The system's long-serving top executive will continue on as board chair for the nonprofit's newly created healthcare investment fund.
Less than three months after announcing the planned retirement of CEO Anthony R. Tersigni, EdD, FACHE, Ascension has named Tersigni's interim successor, along with a revised leadership team for the St. Louis–based Catholic health system and a new investment fund.
Joseph R. Impicciche, JD, MHA, who has been Ascension's president and chief operating officer since a leadership overhaul in January, will assume the duties of transitional president and CEO in less than three weeks, on July 1, the organization said in Tuesday's announcement.
Tersigni, meanwhile, will become board chair for the organization's newly created healthcare investment fund, Ascension Capital LLC. The fund will be led by President and CEO Anthony J. Speranzo, who has been Ascension's executive vice president and chief financial officer. Tersigni will also continue providing consulting services to the Ascension board and working with the Global Solidarity Fund, according to the announcement.
Tersigni described Impicchiche as "a gifted and talented servant leader" whom he and the board selected after a thorough succession planning process.
"Over the past several years, the Board and I have been working to cultivate a leadership team that is fully prepared to take our health ministry boldly into the future," Tersigni said in a statement. "Our focus on leadership development and formation has created a depth of capable, creative and committed virtuous servant leaders with a firm foundation in our Catholic identity and principles, and I have great confidence in the future of this health ministry as we continue to transform ourselves.
"As I reflect on how far our health ministry has come since we joined together nearly 20 years ago, and more importantly, how Ascension is positioning itself for the future, I am grateful for the opportunity I've had to serve as CEO and I'm confident that we will continue our transformation to best meet the needs of the individuals and communities we serve," Tersigni added.
In addition to Impicciche's promotion, the announcement listed several new and continuing members of the Ascension leadership team:
Karen Springer will become executive vice president of performance optimization and nursing operations.
Herbert J. Vallier will continue to serve as executive vice president and chief human resources officer.
Elizabeth Foshage will become executive vice president and chief financial officer. (Speranzo will vacate the position for his new role with Ascension Capital.)
Craig Cordola will become executive vice president and chief operating officer.
Eduardo Conrado will become executive vice president and chief strategy and innovations officer.
Christine Kocot McCoy, JD, will become executive vice president and general counsel after serving as a senior vice president since January.
Joe Cacchione, MD, FACC, will become executive vice president of clinical and network services.
Nick Ragone will become executive vice president and chief marketing and communications officer.
Sister Maureen McGuire, DC, will continue to serve as executive vice president and chief mission integration officer.
Eric Engler will become executive vice president and chief of staff.
The leadership changes that were previously announced in January included the elimination of the Ascension Healthcare CEO position, effective July 1.
Backers of the legislation say it will help to protect rural hospitals from the encroachment of freestanding EDs that don't offer all the services that hospitals do.
With an overwhelming majority in both chambers, lawmakers in Louisiana passed a bill this week to prohibit the establishment of most new freestanding emergency departments in the state.
The bill's stated purpose is to protect rural hospitals from the competitive forces of a freestanding ED that might offer emergency care but no inpatient hospital services.
Sen. Fred Mills, a Republican representing St. Martin Parish and the bill's primary sponsor, says standalone EDs tend to cherry-pick services that generate the most money, as WAFB's Melinda Deslatte reported.
The bill defines a freestanding ED as "a healthcare facility that holds itself out to the public as providing emergency medical services and is not licensed as part of the main campus of a hospital or as an off-site campus of a hospital."
The bill also would prohibit hospitals from creating an off-site ED within the primary service area of a rural hospital. Any freestanding ED that secured a permit by April 1, however, would be allowed to proceed.
After the Senate voted 33-1 and the House voted 92-0 in favor the bill this week, lawmakers sent the measure Thursday to Gov. John Bel Edwards, a Democrat. A spokesperson for Edwards could not immediately be reached Friday morning.
Moving forward, the government will have to complete notice-and-comment rulemaking for a broader set of its decisions.
Hospitals that treat high numbers of low-income patients secured a big win this week at the U.S. Supreme Court.
Seven of the justices agreed that officials in the U.S. Department of Health and Human Services stepped out of line when they rejiggered a Medicare reimbursement formula for disproportionate share hospitals (DSH) five years ago without a formal notice-and-comment process.
The decision carries implications well beyond the money hospitals say they are owed.
"It's a big deal for the hospitals, obviously," says Helen R. Pfister, JD, a New York–based partner with Manatt Health.
By the government's estimates, the dispute implicates $3-4 billion in payments over nine years. That's how much more the Centers for Medicare & Medicaid Services would have paid in DSH reimbursements, had the formula not been changed, according to court records.
"But I think it's also a big deal in terms of the fact that the Supreme Court has clearly indicated that, going forward, CMS is going to have to do notice-and-comment rulemaking for a much more expansive set of agency decisions than they thought and argued in this case that they would need to do," Pfister adds.
Precisely how much of the routine work completed by HHS and CMS will be affected by this broader take on notice-and-comment rulemaking remains to be seen. While some stakeholders have raised concerns the added burden could stifle the government's work, others contend any inconvenience imposed will be both manageable and beneficial.
In any case, the impact of Monday's decision will flow along two distinct paths, affecting not only hospital finances but also, for better or worse, the way HHS and CMS operate.
What's Next, Procedurally?
In 2016, nine hospitals led by Allina Health Services lost their case against HHS at the U.S. District Court in D.C., where a judge ruled that notice-and-comment rulemaking wasn't required. In 2017, however, three judges at the D.C. Circuit Court of Appeals reversed the lower court's decision and sent the dispute back for further proceedings.
In 2018, attorneys for HHS asked the Supreme Court to review the appellate decision. Now that the justices have affirmed the Circuit Court's decision, the parties have up to seven days to file a status report at the District Court level on where the case stands, according to court records. That filing, expected by early next week, could shed light on where things are headed procedurally.
Pfister says she doesn't think anyone knows for the time being whether the government will automatically revise DSH payments for the affected fiscal years, pursue another round of notice-and-comment rulemaking, or take some other course of action in response to the Supreme Court ruling.
And the parties themselves aren't saying much. When asked about the agency's plans, a CMS spokesperson told HealthLeaders on Wednesday that the agency is still reviewing the decision. Allina referred questions to its law firm, which declined to comment.
Beyond the nine plaintiff hospitals involved in this week's Supreme Court decision, there are hundreds of plaintiffs suing HHS on similar grounds. Dozens of follow-on lawsuits have been consolidated into a single docket pending before U.S. District Judge Amy Berman Jackson. Parties to that proceeding have up to 14 days to file a status report in light of the Supreme Court's decision, according to court records.
An Overly Burdensome Decision?
The government's attorneys had issued dire warnings about the potential consequences of the decision the Supreme Court ultimately reached.
The notion that CMS must go through a notice-and-comment process for the sort of routine process at issue in this case could "substantially undermine effective administration of the Medicare program" because it would apply not just to DSH formula calculations but to "nearly every instruction" the agency gives to its contractors as well, U.S. Solicitor General Noel J. Francisco argued on HHS' behalf.
Pfister largely rejects the government's dire take on the decision's impact.
"I think that might have been a little bit hyperbolic," she says.
But other stakeholders outside the government have taken the Supreme Court's ruling as a troubling sign of uncertainty to come.
"This is a frightening decision, that throws a lot of doubt on the validity of thousands of pages of Medicare sub-regulatory guidance," Adam Finkelstein, JD, MPH, counsel with Manatt Health and a former health insurance specialist with the CMS Innovation Center, wrote in a tweet.
Stephanie A. Kennan, senior vice president of federal public affairs for McGuire Woods Consulting in Washington, D.C., tells HealthLeaders that she thinks the government's argument "is somewhat overblown." Officials should be able to manage any added burden from this ruling, even if it slows them down a bit, she says.
"I think it may mean they cannot move as quickly on some policies as they would like to," Kennan says.
A Boon to Public Input?
The benefits of a more-transparent process justify any added hassle that may stem from having to go through a mandatory comment process more often as a result of this decision, Kennan says.
"In this case, they have to do 60-day comment periods, which can seem like an eternity if you want to keep the process moving, regardless of whether you're the agency or a stakeholder," she says. "The transparency is probably worth the 60 days."
But others reject the notion that this decision should be seen as balancing effective governance with transparency.
"Allina isn't a vindication of the importance of public participation in agency decision-making. It's a testimonial to the heedlessness of lawyers who impose silly procedural rules on an administrative state they only dimly understand," Nicholas Bagley, JD, a law professor at the University of Michigan who teaches on administrative law and health law, wrote in a series of tweets.
"Bear in mind," he added, "that CMS is a tiny, beleaguered agency … To further encumber it will make Medicare more capricious, not less, as staffers tend to senseless procedures instead of doing their jobs."
Moving forward, HHS and CMS will continue to have discretion to determine whether to go through notice-and-comment with a given action, Pfister says. The difference now, she says, is that there's a stronger incentive for government officials to cover themselves; otherwise, another case like Allina's could pull them into another round of prolonged litigation.
Clarification: This story has been updated to clarify that Helen R. Pfister, JD, is based in New York.
The numbers submitted by St. Joseph's Hospital and Medical Center would have resulted in more than $11 million in overpayments to hospitals across the state, had they not been corrected.
Editor's note: This story was updated Thursday evening to include a statement from the hospital.
St. Joseph's Hospital and Medical Center in Phoenix, Arizona, overstated its wages and wage-related costs in a way that would have significantly impacted reimbursement rates across the state, according to a Health and Human Services Office of Inspector General report released Wednesday.
The error by the 595-bed nonprofit hospital, which is part of the Dignity Health system, would have thrown off calculations of the so-called "rural floor," a concept in federal law that requires that the Medicare wage index for urban hospitals in a given state be set no lower than that for rural hospitals in the state.
Had the error not been corrected, it would have resulted in $11.6 million in overpayments for fiscal year 2019 for inpatient stays across 54 hospitals in Arizona, nine of which receive the rural wage index and 45 of which are urban hospitals that benefit from the rural floor, according to the HHS OIG audit report.
Auditors selected St. Joseph's for closer review because it had the potential to significantly affect Medicare payments in Arizona for fiscal year 2019 and because "hospitals often report inaccurate wage data," according to the report, which includes links to dozens of past HHS OIG audit reports regarding hospital wage data issued between 2005 and 2017.
This latest audit is the first to be published since the Centers for Medicare & Medicaid Services proposed changes to the wage index that would shift more money to rural hospitals from urban hospitals, which receive a higher reimbursement to account for higher labor costs in urban markets.
The proposal would affect the rural floor calculation, which CMS Administrator Seema Verma said some urban hospitals have used in "gaming the system" through urban-to-rural reclassifications.
A spokesperson for Dignity Health St. Joseph's Hospital and Medical Center released a statement Thursday that says the organization strives for accuracy in its cost reports and for compliance with all state and federal regulations.
"Although we regret that some errors were made with this specific report, they were not made intentionally," the statement says. "The reporting issues had been identified and were being addressed by Dignity Health as the Office of Inspector General was doing their concurrent review. The wage index was finalized correctly and an overpayment did not occur. Dignity Health regularly updates policies and procedures to address changes with regulations and has also revised its preparation and review process."
The errors occurred for three reasons, according to the report. First, the hospital's responsibilities to report its wage data had been reassigned to a new group of Dignity Health staff in the centralized office. Second, the system lacked adequate review procedures to make sure the numbers reported were correct and the forms were filled out properly. Third, the system lacked sufficient quality control over the way contract labor data were tracked in its accounting system.
The Boston-based system's interim CEO says it is giving Care New England a chance to establish an academic medical center within Rhode Island, in cooperation with Lifespan and Brown University.
Rhode Island Gov. Gina M. Raimondo has intervened in long-running negotiations over the future of Providence-based nonprofit health system Care New England, prompting Boston-based nonprofit Partners HealthCare to abandon its efforts to acquire CNE, at least for the time being.
Raimondo said Tuesday that she has asked CNE to instead resume negotiations with Lifespan and Brown University to see if the three parties can establish an academic medical center managed within Rhode Island, rather than ceding control to healthcare executives in Massachusetts.
"While I have little control over private hospital systems, I do have the ability to bring these parties together and ask them to reconvene negotiations on a crucial decision that will impact all Rhode Islanders for decades," Raimondo said in a statement.
"Whether or not Rhode Island affiliates with a larger system at some point, I believe creating a more integrated, locally-run, academic structure first is what's in the best interest of Rhode Islanders now and in the long run," she added.
Partners HealthCare Interim President and CEO Anne Klibanski, MD, said in the same statement that the Boston-based system would withdraw its application to acquire CNE but "look forward to reengaging at the appropriate time."
Partners had itself been engaged in merger talks with Lifespan, but that deal fell through last fall. Shortly thereafter, Partners CEO David Torchiana, MD, retired.
Lifespan, the largest hospital network in Rhode Island, launched an ad campaign this year denouncing the potential Partners-CNE deal as "devastating" for the Ocean State, as WPRI reported.
Raimondo said Tuesday that Lifespan's public criticism of Partners was "unfortunate" but didn't influence her decision on whether to wade into the negotiations, as The Boston Globe's Priyanka Dayal McCluskey and Dan McGowan reported.
Whether the three Rhode Island entities can reach a deal, despite their past failures to do so, remains to be seen. But the parties are putting forward an optimistic message.
"We are confident that with the good faith efforts of all the parties involved, we will finally achieve the vision of unified academic health care system for the state of Rhode Island that will have a positive impact on patient care and our economy for years to come," said Lifespan's President and CEO Timothy J. Babineau, MD, and board chair Lawrence Aubin in the joint statement. "We are excited to get this effort underway."
Raimondo has urged the parties to determine over the summer whether they can find a success path forward, with consultant support from The Partnership for Rhode Island.
Three witnesses plan to testify against the megamerger, and three plan to testify in favor, but there will be no cross-examination allowed.
Six witnesses are slated to testify in a highly unusual hearing beginning Tuesday morning in a D.C. federal courtroom, where Judge Richard Leon is mulling whether to sign off on the U.S. Department of Justice's approval of CVS Health's Aetna acquisition.
The nearly $70 billion transaction closed last fall, but Leon has been thoroughly scrutinizing the DOJ-approved deal, which is why he called for this week's hearing. Three witnesses plan to testify against the megamerger, and three plan to testify in favor, but there will be no cross-examination allowed and no formal evidence required. This isn't a trial; it's merely an opportunity for Leon to gather additional perspective on the acquisition as part of his Tunney Act review process.
The hearings will last up to three days, with three witnesses put forward by amici curiae expected to speak first, followed by three witnesses put forward by CVS and the DOJ:
Neeraj Sood, PhD, a health policy professor and vice dean for research at the University of Southern California Sol Price School of Public Policy, was put forward by the American Medical Association. Sood is listed first on the amici's order of witnesses and may testify for up to two hours. Sood is expected to testify that the divestiture of Aetna's Part D plans "will not even come close to restoring competition to premerger levels," according to the AMA.
Michael B. Wohlfeiler, MD, JD, chief medical officer for the AIDS healthcare Foundation, was put forward by the foundation. Wohlfeiler is listed second on the amici's order of witnesses and may testify for up to one hour. Wohlfeiler is expected to testify on how rising healthcare consolidation has negatively impacted HIV/AIDS care.
Diana L. Moss, PhD, president of the nonprofit American Antitrust Institute and an adjunct faculty member in the Department of Economics at the University of Colorado at Boulder, was put forward by Consumer Action and the U.S. Public Interest Research Group (PIRG). Moss is listed third on the amici's order of witnesses and may testify for up to one hour. Moss is expected to testify that the merger could give CVS-Aetna incentive "to exclude rivals and facilitate anticompetitive coordination among health insurers" served by the pharmacy benefit manager CVS-Caremark, according to groups who proposed that she testify.
Lawrence Wu, PhD, president of the economic consulting firm NERA, was put forward by CVS. Wu is listed first on the parties' order of witnesses and may testify for up to two hours. Wu is expected to testify that the CVS-Aetna transaction won't lead to price increases for consumers.
Alan Lotvin, executive vice president of transformation for CVS Health, who reports directly to CVS President and CEO Larry Merlo, was put forward by his employer. Lotvin is listed second on the parties' order of witnesses and may testify for up to one hour. Lotvin plans to testify on purported consumer benefits of the CVS-Aetna deal.
Terri Swanson, vice president of Medicare product and Part D business at Aetna since 2010, was put forward by both CVS and the DOJ. Swanson is listed third on the parties' order of witnesses and may testify for up to one hour.
The scrutiny of CVS-Aetna's PBM business comes as policymakers in D.C. explore their options on the possibility of new laws and regulations to rein in healthcare middlemen.
The decision means HHS owes hospitals more money because the justices rejected an Obama-era rule change.
In a 7–1 decision issued Monday morning, the U.S. Supreme Court sided with hospitals that sued Health and Human Services over a payment policy change that was implemented by the Obama administration and defended by the Trump administration.
The justices affirmed a 2017 ruling by the D.C. Circuit Court, which found HHS in violation of the Medicare Act for tweaking the reimbursement formula for disproportionate share hospital (DSH) payments without going through public notice-and-comment rulemaking.
The dispute implicates up to $4 billion in payments to hospitals, according to HHS.
"In 2014, the government revealed a new policy on its website that dramatically—and retroactively—reduced payments to hospitals serving low-income patients," Justice Neil Gorsuch wrote in the majority's opinion. "Because affected members of the public received no advance warning and no chance to comment first, and because the government has not identified a lawful excuse for neglecting its statutory notice-and-comment obligations, we agree with the court of appeals that the new policy cannot stand."
The court's newest member, Justice Brett Kavanaugh, wrote the appellate decision at issue in the case, so he recused himself last fall. The court's opinion says Kavanaugh took no part in the Supreme Court's deliberation or decision.
The lone dissenting member was Justice Stephen Breyer, who wrote that he would have sent the dispute back to the D.C. Circuit for a determination as to "whether the agency determination at issue in this case is a substantive rule (which requires notice and comment) or an interpretive rule (which does not)."
Nine hospitals, led by Allina Health Services, are party to the case. But their claims total $48.5 million in additional reimbursement for a single year. Hundreds of similarly situated hospitals have filed follow-on lawsuits making similar claims, so the total amount implicated in this dispute is $3-4 billion for fiscal years 2005 through 2013, HHS said in court filings.
While the government's attorneys warned a decision in the hospitals' favor could have broader consequences that could "substantially undermine effective administration of the Medicare program," the AHA argued in an amicus brief that the government's concerns about workability are "overblown."
The AHA applauded the decision in a statement released Monday afternoon.
"By evading the notice-and-comment process, HHS failed to consider the real-world impact of its changes, leading to policies that may adversely affect patients as well as providers," AHA General Counsel Melinda Hatton said in the statement. "As we stated in our amicus brief, more public participation in policymaking, including by hospitals and health systems, leads to better-thought-out policies with a deeper understanding of their direct impact on health care providers and those they serve."
Editor's note: This story was updated to include a statement from the American Hospital Association.
Market stakeholders have speculated that Humana could make a proposal to combine with Centene as an alternative to Centene's planned merger with WellCare Health Plans.
Humana Inc. signaled in an unusual filing Monday morning with the Securities and Exchange Commission that it has no intention of pursuing a merger with fellow health insurer Centene Corp.
The note—which sent Centene shares tumbling more than 8% shortly after markets opened—came after Centene's proposed merger with WellCare Health Plans hit a bit of a speed bump, with antitrust regulators from the U.S. Department of Justice indicating they will scrutinize the deal that has been criticized by the American Hospital Association and others.
A report last month by Reuters' Carl O'Donnell and Svea Herbst-Bayliss added fuel to rumors that Humana would be interested in merging with Centene if the WellCare deal falls through.
Humana said in Monday's SEC filing that its "long-standing policy is not to comment on rumors or speculation regarding possible M&A activity."
"However, in light of the significant investor speculation and persistent market rumors regarding the Company's intentions with respect to pursuing a combination with Centene … the Company has chosen to make a one-time, limited exception to its no-comment policy (which continues in effect) and confirm that the Company will not make a proposal to combine with Centene as an alternative to Centene's proposed transaction with WellCare Health Plans, Inc.," the SEC filing states.
"The Company does not intend to make any further statement regarding the foregoing," Humana's filing adds.
As Centene shares sank, Humana's rose more than 5% Monday morning.
SVB Leerink analyst Ana Gupte told the St. Louis Post-Dispatch that Humana needed to respond to claims it had been putting pressure on its stock.
"Shorter term activist shareholders of Centene may be disappointed by it, but large long-only institutional share holders of both Centene and Humana are likely relieved," Gupte wrote in an email to the Post-Dispatch.
As planned, the hearing 'violates fundamental principles of procedural fairness,' the DOJ says. Opponents of the megamerger contend the hearing should proceed as scheduled.
Update (5/31/19): The judge denied the DOJ's motion Thursday evening, calling it an "eleventh-hour request to reshape next week's hearing" and "nothing more than a thinly veiled motion to modify the procedures set forth," according to court records.
A highly anticipated court hearing on CVS Health's massive Aetna acquisition is set to begin in just a few days, but the format of that hearing is still the matter of heated debate, suggesting there may be plenty of conflict to come in the already drawn-out review process.
The U.S. Department of Justice said in a filing late last week that the hearing, as currently planned, "violates fundamental principles of procedural fairness" because the DOJ will not be allowed to cross-examine witnesses who plan to testify against the DOJ-approved CVS-Aetna deal.
"At best, this approach will leave the court with an incomplete picture of the merits of the proposed settlement. At worst, it risks leading to a result that harms consumers," the DOJ wrote. "It would be clear error for the Court to rely on evidence introduced in such a flawed hearing to refuse to enter the proposed consent judgment."
U.S. District Judge Richard Leon's signature is the final step in an approval process that, until now, has been poised to greenlight a potentially transformative tie-up that could force hospitals to rethink their business models.
Leon decided there would be no cross-examination at the hearing, even though he had indicated at a hearing in April that cross-examination would be allowed, the DOJ wrote.
Furthermore, when Leon hand-picked six of the 13 proposed witnesses, based on his own determination of who "would be most helpful" for the hearing, he excluded two of the DOJ's three proposed witnesses—Michael Radu, MBA, an executive from WellCare Health Plans, and Nicholas Hill, PhD, MSc, a consultant who worked previously for the DOJ antitrust division and as an economist in the Federal Trade Commission—depriving the government of an opportunity to rebut opponents' testimony, the DOJ attorneys wrote. (The DOJ's third proposed witness had been proposed also by CVS and was selected to testify.)
"By excluding the United States' proposed witnesses, the Court is thus not only depriving itself of the government's views—the information most relevant to the public-interest determination—but also the views that the Court must defer to in making its determination," the DOJ wrote.
Opponents of the nearly $70 billion merger, however, asked Leon to keep next week's hearing as-is, arguing that the Tunney Act does not require cross-examination because this hearing is merely a means by which Leon can gather additional perspectives on the transaction in question.
The American Medical Association, one of the amici curiae that have witnesses slated to testify, responded to the DOJ in a filing Wednesday, accusing the government of playing games with the timing of its objections.
"After the close of business on the Friday before a holiday weekend, without any warning to the American Medical Association, the DOJ moved to completely change the nature of a hearing that is just four business days away," the AMA attorneys wrote, arguing that the DOJ should have spoken up sooner.
The DOJ asked Leon to limit testimony to what the witnesses have previously disclosed and to declare that his decision on the DOJ-approved settlement will be made on the factual basis established in the materials compiled over the course of the government's lengthy investigation and review. The AMA objected to each of those DOJ requests.
Some had expected CVS-Aetna's verticality to unlock regulatory approval without a challenge. But even beyond the DOJ's stipulations, Leon has made clear that his review of the DOJ-approved settlement shouldn't be seen as a rubber stamp.
"It's certainly unusual and interesting that a judge is getting involved with this level of detail, but it is not unprecedented," Andrea Murino, a partner at Goodwin in Washington, D.C., and co-chair of the firm's antitrust and competition practice, told HealthLeadersin February.
The central issue at this hearing is whether the DOJ's stipulations—in which five state attorneys general joined—are sufficient to alleviate any anticompetitive concerns stemming from the CVS-Aetna union. Those stipulations called for Aetna to divest its Medicare Part D business to WellCare Health Plans (which is now looking to be bought by Centene Corp. in a major acquisition of its own that is now undergoing DOJ review).
Up to eight hours of testimony are scheduled to begin Tuesday, June 4, at 10:30 a.m. and conclude no later than 5:30 p.m. on Thursday, June 6, at the U.S. District Court in the District of Columbia.
A survey of hospital and health system CEOs noted opportunities for improvement in board governance, alongside some positive trends.
The boards of trustees governing U.S. hospitals and health systems have relatively low turnover rates in an industry that's shifting rapidly, according to a survey report released Wednesday by the American Hospital Association.
The survey asked more than 1,300 CEOs of nonfederal community hospitals and health systems in the U.S. about their organizations' governance structures and practices, then the AHA compared their responses to data collected in a similar survey five years ago.
The researchers found that the policies and norms in place for most healthcare organizations result in low levels of board turnover.
The report cited several related opportunities for improvement:
Nearly a third of all respondents said their boards do not use term limits at all.
More than 75% of respondents said their organizations either didn't replace board members during their terms or kept reappointing them (when eligible) within the past three years, rather than recruiting a fresh face.
Formal assessments were not conducted within the past three years for boards, board members, or chairpersons at 31% of respondent organizations.
Older board members are increasingly common. Overall, 12% of board members were age 71 or older in 2018, up from 9% in 2005, the report states. The percentage of members age 50 or younger was 22% last year, down from 29% in 2005.
Luanne R. Stout, president of Stout Associates based in the Dallas/Fort Worth area and a retired Chief Governance Officer of Texas Health Resources, wrote in commentary included with the report that healthcare organizations have a number of options when trying to foster a healthy degree of board turnover.
"Term limits (usually three or four consecutive, three-year terms) are helpful in accomplishing board turnover; however, some boards are reluctant to adopt term limits for fear of losing highly valued board members," Stout wrote. "Boards that annually review board member attendance, performance and contribution can achieve desired levels of rotation and competency enhancement without utilizing term limits."
The AHA report also notes some positive trends around healthcare board governance, including the following:
There has been some increase in racial and ethnic diversity among board members. The survey found 58% of respondents had boards with at least one non-white member, up from 53% in 2014. (That means about 42% of boards were still composed last year entirely of white members.)
A majority of boards restructured to improve their governance.
Nearly half of all system boards include members from outside the communities served.
"This year's survey demonstrates how hospitals and health system boards are rising to meet tomorrow's challenges through redefining roles, responsibilities and board structures," said AHA President and CEO Rick Pollack in a statement. "These changes are not surprising given the continued transformation in where, how, when and from whom patients receive care."