March 14, 2014
Volume 58, Issue 11



DHS Leader Tells WHA Council Enrollment Push Continues as Deadline Nears
Moore says DHS 124 reform gives regulators a "clearer set of rules" moving forward

The drive to transition former Medicaid recipients to the health insurance exchange is in high gear as the Department of Health Services (DHS) continues its outreach efforts, according to DHS Deputy Director Kevin Moore.

Speaking at the WHA Public Policy Council meeting in Madison March 13, Moore said the state seems to be on track in meeting their coverage goals related to expanding Medicaid to childless adults with income below the poverty line.

"We believe there will be improvement, with fewer uninsured, but we don’t know what the overall changes will be for people at various income levels," Moore said. "For the Medicaid program, we want to continue to try to ensure that when patients walk through your doors, if they are under 100 percent of the federal poverty level, we get them enrolled in the program."

Moore said the local agencies that have been working to get people enrolled across the state have done an excellent job. The Department plans to continue their outreach efforts to those transitioning from Medicaid to the private exchanges at least 60 days beyond the March 31 deadline.

"We want to make sure we do everything we possibly can for those remaining folks. The message we want to get to them is that we are getting close to the end of the timeline to transition them from Medicaid to the exchange to ensure a continuum of care," Moore said. "There could be a gap in coverage, and we want to build that bridge for them as best as we can."

Moore took the opportunity to thank WHA staff and members for their "persistence" in pursuing reform of the hospital regulatory code, DHS 124. Moore said he believes the Department is in a "good spot" with the regulations now because the regulators will have a "clearer set of rules" moving forward. Moore said their goal as they work to update the remaining portions of DHS 124 is to ensure hospitals are regulated in a fair environment.

"Our regulators are now trying to interpret two sets of rules. They need to have a consistent view and one set of rules to apply," Moore said.

WHA Executive Vice President Eric Borgerding underscored the importance of making sure WHA and its members communicate effectively with DHS throughout the transition to the Medicare Conditions of Participation.

"We don’t want to defeat the purpose of this legislation by repackaging or adding state red tape, which the Legislature, by unanimous vote, said is duplicative, and unnecessary," Borgerding said. "We don’t need to reinvent the regulatory wheel when other states, like Minnesota, have taken this same approach. The burden of justification for keeping or adding a Wisconsin-specific regulation rests heavily on its proponents. In other words, why does Wisconsin need to regulate something more than a high-quality health care state like Minnesota or the highly-popular Medicare program does?"

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WHA Credits Members For State Legislative Success
Process to Reform Hospital Regulations Begins

WHA Executive Vice President Eric Borgerding highlighted several key WHA-supported bills that are awaiting the Governor’s signature for the members of the WHA Public Policy Council (PPC) who met in Madison March 13. Borgerding said the progress that has been made on several priority legislative initiatives would not have been possible without member support.

Several significant WHA-supported bills have passed this session. Among them, the long-anticipated hospital regulatory reform legislation. Borgerding said SB 560, a bill that synchronizes the state and federal hospital regulations, recently passed both houses of the Legislature unanimously (see related story above). The Legislature also passed two mental health-related bills that were on WHA’s behavioral health agenda. AB 453 gives treating care providers access to patients’ mental health records, while AB 488 creates a new third party petition process for emergency detention if a county does not approve the initial request.

"The WHA team, with the support of and assistance from our members, has crossed the finish line on several issues that we have been working on for a number of years," Borgerding said. "The reforms these bills will bring hospitals and their patients may not be felt immediately, but they will make a lasting and positive impact on the way health care is delivered in Wisconsin for decades to come."

WHA continues to work with a growing coalition that is opposed to a fee schedule for providers that participate in the worker’s compensation program. The coalition, which continues to expand, helped stop legislation that would set a fee schedule. Borgerding said the Coalition to Protect Worker’s Compensation, which includes health care provider organizations large and small across the state, is fighting against the misdirected fee schedule proposal. He said lawmakers should instead recognize and protect the high quality of care injured workers receive here and refocus scrutiny on Wisconsin’s seemingly high rate of workplace injuries.

"We can’t control how many workers are injured at their jobs in Wisconsin, but when they do arrive at our hospitals, and a lot of them do, we give them some of the best care in the country, get them back to their families sooner and back to work faster than in most any other state," Borgerding said.

Borgerding said WHA has accelerated its efforts to promote Wisconsin’s high-value health care to a broader audience by commissioning a survey of the state’s employers and engaging an advertising/marketing firm. WHA Public Policy Chair Mike Wallace, president/CEO of Fort HealthCare, noted that health care is an economic development asset in Wisconsin communities.

"Employers should consider the quality and value of Wisconsin’s health care when they are considering expanding or locating to our state," Wallace said. "It is as important an asset as good roads, utilities and education."

WHA federal agenda remains focused on stopping Medicare cuts, protecting hospitals

A trip to Washington DC earlier in the week for WHA staff and members provided an opportunity to remind and motivate Wisconsin’s congressional delegation to support hospitals.

Jenny Boese, WHA vice president for external relations and member advocacy, reviewed the recent Medicare cuts for the PPC members. So far, Wisconsin hospitals have seen reimbursement cuts passed of more than $4 billion. Boese said the current Medicare Sustainable Growth Rate (SGR) "patch" expires March 31. She highlighted legislation, HR 4015/S 2000, that would provide a permanent repeal of SGR and replace it with a system that would provide 0.5 percent payment updates through 2018. In 2018, physician payments would begin to be tied to value by establishing a Merit-Based Incentive Payment System (MIPS) or a five percent bonus for Advanced Payment Models. However, the cost of repealing SGR is $138 billion and that is without important Medicare "extenders" policies that are supported by WHA. Both the House and the Senate must still determine how to pay for this legislation, and WHA is aggressively opposing doing so through continued hospital payment cuts.

On March 11, the Wisconsin Hospitals Issue Advocacy Council, Inc. (WHIAC), a 501(C)(4) organized to promote, develop, and encourage the distribution of information about Wisconsin’s health care climate and the importance of enabling high-quality health care, launched its second radio ad aimed at educating the public about the real impact that the ongoing policy and fiscal negotiations in Washington are having on health care in Wisconsin.

"Wisconsin has some of the best hospitals in the country. In communities across Wisconsin, our hospitals and doctors provide the high quality medical service we need and close to home…but in Washington, Congress keeps cutting Medicare payments to hospitals…and now we hear more cuts are on the way. Wisconsin’s high quality, hometown health care will get hit again," the narrator says.

The ad concludes by encouraging listeners to contact their member of Congress and urge them to "protect Wisconsin hospitals, keep health care close to home and oppose more Medicare cuts."

WHA Monitors Exchange and Medicaid Enrollment Issues

While more people have signed up for insurance coverage through the health insurance exchange website, healthcare.gov, there is still little information about how many have paid premiums, the final step to making coverage effective, according to Joanne Alig, WHA senior vice president, policy and research. Another major question is how many were previously uninsured.

Alig also noted that the April 1 effective date for changes in Medicaid eligibility is fast approaching. As of that date, an estimated 83,000 childless adults with income below the poverty line will become newly-eligible for Medicaid coverage. At the same time, an estimated 75,000 parents and caretakers of children with income above the poverty line will no longer be eligible and will be disenrolled from the Medicaid program. (See page 2 for more information related to the exchange and Medicaid.)

Process to Reform DHS 124 Begins to Take Shape

Laura Leitch, WHA senior vice president and general counsel, reviewed SB 560, the hospital regulatory reform bill. The bill essentially sunsets several subchapters of DHS 124, including the subchapters related to management, medical staff, and clinical services, on July 1, 2016, and adopts at the same time the Medicare Conditions of Participation as the state regulatory standard for Wisconsin hospitals.

Leitch explained that the next steps in the process include DHS presenting a Scope Statement to the Governor for review and approval; the scope statement will indicate the areas of the rule DHS has identified as priorities for updating. At the same time, WHA will work with its members on areas that should be updated, like the physical environment subchapter, and gaps, if any, that should be addressed in the rule.

"We have waited decades to modernize the hospital regulations. It is very exciting to start this process," Leitch said.

Watch for more updates in The Valued Voice regarding DHS 124 in the coming weeks.

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Insurance Exchange and Medicaid Enrollment Updates
HHS releases new exchange enrollment report

By March 1, 71,443 people in Wisconsin had selected a health plan through the exchange marketplace, an increase of about 15,000 people compared to February 1. These latest figures were released on March 11 by the federal Department of Health and Human Services (HHS). The report shows how many selected a qualified health plan, and how many were found eligible for Medicaid by state from October 1, 2013 through March 1, 2014. The full HHS report and the appendixes showing state-level data can be found on WHA’s website at: www.wha.org/exchangeMedicaidEnrollment.aspx.

The report contains no information about how many enrollees had actually paid their premium, which is the final step required for actually obtaining coverage and being enrolled into a health plan. However, the report does reference new surveys aimed at estimating how well the program is achieving the goal of reducing the uninsured—including one from McKinsey & Company reporting that a low number—27 percent of those surveyed who enrolled in health care coverage in 2014—report they were previously uninsured.

In this month’s report, HHS again provided data on the age of participants and the type of plan chosen. In Wisconsin, 41 percent of those who selected a plan were between the ages of 55 and 64, and 21 percent were under the age of 35, numbers that are consistent with previous reports. The figures released by HHS also indicate which type of plan enrollees have selected, with 81 percent of those who selected a plan choosing a silver level plan or higher.

The enrollment numbers also show 68,655 people have been deemed eligible for Medicaid in Wisconsin through the exchange marketplace. This is an increase of about 8,000 people since February. The Department of Health Services (DHS) indicates a large percentage of those are likely to be childless adults, based on the initial files they have received from the federal government. Local county agencies are processing the applications received from the federal government, and eligible childless adults will be able to receive benefits under the Medicaid/BadgerCare program beginning April 1.

Presumptive Eligibility Training Dates Set

DHS will be providing training on the new presumptive eligibility process for hospitals at the end of March. Training will be provided through webinars, and DHS has indicated they will archive a webinar and make it available on demand. The training dates and the link to access the webinar are:

Monday, March 24, 12:00 – 2:00 pm: http://dhsmedia.wi.gov/main/Play/9767eda6dd7f4d69be65208e67216ba81d 

Wednesday, March 26, 9:00 – 11:00 am: http://dhsmedia.wi.gov/main/Play/d1bf92f300a240faa3e250df61ecea661d 

Additional background information about the presumptive eligibility process, including recent guidance from DHS, can be found on WHA’s website at www.wha.org/outreachplans.aspx.

Exchange Open Enrollment and Transition for BadgerCare Recipients

The 2014 federal exchange marketplace open enrollment period will end March 31, 2014.

Generally, for individuals and families, March 15 is the deadline to apply, select a qualified health plan and pay the initial premium to have coverage beginning April 1, 2014. If the plan is selected March 16 through March 31 and the premium is paid, coverage will begin May 1, 2014.

However, there are special enrollment considerations for Medicaid/BadgerCare and HIRSP members who will lose Medicaid/BadgerCare or HIRSP coverage because the program is ending or they no longer meet the program rules. For these individuals, the deadline is extended to March 31, 2014 to apply, select a qualified health plan and pay the initial premium in order to avoid a gap in coverage and have coverage effective April 1. However, losing BadgerCare or HIRSP coverage may be considered a qualifying event. Therefore, if these individuals do not choose a plan by March 31, they will have an additional 60 days from the date their enrollment in Medicaid/BadgerCare or HIRSP ends to purchase health insurance through the exchange marketplace.

In addition, it is important to note that individuals who are eligible for Medicaid/BadgerCare can apply for these health care benefits at any time. Additional information is available at www.badgercareplus.org.

Local health care enrollment events

Additional enrollment events are taking place over the next few weeks to help consumers who require assistance apply for coverage at the exchange marketplace. Enrollment for Health Wisconsin is keeping a list of all of the enrollment events:

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Hospital Leaders meet with Rep. Ribble at Bellin in Green Bay
WHA in DC advocating against Medicare cuts

On March 10, a dozen hospital and health system leaders in Rep. Reid Ribble’s district met with him at Bellin College in Green Bay. The leaders requested the meeting with Ribble to discuss the growing concern they have with Congress continuing to cut Medicare payments to pay for other federal programs.

The most recent example being the Congressional vote to extend Medicare cuts to hospitals, physicians and other providers an additional year (FY 2024) to offset the costs of making a change to military pensions. Attendees expressed appreciation to Rep. Ribble for his vote against this most recent Medicare cut and asked him to continue voting against payment cuts if they are proposed.

"We are pleased that Congressman Ribble continues to acknowledge Wisconsin’s high-value health care and the damage that will occur if Medicare continues to be battered with new cuts," said WHA President Steve Brenton.

On a related note, WHA and several hospital leaders were in Washington, DC on March 11 to meet with Wisconsin Congressional offices. During their meetings the group discussed legislation to repeal the Sustainable Growth Rate (SGR - physician reimbursements under Medicare) and advocated against cutting hospital reimbursement to pay for it.

At a minimum, legislation to repeal the SGR—HR 4014/S 2000—will cost an estimated $138 billion and does not include important Medicare extender polices, such as the Low Volume Adjustment and Medicare Dependent Hospital program. While expressing support for repeal of the SGR, WHA does not support funding repeal through additional Medicare cuts to hospitals. WHA also reiterated its support for including the "extenders" policies into the final legislation.

"Regardless of Wisconsin’s role as a national leader in the health care value and quality movement, our hospitals and systems have been cut at least $4 billion already," said WHA’s Eric Borgerding. "How Congress intends to pay for SGR remains an open issue, but our Delegation needs to know Wisconsin hospitals have taken enough hits already."

The ongoing fight to protect Medicare from cuts has also led to a series of radio ads launched by the Wisconsin Hospitals Issue Advocacy Council, Inc. (WHIAC). The WHIAC is a 501(C)(4) organized to promote, develop, and encourage the distribution of information about Wisconsin’s health care climate and the importance of enabling high-quality health care. The radio campaign, "Enough is Enough," is aimed at educating the public about the real impact that the ongoing policy and fiscal negotiations in Washington are having on health care in Wisconsin. The ads also complement WHA’s ongoing grassroots and advocacy efforts.

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Register Now for WHA’s Premier Advocacy Event, April 16

"Advocacy Day is incredibly valuable…it’s a chance for our staff to connect with other hospital leaders, learn more about priority policy issues and make connections with legislators on important health care issues." - 2013 Advocacy Day attendee

"Advocacy Day helps Wisconsin hospitals focus on key issues that are important to each and every one of us, giving our group a strong, united voice." - 2013 Advocacy Day attendee

"Excellent opportunity to learn, share and speak up." - 2013 Advocacy Day attendee

"We place a high value on this annual event. It serves to keep us informed, engaged and enthused about health care legislation." -2013 Advocacy Day attendee

"This was my first Advocacy Day. It was amazing to me how all of the legislators said what an impact we were making. I was happy to represent my community and my hospital…" - 2013 Advocacy Day attendee

These are just five of the hundreds of comments WHA received after last year’s Advocacy Day event, which broke all previous records with 900 hospital leaders, employees, trustees and volunteers from across the state.

2014 Advocacy Day is set for April 16 at the Monona Terrace in Madison. Here is what you can look forward to this year:

The highlight of Advocacy Day is always the hundreds of attendees who take what they have learned during the day and then meet with their legislators in the State Capitol in the afternoon. WHA schedules all meetings, provides transportation to the Capitol and prepares attendees for their visits. In addition to an issue briefing at Advocacy Day, WHA offers an optional webinar on legislative meetings prior to Advocacy Day.

Whether you come by van, busload or carpool, make sure you get to Madison April 16 for WHA Advocacy Day. Register today at: http://events.SignUp4.net/14AdvocacyDay0416.

For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org. For registration questions, contact Lisa Littel at llittel@wha.org or 608-274-1820.

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AHA Releases ICD-10 Executive Action Guide

This week the American Hospital Association (AHA) released the AHA Executive Action Guide to help hospital leaders manage the transition to ICD-10. October 1 is the confirmed date that all hospitals and health systems must begin using the new ICD-10 coding system, and when Medicare and other payers will reject hospital claims that fail to comply with ICD-10.

The AHA Guide highlights four areas that are critical to ICD-10 implementation and provides a roadmap to evaluate progress. It explains how to organize the ICD-10 transition, how to plan for implementation, what must be done now to implement the transition successfully and how to evaluate your efforts post-implementation. In addition, throughout the guide, there are suggestions on how hospital leaders can work with physicians and caregivers to help them improve their documentation, information on what hospital leaders should be doing now in the implementation timeline and questions they can ask about their organization’s transition efforts.

Other ICD-10 news this week included an announcement from CMS that they have instructed their Medicare Administrative Contractors (NGS for Wisconsin) to provide applications for hospitals, other providers and clearinghouses to volunteer between March 7 and 24 for limited end-to-end testing opportunities of ICD-10 claims. For those chosen, test claims will be submitted July 21-25. (NGS volunteer testing form

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HSHS Eastern Division Hospitals Collaborate to Reduce Harm Across the Board

Improving quality is a resource-intensive activity in hospitals. At Hospital Sisters Health System (HSHS), St. Vincent Hospital, St. Nicholas Hospital, and St. Mary’s Hospital Medical Center have found that one of the ways to increase the efficiency of their quality improvement work is to allocate workload across the system.

On March 10, Travis Dollak, quality advisor with the WHA Partners for Patients project, visited with staff from all three hospitals to learn about their approach. Dollak found that the hospitals’ patient safety and quality departments play an important role in data support and facilitating meetings; however, many of the teams are lead or co-lead by infection prevention, pharmacy and nursing.

Lori Turek, director of patient safety & quality, explained why they have been successful in engaging staff in so many quality improvement initiatives. "Two things that have helped drive this work is our strong leadership support and by having a large number of our staff attend the ‘WHA Catch the Wave’ event last spring," according to Turek. "Events like the one WHA sponsored last spring help take the blinders off of our sometimes ‘siloed’ work and help re-energize staff around the big goal of improving patient safety across the board."

One area of focus for Sue Wheeler, pharmacy director at St. Nicholas Hospital, is creating reliable processes around reducing VTE. "Our entire system is working on implementing a standardized VTE orderset. However, locally we are finding success by using a multi-layered approach to communicating the changes to our physicians. We hold a lot of one-on-one conversations to address their concerns, but we also communicated system-wide to reinforce the importance."

Through these efforts, documentation of delivering the right prophylaxis to each patient has greatly improved. "What really impressed me was the teamwork on a number of the initiatives. In talking with the team leaders, many of them were co-leading their efforts. The greatest example of this was with the infection prevention and OB-Harm prevention teams," said Dollak. "I think the co-lead teams help keep the work manageable for staff already juggling busy schedules."

Through these collaborative efforts across the three hospitals, the HSHS Eastern Division is making progress on reducing all areas of potentially preventable harm. "We are going to continue to use small tests of change and involve more staff in year three of the Partners work. Taking the time to spread unit-by-unit has lead to some strong results for all of our initiatives," said Karen Allard, quality project specialist.

By tapping the talents of their staff across all three hospitals, HSHS Eastern Division has been able to increase the speed of their improvement work. Each site is responsible for leading several initiatives, and then sharing and spreading to the other locations. Not relying on one site to conduct all the learning and testing has lead to some great results this past year for their patients.

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Wisconsin Medicaid Director Davis Resigns to Join Private Sector

Wisconsin Medicaid Director Brett Davis announced he will be leaving his post at the Wisconsin Department of Health Services (DHS) to join the private sector. Davis, a former lawmaker, has served as the state’s Medicaid director since 2011.

Davis has been instrumental in implementing Governor Scott Walker’s plan to reduce the uninsured rate in Wisconsin by 250,000 people by transitioning those with incomes over 100 percent of the FPL to the health insurance exchange. Working closely with WHA, Davis visited every region in Wisconsin to discuss the transition plans with hospitals and assure hospitals that outreach efforts would be aggressive and effective, while at the same time he helped to develop a statewide network to connect former Medicaid patients with coverage.

"Brett has been an excellent resource to WHA and to our member hospitals at a time when health care is under intense pressure. His personal commitment to creating an outreach and education program in Wisconsin that would help connect as many people to coverage as possible was remarkable and commendable," said WHA Executive Vice President Eric Borgerding. "We have appreciated Brett’s willingness to listen to our concerns and then to sincerely work to address them in the most collaborative way possible. We wish him only the best in his future endeavors."

According to DHS spokeswoman Stephanie Smiley, he will leave his post March 31. The Department has not named a replacement.

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DHS Shifting its Male Emergency Detention Beds from Madison to Oshkosh

Beginning April 1, the Department of Health Services (DHS) will begin to combine all of its civil, involuntary mental health inpatient beds at its Mendota and Winnebago Mental Health Institutes at the Winnebago Mental Health Institute near Oshkosh. The change will result in no net change in the number of staff or beds for civil, involuntary mental health services offered by DHS. Currently, the civil inpatient beds at the Mendota Mental Health Institute in Madison serve male patients and the civil inpatient beds at the Winnebago Mental Health Institute near Oshkosh serve female patients.

As a result of these changes and others at the two state mental health institutes, the Mendota facility will primarily provide forensic and criminal mental health services and the Winnebago facility will primarily provide civil, involuntary mental health services. Although the state is not changing the total number of civil inpatient beds, for male patients on an emergency detention or involuntary commitment and depending on one’s location in Wisconsin, the change may lengthen or shorten the distance law enforcement will need to travel to transport a male under an emergency detention to one of the state’s emergency detention facilities.

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