September 19, 2014
Volume 57, Issue 38


HHS Releases County and Zip Code-Level Exchange/Medicaid Enrollment Information

On September 18, the federal Department of Health and Human Services (HHS) made available a new file containing zip code level data on exchange enrollment for the 36 states, including Wisconsin, with federally-facilitated exchanges. This file, long requested by stakeholders, is important for hospitals and health systems to determine the number of people who selected qualified health plans in the exchange in their markets. The file can be accessed at: http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/EnrollmentByZip/rpt_EnrollmentByZip.cfm.

In addition, this week the Wisconsin Department of Health Services (DHS) provided exchange and Medicaid enrollment information at the county level based on information they received from matching data with the federal government and with private insurers.

One document (www.wha.org/pdf/WisconsinFederalMarketplaceEnrollmentbyCounty-June2014.pdf) from DHS shows by county the number of individuals who selected a qualified health plan (QHP) in the exchange marketplace and were found eligible for a premium tax credit. Taken from a data file which was provided to DHS from the federal Centers for Medicare and Medicaid Services (CMS), this information shows the number of people who selected a QHP as of June 13, 2014. It does not indicate if the person has continued to pay premiums or if the person was previously uninsured.

In a second document (www.wha.org/pdf/MedicaidDisenrolledReportFinal.docx), DHS provided the number of people disenrolled from Medicaid/BadgerCare on April 1, 2014 who have NOT selected a qualified health plan or were found as having private coverage. DHS obtained this data by matching records with the federal government for those who selected an exchange plan, and by matching with files it receives from private health insurers. In a WHA analysis, this information was matched with the number of people disenrolled from Medicaid on April 1, 2014, to show the exchange/private insurance coverage take-up rate by county for this population.

The data shows:

"We are very pleased that the Department of Health Services has shared county-level information with us," said Joanne Alig, WHA senior vice president for policy & research. "This data is important for hospitals, health systems and others who are involved in enrollment efforts around the state."

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Agencies Submit Initial 2015-2017 Biennial Budget Requests to DOA
DHS request includes increased Medicaid expenditures of about $760 million in state funding

In what is the start of the 2015-2017 biennial budget process, state agencies were required to submit their initial budget request documents to the Department of Administration (DOA) on September 15, four to six months in advance of the expected release of the Governor’s biennial budget bill.

The proposal submitted by the Department of Health Services (DHS) for the Medicaid program includes approximately $2 billion in added expenditures for major items associated with the Medicaid program. Of this, approximately $760 million is in state general purpose revenue (GPR) expenditures.

Overall costs are expected to be shifted from the federal government to the state as DHS anticipates a reduction in federal funding for the Medicaid program. The reduction of nearly $190 million results from an expected decrease in the federal match rate, which is based in part on the state’s per capita income relative to other states.

Nearly half of the overall requested funding increase is due to caseload growth and higher service intensity for the Medicaid program. Caseload growth alone accounts for $136 million in state funding anticipated for the next biennium as DHS expects enrollment to grow by over 27,000 people. Increases in the extent and type of utilization vary by service line. For inpatient hospital services, intensity is expected to grow by 4.3 percent in 2016 and 4.5 percent in 2017; and for outpatient hospital services DHS expects growth of 4.1 percent and 4.3 percent respectively.

Estimated spending increases also include higher costs for federally qualified health centers (FQHCs) and managed care. The proposal assumes $20.3 million in state funding will be needed for services provided by FQHCs. In addition to an estimated $119 million requested for base managed care payments, DHS requests $46.8 million to offset premium taxes assessed for the managed care Medicaid business under the Patient Protection and Affordable Care Act (PPACA).

It is important to note that the budget proposal does not include any other program or policy modifications. Instead, estimated program costs are based on continuation of the current program.

This is the first step in the 2015-17 biennial budget process. The Governor will work with the DOA to put together a budget package that typically is introduced as legislation sometime in February. That budget is then sent to the Legislature where it is amended by the state’s powerful Joint Finance Committee before it is approved by both houses of the state Legislature. The biennial budget bill is supposed to be signed into law before the beginning of the next fiscal year on July 1, 2015.

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New Legislator Profile: Rep. Mandy Wright (D-Wausau)
Wright: Fair Reimbursement in Worker’s Comp, Medicaid Helps Ensure Patient Access

Access to health care is an important issue to Rep. Mandy Wright. It is one of the reasons she does not support the provider fee schedule that was proposed last session by the Worker’s Compensation Advisory Council.

"We have a successful worker’s compensation system in Wisconsin," Wright said. "I feel strongly that if providers are not adequately compensated, there will come a time that could threaten access for patients."

Wright also extends that to the Medicaid program, and supports Medicaid expansion because of her on-going concern that some people have less access to health care, especially in the more northern reaches of her district. She has appreciated and applauded the efforts of the health systems in her area to connect patients, especially children, with care.

"I have seen some creative opportunities take shape between school districts and health care providers," Wright said. For example, Aspirus and Ministry Health Care have been working with area school districts to open on-site or "near-site" health clinics.

"As a teacher, I can see how this would make it much more convenient for both students and their parents," Wright said.

As a freshman legislator last session, Wright said she was very pleased to participate in some of the "large bills" that passed, including funding for mental health, which she said was a good start, "but more is needed." Wright also supported the increase in technical school funding for worker training.

"The technical college in my district is very strong, and they have an excellent health center where students can receive an associate’s degree in the dental, home care or nursing assistant program. The college is very response to the needs of business," Wright said. "In addition, we have UW-Marathon that has just entered into a partnership to offer a four-year degree for physician assistants in Wausau. That, too, is a step in the right direction."

A new education organization in central Wisconsin, The Medical College of Wisconsin, will accept its first medical students at its Wausau campus in 2015. Wright is optimistic that if medical students are able to advance their education in central Wisconsin, they will be more likely to stay. She noted that Wisconsin’s balanced medical liability system is also a factor in attracting and keeping physicians in Wisconsin, a system she believes requires no changes.

Wright says more needs to be done to encourage students to become physicians.

"We really need to reach more deeply into our schools and work with our students and families to start kids thinking about being a doctor when they are in third or fourth grade," she said. Wright has been actively working on a project that will incorporate more science and math into the school curriculum in a package that teachers can implement in their classrooms.

Wright has a good working relationship with the health care providers in her area, and she understands the key role that health care plays in attracting economic development.

"Health care is an integral part of a community’s infrastructure that creates a healthy climate for a high quality life," Wright said.

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Political Action Fundraising Campaign Surpasses 80%
$50,000 needed to reach goal

The 2014 Wisconsin Hospitals Conduit and State PAC Fundraising Campaign has surpassed the 80 percent mark this week, raising a total of $213,476 to date.

With just six weeks until the November 4 elections, the Campaign continues strong going into the home stretch. There are several candidates running in open seat races and some high profile races like the gubernatorial contest. This week’s Marquette University Law School poll results show the race remains close between Governor Scott Walker and Democratic challenger Mary Burke.

Listed on pages 11-12 are the 282 contributors to date to the 2014 Campaign. Thank you! The next publication of the contributor list will be in the October 3 edition of The Valued Voice.

For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Contributors ranging from $1 to $499
Aittama, Craig Ministry Saint Michael's Hospital
Alstad, Nancy Fort HealthCare
Anderson, Phil Sacred Heart Hospital
Anich, Matthew Memorial Medical Center - Ashland
Appleby, Jane Aurora Health Care
Arnett, James Meriter-UnityPoint Health
Bagnall, Andrew St. Nicholas Hospital
Bair, Barbara St. Clare Hospital & Health Services
Ballentine, Anne Wheaton Franciscan Healthcare
Bayer, Tom St. Vincent Hospital
Brenholt, Craig St. Joseph's Hospital
Brenny, Terrence Stoughton Hospital Association
Buser, Kenneth Wheaton Franciscan Healthcare - All Saints
Campau, Patricia Columbia St. Mary's, Inc.
Cardinal, Lori Agnesian HealthCare
Carlson, Peter Aurora Psychiatric Hospital
Ceelen, John Ministry Health Care
Censky, Bill Holy Family Memorial
Clark, Julie St. Joseph's Hospital
Clark, Renee Fort HealthCare
Collins, Sherry Wisconsin Hospital Association
Coopman, Dianne St. Mary's Janesville Hospital
Cormier, Laura Bellin Hospital
Courtney, Chip Aspirus Medford Hospital & Clinics, Inc.
Dalebroux, Steve St. Mary's Hospital
Danner, Forrest Aspirus Wausau Hospital
Donlon, Marcia Holy Family Memorial
Duda, Carrie Wheaton Franciscan Healthcare - All Saints
Dux, Larry Froedtert & MCW Community Memorial Hospital campus
Dwyer, Maxine St. Mary's Hospital
Erickson, Susan Meriter-UnityPoint Health
Ewald, Sandra Aurora Health Care
Ferrigno, Sandra St. Mary's Hospital
Fielding, Laura Holy Family Memorial
Furlong, Marian Hudson Hospital & Clinics
Gormican, John J. Agnesian HealthCare
Graul, Mark Children's Hospital of Wisconsin
Groskreutz, Kevin St. Joseph's Hospital
Gulan, Maria Aspirus Wausau Hospital
Gullicksrud, Lynn Sacred Heart Hospital
Gustafson, Andy SSM Health Care-Wisconsin
Hafeman, Paula St. Vincent Hospital
Halida, Cheryl St. Joseph's Hospital
Hamilton, Mark  
Harrington, Kathleen Mayo Health System - Eau Claire
Hattem, Marita Aspirus Wausau Hospital
Heaney, Dwight Fort HealthCare
Henricks, William Rogers Memorial Hospital
Hieb, Laura Bellin Hospital
Hill, Juliet Sacred Heart Hospital
Hockin, Jennifer Aspirus, Inc.
Holub, Gregory Ministry Door County Medical Center
Hueller, Julie Wheaton Franciscan Healthcare
Jelle, Laura St. Clare Hospital & Health Services
Jensen, Russell St. Mary's Hospital
Jones, Mary Meriter-UnityPoint Health
Karow, Deborah Ministry Health Care's Howard Young Medical Center
Kaufmann, Marilyn Holy Family Memorial
Kelsey Foley, Kathy Aspirus Wausau Hospital
Kempen, Jacob Aspirus Wausau Hospital
King, Steve St. Mary's Hospital
Kingston, Mary Beth Aurora Health Care
Kinney, Aric Aurora Medical Center Summit
Klay, Chris St. Joseph's Hospital
Klay, Lois St. Joseph's Hospital
Koch, Mark Mayo Clinic Health System
Koebke, Troy Bellin Hospital
Kuehni-Flanagan, Tracy St. Joseph's Hospital
LaBarge, Margie Ministry Health Care
Lakey, Sandy Aspirus Wausau Hospital
Lambrecht, Randy Aurora Health Care
Larson, William St. Joseph's Hospital
Leonard, Mary Kay St. Mary's Hospital
Luehring, Sally St. Vincent Hospital
Lynch, Sue Mayo Health System - Franciscan Healthcare
Marquardt, Amy Hospital Sisters Health System
Mason, Paul Wheaton Franciscan Healthcare - All Saints
Maurer, Mary Holy Family Memorial
Mays, Laura Stoughton Hospital Association
McMeans, Scott Holy Family Memorial
Meicher, John St. Mary's Hospital
Mercer, Carla Reedsburg Area Medical Center
Mohr, Carol Sacred Heart Hospital
Neikirk, Jon Froedtert & The Medical College of Wisconsin
Nevers, Rick Aspirus, Inc.
Newberry-Ferguson, Linda ProHealth Care - Rehabilitation Hospital of WI
Nicklaus, Todd Aspirus, Inc.
O'Brien, Laura  
Ott, Virginia St. Joseph's Hospital
Palecek, Steve St. Joseph's Hospital
Pavelec-Marti, Cheryl Ministry Saint Michael's Hospital
Peck, Lori Aspirus Medford Hospital & Clinics, Inc.
Peiffer, Susan Sacred Heart Hospital
Pempek, Kalynn Aspirus Wausau Hospital
Penovich, Carrie Aurora Medical Center in Two Rivers
Prunty, Brian Aspirus Wausau Hospital
Riddle, Roberta Rusk County Memorial Hospital
Ross, Daniel Wheaton Franciscan Healthcare - All Saints
Roundy, Ann Columbus Community Hospital
Schaetzl, Ron St. Clare Hospital & Health Services
Schweitzer, Susan Columbus Community Hospital
Selle, Ginger St. Clare Hospital & Health Services
Shear, Jim  
Sheehan, Heather Hayward Area Memorial Hospital and Nursing Home
Slomczewski, Constance Wheaton Franciscan Healthcare - All Saints
Sommers, Craig St. Mary's Hospital
Sparacino, Gloria Aurora West Allis Medical Center
Steines, Sara Children's Hospital of Wisconsin
Stephens, Brian Ministry Door County Medical Center
Stranberg, Kevin Memorial Medical Center - Ashland
Strasser, Kathy Aspirus, Inc.
Sullivan, Anne Memorial Medical Center - Ashland
Tapper, Joy Milwaukee Health Care Partnership
Teigen, Seth St. Mary's Hospital
Theiler, Brian Gundersen Tri-County Hospital and Clinics
Turtenwald, Robyn Froedtert & MCW Community Memorial Hospital campus
Van Meeteren, Bob Reedsburg Area Medical Center
Vergos, Katherine Ripon Medical Center
Voelker, Thomas Aspirus Wausau Hospital
Walczak, Laura St. Mary's Janesville Hospital
Waldoch, Timothy Columbia St. Mary's, Inc.
Walker, Troy St. Clare Hospital & Health Services
Washburn, Juliane Bay Area Medical Center
Werkheiser, Cindy Monroe Clinic
Westbrook, Diane River Falls Area Hospital
Wetenkamp, Vicki Holy Family Memorial
Wheeler, Susan St. Nicholas Hospital
Whitinger, Margaret Agnesian HealthCare
Woleske, Chris Bellin Hospital
Wymelenberg, Tracy Aurora Health Care
Ziebarth, Laura St. Mary's Hospital
   
Contributors ranging from $500 to $999  
Andersen, Travis Columbia St. Mary's, Inc.
Anderson, Layton Ministry Saint Joseph's Hospital
Brenton, Andrew Wisconsin Hospital Association
Carlson, Dan Bay Area Medical Center
Connors, Lawrence St. Mary's Hospital Medical Center
Dexter, Donn Mayo Health System - Eau Claire
Dietsche, James Bellin Hospital
Dolohanty, Naomi Aurora Health Care
Eckels, Timothy Hospital Sisters Health System
Frangesch, Wayne Wheaton Franciscan Healthcare
Freimund, Rooney Bay Area Medical Center
Granger, Lorna Aurora Health Care
Gullingsrud, Tim Hayward Area Memorial Hospital and Nursing Home
Huettl, Patricia Holy Family Memorial
Hyland, Carol Agnesian HealthCare
Jacobson, Terry St. Mary's Hospital of Superior
Jensema, Christine HSHS-Eastern Wisconsin Division
Kersten, Juliet Children's Hospital of Wisconsin
Kerwin, Kathleen  
Kocourek, Cathie Aurora Medical Center in Two Rivers
Larson, Margaret Mercy Medical Center
Lentz, Darrell Aspirus Wausau Hospital
Logemann, Cari Aspirus, Inc.
Malone, Virginia St. Mary's Hospital
Mantei, Mary Jo Bay Area Medical Center
McNally, Maureen Froedtert & The Medical College of Wisconsin
Miller, Clint Spooner Health System
Mulder, Doris Beloit Health System
Nelson, James Fort HealthCare
Nesse, Robert Mayo Clinic Health System
O'Keefe, James Mile Bluff Medical Center
Oland, Charisse Rusk County Memorial Hospital
Ordinans, Karen Children's Hospital of Wisconsin
Ose, Peggy Riverview Hospital Association
Peterson, Douglas Chippewa Valley Hospital
Pollard, Dennis Froedtert & MCW Community Memorial Hospital campus
Quinn, George Wisconsin Hospital Association
Richards, Theresa Ministry Saint Joseph's Hospital
Richardson, Todd Aspirus, Inc.
Rohrbach, Dan Southwest Health Center
Rutkowski, Jennifer Grant Regional Health Center
Schmitz, Bonnie Agnesian HealthCare
Sczygelski, Sidney Aspirus Wausau Hospital
Selberg, Heidi HSHS-Eastern Wisconsin Division
Shabino, Charles Wisconsin Hospital Association
Smith, Gregory Wheaton Franciscan Healthcare
Sobal, Larry Ministry Health Care
Sprecher, Lon  
Stuart, Philip Tomah Memorial Hospital
Swanson, Kerry St. Mary's Janesville Hospital
Thoreen, Peter Meriter-UnityPoint Health
VanCourt, Bernie Bay Area Medical Center
White-Jacobs, Mary Beth Black River Memorial Hospital
Worrick, Gerald Ministry Door County Medical Center
Yaron, Rachel Ministry Saint Clare's Hospital
   
Contributors ranging from $1,000 to $1,499  
Ashenhurst, Karla Ministry Health Care
Bablitch, Steve Aurora Health Care
Bedwell, Elizabeth Children's Hospital of Wisconsin
Garcia-Thomas, Cristy Aurora Health Care
Geboy, Scott Hall, Render, Killian, Heath & Lyman
Geraghty, Tricia Children's Hospital of Wisconsin
Gorelick, Marc Children's Hospital of Wisconsin
Gunn, Veronica Children's Hospital of Wisconsin
Gutzeit, Michael Children's Hospital of Wisconsin
Hart, Shelly Aurora Health Care
Hayden, Kevin  
Janis, Gerald Aurora Health Care
Just, Lisa Aurora Health Care
Kosanovich, John Watertown Regional Medical Center
Kostroski, Sharon Ministry Saint Joseph's Hospital
Lappin, Michael Aurora Health Care
Lewis, Jonathan St. Mary's Hospital
Loftus, Philip Aurora Health Care
Martin, Jeff Ministry Saint Michael's Hospital
McDonald, Mary Beth Aurora Health Care
McKevett, Timothy Beloit Health System
Mohorek, Ronald Ministry Health Care
Natzke, Ryan Marshfield Clinic
Nauman, Michael Children's Hospital of Wisconsin
Nelson, Dave HSHS-Western Wisconsin Division
Norbin Killoran, Carrie Aurora Health Care
Potts, Dennis Aurora Health Care
Priest, Geoffrey Meriter-UnityPoint Health
Rakowski, Mark Children's Hospital of Wisconsin
Rickelman, Debbie WHA Information Center
Rislov, Amy Aurora Health Care
Russell, John Columbus Community Hospital
Sanders, Robert Children's Hospital of Wisconsin
Schafer, Michael Spooner Health System
Schmidt, Cheryl St. Elizabeth Hospital
Shanahan, Thomas Children's Hospital of Wisconsin
Stamas, Peter Ministry Saint Joseph's Hospital
Wolf, Edward Lakeview Medical Center
   
Contributors ranging from $1,500 to $1,999  
Anderson, Sandy St. Clare Hospital & Health Services
Bloch, Jodi Wisconsin Hospital Association
Boatwright, Damond SSM Health Care-Wisconsin
Boese, Jennifer Wisconsin Hospital Association
Boland, Susan Wheaton Franciscan Healthcare - All Saints
Byrne, Frank St. Mary's Hospital
Coffman, Joan St. Joseph's Hospital
Court, Kelly Wisconsin Hospital Association
Duncan, Robert Children's Hospital of Wisconsin
Falvey, Patrick Aurora Health Care
Francis, Jeff Ministry Health Care
Frank, Jennifer Wisconsin Hospital Association
Grasmick, Mary Kay Wisconsin Hospital Association
Harding, Edward Bay Area Medical Center
Herzog, Mark Holy Family Memorial
Heywood, Matthew Aspirus, Inc.
Hilt, Monica Ministry Saint Mary's Hospital
Johnson, Jodi Wisconsin Hospital Association
Lepore, Michael Wheaton Franciscan Healthcare
Lewis, Gordon Burnett Medical Center
Meyer, Daniel Aurora BayCare Medical Center in Green Bay
Roller, Rachel Aurora Health Care
Sexton, William Prairie du Chien Memorial Hospital
Sheehan, John  
Stanford, Matthew Wisconsin Hospital Association
Wallace, Michael Fort HealthCare
   
Contributors ranging from $2,000 to $2,999  
Alig, Joanne Wisconsin Hospital Association
Brenton, Mary E.  
Brooks, Alenia Aurora Health Care
Brophy, Michael Aurora Health Care
Clapp, Nicole Grant Regional Health Center
Colman, Gerard Aurora Health Care
Desien, Nicholas Ministry Health Care
Gage, Weldon Children's Hospital of Wisconsin
Hanson, Gail Aurora Health Care
Kachelski, Joe Wisconsin Statewide Health Information Network
Kelch, Elaine  
Kief, Brian Ministry Saint Joseph's Hospital
Leitch, Laura Hall Render Killian Heath & Lyman
Levin, Jeremy Rural Wisconsin Health Cooperative
Normington, Jeremy Moundview Memorial Hospital & Clinics
O'Brien, Kyle Wisconsin Hospital Association
Pandl, Therese HSHS-Eastern Wisconsin Division
Potter, Brian Wisconsin Hospital Association
Sanders, Michael Monroe Clinic
Standridge, Debra Wheaton Franciscan Healthcare
Starmann-Harrison, Mary Hospital Sisters Health System
Troy, Peggy Children's Hospital of Wisconsin
   
Contributors ranging from $3,000 to $4,999  
Jacobson, Catherine Froedtert & The Medical College of Wisconsin
Kammer, Peter The Kammer Group
Katen-Bahensky, Donna  
Kerwin, George Bellin Hospital
Little, Steven Agnesian HealthCare
Mettner, Michelle Children's Hospital of Wisconsin
Neufelder, Daniel Ministry Health Care
Turkal, Nick Aurora Health Care
   
Contributors ranging from $5,000 to $9,999  
Borgerding, Eric Wisconsin Hospital Association
Brenton, Stephen Wisconsin Hospital Association
Size, Tim Rural Wisconsin Health Cooperative
 
Contributors $10,000 and above  
Tyre, Scott Capitol Navigators, Inc


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WHA Shares Price Transparency Message with more than 2,000 WI Employers
Direct mail piece encourages employers to help employees connect with price, quality info

As employers consider their various options for providing health insurance to their employees, they are also interested in sharing information that will help their workers become better informed health care consumers.

In a recent survey sponsored by WHA, only 35 percent of nearly 300 employers who responded were aware of www.WiCheckPoint.org or www.WiPricePoint.org. That response, along with the newly-released update of the WHA Information Center (WHAIC) PricePoint website, prompted WHA to reach out to more than 2,000 employers with a direct mail piece.

"WHA and our member hospitals are committed to creating tools that will help employers and their employees increase their understanding of some of the key elements of health care purchasing—quality and price," said WHA Executive Vice President Eric Borgerding. "We want to build awareness among employers that hospital price and quality information are accessible so they, in turn, can share these tools with their employees."

With higher deductibles on employer-sponsored plans and with more people purchasing private insurance with high deductibles on the health insurance exchange, the importance of connecting people with price and quality information is even more critical.

PricePoint has added several new features, including the ability for the user to create a worksheet that explains the costs that are covered by their health plan. The site frequently prompts the user to contact their insurer and/or the hospital billing office before they schedule an elective procedure so they can get as accurate an estimate of the bill as possible, and understand what portion of it is their personal responsibility.

"The economic health and vitality of our communities is integrally tied to the success of our employers and on our ability as a state to attract new business," according to Borgerding. "It is important that, just as our members have built strong relationships with employers in their local community, that WHA facilitates an ongoing dialogue on the price, quality and accessibility of health care with the state’s business and manufacturing community. I believe we are moving in a direction that will help us meet that goal."

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Sprecher Joins WHA Team

The Wisconsin Hospital Association (WHA) announced Lon Sprecher will join its policy and advocacy team in a newly-created key advisory role. Sprecher, who retired in May, 2014 as CEO of Dean Health Plan, brings more than 30 years of expertise in the areas of health insurance, managed care, reimbursement, risk management and payer/provider relations to the WHA team. Sprecher served as state budget director during the writing of the 1983-85 state budget where he spearheaded the creation of health maintenance organizations.

"How care is provided and paid for is increasingly aligning to achieve better quality and higher value. With that evolution comes new public policy challenges related to payment reform, insurance reform, coverage expansion, care coordination, integration and risk assumption," said WHA Executive Vice President Eric Borgerding. "As the structures of health care delivery and financing evolve, so too are WHA’s public policy priorities and advocacy assets. Lon will bring valuable insight and counsel to WHA in these areas and be a tremendous addition to our team."

"WHA is a widely-respected leader in health care policy development and advocacy," said Sprecher. "I am excited to work with this proactive and forward-looking organization and help keep Wisconsin’s hospitals and health systems among the best in the country."

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Sen. Olsen Meets with Local Hospital Leaders

State Senator Luther Olsen met with hospital leaders from his district during a roundtable discussion hosted by Moundview Memorial Hospital & Clinics (Friendship). Olsen, who is not up for reelection until 2016, used the roundtable discussion as an opportunity to hear directly from leaders about issues already on the horizon in the next legislative session.

The group discussed ongoing issues with inadequate Medicaid reimbursement for hospitals and how this underfunding creates a "hidden health care tax" on Wisconsin employers who provide private insurance coverage to their employees. This led into discussions about the experience hospitals are having with Medicaid and exchange enrollment. It was noted that one attendee, an allergist, was not included in an insurance plan offered on the exchange in his area. In this instance, it meant that patients choosing that insurance plan would have drive up to 50 miles to see an allergist. Many individuals previously covered under Medicaid but who no longer qualify have yet to enroll in the exchange.

The group then discussed proposed changes to Wisconsin’s worker’s compensation program that did not pass the Legislature last session. The group discussed the added administrative workload, clinical administrative burden and other inefficiencies that exist in the current worker’s compensation program. That aside, Wisconsin health care providers are still able to provide high-value care—getting their patients back to work, on average, three weeks earlier than other states and with higher satisfaction scores when compared to other worker’s compensation programs across the nation. A physician in the group discussed how worker’s compensation cases include much more paperwork and can be more severe and complex. A chief financial officer in the group discussed his experience when Florida implemented a fee schedule in worker’s compensation. He said that policymakers used the fee schedule to continually cut reimbursement for providers.

Attendees expressed their appreciation to Olsen for meeting with them. In addition to hospital and physician leaders from Moundview Memorial, other participants included leaders from Riverside Medical Center (Waupaca) and Ripon Medical Center (Ripon).

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WHA Presents "A Future Leader’s Guide to Wisconsin Health Care"

Wisconsin is home to some of the most notable health care leaders in the country. Three of those leaders will join Jamie Orlikoff November 5 in Wisconsin Dells for a panel discussion on how they believe Wisconsin can stay head of the curve. The panel is one session of a day-long conference being presented by WHA in partnership with the Wisconsin Forum for Healthcare Strategy (WFHS).

"Today’s Challenges, Tomorrow’s Opportunities: A Future Leader’s Guide to Wisconsin Health Care" 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. Hospitals and health systems are encouraged to send a team comprised of senior and mid-level leaders.

The panelists who will be participating in the conference include:

Orlikoff, one of the foremost thought leaders in the country, says employers are among the most influential change agents in the health care marketplace today. Health care providers who actively partner with employers and help them lower their health care costs will help boost the state’s economy and create a business climate that attracts employers, especially in the manufacturing sector, which can help build and sustain middle-class jobs.

"We have to grow the economy and restrain the growth of health care at the same time," Orlikoff said. (Read the full story: www.wha.org/Data/Sites/1/pubarchive/valued_voice/WHA-Newsletter-7-25-2014.htm#4)

This event, scheduled November 5 at Glacier Canyon Lodge at The Wilderness Resort in Wisconsin Dells, is the first in a series of leadership development programs co-sponsored by WHA and WFHS.

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

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Collaboration Among Health Care Providers Key in Reducing Readmissions
Readmission rates continue to drop in WI; hospitals assume key role in TOC coalitions

Reducing hospital readmissions is one of the toughest projects for hospitals to tackle. It also presents the largest opportunity to drive down health care costs. Hospitals know going into their work, however, that preventing a readmission is not entirely in their control. That is why Wisconsin hospitals began to form, and often lead, county-wide coalitions.

Nearly 250 people representing hospitals, long-term care, home health, home care and local aging/disability resource centers gathered in Wisconsin Dells September 10 for a one-day best practice-sharing workshop. The workshop was hosted by WHA, MetaStar, and the six other organizations represented on the statewide Transitions of Care (TOC) Coalition.

Wisconsin has reduced readmissions nearly 20 percent over the past few years, a fact that was highlighted at the conference. There are now 22 counties in the state that have an active coalition to improve transitions of care. This effort, supported by MetaStar, encourages local coalition building.

"Once the organizations around the table see their county data, it gives them a sense of a common purpose," according to Myra Weiss, MetaStar quality consultant. "Their next step is to identify the main drivers of a readmission and prioritize action steps."

The Dane County Transitions of Care Coalition shared their story from their first meeting to the changes they have implemented to date. Initiated by the University of Wisconsin Hospitals and Clinics, the coalition has more than 30 organizations working together to improve the patient experience in the Madison-area health care system as well as prevent readmissions.

WHA Quality Manager Stephanie Sobczak presented a breakout session on how to align a group of organizations to implement change across the system.

"Wisconsin hospitals are committed to reducing readmissions, and their hard work is reflected in the decline we’ve seen in the number of patients that are readmitted," said Sobczak. "Hospitals are reaching beyond their campuses and involving many like-minded community partners to address readmissions. When they all realize they are not alone in this work, the community coalitions really begin to take shape. The best results are being achieved by those organizations that recognize this work must take place both inside and outside the hospital."

Sobczak shared the "inside/outside" strategy in a paper published in Readmissions News, a national online publication focused on hospital readmissions. Here is the link: www.wha.org/pdf/Readmissions0614Sobczak.pdf.

The statewide Transitions of Care coalition will continue to coordinate resources as the national push to reduce preventable readmissions continues. Hospitals interested in WHA’s readmissions collaborative should contact Stephanie Sobczak at ssobczak@wha.org or 608-274-1820. Communities interested in launching a local Transitions of Care coalition should contact Myra Weiss at MetaStar at mweiss@metastar.com.

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Registration Now Open for Wisconsin Fall Enrollment Summit
October 21 & 22 in Wausau

Join your colleagues and experts at the statewide Wisconsin Fall Enrollment Summit to prepare enrollment assisters, health care providers, and regional enrollment networks (RENs) for the 2015 health insurance open enrollment period, which begins November 15, 2014 and ends February 15, 2015. The conference will help you learn about the changes for 2015 health coverage enrollment, network with colleagues and hear about the best techniques for helping patients and community residents enroll and re-enroll in coverage.

WHA is a contributing sponsor of this event, which is presented by Covering Kids & Families-Wisconsin in partnership with the Wisconsin Department of Health Services, the Wisconsin Office of Commissioner of Insurance, Wisconsin Primary Health Care Association and Milwaukee Health Care Partnership.

Register by September 30 for early bird rates. Registration closes October 17. For more information about the conference, hotel rooms and to register visit http://e4healthwi.org/2014-wisconsin-enrollment-conference.

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Health Law Manual Webinar: Medical Staff, Labor & Employment

WHA will continue its months-long complimentary webinar series October 2 from 12-1:30 p.m. with a presentation of the "WHA Medical Staff, Labor & Employment Manual." This webinar will cover four broad issues faced by hospitals as employers: caregiver background checks and investigation of caregiver misconduct; family and medical leave and military leave issues; drug testing, including reasonable suspicion versus random drug testing policies; and the intersection of peer review privilege and employment law, including Wisconsin’s peer review privilege, medical staff bylaws, hospital rights and immunities, and reporting requirements.

WHA members are encouraged to register for this webinar as well as any or all of the other webinars remaining in the series. Registration and additional 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 Ralph V. Topinka, Doris E. Brosnan, and Meghan C. O’Connor of the law firm of von Briesen & Roper.

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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ICD-10-PCS Web Series to Focus on Common and Complex Coding Scenarios

The October 1, 2015 deadline for ICD-10 implementation allows Wisconsin hospitals and health systems the opportunity to take full advantage of the additional time to prepare for the ICD-10 transition. This fall, WHA is offering a webinar series featuring well-known coding expert Lynn Kuehn. Kuehn will help coders, coding managers, and members of a hospital or health system’s ICD-10 implementation teams better understand ICD-10-PCS coding system design and root operation groups, as well as work through common and more complex coding scenarios, to be better prepared for on-time and efficient implementation.

A two-part webinar, scheduled October 22 and 29, is aimed at those who need to learn more about the ICD-10-PCS system design and how to use the tools of the system to assign codes. During the two sessions, the nine ICD-10-PCS root operation groups available for coding will be reviewed, including their definitions and unique issues related to assigning the root operation character.

On December 2, Kuehn will lead a webinar focused on making root operations selections and assigning all characters for the codes included in 10 common ICD-10-PCS cases encountered at hospitals and health systems of all sizes.

On December 9, Kuehn will focus on teaching participants to improve critical thinking skills and tackle more complex ICD-10-PCS cases. Kuehn will provide helpful tips to differentiate between root operations groups and similar individual root operations. Intended as the capstone for the webinar series, this session will assist attendees in making decisions to code 10 common but more complex ICD-10-PCS cases.

Full information on all four sessions is included in this week’s packet. In addition, information and online registration are available at: http://events.SignUp4.net/14W-ICD-10-PCSSeries. Encourage your team to gather for this webinar series and learn together through one, low-cost registration.

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WHIO Learning Forum Features Total Cost of Care Metrics

The Wisconsin Health Information Organization’s (WHIO) Fall Learning Forum October 14 features keynote speaker Elizabeth Mitchell, president/CEO, Regional Healthcare Improvement (NHRS), as she addresses the topic of evolving total cost of care policies and practices.

Mitchell, former CEO of the Maine Health Management Coalition and Foundation and former member of the Maine state Legislature, serves on the board of the National Quality Forum (NQF). She has also served on the board of the National Business Coalition on Health, and Maine’s Chartered Value Exchange.

The keynote address promotes the theme of the Learning Forum—"Spotlight on Payment Reform: Finding What Works." Other presentations include:

For more information and to register, go to http://wisconsinhealthinfo.org/whio-learning-forum.

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WHA Foundation’s 2014 Global Vision Award Honors Two Community Initiatives

The WHA Foundation announces the selection of the "Live It! Real Life Nutrition for Teens" program, nominated by Columbus Community Hospital; and the "NEW Community Clinic Dental Clinic" program, nominated by Hospital Sisters Health System (HSHS) - Green Bay, as recipients of the 2014 Global Vision Community Partnership Award.

As a result of the community health needs assessment conducted by Columbus Community Hospital (CCH), the "Live It! Real Life Nutrition for Teens" program was implemented in 2012 for middle school students in four schools in the Columbus and Fall River areas. The needs assessment revealed a high obesity rate in Columbia County, which led to the formation of The Food for Thought Coalition to tackle this issue. In addition to the hospital, the Coalition includes Columbus Community Hospital Foundation, Inc., the University of Wisconsin-Madison (UW) Department of Nutritional Sciences, the UW Department of Food Science, Columbus Middle School, Fall River Middle School, Zion Lutheran School, St. Jerome Catholic School, and the Medical College of Wisconsin. The Coalition implemented the Live It! Program, designed to target and combat childhood obesity at the source, with a goal of improving youth eating and physical activity habits and create long-term retention of the benefits of eating nutrient-rich foods and engaging in physical activity. Originating from the Oregon Dairy Council, the Live It! Program consists of an engaging 14-lesson curriculum presented throughout the school year. Physical activity lessons are taught by CCH’s education staff manager, a former physical education teacher, while the nutrition lessons are taught by CCH registered dietitian staff or UW dietetic students. Each lesson is presented within the health curriculum or class at each of the middle schools, requiring not additional time or travel for participating students or parents. Each class accumulates points based on students completing in-class and take-home activities, with the grand prize of a healthy cooking class led by CCH’s executive chef each semester. Outcomes are measured by pre- and post-surveys of the students and abbreviated fitness testing and BMI measurements collected for future trend analysis.

The NEW Community Clinic Dental Clinic, located on the campus of Northeast Wisconsin Technical College (NWTC) in Green Bay, exists through the collaboration of St. Mary’s and St. Vincent Hospitals, both part of the Hospital Sisters Health System (HSHS) Eastern Wisconsin Division; NWTC; and the NEW Community Clinic, a federally-qualified health center. The dental clinic is part of a medical clinic on the NWTC campus, allowing real-life training experience for NWTC students who provide dental hygiene services to Medicaid and uninsured patients when classes are in session, serving patients who don’t need a higher level of services. While the NEW Community Clinic has had a dentist on staff since 2011, it was clearly not enough to address the growing number of patients presenting at Green Bay hospital emergency departments for dental problems. Over 2,000 patients are seen in Green Bay hospital EDs annually for a preventable dental condition, and the 2012 Brown County community health needs assessment identified oral health as one of the top three health focus areas for Brown County. In 2012, St. Mary’s and St. Vincent Hospitals provided needed funds to open a six-chair operatory in space donated and remodeled by NWTC, an additional dentist was hired, and the new dental clinic was opened in April 2013. In addition to services provided by the two dentists and the NWTC dental hygiene students, beginning early this month, two Green Bay-based oral surgery groups have voluntarily started to see patients a half day each week, with the hopes of eventually bringing oral surgery students to the clinic. The dental clinic had over 4,000 visits in 2013, and between January and May 2014, had nearly 2,200 visits, with the vast majority of these patients on Medicaid. These numbers do not include patient visits to NWTC dental hygiene students during the school year. Clinic collaborators are monitoring hospital ED data via WHAIC data sets and indicate fourth quarter of 2013 data showed a drop in visits for preventable dental conditions that was one standard deviation below the running average.

The WHA Foundation’s Global Vision Community Partnership Award is a competitive grant award created in 1995 to recognize the efforts of WHA members in meeting the documented health needs in their communities through creativity, innovation, partnership, and collaboration. To date, the Award has honored 38 innovative programs in communities throughout Wisconsin.

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Member News: Bellin-ThedaCare Healthcare Partners #1 in CMS Pilot Program

On September 16, the Centers for Medicare & Medicaid Services (CMS) issued quality and financial performance results for its two Accountable Care Organization (ACO) programs, showing the ACOs have successfully improved the quality of care for Medicare beneficiaries by fostering greater collaboration between doctors, hospitals, and health care providers and keeping patients healthy rather than treating them only when they were sick. Bellin-ThedaCare HealthCare Partners ranked tops in quality in the Pioneer ACO Model program, while reducing health care costs.

"Bellin-ThedaCare Healthcare Partners’ success in the Pioneer ACO model demonstrates our ability to control health care costs while also improving the quality of care," said Dave Krueger, MD, executive director and medical director for Bellin-ThedaCare Healthcare Partners. "The success we have achieved is due to our dedicated providers and staff working together to provide efficient and effective care for our patients."

CMS released the results for two programs created under the Affordable Care Act: the Medicare Shared Savings Program and the Pioneer ACO Model. Bellin-ThedaCare HealthCare Partners—a collaborative organization comprised of Bellin Health, ThedaCare and a network of 700 physicians—is in its second year in the Pioneer program, after being selected for the program in 2011. Through its participation, Bellin-ThedaCare HealthCare Partners is responsible for coordinating care for approximately 20,000 Medicare beneficiaries in Northeast Wisconsin.

The report shows that Bellin-ThedaCare HealthCare Partners are #1 among the 23 Pioneer participants with a quality score of 94.11. Participants are judged on 33 factors measured by CMS.

George Kerwin, Bellin Health president and CEO, says the Pioneer Program rewards health care organizations based on three areas that have long been a focus at his organization.

"Bellin focuses on determining how we can simultaneously provide high-quality care, manage cost and create a positive patient experience in the communities we serve," said Kerwin. "We also work collaboratively with organizations in the state, the nation and abroad to better determine the best ways to deliver on these three measures. Our partnership with the physicians and ThedaCare is a prime example of those collaborative efforts and our results in the Pioneer ACO program show we are making a difference for the people of this region."

The organization accomplished its top quality ranking while decreasing cost.

"In the second year of the Pioneer ACO program, we received a target of $8,451 per beneficiary—and we beat that mark by more than two percent. This resulted in more than $3.2 million in savings for CMS, and shows what can be done when we work together to find solutions that benefit our entire community," said Dean Gruner, MD, president and CEO of ThedaCare.

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