December 5, 2014
Volume 57, Issue 39

·         35 Hospitals Identified as Ebola Treatment Centers 

·         Cong. Sean Duffy Leads Bipartisan Letter

·         Register Today for WHA 2015 Physician Leadership Development Conference

·         Wisconsin Health News Panel Focuses on Hospital, Health System Partnerships

·         WHA Webinar Series Focuses on Hot Topics for Hospital HR

·         WHA Provides Testimony on Wisconsin’s Safe Haven Law

·         CMS Issues Final Rule on Medicaid DSH Payment Uninsured Definition

·         Support Statewide Health Care Initiatives with Contribution to WHA Foundation

·         Opportunity to Transform Ambulatory Practices

·         Member News: Crossing Rivers Health to Receive Wisconsin Forward Award

 

 

35 Hospitals Identified as Ebola Treatment Centers 
Froedtert, UW Hospitals and Clinics, Children’s Hospital among those named

Three Wisconsin health systems were among the 35 hospitals identified December 2 by the Department of Health and Human Services (HHS) as Ebola treatment centers. In addition, as part of a tiered-hospital strategy, the Centers for Disease Control and Prevention (CDC) released interim guidance for states and hospitals to use as they identify and confirm Ebola treatment centers and interim guidance to use as they identify Ebola assessment hospitals.

“Wisconsin is served by hospitals and health systems dedicated to caring for all those in need, and being there at times when needs are greatest,” said WHA Executive Vice President Eric Borgerding. “There’s a lot more to being a designated treatment facility than simply agreeing to be one. It takes tremendous preparation from dedicated caregivers and engaged leaders willing to take on this role, and Froedtert, UW and Children’s are some of the finest examples of Wisconsin hospitals’ commitment to care and service.”

Froedtert & The Medical College of Wisconsin Froedtert Hospital campus, Milwaukee; UW Hospitals and Clinics, Madison; and Children’s Hospital, Milwaukee are among the 35 hospitals with 53 treatment beds located in 12 states and Washington, D.C. Additional facilities are expected to be added in the next several weeks. More than 80 percent of returning travelers from Ebola-stricken countries live within 200 miles of an Ebola treatment center, HHS said.

The announcements were part of an update from the White House on the government’s efforts to respond to Ebola and the need for immediate, additional funding to support these efforts. In a statement, AHA President and CEO Rich Umbdenstock said, “America’s hospitals are investing enormous time and resources to enhance our country’s readiness for the new and real threat of Ebola,” and he reiterated the AHA’s request for “Congress to approve at least $500 million in funds to help hospitals better prepare to win the battle against Ebola.” (See AHA Politico ad at www.aha.org/content/14/141202-aha-ad.pdf)

Wisconsin hospitals continue to prepare for the possibility of encountering a patient suspected of Ebola. In the event Ebola is diagnosed in the state, the Wisconsin Department of Health Services will work with partners and the three designated health systems to care for patients, ensuring that each patient receives the best care while protecting health care workers and the general public.

See CDC’s advisory at www.advisory.com/daily-briefing/2014/12/02/cdc-names-35-hospitals-as-designated-ebola-centers.  

 

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Cong. Sean Duffy Leads Bipartisan Letter
Urges President not to cut rural hospital reimbursement   

U.S. Rep. Sean Duffy (WI-07) led a bipartisan letter with 45 other Members of Congress in support of rural hospitals. In a letter delivered to President Obama, the group asked the President to refrain from including arbitrary cuts to critical access hospitals (CAHs) in his upcoming budget request.

The President has previously included proposals reducing Medicare reimbursement for CAHs and removing the “critical access” designation for any hospital within 10 miles of another hospital.

With respect to these two proposals, the letter reads:

“CAHs play an important role in our communities by providing access to primary, emergency and acute care services…We believe these savings are overstated, as patients will still need to seek care at other facilities…indiscriminate cuts to CAHs, similar to those included in previous budgets, are not the answer.”

WHA expressed appreciation to Rep. Duffy for leading this letter and thanked other Wisconsin House Members—U.S. Reps Kind, Ribble and Pocan—for signing on as well.

“Wisconsin’s small, rural citical access hospitals continue to be an important part of the health care fabric of our state,” said WHA Executive Vice President Eric Borgerding. “WHA thanks Rep. Duffy for his leadership on this letter and appreciates all those who continue to champion the cause of rural hospitals.”

Read the full, signed House letter at: www.wha.org/pdf/2014CAHtoObama11-14.pdf

Read Rep. Duffy’s press release at: https://duffy.house.gov/press-release/duffy-to-president-critical-access-hospitals-are-critical-to-rural-america.  

 

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Register Today for WHA 2015 Physician Leadership Development Conference
March 13-14, 2015 in Kohler

Physician leaders must represent both clinical and managerial interests, which is the focus each year ot the WHA Physician Leadership Development Conference. The annual conference benefits both new and seasoned physician leaders, and focuses on 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.

This year’s conference will include a full-day session focused on the tools, techniques and skills to not just manage but lead strategic innovation and change within your organization, presented by William “Marty” Martin, PsyD, one of this event’s most popular faculty. In addition, the half-day session, presented by Barry Silbaugh, MD, will focus on moving a perspective and skill set from that of a physician working autonomously to leading a team and influencing others to change. Both Martin and Silbaugh are faculty from the American Association for Physician Leadership (formerly the American College of Physician Executives).

Registration is now open for the tenth annual “WHA Physician Leadership Development Conference,” scheduled Friday, March 13 and Saturday, March 14 at The American Club in Kohler. Information and registration are available at http://events.SignUp4.net/15PLD. The conference brochure is included in this week’s packet. As a reminder, the special room rate is only available until February 19 or until the room block fills (which it does quickly each year), so make your hotel reservations today.

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Wisconsin Health News Panel Focuses on Hospital, Health System Partnerships

Through mergers, strategic alliances and quality partnerships, Wisconsin hospitals and health systems are increasingly teaming up. At a December 2 Wisconsin Health News briefing, a panel of experts helped explain what’s driving these new agreements and what the ultimate impact will be on the state’s health care market.  

Panelists included Greg Devine, CEO, abouthealthTM; Damond Boatwright, regional president/CEO, SSM Healthcare of Wisconsin; and Peter Pruessing, CEO, Integrated Health Network of Wisconsin. 

Panelists noted what health care experts have known for a long time—that the Wisconsin health care market is different from most others and provides high-quality care.  Nevertheless, the growing number of alliances is a nationwide trend. 

While driven partly by the desire to achieve scale and have a large population base, new affiliations are also driven by the need for affordability for consumers.  

“How do we make health care more affordable?...It is very hard to do that unless you have most of the components that drive the cost of care under single ownership or a very well-defined affiliated partnership,” Boatwright said. “A lot of hospitals and health systems are merging, affiliating and partnering with one another to try to find that ‘secret sauce’ to affordability.”

When asked if all of these mergers and acquisitions will decrease competition and actually raise prices, panelists responded that there is still competition, but an enhanced level of competition. Providers can have their own business plans and compete with each other while collaborating.

“… Competition gets all the attention and collaboration doesn’t get enough attention,” said Pruessing. “These things can coexist, and they can create value together.”  He noted that clinical integration, data and analytics, and a care model are all components of Integrated Health Network’s collaborative strategy.

As the CEO of the newly-announced abouthealthTM, Devine noted the groups are still in the early stages of working together, but they believe that scale matters for affordability and efficiency.

“The focus is about the patient. It’s not just about the work we do for them in their health plans or benefit coverage… we are looking at how we can address individuals’ health but also things that are not just traditional health delivery in the way we commonly consider that,” Devine said.

Their goal is to also improve access to advancing technology and clinical research, which benefits everyone.

While each of the panelists views working with insurance companies a bit differently—some collaborate while others own insurance companies—all agreed that partnerships between care providers and insurers can help drive value.   

A general concern about the mergers and collaborations on the impact of rural health care providers was discussed, with panelists commenting on the continued need for rural hospitals and providers as essential for access.

“In the end, health care is local,” said Boatwright.  

 

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WHA Webinar Series Focuses on Hot Topics for Hospital HR  

Beginning in January, WHA is offering members a three-part webinar series addressing timely and relevant labor and employment issues for all health care providers. The individual webinar sessions will address three important labor and employment issues, each presented by attorneys from the labor and employment practice of Reinhart Boerner Van Deuren s.c., a corporate member of WHA. 

Webinars will be held January 23, February 20 and March 20, each focusing on three different topics.

Full descriptions of each topic covered in the sessions, as well as online registration, can be found at: http://events.SignUp4.net/2015LaborEmployWebSeries.

Health care human resources professionals, hospital and health system in-house counsel and others interested in learning more about these important labor and employment issues should plan to participate. Attendees are encouraged to participate in this webinar series as a team, to gather and learn together through one, low-cost registration. While attendees are encouraged to attend all three sessions, the option exists to register for individual sessions as well.  

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WHA Provides Testimony on Wisconsin’s Safe Haven Law
State Tribal Relations Committee pauses on action to mandate hospital procedures

A special committee of the state Legislature met December 4 to consider legislative options that would create additional responsibilities for hospital staff that take in a child under Wisconsin’s Safe Haven Law. Wisconsin’s Native American tribes have stated they believe hospitals should be required to collect information about the tribal heritage of a mother and father of a relinquished child at the time that child is being relinquished. The tribal community has expressed frustration with the Safe Haven Law and have argued that this tribal affiliation information is necessary to comply with the federal Indian Child Welfare Act (ICWA). 

In a memo to the Committee, Joint Legislative Council staff outlined two separate options to collect information about tribal children relinquished under Wisconsin’s Safe Haven law. The first would require that a hospital employee provide a packet to the parent (mother or father) that would include information related to the anonymity and confidentiality provisions of Safe Haven as well as an explanation of the benefits of tribal enrollment. The packet would also include a form to provide information on tribal affiliation along with a postage-paid envelope to return that form. This option would also require a hospital staff person who receives a relinquished child to review the materials with the parent and assist that parent in completing the forms.

WHA provided written testimony to the Committee stating the difficulty that hospitals would have in fulfilling this requirement for all children relinquished under the law. The testimony said that a child can be relinquished to any employee in the hospital and in any location in the hospital, making this mandate difficult to implement. The testimony went on to say that “many individuals within a hospital do not have the appropriate training to assist parents with this activity and would not be comfortable providing this type of assistance.” Finally, the testimony argued that this type of specific process requirement should not be mandated in the state statutes.

The second option would have required that a hospital collect information from an expectant mother at admission about her tribal affiliation, along with information on the father’s tribal affiliation. The option went on to require that the hospitals must provide any information regarding tribal affiliation of the mother or father to the county social services department.

The Joint Legislative Council staff outlined some complications related to this option in their memo, including their opinion that “it appears that HIPAA would prohibit the use of admission information for this purpose.” WHA stated its opposition to this proposed option and stated that this requirement would go against the original intent of Wisconsin’s Safe Haven law. 

Typically, this special committee produces draft legislation for consideration by the full Legislature in the upcoming session. The chairman of the committee, Rep. Jeff Mursau (R-Crivitz) stated that the committee was not ready to take action at this meeting. The chairman encouraged the tribal community, hospitals and counties to work together to further discuss the tribe’s concerns and encouraged stakeholders to pursue non-legislative solutions.

A copy of the testimony is available at www.wha.org/pdf/2014WHASafeHaven12-4.pdf.  

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CMS Issues Final Rule on Medicaid DSH Payment Uninsured Definition

The Centers for Medicare & Medicaid Services (CMS) on November 28 issued the final rule to define “uninsured” for purposes of calculating the Medicaid hospital-specific disproportionate share hospital (DSH) payment limit. The final rule takes effect December 31.  

The final rule is effective for DSH audits and reports submitted for state plan rate year (SPRY) 2011 and after. All states are required to submit their 2011 SPRY audit report to CMS by December 31. The rule amends the definition of “uninsured” for purposes of calculating the hospital-specific DSH payment limit, which is tied to a hospital’s Medicaid payment shortfall plus uncompensated care costs.

While Wisconsin’s Medicaid DSH program in the past provided limited funding directly to hospitals, this biennium the state recognized the need for a more substantive DSH program and provided DSH funding under a formula directly to hospitals serving Medicaid patients. Even though the rule addresses the hospital-specific DSH limit and hospitals are now subject to its requirements, it will have very limited practical effect on Wisconsin hospitals because the amount of DSH funding received by hospitals is far below the significant Medicaid shortfalls they incur—$960 million across all hospitals in Wisconsin in 2013. 

The rule reverses a more restrictive definition for uninsured implemented by CMS in 2008. The amended definition expands the inclusion of the following costs for purposes of calculating the DSH limit.

·         The cost of inpatient and outpatient hospital services furnished to a Medicaid patient who has exhausted applicable state coverage limits can be included in calculating the Medicaid shortfall.

·         The cost of hospital services for individuals who exhausted their insurance benefits or reached lifetime insurance limits can be counted as uninsured costs. These include costs for services not included in the individual’s benefit package, but identified as covered benefits in the state Medicaid plan.

·         The costs of inpatient and outpatient hospital services provided to individuals covered under the Indian Health Services (IHS) can be counted as uninsured costs if the services are provided by a non-IHS hospital and not through an IHS health services contract.

The final rule reiterates previous CMS policy that certain costs are not allowed to be counted for purposes of calculating the DSH limit. Those “unallowable” costs include: bad debt, unpaid coinsurance and deductibles, and hospital-based physician costs.

CMS will provide further guidance to states, auditors and providers, and it has instructed Medicaid DSH auditors to apply the new policy to the DSH audits for SPRY 2011. The final rule can be found at https://www.federalregister.gov/articles/2014/12/03/2014-28424/medicaid-program-disproportionate-share-hospital-payments-uninsured-definition.  

 

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Support Statewide Health Care Initiatives with Contribution to WHA Foundation

Each year, the WHA Foundation supports a variety of initiatives that have statewide impact on health care in the areas of workforce development, quality and patient safety and community collaboration. In 2014, those initiatives include the WHA/RWHC Quality Residency Program, for which the WHA Foundation provided funding for start-up expenses and five scholarships. The WHA Foundation also provided financial support for the third cohort of the Transforming Care at the Bedside (TCAB) initiative, as well as for maintenance of the BSN completion program website, http://BSN.WHA.org.

In order to continue supporting initiatives like these and others in 2015, the WHA Foundation has officially kicked off its annual fundraising campaign, asking WHA hospital and corporate members to consider supporting the WHA Foundation by making a contribution this month.

Funds raised in the current campaign will be used to continue some of its most successful and long-standing initiatives, including the Global Vision Community Partnership Awards and the annual scholarships to graduating technical college students in health-related programs, and give the Foundation the opportunity to consider new initiatives for funding in 2015.

Each WHA hospital member executive has received a direct appeal for the fundraising effort. A contribution form is included in this week’s packet, for anyone who would like to make an individual contribution or one on behalf of your hospital. For more information on the WHA Foundation’s annual fundraising campaign, contact Jennifer Frank at 608-274-1820 or at jfrank@wha.org.  

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Opportunity to Transform Ambulatory Practices

Clinicians want to improve care for their patients and position their practices to thrive in a pay-for-value system. A new national initiative aims to drive this improvement and our patients, communities and health care providers will likely be in a position to benefit.

The Centers for Medicare and Medicaid Innovations (CMMI) recently released two funding opportunity announcements (http://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/) to support the Transforming Clinical Practice Initiative, which seeks to support 150,000 clinicians in their efforts to move through five stages of practice transformation.

Practice transformation networks (PTNs) and support and alignment networks (SANs) will work together to ensure clinicians will be able to sustain practice and care improvements that will:

     Improve health outcomes for patients;

     Improve care coordination through connectivity;

     Improve patient and staff satisfaction; and,

     Improve efficiencies and reduce cost.

WHA is partnering with MetaStar, Wisconsin Collaborative for Healthcare Quality, Wisconsin Medical Society and other stakeholders to prepare an application to become a PTN. In this role, the group will provide support to primary care and specialty clinicians who would like to use their health information technology to improve efficiency in their practice and to provide better coordination of care for their patients. The PTN will help clinicians transform their practices to thrive under new payment models and meet quantifiable improvement outcomes.

The practice transformation network will be an excellent continuation of efforts in our communities that have been successfully bringing providers and practices the benefits of quality improvement, patient-centered care and health information technology alignment. This initiative will provide additional resources that can help Wisconsin providers leverage their own work and that of existing community partners to continue to improve the quality, safety and value of health care through practice transformation.

For more information on the PTN and the support available to your practice, visit www.metastar.com/ptn or contact Kelly Court at kcourt@wha.org. Physicians and advanced practice providers who are interested in this opportunity are encouraged to complete the online Intent to Participate form by December 15, 2015 for inclusion with the Wisconsin application.  

 

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Member News: Crossing Rivers Health to Receive Wisconsin Forward Award

Crossing Rivers Health, Prairie du Chien, will be honored at the Wisconsin Forward Award ceremony December 10 at Monona Terrace in Madison, along with two other Wisconsin hospitals.

Crossing Rivers Health will receive Proficiency recognition for 2014. Crossing Rivers Health is non-profit 25-bed critical access hospital established in 1957 that employs more than 330 health care professionals. Crossing Rivers Health provides more than 60 services to fulfill the health care needs of communities across Southwest Wisconsin and Northeast Iowa, including medical, surgical, obstetrics, outpatient, rehabilitation and emergency services. Crossing Rivers Health demonstrates the true meaning of service excellence as it strives to deliver high-quality, personalized health care and education.

As previously reported in The Valued Voice, Holy Family Memorial, Inc. in Manitowoc will also receive Proficiency Recognition for 2014, and HSHS St. Joseph’s Hospital in Chippewa Falls achieved the level of Excellence, which is the highest achievement level an organization can earn.

Wisconsin Forward Award is Wisconsin’s premier recognition for workplace excellence involving business, education, government, health care and manufacturing. The program recognizes innovative, future-thinking organizations in their quest for customer-focused quality and excellence in performance management. The Wisconsin Forward Award is based on the Malcolm Baldrige National Quality Award for Performance Excellence.

 

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