March 7, 2014
Volume 58, Issue 10


Gov. Walker Confirmed for WHA’s Advocacy Day
April 16 at Monona Terrace in Madison

WHA’s annual Advocacy Day is one of the best ways your hospital employees, trustees and volunteers can make an important, visible impact in the State Capitol. Make sure you are assembling your hospital contingent for 2014 Advocacy Day set for April 16, 2014 at the Monona Terrace in Madison. Register today at http://events.SignUp4.net/14AdvocacyDay0416.

Advocacy Day 2014 has an impressive lineup of speakers, including morning keynote and nationally-known pollster Larry Sabato, professor of politics and director of the University of Virginia’s Center for Politics (www.centerforpolitics.org); and creator of the website and weekly e-newsletter, "Sabato’s Crystal Ball." As the nation looks to the 2014 elections, Sabato will bring to Wisconsin his years of academic study together with an equally long career as both a political practitioner and commentator.

Governor Scott Walker has been confirmed as the luncheon keynote speaker, and the day will include the always popular legislative panel discussion moderated by WHA Executive Vice President Eric Borgerding.

The highlight of Advocacy Day is the hundreds of attendees who take what they’ve learned during the day and 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 visits prior to Advocacy Day.

Last year Advocacy Day brought 900 hospital advocates to Madison for the first time in the event’s history. Help us reach that goal again in 2014. Learn more about the day’s events in the printed copy of the brochure included in this week’s Friday Packet. Register today at http://events.SignUp4.net/14AdvocacyDay0416.

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Senate Health Committee Hears, Votes on "Apology Bill"

The Senate Committee on Health and Human Services held a public hearing March 6 on the "Apology Bill" (Assembly Bill 120), legislation that would allow a health care provider to express an apology, condolence, sympathy, or other sentiment to a patient or patient’s family without those statements being used as evidence of liability or an admission against interest. Sen. Leah Vukmir (R-Wauwatosa) is the chair of the Committee and lead Senate author of AB 120. The legislation was up for a paper ballot vote in Committee March 7.

When a health care outcome is not what was expected or when a combination of events has led a patient or patient’s family to be disappointed by the health care that the patient received, a statement of apology or condolence can be very helpful.

"A patient and the patient’s family want to know that their health care providers empathize with their situation. A provider, unfortunately, might be reluctant to apologize or express sympathy or condolence because of the provider’s concern that his or her words will be used as evidence of liability," said Charles Shabino, MD, WHA senior medical advisor, in written testimony to the Committee. "This bill would encourage statements of apology or condolence by providers involved in patient care, which can allow the patient, family and provider to move toward resolution. It is more difficult to address an issue if there is a barrier to good communication."

The bill is expected to be recommended by the Senate Committee on Health and Human Services and would then be available for a Senate floor vote.

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President Obama Releases FY 2015 Budget
$407 billion in Medicare reductions

This week President Barack Obama released his FY 2015 budget request, including over $400 billion in reductions to Medicare, of which $354 billion would come from providers. His proposed budget also includes an additional $7.3 billion in Medicaid reductions. The proposed cuts are over 10 years.

The grab bag of Medicare changes includes:

With respect to Medicaid, the budget proposal includes rebasing Medicaid disproportionate share hospitals in FY 2024 for savings of $3.26 billion. Essentially, this retains the previously reduced MA DSH rates for another year.

WHA joined American Hospital Association leadership in condemning the new Medicare cuts.

"The budget proposal is unlikely to gain traction, especially since both the Senate and House agreed in December to spending numbers for FY 2015," said WHA President Steve Brenton. "But the proposals unfortunately offer a lens into the Administration’s continued support for Medicare program cuts, which would be additive to the over $4 billion in cuts for Wisconsin hospitals enacted since 2009."

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WHA Health Law Manuals Now Available

WHA is pleased to announce that the 2013 Health Law Manuals are now available electronically to WHA members. The manuals, of which nine are currently available and two more will be available in the near future, cover the gamut of topics and issues that constitute the intricate world of health law—from consent and signs/postings to record retention and health information, and more.

Special thanks to the law firms that partnered with WHA in producing the manuals: Hall, Render, Killian, Heath & Lyman; Quarles & Brady; Reinhart Boerner Van Deuren; von Briesen & Roper; and Whyte Hirschboeck Dudek. Their assistance was invaluable in making this important resource available to WHA members.

The manuals are available for WHA’s hospital members to view and download, with proper sign-in credentials, within WHA’s website at www.wha.org/healthLawManual.aspx. If you are a hospital member that would like to access the 2013 Health Law Manuals, contact webmaster@wha.org to request a username and password.

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President’s Column: Was Two-Midnight Rule Necessary?
CMS should deal with the real problem: the RACs

The Centers for Medicare & Medicaid Services (CMS) keeps digging an even deeper hole as it attempts to manage a new rule creating confusion. Last summer, the federal agency issued an ill-advised rule (dubbed "Two Midnights") that determined hospitals would be paid Medicare outpatient rates (Part B) for care lasting less than two midnights. Those stays were previously paid for under Part A.

The impetus for the rule? Recovery Audit Contractors (RACs) second guessing clinical decisions made when a Medicare patient sought care at their local hospital—second guessing that can occur years after the care was provided.

The impact of the rule continues to reverberate for hospitals, physicians and for Medicare patients who may find themselves facing significant out-of-pocket costs amounting to thousands of dollars for treatments they expected to be covered as inpatient stays.

First, the rule establishes an arbitrary, time-based policy bearing no clinical foundation. It assumes that physicians will know the length of hospital stay for a yet-to-be-determined medical condition.

Next, the rule is punitive in that it penalizes hospitals and physicians for being efficient users of health care resources. It also penalizes Medicare beneficiaries and creates confusion and potential conflict between seniors and their caregivers.

Finally, the rule attempts to fix a symptom rather than the underlying problem—the RACs—audit organizations that have been aggressive in second guessing clinical decisions. RAC denials have forced providers to appeal countless claims which now wait in adjudication limbo at the federal Office of Medicare Hearings and Appeals (OMHA). The OMHA backlog is so bad it recently was forced to freeze new appeals while it seeks to reduce the 350,000 appeals already in the system. OMHA indicates it could take years before claims are heard. Instead of "fixing" the problem, the CMS "fix" made a bad problem worse.

CMS has delayed enforcement of the two midnight rule until October 1 and recently made several changes to the RAC program. In the meantime it is attempting to "probe and educate" providers on a rule so ill conceived that such action is and will certainly be insufficient.

The wiser course of action would be for CMS to withdraw the Two Midnight rule immediately. If not, Congress must act by passing legislation like the "Two Midnight Delay Act (HR 3698)" which pulls the rule back and replaces it with a suitable solution, or better yet, Congress should pass the "The Medicare Audit Improvement Act (HR 1250/S. 1210)," which puts parameters around the actions of the RACs. Wisconsin Members of Congress—Representatives Ribble, Duffy, Pocan, Sensenbrenner, Moore and Petri—have already signed onto HR 1250 and Reps. Kind and Pocan to HR 3698.

Steve Brenton
President

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Agnesian HealthCare Aligns Partners for Patients with VBP

The performance excellence team at Agnesian HealthCare in Fond du Lac is speeding up the pace of their improvement work. On February 5, Travis Dollak, quality advisor with the WHA Partners for Patients project, visited St. Agnes Hospital to learn about Agnesian HealthCare’s successes in 2013 and their plans for 2014.

Two of the focus areas in 2013 were to reduce urinary tract infections (CAUTI) and prevent venous thromboembolism/deep vein thromboemolism (VTE/DVT).

"We chose these two areas because we saw an opportunity to directly impact patient care and it aligns with our organizational value-based purchasing (VBP) scorecard," said Mike Feudner, director of performance excellence and project management. "A big key to success is to align efforts to improve care with core measures and value-based purchasing."

Agnesian points to two key elements that are driving performance improvement—aligning their QI project with value-based purchasing goals, and a team-based approach to quality improvement.

The CAUTI team is focused on improving the documentation of catheter care to make sure the best care is delivered every time. Through the help of their EMR, RNs can now consistently document care, and it creates greater daily awareness. When asked how Agnesian adopted the workflow into their EMR so quickly, Barb Gorman, project manager, said, "One key was the visibility of the project to senior leadership. This helped get all departments on board and aligned the work of quality and the IT department. We used that along with our RNs testing out the process to improve our postoperative urinary catheter removal measure [SCIP-inf-9] significantly."

The other big gain Agnesian saw by participating in WHA’s Partners for Patients project was around improving VTE prophylaxis. Their rates of prophylaxis have increased to some of the best in the state because of their process improvement activities.

"Agnesian has done a remarkable job of adopting the best practices and not being afraid to use small tests of change to implement them in the local environment. Each month, they measured and received feedback from staff, which has caused their completion of appropriate prophylaxis to continue to trend upward," said Dollak. "Agnesian has already gathered a multidisciplinary team to focus on readmissions in 2014. WHA looks forward to learning more about their continued successes."

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Member News: Neville Named CEO of Memorial Medical Center, Neillsville

Ryan T. Neville was named president/CEO of Memorial Medical Center (MMC) in Neillsville effective March 5. His most recent position with MMC was executive vice president and chief operating officer. Neville replaces David J. Baltzer, who served as interim CEO.

Neville received his bachelor of science in occupational therapy from Shawnee State University in Ohio. He also has his master’s in business administration from Ohio University. Neville is board certified in health care management and is a Fellow in the American College of Healthcare Executives. He is a graduate of the American College of Healthcare Executives Leadership Development Program, and he was named the 2007 Ohio Hospital Association Health Care Worker of the Year.

Previously, Neville served as the director of patient care for rehabilitation services at Ministry Saint Joseph’s Hospital for six years. He is trained in Lean Six Sigma and has utilized his Green Belt Certification to improve operational capacities on dozens of strategic health care initiatives. Neville also worked at Marietta Memorial Hospital in Ohio for a decade and served as the director of rehabilitation services.

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