March 13, 2015
Volume 59, Issue 10


WHA Testifies at Assembly Mental Health Committee
Critical psychiatrist shortage and payment reform pilot savings key topics
 

Wisconsin’s critical psychiatrist workforce shortage was a key concern raised by speakers and legislators during the March 10 Assembly Mental Health Reform Committee meeting.

Citing a 2012 report by Wisconsin’s Department of Health Services (DHS), Matthew Stanford, WHA general counsel, said Wisconsin has a shortage of 271 full time psychiatrists impacting all areas of the state, both urban and rural. The DHS report with a county-by-county analysis can be found at www.dhs.wisconsin.gov/publications/p0/p00376.pdf.

“Not only has the psychiatrist shortage impacted access to outpatient clinical services, but the workforce shortage has also impacted the availability of inpatient services,” said Stanford in WHA’s testimony to the Committee. “While inpatient capacity is typically looked at in terms of number of beds, Wisconsin’s critical shortage of psychiatrists and other mental health professionals is now making it difficult for some hospitals to fully staff those beds.”

Other speakers representing mental health consumers and families echoed concerns about the sufficiency of Wisconsin’s mental health workforce.

Committee Chair Rep. Paul Tittl (R-Manitowoc) said the psychiatric shortage is an issue the Committee needs to address and indicated he is working on a bill proposal. 

“Our work this session is going to be quite intense, and I think we’ll be able to get some good things done for the state,” Tittl said. 

Guided by the work of WHA’s Behavioral Health Task Force and Medicaid Workgroup, Stanford also touched on other opportunities for reform for the Committee to address:

• Payment reform to move away from siloed behavioral health care delivery to mental health care delivery that provides integrated primary care and mental health care across a full spectrum of outpatient, inpatient, and case and care management services.
• Funding for a statewide mental health bed finder based on the successful model funded by Minnesota’s Department of Health Services to help speed transitions of care from an ER setting to a psychiatric inpatient bed or to a community care setting.
• Medicaid prior authorization reform to remove unnecessary and outdated administrative barriers facing mental health care providers and their patients.

Kate Walton, director of state government relations and physician advocacy, UnityPoint Health, echoed the workforce concerns, but also highlighted a successful behavioral health integration and care management pilot one of their facilities in Illinois is participating in with the Illinois Medicaid program. That three-year pilot, which provided UnityPoint Health about $1 million in care management fees for 366 individuals, yielded $8.1 million in savings to the Illinois Medicaid program, said Walton. Key outcomes of the pilot included: “There are an increasing number of examples where providing payments to integrated health care providers to provide care and case management services is yielding net health care savings and resulting in better patient outcomes,” says Stanford. “Identifying and testing these types of payment and delivery models needs to be a priority for Wisconsin’s policymakers.”

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Medicaid In The Spotlight


WHA’s past “Spotlights” highlighted Medicaid program underfunding, which has led to unreimbursed costs for hospitals in the amount of an annual $960 million “hidden health care tax” and the need to re-establish a program in Wisconsin known as the Disproportionate Share Hospital (DSH) program. Unfortunately, Wisconsin’s DSH program is one of the smallest in the nation. In this week’s Spotlight we look at Wisconsin hospital and health systems’ ongoing commitment to moderating costs and providing the highest quality health care in the nation even as government underfunds its health care program obligations. 

In terms of quality, over the past seven years, the federal Agency for Healthcare Research & Quality ranked Wisconsin among the top states for health care quality. In addition, The Commonwealth Fund in 2014 ranked Wisconsin’s overall health care system performance in the top quartile of the country. 

In terms of cost efficiency, one example in Southeastern Wisconsin comes from the Greater Milwaukee Business Foundation on Health’s (GMBFH) study done by Milliman that found southeast Wisconsin hospital operating costs increased less than one percent annually over the last four years, from 2009 to 2012—a substantially lower rate than national indices (see graph). Unfortunately, the GMBFH study also found that up to 27 percent of the price paid for hospital services by private payers resulted from government payment shortfalls. 

While Wisconsin’s hospitals are making tremendous progress in becoming more efficient and lowering costs, the Medicaid program is an anchor on that progress. This is why the Legislature should make the DSH program permanent and target additional key funding to it. 

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Security Trends in Health Care Focus of April 8 Webinar

On April 8, WHA is offering a 90-minute webinar focused on what health care executives need to know about health care security trends in 2015. The discussion will include why attackers are targeting health care today and how recent high-profile attacks are changing the health care IT security landscape. The results of the Office of Civil Rights’ (OCR) pilot HIPAA audit program will be discussed, as well as OCR’s take on securing electronic protected health information (ePHI). Attendees will gain a clearer understanding of how the National Institute of Standards and Technology (NIST) and other federal agencies are working to secure patient information.

This webinar will be presented by Dan Friedrich, who is the executive director of the Center for Advancement of Health Information Technology at Dakota State University. He is a Certified Information Systems Security Professional with more than 30 years of experience. 

Health care CEOs, CFOs, health information and IT professionals 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. 

Find more information and register today at http://events.SignUp4.net/2015AprilWebinar.

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Governor Walker Confirmed as Luncheon Keynote at Advocacy Day, April 28

Gov. Scott Walker has been confirmed as the luncheon keynote speaker at WHA’s 2015 Advocacy Day April 28 at the Monona Terrace in Madison. 

“Each year Advocacy Day attendees appreciate hearing directly from the sitting Governor regarding a vision for Wisconsin’s health care future,” said WHA President & CEO Eric Borgerding. “We are pleased to announce that Governor Walker will join us again on April 28 to address an expected crowd of over 900 hospital leaders, employees, trustees and advocates from across the state.”

Five hundred individuals from 70 hospitals have already registered for 2015 Advocacy Day. They’ll be joined by dozens of WHA’s corporate members who are also registered to show support for their local hospitals and health systems. Over 900 attendees are expected at this year’s event. You won’t want to miss this day! Register now at http://events.signup4.net/15AdvocacyDay0428.

This year’s event is perfectly timed—April 28—to fall during legislative action on the biennial state budget bill, which means hospital advocates will be able to speak up about important budget issues like Medicaid funding during the afternoon legislative meetings. At the morning session, attendees will hear from keynote Tucker Carlson, a nationally-known veteran journalist and political commentator who will share an insider’s view on Washington, D.C. and a look ahead to the 2016 elections. The legislator panel discussion will round out the morning sessions, and the luncheon keynote will be Gov. Walker. 

Attendees will be briefed on the issues before heading to the State Capitol for their scheduled legislative meetings. Make sure you plan to go on the afternoon legislative visits. It’s the most important part of the day.

There is still plenty of time to register your hospital contingent for 2015 Advocacy Day. Find event and registration information at: http://events.signup4.net/15AdvocacyDay0428.

For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org. For registration questions, contact Jenna Hanson at jenna.hanson@wha.org or 608-274-1820. 

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Grassroots Spotlight: Ministry Good Samaritan Health Center Hosts Sen. Tiffany, Rep. Czaja

Ministry Good Samaritan Health Center in Merrill recently hosted 12th District State Sen. Tom Tiffany and 35th State Assembly Rep. Mary Czaja to discuss legislative issues and see the facility. The visit is part of an ongoing effort to continue the dialogue with elected officials on important issues affecting the health care industry, including how Medicaid reimbursement impacts hospital operations. 

During their time at the hospital, Tiffany and Czaja had the opportunity to see Ministry Good Samaritan’s Telehealth program for heart failure patients and learn more about how six Merrill community assistance agencies were moved to the Ministry Good Samaritan campus to strengthen the link between Ministry Health Care and the community.

“We are happy to share with our elected officials some of our success stories in improving quality, lowering costs and expanding services,” said Jackie Frombach, RN, director of patient care services and operations at Ministry Good Samaritan. “It’s important that they know the vital role our facility serves for the Merrill community and people of Lincoln County.”

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Cong. Grothman Dialogues with Hospital Leaders from District
Health care value, Medicare payments, MDH, CAHs, 340 B discussed


More than a dozen hospital leaders in Cong. Glenn Grothman’s district gathered at Holy Family Memorial (Manitowoc) to discuss health care issues. The group provided Grothman, a freshman member of Congress, insight into issues pending at the federal level and of importance to local hospitals and health systems.

Holy Family Memorial President/CEO Mark Herzog initiated the group discussion by providing insight into Wisconsin’s high-quality, cost-efficient care. This led into discussions on Medicare reimbursements for hospitals and doctors, with participants providing thoughts on issues Congress will address. One key issue will be the Sustainable Growth Rate (SGR) patch that expires later this month. The group highlighted inherent geographic disparities in Medicare reimbursement formulas and encouraged Grothman to oppose hospital payment cuts to offset the SGR. Not only do cuts to hospitals impact integrated health systems like those in Wisconsin, but cuts would then doubly disadvantage more efficient states like ours. 

Cathie Kocourek, president of Aurora Medical Center in Manitowoc County, provided insight into the “Medicare Dependent Hospital” designation and its importance to “tweener” hospitals like hers. John Russell, president/CEO, Columbus Community Hospital, provided background on critical access hospital (CAH) designation. Russell indicated that years ago Medicare put into place a one-size-fits-all reimbursement system that was modeled on large, urban hospitals. This system led to the close of hundreds of small rural hospitals. CAH designation was created and turned the tide for these small facilities. In Wisconsin, CAHs create the rural hospital infrastructure statewide. 

Mike Heidt of Aurora Health Care rounded out the topics with a discussion on the importance of the 340 B program. The 340 B statute requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to health care organizations that care for many uninsured and low-income patients. Doing so allows hospitals to “stretch scarce federal resources as far as possible,” as Congress intended. The group encouraged Grothman to support this program. 

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WHA-led TCAB Project Teams “Travel” the World of Improvement 

Twelve of the 14 hospitals now participating in the WHA-led Transforming Care at the Bedside (TCAB) project came together March 5-6, one year after the launch of their cohort to share what they have learned with each other. Each team was asked to select one idea or process they had implemented and match it to a “Wonder of the World” of their choosing to share with others. 

“We used a creative activity that was fun, but educational, to engage the teams in presenting their projects and also to solicit questions about their work,” said WHA TCAB Manager Stephanie Sobczak. “It is really exciting to bring front-line staff from across the state together and watch them learn quality improvement techniques from their colleagues.” 

Sobczak said one participant summed up the experience by saying, “This is a great opportunity to talk to other nurses who experience the same day-to-day challenges that we do. The challenges are the same regardless of whether you are working in a small or large hospital. The way you approach a problem, and solve it, can be applicable to all settings.”

Part of the day was spent with teams networking with colleagues as they visited the project displays. Each team provided something that they had learned—in the form of a “takeaway” card—that participants collected at each hospital’s display. 

TCAB teams and topics:
    Beloit Health System - Charge Nurse Role/Improving Communication
    Columbus Community Hospital - Discharge Instructions
    Froedtert & The Medical College of Wisconsin Community Memorial Hospital, Menomonee Falls - Building Blocks of Patient Care
    Froedtert & The Medical College of Wisconsin Froedtert Hospital Campus, Milwaukee - Bedside Report
    Froedtert & The Medical College of Wisconsin St. Joseph’s Hospital, West Bend  - Hardwiring Purposeful Hourly Rounding
    Lakeview Specialty Hospital, Waterford  - Start of Shift Hydration
    Mayo Clinic Health System-Northland, Barron - Weight by 8
    Mercy Hospital and Trauma Center, Janesville - Improving Communication and Bedside Report
    Midwest Orthopedic Specialty Hospital, Franklin - Discharge Instructions
    Mile Bluff Medical Center, Mauston - Supplies at the Bedside
    ProHealth Care, Waukesha - Bedside Report
    Wheaton Franciscan Healthcare, Franklin - Overcoming Barriers/Increasing Team Vitality

TCAB – Then and Now
Keynote speaker Betsy Lee, MSPH, BSN, RN, was one of the originators of TCAB, and she is a nationally-recognized expert on the approach. Lee was highly complimentary of the WHA-led TCAB effort in Wisconsin. 

“TCAB arose from the state of medical-surgical nursing at the time, but with the rapid changes acute care is experiencing now—it is just as relevant today,” according to Lee. Staff in the audience learned about the major national efforts under health care reform to improve quality of care and patient safety, efficiency and waste reduction, and improve the environment of care for patients, families and health care workers.

WHA quality team members Sobczak and Tom Kaster co-presented a workshop focused on patient and family-centered care and the importance of communication with patients and staff. TCAB teams were encouraged to incorporate elements of WHA’s Patient and Family Engagement project. Started in 2014, the WHA Patient and Family Engagement project has brought education and tools to hospitals to help them focus on the patient perspective as they develop health care improvement projects. WHA has partnered with hospitals to further this work, delivering these tools in monthly learning sessions, as well as two well-attended conferences in 2014. Strategies that have been implemented in the project include:

“WHA’s commitment to helping hospitals in their improvement work is a high priority,” according to WHA President/CEO Eric Borgerding. “It mirrors the dedication of every health care professional working in our hospitals and health systems.” 

For photos and additional information about the TCAB event, visit: www.wha.org/pubArchive/special_reports/2015tcabmidpoint3-5.pdf.

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DHS Announces New Provider Network for Wisconsin Well Woman Program 

The Wisconsin Well Woman Program (WWWP), administered by the Department of Health Services (DHS) Public Health division, released the statewide network that will provide and coordinate medical services for women who qualify for the program. The current and new coordinating agencies will overlap starting April 1, and the new coordinating agencies will assume full responsibility July 1, 2015. The new provider network will be in place beginning July 1, 2015.

The WWWP provides preventive health screening services to women up to 250 percent of the federal poverty level (FPL) who have little or no health insurance coverage. Well Woman pays for mammograms, pap tests, certain other health screenings, and multiple sclerosis testing for women with high risk signs of multiple sclerosis.

DHS said the new provider network will include health systems with mobile units for breast and/or cervical cancer screening. The state will continue to assess where there are gaps in coverage and will work to fill these as soon as possible. For more information on the program, along with a list of the hospitals, health systems and agencies that will provide services to the WWWP, visit: www.dhs.wisconsin.gov/wwwp/model.htm.

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Fast Facts from the WHA Information Center: March is National Kidney Month
Wisconsin hospitals performed 389 kidney transplants in 2013


The Centers for Disease Control and Prevention (CDC) has designated March as National Kidney Month. 

The CDC noted that in 2012, kidney diseases were the ninth leading cause of death in the United States. More than 10 percent (more than 20 million) of U.S. adults aged ≥20 years have chronic kidney disease (CKD), and most of them are unaware of their condition. Major risk factors for CKD include aging, diabetes and high blood pressure. If left untreated, CKD can lead to kidney failure, requiring dialysis or transplantation for survival. However, controlling diabetes and high blood pressure can prevent or delay CKD and improve health outcomes.

According to the WHA Information Center, from October 1, 2013 through September 30, 2014 there were 85,256 inpatient admissions, 25,878 ER visits, and 214,003 other hospital outpatient and ambulatory surgery visits for patients with treatment for chronic kidney disease. In 2013, there were 389 kidney transplants in Wisconsin. 

To sign up as an organ donor, go to: http://donatelifewisconsin.com
For more information on National Kidney Month go to: https://www.kidney.org

Data provided by the WHAIC (www.whainfocenter.com)

The WHA Information Center is dedicated to collecting, analyzing and disseminating complete, accurate and timely data and reports about charges, utilization, quality and efficiency provided by Wisconsin hospitals, ambulatory surgery centers and other health care providers.

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Member News: SSM Health Joins Integrated Health Network of Wisconsin

SSM Health announced that it has joined Integrated Health Network of Wisconsin (IHN). St. Louis-based SSM Health owns three hospitals (St. Mary’s Hospital in Madison, St. Mary’s Janesville Hospital, and St. Clare Hospital in Baraboo), Dean Clinic and Dean Health Plan in Wisconsin.

IHN is a clinically integrated network of major Wisconsin health systems and the Medical College of Wisconsin. The addition of SSM Health will expand the geographic coverage for Integrated Health Network into south-central Wisconsin and increase the growing accountable care organization to 45 hospitals, 555 clinics and more than 5,700 physicians and participating providers.

“We are pleased and excited to become part of this consortium that is transforming health care delivery,” said Damond Boatwright, SSM Health regional president of hospital operations. “To further enhance the patient experience, improve outcomes and make care more affordable, we must continue to provide a personalized and proactive approach. We look forward to doing just that through our partnership with IHN.”

SSM Health joins current IHN network members including Agnesian HealthCare, Columbia St. Mary’s, Froedtert Health, the Medical College of Wisconsin, Hospital Sisters Health System, Ministry Health Care, Wheaton Franciscan Healthcare and many independent physician partners. With the addition of SSM Health, the network will impact more than three million people.

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