January 13, 2012
Volume 56, Issue 2


Pollster Kellyanne Conway to Keynote Advocacy Day, April 24
Registration now open

"…I have to give you credit; this is one of the largest groups I’ve seen in terms of advocacy in the past few months. I give you a lot of credit for that. It is fantastic. This has an impact…I want to thank you for being here..." – Rep. Scott Suder’s comments while meeting with hospital representatives at 2011 Advocacy Day

"It was my first time going to Advocacy Day. I also brought my nurse supervisor. It was an awesome day, and it has inspired me to become more knowledgeable in my local, state and federal government. It was eye opening…thank you for a wonderful educational day. I plan on attending next year also." – hospital employee

"Great job to you and your team. Our group had a great time and our legislative session was perfect." – hospital employee

"[Advocacy Day] was an amazing day - absolutely loved it!!!" – hospital employee

As you can see from the comments from last year’s record-breaking number of attendees, Advocacy Day is one of the best ways your hospital employees, trustees and volunteers can make an impact in Madison. Over 750 individuals attended Advocacy Day in 2011, and WHA wants this year’s event to be even larger. Make sure you are assembling your hospital contingent for 2012 Advocacy Day set for April 24, 2012 at the Monona Terrace in Madison. Registration is now open.

"WHA’s Advocacy Day is a powerhouse event in Wisconsin’s State Capitol each year," said WHA President Steve Brenton. "We can’t help but make a statement when 750 hospital employees, trustees and volunteers travel to Madison, some by the busload, to make their voices heard on behalf of their hospitals, their patients and their communities."

As always, WHA has a great lineup of speakers, including morning keynote and nationally-known pollster Kellyanne Conway, who will discuss the "pulse of the nation" as we move into this important and volatile 2012 election cycle. Conway is founder and president of the polling company™, inc., founded in 1995, and headquartered in Washington, DC. She is one of the most quoted and noted pollsters on the national scene, having provided commentary on over 1,200 network and cable television shows and countless radio shows and print stories. Luncheon keynote will be Governor Scott Walker (invited), and our legislator panel discussion will round out the morning sessions.

The highlight of Advocacy Day is always the hundreds of attendees who take what they’ve learned during the day and then meet with their legislators in the State Capitol in the afternoon. WHA facilitates these meetings and even provides transportation to the Capitol, only a scant two blocks away. Speaking up on behalf of your hospital by meeting with your legislators during Advocacy Day is essential in helping educate legislators on your hospital and on health care issues.

Join 750 of your peers from across the state at Advocacy Day 2012 on April 24. Register today. A complete program and online registration are available at http://events.SignUp4.com/AdvocacyDay12. A printed copy of the Advocacy Day 2012 brochure is included in this week’s Friday Packet.

For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org. For registration questions, contact Lisa Littel at llittel@wha.org or 608-274-1820.

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WHA Forms Task Force on Graduate Medical Education

Wisconsin will face a shortfall of over 2,000 physicians by 2030—a number that equates to 20 percent of the current workforce—if steps are not taken now to address the shortage. A WHA workgroup that studied the physician workforce issue in advance of the release of the WHA report "100 New Physicians a Year: An Imperative for Wisconsin," identified that the only way to build an adequate physician workforce would be to make significant changes to the state’s graduate medical education system.

WHA has taken the first step to begin addressing graduate medical education (GME) with the formation of a new task force. The WHA Task Force on Graduate Medical Education will act as a catalyst for the expansion of graduate medical education in Wisconsin by:

"There is not a ‘magic bullet’ that will meet the daunting challenge of addressing a conservatively-estimated shortfall in Wisconsin of 2,000 physicians by 2030," according to WHA President Steve Brenton. "However, we know the key to building a more robust physician workforce in Wisconsin starts with a review of and a discussion about the current GME system to identify where improvements can be made, and then implement changes that will lead to more physicians completing a residency here, especially those with ties to Wisconsin."

The members of the new Task Force are:

The first meeting of the Task Force will be January 27 at WHA headquarters in Madison.

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"Safe Haven" Law Subject of Assembly Hearing
Proposal would extend window for relinquishing newborns

This week the Assembly Committee on Children and Families held a hearing on Assembly Bill (AB) 396 relating to relinquishing custody of a newborn child, also known as Wisconsin’s "safe haven" law.

In effect since April 2001, this law allows a parent to relinquish control of her unwanted, unharmed newborn, up to three days old, confidentially to any hospital employee, EMT, or police professional in the state without fear of prosecution. The hospital, EMT, or police must protect the health and safety of the newborn and deliver the newborn to the court intake worker in that jurisdiction.

AB 396—authored by Representative Dale Kooyenga (R-Brookfield) and others in the Assembly, and its companion Senate Bill (SB) 313 authored by Senator Mary Lazich (R-New Berlin) and others in the Senate—would expand Wisconsin’s "safe haven" law to allow a parent to relinquish custody of a child 30 days old or younger and add health care clinic staff to the list of individuals to which a parent could relinquish their newborn.

WHA provided written testimony at the hearing (available at www.wha.org/data/sites/1/pdf/WHAmemo-safehaven1-11-12.pdf) in support of the "safe haven" law and AB 396, but also seeking an amendment that would clarify hospital requirements related to filing newborn birth information.

Under current law, when a parent gives birth in a hospital and relinquishes custody of the newborn child to the hospital during the newborn admission, the procedures related to filing a birth certificate and allowing the parent to remain anonymous are inconsistent. Hospitals are required to complete and file the newborn’s birth certificate with parental information within a specified time period, which conflicts with the anonymous filing required by the "safe haven" law.

The proposed expansion in AB 396 of the allowable time during which a parent can relinquish custody of their newborn to 30 days of birth makes this inconsistency even clearer as a parent may choose to relinquish custody of their newborn after the hospital in which the birth occurred necessarily has filed a birth certificate.

The amendment sought by WHA would recognize that whether a child is three days old or up to 30 days old, the baby might have two birth certificates, one filed by the hospital or other facility at which the baby was born and one anonymous certificate completed when the parent relinquishes control of the baby. This change would help ensure that the "safe haven" law does not conflict with other applicable law relating to hospitals and the filing of newborn birth information.

Representative Kooyenga and Senator Lazich are both supportive of the amendment and are working to have language drafted and added to the proposal.

A hearing on SB 313 and committee votes on both bills are expected soon.

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WHA Receives Huge Member Response to "Partners for Patients" Quality Initiative

The number of hospitals that joined the WHA quality initiative "Partners for Patients" surpassed the initial enrollment goal set at 80 hospitals. As of January 13, 97 hospitals have signed on to the project. However, the larger-than-expected response did not surprise WHA’s Chief Quality Officer Kelly Court.

"Wisconsin hospitals have a long history of quality improvement, and they quickly signed up to take advantage of new resources to help them take their quality to an even higher level. They also understand the value of sharing best practices within the state, which will be a key part of this project," according to Court. This project will raise the bar on the quality and safety of patient care in our state even higher."

WHA is working closely with the Health Research and Education Trust (HRET), an affiliate of the American Hospital Association (AHA), which currently involves 33 states and over 1,800 hospitals. HRET’s Hospital Engagement Network will help identify solutions already working to reduce health care acquired conditions and readmissions, and work to spread them to other hospitals and health care providers. According to Court, "being part of the largest network will allow some of our more specialized hospitals such as our children’s, psychiatric and rehabilitation hospitals to connect with true peers in other states."

WHA will convene Wisconsin improvement collaboratives for hospitals to improve patient safety and reduce readmissions. They will conduct intensive training programs to teach and support hospitals in making patient care safer, provide technical assistance to hospitals so that hospitals can achieve quality measurement goals, and establish and implement a system to track and monitor hospital progress in meeting quality improvement (QI) goals. WHA will be increase staff to ensure each hospital has a one-on-one quality coach to guide them through the work of this project and ensure they are able to maximize their improvement opportunities.

For information on the Partnership for Patients, visit: www.healthcare.gov/partnershipforpatients. To see the list of participating hospitals, visit www.wha.org/partnersforpatients.aspx. To enroll in the project, contact Kelly Court, WHA, at kcourt@wha.org or 608-274-1820.

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President's Column:  Partners for Patients Initiative…Key 2012 Priority

WHA launched our public reporting initiative, CheckPoint, eight years ago this spring. At that time, the effort represented one of the earliest hospital voluntary reporting programs in the country. Today, 99+ percent of Wisconsin hospitals continue to publicly report performance measures. And new measures of meaningful interest to providers, payers and consumers are added regularly. The current initiative remains one of the most robust efforts in the nation that is not the byproduct of state-level regulation.

Importantly, there has been significant improvement in almost every clinical and outcomes measure publicly reported by CheckPoint. That success has propelled Wisconsin’s consistently high ranking in the annual Agency for Healthcare Research and Quality (AHRQ) state by state rankings. It has also facilitated a level of cooperation and trust between WHA’s quality team and hospital and health system quality leaders throughout the state of Wisconsin. That’s why almost 100 Wisconsin hospitals have agreed to participate in WHA’s Partners for Patients Initiative, a program funded by CMS and contracted by WHA through AHA’s research and education foundation. The fact that 100 Wisconsin hospitals (many of whom had other options) chose to participate through WHA is a testament to the proven collaborative relationship we have with our members and the demonstrated track record of public reporting and performance improvement.

WHA’s Partners for Patients initiative is a two plus year "bottom up" approach to reduce readmissions and hospital acquired conditions such as infections and other areas of patient harm. The more specific goal is to decrease preventable hospital acquired conditions by 40 percent by the end of 2013 and to reduce preventable hospital readmissions by 20 percent. The operational strategy will be to convene and support hospital improvement collaboratives and provide direct consultative support to hospital-based QI teams. WHA will also implement a system to track hospital progress in meeting the ambitious goals.

We look forward to working with our members on this project and appreciate the overwhelming support for the statewide effort. We also look forward to sharing progress with all stakeholders as we move forward.

Steve Brenton                         Kelly Court
President                                Chief Quality Officer

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WHA to Lead DC Trip in February; Will Participate in AHA Capitol Hill Fly-in

The Wisconsin Hospital Association will lead a trip to Washington, DC on February 15 to tell Congress that cuts in hospital payments cannot continue to be on the chopping block. The trip coincides with the American Hospital Association’s Capitol Hill fly-in.

"Congress is again discussing cuts to hospital bad debt payments, outpatient evaluation and management services among others as a means to pay for other Congressional legislation," said WHA President Steve Brenton. "We encourage hospital senior leaders to join the WHA in DC on February 15 to make our opposition to these proposals known."

During 2011, the Congress and Administration pushed a variety of Medicare and Medicaid cuts as they searched for deficit reduction savings. In response, WHA launched one of its most aggressive grassroots campaigns to date. The upcoming trip to Washington, DC continues WHA’s sustained advocacy efforts in opposition to hospital cuts.

WHA will coordinate, schedule and staff Hill visits on February 15 with Wisconsin’s Members of Congress. If you are planning to travel to DC for this event, please let WHA’s Jenny Boese know at 608-268-1816 or jboese@wha.org.

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MedPAC Votes on Hospital Payment Recommendations
Includes E/M hospital outpatient department payment reduction and 1% payment update

On January 12, the Medicare Payment Advisory Commission (MedPAC) voted to recommend to Congress a policy that would reduce payment rates for outpatient hospital based evaluation and management (E/M) services, a measure similar to one that Congress had included in a bill this past December. That bill failed to be passed into law, but, coupled with MedPAC’s action, is an indication that the measure could be included in federal legislation in the coming months.

If adopted, MedPAC’s recommendations would add to the fiscal pressure already being faced by hospitals. The proposal is estimated to reduce hospital outpatient department payments for E/M clinic visits by more than 70 percent, costing Wisconsin hospitals an estimated $410.9 million over the next 10 years.

Under the proposal, Medicare payment rates for non-emergency evaluation and management (E/M) services that are provided in hospital outpatient departments would be reduced so that the payment for the service equals payment for the same service provided in a physician office setting.

MedPAC had previously indicated that the policy was an attempt to equalize payments for the same services provided in different settings. In a letter to MedPAC (see www.wha.org/Data/Sites/1/reimbursement/WHAletterMedPac1-10-12.pdf), WHA urged the Commission to vote against this policy, noting that costs in a hospital differ from costs for a physician office for very important patient safety and treatment reasons, and due to packaging of services. Thus, rather than equalizing payments, the policy would simply result in greater reimbursement disparity, and potentially limit access to care.

To address concerns for hospitals that serve large numbers of low-income patients, MedPAC recommends phasing in the E/M payment changes over three years, during which reductions for hospitals with a disproportionate share percentage of 0.25 or higher would be limited to 2.0 percent of overall Medicare payments. The commission also recommended that by 2015 the Health and Human Services secretary study whether access to care for low-income patients would be impaired by the E/M payment change. Despite MedPAC’s recommendations to phase-in and/or cap the E/M changes, WHA remains opposed to this policy change.

In addition to the E/M policy, MedPAC voted to recommend an update of 1.0 percent for fiscal year 2013 inpatient and outpatient hospital payments.

WHA continues to be concerned by the trend to reduce Medicare payment rates and will oppose these potential reimbursement cuts in Congress and through the CMS regulatory process in the coming year.

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Participate in the 2012 Wisconsin Health Care Employee Pride Program
Don’t miss an opportunity to recognize your health care workforce

The Wisconsin Hospital Association’s commitment to publicly recognize the dedication of Wisconsin’s health care workforce now spans a decade. Since 2002, the WHA Health Care Employee Pride Program has received hundreds of essays, poems and stories written by health care employees that passionately describe why they chose a career serving others.

The program encourages WHA member hospitals to invite their employees to express themselves in an essay and tell others why they chose a health occupation. The Pride Program gives employees the opportunity to share why they love their career of service to others, while giving the Association an opportunity to honor their contributions to their hospital, community and profession.

A designated leader from administration, human resources, public relations or patient care from WHA member hospitals is asked to coordinate the program. Employees are encouraged to submit to the hospital a 300-word essay, poem or story that explains why they chose to work in health care. From those essays, a committee at the hospital will pick one employee to represent their hospital and forward that person’s essay to WHA. WHA will send the hospital representative a certificate and pin to present to their honoree in May, and will also post the essays on the WHA website at that time.

Pride Program materials are available on WHA’s website at www.wha.org/pride-program.aspx. Don’t miss this opportunity to participate in the 2012 Pride Program. For more information contact Shannon Nelson at snelson@wha.org or Mary Kay Grasmick at mgrasmick@wha.org, or call 608-274-1820.

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Daubert Summit a Success

The Wisconsin Hospital Association sponsored a Wisconsin Civil Justice Council (WCJC) event aimed at educating the legal community on the Daubert standards. Wisconsin’s adoption of the Daubert standards for the admission of expert opinion evidence was part of an important piece of legislation supported by the WCJC, WHA, and other leading business organizations earlier this year. The legislation brought Wisconsin in line with the entire federal system and a majority of states. In an effort to educate the legal community on these important new standards, WCJC organized and hosted "Daubert Comes to Wisconsin – A CLE Summit on Expert Opinion Evidence" on January 11, 2012.

Ric Gass, of Gass Weber Mullins LLC, led the Summit with a discussion of how the Daubert standard improves the quality of scientific information presented to juries and why that is a good thing. Dan La Fave, of Whyte Hirschboeck Dudek, then gave attendees an introduction to the American Society for Testing and Materials (ASTM) standards, which included information on how to assess both your experts and those of the opposing party.

Don Best and Ed Sarskas, of Michael Best & Friedrich LLP, provided an example of how Daubert is used in intellectual property cases. John Sear, of Bowman and Brooke, provided attendees with an overview of the case law since Daubert, and an overview of his recommended Daubert Checklist.

Judge Rudolph Randa of the U.S. District Court for the Eastern District of Wisconsin, who has written more Daubert decisions than any other judge in the Eastern District, then provided practical advice to attendees. Judge Randa reminded attendees that it is their responsibility to educate the judges about their experts, but that judges must also educate themselves about expert evidence.

Crivello Carlson attorneys Sam Hall and Travis Rhoades provided an informative look at special issues related to medical evidence and reviewed common fallacies. Michael Brennan and Brian Cahill of Gass Weber Mullins provided attendees with resources they can use when dealing with experts in "soft science."

WCJC thanked the program sponsors, which, in addition to WHA, included the Wisconsin Defense Counsel, the Wisconsin Insurance Alliance, the Wisconsin Association of Manufacturers and Commerce, the Wisconsin Utilities Association, and the Wisconsin Electric Cooperative Association. WHA and other leading business organizations formed and support the WCJC. WHA Executive Vice President Eric Borgerding is a member of the WCJC Board.

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Member News: Rogers Behavioral Health System President and CEO David Moulthrop Announces Retirement

David L. Moulthrop, PhD, president and CEO of Rogers Behavioral Health System will retire in August of 2012 after being a member of the Roger’s team since 1993.

Moulthrop, who holds a doctorate in clinical psychology from the Illinois Institute of Technology and a master’s from George Williams College (Aurora University), admits the hospital has seen tremendous growth during his tenure. "I am just proud I have been able to be a part of its success," he said. "I am confident the staff will continue their tradition of providing the utmost in comprehensive behavioral health services and the entire System will continue to grow and thrive."

Moulthrop will remain a valued resource after he retires, and the Roger’s team is thankful for Dave’s legacy. According to W. Carl Templer, Board President, "Dave has taken us from a small, regional hospital to a much larger power as a mental health organization. He’s definitely played an important role in Roger’s history."

Rogers Memorial Hospital is currently ranked #7 in the country for mental health services. As president/CEO, Moulthrop has helped to oversee four key system components: Rogers Memorial Hospital, Inc.; Rogers Partners in Behavioral Health, LLC; Rogers Center for Research and Training; and Rogers Memorial Hospital Foundation, Inc. Under his leadership, the hospital has become nationally recognized for its specialized residential treatment services and affiliations with academic institutions and teaching hospitals in the area. Rogers Memorial Hospital is currently Wisconsin’s largest not-for-profit, private behavioral health hospital.

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Wisconsin Division of Public Health Names McKeown Administrator

On January 9, Wisconsin Health Services Secretary Dennis Smith announced the appointment of Karen McKeown as administrator of the Wisconsin Division of Public Health.

McKeown is an oncology-certified nurse and certified hospice and palliative nurse who joins the Wisconsin public health division from the East Texas Medical Center in Tyler, Texas, where she was a staff nurse and manager. She recently served as a graduate fellow in health policy at the Heritage Foundation and as a student fellow with the U.S. Senate Finance Committee.

McKeown has written for the Heritage Foundation on rising health care costs and health care economics. A link to her paper is here: www.heritage.org/research/reports/2011/12/empowering-patients-as-key-decision-makers.

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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 in 2010. 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.


Beverly Murk

Following a career-threatening shoulder injury and subsequent troubles with her insurance company, violin instructor Beverly Murk made the decision to discontinue her insurance. She felt she was paying a great deal for something that wasn’t providing much help when she needed it.

So in January 2011 when Beverly suffered a fall down the stairs that fractured both sides of her left ankle, she was without insurance. The bills for an emergency room visit, x-rays and a cast added up quickly, leaving her unable to cover the expenses. That is when she was approached by a Lakeview Medical Center (LMC) patient assistance representative offering the chance to apply for charity care.

"The hospital took care of things," Beverly said.

LMC’s charitable outreach helped Beverly get back on her feet and on the road to recovery without looming debt hanging over her head. A quick recovery was very important to Beverly as she also serves as the full-time, live-in caregiver to her mother, who is partially paralyzed and unable to speak or swallow due to a series of strokes. The hospital helped to take care of Beverly’s needs so that she could get back to taking care of her mother.

"The hospital’s help was an incredible relief during this time," said Beverly. "For the hospital to consider us for this … we were really, really grateful."

Beverly added that she would love to volunteer to play violin for LMC patients to help repay the hospital for its generosity.

Lakeview Medical Center, Rice Lake


We understand patients aren’t always prepared for medical expenses

Current economic hardships have forced many people to struggle with income priorities. All too often, medical attention is postponed, as electricity, heat and food bills seem more critical. Meanwhile, potentially manageable illnesses are left to grow quietly out of control.

When a recent Mayo Clinic Health System patient, who asked to remain anonymous, found out she needed to have necessary surgery, she was left to figure out how to make that possible.

"I initially went in to make arrangements," she said. "I didn’t have any insurance. I didn’t know how I was going to pay for the surgery."

Fortunately, Mayo Clinic Health System has found a way to solve the problem and make health care available for everyone, whether it’s preventive or urgent.

If patients need financial assistance, they can apply for it before or after services are rendered. In some cases, part or all of a medical bill may be forgiven. If treatment extends to multiple Mayo Clinic Health System facilities, financial assistance information can be transferred among providers. This streamlines the process and reduces patients’ paperwork obligations and emotional anxieties.

"Our job is to make sure we are finding the best possible payment option for the patient," says Becca McHugh, patient financial planning supervisor. "We understand patients aren’t always prepared for medical expenses. That’s why we have this program."

The patient was diagnosed as having a prolapsed uterus requiring a hysterectomy. As a self-employed housekeeper, the pain and discomfort she endured was keeping her from performing her job. Without a job, there is no income.

"During my consultation, they told me about the financial assistance program that is offered to patients who need help," she says.

After being treated in Eau Claire, the patient applied to the medical center’s financial assistance program where trained counselors are available free of charge to help navigate the application process. Together, patients and counselors can examine payment options, billing processes, financial need and available government assistance. After an evaluation of income, assets, expenses and property, a plan to fund medical expenses is made. This made it possible for the housekeeper to receive the care she needed to return to her normal activities.

"I received excellent care from Mayo Clinic Health System," she says. "I was very pleased with my experience."

Mayo Clinic Health System, Eau Claire


Help is there when help is needed

Her eyes were itchy, red and swollen with persistent tearing. Pam came to the emergency department at Aurora Sinai Medical Center, where the doctor diagnosed conjunctivitis. Conjunctivitis is an allergic, bacterial, chemical, or viral inflammation of the conjunctiva eyelid.

Pam is an 18-year-old homeless teenager, unemployed, uninsured. She lived with a friend. Pam never had a stable family—her mother was in jail and her father left the family when she was a child. A friend with whom Pam was staying suggested she inquire about the BadgerCare Plus Program application process while they waited for her medication.

Pam met Financial Counselor Sharon Rapp. Sharon assisted Pam with the online application for the BadgerCare Plus Program, and also with the Aurora Helping Hand Patient Financial Assistance Program application. Both applications were successfully submitted.

Two weeks later, Sharon was able to share the good news with Pam that the Aurora Helping Hand Patient Financial Assistance Program provided a $300 discount on her hospital bill. Pam also received great news from the BadgerCare Plus Program that she qualified for full coverage.

Sharon recalls, "The young lady was extremely grateful for my help. I am glad that my job puts me in a position to have an impact on someone’s life."

Aurora Sinai Medical Center, Milwaukee


Patient grateful Westfields Hospital was there for them

In our mission to improve the health of our patients and community by providing high quality health care that meets the needs of all people, it is the patient’s right to receive appropriate care regardless of source of payment. Westfields Hospital receives countless letters of appreciation each year from patients for whom we have provided charity care. Here’s just one example:

"I wanted to write a thank you letter to the hospital about what great service I had for me and my new baby. When my baby was a week late and in no hurry to come, the doctor assured me everything was fine since the baby and I are healthy. During that time I was in and out of the OB department for a week. I met a lot of the OB staff and loved every one of them. When the day finally came, I experienced a tough delivery, almost having a Cesarean, but with all the ups and downs, the doctor and nurses stayed calm and reassured me things would be fine and everything ended up okay. I’m just very thankful to have been in such a wonderful hospital with great staff that made my experience as a new mom wonderful.

During my pregnancy, I lost my insurance. I didn’t realize how much it cost to have a baby, and oh my, it is a lot! My husband and I will do our best to pay what we can a month but money is tight. I’m sorry we can’t do more right now.

Just wanted to say thanks and to let your staff know that I love the hospital and will suggest it to others as I have felt such warmth there."

From people who have lost their jobs or insurance, to those with chronic diseases who have reached caps or have high deductibles for their health care plans, Westfields Hospital will continue to provide appropriate care and financial counseling services to meet the needs of our community.

Westfields Hospital, New Richmond


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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