September 20, 2013
Volume 57, Issue 38



Pandl to Serve as 2014 WHA Chair-Elect
Harding will chair Association in 2014

Therese Pandl, president/CEO of the Hospital Sisters Health System’s (HSHS) Eastern Wisconsin Division, has been selected by the Wisconsin Hospital Association Nominating Committee to serve as WHA’s chair-elect in 2014 and chair in 2015. A member of the WHA Board since 2012, Pandl currently co-chairs the WHA Enrollment Action Council.

Prior to joining HSHS, Pandl served as executive vice president and COO at Columbia St. Mary’s in Milwaukee. During her tenure with Columbia St. Mary’s, she served in a variety of roles, including lead executive for St. Mary’s Hospital Ozaukee, vice president of operations, vice president of inpatient services and nurse executive, as well as director and staff positions.

Pandl earned both her bachelor’s degree in nursing and her MBA at the University of Wisconsin-Milwaukee and a master’s in nursing from the University of Washington, Seattle. She was a Commonwealth Fund Nurse Executive Fellow and is a Fellow of the American College of Healthcare Executives.

Pandl serves on the Board of Directors for Nicolet National Bank, the Green Bay Area Chamber of Commerce, the Greater Green Bay Community Foundation and the American Hospital Association Governing Council.

Edward Harding, president/CEO, Bay Area Medical Center in Marinette, will chair the Association in 2014.

Harding joined Bay Area Medical Center in December 2010. Prior to that, he served as president/CEO of Columbus Community Hospital from 2000 to 2010. His experience also includes being vice president of strategic planning, marketing and professional services at Mercy Medical Center, Clinton, Iowa.

A WHA Board member since 2006, Harding currently chairs the Council on Rural Health and the Wisconsin Hospitals Issue Advocacy Council, is a member of the WHA Executive Committee and serves on the Medicaid Reengineering Group.

A native of Sturgeon Bay, Harding received his master’s degree from the University of Minnesota and his bachelor’s degree from the University of Wisconsin-Stout. He is a Fellow of the American College of Healthcare Executives and is ACHE-board certified in health care planning and managed care.

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Insurer Participation by County in the Exchange Released
Choice and competition will vary by region

There will be at least one insurer participating in the health insurance exchange in the individual market in every county in Wisconsin, according to information released from the Office of the Commissioner of Insurance (OCI) this week. This long-awaited information has just been released, according to OCI, now that the insurers have signed agreements with the federal government.

The announcement eases concerns that consumers in the individual market in some areas of the state would be unable to purchase coverage in the exchange because no insurer would participate. This concern was heightened with the biennial budget provisions making some current Medicaid recipients no longer eligible for the program beginning January 1, under the assumption that these recipients could obtain subsidized coverage in the exchange. Legislators included a WHA-backed provision in the state budget that would have prevented the Medicaid policy from going into effect in a county where no insurer is participating in the exchange. While the news that a qualified health plan (QHP) will be available in each county is welcome, and for now negates the triggering of this so-called "off ramp" provision, in 13 of those counties there will only be one QHP available, meaning consumer choice and insurer competition could be limited.

"One of the many strengths of Wisconsin’s health care system is our pluralistic insurance marketplace, which offers consumers choice and fosters healthy competition," said WHA Executive Vice President Eric Borgerding. "As a state we need to adopt policies that preserve and encourage competition and choice, whether that be on the federally-facilitated exchange or in other venues, such as the state employee health plan. Competition and choice have served Wisconsin well."

Under the list released by OCI, 13 counties will have just one insurer selling health plans through the exchange in the individual market. Most counties will have at least three insurers to choose from, with some counties having as many as six.

However, there will be less competition in the small group market exchange, known as the SHOP, with five counties having no insurer participation in the SHOP for 2014. Those counties include Florence, Green Lake, Lafayette, Marquette and Menominee.

OCI’s press release can be found at: http://oci.wi.gov/pressrel/pressrel.htm.

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GME Expansion Grant Funds Available: Application Deadline October 21

Wisconsin graduate medical education (GME) programs can now apply for grants to help fund additional residency positions, the Department of Health Services (DHS) announced September 16. The grant funds were made available in the state budget as a result of WHA’s efforts on the statewide physician workforce agenda. One of WHA’s priorities is to increase the number of GME positions in Wisconsin. Targeted specialties include family medicine, psychiatry, internal medicine, pediatrics and general surgery.

The announcement is available on the DHS website at www.dhs.wisconsin.gov/rfp, RFA #G211 OPIB-14. The deadline for final applications is October 21, 2013 at 2 pm.

"I strongly urge our members with accredited GME programs in the targeted specialties to apply for these funds," said WHA President Steve Brenton. "The grants represent one of the quickest ways for us to increase the number of GME positions in Wisconsin and will help meet the WHA goal of adding 100 new physicians a year."

If you have questions regarding the grant application, contact Linda McCart, policy chief, Office of Policy Initiatives & Budget, DHS, at 608-266-9296, or George Quinn or Charles Shabino, MD at WHA at gquinn@wha.org or cshabino@wha.org.

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Political Action Campaign at 67% of Goal

Totals for the 2013 Wisconsin Hospitals Conduit and State PAC fundraising campaign continue to climb. Surpassing the two-thirds mark this week, the campaign has raised an additional $32,000 from 55 individuals in the past month. The campaign year-to-date total is at $176,000 with 262 individuals participating.

Of the total contributors so far, 52 are members of the Platinum Club who have contributed $1,500 or more to the 2013 campaign, which is ahead of the 2011 and 2012 Platinum Club membership pace. The median contribution is at $400, while the average contribution is $662.

Individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. Thank you to the 2013 contributors to date who are listed on page 9. Contributors are listed alphabetically by contribution amount category. The next publication of the contributor list will be in the October 4 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
Allen, Patricia Columbia St. Mary's, Inc.
Ambs, Kathleen St. Mary's Janesville Hospital
Anderson, Phil Sacred Heart Hospital
Ashenhurst, Karla Ministry Health Care
Bagnall, Andrew St. Nicholas Hospital
Bair, Barbara St. Clare Hospital & Health Services
Ballentine, Anne Wheaton Franciscan Healthcare
Baltzer, David Memorial Medical Center - Neillsville
Bayer, Tom St. Vincent Hospital
Bergmann, Ann Spooner Health System
Bloom, Deborah Sacred Heart Hospital
Boson, Ann Ministry Saint Joseph's Hospital
Bowman, Andrew Sacred Heart Hospital
Breeser, Bryan Aurora Medical Center Summit
Brenholt, Craig St. Joseph's Hospital
Brennan, Karen St. Mary's Hospital
Brenny, Terrence Stoughton Hospital Association
Brenton, Andrew Wisconsin Hospital Association
Burgener, Jean Aspirus Wausau Hospital
Buss, Diane St. Mary's Hospital
Campau, Patricia Columbia St. Mary's, Inc.
Capelli, A.J. Aurora Health Care
Cardinal, Lori Agnesian HealthCare
Casey, Candy Columbia Center
Censky, Bill Holy Family Memorial
Coniff, Barbara St. Mary's Hospital Medical Center
Connors, Lawrence St. Mary's Hospital Medical Center
Cormier, Laura Bellin Hospital
Culotta, Jennifer St. Clare Hospital & Health Services
Dahl, James Fort HealthCare
Dalebroux, Steve St. Mary's Hospital
Danner, Forrest Aspirus Wausau Hospital
DeMars, Nancy Sacred Heart Hospital
Drengler, Kathryn Aspirus Wausau Hospital
Dux, Larry Froedtert Health - Community Memorial Hospital
Ferrigno, Sandra St. Mary's Hospital
Fielding, Laura Holy Family Memorial
Folstad, John Sacred Heart Hospital
Fox, Stephen Aspirus Wausau Hospital
Furlong, Marian Hudson Hospital & Clinics
Gagnon, Annette HSHS-Eastern Wisconsin Division
Garvey, Gale St. Mary's Hospital
Gille, Larry St. Vincent Hospital
Granger, Lorna Aurora Health Care
Gresham, James Wheaton Franciscan Healthcare
Grundstrom, David Flambeau Hospital
Guffey, Kerra Meriter Hospital
Gulan, Maria Aspirus Wausau Hospital
Hafeman, Paula St. Vincent Hospital
Halida, Cheryl St. Joseph's Hospital
Hamilton, Mark
Hansen, Karen Memorial Medical Center - Ashland
Hardy, Shawntera Hudson Hospital & Clinics
Hattem, Marita Aspirus Wausau Hospital
Hieb, Laura Bellin Hospital
Hockers, Sara Holy Family Memorial
Hockin, Jennifer Aspirus, Inc.
Hofer, John Bay Area Medical Center
Jelle, Laura St. Clare Hospital & Health Services
Jensema, Christine HSHS-Eastern Wisconsin Division
Jensen, Russell St. Mary's Hospital
Johnson, Charles St. Mary's Hospital
Johnson, Kimberly Sacred Heart Hospital
Josue, Sherry St. Mary's Hospital
Karuschak, Michael Amery Regional Medical Center
Keene, Kaaron Memorial Health Center
Kelsey Foley, Kathy Aspirus Wausau Hospital
Kempen, Jacob Aspirus Wausau Hospital
King, Steve St. Mary's Hospital
Klay, Lois St. Joseph's Hospital
Klein, Tim Holy Family Memorial
Knutzen, Barbara Agnesian HealthCare
Kocourek, Cathie Aurora Health Care
Lange, George Westgate Medical Group, CSMCP
Larson, William St. Joseph's Hospital
Lentz, Darrell Aspirus, Inc.
Leonard, Mary Kay St. Mary's Hospital
Lepien, Troy St. Mary's Hospital
Lucas, Roger Aspirus Wausau Hospital
LuCore, Patricia Sacred Heart Hospital
Luehring, Sally St. Vincent Hospital
Maroney, Lisa
Martin, Nancy Ministry Saint Michael's Hospital
Maurer, Mary Holy Family Memorial
McManmon, Kristin St. Mary's Hospital
Meicher, John St. Mary's Hospital
Natzke, Kristin
Nevers, Rick Aspirus, Inc.
Nguyen, Juliet Sacred Heart Hospital
Nicklaus, Todd Aspirus, Inc.
O'Brien, Laura
O'Hara, Tiffanie Wisconsin Hospital Association
O'Keefe, Robert
Oland, Charisse Rusk County Memorial Hospital and Nursing Home
Olson, Bonnie Sacred Heart Hospital
Ose, Peggy Riverview Hospital Association
Ostrander, Gail Hospital Sisters Health System
Ott, Virginia St. Joseph's Hospital
Palecek, Steve St. Joseph's Hospital
Pavelec-Marti, Cheryl Ministry Saint Michael's Hospital
Pempek, Kalynn Aspirus Wausau Hospital
Penczykowski, James St. Mary's Hospital
Pinske, Heather St. Mary's Hospital
Reinke, Mary Meriter Hospital
Reising, Chris Aspirus, Inc.
Rocheleau, John Bellin Hospital
Roundy, Ann Columbus Community Hospital
Sanicola, Suzanne Columbia St. Mary's Columbia Hospital
Schaetzl, Ron St. Clare Hospital & Health Services
Schneider, David Langlade Hospital - An Aspirus Partner
Schubring, Randy Mayo Health System - Eau Claire
Scieszinski, Robert Ministry Door County Medical Center
Scinto, Jeanne Aspirus Wausau Hospital
Sheehan, Heather Hayward Area Memorial Hospital and Nursing Home
Simaras, Jim Wheaton Franciscan Healthcare
Slomczewski, Constance Wheaton Franciscan Healthcare - All Saints
Smith, Brian Aspirus, Inc.
Statz, Darrell Rural Wisconsin Health Cooperative
Stelzer, Jason St. Clare Hospital & Health Services
Strasser, Kathy Aspirus, Inc.
Swanson, Becky Sacred Heart Hospital
Tandberg, Ann St. Joseph's Hospital
Teigen, Seth St. Mary's Hospital
Thornton, Eric St. Mary's Janesville Hospital
Tuttle, Kathryn Memorial Medical Center - Ashland
Voelker, Thomas Aspirus Wausau Hospital
Walker, Troy St. Clare Hospital & Health Services
Westrick, Paul Columbia St. Mary's Columbia Hospital
Whitinger, Margaret Agnesian HealthCare
Woleske, Chris Bellin Psychiatric Center
Wymelenberg, Tracy Aurora Health Care
Wysocki, Scott St. Clare Hospital & Health Services
Yaron, Rachel Ministry Saint Clare's Hospital
Contributors ranging from $500 to $999
Anderson, Rhonda Columbia St. Mary's Milwaukee Hospital
Bablitch, Steve Aurora Health Care
Boecker, Ron Wheaton Franciscan Healthcare
Borgerding, Dana
Bukowski, Cathy Ministry Health Care
Bultema, Janice
Busch, Rebecca Spooner Health System
Carlson, Dan Bay Area Medical Center
Chumbley, Clyde ProHealth Care, Inc.
Deich, Faye Sacred Heart Hospital
Dewitt, Jocelyn
Dietsche, James Bellin Hospital
Dolohanty, Naomi Aurora Health Care
Dube, Troy Chippewa Valley Hospital
Eckels, Timothy Hospital Sisters Health System
Frangesch, Wayne Wheaton Franciscan Healthcare
Freimund, Rooney Bay Area Medical Center
Hinner, William Ministry Saint Clare's Hospital
Houlahan, Beth
Hyland, Carol Agnesian HealthCare
Jacobson, Terry St. Mary's Hospital of Superior
Johnson, Kenneth St. Mary's Hospital Medical Center
Joyner, Ken Bay Area Medical Center
Kellar, Richard Aurora West Allis Medical Center
Krueger, Mary Ministry Saint Clare's Hospital
Larson, Margaret Mercy Medical Center
Lewis, Gordon Burnett Medical Center
Logemann, Cari Aspirus, Inc.
Mantei, Mary Jo Bay Area Medical Center
May, Carol Sauk Prairie Memorial Hospital
Mueller, Joan Mayo Clinic Health System-Franciscan Healthcare in La Crosse
Mugan, James Agnesian HealthCare
Mulder, Doris Beloit Health System
Nelson, James Fort HealthCare
Pollard, Dennis Froedtert Health
Quinn, George Wisconsin Hospital Association
Richards, Theresa Ministry Saint Joseph's Hospital
Richardson, Todd Aspirus, Inc.
Rickelman, Debbie WHA Information Center
Rocole, Theresa Wheaton Franciscan Healthcare
Rohrbach, Dan Southwest Health Center
Schafer, Michael Spooner Health System
Sczygelski, Sidney Aspirus Wausau Hospital
Selberg, Heidi HSHS-Eastern Wisconsin Division
Shabino, Charles Wisconsin Hospital Association
Simaras, James Wheaton Franciscan Healthcare
Smith, Gregory Wheaton Franciscan Healthcare
Sommers, Craig St. Mary's Hospital
Stuart, Philip Tomah Memorial Hospital
Swanson, Kerry St. Mary's Janesville Hospital
Thurmer, DeAnn Waupun Memorial Hospital
Van Meeteren, Bob Reedsburg Area Medical Center
VanCourt, Bernie Bay Area Medical Center
Worrick, Gerald Ministry Door County Medical Center
Zenk, Ann Ministry Saint Mary's Hospital
Zorbini, John Aurora Health Care
Contributors ranging from $1,000 to $1,499
Bedwell, Elizabeth Children's Hospital of Wisconsin
Britton, Gregory Beloit Health System
Dexter, Donn Mayo Health System - Eau Claire
Gullingsrud, Tim Hayward Area Memorial Hospital and Nursing Home
Heifetz, Michael SSM Health Care-Wisconsin
Herzog, Sarah Wheaton Franciscan Healthcare
Huettl, Patricia Holy Family Memorial
Hymans, Daniel Memorial Medical Center - Ashland
Kerwin, George Bellin Hospital
Kosanovich, John Watertown Regional Medical Center
Lappin, Mike Aurora Health Care
Lewis, Jonathan St. Mary's Hospital
Martin, Jeff Ministry Saint Michael's Hospital
McKevett, Timothy Beloit Health System
Mohorek, Ronald Ministry Health Care
Natzke, Ryan Marshfield Clinic
Nauman, Michael Children's Hospital of Wisconsin
Rakowski, Mark Children's Hospital of Wisconsin
Roller, Rachel Aurora Health Care
Russell, John Columbus Community Hospital
Sanders, Robert Children's Hospital of Wisconsin
Sohn, John Wheaton Franciscan Healthcare
Wolf, Edward Lakeview Medical Center
Contributors ranging from $1,500 to $1,999
Alig, Joanne Wisconsin Hospital Association
Anderson, Sandy St. Clare Hospital & Health Services
Bloch, Jodi Wisconsin Hospital Association
Boese, Jennifer Wisconsin Hospital Association
Byrne, Frank St. Mary's Hospital
Clapp, Nicole Grant Regional Health Center
Coffman, Joan St. Joseph's Hospital
Court, Kelly Wisconsin Hospital Association
Eichman, Cynthia Ministry Our Lady of Victory Hospital
Francis, Jeff Ministry Health Care
Frank, Jennifer Wisconsin Hospital Association
Geboy, Scott Hall, Render, Killian, Heath & Lyman
Grasmick, Mary Kay Wisconsin Hospital Association
Harding, Edward Bay Area Medical Center
Heywood, Matthew Aspirus, Inc.
Hilt, Monica Ministry Saint Mary's Hospital
Khare, Smriti Children's Hospital of Wisconsin
Lepore, Michael Wheaton Franciscan Healthcare
Levin, Jeremy Rural Wisconsin Health Cooperative
Meyer, Daniel Aurora BayCare Medical Center in Green Bay
Millermaier, Edward Bellin Hospital
Olson, David Froedtert Health
Potter, Brian Wisconsin Hospital Association
Sanders, Michael Monroe Clinic
Sexton, William Prairie du Chien Memorial Hospital
Stanford, Matthew Wisconsin Hospital Association
Wallace, Michael Fort HealthCare
Warmuth, Judith Wisconsin Hospital Association
Contributors ranging from $2,000 to $2,999
Brenton, Mary E.
Desien, Nicholas Ministry Health Care
Duncan, Robert Children's Hospital of Wisconsin
Gage, Weldon Children's Hospital of Wisconsin
Herzog, Mark Holy Family Memorial
Jacobson, Catherine Froedtert Health
Kachelski, Joe Wisconsin Statewide Health Information Network
Kammer, Peter The Kammer Group
Katen-Bahensky, Donna
Kief, Brian Ministry Saint Joseph's Hospital
Leitch, Laura Wisconsin Hospital Association
Little, Steve Agnesian HealthCare
Mettner, Michelle Children's Hospital of Wisconsin
Neufelder, Daniel Affinity Health System
Normington, Jeremy Moundview Memorial Hospital & Clinics
O'Brien, Kyle Wisconsin Hospital Association
Oliverio, John Wheaton Franciscan Healthcare
Pandl, Therese HSHS-Eastern Wisconsin Division
Starmann-Harrison, Mary Hospital Sisters Health System
Taylor, Mark Columbia St. Mary's, Inc.
Troy, Peggy Children's Hospital of Wisconsin
Woodward, James Meriter Hospital
Contributors ranging from $3,000 to $4,999
Borgerding, Eric Wisconsin Hospital Association
Size, Tim Rural Wisconsin Health Cooperative
Turkal, Nick Aurora Health Care
Contributors $5,000 and above
Brenton, Stephen Wisconsin Hospital Association
Tyre, Scott Capitol Navigators, Inc

 

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DHS to Notify Medicaid/Badgercare Recipients about Enrollment Changes

Starting Monday, September 23, the Wisconsin Department of Health Services (DHS) will begin sending letters to current Medicaid/BadgerCare recipients and to individuals on the Core Plan Waitlist regarding possible changes to their enrollment that could occur January 1, 2014. Letters will also be sent to people enrolled in the BadgerCare Basic program.

Wisconsin Act 20, the recently-enacted biennial budget, makes changes to the Medicaid/BadgerCare program. Beginning January 1, 2014, an estimated 92,000 parents, caretakers and childless adults with income above the poverty line will no longer be eligible for the program. At the same time, an estimated 83,000 childless adults—adults without dependent children—with income up to the poverty line will become newly-eligible for the program, as long as the state’s waiver is approved. Finally, the state’s BadgerCare Plus Basic program will end January 1.

Letters will be sent to all recipients who could be impacted by changes on January 1, including those Medicaid/BadgerCare plus members who could lose eligibility, informing them of the health insurance exchange. Letters will also be sent to those on the Core Plan Waitlist notifying them that the waitlist and Core Plan are ending, and directing them to the health insurance exchange if their income is above the poverty line. The Core Plan is the benefit plan for childless adults population. Enrollment into that plan has been frozen for more than three years, and those applying since that time have been placed on a waitlist. DHS has estimated the waitlist includes over 155,000 people.

DHS has released the templates for these letters. You can find a link to the letters on the WHA website at www.wha.org/outreachplans.aspx.

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CMS to Host Call For Providers on Health Insurance Exchange

On September 25, 2013, the Centers for Medicare and Medicaid Services (CMS) will host a call for Wisconsin providers regarding the health insurance exchange. CMS indicates the presentation is intended to provide an overview of the exchange principles that will enable providers to better communicate with their patients and anticipate inquiries of how to enroll in the exchange. The call will feature CMS chief medical officers and CMS health insurance exchange state leads. There will be an opportunity to ask questions and provide feedback.

The call will be approximately one hour long, beginning at 1 pm. Registration is required at: http://cmsregion5providerhimwi1.eventbrite.com.

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Opportunities for In-Person State Training for Certified Application Counselors

The Department of Health Services and the Office of the Commissioner of Insurance have announced additional on-site training for certified application counselors. Under state law, certified application counselors assisting consumers enrolling in qualified health plans in the exchange must complete 16 hours of initial training. This training would satisfy that requirement.

On-site training will be held in Iron River, Lac du Flambeau, Weston and Madison September 24 and 25. On-site training will also be held October 9 and 10 in Racine, Menasha, Rice Lake and Green Bay.

To register for these events and for more information, go to www.wha.org/stateLevelTrainingEvents.aspx.

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Senate Committee Hears Bill on CNA Bridge Program
Sen. Harsdorf, Rep. Bernier author legislation to help license CNAs from other states

WHA provided testimony at the Senate Committee on Health and Human Services hearing September 18 in support of Senate Bill 212 that would create a "bridge" program for licensure of certified nurse aides (CNA) who have already received training in another state. Currently, if CNAs from outside Wisconsin seek certification here, they must have 120 hours of training or retake the entire CNA course. This legislation would allow DHS to approve educational programs that provide a "bridge" between the 120 hours required in Wisconsin and the 75-hour program that the CNAs completed in their home state. Minnesota, Iowa and Michigan only require 75 hours of training, so the "bridge" course would be designed to make up the difference. Senator Sheila Harsdorf (R-River Falls) and Rep. Kathy Bernier (R-Chippewa Falls) are the lead authors on this legislation.

In submitted testimony, WHA stated: "Nurse aides are an important component of care delivery in hospitals and in other health care settings. Many individual CNAs employed by hospitals are temporarily in the role while studying to be nurses or other members of the health care team. These students quickly exit the CNA role when they complete their programs. The result is that health facilities must continually recruit and hire individuals into CNA positions. For hospitals that provide service along or near Wisconsin borders, the current situation inhibits a health care facility’s ability to recruit individuals that were trained in Minnesota or Michigan."

In 2012, Wisconsin hospitals employed over 7,000 individuals as certified nurse aides. That same year, the WHA vacancy survey revealed 435 vacant CNA positions in Wisconsin hospitals. The change proposed by SB 212 creating a shortened course to prepare CNAs that do not meet the current Wisconsin education requirement from other states could allow for these positions to be more easily filled.

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Medicaid Advisory Group Discusses 2014 Rates, Primary Care Payment Increase

The Medicaid Advisory Group (MAG) discussed several important payment and policy issues at the September 6 meeting in Madison.

Brett Davis, the state’s Medicaid director, and Curtis Cunningham and Krista Willing from the Wisconsin Department of Health Services (DHS), briefed the group on a wide variety of topics. DHS staff presented the 2014 hospital rate-setting timeline and outlined work being done by the department using feedback from WHA and hospitals around the state to increase the stability and transparency of the hospital rate-setting process moving forward.

DHS noted that they are in the process of modeling the distribution of the disproportionate share hospital (DSH) payments that were included in the biennial budget for hospitals. Under the provision, hospitals will receive nearly $75 million in DSH funding over the biennium. DHS expects to begin payments to hospitals in January.

The group also discussed the status of the primary care physician payment increase for the Medicaid program. Although the Affordable Care Act (ACA) requires states to raise their Medicaid fees to Medicare levels for family physicians, internists, and pediatricians for many primary care services, the lack of CMS rules until late last year and the complex nature of system changes has caused a delay in getting those payments out the door. Initial payments are expected in late 2013 and will be retroactive to January 1, 2013.

However, in order to receive payments, physicians must first complete an attestation. This is an extremely important step in the process. Providers are reminded that if they do not submit this attestation by December 31, 2013, they will not receive the rate increase for 2013 services. The process is explained in the September 2013 ForwardHealth Update (2013-44), titled "Policy Clarifications for the Affordable Care Act Primary Care Rate Increase Provider Attestation." at https://www.forwardhealth.wi.gov/kw/pdf/2013-44.pdf.

The payment increase can be significant. Kaiser has estimated an average increase of 78 percent in physician fees for Wisconsin as a result of this policy—an indication of the low rates of reimbursement in our state Medicaid program. The primary care fee increase applies in 2013 and 2014, is fully federally funded up to the difference between a state’s Medicaid reimbursement amounts in effect on July 1, 2009 and Medicare reimbursement rates for 2013 and 2014 as determined under a formula. The payment was only authorized for two years, leaving many to wonder what will happen in 2015 when the higher reimbursement rates revert back to previous levels.

Materials from the September 6 meeting, along with other information about the Medicaid Advisory Group can be found on the WHA website at: www.wha.org/MAG.aspx.

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Join the Statewide Conversation to Expand GME in Wisconsin

Taking the Next Step: A Statewide Conference on Graduate Medical Education
October 24, 2013
Best Western Bridgewood Resort Hotel, Neenah

Register today at: http://events.SignUp4.com/13GME

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WHIO Fall Learning Forum October 16

WHIO will hold its Fall Learning Forum October 16 at the Kalahari Resort in Wisconsin Dells. There will be sessions on the Colorado All Payer Claims Database, the Consumer’s Perspective on Transparency & Public Reporting, quality and three breakout sessions. Register by October 1 to receive a discounted rate. Register at www.wisconsinhealthinfo.org.

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High Value Health Care – Wisconsin’s Competitive Advantage: Community, Provider Education Helps Lower EED Rate at Baldwin Area Medical Center

"40 weeks… chubby cheeks."

That is the message being shared with expectant mothers at Baldwin Area Medical Center. Boosted by a national campaign sponsored by the March of Dimes and reinforced by materials shared by the WHA Partners for Patients staff, Baldwin Area Medical Center has gained the backing of physicians and the community in setting a goal to prevent early elective deliveries (EEDs).

Team members Ann Findlay, OB nurse manager; Jean Peavey, quality and compliance; Rhonda Hill, MSN, and Jolene Gustafson, RN worked closely with physicians, expectant mothers, nurse practitioners and staff to build awareness of the 39-week goal. Prenatal visits included patient education aimed at instilling the importance of carrying a baby to full term.

Their education efforts paid off. As their improvement project took hold, they were able to change elective previously scheduled C-sections (originally scheduled for earlier than 39 weeks) to occur after 39 weeks. Staff is prompted to answer the question, "What is the gestational age?" when they do online scheduling for C-sections and inductions to ensure that they are in compliance with the 39-week policy.

"Baldwin Area Medical Center’s work on reducing early elective deliveries demonstrates the power of teamwork between physicians and nursing staff to improve patient care. This project clearly requires support from both groups of providers," said Kelly Court, WHA chief quality officer.

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Experts Share Insights about Health Care Reform with Employers

Employers in the Milwaukee area had an opportunity to learn more about how they can prepare for and respond to the implementation of the health reform law at an education session sponsored by the Biz Times September 13. Joanne Alig, WHA senior vice president, research and policy, participated on an expert panel along with representatives from insurance, legal and financial organizations.

To view the opening remarks of the expert panelists, go to www.youtube.com/watch?v=9J_r6_02OKo

To view the closing remarks of the expert panelists, go to www.youtube.com/watch?v=Hqc-1p7v4Nc

Or watch it on Wisconsin Eye at: www.wiseye.org/Programming/VideoArchive/EventDetail.aspx?evhdid=7955

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WHA Focuses on Improving Wage Index and Occupational Mix Reporting

WHA again this year is working with RC Healthcare on Wisconsin’s wage index improvement project. This is a major WHA commitment and member benefit aimed at helping hospitals accurately report data in their cost reports, which is used to calculate the hospital wage index—a key component of Medicare payment for PPS hospitals.

To kick off this year’s wage index improvement project, WHA and RC Healthcare will be offering a wage index education webinar October 2 at 10 am. This program will provide important information on the wage index correction process. Over the years, this engagement, which is provided as a member service, has resulted in substantial corrections of various hospital data errors or fiscal intermediary adjustment errors and has been critically important to maintaining the integrity and accuracy of the wage index for Wisconsin hospitals.

New topics covered by this year’s webinar will include contracted administrative and general costs, current wage index impact of occupational mix survey and the new survey that will be due July 1, 2014. Pension reporting guidelines discussed last year will be reviewed to answer any questions hospitals have in preparing the form. Also, findings during last year’s audit and appeals process, and CMS proposals to Congress for wage index reform will be reviewed. CMS has moved up the deadline for wage index revisions so all revisions must be submitted by November 21, 2013.

PPS hospital members are encouraged to participate. More detailed information about the upcoming webinar was recently emailed to hospital CFOs.

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

RC Healthcare also helps hospitals prepare the occupational mix survey, which is an additional adjustment factor used to modify Medicare PPS rates. Through several rounds of occupational mix survey submissions, RC Healthcare has educated Wisconsin hospitals on how the survey works and how it should be completed.

If you have questions about WHA’s Wage Index Improvement Project, contact Brian Potter at WHA at bpotter@wha.org or 608-274-1820.

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Member News: ThedaCare, Mayo Announce Collaboration
ThedaCare becomes Wisconsin’s first Mayo Clinic Care Network member

ThedaCare is the newest member of the Mayo Clinic Care Network, giving ThedaCare-aligned physicians direct access to Mayo Clinic experts and clinical resources. ThedaCare is the first member located in Wisconsin.

"Our mission is to improve the health of the communities we serve," says Dean Gruner, MD, president and CEO, ThedaCare. "ThedaCare already partners with some of the best specialists in the state. Now, these same specialists will be able to electronically consult with Mayo specialists about complicated cases. This should benefit patients of our ThedaCare physicians. It will allow us to provide the perspective of another respected health care system, and this consult is free to a ThedaCare patient and can be delivered within a couple of business days."

The Mayo Clinic Care Network represents non-ownership relationships with Mayo Clinic. Mayo Clinic established the network in 2011 to extend knowledge and expertise to physicians and providers interested in working together to benefit patients and enhance the delivery of health care at the local level.

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Member News: Osceola Medical Center Names CEO and CMO

Osceola Medical Center (OMC) has named Tom Geskermann chief executive officer to replace retiring CEO Jeff Meyer. Geskermann will begin at the end of September. Also joining the staff as chief medical officer will be Rene Milner, MD.

"We’re excited to fill these top two key positions with individuals that have the skills and outlook we need to help lead us through the changing face of health care," said Board Chair Peggy Weber.

Geskermann comes to OMC with 33 years experience in health care, most recently as vice president of operations for St. Paul-based Regions Hospital and HealthPartners Medical Group and Clinics, and chief operating officer for RHSC, Inc., a corporation that provides clinical support staff to Regions specialty clinics, hospital and foundation. He also held higher level positions with Allina Health Systems and Behavioral Health Services, Inc., both of Minneapolis.

Milner, currently an emergency department physician with OMC, will be stepping into a new position as he assumes the CMO role. As a family physician, Milner owned his own practices in Manitoba, Canada, and St. Croix Falls before coming to OMC.

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Member News: Ministry Health Care Joins Quality Health Solutions

Ministry Health Care is joining Quality Health Solutions, Inc. (QHS), a collaborative group of Wisconsin health care systems and the Medical College of Wisconsin. QHS, which recently announced a major shared savings initiative with UnitedHealthcare, is expanding its accountable care network. The network is clinically integrated, allowing it to contract directly with health plans on behalf of its members for shared savings, pay-for-performance, and other innovative payment programs. The network expects to enter into risk arrangements on behalf of its members.

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Untreatable: CDC Report Details Drug-Resistant Health Threats

Every year, more than two million people in the United States get infections that are resistant to antibiotics and at least 23,000 people die as a result, according to a new report issued by the Centers for Disease Control and Prevention (CDC). The report, Antibiotic Resistance Threats in the United States, 2013, presents the first snapshot of the burden and threats posed by antibiotic-resistant germs having the most impact on human health. The threats are ranked in categories: urgent, serious, and concerning.

"Antibiotic resistance is rising for many different pathogens that are threats to health," said CDC Director Tom Frieden, MD, MPH. "If we don’t act now, our medicine cabinet will be empty, and we won’t have the antibiotics we need to save lives."

In addition to the toll on human life, antibiotic-resistant infections add considerable and avoidable costs to the already overburdened U.S. health care system. Studies have estimated that, in the United States, antibiotic resistance adds $20 billion in excess direct health care costs, with additional costs to society for lost productivity as high as $35 billion a year. The use of antibiotics is the single most important factor leading to antibiotic resistance. Up to 50 percent of all the antibiotics prescribed for people are not needed or are not prescribed appropriately.

To see the full report, visit www.cdc.gov/drugresistance/threat-report-2013. For more information about drug resistance and the serious impacts it has on human health, www.cdc.gov/drugresistance.

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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.


Caring Hearts Program helps couple on fixed income

Carol and Raymond Olejnik of Neenah are on Medicare limited income so when medical bills for services at Theda Clark Medical Center in Neenah began to build up throughout the year, they wondered how they were going to pay them all.

"We just could hardly make it," said Carol Olejnik, 79. Sadly, Raymond passed away in April of this year from a heart attack.

When the bills, which included about $12,000, started coming in, Olejnik called the billing department and learned about ThedaCare’s Caring Hearts Financial Assistance Program. She applied for the program and the couple was accepted.

"They’ve been a big help," Olejnik said. "I don’t know what we would have done without them."

She said she was surprised to learn about the program. Those on a fixed income could really benefit from it. "I know it has helped us out a lot," said Olejnik. "It’s too bad maybe other people don’t know about it. If they were in a situation like we were, it really helps."

Theda Clark Medical Center, Neenah


When pain makes it hard to hold a job

The ability to obtain medical care can determine whether or not a person is capable of obtaining and maintaining a job, and employment is often essential to an individual’s ability to survive and lead a productive life.

A young man in his mid-twenties was finding it difficult to hold a job due to pain in his knee. He contacted Upland Hills Health because he had been referred to an Orthopedic Surgeon for possible knee surgery. He was unemployed, living with his parents and without health insurance. A patient benefit specialist at Upland Hills Health spoke to the young man about the Uncompensated Care program, and he completed an application. Based on his financial situation and his medical need, he was granted a discount on the hospital’s facility charge. The young man expressed his gratitude to the patient benefit specialists at Upland Hills Health.

Upland Hills Health, Dodgeville


When the unexpected happens...

Jennifer moved back to Manitowoc after a difficult divorce to be close to family. She was in the process of looking for employment when the unexpected happened. She fell and severely fractured her leg. Jennifer did not have any health insurance coverage and was greatly concerned about how she would ever be able to pay for such huge expenses. Jennifer was an inpatient at Holy Family Memorial for seven days and had major surgery on her leg. She also had follow-up therapy and homecare.

Through the Community Care Program, Holy Family Memorial was able to help Jennifer with over $50,000 in medical expenses. Our hope was that by doing so, Jennifer’s leg would heal and she would be able to find employment with affordable health insurance benefits and return to a good quality of life! That has now happened.

Holy Family Memorial, Inc., Manitowoc


Free to focus on healing

Imagine being unemployed, recently widowed, and caring for your three grandchildren and your daughter who suffers from mental illness. Now imagine trying to balance all of this when you receive a cancer diagnosis.

This is exactly what happened to a patient at Aurora St. Luke’s Medical Center: This caring grandmother of three received her melanoma diagnosis and was informed she needed multiple treatments that were going to cost $120,000 per hospital admission.

Needless to say, she was beside herself with worry about paying for treatments, as she was already selling off personal possessions just to make ends meet while caring for her family. She met with the hospital financial counselor before her first admission and applied for the Aurora Helping Hand Patient Financial Assistance Program. A few days before her first treatment, the counselor called the patient with great news that she was approved for a 100 percent discount for all of her necessary treatments. In addition, the financial counselor also was able to help her get the drug she needed through the Prometheus Patient Support System.

Free of the financial burden associated with her cancer diagnosis, the patient was able to focus on healing and "being there" for her family for years to come.

Aurora St. Luke’s Medical Center, Milwaukee


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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