January 25, 2013
Volume 57, Issue 4
Walker Announces Report that Recommends Reforming Outdated Hospital Rules
DHS 124 singled out as "outdated, duplicative, confusing"
In his State of the State speech January 15, Governor Scott Walker released the 2013 Wisconsin Regulatory Review Report. The Report highlighted 218 different rules with 307 modifications across the entire Wisconsin Administrative Code. One of those rules, DHS 124, was specifically mentioned in the report as a rule that "…is outdated, duplicative, and confusing for health care operators because of contradictory state and federal regulations. This modernization will reduce hospital regulatory compliance costs and confusion."
The report was developed by the Walker Administration and highlights for state agencies and lawmakers state rules and regulations that are in need of review due to their significant impact on small business or because they have become unnecessary or obsolete. Now, agencies can either begin to repeal or modify rules themselves through the normal rulemaking process, or the Legislature can pass a law that will make changes to the current rules.
Reforming DHS 124 has been a longstanding priority for WHA and is one of WHA’s 2013 public policy priorities. Work on reforming the decades-old regulations began during the Doyle Administration, and despite various starts and stops, has remained on WHA’s advocacy front burner.
"Our proposal, in brief, would use the Ohio and Minnesota models of relying primarily on the Medicare Conditions of Participation (CoP) for hospital regulation, but would establish a process for determining if there are standards that Wisconsin should retain or adopt in addition to the federal standards," said WHA President Steve Brenton in a January 10, 2012 letter to DHS Secretary Dennis Smith. "Beyond the Medicare CoP, over 80 percent of Wisconsin hospitals demonstrate their strong commitment to excellent patient care by voluntarily being held to the even stricter standards of the accreditation agencies."
WHA staff has been meeting with Republican and Democrat legislators (and candidates) since August of 2012, highlighting the organization’s 2013 public policy and advocacy priorities, including reform of DHS 124. Those meetings continued this week, and included a strong push for regulatory reform bolstered by the Regulatory Review Report’s call to "modernize" state hospital regulations.
The "Right the Rules" effort is highlighted on a website that will track the progress of rule reform in the Joint Committee and in the Legislature. View the website here.
View the Wisconsin Regulatory Review Report here.
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The Wisconsin Civil Justice Council (WCJC) released their 2013 Guide to the Supreme Court January 17 that indicated which justices ruled in favor of positions taken by the Civil Justice Council. The WCJC is a group that was formed in 2009 designed to promote fairness and equity in Wisconsin’s civil justice system. WCJC actively pursues legislation and advocates for policies that promote that fairness and equity. The group is made up of several different business groups throughout Wisconsin. Wisconsin Hospital Association Executive Vice President Eric Borgerding is a WCJC Board member, along with several other executives from leading business and industry associations.
The newly-released scorecard indicated that Justice Patience Roggensack, who is up for reelection this April, scored the highest out of all Supreme Court justices in deciding in favor of positions taken by the WCJC. The positions highlighted within the report and used as a metric for the scorecard are all the most important business decisions issued by the Court in 2011 and 2012. The Justices’ scores were: Roggensack (74 percent), Prosser (70 percent), Gabelman (70 percent), Ziegler (68 percent), Crooks (55 percent), Bradley (27 percent) and Abrahamson (17 percent).
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Mark R. Taylor, president/CEO for Columbia St. Mary’s Health System, will serve as the next chairperson for the Milwaukee Health Care Partnership, a public-private consortium dedicated to improving health care for underserved populations in Milwaukee County. Taylor succeeds Bill Petasnick, immediate past president/CEO for Froedtert Health and a founding member of the consortium.
Taylor will work with Joy Tapper, the Partnership’s executive director, to advance the members’ strategic goals, focused on ensuring adequate and affordable health insurance coverage, improving access to quality health care providers and services, and enhancing care coordination across the delivery network. His two-year term, which began in January, will coincide with impending Medicaid reforms, the implementation of the health insurance exchange and significant changes under the Affordable Care Act that will affect low-income individuals.
Taylor brings more than 36 years of experience in health care administration and community collaboration having actively participated in access coalitions in various communities in Michigan and Missouri.
"As a relative new-comer to the community, I am eager to maintain and strengthen the relationships among health systems, health centers, academic institutions and public health agencies to improve health care for vulnerable populations—especially low income individuals. The Partnership provides a unique forum to improve health outcomes, reduce disparities and reduce the overall cost of care. I am grateful for the leadership Bill and his predecessors have provided and am pleased to lend my support to our collaborative work," said Taylor. "Our collaborative efforts to improve access and quality of care are extremely important during this time of health care reform, given that more than 30 percent of the County population is at or below the federal poverty level and either enrolled in a Medicaid program or uninsured."
Founded in 2007, The Milwaukee Health Care Partnership is a public/private partnership dedicated to improving health care for underserved populations in Milwaukee County. For more information, visit www.mkehcp.org.
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Debbie Rickelman, RHIT, has been promoted to vice president of the WHA Information Center (WHAIC). Rickelman has been managing the day-to-day operations of WHAIC and representing WHA and WHAIC on many important data and coding/ICD-10 collaborations.
"Debbie was with the Info Center during its infancy and early development and returned in 2010 to lead the organization as it has continued to mature and expand into new areas," according to Brian Potter, WHA senior vice president. "Her knowledge and organizational skills have been a tremendous asset in growing the organization and in meeting the data needs of our members and other data-driven organizations."
Rickelman’s experience includes coalition building, provider and staff education, data and quality initiatives and medical coding. She has held positions at Amphion, MetaStar, Dean Medical Center, St. Mary’s Hospital in Madison and the Wisconsin Medical Society. She is a graduate of the Health Information Technology program from Ottumwa Heights College, Iowa.
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A recent edition of The Boston Globe included a story about a Massachusetts manipulation of the Medicare wage index rural floor that unless remedied will lead to billions in additional payments to Bay State hospitals, paid for by the rest of the country. You may recall, I wrote about the rural floor problem in a column in 2011 and the Globe ran their first story in August of the same year. A lot has changed since 2011, however the issue remains unresolved.
This year, Massachusetts will gain more than $256 million from the wage index increase at the expense of hospitals throughout the country. Wisconsin’s loss will be about $10 million. Frankly, it’s unfair. And, it is very bad policy.
We’re not alone in thinking this way. According to Don Berwick, a well-known health care visionary and former CMS administrator, "The entire way the payment system is now calculated has become so complex and so susceptible to gaming and manipulation that you’d play the game yourself if you were running a hospital, to make sure your reimbursements continue to go up. It’s a zero sum game. What Massachusetts gets comes from everybody else."
This week, 21 hospital associations and the National Rural Health Association sent a letter to President Obama urging him to include a provision in his 2014 budget submission reversing the rural floor payment transfer. The coalition—known as The Alliance of America’s Hospitals—is raising awareness of the issue throughout the country. The Wisconsin State Journal covered the issue as have news organizations throughout the nation.
Now, more than ever, reimbursement issues matter. Wisconsin’s hospitals are fighting Medicare cuts on multiple fronts. And, that’s hard enough when the pain is being shared equally. However, it is unfair to expect Wisconsin hospitals to bear these cuts while others play by their own set of rules.
Allowing manipulation of the wage index to stand sends a strong message that gaming the system is acceptable. Worse yet, it is a tacit agreement that politics will be allowed to influence health care reimbursement, without regard to consequences or equity.
We can’t afford a zero-sum game. The money chase would spread like a virus through the hospital community. And, we would spend valuable resources figuring out how to manipulate the system to our advantage rather than improving it as is now the case in Wisconsin.
WHA is working with the coalition to cast light on the problem. That’s an important step toward a solution.
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Alistair Carr has joined WHA Information Center (WHAIC) as a senior health care data analyst as of January 18. In this role he will be focusing on quality and efficiency metrics and public policy analyses using the Wisconsin Health Information Organization and WHA Information Center databases.
Carr previously worked at Dean Health Plan as an analytics manager in their medical affairs department. Prior to that, he was a clinical informatics consultant for Physicians Plus Insurance Corporation. Carr has several years experience in clinical trials and has several presentations, poster sessions and publications to his credit.
"We are very excited to have Alistair as part of our team as we leverage various data resources to promote the value of health care in Wisconsin. Alistair’s experience in clinical informatics combined with his passion to make a difference will be great assets as we work to enhance our data services," said Debbie Rickelman, vice president, WHA Information Center.
Carr has a B.Sc. in marine and freshwater biology from University of London and a M.S. in zoology from Miami University, Ohio.
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Successful physician leaders must be able to represent both clinical and managerial interests, and those new to this role are often challenged to move beyond their clinical training and take a new approach to managerial decision-making, problem solving, communication and negotiation. Attendance at the annual Physician Leadership Development Conference is an opportunity to expose your physician leaders to these important leadership skills.
At the 2013 WHA Physician Leadership Development Conference March 8-9, attendees will focus on practical strategies physician leaders can implement to engage colleagues, create buy-in for change and manage difficult behavior. In addition, they will focus on how the Affordable Care Act will affect physicians and their profession.
Each year attendees express the value of attending the conference as a team—physician leader and management leader—allowing for invaluable informal, one-on-one conversation and team building during the event. This opportunity is available at the 2013 conference with a special "host" registration option available to those hospital representatives/management leaders who would like to accompany their attending physicians to the conference but do not need the CME credit.
Register today for this important annual event at http://events.SignUp4.com/13PLD. Contact Lisa Littel at firstname.lastname@example.org or 608-274-1820 for registration questions.
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The Wisconsin Hospital Association joins other partnering organizations, including host organization Wisconsin Manufacturers & Commerce, in co-sponsoring "Business Day in Madison," which will be held February 13 at Madison’s Monona Terrace. WHA co-sponsors and participates in Business Day as part of its overall advocacy strategy to collaboratively find policy solutions to important issues.
The Business Day in Madison 2013 program will focus on three issues dominating the landscape this year: geopolitics, politics & elections, and the economy. Key speakers on those issues are:
Geopolitics: General Michael Hayden – former director of the Central Intelligence Agency and the National Security Agency
Speech Topic: "Hot Spots at Home and Around the World"
Politics & elections: Stephen Hayes – political analyst, media personality and author
Speech Topic: "America’s Political Landscape: 2013 and Beyond"
Economy: Dr. Barry Asmus – economist and best-selling author
Speech Topic: "Creating a Favorable Climate for Business"
Governor Walker will be a guest speaker at the event. Business Day annually brings business leaders to Madison to learn about issues impacting the business community, to meet with their legislators in the State Capitol and to network with one another. Learn more or register for Business Day in Madison online at: www.wmc.org/programs/business-day-in-madison.
Important Note: Business Day in Madison in no way duplicates nor takes the place of WHA’s premier legislative grassroots event, WHA’s Advocacy Day, to be held on April 23, 2013 in Madison. Some 750 hospital leaders, employees, trustees and volunteers from across Wisconsin are expected at this year’s event.
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Described as one of the largest and most devastating hurricanes on record, Hurricane Sandy left many people homeless and with lives to restore and rebuild. The storm’s victims include members of our hospital family who worked tirelessly to evacuate patients and tend to the sick, putting the health and well-being of countless others above their own. In a direct and tangible way, we now have a critical opportunity to show these caregivers that we greatly appreciate their unyielding dedication and that their sacrifice—and ongoing struggle—has not gone unnoticed.
The American Hospital Association has created the Hurricane Sandy Health Care Employee Relief Fund. One hundred percent of the donations received will be used to benefit employees of hospitals and other health care organizations in affected communities who have suffered serious personal losses. Federal flood insurance does not cover the contents of a home, and most homeowner’s insurance policies do not cover water damage, leaving many affected employees struggling to regain a semblance of normalcy that Sandy washed away. The health care professionals who are themselves victims of Hurricane Sandy need your help now.
Relief funds are being administered by the United Hospital Fund (UHF) and will be distributed to employees in need through area hospitals and other health care organizations. While many in the national hospital family have given, the need is great. More than 5,000 hospital employees have asked for help.
Time is of the essence, so AHA is requesting donations be received by February 15. Your contribution is tax-deductible and can be made online at www.uhfnyc.org/hurricane_sandy_relief_fund.
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The WHA-led Wisconsin Transforming Care at the Bedside (TCAB) project is fostering innovations and improvement to the quality and safety of patient care—and participants are anxious to share what they have learned.
Judy Warmuth, WHA vice president, workforce, has been conducting site visits at the 22 nursing units participating in the TCAB project. Warmuth said the site visits help to ensure that each team has successfully launched TCAB on their unit. Reports for the units are promising, according to Warmuth.
Mercy Hospital in Janesville has focused much of their TCAB effort on patient discharge. The team created a toolkit with all the necessary discharge tools. When discharge teaching is being done, a bright sign on the door asks that staff not interrupt the learning session. The signs have worked well and are now used for other privacy needs for patients.
The team has also worked on an isolation "safe zone" and a medication "safe zone." Each new initiative has a team leader who is responsible for keeping the initiative on track.
The Fort HealthCare TCAB team has begun PM huddles with the hospitalists with a goal of reducing late discharges from the unit. They have implemented yellow slippers and wristbands, and they created new strategies for capturing changes for IVs and admission supplies.
Beginning with a skit at a unit meeting, the TCAB team will focus next on a bedside shift report. They also plan to collect data and conduct a "small test of change" to the length of weekend shifts.
Calumet Medical Center in Chilton started each initiative with data collection. For their hourly rounding project, they gathered information on the number of and the reason for each call light. The team graphed the reduction in the number of call lights by each reason. For their project on pain management, they began indicating the time that medication was administered on the patient white board so that both patients and families would know when the last dose was administered. The physical therapy department has been pleased to have this information as well. Team communication and recognition have also been a focus for this group.
The Wisconsin TCAB initiative is an 18-month project that will end March 2014. Participants will each be expected to outline a plan to sustain the project after that date. Transforming Care at the Bedside is a WHA project funded through the Wisconsin Collaborative for Healthcare Quality by the Robert Wood Johnson Foundation.
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Where do you go when you need a doctor and you don’t have insurance? More and more hospitals are establishing free clinics to serve those who do not have a "medical home." Every effort is made to connect patients with follow up care and even help them obtain the medical supplies or prescription drugs that they need.
Allie remembers how painful her tooth decay had become. "I was recommended to the Riverview Community Dental Clinic by my doctor, who knew I was in serious pain and wasn’t able to find a dentist anywhere in the area to help me." She also remembers how her tooth loss affected her life. "I wouldn’t smile. I didn’t talk to people; I would cover my mouth with my hand a lot. I didn’t like to go out, and I really didn’t like getting my picture taken."
After losing her front teeth to tooth decay, Lucy found it nearly impossible to get a job. "They wouldn’t say anything when I was missing my two front teeth, because people didn’t talk about it."
At the Riverview Community Dental Clinic, thousands of low-income adults and children are getting relief from the pain of tooth decay. As Allie and Lucy know firsthand, the pain is more than physical. It affects their overall health, as well as their ability to eat, speak, earn a living, concentrate on learning and enjoy socializing.
"The Riverview Community Dental Clinic has changed my life very much," says Lucy. "I looked for services for three years, had two teeth in front that the caps had broken off. I’m a professional, and trying to get a job was fairly impossible because my teeth were missing. After three years, I now have new dentures and am very, very pleased with everyone at the Riverview Community Dental Clinic."
Riverview Medical Center in Wisconsin Rapids has a mission "to provide compassionate, affordable, state-of-the-art health care to our communities." That is why Riverview opened the Riverview Community Dental Clinic in June 2009. The clinic serves only patients with Medicaid or BadgerCare insurance.
"It’s astonishing how down on yourself you can feel when you’re missing teeth, and that’s what people look at," remembers Lucy. "I feel extremely better about myself now. Thanks, Riverview Community Dental Clinic."
Riverview Medical Center, Wisconsin Rapids
SPMHC supports dental clinic for low-income patients
Thanks to a collaborative effort within the community, low-income residents of Sauk and Columbia Counties have access to basic dental care.
"The need is definitely there," said Karen Fabisiak of St. Vincent de Paul. "We just had to come together to figure out how to provide the service."
With contributions from 16 Sauk County organizations including SPMHC and the Sauk Prairie Memorial Hospital Foundation, St. Vincent de Paul’s Dental Clinic began taking dental appointments last August.
SPMHC originally contributed to the cost of writing grant applications to hire a dentist for the clinic. Once a dentist was hired, SPMHC and the Foundation contributed matching gifts toward the salary of a dental hygienist. Last fall, it became clear that equipment updates were in critical need, and SPMHC donated $20,000 to cover half these costs.
"By helping people access dental care, we help the overall community," said Carol May, SPMHC’s Chief Financial Officer.
The dental clinic will accept qualified uninsured or underinsured patients who are on Medicare, Medicaid and BadgerCare. Applications must be completed to determine if a patient qualifies based on income and need. The clinic now has four dentists on staff and is open frequently, as often as four days a week. For more information, call the St. Vincent de Paul Resource Center at 608-644-0504.
Sauk Prairie Memorial Hospital & Clinics, Prairie du Sac
Seton Dental Clinic: A new smile and renewed hope
Prior to 1994, Toni Tysdale was a healthy woman. She enjoyed helping others in her job as a nursing assistant. That all changed when she suffered a massive stroke. The stroke left her in a coma for one month. After awaking from the coma, over the next several years, Toni would struggle to care for herself while dealing with the residual effects of the stroke. While hospitalized, Toni’s oral health had been neglected. Without the full use of her hands and arms, even as Toni recovered, it remained difficult for her to maintain her oral health. Eventually, Toni started to develop dental pain.
During her recovery, Toni was unable to work. When she became healthy enough to work, her part-time job did not offer dental insurance. Neither could Toni afford to pay out of pocket for her much needed dental care. She went without dental care for years. Day to day Toni experienced pain, was unable to eat comfortably, and never smiled because she was embarrassed about her teeth. The pain became unbearable. So Toni searched for a place that could remove the painful teeth. She found the Elizabeth Ann Seton Dental clinic. She was treated during one of the clinic’s Urgent Care appointments. It was determined that every tooth would have to be removed. Toni felt "helpless and defeated" at the prospect of losing all her teeth. However, we also discovered that Toni was eligible for the prosthodontic program offered at Seton Dental. This program allowed Toni to receive both a full upper and lower denture to replace her teeth. When she received the great news, Toni began to cry.
"I have never been the exception or won anything before, but I feel like I won the lottery!" she said.
Upon receiving her new teeth, Toni is looking forward to being pain free, eating her favorite foods, and smiling with confidence. Most importantly, she has regained the confidence to return to the workforce and continue doing what she loves most-- helping others. Toni has overcome many obstacles since her stroke. Her goal is to become a spokesperson for stroke victims, in hopes of inspiring those who may have lost hope. Toni is a true example of Seton Dental Clinics motto of "Dental Care That Changes Lives."
Columbia St. Mary’s, Inc., Milwaukee
NEW Dental Clinic
Nationally, tooth decay is four times more common than childhood asthma and seven times more common than hay fever. A recent dental Medicaid mapping found Brown County to be one of seven counties statewide with less than 20 percent of Medicaid recipients receiving dental care.
The NEW Dental Clinic at Northeastern Wisconsin Technical College hopes to change that, thanks to support from St. Vincent Hospital, St. Mary’s Hospital Medical Center, Bellin Health and other Brown County health care providers.
Typically, Medicaid recipients receive little or no dental care. And in the Green Bay area there are currently no dentists who accept new Medicaid clients. Thus, these individuals end up in hospital emergency rooms seeking pain relief. In fact, St. Vincent alone served 504 dental patients last year; St. Mary’s provided care to another 95 dental patients.
The NEW Dental Clinic, begun in December 2011, has begun seeing these dental patients post-ER visit. Most seek the clinic upon referral from the ER, just seeking relief from their pain, which, according to NEW Clinic Executive Director Bonnie Kuhr, is just a part of the overall problem.
Many of the Clinic’s dental patients have never seen a dentist in their entire lives. And so the concerns needing to be addressed are many. The first step is often treatment of the infection that is causing the immediate pain. Once that is resolved, the tooth can be filled, pulled or have a root canal, depending on the severity of the problem.
That is only a first step, but one for which patients are very appreciative. They are thankful to have gotten rid of the pain. But that is generally only the solution for the worst tooth, according to Kuhr. The goal is to gradually address all of the individual’s oral health concerns and progress to a complete care plan that can be maintained to avoid future issues.
This goal begins with the very first treatment as, never having had oral care, many of the Clinic’s patients do not value it. So care needs to be provided in the most accepting environment and made as pain-free as possible. Caregivers strive to make a connection with the patient, give them time to process what needs to be done and to become comfortable with it. In this way, the hope is that they will continue to come back, not just two or three times, but as many as are needed to resolve their personal mouthful of issues and then for ongoing preventive care.
St. Vincent Hospital/St. Mary’s Hospital Medical Center, Green Bay
Submit community benefit stories to Mary Kay Grasmick, editor, at email@example.com.
Read more about hospitals connecting with their communities at www.WiServePoint.org.
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