July 10, 2015
Volume 59, Issue 27


Legislature Passes State Budget, Moves on to Governor Walker
Rep. Nygren points to Medicaid DSH program as key provision

Within nearly a 24-hour span, both chambers of the Legislature passed a biennial budget bill this week. The $73 billion budget bill establishes the spending plan for state government for the next two years, and includes funding for critical government programs such as Medicaid. The bill is now on its way to Governor Scott Walker, who will review the legislation, including making vetoes, before he signs the bill into law. The Governor has a powerful veto pen in Wisconsin that allows him to strike individual provisions in a piece of legislation that has an appropriation.

Prior to review by the full chambers of the Legislature, the Joint Finance Committee passed the budget early in the morning on Friday, July 3. In his final remarks during the Committee process, Joint Finance Co-Chair John Nygren stated that "DSH payments, Disproportionate Share Hospital payments, are now permanent in this budget," indicating that DSH was one of several reasons he believed "there is plenty to be proud of in this budget." Gov. Walker included funding for DSH in his version of the state budget, but only for two years. The action taken by Joint Finance will allow the program to continue indefinitely. Both Republicans and Democrats supported making DSH permanent.

"We appreciate the support of both Gov. Walker and the Legislature in making DSH a key and ongoing component of Wisconsin’s overall Medicaid program and comprehensive approach to expanding access to care," said WHA President/CEO Eric Borgerding. "The fact that this proposal had widespread bipartisan support speaks to its importance."

Nygren also echoed his previous comments on DSH during debate on the full Assembly floor July 8, stating in his opening speech that "the Disproportionate Share Hospital program will be permanently written into our state statutes."

The Committee’s action last week included a wrap-up motion making several changes to the proposed budget bill. Some of these changes include:

All of these changes, along with previous action by the Joint Finance Committee, needs to survive a veto by Gov. Walker in order to become law. The Governor is expected to review and sign the budget bill in the coming days.

For more information about key health care issues in the state budget, see:

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DHS Secretary Rhoades Discusses Family Care, Nursing Home Bed Policy

Gov. Scott Walker’s cabinet secretary to the Department of Health Services (DHS) Kitty Rhoades commented on several pieces of proposed public policy during a luncheon event in Madison hosted by Wisconsin Health News. The Secretary used this opportunity to talk about the Department’s efforts to manage the overall Medicaid budget, comment on changes made by the Joint Finance Committee to change the state’s Medicaid long-term care program and a proposal by a company called Mainstreet Investments to eliminate the current nursing home bed cap for "transitional care facilities."

Talking about Gov. Walker’s first budget in office, Rhoades said, "We found that Medicaid, just Medicaid, was $1.8 billion in the hole." Rhoades went on to talk about the commitment that the Governor and Legislature have made to fund the program. "Thankfully to the Governor and the Legislature, they gave us $1.3 billion and said, ‘you need to find the rest’."

Rhoades said she was proud that DHS was able to make up a $500 million difference "without going to rates, benefits or eligibility." She added, "We’re not going to do that; we’re going to become more efficient and figure out how to do this right."

Tim Stumm, editor of Wisconsin Health News, interviewed Rhoades and asked about the Governor’s proposed changes to the current Family Care program and the Joint Finance Committee’s actions modifying the Governor’s proposal. The Joint Finance Committee adopted a model that hinges on at least five regional "integrated health agencies" to coordinate and manage Family Care services.

Rhoades was unable to give specifics because the budget bill hasn’t been signed into law, but said she assumed the integrated health agencies would be similar to the definition of managed care organizations. She said the idea is to provide uniformity across the state in the benefit design and care delivery for individuals served in the Family Care program. The changes would also incorporate Medicaid card services (e.g. hospital, acute care benefits) into the overall Family Care benefit. Currently, these "card services" are provided separately from the Family Care benefit and are not managed by the eight managed care organizations in charge of coordinating care for beneficiaries.

When asked whether or not she thought DHS could have done something different to reach out to stakeholders about the Governor’s plan, Rhoades said, "We have never initiated a major reform other than through the budget process." She continued, "Change is always scary, particularly when it’s about health care, because we are all convinced we are going to end up with less than we had before. That’s not the intent. The intent is to build the program that addresses the whole population, the total person."

When discussing a proposal to establish a regulatory scheme for newly-constructed skilled nursing facilities providing primarily transitional care services, Rhoades said, "Transitional care is not a new idea. We’ve been doing it for years, and actually, many of the systems have been engaged in getting nursing home beds to be able to do rehabilitative therapies." Rhoades went on to discuss her concerns with losing control of the location of nursing home beds, saying it is a concern for rural Wisconsin potentially losing beds to urban or suburban areas with more profitable margins.

"We only have three or four counties that are anywhere near 90 percent occupancy," said Rhoades about current nursing home bed capacity statewide. "We do not have an access issue."

When asked directly about whether she thinks there is a need for lifting the nursing home bed cap for a new classification of "transitional care facilities," Rhoades stated "No, I don’t."

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Political Action Fundraising Campaign Climbs to $154K
34 more participants joined in last month

The Wisconsin Hospitals Conduit and State PAC annual campaign so far has raised $153,752 from 183 individuals. This puts the 2015 campaign at 57 percent of the goal to raise $270,000 by the end of the year.

Individuals are contributing an average $840, which is up $100 from last year’s average with the number of participants up just slightly. This year’s campaign continues outpacing both the 2014 campaign ($136,000) and the 2013 campaign ($98,000) in dollars raised and numbers of participants.

Of the total contributors so far, 50 are members of the Platinum Club who have contributed $1,500 or more so far to the 2015 campaign.

Individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. Thank you to the 2015 contributors to date who are listed below. Contributors are listed alphabetically by contribution amount category. The next publication of the contributor list will be in the July 24 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Contributors Ranging from $1 - $499  
Anderson, Phil Sacred Heart Hospital
Appleby, Jane Aurora Health Care
Ballentine, Anne Wheaton Franciscan Healthcare
Bayer, Tom St. Vincent Hospital
Bard, Jeffrey Aurora Medical Center - Oshkosh
Brenny, Terrence Stoughton Hospital
Brisch, Donald Holy Family Memorial
Cardinal, Lori Agnesian HealthCare
Carter, Shane Aurora Medical Center - Oshkosh
Clark, Renee Fort HealthCare
Collins, Sherry Wisconsin Hospital Association
Colman, Gerard Aurora Health Care
Coopman, Dianne St. Mary's Janesville Hospital
Cormier, Laura Bellin Hospital
Culotta, Jennifer St. Clare Hospital & Health Svcs
Curran-Meuli, Jane Holy Family Memorial
Davidson, Lisa Wisconsin Primary Health Care Association
Dettman, Amy Bellin Hospital
Dux, Larry Froedtert & MCW Community Mem. Hosp
Evans, Kim Bellin Hospital
Feeney, John Community Health Network, Inc.
Fielding, Laura Holy Family Memorial
Freitag, Vanessa                       Our Lady of Victory Hospital
Gullicksrud, Lynn Sacred Heart Hospital
Hafeman, Paul St. Vincent Hospital
Halida, Cheryl St. Joseph's Hospital
Hamilton, Mark UW Hospitals and Clinics
Harrington, Kathleen Mayo Health System - Eau Claire
Hernandez, Terri HSHS-St. Joseph's Hospital
Jelle, Laura St. Clare Hospital & Health Services
Kaufmann, Marilyn Holy Family Memorial
Klay, Chris St. Joseph's Hospital
Knutzen, Barbara Agnesian HealthCare
Krueger, Kari St. Mary's Janesville Hospital
Lampman, Sandra St. Mary's Hospital
Leschke, John Mercy Medical Center
Lynch, Sue Mayo Health System - Franciscan HC
Maurer, Mary Holy Family Memorial
McArdle, PeggyAnn Agnesian HealthCare
McMeans, Scott Holy Family Memorial
Mercer, Carla Reedsburg Area Medical Center
Miller, Thomas Children's Hospital of Wisconsin
O'Hara, Tiffanie Sundial Software
Olson, Bonnie Sacred Heart Hospital
Peiffer, Susan Sacred Heart Hospital
Range, Bonnie Holy Family Memorial
Riddle, Roberta Rusk County Memorial Hospital
Rocheleau, John Bellin Health
Roethle, Linda Bellin Memorial Hospital
Roundy, Ann Columbus Community Hospital
Schubring, Randy Mayo Health System - Eau Claire
Selle, Ginger St. Clare Hospital & Health Services
Statz, Darrell Rural Wisconsin Health Cooperative
Stelzer, Jason St. Clare Hospital & Health Services
Swanson, Kaitlin HSHS-Eastern WI Division
Tapper, Joy Milwaukee Health Care Partnership
Theiler, Brian Gundersen Tri-County Hospitals & Clinics 
Van Abel, Lois Bellin Hospital
Walker, Troy St. Clare Hospital & Health Services
Werkheiser, Cindy Monroe Clinic
Wheeler, Susan St. Nicholas Hospital
Whitinger, Margaret Agnesian HealthCare
Wold, Gwen Amery Regional Medical Center
Contributors Ranging from $500 - $999  
Bagnall, Andrew St. Nicholas Hospital
Bailet, Jeffrey Aurora Health Care
Dexter, Donn Mayo Health System - Eau Claire
Dicus-Johnson, Coreen Wheaton Franciscan Healthcare
Dietsche, James Bellin Hospital
Dolohanty, Naomi Aurora Health Care
Ericson, Allen Froedtert & MCW St. Joseph's Hospital Campus
Frangesch, Wayne Wheaton Franciscan Healthcare
Furlong, Marian Hudson Hospital & Clinics
Golanowski, Marie Aurora St. Luke’s Medical Center
Graul, Mark Children’s Hospital of Wisconsin
Gullingsrud, Tim Hayward Area Memorial Hospital & Nursing Home
Gustafson, Andy SSM Health Care-Wisconsin
Hanson, Gail Aurora Health Care
Heaney, Dwight Fort HealthCare 
Jacobson, Terry St. Mary’s Hospital of Superior
Jensema, Christine HSHS-Eastern Wisconsin Division
Kingston, Mary Beth Aurora Health Care
Kirsch, Jennifer Gundersen Health System
Lange, George Westgate Medical Group, CSMCP
Larson, Margaret Mercy Medical Center
Latta, Richard Godfrey & Kahn, SC 
Lindberg, Steve Mayo Clinic Health System - Red Cedar
Mohorek, Ronald Ministry Health Care
Mulder, Doris Beloit Health System 
Nelson, James Fort HealthCare
O’Day, Thomas Godfrey & Kahn, SC
Oland, Charisse Rusk County Memorial Hospital
Ose, Peggy Riverview Hospital Association 
Peterson, Douglas Chippewa Valley Hospital
Quinn, George Wisconsin Hospital Association
Reardon, Brian Hospital Sisters Health System
Roesler, Bruce The Richland Hospital
Rozenfeld, Jon St. Mary’s Hospital - Madison
Rude, Nels The Kammer Group
Seitz, Verna ProHealth Care, Inc.
Selberg, Heidi HSHS-Eastern Wisconsin Division
Shabino, Charles Wisconsin Hospital Association
Shorter, Tom Godfrey & Kahn, SC
Simaras, Jim Wheaton Franciscan Healthcare
Sisney, Mary Children's Hospital of Wisconsin
Stuart, Philip Tomah Memorial Hospital
Teigen, Seth St. Mary’s Hospital 
Thurmer, DeAnn Waupun Memorial Hospital
Van Meeteren, Bob Reedsburg Area Medical Center
Yaron, Rachel Ministry St. Clare’s Hospital
Zenk, Ann Ministry St. Mary’s Hospital
Contributors Ranging from $1,000 - $1,499  
Ashenhurst, Karla Ministry Health Care
Bedwell, Elizabeth Children's Hospital of Wisconsin
Bloch, Jodi Wisconsin Hospital Association
Brenton, Andrew Wisconsin Hospital Association 
Connors, Larry St. Mary's & St. Vincent Hospital
Cullen-Schultz, Jeannie JP Cullen & Sons
Geboy, Scott Hall, Render, Killian, Heath & Lyman
Just, Lisa Aurora Health Care-South Region
Kerwin, George Bellin Hospital
Killoran, Carrie Aurora Health Care
Lewis, Jonathan St. Mary's Hospital 
McCawley, Thomas Beloit Health System
Punzenberger, Lindsay Children’s Hospital of Wisconsin 
Reynolds, Sheila Children’s Hospital of Wisconsin 
Rickelman, Debbie WHA Information Center
Robertstad, John ProHealth Care - Oconomowoc Memorial Hospital
Roller, Rachel Aurora Health Care
Rush, Steven Wisconsin Hospital Association
Sato, Thomas Children’s Hospital of Wisconsin
Schafer, Michael Spooner Health System
Swanson, Kerry St. Mary’s Janesville Hospital
White-Jacobs, Mary Beth          Black River Memorial Hospital
Wolf, Edward Lakeview Medical Center
Contributors Ranging from $1,500 - $1,999  
Boese, Jennifer Wisconsin Hospital Association 
Clapp, Nicole Grant Regional Health Center 
Coffman, Joan St. Joseph's Hospital
Court, Kelly Wisconsin Hospital Association 
Decker, Michael Divine Savior Healthcare 
Dotson, Jason Beloit Health System
Frank, Jennifer Wisconsin Hospital Association 
Grasmick, Mary Kay Wisconsin Hospital Association 
Harding, Edward Bay Area Medical Center
Kammer, Peter The Kammer Group
McKevett, Timothy Beloit Health System
Natzke, Ryan Marshfield Clinic 
Nauman, Michael Children's Hospital of Wisconsin
Olson, David Froedtert & The Medical College of Wisconsin
Russell, John Columbus Community Hospital 
Schulze, Connie Ministry Health Care 
Sexton, William Crossing Rivers Health Medical Center
Sheehan, John UW Hospitals and Clinics
Wallace, Michael Fort HealthCare
Contributors Ranging from $2,000 - $2,999  
Alig, Joanne Wisconsin Hospital Association
Anderson, Sandy St. Clare Hospital & Health Svcs
Duncan, Robert Children's Hospital & Health System
Herzog, Mark Holy Family Memorial
Hilt, Monica St. Elizabeth Hospital
Kachelski, Joe WI Statewide Health Info Network 
Leitch, Laura Hall Render
Levin, Jeremy Rural Wisconsin Health Cooperative 
Lewis, Gordon Burnett Medical Center 
Mettner, Michelle Children’s Hospital of Wisconsin 
Pandl, Therese HSHS-Eastern Wisconsin Division
Meyer, Daniel Aurora BayCare Medical Ctr Green Bay
Potter, Brian Wisconsin Hospital Association
Potts, Dennis Aurora St. Luke’s Medical Center
Sanders, Michael Monroe Clinic 
Sliwinski, Ron UW Hospitals and Clinics
Stanford, Matthew Wisconsin Hospital Association
Troy, Peggy Children’s Hospital of Wisconsin
Contributors Ranging from $3,000 - $4,999  
Boatwright, Damond SSM Health Care-Wisconsin
Jacobson, Catherine Froedtert & The MCW 
Little, Steve Agnesian Health Care
Neufelder, Dan Ministry Health Care
Normington, Jeremy Mercy Medical Center
O’Brien, Kyle Wisconsin Hospital Association
Size, Tim Rural Wisconsin Health Cooperative
Standridge, Deb Wheaton Franciscan Healthcare
Starmann-Harrison, Mary  Hospital Sisters Health System
Turkal, Nick Aurora Health Care
Contributors Ranging from $5,000+  
Borgerding, Eric & Dana   Wisconsin Hospital Association
Brenton, Stephen Wisconsin Hospital Association
Tyre, Scott Capitol Navigators, Inc.


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OPPS Proposed Rule Released, Includes Changes to Two-Midnight Policy

In its proposed CY 2016 Outpatient Prospective Payment System (OPPS) rule released July 1, the Centers for Medicare & Medicaid Services (CMS) proposes altering its "Two-Midnight" policy.

In general, the current two-midnight policy sets a time-based threshold for inpatient versus outpatient stays and accompanying payments. CMS generally considers a stay spanning two midnights or more as appropriate for inpatient payment under the Inpatient Prospective Payment System (IPPS), but anything less than two midnights (with a few exceptions) appropriate for payment under the OPPS.

Under the proposed changes, CMS would adjust its policy for stays spanning less than two midnights, which have been the source of intense recovery audit denials nationally. In these instances, inpatient payment would be appropriate on a "case-by-case basis" based on the medical judgment of the admitting physician. The medical record must document and support the need for inpatient admission in these instances and will be prioritized for medical review. CMS then proposes removing recovery auditors and Medicare administrative contractors from the first line medical review for these shorter stays. Instead, initial reviews of stays less than two midnights will be done by quality improvement organizations (QIOs).

The exceptions to QIO review include instances where a hospital demonstrates a pattern of unnecessary short stays or fails to improve two-midnight policy adherence in spite of QIO education, as examples. In these instances and other instances the claims may be sent to recovery auditors for payment review.

CMS proposes no changes to its policy for stays spanning longer than two midnights.

The Wisconsin Hospital Association is pleased to see CMS take these steps to improve the burdensome two-midnight policy. WHA also supports delayed enforcement through the end of calendar year 2015 (current enforcement delay ends in October).

WHA continues to review the entire proposed OPPS rule. WHA will make a full summary of the proposed rule available soon at: www.wha.org/pps_outpatient.aspx. Comments on the OPPS rule are due to CMS by September 8. WHA plans to submit comments.

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Wisconsin Board of Nursing Holds Public Hearing on Nurse Licensure Compact

The Wisconsin Board of Nursing (BON) held a public hearing regarding the endorsement of the new Nurse Licensure Compact (NLC) July 9, 2015. The new NLC, which is significantly different from the compact currently in place for Wisconsin nurses, is a joint effort from the National Council of State Boards of Nursing (NCSBN) and the National Nurse Licensure Compact Administrators (NLCA) to modernize the compact and to better reflect the health care environment of today. NCSBN has available on their website detailed information regarding the NLC at https://www.ncsbn.org/compacts.htm.

Currently, Wisconsin is one of 24 states that belong to the NLC. BON is considering support and future endorsement of the new compact, which would require a legislative appeal of current statute (https://docs.legis.wisconsin.gov/code/admin_code/n/9.pdf) and a replacement with the new model language (https://www.ncsbn.org/95.htm). The only border state that is also a member of the current compact is Iowa.

During the July 9 hearing, Steven Rush, vice president, workforce and clinical practice at Wisconsin Hospital Association, testified that maintaining the benefits a compact affords is a concern WHA will keep central in discussions going forward.

"We have member hospitals that are near the Wisconsin-Iowa border that employ a significant number of nurses who reside in Iowa," Rush stated. "The ability of these nurses to work in Wisconsin without carrying an additional single-state license lessens the licensure burden of nurses currently employed, as well as makes easier the recruitment and hiring of new nurses." Rush further explained, "If Wisconsin is quick to adopt the new compact, and Iowa does not, we would in essence eliminate any benefits of a compact."

Rush did not comment on the merits and challenges of the current compact versus the new compact, but instead urged the BON to thoughtfully consider their endorsement and recommendations of entering into any new agreement that would not provide compact benefits with other states.

Sharon Henes, administrative rules coordinator for the Department of Safety and Professional Services clarified for those present at the public hearing that the BON can only recommend to Wisconsin legislators a position on the compact.

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DHS Releases ForwardHealth Update on EHR Incentive Program
Medicaid EHR application date TBA

The Wisconsin Department of Health Services (DHS) announced in its June ForwardHealth Update No. 2015-25 that the Wisconsin Medicaid EHR Incentive Program is not currently accepting applications for Medicaid meaningful use incentive payments but will do so at a later date. This decision is a result of proposed rulemaking by the federal Centers for Medicare and Medicaid Services (CMS) regarding modifications to Meaningful Use for 2015 through 2017, according to the ForwardHealth Update.

The Update also reminds hospitals that the 2015 EHR reporting period for the Wisconsin Medicaid EHR Incentive Program is from October 1, 2014, through September 30, 2015. Because of an additional grace period at the end of the reporting period to apply for an incentive payment, currently the last day for hospitals to submit 2015 applications is January 31, 2016. Any extension to the grace period will be communicated by the Wisconsin Medicaid EHR Incentive Program once the federal proposed rulemaking is finalized according to the Update.

In addition, the Update also provides hospitals with information regarding patient volume determinations, documentation requirements, and other technical issues regarding applying for the Medicaid EHR incentive.

The June ForwardHealth Update can be found at: https://www.forwardhealth.wi.gov/kw/pdf/2015-25.pdf. Additional information regarding the Medicaid EHR Incentive Program, including provider eligibility, registration, attestation, and incentive payments can be found at https://www.dhs.wisconsin.gov/ehrincentive/index.htm. Questions about the Program can be directed to dhsehrincentiveprogram@dhs.wisconsin.gov, or you can contact Andrew Brenton, WHA assistant general counsel, at 608-274-1820 or abrenton@wha.org.

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DHS Begins Implementing New Wisconsin Well Woman Program Model

On July 1, the Wisconsin Department of Health Services (DHS) announced the implementation of a new care delivery model to provide breast and cervical cancer screenings for women receiving benefits from the Wisconsin Well Woman Program (WWWP). DHS, which administers the WWWP, embarked on reforming the old care delivery model to better manage the number of providers participating in the program and also account for an expected reduction in the number of women served by the program.

From 2013 to 2014, the number of women served by WWWP dropped from a little over 10,000 to about 5,800. DHS attributes this change in enrollment to the availability of comprehensive health care coverage through new Medicaid eligibility for childless adults or health plans on the insurance exchange.

The new model required providers to apply to participate in the program through a Request For Application (RFA) process. DHS announced earlier this month that they decreased the number of providers from 400 to 44 and decreased the number of provider sites from over 1,000 to nearly 500. DHS indicated the large number of providers was administratively burdensome for the agency and hoped to decrease the number of providers to create efficiencies within the program.

DHS also made changes to the care coordination function of WWWP, changing from a county-based coordinating agency model to a regional service coordinating agency model. This decreased the number of coordinating agencies from 67 down to 13.

For more information on the changes to the Wisconsin Well Woman Program, including a list of providers participating in the program, visit the DHS website at: www.dhs.wisconsin.gov/wwwp/model.htm.

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Member News: Ministry Health Care Names Anderson to Leadership Role

Ministry Health Care has announced Sandra Anderson has accepted the role of regional vice president for Ministry Health Care’s Northern Region and president of the Northern Region Hospitals. She began her new responsibilities July 6, 2015, and reports directly to Daniel E. Neufelder, president and CEO of Ministry Health Care.

In her new role, Anderson is responsible for directing the daily operations and overall performance of Ministry Sacred Heart Hospital (Tomahawk), Ministry Saint Mary’s Hospital (Rhinelander), Howard Young Medical Center (Woodruff), Ministry Eagle River Memorial Hospital (Eagle River) and Howard Young Foundation.

Anderson previously served as president of St. Clare Hospital & Health Services in Baraboo since 2002. She led St. Clare’s through a major cultural transformation resulting in significant improvement in patient satisfaction scores, employee engagement scores and physician engagement scores. Anderson was also named the regional vice president of affiliates of SSM of Wisconsin (SSMW) in Madison in 2012. Prior to joining St. Clare’s, she held positions at Greene Memorial Hospital, Inc. in Xenia, Ohio and Sacred Heart Hospital in Eau Claire, Wisconsin.

Anderson has served on the Wisconsin Academy of Rural Medicine Steering Committee, Baraboo National Bank board of directors, Baraboo Economic Development Council, the State of Wisconsin Legislative Council on Health Access, Wisconsin Hospital Association board of directors (serving as WHA board chair in 2012) and is a member of the American Hospital Association Regional Policy Board, Region 5.

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Last Call for Nominations: WHA Foundation’s 2015 Global Vision Award
Nominations due July 15

Nominations for the 2015 Global Vision Community Partnership Award, presented by the WHA Foundation, are due by July 15, 2015. The official call for nominations for the 2015 Award is included in this week’s packet or can be found on the WHA website at www.wha.org/global-vision-comm-partnership.aspx.

The Award is a competitive grant presented to a community health initiative that successfully addresses a documented community health need. Any WHA hospital member can nominate a project that has been in existence for a minimum of two years and is a collaboration between the hospital and an organization within the community.

Launched by the WHA Foundation in 1993, the Award seeks to recognize ongoing projects that support community health. Honor one of your hospital’s community health projects by submitting a nomination today. For more information about the Award, contact Jennifer Frank at jfrank@wha.org or 608-274-1820.

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