January 10, 2014
Volume 58, Issue 2



Senate Committee Holds Hearing on WHA Behavioral Health Priorities
Mental Health Care Coordination and Emergency Detention Reform Receive Action

The Senate Committee on Health and Human Services held a public hearing January 9 on legislation addressing key issues in Wisconsin’s mental health system, including two of WHA’s legislative priorities.

The Committee heard testimony on AB 453/SB 360, bipartisan legislation that would update Wisconsin’s mental health medical records law to enable better coordinated, more holistic integrated health care for individuals with mental illness. The bill was a bipartisan recommendation of the Speaker’s Mental Health Task Force and has 41 co-sponsors.

"While the views and treatment of mental illness have evolved, our laws have not kept pace with that change," said WHA Executive Vice President Eric Borgerding. "This bill removes barriers to care coordination for individuals with mental illness that do not exist for physical illnesses. WHA thanks Chair Vukmir for taking action this week to move this important legislation forward."

Sen. Leah Vukmir (R-Wauwatosa), lead author and chair of the Senate Health and Human Services Committee, said, "The updates provided with SB 360 will make Wisconsin’s mental health statutes more consistent with modern integrated approaches for individuals with mental health needs." With passage of this legislation, "patients with a mental health diagnosis will see benefits from optimized care through enhanced coordination among providers," said Vukmir.

"Current Wisconsin law treats mental health information significantly different than other health information, perpetuating mental health stigma by segregating mental health from physical health," said Sen. Tim Carpenter (D-Milwaukee), lead co-author of SB 360. "SB 360 ends our outdated disparate treatment of mental and physical health information."

The Committee also heard testimony from clinicians, hospital administrators and policy experts including WHA Vice President of Policy and Regulatory Affairs Matthew Stanford; Peg Schmidt, chief privacy officer for Aurora Health Care; and Jerry Halverson, MD, medical director for adult services at Rogers Memorial Hospital-Oconomowoc.

"As the chief privacy officer, I often encounter situations where our inability to exchange patient information within the system negatively impacts our patients’ care and frustrates our providers and patients. The outdated laws and subsequent inability to efficiently exchange information is an obstacle to coordinated care," said Schmidt.

"Mental illness is a medical illness," said Halverson. "Psychiatrists are very excited about this bill, as it is a step toward ending the systematic stigmatization of these medical illnesses."

Another bill heard in Committee was AB 488, which reforms Wisconsin’s emergency detention law to better enable court review of requests to initiate an emergency detention using the existing three-party petition process. In testimony provided to the Committee, Stanford said AB 488 "provides families an opportunity to have a court review a three-party petition for involuntary care, while maintaining county corporation counsel’s role in drafting and filing the petition and representing the interests of the public in the process."

This legislation is expected to pass out of the Senate Committee on Health and Human Services during the week of January 13. The full Senate is expected to take up the measures before the end of January.

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Wisconsin Hospital Leaders in DC, Tell Congress: "We Need Time to Breathe"

Wisconsin hospital leaders and the Wisconsin Hospital Association traveled to Washington, DC this week to discuss important issues with Wisconsin’s Congressional Delegation. The message they left with Congress as it faces several significant fiscal deadlines in the coming months was that hospitals and health systems are in the midst of massive health care transitions and need a little time to breathe.

From moving forward with electronic medical records, implementing major care delivery reforms, testing new payment models, adjusting to changes in the health care insurance market, managing regulatory policy shifts while absorbing billions of dollars in reduced federal payments for hospital care provided to Medicare and Medicaid patients, hospitals need some breathing room as all of these changes converge.

"This was my first trip to educate our federally-elected officials and key members of their staff. We had a great, engaged team that spoke to relevant issues impacting hospitals throughout Wisconsin," said Burnett Medical Center CEO Gordy Lewis. "It is edifying to know that our story of providing valued, quality health care resonates with our elected officials and staff. They listened, they learned, and I am confident that they will act in the best interests of Wisconsin hospitals."

Leaders discussed several newer issues that are adding increased regulatory burdens on hospitals and should be legislatively addressed. Those issues include support for HR 3698 to delay the new "two midnights" policy an additional six months and a request for legislators to support legislation resolving two differing "96 hour" statutes for critical access hospitals (CAHs).

During discussions on the need to harmonize the 96 hour rule for payment with the 96 hour rule for conditions of participation for CAHs, Stoughton Hospital Association CEO Terry Brenny provided each legislative office a signed letter from his physicians. The letter was another way to demonstrate to legislators that changes—be they regulatory or fiscal cuts—are having real-life impacts on physicians, health care providers and patients.

"I was impressed with how well the DC Capitol itinerary was organized, the ready access we had to our Congressional Delegation and their staffs, and how warmly we were received. Our legislators were very knowledgeable on health care and rural issues. Several expressed support for our positions, which I hope plays out well for our industry’s future," said Brenny. "Hospital leadership, trustees, medical staff and constituents need to stay engaged and connected with our key Congressional leaders who are in a position to define, and possibly redefine our fate."

Additional issues discussed included the prospects for a permanent repeal of the sustainable growth rate and opposition to proposals cutting hospital outpatient department payments, known as "site neutral" policies.

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State Receives BadgerCare Waiver Approval
Plans for outreach/education on Medicaid changes

The Department of Health Services (DHS) announced January 9 that the federal Centers for Medicare and Medicaid Services (CMS) has formally approved their new BadgerCare waiver request.

The waiver formally allows the state to implement changes to the Medicaid/BadgerCare program, making childless adults with income below the poverty line eligible for the program, and allowing childless adults to receive standard plan benefits. DHS has estimated that approximately 83,000 new adults will become eligible for Medicaid under this program.

It also allows the state to require all parents and caretaker relatives who qualify for transitional Medicaid to pay a monthly premium. Transitional Medicaid is a program that allows certain adults transitioning from welfare to work to remain eligible for Medicaid even if their income exceeds the required thresholds. Adults on transitional Medicaid with incomes above 133 percent of the federal poverty level (FPL) have been required to pay a monthly premium since July 2012. Under the waiver, adults on transitional Medicaid with incomes above 133 percent of the FPL will continue to be required to pay a monthly premium, and adults with incomes from 100 percent to 133 percent of the FPL will begin paying monthly premiums after the first six months of transitional Medicaid coverage.

The approval letters and other waiver documents can be found at: www.dhs.wisconsin.gov/badgercareplus/waivers.htm.

In related news, on January 8 the Joint Finance Committee approved two technical bills (AB 610 and SB 475) modifying the implementation date of the new income eligibility criteria for new parent and caretaker applicants to February 1. The bills were passed on a vote of 11-4 with one committee member absent. The modification is a result of a recent agreement between DHS and CMS. Under the change, new parent and caretaker applicants who apply after February 1, 2014, would have eligibility determined under new modified adjusted gross income (MAGI) rules, and could be eligible for Medicaid only if income is below 100 percent of the FPL. All parents and caretakers currently enrolled and those who apply for Medicaid before February 1, 2014, with income above 100 percent FPL but below 200 percent FPL, can remain on the program until March 31.

Also on January 8, DHS offered a webcast about the new changes and new forms for current BadgerCare enrollees. An archive of the webcast can be accessed at: www.dhs.wisconsin.gov/health-care/training/index.htm.

DHS has also announced it will host a series of in-person meetings throughout the state, including a webinar that will be archived and made available for those that are not able to attend in person. The meetings will provide an overview of the updated timeline for implementation of the policy changes in Medicaid; what Medicaid recipients and applicants can expect; the February 3, 2014, system updates for ACCESS.WI.GOV that will allow newly-eligible BadgerCare Plus populations to apply for BadgerCare Plus coverage; and other relevant updates.

The dates and times of the meetings are posted on the WHA website at: www.wha.org/badgercare-update-meetings.aspx.

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Aurora Medical Center-Kenosha Takes Aim at Driving Infection Rates to Zero
Hospital has had no central-line infections since October 2012

Every hospital strives to drive their infection rates to zero. However, Aurora Medical Center-Kenosha achieved that goal by having no central-line infections since October 2012.

It started with Kelly Gronli, quality coordinator at Aurora Medical Center-Kenosha, attending a WHA Partners for Patients Conference in Wisconsin Dells. At that conference, Gronli was impressed with WHA’s approach to quality improvement, which relies heavily on methods that teach teams to improve how they approach quality improvement. The toolkits and assistance from the WHA quality staff, along with the ability to network with hospitals were important factors that influenced the Kenosha team’s decision to join the WHA quality improvement project.

An interdisciplinary team was formed at the hospital, which included nursing, quality, education and other staff members, to work on infection prevention projects. The team focused their improvement efforts on central line (CLABSI) and urinary tract infections (CAUTI). Physicians and nurses were re-educated on the proper maintenance of central lines and urinary catheters. Paige Mueller audited all central lines, and Susan Perusich audited urinary catheters one day per week. Data was tracked and real-time feedback was provided to caregivers.

"We have really increased our focus on daily monitoring and removal of urinary catheters and worked with staff to ensure we are doing everything we can to prevent these infections," according to Perusich, clinical nurse specialist.

Physicians played a key role in the hospital’s success in preventing infections. All measures have standardized order sets, and physicians are strongly encouraged to use the standardized order sets to meet measures and to provide the best evidenced-based patient care. The quality medical director is involved in all of the hospital’s quality projects.

The team credits WHA with providing tools and education that have helped keep the teams energized, while other hospitals have shared information that has been helpful as well.

"The key to preventing infections is to remain vigilant in monitoring clinical care and to keep infection prevention ‘front and center,’" said Stacey Aker, infection preventionist. "We plan to continue giving our nursing staff positive feedback on the great job they are doing and remain vigilant in monitoring our care to help us sustain the improvement we’ve made in preventing infections in these two key areas.

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AHA Requests Feedback on Proposed Emergency Preparedness Rule

The American Hospital Association (AHA) is requesting hospital feedback as it prepares to submit comments on a Centers for Medicare and Medicaid Services (CMS) proposed rule to add certain emergency preparedness responsibilities to a hospital’s Medicare Conditions of Participation (COPs).

In the proposed rule, published in the Federal Register December 27, CMS seeks to establish emergency preparedness requirements for Medicare- and Medicaid-participating health care providers, including hospitals and critical access hospitals. The requirements would fall into four broad categories, with specifics being different for various types of providers:

The proposed rule is located in its entirety here: www.gpo.gov/fdsys/pkg/FR-2013-12-27/pdf/2013-30724.pdf.

AHA is conducting a web-based meeting January 15 at 11 a.m. to discuss the new CMS proposed rule. Contact Andrew Brenton, WHA assistant general counsel (abrenton@wha.org) for more information.

In Wisconsin, hospital emergency preparedness planning and response is supported at the state level by the Wisconsin Hospital Emergency Preparedness Program (WHEPP), which is largely funded by a federal grant administered by the Department of Health Services. WHA has partnered with WHEPP since the program’s inception and has always been at the forefront of statewide hospital emergency preparedness, helping our member hospitals prepare for and respond to disasters in our communities. WHA serves on the WHEPP leadership council, effectively and quickly communicates relevant WHEPP-related issues to member hospitals and utilizes the time and resources of staff to assist WHEPP in program strategizing and implementation. Most recently, WHA staff joined emergency response partners in attending the 2013 National Healthcare Coalition Conference December 11-13 in New Orleans, where conference presenters showcased best practices aimed at strengthening emergency response capabilities.

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Fox Valley Hospital Expands and Updates Behavioral Health Unit

On January 6, ThedaCare announced the opening of a $4.3 million renovation of the inpatient behavioral health unit at Theda Clark Medical Center in Neenah, which nearly doubled the amount of day space and tripled the number of private rooms.

As reported by the Appleton Post-Crescent, Jake Lepke, project lead for ThedaCare Behavioral Health, said the changes were made to improve safety and the overall patient experience, as well as to increase staff and provider productivity. The 14-month renovation included input from staff and patients.

"We are achieving our goal of improving patient care," Lepke said. "The new inpatient environment helps us work better as a team, and the beneficiaries are our patients, who have the treatment, privacy and safety they need and deserve."

"This is another example of hospitals’ commitment to make investments to serve their communities’ mental health needs and improve patient care, despite reimbursement that is often well below the cost of providing those mental health services," said WHA Executive Vice President Eric Borgerding.

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Influenza Hospitalizations Increasing in Wisconsin
Young and middle-aged adults especially affected

Wisconsin has seen a recent dramatic increase in the number of hospitalizations resulting from influenza, including admissions to intensive care units (ICU) and an increase in the number of young and middle-aged adult patients requiring mechanical ventilation, according to the Wisconsin Department of Health Services. The influenza virus causing most of these serious infections is the 2009 A/H1N1 virus, the same virus that caused the influenza pandemic during 2009. Once again, state health officials are strongly encouraging Wisconsin residents to get vaccinated against the flu.

"For the best protection against the flu, you need to be vaccinated annually," said Karen McKeown, state health officer. "Getting vaccinated during past years, or having the flu in the past, does not fully protect against this year’s A/H1N1 strain. The good news is that the H1N1 strain in this year’s vaccine is well matched against the 2009 A/H1N1 flu strain and should be very effective."

Influenza occurrence is approaching peak levels in Wisconsin, making it especially important to get vaccinated now to prevent future cases, McKeown noted. There have already been 565 influenza-associated hospitalizations reported since October 5, with 22 percent admitted to the ICU and nine percent requiring mechanical ventilation. Notably, 75 percent of these hospitalizations have been reported since December 14. Although deaths caused by influenza are reportable only among pediatric patients, flu-associated fatalities among non-vaccinated young and middle-aged adults have also been noted, according to DHS.

Throughout the influenza season, Jon Temte, MD, PhD, shares his weekly influenza surveillance updates with WHA. Temte’s updates are posted in the emergency preparedness section of WHA’s website at www.wha.org/weekly-influenza-update.aspx.

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WHA Physician Leadership Development Conference, March 14-15, 2014
Early bird discount available through January 15; Register today

Take advantage of the registration fee discount by registering yourself and your team by January 15 for WHA’s ninth annual Physician Leadership Development Conference. This year’s event is scheduled March 14-15, 2014, at The American Club in Kohler.

The full event agenda is included in this week’s packet. More information and online registration are available at http://events.SignUp4.com/14PLD.

The conference will include a Friday full-day session focused on the role physician leaders play in supporting a culture in which quality improvement is an expectation, present by David Nash, MD, internationally recognized for his work in quality outcomes management, medical staff development and quality-of-care improvement. In addition, the Saturday morning half-day session, presented by Tim Keogh, PhD, will focus on building the communications skills physician leaders need to gain influence, cooperation and colleague engagement.

Both Nash and Keogh are nationally-recognized faculty from the American College of Physician Executives (ACPE), and both will discuss important and practical leadership skills that help physician leaders move beyond their clinical training and take a new approach to managerial decision-making and problem solving.

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ICD-10 Summit: Ready. Set. Go Live! Set for March 17-19 in WI Dells

ICD-10 will affect all aspects of health care in 2014, and WHA, the Wisconsin Medical Society and the Wisconsin Medical Group Management Association have teamed up to make sure hospitals and clinics throughout Wisconsin are ready. The ICD-10 Summit: Ready. Set. Go Live! is scheduled March 17-19, 2014 at the Kalahari Resort in Wisconsin Dells.

The full Summit agenda and registration can be accessed online at: www.wha.org/icd-10summit.aspx.

The ICD-10 Summit is for practice managers, hospital and clinic coding and billing specialists, and health information professionals, with an emphasis on setting you on the path to a successful implementation. Summit attendees will have the tools and confidence needed for a smooth transition when on the go-live date of October 1, 2014.

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WHA Wisconsin RAC Summit Scheduled for March 26; Register Today

Join your hospital and health system colleagues at WHA’s first ever "Wisconsin RAC Summit" on March 26 at Glacier Canyon Lodge in Wisconsin Dells. An event brochure is included in this week’s packet, which includes the full agenda, and online registration is available at http://events.SignUp4.com/14RACSummit.

This one-day event will help educate and connect WHA hospitals and systems with top-of-mind issues related to the ever-changing audit landscape. Attendees will hear directly from Wisconsin audit contractors, physician leaders, RAC appeals gurus and case management specialists. Gain practical tips you can immediately put into action in your facility and take advantage of a valuable networking opportunity.

A discounted "early bird" registration fee is available to those registering by February 21. Make sure to register today for this important event at http://events.SignUp4.com/14RACSummit.

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Education: WHA Webinar on Aurora Health Care’s Behavioral Health ED-Intake Team Study

On February 7, 2014, from12:00 to 1:00 pm, WHA will host a one-hour webinar presentation of the results of Aurora Health Care’s study on the use of a Behavioral Health Intake Team in the Emergency Department setting to reduce ED length of stay and inappropriate admissions.

Presenters will include Dr. Vani Ray and Joy Mead-Meucci from Aurora Health Care. This study was presented at the Academy of Psychosomatic Medicine’s Annual Meeting in November 2013. An abstract of the presentation can be found at: http://apm.org/ann-mtg/2013/poster-details.shtml#po126.

To sign up for this free webinar open to WHA members and their staff, go to: http://events.SignUp4.com/BevHealthEDIntake.

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2014 Wisconsin Rural Hospital Stroke Workshop to be held on March 21

On Friday, March 21, 2014, the Wisconsin Office of Rural Health and the American Heart Association will host the annual Wisconsin Rural Hospital Stroke Workshop at the Kalahari Resort in Wisconsin Dells. The event is designed to help rural hospitals close the treatment gap in rapid diagnosis of stroke care and to implement continuous quality improvement of care. Learning objectives include:

Your hospital’s stroke team is encouraged to attend. CEUs are available. Registration is $25. Full information and online registration are available at: www.worh.org/events/wisconsin-rural-stroke-workshop-2014. The deadline for registration is March 10.

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