January 24, 2014
Volume 58, Issue 4


WI Hospitals’ Quality Improvement Efforts Garner National, State Accolades
Legislators from both parties commend hospitals’ efforts to improve quality, lower costs

Wisconsin hospitals’ work to lower health care costs by raising quality attracted state and national media coverage and positive attention from state legislators this week following the release of the WHA 2013 Quality Report. In a joint statement, leaders of the Health Committee commended Wisconsin’s hospitals for "working to lower health care costs by raising the quality of care."

Representatives Erik Severson (R-Star Prairie) and Sandy Pasch (D-Shorewood) along with Senators Leah Vukmir (R-Wauwatosa) and Tim Carpenter (D-Milwaukee) said in a statement, "These impressive results would not have been possible without the dedication of our nurses, physicians and the entire care team working together to implement better and safer ways to care for patients. We commend Wisconsin’s hospitals for their success to date and for their ongoing commitment to improve the quality and safety of patient care in our state."

Wisconsin hospitals’ efforts to improve the quality and safety of the patient care have improved care for more than 4,000 patients and reduced health care costs in Wisconsin by an estimated $45.6 million, according to the WHA report released January 21. (See related story below)

More than 100 hospitals working together with WHA have reduced readmissions, prevented hospital-associated infections and adverse events related to insulin, and reduced the number of babies delivered before 39 weeks.

One of the most dramatic decreases was in the number of patients readmitted to the hospital after an inpatient stay. The average readmission costs $9,600. The hospitals that are working on this have already prevented 3,556 readmissions and reduced health care costs in Wisconsin by $34 million.

Another equally important focus area is infection prevention. Hospitals have worked to reduce three types of infections: central line-associated blood stream, surgical site and catheter-associated urinary tract. The hospitals’ dedicated efforts to stop hospital-associated infections saved more than $10 million in health care costs and improved the care for more than 1,000 patients who were at an increased risk for an infection.

The WHA report documents quality improvement results in the following areas:

Topic Area

Patients with Improved Care

Estimated Cost Savings

Readmissions

3,556

34,137,600

Central Line-Associated Blood Stream Infection

311*

$5,909,000

Surgical Site Infections

228

$4,560,000

Catheter-Associated Urinary Tract Infection

573**

$429,750

Adverse Drug Events

143

$429,000

Early Elective Deliveries

291

$211,922

Falls

176

-

Pressure Ulcers

54

-

Venous Thromboembolism

0

-

Grand Totals

4,448

$45,677,272

*Since 2008; **Since 2011 All others are since Jan 2012 – Sept 2013

"Achieving and delivering this high level of excellence in clinical performance does not happen by chance. It takes organizational commitment and human and financial resources to design and improve processes that drive out harm and reduce waste," according to WHA Chief Quality Officer Kelly Court. "Every member of the health team, including physicians, nurses, support staff and leaders at all levels must adhere to the clinical processes and hold others accountable as well."

WHA and 108 hospitals have just completed the second year of improvement work under a subcontract with the American Hospital Association Health Research & Educational Trust to work on the federal Partnership for Patients initiative. The Partnership for Patients’ goal is focused on reducing hospital readmissions by 20 percent and hospital acquired harm by 40 percent. While 108 Wisconsin hospitals are working directly with WHA, 19 more are working with other hospital engagement networks to achieve the same aims. That means 98 percent of Wisconsin hospitals are actively engaged in improving care on these important topics.

"Wisconsin is a recognized leader in health care quality and value. Our goal is to ensure that every patient in our state receives the finest care possible no matter where they go for that care. Through our collaboration on quality improvement, that goal is in range," said WHA President Steve Brenton. "As much as hospitals have been able to significantly improve care, however, Wisconsin health care leaders are aware that their work is far from over."

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Advocacy Day, April 16—Registration Now Open
Larry Sabato to keynote

Last year was a record-breaking year for Advocacy Day, surpassing 900 attendees for the first time in the event’s history. WHA expects this year’s Advocacy Day to continue the trend. Advocacy Day is one of the best ways hospital employees, trustees and volunteers can make an important, visible impact in the State Capitol. Start assembling your hospital contingent for 2014 Advocacy Day April 16, 2014 at the Monona Terrace in Madison. Registration is now open at http://events.SignUp4.net/14AdvocacyDay0416.

"WHA’s Advocacy Day continues to be a powerhouse event in Wisconsin’s State Capitol each year because of the commitment of our hospital leaders, staff, trustees and volunteers to this day," said WHA President Steve Brenton. "Having over 900 people gather in Madison for education and then meet with legislators demonstrates the value our hospitals place on advocating for their community hospital and patients."

As always, Advocacy Day 2014 will have a great line up of speakers, including morning keynote and nationally-known pollster Larry Sabato, professor of politics and director of the University of Virginia’s Center for Politics (www.centerforpolitics.org) and creator of the website and weekly e-newsletter, "Sabato’s Crystal Ball." As the nation looks to the 2014 elections, Sabato will bring to Wisconsin his years of academic study together with an equally-long career as both a political practitioner and commentator on elections.

The luncheon keynote will be Governor Scott Walker (invited), and our legislator panel discussion will round out the morning sessions.

The highlight of Advocacy Day is always the hundreds of attendees who take what they’ve learned during the day and then meet with their legislators in the State Capitol in the afternoon. More than 500 visits were made in 2013. WHA schedules all meetings, provides transportation to the Capitol and prepares attendees for their visits. In addition to an issue briefing at Advocacy Day, WHA offers an optional webinar on legislative visits prior to Advocacy Day. Speaking up on behalf of your hospital by meeting with your legislators during Advocacy Day is essential in helping educate legislators on your hospital and on health care issues.

Join over 900 of your peers from across the state at Advocacy Day 2014 April 16. Register today. A complete program and online registration are available at http://events.SignUp4.net/14AdvocacyDay0416. A printed copy of the Advocacy Day 2014 brochure is included in this week’s Friday Packet.

For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org. For registration questions, contact Lisa Littel at llittel@wha.org or 608-274-1820.

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State Medicaid Director Shares Latest Enrollment Developments

In a special WHA member webinar held January 22, Brett Davis, Wisconsin’s Medicaid director, shared the latest on Medicaid/BadgerCare and exchange enrollment information with hospitals and health systems.

Davis reviewed the latest developments in the Medicaid/BadgerCare program (see The Valued Voice, January 17 and December 20). In addition to the changes in eligibility requirements as previously reported, Davis particularly noted that all who are on the Medicaid/BadgerCare program will have a standard set of benefits, and will no longer have the benchmark or core benefit packages.

Davis provided more details about the Department of Health Services (DHS) outreach plans. In addition to implementing regional enrollment networks, the DHS has attempted to directly contact individuals through phone calls. Also, since last fall, DHS has sent over 150,000 letters to individuals that will be disenrolled from Medicaid due to the new income rules, and 300,000 letters to individuals on the childless adults (or Core plan) waiting list.

Davis discussed working with the federal government and indicated that as of January 14, the Department has received information from the federal government through the Enhanced Weekly Flat File for about 65,000 individuals who applied for coverage through the exchange marketplace and were deemed eligible for Wisconsin’s Medicaid program. While the Department is still working through the Enhanced Weekly Flat file and working to fully validate the account transfers and process those applications, early estimates are that as many as 80 percent of the 65,000 are childless adults and they are newly-eligible for the program.

Of note for hospitals, Davis discussed the ability of hospitals to conduct presumptive eligibility determinations. Hospitals can currently use the presumptive eligibility process for children and pregnant women. In April, hospitals will be able to also implement presumptive eligibility for the new childless adults population group as well as parents and caretakers. DHS is finalizing details of the presumptive eligibility process and has revised the original proposal based on feedback from hospitals through WHA. The new process will be described in a DHS ForwardHealth update expected to be released in the coming weeks.

Davis said he was pleased with the partnership he has had with WHA, adding that these relationships have helped lead to many positive resolutions on issues. If you are a WHA member and would like to access the webinar, visit http://members.wha.org/General.aspx.

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HRET’s Joshi Says Pace of Quality Improvement in Wisconsin is "Stunning"
2014 Partners for Patients project adds new initiatives

More than 90 hospitals across Wisconsin participated in a webinar January 16 that marked the official launch of the third year of the WHA Partners for Patients project. In the first two years of the project, participating hospitals produced outstanding results, documented in the WHA 2013 Quality Report (see story above). Hospitals have improved care for nearly 4,500 patients while decreasing the cost of health care in Wisconsin by an estimated $45.6 million.

The webinar keynote speaker was Maulik Joshi, Dr.P.H., president of the AHA Health Research & Educational Trust (HRET) and an AHA senior vice president. HRET is working with 31 states, including Wisconsin, to help facilitate statewide education, collaboration and sharing of best practices among hospitals nationwide. Maulik complimented Wisconsin’s quality improvement achievements to date.

"I have a lot of admiration and respect for your organization (WHA) and your hospitals for the quality of care that you are delivering for patients in Wisconsin," Maulik said. "It is quite stunning when you think about the pace of improvement you have maintained and all the while you were taking care of patients every day."

Joshi shared the combined results of all the states and 1,500 hospitals that are participating in the HRET Partnership for Patients. According to Dr. Joshi, over 60,000 patients have had harm prevented and over $188 million in health care costs have been avoided collectively among all the states they are working with, but he added, "We are not there yet." Hospitals will continue to work to reduce readmissions and decrease hospital-associated harm.

Joshi said the focus in 2014 will be on "Reducing Harm across the Board" (HAB). HAB is a new way of looking at total harm that uses simple numbers and focuses on reducing the risk of patients being harmed in hospitals, regardless of the cause. It has been highly effective at removing the siloed, project- by-project focus on patient safety and it promotes a hospital-wide effort.

The WHA quality team highlighted the many new resources, initiatives and opportunities that are available to hospitals in 2014. In addition to the original 10 topics that hospitals have worked on improving in 2013, WHA will be providing several new initiatives including:

Throughout the webinar, there was a noticeable excitement and energy among the participants and a desire to "get started."

"The hard work, engagement and focus by hospitals in Partners for Patients has been tremendous. The evidence is in the great outcomes we have achieved to date, but we know we are not where we want to be…yet," according to Kelly Court, WHA chief quality officer. "In 2014, we are prepared to drive even harder, tackle more topics and help the hospitals in our state continue to excel and reach the aim of reducing readmissions by 20 percent and overall harm by 40 percent."

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WHA Wisconsin RAC Summit, March 26, 2014
Glacier Canyon Lodge at Wilderness Resort, Wisconsin Dells

Register by February 21 for Early Bird Discount

More information and online registration can be found at: http://events.SignUp4.com/14RACSummit

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WHA Praises Wisconsin State Senate for Passing Mental Health Bills
Mental Health Care Coordination Bill among those passed

The Wisconsin Hospital Association (WHA) praised the Wisconsin State Senate for passing a series of bipartisan bills on January 22 that reform and modernize Wisconsin mental health laws, including a WHA priority—the Mental Health Care Coordination Bill.

"Wisconsin’s behavioral health care system is facing serious challenges. Identifying problems and finding solutions to help remove barriers to a more modern, accessible, integrated and consistent mental health system for Wisconsin is one of WHA’s top priorities," according to WHA Executive Vice President Eric Borgerding. "We want to thank members of the Senate who supported these important reforms that will help improve outcomes for individuals with mental illness."

WHA was particularly pleased with the Senate passage of the Mental Health Care Coordination Bill, which removes statutory obstacles to providing integrated and coordinated care to individuals with mental illness. This legislation was a key component of recommendations developed by WHA’s own Behavioral Health Task Force to improve the outcomes and efficiency of Wisconsin’s mental health care system.

"While the views and treatment of mental illness have evolved, our laws have not kept pace with that change. WHA is very pleased to see the Senate’s bipartisan passage of the Mental Health Care Coordination Bill," said Borgerding. "This bill removes outdated barriers to care for patients with mental illness and brings long overdue reform, and parity, to behavioral health care."

WHA particularly acknowledges the leadership of Senator Leah Vukmir, Senator Tim Carpenter, and Senator Jennifer Shilling for their work on the Mental Health Care Coordination Bill in the Senate.

Other key WHA proposals and WHA-supported proposals passed by the Senate include:

The bills were passed by the Assembly in November and now move to the Governor’s desk for his signature.

In the coming weeks, look for WHA member education opportunities detailing these important bills. Links to the bills, WHA testimony and memos on the bills can be found at www.wha.org/mentalhealth.aspx.

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State Awards Grants Expanding Primary Care Residencies  
WHA-backed program will mean more doctors in Wisconsin 

The Wisconsin Department of Health Services (DHS) announced that more than $1.9 million in grants will be awarded to three graduate medical education programs to expand their residency programs and place more medical residents in rural and underserved areas over the next five years. 

The three grantees and their projects are: Fox Valley Family Medicine Residency Program, funding three family medicine residents in the Appleton/Fox Valley area; Gundersen Health Systems, funding one general surgery resident in La Crosse and the surrounding area; and UW Hospitals and Clinics, funding three psychiatry residents in Madison and the surrounding area.

“I am very pleased to make these awards to expand access to high-quality health care in our rural and underserved areas,” said DHS Secretary Kitty Rhoades. “Research suggests that providing graduate training in rural areas significantly increases the likelihood that physicians will return to their training sites to practice.” 

A WHA report on the physician workforce found that there is a 70 percent chance of keeping a physician in Wisconsin when they graduate from a medical school here and complete an in-state residency. 

“This is another important step forward in addressing the physician shortages in Wisconsin, particularly in rural areas, which is a top WHA priority,” said Chuck Shabino, MD, WHA senior medical advisor. 

WHA led a coalition of provider groups to request funding in the last state budget to create these new opportunities for medical school graduates to train in the state’s rural and underserved areas. Up to $750,000 per year has been allocated to expand existing graduate medical education (GME) programs and $1.75 million per year is available to develop new programs. Both components, totaling $5 million over the two-year budget period, target five specialties—family medicine, general internal medicine, general surgery, pediatrics and psychiatry. Additional funding opportunities will be announced this spring. 

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