February 1, 2013
Volume 57, Issue 5
WHA Board Endorses Lifting Enrollment Freeze for Childless Adults
Takes cautious position on transition to exchanges
On January 30 the WHA Board of Directors unanimously supported lifting the existing enrollment freeze in BadgerCare Core for childless adults with incomes below 133 percent of the federal poverty level (FPL).
Under the Affordable Care Act (ACA), the federal government will pay 100 percent of the cost for states that increase Medicaid eligibility for childless adults with incomes below 133 percent FPL. The 100 percent federal cost share will be in effect for three years, beginning in 2014. By 2020, federal funding phases down to 90 percent, but states can pull out of the eligibility expansion at any time. For many states, going to 133 percent FPL is an increase in eligibility standards, but not in Wisconsin.
More than four years ago, with bipartisan support and long before enactment of the ACA, Wisconsin sought and received approval from the federal Centers for Medicare and Medicaid Services (CMS) to expand coverage to childless adults with income up to 200 percent of the FPL (BadgerCare Core), but only at the usual 40 percent state/60 percent federal cost sharing formula.
Enrollment in BadgerCare Core is currently frozen with a waiting list. The position endorsed this week by WHA would essentially lift the enrollment freeze in BadgerCare Core, but only for childless adults with income up to 133 percent of FPL, and in doing so capture 100 percent federal funding for three years to cover the costs.
"Above all, our hospital and health system members—national leaders in innovation and reform—are looking for stability, especially when it comes to covering our most vulnerable populations," said WHA President Steve Brenton. We believe WHA’s position is a measured approach that makes good fiscal and policy sense. There will be much debate on this issue with valid opinions on both sides, but at the end of the day, in this time of uncertainty, we cannot have fewer people with coverage and more uncompensated care."
Over the last five years, uncompensated care in Wisconsin hospitals increased from about $700 million per year to over $1.1 billion per year. Adding to the financial uncertainty are significant ongoing cuts to hospital reimbursement in the Medicare program. The ACA alone included $2.6 billion in Medicare reimbursement cuts to Wisconsin hospitals through 2019. Those reductions are being used, in part, to fund soon-to-be-implemented coverage expansion in the ACA.
"Governor Walker and the Legislature have made significant commitments to Medicaid in this biennium, support for the health care safety net that is recognized and appreciated by health care leaders and those who have access to care as a result," Brenton said. "We will again work constructively with the Walker Administration and the Legislature to leverage already authorized federal funding to help provide coverage to very low-income uninsured and reduce provider cost shifting to Wisconsin employers."
Once again tapping its member-"staffed" Medicaid Reengineering Group, WHA thoroughly weighed several issues and options before arriving at its position, including the role new health insurance exchanges can play in connecting those with income above 133 percent FPL to affordable coverage.
WHA is open to reforms that transition this population, some of whom are currently enrolled in Medicaid, into premium-subsidized, private-market exchanges, but only if and when those exchanges can show a track record of success. If lower income individuals are unable to access coverage in exchanges, there is a greater likelihood they will become uninsured.
"We believe our position, covering childless adults with annual incomes no higher than $21,000, can be the basis for larger Medicaid reforms that transition coverage to subsidized commercial insurance, but only when we have properly functioning exchanges," according to WHA Executive Vice President Eric Borgerding. "It may be awhile until we have truly functioning exchanges, and until then, we must proceed with extreme caution and only with a stable safety net in place."
"Ultimately, we want a strong economy that is creating good-paying, family-sustaining jobs with affordable, employer-sponsored health insurance, which will reduce the number of people who need Medicaid," Borgerding said. "We believe private sector job creation and a stable and reasonable health care safety net can go hand-in-hand, and that’s the position our Board adopted this week."
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On January 29, U.S. Rep. Reid Ribble (R-Sherwood), hosted a small group listening session in Appleton to identify barriers to better mental health care and how to remove those barriers. The listening session included representatives from WHA, Affinity Health System, Bellin Health System, ThedaCare, and Catalpa Health—a collaboration of Affinity, ThedaCare and Children’s Hospital of Wisconsin, the National Alliance on Mental Illness-Fox Valley Chapter, the United Way and others.
Rep. Ribble referenced the Sandy Hook tragedy as one impetus for the listening session. "When you’re dealing with complex issues, the key is to slow down," Rep. Ribble said. "The American people are anxious for some decisions, and politicians are anxious, but that’s how bad decisions get made."
Wisconsin laws that create special barriers to the sharing of mental health information between a patient’s treating providers was one barrier identified by the group.
"Right now the barrier is that the two systems, the mental health system and the primary care system, can’t communicate effectively," said Dr. Larry Donatelle, vice president of medical affairs for St. Elizabeth Hospital.
"The barriers to communication in Wisconsin are largely caused by Wisconsin law and not Federal law," said Matthew Stanford, vice president of policy & regulatory affairs for WHA. "Unlike Federal HIPAA laws which generally allow mental health information to be shared between a patient’s treating providers, it is Wisconsin’s mental health laws that restrict the sharing of such information between treating providers."
Stanford also said that WHA has been working with a coalition of interested organizations and people to introduce and pass the Mental Health Care Coordination & HIPAA Harmonization Bill to improve the care for individuals with mental health needs by removing the Wisconsin-specific barriers to the sharing of mental health information between treating providers.
Stigma surrounding mental illness was also a key area of discussion.
"It’s great to start this dialogue, said Karen Schiller from the National Alliance on Mental Illness – Fox Valley. "But we have a long way to go to talk about it, especially around stigma."
Stanford also highlighted how stigma has been "institutionalized" in federal and state policy, and the need to reassess policies that treat mental health care differently from other health care in general.
"For example, federal laws governing critical access hospitals specifically limit the number of psychiatric beds that a critical access hospital can have to 10 and also pay critical access hospitals at a reduced PPS rate for those psychiatric beds," said Stanford. "These limitations specific to mental health care have made inpatient psychiatric services financially unviable for many critical access hospitals in rural areas."
Stanford also identified federal regulations stemming from the 1960s that prohibit psychiatric hospitals with more than 16 beds from receiving certain Medicaid funding and overall inadequate funding for mental health services that is exacerbated by a difficult payer mix for mental health providers.
The group was generally skeptical about proposals to create a database that would prohibit all individuals with mental illness from purchasing a firearm. Instead, the group discussed policies for identifying individuals and intervening before an individual is an imminent danger to others.
"I think what would be more effective would be looking at our treatment laws, balancing civil rights, and getting people treatment," said Schiller.
Stanford said that emergency mental health treatment was another area where policy treats mental health care differently from other health care.
"In Wisconsin, decisions about whether a patient in an ER needs emergency involuntary treatment are not made by physicians," said Stanford. "Instead, those decisions are made by law enforcement and county crisis agencies—even though it’s a medical issue."
The group listening session lasted about an hour, and Rep. Ribble thanked the group for their insight and expertise on these complex issues.
"This will trigger additional questions that I’ll begin to circle back individually with some of the experts in the room and begin to get a better understanding of it. This is really critical to help inform me on my decisions, and I hope to continue to have more of these types of conversations," Rep. Ribble said.
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Hear from key state and national leaders at WHA’s premier advocacy event, Advocacy Day. WHA’s 2013 Advocacy Day on April 23 will take place at the Monona Terrace in Madison. Registration is now open.
David Rehr, PhD, noted national association leader and adjunct professor for George Washington University will keynote the event. Rehr is the author of The Congressional Communications Report, the largest, most in-depth study of grassroots advocacy and lobbying practices and how they are received by Congress. With the state budget process unfolding concurrently with Advocacy Day, the ever-popular state legislative panel will provide insight into budget deliberations and other pending health care issues of importance. Plus, Governor Scott Walker is invited to present the luncheon keynote address.
The highlight of Advocacy Day is always the hundreds of attendees who take what they’ve learned during the day to then meet with their legislators in the State Capitol in the afternoon. WHA facilitates these appointments and even provides transportation to the Capitol. 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.
Plan to attend and register your hospital team today, including your senior leaders, trustees and volunteers, for this important event. Advocacy Day is a free event, but pre-registration is required. A complete program and online registration are available at:http://events.SignUp4.com/13AdvocacyDay0423. For registration questions, contact Lisa Littel at firstname.lastname@example.org. For legislative visit questions, contact Tiffanie O’Hara at email@example.com.
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Berwick to Keynote WHA’s Partners for Patients Event, March 12-13
Staff from all Wisconsin hospitals invited to attend
WHA is honored to have Don Berwick, MD, the nation’s leading voice on health care quality, former head of CMS and the founder of the Institute for Healthcare Improvement (IHI), as the featured speaker at the upcoming Partners for Patients event, "Catch the Wisconsin Wave," scheduled March 12-13 in Wisconsin Dells.
WHA hospital leaders, physicians, nursing leaders, improvement leaders and champions, care-giving staff and clinical experts from all Wisconsin hospitals are invited and encouraged to attend this two-day event. In particular, teams from the 108 Wisconsin hospitals participating in WHA’s Partners for Patients collaborative are encouraged to attend.
In addition to Dr. Berwick, the agenda has a variety of national-caliber keynote speakers on hand to inform and inspire staff of Wisconsin hospitals, including:
This is a great opportunity for improvement teams to gear up for their 2013 efforts. The event theme, "Catch the Wisconsin Wave," reflects the great progress Wisconsin hospitals have made toward the 20/40 CMS goals and the continued efforts into 2013.
Hospitals across the state have used Partners for Patients to re-charge their improvement work. There will be breakout sessions on all of the initiative topics with best practice sharing by Wisconsin hospitals. The event offers hands-on workshops and plenty of networking opportunities.
Register today for this important event at http://events.SignUp4.com/13PFP031112. There is no registration fee to attend this event, but pre-registration is required and space may be limited. Direct registration questions to Lisa Littel at firstname.lastname@example.org or 608-274-1820.
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Governor Scott Walker announced this week that he has chosen the Interim CEO of the Wisconsin Economic Development Corporation (WEDC), Reed Hall, to serve as the new permanent CEO of the state economic development agency. Hall replaces the former WEDC CEO Paul Jadin after Jadin accepted a position with Thrive, a regional economic development organization in Madison.
Recently, WHA met with then Interim CEO Hall and WEDC Chief Operating Officer Ryan Murray to discuss how Wisconsin’s excellent health care quality and high value is an asset to the state’s economic development efforts.
"One of the best selling points for Wisconsin to attract businesses or encourage businesses to grow here is that we have a world-class health care system that provides tremendous value to our state’s employers," said WHA Executive Vice President Eric Borgerding. "The competitive advantage that our value-driven health care system has brought to Wisconsin is not going unnoticed. The Governor and his agency heads at WEDC realize this important aspect of job creation and have been actively communicating that message across the state."
Hall, who served Marshfield Clinic since 1976 as general counsel and then executive director from 2000 to 2010, was chosen through a national selection process conducted by the WEDC Search Committee. The Governor’s statement noted that when Hall was at Marshfield, the clinic added 63 regional clinics and grew from 145 to 180 physicians, with a total of 7,500 staff.
View the Governor’s statement here: www.wha.org/pdf/ReedHall1-29-13.pdf.
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Reports from hospitals participating in Transforming Care at the Bedside (TCAB) continue as WHA staff complete site visits. Each hospital unit that is participating is visited twice during the project and asked to report on initiatives and activities conducted by the team.
The TCAB team at Mayo Clinic Health System – Franciscan Healthcare in La Crosse began their visit with a report on their "Ticket to Ride," which is a label on the chart that travels with a patient to other departments and ensures that all caregivers have the information necessary to provide care to a patient. They have completed several plan-do-check-act cycles (PDCA) and will begin expansion of the project.
They have done several snorkels, including one on how to communicate new processes and changes to all staff and a second on how to improve delivery of isolation meal trays. The team has used PDCA cycles with each change implemented. Having a buddy to ensure that staff can be free for a break was a quick win for the team.
The team is using many communication channels to ensure that all staff on the nursing unit is aware of TCAB efforts.
At Tomah Memorial Hospital, the TCAB team has been successful in working with central supply to track items as they are distributed to patients. They have also changed the way that call lights are answered so that the staff best suited to respond to the patient’s request is notified. They are working on what information should be on the white boards in patient rooms.
The team has implemented a "restful menu" that allows patients to select the interventions they desire to allow rest at night. There are a variety of items for the patient to select as his or her sleep preferences. The most innovative is an item that asks if the patient wishes to be awakened for bedside report in the morning. The team reports that patients really appreciate nursing support for sleep, but they almost all want to be awakened to participate in report.
The team at St. Elizabeth Hospital started with a list of recommendations from unit staff. They have systematically implemented many of them—small changes to unit materials and routine. Stock in unit refrigerators, filling of water mugs, pressure cushions and bed alarm reminders are examples. They have also worked on suggestions and ideas to improve communication among team members. For example, a new form for patient care technician reports has received very positive feedback from support staff.
This group has also been working on team recognition. They have initiated new "star" boards and peer feedback forms. A monthly calendar for the unit and monthly potlucks also help with recognition.
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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Site visits are an important component of WHA’s Partners for Patients initiative. Tom Kaster, WHA quality coordinator, recently visited Cumberland Memorial Hospital and Baldwin Area Medical Center to discuss their quality improvement work. Both facilities are fully engaged in continuous patient care quality improvement efforts.
At Cumberland, Kaster met with Mike Gutsch, CEO; Nancy Ruppel, director of health information; and Mary Ann Clark, director of nursing. Cumberland is participating in the OB and Readmissions initiatives.
Cumberland is in the final stages of implementing an OB early elective delivery hard stop policy. By doing this, Cumberland moves Wisconsin closer to the goal of having 100 percent of hospitals here attain an early elective delivery rate of less than 3 percent.
For readmissions, Cumberland is implementing post discharge phone calls. These phone calls provide an opportunity to ensure that the patients are adhering to their care plan and answering any questions patients may have, Cumberland has also focused on their pre-discharge conversations with patients. Both initiatives ensure their patients are able to remember and adhere to the care plan, which in turn helps reduce readmissions.
At Baldwin Area Medical Center, Kaster met with Allison Page, CEO; Jean Peavey, director of patient care, and their improvement project teams to discuss their progress so far with the Partners for Patients project and to make plans for year two. In the first year, Baldwin focused on readmissions, OB and Just Culture.
Baldwin implemented an early elective delivery hard stop policy very early in the 2012 initiative. As a result, their early elective delivery rate has been at zero since August. This is an amazing accomplishment.
For readmissions, Baldwin has worked with providers in their county to help improve transitions of care. They have collaborated with area hospitals, home health care facilities, social services and nursing homes, which has gone a long way toward opening lines of communication and finding improvement opportunities. In addition, they have started post-discharge phone calls and are working through small tests of change to perfect that process.
Baldwin has also focused on implementing just culture. Fortunately, Page has an extensive background in implementing Just Culture in a health care setting. As a result, they are poised to integrate Just Culture throughout their organization in 2013.
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Black River Memorial Hospital (BRMH) has announced the selection of Mary Beth White-Jacobs, as BRMH’s new president and chief executive officer, effective June 28, 2013. White-Jacobs has served in numerous capacities with the hospital for 30 years, most recently as vice president of patient care services.
White-Jacobs will replace retiring president and CEO Stan Gaynor, who said the advance announcement allows for a seamless transition for the entire community. Gaynor will work with White-Jacobs during the transition to allow for continuity and effective succession.
"After 20 years at BRMH, I have enjoyed the opportunity to serve as the chief executive officer and appreciate the accomplishments of our organization. I am confident that Mary Beth will build upon our successes through her vision, leadership and integrity. She will serve the hospital very well," said Gaynor.
White-Jacobs earned her bachelor’s degree in nursing from the University of Wisconsin-Eau Claire, and a master’s in health administration from the University of Minnesota. She has significant experience as a nurse and executive. In her tenure at BRMH, White-Jacobs has led the performance improvement initiatives of the Wisconsin Forward Award (WFA), which is one of 34 state-based quality programs in the country dedicated to raising productivity and operational excellence. The hospital has earned recognition three times, most recently in December at mastery level.
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Did you know that February is American Heart Month and May is National Mental Health Month? There are literally hundreds of health care observances. WHA has compiled a list of health care-related observances and posted them to WHA’s website at www.wha.org/national-health-observances.aspx.
Among the most popular is National Hospital Week, which is May 6-12. Hospital Week is one of the nation’s most traditional health care events that honors the health care workforce and recognizes the value that a hospital brings to a community.
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The Hermes Monato, Jr. Prize of $2,500 is awarded annually for the best rural health paper. It is open to all students of the University of Wisconsin (any campus). Students are encouraged to write on a rural health topic for a regular class and then to submit a copy to the Rural Wisconsin Health Cooperative as an entry by April 15.
Previous award winners as well as judging criteria and submission information are available at: www.rwhc.com/Awards/AnnualMonatoEssay.aspx.
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Hospitals do what they can to move health care services out of the clinical setting into the heart of the community. Community health screenings and education classes help raise awareness of steps that individuals can take to improve their health. When people learn more about how their lifestyle decisions affect their health, they make changes that ultimately lead to better health, which raises the health status of the entire community.
Free health screenings at home & business shows
Approximately 7,000 people attend the three major home and business shows put on each spring in Taylor and Price Counties. In the spring of 2011, Memorial Health Center committed to providing those attending these events with free health screenings and information vital to their health.
Together, about 25 Memorial Health Center staff members devoted more than 100 hours to getting people checking out the annual home and business shows in Medford, Phillips, and Park Falls to pause a moment and take a closer look at the state of their health.
Those taking advantage of Memorial Health Center’s free blood pressure, blood glucose (diabetes), body mass index (BMI), and osteoporosis checks received immediate results they could share with their health care providers and use to make healthy lifestyle changes. Those undergoing Memorial Health Center’s free cholesterol screening were mailed their results within a few days.
In addition to the screenings, people visiting Memorial Health Center’s screening booths were treated to a wealth of useful health information and tips for improving their quality of life.
Memorial Health Center (An Aspirus Partner), Medford
To engage individuals in our communities, Bellin Health provides a number of services including health information, screenings, translation services, a 24/7 community health line and more. Bellin Health is a strong supporter of community initiatives and is a founding partner of Unity Hospice.
What better way to understand how a heart works and to increase heart health awareness than to be able to actually walk through a heart? That’s the premise for the AmeriHeart, presented by the Heart & Vascular Center of Bellin Health.
The inflatable exhibit measures 21 feet in height and is 17 feet wide. As people walk through this interactive, anatomically correct display, they can view the heart’s four chambers and valves, along with the arteries and veins leading to the heart organ. The educational exhibit demonstrates changes from a heart attack, shows a hole in the heart, illustrates a heart valve problem and displays a bypass graft.
The AmeriHeart is designed to be portable and has traveled to numerous community events, businesses and schools. The exhibit was open for children and adults to view during the 12th Annual Superbowl of Safety, sponsored by Bellin Health and Safe Kids. The free family event at Lambeau Field offered important educational tips on a wide range of child safety topics including car seats, physical fitness, sun, water safety, poison and more.
The AmeriHeart proved to be a hit with the children, fulfilling its role as an excellent learning tool that is educational, yet fun to experience.
Bellin Health, Green Bay
Unique partnership provides Primary Access for Kids
Sam is an 18 year old high school student who lived alone after his parent died. He sought out a school nurse because of a respiratory illness. The school nurse assessed Sam had symptoms of pneumonia, was suffering from severe grief, depression, and was actively suicidal. He was also uninsured.
Sam was then enrolled in the Primary Access for Kids (PAK) program, a public/private partnership to provide primary and preventive health care to uninsured children in the Madison Metropolitan School District (MMSD). Sam’s primary care provider performed a physical exam, treated the pneumonia, and prescribed medication for depression.
The unique partnership of PAK has been made possible through the leadership and work of the Health Council in Dane County. Members of the Health Council include ABC for Health, Access Community Health Centers, Children’s Dental Center of Madison, City of Madison, Dane County, Dane County Medical Society, Dean Health System, GHC-SCW, Greater Madison Chamber of Commerce, Journey Mental Health Center, Meriter Health Services, MMSD, Public Health Madison-Dane County, St. Mary’s Hospital, Pfizer, Inc., United Way of Dane County and UW Hospital and Clinics and UW Medical Foundation.
Organizations collaborating to make this program possible include Access Community Health Centers, Dean Health System, GHC-SCW, Meriter Health Services, MMSD, Public Health Madison-Dane County, St. Mary’s Hospital, United Way of Dane County, UW Hospital and Clinics, UW Medical Foundation, and Wildwood Clinic.
UW Health’s Director of Community Partnerships Shiva Bidar-Sielaff says, "We live in a truly remarkable community where organizations work cooperatively together for the good of our children."
Primary Access for Kids provides annual physicals, primary care office visits at an assigned clinic, access to transportation, and medications at no cost to uninsured children.
Since this collaborative program began in 2010:
$319,200 primary and preventive health care has been provided
460 students have been enrolled, out of an estimated 800 uninsured students in MMSD.
1217 total encounters, averaging to 2.9 encounters per student
Most importantly, the efforts of PAK are trending in the right direction. In 2011-2012, 93.6 percent of enrolled children saw a primary health care provider in the last year. This was an increase from 91.4 percent in 2008-2009.
"This remarkable partnership has effectively removed access to health care as a barrier to learning for children in Madison’s public schools. It is wonderful to see a project that started as a collaboration between the school district, school foundation and GHC-SCW evolve into a provider collaborative involving our three local hospitals, clinics, and public health department," said Larry Zanoni, Executive Director of GHC-SCW.
University of Wisconsin Hospitals and Clinics, Madison
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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