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LINCOLN, NEB., Dec. 2, 2013 (GLOBE NEWSWIRE) -- The Governance Institute, a service of National Research Corporation, has published the results of its 2013 biennial survey of governance structure and practices in the nation's non-profit hospitals and health systems. This is the only survey of its kind focusing on how four different types of healthcare boards—health systems, independent hospitals, subsidiary hospitals, and government-sponsored hospitals—conduct business and view their performance. This year's data from 541 respondents shows that organizations are moving forward with preparations for value-based payments and population health management. Over half (58%) of respondents have added population health goals such as IT infrastructure and physician integration to the strategic plan; 52% have added value-based payment goals to strategic and financial plans. Other major findings include:


• The percentage of respondents affiliated with a system has risen from 35% in 2011 to 45% in 2013. Since 2009, the percentage of total respondents from independent hospitals has decreased from 41% to only 29% this year. • This is the second reporting year showing a slight increase in compensation of board members. However, this increase is due only to that of government-sponsored hospitals (35% compensate board members, up from 28% in 2011). Compensation rates actually decreased from 2011 levels for systems, subsidiaries, and independent hospitals. • An increase to 53% of responding boards use a board portal in 2013, up from 34% in 2011; and 59% of hospitals provide board members with tablets or laptops to access online board materials, up from 30% in 2011. • Most systems (44%) have a system board as well as local or subsidiary boards with fiduciary responsibilities. Seventy percent (70%) of system boards approve a document or policy specifying allocation of responsibility and authority between system and local boards. Culture

For the first time, we asked questions related to board culture. There was relatively strong agreement with most of the statements. Those that had the lowest level of agreement (respondents who answered "strongly agree" and "agree") are: • The board ensures appropriate physician/clinician involvement in governance (86%). • The board has an effective system in place to measure whether strategic goals will be met (83%). • The board is effective at setting appropriate short- and long-term goals for management and physician leaders in accordance with the strategic plan (82%). Practices • Adoption of the recommended practices continues to be generally widespread. However, adoption rates have not increased significantly; in most cases adoption has either remained stagnant or decreased slightly from 2011. Community benefit and advocacy is the only area demonstrating increases in practice adoption rates. • Performance (percentage of boards rated as "excellent" and "very good") of the recommended practices for financial oversight has declined again this year (from 94% in 2009 to 91% in 2013), potentially indicating the increasing pressure on reimbursement levels and boards' anticipation of new reimbursement models and metrics. • Performance in quality oversight practices continues to improve (85% of boards rated as "excellent" and "very good," up from 83% in 2011), with health systems showing the largest difference (95% of system boards rated as "excellent" and "very good" compared with 89% in 2011). However, this critical oversight responsibility continues to score well below the fiduciary duties and financial oversight. The analyses this year shows that 90 out of the 95 recommended practices have a relationship between adoption of the practice and overall board performance, so we consider this list practices to be particularly relevant and an indicator of how boards should be spending their time during this transition to a value-based business model. "As the boards continue to move their organizations forward we consider this survey to be an important indicator of how boards are spending their time, and thus what issues are important to these hospitals and health systems," says Jona Raasch, CEO of The Governance Institute. "The signs of movement towards value-based payments and population health models are promising for what lies ahead."

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