Registrations for WHA’s Advocacy Day 2008 soared past the 500 mark for the third straight year. More than 80 different hospitals will be represented at this event, and 275 representatives from those hospitals will visit with their legislators the afternoon of May 15. Even though Advocacy Day is only a few days away, there is still time to send in your registrations.

Advocacy Day 2008 will allow you to hear from national speaker Fred Barnes, co-host of Fox News Beltway Boys as well as state legislators and Governor Jim Doyle. Each of these individuals will help you understand the intersection of health care and public policy so you are better able to impact that debate.

Advocacy Day coincides with National Hospital Week this year, so you won’t want to miss the luncheon where Governor Doyle will present a proclamation honoring all that you do on behalf of your communities.

Then it’s off to the State Capitol to meet with your legislators on issues of importance to your hospitals. Don’t miss this important opportunity to make your voice heard!

Access a complete program and registration form at www.wha.org. For questions, contact Jenny Boese at jboese@wha.org. For questions specific to registration, contact Lisa Geishirt at lgeishirt@wha.org. Both can be contacted at 608-274-1820.

The Centers for Medicare and Medicaid Services (CMS) has released two rules for 2009; first, a proposed rule for the Skilled Nursing Facility Prospective Payment System (SNF PPS) and second, an Update Notice for the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS). Both rules were published in the May 7 Federal Register.

Skilled Nursing Facility PPS

In the federal fiscal year (FFY) 2009 SNF PPS proposed rule, CMS is calling for a full market basket update of 3.1 percent; however, overall SNF payments would actually decrease by about 0.3 percent due to a downward recalibration of the case-mix weights.

CMS states that, nationally, the expanded Resource Utilization Groups (RUGs) (implemented in FFY 2006) resulted in an unexpected and inappropriate increase to SNF payments because more patients were classified into the newly created RUGs than CMS had originally estimated. CMS further states that much of this increase was due to coding behavior changes and not actual changes in SNF patient acuity. As a result, CMS is proposing to apply a 3.3 percent reduction to SNF payments by reducing the FFY 2009 RUGS weights. The net impact of a 3.3 percent reduction and a 3.1 percent market basket update is a decrease to SNF PPS payments. CMS has proposed no other major policy changes in this rule for FFY 2009.

Comments on the FFY 2009 SNF PPS proposed rule are due to CMS by June 30, 2008.

CMS released the final rule for the IPF PPS for rate year (RY) 2009 as an update notice, which contains only updates to the rates, with no major policy provisions. Therefore, CMS will not accept comments on the IPF PPS rule.

Highlights of the IPF PPS rule include:

• Per Diem Amount: CMS will increase the per diem amount from $614.99 in RY 2008 to $637.78 in RY 2009 due to; 3.2 percent market basket increase, stop-loss adjustment of 0.39 percent, and budget neutrality adjustments of 1.0010.

• Electroconvulsive Therapy (ECT) Rate: CMS will increase the ECT rate from $264.77 in RY 2008 to $274.58 in RY 2009.

• Outlier Fixed-Dollar Threshold: CMS will decrease the outlier threshold from $6,488 in RY 2008 to $6,113 in RY 2009 to ensure that the outlier policy remains at 2 percent of total IPF payments.

Four years ago, WHA kicked off its hospital quality-reporting program—CheckPoint (www.wiCheckPoint.org). CheckPoint was the first voluntary hospital quality reporting initiative in the country, and was designed to meet the growing needs of consumers for information on the quality of care they can expect to receive in their community hospitals. Consumers, employers and hospitals are able to view quality and error prevention information on every Wisconsin hospital.

A recent national report claimed that patients are only receiving 55 percent of the care that research has shown they should be given for their condition. Consumers don’t need to look any farther than CheckPoint to see that Wisconsin hospitals are performing well above the national average in providing recommended care to patients.

WHA’s Dana Richardson, vice president, quality initiatives has written a new paper on CheckPoint that is now in the WHA toolkit. The paper contains numerous charts that illustrate how Wisconsin hospitals have improved their performance on key quality measures reported in CheckPoint.

The payment of expenses by an ERISA plan [401(k), defined benefit plan, money purchase plan, etc.] out of plan assets is subject to ERISA’s fiduciary rules. The "exclusive benefit rule" requires a plan’s assets be used exclusively for providing benefits. ERISA also imposes upon fiduciaries the duty to defray reasonable expenses of plan administration. Certain expenses (recordkeeping, compliance work, etc.) easily fall objectively within the parameters of this standard, but other expenses may be more subjective in nature. General principles of allowable expenses include the following:

• The expenses must be necessary for the administration of the plan.
• The plan’s document and trust agreement must permit use of plan assets for payment of expenses.
• The expenses must be reasonable in nature and must be incurred primarily for the benefit of participants/beneficiaries.
• The expense cannot be the result of a transaction that is a prohibited transaction under ERISA, or it must qualify under an exemption from the prohibited transaction rules.

In light of today’s plan fee environment, it is incumbent upon fiduciaries to request full disclosure of fees and expenses, how they break down with services provided, as well as a request for full explanation of who will be the recipient of fees. Ultimately, the ability to pay expenses from a plan trust is a facts and circumstances determination that needs to be made by plan fiduciaries. Because it is possible that the Department of Labor may challenge such determinations, it is important that fiduciaries consult ERISA counsel prior to paying questionable expenses from a plan trust and document the decision and reasoning.

Each resident of the state of Louisiana receives $16,263 in federal spending annually. That means that for each dollar paid in federal taxes, Louisianans receive $1.78 back from the Federal Treasury. That "return on investment" has grown by almost 40 percent in just 10 years.

Each resident of the state of Wisconsin receives $6,219 in per capita federal spending annually. For each dollar in federal taxation, Badger state residents receive 86 cents in federal spending. That "return on investment" makes Wisconsin the 47th lowest state in the nation in per capita spending. Hence, Wisconsin—a state that is ‘very average’ when it comes to per capital wealth and annual income—is very much a donor state when it comes to federal spending.

Increased Medicaid spending is one available option to capture new federal dollars and close the current disparity gap. An additional $400 million (over two years) is on the table right now in the form of higher Medicaid hospital payments that can shore up Wisconsin’s safety net hospitals and reduce the "hidden tax" on health insurance premiums caused by too many years of leaving available federal dollars on the table.

Despite this real opportunity, several state lawmakers are actually opposing the "more federal money for Medicaid" theme because the maneuver will increase the federal deficit. The natural extension of such logic would argue against any provider payment increases….ever…as Wisconsin’s contribution to federal deficit reduction. Such a course of action, of course, has been going on now for well over a decade and will likely continue throughout the current biennium.

It’s not an exaggeration to opine that Wisconsin taxpayers (and health insurance premium payers) are subsidizing the health care expenses of state governments in such locales as Alabama, Louisiana, Missouri and New Hampshire—states that over the years have made generous and creative use of Medicaid matching dollar vehicles that have resulted in hundreds of millions of dollars in federal Medicaid funds that were financed by Wisconsin tax payers.

It’s time for Wisconsin to become more proactive in its efforts to secure Federal dollars. Medicaid is a good place to begin.

Steve Brenton
President

Join your rural colleagues on the beautiful shores of Elkhart Lake for this year’s Wisconsin Rural Health Conference, scheduled June 18-20 at The Osthoff Resort.

This year’s theme is "Living Great Leadership," and we encourage you to make attendance for yourself, your senior staff and your trustees a priority, taking advantage of the opportunity to talk about similar issues and challenges rural health care providers face while trying to "live great leadership" both inside and outside your hospital each day.

As a reminder, if you plan to attend, you need to make your hotel room reservation before May 28. There will very likely be no hotel rooms available after this date, due to races at Road America starting the Friday of our conference.

Like a sudden snap in a power line, a stroke sent 60-year-old Joann Lehman to Sacred Heart Hospital on November 9, 2005, startling everyone around her. "She was so healthy, the last person you would expect to have a stroke," says her daughter, Julia. Two days later, on November 11, a Critical Care nurse spotted signs of rising intracranial pressure (pressure exerted by the cranium on the brain tissue). The surgeon was notified and, within hours, a neurosurgical procedure allowed the brain to swell without further damage.

Joann’s family maintained a vigil in Sacred Heart Hospital’s Center for Critical Care where each minute was "a world of uncertainty" as they waited to see if the surgery had been successful. The hospital’s team allowed family members to be with Joann at all hours: massaging her feet and hands, playing music, reading and talking to her. "I firmly believe allowing our family to be so involved with her care helped pull her through this crisis," says Joanna Enerson, another daughter. Having been an intensive care nurse herself, Joanna appreciated the extra time the nursing staff and physicians spent in answering questions, explaining procedures and reassuring and caring for the whole family.

After 14 days in intensive care, Joann was able to move on to the hospital’s rehabilitation floor where she spent more than three months in physical therapy. She made many friends, including a nursing assistant who began her 5:30 a.m. shift by helping Joann shower and get ready for her day. "She always had a laugh and a story," says Joann. Her family was astonished by her progress: in four months she went from being dizzy when she sat up in bed to walking unassisted with a cane.

Joann was not quite finished with her rehabilitation therapy when she was given notice that her insurance benefits would soon end. She left the hospital, spent two weeks in a nursing home, but then returned to the hospital for one more week of intensive physical therapy, a gift from Sacred Heart Hospital and an example of joining clinical practices with the sacred healing mission of the Franciscan Hospital Sisters.

Joann is home now and thinking about her garden of flowers; she might even plant some tulips in the safety helmet she once wore to cover the missing piece of skull. She stops to visit her friends at the hospital when she can. Her family wrote a letter to Sacred Heart Hospital, thanking everyone from physicians and nurses to waiting room volunteers and Critical Care cleaning staff: "The core values of your hospital — respect, care, competence and joy — are reflected every day in the care your staff provides."

The program was launched in 2005. An advisory committee consisting of public health personnel, local pediatricians, nurse practitioners, exercise specialists and a parent and youth representative met to review the project. Parents with overweight children participated in focus groups to identify their needs, as well as resources and obstacles to prevent and address childhood obesity. Parent partners stressed the importance of fostering individualized and family care while focusing on nutrition, fitness, improved health and a healthy lifestyle. Focus groups with children identified their needs and issues.

A 12-week curriculum was developed and project evaluation tools were created along with outreach tools. The first Fit Kids Fit Families session started on April 11, 2005 in Washington County with 11 youths and their parents participating.

Outcomes include:

• 91% completed primary phase
• Nutrition – 80% met
• Exercise – 90% met
• Habits Inventory
• Youth report -- 60% increased scores representing healthier lifestyle behaviors
• Parent report – 75% increased scores representing healthier lifestyle behaviors
• Maintained or improved BMI – 90% met
• Decrease body circumference – 90% met
• Increased physical activity – 100% met
• Decreased sedentary activity – 88% met
• Self-esteem improvements measured by Rosenberg self esteem scale – 90% met

During 2006, the program was replicated in Waukesha County at the Oconomowoc YMCA, with a total of 100 children and their families participating in Washington and Waukesha Counties.

Fit Kids Fit Families is funded through a grant provided by the UW School of Medicine and Public Health from the Wisconsin Partnership Fund for a Healthy Future. Aurora Health Care provides program leadership and staff through in-kind and financial support.

Cumberland Memorial Hospital-Extended Care Unit, Inc. recognizes the need for stopping serious health conditions before they happen. Because of our belief in prevention, we set up a health fair at the Turtle Lake Inter-County Fair. We were there each day doing FREE preventive tests, including total cholesterol, blood glucose, blood pressure and waist circumference. Nurses shared the results with the patients and explained the risk factors and what they meant toward a person’s overall health. They also shared information as to how a patient may improve their numbers. Other displays included bicycle safety, rehabilitation and sun health. Free bottles of sunscreen were given to all attendees as well, helping in the fight against skin cancer. Over 100 adults took part in the free health screenings and many more enjoyed the health fair.

In October 2000, a group of community leaders from Waukesha County Social Service Agencies and Waukesha Memorial Hospital met to discuss the unmet needs of children in Waukesha County. It was quickly determined that one of the greatest needs was behavioral health service for uninsured patients. Since then, Waukesha Memorial Hospital’s Behavioral Medicine Center has been reaching out to uninsured children and adolescents through its Psychiatric Assistance Program.

Jose is a 10-year old, Spanish-speaking boy who relocated from Mexico to Waukesha. When living in Mexico with his family, he witnessed his father physically abusing his mother. When trying to protect her, he too became a victim of his father’s abuse. Eventually, his parents separated and Jose had very little contact with his father. He developed a fear of going to school, suffered from headaches, and began to show his emotional tension through self-injury. School professionals referred him to the Waukesha Memorial Hospital’s Psychiatric Assistance Program for uninsured children and adolescents.

Thanks to the program, Jose was offered a treatment plan with a Spanish-speaking psychologist. Medication to treat his anxiety disorder was prescribed by a psychiatrist. When necessary, and to help with the language barrier, a Spanish-speaking translator from the hospital’s Interpreter Services was provided to assist Jose and his mother.

Teachers now report that Jose has become very confident in school, has made friends and is respectful of his peers. He is showing more effort and improved grades. Jose’s headaches have decreased and he is now able to talk about his physically abusive father and the fears he experienced in the past.

Jose is just one example of the growing number of children suffering because their emotional, behavioral and developmental needs are not being met. The cost of treatment is the most prevalent deterrent to seeking care. The Psychiatric Assistance Program provides psychiatric evaluation, medication management, medication and therapy (including bilingual therapy) for uninsured children and adolescents. The program serves patients age four through 17 who have no insurance. Most of the participating children are referred to the program by Waukesha County school system social workers, ProHealth Care parish nurses and partner agencies.

The program’s most common diagnoses are ADHD, bi-polar disorder, depression and anxiety. By improving the delivery of mental health services to these children and adolescents, the program has helped make the children more manageable at school and at home, and improves grades and behavior at school. Since 2000, the program provided more than 1,100 outpatient visits, and the majority of its patients successfully completed their treatment. More than $200,000 has been provided towards meeting these needs.

"The Behavioral Medicine Center at Waukesha Memorial Hospital has been, and remains committed to making a difference in the lives of all children, including those who have no insurance or means of payment for mental health services," said Kathy Becker, Director of the Behavioral Medicine Center. "The Psychiatric Assistance Program has touched the lives of so many children and their families here in Waukesha County."

In June of 2007, Lakeview Medical Center (LMC) offered its first Breathe Well, Live Well program for members of its community suffering from asthma.

Breathe Well, Live Well is an American Lung Association education program for adults with asthma. The focus is on reducing illness and disability by improving asthma knowledge and self-management skills. LMC offered the program to help asthmatic adults understand their disease and medications so they can keep themselves healthy through self-management, thereby improving their quality of life.

LMC’s Breathe Well, Live Well program was facilitated by certified facilitator Char Mlejnek, LMC Health Promotions Director. The program was a two-day session, running for two hours each day. It was free of charge to participants, who also received gifts such as peak flow meter and pill trays.

The American Lung Association stipulates that up to 10 participants can be part of the Breathe Well, Live Well program at one time. LMC’s first program had nine participants, all of whom said they learned more during the comprehensive two-days than they had anywhere else since being diagnosed with their disease. LMC plans to continue offering the valuable program on an annual basis.

Breathe Well, Live Well was developed with grant support from the Centers for Disease Control (CDC) and the National Center for Environmental Health.

More than 22 million Americans have asthma, which caused over 1.8 million emergency room visits in 2004. Asthma accounted for an estimated 14.5 million lost work days in 2004, and the annual direct health care cost of asthma is approximately $11.5 billion.

Loaded with Petri dishes and lab slides, Upland Hills Health staff member Amy Steffes, made the behind-the-scenes world of health care come alive for the second grade students of Mineral Point.

Keeping the lesson practical Steffes, worked with her co-workers to create bacteria specimens that showed the impact of not washing your hands and not washing your hands thoroughly. A chorus of "yuk" and "eeew" could be heard as the students passed around the fuzzy bacterial growth in the Petri dishes. "It gave the kids a chance to see the role of the lab in the hospital as well as reinforce the common-sense but important practice of washing hands," explained Steffes.

Blood sample slides for the children to view through classroom microscopes were also part of the presentation.

Steffes saw the Mineral Point Parent Career Days held at the end of the school year as a golden opportunity to create interest in health care and awareness of Upland Hills Health as the local provider. Steffes’ son, Lance, was a second grader in Ms. Niehaus’ classroom.

If you would like a presentation on a health care topic or issue for your organization or group contact Patricia Lawson 930-7112.

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

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