August 15, 2014
Volume 57, Issue 33


Primary Elections Set Up Nov. 4 Faceoff in Many Elections
Some races still "too close to call"

Wisconsin held its partisan primary election August 12, setting up the final candidates for the upcoming general election November 4. In some districts, there are only candidates registered from one political party, causing the primary to effectively determine the next lawmakers from that district.

Statewide, former Trek Bicycle executive Mary Burke defeated her opponent in the Democratic primary for Governor by a significant margin. Burke, who beat sitting Assembly Rep. Brett Hulsey (D-Madison), garnered 83 percent of the vote statewide and solidified the Democratic nomination to challenge Republican incumbent Governor Scott Walker.

Also on the statewide ballot, Jefferson County District Attorney Susan Happ defeated two other candidates to win the Democratic nomination in the race for Attorney General. Happ will face Waukesha County District Attorney and Republican candidate Brad Schimel to replace retiring Attorney General JB Van Hollen (R).

In Wisconsin’s 6th Congressional District, a three-way Republican primary resulted in a razor-thin margin for State Sen. Glenn Grothman (R-West Bend), who narrowly edged out State Sen. Joe Leibham (R-Sheboygan) by 214 votes, according to the Milwaukee Journal Sentinel’s election results. Because the margin was less than 0.5 percent, the candidates can request a publicly-funded recount of the vote, and many political experts expect a recount to begin soon.

The Democratic primary in the 17th Senate District resulted in a virtual tie between two candidates vying to replace retiring State Sen. Dale Schultz (R-Richland Center). Preliminary results showed Ernie Wittwer leading Pat Bomhack by only two votes out of over 7,600 votes cast. A recount is expected in that race as well. The winning candidate will go on to face sitting Rep. Howard Marklein (R-Spring Green) in the general election.

Some State Assembly primary elections resulted in a candidate who will face no opponent in the upcoming general election. These candidates will likely be voted into office November 4:

If any member has questions about election results, contact Jenny Boese at jboese@wha.org or Kyle O’Brien at kobrien@wha.org from WHA’s Government Relations team.

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Wisconsin Health News Panel Focuses on Behavioral Health
Aurora President/CEO Turkal says reform necessary to improve care

An August 5 Wisconsin Health News luncheon highlighted Wisconsin hospital, health system and state government efforts to address mental health issues. Buoyed by Governor Scott Walker’s budget investment, the work of the Speaker’s Task Force and efforts in Milwaukee and elsewhere to move toward increased community-based care, mental health is undergoing a facelift in Wisconsin.

A panel of experts discussed the impact of the increased focus and funding, and what it means for the future of mental health in the state. Milwaukee Journal Sentinel reporter Meg Kissinger moderated the discussion led by panelists Nick Turkal, MD, CEO, Aurora Health Care; Kevin Moore, deputy secretary, Department of Health Services (DHS); and Barbara Beckert, Milwaukee office director, Disability Rights Wisconsin.

The main areas of discussion focused on demand vs. supply of mental health services, HIPAA harmonization and the role of law enforcement in managing individuals with mental health issues. While progress has been made, there is still a lot of work to be done.

Turkal discussed the important role that integration will play in providing access to psychiatric services for individuals suffering from mental illness. Turkal emphasized that psychiatric care is best delivered in a team-based, patient-centric model. Turkal noted that real-time care and the use of technology, such as telemedicine, could play an important role in improving access for patients.

Demand for health care services is rising in Wisconsin, although the supply of mental health care providers has been stagnant. Turkal suggested some solutions to the increased demand for mental health services, such as for universities to offer more and larger psychiatric programs, place more focus on behavioral health in nursing programs and offer additional training and residencies in mental health. However, Turkal said there are problems with the reimbursement and funding mechanisms currently in place.

"Funding is a problem," according to Turkal. "It is no secret that Medicaid reimbursement in Wisconsin is among the lowest in the nation."

Beckert noted that many mental health care users are low-income people on Medicaid and that usually the primary care physician is the mental health provider. She suggested the state invest not only in physicians as providers, but in housing and unemployment specialists to help low-income people.

Kissinger asked if the state is doing enough to increase mental health services. Moore responded that the state is increasing graduate medical education (GME) funding to focus on psychiatry, but there is a need to increase the role of peers in order to move toward increased community-based care. Walker has increased funding for community services so people can be screened and treated earlier.

However, according to Beckert, coverage does not equal access.

Turkal discussed HIPAA harmonization, which he said physicians favor because it allows them limited, but important, access to patients’ mental health records, such as what medications they are taking.

Moore said that while legally, there is health care parity in Wisconsin, in practice, often there is not. Stigma is still a challenge, but he noted that progress is being made.

For Wisconsin Health News coverage of the panel, go to: http://wisconsinhealthnews.com/topstories/panelists-providing-mental-health-services-is-a-team-game.

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WHA Health Law Manual Webinar: Managing Health Information

WHA will continue its months-long complimentary webinar series August 28 from 12-1:30 p.m. with a presentation of the WHA Managing Health Information Manual. This webinar will cover the confidentiality of patient health information and records, a patient’s right of access to his or her health information and records and his or her children’s health care records, requirements for reporting certain matters to public authorities, the discoverability of hospital and medical staff committee reports, Joint Commission sentinel event reporting, incident reports, and electronic health information and records.

WHA members are encouraged to register for this webinar as well as any or all of the other webinars in the series. Registration and more information about each of the remaining webinars in the series may be found at http://events.SignUp4.net/HealthLawManual. Attorneys in attendance may earn CLE credit.

This webinar will be presented by Sarah Coyne and Kerry Moskol of the law firm of Quarles & Brady.

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

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Passionate Drivers of Positive Change
By Susan Kreimer, H & HN Magazine, August 2014

Wisconsin has a national reputation for its high-quality, high-value health care. The American Hospital Association recently recognized WHA’s role in helping to facilitate quality improvement with the 108 hospitals that are participating in the WHA Partner’s for Patients initiative and other leading-edge activities that have helped Wisconsin raise the bar for clinical excellence. Below is an article reprinted with permission from H&HN magazine that features an interview with WHA President Steve Brenton.

The Wisconsin Hospital Association has achieved statewide clinical improvement milestones worthy of recognition by building strategic partnerships that advance quality care.

WHA leads a collaborative of 108 hospitals. The 80 hospitals aiming to decrease early elective deliveries—babies born for nonmedical reasons or at the mother’s request before 39 weeks—achieved a 78 percent reduction. Altogether, they avoided more than $210,000 in health care costs.

Working with WHA, Wisconsin hospitals also decreased readmissions by 22 percent, surpassing the government’s goal of a 20 percent reduction. More than 3,500 patients were not readmitted, which averted $34 million in health care spending.

"We are fortunate to have health care leaders—both lay leaders and physician leaders—who have been profoundly proactive in quality improvement," WHA president and CEO Steve Brenton says, elaborating on the Association’s successful engagement of hospitals in all areas, from rural to urban.

Nine years ago, Wisconsin became the first state to begin voluntarily reporting quality results on a web-based, hospital-specific basis at www.wiCheckPoint.org. Research conducted in the state showed that transparency correlates with improvement. Hospitals can access an online data repository to compare their results with a state benchmark.

"We want to be ahead of the curve," Brenton says. "And we think it has served us well—both to stave off bad legislation and mandates, as well as to accelerate improvement activities within our member hospitals."

As hospitals strive to make positive changes, they also recognize that forming new partnerships within their communities is vital. WHA facilitates work groups and coalitions with long-term care and home health providers, and with agencies on aging to address readmissions. Representatives from all areas of the care continuum meet monthly to discuss the challenges of care transitions.

Hiring employees at the association level who have experience in the health care quality field eliminated a lot of trial and error. "That really helped us get moving faster," says Kelly Court, WHA’s chief quality officer.

Monthly webinars, regular mentoring and site visits also make a difference. For instance, one series of webinars tackled each type of health care-acquired infection.

"If the hospital is struggling, then we will have coaching calls," Court says. The site visits serve a proactive purpose to ensure that hospitals are accessing WHA’s resources, to congratulate them on their successes, and to help solve problems in specific areas.

Hospital quality departments often are spread thinly. As a result, "the efficient adoption of best practices can only occur when a large number of front-line staff serve as the passionate drivers of change," the association stated in its application for the Davidson award.

Training quality leaders is also paramount. Many nurses are hired or promoted from within to fill a quality director vacancy, but are not given the proper guidance to excel in this role. To prevent turnover in this position, the Association partnered with the Rural Wisconsin Health Cooperative to create a two-year track of on-the-job education for novice quality directors. To learn more about WHA’s quality improvement activities, visit WHA.org.

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Medicaid Transitions, Exchange Enrollment Highlight WHA Council Meeting

The progress the Wisconsin Department of Health Services (DHS) has made in enrolling eligible childless adults in Medicaid and transitioning parents and caretakers over 100 percent of the federal poverty level from Medicaid to the federal marketplace was shared with the WHA Finance and Payment Council at their August 13 meeting by Craig Steele, DHS project manager, division of health care access and accountability.

Steele told Council members that the childless adults enrollment is 20,000 higher than Department estimates so the rollout has been very successful. He also shared the latest enrollment figures from the federal exchange, which showed that 140,000 individuals have selected a federal marketplace plan through April of 2014. Steele also reviewed the regional enrollment network and discussed DHS’s plan with regards to sustainability and infrastructure support as the 2015 enrollment period nears. He said plans are in place to monitor and evaluate the progress of getting people enrolled in the appropriate plan.

Steele said 80 hospital sites that cover 43 Wisconsin counties have been approved for adult presumptive eligibility. Presumptive eligibility is a tool hospitals can use to improve access to care and get eligible recipients enrolled in Medicaid. DHS plans to roll out a new streamlined process for hospitals this fall. More information about training on the new system will be provided in future editions of The Valued Voice.

The Council also heard from Matthew Stanford, WHA general counsel, about the Association’s work on issues related to telemedicine. Stanford said the work is focused on eliminating potential barriers around regulation, payment, technology and integration that when addressed, will increase health systems’ efficiency and improve access to medical services in what is an evolving delivery environment.

The WHA Information Center (WHAIC) is due to release the newest version of PricePoint soon. WHA Senior Vice President Brian Potter, and Debbie Rickelman, WHAIC vice president, said the recently-released guidelines from the Healthcare Financial Management Association and the American Hospital Association on price transparency and responsibility were helpful as WHAIC developed content for the new site.

The new PricePoint website has a cleaner look and enhanced comparison features. It also includes a guide that helps users identify factors that will determine their responsibility toward payment of their bill.

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WHA Focuses on Improving Wage Index Reporting

WHA is working with RC Healthcare again this year on a wage index improvement project. WHA is committed to helping hospitals accurately report data in their cost reports that is then used to calculate the hospital wage index, a key component of Medicare payment for PPS hospitals.

To launch this year’s wage index improvement project, WHA and RC Healthcare are offering a wage index education webinar September 4 at 10:00 a.m. The webinar will provide important information on the wage index correction process. Over the years, this engagement, which is provided as a member benefit, has resulted in substantial corrections of various hospital data errors or FI adjustment errors and has been critically important to maintaining the integrity and accuracy of the wage index for Wisconsin hospitals.

CMS has moved the deadline up for making wage index revisions, so all changes must be submitted by early October. PPS hospital members are encouraged to participate. Detailed information about the upcoming webinar was recently emailed to hospital CFOs and wage index contacts.

While the education component of the wage index improvement project is important, it is only one piece of the overall effort. RC Healthcare also identifies a wage index contact at each hospital and then either visits or makes individual phone calls to each facility as they work on wage index reporting issues. These additional proactive efforts have led to more accurate reporting and increased reimbursement to Wisconsin hospitals.

Direct questions about WHA’s wage index improvement project to Brian Potter, WHA senior vice president, at bpotter@wha.org or 608-274-1820.

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Member News: Froedtert Health, Ministry Health Care Agree to Pursue Co-Ownership of Network Health

Froedtert Health and Ministry Health Care have agreed to pursue co-ownership of Network Health, a Menasha, Wisconsin-based health insurance plan.

Network Health provides commercial and Medicare Advantage health insurance plans to employers and individuals in northeastern Wisconsin. The company has been solely owned by Ministry Health Care since 2012.

"The anticipated transaction will position Froedtert Health and Ministry to jointly expand the Network Health service area into southeastern Wisconsin with Network Health offering Integrated Health Network as its provider network in southeast Wisconsin," said Nick Desien, president/CEO, Ministry Health Care.

"This is a natural partnership that flows from the existing Integrated Health Network of Wisconsin relationship between Ministry and Froedtert Health," said Catherine Jacobson, president and CEO of Froedtert Health and chair of Integrated Health Network.

Integrated Health Network is a clinically integrated alliance of independent health systems, hospitals and physicians. Integrated Health Network includes the following Wisconsin organizations: Froedtert Health, the Medical College of Wisconsin, Columbia St. Mary’s, Wheaton Franciscan Healthcare, Agnesian HealthCare and Ministry Health Care. It is one of the first multiple–system accountable care networks in the country.

"With clinical integration, a proven care coordination model and IT connectivity solidly in place, Integrated Health Network has the infrastructure to contract directly with all payers and insurers on behalf of its members," said Jacobson.

"We believe this partnership and expansion of Network Health will accelerate the growth of population health management programs in the communities we serve, and we welcome the prospect of expanding our relationship and look forward to our continued discussions," said Desien.

Ministry Health Care joined Integrated Health Network in September 2013. Since January, Integrated Health Network has been managing care for approximately 90,000 lives, including 55,000 lives through a partnership with UnitedHealthcare that created one of the nation’s largest accountable care initiatives.

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Small Group makes a Big Impact at Aspirus Medford

The following was shared with WHA quality department staff, as written by Nicole Kollmansberger, a surgical/quality RN, Aspirus Medford Hospital and Clinics, for their internal newsletter. Aspirus Medford is a participant in WHA’s Partners for Patients collaborative. According to Tom Kaster, WHA quality coordinator, "This is a great example of the passion and enthusiasm that can result when a staff works as a team to reduce patient harm." In addition, this illustrates for small hospitals measuring the "days between" events is more meaningful than only looking at rates – which can fluctuate greatly from month to month because of small numbers of patients.

Last August it was decided to revitalize the Aspirus Medford Falls Taskforce. As many things do, this group had fallen stagnant through the years. That may be contributed to the thought that "we already do well compared to others" with fewer than four falls on average per year.

But then I was inspired, listening to a story of 180 days or more without a fall. I had the opportunity to hear these stories through our work with WHA Partners for Patients. Aspirus Medford Hospital & Clinics saw the benefit in being part of this important work happening in Wisconsin health care and enlisted change leaders in our organization to partake, myself being one of them.

Through that work, many patient-centered improvement initiatives have come to be in our patient care areas, but today we celebrate a new feat, in inpatient falls reduction. So many things were accomplished by the task force members, volunteers, and staff on the Medical Surgical Unit to make this achievement happen. A few of those accomplishments were:

And the result of those actions and passion…today we mark 171 days without a patient fall and going strong! That is 171 days, nearly half a year that we kept every patient that stayed on our inpatient unit safe from fall-related harm. Consider that our original goal was 90 days without a fall, and we have nearly doubled it in just one year. That makes a huge statement about what this small group of people working together can accomplish. I am so proud of all of our work and grateful for the intuitive minds that came together here.

The most sentimental part of me thinks "Now Aspirus Medford very well may be the organization to inspire others." We can say this in many areas that we have made great strides in, and now we can add fall prevention to that list.

Thank you to all Aspirus Medford employees and volunteers that made an impact for these patients and many to come.

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