March 15, 2013
Volume 57, Issue 11


WHA Exclusive Interview: A Conversation with Don Berwick, MD

Don Berwick, MD, is perhaps the most recognizable and well-respected international authority on health care quality and safety improvement. On March 12, WHA Chief Quality Officer Kelly Court and Mary Kay Grasmick, vice president, communications, had an opportunity to sit down with Dr. Berwick, and he shared his thoughts about Wisconsin’s quality improvement efforts and what he believes lies ahead.

Wisconsin hospitals’ commitment to improve the quality and safety of patient care is indisputable. As one of the leading states in the nation, Wisconsin has achieved a reputation for delivering high quality, high value care that sets it apart from other states.

In an exclusive interview with WHA, Chief Quality Officer Kelly Court asked Don Berwick, MD, what makes Wisconsin different.

"Maybe it is because in the 1980s, the intellectual roots for quality improvement were here with George Box and Brian Joiner. There were clusters of people in the world who were working on process and quality improvement," Berwick said. "You are in a place where so much is happening and you are leading the country."

Why here? "Perhaps it is your history in this state of progressive community spirit. It is almost unique in the country and it’s not just Wisconsin, it extends to the whole upper Midwest."

A former CMS administrator, Berwick is now president emeritus and senior fellow of the Institute of Health Improvement (IHI), where he served as the founder and first CEO. He was in Wisconsin to present at the WHA Partners for Patients "Catch the Wisconsin Wave" event March 12.

Court described for Berwick the long-standing commitment that Wisconsin hospitals have with health care transparency and public reporting. Wisconsin hospitals fared well—among the best in the nation—in the first round of the Centers for Medicare and Medicaid Services (CMS) readmission penalty program, which is evidence that Wisconsin has worked hard to get out ahead—and lead—in health care quality and safety improvement.

Court said Wisconsin hospitals are achieving impressive results in the Partners for Patients initiative and are showing better results than the national average in several areas, including infection prevention and readmissions work.

"The hospitals that are working on improvement projects are participating in WHA’s monthly webinars, they are using the Plan-Do-Study-Act cycles, and they are achieving their aims in about nine months."

Court said WHA’s goal is to get even more hospitals engaged in this improvement work.

Court shared the WHA annual quality report with Berwick, which she said highlights "where we’ve been, but also focuses on where we are going—we are not resting on our laurels." Berwick called the results "stunning."

"Something right is happening in Wisconsin. Given the success you have had for a decade or more, you are obviously good at quality improvement," he said.

Berwick said as quality improvement has taken hold in health care, the field has advanced and perhaps there are "new basics" in the quality movement, which he described as follows:

"You are already a low-cost area so it is a challenge to reduce costs, but there is still waste so there is still work to do," said Berwick. "We may not have them in place now, but once we work on it, the cost metrics and the measures will follow."

Berwick cited Wisconsin as having an advantage in addressing community health and said hospitals are now, "re-work facilities for defects that cause us to be ill. The past and present are focused on that function. We have to break out of that and begin to address community health and the problems that generate the health issues. Hospitals are in a good position to think about healthy communities."

Court noted that hospitals are acting as conveners in their communities to find and engage health-related organizations who can help them with care transition work. This approach has worked well to reduce readmissions.

In summarizing Wisconsin’s experience in and reputation for improving quality, Berwick praised the state’s hospitals and health systems by saying, "Given the success you have had here for a decade or more, you are good at improvement work."

Court and Berwick agreed that the work must continue because it is critically important to continuously improve the quality and value of patient care.

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CMS Outlines Details of Federally-Facilitated Exchanges

On March 1, CMS issued a letter to insurers on operational and technical information for participating in federally-facilitated and state partnership exchanges. The letter serves as a reminder of key dates and short timelines that must be met for people to have coverage by January 1, 2014.

"The letter is released March 1, just seven months before the exchange is supposed to be operational on October 1," said Joanne Alig, WHA senior vice president for policy and research. "It highlights some of the concerns we have about whether the exchange will truly be functional in Wisconsin, and especially what that might mean for low-income individuals and families who, under the pending budget bill, will become ineligible for Medicaid on January 1 of next year."

The letter lays out the timeline for insurers to submit applications to offer qualified health plans in the exchange and for CMS to certify and approve those plans. Insurers will have to file applications between April 1 and April 30. The target date for initial results to be sent to insurers is June 17. The timeline anticipates some needed back and forth on issues, with a final notification to issuers not expected until September 4, and insurers will have until just September 9 to sign agreements with CMS—this is less than one month before the go-live date, when those who will be seeking coverage in the exchange will begin to apply under open enrollment.

Additionally, the letter points out a key factor in timing for consumers. Consumers must enroll in a qualified health plan and submit an initial premium payment by December 31, 2013 in order for coverage to begin January 1, 2014. This will be an important step for consumers, including those in Wisconsin who would, under the pending state budget bill, lose Medicaid eligibility on January 1, 2014, to ensure there are no coverage gaps.

CMS also provides additional information about network adequacy. Federal law and previous rules require qualified health plan insurers to maintain a network that is sufficient in number and types of providers, including essential community providers. The letter provides standards for meeting the essential community provider requirement. Essential community providers include DSH and DSH-eligible hospitals, children’s hospitals, rural referral centers, sole community hospitals, free-standing cancer centers and CAHs, as well as FQHCs, Ryan White providers, family planning providers, Indian providers and other entities that serve predominantly low-income, medically underserved individuals.

A link to the letter can be found here: www.wha.org/pdf/issuerletter3-1-13.pdf

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Advocacy Day: A Perspective from the Hospital Trustee and Hospital CEO

Recently WHA talked with Prairie du Chien Memorial Hospital (PDCMH) Chief Executive Officer Bill Sexton and Board President Paul Ginkel about the importance of having hospital trustees at WHA’s Advocacy Day. Every year PDCMH assembles a group of close to a dozen individuals—leaders, trustees and volunteers—for this annual event.

Advocacy Day 2013 takes place April 23 in Madison at the Monona Terrace Convention Center.

Questions for PDCMH CEO Bill Sexton:

Q: As a regular attendee to Advocacy Day, why are you so committed to this event?

Sexton: Advocacy Day not only provides an opportunity to hear from Wisconsin leaders but it helps prepare us for meetings at the Capitol with our state officials on issues of concern. During legislative visits, fellow hospital leaders and supporters from throughout a legislative district all come together and deliver a common message to our legislators. It is clear our views are not just in the interest of one organization or community, but of all hospitals.

Q: What is the value of having your trustees join you at Advocacy Day?

Sexton: Having trustees attend Advocacy Day brings forward the voice and support of the community. This is an important asset when meeting with the legislators who represent their districts. Trustees lend credibility to our message on issues that impact our community needs.

Questions for PDCMH Board President Paul Ginkel:

Q: As a trustee for Prairie du Chien hospital, why do you think it’s important to attend Advocacy Day each year?

Ginkel: Attending the WHA Advocacy Day each year is important to me because it gives me the opportunity to better understand the legislative issues during the morning sessions, but also to network with old friends. After a great lunch, the opportunity to meet with our legislators and personally share my concerns not only from a trustee’s point of view but from my community’s perspective, I think is very powerful.

Q: Would you recommend other trustees make time to attend Advocacy Day? What is the value of doing so?

Ginkel: My belief is when community members (trustees) attend, it demonstrates that we are deeply concerned about the health care issues facing Wisconsin and the decisions of our legislators. The value in my attendance gives me the chance to personally share with our legislators how I feel about important issues facing our hospital and the region we serve.

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Worker’s Compensation Proposal Links Provider Pay to Medicare Rates
Could jeopardize the access to excellent care injured workers have relied on for over 100 years

The Worker’s Compensation Advisory Council on March 12 started its process of negotiating this legislative session’s "agreed-to bill." The Council is comprised of an even number of representatives of management and organized labor. Over the course of several months, the management and labor representatives on the Council negotiate a draft bill that is then introduced and traditionally passed by the Legislature without amendment. It is important to note that WHA, Wisconsin Medical Society, Wisconsin Chiropractic Association, and Wisconsin Physical Therapist Association, while sending liaisons to the meetings, do not have a seat at the table and cannot vote on the bill.

During the March 12 meeting of the Council, labor and management representatives exchanged their initial proposals for this session’s bill. Both sides included proposals that are troubling for health care providers that care for injured workers. The proposal from Labor is available here: http://dwd.wisconsin.gov/wc/councils/wcac/labor%20proposals.pdf and the proposal from Management is available here: http://dwd.wisconsin.gov/wc/councils/wcac/mgmt%20proposals.pdf. In particular, note the following proposals:

Management:

Medical fee schedule. Establish a medical fee schedule that uses Medicare rates as the basis for the schedule. Providers to be paid 175 percent of the then-current Medicare rate.

Employer directed care. Allow for employer-directed care for the first 90 days after an injury. Where there is a union agreement covering the workplace, allow Labor and Management to negotiate regarding this provision, to agree upon a panel of providers and to create incentives for the use of agreed-upon panel of providers.

Statute of limitations. Reduce the statute of limitations from 12 years to three years.

Treatment parameters. Implement the current treatment guidelines as treatment parameters. For treatment outside the scope of the parameters or alternate treatments, require that the treating physician contact the carrier or self-insured employer to discuss the treatment plan with a medical professional before providing care. If the carrier or employer denies further care, it shall state the reasons why in writing. The treating physician can appeal the decision of the carrier/employer to the Department of Workforce Development (DWD).

Labor:

Surgical implant fee formula. Establish a limitation on pricing for implanted devices based on the provider’s invoice cost for the device (after all discounts or rebates applied) plus a 10 percent markup over the net cost.

Pharmacy fee schedule. Apply the pharmacy fee schedule to health care provider office-provided medication.

Electronic medical records. Allow medical providers to provide copies of medical records in electronic format for a fixed per-request fee of $20.

Medical expense liability equity. Require DWD hearing awards for medical expenses to provide the health care provider the same remuneration for medical care whether it is a conceded case or won by the applicant at hearing. Provide an attorney for applicant fees limited to 20 percent of the medical expenses that are unpaid as of the time of the hearing.

Given the tremendous uncertainty in the health care system at both the state and federal levels, WHA is concerned that adding another unknown variable to the system will jeopardize the access to excellent health care injured Wisconsin workers have relied on for over 100 years. WHA is working with its member hospitals, health systems and its partners to protect the Wisconsin Worker’s Compensation system.

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Berwick to Health Care Leaders: "No Other State Carries Quite the Heft as Yours"
Commends WHA, member hospitals, for achieving "stunning" quality improvement results

At a WHA-sponsored luncheon event, Don Berwick, MD, commended Wisconsin health care leaders for their commitment to quality improvement.

"No other state carries quite the heft as yours," he told about 50 health care leaders gathered in Wisconsin Dells March 12. "You have world-class leaders here."

In his remarks, Berwick said he believes "proper public policy" would liberate health care clinicians, leaders, trustees, patients and families "to do well."

"There is a skepticism and jadedness that the only way to ‘rescue’ care is to ‘hurt’ care (through payment cuts)," according to Berwick. "There are those who feel the need to change. In this state, you are making changes; you are collaborating and putting your energies together, measuring your successes and proving them to yourself and others. There are those who know that better care is a way to save money."

WHA President Steve Brenton referenced the fact that WHA’s newest quality report documents Wisconsin hospitals’ progress in raising the standard for high quality, safe care that delivers value to patients, insurers and employers. Berwick called the results outlined in the report "stunning" that showed hospitals’ progress in reducing infections and preventing patient harm. He acknowledged that improving quality is difficult, but critically important work.

"I commend you for your leadership and commitment," Berwick said, "You are lucky to live in a part of the country where you care about health care costs. Don’t ever let up. Play a different game and lead the country. It is important that you just keep going. Fight the battle."

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Berwick Praises WHA Effort to Help Hospitals Improve Quality, Safety
"Change is taking place because we can see it in Wisconsin…you are on the right path."

As Don Berwick, MD, looked out across the crowd of almost 500 hospital staff members representing nearly every hospital in the state of Wisconsin, who are all participating in the WHA Partners for Patients initiative, he was duly impressed.

"You lead the country…and it is almost mystical how involved you all are in this collaborative effort," he told the standing-room only crowd assembled in Wisconsin Dells March 12. "I remember when this initiative was born in the White House in the new CMS Innovation Center. I was there because of the Institute of Healthcare Improvement 100K Lives work. We knew we could harness some new resources for the (health care improvement) effort, and look at it now. You are here working on it (Partnerships for Patients). It is marvelous to see."

Berwick recognized WHA Chief Quality Officer, Kelly Court, for her leadership in helping hospitals to improve quality in Wisconsin.

"If you are into quality, think about what you want to learn and have a system. Kelly is teaching you how to change systems. And we know this change is taking place because we can see it in Wisconsin," Berwick said.

Berwick described how "new bridges" must built that help to broaden the view toward health care improvement.

"Today, we can do miraculous surgery, and we have cures for diseases and conditions that in the past were not curable. That is the first bridge—we have produced miracles," he said. "But the other need is to produce healthy communities, to be truly patient-centered in our hospitals and to create a health-production system that is capable of allowing us to live long and to live well. We need to discover different miracles that have not yet been built."

Standing in a room surrounded by poster boards that documented the progress that Wisconsin hospitals are making to improve health care quality, Berwick noted that "every system is perfectly designed to achieve exactly the results it gets, but these poster boards illustrate system change."

Berwick said it is not easy to change health care. It requires the best minds and a united society, but the major issue is economics. Governors are making choices, according to Berwick, between health care and other priorities.

As the former administrator of the Centers for Medicare and Medicaid Services (CMS), Berwick said he is all too familiar with what he referred to as the "rancor that has enveloped Congress and created political polarization" that has "confused the public and led to a loss of authentic dialogue" in Congress. However, Berwick called upon health care professionals to lead reform and the improvement of American health care as a system.

"Act locally—here in your state, in your community," Berwick said. "If I need proof that this is possible, I come here because you are on the right path. I just ask that you don’t let up, and stay on course."

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OCI Health and Life Advisory Committee Discusses Insurance Exchange

The OCI Health and Life Advisory Committee met March 11 and shared important and timely information to a forum for stakeholders interested in the upcoming changes to the health care market in Wisconsin. Despite the fact that the state will have a federally-facilitated health insurance exchange (FFE), OCI recognizes the need for information sharing and their role in continuing to regulate the market in general.

OCI is working on a website for consumers to share answers to frequently-asked questions about the major changes for health insurance in 2014. The website will also include information such as links to the essential health benefits package and other important consumer information.

Recent announcements, guidance and letters from the federal government about the health insurance exchanges were also discussed by the group. OCI staff noted the announcement by the federal government that a key functionality of the exchange for small businesses—employee choice—will not be implemented on January 1, 2014 for states with an FFE. The timeline for insurers to file rates to participate in the exchange was also noted, as the deadline is fast approaching (see related story on new guidance on FFEs from CMS above).

One important change for insurers in 2014 is rating areas. Currently, insurers in Wisconsin are allowed to set their own geographic rating areas as long as it is actuarially justified. In 2014, HHS is allowing Wisconsin 16 rating areas. OCI plans to submit a proposal to CMS that would provide for 16 rating areas along county boundaries. A map to the OCI proposed rating areas can be found here: www.wha.org/pdf/geographicRatingAreas.pdf

On legislative issues, OCI noted that they expect to see statutory language related to regulating navigators, including training requirements as well as requirements around liability. In addition, OCI noted that they are working with the HIRSP authority on language that would end the HIRSP program. The HIRSP Board voted to end the program on December 31, 2013, or when the health insurance exchange is operational. HIRSP is working on a comprehensive communications plan to notify members as soon as possible about the change.

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DHS Prepares for Medicaid Primary Care Rate Increase

Although the Affordable Care Act (ACA), requires states to raise their Medicaid fees to Medicare levels for family physicians, internists and pediatricians for many primary care services, the lack of CMS rules until late last year and the complex nature of system changes is causing a delay in getting those payments out the door. But DHS has plenty of company. It has been widely reported that no state is yet ready to implement the payment change.

Kaiser has estimated for Wisconsin an average increase of 78 percent in physician fees as a result of this policy—an indication of the low rates of reimbursement in our state Medicaid program. The primary fee increase applies in 2013 and 2014, is fully federally funded up to the difference between a state’s Medicaid reimbursement amounts in effect on July 1, 2009 and Medicare reimbursement rates as determined under a formula for 2013 and 2014. The payment is no longer funded after 2014, leaving many to wonder what will happen when 2015 hits.

In the meantime, DHS is working on implementation. States are required to submit state plan amendments to CMS by March 31. Although they are on track to meet that deadline, DHS estimates it will take much longer to complete the complex system changes that are required. Once implemented, payments will be retroactive to January 1, 2013. Physicians in both fee-for-service and managed care environments will be eligible for the enhanced rates for evaluation and management services (codes 99201 through 99499).

To qualify for the higher reimbursement, physicians will have to demonstrate that they are board certified, or must attest that 60 percent of the Medicaid services they provide are within the applicable code set. WHA has encouraged DHS to finalize the attestation process as soon as possible, even if full system changes to implement the rate change aren’t yet in place. DHS expects the attestation to be rolled out in the spring, although system implementation may run into the summer months.

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Boyle Shares his Amazing Medical Journey
Praises health care team that saved his life

In the summer of 2004, Brian Boyle was just 18 years old, but in a second, his life changed forever.

Driving home from swim practice, a speeding dump truck slammed into his car, thrusting his heart across his chest, breaking most of his ribs, clavicle, pelvis, collapsing his lungs, with a blood loss of nearly 60 percent that damaged every major organ in his body, leaving him in a coma and on life support for two months at a hospital in Maryland.

On Tuesday, March 13, Boyle shared his experience at the WHA Partners for Patients "Catch the Wisconsin Wave" event in Wisconsin Dells.

"I have the privilege to stand before you all as a former intensive care patient and proudly present the result of the life-saving abilities of modern medicine and health care," Boyle said. "What you are doing truly saves (patients), you save families, you save communities, and that is a result of your hard work, your expertise and your dedication to what you do."

Boyle recalls his fight to stay alive. "My trach clogged, I turned purple one day, I had staph infections, I got pneumonia from the ventilator," he said. "But those things happened, and I made a full recovery and speak about the positives of my experiences. Certain things did happen, but I speak about the positives, and the communication and interaction."

Boyle said the most important message he shares with health care audiences is the importance of both verbal and non-verbal communication.

"When my medical team came into my room, I could sense by their energy, by their body language, their gestures, their mannerisms if they were having a good day or bad day," Boyle said. "If they were having a good day, it would reflect well on me. If they were having a bad day, it would reflect badly on me."

Boyle recognized the professionals in the room and praised them for working together to improve quality.

"Collaboration brings forth miracles," he concluded.

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Governor Signs First Workforce Bill in WI Fast Forward Legislative Initiative

Governor Scott Walker signed Assembly Bill 14 into law March 13, creating a state-funded grant program for workforce education and training within the Department of Workforce Development (DWD). The bill appropriates $7.5 million annually for public and private organizations to provide additional workforce training to new and current employees. The initiative was announced prior to the Governor’s budget address, as part of a workforce package that also included significant investments in Graduate Medical Education (See Feb. 15, 2013 edition of The Valued Voice).

During the legislative process, the bill was amended to require DWD to implement a labor market information system to collect, analyze and disseminate information on current and projected employment opportunities in the state. The bill also establishes positions within DWD in the new Office of Skills Development to administer these worker training grants.

The bill reverses a trend of only federally-directed funding and programming for Wisconsin and Wisconsin’s workforce. It creates a state-based process for helping employers and public and private institutions train the workforce that Wisconsin needs while preparing unemployed and underemployed workers for family-supporting Wisconsin jobs.

These initiatives, along with others included in the Governor’s budget proposal, are aimed at preparing students and current workers for job opportunities that are available and in demand now in Wisconsin.

WHA supported the ‘Wisconsin Fast Forward’ legislation because it is another significant investment in workforce development that helps employers recruit and retain employees through training and education. Also, WHA’s 2012 Health Care Workforce Report recommended that the state begin collecting professional workforce data and establish a statewide entity to utilize that data for employers. WHA is pleased to see the emphasis on workforce data collection in this legislation and looks forward to working with the Governor, DWD, and the Legislature to enhance the collection of data for Wisconsin’s health care workforce.

Wisconsin’s health care industry supports more than 13 percent of Wisconsin jobs, employing over 300,000 people. The WHA’s 2012 Health Care Workforce Report has identified key recommendations that will be crucial to ensure the proper workforce is in place for Wisconsin’s hospitals. As more people retire out of Wisconsin’s health care workforce, Wisconsin will see a growing need for highly skilled and knowledgeable staff to fill these positions. With this additional training funding, organizations like Wisconsin hospitals will be able to provide employees even greater opportunities for advancement in their own careers.

In a prepared statement, the Governor said, "The bipartisan and nearly unanimous support for our ‘Wisconsin Fast Forward’ legislation shows how important it is to develop our state’s workforce and close the skills gap. We all agree we need to continue to do everything we can to ensure workers have the necessary skills for the jobs available today."

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Wisconsin Health News Panel Tackles Mental Health

Mental health reform was the topic of discussion at a March 14 Wisconsin Health News panel sponsored by the Wisconsin Psychiatric Association. Panelists included Dr. Jeremy Lazarus, president of the American Medical Association and the first psychiatrist in 72 years elected to that position; Rep. Sandy Pasch (D-Shorewood), vice chair of the Speaker’s Task Force on Mental Health; Kevin Moore, deputy secretary, Department of Health Services; Dr. Jerry Halverson, a psychiatrist with Rogers Memorial Hospital and member of WHA’s Mental Health Task Force; and Paula Beuge with Wisconsin Family Ties.

Rapid changes in how care is being delivered to individuals with mental health was a consistent theme of the panel.

"Mental health care is rapidly transitioning into an integrated care setting," according to Lazarus. The integration of mental health care into a team concept and moving away from a fractured system of mental health care was a theme throughout Lazarus’ discussion.

The panel discussed fostering integrated care and coordination between a patient’s psychiatrist and other treating professionals through changes to Wisconsin’s mental health records laws. These changes would remove state law barriers to integrated and coordinated care that do not exist in federal HIPAA privacy and security laws.

Halverson said that the reforms in the WHA-supported HIPAA Harmonization and Mental Health Care Coordination Bill are necessary to break down Wisconsin statutory barriers that "are getting in the way of care patients could be given to treat the whole person." Halverson said that this is an issue of quality of care and "treating mental illness like any other illness."

Beuge said that some consumer advocates are concerned about making such a change because of the stigma that surrounds individuals with mental illness, though she added that in the provider community "no one is doing it intentionally."

Pasch said that there are very good arguments on both sides of this issue. In regards to breaking down communication barriers, she also added that the clinical community needs to better understand what individuals with mental illness experience and needs to work to avoid making assumptions about mental illness that shouldn’t happen.

Deputy Secretary Moore touched on the multiple reforms in Governor Walker’s proposed budget and added insight on potential future infrastructure reforms.

Moore said DHS is looking at the infrastructure of how mental health services are delivered. The Department is also re-examining the county-based mental health system. As part of that review, Moore indicated that DHS currently has two pilot programs looking at regional delivery of services.

"There are some counties that are very advanced, and there are some that have nothing," said Moore. "We can do better."

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CMS Alters Rebilling Policy

This week the Centers for Medicare & Medicaid Services (CMS) released two items regarding rebilling for Part B payment when Medicare Part A claims have been denied because the beneficiary should have been treated in the outpatient setting rather than be admitted to the hospital. This has been an area of significant concern to WHA and its member hospitals along with many others across the country.

The first of the two items released by CMS is a proposed rule, which applies to all hospitals, including Critical Access Hospitals, and covers rebilling prospectively. The rule proposes that if the beneficiary is enrolled in Part B, Medicare would pay for all reasonable and necessary Part B hospital inpatient services when a Part A inpatient admission is denied as not reasonable and necessary or when a hospital determines that a beneficiary should have been treated as an outpatient, rather than admitted to the hospital. Part B inpatient claims filed in accordance with the policies established under the proposed rule would have to be submitted within 12 months of the date of service, consistent with the statutory timely filing requirements.

"While we are pleased that CMS is making important steps in the right direction to adjust its rebilling policy," said WHA’s Vice President of External Relations & Member Advocacy Jenny Boese. "We are concerned that the policy does not go far enough and will restrict hospitals’ ability, especially with respect to the timely filing requirement, to receive reimbursement for all reasonable and necessary services provided."

WHA will submit comments to CMS on the proposed rule.

The second item issued by CMS today is an Administrator’s Ruling to address appeals that are already pending relating to Part A hospital inpatient reasonable and necessary denials. Under the Administrator’s Ruling, Medicare will pay for all Part B inpatient services that would have been reasonable and necessary if the beneficiary had been treated as an outpatient, rather than admitted as an inpatient (except for services for which an outpatient status is required). Hospitals that have Part A appeals pending will need to withdraw them to seek payment for all Part B inpatient services. The Administrator’s Ruling will apply until the proposed rule mentioned above is finalized and a final rule is issued.

Finally, due to these developments, CMS is terminating the Part A to B Rebilling Hospital Demonstration. Instructions to participating hospitals will be forthcoming from CMS.

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13 Wisconsin Hospitals among Top 100 Critical Access Hospitals in Nation

Wisconsin had the most hospitals of any state—13 in all—named to the HealthStrong™ Top 100 Critical Access Hospital (CAHs) list for 2013.

Hospitals making the top 100 list scored best among CAHs on iVantage Health Analytics’ Hospital Strength Index™. This index is the first-ever comprehensive rating of CAHs, measuring them across 56 different performance metrics, including quality, outcomes, patient perspective, affordability and efficiency. The top 100 list is compiled in an unbiased, independent manner by iVantage. All CAHs in the country are considered for inclusion on the list.

The 13 hospitals are:

There are more than 1,300 CAHs throughout the United States. For a complete list visit: www.ivantagehealth.com/wp-content/uploads/2013/03/Top-100-CAH-List_new.pdf

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Wisconsin Hospitals Community Benefits: Injuries and Violence

A teen arrives in the emergency department by ambulance following a terrible car accident. A child receives head injuries while bicycling without a helmet. A woman walks into the emergency department with injuries inflicted by an abusive spouse. These are stories of pain and tragedy that hospital personnel see all too often. Injury is the most under recognized major public health problem facing the country and it is the leading cause of death in people ages 1 to 44 in Wisconsin. Wisconsin hospitals devote significant resources to reduce the number of intentional and unintentional injuries that occur in the communities they serve.


Free car seat safety: using it right!

St. Croix Regional Medical Center offers free car seat safety checks for parents of any age child as a community service as four out of five seats are installed incorrectly. As SCRMC is committed to injury prevention, during the installation and inspection by our certified car seat technician, family members learn how to keep their little ones safe using an age and size appropriate car seat installed correctly.

We know parents love their children, and they want to do everything possible to keep them safe. But, are they buckled in safely every time they ride in the car? Does the seat provide the safest fit? Is the seat installed correctly? To be sure, SCRMC offers this free injury prevention service to encourage safe, effective use of a car seat to protect children from injuries in motor vehicle accidents.

Parents (or grandparents) can come with the child, the vehicle, and the instructions for both the vehicle and safety seat being used. A certified car seat technician will examine the seat to ensure it is safe, check the seat’s components, check to see that the seat is not under a product recall, be sure that the seat is appropriate for the child using it, and teach the proper installation techniques so caregivers are comfortable using the seat.

Jenny and Dave Kirchberg, parents of two girls, ages six and two, regularly get their car seat inspected. "We really appreciate this free safety check, offered conveniently at SCRMC, helping to keep our girls riding safely as they grow. They are both very precious to us!"

The inspections which take approximately a half hour are valued at $25. Also to maintain certification, the technician must submit five hours of continuing education and 6-10 hours of hands-on review signed off by a senior inspector. During the last year, Sarah Shaw, education specialist at SCRMC, has provided almost 50 free car seat inspections since March of 2012, a total value estimated at $1,600.

St. Croix Regional Medical Center, St. Croix Falls


Choose Safe takes message to the community

Sometimes it’s the small things we do that make a permanent difference in life. With Choose Safe, the Trauma Center at Froedtert & The Medical College of Wisconsin aims to change those little actions into injury prevention rather than a life-threatening trauma.

"Serious injuries can often be predicted and avoided," says Lisa Hass-Peters, RN, injury prevention coordinator with Froedtert’s trauma team. "When people take time to think about their actions, they really can reduce their level of trauma risk. Our goal with Choose Safe is to draw attention to unsafe situations in everyday life, like driving without a seatbelt or skateboarding without a helmet."

Choose Safe gets its message out through injury prevention outreach in the community, customized presentations to community groups, and an interactive website. One of the most impactful programs is Forever Changed, a car crash simulation that Lisa and her team take to area high schools. The program involves real cars staged in a crash on the school grounds, participation by local emergency rescue services in the scenario, student actors from the school, and on occasion, Flight for Life. Choose Safe puts on the highly realistic simulation for up to four high schools each semester.

Parents, teachers, students and community groups can explore Choose Safe’s website for interesting activities and downloadable safety resources. Choose Safe also spreads the word about safety through a series of free downloadable posters. The posters address drunk driving, distracted driving, sports-related brain injuries and other safety risks with eye-catching images and surprising data.

"All it takes is a small change in your behavior or environment to increase safety for your family, your friends and yourself," says Lisa. "We hope everyone will take a look at the Choose Safe website, and pass the message on to their children, friends and co-workers."

For more information on Choose Safe, visit www.froedtert.com/choosesafe or call 414-805-3666.

Froedtert & The Medical College of Wisconsin, Milwaukee


SANE picture book helps child victims

While all sexual assault victims are treated with respect and dignity, child victims need a special approach. That is why the SANE story picture album was developed. It is a tool that helps explain openly and honestly what a child will experience during their examination process. The red book contains 8x10 photos in clear sleeves depicting the step-by-step process.

"The book allows us to sit with the child and parent/parents and walk them through everything that will be happening," said Dana Stueber, BSN, SANE-A, SANE-P team leader. According to Stueber, "Honesty is vitally important in dealing with children and helps develop a trust that is crucial for the examination and collection of evidence."

Unfortunately the book is used often. St. Vincent Hospital SANE records show sexual assault victim ages range from three months to 91 years and approximately half are under the age of 18.

"We found that with more knowledge there is less fear and this increases the child’s trust in the nurse."

They say a picture is worth a thousand words. In the case of children examined by SANE nurses, this picture book is worth so much more.

"It simplifies and humanizes the highly technical process and helps put the child more at ease during such an emotional and stressful experience."

St. Vincent Hospital, Green Bay


Promoting bike helmet use

The staff of the emergency department at Mayo Clinic Health System in Sparta is working hard to make bike helmet use a priority in their community. In cooperation with the Knights of Columbus, they provide bike helmets to all school-age children in the Sparta Area School District. The organization also donates funds to purchase gift certificates for free ice cream cones that the Sparta Police Department’s Bike Patrol gives out to any child seen wearing a bike helmet.

When a child who has been in a bike accident comes to the emergency department, he/she is given a free bike helmet to take home. If anyone in the community cannot afford a helmet, they can get a free one from the hospital.

Emergency department nurses and staff also spend hours educating the community about bike helmet use at various wellness fairs and events such as the opening of the Elroy-Sparta State Trail each spring.

Mayo Clinic Health System-Franciscan Healthcare in Sparta

Submit community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

Read more about hospitals connecting with their communities at www.WiServePoint.org.

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