Governing members of the American Health Care Association voted Tuesday to restructure their leadership tree, drastically reducing the number of voting members and renaming several leadership panels. The leadership redesign, which was promised after the announced withdrawal of numerous disgruntled large nursing home chains, passed with scant dissent at the association’s annual meeting at the Las Vegas Hilton.

Changes to the governance of the nation’s largest nursing home association include:

– The 500-plus member House of Delegates is replaced by a 49-person Council of States (one per state chapter). More than 275 members of the House of Delegates took part in the vote, which was opposed only by a past president and a past board chairman.

– Following that vote, the Council of States shrank the 75-person Board of Directors into a 15-member Board of Governors.

– Further, a five-member Executive Committee has been carved out of the Board of Governors.

Outgoing Board Chairman Steve Chies said the changes would help streamline decision making and allow the organization to be more “nimble.” AHCA leadership has come under fire lately, most notably from its largest provider members, who are believed to have forced the resignation of former AHCA President and CEO Hal Daub a few months ago. Acting President and CEO Bruce Yarwood, who is reported to be interested in erasing the “acting” label, said Tuesday he would stay on the job. The governing board is expected to determine in the coming weeks what strategy they will use to replace Daub.

Also on Tuesday, the slimmed down AHCA leadership panel approved a measure that would retain members of the Alliance for Quality Long-Term Care as members of AHCA until the end of 2006. At least some in the 16-member alliance have said they are pulling out of AHCA national affairs after this meeting to pursue their group’s own policy and advocacy goals.

The giants’ departure could lead to a loss of $3.3 million, or 17%, of AHCA annual revenues, leaders acknowledged Tuesday. To deal with that “worst-case” scenario, they said cutbacks could be made in personnel ($1.25 million), travel ($400,00), contract savings ($400,000), governance reform measures and dues payment restructuring.

The 56th annual AHCA meeting, which continues today, has seen a record attendance of nearly 4,000, including vendor representatives and others, AHCA officials said.