September 2, 2011
Volume 55, Issue 34


Medicaid EHR Incentive Application Webinar Offered September 8
Due date for PPS and CAH Medicaid EHR payment application is September 30

On Thursday, September 8 at 3:00 p.m., WHA will host a teleconference aided by Webex technology discussing the application process for the Wisconsin Medicaid EHR Incentive Program for Hospitals. Elise Braun from the Wisconsin Department of Health Services will provide guidance to teleconference participants on the application process, including updated guidance on cost report data, fiscal year start dates, unique border hospital issues, and commonly asked questions by hospitals. Participants will also have the opportunity to participate in a Q&A session.

Hospital staff responsible for completing the Medicaid EHR Incentive application process are encouraged to attend. Invitations to the teleconference were sent to WHA’s CFO and information services email lists.

To register for the teleconference, go to http://events.SignUp4.com/EHRApply090811. Registrants will receive a call-in number and further instructions the week of September 6.

As a reminder, PPS hospitals and critical access hospitals are eligible to receive a Medicaid EHR incentive payment for federal fiscal year 2011 if they have adopted, implemented, or upgraded to certified EHR technology. Meaningful use is not required to receive a first payment under the Medicaid EHR Incentive Program. However, a multi-step application process must be completed by September 30, 2011 to receive a payment for federal fiscal year 2011.

Additional information on the Medicaid and Medicare EHR Incentive Programs can be found at: www.wha.org/toolKit/EHR.pdf and www.dhs.wisconsin.gov/ehrincentive

For more information contact Matthew Stanford, WHA vice president, policy & regulatory affairs, and associate general counsel, at 608-274-1820 or mstanford@wha.org.

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WHA Comments on CMS Outpatient PPS Rule for FY 2012
Includes wage index, value-based purchasing, outpatient therapy supervision

On July 18 the Centers for Medicare & Medicaid Services (CMS) issued its hospital outpatient prospective payment system (PPS) proposed rule for fiscal year (FY) 2012. The proposed rule updates outpatient payment rates and policies and implements provisions of the health care reform law, the Patient Protection and Affordable Care Act (PPACA).

In the proposed rule, CMS appropriately raises issues about hospital actions involving the inpatient PPS wage index rural floor that have resulted in significant wage disparities across the nation. WHA President Steve Brenton has commented on the manipulation of the inpatient rules by Massachusetts in recent columns (see August 19 and August 12 issues of The Valued Voice). WHA shared with CMS its concerns on this issue, and the strong belief that the flawed inpatient policies should not be similarly applied to Medicare outpatient payments. Rather, CMS should seek to develop a methodology that prevents a small number of hospitals from using the rural floor policy to benefit all hospitals in the state at the expense of numerous other hospitals throughout the country.

In addition to updating outpatient payments, the rule includes new policy proposals related to the federal fiscal year 2014 implementation of PPACA’s Medicare inpatient value-based purchasing (VBP) program. WHA notes in its comment letter that CMS’s proposed inclusion of composite measures does not align well with the intent of VBP—to drive improvement. WHA also recommends that CMS avoid duplication of measures, include only measures that have been well established, and follow the original intent and stated guideline of a 12-month review period. WHA continues to emphasize that the number of measures hospitals are required to report is a continued burden, particularly for small PPS hospitals.

WHA also urges CMS to revise its unfair proposal which essentially eliminates its obligation for a hold harmless provision for transitional outpatient payments for cancer hospitals, estimated at $158 million, and shifts this financial burden to all other hospitals. Finally, WHA expresses its support for an independent review process that would allow for an assessment of the appropriate supervision levels for individual hospital outpatient therapeutic services, but identifies specific concerns about the supervision levels for these services and specifics in CMS’s proposed rule regarding the selection of the review body, the review process, and the evaluation criteria.

For a summary of the proposed rule, go to www.wha.org/financeAndData/pps_outpatient.aspx.

To access WHA’s comment letter, go to www.wha.org/WHAcommentLetterNPRMOPPS.pdf.

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Political Action Spotlight: Out-of-state Groups Spent Millions on Recall Elections
Wisconsin Hospitals PAC & Conduit Updates its Yearly Totals

More than $35 million was spent in just over two months on the recently-completed nine recall elections, the majority of which came from out-of-state contributors. And this could just be the beginning, as some groups are already setting their sights on a gubernatorial recall early next year, and the November 2012 elections are just around the corner.

Unlike these out-of-state entities, the Wisconsin Hospitals Conduit and PAC fundraising campaign raises funds from those who live or work in Wisconsin to support Wisconsin candidates for office. To date the campaign has raised an additional $15,000 in the last three weeks putting the campaign at 58 percent of goal. The goal of the campaign is to raise $250,000. The total raised to date is $143,538 from 243 individuals.

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 September 16 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

 

Adams, Daniel

Memorial Medical Center - Ashland

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

Boecker, Ron

Wheaton Fransican Healthcare

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

Calhoun, William

Mercy Medical Center

Campau, Patricia

Columbia St. Mary's, Inc.

Campbell-Kelz, Nancy

Aspirus Wausau Hospital

Casey, Candy

Columbia Center

Caven, Michael

Memorial Medical Center - Ashland

Ceelen, John

Ministry Health Care

Censky, Bill

Holy Family Memorial, Inc.

Clapp, Nicole

Grant Regional Health Center

Clark, Renee

Fort HealthCare

Connor, Michael

Aurora Health Care

Colby, Dan

Mercy Health System

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.

Ela, Susan

Aurora Health Care

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

Gjolberg, Skip

Prairie du Chien Memorial 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

Hamilton, Mark

 

Hattem, Marita

Aspirus Wausau 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

King, Steve

St. Mary's Hospital

Klay, Lois

St. Joseph's Hospital

Klein, Rick

Aurora Health Care

Kuehni-Flanagan, Tracy

St. Joseph's Hospital

Lachecki, Therese

Memorial Medical Center - Ashland

Laird, Michael

Froedtert Health St. Joseph's Hospital

Lange, George

Westgate Medical Group, CSMCP

Marcouiller, Don

Memorial Medical Center - Ashland

Margan, Rob

Wisconsin Hospital Association

Maroney, Lisa

 

Marquardt, Amy

 

Mason, Paul

Wheaton Franciscan Healthcare - All Saints

Maurer, Mary

Holy Family Memorial, Inc.

McKevett, Timothy

Beloit Health System

McNally, Maureen

Froedtert Health

Meicher, John

St. Mary's Hospital

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

Ojala, Theresa

St. Mary's Hospital

O'Keefe, James

Mile Bluff Medical Center

Olson, Bonnie

Sacred Heart Hospital

Ose, Peggy

Riverview Hospital Association

Page, Alison

Balwin 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

Quinn, George

Wisconsin Hospital Association

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

Rubenzer, Deanne

St. Joseph's Hospital

Rudolph, Wade

Sacred Heart Hospital

Rutkowski, Jennifer

Grant Regional Health Center

Samitt, Craig

Dean Health System

Saunaitis, Tamara

Meriter Hospital

Schaefer, Mark

Froedtert Health

Schaetzl, Ron

St. Clare Hospital & Health Services

Schraufnagel, Patricia

Memorial Medical Center - Ashland

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, Anne

Memorial Medical Center - Ashland

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

Turner, Sally

Aurora Health Care

Van Meeteren, Bob

Reedsburg Area Medical Center

VanDeVoort, John

Sacred Heart Hospital

Walker, Troy

St. Clare Hospital and Health Services

Yaron, Rachel

Ministry St. Clare’s Hospital

Omdahl, Nicholas

Wheaton Franciscan Healthcare - All Saints

Barkovich, Catherine

Sacred Heart 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

Dicus-Johnson, Coreen

Wheaton Franciscan Healthcare

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

Hymans, Daniel

Memorial Medical Center - Ashland

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

Nelson, Dave

SSM Health Care-Wisconsin

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 Campus

Worrick, Gerald

Ministry Door County Medical Center

Zenk, Ann

Ministry Saint Mary's

 

Contributions ranging from $1,000 - 1,499

 

Alig, Joanne

Wisconsin Hospital Association

Boese, Jennifer

Wisconsin Hospital Association

Boland, Susan

Wheaton Franciscan Healthcare - All Saints

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

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

Size, Pat

Rural Wisconsin Health Cooperative

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

Mohorek, Ronald

Ministry Health Care

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 Network

Katen-Bahensky, Donna

 

Kief, Brian

Ministry Saint Joseph’s

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

 

Desien, Nicholas

Ministry Health Care

Taylor, Mark

Columbia St. Mary's, Inc.

 

Contributions ranging from $3,000 - 3,999

 

Borgerding, Eric

Wisconsin Hospital Association

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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WI Medicaid Implements HIPAA Version 5010 Transactions October 15, 2011

Starting October 15, hospitals will be able to start submitting Medicaid claims in the new HIPAA version 5010 format. The Department of Health Services is currently testing the new "5010" format with providers who wish to ensure their claims will process correctly using the new format.

Any provider that would like to submit a "test run" of claims using the new format can do so by submitting a request after reviewing the testing information and timelines available at www.forwardhealth.wi.gov/WIPortal/Tab/42/icscontent/HTML/5010Info/5010Home.htm.spage.

For providers who are not ready to convert to the new 5010 format on October 15, WI Medicaid will continue accepting claims in the 4010 format until the federally-mandated implementation date on January 1, 2012.

The Wisconsin Medicaid program is starting its initial planning phase of the ICD-10 project by identifying the impacts of ICD-10 on current policy and business related functions.

WI Medicaid plans to develop a separate page on its Forwardhealth portal dedicated to ICD-10. This page will be similar to the one used today for the HIPAA 5010 project. Information on what Wisconsin Medicaid is doing to prepare and implement ICD-10, the status of the project, and the how ICD-10 impacts Medicaid providers will be posted on Forwardhealth as it becomes available.

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Guest Column: What’s New in Quality?
By Kelly Court, WHA Chief Quality Officer

Wisconsin is well known for providing high quality care, a reputation that our hospitals and health systems have worked hard to attain—and keep. Wisconsin hospitals have led the way in public reporting and quality improvement. WHA has played a role in helping our hospitals raise the bar on quality by promoting public reporting through CheckPoint, and by fostering collaborative learning opportunities.

I wanted to provide a status report on several key public reporting and quality improvement activities, including:

WHA recruited 42 hospitals, in 2009 and 2010, to participate in the national patient safety program to eliminate central line-associated bloodstream infections (CLABSI) using the Comprehensive Unit-based Safety Program (CUSP). This is one of the Hospital Acquired Conditions targeted by CMS. Sometimes maintaining an improvement strategy is the hardest work. As you can see in the chart below, Wisconsin improved faster than the rest of the nation and continues to maintain the achieved lower rate of infections. WHA has begun facilitating a similar project with the Wisconsin Neonatal Perinatal Quality Collaborative as the next phase of the program. In this phase, 16 neonatal intensive care units will implement similar guidelines to eliminate infections in neonates.

CMS has finalized a number of changes to the measures that PPS hospitals are required to report for both the inpatient and outpatient quality reporting programs. As older measures are retired, the plan calls for new measures to be added each year, which will increase the data collection burden to hospitals. The plan is to eventually convert from manually collected data to measures collected through meaningful use; however, that is not projected to start until 2015. As measures are added to the requirement we can expect many of them to also be added to the value-based purchasing program. WHA sends regular updates to the quality leaders at each hospital to ensure everyone is knowledgeable about all of these changes. The table that follows summarizes the change in the number of measures that will be required over the next two years.

Inpatient – Measure Type

2011

2012

2013

Chart Abstraction

28

22

36

CDC/NHSN – Infections

1

3

6

HCAHPS – Patient Satisfaction

10

10

10

Measures Derived from Medicare Claims

15

16

16

Hospital Acquired Conditions

8

   

Outpatient – Measure Type

2011

2012

2013

Chart Abstraction

7

14

21

Chart Abstraction

28

22

36

CMS has also finalized their Readmission Reduction Program. The reduction will be in what PPS hospitals are paid for all DRGs, based on "excessive readmission rates" for heart attack, heart failure and pneumonia. CMS will be using baseline data from 7/1/2008 through 6/30/2011 to calculate each PPS hospital’s readmission rate for the three conditions. The reduction in DRG payments will start at one percent in FFY 2013 and increase to as high as three percent by FFY 2015. Additional clinical conditions will be added into the readmission rate calculation in the future. This program makes it especially important for hospitals to be actively working to reduce readmission rates.

The readmission issue is a perfect lead in to the work WHA is hoping to undertake as a Hospital Engagement Contractor for CMS. This contract is in support of the CMS Partnership for Patients initiative, which has a goal of 40 percent reduction in inpatient harm and 20 percent reduction in readmissions over three years. Under this contract WHA would recruit Wisconsin hospitals to work on nine areas of patient safety and readmissions. Most of these areas are part of the CMS hospital acquired conditions, which will be incorporated into the value-based purchasing program in 2013. Working on these areas is not only the right thing to do for patients, it will also eventually affect your future reimbursement. WHA will coordinate the delivery of educational content and assist with the development and use of simple measures to track progress on each condition.

WHA is committed to working with every hospital in the state on one or more of these quality-related topics. We hope to hear from CMS regarding our contract proposal by the end of September. Once we receive notification we will be in contact with all hospital CEOs and quality leaders to encourage your support of and participation in this important work.

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Rep. Ripp Shadows Columbus CEO John Russell

State Rep. Keith Ripp (R-Lodi) visited Columbus Community Hospital recently in order to shadow hospital President/CEO John Russell. Shadow days are a WHA initiative connecting elected officials with hospital CEOs so elected officials can see all that it takes to run a hospital in today’s health care environment.

During the shadow day visit Rep. Ripp had an opportunity to learn from Russell and other hospital staff about quality, emergency preparedness and other important issues facing the health care industry.

"We appreciated the opportunity to meet with Representative Ripp and share some of the challenges faced by rural community hospitals," said Russell. "I think Rep. Ripp was surprised by the complexity of our industry.

Several of the meetings Rep. Ripp participated in during the shadow day included medical staff. Those meetings focused on understanding emergency room utilization by Medicaid beneficiaries with chronic conditions as well as issues facing physicians in private practice. Ripp was then also able to spend some time with several hospital Board members who participated in the day.

"Our group found Rep. Ripp had a true understanding of the issues faced by rural communities," said Russell. "He was genuinely interested in our facility and the role we play in the health of our patients and the economy of our local community."

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Grassroots Spotlight: Sen. Galloway Visits Memorial Health Center (Medford)

State Senator Pam Galloway (R-Wausau) made a special stop in Medford to visit the Memorial Health Center on Monday, August 22. During her trip, Sen. Galloway, a physician, was able to gain an understanding of the depth, breadth and importance of services Memorial Health Center provides to the people of Taylor, Price and Clark counties, and to discuss various legislative topics.

"We really enjoyed meeting with Senator Galloway," said Gregg Olson, Memorial Health Center’s president/CEO. "Having a unique insight as both a physician and legislator, Doctor/Senator Galloway understands well how legislative policies can affect the medical industry. This session helped to further elaborate on the specific implications that rural facilities such as Memorial Health Center are facing on both the state and federal levels."

Memorial Health Center’s senior leadership team, as well as Sally Sadowska, executive director of Senior Care Services; Patti Prusinski, volunteer coordinator; and Nancy Potter, volunteer’s legislative liaison discussed with Sen. Galloway the community benefits and economic contributions that Memorial Health Center provides to the area.

Other topics of discussion included the health insurance exchanges, Medicare reform, and the importance of preserving access to the top quality care provided by Wisconsin health care institutions, such as Memorial Health Center.

Sen. Galloway was also able to visit with the Medford Economic Development Foundation at the Medford Area Chamber of Commerce later that afternoon.

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WISHIN Direct Ready for Health Information Exchange

Hospitals, physicians and other health care professionals may now sign up for Wisconsin State Health Information Network (WISHIN) Direct, which enables secure electronic health information exchange.

The WISHIN Direct allows hospitals, physicians, clinics, pharmacies, labs and others to exchange health information to known and trusted recipients. This secure clinical messaging reduces manual handling of paper records and allows health care professionals and entities to share a patient’s medical history including lab results, discharge summaries, and other important information with other providers who have seen the patient—even if those providers are not part of the same practice or health system.

WHA was one of four organizations that formed WISHIN last year. WHA President Steve Brenton is a member of the WISHIN Board of Directors and he serves as treasurer of the group. More information on WISHIN Direct is available at www.wishin.org or at wishin.support@wishin.org.

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Community Health Improvement: Choosing the Strategic Issues to Act On

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

A Series of Articles on Community Health Improvement

Previous articles in this series covered an overview of the Community Health Improvement cycle (8/5/11) and the first step in the cycle, assessing needs and resources (8/19/11). The next step is prioritizing strategic issues. The IRS states that your Community Health Needs Assessment must include a prioritized description of all of the needs identified by the CHNA, as well as the process and criteria used for prioritizing those needs. This article outlines principles to consider when addressing these areas.

Engage the Community

The entire community health improvement process will be most effective in the long run by involving a broad cross-section of the community in assessment and prioritization. This full engagement will strengthen the data considered and build momentum for partner support in the implementation phase. There are many appropriate players to include such as other health care providers, schools, and law enforcement. In particular, the current IRS guidelines require hospitals to include:

  • Persons with special knowledge of or expertise in public health
  • Federal, tribal, regional, state, or local health or other departments or agencies
  • Leaders or representatives or members of medically underserved, low-income, and minority populations with chronic disease needs.

Review the Data

When these stakeholders are brought together, present the community health data to them in a way that will help them see the big picture and grasp what the data is showing. Useful strategies for making data understandable include:

  • Use a framework to organize the data such as Healthiest Wisconsin 2020 or the County Health Rankings model
  • Use comparative data that answers the "so what?" question: compare over years, compare to other communities, compare to state or national benchmarks
  • Present the data in a way that paints a picture: pie charts, bar graphs and similar tools help to tell the story

Collectively Identify the Top Health Issues

After reviewing the data, participants should list all the issues that seem to be most important to address in the community. Then narrow down the list to choose just a few areas (3-6) to act on. This can be a difficult process because there may be many important issues, including those that some participants may be particularly passionate about. However, it is critical to do this effectively because it will help to target limited resources and maximize impact during your implementation stage. Recommended best practices for effective prioritization include:

  • Use a skilled and neutral facilitator to lead the process
  • Establish a set of criteria for rating the various issues that emerge in the discussion (agreed upon by the key stakeholders)
  • Use a group decision making process that builds consensus. (County Health Rankings tips and tools: www.countyhealthrankings.org/take-action/pick-priorities)

Local Example

Prioritization Criteria used by Healthy Marathon County:

1. Actionable at the local level
2. Able to be impacted in 3-5 years
3. Viable strategies exist to impact the issue
4. Affects many people
5. Has a serious impact on population health

Next article: Developing an effective action plan around your strategic health priority issues.

Sources: Current IRS Guidelines on CHNA: http://www.irs.gov/irb/2011-30_IRB/ar08.html

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Wisconsin Hospitals Community Benefits: Healthy Growth and Development

Early growth and development have a profound effect on health across the life span. Developmental disabilities can often be mitigated if they are detected early. Every week in Wisconsin almost 100 infants are born with low birth weight, and about six percent of those will die before their first birthday. Hospitals are striving to decrease infant mortality by providing pre-conception and inter-conception care to those affected by poor birth outcomes.

Addressing infant mortality

Nurses at Froedtert & the Medical College initiated and are leading a new project addressing the high infant mortality rate in our community. Called We CARE, the project will help new parents understand safe sleep practices and the risks of bed sharing. It was initiated by nurses in the Birth Center and the Mother/Baby Unit after a series of high-profile infant deaths in Milwaukee resulting from adults co-sleeping with babies.

"It is heart wrenching – some of the babies who died came through our unit,’ said Marilynn Klemstein, BSN, RN, and an international board-certified lactation consultant, who developed We CARE with colleague Nicole Abraham, BSN, RN, who is a certified lactation counselor.

Now, patients receive safe-sleep education, including an overview of factors that can reduce Sudden Infant Death Syndrome (SIDS), an explanation of the difference between room- and bed-sharing and a discussion of alternatives to expensive cribs, Marilynn said.

"Through the project, we will also follow up with phone calls to re-emphasize safe-sleep practices," she said. The program will eventually repeat safe-sleep concepts at numerous touch points, such as during prenatal consultations, upon patient admission to the hospital, during their stay and at discharge.

"It sounds cliché, but it’s all worthwhile if we can save even one life," Marilynn said.

Froedtert Hospital, Milwaukee


Centering Pregnancy to address teen pregnancy and infant mortality

In Milwaukee, the African American infant mortality rate in 2008 was 17.6 deaths per 1,000 live births, more than 3 times greater than the white infant mortality rate (Milwaukee Health Department figures). The leading causes of infant mortality in this population are disorders related to preterm birth (<37 weeks gestation) and low birth weight (<2,500 grams). According to the United Way, the City of Milwaukee has one of the highest teen birth rates in the US. Only about 30 percent of teen mothers finish their high school education.

The Centering Pregnancy model gathers pregnant girls together in a group for their prenatal care and education at the high school they attend. This decreases their need to miss school for prenatal visits that are essential for healthy birth outcomes. The group is facilitated by a clinical team led by a nurse midwife. During the course of their pregnancies the girls weigh themselves, estimate gestational ages and record their health information. Within their peer group they discuss topics related to pregnancy, childbirth, parenting, personal growth, development, relationships and birth control. By taking more control in their own prenatal care as a group, and supporting one another, they are able to build on each other’s knowledge, increase personal interactions, and expand a social support network with their pregnant peers for moving forward with their lives.

In Milwaukee, the Centering Pregnancy program is a partnership between the Aurora Midwifery and Wellness Center (MWC) based at Aurora Sinai Medical Center (ASMC); Aurora School-based Clinics, Milwaukee Public Schools, and the Wisconsin Partnership Fund. The program meets on the North Division High School campus. The young women deliver their babies at Aurora Sinai Medical Center and are referred to other Aurora services that support healthy birth/healthy life outcomes, including Aurora Family Service programs; the Women, infant and Children’s clinic at ASMC; and Safe Mom Safe Baby (for pregnant women experiencing domestic violence).

Case #1: Tara

Tara is a Milwaukee-area high school student who comes from a family that has its own challenges. She is mature enough to both attend school full time and work full time, evenings, at a McDonald’s. She does this so that she can live on her own, yet still provide support her two younger siblings still living at home but suffering from neglect.

That Tara responded to the attentions of a young man who was attracted to her is not surprising. That she found herself pregnant and suffered his resultant verbal abuse was a tragedy. That she became a more centered and stronger young woman is a testament to her fortitude and the value of participating in the Centering Pregnancy program.

Tara thrived in the Centering Pregnancy model. Along with her peers who were at varying gestational stages, she learned the many things that her mother did not teach her. She learned about her cycle, about sexually transmitted diseases, about preventing a second pregnancy, about nutrition for herself and her baby, about safe sleep, about parenting her baby going forward and the importance of breastfeeding.

As did her peers, Tara delivered her baby full term, exceeding the goal of 37 weeks gestation and a birth weight goal of 5 pounds 8 ounces. She also finished high school and now successfully breast-feeds her baby.

Case #2: Sheila

When Sheila told her mother she was pregnant, Mom was visibly angry and refused to accept the diagnosis. Mom returned to the Aurora School-based clinic with her daughter where the pregnancy test had been performed. When the clinic manager repeated the procedure, she allowed Sheila’s mother to observe the results.

Then, and only then, did Sheila’s mother accept the truth. The school-based clinic manager referred them both to the Centering Pregnancy program at the school. One session was all it took for Sheila and her mom to take to the program. They came to every session together. Sheila’s mom brought her younger daughter along, and together, their support for one another grew.

During her pregnancy, the pediatric nurse practitioner at the Aurora School-based Health Clinic recognized and diagnosed the symptoms of gestational diabetes. Working together with Sheila and her mom, the condition was well-managed and Sheila delivered her baby at term.

Sheila is proud of what she has accomplished. She and her mom enjoy returning to the group to tell their story and support young women who are pregnant.

Aurora Sinai Medical Center, Milwaukee


Family center helps parents prepare for new babies

Anticipating the arrival of their first child, Dawn and her husband attended free prenatal classes taught by the skilled and experienced staff of Memorial Health Center’s birthing and delivery unit, the Family Center.

Together, the couple learned about the signs and symptoms of labor, how to manage labor pains, breathing and relaxation techniques, the process of birth, breastfeeding, how to care for an infant, how baby’s introduction to the home may change family dynamics and how to cope, and much more.

"I especially appreciated the "Care of the Newborn" class," Dawn says. "The instructors showed us how to bathe a baby using a real newborn. The baby was screaming and crying. It tugged at my heart to hear that little baby screaming, but it helped us prepare for getting that reaction when our own baby came along. We also learned how to hold the baby, what to do, how to calm it down, things that might work. It was so useful."

Dawn says without the classes she wouldn’t have been nearly as ready to give birth and take care of a new baby.

"As a first time parent, you have no idea about what to expect," she says. "The Family Center classes gave us a heads up so we could be better ready to handle everything. Thanks to the classes, I felt like ‘okay, I can do this; the nurses teaching these classes can help me do this.’ That’s incredibly reassuring."

Memorial Health Center – An Aspirus Partner, Medford


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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