October 10, 2014
Volume 57, Issue 41
Wisconsin Hospitals’ Community Outreach Efforts Total $1.78 Billion
Hospitals provide $328 million in charity care; lose nearly a billion on Medicaid
A report released by WHA October 8 showed Wisconsin hospitals provided $1.78 billion in 2013 on programs that benefitted the community, ranging from free care for those unable to pay their bills, to outreach activities related to health education, free screenings and community support groups.
Hospitals also reported they incurred nearly a billion dollars in losses ($967 million) associated with caring for patients in the Medicaid program. Medicaid pays hospitals only about 65 percent of what it costs to care for this vulnerable, and often medically-complex, patient population.
The Wisconsin Hospital Association (WHA) surveys its 135 member hospitals and health systems annually and asks them to describe and quantify the programs, services and activities they provide at or below cost, solely because those programs fulfill a health need in the community. (See report: www.wha.org/pubarchive/special_reports/CBreport2014.pdf). The hospitals reported that in 2013 they provided nearly $1.8 billion in community benefits. Included in that total is $328 million in charity or free care (at cost), $70 million on activities aimed at improving community health and $193 million on education for health care professionals.
While the $328 million in charity care hospitals reported in 2013 was fairly close to 2012, the number of patient encounters that qualified for free care rose dramatically. In 2013, hospitals reported 1.4 million instances of charity care, compared to 1.2 million in 2012.
“Charity care can vary from year to year, depending on the types of cases that qualify,” according to WHA Senior Vice President Brian Potter. “The fact that there were 200,000 more instances of free care in hospitals in 2013 than the previous year, yet the dollar value of that care stayed fairly even with past years, may reflect the fact that more services are provided in the less costly outpatient setting than in the hospital, which is consistent with what we are seeing with all patient care.”
In 2013, hospitals reported they were unable to collect $276 million in hospital costs. Anecdotally, hospitals attributed the nearly $6 million increase in bad debt over 2012 figures, in part, to the increase in deductibles and co-pays.
“While more people may be gaining coverage, we are still seeing many patients struggle to meet their co-pays and deductibles,” Potter said. “That is a real and growing concern for hospitals.”
Hospitals Absorb Nearly $13 Million Loss Operating Nursing Homes
those who are elderly or in need of rehabilitation services in the community is
one of the most valued and necessary services requested by their families and
friends. In some communities, hospitals are the sole providers of those
services. In 2013, the hospitals that operated nursing homes reported losses
totaling $13 million. Hospice care is also becoming increasing more available
because hospitals recognize the value of end-of-live services for their patients
and families. Hospitals typically report hospice services are operated at a
hospitals offer thousands of access points in their communities to services as
wide ranging as medical care at a free or reduced-fee medical clinic, to health
screenings at health fairs, schools and other public events. By offering free
health screenings and other medical services closer to where people shop, work
or play, hospitals live out their missions to raise the health status of people
living in their communities.
A Transition Year in Hospital Community Benefit Planning and Implementation
heart of every hospital and health system mission has been and continues to be
to improve population health. In 2013, under a new requirement of the Affordable
Care Act, hospitals were required to complete a formal community health needs
assessment (CHNA) in partnership with public health and other community partners
to assess, address and prioritize community health needs. The UW Population
Health Institute (UWPHI) collected the CHNAs and implementation plans and
created a new website www.improvingwihealth.org
that displays this information on every hospital and health department in the
state. The researchers also analyzed local health department (LHD) community
health improvement plans, conducted by local health departments under provisions
of Wisconsin state law. Where available, UWPHI also captured snapshots of the
specific strategies, tactics and programs being deployed or planned in
communities to drive improvement in these health priority areas.
new web-based resource is designed to help those working on common challenges
across the state to connect with each other, share ideas, and accelerate
progress,” according to UWPHI Director Karen Timberlake.
www.wiServePoint.org to review the
2014 WHA Community Benefits Report. It also has patient stories and descriptions
of free and reduced cost services that hospitals provide in their communities.
benefits and related issues have been an area of emerging interest to the
hospital community. For more information, WHA members are encouraged to refer to
the WHA Special Issues Facing Tax-Exempt Organizations Manual in 2013. Von
Briesen & Roper attorneys David Edquist and Bill Jackson prepared this
Manual, which includes valuable information on community benefits. Members who
would like to access the WHA Special Issues Facing Tax-Exempts Manual or any
other WHA Health Law Manual, should contact firstname.lastname@example.org
to request a username and password.
Health Care Ranks Third Highest in Nation
follows Minnesota, Massachusetts in overall performance
is the third most highly-rated state in the country based on the quality of its
health care according to the federal Agency for Healthcare Research and Quality
(AHRQ). Wisconsin had the third best overall health care quality measure score
among all 50 states based on more than 100 measures that AHRQ used to evaluate
health care performance. Wisconsin has consistently placed at or near the top of
AHRQ’s ranking since 2005.
measures health care quality in three different contexts: by types of care (such
as preventive, acute or chronic care), by settings of care (such as hospitals,
nursing homes, home health or hospice), and care by clinical area (such as care
for patients with cancer or respiratory diseases).
Chief Quality Officer Kelly Court said the high ranking could be a reflection of
the benefit of Wisconsin’s highly-integrated health care system.
AHRQ rankings pull many different segments of the delivery system together to
develop an overall rating. In a state like ours that has a highly-integrated
health delivery system, care is more coordinated and therefore, improvements can
take hold much more quickly and be sustained over time,“ according to Court.
“Our hospitals and health care systems are highly collaborative, too—they
share what they learn with each other and with other providers in the community.
We still have work to do, but it’s rewarding when we can stand back and see
how much progress we have made on our journey.”
State Snapshots web tool was launched in 2005. It is an application that
helps state health leaders, researchers, consumers and others understand the
status of health care quality in individual states, including each state’s
strengths and weaknesses.
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Physician Leadership Development Conference
American Club, Kohler *** March 13-14, 2015
Bird Registration: Register by January 15 to Qualify
information and online registration can be found at: http://events.SignUp4.net/15PLD
Need Hotel Reservations? Contact The American Club at 800-344-2838 ASAP.
of page (10/10/14) n Has Plans in Place to Respond to Ebola if Case Presents
n Has Plans in Place to Respond to Ebola if Case Presents
a news release issued October 10, the Wisconsin Department of Health Services
(DHS) said, in collaboration with the Centers for Disease Control and Prevention
(CDC), it has plans in place to respond in the event a case of Ebola virus
appears in the state. There is currently an Ebola outbreak in West Africa;
however, no one has contracted the Ebola virus in Wisconsin.
understand people are concerned about the Ebola virus, especially with a
recently diagnosed case in the United States. While there are no cases of Ebola
in Wisconsin, and the risk of contracting it remains low, it’s important that
medical and public health professionals are able to respond in the event there
is a case in the state,” said Karen McKeown, state health officer. “Should
someone in the state contract Ebola, DHS will ensure that the public and health
care providers receive prompt public health information.”
the Ebola virus outbreak began in West Africa, DHS has been assisting health
care partners by providing guidelines for monitoring individuals returning from
affected countries in that region. DHS also continues to ensure that all health
care providers are prepared with the appropriate infection control protocols and
required precautions for managing an Ebola patient. DHS continues to communicate
with the CDC for current developments and guidelines and shares that information
with health care providers and local health departments in Wisconsin.
the general public, we want to stress that the chances of anyone in Wisconsin
contracting the Ebola virus are very low,” McKeown continued. “Ebola is only
spread through contact with the body fluids of people who are sick with the
virus. It cannot be transmitted through the air. In fact, influenza is more
contagious than the Ebola virus. That said, DHS remains vigilant in its
monitoring of the Ebola virus, and will continue to provide our partners and the
public with the most current information and guidance concerning this
information on the Ebola virus, visit: www.dhs.wisconsin.gov/communicable/diseasepages/ViralHemorrhagicFevers.htm.
Additional information about the Ebola virus can be found at on the WHA website
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WHA Sponsors WisconsinEye Interviews – Elections Just Weeks Away
has completed hundreds of candidate interviews over the past few months. WHA has
been a proud sponsor of WisconsinEye’s 2014 election coverage. The interviews
posted by WisconsinEye are an excellent resource for the public to help them
become better informed voters. WisconsinEye interviewed every candidate running
for office this election cycle.
“In the next few weeks leading up to the November 4 election, you will hear candidates share their views on many important issues, including health care. I encourage you to listen carefully and participate in those discussions,” WHA Executive Vice President Eric Borgerding says in a taped introduction featured in WisEye’s Campaign 2014 coverage. “For over 90 years, WHA has been an advocate for sound health care policy, and that is why today we are proud to sponsor WisconsinEye’s candidate interviews and election coverage.”
The WisconsinEye interviews include statewide races, Congressional races and state legislative races. WisconsinEye is a statewide, non-partisan, non-profit, independent television network devoted to covering state government and civic activities throughout Wisconsin.
Learn more and watch the candidate interviews by logging onto WisconsinEye’s “Campaign 2014” portal at: www.wiseye.org/Programming/Campaign2014.aspx or www.wiseye.org.
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Guest Column: Wisconsin Hospitals: Caring for Our Neighbors
Edward Harding, Chairman, WHA Board of Directors,
Bay Area Medical Center, Marinette
Bay Area Medical Center, Marinette
a CEO, I am very familiar with the challenges that hospitals in Wisconsin have
faced over the past year. Those challenges, however, have not deterred any of us
from meeting our primary mission—to provide high-quality, compassionate care
to people who live in our communities. Whether it is a patient facing a
diagnosis of cancer or a person who falls very ill and can no longer work, a
hospital is there to help restore their health and their hopes for the future.
The inability to pay a bill should never be a barrier to seeking necessary
are open 24 hours a day, 365 days a year, acting as the community’s health
care safety net. In 2013, Wisconsin hospitals provided more than $328 million in
free care on 1.4 million patient encounters. That is 200,000 more encounters
care a hospital provides reaches far beyond the boundaries of their campuses. A
local example in Marinette is the Twin Counties Free Clinic established in 1998.
The Free Clinic provides a variety of health care services to the uninsured and
underinsured residents of Marinette and Menominee (MI) Counties. Bay Area
Medical Center (BAMC) and Aurora Health Care both supported the creation of the
clinic with considerable startup donations. Both of our organizations continue
to support the clinic, which sees nearly 400 patients a year, through free
office space, financial contributions, lab testing and diagnostic services. Last
year BAMC and the Free Clinic partnered to provide certified counseling to the
clinic’s patients to enroll them in the health care marketplace and will be
doing the same in 2015.
hospitals are staffed by dedicated and skillful health care professionals who
make it possible for our organizations to provide thousands of hours of free
health screenings and education programs. Statewide, hospitals spent more than
$50 million operating programs aimed at helping people live healthier lives.
year, all WHA member hospitals—135 in total—complete the WHA community
benefits survey. Wisconsin is one of a handful of states where 100 percent of
the hospitals voluntarily report community benefits. While the dollar amounts
spent are impressive, the real value of care is best told by those who receive
it. Read the full report and personal stories at: www.wha.org/pubarchive/special_reports/CBreport2014.pdf.
would like to express my thanks to the dedicated health care professionals
working in our hospitals for their unwavering commitment to deliver
high-quality, high-value, compassionate health care to every resident of our
great state. Health care contributes to the quality of life we all enjoy, and it
is one more reason to live, work and play in Wisconsin.
of page (10/10/14) eneration of Wisconsin Health Care Leaders
Orlikoff to Address Next G
eneration of Wisconsin Health Care Leaders
November 5, Jamie Orlikoff, a member of Modern Healthcare’s inaugural
list of “100 Most Powerful People” in health care and one of the foremost
thought leaders in the country, will address Wisconsin’s next generation of
health care leaders.
Challenges, Tomorrow’s Opportunities: A Future Leader’s Guide to Wisconsin
Health Care” is a one-day event offered by WHA in partnership with the
Wisconsin Forum for Healthcare Strategy (WFHS). The event will focus on the role
the next generation of health care leaders will play in effectively addressing
current health care trends, as well as describe strategies that will ensure
Wisconsin continues to be a ‘leader’ state.
day’s agenda will also include a moderated panel discussion that features
three of Wisconsin’s health care leaders. The panelists will share their
experiences in addressing challenges they have faced during their careers,
discuss how they have prepared their organizations to be ahead of the curve, and
describe how they are responding to the fast-changing environment.
and mid-level leaders, directors and managers—those who are the next
generation of administrative leaders in Wisconsin hospitals and health
systems—are encouraged to attend. CEOs are invited to identify several
‘rising stars’ in their own organizations and encourage them to attend.
the generous support of WFHS, a discounted registration fee is available. Space
is limited, so register today at http://events.SignUp4.net/14TCTO-1105.
of page (10/10/14) p
Circuit Court Judge Does Not Apply Ca
Milwaukee County Circuit Court judge has refused to apply Wisconsin’s cap on
noneconomic damages in a medical malpractice case. While earlier in the
proceedings the Court had ruled the cap was not facially unconstitutional, after
the verdict the Court found the cap, as applied to the specific facts of the
case, was unconstitutional.
jury in the case found the defendant physician and physician assistant were not
medically negligent in their diagnosis and treatment of the patient, but that
they failed to obtain her informed consent. The jury was instructed to apply the
“reasonable patient” standard for informed consent. (The Legislature amended
the informed consent statute in 2013 to require disclosure of “information a
reasonable physician in the same or similar medical specialty would know and
disclose under the circumstances.”) The jury awarded the plaintiff, who lost
all of her limbs as the result of a septic infection caused by Strep A, nearly
$9 million in economic damages and $16.5 million in noneconomic damages.
Wisconsin, plaintiffs receive awards for economic and noneconomic damages in
excess of the provider’s liability insurance through the Wisconsin Injured
Patients and Family Compensation Fund, which is funded by assessments on
physicians and hospitals. The Fund covers the full amount of the award for
economic damages and up to the cap amount, $750,000, for noneconomic damages
(pain and suffering).
finding the cap, as applied to the plaintiff, was unconstitutional, the judge
wrote, “[I]t is the intent of this Court to rule on the specific facts of the
Plaintiffs’ case, and those facts alone. This decision is not meant to be
precedential, nor is it intended to dictate the legal outcome of any other
factual matters. With that said, and with a view of the Plaintiffs’ particular
facts in mind, this Court finds that the cap violates the Plaintiffs’ rights
to due process and equal protection as applied in this instance.”
The Valued Voice for updated information concerning Mayo v. Wisconsin
Injured Patients and Families Compensation Fund.
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Telemedicine Panel: Medicare Policies a Barrier to Telemedicine Expansion
for telehealth fueled by physician shortage, patient demand
panel of payers, providers and regulators agreed that telemedicine is a
promising tool for providing high-quality, more accessible and more timely
health care, but also expressed frustrations that payment policy and access to
broadband is impeding greater use of that tool.
particular, Medicare’s outdated and restrictive reimbursement policies
regarding telemedicine, and adoption of Medicare’s telemedicine policies by
some private payers, were identified as a barrier to greater use of this access
tool. In contrast, Wisconsin’s Medicaid policies regarding telemedicine were
held out as a model from which to build.
Medicare model of payment for telemedicine does nothing to help the state of
Wisconsin,” said Nina Antoniotti, PhD, director of teleHealth at Marshfield
Clinic Health System. “Somehow, payment is following the Medicare model. Those
legal and regulatory improvements are what we really want.”
Medicare rules developed in the 1990’s, Medicare has narrowly restricted the
geographic areas that Medicare will pay for health care services provided via
telemedicine. Generally, only health care services provided via telemedicine
originating from an urban area to a location in a rural area are eligible for
contrast, while there are some issues that Medicaid could improve upon,
particularly regarding telestroke, Antoniotti highlighted a recent report by the
American Telemedicine Association that gave the Wisconsin’s Medicaid program
high grades for its telemedicine payment policies. That report noted that
Wisconsin’s Medicaid program does not impose payment restrictions based on the
patient setting or originating site.
access necessary to enable greater use of telemedicine as a health care access
tool was also raised by payers and providers.
is huge potential in telemedicine,” said Larry Schreiber, president, Anthem
Blue Cross and Blue Shield in Wisconsin. “However, we still have rural areas
that do not have the level of broadband bandwidth needed to leverage this
technology to the fullest.”
Stanford, WHA vice president, policy and regulatory affairs, and associate
counsel, noted earlier discussion that some states have enacted telemedicine
payment mandates and asked the panel whether Wisconsin could expect to see a
trend among payers to pay for care on a “site agnostic” basis, where payment
is made based on the value provided regardless whether it is provided in person
versus via telemedicine between clinical locations, versus via telemedicine
between a clinical location and a patient’s home.
are moving to “essentially have the same type of payment based on the service
provided,” said Schreiber. “What is more important is getting the right
professionals around the patients. Site agnostic is fine as long as you are
getting the right care at the right place from the right person.”
Insurance Commissioner Dan Schwartzer also recognized that not all private
payers pay for telemedicine services as they do for non-telemedicine services in
Wisconsin, but was not sure that reimbursement mandates, such as those in 21
other states, made sense for Wisconsin.
also discussed the involvement of the Office of the Commissioner of Insurance (OCI)
in a National Governor’s Association to remove barriers to telemedicine. He
said that physician licensure issues and the potential for developing a broad,
but basic definition for telemedicine are issues that OCI is reviewing.
Health News (WHN) organized the panel held in Madison October 7. WHA is a WHN
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Complex ICD-10-PCS Coding Scenarios Focus of WHA Webinars
it is gaining a better understanding of ICD-10-PCS coding system design and root
operation groups, or working through common and more complex coding scenarios,
hospitals will find WHA’s ICD-10 webinar series featuring coding expert Lynn
opening two-part webinar, scheduled October 22 and 29, is aimed at those who
need to learn more about the ICD-10-PCS system design and how to use the tools
of the system to assign codes. During the two sessions, the nine ICD-10-PCS root
operation groups available for coding will be reviewed, including their
definitions and unique issues related to assigning the root operation character.
December 2, Kuehn will lead a webinar focused on making root operations
selections and assigning all characters for the codes included in 10 common
ICD-10-PCS cases encountered at hospitals and health systems. This interactive
webinar will be a great way to work through some of the most common cases that
will be encountered after October 1, 2015.
December 9, Kuehn will teach participants to improve critical thinking skills by
tackling more complex ICD-10-PCS cases. Kuehn will provide helpful tips to
differentiate between root operations groups and similar individual root
operations. Intended as the capstone for the webinar series, this session will
assist attendees in making decisions to code 10 common, but more complex,
information on all four sessions is included in a brochure in this week’s
packet. In addition, information and online registration are available at: http://events.SignUp4.net/14W-ICD-10-PCSSeries.
Encourage your team to gather for this webinar series and learn together through
one, low-cost registration.
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