November 4, 2011
Volume 55, Issue 42

"Massachusetts Windfall" Part II
Wisconsin hospitals hit again under final outpatient rule

Earlier this year, WHA President Steve Brenton joined several of his national colleagues in expressing outrage when an amendment, slipped into the 2,000+ page PPACA, was finalized under the Inpatient Prospective Payment System Rule. That change significantly benefited a small handful of states, including Massachusetts, which alone will reap $275 million in increased reimbursements, and at the expense of hospitals nationwide. Wisconsin hospitals’ share of that tab is $7 million in lost Medicare payments annually. On the heels of that massive redistribution of inpatient Medicare dollars, this week the Centers for Medicare & Medicaid Services (CMS) finalized the 2012 outpatient rule, codifying the same flawed payment methodology into the outpatient setting. Because of budget neutrality, Massachusetts hospitals will gain another $92 million annually under the final outpatient rule, while Wisconsin hospitals will lose another $3 million annually.

"It’s truly outrageous, something that can only make sense in the most cynical corners of Washington, DC," said Brenton. "Not only are hospitals and taxpayers in Wisconsin and across the country paying for this blatant manipulation of the wage index, but the strategy itself will usher in a new era of baseless backroom deals taking from one state, or many states, to give to another. This is especially troubling as it relates to implementation of PPACA and its state-by-state disparities, which these tactics will exacerbate."

The saga was set in motion with an amendment by Sen. John Kerry (D-MA) to PPACA. That amendment required hospital wage reimbursements to be fixed at a national amount as opposed to the previous state-based amounts. The end result was that any changes in one state could result in fluctuations, either up or down, in other states.

Flash forward to a small hospital in Nantucket which reclassified itself as a rural hospital. Due to another Medicare rule and the significantly higher wages in Nantucket, that reclassification required Medicare to reimburse all of Massachusetts hospitals at that higher Nantucket rate. Add in the budget neutrality provision mentioned earlier and the so-called windfall to Massachusetts’s hospitals is now in effect.

In finalizing both the inpatient and outpatient rules, CMS has expressed concern about hospital actions that result in significant wage index disparities; however, given the fact that other wage index reform is currently under way, including by Medicare and the Institute on Medicine, it choose to maintain current policy regardless, thereby keeping the vast disparity in place—at least for the time being. The agency indicated it will continue to review and consider changes in future rulemaking.

"I don’t think this is over," Brenton said.

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Wisconsin Hospitals Generate $28 Billion in Economic Activity
Contribute $1.4 billion in community benefits

Hospitals have a major impact on the state’s economy, generating $28 billion annually in economic activity and employing more than 110,000 people in communities throughout the state. In addition, hospitals spent millions more providing charity care and supporting free clinics and health screenings while absorbing more than $800 million in payment shortfalls associated with medical assistance programs.

A new study released this week by the University of Wisconsin-Cooperative Extension Department of Agricultural and Applied Economics and the Wisconsin Hospital Association, "Healthy Hospitals. Healthy Communities," sheds light on a less-known aspect of community hospitals—their significant impact on the local, regional and state economies.

Hospitals are important to a community for a number of reasons, according to the lead author of the report, Professor Steven Deller, an economist with the Department of Agricultural and Applied Economics at the University of Wisconsin-Madison and the University of Wisconsin-Extension, Cooperative Extension.

"Hospitals are a good source of employment in Wisconsin, and they are able to provide a range of employment, from entry level jobs to highly-specialized, higher-wage positions," Deller said. "The employees earn a wage and then spend it in the local economy, and that generates a multiplier effect. In Wisconsin, there are about 110,000 people employed by hospitals, but once you take the multiplier into effect, the total number of jobs that are supported by the hospitals is 226,000."

Deller said the second benefit of having a hospital in the community is that they help improve the health and wellness of the people living there.

"From an economist’s perspective, it a labor productivity factor," Deller explained. "If workers are ill, they cannot go to work, productivity decreases. Businesses don’t sell or produce as many goods or services, so hospitals provide a key service to our economy by helping Wisconsin’s labor force be the most productive that it can possibly be."

Hospitals less sensitive to economic downturns

Hospitals remain less sensitive—but not immune—to economic downturns. Employment in most hospitals through the recession remained fairly steady compared to other industries.

"The impact of the recession has been less severe than you would see in manufacturing or construction. It tends to be a relatively stable industry," according to Deller. "But, people still become ill. There are still accidents that require an ER. So there is a fair amount of stability—a buffer if you will—to the recession. But that doesn’t mean that hospitals are not experiencing fiscal stress themselves. If people are not working, they are not able to pay their bill in full and hospitals find themselves absorbing those costs."

While the recession continues to dog Wisconsin’s economy, hospitals face a lot of uncertainty in the future as health reform is implemented and Congress looks for more cuts as it grapples with a daunting deficit.

"There are already $2.6 billion in cuts to Wisconsin hospitals ‘baked into’ health reform, and our concern is we’ll see even more as a result of efforts to reduce the national deficit," said WHA President Steve Brenton. "Even Wisconsin’s smallest, most rural hospitals are under attack and facing cuts for the first time since the mid-1990s. There comes a point when hospitals have to say, ‘enough is enough’ if we are going to meet our missions of service in our communities."

Hospitals help drive economic development

When a new industry or even a small business is considering a move, the quality, accessibility and cost of health care factors into the decision on where they will locate. Baby boomers looking to retire also rank "a good nearby hospital" as an important factor in their decision.

"As Wisconsin leaders consider the state’s economic priorities and look for ways to create more jobs, it is important to recognize the important role that hospitals have in our state’s economic health," according to WHA President Steve Brenton. "This study shows that health care is much more to Wisconsin than hospitals, doctors and clinics. The ripple effect of the health care sector in our state’s economy is enormous. Hospitals are not only tied to the physical health of our communities, they are also directly connected to the state’s economic health."

Millions Spent on Charity Care, Government Program Shortfalls, and Health Efforts

WHA, released its annual community benefit report, entitled "Caring for Our Neighbors," in tandem with the economic impact report. "Caring for Our Neighbors" illustrates the significant financial investments that hospitals make in their communities that contribute to the overall health of Wisconsin’s citizens.

In 2010, more than 700 patients each day qualified for charity care. Together, Wisconsin hospitals provided $232 million in charity care. In addition, hospitals absorbed nearly $800 million in government program shortfalls. They spent millions more supporting free medical and dental clinics, medical screenings, and providing health education programs. In total, hospitals contributed $1.4 billion in community benefits.

WHA member hospitals submitted more than 100 stories that illustrate the impact that they have had in their communities. Read them at

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WHA Unveils New Website

The Wisconsin Hospital Association this week re-launched its website, The new site will enable visitors to more easily locate resources that are related to issues that have been identified as high priorities by our members.

The front page now clearly showcases the Association’s top issues. On inside pages, content is organized by topic under a tab labeled, "Health Care Issues." And at the bottom of each individual issue page, members will find a "file folder" system where related links and additional resources can be found.

"We re-designed our website with a goal of making it easier for our members to find information more rapidly, but we also believe it contributes to the value that we seek to deliver every time we interact with a member, whether it is in person or through our website," according to WHA President Steve Brenton. "The new website allows us to better communicate our key issues while we continue to strive to deliver the best member experience possible."

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Political Action Spotlight: Wisconsin Hospitals Conduit & PAC Campaign Update
Forty-three more participants added in October as goal approaches 76%

In the last month, 43 more individuals joined the campaign putting the Wisconsin Hospitals Conduit and State PAC fundraising campaign at 76 percent of the goal to raise $250,000 by year’s end. The average individual contribution is $509. In addition, the total raised to date is $189,678 from 374 individuals.

Individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. 2011 contributors to date are listed below. Contributors are listed alphabetically by contribution category.

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

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Assembly Concurs on Streamlined Nursing Home Regulations
"Apology Bill" advances

After passing the Senate last week, the Assembly this week gave bipartisan approval to Senate Bill (SB) 212, which would reform duplicative and outdated nursing home regulations. The bill was introduced by Sen. Pam Galloway (R-Wausau) and others in the Senate, and Rep. Dan Knodl (R-Germantown) and others in the Assembly.

The proposal does not repeal any current regulations or expectations of nursing homes. Instead, and among other provisions, the proposal eliminates the potential for nursing homes to be assessed a double state and federal penalty for a single incidence of alleged non-compliance. The bill also expands the authority of the Department of Health Services (DHS) to cite federal deficiencies, in addition to state citations, as grounds for state licensure action.

WHA supports the bill being pursued by the Wisconsin Health Care Association (WHCA), the Wisconsin Center for Assisted Living (WiCAL) and Wisconsin Association of Homes and Services for the Aging (WAHSA).

SB 212 had passed the Senate 24-7 and now has passed the Assembly 70-22, both strong bipartisan votes. The bill is now available for consideration by Gov. Walker, who is expected to approve the measure.

Assembly Approves Apology Bill

This week the Assembly also approved AB 147, the "Apology Bill" on a bipartisan 62-33 vote.

Introduced by Representatives Erik Severson, MD (R-Star Prairie), John Nygren (R-Marinette) and others in the Assembly, AB 147 would protect statements of apology by health care providers to patients and families from being used against the provider in a medical malpractice lawsuit.

WHA testified in support of the proposal at public hearings explaining that when a health care outcome is not what was planned or expected, a heartfelt statement of concern or apology can be very helpful for all involved (see previous Valued Voice story).

A companion bill, SB 103 authored by Senator Pam Galloway, MD (R-Wausau) and others has also passed out of committee, but has not yet been scheduled for a vote in the Senate.

Thanks to all hospital and WHA H.E.A.T. advocates who have made over 450 contacts into their legislator’s offices in support of the bills.

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Care Transition Improvement Starts with Health Care Providers, Local Agencies Working Together
Skinner: "A care transition is a continuous process, not an event"

Being discharged from the hospital can be a challenging and sometimes confusing time for the patient and their family. While discharge instructions seemed clear when they were reviewed in the hospital setting, once at home, families can feel bewildered and alone as they try to comply. Medications might be missed, instructions are not followed. That can lead to a readmission.

Reducing readmission rates and improving care transitions for patients requires health care providers, long-term nursing care, and other local agencies to work together to ensure that the move from acute care setting to home, nursing home, or long-term acute care setting (LTAC) goes smoothly.

On November 2, more than 200 people representing all the groups listed above, met in Wisconsin Dells to learn how they could form a "community" that would help patients and their families successfully transition among the various care settings they require.

Reduced Readmissions: Health Care’s Low Hanging Fruit - Pat Rutherford, vice president at the Institute for Healthcare Improvement (IHI), kicked off the event with an overview of many of the methods and tools that are being used around the country to improve care transitions and reduce hospital readmissions. Rutherford cited national rankings from the Commonwealth Fund that rate Wisconsin 12th in the country with a relatively good overall readmission rate of 16.2 percent.

Rutherford noted that "IHI considers Wisconsin as having many forward thinking leaders in quality. However, though your rates are good there is still room for improvement." She encouraged providers across the continuum, including hospitals, nursing homes, home care agencies and physician offices to work together to find the best practices and customize them to work in local settings.

"There is no ‘silver bullet,’ however, there are some organizations showing promising progress," according to Rutherford. Some of the most promising work is being done in the areas of better assessment of post-discharge needs before the patient leaves the hospital and increased use of evidence-based practices in community care settings. IHI uses a combined model of Will, Ideas and Execution. She noted that Wisconsin providers clearly have the will to move from good to great and there are many promising ideas. She encouraged participants to work together to implement these ideas in a meaningful way for patients. Best practices related to reducing readmissions are at

Care Transitions Intervention - Kim Irby, project manager at Colorado Foundation for Medical Care provided a summary of the Care Transitions Intervention (CTI) model for improvement, developed by Dr. Eric Coleman. Irby has helped implement this model in Colorado. The CTI model is based on patient coaching around four pillars: patient self-management of medications, use of a personal health record, timely physician follow-up after discharge, and patient knowledge of red flags that indicate a worsening condition and how to respond to these flags. Colorado has seen a 50 percent reduction in 30, 90 and 180-day readmissions that were related to patient-controlled factors. Descriptions of the CTI model and associated tools can be found at

INTERACT - Irby also presented the INTERACT model and tools to a capacity crowd of long-term care providers. This model focuses on interventions to processes and communication in skilled nursing facilities. Outcomes of good implementation of the INTERACT toolkit results in reduced acute care transfers and improved teamwork among staff. Irby reminded the audience that "the residents are what matter most and in order to improve their care, all contributors to improving care must be acknowledged. Irby reviewed several tools that can be used to recognize a change in a resident’s condition sooner and the guidelines to follow when this occurs; she described SBAR for communication between providers and shared simple tools for facilitating advance care planning. Participants were encouraged to access additional information at

Ensuring a Successful Community-Based Collaborative Improvement - Nancy Skinner, principle consultant with Riverside Health Consulting, provided an overview of how to get all of the different providers a patient comes in contact with working together to improve transitions. She noted "patients have to be their own GPS as they travel through a health care crisis."

Skinner said Wisconsin providers should form partnerships to better coordinate when patients move from one provider or setting of care to another. Skinner noted, "the way we do things now isn’t how we will do things in the future."

Providing patients with the better transitions to achieve the status they are seeking will require new levels of collaboration between hospitals, nursing homes, home health providers, agencies on aging and other community-based providers. Skinner cited national statistics that show only 48 percent of patients report they were involved in developing their plan of care, and only 29 percent knew who was in charge of their care.

"If all providers work together to ‘act like a village’ and begin to view transitions as a continuous process rather than an event, we will be much more likely to meet patients’ needs and provide good, cost-effective care," Skinner said.

Creating a Statewide Approach - Kelly Court, WHA chief quality officer, concluded the day with a highly-interactive session. Participants brainstormed with others from their geographic region to identify improvements that are already happening to improve care transitions. WHA will aggregate this information and share success stories. Participants also identified barriers to participating in a local or statewide improvement collaborative and identified how WHA can assist with this work. Court noted that "WHA leaders and quality staff are meeting regularly with staff from MetaStar and other organizations to create a unified state approach to improving transitions and reducing readmissions." WHA will be using the input from this session to guide the work they are undertaking as a Hospital Engagement Contractor under the CMS Partnership for Patients work that will start in the coming months.

Aligning Forces Reducing Readmissions Case Study - Sauk Prairie Memorial Hospital has been enrolled in the Aligning Forces Reducing Readmissions improvement collaborative since it launched in September 2010. Dawn Procter, Manager of Care Management at Sauk Prairie Hospital, shared their approach to addressing readmissions through better internal practices, and the importance of partnering with area long term care organizations and community resources. Currently, SPMH’s readmission rate is 6 percent, a rate which has dropped by nearly one-third since joining the collaborative.

Detecting Potentially Preventable Readmissions - Stephanie Sobczak, WHA’s manager of quality improvement, presented a powerful new readmissions analysis tool by 3M - Potentially Preventable Readmissions Reports. In partnership with the WHA Information Center and the Wisconsin Office of Rural Health, hospitals can now obtain a set of reports that analyzes which inpatient readmissions might have been preventable, and groups these into types of services, diagnostic categories and severity levels.

"Examining all causes of readmissions is like peeling an onion," according to Sobczak, "The PPR reports give hospitals a head start on where to look for improvements that can make the most impact on patient readmissions."

Hospitals interested in receiving their PPR reports should contact Debbie Rickelman, senior director of the WHA Information Center, at

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Grassroots Spotlight: Rep. Ringhand Visits Beloit Health System

State Rep. Janis Ringhand (45th Assembly District) of Evansville recently visited Beloit Health System as the new representative for Beloit Township and the west side of Beloit. Under new redistricting plans, Rep Ringhand’s district will include a Beloit Health System outreach medical center and an assisted living facility. Beloit Health System invited Rep. Ringhand to meet with hospital leaders and tour the hospital.

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New Proposal Would Eliminate QIA
Legislation seeks to abolish recently updated peer review laws

Earlier this year, long sought after improvements to Wisconsin’s antiquated peer review statutes finally became reality when a comprehensive tort reform bill was signed into law by Governor Walker. Special Session Senate Bill 1 (SS SB 1) became 2011 Wisconsin Act 2 and included provisions known as the Quality Improvement Act, or QIA. (See story from January 28, 2011 Valued Voice) The QIA helps improve health care quality, safety, and efficiency by encouraging more and better quality improvement activity.

WHA staff worked closely with the Walker Administration and key legislators and their staff to craft the bill and respond to misleading claims, false statements, and misinformation about the proposal. WHA also organized and led what grew into a large and diverse coalition of over 30 interested health care providers, purchasers and patient safety groups that strongly supported the bill.

Bills introduced this week, AB 345 from Representative Jon Richards (D-Milwaukee), and SB 244 from Senator Chris Larson (D-Milwaukee) would eliminate the hard-fought improvements to health care quality efforts achieved in the QIA.

As previously reported (see story in last week’s Valued Voice), during Senate floor debate last week on a bill to reform duplicative and outdated nursing home regulations, an amendment was also introduced to eliminate the QIA. The amendment was voted down.

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Rep. Tranel Shadows CEO Nicole Clapp at Grant Regional

Rep. Travis Tranel had the opportunity to shadow Grant Regional Health Center’s (GRHC) Nicole Clapp on October 17.

"We really appreciate Rep. Tranel taking the time to visit our hospital," explains Nicole Clapp, President/CEO of Grant Regional Health Center. "Shadow days are an opportunity for us to help educate our legislators regarding the needs and concerns of delivering healthcare in rural Wisconsin."

WHA initiated the shadow day program several years ago to promote better understanding by legislators about the complexities of running a hospital in today’s health care environment. This is the twelfth shadow day hosted by a hospital CEO this year.

During his time at GRHC, Rep. Tranel accompanied Nicole Clapp to meetings with the rehabilitation and emergency room departments. Tranel was also able to see several hospital technology advancements, including in the radiology department and electronic medical records system.

Rep. Tranel spent in-depth time with the hospital’s leadership team where he was able to learn about issues pending at the state and federal levels that would negatively affect CAHs, such as GRHC. He also expressed his support for the CAHs in his district. He closed the day by having lunch with hospital staff.

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Paramedic Pilot Project, MEB Reports Shared with WHA Council on Medical and Professional Affairs

A project being piloted in the Baraboo area could become a model for community-based efforts to reduce hospital readmissions and prevent avoidable emergency department visits. The "Community Paramedic: Bridging the Gap in Primary Health Care" is a new project that proposes training well-experienced paramedics to extend the delivery of primary care services in the home. It is designed to enhance access to primary care, particularly in the rural and inner city areas of Wisconsin. Successful projects in other parts of the world have shown reductions in hospital readmissions, ED visits and unnecessary ambulance transports. The Baraboo project is a collaborative that includes participation and support from the hospital, local physicians, home care agency, nursing homes and the paramedic service.

Marvin Birnbaum, MD, emeritus professor of Medicine and Physiology at the University of Wisconsin School of Medicine and Public Health, the principle investigator on the project, said access to primary care services will worsen as the population ages and demand outstrips the supply of physicians. One way to extend primary care services is to bring paramedics up to a level of care where they can evaluate and treat patients, under physician orders, in the home. It should, according to Birnbaum, generate substantial cost savings.

Birnbach, along with Jan Brown, RN, BSN, critical care transport course coordinator at UW Hospitals and Clinics and Lori Spencer, RN, EMTP, with the Baraboo District Ambulance Service, presented the project at the WHA Medical and Professional Affairs Council held November 3 in Madison. The Council is chaired by Brad Manning, MD.

Wisconsin Examining Board (MEB) staff attorney, Tom Ryan, presented on a number of issues related to physician licensure. He said the turnaround time from when all the documentation is received to issuance is about one week. When the file is complete, according to Ryan, there is virtually no delay. Delays can occur if the physician has been in practice for a long time, or if they have practiced in multiple jurisdictions.

Ryan said MEB has expressed interest in a future pilot in Wisconsin on maintenance of licensure. This is a longer term project that has many details that need to be considered. The MEB is also participating in a program funded by a grant that created a multi-state task force that will guide the implementation of an interstate licensure portability program to reduce and eliminate barriers to cross-border licensing. The strategy is to adopt a regional expedited endorsement process that utilizes a uniform application and addenda; adopt compatible licensure laws and regulations where possible; and to adopt a common online licensure verification system. The Council requested that Ryan or another member of the MEB staff present the results from either study when they are available.

Chuck Shabino, WHA senior medical advisor and Mary Kay Grasmick, WHA vice president of communications presented progress report on the Wisconsin hospital standardized alert code recommendation. In December 2010, the WHA Board approved a proposal forwarded to them from the WHA Medical and Professional Affairs Council to recommend that Wisconsin hospitals move to standardize to the use of clear language in their overhead alerts. To date, more than 100 hospitals have indicated they will standardize to clear language by the January 1, 2012 deadline.

The Wisconsin Hospital Emergency Preparedness Program (WHEPP) has enabled Wisconsin hospitals to achieve high levels of preparedness statewide. To date, the program has focused on ensuring that hospitals have the supplies, equipment and physical plant requirements to meet the demands that would be placed on them during a full-scale disaster. While hospitals will always have the need for physical resources, WHEPP is now looking at ensuring that hospital personnel have the training that they need to respond to a disaster.

Mary Kay Grasmick, WHA’s representative on the WHEPP Leadership Team, said one of the challenges is to have more physicians involved in disaster drills and planning activities. The Council members suggested that a combination of face-to-face training and then practicing the newly-learned skills at a drill scheduled at a time when physicians are more likely to participate could be one way to encourage more participation among physicians.

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CEOs Take to Local Papers to Express Concerns on Federal Deficit Cuts

As the "super committee" continues its effort to come up with at least $1.2 trillion in federal deficit savings, several proposals being vetted would impact small, rural hospitals knows as Critical Access Hospitals (CAHs). Over the past several months CAHs and WHA have taken their message to rural papers about what federal deficit cuts would mean to local communities. We wanted to make sure you saw excerpts of what they are saying in their opinion editorials and letters to the editor.

Federal Proposals Could Hurt Rural Communities

Years ago, Congress afforded qualifying small, rural hospitals like ours (known as "critical access hospitals") enhanced Medicare payments to help them keep their doors open to the communities they serve. Now, those payments are under threat as the deficit "super committee" continues to meet…Osceola and St. Croix medical centers are proud to serve not only the health care needs of this region, but its economic needs as well. We employ a large number of community members who, in turn, impact our local economies, and we’re considered a "selling point" – along with our fine schools – for families looking to settle here. Our commitment to our communities-at-large is also demonstrated by our involvement with many community activities and events. And our community care programs already provide millions of dollars in free or reduced cost care to those under financial stress.
Dave Dobosenski, CEO, St. Croix Regional Medical Center & Jeff Meyer, CEO, Osceola Medical Center in The Sun and the New Richmond News

Federal Proposals Could Hurt Rural Communities

Local health care provided by local health care professionals is something we all value, and Memorial Health Center is proud to be a part of our state’s rural health care network. However, proposals currently being discussed in Washington, DC could negatively impact hospitals like ours…Should Congress eliminate this important program or scale back its payments, it would impact many Wisconsin communities where rural hospitals are located, including ours…Memorial Health Center employs 623 people and gives back over $47 million to the local and regional economy through the wages and benefits paid, and the goods and services purchased. Our commitment to the communities we serve is also evident by our $277,000 investment in community health improvement services (in fiscal year 2010), in addition to over $1.3 million in our community benefits, including charity care.
Gregory A. Olson, President & CEO, Memorial Health Center in the Medford Star News

Super Committee Should Not Institute Further Reductions to Medicare, Medicaid

Over the past decade Medicare and Medicaid have regularly reduced or failed to reimburse hospitals for the actual cost of providing care. Now, a Congressional "super committee" is working to develop $1.5 trillion in deficit reductions with the potential for their recommendations to cut both these programs - programs that support rural hospitals like Vernon Memorial Healthcare. Such drastic cuts would severely cripple the rural health care system and harm seniors’ and low-income individuals’ ability to access care…Additional Medicare and Medicaid cuts will only undermine the ability of VMH and other Wisconsin hospitals to continue to provide care for our patients. We ask our U.S. Sens. Herb Kohl and Ron Johnson and Rep. Ron Kind to stand with our hospital by telling the super committee and Congressional leadership that cuts to Medicaid and Medicare will negatively impact rural hospitals and patients who need care.
Garith Steiner, CEO, Vernon Memorial Hospital, in the Vernon County Broadcaster

Proposals Could Hurt Rural Areas

Reedsburg Area Medical Center is proud to serve not only the health-care needs of this community but the economic needs as well. We employ nearly 500 people and give back $18 million in wages to the local economy on an annual basis. Our commitment to the community at large is also seen in our support of many local initiatives, the wellness education we provide and the health care services provided to those who could not otherwise afford it. Reedsburg Area Medical Center is committed to our patients and to our community. We ask that you stand with us as we urge Congress to oppose proposals that hurt critical access hospitals and the care that we provide to our friends, our families and our neighbors.
Bob Van Meeteren, President, Reedsburg Area Medical Center

Hospital cuts impact lifeblood of rural communities

We believe Wisconsin should be proud that its health care system provides high quality, cost-efficient care, and our rural hospitals are a key part of that equation. In fact, 10 of Wisconsin’s smallest hospitals, known as Critical Access Hospitals (CAHs), were recently ranked in the top 100 CAHs nationally. Yet right now there are proposals afoot in Congress that target these very hospitals, and by extension, the lifeblood of many rural Wisconsin communities. Both the Wisconsin Hospital Association and the Rural Wisconsin Health Cooperative are fighting these proposals on behalf of Wisconsin’s hospitals and rural communities. Rural hospitals are often one of, if not the largest local employers in many areas. Statewide, Wisconsin hospitals generate $28 billion of economic activity and account for one of every nine jobs—jobs that provide family-supporting wages with ripple effects throughout communities. We heard it put recently that "if you lose a hospital, you lose a town." We could not agree more and ask our Members of Congress to continue their strong support for Wisconsin’s rural hospitals by standing with us against ill-advised deficit reduction proposals. Rural seniors and communities deserve top-notch care provided by health care providers in their local communities. Cuts to rural hospitals do nothing to serve these desired goals.
Stephen Brenton, President, Wisconsin Hospital Association, and Tim Size, Executive Director, Rural Wisconsin Health Cooperative in the Vernon County Broadcaster, Medford Star News and Price County’s The Bee.

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DHS extends Medicaid EHR Incentive Deadline to Dec. 31

DHS announced on October 28, that it is extending the deadline for submission of Wisconsin Medicaid Electronic Health Record Incentive Program applications from eligible hospitals for federal fiscal year (FFY) 2011 until December 31, 2011.

DHS also published this week a new Forward Health Update (2011-68), titled "Additional Information and Clarifications Regarding the Wisconsin Medicaid Electronic Health Record Incentive Program." The update discusses an appeals process for denied or disputed Medicaid EHR incentive payments, new functionality to the online Wisconsin Medicaid EHR application program, including the ability to upload supporting documentation, some clarifications regarding the input of NPI and cost data information in the application, and the process for receiving FFY 2012 incentive payments.

The Forward Health Update can be found at

If you have questions, contact Matthew Stanford at 608-274-1820 or

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WHA Spearheads CAH Dear Colleague Letter; Thanks Wisconsin Delegation for Strong Support

The Wisconsin Hospital Association (WHA) continues to fight against federal deficit cuts aimed at Critical Access Hospitals (CAHs). In conjunction with an aggressive legislative and grassroots campaign against cuts to all hospitals, WHA asked U.S. Rep. Ron Kind (D-3rd District) if he would lead a bipartisan "dear colleague" letter to the deficit super committee on proposals aimed at CAHs.

Rep. Kind agreed to be the Democratic lead on the letter with Rep. Joann Emerson of Missouri serving as the Republican lead. In just one week, the letter garnered 66 co-signatures from U.S. House Members in 32 states and sends a strong message to the super committee that CAHs are vital to hundreds of communities across the country.

"There are some proposals now circulating that target the critical access hospital (CAH) program and its reimbursement. Those proposals include reducing reimbursements, eliminating the CAH designation for some hospitals or outright repeal of CAH designation altogether," the Kind-Emerson dear colleague letter reads. "While these proposals will result in savings, we urge you to carefully consider the potentially devastating consequences of such cuts on access to care for patients and economic development in rural communities."

WHA thanks Rep. Ron Kind for his leadership on this letter as well as Rep. Sean Duffy (R-7th District), Tammy Baldwin (D-2nd District), Reid Ribble (R-8th District) and Tom Petri (R-6th District) who each signed on as well.

"We are grateful for the bipartisan effort against cuts to Wisconsin’s small, rural hospitals," said WHA President Brenton. "Our appreciation goes out to Rep. Kind for his leadership and to Reps. Duffy, Baldwin, Ribble and Petri for continuing to stand firmly with their hospitals."

The letter went on to say, "Rural hospitals are unique in many respects and face a dynamic vastly different than hospitals located in urban or suburban areas. Recognizing these distinctions—remote geographic location, small size, workforce scarcity, physician shortages, constrained financial resources among others—Congress enacted a special designation called the ‘critical access hospital’ under the Balanced Budget Act of 1997."

"Since enactment, this designation and accompanying reimbursement have helped ensure and protect stable access to health care services for the elderly and others living in rural America…we ask the Joint Select Committee to protect critical access hospitals from cuts or other detrimental policy changes," the letter closed.

Dear colleague letters are a way for multiple Members of Congress to co-sign one letter, showing strength in numbers on a particular issue. WHA worked with other state hospital associations nationwide in gaining Congressional support for this letter. The American Hospital Association, National Rural Health Association and the Rural Wisconsin Health Cooperative were also involved in this effort.

Read the full dear colleague letter at:

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CMS Releases Several Payment Rules This Week

CMS releases final 2012 OPPS rules

The Centers for Medicare & Medicaid Services (CMS) issued a final rule updating Medicare payment policies and rates for the hospital outpatient prospective payment system and ambulatory surgical centers for calendar year 2012. In addition to updating OPPS payments by 1.9 percent, the final rule extends through 2012 the period of non-enforcement of the direct supervision requirements for outpatient therapeutic services for critical access hospitals and small rural hospitals. This is intended to give CMS time to put in place an expanded Ambulatory Payment Classification Panel to make independent recommendations to the agency regarding the appropriate supervision level for individual hospital outpatient therapeutic services. CMS also revised its proposal for the inpatient Value-Based Purchasing program under Medicare. Specifically, the agency will not include the hospital-acquired condition measures, Agency for Healthcare Research and Quality composite measures, or the efficiency measure for the fiscal year 2014 VBP program.

CMS releases final 2012 physician fee schedule

The Centers for Medicare & Medicaid Services also released a final rule updating the Medicare physician fee schedule for calendar year 2012. While the rule implements a multiple procedure payment reduction to the professional component of advanced imaging services, it applies a 25 percent reduction for CY 2012 rather than the 50 percent reduction the agency proposed. CMS also is moving forward its three-day policy window payment provisions, which will pay physicians services at the lower facility rate if they are delivered in a physician office wholly owned and operated by the hospital and provided within three days of a hospital admission. The rule delays implementation of the provisions to July 1, 2012. Without a change in law, physician payments will decline by an estimated 27.4 percent beginning January 1, 2012. While this estimate is lower than the 29.5 percent reduction in the proposed rule given Medicare cost growth to be lower than expected, cuts of this magnitude are unsustainable. WHA continues to urge Congress to permanently fix the flawed physician payment formula. Among other provisions, the rule finalizes a proposal to consolidate the two group practice reporting options, so that "group practice" is now defined as a group with 25 or more eligible professionals.

CMS releases final 2012 home health rule

Medicare payments to home health agencies will decrease by about 2.31 percent in calendar year 2012 under the final rule updating Medicare home health prospective payment system rates, released by the Centers for Medicare & Medicaid Services. The 2012 net decrease includes a 2.4 percent market basket update, a 1.0 percent cut mandated by the Patient Protection and Affordable Care Act, a wage index update, and a 3.79 percent coding offset to adjust for changes in case mix. The 2012 coding offset is the first of two installments that total 5.06 percent. Hospital-based agencies will receive a net update of approximately 0.53 percent. Among other changes, the rule allows hospital and post-acute care physicians to satisfy the home health requirement for a face-to-face encounter by informing the certifying physician of their encounters with the patient.

All of these rules will be posted in the Federal Register in the coming days. They can be reviewed currently at the following links:

OPPS Rule:

Physician Fee Schedule:

Home Health PPS Rule:

WHA is reviewing these rules and will provide a comprehensive summary in the near future. Information on Medicare PPS and other payment rules can be found at

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Wisconsin Hospitals Community Benefits: Tobacco Use and Exposure

Tobacco use is the single most preventable cause of disease and death in Wisconsin. More people die of tobacco-related disease than alcohol, cocaine, heroin, homicide, suicide, motor vehicle accidents and HIV/AIDS combined. Wisconsin hospitals offer a variety of education and smoking cessation classes to help people kick the habit. In addition, all Wisconsin hospitals are tobacco free, campus wide, to signal their support of creating an environment that promotes wellness.

Kicking the habit: A tobacco cessation success story

Every smoker who quits has a turning point.

Christine McKahan had tried to quit on and off for 20 years, but she kept going back to her cigarettes. She finally decided that the cost of her three-pack-a-day habit — in money and in time — wasn’t worth it. Her habit kept her from her art of crocheting hats for a living.

"I wasn’t crocheting that much, I’ll tell you that," says McKahan of her smoking days. "I really didn’t have time to pursue my art the way I wanted to."

She resolved to quit many times, but had a difficult time going the distance. "I could never get to six months off cigarettes," says McKahan. "Things were too stressful, or something would happen, and I’d be lighting up again."

After seeing information about the free tobacco cessation program at Mayo Clinic Health System in Menomonie, she decided it was time for a little more help. "I just knew I didn’t have all the tools I needed to quit for good," McKahan says.

"Christine was already in a really good place — she was committed to wanting to quit," says Sonja Kamrath, tobacco counselor.

At their first meeting, McKahan was using nicotine lozenges, but feeling guilty about it. "The instructions say to taper off and not use them after 12 weeks," says McKahan. "But I felt like I still needed them."

Kamrath talks to many people who feel the same way. "The taper-off instructions on the package make many people feel conflicted," she says. "But studies have shown that it’s safe and effective to continue on the therapy for up to a year. It’s certainly better than smoking."

In addition to easing guilt and dispelling myths, Kamrath gave McKahan some other practical tools to help with cravings. She encouraged her to start a "tobacco money" savings account to see how much she was saving by not buying cigarettes. Kamrath also helped McKahan know what to do in situations where the temptation is strongest, by using deep-breathing techniques, having something in her hands or something to nibble on. "Sonjia also told me that whenever I feel like I need to, I could call her," says McKahan. "It meant a lot that there was support if I was feeling shaky."

But she still worried about "staying quit" for the long term. Kamrath helped with that, too. "Right at the six-month mark, Sonja gave me a call," recalls McKahan. "I was really feeling vulnerable, and her encouragement was really inspiring to me."

"Every patient is different, so I really focus on what they need," says Kamrath. "It’s a difficult process, but we’re here to help them ease that stress. It’s never too late to quit, and they can have a better life afterward."

McKahan can attest to that. She now has more time and resources to devote to her crocheting business, and she was able to use her "tobacco money" for a trip to the west coast to visit family last spring. "I don’t even think about smoking that much anymore," she says. "I feel a whole lot better."

Call 715-233-7766 for more information on Mayo Clinic Health System’s tobacco cessation program.

Red Cedar Medical Center - Mayo Health System, Menomonie

Making tobacco free a reality

Gundersen Lutheran Health System understands that breaking tobacco dependence is difficult and there is not a one-size-fits-all approach. For those struggling with a nicotine addiction, Gundersen Lutheran’s Community & Preventive Care Services offers a free Journey to Freedom Nicotine Cessation and Relapse Prevention Support Group.

This is a free support group for individuals of all ages who are thinking about quitting tobacco use, are currently working on it or need help in coping once they’ve quit. It is intended to be one tool among many offered at Gundersen Lutheran that can provide tobacco users with ongoing support and relapse prevention. A different health and wellness topic is offered each month.

Not only does this group save participants hundreds of dollars, but it offers users helpful tools such as free quit packs and carbon monoxide screenings just for attending. However, its rewards have a far greater impact down the road, such as saving thousands of dollars in health care costs due to chronic illnesses such as asthma, COPD and cancers of the lung and mouth.

Gundersen Lutheran has formed a partnership with community organizations, including the County Health Department and neighboring hospitals. Interested tobacco users often receive referrals to this free monthly support group, which is unique to our area. Those who have taken advantage of the support group and Gundersen Lutheran’s Journey to Freedom Nicotine Cessation Clinic have an increased chance of success with an average 40 to 50 percent cessation rate—much higher than a smoker quitting on their own, which is about 3 to 5 percent.

Gundersen Lutheran Health System, La Crosse


Submit community benefit stories to Mary Kay Grasmick, editor, at

Read more about hospitals connecting with their communities at

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