October 18, 2013
Volume 57, Issue 42


Senate Approves Legislation Addressing the Supreme Court’s Jandre Decision
Top WHA priority takes important step forward

On October 15, the State Senate passed by voice vote Assembly Bill 139, a key WHA legislative priority for 2013. Known as the "Jandre Fix," the bill creates a clear, reasonable physician standard for providing informed consent to patients and clarifies that a negligent diagnosis claim is separate from an informed consent claim.

"Legalese aside, the bottom line is the Jandre decision could lead to increased health care costs related to the overutilization of tests and, because of those tests, unnecessary angst and increased potential risks for patients," said WHA Executive Vice President Eric Borgerding following the final Senate vote Tuesday evening. "With this bill, Wisconsin hospitals, physicians and health systems can continue to provide high-quality, efficient, outcome-focused care."

When the Jandre decision was released in April 2012, WHA made enacting a legislative "fix" one of its top priorities. Working with Rep. Jim Ott (R-Mequon) and Sen. Glenn Grothman (R-West Bend), AB 139 was introduced to protect Wisconsin’s high-quality, high-value health care system.

Early next month AB 139 will go back to the State Assembly for final concurrence, the last legislative step before moving to Governor Walker’s desk where it is anticipated this important legislation will be signed into law.

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DHS Set to Implement Primary Care Rate Increase
Payments to be retroactive to January 1, 2013; Providers must complete attestation

The Department of Health Services (DHS) released updated information October 15 to providers regarding reimbursement for services that qualify for the primary care rate increase included in the Affordable Care Act (ACA). This can be a significant reimbursement increase, and providers are encouraged to investigate the program to take advantage of the full payment increase retroactively and for the limited amount of time the higher reimbursement is available.

In order to receive the reimbursement retroactive to January 1, 2013, providers must submit an attestation to DHS by December 31. Providers who attest on or after January 1, 2014, will only be eligible for the rate increase beginning on the date of attestation going forward.

Under the ACA, states are required to raise their Medicaid fees to Medicare levels for family physicians, internists, and pediatricians for many primary care services. The ACA provision was to be effective January 1, 2013; however, the lack of CMS rules until late last year and the complex nature of system changes has caused a delay in implementing the payments.

Kaiser has estimated an average increase of 78 percent in physician fees for Wisconsin as a result of this policy—an indication of the low rates of reimbursement in our state Medicaid program. The primary care fee increase applies only for two years—in 2013 and 2014. It is fully federally funded up to the difference between a state’s Medicaid reimbursement amounts in effect on July 1, 2009 and Medicare reimbursement rates for 2013 and 2014 as determined under a formula.

The physician attestation process is explained in the September 2013 ForwardHealth Update (2013-44), titled "Policy Clarifications for the Affordable Care Act Primary Care Rate Increase Provider Attestation." at https://www.forwardhealth.wi.gov/kw/pdf/2013-44.pdf.

The reimbursement policy is explained in the October 2013 ForwardHealth Update (No. 2013-54), titled "Reimbursement for Services Provided Under the Affordable Care Act Primary Care Rate Increase," and can be found at: https://www.forwardhealth.wi.gov/kw/pdf/2013-54.pdf.

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Campaign Update: $60,000 More to Go to Meet Year End Goal

With a few months left in the annual Wisconsin Hospitals Conduit and State Political Action Committee fundraising campaign, we are just a few hundred dollars shy of the $200,000 mark and at 77 percent of the annual goal. The campaign needs to raise just $60,000 by year end to reach the 2013 goal of $260,000.

The campaign has added 14 more participants and raised an additional $8,000 over the past two weeks, putting the total so far at $199,411 from 296 individuals. Of the total contributors to date, 63 are members of the Platinum Club—a new record! The Platinum Club members are those who have contributed at the highest donor level giving $1,500 or more to the 2013 campaign. The average contribution is $692 while the median contribution is $400.

All individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. Thank you to the 2013 contributors to date who are listed below. Contributors are listed alphabetically by contribution amount category. The next publication of the contributor list will be in the November 1 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

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HIRSP Authority to Sunset December 31
Provider letter outlines timely claims filing

This week the state’s Health Insurance Risk Sharing Program Plan (HIRSP) Authority sent a letter to providers informing them that the program will sunset on December 31, and providing information for providers about submitting claims for reimbursement.

The sunset of the HIRSP Authority was included in 2013 Wisconsin Act 20, the state’s biennial budget act. A key factor in the decision is a new requirement for guaranteed issue in the private market beginning January 1, 2014. HIRSP was created in 1979 and offers health insurance to Wisconsin residents who generally are unable to find adequate coverage in the private market due to their medical conditions. Guaranteed issue in the individual market as required under the Affordable Care Act (ACA) beginning January 1, 2014 means that HIRSP members, regardless of their health status, will now have access to commercial insurance.

Moving HIRSP members to the commercial market will eliminate the special HIRSP provider discounts and insurer assessments long used to supplement HIRSP members’ premiums to support the plan. For providers, it is also important to know that all claims must be submitted by March 31, 2014, with dates of service on or before December 31, 2013. Claims filed after March 31 will not be payable by the HIRSP Authority.

A template of the letter sent to providers can be found on the WHA website at: www.wha.org/pdf/HIRSPdeadline3-31-14.pdf.

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President's Column: Not Just One But Two.... And Kudos to Congressman Ribble
The nation’s Capitol has been the site of not one but two train wrecks over the past couple of weeks....

  1. The launch of the much-anticipated Obamacare website has sputtered. And that might be a kind statement given critiques coming from stalwart ACA supporters like Washington Post blogger Ezra Klein who used descriptors including "failure," "disaster" and "floundering" in a recent column.
  2. Digging deeper into this dilemma was Wisconsin native and insurance industry consultant Robert Laszewski who penned a pointed and detailed account as to what is really going on from an IT perspective. Bottom line...the federal exchange’s "back room connection between the insurance companies and the federal government is a disaster. Things are worse behind the curtain than in front of it."

    Laszewski’s analysis and takeaways, shared by others, is that things are unlikely to get much better anytime soon. And that’s a troublesome conclusion for the Obama Administration, for a low income population seeking coverage, and for hundreds of coverage "assisters" in Wisconsin who’ve been trained and are eager to help people connect to coverage.

    First hand reports confirm that things are so bad right now in Wisconsin that health plans are reporting "sign ups" in the single digits, many of which have occurred on-site at health plan offices and must still be entered successfully into the exchange web portal.

  3. About the only thing that has helped prevent Train Wreck #1 from being even worse for Obama Administration officials is Train Wreck#2...the pathetic way a handful of Republicans for two weeks thwarted the very necessary address of averting first a government shut down and then a potential looming default. Instead of the media focusing on millions of people failing to connect to the Obamacare website, we witnessed a jittery stock and bond market and talk of delayed vendor payments and locked gates to national parks. Predictably, the media largely blamed Republicans and found quite a few easy targets to showcase.

Regarding Train Wreck #2, special kudos to Green Bay Republican Congressman Reid Ribble for setting aside partisan politics and voting for the Government Shut Down and Debt Ceiling deal. Congressman Ribble has consistently demonstrated his willingness to place his district and constituents above the increasingly dysfunctional D.C. environment. Ribble reminds some of us of how things used to get done in Congress. No doubt he will be pilloried for taking a principled stand.

We will welcome Congressman Ribble to WHA headquarters on Tuesday, November 5 when he will be the featured speaker at the meeting of the WHA Council on Public Policy.

Steve Brenton
President

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Wisconsin Legislators Show Bipartisan Unity In Support of CAHs
Rep. Kind letter garners support of all Wisconsin House Members

In what seems to be an era of increasing partisan rancor, Wisconsin Members of Congress came together quickly and showed uncompromising and united support for the essential role of critical access hospitals (CAHs) in Wisconsin.

"When critical access hospitals were threatened by a federal agency’s misguided policy recommendation, our Members of Congress quickly came to their defense," said WHA President Steve Brenton. "We thank Rep. Ron Kind for spearheading a letter among his House colleagues in support of CAHs, and we thank our entire House Delegation for cosigning this letter."

Reps. Kind (D-WI) and David McKinley (R-WV) took the lead on a "dear colleague" letter in response to a report released by the U.S. Department of Health & Human Services’ (HHS) Office of Inspector General (OIG). In its report, the OIG recommended that Centers for Medicare & Medicaid Services (CMS) seek legislative authority to eliminate "necessary provider" designation for certain CAHs. In essence, the report is recommending CMS be able to remove CAH designation for virtually all of Wisconsin’s CAHs and approximately 64 percent of the nation’s CAHs.

"If recommendations in the report were to be implemented, hundreds of critical access hospitals (CAHs) could lose their status leading to huge voids in access to health care in rural America," the letter to HHS Secretary Sebelius reads. "We urge you to oppose any legislative proposal following the OIG recommendation to eliminate the "necessary provider" status for CAHs."

The letter expressed strong opposition to any changes to "necessary provider" status.

"We are all in support of smart, thoughtful and targeted Medicare reforms to reduce costs and maintain high quality care. However, eliminating the necessary provider CAH designation does not fall into any of those categories.

"We urge you to re-evaluate the proposed changes to the CAH system and stand with us in guaranteeing access to health care, and quality jobs in rural America."

All total, 78 Members of the U.S. House of Representative signed onto the letter, including Wisconsin’s eight House Members: Reps. Ron Kind (D-WI 3rd), Paul Ryan (R-WI 1st), Mark Pocan (D-WI 2nd), Sean Duffy (R-WI 7th), Gwen Moore (D-WI 4th), Reid Ribble (R-WI 8th), Tom Petri (R-WI 6th), Jim Sensenbrenner (R-WI 5th).

The Wisconsin Hospital Association and Wisconsin hospitals express gratitude for the strong commitment to CAHs and rural health care.

Read the full letter at: www.wha.org/pdf/CAHletter10-10-13.pdf.

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TCAB Improves Nurse Teamwork at Mayo Clinic Health System

The inspiration for change can strike at any moment. For a group of front-line nurses from Mayo Clinic Health System-Franciscan Healthcare, La Crosse, their motivation to try "small tests of change" was sparked when they attended WHA’s first Transforming Care at the Bedside (TCAB) Conference in September 2012.

"Without the education and pep talk staff received at the initial WHA TCAB Kick-Off event, our nurses from 9 Center would not have had the tools to be successful. The staff who attended used the information learned to problem solve and complete small, very small tests of change," according to Shannon Klar, director of patient care for 9 Center. "It also gave them motivation and enthusiasm to come back to the unit to make things better for our patients, and ourselves. They had the mindset that any idea is a good one, and if it doesn’t work, that doesn’t mean we failed; it means we can now start on something else that might work better!"

The nurses started small, with a project aimed at improving teamwork by helping each other get a timely break. The idea was simple—two RNs paired up for one shift for one day. They were instructed to coordinate break times with their "break buddy," so they could cover for each other when one took a break. With each new trial, or cycle, of change, more nurses were grouped together to provide break coverage. At the end of the implementation period, all RNs on the unit were regularly receiving a break. Now, a year later, staff appreciates their breaks, and they continue to encourage one another to get a break even during the busiest days.

Why is a break so important?

"Not only do nurses have more energy and improved attitudes, but by encouraging staff to get breaks, we have seen increased accountability, teamwork and patient safety," according to Diane Holmay, chief nursing officer. "Break buddies help each other get to break, are there to help you work through those unexpected situations, and your buddy is the first person you seek out when you have a hand to offer."

Kathy Moritz, former director of 9 Center and current administrator for surgical services, said she was aware of TCAB, so she saw the value of sending staff to the WHA TCAB conference.

"When I saw this opportunity, I felt it would be a great way to involve our front-line staff in improving work processes, the unit environment, and patient care," Moritz said. "The program sounded exciting, and I felt it would be a good tool to motivate the 9 Center team to continue to work as a strong unit."

What advice would the TCAB unit have for other hospitals? Don’t be afraid to fail; it is just giving you a new opportunity.

TCAB participants who attended a recent WHA-sponsored event selected "Break Buddies" as the "best idea to steal" from the more than 24 projects that were showcased.

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WHA’s Warmuth Announces Retirement Plans

After a decade of service to the Wisconsin Hospital Association and a long career in health care, Judy Warmuth, vice president of workforce development, announced she plans to retire. Her last day at WHA is January 2.

At WHA, Warmuth has been responsible for workforce policy development, advocacy and education, including monitoring workforce data, creating and maintaining initiatives to recruit and educate health care professionals, promoting better understanding of the challenges facing current and future health care professionals and working with partners to advance key initiatives. Warmuth compiled WHA’s regular Health Care Workforce Reports, which have become well-respected sources of data on Wisconsin’s health care employment landscape.

Over her career, Warmuth was manager of patient care services at Group Health Cooperative of South Central Wisconsin, she served as director of nursing-acute care at Meriter Hospital, Madison, and held staff nurse positions in the ER and ICU.

"Judy has been a key member of the WHA policy and advocacy team. Her deep clinical knowledge and understanding of workforce issues made her a valuable resource to WHA staff and, most importantly, our member hospitals and health systems," said WHA Executive Vice President Eric Borgerding. "We have all learned from Judy—she is a tremendous colleague and team member. We thank her for 10 years of valuable service and wish her and her family nothing but the best in the future."

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WHA Seeks Candidates for Vice President, Workforce Development

With Judy Warmuth’s retirement announcement, WHA is seeking candidates interested in the position of vice president of workforce development in the Government Relations Department. Specific expectations for the position include background in regulatory and policy functions, and clinical knowledge and experience. For more information contact Mandy Ayers at WHA at mayers@wha.org or 608-274-1820.

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Wisconsin Reputation for Health Care Transparency Highlighted at State Forum

Wisconsin is a national leader in health care quality and cost transparency. That reputation prompted the University of Pittsburgh Institute of Politics to invite Debbie Rickelman, vice president of the WHA Information Center (WHAIC) to deliver a presentation October 10 on PricePoint (WiPricePoint.org) at a best practices forum held in Pennsylvania.

At the request of the Institute of Policy staff, Rickelman discussed the culture of transparency in Wisconsin, how discharge and fiscal survey data is used to populate PricePoint, and how users are able to access information on inpatient services, outpatient surgeries, emergency department and urgent care visits and ancillary services such as radiology and therapies, all through a simple online search engine.

"The audience was interested in the fact that we did not implement PricePoint based on state mandate," Rickelman noted. "Rather we added value for consumers, employers and policymakers by using data that is already available. Our goal was not to add an administrative or reporting burden to Wisconsin’s health care facilities."

Rickelman said PricePoint is just one tool that supports health care transparency in Wisconsin. It can be used effectively with other tools, such as WHAIC’s four annual publications, along with other online transparency resources that have been recently developed by payers, providers and employers.

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Wisconsin Hospitals Community Benefits – Charity Care

Fear of a bill should never prevent a patient from seeking care at a Wisconsin hospital. Wisconsin hospital charity care programs provided $232 million to more than 700 patients each day last year. The stories that follow illustrate the deep commitment and continuing concern that hospitals have to their patients to ensure they receive the care they need regardless of their ability to pay.

Community Care helps a devoted husband in need

In the early hours of the morning, Thomas DeNoble was experiencing severe abdominal pain, so he decided to go to the Emergency Department at Wheaton Franciscan Healthcare – Franklin Hospital. It turned out that he had a complete blockage in his intestines caused by past hernia surgeries. He was admitted into the hospital and stayed there for two days until the blockage was cleared. But this was not the end of his worries.

At age 56 and retirement around the corner, Thomas also had to worry about finding a job. He quit his past job as a tool manufacturer to take care of his wife who was diagnosed with Alzheimer’s disease and a form of muscular dystrophy. He received financial aid for taking care of his wife, but when his wife was admitted into a nursing home, he was left with no income and no insurance.

While facing the burden of his job search and recent hospitalization, Thomas’s heart began to race. He called his doctor’s office and found out that he was having a reaction to his new blood pressure medicine. The nurse told him to go to the emergency department right away to get immediate attention. He was later was prescribed a new blood medication that would better suit him.

Wheaton Franciscan Healthcare provided services at no cost to Thomas through Community Care, the System’s charity care program that assists patients with financial need.

"I feel like the luckiest man on earth to receive this care," Thomas expressed. "It feels like I won the lottery."

Thomas was so pleased with his care that he brought the staff treats and homemade cards to show his appreciation.

"This is the best hospital there ever was. The staff and the care are top notch," Thomas said. "There aren’t any words to express my gratitude for their compassion," he added.

Wheaton Franciscan Healthcare – Franklin


A Helping Hand when new symptoms arise

M.J. was admitted to the Emergency Department at Aurora Medical Center Grafton (AMCG). She is a single woman with diabetes who recently lost her BadgerCare Core when her income increased due to working overtime. She was very concerned about how she was going to pay for her services; however, she felt she had no choice but to seek emergency assistance when she began experiencing new symptoms of light-headedness upon standing and an increased heart rate.

Diabetes can be difficult for many patients to manage on their own. Without proper management, an elevated level of blood glucose for a long period can cause irreversible damage to nerves causing diabetic neuropathy, which is the most common complication of diabetes. This is what was causing M.J.’s new symptoms.

While receiving care in the hospital, M.J. asked to speak with a financial counselor. She was very relieved to know that Aurora Health Care offered the Aurora Helping Hand Patient Financial Assistance program to patients who meet the requirements. M.J. completed the Aurora Helping Hand application right away and provided the required documentation. She was approved for a 75 percent discount on her hospital expenses. When she received her approval in the mail, she called the financial counselor immediately to express her gratitude for the excellent service she received at AMCG.

Aurora Medical Center in Grafton


Helping the uninsured laborer

Sarah was living here and there staying with friends trying to find steady employment with benefits. This was quite difficult to do in Sarah’s line of work as a cook. Most restaurants do not offer health insurance or other benefits for their staff. Sarah was currently between jobs when one afternoon she had what everyone would dread—CHEST PAIN! Sarah was afraid to go to the hospital because she did not have any health insurance but she also knew that her life could depend on treatment. So she swallowed her pride and came to Holy Family Memorial’s emergency room. She was admitted for observation and had numerous tests to diagnose her condition. Luckily Sarah’s results were all very positive and relief giving.

Sarah applied for Community Care and Holy Family Memorial was able to help her through this difficult time both medically and financially.

Holy Family Memorial, Inc., Manitowoc


Submit community benefit stories to Mary Kay Grasmick, editor, at
mgrasmick@wha.org.

Read more about hospitals connecting with their communities at www.WiServePoint.org.

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