December 27, 2013
Volume 57, Issue 52
WHA Membership Engagement Helps Drive 2013 Accomplishments
As the door closes on 2013, Wisconsin health care leaders are looking back at the past year as one of the most tumultuous they have faced. The implementation of health reform, the launch of the federal health insurance exchange, and a myriad of other payment and policy issues at both the state and federal levels kept health care in the news and health care leaders on the edge of their seats for most of the year.
WHA President Steve Brenton called 2013 one of the busiest and most successful he can remember in his 25 years as a hospital association executive. That success was driven by an engaged membership as health care leaders came together on WHA Councils, Task Forces and Committees to dialogue on complex issues and develop recommendations that provided invaluable guidance on legislative and policy issues. The work products, recommendations and motions that were acted upon by the WHA Board in 2013 generally began as discussions that required expertise, experience and vision—all hallmarks of Wisconsin’s health care leaders.
"We are very fortunate in Wisconsin to have some of the most highly-recognized health care organizations in the country contributing to our reputation as a state that delivers high-quality, high-value health care," according to Brenton. "We don’t wait to see what the future will bring, rather, we help shape it to ensure that we can continue to provide the very best care possible to the patients we serve."
Over the past year, the Association made a significant and meaningful difference in a number of key areas, from coverage to tort reform to performance improvement. The 2013 WHA Results summarizes the Association’s major advocacy efforts, quality initiatives and program activities over the past year. A copy was sent to hospital and health system CEOs. Contact Mary Kay Grasmick at WHA firstname.lastname@example.org or 608-274-1820 for more information.
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Guest Column: WHA Chair Dan Neufelder Reflects on 2013
"I remember the day that then-WHA Board Chair Bob Fale asked me if I would consider serving on the WHA Board, and I thought, ‘what an honor!’ I feel I have received more than I put in. I am impressed with the members who come together throughout the state and dialogue on a variety of issues. Because of that, I have a much broader understanding of the issues facing every hospital in our state. While all our hospitals are different, the desire to do our best for the communities we serve is the same. It’s that drive we all have to come together and be recognized as one of the best health care states in the country.
It’s been an honor to be on the Board and to serve as your Chair. The engagement of this Board has been positive and powerful. I have tremendous respect for all the Board members, Steve, Eric and the entire team at WHA. It has been a year of remarkable achievement in an era of uncertainty and confusion. In spite of those challenges, we have been able to move forward and make significant changes on issues ranging from Medicaid, the physician workforce, behavioral health and quality. The integration of quality improvement into the clinical setting has been incredible. It has not only improved the quality of care, but also our patients’ satisfaction with the care that they receive.
It is an honor and privilege to serve the Board and our members, and I know you will be in good hands with incoming Chair Ed Harding."
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Wisconsin has an increasing presence of influenza according to weekly reports provided to WHA by Jonathan Temte, MD, PhD. Temte, a professor of family medicine at the University of Wisconsin School of Medicine and Public Health, serves on the U. S. Advisory Committee on Immunization Practices. Throughout the influenza season, he shares his weekly 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.
According to the state influenza report from the week of December 16, 12.5 percent of the 762 influenza specimens in Wisconsin were positive. There have been 146 reported influenza-associated hospitalizations across Wisconsin (71 percent were for individuals aged 18-64) with 21 ICU admissions (81 percent for persons aged 18-64). Bottom line so far—this is an A[H1N1] season, hitting younger folks more than usual.
The prevalence of influenza-like illness (fever of 100 degrees F or higher and either cough or sore throat) among Wisconsin’s primary care patients is estimated to be 1.9 percent and is increasing, while 12.1 percent of the primary care patients seen the week of December 16 had all-cause respiratory infections.
Temte said there is an excellent match between the circulating strains of the flu and the vaccine this year.
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Need Hotel Reservations? Contact The American Club at 800-344-2838 before February 20.
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Under a bill supported by WHA and signed into law December 19, 2013 by Governor Scott Walker, nursing students, with the written approval of their school, will be allowed to take their licensure exam before graduation. While graduation will still be a requirement for licensure, individuals that choose this early testing option will be licensed more quickly.
Employers often prefer to employ new nurses that have already taken and passed the licensure exam and are fully licensed. Traditionally, nursing students have not been able to apply to take the NCLEX (licensure exam) until completion of their educational program and certification by their educational program. For those students ready and wanting to work as a registered nurse, this may lead to weeks of delay before beginning their career and earning a salary.
Nursing programs will be able to set policy about how long before graduation and to which students approval will be given. This bill creates an opportunity for new nurses to more quickly move into professional employment.
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The Wisconsin Legislature recently passed and, on December 13, 2013, the Governor signed 2013 Wisconsin Act 111 (the "Act"), a comprehensive overhaul of the Wisconsin informed consent doctrine codified at Wis. Stat. § 448.30. The Act effectively overrules the Wisconsin Supreme Court decision in Jandre v. Wis. Injured Patients & Families Compensation Fund ("Jandre"). The supporters of the Act believe that its enactment should be a positive development for both patients and health care providers in Wisconsin.
The Act should benefit patients by promoting practices whereby more consumer-helpful information gets to patients regarding the risks of and alternatives to the treatments proposed by their physicians for their diagnosed medical conditions. This should make health care more understandable, accessible and affordable generally. It should minimize the unhelpful practices that resulted under the overturned court precedent, which encouraged physicians to practice defensive medicine and potentially overwhelm patients with more information than was useful, including information about tests and treatments for conditions ruled out by the physician.
The Act is also a positive for health care providers, because it correlates the requirements of providing informed consent to sound common-sense medical practices. The amended statute does not require a physician to provide information about alternative medical treatments for conditions the physician has not included in his or her diagnosis. Importantly, the Act also makes the test for evaluating a physician’s compliance with the revised informed consent doctrine what a reasonable physician in the same or a similar medical specialty would disclose under the circumstances. This is a significant change from the standard discussed in Jandre, in which the lead opinion said physicians are required to obtain informed consent by providing what a reasonable patient, with the benefit of hindsight, would wish to have known. The Act will result in Wisconsin’s informed consent requirements being more consistent with the requirements in other states.
The Informed Consent Obligation
Like most states, Wisconsin imposes two distinct legal duties on physicians—(1) to provide non-negligent medical care, and (2) to secure a patient’s informed consent to that care. The modern informed consent doctrine has evolved far beyond its origins in battery law (based on the notion that a physician should not be able to conduct intrusive physical treatments without the patient’s informed consent). Although the language of the informed consent statute in Wisconsin in effect prior to the Act only required information about "treatment" options, our Supreme Court had interpreted the term "treatment" to encompass diagnostic testing. It also declined to permit physicians to defend the adequacy of their disclosures based on what other comparable health care providers would have done under the same circumstances.
The Jandre Decision
The physician in Jandre argued to the Wisconsin Supreme Court that the informed consent obligation in Wisconsin requires disclosures related to the condition(s) the physician believes the patient has. The physician argued that requiring disclosures about excluded diagnoses would encourage the practice of defensive medicine and, in most instances of patient care, would actually impair decision-making by increasing the amount of largely irrelevant information before the patient. The Wisconsin Supreme Court rejected the physician’s arguments in a sharply-divided opinion.
The Act’s authors, Rep. Ott and Sen. Grothman, with the bill’s proponents, including the Wisconsin Hospital Association, the Wisconsin Medical Society, ProAssurance of Wisconsin, and others, worked to address the issues created by the Jandre decision by reevaluating and revising the duties of disclosure. The new statutory language should be a positive development for Wisconsin health care providers and patients alike.
Mr. Van Sicklen argued Jandre before the Wisconsin Supreme Court.
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The Wisconsin Office of Rural Health in conjunction with the Wisconsin EMS Association is hosting a Community Paramedic Stakeholder’s Symposium January 28 at the Hilton City Center in Milwaukee.
Wisconsin, like many states, is facing shortages and misdistribution of health care providers. This problem is expected to become worse as the population ages and as more people gain access to health care through coverage expansions. Community Paramedicine and Integrated Mobile Healthcare are valuable responses to this challenge, as well as being an opportunity to provide preventive care, which can keep patients out of the emergency room and the hospital. Community Paramedicine programs have been successfully implemented in other states and communities. To be successful, these efforts require stakeholders to sit down together to develop programs. These include not just the health care sector (hospitals, EMS, clinics) but technical colleges and universities, insurers, home health, long-term care and policymakers.
The Symposium will bring together these diverse groups to learn more about Community Paramedicine. Presenters will discuss the successful implementation of Community Paramedicine programs. There will be a panel discussion on what’s been happening in Wisconsin, as well as plenty of opportunities for questions and discussion.
The agenda and registration are at: www.worh.org/events/wisconsin-community-paramedic-stakeholder%E2%80%99s-symposium. This event is free and lunch will be provided. Contact Kevin Jacobson at the Office of Rural Health at email@example.com if you have any questions.
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The Wisconsin Chapter of the Healthcare Financial Management Association (HFMA) now offers two scholarships, up to $2,000 each, to eligible full- and part-time college students with junior status or higher, pursuing degrees in accounting, business, economics, finance, public policy, public health or a related degree. This new program serves several purposes:
Carmen Wolf, president of the Chapter, states, "The Wisconsin Chapter of HFMA is pleased to offer this program to the dedicated workers and their families who provide health care in the state. Our goal is to say thank you for a job well done and increase awareness of the many challenges facing the health care industry."
For complete eligibility requirements and application forms, please visit HFMA’s website at www.hfmawisconsin.com. Click on "Information" and then "Resource Library." Applications will be accepted until February 28, 2014.
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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.
Community Chronic Disease Management (CCDM) Clinic of Columbia St. Mary’s
Ernell doesn’t like needles. A burly, muscular man, he sits tensely, mumbling as a CCDM technician carefully locates the right spot on his forearm to draw blood. As she gently inserts the needle, Ernell winces, turns away and kiddingly lets out a howl.
That Ernell should harbor such fears about needles is striking, considering that, as a self-employed electrician, he is accustomed to scaling ladders up to 300 feet high inside the huge wind-power turbine towers he helps to wire, carrying a 100-pound load of tools over his shoulder. The full climb takes 45 minutes in either direction.
Ernell has diabetes. He learned about the disease when he lived in Phoenix and was still insured. His blood sugar readings went as high as 500 and 600. Ernell initially refused to go to the hospital, unwilling to admit he had a problem.
He changed his mind as symptoms developed. He needed to use the bathroom several times each night and became dizzy whenever he stooped or squatted down.
Later, after moving to Milwaukee, Ernell monitored his blood sugar daily. But he had no insurance or medicine. He learned about CCDM through his church two years ago.
CCDM treats Ernell for diabetes and borderline hypertension. He quibbles about the latter, claiming that his aversion to needles will cause his blood pressure to spike whenever he visits a clinic. "I don’t care if it’s a foot doctor," he said. "I feel the same way."
Ernell has learned a lot since coming to CCDM. On his first visit, he weighed 280 pounds. Today he weighs about 240. "If I lose this," he said, pointing to his stomach, "my diabetes will improve. I’m working on it, but it’s a battle. It sticks to you like glue."
He now eats more vegetables, salads, dates, pecans, and cashews, and he avoids chips, sweets, and sodas. "I drink fresh squeezed orange juice and stay away from processed sugar," he said.
An electrician for 23 years, Ernell gets exercise on the job. Climbing up the wind towers is extremely challenging, but the work is seasonal. He also does residential, commercial, industrial, and marine work, which keeps him physically active.
CCDM has been good for Ernell. He calls the clinic’s staff friendly and helpful. "They don’t have any attitude," he said. "They’re nice to you, want to know how you’re doing. They’re real cool and help you unwind."
Columbia St. Mary’s - Sacred Heart Rehabilitation Institute, Milwaukee
Submit community benefit stories to Mary Kay Grasmick, editor, at firstname.lastname@example.org.
Read more about hospitals connecting with their communities atwww.WiServePoint.org.
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