September 12, 2014
Volume 57, Issue 37


Wisconsin Hospitals Invested $176 million to Train Health Professionals

This information will be released to the media Monday, September 15. Watch for more in-depth coverage in The Valued Voice of the 2013 WHA Annual Community Benefits Survey results.

Wisconsin hospitals invested more than $176 million in 2013 to support training for physicians, nurses and other health care and allied professionals according to the Wisconsin Hospital Association (WHA) annual hospital community benefit survey.

On-site clinical training is an essential element in the education process for all health care professionals, but it requires a major commitment of time and financial resources from hospitals and clinics to implement and administer. Hospitals provide on-site clinical and education experiences ranging from a few weeks to several years for nurses, physicians, therapists, pharmacists, even dentists.

"The commitment our hospital and health system members have made to advance medical education across a broad spectrum of professions helps ensure access to quality health care in our state regardless of where you live," according to WHA Executive Vice President Eric Borgerding. "While they have voluntarily assumed the responsibility to serve as ‘learning labs’ for health professionals, the cost that is implicit in these types of programs must be a shared responsibility with state government. Hospitals can’t continue to bear the brunt of the costs for training health professionals who may not even seek employment in their organizations."

WHA strongly supported initiatives in the last state budget that funded new graduate medical education (GME) initiatives. The new funding was a "good step," according to WHA, because it targeted dollars, much of which came in the form of matching grants, to create new specific high-need residency positions in Wisconsin in primary care, including psychiatry and general surgery.

The state funding was helpful, but in 2013, Wisconsin hospitals provided:

In addition, hospitals gave more than $1.3 million in scholarships and tuition payments to help nurses and other health professionals not employed in their organizations pay their education expenses.

"Investing now in our health care workforce means Wisconsin will have trained health care professionals to meet future demand," Borgerding said. "These are also investments that produce great jobs and long-term careers that have a positive impact on Wisconsin’s economy."

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Non-Partisan Legislative Fiscal Bureau Says $1.8 Billion Needed for Next Budget
State Medicaid agency needs $93 million in state taxpayer savings in current biennium

The state Legislature’s non-partisan budget office, the Legislative Fiscal Bureau (LFB), released a memorandum to Assembly Democratic Leader Peter Barca September 8, outlining its projections of expected revenues and expenses for the next budget cycle. This exercise, done regularly by the LFB during the budget process and at the end of each legislative session, is designed to show policymakers what expenses are estimated for the next budget cycle without accounting for additional revenue growth or changes in program caseloads. The September 8 document found that this projected out-year commitment is now at $1.8 billion, up roughly $1.1 billion since their last projection in May 2014.

This number is called the "structural deficit" by policy experts, because it is the amount of money that needs to be accounted for in the next state budget to pay for program expenditures authorized in the prior biennium. Previously, the LFB had estimated the out-year commitment for 2015-2017 at approximately $650 million. The new estimate takes into account lower revenue projections released by the Wisconsin Department of Revenue in late August, which indicated that actual revenues for 2013-14 trail earlier estimates by nearly $281 million. In addition, the LFB indicated their economic forecasting data has shown a significant downgrade in the national economy, resulting in the office lowering expected revenue projections for the next budget cycle in 2015-2017.

The Legislative Fiscal Bureau notes in a separate memo that by October 15, 2014, the Department of Administration will publish the state’s 2013-14 Annual Fiscal Report. In addition to tax collections, the report will include other revenues to the general fund and final expenditure data, which may result in further changes to these estimates.

Separately, in June, the Medicaid program stated it would need to find $93 million in state taxpayer dollars (General Purpose Revenue) to remain within their budget for the 2013-2015 budget cycle. In total, the program needs to find $232.5 million (both state and federal funds) to stay within the budget. The Department of Health Services (DHS) indicated that increased expenses were partially a result of higher-than-assumed enrollment of childless adults in the BadgerCare Plus program, as well as shortfalls in federal revenue for costs incurred by county-owned nursing homes. DHS notes that small changes in enrollment or utilization can impact these projections significantly.

WHA will continue to monitor these projections over the coming months as the 2015-2017 biennial budget process begins.

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Two New Insurers Have Submitted QHPs for Wisconsin

On September 9, the Wisconsin Office of Commissioner of Insurance (OCI) issued a press release indicating that it has completed its review of rates and forms filed by insurers wishing to participate in the federally-facilitated exchange.

According to OCI, two new insurers—All Savers (United Health Care) and Managed Health Services Insurance Corporation—have submitted filings for qualified health plans (QHPs) in the individual market in the health insurance exchange in Wisconsin for 2015. The other 13 insurers that have requested their plans be certified in the individual market participated in the exchange in 2014. Separately, 10 insurers filed plans to participate in the Small Business Health Options Program (SHOP) exchange. OCI did not release information about the specific service areas for each insurer.

In order to be eligible to offer qualified health plans (QHPs) in the federally-facilitated exchange, insurers are also required to file their rates and forms with OCI. Insurers wishing to participate in the federal exchange will still need to complete the full federal review process and sign a contract with the federal exchange in order to participate for the 2015 benefit year. Open enrollment will begin November 15.

The following is a list of all of the health insurers that have submitted rate and form filings to OCI:

Individual Market:

All Savers Insurance Company
Arise (WPS Health Plan, Inc.)
Common Ground Healthcare Cooperative
Compcare Health Services Insurance Corporation
Dean Health Plan, Inc.
Group Health Cooperative of South Central Wisconsin
Gundersen Health Plan, Inc.
Health Tradition Health Plan
Managed Health Services Insurance Corporation
Medica Health Plans of Wisconsin
MercyCare HMO, Inc.
Molina Healthcare of Wisconsin, Inc.
Physicians Plus
Security Health Plan of Wisconsin, Inc.
Unity Health Plans Insurance Corporation

Small Group Market:

All Savers Insurance Company
Arise (WPS Health Plan, Inc.)
Common Ground Healthcare Cooperative
Group Health Cooperative of South Central Wisconsin
Gundersen Health Plan, Inc.
Health Tradition Health Plan
Medica Insurance Company
MercyCare HMO, Inc.
MercyCare Insurance Company
Security Health Plan of Wisconsin, Inc.

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Guest Column: We’ve Digitized our Health Information. Now What?
By Joe Kachelski, Chief Executive Officer, Wisconsin Statewide Health Information Network

Health Information Technology Week 2014 will be observed September 15-19.

It’s a good time to consider how Wisconsin health care organizations have made use of information technology to advance the quality and cost-effectiveness of care delivered in the Badger State.

Wisconsin continues to be among the "most wired" states in the nation in terms of adoption of electronic health record (EHR) technology. Wisconsin is also consistently among the top states in measures of health care quality, which suggests that we’re doing a pretty good job of leveraging our investments in health information technology.

One of the chief advantages of EHR adoption is that it makes health care data more "liquid," as the federal Office of the National Coordinator for Health Information Technology describes it. Digitizing health care information makes it more portable and more usable in both clinical and administrative contexts.

The next big challenge is interoperability, and that’s where organizations like WISHIN come in. Too often, after spending thousands if not millions of dollars to digitize their health care data, organizations are still "de-digitizing" it in order to share it outside their organization. How many times a day are health care organizations using 1980s technology—fax machines—to transport health information to another provider or to a payer? Far too many, in my opinion.

WISHIN—the Wisconsin Statewide Health Information Network—was founded by the Wisconsin Hospital Association, Wisconsin Medical Society, the Wisconsin Collaborative for Health Care Quality (WCHQ), and the Wisconsin Health Information Organization (WHIO). WISHIN is the "state-designated entity" for health information exchange—an independent, multi-stakeholder, not-for-profit organization dedicated to bringing the benefits of widespread, secure, interoperable health information technology to patients and caregivers throughout Wisconsin.

We have been working hard to build out our statewide network, and we have a lot to celebrate during Health Information Technology Week 2014.

The WISHIN network will soon include more than 800 points of care, located in 60 of Wisconsin’s 72 counties. As of the end of August, our WISHIN Pulse community health record included information about 800,000 unique patients and more than 13 million patient encounters. And these numbers are growing each week.

WISHIN’s one-to-many network architecture offers health care organizations the opportunity to avoid the expense and administrative complexity of multiple point-to-point connections. One connection with WISHIN provides access to information from all other participating organizations.

As an independent, not-for-profit organization, WISHIN is vendor-agnostic, meaning that regardless of the various EHR systems that are being used by its clients, information can flow among them in ways that can support clinical decision-making and reduce the administrative burden of fulfilling health information requests from other organizations. That’s real interoperability.

By participating in WISHIN, health care organizations have the opportunity to automate many processes related to transitions of care. Ensuring that vital information follows the patient can mean better outcomes, fewer preventable readmissions, and lower administrative costs.

WISHIN is proud to play a key role in advancing EHR interoperability in Wisconsin, and we thank the hospitals and other health care organizations that have partnered with us to make a statewide HIE network a reality. We look forward to celebrating more successes in the coming years.

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Presumptive Eligibility – New Functionality and Training

The Department of Health Services (DHS) is updating the process for hospitals to make presumptive eligibility determinations. DHS is rolling out a new web-based system and new functionality beginning September 28. New training will be available. The details are provided in the ForwardHealth Update (2014-50), titled "Updated Process for Qualified Hospitals to Make Presumptive Eligibility Determinations for Individuals."

Hospital staff who make presumptive eligibility determinations are required to attend either an on-site training or watch the webcast. Staff may choose the on-site training they will attend by registering online at: dhs.wisconsin.gov/forwardhealth/expressenrollment.htm. Registration is not required for the webcast.

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Today’s Challenges, Tomorrow’s Opportunities: A Future Leader’s Guide to Wisconsin Health Care
November 5, 2014 *** Glacier Canyon Lodge, Wisconsin Dells

Register today for WHA’s one-day event featuring Jamie Orlikoff, a member of Modern Healthcare’s inaugural list of "100 Most Powerful People" in health care. Orlikoff, who is one of the foremost thought leaders in the country, will focus on the role the next generation of health care leaders will play in effectively addressing current health care trends, as well as describe strategies that will ensure Wisconsin continues to be a ‘leader’ state.

Through the generous support of the Wisconsin Forum for Healthcare Strategy, a discounted registration fee is available. This event is expected to sell out, so register today at http://events.SignUp4.net/14TCTO-1105.

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Wisconsin Health Care: Ahead of the Curve Message is in Wisconsin Health News

Wisconsin hospitals and health systems deliver high-quality, high-value care in communities throughout the state. It is important that employers, policymakers, legislators and the public understand the important role that health care plays not only in their everyday life, but also in Wisconsin’s ability to attract economic development. WHA continues to build out the messaging on the theme "Wisconsin Health Care: Ahead of the Curve." Starting Monday, September 15, Wisconsin Health News will carry the banner shown below.

Wisconsin Hospital Association. Wisconsin Health Care: Ahead of the Curve.

Wisconsin health care is rated among the best in country. In fact, health care is considered an important part of a community’s infrastructure. In a recent survey sponsored by the Wisconsin Hospital Association, employers ranked "health care" second only to "education" as one of the assets that employers look for when making site location decisions. In Wisconsin, health care providers are committed to increasing efficiency, improving quality and safety and to helping employers hold the line on health care costs.

The Wisconsin Hospital Association has created a new website: www.WiHealthCareValue.org that connects Wisconsin employers with research studies, news reports and information that will be helpful as they make health care-related decisions.

Wisconsin hospitals and health systems are always looking for new ways to partner with employers and organizations that are committed to building a healthier community.

 

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WHA Physician Leadership Council Discusses Key Issues
Physician health program, potential APNP changes, telemedicine discussed

Health care in Wisconsin is delivered in one of the most highly-integrated models in the country. Over the past decade, the growth in physician integration has created an impetus for WHA to look beyond the traditional "walls" of the hospitals to evolve its focus beyond the hospital to that of the broader spectrum that encompasses its members’ presence as regional and local community health systems.

Formed as a natural response to the growing need to tap into the significant resources and perspectives that WHA member physician leaders bring to Wisconsin’s health and hospital systems, WHA’s Physician Leadership Committee held its second meeting September 10 at WHA headquarters in Madison. The Council helped set direction for the important public policy role that WHA member physician leaders have in WHA’s advocacy agenda.

WHA Chief Medical Officer Chuck Shabino, MD, chaired the meeting, which featured a discussion of emerging policy issues impacting physician leaders.

  • Proposed Physician Health Program: At the previous meeting of the Council, representatives from Rogers Memorial Hospital shared information with the Council on their proposal to recreate a statewide Wisconsin Physician Health Program to address provider behavioral and mental health issues. The Council discussed the issue at the September 10 meeting and provided input to WHA staff on the need for such a program, as well as preferences on how such a program should interact with physician employers, medical staffs and the Medical Examining Board. WHA will use the input to guide its advocacy efforts regarding the proposal.
  • The next meeting of the Council is December 9, 2014.

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    WHA Publishes Health Care Terminology Guide

    The Wisconsin Hospital Association (WHA) has prepared a web-based guide entitled Health Care Acronyms and Terminology to help provide a basic understanding of various acronyms and terms used in health care. The guide contains definitions that apply to topics related to reimbursement, health reform, medicine, quality and workforce. It will be helpful to a variety of audiences, including hospital and health system employees, physicians and trustees.

    The guide has been posted on www.wha.org in the Members Only section, under the "General" tab. If you are employed by a WHA member and have not registered for access to the Members Only section, go to http://members.wha.org.

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    WHA, WONE Sponsor CNO Leadership Development

    As the health care environment changes and the role of a health care leader becomes more complex, the Wisconsin Hospital Association and the Wisconsin Organization of Nurse Executives (WONE) recognized their two organizations could offer nurse executives a unique opportunity to broaden their statewide perspective.

    On September 5, Jodi Johnson, WHA vice president, workforce and clinical practice, and WONE President Doris Mulder facilitated a day-long chief nursing officer (CNO) orientation. WHA Executive Vice President Eric Borgerding welcomed the group to WHA and provided an overview of WHA’s mission and strategic initiatives.

    WHA staff had an opportunity to present on topics ranging from advocacy, public policy, media relations and workforce development. Both WHA and WONE described the resources that each organization had available that CNOs would find helpful.

    "The information provided by WHA and WONE is essential for nurses in this role. The opportunity to spend a day at WHA headquarters, meet key people and become aware of important tools and resources is invaluable," according to Mulder.

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    Fast Facts from the WHA Information Center: September is Prostate Cancer Awareness Month

    Prostate cancer is one of the most common cancers in men, after skin cancer. According to the American Cancer Society, there are more than two million men in the U.S. who count themselves as prostate cancer survivors.

    Data from the WHA Information Center collected in 2013 showed there were 1,523 inpatient stays for prostate cancer and 29,771 outpatient visits, which included outpatient surgery, emergency room, observation and ancillary services over the same time period.

    For more information on prostate cancer, visit: www.cancer.org/cancer/prostatecancer/index.

    * Data provided by the WHAIC (www.whainfocenter.com)

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    ACHE-Wisconsin Chapter Northern Getaway Offers Face-to-Face Credit

    The ACHE-Wisconsin Chapter is offering its fourth Annual Northern Getaway September 29-30 at the Osthoff Resort in Elkhart Lake. The event will provide learning and networking opportunities and includes the option to attend one of two concurrent programs, each offering 12 face-to-face credit hours. Programs offered include a session on the process and techniques of negotiating, presented by ACHE faculty Chris Laubach, as well as a session on creating a committed workforce, presented by ACHE faculty Michael Frisina, PhD.

    Space is limited but registration is still open. More information is available at http://wisconsin.ache.org/Documents/2014%20Northern%20Getaway%20Flyer%20v2web.pdf.

    Online registration is available at https://events.r20.constantcontact.com/register/eventReg?oeidk=a07e98uwq07ed8a7159&oseq=&c=&ch=

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    WAFP to Host CME Webinar on "Honoring Choices"

    The Wisconsin Academy of Family Physicians (WAFP) is hosting "Honoring Choices: End of Life Care," with James Deming, MD, from the Mayo Clinic leading the presentation. This CME webinar will be held Wednesday September 17, from 7-8 pm. Register at:
    www.wafp.org/eventdetail/1509/after-office-hours-webinar-honoring-choices

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    HHS Urges Vigilance in Ebola Virus Preparedness

    The Office of the Assistant Secretary for Preparedness and Response (ASPR) is always concerned when diseases threaten human health. To better prepare U.S. hospitals and coalitions for potential Ebola virus disease (EVD) and similar threats, ASPR is working closely with the Centers for Disease Control and Prevention (CDC) to provide guidance.

    Ebola poses no substantial risk to the general population of the United States. The only cases of EVD that have been treated in U.S. health care facilities were American citizens who contracted the disease in West Africa and were medically evacuated to the United States to receive care. ASPR and CDC continue to monitor the situation closely, and we recognize the potential for further EVD cases and clusters globally, including the United States.

    HHS is asking all components of the U.S. health care system to remain vigilant and take steps to be as prepared as possible to protect our communities and our nation from emerging infectious diseases such as EVD. CDC has numerous published resources and references to help you prepare, and guidance posted on these resources may change as experts learn more about EVD.

    A detailed hospital checklist for Ebola preparedness to assist in hospital preparedness efforts is located at www.cdc.gov/vhf/ebola/pdf/hospital-checklisk-ebola-preparedness.pdf.

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