December 20, 2013
Volume 57, Issue 51
WHA Board Announces Leadership Succession Transition
The Wisconsin Hospital Association (WHA) Board announced December 12 that WHA Executive Vice President Eric Borgerding will succeed Steve Brenton as president and chief executive officer of the Association effective January 1, 2015. Brenton, who has more than 23 years with the organization, will assume duties as WHA’s senior policy advisor at that time.
Borgerding will bring nearly 25 years of experience in government relations and advocacy to the top WHA post, including the past 12 years leading WHA’s advocacy efforts. He was named director of legislative affairs for WHA in 1992 and became the chief state lobbyist for the University of Wisconsin-Madison in 1994. In 1997 he was named director of legislative relations at Wisconsin Manufacturers and Commerce where he directed the business group’s lobbying efforts in the areas of energy, transportation and health care. When Brenton was named President of WHA in 2002, he recruited Borgerding back to the organization as vice president of government affairs. Borgerding was named senior vice president in 2003 and executive vice president in June 2007.
Brenton rejoined WHA in January 2002 after working for the Association earlier in his career when he served as WHA’s senior vice president for Government Relations. He left WHA in 1988 to become president of the West Virginia Hospital Association. In 1992, Brenton returned to the Midwest when he was named president of the Iowa Hospital Association until his return to Madison.
Brenton’s professional background focuses heavily on federal and state government relations and advocacy. He has been in leadership positions on numerous state boards and health-related organizations.
"WHA has become a powerful, valued voice for hospitals and health systems under Steve and Eric’s leadership. Their ability to develop thoughtful, effective strategies to address legislative, regulatory and reimbursement issues, and assemble a team of highly-talented, dedicated staff has made WHA one of Wisconsin’s top advocacy organizations," according to WHA Board Chair Dan Neufelder, senior vice president, hospital operations, Ministry Health Care. "With today’s announcement, we have taken a significant step in ensuring that WHA will continue its track record of strong leadership and effective advocacy for health care in Wisconsin."
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Governor Walker signed special session bill AB 1 into law December 20, officially extending Medicaid eligibility for three additional months for approximately 77,000 people currently enrolled in the program. The legislation would also extend the state’s Health Insurance Risk Sharing Program (HIRSP) for an additional three months, to March 31, 2014. Governor Walker proposed this legislation in a special session of the Legislature in response to concerns that the federal health insurance exchange would not be operational for those who would otherwise have lost Medicaid and HIRSP eligibility January 1, 2014.
The special session bill was introduced in early December and was finally passed out of the state Senate on December 19 on a party line vote. The bill passed the Joint Finance Committee and the state Assembly with a bipartisan vote earlier this month. Senate Republican Majority Leader Scott Fitzgerald (R-Juneau) released a statement after Senate action this week, committing that state Republicans will continue to "work with the Walker Administration to implement our budget plan that will reduce the total number of uninsured and cover everyone living in poverty for the first time in state history."
As reported in the December 6 edition of The Valued Voice, an amendment was included in the bill that would ensure that any surplus created in the HIRSP program from provider discounts would go back to providers. This amendment was incorporated into the bill unanimously by the Joint Committee on Finance and approved by both chambers of the Legislature.
WHA continues to work through its Enrollment Action Council and with the Department of Health Services (DHS) and other partner agencies to assist patients and consumers in understanding their coverage options. DHS released information December 19 indicating that they will communicate these most recent changes to current Medicaid recipients and to childless adults who are on the Core plan waiting list through letters to be sent beginning on Monday, December 23. DHS has reported they will also make phone calls to affected individuals in January. To view the DHS letters, see the WHA web page at: www.wha.org/outreachplans.aspx.
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The demand for advanced practice professionals (APPs) in Wisconsin remains strong as health care providers expect the Affordable Care Act (ACA) to trigger an increase in demand for basic medical services. Evidence is mounting that the predicted shortage of primary care physicians is being partially addressed by incorporating APPs into hospitals and clinics. The reported 2012 vacancy rate of 7.6 percent for advanced practice nurses and physician assistants is the highest reported by hospitals in the annual WHA hospital personnel survey. The survey includes all hospitals in Wisconsin and represents an accurate picture of hospital-based employment.
While employment in health care has remained fairly steady during and after the recent recession, hospital vacancy rates in the 17 clinical occupations included in the survey, excluding APPs, have steadily declined.
According to a new report released by the Wisconsin Hospital Association, vacancy rates in most health care occupations have slowly declined over the past five years. However, "The recession reshaped the health care landscape. At one time, health care workers expected to retire in their late 50s; now, the economy has caused these folks to stay in the workforce longer," according to Judy Warmuth, RN, PhD, vice president of workforce at WHA. "Many hospitals are reporting that at least 20 percent of the people working in some areas of the hospital are over 55. When these individuals begin to retire over the next decade or so, that will open the door for new graduates."
The shift of surgeries and procedures from inpatient to the outpatient settings continues, which means that hospital employment has seen a slight decline with a parallel increase in employment in other types of care facilities.
Registered nurses (RNs) remain the largest occupation group in health care with 90,000 RNs currently in Wisconsin, with a hospital registered nurse vacancy rate of only 3.4 percent. Aging of the RN workforce continues to be a concern. Nearly 30 percent of all Wisconsin working nurses are over age 55. An almost alarming number of nurse educators and faculty are over age 55.
"With more than 30 percent of working nurses saying they plan to retire over the next nine years, it will open employment opportunities for new graduates; however, it also means that a great deal of knowledge and experience will be leaving with those retiring nurses," Warmuth said.
The WHA report also found:
The uncertainty brought on by health reform over the past 24 months is complicating the already dynamic process that is required to staff a hospital 24/7, 365 days a year.
"Our employees are our greatest resource as we create and sustain the high-quality, high-value care delivery system that we expect in Wisconsin," said WHA President Steve Brenton. "But, as hospitals continue to navigate through health reform, facing deep payment cuts while at the same time seeing more patients, staffing will continue to be a challenge."
To ensure that Wisconsin maintains an adequate number of prepared health care professionals, WHA makes the following recommendations in the report:
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Physicians eligible for the Medicaid primary care payment increase must submit their attestations by December 31, 2013, or forego receiving 2013 payments. The payment increase can be significant—a Kaiser Family Foundation report indicates that in Wisconsin the new payments are estimated to be about 78 percent higher than current Medicaid rates.
"This is a great opportunity to take advantage of this temporary higher reimbursement which is a positive provision for providers in the ACA," said Brian Potter, WHA senior vice president, finance. "While this is great news, it does require organizations to take action to qualify," he added.
Under the Affordable Care Act (ACA), states are required to raise their Medicaid fees to Medicare levels for family physicians, internists, and pediatricians for many primary care services. Advanced practice providers who are physician assistants, nurse practitioners, or nurse midwives are also eligible for the primary care rate increase if they are supervised by an eligible physician.
Providers must complete an attestation in order to be eligible for the higher payments. If the attestation is completed before December 31, 2013, physicians can receive retroactive payments for qualifying services. If the attestation is completed on or after January 1, 2014, the provider will only be eligible for the rate increase beginning on the date of attestation going forward.
The Department of Health Services (DHS) began reimbursing for primary care services at the higher Medicare rate for current claims submissions earlier this fall. The primary care fee increase applies only for two years—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 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.
The payment is required to be made for both fee-for-service and managed care payments. FFS payments will be made on a claim-by-claim basis. DHS is requiring Medicaid HMOs to pay providers the difference between the Medicare rate and their contracted provider rate. Department staff has indicated they will be monitoring the payment process through the Medicaid HMOs.
The bottom line is that physicians should make sure they follow the DHS process and submit their attestations by the end of the 2013 calendar year, or they could miss out on a full year’s worth of higher payments.
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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The National Summit on Transparency in Health Care Cost, Prices and Quality, sponsored by the Robert Wood Johnson Foundation (RWJF), was held in Washington December 2-4. Approximately 175 cross-industry stakeholders attended in person with another 41 participating via web cast.
Debbie Rickelman, vice president, WHA Information Center, participated on a panel addressing hospital pricing transparency initiatives. She outlined the development of PricePoint (WHAIC’s pricing transparency website), described other transparency tools used in Wisconsin, and informed the audience on how the Wisconsin approach has helped industry partners respond to consumers, regulators and the media.
AHA President/CEO Richard Umbdenstock participated in a panel titled, What Are the Policy Objectives of Increased Transparency? To that point, Umbdenstock said, "We need better informed patients and providers to drive improvement. This can be accomplished using a variety of tools to generate a wider distribution of knowledge."
Susan Dentzer, RWJF senior policy adviser, noted in a separate session, "Transparency in the hands of consumers could be powerful—but in the hands of providers, even more so."
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On February 7, 2014, from12:00 noon to 1:00 p.m., 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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The Wisconsin Hospital Association is now publishing a quarterly Behavioral Health Bulletin, a new e-publication for hospital and clinic administrators, physicians and other clinicians affiliated with WHA members interested in receiving regular information on key behavioral health policy and emerging practice models. Originating from a recommendation of WHA’s Behavioral Health Task Force, this new quarterly, bulletin-style publication will be brief in format with links for more in-depth information. It will focus on education and trends on emerging behavioral health practice models, especially integrated care models. See the latest Bulletin at www.wha.org/behavioralhealthbulletin.aspx. If you would like to receive this Bulletin, contact Tammy Hribar at firstname.lastname@example.org or 608-274-1820 for inclusion on the email list.
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Where do you go when you need a doctor and you don’t have insurance? More and more hospitals are establishing free clinics to serve those who do not have a "medical home." Every effort is made to connect patients with follow up care and even help them obtain the medical supplies or prescription drugs that they need.
Aurora Walker’s Point Community Clinic
Founded in 1992, Aurora Walker’s Point Community Clinic is one of Milwaukee’s oldest health clinics for families who do not have health insurance and cannot afford health care. Located on Milwaukee’s south side, the clinic provides medical services such as general check-ups, minor injury care, various lab services, children’s vaccinations, walk-in blood pressure and blood sugar checks, ophthalmology and referrals for other medical services. Patients can also take part in diabetes education, spiritual counseling, psychological counseling, prescription assistance, social services, and adolescent health programs. Walker’s Point Community Clinic served 4,300 patients in 2011, with 11,943 medical visits, 700 mental health visits and more than 1,400 social service visits.
E.S. is a young man who arrived at the clinic one morning with a swollen and bruised ankle. At the time, he was a participant of a work-study program and had no income or medical insurance coverage. When the nurse practitioner examined him, it was determined that his ankle was badly sprained. The practitioner was able to wrap his ankle properly and provide him with a prescription through the prescription assistance program to help with the severe pain he was experiencing. Once his ankle healed, E.S. was able to complete his work-study program and is now employed full-time, insured, and established with a primary care provider.
"Walker’s Point was there for me when I needed help. There was no way that I could afford a visit to the emergency room. I am forever grateful for the support they gave me." -E.S.
Aurora Health Care, Milwaukee
Submit community benefit stories to Mary Kay Grasmick, editor, at
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