October 10, 2014
Volume 57, Issue 41

Wisconsin Hospitals’ Community Outreach Efforts Total $1.78 Billion
Hospitals provide $328 million in charity care; lose nearly a billion on Medicaid

A report released by WHA October 8 showed Wisconsin hospitals provided $1.78 billion in 2013 on programs that benefitted the community, ranging from free care for those unable to pay their bills, to outreach activities related to health education, free screenings and community support groups.

Hospitals also reported they incurred nearly a billion dollars in losses ($967 million) associated with caring for patients in the Medicaid program. Medicaid pays hospitals only about 65 percent of what it costs to care for this vulnerable, and often medically-complex, patient population.

The Wisconsin Hospital Association (WHA) surveys its 135 member hospitals and health systems annually and asks them to describe and quantify the programs, services and activities they provide at or below cost, solely because those programs fulfill a health need in the community. (See report: www.wha.org/pubarchive/special_reports/CBreport2014.pdf). The hospitals reported that in 2013 they provided nearly $1.8 billion in community benefits. Included in that total is $328 million in charity or free care (at cost), $70 million on activities aimed at improving community health and $193 million on education for health care professionals.

“Whether it is providing financial assistance to patients with limited resources through charity care programs, or improving access to essential or primary health care services by sponsoring free medical and dental clinics, Wisconsin hospitals provide a ‘safety net’ of care in the communities they serve,” according to WHA Executive Vice President Eric Borgerding. “Without that care in place, state and local government would have a much greater burden in trying to deliver these essential services to a vulnerable population.” 

While the $328 million in charity care hospitals reported in 2013 was fairly close to 2012, the number of patient encounters that qualified for free care rose dramatically. In 2013, hospitals reported 1.4 million instances of charity care, compared to 1.2 million in 2012.

“Charity care can vary from year to year, depending on the types of cases that qualify,” according to WHA Senior Vice President Brian Potter. “The fact that there were 200,000 more instances of free care in hospitals in 2013 than the previous year, yet the dollar value of that care stayed fairly even with past years, may reflect the fact that more services are provided in the less costly outpatient setting than in the hospital, which is consistent with what we are seeing with all patient care.”

In 2013, hospitals reported they were unable to collect $276 million in hospital costs. Anecdotally, hospitals attributed the nearly $6 million increase in bad debt over 2012 figures, in part, to the increase in deductibles and co-pays.

“While more people may be gaining coverage, we are still seeing many patients struggle to meet their co-pays and deductibles,” Potter said. “That is a real and growing concern for hospitals.”

Hospitals Absorb Nearly $13 Million Loss Operating Nursing Homes

Keeping those who are elderly or in need of rehabilitation services in the community is one of the most valued and necessary services requested by their families and friends. In some communities, hospitals are the sole providers of those services. In 2013, the hospitals that operated nursing homes reported losses totaling $13 million. Hospice care is also becoming increasing more available because hospitals recognize the value of end-of-live services for their patients and families. Hospitals typically report hospice services are operated at a loss. 


Wisconsin hospitals offer thousands of access points in their communities to services as wide ranging as medical care at a free or reduced-fee medical clinic, to health screenings at health fairs, schools and other public events. By offering free health screenings and other medical services closer to where people shop, work or play, hospitals live out their missions to raise the health status of people living in their communities. 


2013: A Transition Year in Hospital Community Benefit Planning and Implementation

The heart of every hospital and health system mission has been and continues to be to improve population health. In 2013, under a new requirement of the Affordable Care Act, hospitals were required to complete a formal community health needs assessment (CHNA) in partnership with public health and other community partners to assess, address and prioritize community health needs. The UW Population Health Institute (UWPHI) collected the CHNAs and implementation plans and created a new website www.improvingwihealth.org that displays this information on every hospital and health department in the state. The researchers also analyzed local health department (LHD) community health improvement plans, conducted by local health departments under provisions of Wisconsin state law. Where available, UWPHI also captured snapshots of the specific strategies, tactics and programs being deployed or planned in communities to drive improvement in these health priority areas.


“This new web-based resource is designed to help those working on common challenges across the state to connect with each other, share ideas, and accelerate progress,” according to UWPHI Director Karen Timberlake.


Visit www.wiServePoint.org to review the 2014 WHA Community Benefits Report. It also has patient stories and descriptions of free and reduced cost services that hospitals provide in their communities.


Community benefits and related issues have been an area of emerging interest to the hospital community. For more information, WHA members are encouraged to refer to the WHA Special Issues Facing Tax-Exempt Organizations Manual in 2013. Von Briesen & Roper attorneys David Edquist and Bill Jackson prepared this Manual, which includes valuable information on community benefits. Members who would like to access the WHA Special Issues Facing Tax-Exempts Manual or any other WHA Health Law Manual, should contact webmaster@wha.org to request a username and password.  

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Wisconsin Health Care Ranks Third Highest in Nation

Wisconsin follows Minnesota, Massachusetts in overall performance


Wisconsin is the third most highly-rated state in the country based on the quality of its health care according to the federal Agency for Healthcare Research and Quality (AHRQ). Wisconsin had the third best overall health care quality measure score among all 50 states based on more than 100 measures that AHRQ used to evaluate health care performance. Wisconsin has consistently placed at or near the top of AHRQ’s ranking since 2005.


AHRQ measures health care quality in three different contexts: by types of care (such as preventive, acute or chronic care), by settings of care (such as hospitals, nursing homes, home health or hospice), and care by clinical area (such as care for patients with cancer or respiratory diseases).


WHA Chief Quality Officer Kelly Court said the high ranking could be a reflection of the benefit of Wisconsin’s highly-integrated health care system.


“The AHRQ rankings pull many different segments of the delivery system together to develop an overall rating. In a state like ours that has a highly-integrated health delivery system, care is more coordinated and therefore, improvements can take hold much more quickly and be sustained over time,“ according to Court. “Our hospitals and health care systems are highly collaborative, too—they share what they learn with each other and with other providers in the community. We still have work to do, but it’s rewarding when we can stand back and see how much progress we have made on our journey.” 


AHRQ’s State Snapshots web tool was launched in 2005. It is an application that helps state health leaders, researchers, consumers and others understand the status of health care quality in individual states, including each state’s strengths and weaknesses.  


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WHA Physician Leadership Development Conference

The American Club, Kohler *** March 13-14, 2015


Early Bird Registration: Register by January 15 to Qualify

More information and online registration can be found at: http://events.SignUp4.net/15PLD

Need Hotel Reservations? Contact The American Club at 800-344-2838 ASAP.


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DHS: Wisconsin Has Plans in Place to Respond to Ebola if Case Presents


In a news release issued October 10, the Wisconsin Department of Health Services (DHS) said, in collaboration with the Centers for Disease Control and Prevention (CDC), it has plans in place to respond in the event a case of Ebola virus appears in the state. There is currently an Ebola outbreak in West Africa; however, no one has contracted the Ebola virus in Wisconsin.


“We understand people are concerned about the Ebola virus, especially with a recently diagnosed case in the United States. While there are no cases of Ebola in Wisconsin, and the risk of contracting it remains low, it’s important that medical and public health professionals are able to respond in the event there is a case in the state,” said Karen McKeown, state health officer. “Should someone in the state contract Ebola, DHS will ensure that the public and health care providers receive prompt public health information.”


Since the Ebola virus outbreak began in West Africa, DHS has been assisting health care partners by providing guidelines for monitoring individuals returning from affected countries in that region. DHS also continues to ensure that all health care providers are prepared with the appropriate infection control protocols and required precautions for managing an Ebola patient. DHS continues to communicate with the CDC for current developments and guidelines and shares that information with health care providers and local health departments in Wisconsin.


“For the general public, we want to stress that the chances of anyone in Wisconsin contracting the Ebola virus are very low,” McKeown continued. “Ebola is only spread through contact with the body fluids of people who are sick with the virus. It cannot be transmitted through the air. In fact, influenza is more contagious than the Ebola virus. That said, DHS remains vigilant in its monitoring of the Ebola virus, and will continue to provide our partners and the public with the most current information and guidance concerning this disease.”


For information on the Ebola virus, visit: www.dhs.wisconsin.gov/communicable/diseasepages/ViralHemorrhagicFevers.htm. Additional information about the Ebola virus can be found at on the WHA website at www.wha.org/ebola.aspx.  


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WHA Sponsors WisconsinEye Interviews – Elections Just Weeks Away


WisconsinEye has completed hundreds of candidate interviews over the past few months. WHA has been a proud sponsor of WisconsinEye’s 2014 election coverage. The interviews posted by WisconsinEye are an excellent resource for the public to help them become better informed voters. WisconsinEye interviewed every candidate running for office this election cycle.  

“In the next few weeks leading up to the November 4 election, you will hear candidates share their views on many important issues, including health care. I encourage you to listen carefully and participate in those discussions,” WHA Executive Vice President Eric Borgerding says in a taped introduction featured in WisEye’s Campaign 2014 coverage. “For over 90 years, WHA has been an advocate for sound health care policy, and that is why today we are proud to sponsor WisconsinEye’s candidate interviews and election coverage.”

The WisconsinEye interviews include statewide races, Congressional races and state legislative races. WisconsinEye is a statewide, non-partisan, non-profit, independent television network devoted to covering state government and civic activities throughout Wisconsin.

Learn more and watch the candidate interviews by logging onto WisconsinEye’s “Campaign 2014” portal at: www.wiseye.org/Programming/Campaign2014.aspx or www.wiseye.org.


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Guest Column: Wisconsin Hospitals: Caring for Our Neighbors

By Edward Harding, Chairman, WHA Board of Directors, President/CEO, Bay Area Medical Center, Marinette


As a CEO, I am very familiar with the challenges that hospitals in Wisconsin have faced over the past year. Those challenges, however, have not deterred any of us from meeting our primary mission—to provide high-quality, compassionate care to people who live in our communities. Whether it is a patient facing a diagnosis of cancer or a person who falls very ill and can no longer work, a hospital is there to help restore their health and their hopes for the future. The inability to pay a bill should never be a barrier to seeking necessary medical care.


Hospitals are open 24 hours a day, 365 days a year, acting as the community’s health care safety net. In 2013, Wisconsin hospitals provided more than $328 million in free care on 1.4 million patient encounters. That is 200,000 more encounters than 2012.


The care a hospital provides reaches far beyond the boundaries of their campuses. A local example in Marinette is the Twin Counties Free Clinic established in 1998. The Free Clinic provides a variety of health care services to the uninsured and underinsured residents of Marinette and Menominee (MI) Counties. Bay Area Medical Center (BAMC) and Aurora Health Care both supported the creation of the clinic with considerable startup donations. Both of our organizations continue to support the clinic, which sees nearly 400 patients a year, through free office space, financial contributions, lab testing and diagnostic services. Last year BAMC and the Free Clinic partnered to provide certified counseling to the clinic’s patients to enroll them in the health care marketplace and will be doing the same in 2015.


Wisconsin hospitals are staffed by dedicated and skillful health care professionals who make it possible for our organizations to provide thousands of hours of free health screenings and education programs. Statewide, hospitals spent more than $50 million operating programs aimed at helping people live healthier lives.


Every year, all WHA member hospitals—135 in total—complete the WHA community benefits survey. Wisconsin is one of a handful of states where 100 percent of the hospitals voluntarily report community benefits. While the dollar amounts spent are impressive, the real value of care is best told by those who receive it. Read the full report and personal stories at: www.wha.org/pubarchive/special_reports/CBreport2014.pdf.


I would like to express my thanks to the dedicated health care professionals working in our hospitals for their unwavering commitment to deliver high-quality, high-value, compassionate health care to every resident of our great state. Health care contributes to the quality of life we all enjoy, and it is one more reason to live, work and play in Wisconsin.


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Orlikoff to Address Next Generation of Wisconsin Health Care Leaders 


On November 5, Jamie Orlikoff, a member of Modern Healthcare’s inaugural list of “100 Most Powerful People” in health care and one of the foremost thought leaders in the country, will address Wisconsin’s next generation of health care leaders.


“Today’s Challenges, Tomorrow’s Opportunities: A Future Leader’s Guide to Wisconsin Health Care” is a one-day event offered by WHA in partnership with the Wisconsin Forum for Healthcare Strategy (WFHS). The event will focus on the role the next generation of health care leaders will play in effectively addressing current health care trends, as well as describe strategies that will ensure Wisconsin continues to be a ‘leader’ state.


The day’s agenda will also include a moderated panel discussion that features three of Wisconsin’s health care leaders. The panelists will share their experiences in addressing challenges they have faced during their careers, discuss how they have prepared their organizations to be ahead of the curve, and describe how they are responding to the fast-changing environment.


Executive and mid-level leaders, directors and managers—those who are the next generation of administrative leaders in Wisconsin hospitals and health systems—are encouraged to attend. CEOs are invited to identify several ‘rising stars’ in their own organizations and encourage them to attend.


Through the generous support of WFHS, a discounted registration fee is available. Space is limited, so register today at http://events.SignUp4.net/14TCTO-1105.  


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Circuit Court Judge Does Not Apply Cap


A Milwaukee County Circuit Court judge has refused to apply Wisconsin’s cap on noneconomic damages in a medical malpractice case. While earlier in the proceedings the Court had ruled the cap was not facially unconstitutional, after the verdict the Court found the cap, as applied to the specific facts of the case, was unconstitutional.


The jury in the case found the defendant physician and physician assistant were not medically negligent in their diagnosis and treatment of the patient, but that they failed to obtain her informed consent. The jury was instructed to apply the “reasonable patient” standard for informed consent. (The Legislature amended the informed consent statute in 2013 to require disclosure of “information a reasonable physician in the same or similar medical specialty would know and disclose under the circumstances.”) The jury awarded the plaintiff, who lost all of her limbs as the result of a septic infection caused by Strep A, nearly $9 million in economic damages and $16.5 million in noneconomic damages.


In Wisconsin, plaintiffs receive awards for economic and noneconomic damages in excess of the provider’s liability insurance through the Wisconsin Injured Patients and Family Compensation Fund, which is funded by assessments on physicians and hospitals. The Fund covers the full amount of the award for economic damages and up to the cap amount, $750,000, for noneconomic damages (pain and suffering).


In finding the cap, as applied to the plaintiff, was unconstitutional, the judge wrote, “[I]t is the intent of this Court to rule on the specific facts of the Plaintiffs’ case, and those facts alone. This decision is not meant to be precedential, nor is it intended to dictate the legal outcome of any other factual matters. With that said, and with a view of the Plaintiffs’ particular facts in mind, this Court finds that the cap violates the Plaintiffs’ rights to due process and equal protection as applied in this instance.”


Watch The Valued Voice for updated information concerning Mayo v. Wisconsin Injured Patients and Families Compensation Fund.


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WHN Telemedicine Panel: Medicare Policies a Barrier to Telemedicine Expansion

Demand for telehealth fueled by physician shortage, patient demand


A panel of payers, providers and regulators agreed that telemedicine is a promising tool for providing high-quality, more accessible and more timely health care, but also expressed frustrations that payment policy and access to broadband is impeding greater use of that tool. 

In particular, Medicare’s outdated and restrictive reimbursement policies regarding telemedicine, and adoption of Medicare’s telemedicine policies by some private payers, were identified as a barrier to greater use of this access tool. In contrast, Wisconsin’s Medicaid policies regarding telemedicine were held out as a model from which to build.


“The Medicare model of payment for telemedicine does nothing to help the state of Wisconsin,” said Nina Antoniotti, PhD, director of teleHealth at Marshfield Clinic Health System. “Somehow, payment is following the Medicare model. Those legal and regulatory improvements are what we really want.”


Under Medicare rules developed in the 1990’s, Medicare has narrowly restricted the geographic areas that Medicare will pay for health care services provided via telemedicine. Generally, only health care services provided via telemedicine originating from an urban area to a location in a rural area are eligible for Medicare payment. 


In contrast, while there are some issues that Medicaid could improve upon, particularly regarding telestroke, Antoniotti highlighted a recent report by the American Telemedicine Association that gave the Wisconsin’s Medicaid program high grades for its telemedicine payment policies. That report noted that Wisconsin’s Medicaid program does not impose payment restrictions based on the patient setting or originating site.


Broadband access necessary to enable greater use of telemedicine as a health care access tool was also raised by payers and providers.


“There is huge potential in telemedicine,” said Larry Schreiber, president, Anthem Blue Cross and Blue Shield in Wisconsin. “However, we still have rural areas that do not have the level of broadband bandwidth needed to leverage this technology to the fullest.”


Matthew Stanford, WHA vice president, policy and regulatory affairs, and associate counsel, noted earlier discussion that some states have enacted telemedicine payment mandates and asked the panel whether Wisconsin could expect to see a trend among payers to pay for care on a “site agnostic” basis, where payment is made based on the value provided regardless whether it is provided in person versus via telemedicine between clinical locations, versus via telemedicine between a clinical location and a patient’s home.


Payers are moving to “essentially have the same type of payment based on the service provided,” said Schreiber. “What is more important is getting the right professionals around the patients. Site agnostic is fine as long as you are getting the right care at the right place from the right person.”


Deputy Insurance Commissioner Dan Schwartzer also recognized that not all private payers pay for telemedicine services as they do for non-telemedicine services in Wisconsin, but was not sure that reimbursement mandates, such as those in 21 other states, made sense for Wisconsin.


Schwartzer also discussed the involvement of the Office of the Commissioner of Insurance (OCI) in a National Governor’s Association to remove barriers to telemedicine. He said that physician licensure issues and the potential for developing a broad, but basic definition for telemedicine are issues that OCI is reviewing. 


Wisconsin Health News (WHN) organized the panel held in Madison October 7. WHA is a WHN sponsor.


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Common, Complex ICD-10-PCS Coding Scenarios Focus of WHA Webinars


Whether it is gaining a better understanding of ICD-10-PCS coding system design and root operation groups, or working through common and more complex coding scenarios, hospitals will find WHA’s ICD-10 webinar series featuring coding expert Lynn Kuehn helpful.


The opening two-part webinar, scheduled October 22 and 29, is aimed at those who need to learn more about the ICD-10-PCS system design and how to use the tools of the system to assign codes. During the two sessions, the nine ICD-10-PCS root operation groups available for coding will be reviewed, including their definitions and unique issues related to assigning the root operation character.


On December 2, Kuehn will lead a webinar focused on making root operations selections and assigning all characters for the codes included in 10 common ICD-10-PCS cases encountered at hospitals and health systems. This interactive webinar will be a great way to work through some of the most common cases that will be encountered after October 1, 2015.


On December 9, Kuehn will teach participants to improve critical thinking skills by tackling more complex ICD-10-PCS cases. Kuehn will provide helpful tips to differentiate between root operations groups and similar individual root operations. Intended as the capstone for the webinar series, this session will assist attendees in making decisions to code 10 common, but more complex, ICD-10-PCS cases.


Full information on all four sessions is included in a brochure in this week’s packet. In addition, information and online registration are available at: http://events.SignUp4.net/14W-ICD-10-PCSSeries. Encourage your team to gather for this webinar series and learn together through one, low-cost registration.


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