September 9, 2011
Volume 55, Issue 35


Engage Your Medical Staff in ICD-10 Planning: Focus of Sept. 29 Webinar

The transition to ICD-10 is a wide-reaching regulation that impacts financial and clinical systems and operations throughout health care, payer and vendor operations. Physician preparedness is a key component to a successful ICD-10 implementation for hospitals and clinics.

On September 29, WHA is offering a complimentary Member Forum webinar, through the Wisconsin ICD-10 Partnership (WICD-10), to provide an overview for physician leaders and other members of a hospital’s ICD-10 implementation team of ways to work together to engage their medical staff in a timely, manageable ICD-10 implementation.

During this session, participants will learn how the ICD-10 regulation affects physicians in both hospitals and clinic practices. Specific examples of how physician documentation impacts ICD-10 coding accuracy, and in turn, the revenue cycle, will be shared. Also, tools for physician leaders to use in supporting their medical staff with the ICD-10 transition will be identified and shared.

All hospital and clinic physician leaders, coding supervisors and managers, and clinical documentation specialists are encouraged to attend this event, especially as a team, if possible. Any other members of your ICD-10 implementation team are also welcome to participate. This Member Forum is offered at no cost to WHA hospital members; however, pre-registration is required. Space is limited but registration is still available at http://events.SignUp4.com/EngagingICD10.

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Guest Column: Some Thoughts on Physician Retention
By Kurt Mosley

Physician retention is particularly important in an era of pervasive physician shortages. Following are 10 guidelines to consider when developing a physician retention plan.

  1. Understand the physicians’ perspective. Knowing what motivates doctors—and what upsets them—is a critical first step toward positive physician retention. Some useful insights into the mindset of doctors is provided by a recent book written by executives with The Physicians Foundation and Merritt Hawkins. Entitled, In Their Own Words, 12,000 Physicians Reveal Their Thoughts on Medical Practice in America, the book is available at www.amazon.com or at most bookstores.
  2. Doctors are pushed, not pulled. Physicians usually leave because they are dissatisfied with some element of their current practice, not because they have spoken to a silver-tongued recruiter offering a greener pasture. To ensure physicians are not pushed, hospitals and medical groups need to know how staff physicians feel about where they work and where they live.
  3. You have to ask. If you want to know how physicians on staff feel about their practices, you have to ask them. Part of this process includes conducting a yearly physician satisfaction/retention survey. The survey will seek to elicit physician pain points, recruiting needs, equipment needs, marketing needs, specialty support, retirement plans and ways in which the facility can assist them.
  4. Good recruiting leads to good retention. Physician turnover often takes place because of lapses in the initial recruiting effort. If expectations regarding hours, group governance, quality of care, financials and related issues are not clearly communicated on the front end during recruiting, misunderstandings that lead to turnover can result on the back end. Make sure to spell out in writing exactly what is expected of the physician.
  5. Formalize follow-up. It is natural when a recruiting project is completed to go on to the next challenge. Unfortunately, a physician who has been the subject of considerable positive attention can quickly come to feel neglected and uncertain about his or her position. A regular schedule of one-on-one meetings should be conducted to avoid this at 30, 90, 180 and 365 days.
  6. The primacy of the workplace. Like snowflakes, no two practices are alike. Some practices are more appealing than others, not necessarily because they are located by a beach or the mountains, but because they feature a practice style and a work environment tailored to what doctor’s today prefer. You cannot control the fact that you are not close to an ocean, but you can to some extent control the quality of the medical practice environment you are offering.
  7. The move toward integration/employment. Health reform and market forces are promoting the integration and consolidation of hospitals, medical groups and individual physician practices. Physicians will want to be aligned with facilities that are responding to this trend, and that are moving toward the value-based reimbursement systems of the future.
  8. Pay for ED call. ED call may be a part of the hospital’s physician employment agreement. If not, or if independent physicians are on staff, paying for ED call can be a good retention tool.
  9. Learn when they leave. It is disappointing to lose a physician from the staff, but a doctor departure can be a learning experience. Schedule exit interviews with departing physicians to understand their motivations and to gain insight into what policies and procedures you may need to adjust.
  10. The "Three C’s" – Communication, Communication, Communication. Above all else, physician retention is a matter of communication. Physician communication should be both:

You can get ahead of the competition and reduce turnover by having a really good relationship with your doctors.

Kurt Mosley serves as vice president of strategic alliances with Merritt Hawkins and Staff Care, physician staffing firms and companies of AMN Healthcare (NYSE: AHS), the largest health care staffing company in the United States. He can be reached at kurt.mosley@amnhealthcare.com.

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Rep. Larson Shadows Chippewa Falls CEO Joan Coffman

St. Joseph’s Hospital President and CEO Joan Coffman hosted State Rep. Tom Larson (R-67 Assembly District), for a "shadow day" opportunity. 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.

"Hosting Representative Larson was an opportunity for us at St. Joseph’s Hospital to share our story, mission, ministry and heritage along with the challenges we face in serving the poor and marginalized in an unstable health care climate," said Joan Coffman, St. Joseph’s Hospital president and CEO, and vice president for physician relations, HSHS Division (Western Wisconsin). "As one of the top six hospitals in the state for disproportionate share, Rep. Larson understands that our hospital is an anchor of the community having served the Chippewa Valley for more than 125 years. We, too, can serve as a resource for him on health related issues."

During his time at St. Joseph’s, Rep. Larson was also able to attend a meeting with nearly 30 St. Joseph’s Hospital directors and administrators. His goal was to get to know his hospital constituent and hospital issues.

When Larson spoke, he talked about being an electrician and owning his own business—Bear Valley Electric—for 19 years. When asked why he got into politics, Larson said it had to do with being a small business owner.

"There is so much red tape…" he said. "I thought, ‘At some point I’m going to hand this down to my sons. What am I handing down to my children? What will they be getting?…Maybe I should do something about this.’ I was never in the Army. I thought maybe this is my way to serve my country."

Rep. Larson was also able to tour several areas of the hospital, including the L.E. Phillips-Libertas Treatment Center. When talking with Director Tom Fuchs, Fuchs asked how hospital employees could be of assistance. Rep. Larson, a freshman politician, succinctly said: "I don’t know what I don’t know. I need you to tell me what you need. I need you to tell me how I can help you."

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President’s Column: The Business Case for Health Information Exchange Just Got Clearer

For some time now policymakers, commentators and IT vendors have been telling us that the health care field’s investment in EHRs and related health information exchange (HIE) services will "pay off" with improved quality and clinical efficiency—two important pillars of delivery and payment reform necessary to "bend the cost curve."

Now, a major study finds that the implementation of a Wisconsin community-based information exchange in Milwaukee-area hospital emergency departments (EDs) saved an average of $29 per ED visit for Humana’s southeast Wisconsin health plan. The cost savings were fueled by decreased utilization of imaging procedures and diagnostic tests. The study (www.ahdbonline.com/feature/business-case-payer-support-community-based-health-information-exchange-humana-pilot-evaluat), underscores the important symmetry between the delivery of and payment for health services and makes a strong case that commercial payers should be involved in helping finance HIE infrastructure.

The HIE in southeast Wisconsin is the Wisconsin Health Information Exchange (WHIE), historically heavily supported by the Milwaukee-area health systems and by Wisconsin’s Medicaid program. WHIE’s current primary function is to serve as "linkage" between Milwaukee-area EDs. WHIE promotes the "real time" querying of a clinical database by clinicians, thus providing access to historic encounter data including patient demographics, recent encounter history and venues, and medical information. Patient care diagnosis and care is improved significantly by access to the data and unnecessary care can be avoided. For Medicaid patients in particular, frequent ED users who are often seeking prescription medications can be identified and better managed.

Special kudos to Humana for undertaking and publishing the study, and for being an early supporter of HIE. It is noteworthy that Humana also suggests that the study findings should "encourage other plans toward an additional investment in HIE, which will advance HIE sustainability, and to embrace HIE standards and services." Providers shouldn’t be the sole funders of HIE ventures and the "business case" here for payers is clear.

Steve Brenton
President

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Three Health Care Organizations Receive 2011 Wisconsin Forward Award

Health care organizations continued their domination of the Wisconsin Forward Awards, the state’s premier organization for the promotion and recognition of high performance management principles. Three Wisconsin hospital systems were honored at a ceremony at the Monona Terrace Conference and Convention Center in Madison August 31.

Two health care organizations were recognized at the Mastery level, demonstrating significant maturity in developing and refining processes that are tied to good results in such areas as building a highly-skilled workforce, financial and organizational performance, and exceptional customer satisfaction and retention. They are Bay Area Medical Center, Marinette and SSM Health Care of Wisconsin-Madison. Black River Memorial Hospital, Black River Falls also received recognition.

"Wisconsin hospitals and health systems are recognized as providing some of the highest quality health care in the country, and the fact that they are continuously striving to improve demonstrates their commitment to excellence," according to WHA President Steve Brenton. "The Forward Award winners deserve the visible recognition that they receive as they stand as a real benchmark for others to emulate."

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Due date for PPS and CAH Medicaid EHR Payment Application is September 30
Nearly 100 Participate in WHA Webinar Medicaid EHR Incentive Application Webinar

Little time is left for hospitals to apply for a fiscal year 2011 Medicaid EHR incentive payment. To receive payment this year, hospitals must complete the multi-step application process by September 30, 2011.

As a reminder, both PPS hospitals and critical access hospitals can receive a Medicaid EHR incentive payment merely by showing that they have adopted, or are in the process of implementing or upgrading to certified EHR technology. Meaningful use is not required to receive a first payment under the Medicaid EHR Incentive Program.

To help guide hospitals through the process, WHA offered a webinar on the application process to hospitals September 8, and nearly 100 individuals participated. This was just one of nearly a dozen WHA Member Forum webinars offered during 2011 that focused on timely legislative and regulatory-related subjects.

"A key message of the webinar was that the application process involves multiple steps," said Matthew Stanford, WHA vice president, policy and regulatory affairs, and associate general counsel. "Hospitals should begin the application process now to help ensure they can meet the September 30 deadline."

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 Stanford at 608-274-1820 or mstanford@wha.org.

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Member News: Rohrbach Will Lead Southwest Health Center

Dan Rohrbach has been selected as chief executive officer at Southwest Health Center in Platteville. Rohrbach succeeds Anne Klawiter who retired in April after serving 22 years. He assumed his full leadership responsibilities August 29.

According to Southwest Health Center Board Chair Jim Schneller, Rohrbach’s experience will be an asset to both the organization and the community. "Dan’s accomplishments include a strong track record of leading and developing staff as well as growing and expanding services," says Schneller. "We’re proud to continue attracting talent at such a high level, and we’re excited about the future of health care in southwest Wisconsin under Dan’s leadership."

Rohrbach comes to Southwest Health Center from his position as CEO of Essentia Health in Ada, Minnesota, a health care system that includes a 14-bed critical access hospital, 49-bed skilled nursing facility, a rural health clinic and emergency medical services department. Schneller says that during his tenure, Rohrbach led the organization from critically-poor financial and operational performance to a stable and thriving situation supported by a strong and dedicated team of employees and medical staff.

Rohrbach’s career has also included successful leadership and management positions with Benedictine Health System of Ellendale, North Dakota and Cuyuna Regional Medical Center in Crosby, Minnesota. He received his Master’s degree in management from the college of St. Scholastica in Duluth. He is a member of the American College of Healthcare Executives.

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20th Annual $1,000 Rural Health Prize - April 15 Deadline

The Hermes Monato, Jr. Prize of $2,500 is awarded annually for the best rural health paper. It is open to all students of the University of Wisconsin (any campus). Students are encouraged to write on a rural health topic for a regular class and then to submit a copy to the Rural Wisconsin Health Cooperative as an entry by April 15.

Additional information is available at www.rwhc.com/Awards/AnnualMonatoEssay.aspx.

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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.

Teen pregnancy program

According to The National Campaign to Prevent Teen and Unplanned Pregnancy, three in ten girls in the United States get pregnant at least once by the age of 20, and six in ten teens that have had sex say they wish they had waited. Statistics like these make Affinity Health System’s Teen Pregnancy Program at St. Elizabeth Hospital an important resource for pregnant teens in Northeast Wisconsin.

Jacki Karlin, R.N., LifeSpan educator, believes the program is a vital asset to pregnant teens in helping prepare for the road ahead.

"The program offers expectant teen mothers with not only invaluable information, but with support as well," Karlin said. "Pregnant teens face more challenges and pressures than pregnant adult women do. We provide a learning environment where they can be themselves and not worry about negative comments or judging looks."

The Teen Pregnancy Program covers a variety of topics that are important to pregnant teens, such as physical changes to your body during and after pregnancy, nutrition and exercise, delivery, newborn care, breastfeeding and parenting skills. All participants of the program also receive a tour of BirthPlace, Affinity’s birthing department.

Any pregnant and parenting teens up to age 20 at delivery are eligible to participate, as well as their families or support people. Financial assistance is available to those who cannot afford the $25 fee.

St. Elizabeth Hospital, Appleton


Infant mortality focus at health fair held in Kenosha

More than 100 parents and children attended the Kenosha Health Fair event held during summer of 2010, focused on infant mortality. The event was hosted by the Kenosha County Health Department and supported by Aurora Medical Center in Kenosha (AMCK), various community based organizations and the local high school.

The fair provided participants with education on prevention of infant mortality. Mary Kay Belcher, a nurse in the Neonatal Intensive Care Unit (NICU) at AMCK, staffed one of the booths. She was able to raise enough money in the NICU department to purchase a new car seat for a raffle drawing at the fair to use as an incentive to encourage more visitors to her booth, at which Mary Kay and her co-workers addressed both co-sleeping and car seat safety.

"Most of the young women who visited our booth were unaware that car seats come with expiration dates. The young moms stopped by our booth because we had other fun stuff to give away," said Mary Kay. "We gave out free t-shirts and door hanger cards as an educational reminder to babysitters and parents regarding the danger of co-sleeping with their babies.

At the end of the fair, a lucky teen mom won the car seat that was raffled.

"I will never forget the big smile on the young woman’s face. We definitely made her day. I am so glad to be in a position to make difference in someone’s life. That makes my job even more rewarding," said Mary Kay.

Aurora Medical Center in Kenosha


Support for teen parents and prenatal teaching

Most teenagers don’t plan to get pregnant, but many do. Teen pregnancies pose health risks to the mother and the baby, often because teens don’t receive timely prenatal care. Their bodies are still growing and maturing and this can also increase the risk for pregnancy-related complications. And for teens who are unaware that social drinking, smoking and drug abuse, even only in tiny amounts, the risk and scope of complications is greatly increased.

That’s what makes the class for pregnant teens at Lincoln High School in Manitowoc so important to Ashley Beeman, an obstetrical nurse at AMCMC who educates the students for one hour every week to impart critical prenatal health information to prepare the young women for what to expect during their pregnancy through labor and delivery. Ashley also advises the students on how to care for their babies while they complete their education and pursue meaningful and productive lives for themselves and their children.

As an obstetrical nurse, Ashley is a credible healthcare expert and students respond positively to her instruction. But what really enhances their learning curve and inspires the students to finish school is the fact that Ashley willingly shares her own story of having once been in the same position, pregnant as a senior in high school. Ashley admits that the challenges are really rough for some pregnant teens and the Teen Support Class at Lincoln High School helps get them on the right track.

Aurora Medical Center in Two Rivers


Safe sleep initiatives

Our safe sleep initiatives evolved and were energized after staff attended a meeting of WAPC (Wisconsin Association for Perinatal Care). This group promotes safe sleep practices, breastfeeding and other initiatives. We have three initiatives in place at our hospitals to educate parents, supporting safe sleeping practices for newborns.

ProHealth Care had a long tradition of providing hand-made blankets to babies born at our facilities. But after we investigated the Halo Sleep Sack (a wearable blanket replaces loose blankets in the crib that can cover baby’s face and interfere with breathing), we decided to alter this practice. The Safe Sleep Sacks are now given to everyone who delivers at ProHealth Care—a fleece version is provided to babies born on in the cooler months and a lighter-weight cotton blend one is provided during the summer months. Although the blankets were lovely, parents are much more appreciative of this safety-based gesture of warmth and congratulations!

By working collaboratively with Milwaukee Public Health, we are able to purchase Pack N Play portable bassinettes with a quantity-rate discount. On admission our nurses ask the parents if they have a safe place for their baby to sleep. If they do not have a suitable crib, a social worker or care coordinator meets with the parents and provides a Pack N Play free of charge. We also review safe sleep principles and show them a safe sleep video.

Finally, the WAPC Safe Sleep group also designed the Safe Sleep Crib cards that we trialed at Waukesha Memorial Hospital for a few months. The cards reinforce the safe sleep teaching that we provide to all our new moms. After overwhelming support and positive feedback, WAPC printed and distributed these cards to every birth hospital in Wisconsin.

ProHealth Care, Waukesha


Helping new dads bond with their babies

Ask any new dad who has attended Daddy Talk, Bonding With Baby: it’s good to talk to an experienced father – especially one who is a family doctor.

Daddy Talk is offered to new dads each year at the Aurora Hales Corners Clinic. David Stolp, MD, Family Practice, delivers an informative and interactive presentation on the importance of creating healthy family strategies for the benefit of everyone: moms, dads and their babies.

Dr. Stolp covers it all: The first days at home; basic milestones for dads; great ways to bond with baby; how to support Mom; medical concerns; strategies for creating a healthy balance between work and family, and infant toy safety.

Reflecting on the many times he has conducted this workshop he says, "I think the most interesting thing for me is that every time I lead this program there’s always new and different information to cover. Many times I’ll get insights from other dads about what they’ve discovered and I try to integrate that information into the next program.

"Also, it gives me a chance to give credit to my wife for all the amazing work she does. I tell the other dads about my mistakes in order to prevent them from making the same ones I did, while also letting them know that being a new parent is about learning as you go and that it’s okay to make mistakes."

Aurora West Allis Medical Center


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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