August 30, 2013
Volume 57, Issue 35


Bipartisan Letter Opposing OIG Recommendations Garners 81 Signatures
Republican and Democratic state legislators join WHA in the fight for rural health care

A recent report from the federal Office of Inspector General (OIG) has caused a bipartisan group of legislators to take action in the state capitol, opposing a recommended change that would essentially eliminate the critical access hospital (CAH) designation for most of Wisconsin’s CAHs. Working alongside WHA, 81 Wisconsin state legislators sent a letter August 29 to Wisconsin’s Congressional delegation asking them to reject the OIG’s proposal and oppose detrimental and arbitrary mileage changes. (See their press statement at www.wha.org/pdf/PressStatementStateLegislatorsUrgeKeepingCAHDefinition8-29-13.pdf.)

In a news release issued by WHA applauding legislators’ support of rural health care in Wisconsin, WHA Executive Vice President Eric Borgerding said, "This level of bipartisan support sends a strong, irrefutable message about the importance of hospitals and health systems in every corner of Wisconsin. WHA commends the legislators who led this effort and thanks all those—Republicans and Democrats from urban and rural Wisconsin—who signed the letter and are standing with their hospitals today."

State Senator Sheila Harsdorf (R-River Falls) initiated the letter with Republican Assembly counterpart Rep. Kathy Bernier (R-Chippewa Falls), Sen. Bob Jauch (D-Poplar) and Rep. Chris Danou (D-Trempealeau). In a statement, Sen. Harsdorf said, "I am pleased that so many state legislators have joined us in a bipartisan manner to sign this letter. We recognize that critical access hospitals play a vital role in ensuring local access to health care services and providing important jobs in our rural communities."

Sen. Bob Jauch (D-Poplar) added that "the simple fact is that many of these hospitals would not be open, and the rural citizens they serve would be deprived of having access to quality health care services."

Rep. Kathy Bernier (R-Chippewa Falls) said, "The loss of just one critical access hospital, like Ministry Our Lady of Victory Hospital in Stanley or Mayo Health System-Oakridge in Osseo, could mean the loss of over 100 family-supporting jobs." The letter from legislators referenced a 2011 study conducted jointly by the UW-Extension and the Wisconsin Hospital Association, which found that hospitals are one of the top ten employers in 44 of Wisconsin’s 72 counties, and one of the top five employers in 20 counties.

The changes being sought by the OIG are the most recent attack on rural critical access hospitals. Previous proposals by the federal government have threatened CAH designation by implementing an arbitrary mileage rule to eliminate hospitals from the program.

"Every one of these hospitals that we are talking about passed specific criteria established by the state to get into this program," said WHA President Steve Brenton in an interview on "Here and Now," a Wisconsin Public Television news magazine. "Without this status, many of these hospitals over time would either close or immediately have to reduce employment and local services provided to local communities."

See the Wisconsin Public Television "Here and Now" interview with Brenton here: http://video.wpt.org/video/2365067420/

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Wisconsin Medicaid Director Meets with Hospitals Across the State

Wisconsin Medicaid Director Brett Davis wrapped up his seven-region tour on August 29 by meeting with hospitals and health systems from the Southern Region. Davis has been on the road with WHA staff and members since August 16 to discuss upcoming changes to the Medicaid program and the outreach and educational efforts the Department of Health Services (DHS) is taking to help people enroll in coverage this fall.

"Part of our vision is to reduce the number of uninsured non-elderly adults in our state and encourage consumers to be active participants in their health care," said Davis. "We’ve estimated that the uninsured rate for this population is about 14 percent, and our goal is to cut that in half."

More than 150 individuals representing 80 different hospital facilities in the state, and every health system, participated in the meetings. Davis described the changes in the Medicaid program, noting that they are proposing to move from the Core plan benefit package for childless adults to a standard benefit package that includes more comprehensive mental health and dental benefits. The proposed change is part of the waiver that DHS submitted to the federal government that must be approved before the changes can take place. The waiver was submitted in early August to CMS, and Davis described the interactions with CMS thus far as positive.

Davis provided hospitals with more details about ways they can become engaged in enrollment efforts through regional enrollment networks. He also noted that DHS outreach efforts will include sending letters and making phone calls in September to current Medicaid recipients that might no longer be eligible for Medicaid starting January 1, and to those on the Core plan waiting list. Providers will also be able to access lists of Medicaid patients to whom they have provided services. Finally, the Department is working on a process to allow hospitals to make presumptive eligibility determinations for Medicaid (see related story on page 3).

"This fall, we will find thousands of Wisconsin residents changing coverage or becoming newly eligible for Medicaid or the health insurance exchange marketplace," said Joanne Alig, WHA senior vice president for policy and research. "One of the first places they will go for help is their health care provider, so it is very important that our members get to hear directly from the state Medicaid director about these changes. We appreciate his commitment to these events."

More information about DHS outreach plans, regional enrollment networks, presumptive eligibility and other enrollment topics can be found on WHA’s website at: www.wha.org/outreachplans.aspx.

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Training Opportunities for Certified Application Counselors (CACs)

WHA is working with the Office of the Commissioner of Insurance (OCI), and the Department of Health Services (DHS) to develop a plan to offer in-person training opportunities for certified application counselors (CACs) throughout the state, and in some cases to allow access to these trainings remotely at no charge. Dates, times and locations are still to be determined.

In partnership with the Rural Wisconsin Health Cooperative (RWHC) and the Healthcare Financial Management Association (HFMA), one training opportunity will be through RWHC facilities. More information about this training and how to register will be coming soon.

The Milwaukee Health Care Partnership (MHCP) is also providing an in-person training event with OCI September 10-11. Although registration has closed due to high demand, MHCP is working on another opportunity in late September.

Under Wisconsin Act 20, CACs are required to take a 16-hour training course and pass an exam. The training may be accessed through the in-person opportunities or through a web-based course. The OCI website includes information about how to access the web-based course, for which fees will apply. OCI estimates the fee for the exam at around $75. For links to the OCI website to access information about the web-based training and for more information about the exam test sites, visit WHA’s website at: www.wha.org/assistersNavigators.aspx.

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OCI Holding Statewide Federal Health Care Sessions for Consumers

The Office of the Commissioner of Insurance (OCI) and the Department of Health Services (DHS) are holding informational sessions across the state in the form of town hall meetings. According to OCI, these 90-minute meetings are open to the general public and are intended to educate consumers about the Patient Protection and Affordable Care Act (ACA). The meetings are informal and will be guided by the issues those in attendance bring to the table. OCI and DHS staff will be available to answer questions.

Meeting locations are below:

Tuesday, September 3, 2013, 10:30 a.m. - 12:00 p.m.

Oneida County Sheriff’s Department Training Center, 2000 East Winnebago Street, Rhinelander

Tuesday, September 3, 2013, 3:00 p.m. - 4:30 p.m.

North Central Technical College, 1000 West Campus Drive, Wausau

Tuesday, September 3, 2013, 10:00 a.m. - 11:30 a.m.

LE Phillips Memorial Library, 400 Eau Claire Street, Eau Claire

Tuesday, September 3, 2013, 3:00 p.m. - 4:30 p.m.

La Crosse Public Library, 800 Main Street, La Crosse

Wednesday, September 4, 2013, 11:00 a.m. - 12:30 p.m.

West Allis Public Library, 7421 W. National Avenue, West Allis

Wednesday, September 4, 2013, 2:00 p.m. - 3:30 p.m.

Pewaukee Public Library, 210 Main Street, Pewaukee

Thursday, September 5, 2013, 10:00 a.m. - 11:30 a.m.

Kenosha Public Library, 7979 39th Avenue, Kenosha

Thursday, September 5, 2013, 10:00 a.m. - 11:30 a.m.

Northeastern Technical College, 2740 West Mason Street, Green Bay

Thursday, September 5, 2013, 2:00 p.m. - 3:30 p.m.

Appleton Public Library, 225 N. Oneida Street, Appleton

Friday, September 6, 2013, 2:00 p.m. - 3:30 p.m.

American Family Insurance Training Center, 6000 American Family Drive, Madison

Friday, September 6, 2013, 3:00 p.m. - 4:30 p.m.

Lakeshore Technical College, Lake Michigan Conference Room, 1290 North Ave., Cleveland, WI

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Presumptive Eligibility Toolkit Available

Under the Patient Protection and Affordable Care Act (ACA), hospitals are allowed to help patients who are potentially eligible for Medicaid apply for health coverage. Under the new Medicaid "presumptive eligibility" regulations, hospitals can temporarily enroll patients in Medicaid coverage at the point of service with a few basic pieces of information such as income and household size. In Wisconsin, the Department of Health Services intends to allow presumptive eligibility for all BadgerCare populations including pregnant women, children, parents/caretakers and the newly-eligible childless adult population.

DHS is working to develop the details of a process for presumptive eligibility determinations. In the meantime, to help hospitals get started and learn more about making presumptive eligibility determinations, Enroll America has developed a web-based toolkit. You can find the toolkit on WHA’s website at www.wha.org/outreachplans.aspx.

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Current Exchange Information to be Shared at WHA Member Forum, Sept. 17

For the most current information available on the implementation of the health insurance exchange in Wisconsin, plan to attend an upcoming WHA member forum, offered via webinar, September 17.

Presented just two weeks from the October 1 launch date, the member forum will 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 programs 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 this member forum, but pre-registration is required and attendance is limited to WHA hospital and corporate members. To register for the September 17 webinar, visit http://events.SignUp4.com/13HCExch14Days. If you cannot participate in the scheduled webinar, the option to request an audio recording is available.

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Register Today for WCMEW Statewide GME Conference, October 24

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 graduate medical education (GME) program within their organization should register today at http://events.SignUp4.com/13GME.

The conference agenda aligns well 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 with planning for and implementing GME programs, will share their lessons learned on making consortiums work and gaining physician engagement around GME.

In addition, the day’s agenda will focus on how GME fits into an organization’s strategic plan and items to consider when starting a GME program, including personnel, budgeting, infrastructure development, and accreditation. One session will specifically focus on the current GME funding environment, including information from a representative of Wisconsin’s Department of Health Services to discuss their grant programs. (See related story below)

The conference will be held Thursday, October 24, at the Best Western Bridgewood Resort Hotel & Conference Center in Neenah. A full agenda and online registration are available at: http://events.SignUp4.com/13GME.

For questions, contact Chuck Shabino, MD, WHA senior medical advisor at cshabino@charter.net or George Quinn, WHA senior policy advisor at gquinn@wha.org.

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DHS Anticipates Issuing GME Grant Request Applications in September

WHA-supported initiatives that Governor Scott Walker included in the state budget to expand graduate medical education (GME) are moving closer to implementation. The Wisconsin Department of Health Services (DHS) announced that it will issue a Request for Applications (RFA) in September with a four-week turnaround for funds that can be used to expand current residency programs.

The state budget includes new funding to support GME. There are two components:

WHA worked with the Legislature’s budget writing committee to lift the initially proposed $50,000 per hospital cap and replaced it with a $75,000 per residency slot cap, which allows a hospital or residency program to potentially receive multiple grants—up to $225,000 per year per hospital. This investment in graduate medical education comes at a critical moment for Wisconsin’s health care workforce. In 2011, WHA released a report showing a need for 2,000 additional physicians in Wisconsin by 2030. Other Midwestern states invest more funds in Medicaid GME, as a proportion of overall Medicaid spending, than Wisconsin. These additional funds will help Wisconsin attract and retain needed physicians during this biennium, and for years to come.

Both allocations target five specialties—family medicine, pediatrics, internal medicine, psychiatry and general surgery. The Department has created an ad hoc committee to help develop guidelines and criteria for funding. The membership of the ad hoc committee draws heavily from the membership of the Wisconsin Council for Medical Education and Workforce (WCMEW), including George Quinn, WHA senior advisor, and Chuck Shabino, MD, WHA senior medical advisor. 

WHA encourages hospitals interested in expanding their GME program to begin planning for program expansion. Here is what is known to date:

"We are beginning to make real progress toward a high-priority WHA goal and that is to address the physician shortage by creating more opportunities to complete a residency in Wisconsin," according to Shabino. "The state funding, combined with the commitment of our hospitals and health systems to support GME in their organizations, will help us build a workforce that will help us keep pace with the growing demand for care."

Register for WCMEW’s statewide GME conference at http://events.SignUp4.com/13GME.

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Grassroots Spotlight: U.S. Senator Baldwin Visits Essentia Health – St. Mary’s, Superior

Recently, U.S. Senator Tammy Baldwin visited Essentia Health—St. Mary’s Hospital, Superior. During her time at the hospital, Baldwin was able to tour the facility and talk one-on-one with various hospital leaders and front-line staff.

Among the issues raised by hospital Administrator and Vice-President Terry Jacobson was a recently-released report by the federal Department of Health Services’ Office of Inspector General (OIG) which recommends stripping small rural hospitals of the "critical access hospital" (CAH) status.

"Senator Baldwin’s timely visit to Superior allowed us the opportunity to give her a firsthand account of how we are able to deliver care to the people of our region and the potential devastation that would happen if we lost our critical access status," said Jacobson.

Jacobson expressed concerns with this proposal or any other similar proposal that would negatively impact rural health care. Sen. Baldwin expressed her strong support for Wisconsin’s CAHs, including leading an effort with her colleagues in the U.S. Senate in support of CAHs.

Baldwin was able to tour the main hospital and also visit the Twin Ports VA Outpatient Clinic and the Fresenius Dialysis Unit.

Sen. Baldwin ended her visit with a Q&A session with hospital physicians, managers and other staff.

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Klinge Joins WHA Quality Department

WHA is pleased to announce that Jana Klinge has joined the WHA quality reporting and performance improvement department as a quality assistant. In her role, Klinge will support the WHA Partners for Patients initiative as well as other WHA efforts including Transforming Care at the Bedside.

Klinge received her bachelor’s degree in organizational behavior and leadership from Edgewood College in May 2013. Prior to joining WHA, Klinge worked at Fiskars Americas as their operations assistant.

"We are very excited to have Jana join the WHA staff," said WHA Quality Manager Jill Hanson. "Jana’s health care work experience, process improvement knowledge, exceptional customer service and website design interests are excellent additions to our team."

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High Value Health Care – Wisconsin’s Competitive Advantage: Ministry Howard Young Health Care Reduces Falls by Addressing Delirium

As people age, their health care needs change. At Ministry Howard Young Health Care in Woodruff, the staff took that into consideration as they designed their fall prevention initiative. The staff found that delirium was a common associated factor among patients who experienced a fall. A number of medical conditions can contribute to delirium, including nutrition, hydration, family involvement and activity. Once they identified the root cause of delirium, they were able to implement a robust care plan that reduced the incidence by 50 percent for all hospitalized patients over a 12-month period, ending June 2013.

"Howard Young’s work on preventing falls for their elderly patients and patients with delirium has been significant," according to Tom Kaster, WHA quality improvement coordinator. "It is a perfect example of identifying the general needs in a service area, based on population demographics, and being proactive to ensure patient safety in an organization."

The Hospital Elder Life Program (HELP) trains volunteers to interact in clinically meaningful ways to keep patients engaged and oriented to their surroundings. In addition, staff improved their communication with patients to ensure that the patient’s needs are met. Addressing basic needs, such as helping patients keep track of their hearing aids, glasses and personal possessions, plays a big role in reducing confusion and lessoning the chances of delirium.

"There are so many variables that may create a fall that you must address it at the individual patient level," Kaster said.

Nursing leadership played a critical role by setting the expectation that all falls will be reported, reviewed and analyzed. That level of transparency reinforces the importance of the interventions as it "hardwires" them into patient care, practice and culture. Falls teams have been instituted at each of Ministry’s organizations, led by nursing leadership, and they are primarily comprised of direct patient care staff. The teams’ focus is to complete data review, evaluate ongoing strategies to reduce falls and implement small tests of change. Through small tests of change, the front line staff has been able to try the various interventions, provide feedback and help develop sustainable processes.

The hospital also implemented a new nurse call system that supports clear visual notification of patients who are at high risk for falls. The system supports direct access to patient care staff with immediate contact when a bed or chair alarm is triggered. A safe patient handling system was instituted in patient care areas of the hospital, including radiology, therapy, nursing and the emergency department. Devices are in place that assist or support patients and staff during transfers and ambulation.

"Our strategies have reduced our fall rates so we are now within the top 10 percent of the national benchmark," said Laura Magstad, director of patient care services. "WHA has been very helpful. They have provided education and support for our team via monthly webinars, resources, and clinical conferences. Beyond that, the sharing of best practices within the state has been extremely valuable."

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Bujak to Focus on Hospital-Physician Relations at WHA Leadership Summit

Joe Bujak, MD, FACP, a popular national speaker, author and facilitator, will present a session focused on improving hospital-physician relations and discuss ways to engage physicians in support of organizational goals at the 2013 WHA Leadership Summit on September 19 at the Country Springs Hotel in Pewaukee.

Bujak is an expert on issues related to health care organization-physician relationships, clinical quality and patient safety, and leading and managing transformational change. His experience in clinical research, primary care and specialty medical practice, teaching, and administration give him a unique breadth of perspective and help establish credibility in the provider community. Bujak is the author of the book Inside the Physician Mind: Finding Common Ground With Doctors; and co-author of the book Leading Transformational Change: The Physician-Executive Partnership, with Tom Atchison.

In addition to Bujak’s session, this year’s event will include several other education options, including the option of a 4.5 hour or 6.0 hour ACHE Face-to-Face education track, nursing contact hours, CME and long-term care administration clock hours.

An agenda and online registration are available at: http://events.SignUp4.com/13LeadershipSummit0919.

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Wisconsin Hospitals Community Benefits: Charity Care

Fear of a bill should never prevent a patient from seeking care at a Wisconsin hospital. Wisconsin hospital charity care programs provided $232 million to more than 700 patients each day last year. The stories that follow illustrate the deep commitment and continuing concern that hospitals have to their patients to ensure they receive the care they need regardless of their ability to pay.

Thankfully, she didn’t have to choose

Nikki, a single mom, was working as a certified nursing assistant and living without insurance. She wasn’t able to afford housing and health insurance, so she had to choose what was most important: providing for her son.

"Insurance through work was just too costly," said Nikki. Her son was covered by Badger Care.

Nikki unexpectedly became ill and was hospitalized at Mayo Clinic Health System - Red Cedar for a week. Following her hospitalization, she needed therapy through Behavioral Health at Mayo Clinic Health System in Menomonie.

She was struggling to make payments for her bills, so a staff member at Mayo Clinic Health System - Red Cedar called her to tell her about the Financial Assistance Program that the medical center offers. She submitted her application and qualified for a full discount.

"I was wondering how I was going to pay these bills. This way, it didn’t have to go through collections," she said with gratitude. "It was huge. It took a huge burden off of me. To pay the bills was to take money away from my son’s needs."

Nikki now has peace of mind as she is able to afford insurance coverage for her own medical needs.

Mayo Clinic Health System – Red Cedar, Menomonie


Financial assistance for Fort HealthCare patients

Concern over a medical bill should never prevent a patient from receiving good health care. Our goal is to arrange a manageable payment plan based on one’s ability to pay.

Fort HealthCare offers two financial aid options to patients who meet our income, asset and need criteria. They are the Self Pay Discount and the Community Care Program.

The Self Pay Discount is a discount of up to 20 percent on Fort Memorial Hospital’s inpatient and outpatient services. Potential Self Pay candidates are defined as those who have no health insurance and those receiving services that are not covered by health insurance or another state, government, liability or workers’ compensation program.

The Community Care program is a partial or complete write-off of all outstanding charges. The program serves patients requiring medically necessary treatment with no or limited ability to pay and whose income does not exceed current federal poverty guidelines. Also persons whose income exceeds current federal poverty guidelines, but whose expenses also exceed income are eligible. Community Care candidates are required to complete a financial questionnaire and provide proof of income.

Fort HealthCare, Fort Atkinson


Wheaton Franciscan Healthcare provides a home away from home

61-year-old Tahereh Samakar lived in Iran and occasionally traveled to visit her daughter in Wisconsin. On her trip in 2011, what Tahereh expected to be an ordinary visit took a serious turn when she was diagnosed with breast cancer. Not only was Tahereh sick while abroad, but she also did not speak English and needed an interpreter.

"I had no idea that I had cancer when I left Iran. I was so shocked and I had no idea what to do," shared Tahereh.

Although she was far from home, Tahereh knew she needed to move quickly and had a right breast ultrasound-guided needle core biopsy at Wheaton Franciscan - St. Francis.

When Tahereh needed more surgeries, she worried about how a visitor without health insurance would handle the costs. That is when her doctors introduced her to Donna Semons, a financial counselor with Wheaton Franciscan Healthcare. With Donna’s help, Tahereh applied to Wheaton’s Community Care program and was approved to receive free care.

"I was so surprised and happy," said Tahereh. "Everyone treated me like I was an ordinary person who had health insurance. I am really grateful."

While Tahereh received treatment at several Wheaton Franciscan campuses, she has daily radiation at the Elmbrook Memorial Campus. Tahereh will be extending her visa so she can finish her treatments before going home. Though Tahereh is eager to return to Iran, she said Wheaton has helped her more than ever in her time of need.

Wheaton Franciscan Healthcare St. Francis, Milwaukee/Elmbrook, Brookfield


Submit community benefit stories to Mary Kay Grasmick, editor, at
mgrasmick@wha.org.

Read more about hospitals connecting with their communities at www.WiServePoint.org.

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