August 2, 2013
Volume 57, Issue 31
Worker’s Compensation System Focus of Joint Legislative Hearing
A clear message emerged July 31 at a joint hearing of the Assembly Labor and Senate Judiciary and Labor Committees—Wisconsin Worker’s Compensation system is among the best in the country, providing real value for Wisconsin employers’ premium dollars.
The Department of Workforce Development’s John Metcalf, administrator for the division of worker’s compensation, opened the hearing. Touting the sometimes-overlooked advantage for businesses and workers in Wisconsin, Metcalf testified, "Wisconsin’s pioneering worker’s compensation system offers reasonable benefits, efficient service delivery and low cost to employers and is frequently recognized as a national model."
Metcalf’s presentation included information showing Wisconsin’s low average claims cost compared to much of the rest of the country (See Graph A). The premiums paid by Wisconsin employers reflect those low costs. Metcalf noted, "Wisconsin has the lowest average worker’s compensation premium rates among the border states of Minnesota, Michigan, Illinois and Iowa." And those premiums are going down in Wisconsin (See Graph B).
Addressing the health care costs in the system, Metcalf explained the Wisconsin system offers real value. He pointed to the efficiency of the health care provided in Wisconsin, with fewer visits per claim and fewer services per visit compared to other states. The health care provided is not only efficient, but also effective. Metcalf said data from the Worker’s Compensation Research Institute (WCRI) indicates that Wisconsin workers have a shorter than typical duration of temporary disability, better recoveries and return to work, higher satisfaction with care, and better access to care.
In response to a legislator’s question about what could be done to reduce overall costs in the worker’s compensation program, Metcalf stated that, "Return to work is the biggest factor there; the quicker you can get an employee back to productive employment and off of this system, the more money you are going to save…that’s the fastest route."
Metcalf closed his testimony with a quote from WCRI, "Past WCRI studies have shown that Wisconsin worker’s compensation system provides one of the best value propositions for workers and their employers. Workers are paid more promptly and achieved better-than-average outcomes (recovery of health, return to work and access to and satisfaction with care). Employers paid lower-than-average costs per claim."
Commenting on Metcalf’s testimony, WHA Executive Vice President Eric Borgerding said, "Wisconsin hospitals, health systems and their physician partners provide their patients with excellent, efficient care. That is real health care value. We hope legislators, businesses, employee representatives and others who testified at the hearing appreciate the good Wisconsin story laid out by DWD and work to spread the word."
Representatives from business, labor and insurers criticized health care prices and called for a government-imposed fee schedule.
"Price control is not cost control. We support changes to the system that reduce costs, including reforming the bureaucracy and red tape associated with an antiquated worker’s comp claims processing system the rest of the health care system is leaving behind. All stakeholders must be a part of addressing concerns in ways that improve the system."
Connie Kinsella, vice president of revenue cycle for UW Health, testified on behalf of WHA and its members. Kinsella recognized previous testimony that explained how increased health care costs are often related to advances in health care that have saved patients who previously couldn’t be saved and retuned them to a life that is meaningful.
Kinsella said, "I am proud to be part of that industry." She continued, "We are supportive of initiatives that reduce costs in the system. Worker’s compensation for providers represents the single most burdensome third-party insurer with which we deal." Providing an example of current inefficiencies that are a real cost for providers, Kinsella said, "With the exception of our uninsured patients, worker’s compensation claims represent the largest percentage of aged claims, those claims that are over 90 days old."
Kinsella emphasized, "If we want to reduce costs in the system, we need to reduce costs. Reducing costs means introducing administrative efficiencies into how worker’s compensation operates." Testifying with Kinsella were representatives from the Wisconsin Medical Society, Wisconsin Physical Therapy Association, and the Wisconsin Chiropractic Association. The four groups released a media statement following the hearing (see www.wha.org/pdf/WCHealthcareLiaisonsStatement7-31-13.pdf.
Members of the Worker’s Compensation Advisory Council told the legislators on the committees that they hoped to have the Council’s biennial worker’s compensation bill to the Legislature by mid-October.
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When the American Hospital Association held its annual Leadership Summit in San Diego July 24-26, Don Berwick, MD, a nationally-recognized quality improvement expert, addressed an audience comprised of representatives from hundreds of hospitals. Berwick said he has visited many hospitals, but during his speech, he singled a couple of states out—including Wisconsin—for achieving "impressive results" in reducing patient harm and improving quality.
"I’ve visited hospitals in Wisconsin and Oregon recently, and I saw some very impressive results," Berwick said. "This provides me with the proof that this important work can be accomplished."
Berwick mentioned that he has recently visited several hospitals in Wisconsin and that he personally observed their "exceptional" progress to improve quality. To achieve that level of success, Berwick said hospital leadership must be engaged with and support organization-wide quality improvement.
Two Wisconsin hospitals were among the 30 AHA selected to share their success stories during a poster board session. Sauk Prairie Memorial Hospital & Clinics (SPMHC) and Froedtert & The Medical College of Wisconsin St. Joseph’s Hospital, West Bend, presented their quality improvement progress.
SPMHC’s Christy Wehler and Carla Peck shared their results and the strategies they employed to reduce patient harm.
"The single, biggest driver in reducing harm has been the involvement of our Board in conjunction with patient safety rounds," according to Wehler. They said the hospital used quality as a strategic priority, transparency of errors, and dashboards to drive and sustain their results.
"Sauk Prairie has accomplished some amazing results, and they have data to back it up," said Tom Kaster, WHA improvement advisor. "I get the sense that something really special is happening there in regards to their top down commitment to quality and patient safety."
Froedtert & The Medical College of Wisconsin St. Joseph’s Hospital was also selected to share their impressive results in reducing harm across the board. Froedtert’s Patrick Gardner, MD led discussions around his hospital’s efforts to reduce adverse drug events, surgical site infections and OB harm. Gardner highlighted the importance of sharing data with caregivers.
"One of our key drivers of success was the engagement of nursing and physician leaders in these areas of potential harm," Gardner said.
Travis Dollak, WHA quality advisor who attended the conference, said, "Small hospitals are often touted for their agility and ability to make rapid improvements in short periods of time. Froedtert’s performance on reducing harm across the board at both St. Joseph’s and Community Memorial Hospital demonstrates that mid- to large-size hospitals can make improvements just as fast with the right support."
That dedication to be the best of class in all aspects of care is what sets Wisconsin hospitals apart, according to Kelly Court, WHA chief quality officer.
"It is great that our hospitals are receiving recognition for all their hard work and results," Court said. "What is even more impressive is that our hospitals are not satisfied yet. Their intense commitment to their patients is what makes Wisconsin a national leader in high-quality, high-value health care."
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The Department of Health Services (DHS) will hold Medicaid policy overview and training webinars for providers and partners beginning in August 2013. The first webinar is scheduled Monday, August 12, 10am to noon. Additional information, including how to participate in the webinar, will be available in the near future on the DHS website at www.dhs.wisconsin.gov.
State Medicaid Director Brett Davis said Regional Enrollment Networks (RENs) will be developed at the local level, comprised of various community partners, health care providers, income maintenance consortia, managed care entities, and other key stakeholders including hospitals and health systems. According to Davis, the RENs were modeled after and leverage the current outreach and enrollment efforts underway in Milwaukee through the Milwaukee Enrollment Network. The presentation announcing the RENs is available online at: www.dhs.wisconsin.gov/aboutdhs/initiatives/budget/initiatives/er/071613ren.pdf
Each REN will have dedicated facilitators that will lead each region’s efforts of supporting partners and mobilizers. For a complete list of the facilitators, click here: www.wha.org/medicaid.aspx.
Davis said those interested in partnering with the Regional Enrollment Network in their area should complete the form at: http://4.selectsurvey.net/dhs/TakeSurvey.aspx?PageNumber=1&SurveyID=m61L3895&Preview=true. Once completed, the co-conveners of the RENs will contact you within the next couple of weeks to announce a REN kick-off meeting in each region.
Many partner organizations including public health departments, community based organizations, advocacy groups, Qualified Health Plans (QHPs), veterans groups, tribes and others have shown interest in collaborating to assist Wisconsin individuals and families navigate these new health care coverage changes, according to Davis.
"As you know, we are faced with a very aggressive timeline to operationalize the RENs and begin the very important task of assisting Wisconsin individuals and families enroll in the appropriate public or private health care coverage," according to Davis.
WHA continues to be engaged with policymakers including the federal Department of Health and Human Services (HHS), the state Office of the Insurance Commissioner (OCI) and DHS. Representatives from each will be participating in the August 14 WHA webinar and elaborating on their respective roles in enrollment assistance. (See related story.)
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On October 24, the Wisconsin Council on Medical Education and Workforce (WCMEW) will host the one-day conference "Taking the Next Step: A Statewide Conference on Graduate Medical Education." Hospital and health system leaders, including CEOs, CFOs, CMOs and other senior decision makers involved in the process of evaluating and/or implementing a GME program within their organization are encouraged to participate.
Agenda topics will include the role of academic medical centers and community teaching hospitals with graduate medical education (GME); how GME fits into an organization’s strategic plan; items to consider when starting a GME program, including personnel, budgeting, infrastructure development and accreditation; and, a review of the current GME funding environment. Also, a variety of Wisconsin case studies will be examined, with panelists sharing lessons learned on making consortiums work and gaining physician engagement.
Chuck Shabino, MD, WHA senior medical advisor, and George Quinn, WHA senior policy advisor, contributed to the development of the conference agenda, which aligns with the recommendations from WHA’s report "100 New Physicians a Year: An Imperative for Wisconsin." Several WHA members, who have varying levels of experience in planning for and implementing GME programs, will participate as presenters and panelists during the event.
The conference will be held Thursday, October 24 at the Best Western Bridgewood Resort Hotel & Conference Center in Neenah. An agenda and online registration are available at: http://events.SignUp4.com/13GME.
For questions, contact Chuck Shabino, MD at email@example.com or George Quinn at firstname.lastname@example.org.
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Montana Senator Max Baucus a few weeks ago predicted a possible "train wreck" when 51 state-level insurance exchanges/marketplaces are scheduled to be up and running October 1. Whether or not we will see a train wreck or a more modest fender bender, the date is widely anticipated by many.
But another train wreck is increasingly likely. And this one also has the potential of being really messy. The failure of Congress to address a looming federal budget crisis by October 1 may lead to a government shut down and a default on the national debt. While that may be hard for many to fathom, divisive D.C. politics may be just the special sauce necessary to make the unthinkable happen.
While a handful of moderate lawmakers try to develop a "grand bargain" via a budget spending plan featuring major reform of tax and entitlement programs, the more radical factions on both sides of the aisle are proclaiming fierce opposition to compromise on delicate issues like higher taxes (a nonstarter for many Republicans) and Medicare and Social Security beneficiary-related spending cuts (anathema to many Democrats although reportedly acceptable to President Obama).
Perhaps even more bizarre and complicating, a handful of Republicans are considering blowing up any budget deal as a strategy to de-fund Obamacare...even though only a small amount of Obamacare-related federal spending is involved, which makes the approach largely symbolic.
In addition to the need to pass something by October 1 to avert fiscal disaster, a vehicle is needed to advance a Medicare physician payment "fix" before year end. The "must pass" budget deal, which must also raise the federal deficit spending cap, was viewed as such a vehicle. But all parties are increasingly skeptical that this can get done.
Congress is now on recess through August. September is a short month and when congress returns there will be only nine legislative days to act. October 1 will be here soon with a couple of locomotives chugging down two different but perilous tracks.
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The Wisconsin Health Information Organization (WHIO) has developed a detailed strategy to report provider performance to the general public in an effort to advance WHIO’s mission. The vehicle for this public reporting initiative is a web portal, which is in its final stages of development.
WHA and the Wisconsin Medical Society are jointly sponsoring webinar opportunities for hospital and health system staff and physicians to learn more about the WHIO site-level physician group reporting website. There are six dates available for this one-hour webinar, which will include a demonstration of the public reporting website and ample opportunity for questions and discussion.
Registration is required to participate. Register at http://events.SignUp4.com/13WHIO.
WHA encourages participation as the final reporting system may change based on input from providers and other stakeholders during these webinars and at other meetings.
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Ten Wisconsin hospital leaders traveled to Washington, DC this week to advocate on behalf of rural health care. The trip was in conjunction with the National Rural Health Association’s "March for Rural Hospitals." The Rural Wisconsin Health Cooperative and Wisconsin Hospital Association led the trip as part of their cooperative efforts to protect rural hospitals. The Wisconsin hospital delegation was the largest attending the event.
"Wisconsin’s rural hospitals are vital to their communities as heath care providers and key local employers," said WHA Executive Vice President Eric Borgerding who traveled to DC for this trip. "Ensuring these facilities can continue to provide services in rural communities across the state is essential for the future of Wisconsin health care."
Expiring later this year are two payments called the Medicare Dependent Hospital program and the Low-Volume Adjustment. Both focus on hospitals that could otherwise struggle to maintain financial stability under Medicare’s fee schedule because of their smaller size and share of Medicare beneficiaries.
"For us, it (Low Volume Adjustment) essentially allows us to provide access to free or low-cost primary care in our community," Fort Healthcare President & CEO Mike Wallace told Members and staff. "We know that when access to care goes down, the cost of care goes up. The Low Volume Adjustment is an investment in our communities that brings a tremendous return."
WHA is strongly supportive of the Rural Hospital Access Act (HR 1787 and S 842) which extends these payments, and expresses its appreciation to Sen. Baldwin and Reps. Duffy, Kind, Petri, Pocan and Ribble for co-sponsoring this legislation.
Other issues the group discussed included strong opposition to proposed outpatient supervision requirements and application of therapy caps to Critical Access Hospitals (CAHs). Altering mileage requirements for CAHs continues to be floated as a means for federal budget "savings," and drew strong opposition from the Wisconsin group.
"There are eight CAHs in Wisconsin that could be severely affected by the 10 mile proposal," said Spooner Health System CEO Mike Schafer during the group’s meetings on Capitol Hill. "CAHs are more than just hospitals; they help support long term care, home health, primary care and a host of other critical services that could be decimated by this ill-conceived proposal."
The Wisconsin group also urged continued support for the Pharmacy 340B drug program, which provides discounted drugs to CAHs and Medicare Disproportionate Share Hospitals.
"It really is a win-win-win program for our patients, the Medicare program and hospitals," Reedsburg Area Medical Center President Bob Van Meeteren told legislators and their staff, while urging them to sign-on to a letter of support for 340B co-authored by Senator Tammy Baldwin in the Senate and led by Reps. Capito (R-WV) and Castor (D-FL) in the House. Congressman Reid Ribble heeded the request, and affixed his signature to the House letter before the Wisconsin hospital group left for home.
In addition, hospital leaders asked legislators to sign onto the Medicare Audit Improvement Act (HR 1250 and S 1012). This legislation is needed to address the growing burden of auditors like the Recovery Audit Contractors. WHA greatly appreciates Reps. Duffy and Ribble for quickly signing on HR 1250.
Graduate medical education (GME) topped off the rural Wisconsin contingent’s already full plate of issues. The group urged Members to be vigilant in opposing cuts to medical education and residencies, which would negate the progress being made in the state Legislature.
"Trips like these remain a fundamental component of effective advocacy," Borgerding said. "We are so fortunate in Wisconsin to have such engaged, knowledgeable and passionate hospital leaders—an asset that was on full display this week in Washington, DC."
Wisconsin hospital leaders in DC included: Mike Wallace, Fort HealthCare (Fort Atkinson); James O’Keefe, Mile Bluff Medical Center (Mauston); Mike Schafer, Spooner Health System; John Russell, Columbus Community Hospital; Bob Van Meeteren, Reedsburg Area Medical Center; Tim Size and Jeremy Levin, RWHC; and Eric Borgerding, WHA.
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For the most current information available on the implementation of the health insurance exchange in Wisconsin, plan to attend two upcoming WHA member forum webinars.
The August 14 webinar will include Jackie Garner, interim regional director of HHS Regional Office V for the Centers for Medicare & Medicaid Services (CMS), sharing information available related to implementation timelines, development of the online tool for consumers, information about the federal call centers, and other consumer assistance. In addition, Brett Davis, Medicaid director for the Wisconsin Department of Health Services (DHS), will discuss the transition of Wisconsin Medicaid recipients to the federal exchange; and J.P. Wieske, legislative liaison/public information officer for the Office of the Commissioner of Insurance (OCI), will discuss the most current information available regarding insurers participating in the exchange, as well as information on training and registration for enrollment assisters.
On September 17, just two weeks out from the October 1 launch date, WHA is offering another member forum webinar to provide the most up-to-the-minute information on the exchange implementation.
Joanne Alig, WHA’s senior vice president for policy and research, will provide the latest information available about the implementation. In addition, Lisa Olson, interim director of Enrollment for Health Wisconsin and director of policy and program for the Wisconsin Primary Health Care Association, will provide an update on the progress of the statewide strategy for exchange enrollment activities.
There is no cost to participate in these member forum webinars, but pre-registration is required and attendance is limited to WHA hospital and corporate members. To register for the August 14 webinar, visit: http://events.SignUp4.com/13HCExchange0814. To register for the September 17 webinar, visit: http://events.SignUp4.com/13HCExch14Days. If you cannot participate in the scheduled webinars, the option to request audio recordings is available.
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As Wisconsin hospitals prepare to comply with Stage 2 Meaningful Use (MU2) requirements, the development of a statewide health information network to help hospitals address MU2 health information exchange requirements is progressing.
The Wisconsin Statewide Health Information Network (WISHIN), co-founded by WHA, is the governance and policy entity for statewide health information exchange (HIE). WISHIN is actively implementing query-based HIE services with about two dozen health care organizations. Implementations with another two dozen are pending.
The hospitals that have indicated they will participate in WISHIN collectively represent about 70 percent of total annual statewide inpatient discharges. In other words, WISHIN will soon be able to make clinical information available for nearly three of every four patients who are discharged from Wisconsin hospitals.
Under MU2, at least ten percent of care transitions and referrals must be informed by a care summary delivered electronically, a measure that is expected to become more stringent under Stage 3. By enabling electronic exchange of care summaries, WISHIN is playing a key role in advancing MU2 compliance among Wisconsin hospitals and eligible professionals.
WISHIN’s first interface, with UW Health Partners Watertown Regional Medical Center, went live in mid-July. More will soon follow, including the Milwaukee-based health systems, Agnesian HealthCare, and hospitals served by the Wisconsin Rural Health Cooperative’s Information Technology Network.
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Gundersen Health System in La Crosse has received a Circle of Life Citation of Honor for 2013 in recognition of its work to bring advance care planning and palliative care to all parts of its community.
The Circle of Life Award celebrates programs across the nation that have made great strides in palliative and end-of-life care. Major sponsors are the American Hospital Association, the Catholic Health Association and the National Hospice and Palliative Care Organization & National Hospice Foundation. The Circle of Life Award is a program administered by the Health Research & Educational Trust.
Circle of Life nominations were received and reviewed by a selection committee that included leaders from medicine, nursing, social work and health administration. The committee visited programs that provide effective, timely, safe, efficient, equitable patient and family-centered palliative and end-of-life care; use innovative approaches to critical needs and serve as sustainable, replicable models for the field; seek to address multi-faceted needs of persons living with serious illness; and, are actively working with other health care organizations, education and training programs, and the community.
For more information on the Circle of Life Award, visit www.aha.org/circleoflife.
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Hospitals are well aware of the critical role they have in protecting public health. Whether it is working with public health agencies to develop protocols and responses to pandemic flu outbreaks, teaching children proper hand-washing techniques or educating people about how to live with chronic conditions, Wisconsin hospitals partner with key stakeholders to improve the health status of their communities.
Community Outreach fights the flu
Froedtert Health Community Memorial Hospital takes care of its community with the approach of every flu season. With Community Outreach serving as the liaison between flu clinics and the hospital, a total of 93 individuals were vaccinated against the flu in 2012. Through these Community Outreach subsidized flu clinics, free flu shots were administered to clients of local food pantries and patients of the Community Outreach Health Clinic at Community Memorial Hospital. These individuals would not have otherwise had access to a free flu shot.
Community Memorial Foundation funded the vaccines and supplies, valued at $930, associated with these free flu clinics. The Foundation, together with the generosity of its donors, supports the mission of Community Memorial Hospital. All vaccinations were administered by pharmacists, certified by the state to give immunizations, from the Outpatient Pharmacy at Community Memorial Hospital.
Jacob Heffter, a pharmacy resident at Community Memorial Hospital, administered some of these free vaccinations. "It was a privilege to be part of such a worthwhile program. Administering the flu vaccine to under insured and uninsured individuals in our community makes for rewarding work, definitely a win-win situation." Several pharmacy residents from the hospital volunteered their time to participate in these clinics.
Clients of local food pantries appreciated the service, value and convenience of the flu clinics. Kathy Wodushek, director of the Menomonee Falls Food Pantry, praised the program. "So many community residents use the food pantry, but their needs often go beyond putting food on the family table. The free flu clinics subsidized by Community Memorial Hospital provide a valuable resource."
Subsidized flu clinics throughout the community offered preventive health care to individuals who were unable to pay for needed health services. Community Outreach at Community Memorial Hospital continues to deliver compassionate and quality health care to all residents of the communities they serve.
Froedtert Health Community Memorial Hospital, Menomonee Falls
Children’s Hospital’s Project ADAM celebrates 71 lives saved
Project ADAM™ (Automated Defibrillators in Adam’s Memory) recently announced 71 lives have been saved since it was founded in 1999. Project ADAM is a Children’s Hospital of Wisconsin program that helps schools throughout the nation prepare for and respond to cardiac emergencies.
The most recent saves occurred in Georgia and Wisconsin. There have been 26 lives saved in Wisconsin schools, 38 in Georgia, two in Pennsylvania, two in Texas, one in Washington, one in Florida and one in Tennessee as a direct result of Project ADAM. About half of the people saved are adolescents.
"As a national leader in pediatric health care, Children’s Hospital strives to ensure the safety of our children within and outside our doors," said Stuart Berger, MD, medical director of Children’s Hospital’s Herma Heart Center, medical director of Project ADAM, and professor at the Medical College of Wisconsin. "Knowing you helped save one life is fantastic. To know you have helped save 71 lives truly is incredible."
Project ADAM was created in honor of Adam Lemel, a 17-year-old Whitefish Bay high school student who collapsed and died while playing basketball.
"I take great comfort in knowing that honoring Adam’s memory has helped schools around the country save so many lives," said Joe Lemel, Adam’s dad.
Children’s Hospital of Wisconsin, Milwaukee
Submit community benefit stories to Mary Kay Grasmick, editor, at
Read more about hospitals connecting with their communities at www.WiServePoint.org.
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