# Presentation: 356786

## Nevada Rural Hospital Partners (NRHP)

- Advocacy

- Nevada Rural Hospital Partners

## About NRHP

- 18 years old
- Established with grant from RWJF
- 14 small, rural, frontier facilities
- Soon to add 2 more, then will represent all in the state
- Adds credibility to advocacy efforts
- Serve 300,000 people across 91,000 square miles

- Nevada Rural Hospital Partners

## About NRHP

- Funded with dues (17%), grants (33%), and fee-for-service programs (50%)
- Governed by members – one member, one vote
- Staffed with 6.3 FTEs
- Wide variety or programs and services, only one of which is advocacy

- Nevada Rural Hospital Partners

## About NRHP

- Purpose:  Maintain access to hospital-based healthcare services for rural residents
- Mission:  Support viability of small and rural hospitals through shared resources, services, and advocacy
- This has been the mission from the beginning

- Nevada Rural Hospital Partners

## Genesis of NRHP’s Advocacy

- Genesis for NRHP was sense of powerlessness
- Nevada very urbanized – Reno, Las Vegas, and miles of mountains and sagebrush, with small communities separated by great distance
- Perception that small hospital issues were overshadowed by urban hospital issues
- Desire for some sense of control over destiny

- Nevada Rural Hospital Partners

## Genesis

- Sense of powerlessness also came from
- Small size
- Small numbers
- Lack of coordinating force
- Limited hospital human and financial resources to devote to the group

- Nevada Rural Hospital Partners

## Advocacy

- The good news was
- The group had a sense of camaraderie, was cohesive, and had a vision of solidarity
- Help from the Nevada Office of Rural Health (wrote the initial grant)
- Bumpy road with the hospital association for awhile
- Now work together closely, and very well

- Nevada Rural Hospital Partners

## Advocacy As Mission

- Mission is to support viability of small, rural, and frontier hospitals
- Viability rests, partially, on a supportive operating environment
- A supportive operating environment can be shaped through advocacy

- Nevada Rural Hospital Partners

## Effective Advocacy

- NRHP asked itself the question:  Absent money and votes, how can we be effective advocates?
- We can be useful and valuable
- We can be fair and up front
- We can be collaborative instead of competitive
- We can build a reputation for quality
- We can be credible, trusted
- We can speak with one voice
- If we are these things, we can be at the table

- Nevada Rural Hospital Partners

## NRHP Advocacy

- Advocacy happens in lots of ways
- In the legislative process
- In the regulatory process
- Through many kinds of relationships
- Through the synthesis and dissemination of information
- NRHP actively uses all of these avenues as part of its advocacy program

- Nevada Rural Hospital Partners

## Effective Advocacy

- The point is that small hospitals can influence the outcomes that affect them

- Nevada Rural Hospital Partners

## Favorite Chinese Proverb

- Man have to sit in chair with mouth open long time before roast duck fly in

- Nevada Rural Hospital Partners

## Getting Off The Chair

- Thoughts about how to be an effective advocate
- Be clear about what you want from your advocacy efforts
- Establish priorities
- Balance desired outcomes with available resources
- Develop or buy some political expertise
- Political naiveté can be charming but not very productive
- What you want fits within a larger context, so examine that and develop your strategy with that in mind

- Nevada Rural Hospital Partners

## Getting Off The Chair

- Learn the political ropes – who and how it all works
- Think about issues not only in terms of what you want, but what others want/need as well
- Pick your battles

- Nevada Rural Hospital Partners

## How NRHP Advocates

- Primarily the responsibility of the President
- Personal presence, involvement in the process
- Known
- “The face of NRHP”
- Can’t cry poverty and hire a high priced lobbyist
- Contract for small amount of time from a big” lobbyist

- Nevada Rural Hospital Partners

## How NRHP Advocates

- Contract for small amount of time from a “big” lobbyist
- Access to information
- Strategy development
- “Muscle” if needed
- Pay attention to interim activities
- Track all legislation during session
- Healthcare, employment, public bodies, local government, professions, insurance/finance, etc.
- Actively working about 115 bills currently

- Nevada Rural Hospital Partners

## How NRHP Advocates

- Spend a lot of time in the capitol during session
- Stay coordinated with other healthcare lobbyists so know when on same page and when not
- Visit with legislators on various issues prior to hearings
- NRHP “Day At The Legislature”

- Nevada Rural Hospital Partners

## How NRHP Advocates

- Paying for it
- IRS has rules
- Non-profits can lobby, but within those rules
- NRHP is a 501 (e) – so can’t lobby
- NRHP has a 501 (c) (3) Foundation, and we do our lobbying through that
- A lot of our work is about educating, and that’s freely allowed

- Nevada Rural Hospital Partners

## How NRHP Advocates

- Things happen too fast for constant discussion with members
- Members have high level of trust
- Hospital admin and clinical background very helpful in assessing proposed legislation
- Communicate via email, conference calls
- Provide regularly scheduled teleconference updates

- Nevada Rural Hospital Partners

## Why NRHP Advocates

- Examples of successes (almost always accomplished with others):
- Dental access – licensure requirements eased
- Improved Medicaid reimbursement/budgets
- Doubling nursing “slots” throughout  University and Community College system
- Disproportionate share payments increased ($300K/year)
- Shaped the State Strategic Plan for Rural Healthcare

- Nevada Rural Hospital Partners

## Why NRHP Advocates

- Passed cap on non-economic damages
- Passed joint and several liability reform, making defendants responsible for their own acts
- Exempted non-profits from new business taxes ($350,000/year)
- Exempted hospital-based long-term care beds from tax

- Nevada Rural Hospital Partners

## Why NRHP Advocates

- Capped county liability for the cost of long term care (worth about 2 million in the first biennium)
- Maintained cost-based Medicaid reimbursement for LTC (worth about $10 million/year)
- Two current bills
- Hospital district dissolution process
- Rural loan pool – 1 million dollar appropriation

- Nevada Rural Hospital Partners

## Why NRHP Advocates

- Examples of policy bombs that didn’t fall:
- Staffing ratios
- Re-licensing exams for physicians
- Required college degrees for EMS
- Abolition of rural certificate of need
- Public reporting of errors

- Nevada Rural Hospital Partners

## Conclusion

- Hospital and healthcare networks can shape their operating environments through advocacy
- Operating environments affect viability of network members
- Effective advocacy requires investment of time, effort of staff (or hire someone to do it)

- Nevada Rural Hospital Partners

## Conclusions

- Effective advocacy rests on credibility and involvement in the political process
- Effective advocacy rests on group cohesion, ability to speak with one voice

- Nevada Rural Hospital Partners

## Value

- When our members are asked what they value most about their network, they always say it’s advocacy
- Make the results of your work known to your members, and quantify if possible

- Nevada Rural Hospital Partners