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LGBT Forum Chair
Robert S. Chaloner, FACHE
LGBT Forum Chair
Chief Administrative Officer
Stony Brook Southampton (N.Y.) Hospital
Dear LGBT Forum Members:
Welcome to 2019! I am pleased to report that our LGBT Forum is already off to a good start for what promises to be an exciting and busy year.
I hope you are making your 2019 Congress plans and will join us at our special events. On Sunday,
March 3, our Forum will again participate in the Better Together Reception to network with ACHE’s diverse partner groups and to celebrate our shared interest in promoting healthcare leadership diversity. Immediately following this event, the LGBT Forum will host another reception for our members and those who may be interested in learning more about the LGBT Forum. On Monday and Tuesday,, March 4 and 5, LGBT Forum committee member Stephan Davis, DNP, FACHE, and former LGBT Forum Chair, Ken White, PhD, RN, FACHE, will lead two sessions on “The Journey to Inclusive Excellence for the LGBTQ Patient Population and the Healthcare Workforce.” Following their session on Tuesday morning, we will have our annual LGBT Forum member meeting at 11 a.m.–12 p.m. We hope you will be able to attend.
I would also like to applaud Dr. White as the recipient of the 2019 ACHE Gold Medal Award, which will be bestowed on him at Congress. This is the highest honor a member can achieve. Additionally, I would like to congratulate Timothy J. Perlick, PharmD, FACHE, an ACHE LGBT Forum member who became a Fellow in 2018. We applaud your achievement in earning this credential, and we look forward to your inclusion during the Convocation Ceremony at Congress.
We hope you were able to join our highly successful and interesting Dec. 6, 2018, webinar on “LGBTQ Healthcare: Current State of Legal and Regulatory Standards.” For those Forum members who may have missed the webinar, the recording is now available on the LGBT Forum member-only webpage. Additionally, we assisted in updating the ACHE policy statement on “The Healthcare Executive’s Role in Fostering inclusion of LGBTQ Patients and Employees,” which the ACHE Board approved in Nov. 2018. We encourage you to take a moment to review it before Congress.
We now look forward to the coming year and have begun development of new educational offerings. We would like to hear from you. Please let us know if there are topics you would like us to consider or develop. Please email our Director of Diversity and Inclusion, Cie Armstead, at carmstead@ache.org, soon with your suggestions.
As always, it is a pleasure to hear from you, and I hope to see you at Congress!
Bob Chaloner, FACHE
LGBT Forum Executive Profile
Mary F. Temm, DSc, FACHE,
CEO/President
Temm & Associates Inc.
Phoenix
Q. What inspired you to pursue a career in healthcare administration?
A. I’m often asked how I first started in healthcare back in the early 1980s when managed care was foreign to most people. Truthfully, it was really by accident. When I started college, I had thoughts of eventually going to medical school to become a doctor but after a few personal experiences, I decided I wasn’t cut out for the “blood and guts” stuff. After receiving my undergraduate degree in accounting, I held a few positions in the banking industry. During that time, a colleague told me about an opening with a new healthcare organization in Phoenix. The company was looking for an accounting manager to help with regulatory reporting.
When I applied for the job, I learned the company was a large Medicaid managed care HMO—one of the first in the country. Arizona has the distinction of being the last state to enter into Medicaid (in 1982), but the first state to create a mandatory managed care model without operating a fee-for-service model. The health plan was struggling financially and undergoing a reorganization. I was intrigued and started working for them four days after they filed Chapter 11 bankruptcy.
When I first started working at the health plan, I was working side-by-side with an investigator from the Arizona attorney general’s office. It turned out that not only did the health plan file for bankruptcy, but also the original owners had violated a number of federal and state laws. In addition, the former CFO actually took “the books” with him and we had to reconstruct the financial statements for the health plan’s first two years of operations. It was an arduous task sifting through “green bar” reports of claim payments, manual checks and monthly capitation reports from the state Medicaid agency. I had to learn not only the unique accounting standards for health plans, including incurred but not reported claims —a concept the original owners never applied—but also the complex workings of managed care.
It took almost 18 months to compile the operating reports and financial statements for the first two years of operations, plus successfully complete the bankruptcy reorganization. It took a few additional years, but eventually 144 fraud and racketeering charges were filed against the original owners. For a number of years, I would still receive calls from the attorney general’s office requesting my help in reviewing various documents.
Once I began working at the health plan, I felt like I had finally found the connection I was looking for in healthcare. I wasn’t delivering the care, but I could make a difference managing the coordination and delivery of care to some of the most vulnerable populations. I learned so much from my first experience—the intricacies of managed care, Medicaid regulations, capitation rate development, and perhaps most importantly, how NOT to run a health plan.
Q. What have been the hallmarks of your career in healthcare leadership?
A. I have been privileged to be associated with many “firsts” in the healthcare industry. As I mentioned, I started my healthcare career at one of the first mandatory, statewide Medicaid managed care programs in the country. I was also fortunate to be selected as the executive director for one of the first mandatory, Medicaid Long-Term Services and Supports (MLTSS) health plans in the country. The exposure and lessons learned from these experiences have greatly impacted my consulting career over the past 25 years.
Another hallmark of my career has been my passion to serve special needs populations, including the elderly and physically disabled, intellectually and developmentally disabled, children with special healthcare needs, and Medicaid and Medicare beneficiaries. Navigating the fragmented and often siloed delivery systems can be difficult for anyone, but especially for individuals with complex care needs. I have been focused throughout my career on developing programs to enable special needs populations to obtain the services they need in an integrated delivery model.
As a lifelong learner, I am always focused on continuous development and improvement of my knowledge and leadership skills. I believe this is best illustrated by my having obtaining my doctoral degree in health services administration while I was working full-time. I take great pride in achieving this monumental task that has enabled me to enhance my consulting practice with evidence-based management and additional research skills.
Q. Do you believe that being a member of the LGBT community or an LGBT champion impacts career advancement for healthcare leaders?
I think this really depends on a number of variables including gender of the individual, the geographical location, type of organization and comfort level of the individual. Over thirty years ago when I first started my career, being a member of the LGBT community was viewed very differently than it is today. I have personally had both very negative and very positive experiences. In addition, women continue to struggle to be recognized as leaders in business. I made a conscious decision to start my own consulting firm over 25 years ago to have more control over my career path and interactions with organizations. This empowered me to be more open and “out” with my clients, employees and industry colleagues. I now serve as a mentor for younger members of the LGBT community.
Q. What would be your advice to LGBT individuals pursuing careers in healthcare management?
A. I wish I could simply say, "just be yourself," but I don’t think society overall is totally accepting of the LGBT community. I would advise LGBT individuals to assess their personal situation before being open about their LGBT identity. If they feel safe and comfortable within the organization, I would encourage them to be open and trusting with their subordinates, coworkers and leaders. If they don’t feel comfortable, I would suggest listening to their intuition—they probably aren’t welcome in the organization and may have a difficult time pursing their career inside that organization. If you can’t be yourself, you not only do a disservice to yourself, but also to the organization. With that said, I do think the healthcare industry overall is more accepting than other industries, and I would encourage LGBT individuals to pursue healthcare management careers. There are many LGBT mentors who can assist you with your journey.
Q. Why did you decide to join the ACHE LGBT Forum, and what do you feel is the value added by this group?
A. I decided to join the ACHE LGBT Forum in hopes of advancing diversity and inclusion of LGBT individuals in healthcare leadership. I believe to make a difference, you have to be seen and heard. Hopefully I can share my experiences as well as learn from others. The ACHE LGBT Forum provides a safe forum for education, socialization, personal and professional growth, and LGBT advocacy. I look forward to connecting with more ACHE LGBT members.
LGBT Forum Organizational Profile
NYC Health + Hospitals
NYC Health + Hospitals is deeply committed to ensuring an affirming experience for its LGBTQ patients and families.
NYC Health + Hospitals is also proud of the many unique training opportunities made available to staff across the System. In 2017, in conjunction with The Fenway Institute, NYC Health + Hospitals launched the groundbreaking “Certificate of Advanced Training in LGBTQ Healthcare,” a comprehensive, multi-mode learning program designed to provide clinical providers with the skills needed to provide affirming care in an inclusive clinical environment. A number of other exciting initiatives over the years have included installing affirming restroom signs in every facility and updating our electronic medical and billing records to include comprehensive information about a person’s name, gender pronouns, gender identity and sexual orientation.
Q. How has the organization engaged LGBT patients and/or the local LGBT community?
A. As the public hospital system for New York City, NYC Health + Hospitals is in many ways embedded in the communities that our hospitals and health centers serve. The System is proud to participate in community events, such as the annual Pride events that take place in each of New York’s five boroughs. In addition, the System values its partnerships with LGBTQ community organizations and enjoys participating in other local events, such as LGBTQ healthcare town halls, sponsoring a film screening and panel discussion at our facilities, or hosting “meet and greets” with members of the public and staff from our Pride Health Centers.
Q. How has the organization advanced inclusion for healthcare professionals and leaders?
A. Fostering a sense of community and empowerment among LGBTQ healthcare professionals is as important to NYC Health + Hospitals as improving the quality of LGBTQ patient care. Several recent steps have been taken to make progress on this commitment. We recognize the importance of training on best practices related to workplace inclusion, in addition to providing affirming patient care. This is why the Health System provides numerous in-person and on-demand trainings that are available to all staff. These events include the principles and behaviors involved in creating an affirming work environment for colleagues of all gender identities and sexual orientations. Furthermore, the Health System published its first ever “Out at Work” newsletter during Pride Month, which highlighted a number of openly LGBTQ staff members who discussed the importance of an inclusive working environment and what being “out” in the workplace meant to them. Additionally, the Health System took important steps in affirming the benefits offered to transgender and non-binary employees by collaborating with the city’s Office of Labor Relations to ensure that the coverage of gender-related health services was explicitly stated in the benefits documents provided to future and current employees. Finally, the Health System has sponsored a number of LGBTQ+ employee-networking events designed to build community among our many LGBTQ+ colleagues who may work in different locations around the city.
A. We believe that in order to truly improve clinical outcomes for LGBTQ communities, we need to first understand what the barriers in accessing care and the health disparities are. The optimization of the Health System’s electronic health records to capture comprehensive information about sexual orientation, gender identity, name used, gender pronoun and other relevant information is a crucial step in collecting this much-needed data about healthcare within LGBTQ communities. NYC Health + Hospitals collaborated with The Fenway Institute to roll out training for all staff who interact with the electronic record to ensure accurate and affirming collection of this information. The Health System is also currently working to analyze the sexual orientation and gender identity (SOGI) data, which will inform future clinical and programmatic interventions designed to improve LGBTQ patient experience and outcomes.
Feature Article
Helping LGBTQ Patients Navigate the Healthcare Maze
By Mark E. Albert Sr., RMA
Many of us, at some stage in our lives, have gone through a cornstalk maze. If you've experienced it, think back to the time when you first entered it. You did not know if you should go left or if you should go right. You decided to pick right and ran into a wall, then realized you should have gone left. You navigate through the maze and you make it through. Now imagine attempting the same task blindfolded. The blindfolded maze is how some lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) patients feel about healthcare. The LGBTQ patient knows they need care, but how do they navigate the complicated maze of healthcare?
Many LGBTQ individuals avoid care for preventable or life-threatening conditions due to fear and experiences of discriminatory treatment. Obtaining health coverage, finding a healthcare facility and receiving unbiased care can be overwhelming. What happens to transgender patients who present themselves to the ED and are admitted? Where are these patients placed when private rooms are not available? They may not feel comfortable with another patient who shares the sex they were assigned at birth, and vice versa. Conversely, the hospital may not be able to place these patients in a shared room based on these patient’s gender identities. These are issues that not only the LGBTQ patient faces, but also may be challenging to organizations seeking to provide inclusive healthcare services to all people.
While admitting LGBTQ patients to the hospital can be complicated within itself, achieving a patient stay that is free of perceived bias is important and can be challenging for some organizations. Depending on geographical location and other factors, hospitals, clinics and urgent care facilities may not be staffed with personnel accustomed to treating LGBTQ patients, especially transgender patients. Imagine encountering "James" who presents with vaginitis, or "Sally" presenting with an elevated prostate-specific antigen. It takes incredible courage for a transgender patient to seek treatment, and we have only one chance to get the initial contact right. How we address the patient, protect the patient's dignity and prevent insensitive treatment within our organizations may have implications for the ways in which the patient will seek care in the future. Additionally, their experience may affect how others in the LGBTQ community and LGBTQ allies perceive the organization.
We live in a country that is becoming more diverse, richer in culture, and more technologically advanced in healthcare than any other country in the world. Eradicating discrimination may be far-fetched, but providing equitable healthcare to LGBTQ patients is not impossible. There are multiple hurdles to jump to accomplish this goal, but it can be achieved with understanding, compassion and empathy.
Mark E. Albert Sr, RMA, is a Supervisor, Clinical Support Services, in the Department of Surgery, Division of Urology, at Washington University in St. Louis, School of Medicine.
Upcoming ACHE Diversity and Inclusion Events:
Congress on Healthcare Leadership
Sunday, March 3, 2019, 5:30 p.m. – 7 p.m.
Better Together Joint Reception, Williford A-C
Hilton
Monday, March 4, 2019 4:15 p.m. – 5:45 p.m.
Seminar 331A/B: The Journey to Inclusive Excellence for the LGBTQ Patient Population and the Healthcare Workforce,
Various locations
Tuesday, March 5, 2019, 8:45 a.m. – 12 p.m.
The Hospital Community Cooperative: A Path Toward Health Equity,
Various locations (Palmer House)
Tuesday, March 5, 2019, 11 a.m. – 12 p.m.
LGBT Business Meeting, PDR 1
Hilton
Tuesday, March 5, 2019, 2:30 p.m. – 5:30 p.m.
Seminar 55: Diverse Candidates’ Journey to the C-Suite: A Practical Approach for Early Careerists,
Various locations (Palmer House)
Wednesday, March 6, 2019, 8:45 p.m. – 12 p.m.
Seminar 86: Advancing Health Equity with Culturally and Linguistically Appropriate Services,
Various locations (Palmer House)
Special LGBT Forum Member Exclusives
Free Webinar: As an LGBT Forum member, you have ongoing access to the webinar recording, "LGBTQ Healthcare: Current State of Legal and Regulatory Standards", recorded Dec. 6, 2018. In this 90-minute online session, two healthcare lawyers address the complex issues related to adapting and maintaining appropriate and accurate EHRs that meet the needs of LGBTQ patients, and employment-specific issues relevant to LGBTQ individuals. Access this MP4 recording from the LGBT Forum Benefits website.
Student Scholarship: Do you know healthcare management graduate students in need of financial assistance? Encourage these students to apply for an ACHE scholarship. Each year, ACHE offers up to 15 scholarships valued at $5,000 each to students in the final year of a full-time healthcare management graduate program. The Albert W. Dent Graduate Student Scholarship, established in honor of ACHE’s first African-American Fellow, is available to racially diverse students. The Foster G. McGaw Graduate Student Scholarship, named for the founder of the American Hospital Supply Corporation, is open to all eligible students. Students may apply online through March 31, 2019, at ache.org/Students. Contact Audrey Meyer for additional information at (312) 424-9308 or ameyer@ache.org.
Chair
Robert S. Chaloner, FACHE
Chief Administrative Officer
Stony Brook Southampton (N.Y.) Hospital
Leslie E. Burnside, FACHE
System VP of Network Affiliations & Development
UNC Health Care
Chapel Hill, N.C.
Stephan Davis, DNP, FACHE
Founder/Principal
Illuminant
Atlanta
Daniel Gentry, PhD
University of Iowa College of Public Health
Professor and MHA Program Director
Iowa City, Iowa
Tari Hanneman
Director, Health Equality Project
Human Rights Campaign
Washington, D.C.
Vivek Khanna
Director, Administration, Contracts Management
Tulane University Hospital & Clinic
New Orleans
Jake P. Reyna-Casanova
Senior Development Associate
CommuniCare Health Centers
San Antonio
Cie Armstead
Director of Diversity and Inclusion
American College of Healthcare Executives
300 S. Riverside Plaza, Suite 1900
Chicago, IL 60606
(312) 424-9306
carmstead@ache.org
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Please note that any views or opinions presented in this online newsletter are solely those of the author and do not necessarily represent those of ACHE.