If there is an environment that is nearly as stressful as an operating room, it might be operating in the Arkansas Legislature. The past five years since Robert “Bo” Ryall has been president and CEO of the Arkansas Hospital Association (AHA) have seen some of the most tumultuous changes in the history of American healthcare.
Ryall has nearly 27 years’ experience working on Arkansas legislative issues, including the past ten years at the AHA. Most recently, Ryall has directed efforts toward preserving the Private Option Medicaid expansion, vital to Arkansas hospitals, by providing insurance for about 250,000 Arkansans.
Ryall began his career as an analyst for legislation being considered in the Arkansas House of Representatives. A lot of the projects he worked on for 13 years were healthcare related. He served as executive director of the HomeCare Association of Arkansas before joining the AHA in 2005 as executive vice president. In 2010 when Phil Matthews retired, Ryall was appointed to replace him as president and CEO.
“It certainly can be stressful,” Ryall said. “We have had a lot of close votes. The 2013 legislative session when the Private Option first passed, trying to obtain the three-quarters vote threshold was very challenging. It took a lot of people getting involved. The governor, legislators and other groups of supporters were all needed to secure its passage. Then it was the same thing for 2014.”
This year, while the vote was being considered, Ryall was working to inform legislators that hospitals couldn’t afford to stop getting payments for the 250,000 newly insured people at the same time that the Affordable Care Act (ACA) has made huge reductions in Medicare reimbursements for hospitals representing a loss of $2.5 billion for state hospitals over a ten-year period.
Uncompensated care costs for hospitals in Arkansas were $380 million per year prior to the Private Option, which reduced the uncompensated care costs by $149 million from 2013 to 2014.
“It is huge,” Ryall said. “Look at the percentage of people coming in from uninsured to insured. We had a 48 percent reduction in the number of people admitted as inpatients who were uninsured. In 2013 before the Medicaid expansion, we saw some hospitals in financial difficulty, and layoffs. Since then jobs have been added and hospitals have stabilized. It has obviously been good for hospitals.”
Legislators opposed to the Arkansas Works program have stated the state’s share of costs for Medicaid will grow in the future to the point of being a major strain on the state’s budget. Ryall considers it a big part of his job to communicate to legislators that Arkansas Works is good for the state budget.
“There is a benefit of $757 million to the state budget from 2017 to 2021 even with paying the state match over that period,” Ryall said. “This also sustains employment at hospitals, which are often the largest employer in the area where they are located.”
Ryall regrets that healthcare has gotten so politicized.
“Not everything that has to do with healthcare has something to do with Obamacare,” Ryall said. “That has been a significant challenge since the Supreme Court ruling upheld the ACA in 2012.”
Ryall said he feels his success leading the AHA comes from hiring good people and recognizing good talent.
“We have some excellent experienced people,” Ryall said. “People stay around a long time. Paul Cunningham has been here 35 years. Paul is excellent on data and research, and knows hospital finances. Jodiane Tritt does an excellent job representing us at the state capital. We have an excellent staff here. They know their jobs and do them well.”
About four years ago, AHA started a quality program and hired Pam Brown as vice president for quality and patient safety. Brown has worked with state hospitals to improve quality, reducing infections and readmission rates – factors deemed important by Medicare.
“We have about 50 hospitals in our healthcare engagement network,” Ryall said. “They regularly share information and data with us which we can reproduce and allow hospitals to compare themselves to benchmarks and improve quality. This program has been very successful and has helped hospitals tremendously.”
About 100 hospitals in Arkansas are members of AHA, nearly every hospital in the state. Ryall said they join AHA because they are too busy for each to monitor legislation and regulations.
“The hospitals excel at patient care and we strive to improve on all aspects of our association work, from advocacy to education to quality,” Ryall said.
Ryall and his wife, Karen, who have been married for 20 years, have daughters ages 11, 14 and 16.