April 29, 2011
Volume 55, Issue 17
WHA 2011 Advocacy Day Crowd Shatters Past Attendance Records
Clouds lingered over Madison April 27, but the threat of rain didn’t dampen the enthusiasm of the more than 700 hospital advocates who attended the Wisconsin Hospital Association’s 2011 Advocacy Day. The record-shattering crowd arrived by car, bus and motor coaches to converge on Madison to demonstrate their commitment to Wisconsin’s community hospitals by learning more about pertinent health care issues. Later, more than 450 hospital advocates met with their legislators in the State Capitol.
In his opening comments, WHA President Steve Brenton announced that it was "the biggest Advocacy Day in WHA’s history."
WHA Chair Nick Turkal, MD acknowledged the level of commitment among the advocates in the room.
"You have traveled from all corners of our state this morning to ensure that legislators know where you stand on the issues that matter most to our patients," Turkal noted in his opening comments. "Our voice is loud, and we can make a difference!"
Turkal encouraged the advocates to remind legislators that hospitals are economic drivers in the communities they serve. He said he has been an outspoken advocate on reframing how policymakers and business leaders view health care.
"Health care should not be viewed just as a cost of doing business, or simply as an important part of the health and wellness of our citizens, it is also as an economic force," according to Turkal.
The economic future of Wisconsin is still not certain, and discussions are focused on job creation and growth. Turkal noted that throughout the recession, hospitals were one of the industries that were able to provide a stable source of jobs and provide economic growth in the state.
"With a $22 billion annual economic impact in Wisconsin, along with providing hundreds of thousands of jobs, we in health care make a difference – and we have the potential to do more," Turkal said.
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Governor Walker: Medicaid Provider Reimbursement Cuts "Not an Option Here"
Says provider Medicaid cuts essentially become a "hidden tax" on employers
Speaking before a record-setting Advocacy Day crowd, Governor Scott Walker acknowledged that a "good chunk of the state’s budget deficit is related to the rising cost of Medicaid." To shore up the program, the Governor committed $1.3 billion of general purpose revenue (GPR) to Medicaid in his budget. "Other states have looked at things like changing the reimbursement rates for medical providers," according to Walker. "That is not an option here. That just gets passed on. That is just a hidden tax on employers."
The Governor referenced a recent editorial he penned that ran in the New York Times. In it, Walker noted that the current Medicaid system has not seen any fundamental changes since 1965. The Governor favors administering the Medicaid program through a block grant system, allowing states to have more flexibility over the program.
"We need to provide for the people in need, but we need to do it in a way that makes sense," Walker said. "We have been leading the way for years in our community hospitals around the state," Walker added. "We should not just be paying for procedures; we should be paying for a whole package (of care)."
Wisconsin health care providers have been early adopters to systems of care that connect patients with medical homes while also providing services aimed at prevention to hold down health care costs.
"We could show the rest of the country and the world how to do that, but because of the arcane rules of Medicaid, we don’t have that flexibility," according to Walker. "We could still provide that basic safety net, and we could do that without the medical providers having to absorb more and more of the cost of unsubsidized care, and we can do so in a way that provides long term stability, not just for those in the medical profession, not just for our hospitals, but ultimately for our state as a whole."
As WHA President Steve Brenton emphasized in his introduction of the Governor, Walker’s tort reforms will advance quality improvement. The WHA-supported Quality Improvement Act, signed into law earlier this year, helps health care providers improve quality by promoting the sharing of information among medical professionals.
"We expect colleagues to look at the work of others and help them improve," he said. "And we need to ensure that they are not constantly under fire and that there is a free and open forum. We need to put all those things in place, but we also said we need to make changes in our budget so we can continue to provide for those who face the greatest need here in the state of Wisconsin. We have got to continue to provide a basic safety net."
Walker’s plan to bring Wisconsin’s economy out of the doldrums and create jobs begins with the words, "Wisconsin is open for business." And the new Governor believes hospitals have an important role to play in creating that new economic future.
"The quality of health care and how we provide it will be a benefit for all our citizens," Walker said. "That is going to be a core attraction not for just more residents, but for more employers who want to come to a state that provides that kind of quality and cost effective care at the same time. That is our goal."
The biggest challenges facing Wisconsin, according to Walker, are economic and fiscal. Too many jobs are leaving the state. Health care has a tremendous impact on businesses in terms of cost, but Walker believes the conversation also needs to include a discussion about quality and evidence-based care.
"We need to talk about health care, quality and job creation and find more ways to improve the quality of care and contain costs," Walker said. "Sometimes they (business) only talk about health care cost, but quality is also important."
"You have our commitment that we are going to move forward and not just tread water," Walker said. "You are on the cutting edge of providing quality, cost-effective health care in the State of Wisconsin. We want to find more ways that we can highlight your leadership and success, and we are going to show the rest of the world that Wisconsin can lead the way."
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"We are living in a period of volatility and elasticity where things are moving fast," according to Oshkosh-native Jim VandeHei, who delivered the keynote address at the WHA 2011 Advocacy Day. "For the next ten years, things will just be unsettled."
VandeHei, co-founder and executive editor of Politico in Washington, DC, attributed the lack of stability to the quest for democracy in the Middle East and in other parts of the world combined with the fact that the United States is active in three live wars. When those factors are mixed in with the current political situation in the United States, it fuels instability.
"We live in a global economy. When big things happen in little places now, it has ramifications on us. We pay for turmoil in the Middle East at the gas pump," said VandeHei. "The tsunami in Japan has had a real affect on our economy--there is a big spillover effect. Everything is interconnected, and it is inconceivable that it will change anytime soon."
In the United States, politics have taken an interesting, if not frustrating turn, as the country is nearly evenly split into two political camps. When he is asked what direction politics are moving, VandeHei says truthfully, there is no movement. While attempts are made to draw conclusions about where the country is heading after an election, the reality is the country is so deeply divided it makes it nearly impossible to predict the future. The party in power has a tendency to "over reach" and alienate the independent voters that favor less government—and swing elections.
The repeal of health reform has emerged as the litmus test for politicians. VandeHei said in the upcoming Presidential race, he predicts that successful candidates will be those that come out against health reform, which he believes may cause President Obama to consider changes to his current package of health reforms.
Politicians do not like to do things that are politically difficult, but doing nothing is no longer an option, according to VandeHei.
"I don’t know anyone who thinks we can do nothing. That is what DC has done for a long time," he said. "Politicians don’t do any difficult political things, but there is an emerging consensus that the public wants to see change in these systems."
Politicians that are doing difficult things get noticed. He pointed to what Governor Scott Walker is doing in Wisconsin, which has made Wisconsin a "state to watch." Congressman Paul Ryan is another Wisconsinite to watch.
"On most days, Paul Ryan is the second most powerful person in the country," according to VandeHei. "He is the mastermind of Medicare and changes to the budget. He talked about this plan a year ago, but no one wanted to touch it. Suddenly, they have rallied around it. He pushed in defiance of everything."
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The legislative panel discussion is among the most popular—and often most lively—aspects of Advocacy Day, and this year was no exception. Moderator Eric Borgerding, WHA Executive Vice President, introduced the four distinguished members of Wisconsin’s Legislature serving as panelists. They included:
Here are a few excerpts from their discussion:
Borgerding: The Governor’s budget includes an important influx of $1.3 billion general purpose tax dollars back into Medicaid. Do you support the $1.3 billion being put into the Medicaid program? What should the state do to address the rising costs of the program to ensure that it remains as a safety net for our neediest citizens?
Darling: I support the $1.3 billion in the state budget going into Medicaid. I also support Medicaid reform. The Medicaid budget hole is growing and unless we reform the cost and delivery of Medicaid, we will not be effective in using resources in other places … Our priority should be to encourage a healthier citizenry.
Jauch: Remember we are not protecting a program, but we are protecting people…You have to realize that when this program is impacted, fewer people will have insurance and more cost will be transferred to private payers. People will still need care, and they will depend on our emergency rooms.
Severson: I support the $1.3 billion of general purpose revenue to support the Medicaid program … We need to try to look at more efficient ways to manage this and how we are going to serve the people that are truly in need. If that means those services are diverted away from those that don’t really need it, such as those that have access to other insurance [then] that is one way we could save money and use it for those that are truly in need.
Seidel: I think it is critical we look at getting all the efficiencies that are necessary and look at the significant cost drivers of Medicaid. Chronic disease and issues like obesity are problems throughout our state, especially with our young children, and we need to address those because of what it will mean to our future.
Borgerding: We have a very serious, identifiable crisis on the horizon, which is a pending shortage of physicians. With that in mind, as a state, what can Wisconsin do to address what we know is the coming physician shortage?
Seidel: This is an extremely complicated issue … We need to figure out ways to provide incentives to interest those in the medical field to enter family practice and then reward them for the work they do with their patients around prevention and case management. It is very difficult for us to do in today’s current economy.
Severson: It is complex … One of the things we have talked about before is another medical school to bring in more people into the physician field. That will cost money. I would favor another medical school especially if it is in western Wisconsin … Loan forgiveness would be a fantastic way to go, however, the question is where would that money would come from?
Jauch: Government has to invest resources in a smart way to make sure that people have opportunities to access care in rural Wisconsin the same as they do in more populated areas. The Wisconsin Academy for Rural Medicine (WARM) has added 25 more medical students that are specifically going into family medicine…I am deeply concerned that if we fail to provide adequate reimbursement we won’t have providers who will serve those populations.
Darling: The issue is how will we be able to grow more physicians in Wisconsin? The economic medical malpractice environment definitely affects our ability to attract physicians…If we keep our legal environment very competitive and create a good environment for our physicians to do business here, we will attract and keep our physicians.
Borgerding: Legislation is being drafted that will allow the carrying of concealed firearms in Wisconsin. What are your thoughts on this legislation and what do you think about allowing some organizations to be exempt or to allow individual property owners to decide whether concealed weapons are allowable?
Severson: I think it is a good bill. I agree that individual property owners, whether it is a hospital or a gas station, should have the right to not allow concealed weapons. I support concealed carry and I support individuals saying "not on my property."
Seidel: I oppose concealed carry, however I think it is safe to say in the current legislative environment we will see this legislation move forward and it will pass. There will be many conversations as we move forward as to where the right to carry will not be permitted. Health care facilities will be one of the prime locations that will be under discussion.
Jauch: I opposed it in the past…When it is introduced, I hope that there are some specific restrictions on who is able to get one of these. We would want to exempt the state capitol, schools, and health care facilities.
Darling: I support concealed carry. We are only one of four states that do not allow it. Hospitals and schools should be exempt. Private property owners should be able to say I don’t want guns on my property.
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In his introduction of Wisconsin Governor Scott Walker, WHA President Steve Brenton made clear the connection between the WHA mission and the Association’s advocacy efforts. Brenton explained that WHA’s mission is to help foster an environment in which community hospitals are able to provide high quality, affordable and accessible health care services resulting in healthier Wisconsin communities. The regulatory environment, according to Brenton, must help foster public reporting of patient outcomes and it must promote and encourage clinical teamwork necessary to improve performance.
Just eight weeks ago, Governor Walker championed and signed into law the Quality Improvement Act, legislation that WHA and the medical community has supported for years. That new law, Brenton said, will help foster a non-punitive environment for provider collaboration leading to clinical performance improvement.
To ensure access and sustain a positive medical malpractice environment, Governor Walker’s budget proposal includes a plan to restore over $200 million taken from the Injured Patients and Families Compensation Fund a few years ago to finance a previous budget’s red ink.
"That commitment, along with Governor Walker’s long history of favoring a reasonable medical malpractice environment, positions Wisconsin well for recruiting and retaining tomorrow’s medical professionals," according to Brenton.
Brenton emphasized the need for a financially-sustainable Medicaid program that is a safety net for Wisconsin’s most vulnerable citizens. Governor Walker inherited a Medicaid program in severe deficit—over $1.8 billion—when he began his term in January. Much of that deficit is backfilled in his biennial budget legislation, which was not an easy decision, but it demonstrates a real commitment to make tough decisions on behalf of one million of Wisconsin’s most financially-fragile citizens.
"Nothing that any of us do in health care policy making is without controversy. It is an arena that requires bold thinking and leadership," Brenton said. "Governor Walker’s new health care team, in just three months, has demonstrated that they want to be problem solvers and that Wisconsin’s community hospitals are partners in that journey."
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Senator Luther Olsen (R-Ripon) received WHA’s 2011 Health Care Advocate of the Year Award April 27 at WHA’s Advocacy Day in Madison. The WHA annually presents the award to an individual who demonstrates outstanding efforts on behalf of Wisconsin hospitals and a strong commitment to health care policy.
Well known for his bipartisan approach to policy making, Olsen was instrumental in passing the 2010 Rural Healthcare Access Act, one of WHA’s top priorities last year. The bill was approved by both the Senate and Assembly on Advocacy Day last year. This bipartisan legislation not only restored a harmful 10 percent Medicaid cut to rural hospital reimbursement, but it also set aside $1 million annually to invest in more rural physician residencies and bolster the rural physician loan forgiveness program.
"Those dollars are having an impact as we speak," said Paul Merline, WHA vice president, government affairs, who presented the award. "And they simply would not have been possible without the bipartisan efforts of Senator Olsen."
Last year Olsen was appointed as vice chair of the Joint Legislative Council’s Special Study Committee on Health Care Access. This year he became chair of that committee which, among other things, was directed to study potential solutions to the shortage of health care providers, particularly in rural areas and inner cities.
He also brings the perspective of an urban teaching hospital to the Capitol through his appointment as a member of the University of Wisconsin Hospital and Clinics Authority Board.
Senator Olsen was joined in the Advocacy Day audience by representatives of several of his district hospitals including: Divine Savior Healthcare in Portage, Ripon Medical Center, Riverside Medical Center in Waupaca, and St. Clare Hospital and Health Services in Baraboo.
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Ministry Saint Joseph’s Hospital of Marshfield was presented with the 2011 Advocacy All-Star Award at WHA’s Advocacy Day held in Madison this week. In front of 750 hospital peers, President & CEO Brian Kief accepted the award on behalf of the hospital. The award is given out to one hospital that exemplifies dedication to grassroots advocacy.
"Ministry Health Care works as one ministry here in Madison and in Washington advocating on issues that are really important to all of us," said Kief in accepting this year’s award. "Most importantly I want to thank the team at Ministry who’ve made advocacy one of the top priorities."
In the past year, Ministry Saint Joseph’s Hospital has hosted their legislators multiple times, including one "shadow day" opportunity. Shadow days are when elected officials shadow a hospital CEO to see all that it takes to run a hospital in today’s health care environment. Kief hosted State Rep. Vruwink.
"Ministry Saint Joseph’s Hospital has elevated their grassroots activity this past year," said Jenny Boese, WHA vice president, external relations & member advocacy, in presenting the award. "From shadow days to increased participation in WHA’s grassroots program, they are a model for others to follow."
The hospital significantly increased its participation in WHA’s grassroots program, HEAT. They now have 68 HEAT members, 52 of whom were recruited in the past year. In addition the hospital regularly has more than 20 individuals attend Advocacy Day and participate in the afternoon’s legislative visits.
"Participating in government affairs activities really does need to be an integral part of the job we do," said Kief in accepting the award. "I know we all are busy, but adding time to build relationships with policymakers who impact our futures is but a fraction of that time. So in that vein I want to commend us all for taking the time to be here today and to build those relationships with our state representatives up at the Capitol."
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It is what WHA Executive Vice President Eric Borgerding believes is the most valuable aspect of WHA’s Advocacy Day…the capitol visits with legislators. This year, nearly 500 hospital advocates made the trek down Martin Luther King Boulevard to the State Capitol to personally visit with their elected representatives.
"Your hospitals are the safety net of this health care system and the economic backbone of so many Wisconsin communities, you have one of the best stories to tell in the entire state," Borgerding said during the briefing he held at Monona Terrace shortly before the participants departed for the Capitol.
"Tell that story—don’t be intimidated at the thought of going into the Capitol or talking to your legislators. Today, you are the loudest voice in Madison," Borgerding urged the capitol-bound crowd.
Borgerding reviewed several key issues for the group, which included:
Preserve the Medicaid safety net – First, support the influx of $1.3 billion in general purpose dollars into the Medicaid program. Second, as the Medicaid program looks for more than $500 million in cost savings, support reforms that do not shift costs to employers by cutting Medicaid payments to hospitals, which are already among the lowest in the country.
Oppose the elimination of hospital Medicare "dual eligible" payments – Dual eligibles are those individuals that qualify for both Medicare and Medicaid. They are among Wisconsin’s most vulnerable citizens. The Medicaid program currently pays the hospital coinsurance for this population. The elimination of this payment will shift these costs to other employers and families.
Wisconsin hospitals’ economic impact on the communities they serve – Hospitals are a stable source of family-sustaining employment opportunities, supporting more than a 100,000 jobs annually.
"Hospitals have a massive impact on our local and state economies," Borgerding said. "We purchase more than $13.7 billion in goods and services from Wisconsin businesses and hospitals account for a $28 billion ‘ripple’ effect on the state’s economy."
Wisconsin hospitals serve the community’s health care needs – Hospitals serve all patients, regardless of their ability to pay. In 2009, more than 700 patients received free care in a hospital every day, and hospitals provided more than $226 million in charity care. In addition, hospitals sponsor or participate in more than 60 free clinics statewide.
And, last but by no means, least, Borgerding emphasized the importance that volunteers have in local hospitals.
"You lead the way in your local communities," Borgerding said. "Hospital volunteers logged more than one million hours in 2009, donated more than $2 million to their local hospitals, and awarded nearly $450,000 in health care scholarships. You are truly one of our community’s greatest assets!"
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CMS will hold a national call for hospitals on May 3 from 1 - 2:30 p.m. CDT that will walk through the attestation process for the Medicare electronic health record incentive program. A similar call will take place May 5 from 12:30 - 2:00 p.m. CDT for physicians.
CMS indicates that the agenda for the programs will be the following:
To register for the May 3 hospital program call, go to: www.eventsvc.com/palmettogba/register/584ef9d0-601f-4aa9-8389-f5e775d21c39. To register for the May 5 physician program call, go to www.eventsvc.com/palmettogba/register/33e1738d-1283-4f6c-b56f-551002cb4f45. Registration will close when all available space has been filled, or 24 hours before each call.
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Millie Nutini says that no matter how simple the exercises are, it’s not fun doing them at home.
This no doubt accounts for a steady average attendance of 35 to 40 seniors who come three times a week to the Kenosha Senior Center for group exercise led by Aurora Licensed Athletic Trainer Nikolai "Nick" Laitamaki.
"We just love Nick," Millie states enthusiastically. "He has the greatest sense of humor. When he’s not there, we miss him."
The hour-long fitness class consists of stretching and activities both sitting and standing, Nick explains. But Millie tells it best.
"The whole body gets worked. We start by sitting and stretching our necks, arms and legs. Then we stand behind our chairs and tone and strengthen the rest of our bodies."
Millie credits the classes with keeping her young and able to keep up with gardening and lawn mowing, which she enjoys. She is 78.
Harold Kahlert, 93, is one of the few men who attend the sessions regularly.
"It keeps me in pretty good shape," says Harold, who still cuts his grass and shovels snow – even for the neighbors on either side of his property.
A former drill instructor in the Army, Harold takes over on the rare occasions that Nick can’t make it, and notes that most of the participants are women.
"I slip in a dance step Nick doesn’t know about," he confesses.
The class is clearly popular. Nick has been leading the class for six years and reports that as many as 60 participants have filled the room on some days.
Aurora Medical Center, Kenosha
SPMHC program helps tackle obesity, one small group at a time: "It really is about getting better."
For so many people, addressing obesity is not as simple as trying to lose weight. Conditions like asthma, chronic obstructive pulmonary disease, diabetes or metabolic syndrome can complicate a person’s ability to exercise. Mental health struggles can also contribute to feelings of low self-worth and make it very difficult to garner the motivation to do anything.
It is for people struggling with these problems that Sauk Prairie Memorial Hospital & Clinics (SPMHC) worked with Paul Scharfman to start the Getting Better program with the goal of improving their short-term and long-term health.
The Getting Better program
"It really is about getting better," said Scharfman. "This is a wellness program. People tend to lose weight. But possibly more importantly, their mood improves. Their ability to walk improves. Their aches and pains decrease and their satisfaction with life increases."
Getting Better is a group wellness program that lasts for two-and-a-half years. The groups are small and participants are referred by their physicians.
Participants are surrounded by people just like them. From this, they feel a sense of respect. They talk about their struggles, their successes and what they like to do — together.
Staff, also called leaders, help facilitate the conversations. They don’t focus on what’s been going wrong. They focus on how to enjoy getting better.
"We show them how to enjoy physical activity. We don’t start with walking or huffing and puffing but with stretching and relaxation — which feels good!" said Scharfman.
They also talk about food.
"We try to teach people to enjoy eating less," said Scharfman. "It sounds counterintuitive, but it works really well. Talk about food. Love it, savor it, think about it. You’ll end up eating less. Eat what you want but not everything you want."
And one of the most important skills they work to develop is how to focus on the things that bring pleasure.
Scharfman explained, "If you love a hot bath, take one. But don’t let your mind wander. Take a hot bath and focus on how great it feels."
For the Getting Better program, success is not measured by how much weight has been lost. Success is knowing that the participants feel better. Physically, success is when the participants can walk comfortably.
And so far, the participants have learned to enjoy getting better. Statistics show participants have fewer struggles with symptoms of their chronic conditions and they report their quality of life has improved.
"They tell me they’re always looking forward to the next session," said Scharfman. "They like coming because they’re respected. They like exercising because it feels good. And they like talking about food."
By the end of the program, participants have been given tools and learned skills that allow them to take that next step and use the Wellspring Plus Center to continue their physical wellness.
Scharfman has seen some remarkable transformations, and he has confidence that the participants will continue on their new path of wellness.
"We’ve given them enjoyable tools to handle what life throws at them," he said. "And they don’t want to go back to their old habits. It doesn’t feel good anymore."
Sauk Prairie Memorial Hospital & Clinics, Prairie du Sac
The gestation period was nearly two years, but once born the healthYouth (pronounced healthy youth) program caught fire and offered exciting opportunities to participants.
The healthYouth program began when an area pediatrician saw the need in our community. She approached the Ripon Medical Center Rehab department and asked for the creation of a program geared towards overweight and obese youth. Jamie Teuteberg, a licensed athletic trainer at Ripon Medical Center was given the opportunity to develop and create the program from the ground up.
"There was no funding and no real timeline, I just knew I wanted it to be great and to impact those who really needed it," said Teuteberg.
Teuteberg dove into research, development, grant writing and planning with a small detour for a maternity leave. After 20 months healthYouth finally came to life.
The healthYouth program is a year-long program that is a mixed bag of tricks to include weekly and monthly gatherings as well as individual and group sessions. Every session has educational and activity portions built in. The youth learn such skills as goal setting, label reading, correct portion size and much more. At this point the healthYouth program is a cash-based service at RMC. However, the program does not "make money" for Ripon Medical Center. The hospital has to subsidize the cost of running the program through grants, fundraising and other methods.
The cost of the program has not deterred the families that are involved. They are anxious to learn new ways how to make healthy lifestyle changes not only for the youth enrolled in the healthYouth program, but for the entire family. The healthYouth program is not a weight loss program, but a lifestyle modification and behavior change program. It is through that we can see healthy changes in kids and parents alike.
"I am a true believer that you MUST be passionate about the work that you do, especially if you want to make an impact," said Teuteberg. "Ups and downs are definitely part of the healthYouth program, but the rewarding high-fives and big smiles when a kid says, ‘hey, I think I am sweating and it feels great’ makes my heart leap for joy. I love my job!"
Ripon Medical Center, Ripon
Submit community benefit stories to Mary Kay Grasmick, editor, at firstname.lastname@example.org.
Read more about hospitals connecting with their communities at www.WiServePoint.org.
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