May 9, 2014
Volume 58, Issue 19


Wisconsin Hospital Leaders in Washington, DC
AHA recognizes Russell as "Grassroots Champion"

Fifteen Wisconsin hospital and health system leaders were in DC this week for the American Hospital Association’s Annual Meeting and the Wisconsin Hospital Association’s annual day on Capitol Hill.

At the top of the list of issues hospital leaders discussed with Wisconsin Members of Congress was their continued push to provide health care "value"—high-quality, cost-efficient care—to patients throughout Wisconsin. Attendees highlighted WHA’s recent 2013 Quality Report, which showed excellent achievements in quality and patient safety initiatives that diverted $46 million in health care costs statewide.

Hospital leaders also discussed how burdensome regulatory policies waste valuable health care dollars, citing the surprising Congressional decision to delay implementation of ICD-10. Another example attendees highlighted was Wisconsin-specific data with respect to the Recovery Audit Contractor (RAC) program and the need for program reforms, as contained in the Medicare Audit Improvement Act (HR 1250/S1012).

The group also pointed out other recent policy changes, such as the "two midnight" rule and the "96 hour" rule for critical access hospitals (CAHs), that should be fixed yet this year by passing the "CAH Relief Act" (HR 3991/S2037) and the Two Midnight Act (HR 3698/S 2082).

WHA and hospital leaders thank our Members of Congress and staff for their time.

John Russell Receives AHA "Grassroots Champion" Award

The American Hospital Association (AHA), in partnership with WHA, awarded John Russell, President/CEO of Columbus Community Hospital, the "Grassroots Champion" award for Wisconsin. Grassroots champions were honored at a breakfast event held during the AHA Annual Meeting in Washington DC May 6.

As an award honoree, Russell was recognized for his exceptional leadership in generating and being personally involved in grassroots activity on important hospital and health care issues.

"John is an outstanding and effective advocate in delivering the hospital message to his elected officials," said Jenny Boese, WHA vice president of external relations & member advocacy. "His knowledge, commitment and involvement in advocacy efforts should be viewed as a model by his peers. He is well-deserving of this award."

The Grassroots Champion Award was created by AHA to recognize hospital leaders who most effectively educate elected officials on how major issues affect the hospital’s vital role in the community and who are tireless advocates for hospitals and patients.

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Wisconsin Hospitals Care for over 50,000 Patients Daily
Celebrate Hospital Week May 11-17

This news release was shared with the statewide press May 9, 2014.

Nearly 53,000 people were cared for in a Wisconsin hospital every day in 2012 according to data collected by the Wisconsin Hospital Association Information Center (WHAIC) and published in the Guide to Wisconsin Hospitals. The WHAIC is responsible for collecting and disseminating Wisconsin hospital and freestanding ambulatory surgery center data.

Wisconsin hospitals welcomed 64,255 babies into the world in 2012; 2,419 of those newborns required care in a neonatal intensive care unit (NICU).

WHAIC reported that in 2012, 148 Wisconsin hospitals provided uncompensated health care services on more than 1.2 million hospital visits by patients who were uninsured, underinsured and low income.

Hospitals continue to report an uptick in the number of patients they see on an outpatient basis. In 2012, there were more than 16.3 million outpatient visits, or about 44,685 patients per day, which is up three percent over 2011. More than 70 percent—or 539,740—of the surgeries and procedures performed in hospitals were delivered in the outpatient department.

"We continue to see a steady increase in hospital outpatient visits. Medical and technological advancements are making procedures and treatments available in the outpatient setting that just a few years ago would have required an overnight stay," according to WHAIC Vice President Debbie Rickelman.

Wisconsin emergency rooms (ERs) were busy, with more than 1.65 million visits in 2012, which is the most recent year that data is available. The most common reason for an ER visit was abdominal pain, followed by chest pain, which replaced complications from pregnancy or childbirth, which had been in the second position for a number of years. Injury-related visits accounted for 24 percent of total ER volume.

There were 150 hospitals that submitted data to the WHAIC in 2012. Hospitals are among the largest employers in the state, employing more than 100,000 people with a broad range of skills, from high school graduate to highly-specialized health care professionals. The 24/7, 365-days-a-year nature of health care requires that hospitals have a flexible, well-trained workforce.

"Hospitals are the health care safety net in every community they serve, and our employees are at the front lines of care," said Wisconsin Hospital Association President Steve Brenton. "As we observe Hospital Week, it is a good time to celebrate our hospitals and the professional and support staff who are focused on providing high-quality, compassionate care to our patients and their families."

Begun in 1921, National Hospital Week celebrates the history, technology and dedicated professionals that make hospitals beacons of confidence and care.

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CMS Revises, Clarifies CoP Provisions

As part of its ongoing regulatory retrospective review initiative in which the Centers for Medicare and Medicaid Services (CMS) is "modifying, streamlining, or eliminating excessively burdensome and unnecessary regulations," CMS issued a final rule May 7 to revise and clarify certain Conditions of Participation (CoP) and Conditions of Coverage for hospitals and other providers.

Among the changes and clarifications, CMS will allow greater flexibility for hospital medical staff structures, such as allowing hospitals in multi-hospital systems to have either a unique medical staff for each hospital or a unified and integrated medical staff shared by multiple hospitals within the system. CMS will require unified medical staffs in multi-hospital systems to meet certain conditions, including allowing the medical staff members holding privileges at each separately certified hospital in the system to vote by majority either to participate in a unified and integrated medical structure or to opt out.

WHA Executive Vice President Eric Borgerding noted the link between the CMS efforts to improve health care efficiency by eliminating red tape and the recently-enacted WHA-supported bill that reforms state hospital regulations.

Borgerding said, "By synchronizing our state hospital regulations with the federal regulations, Wisconsin hospitals will be required to meet the most up-to-date standards. With separate regulatory schemes, regulatory improvements like the ones finalized by CMS this week created new inconsistencies between the state and federal rules, further underscoring the need for state-level reform. We appreciate the action taken by the Wisconsin Legislature and Walker Administration that enables broader reforms."

A copy of the final rule is available at www.ofr.gov/OFRUpload/OFRData/2014-10687_PI.pdf.

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Call for Presenters, Papers at WCMEW Conference on Team-Based Care

The Wisconsin Council on Medical Education and Workforce (WCMEW) will convene a statewide conference on team-based care November 12 in Wisconsin Dells. A key part of the conference will be presentations by those who are practicing team-based care. WCMEW is looking for teams who can share their success stories.

The all-day conference will kick off with two keynotes, "The New Role of Teams in the New American Population Health," and "Cultures that Make Teams Successful." The keynotes will be followed by three panel presentations, where teams will present on the topics of "Mission and Driving Force," "Team Interaction and Culture," and "Patient Population and Outcomes."

There will also be poster presentations and a conference compendium will be available.

More detailed information on the conference and how to apply as a presenter is available now. The deadline for teams to apply is June 6. Conference registration will be available in July.

WCMEW is a multi-stakeholder organization whose purpose is to facilitate strategies to ensure an adequate supply of health care providers to meet the needs of Wisconsin citizens today and into the future. In addition to the Wisconsin Hospital Association, stakeholders include the Wisconsin Medical Society, the Medical College of Wisconsin, Pharmacy Society of Wisconsin, Rural Wisconsin Health Cooperative, UW School of Medicine and Public Health, Wisconsin Academy of Family Physicians, Wisconsin Academy of Physician Assistants, and the Wisconsin Nurses Association.

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Register today for the 2014 Wisconsin Rural Health Conference
The Osthoff Resort, Elkhart Lake *** June 18-20, 2014

More information and online registration is available at http://events.signUp4.net/14Rural

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WHA to Offer Health Law Manuals Webinar Series

WHA will be hosting a complimentary webinar series over the next few months focused on the WHA Health Law Manuals. Each webinar will showcase a specific topic covered by a respective Health Law Manual—for example, consent, mental health issues, health information, record retention and issues facing tax-exempt entities. WHA members are encouraged to register for any or all of the webinars in the series. Sign-up information, as well as more information about each of the webinars in the series, may be found at http://events.SignUp4.net/HealthLawManual. Attorneys in attendance may earn CLE credit.

Each webinar in the series will be presented by one of the following WHA corporate member law firms: Hall, Render, Killian, Heath & Lyman; Quarles & Brady; Reinhart Boerner Van Deuren; von Briesen & Roper; and Whyte Hirschboeck Dudek. These firms’ assistance was invaluable in the development of the Manuals.

The Health Law Manuals are available for WHA members to view and download. WHA members who would like access to the Manuals should contact webmaster@wha.org to request a username and password.

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EHR Meaningful Use Update
Key July 1 meaningful use date is approaching

The Wisconsin Department of Health Services (DHS) is accepting applications for Medicaid EHR Incentive Payments for Program Year 2014. Per federal regulations, the Program Year 2014 for hospitals includes the dates between October 1, 2013, and September 30, 2014. The last day to apply for a Program Year 2014 Medicaid incentive payment for hospitals is January 31, 2015.

Additional information regarding the Medicaid EHR Incentive Program and on reporting meaningful use public health information to DHS can be found in DHS’s Forward Health Update No. 2013-51 (https://www.forwardhealth.wi.gov/kw/pdf/2013-51.pdf) and at the Wisconsin Medicaid EHR Incentive Program website. You can also receive additional information by contacting DHS staff with the Medicaid EHR Incentive Program at: dhsehrincentiveprogram@dhs.wisconsin.gov.

Also, as a reminder, hospitals that first attested to meeting Stage 1 meaningful use in Program Year 2011 or 2012 are required to meet Stage 2 meaningful use for Program Year 2014 to remain in compliance with the meaning use rules for the Medicaid or Medicare EHR programs. In addition, all hospitals seeking compliance with the meaningful use rules must upgrade to a v.2014 Certified EHR Technology in Program Year 2014. Thus, for 2014 only, all hospitals, regardless of their stage of meaningful use, are only required to demonstrate meaningful use of v. 2014 Certified EHR Technology for a 3-month EHR reporting period that corresponds to a federal fiscal quarter. For hospitals, the last chance to demonstrate such compliance during a 3-month EHR reporting period is July 1, 2014 – September 30, 2014.

Additional information can be found at www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html.

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TCAB Kicks-Off Inside Agnesian HealthCare

For a Wisconsin first, Agnesian HealthCare conducted its own internal launch of Transforming Care at the Bedside (TCAB) with the goal of spreading involvement throughout St. Agnes and system hospitals Ripon Medical Center and Waupun Memorial Hospital. St. Agnes Hospital enrolled the 5 South Medical-Surgical unit in the second TCAB cohort, and based on the team’s experience, hospital leaders wanted to capture the excitement and learning and spread it throughout the system.

Jill Stenson, Agnesian’s chief nursing officer, and Jim Mugan, chief operating officer, championed the idea to move forward with the internal launch of TCAB. After discussing options with Stephanie Sobczak, WHA quality manager and co-leader of TCAB, the plan for a one-day kick-off event on-site at the St. Agnes Hospital campus was a go.

"We’ve not had a system-wide TCAB launch before," says Sobczak. "But seeing the commitment of Jill and Jim, and knowing what good work the team from 5 South did in Cohort 2, I had no hesitation to help Agnesian get started."

The TCAB Kick-off included teams from the three hospitals and clinical departments who would receive the essential elements needed to engage their colleagues, encourage innovation, and conduct systematic improvement cycles. According to Stenson, "As nursing leaders, we were looking for opportunities on the best ways to bring nursing associates from the three hospitals—Ripon Medical Center, St. Agnes Hospital and Waupun Memorial Hospital—on board with TCAB in a timely manner."

A total of 52 nursing associates from all three Agnesian HealthCare hospitals participated in a seven-hour TCAB training session. The associates organized into nine teams and used the opportunity to identify department-specific rapid cycle improvement projects.

"It was energizing to see so many nursing associates across the Agnesian HealthCare system working together—they are really motivated to improve patient care at the bedside with their ideas, which brings ownership," according to Mugan. "These ideas and initiatives will bring results that can be quite difficult to achieve when initiated by formal leadership. I would highly recommend WHA’s TCAB program."

At the end of the day, the teams identified a plan for project management and how to bring TCAB to their departments. Once established, teams planned to share learning and outcomes through Agnesian HealthCare’s nurse practice council. To ensure good progress is made, the unit managers and nursing leaders committed to making TCAB a success by planning a best practice sharing gathering six months from the kick-off date.

"I’m really looking forward to watching Agnesian take TCAB to a new level in Wisconsin," Sobczak said.

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Nursing Profession Adapts, Evolves as Health Care Delivery Model Changes
WHA recognizes nurses during National Nurses Week, May 6- May 12

Nurses comprise the largest group of workers in health care. Currently, there are over 90,000 nurses employed in the health care sector in Wisconsin; over 60 percent are employed in hospitals and ambulatory care settings, according to the WHA 2013 Health Care Workforce Report. The shift in health care with the implementation of the Affordable Care Act and changing models of care delivery will lead to an increase in demand for nurses in the ambulatory care and outpatient settings.

"National Nurses Week provides an opportunity for all of us to acknowledge nurses for their dedication and for their commitment to delivering innovative, cost-effective care that alleviates and prevents illness and improves the health of everyone living in Wisconsin," said WHA president Steve Brenton.

As the state continues to age, so does its health care workforce. That raises concerns about future workforce shortages. According to the 2012 Wisconsin RN Workforce Survey, the average age of a nurse is 48. Nursing, like health care, is changing and evolving to meet the needs of the community to encompass all work settings. The work setting with the highest expected demand by 2035 is nursing homes and home health. The need for nurses in elderly care and home health settings is consistent with the Wisconsin aging projection increase of 132 percent in those 85 and older by 2035.

Nurses with graduate education are also needed in advanced practice roles. In Wisconsin, 8,095 advanced practice registered nurses (APRNs) are licensed with the largest percentage being nurse practitioners. Approximately 3,023 are nurse practitioners, with the largest percent (8.6 percent) holding adult credentials and 3,267 (78.6 percent) report being currently licensed as advanced practice nurse prescribers, according to the Wisconsin Center for Nursing.

Wisconsin’s schools of nursing are working collaboratively among themselves and with other stakeholders to meet the demand for nurses. On average 7,500 new nurses are needed here each year to ensure there is an adequate number of trained nurses in the field. The major challenge in meeting the nursing demand is the capacity of nursing schools and having an adequate number of nursing faculty positions. In Wisconsin, 33 percent of nursing faculty plan to retire in four years or less (Wisconsin Center for Nursing Workforce Report, 2013).

WHA continues to work with its members, public agencies, regulating bodies, the Legislature and the education system to create action plans to meet future workforce demands.

"Nurses have an important role in our evolving health care delivery system," said Jodi Johnson, WHA vice president of workforce and clinical practice. "The nursing profession plays a crucial role in delivering the high-quality patient care that is a hallmark in Wisconsin."

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Fast Facts from the WHA Information Center: May is Mental Health Awareness Month

May is Mental Health Month. WHA has worked closely with Gov. Scott Walker, the state Legislature and with health care providers statewide to reform Wisconsin’s mental health system. During the last legislative session, WHA advocated for several bills, including the Mental Health Care Coordination/HIPAA Harmonization Bill (Act 238), that were signed into law to help improve outcomes for those with mental illness.

Data from the WHA Information Center illustrates the importance of addressing mental and behavioral health issues. The data below was collected by the WHA Information Center from the last four quarters (Q4 2012 – Q3 2013). Unless specified below, WHA Information Center reviewed inpatient, observation and ER visits.

* Data provided by the WHAIC (www.whainfocenter.com). Watch for more information in future editions of The Valued Voice.

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