March 20, 2015
Volume 59, Issue 11


Loudenbeck Updates WHA Public Policy Council on State Budget Process
Stakes are high in Wisconsin on King v. Burwell decision

After participating in her first public hearing as a new member of the powerful Joint Finance Committee (JFC), Rep. Amy Loudenbeck (R-Clinton) told members of the WHA Public Policy Council at their meeting in Madison March 19 that the hearings are truly for the people. After listening to nearly eight hours of public testimony March 18 in Brillion, Loudenbeck said one of the more high-profile issues that was presented involved proposed changes to the Family Care program. On March 20, the JFC public hearings will move to Milwaukee.

"It’s an interesting process, and we are truly listening to the public," Loudenbeck said.

Loudenbeck said she appreciates meeting with hospital constituents to learn more about the issues facing Wisconsin providers. Holding up a WHA issue paper for the Council, Loudenbeck said she has shared with her colleagues the fact that hospitals across the state benefit from the Disproportionate Share Hospital program (DSH).

The Governor’s budget proposes moving the administration of the Wisconsin Worker’s Compensation program away from the Department of Workforce Development (DWD) to the Office of the Commissioner of Insurance (OCI), a shift that has many groups perplexed. Loudenbeck said she is hearing from stakeholders that the Worker’s Compensation program is "working well" and that it should "stay where it is." Loudenbeck said some believe the shift from DWD (which also administers the vocational rehabilitation program) to OCI may cause confusion for injured workers seeking the assistance they need to get them back to work.

Council Chair Tim McKevett, president/CEO, Beloit Health System, commended Loudenbeck for her advocacy efforts on behalf of the health systems in her district and asked for her support of DSH funding. The Wisconsin Medicaid DSH program is one of the smallest in the country.

State Budget Overview

Joanne Alig, WHA senior vice president, reviewed the Governor’s budget for the Council and asked all hospitals for feedback on specific budget items. Alig compared the Governor’s proposed budget to the Department of Health Services (DHS) budget request from September 2014. DHS had identified specific intensity rate increases for hospitals, but it is still unclear whether those full amounts made it into the proposed Governor’s budget. Nevertheless, based on conversations with DHS and information presented to hospitals from DHS, WHA anticipates rates in the next two years to be established using a new methodology that doesn’t rely on imprecise utilization projections, which is a positive step and one that WHA has supported.

DHS and the Governor’s budget are both anticipating that the Medicaid caseload will continue to grow, but the Governor is projecting by the end of 2017, there will be 20,000 fewer people in the program compared to the DHS estimates. The Medicaid cost-to-continue in the Governor’s budget request is $647 million.

The federal match to the state Medicaid program decreased slightly, Alig said, and that will require an increase in general purpose revenue (GPR) to fill the gap. The Children’s Health Insurance Program (CHIP) requires reauthorization at the federal level, a discussion that is taking place within the SGR debate. DHS is assuming the CHIP will be reauthorized—a significant savings in GPR—but if it is not, again, GPR will be required in its place.

As Loudenbeck mentioned in her remarks, there is a great deal of public concern about changes in the Family Care program. Alig said WHA is reviewing the changes and participating in discussions to more fully understand the dynamics of the proposed changes. There are about 41,000 people statewide in the Family Care program, PACE and Partnership program. The budget proposal would change how hospitals are reimbursed for these individuals. Rather than reimbursement on a fee-for-service basis, acute and primary care services would be integrated into the family care benefit and would be administered by insurers operating the program on a statewide basis.

Alig also discussed several other budget provisions, including the elimination of the Wisconsin Rural Residency and Physician Loan Program. The program is funded by the critical access hospital (CAH) assessment, and was eliminated as part of the University of Wisconsin system changes. In discussions at the Capitol, staff believes the programs have support and are hopeful they will be restored.

State Budget: Behavioral Health-related Issues

A proposed clarification in the emergency detention law is of interest to hospitals, according to Matthew Stanford, WHA general counsel. Specifically, the budget creates a new requirement that before a county department may approve an emergency detention, a psychiatrist, psychologist, or "mental health professional" must perform a crisis assessment and agree with the need for the detention. Stanford said "mental health professional" must be defined and there must be an understanding of what "crisis detention" means. WHA has been tracking this issue closely and in fact, it has been discussed with the WHA Behavioral Health Task Force, and they agreed these terms required further clarification.

WHA Medicaid Advocacy Efforts in High Gear

Kyle O’Brien, WHA senior vice president, reported that WHA staff have now completed 80 legislative meetings in the capitol since the start of the legislative session January 3. This number does not include the dozens of meetings that members have hosted or attended in legislators’ districts. O’Brien said the discussions are keenly focused on cutting the hidden health care tax by reauthorizing funding for and making the DSH program permanent and creating opportunities to make additional investments in the Medicaid program.

Borgerding reminded the Council that legislators must be educated that hospital funding is actually just one part of the Medicaid program. Further, through the hospital assessment, hospitals are actually funding 65 percent of the total state obligation for Medicaid hospital reimbursement.

"The State of Wisconsin is only providing 16 percent of all funding for hospital payments in the Medicaid program," Borgerding said.

King v. Burwell, SGR Debate: Hot Topics at Federal Level

The stakes are high for Wisconsin in the King v. Burwell case that is now before the Supreme Court. A decision that would disallow federal subsidies in the federal health insurance exchange would be a devastating blow to coverage in Wisconsin. HHS determined that about 89 percent of the 207,000 people who signed up for coverage were eligible for premium assistance—higher than the national average of 87 percent, and higher than many states in the country. On average in Wisconsin, the subsidy reduces the monthly premium by more than $300 per month. This data, along with maps showing these enrollment trends can be found on WHA’s website at www.wha.org/exchangemedicaidenrollment.aspx.

"States like Wisconsin have to think about state-based solutions. Punting this problem back to the President and Congress is likely not a viable option," Borgerding told Council members. Borgerding said WHA will work with stakeholders and policymakers to help develop options.

The federal debate on the sustainable growth rate (SGR) takes on greater importance in Wisconsin where nearly 70 percent of all physicians are employed by a hospital or health system. Borgerding said Congress might be getting closer to a permanent fix. According to Borgerding, WHA staff and members are now in Washington DC meeting with Wisconsin’s Congressional delegation to discuss SGR repeal and related issues, including opposition to further delays to the implementation of ICD-10. (See related story on page 1.)

WHA Reports Progress on DHS-124 Reform Process

Eliminating inconsistencies between federal and state hospital standards creates efficiencies for Wisconsin hospitals. In Wisconsin, this streamlining of the hospital regulations, DHS 124, was set in motion by 2013 WI Act 236, which became law last spring. Matthew Stanford, WHA general counsel, and Andrew Brenton, WHA assistant general counsel, briefed the Council on WHA’s continuing work on the DHS 124 reformation process. Act 236 sunsets several subchapters of DHS 124 and establishes the federal Conditions of Participation as the state regulatory standard—both beginning July 1, 2016. Shortly after last year’s passage of Act 236, WHA established a DHS 124 Task Force which includes hospital leaders from large and small hospitals and health systems across the state. The Task Force has been developing recommendations for updates to those portions of DHS 124 that remain and other reformed provisions to DHS 124. The input from the Task Force and other WHA members is helping to guide WHA’s regulatory advocacy regarding updates to the hospital regulations between now and July 2016.

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SGR Repeal Negotiations: Hospitals and WHA in Washington, D.C.
Senate, House budget resolutions released

It has been a busy week in Congress, and a dozen hospital leaders and the Wisconsin Hospital Association were in Washington, D.C. March 18-19 to advocate on issues with members of Wisconsin’s Congressional Delegation.

Work continues in Congress to fully repeal and replace the Medicare Sustainable Growth Rate (SGR). The current SGR "patch" expires March 31, 2015 and, if not addressed, will result in a 21 percent cut to physician reimbursement. There has long been a desire to repeal the SGR, but how to pay for it has stymied Congressional success. Serious negotiations are ongoing with respect to the latter, but discussions continue to be fluid.

Also in the mix with the SGR package are policies of importance, including a two-year extension of various "Medicare extenders" and extension of the CHIP program. WHA and hospital leaders indicated support for SGR repeal and support for Medicare extenders and CHIP, but advocated against hospital/system payment cuts, such as "site neutral" policies among others, as a means to offset the cost of the SGR repeal package.

In related news, both the Senate and House released budget resolutions this week. House Budget Committee Chairman Tom Price (R-GA) released the committee’s fiscal year (FY) 2016 budget proposal. In total, this budget would cut Medicare spending by $148 billion and other Medicaid/health spending by $913 billion over 10 years.

With respect to Medicare, the House proposal would:

With respect to Medicaid, the proposal would:

Senate Budget Committee Chairman Mike Enzi (R-WY) also released the draft Senate budget resolution for fiscal year (FY) 2016. It would repeal the Affordable Care Act (ACA) and adopt the President’s overall Medicare reductions of nearly $431 billion over 10 years. Additionally, the resolution balances the budget over 10 years and calls for modernization of Medicaid based on the Children’s Health Insurance Program by increasing state flexibility in designing benefits and administering its programs, among other items.

Keep in mind the release of these budget resolutions are only the first step in a much longer process. WHA will continue to be engaged on these issues.

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Registrations Top 550 With Six Weeks to go Before WHA 2015 Advocacy Day

Advocacy Day registrations have already surpassed 550, and the event is still six weeks away. Close to 80 hospitals are represented in those numbers along with dozens of WHA’s corporate members. This year, more than 900 hospital supporters are expected to attend the one-day annual event being held April 28 at Monona Terrace in Madison. Don’t miss this day of learning, networking and advocating for your patients, hospitals and communities. Register now at: http://events.signup4.net/15AdvocacyDay0428.

Gov. Scott Walker has been confirmed as the luncheon keynote speaker, and attendees will hear from morning keynote Tucker Carlson, a nationally-known veteran journalist and political commentator who will share an insider’s view on Washington, D.C. and a look ahead to the 2016 elections. The bipartisan legislator panel discussion will round out the morning sessions, moderated by WHA President/CEO Eric Borgerding.

This year’s event is perfectly timed—April 28—to fall when the Legislature is deliberating on the biennial state budget bill. This means the afternoon legislative meetings between hospital advocates and elected representatives or their staffs will take on even greater importance as the Legislature will be in the midst of making decisions on pertinent issues, such as Medicaid and other important topics. Attendees will be well-prepared for the scheduled legislative meetings at the State Capitol after an issues briefing presented by WHA staff. Optional pre-event webinars are also available for those going on legislative visits.

There is still time to register your hospital contingent for 2015 Advocacy Day. Event and registration information is at: http://events.signup4.net/15AdvocacyDay0428.

For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org. For registration questions, contact Jenna Hanson at jenna.hanson@wha.org or 608-274-1820.

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Health Care IT Security Trends the Focus of April 8 Webinar

Why is it that more and more hackers are targeting health care organizations? How have recent high profile attacks changed the health care IT security landscape? Learn the answers to these questions and more on April 8, when WHA hosts the 90-minute webinar "Health Care Security Trends in 2015."

This webinar will be presented by Dan Friedrich, executive director of the Center for Advancement of Health Information Technology at Dakota State University. He is a Certified Information Systems Security Professional with more than 30 years of experience. Freidrich will focus on what health care executives need to know about health care security trends, including how the National Institute of Standards and Technology (NIST) and other federal agencies are working to secure patient information.

Health care CEOs, CFOs, health information and IT professionals should plan to participate in this ‘can’t miss’ webinar. Attendees are encouraged to participate in this webinar series as a team, to gather and learn together through one, low-cost registration. Find more information and register today at http://events.SignUp4.net/2015AprilWebinar.

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Record Number Attend 10th Annual WHA Physician Leadership Conference

Seventy-four different hospitals, health systems and physician groups were represented at the tenth annual WHA Physician Leadership Development Conference, which was held March 13-14 in Kohler. This year’s event drew nearly 170 physicians and 50 hospital leaders. With 220 in attendance, the 2015 conference was the largest ever. A growing number of physician and hospital leaders use WHA’s annual Physician Leadership Development Conference as one tool to help new and seasoned physician leaders bridge the gap between their traditional clinical training and the new approaches to decision making and problem solving they need to consider in their leadership roles.

Columbus Community Hospital CEO John Russell was a first-time attendee, accompanying a team of four physician leaders. Reflecting on his experience at the event, Russell shared, "The networking with the physicians from my organization was great, as well as the opportunity to network with physicians and administration from other organizations. I really believe this type of conference requires physicians and hospital leaders to look at their relationships, strategies and the way collaboration impacts our success from a different perspective."

According to WHA Chief Medical Officer Chuck Shabino, MD, physicians find great value in participating in the conference.

"Physicians attending this year’s conference once again pointed out that in addition to the information learned from the presenters, the opportunity to build relationships with hospital colleagues away from the everyday rush makes this conference invaluable," Shabino said. "WHA estimates more than half of the 2015 attendees had attended this annual conference previously. The fact that physicians attend year after year speaks well of their perception of its value to them."

The 2016 event is scheduled March 11-12 at The American Club in Kohler. Mark your calendar, share this date with your medical staff, and encourage your new and potential physician leaders to consider attending as part of your team.

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WHA Facilitates Workshop to "Sustain and Spread" TCAB

On March 6, hospitals from earlier WHA-led Transforming Care at the Bedside (TCAB) cohorts participated in a special workshop to re-think the TCAB approach established nearly 12 years ago. Nearly 50 WHA member hospitals have participated in the various TCAB cohorts since 2011. Leaders of these units expressed a desire for further support from WHA for spreading the approach.

Two of the originators of TCAB, who developed the model and secured the Robert Wood Johnson Foundation grant funding in 2003, facilitated the workshop. Betsy Lee, RN, MSPH, IHI Improvement Advisor, and Jane Taylor, EDd, IHI Improvement Advisor, have worked with many states to train TCAB facilitators. WHA sponsored their workshop participation to bring together nurse leaders and staff who are passionate about TCAB and wish to spread the practice across units, or across their systems. Lee and Taylor said this initiative has provided a means for front-line nurses to actively participate and lead quality improvement activities. Moreover, with today’s focus on patient safety and patient-centered care, the importance of engaged nurses is greater than ever. Lee shared a quote from the Lucian Leape Institute that speaks to this:

"To create a safe and supportive work environment, health care organizations must become effective, high-reliability organizations, characterized by continuous learning, improvement, teamwork and transparency." - Lucian Leape Institute, 2013

The workshop began with a review of the state of medical-surgical nursing that precipitated the idea for TCAB. Lee compared and contrasted the environment for nursing today with developments over the past 10 years. Participating nurses related their perspectives on the changes in patient care they have experienced in their local settings. Next, the group discussed results of the pre-work they were given. In a fishbowl-style discussion, the nurse leaders shared what they learned by interviewing bedside staff. They related what TCAB has meant for the daily work of nurses, including a discussion of the barriers that may inhibit the spread of TCAB practices in their hospitals.

With these exercises as background, the group brainstormed the characteristics of successful TCAB leadership, the beneficial TCAB practices, and barriers. With a large paper model of the TCAB pillars, the group contributed what strengths are currently part of TCAB, where there is room for better adoption of best practices, and "off the wall" ideas for future innovations. These ideas were coded green, yellow or red for the strength of adoption. The outcome of this exercise was a list of next steps for WHA to explore as a way to support spread.

These ideas included:

The consensus of the group was clear: TCAB is an effective method of building improvement capacity among hospital staff. WHA will continue to work actively with past participants of TCAB who wish to champion sustainability and spread in their hospitals and systems. More information will be coming as plans are finalized.

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WHA Education: Health Care Administrative Professionals Conference, May 7

WHA’s annual one-day conference for hospital executive assistants and other administrative support staff will be held May 7 at the Blue Harbor Resort in Sheboygan.

This program is a full day of interesting and interactive education, focused on methods to improve attitude, communication, listening skills, and organizational skills, as well as tools to balance life and work. Kim Hodous, national best-selling author, will share her business expertise and practical strategies for making administrative professionals more productive and efficient.

This program is designed for executive and administrative assistants, business office managers, and other support staff in hospitals and other health care settings. Additional conference details and online registration for this event are at: http://events.SignUp4.net/15HCADMIN0507.

Route the above link on to administrative support professionals in departments throughout your organization. For questions, contact Sherry Collins at 608-274-1820 or email scollins@wha.org.

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