August 5, 2011
Volume 55, Issue 30



Massachusetts Hospitals Medicare Windfall Costs Wisconsin $7 Million
WHA’s Brenton: "I am outraged that Wisconsin hospitals will pay for this money grab"

It may have been a win-win in Massachusetts, but Wisconsin and hospitals all across the country are big losers due to a provision that was inserted into the federal health care law to benefit Massachusetts hospitals. Hospital association executives across the nation are expressing their anger.

"If I could think of a different word than outrageous, I’d use it," WHA President Steve Brenton told an Associated Press reporter earlier this week.

An obscure change tucked into the reform law netted Massachusetts hospitals $275 million more a year at the expense of nearly every other state, including Wisconsin, which will lose $7 million per year in Medicare payments.

"What I am outraged about is that my hospitals in communities like La Crosse, Green Bay, and Madison and smaller communities like Watertown are going to pay for the calculated manipulation of this wage index," Brenton told the Boston Globe.

He said Wisconsin hospitals will lose $7 million a year due to changes in the wage index, on top of other Medicare payment cuts expected to pay for expanded coverage for Americans.

"This was a hardball political effort, and others can play that game going forward," Brenton said.

According to an article in the Boston Globe August 5, Medicare adopted the change last week, as required by an amendment to the health care law cosponsored by Senator John F. Kerry, a Massachusetts Democrat.

The amendment essentially requires Medicare to reimburse all Massachusetts hospitals for employee wages at the same rate that it reimburses Nantucket Cottage Hospital, a windfall that Partners HealthCare set in motion in 2007, when the Nantucket hospital became its subsidiary. Wages on the island are hefty because of its isolated location and high cost of living.

"You have this small hospital, sitting on an island in the Atlantic Ocean, having a profound impact on hospital payments across the country," said Herb Kuhn, president of the Missouri Hospital Association.

Kerry’s amendment requires that the money for Medicare hospital wage reimbursements be a fixed amount nationally, rather than a fixed amount for each state, meaning that any increase for Massachusetts requires a decrease for other states.

Kuhn called it an example of "Yankee ingenuity’’ in a column he wrote last week for his association newsletter. Steve Brenton, president of the Wisconsin Hospital Association, said he is "extremely upset" that Massachusetts engineered "a money grab" won through "political hardball."

Kerry, who cosponsored the amendment with Senator Robert Menendez, a Democrat from New Jersey, defended the provision yesterday. He said that when the Centers for Medicare & Medicaid Services previously changed its wage reimbursement rules five years ago, it hurt Massachusetts. The state, he said, is making up lost ground.

"The rest of the country gained at our expense, and Massachusetts took a big hit," he said in a statement. "These new rules just provide some correction."

According to the Boston Globe article, Senator Kerry pointed out that, despite criticism from some other hospitals, the American Hospital Association—as well as hospitals in New Jersey, Connecticut, and California—supported the amendment to the Affordable Care Act, which will extend health insurance to most Americans. The Associated Press, which first reported on the provision yesterday, said six other states also come out ahead, although none do as well as Massachusetts.

Medicare has a rule saying that a state’s urban hospitals must be reimbursed for wages at least as much as rural hospitals. Wages are one component of the payment a hospital gets for Medicare patients.

In 2008, Nantucket, which had previously been paid under a different system, converted back to the rural hospital payment system, with the help of Partners. Nantucket became the only hospital in the state paid under the rural system, so under the Medicare rules its wages set the floor for reimbursing all Massachusetts hospitals. Massachusetts hospitals were aware that the switch could lead to a financial bonus.

In a press statement the Nantucket hospitals said while the switch would decrease its Medicare reimbursement, the affiliation agreements between Massachusetts General Hospital, a Partners member, and Nantucket "ensure that the MGH and Partners would provide the funds that would make us whole."

"It’s a win-win for all hospitals in Massachusetts to make such a switch," the statement said.

Partners Spokesman Rich Copp said yesterday that recent calculations show that Partners stands to gain $40 million to $50 million. Partners did not affiliate with Nantucket because of the potential Medicare windfall, he said, but because of the longtime relationship between the hospital and Mass. General and to improve clinical services on the island for patients.

Under Medicare rules, the new rural payment designation for Nantucket does not begin until October. Medicare, however, apparently saw this windfall for Massachusetts on the horizon and made a new rule in 2009 designed to keep any one state from cashing in on the change. Kerry’s amendment reversed that rule.

Alan Sager, professor at Boston University School of Public Health, agreed that the state could face retribution. In Medicare financing, "if some people gain money, other people suffer from reductions in money," he said. "There’s payback, and Massachusetts hospitals can count on other states and their senators and representatives paying us back."

Medicare and the Institute of Medicine, an independent advisory organization, are both working on recommendations for reforming Medicare’s system for reimbursing hospital wages.

The full Boston Globe article is available at: www.boston.com/lifestyle/health/articles/2011/08/05/medicare_gives_massachusetts_hospitals_275_million_lift/

Chelsea Conaboy of the Globe staff contributed to this report. Liz Kowalczyk can be reached at kowalczyk@globe.com. © Copyright 2011 Globe Newspaper Company.

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Medicaid Chief Says Health Insurance Exchange Plan Aligns with WHA Principles
Davis: "Exchange is being built using free market concept and consumer education"

As the state moves forward with the implementation of a health insurance exchange, Wisconsin Medicaid Director Brett Davis said the state’s plan largely aligns with the WHA white paper, "Guiding Principles for Establishing Wisconsin’s Health Insurance Exchange (HIE Principles)."

Davis said how the Exchange will be implemented was heavily influenced by the WHA HIE Principles, which emphasize the importance of maintaining employer-sponsored coverage options, avoiding price controls within the Exchange, and promoting consumer education. Davis also noted that WHA was one of only three groups that submitted comprehensive recommendations on the structure of the exchange.

"We have the best team in the country working on the health exchange," according to Davis. Davis spoke at the WHA Public Policy Council meeting August 4 in Madison.

Davis, joined by Craig Steele, project manager of the Office of Free Market Health Care (OFMHC), explained the Department of Health Service’s plan to implement a health insurance exchange that will bring buyers and sellers together using the free market concept. Education will be an important component of the Exchange to help consumers access information on public and private coverage programs and be able to make informed health care decisions.

"We need to push out education so common people on the street can compare quality metrics, for example," according to Steele. "You’ve done a very good job with PricePoint and CheckPoint, and fundamentally, Wisconsin has done a good job at this because of the relationships that have been built up with WHA, the health providers and the Administration."

"We are more in alignment with the stakeholder community, and we are taking a much different approach to stakeholder engagement," according to Steele. "We want to know what the issues are and get the perspectives of the stakeholders now so we know what is in scope for this project."

By January 1, 2013, states must demonstrate that they are well on the way to creating a fully-functioning exchange that will begin operation on January 1, 2014. Tax credits and reduced cost sharing are available only for individuals purchasing coverage through an exchange.

"The PPACA version of a health insurance exchange attempts to create a one-size-fits-all approach to the development of an exchange that ignores Wisconsin’s current competitive health insurance market," Steele said.

If Wisconsin elects to apply for the final HIE funding after the early innovator funding is gone, it must be able to show that it has the legal authority to "stand up" an exchange. To do that, Davis said, requires legislation. Importantly, by July 30, 2012 states must have any legal authority and exchange governance legislation in place.

"We have had initial meetings with interested legislators. This is a bipartisan effort moving forward," Davis said. "You expect pushback; other states have had some pushback because it’s a political process, but it is helpful to work in partnership with organizations like WHA to get something done."

David said, "If you want Wisconsin to have an exchange that is done for Wisconsin citizens, we need to pass governance. If we do nothing, we will have an exchange like Massachusetts. We know the feds are moving forward to build an exchange."

Executive Order #10 contains the guiding principles for the exchange and lays out the scope of the project. It directs how the exchange will work using consumer education and the free market concept. Davis reiterated that their implementation plans also closely align with WHA’s HIE Principles.

According to the most recent Medical Expenditure Panel Survey (MEPS), 14.9 percent of employers dropped insurance between 2005 and 2009. Steele said employer-sponsored insurance needs to be strengthened, and the Office will engage Wisconsin stakeholders to identify potential market opportunities that can strengthen employer sponsored insurance. PPACA will only worsen this trend in the small group market. Steele said the OFMHC will work with stakeholders to identify potential market opportunities that would strengthen employer-sponsored insurance.

Steele pointed out that health care reform will force a "hidden tax" on working class and higher income families that will subsidize the purchase of health insurance for low income families, according to a study by Gorman Actuarial and Dr. Jonathan Gruber. The study also pointed out that under PPACA, the majority of individuals in the non-group market will see an increase in their health insurance premiums

"This is important to get out. They (residents) think health reform will lower premiums, and that will not happen in Wisconsin," according to Steele. "There is a balancing act and we need to start developing options."

WHA Executive Vice President Eric Borgerding pointed out that in other states with exchange-like structures, providers have seen rates slashed in attempts to control premium costs. In Massachusetts, for example, when this dynamic emerged, rather than increase premiums, officials "ratcheted down on providers and cut rates."

Davis said a process is in place to reduce costs in the Medicaid program. A lot of savings were achieved in the state budget, which whittled the Medicaid shortfall down to $181 million GPR. Davis complimented the WHA Medicaid Reengineering Group (MRG), chaired by WHA Board member Nick Desien, for assisting the Department in the process of identifying cost savings and efficiencies in the Medicaid program.

"Your group did fantastic work," Davis said. "The work of your Task Forces is being taken seriously and it has influenced us on the staff level. As we develop our policy papers for DHS Secretary Smith, your ideas have made it through the process."

Steele identified the next steps to establish the Exchange, which are:

No Provider Cuts in Medicaid Budget, but Concerns Still Abound

Borgerding asked Medicaid Director Brett Davis about the timing of a decision by CMS on the DHS request for a waiver to permit eligibility standards, methodologies and procedures that are more restrictive than those in place on March 23, 2010. If the waiver request does not receive federal approval before December 31, 2011, DHS would be required to reduce the BadgerCare Plus income limit to 133 percent FPL for non-pregnant, non-disabled adults. Wisconsin would have to certify to the Secretary of the federal DHHS that it has a budget deficit. That would mean formerly-eligible Medicaid patients would seek treatment in hospital emergency departments as their last resort.

Davis said the MOE waiver is an option that remains on the table. If other savings cannot be generated, then rolling back eligibility may be necessary. However, Davis was optimistic that savings will be realized and he credited the WHA Medicaid Reengineering Group with developing ideas that will help ensure Medicaid remains a viable safety net program.

Borgerding said unlike other states, Wisconsin did not slash provider payments as a means of balancing its Medicaid budget. Instead, Governor Scott Walker provided $1.3 billion to backfill the $1.8 billion Medicaid deficit. The Legislature later added another $100 million to the Medicaid budget, $56 million that would reflect more conservative caseload forecasts. About $200 million in GPR savings still needs to be found through reforms.

Brian Potter, WHA Senior Vice President, reviewed the 2012 Medicaid hospital rates. The rate results were positive, with Wisconsin hospitals receiving increases for the first time in over a decade. Throughout the budget process, the Administration assured WHA that hospitals would not experience rate cuts. WHA, along with the Medicaid Advisory Group, had several meetings with DHS and provided constant reminders of the no-cut pledge. "We are appreciative of the higher rates particularly in this tough budget environment," said Potter. Potter also reminded the Public Policy Council that there will continue to be additional activity around the rates, including the one percent withhold for pay-for-performance measures.

Borgerding noted that the pay-for-performance measures were one element of Medicaid reforms discussed by the MRG. The MRG, comprised of member CEOs and CFOs, was created earlier this year to study various aspects of the Wisconsin Medicaid program and develop recommendations for and reaction to Medicaid reforms being developed by the Walker Administration and Legislature. Other topics addressed by the MRG include Medicaid eligibility and enrollment, care coordination and benefit options.

Joanne Alig, WHA vice president, payment policy & reform, elaborated that the pay-for-performance measures are a perfect example of the impact the MRG has had on Medicaid program operations. Alig noted that the proposed measures released by DHS are heavily influenced by the recommendations of the MRG. Moreover, DHS modified their initial plan to base payment for each hospital on performance against a statewide average, and instead use an alternative payment methodology. Details about the new pay-for-performance program are still under development, and WHA will continue to work with the MAG and DHS as the program is implemented.

Discussing the many other issues WHA remains involved with, Borgerding said with the Legislature now adjourned, WHA staff will:

Public Policy Council Reviews Preliminary WHA Physician Workforce Report

As WHA’s George Quinn presented the draft physician workforce report, it was clear that it will encourage a lively debate among stakeholders on just how the challenge of ensuring Wisconsin has enough physicians will be met. Quinn said aggressive action must be taken to avert a statewide crisis. For every year that no action is taken, the shortage of physicians becomes more acute.

All members agreed that the report provided a good outline of the workforce issues, while offering options and opportunities that could be available to address the shortage. The necessity to grow the physician workforce is evident, as health reform combined with an aging population could fuel the demand for medical care.

Federal Deficit Triggers Wisconsin Hospital Grassroots Action

Jenny Boese, WHA vice president of external relations and member advocacy, described WHA’s grassroots and media campaign launched in July which was aimed at the Wisconsin Congressional delegation when the federal debt ceiling and deficit reduction negotiations hit a critical juncture. WHA coordinated high-level, in-district meetings between hospital CEOs and Members of Congress across the state. CEOs placed letters to the editors in their local papers to educate their communities on the serious consequences that more Medicare and Medicaid cuts would have on them and on their friends and neighbors. WHA engaged HEAT grassroots advocates who made over 1,100 contacts (email, phone) to their legislators.

Members’ efforts were backed by a radio campaign in targeted markets initiated by the Wisconsin Hospitals Issue Advocacy Council. To hear the ad, go to www.wha.org/WisconsinHospitalAssociation-MedicareMedicaidRadio60V04.mp3.

Boese explained the federal debt deal, and cautioned hospitals that Medicare and Medicaid cuts could still be on the line during future action (see story below).

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Political Action Spotlight:  Wisconsin Hospitals Conduit & PAC Campaign Surpasses Halfway Mark

The Wisconsin Hospitals Conduit and PAC fundraising campaign has raised more than $11,000 in the last two weeks from 18 additional contributors putting the campaign over the halfway mark at 51 percent of goal. The goal of the campaign is to raise $250,000. The total to date raised is at $127,783 from 215 individuals contributing an average of $594.

Individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. 2011 contributors to date are listed below. Contributors are listed alphabetically by contribution category. The next publication of the contributor list will be in the August 19 edition of The Valued Voice.

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

Contributions ranging from $1 - 499

Alstad, Nancy         Fort HealthCare

Ashenhurst, Karla         Ministry Health Care

Ayers, Mandy         Wisconsin Hospital Association

Bablitch, Steve         Aurora Health Care

Banaszynski, Gregory         Aurora Health Care

Beall, Linda         Hudson Hospital

Biros, Marilyn         SSM Health Care-Wisconsin

Bloom, Deborah         Sacred Heart Hospital

Boson, Ann         Ministry Saint Joseph’s Children’s Hospital

Boudreau, Jenny         Wisconsin Hospital Association

Braunschweig, Jennifer         Gundersen Lutheran Medical Center

Brenny, Terrence         Stoughton Hospital Association

Byrne, Frank         St. Mary’s Hospital

Campbell-Kelz, Nancy         Aspirus Wausau Hospital

Casey, Candy         Columbia Center

Censky, Bill         Holy Family Memorial, Inc.

Clapp, Nicole         Grant Regional Health Center

Clark, Renee         Fort HealthCare

Connor, Michael         Aurora Health Care

Cooksey, Patricia         Hudson Hospital

Dahl, James         Fort HealthCare

Dalebroux, Steve         St. Mary’s Hospital

Decker, Michael         Divine Savior Healthcare

DeMars, Nancy         Sacred Heart Hospital

DeRosa, Jody         St. Mary’s Janesville Hospital

Devermann, Robert         Aurora Medical Center in Oshkosh

Dolohanty, Naomi         Aurora Health Care

Donlon, Marcia         Holy Family Memorial, Inc.

Elliott, Roger         St. Joseph’s Hospital

Erickson, Susan         Meriter Hospital

Erickson, William         Ministry Saint Mary’s Hospital

Evans, Kim         Bellin Hospital

Facey, Alice         St. Clare Hospital and Health Services

Fielding, Laura         Holy Family Memorial, Inc.

From, Leland         Beloit Health System

Fuchs, Thomas         St. Joseph’s Hospital

Furlong, Marian         Hudson Hospital

Giedd, Janice         St. Joseph’s Hospital

Govier, Mary         Holy Family Memorial, Inc.

Grohskopf, Kevin         St. Clare Hospital and Health Services

Groskreutz, Kevin         St. Joseph’s Hospital

Grunwald, Patricia         Meriter Hospital

Gullicksrud, Lynn         Sacred Heart Hospital

Gutsch, Mike         Southwest Health Center

Halida, Cheryl         St. Joseph’s Hospital

Hemes, Jim

Hieb, Laura         Bellin Hospital

Hill, Nick         St. Joseph’s Hospital

Hockers, Sara         Holy Family Memorial, Inc.

Hoege, Beverly         Reedsburg Area Medical Center

Holub, Gregory         Ministry Door County Medical Center

Jelle, Laura         St. Clare Hospital and Health Services

Keene, Kaaron         Memorial Health Center - An Aspirus Partner

Klay, Lois         St. Joseph’s Hospital

Klein, Rick         Aurora Health Care

Kuehni-Flanagan, Tracy         St. Joseph’s Hospital

Laird, Michael         Froedtert Health St. Joseph’s Hospital

Lange, George         Westgate Medical Group, CSMCP

Margan, Rob         Wisconsin Hospital Association

Maroney, Lisa         UW Hospital and Clinics

Marquardt, Amy

Mason, Paul         Wheaton Franciscan Healthcare - All Saints

Maurer, Mary         Holy Family Memorial, Inc.

McKevett, Timothy         Beloit Health System

McNally, Maureen         Froedtert Health

Merline, Karen

Meyer, Jeffrey         Osceola Medical Center

Muellerleile, Steven         Westfields Hospital

Mulder, Doris         Beloit Health System

Myers, Lynne         Meriter Hospital

Needham, Jean         Westfields Hospital

Niemer, Margaret         Children’s Hospital and Health System

O’Keefe, James         Mile Bluff Medical Center

Olson, Bonnie         Sacred Heart Hospital

Ose, Peggy         Riverview Hospital Association

Page, Alison         Baldwin Area Medical Center

Palecek, Steve         St. Joseph’s Hospital

Peiffer, Susan         Sacred Heart Hospital

Penczykowski, James         St. Mary’s Hospital

Peters, Kenneth         Bellin Hospital

Petonic, Mary Frances         Meriter Hospital

Piper, Barbara         Sacred Heart Hospital

Polenz, Scott         Memorial Medical Center - Neillsville

Potts, Dennis         Aurora Health Care

Powell, Stacey         Sacred Heart Hospital

Priest, Geoffrey         Meriter Hospital

Proehl, Sheila         Hudson Hospital

Radoszewski, Pat         Children’s Hospital and Health System

Rambo, Kari         Hudson Hospital

Reinke, Mary         Aurora Health Care

Rickelman, Debbie         WHA Information Center

Roethle, Linda         Bellin Hospital

Roller, Rachel         Aurora Health Care

Rutkowski, Jennifer         Grant Regional Health Center

Samitt, Craig         Dean Health System

Saunaitis, Tamara         Meriter Hospital

Schaefer, Mark         Froedtert Health

Scieszinski, Robert         Ministry Door County Medical Center

Sheehan, Heather         Hayward Area Memorial Hospital and Water’s Edge

Smith, Greg         Wheaton Franciscan Healthcare

Stanford, Cynthia

Stelzer, Jason         St. Clare Hospital and Health Services

Stoffel, Julie         St. Joseph’s Hospital

Sullivan, Gail         St. Joseph’s Hospital

Tapper, Joy         Milwaukee Health Care Partnership

Taylor, Steve         Beloit Health System

Tews, Carol         Memorial Medical Center - Neillsville

Tincher, Pat         Langlade Hospital - An Aspirus Partner

Van Meeteren, Bob         Reedsburg Area Medical Center

VanDeVoort, John         Sacred Heart Hospital

Walker, Troy         St. Clare Hospital and Health Services

Worrick, Gerald         Ministry Door County Medical Center

Yaron, Rachel         Ministry St. Clare’s Hospital

Zeller, Brad         Hayward Area Memorial Hospital and Water’s Edge

Contributions ranging from $500 - 999

Andersen, Travis         St. Elizabeth Hospital

Anderson, Sandy         St. Clare Hospital and Health Services

Bailet, Jeffrey         Aurora Health Care

Bayer, Tom         St. Vincent Hospital

Bjork, Tanya

Bukowski, Cathy         Ministry Eagle River Memorial Hospital

Bultema, Janice

Canter, Richard         Wheaton Franciscan Healthcare

Cardamone, Dr. Steve         Wheaton Franciscan Healthcare

Carlson, Dan         Bay Area Medical Center

Clough, Sheila         Ministry Health Care’s Howard Young Medical Center

Court, Kelly         Wisconsin Hospital Association

Deich, Faye         Sacred Heart Hospital

Dietsche, James         Bellin Hospital

Eckels, Timothy         Hospital Sisters Health System

Frank, Jennifer         Wisconsin Hospital Association

Garcia, Dawn         St. Joseph’s Hospital

Granger, Lorna         ProHealth Care

Grundstrom, David         Flambeau Hospital

Guirl, Nadine         ProHealth Care

Heifetz, Michael         SSM Health Care-Wisconsin

Huettl, Patricia         Holy Family Memorial, Inc.

Johnson, Patricia         Hayward Area Memorial Hospital and Water’s Edge

Kerwin, George         Bellin Hospital

Lewis, Gordon         Burnett Medical Center

Mantei, Mary Jo         Bay Area Medical Center

Mohorek, Ronald         Ministry Health Care

Nelson, James         Fort HealthCare

Nelson, Nanine         ProHealth Care

Oberholtzer, Curt         Bay Area Medical Center

Postler-Slattery, Diane         Aspirus Wausau Hospital

Richards, Theresa         Ministry Saint Joseph’s Children’s Hospital

Rocole, Theresa         Wheaton Franciscan Healthcare

Russell, John         Columbus Community Hospital

Schafer, Michael         Spooner Health System

Selberg, Heidi         HSHS-Eastern Wisconsin Division

Shabino, Charles         Wisconsin Hospital Association

Stuart, Philip         Tomah Memorial Hospital

Swanson, Kerry         St. Mary’s Janesville Hospital

VanCourt, Bernie         Bay Area Medical Center

Volpe, Joseph         Wheaton Franciscan Healthcare

Westrick, Paul         Columbia St. Mary’s, Inc. - Milwaukee

Zenk, Ann Ministry         Sacred Heart Saint Mary’s

Contributions ranging from $1,000 - 1,499

Alig, Joanne         Wisconsin Hospital Association

Boese, Jennifer         Wisconsin Hospital Association

Brenton, Mary E.

Britton, Gregory         Beloit Health System

Buser, Kenneth         Wheaton Franciscan Healthcare - All Saints

Duncan, Robert         Children’s Hospital and Health System

Fale, Robert         Agnesian HealthCare/St. Agnes Hospital

Francis, Jeff         Ministry Health Care

Hahn, Brad         Aurora Health Care

Harding, Edward         Bay Area Medical Center

Hilt, Monica         Ministry Saint Mary’s Hospital

Karuschak, Michael         Amery Regional Medical Center

Kerschner, Joseph         Children’s Hospital and Health System

Kosanovich, John         UW Health Partners Watertown Regional Medical Center

Loftus, Philip         Aurora Health Care

Martin, Jeff         Ministry Saint Michael’s Hospital

Mohorek, Ronald         Ministry Health Care

Morgan, Dwight         Aurora Health Care

Normington, Jeremy         Moundview Memorial Hospital and Clinics

Olson, David

Potter, Brian         Wisconsin Hospital Association

Robertstad, John         ProHealth Care - Oconomowoc Memorial Hospital

Sexton, William         Prairie du Chien Memorial Hospital

Sohn, Jonathan         Wheaton Franciscan Healthcare

Standridge, Debra         Wheaton Franciscan Healthcare

Stanford, Matthew         Wisconsin Hospital Association

Troy, Peggy         Children’s Hospital and Health System

Wallace, Michael         Fort HealthCare

Wolf, Edward         Lakeview Medical Center

Contributions ranging from $1,500 - 1,999

Bloch, Jodi         Wisconsin Hospital Association

Borgerding, Dana

Coffman, Joan         St. Joseph’s Hospital

Eichman, Cynthia         Ministry Our Lady of Victory Hospital

Grasmick, Mary Kay         Wisconsin Hospital Association

Herzog, Mark         Holy Family Memorial, Inc.

Kammer, Peter         Essie Consulting Group

LePore, Michael         Wheaton Franciscan Healthcare

Mettner, Michelle         Children’s Hospital and Health System

O’Brien, Mary         Aurora St. Luke’s Medical Center

Olson, Edward         ProHealth Care

Starmann-Harrison, Mary

Warmuth, Judith         Wisconsin Hospital Association

Woodward, James         Meriter Hospital

Contributions ranging from $2,000 - 2,499

Fish, David         Hospital Sisters Health System

Kachelski, Joe         Wisconsin Statewide Health Information etwork

Katen-Bahensky, Donna

Leitch, Laura         Wisconsin Hospital Association

Levin, Jeremy         Rural Wisconsin Health Cooperative

Merline, Paul         Wisconsin Hospital Association

Neufelder, Daniel         Affinity Health System

Pandl, Therese             HSHS-Eastern Wisconsin Division

Sanders, Michael         Monroe Clinic

Contributions ranging from $2,500 - 2,999

Borgerding, Eric         Wisconsin Hospital Association

Desien, Nicholas         Ministry Health Care

Contributions ranging from $3,000 - 3,999

Erwin, Duane         Aspirus Wausau Hospital

Size, Tim Rural         Wisconsin Health Cooperative

Turkal, Nick         Aurora Health Care

Contributions ranging from $4,000 - 4,999

Contributions $5,000 +

Brenton, Stephen         Wisconsin Hospital Association

Tyre, Scott         Capitol Navigators, Inc.

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State Pays Back Injured Patients and Families Compensation Fund
"This is another step toward honest budgeting in Wisconsin"

Governor Scott Walker this week announced that the state had paid back the Injured Patients and Families Compensation Fund. The payment made by the state included a $200 million transfer and $33 million lost earnings and interest. At a press conference announcing the payment, Governor Walker said, "This is another step toward honest budgeting in Wisconsin. With this payment, we are further restoring confidence in Wisconsin’s ability to manage its finances."

The 2007-2009 Wisconsin State Budget (Act 20) transferred $200 million from the Fund to balance the state’s books. In 2010, the Wisconsin Supreme Court held that the transfer was unconstitutional and remanded the case with directions that the circuit court issue an order requiring the state to replace the money removed from the Fund, together with lost earnings and interest. The Court also directed the circuit court to issue a permanent injunction prohibiting the state from again transferring money out of the Fund. Last month, the circuit court signed the final order directing the state to make the payment on or before October 1, 2011.

In October 2007, after Act 20 was published directing the transfer from the Fund, the Wisconsin Medical Society filed a lawsuit against the State of Wisconsin. WHA supported the Society’s efforts filing amicus briefs also arguing that the transfer was unconstitutional. In 2008, the Dane County Circuit Court ruled in favor of the state and the Society appealed. Bypassing the appellate court, the Supreme Court accepted the case in January 2010. In a 5-2 decision issued in July 2010, the Supreme Court determined that health care providers have a constitutionally protected property interest in the Fund.

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WHA Annual Convention
"Looking Toward Tomorrow’s Health Care"

September 14-16, 2011 *** Grand Geneva Resort, Lake Geneva

Final cut-off for hotel reservations: August 24

Brochure and registration information can be found online at http://events.SignUp4.com/Annual2011.

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President’s Column: Deficit Reduction Bill is New Glide Path to Big Provider Cuts—$100 Million Annually for Wisconsin Hospitals

Physicians and hospitals are staring at a two percent Medicare payment cut thanks to the bipartisan debt ceiling deal reached in Washington D.C. this week.

Under terms of the deal, a 12-member Congressional Committee is charged with cobbling together a new proposal that will trim another $1.2 trillion in federal spending over the next decade. That specific proposal is due by Thanksgiving (about 100 days from now) and must be voted on by Congress by December 23. If Congress rejects the Special Committee’s proposal, across-the-board spending cuts would be triggered. Those cuts, as specifically prescribed in this week’s legislation, include a permanent reduction in Medicare payments of two percent for PPS hospitals (details are unclear regarding CAHs), physicians, home health agencies, hospices and nursing homes. For Wisconsin hospitals, the annual impact would be almost $100 million for hospital inpatient and outpatient services.

Over ten years, the two percent hospital pay cut will total $1 billion for a program that pays Wisconsin hospitals about 80 cents on the dollar for the actual costs of providing patient care.

Complicating the dynamic in play here is the fact that the Special Committee may also look at Medicare pay cuts as a part of their own $1.2 billion package. And Congress must still "fix" Medicare’s Sustainable Growth Rate (SGR) formula. Failure to address the physician payment issue by year end will result in a 29 percent pay cut. While most observers find such a catastrophe to be unimaginable, no one has started talking about where the money will be found to block that cut. The ugly reality is that the SGR "fix" will be debated within the context of the next round of federal spending "savings," thus escalating the likelihood that some level of payments cuts are in our future.

One of the disappointments in all of this is the fact that our message that hospitals already gave $155 billion to fund coverage improvements in the Accountable Care Act (ACA) doesn’t seem to resonate, even with the Democrats with whom that deal was cut less than two years ago. Vice President Joe Biden was at the table with national health care leaders during ACA discussions and he was at the table with legislative leaders during recent talks that resulted in the deficit reduction compromise. Memories are short in the nation’s capitol.

Wisconsin’s share of the $155 billion over the next decade amounts to almost $2.7 billion. The specifics of how those cuts are arrived at include annual market basket adjustments, value-based purchasing cuts, readmission penalties as well as penalties for hospital-acquired conditions. There are also big penalties for failing to comply with Meaningful Use requirements beginning in late 2014. A chart outlining these details can be found here: www.wha.org/AHAippsAppendix.pdf. The result is something of an ugly grab bag of payment reductions that for some organizations will well exceed the annual market basket increase. And now we have very real vulnerability for another two percent cut which will be difficult to avoid.

Our message will need to evolve from the "we’ve already given our fair share" to specifically describing the fallout to our communities of another round of unprecedented payment cuts. And we don’t have much time to advance that message.

Steve Brenton,
President

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Debt Ceiling Proposal Now Law
Medicare and Medicaid cuts still on the line

Just about everyone will be able to find something to dislike in the recently enacted debt ceiling agreement. For hospitals, it will be the continued threat of reimbursement cuts to Medicare and Medicaid.

"Hospitals could face $100 million in Medicare reductions annually under the new debt ceiling law," said WHA President Steve Brenton. "This comes from automatic, across-the-board cuts that trigger if Congress rejects proposals put forth by this newly created Congressional super-committee."

Under the negotiated compromise, a two-step process is put in place. The first step raises the debt ceiling by $900 and enacts cuts of $917 billion over the next 10 years. Medicare and Medicaid are safe from cuts under step one. The 12-member bipartisan committee Brenton referred to, known as the Joint Select Committee for Deficit Reduction, begins step two of the process and is tasked with developing recommendations for finding another $1.5 trillion in cuts.

The Joint Select Committee will be able to recommend any type of cuts, including those to Medicare and Medicaid. If the Congress defeats the recommendations or does not send a Balanced Budget Amendment (BBA) to the states, then automatic, across-the-board cuts totaling $1.2 trillion will go into effect. Those cuts would be split 50/50 between defense and domestic spending, beginning in 2013. They would apply to Medicare—capped at two percent—but not to Medicaid.

If the Congress passes the committee’s recommendations or passes a BBA and sends that to the states, the President can request an additional $1.5 trillion debt ceiling increase. The committee’s recommendations are due November 23 and will be sent to the Congress for an up or down vote by December 23, 2011.

"The message we need to deliver to Congress will continue to be that reimbursement cuts will have direct and negative impacts on our communities, our hospitals and our patients," said Brenton.

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Final Rule for FY 2012 Inpatient PPS Released; Coding Offset Reduced
WHA thanks Wisconsin congressional delegation for support

On August 1, the Centers for Medicare & Medicaid Services (CMS) issued its hospital inpatient and long-term care hospital prospective payment system (PPS) final rule for fiscal year (FY) 2012. Due to strong concerns from the hospital industry, including the Wisconsin Hospital Association and the American Hospital Association among others, the final rule reduces the amount of the proposed cut for changes in documentation and coding from 3.15 percent to 2.0 percent. Nationally, this represents $1.2 billion more in payments to hospitals in FY 2012 compared to the proposed rule.

"We are happy to see that CMS is rolling back a portion of these cuts," said WHA President Steve Brenton. "While we believe the coding adjustment should be eliminated totally, reducing its negative impact should be good news to everyone."

Earlier this year WHA expressed concerns to the Wisconsin congressional delegation and asked for their support of a Dear Colleague letter to CMS opposing the coding offset policy. A total of 219 House members and 45 Senate members signed on to those letters, including six Wisconsin members.

"We are grateful for the bipartisan efforts of Wisconsin’s Members of Congress in pushing back against CMS’ flawed policy," said Brenton. "Their support for our community hospitals was vital in mitigating these potential cuts."

WHA thanks U.S. Representatives Tammy Baldwin (D-2nd District), Sean Duffy (R-7th District), Ron Kind (D-3rd District), Gwen Moore (D-4th District), Tom Petri (R-6th District) and Reid Ribble (R-8th District) for signing on to the letter.

Of concern in the proposed rule were cuts to eliminate the alleged effect of coding changes associated with the new DRG system implemented a few years ago (see Valued Voice articles, April 22, 2011).

Overall, the proposed rule called for an average decrease of 0.55 percent in hospitals’ FY 2012 operating payments compared to FY 2011, but the final rule increases average payments by 1.1 percent. This amounts to a $1.2 billion increase in operating payments compared to FY 2011.

In addition changes noted above, the final rule addresses the rural floor budget neutrality adjustment; quality reporting, including quality measures, hospital acquired conditions and readmissions; value based purchasing; changes to the wage index; outliers; and other payment issues.

The final rule will take effect October 1. In the next few weeks, watch for a more detailed summary of the proposed rule on the WHA Web site. At the same time, an analysis of the impact of the final rule on each hospital will be emailed to hospital CFOs.

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Grassroots Spotlight: CEO Takes to the Radio to Talk Debt Ceiling

Recently Fort HealthCare CEO Mike Wallace wrote a letter to the editor to the Fort Daily Union outlining his concerns with cuts to Medicare and Medicaid as those were being debated in Washington, DC. His letter prompted the local radio station, WFAW, to contact him for an interview. The following is an excerpt.

Mike Wallace is an active member of the Wisconsin Hospital Association (WHA). He currently serves on the WHA Board, a term that expires in 2013. He is a member of the WHA Advocacy Committee and is a contributor to the Wisconsin Hospitals Conduit. Additionally, he is a member of the association’s legislative grassroots program, HEAT (Hospitals Education & Advocacy Team). The radio interview below is an example of his continued commitment and participation in the association’s advocacy initiatives.

Wallace:
I think it was important for our listeners to know from the local perspective our concerns and that’s why I wrote the letter to the editor. I appreciate the opportunity to be on the show. The concern in health care is that they’re just going to make significant cuts to Medicare and Medicaid to providers who are already getting less reimbursement for the services we provide.

Announcer: They seem to want to cut spending by just spending less rather than making changes or improving or eliminating.

Wallace: That’s exactly right. I don’t think we solve this by just cutting spending…They’re not getting any costs out of the system. They’re just going to pay providers less. We still have many of the cost drivers in the system. At Fort HealthCare, we will continue to be prudent. We will try to improve our processes and programs and seek efficiencies, but there’s only so much we can do. We’re already looking at over the next 10 years $14 million in reduced payments and reimbursements…that’s an unsustainable model.

What listeners need to understand…over 50 percent of the volume or activity or patients we see at a typical hospital are from government programs…Medicare and Medicaid. We lose money on those patients. We’re not about making money [but] as a not-for-profit we’re about having enough revenues to cover our expenses and have a rainy day fund to replace physical plants, buy new technologies, to recruit new providers. We’re not unlike the general household consumer. You like to have a little money set aside to fix a leaky roof or renovate…and 50 percent of our business, again, we lose money on and they want to continue to cut us.

Announcer: What do you do?

Wallace: There’s a lot we can do. . . personal accountability is where we need to go as a society. We have insulated the consumer too much from the true cost of health care. There are lifestyle choices that people make that are significant drivers of some of the cost. Where you’ll see Fort HealthCare headed—in restating our mission to improve the health and well-being in the community and our vision to be the healthiest community—is engaging the individual, engaging employers, the school systems, the faith community, city governments. We believe we have an opportunity over time to significantly impact the cost of health care. So, we’re focused more on health. Today I’m in the health care business, tomorrow I want to be in the health business.

We believe our electronic medical records have great promise to help give us clinical information, operational information that’ going to help us do a better job of managing chronic disease and engaging consumers in being more accountable for their health.

You’ll continue to see us try to reach out to our patients, our employers, our city governments. I think there are opportunities. There are ways to incent behaviors. Some of the best ways to reduce expense is to avoid the illness to begin with….I would encourage consumers, patients, listeners to make sure you have a relationship with a provider…We’re not going to catch all disease and stop it, but if we catch it earlier we can get a better outcome, which is what it’s all about. The secondary outcome is we spend less money. We cover more people, spend less money, get a better outcome. They’re not mutually exclusive.

Announcer: What is the health care industry doing? Plan to do? Hope to do?

Wallace: Wisconsin has consistently been a leader in outcomes and value in terms of cost and quality associated with care. We’ve certainly tried to raise these issues with our local and federal representatives to make sure they understand. We try to influence and make sure they understand this decision has a cascading effect in how it plays out in rural America and in rural Wisconsin.

I think we’re very organized through the Hospital Association, a lot of talent, a lot of good leadership there that is representative of much of the thinking with what the issues are, the impacts as well as offering up suggestion on how we can improve it.

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Rep. Kind Meets Virtually With District Hospital CEOs on Debt Ceiling

Just days before the U.S. Congress voted on the federal debt ceiling proposal, hospital CEOs in Rep. Kind’s district met with him virtually at Mayo Clinic Health System-Eau Claire. Rep. Kind was scheduled to meet in person with CEOs but was forced to stay in DC as an agreement was reached and votes scheduled. The meeting was one of several coordinated by WHA as part of its grassroots campaign to push back against the proposed health care cuts.

Participants at this meeting were able to discuss a variety of issues and solutions with Rep. Kind, ranging from the need for delivery system and payment reforms to addressing geographic disparity as opposed to current debt ceiling proposals focused purely on mathematical, across-the-board cuts. "Real health reform must focus on rewarding value, not on arbitrarily cutting hospital and physician payments," Kind stated.

Both Rep. Kind and Wisconsin hospitals have been leaders on delivery system and payment reforms. Rep. Kind led efforts in Congress to have the Institute on Medicine study and make recommendations on issues related to geographic variation in Medicare spending. The multi-state, multi-provider Healthcare Quality Coalition, of which WHA and many Wisconsin providers are members, was a key impetus in moving this issue to the fore.

Along those lines, Rep. Kind indicated that Don Berwick, head of the Centers for Medicare & Medicaid Services, is an important ally in this fight and understands the need for structural system reforms. One example mentioned of Wisconsin’s leadership on the issue was a meeting in Appleton between Don Berwick and Theda Clark. Theda was able to discuss how they have implemented Lean and 6 Sigma approaches to reduce variation, improve quality and control cost. Kind is also arranging to host Berwick in Eau Claire, La Crosse and Black River Falls later this summer.

Many hospitals in Rep. Kind’s district are small, rural providers that are essential in maintaining health care access in rural communities, and attendees urged Rep. Kind to remember that cuts to rural providers can have a devastating impact not just on the hospital, but to the entire community.

Overall, hospital representatives stressed the negative impact additional cuts could have on Rep. Kind’s district and that they are already preparing for reductions from other unrelated federal policies.

WHA is coordinating similar high-level CEO/legislator meetings across the state in the comings days.

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ICD-10 Planning & Implementation Webinar Series Available

Converting from ICD-9-CM to ICD-10-CM/PCS presents both opportunities and challenges for all health care delivery entities. The scope and complexity of the classification system changes are significant, and the transition requires substantial changes affecting many systems, processes, and people. Those significantly affected by the change will be coders and documentation improvement specialists; however, the planning for and implementation of ICD-10 extends well beyond, into many areas of the hospital’s daily operations.

In an effort to assist with your organization-wide ICD-10 readiness, WHA is offering a four-part webinar series designed specifically for hospital HIM managers, business office managers, compliance officers, CFOs, chargemaster managers and others on the hospital’s ICD-10 planning and implementation team. The series, offered by AHIMA certified ICD-10 trainer Karen Scott, will include a two-part session on steps for success, as well as a focus on rules, regulations and root operations for both ICD-10-CM and ICD-10-PCS. The sessions will be offered on August 9, September 13, October 11 and November 8.

Online registration is now open for this series at http://events.SignUp4.com/ICD10AugNov. Participants can register for individual sessions or for a full series at a discounted fee. For registration questions, contact Lisa Littel at llittel@wha.org or 608-274-1820.

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National Groups Issue a Disparities Call to Action
WHA and WHAIC helping hospitals improve data collection

The Association of American Medical Colleges, American College of Healthcare Executives, American Hospital Association, Catholic Health Association of the United States and National Association of Public Hospitals and Health Systems have joined together with the goal of making the most progress possible in improving the quality of care for each and every patient regardless of their race, ethnicity, or language.

Link to national press release: www.wha.org/qualityAndPatientSafety/pdf/DisparitiesCalltoAction7-18-11.pdf

As an Aligning Forces for Quality community, many Wisconsin hospitals have been making progress toward improving the collection of patient self-reported race, ethnicity, and language preferences. The WHA Information Center has been educating hospitals on the topic since 2007 and currently 41 hospitals enrolled in various Aligning Forces initiatives have received best practice training to improve their processes.

Eliminating disparities requires a data driven approach, and in order to do that hospitals need accurate demographics. According to WHA’s Manager of Quality Improvement, Stephanie Sobczak, "Our approach is a collaboration between the Information Center who notifies hospitals when there are indications of a data collection problem, and the quality staff who follow up with resources for hospitals to educate front-line staff on how to ask patients the questions to get the best information. We have made good progress in raising awareness of the issue."

National groups are coming together to provide materials and education to all health care providers about the issue of care disparities. Recommendations for hospitals include:

For more information or if you have any questions, contact Stephanie Sobczak at ssobczak@wha.org or call 608-274-1820.

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Over 150 Participate in WHA Concealed Carry Webinar

On August 3, hospital staff from all across Wisconsin, and even the UW-Madison Police Department, participated in WHA’s webinar, "Concealed Carry and Implications for Hospitals" to learn more about the recently-enacted concealed carry law that will go into effect November 1. The webinar discussed key elements of the law including signage, employee provisions, and parking facilities. This was just one of nearly a dozen WHA Member Forum webinars offered during the first six months of 2011 that focused on timely legislative and regulatory-related subjects.

WHA has also created a summary of key aspects of the concealed carry law as well as model signage that hospitals may choose to use or modify. The summary and model signage can be found at: www.wha.org/SummaryKeyIssuesConcealedCarryAct7-11.pdf and www.wha.org/NoWeaponsPoster.ppt.

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TCAB Visits Continue

As part of the Wisconsin Transforming Care at the Bedside (TCAB) Project, Judy Warmuth, WHA vice president of workforce and clinical leader for this Aligning Forces for Quality Project, is visiting each participating medical/surgical unit. Nearing the end of this round of visits, this week’s report is on four units in three hospitals. Next week will be the final visit and report for this component of the project.

Boscobel Area Health Center

Boscobel has a large TCAB team with great representation. There is a banner in the lobby that has been in the 4th of July parade and at the county fair! The team had a kick-off for the community on Nurses’ Day and has received a good deal of local publicity. Boscobel had initiated a unit-based improvement project just before the Wisconsin TCAB project began, and had done a "time at the bedside" study and two projects before they even got to the Dells. They felt like they got great ideas, support for what they had started and a boost of energy from the TCAB kick-off event. They are working on a visit and sharing with another TCAB unit.

Good Samaritan Hospital

TCAB is being used as the framework for implementing change on the Medical/Surgical unit and the team reported on many items they are working on including: role specific uniforms, caregiver pictures in patient rooms, huddles at change of shift, patient interruptions (delayed), medication times, trash cans in patient rooms, medication sticker move (abandoned), HUC use of patient name when answering call lights, bin swap for nurse servers, bedside care conferences and nurse/physician rounding (very well received by the physicians). This team has many great ideas and has a plan for spread to other departments.

Aspirus Hospital Wausau

This visit began with a T-CAB greeting and ride at the front door with help from the volunteer department. The units have presented to their senior management team to garner support and interest throughout the entire hospital.

The ortho/neuro unit did an energetic "snorkle" which generated lots of ideas. They have a TCAB Web page with all of their projects, pictures and reports which was impressive and developed by one of the team members. They have great boards and staff communication tools and are working on topics under all of the pillars. The nurse leader for this unit articulated the complexity of stepping back and letting caregivers do their projects.

On the surgical care unit, the TCAB is also primarily led by staff members who show lots of enthusiasm. They have a "road" posted along the hallway ceiling with little cabs showing their projects and dates…they have traveled only a short distance along a very long road into the future. They have a unit newsletter with a TCAB feature each month. They have moved overhead lift slings and have otherwise primarily worked on falls.

Again, these visits all reflect great progress made by enthusiastic teams. This project officially kicked off at the end of March and with only slightly more than 90 days of work, many improvements for patients and staff have already been made. The Wisconsin TCAB initiative is an 18-month project that will end September 2012. Participants will each be expected to outline a plan to sustain the project after that date.

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Community Health Needs Assessment: Overview of Models and Resources
First in a Series of Articles on Community Health Improvement

By: Julie Hladky, CHIPP Research and Support Specialist
Wisconsin Association of Local Health Departments and Boards (WALHDAB) 


As Wisconsin hospitals move forward with the new Community Health Needs Assessment requirements in the Affordable Care Act, the Wisconsin Hospital Association has partnered with the Wisconsin Association of Local Health Departments and Boards (WALHDAB), the University of Wisconsin Population Health Institute, and other statewide organizations in a project to strengthen community-based health improvement efforts.

Based on a review of many national resources, this model (described further below) depicts the general process, grounded in local partnerships, of continuous community health improvement.

In this article, we outline the key principles and activities at each stage of the community health improvement cycle. In future articles, we will review each stage in more detail and provide resources to help you in creating your local Community Health Needs Assessment and Implementation Strategy.

Partner with Stakeholders and Community Members: Crucial throughout the process is the central practice of community partnership. If the long-term goal is to improve key health indicators in the community, and given the complexity of today’s health issues, engaging community stakeholders in the process will be critical to success.

Assess Needs and Resources: As partners work together, the first step is to assess the health of the community. There are many sources of health-related data that are available on a county or occasionally at a smaller geographic level. These include not only health outcomes (e.g. morbidity and mortality data) but also factors that influence those outcomes such as health behaviors, clinical care, social and economic factors and the physical environment. Including the voice of the community through surveys, focus groups, or interviews is another important source of data. Finally, assessment includes analyzing community assets that are available to support action to improve health.

Prioritize Strategic Issues: Once all the community data is reviewed, the partners collaboratively determine which issues to focus on in the upcoming years. Choosing just a few issues helps to target limited resources and maximize impact. While the community as a whole picks the top issues to address, each participating organization can select what their contribution will be to that larger effort.

Planning for Effective Implementation: Before implementation, it is important to develop specific intervention plans. That includes targeting efforts at a specific measurable outcome and choosing intervention strategies that are evidence-based. Then a detailed work-plan should be drafted which combines accountabilities for each partner, a budget and a timeline.

Implementing Strategies: Effective implementation also requires strong partnership and ongoing management. Many communities function well with a structure that includes a steering committee representing all key stakeholders and a workgroup for each identified local priority. Shared leadership of the workgroups increases community engagement in ongoing implementation and resource identification.

Evaluation: Clearly defining and regularly tracking both process and outcome measures for each initiative will help to document the impact of your efforts. Choosing indicators that are already measured in current statewide and national data will assist in evaluating outcomes.

More resources are available at: www.wiservepoint.org/Resources.aspx

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Save the Date! Care Transitions Connection
November 2, 2011 - Kalahari Resort, Wisconsin Dells

Care Transitions Connection, sponsored by WHA and other organizations, will be held November 2. It is designed to begin a conversation about how to improve transitions from hospital to long-term care or home and to reduce preventable hospital readmissions. Experts will be sharing several tried and tested methods for improving care transitions, including: STAR, Project RED, BOOST, and IMPACT.

Hospital, long-term care center, and home care staff are encouraged to attend as a community and participate in shared learning. Part of the day will be spent exploring the design of a statewide collaborative involving all aspects of the care continuum.

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Wisconsin Hospitals Community Benefits: Acute, Chronic and Communicable Disease Prevention and Control

Hospitals are well aware of the critical role they have in protecting public health. Whether it is working with public health agencies to develop protocols and responses to pandemic flu outbreaks, teaching children proper hand-washing techniques or educating people about how to live with chronic conditions, Wisconsin hospitals partner with key stakeholders to improve the health status of their communities.

Anemia Clinic fills unique niche

"I certainly wouldn’t be here if it wasn’t for them," claims Dorothy Plautz, now 82 years old.

There was a point when Dorothy was quite sick. She was admitted to Wheaton Franciscan – Elmbrook Memorial with congestive heart failure and failing kidneys.

It turns out her iron levels were low from the chronic kidney disease to the point of putting her health in jeopardy and making it difficult to enjoy life because she had to be attached to an oxygen tank and tubing. Dorothy received blood transfusions and iron treatments in the hospital. Upon release, she was referred to Wheaton’s Anemia Management Clinic where many patients with chronic conditions are treated.

The health system has three hospital outpatient clinics located on the Wheaton Franciscan – Elmbrook Memorial and St. Joseph Campuses as well as at Wheaton Franciscan Healthcare – St. Francis. The clinics serve patients with B12 and iron deficiency as well as chronic anemia related to a number of disease states. These patients often experience loss of appetite, depression, fatigue, and shortness of breath.

The anemia management team consists of highly skilled nurses and pharmacists and is coordinated by a nurse practitioner at all sites.

"When we met Dorothy, she was on oxygen and was in poor condition," shares Mary Sinnen, director of nephrology services.

Because her levels were dangerously low, taking iron pills, which are hard to absorb, was not the best option and Dorothy started IV treatments.

"Everyone at the clinic was so great. I thought I’d need to be on oxygen the rest of my life, which was a grim thought. They really care about patients and worked to get to the bottom of my problems," Dorothy says.

That was five years ago, and Dorothy is still undergoing treatments. At her monthly visits to the anemia clinic, her hemoglobin level is tested, and she gets medication to help her body produce red blood cells so that that her anemia remains in check, and she is free to enjoy an active lifestyle.

Dorothy says it’s a miracle, but she’s now living a relatively healthy life: "I really give them credit for saving my life. They’ve given me years of healthy living."

Wheaton Franciscan Healthcare, Milwaukee

Asthma class

Statistics from 2005 reveal that 13 percent of adults and children in Wisconsin were diagnosed with asthma. In the same survey, 5,500 residents were hospitalized, and over 22,000 visits to the E.R. were asthma-related.

Worse, 5,000 people die each year in the U.S. due to asthma-related causes.

In response, Aurora BayCare Medical Center began offering Asthma School – a two-hour class on living with asthma and managing it. The class is open to the community. Nicole Goolsbey, a respiratory therapist for the past16 years conducts this course and has been certified to do so for over three years.

A session is held every two months.

"The classes are usually small (on average, two to three newly diagnosed patients)," Nicole explains, adding, "which affords me the opportunity to work closely with each student and provide a truly hands-on approach. And that’s important, because asthma tends to affect children, so our classes also include parents who often are just as nervous about administering asthma medications as their child," she pointed out.

She recalls a seven-year old who came to class and left quite an impression. His parents had many questions, starting with not really knowing what medications he was on and when he should be taking them. They were so distressed that they had arranged for their son to be excused from gym class for fear of an asthma flare-up.

Nicole was able to provide a comprehensive review of the boy’s medications and the instructions for taking them. She was also able to encourage the student to return to the gym and get acclimated to a normal life.

Several months later Nicole received an e-mail from the mother, stating how well her son was doing, that there were no more visits to the E.R., and that he was really happy again.

"We feel more confident in the care of our child now," the mother explained.

Through her years of experience, Nicole believes her classes and others like it are important for successfully managing asthma and preventing needless fear.

Aurora BayCare Medical Center, Green Bay

American Parkinson Disease Association Information & Referral Center: Information = Power

• 700 people throughout Wisconsin served

• 11 support groups, including those for caregivers

• 5 free educational symposia conducted in 2010

When Gary was diagnosed with Parkinson’s disease a decade ago, most people didn’t know the difference.

Nevertheless, his wife, Pam, began research through the American Parkinson Disease Association. But she was fearful of knowing too much, knowing what might lie ahead. As Gary’s health issues required 24/7 monitoring, the information had proven powerful.

"We were better prepared to manage his health and our lives because of the education, compassionate support and network of friends we’ve made through APDA," says Pam. "In many ways, it’s been an extension of our family."

The Wisconsin Chapter of the American Parkinson Disease Association is headquartered at St. Mary’s Hospital in Madison. In 2010, the Information and Referral Center served 700 people statewide. In addition, its outreach activities included five free educational symposia and the facilitation of 11 support groups for people with Parkinson’s as well as their caregivers.

St. Mary’s Hospital, Madison

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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