Since his college days, Rich Umbdenstock has never thought of working in any field other than health-care administration, and on Jan. 1 hell reach a new high in that profession.


Thats when, in addition to serving as CEO and president of the Spokane-based, 12,000-employee, nonprofit Providence Services Corp., hell become chairman of the American Hospital Association, the largest hospital and health-system advocacy group in the U.S.


Hell become the chief elected spokesman for an association launched in 1898 that today represents about 4,200 of the nations 5,000 hospitals, and hes not surprised that an administrator from Spokane would be elected to that position.


Spokane is the center of the health-care universe, Umbdenstock gushes. Health care is a wonderful resource in Spokane. Some things done here are unique, things that arent done anywhere else.


He points to Inland Northwest Health Services, which is jointly owned by Empire Health Services and Providence Services, and operates a regional computer network and a 50-location Northwest TeleHealth communication system.


For two competing health-care systems to be collaborating to this extent is pretty unique, Umbdenstock says.


The computer network is a repository of both medical records and hospital financial information, while Northwest TeleHealth links sites visually, using video carried over high-speed networks.


Other hospitals, software vendors, and computer companies from as far away as Great Britain send delegations to Spokane on a weekly basis to study those two systems, Umbdenstock says.


In the computer network, 35 hospitals in Washington and North Idaho are linked into a system that enables a physician to pull up in seconds the medical records of any patient whos been seen at any hospital in the network within about the past 10 years, he says.


Were not fully electronic yet, but were getting there, he says, adding that about 2.6 million peoples records already are stored in the system.


Through Northwest TeleHealth, an emergency-room doctor in Spokane can visually look at an emergency room in Newport, says Umbdenstock. He can literally see the patient, and (thanks to the other network) have both the same medical data and digital images that are available to the doctor in Newport.


Information can be added to the network just as quickly. For about three years here physicians have often used palm-held computers to input patient data, Umbdenstock says. But that is still new and advanced for hospitals generally.


A major deterrent to employing an even larger network beyond the 35 hospitals is the medical professions inability to agree on a language for such health-data transmissions, he says.


The profession has not yet set a common electronic standard for health-care data, Umbdenstock says. The AHA is trying to promote common standards.


Providence Services, the smaller of two holding companies owned by the Provincial Council of the Sisters of Providence-Mother Joseph Province, administers health care at institutions in Eastern Washington and Montana. The larger company, Seattle-based Providence Health Services, covers an area along the West Coast from Alaska to Los Angeles.


Properties under Umbdenstocks direction include nine acute-care hospitals, several skilled-nursing facilities and home-health agencies, a regional laboratory, a university, an adult day-health center, an early childhood development center, and a personal-care services agency for rural homebound clients.


One of six organizations under the Providence Services umbrella is Providence Health Care, of Spokane, which includes Sacred Heart Medical Center, Holy Family Hospital, The Heart Institute of Spokane, Pathology Associates Medical Laboratories Inc., and several other entities.


A national role


Umbdenstock is nearing the end of the first year of a three-year commitment to lead the American Hospital Association. Hes served in 2005 as chairman-elect of the organization, will become chairman next year, and will spend 2007 as immediate past chairman.


This year, one of his primary duties has been to chair the AHAs long-range policy committee, which each year tackles a different problem the hospital industry anticipates facing in the future.


What would make a national single-payer health system acceptable to hospitals? was the issue the committee addressed this year and, though it hasnt completed its report, Umbderstock believes that the U.S. government wont take over health care.


Government struggles at meeting the costs of Medicare and Medicaid, and Ive seen no indication that it wants to take on more than that, he says.


Although the long-range policy committee wont endorse any single alternative, possibilities for a single-payer system include government contracting with a single private commercial provider or creating a quasi-governmental agency like the Federal Reserve Board, he says.


Most of the Western European nations and Canada are single payers, he says, and they spend a lot less of gross domestic cost on health care than we do. Yet, there is always the argument that they restrain costs by restraining access.


Umbdenstock, who already is asked frequently to speak before groups, says hell do even more of that when he becomes AHAs chairman. In addition to speaking before state and regional AHA associations and other health-care groups, the AHA chairman sometimes is asked to testify before Congress on health-care issues, he says.


As chairman, he will lead the associations six-person executive committee and 26-member board, plus work closely with Dick Davidson, the AHAs CEO and president.


In 2007, when hell be the AHAs immediate past chairman, Umbdenstock will represent the AHA on regional policy boards and at state association meetings.


Biggest problems


The biggest problems facing the health-care industry in the U.S. today are coverage, access, and financing, says Umdenstock, a Long Island, N.Y., native, whos lived in Spokane for 26 years.


The U.S. has a patchwork system of health-insurance coverage, Umbdenstock says, and estimates that 45 million Americans have no health insurance.


The numbers of those without insurance is growing faster than the systems ability to take care of them and still balance finances, he says.


When patients who dont have insurance arrive at the emergency rooms of nonprofit hospitals, knowing they will receive treatment, those hospitals become primary-care providers, compounding the cost problem, Umbdenstock says.


A hospital emergency room is a resource best used for truly emergency situations, not for primary care, due to the technological and staff capabilities which are geared for the worst, not the routine, says Umbdenstock. Inappropriate hospital utilization for cases that can be handled in a physicians office results in more expensive care and a potential diversion of emergency-room resources to non-emergency situations.


And without insurance, people will put off going for help longer, often allowing their health condition to get worse.


Access to health-care services is another major area of concern, especially with diabetes, obesity, smoking, and other growing health-care problems placing new demands on the system, he says.


The demands are outstripping the coverage, Umbdenstock says. The emergency room may be full, and there may not be enough nurses.


The cost of health care is yet another problem, he says. Health-care costs are rising more rapidly than inflation, and we all have to pay for it, whether out-of-pocket, through tax-supported costs, or through philanthropy.


At Providence Services operations in Washington and Montana, Umbdenstock says, The cost of energy is one of our biggest challenges this year.


Umbdenstocks desire to become a high-ranking AHA official were fueled in the mid-1970s, when he worked as special assistant to the organizations CEO and president in Chicago. A recent health-services administration graduate of State University of New York at Stony Brook, Umbdenstock provided staff services at the AHAs offices and often managed the AHA presidents office when he was away.


After leaving that position, and before becoming Providence Services top executive in 1993, he managed and directed health services for hospital associations in Albany, N.Y., Chicago, and Spokane for five years, then became an independent governance consultant for hospitals throughout the U.S. and Canada for 10 more years.


Prior to becoming chairman-elect of the AHA, Umbdenstock spent five years serving on that organizations board.