Horizon, Host: Ted Simons

June 16, 2010


Host: Ted Simons

Arizona Hospital and Healthcare Association


  • John Rivers has served as the President and CEO of the Arizona Hospital and Healthcare Association since 1986. Now, after more than two decades as an advocate for hospitals and improving health care, Rivers is retiring from his post. Join us as we talk to Rivers about his job and how it’s changed through the years.
Guests:
  • John Rivers - President and CEO, Arizona Hospital and Healthcare Association
Category: Medical/Health   |   Keywords: healthcare,

View Transcript
Ted Simons:
He's led the Arizona hospital and healthcare association since 1986, but later this year, John Rivers will retire. Under his leadership, the association sponsored successful ballot measures to raise taxes on tobacco products and expand access to health care. Here now to talk about Arizona healthcare issues past, present and future is president and CEO of the Arizona hospital and healthcare association, John Rivers. Always a pleasure. Good to have you.

John Rivers :
Thank you, Ted. Good to be here.

Ted Simons:
Why are you retiring?

John Rivers:
That's a simple answer. I've been working hard really ever since I started high school which is about 50 years ago. I'm going to be 65 in January of next year, and I think it's time for me to kick back and do a number of things that I've been postponing for the last 50 years. I'm very fortunate to have reached this stage. I'm in good health. Don't feel like pushing my luck. So I'm going to go do the things I've wanted to do all my life.

Ted Simons:
Before we get into current issues, what got you in this line of work?

John Rivers:
It was a fluke. I have found over the years most people end up in jobs they never imagined they would be in when they were in, you know, college. I had work when I got out of the service in 1971. I had walked into my hometown congressman's office. I was kind of a skinny kid at the time and brown from all the sun in Vietnam. I think he felt sorry for me. He hired me on a temporary basis. Three years later a lobbyist for the American Hospital Association came around to visit, and we got to talking and he thought I might enjoy a career in health care. I wound up being a lobbyist for our national hospital association for, for you know, a period of about five years. That was how I got into health care. So I just kind of snuck into it through the public policy side of the business.

Ted Simons:
The experience as an army infantryman, graduate of Notre Dame before heading overseas, those two particularly helped you along the line in certain ways?

John Rivers:
Well, those -- college and the military especially during war can be very defining experiences in your life. And that was true. I think anybody who was in college during the 1960s, if they can remember it, will tell you that it was a defining time in their life. A lot of turmoil in the country. You know, I'm very proud to be a Notre Dame graduate. I don't make any bones about it. You made me take off my pin a couple of times because it was glimmering in the camera. Of course the military is a different world altogether. It's an experience you don't ever forget, especially during wartime.

Ted Simons:
You are leaving during a very critical time in the health care industry.

John Rivers:
Yes.

Ted Simons:
Here in Arizona and really around the country. Talk to us about that.

John Rivers:
Well, I think, you know, every year that I've been in health care, 25 years now, almost 25, I have said to myself that it's going to be tougher next year than it was the year before. That's still true today. In fact, I think health care is going to be -- going to undergo -- it is undergoing a revolution right now in many, many ways. I think health care in this state is far better than it was when I came here 25 years ago.

Ted Simons:
How so?

John Rivers:
In a number of ways. Just look at our population alone. I mean, the population of Phoenix is three times what it was in 1986. So the Mayo Clinic wasn't here in 1986. You have all these brand new health care facilities built by Banner and CHW and other companies in areas that were vacant lots 25 years ago. So the physical side of healthcare has changed, but the delivery of health care has changed. We now have diagnostic tools that no one had even thought of 25 years ago. We have treatments that hadn't been invented yet. We have far more accountability in health care today than we had 25 years ago, far more transparency in health care than we had 25 years ago, and I think far more clinical integration which in laymen's terms means care coordination among different providers of care, including physicians and hospitals and others. It's a whole different game today than it was 25 years ago.

Ted Simons:
And yet the game, as you mentioned, is changing big time. Medicaid, $400 million from the feds supposed to be heading towards Arizona. Now, all of a sudden, that looks to be in jeopardy. What's going on there?

John Rivers:
Everybody thought this was going to be a slam dunk I'd say three or four months ago because there are a number of states, including Arizona, I think there are about 30 states altogether that are just going to be in really serious trouble without this added federal matching money for Medicaid. In Arizona, the State Legislature is counting on that money to fund what's called the prop 204 population, the childless adult population that is covered under our state Medicaid program and to fund a continuation of a scaled down KidsCare program. Without that additional federal money, they're going to have to find that money somewhere else and that's going to be very tough to do in this environment.

Ted Simons:
I was going to say, what happens if Congress doesn't pass?

John Rivers:
Well, if Arizona wishes to stay -- participate in the Medicaid program, which they're at least a million and a half people who hope they don't lose their health care coverage if Medicaid goes away, it's actually 1.2 million people in our state who are enrolled in access, the state simply has to comply with the federal what are called maintenance of effort requirements if they want to continue to participate in Medicaid and get that two for one match. Medicaid is roughly a $10 billion effort in the state of Arizona. Withdrawal from Medicaid would, in effect, shrink the Arizona economy by $10 billion. It would be interesting to hear Dennis Hoffman, what would it mean to the economy if you shrank it $10 billion overnight. I think he would tell you it would be a calamity for the state, not just the 1.2 million that would lose their health care coverage.


Ted Simons:
Long range, short range, vice versa strategy for health care providers in what looks to be a brave new world for health care, what are you seeing?

John Rivers:
I see a few things. Number one, I think I grew up in a world where it was a revenue game, you know, for health care providers. In the future it's going to be a cost game. It's not going to be how much revenue you can realize by providing more services. It's going to be based on your ability to control the costs. That's going to be a big drive in the future. I think the drive for further clinical intergration is going to be huge in health care. In laymen's terms means far more coordination between providers of care like physicians, far more coordination between hospitals, nursing homes, home care agencies and all the rest all centered around meeting the needs of the patient. And I think -- and I think we're just going to be more accountable and more transparent in the future as well.

Ted Simons:
What do you see regarding the immigration law? Obviously we talk about the societal impacts, economic impacts. What about your industry?

John Rivers:
Well, there has been an impact in health care. Our hospitals are telling us that they have seen, you know, fewer undocumenteds that appear in our emergency rooms needing care. We can document for, a fact, fewer births. In our hospitals now, I can't scientifically prove to you that there's a connection between that and declining number of Latinos in our community, but we think there is a connection between the two. So it has impacted health care, yes.

Ted Simons:
What about border area hospitals? How are they holding up?

John Rivers:
The border hospitals are of course affected more dramatically. Although the undocumented population, you know, it goes all the way up to the Utah border. It effects every corner of our state. The border hospitals, yes, more than other facilities. Where it tends to affect them are hospitals closer to the border is if you have a van filled with 15 undocumenteds that rolls over on the highway and all of a sudden you've got 15 critically ill patients that need to be transported to trauma centers where care is very expensive, that's where it impacts the hospitals on the border more than it does hospitals elsewhere.



Ted Simons:
I've heard concern that the law might hinder recruitment of health care professionals to Arizona. Viable? Valid I should say?

John Rivers:
I would hate to admit after 25 years I don't know everything. Ted, I don't know the answer to that question. You know, I think that's part of a broader issue of whether Arizona becomes a more desirable or a less desirable state for Latinos to live in, because we draw our caregiver population from the people who live here, you know. And frankly, we need more ethnic diversity on other health care work force, not less. I hope that doesn't happen. Quite honestly, I don't know if that's going to happen or not.

Ted Simons:
As far as advice for the incoming CEO, been there a long time, seen a lot of things, what would you say?

John Rivers:
Well, Laurie is a very capable young woman. She'll do an excellent job. I think she'll surpass me in pretty short order. My advice to her, and I'm careful how much advice I give her, is keep your head down. Keep in mind what's best for health care in Arizona. Keep in mind what's best for our community. If you do that, you're really going to serve the membership of the association very well. We've never thought of ourselves as a guild to use a Medieval term where we're here just to protect turf. The ballot measures you mentioned earlier, those were designed to expand access to health care for people in our community who are medically underserved. We think our mission is to do good, not just to do well. I think if she stays focused on that, then if she does well by Arizona, she'll be doing well by our members.

Ted Simons:
Got about a minute left.

John Rivers:
Okay.

Ted Simons:
Best memory, proudest achievement, all those years on the job, what do you got?

John Rivers:
Wow! I wished I had thought about that before I came on here. That's a very good question.

Ted Simons:
What comes to mind first?

John Rivers:
I would say probably the ballot measures that we've been involved in that have advanced health care significantly in Arizona. We have probably hundreds of thousands of people today in our state who are getting health care because of measures that we have supported in one way or another. So if -- I've never really thought of these things quite honestly as legacy stuff, for lack of a better term. We've always done them because we thought it was the right thing to do, not because it was going to look great on my resume. I would say those are the things I'm most proud. The other thing I would have to say, this will sound a little hokey, but I'm most proud of our members and the tremendous commitment they have to serving these communities here. That's what has really sustained me for 25 years.

Ted Simons:
It's always a pleasure having you on the program. Good to see you again. Good luck in the retirement.

John Rivers:
Thank you, Ted.

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