdrawn based upon the Representatives' voting position on one or more of the others. As it turned out, two pieces of legislation were passed impacting the authority given to the Joint Boards. This legislation could/should change forever the foot print and operating culture of SHC as a specialty health care system. The first item passed was the change in definition of the word "hospital" in the Colorado Corporation's articles of incorporation and its bylaws. The language expands the definition to include "other care models" such as ambulatory centers with or without day surgery, and outpatient centers. Furthermore, the Joint Boards were given the authority to change a current hospital's care model after consultation with its Board of Governors. The second ground breaking legislation is the change in the definition of "pay patient" to allow our organization to accept payment for services rendered by SHC from insurance companies, government agencies, etc. The representatives were asked by Imperial Sir Maxwell, then acting as Imperial Potentate, if their vote meant to study the issue or implement the process. The representatives, resoundingly, responded to immediately implement the process of accepting third party payment for services rendered. (More on this subject below). Finally, the Representatives voted to lift the suspension of operations at SHC, Galveston and resume operations there. In the (paraphrased) words of our Boards’ leadership, it is clear that we will have 22 locations where some form of SHC Shrine Care or a Shriners presence will be provided. The idea of closing any of the current SHC facilities is a dead issue.
The Budget for 2010:
During the time between the March Board meeting and the Imperial Session, many communications were sent out addressing the various scenarios for dealing with the projected financial crisis as a result of years of deficit spending and the resultant impact on our endowment. One action presented, should the closure of six hospitals not pass the Representatives vote, was an across the board 30% budget cut equally distributed among all 22 hospitals. At the session, the representatives were presented with a 2010 budget that was modified by amendment to direct each hospital, with no exceptions, to take a 5% budget cut off of the previously revised 2009 budgets of each of the hospitals. (Corporate Headquarters was assessed a 10% budget cut for 2010) This still leaves a $71m deficit in the budget for 2010 that will not be allocated to the hospitals. How or if that deficit will be addressed in the 2010 budget is a topic for the Joint Boards at some future date. Furthermore, as of this writing, we are not expecting any change to our benefit suspensions, we do not expect any pay raises for 2010, and we do not expect a capital budget for 2010. However, these topics are unsettled and again may be addressed by the Joint Boards at some near future date. We do expect the re-activation of the Boards' Cost Reduction subcommittee of the Strategic Planning Committee. Based upon our meeting with Imperial Sir Maxwell, we do expect an emphasis on cost cutting and efficiencies of scale from the regionalization and the centralization of functional areas, as appropriate.
Third Party Pay:
It appears, based upon feedback I am getting from some of you, that there's some chomping of the bit to get yourself involved locally with third party pay. The Administrators' bamboo telegraph has been activated regarding the initiatives of Lexington and Salt Lake City to spin off their medical staff to their affiliated university's physician practice plan. In Lexington, that's already the case except for their Chief of Staff. In Salt Lake City's case that's a new initiative, as the medical staff are our employees. The other piece of low hanging fruit we hear about is your current consulting and courtesy staff physicians that you pay a stipend or straight dollar amount for their services on an as needed basis.
Let's take a step back. We have been directed to move out on putting into place all the tenants associated with implementation of an infrastructure for a successful Third Party payment system. We are doing this from scratch! We have before us the unprecedented opportunity to do it right with no legacy systems or processes constraining our ability to maximize our reimbursements for qualified services rendered. We do have to overcome a steep "lack of knowledge" curve that will require a focus on education and training. We must all acknowledge that we have but one chance to get it right. Therefore, we need outside help to guide us down this path of opportunity. To that end, Chairman, Maxwell has directed our Vice President of Planning, Scott Laubisch, to write up a RFP to hire, through this competitive process, a proven company that will help us develop a comprehensive plan of implementation. In a parallel track, Gene D'Amore, our Vice President of IS has been given the green light to put on the street a RFP for the information systems tenant to this process implementation. Will this initiative be ready for employment within a year or less? That's the goal. What about you and what you can or should do? Is there low hanging fruit?
To my first question, I believe you need to consider what is your level or state of readiness. Some of you have had experience of varying degrees with third party pay, some more recently than most. I suggest you conduct a planning session with your executive team to assess yourselves and come up with a requirements list and determine what you can positively affect locally with the resources you have, and what you will need from a central authority to satisfy all your other requirement gaps. Four things come to mind for you to consider: what services, in terms of volume, are you providing now both inpatient and outpatient that would "qualify" for reimbursement, and what do you need to do to increase qualifying services; documentation and coding readiness, training and education needs assessment, and the organization of the medical staff (what is the best organizational structure to maximize our total reimbursements, including professional services). Back to the low hanging fruit question; if you believe changing your "contractual" arrangement for consulting and courtesy staff members, etc, from a fee for service to a reimbursement through billing insurance arrangement is best for you financially and you can get those physicians to agree, I say you should carefully consider it. For the short term, we believe your utilization of Access Mediquip should be continued. As you explore these options, please keep HQ staff informed, so that we can provide you with support and act as a resource on the multitude of issues ( both operational and legal ) that these arrangements present.
However, in concluding this section, I remind you that this is a most complicated and foreign process for us, and it is an unprecedented opportunity for us to become the poster child for the future state of reimbursement processing. Let's all demonstrate some patience as we begin down this pathway.
Reconfiguration of the System:
As I mentioned above, the Joint Boards were given the direction and authority to reconfigure SHC from a pure hospital organization to a system of health care venues that range from outpatient clinics and ambulatory centers, with or without day surgery, to hospitals of some physical form. You recently received a questionnaire from Scott Laubisch that focuses on four major areas of information gathering. They are your local market, your affiliation opportunities that could result in an alternative care model, third party pay, and inclusive to this effort the identification of opportunities for two or more of you to collaborate on shared services or functions in a regional geographical setting. As mentioned in Scott Laubisch's email to you, the Strategic Planning committee of the Joint Boards is meeting July 31 to August 1st. Hopefully they will be using this opportunity to map out the timetable for achieving a re-configured SHC for presentation to the voting Representatives at the 136th Imperial Council Meeting in Toronto, Canada, in July of 2010. I strongly urge you to be timely and thorough yet concise in your response. A note of explanation may be in order. The Boards will be looking at all 22 hospitals regarding reconfiguation, not just those six identified for closer in their March Joint Boards meeting. Those of you who are in the process of re-configuration initiatives, you are encouraged to continue down that pathway, however, perhaps this may be a good time for you to hit the "pause" button, take a deep breath, and ask yourself some questions:
Is what we are trying to achieve make good business sense, relevant to the changed landscape before us? Are we mired in survival mode thinking, when with the onset of implementing third party pay, we should also be thinking equally of how we can maximize revenue through increasing qualified services that result in reimbursement? Should we be thinking of retaining and recruiting medical staff as opposed to thinking we should spin them off our employment payroll as a cost avoidance action? ( We recognize the paradox here, especially since you are in the midst of figuring out a 5% cut from your 2009 budget for your 2010 budget.) However, we assure you that there will be more dialogue on these and other questions as the Joint Boards consider the larger challenge of system re-configuration commensurate with achieving financial stability.
Epilogue:
It is clear that we have concluded another era in the history of SHC. With the passage of the legislation at the Imperial Session, Shriners Hospitals for Children is forever changed. Many of us will look upon these events with great sadness. However, we also knew, in our heart of hearts, the time had come to say goodbye to the "good old days". We must put aside our fears and rally together with optimism, enthusiasm, and assurance, that we will succeed to grow our mission in the service of children for years to come.
Warm Regards,
Joe Melchiorre
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A Message from First Lady Charlene McGuire
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Dear Nobles,
At the 2009 Imperial Council Session in San Antonio, Texas, I announced my fundraising program, “Giving the Gift of Hope, Life and Dreams,” which benefits the Shriners Hospitals for Children emergency patient transportation fund. This fund will help sponsoring temples cover transportation costs for burn patients, who often need to be transported to Shriners Hospitals for Children in medically equipped airplanes, with medical professionals onboard to monitor them.
These flights can be very expensive, but with your help and support we can ensure the necessary funding is available when a child needs to be transported to one of our burn facilities for care. Below are a couple of ways you can support “Giving the Gift of Hope, Life and Dreams”:
Make a Donation
For each donation of $25, donors will receive a choice of a beautiful gold and silver lady’s pin, designed as a Hope, Life and Dreams gift box with a bow, or a handsome burgundy men’s tie, with the Editorial Without Words image. Orders can be placed online by visiting www.donate2shc.org/firstlady, or by calling the Office of Development at Shriners International Headquarters at (813) 281-GIFT.
Spread the Word
Please encourage the nobles and ladies at your temple to support this program, so burned children can receive the specialized care they need at Shriners Hospitals for Children. You may have opportunities to share information about this important program with church groups, civic organizations, and the ladies at your temple throughout the year.
Please feel free to download the following resources, available online, to print and use as you see fit:
· One-Sheet in Black-and-White
· Poster
· Speech for Shriner Audiences
· Speech for Non-Shriner Audiences
I would also greatly appreciate you sharing this e-mail with your lady. The ladies are always such invaluable advocates of the First Ladies’ fundraising programs.
Thank you very much for supporting the “Giving the Gift of Hope, Life and Dreams” program, Shriners Hospitals for Children and Shriners International.
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