March 21, 2014
Volume 58, Issue 12


Record Number of Physicians Attend WHA Annual Leadership Conference

As WHA’s ninth annual Physician Leadership Development Conference officially opened, David Nash, MD, the event’s keynote speaker internationally recognized for his work in quality outcomes management and medical staff development, shared his amazement of so many physician leaders coming together to learn at one event. And, he was even more amazed that it was the state’s hospital association who brought them together. This year’s event, held March 14-15, drew more than 170 physicians and 43 hospital leaders, representing 70 different hospitals, health systems and physician groups.

With more than 210 in attendance, the 2014 conference was the largest to date, as growing numbers 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.

While discussing the history of the quality and safety movement in the United States, Nash recognized Wisconsin as a leader in improving quality outcomes, as well as public reporting of those outcomes. He also discussed the connection between quality improvement and health reform, its effect on physicians, and shared strategies for physician leaders to engage their physician colleagues in supporting a culture where quality improvement is the expectation.

In addition, WHA President Steve Brenton discussed the Association’s top priorities, and WHA Chief Quality Officer Kelly Court shared highlights from WHA’s 2013 Annual Quality Report and discussed practical ways physician leaders can engage their colleagues in the many efforts occurring in hospitals throughout Wisconsin.

The conference’s closing presenter was Tim Keogh, PhD, focusing on the importance of communication and how physician leaders can be more successful by understanding their own communication style and those of their physician colleagues.

According to WHA Senior Medical Advisor Chuck Shabino, physician leaders and hospital leaders alike find great value in participating in the conference.

"The opportunity to learn essential leadership skills, network with fellow physician leaders and build relationships with hospital colleagues away from the everyday rush makes this conference successful. The fact that physicians attend year after year speaks well of their perception of its value to them," said Shabino.

The 2015 event is scheduled for March 13-14 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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Guest Column: CMS Issues Rule Requiring Insurers Offering QHPs in the Marketplace to Accept Ryan White Program Premium Payments
By Attorneys Steve Hahn and Dave Snow of Hall, Render, Killian, Heath & Lyman, P.C.

On Friday, March 14, 2014, CMS issued an interim final rule, which states that issuers of Qualified Health Plans ("QHPs") and stand-alone dental plans ("SADPs") must accept premiums and cost-sharing payments from the Ryan White HIV/AIDS Program; Indian tribes, tribal organizations or urban Indian organizations; and state and federal government programs or face potential civil monetary penalties ("Rule"). The Rule was effective immediately and appears to have been issued in direct response to the announcement by certain QHP insurers that they would not accept QHP insurance premium payments from the Ryan White HIV/AIDS Program and the subsequent litigation that resulted therefrom.

While the Rule is primarily focused on the acceptance of premium payments from the Ryan White HIV/AIDS Program, CMS also took the opportunity to reiterate its concern about premium payments made by health care providers, stating that it "remain[s] concerned that third party payments of premium and cost sharing provided by hospitals, other health care providers and other commercial entities could skew the insurance risk pool and create an unlevel competitive field in the insurance market. We continue to discourage such third party payments of premiums and cost sharing, and we encourage QHPs to reject these payments." CMS specifically states that the Rule does not preclude QHPs and SADPs from contractually opting out of accepting premiums and cost sharing payments from third-party payers other than the organizations mentioned in the Rule.

CMS did not, however, provide any additional guidance in either the Rule or its commentary about whether hospitals and other health care entities can provide premium and cost-sharing payments by and through not-for-profit foundations. This is noteworthy because CMS’ February 7, 2014 FAQ indicated that its concerns regarding third-party premium payments do not extend to premium payments made by private, not-for-profit foundations so long as the premium payment is provided pursuant to a defined set of criteria that are based on financial status and do not consider the enrollees’ health status. CMS also stated in that FAQ that it would expect any third-party premium assistance program to cover an entire policy year.

Although CMS continues to encourage QHP insurers to not accept premium payments from third parties, such as hospitals and other health care entities, it has not prohibited such entities from providing premium support; indeed, CMS’ authority to prohibit hospitals and other health care entities from offering such support remains questionable if QHPs are not federal health care programs.

Finally, CMS waived the usual public notice period when issuing the Rule because it was concerned that a delay in coverage could result in worsening medical conditions for individuals who rely on the Ryan White HIV/AIDS Program to pay their premiums. However, the public has until May 13, 2014 to offer comments on the Rule and the broader issue of third party premium and cost sharing payments.

The Rule can be found at: www.gpo.gov/fdsys/pkg/FR-2014-03-19/pdf/2014-06031.pdf.

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Wisconsin Hospitals Join Forces to Transform Care at the Bedside

More than 130 participants from 14 hospitals joined the Wisconsin Hospital Association to launch the third cohort of Transforming Care at the Bedside (TCAB). WHA has facilitated the TCAB work in Wisconsin for the past three years. Hospitals have reported tremendous progress in improving quality and patient experience of care using the TCAB tools. TCAB is a framework that hospitals can use to improve quality patient care by engaging front-line staff. The two-day kick-off event provides caregivers an opportunity to network and share the knowledge and tools to empower innovative care.

WHA’s Stephanie Sobczak, quality manager; Tom Kaster, quality coordinator and Jodi Johnson, vice president of workforce and clinical practice, facilitated the sessions with assistance from Melissa Parkerton, Oregon Patient Safety Commission. The keynote presentation was provided by Barb Pinekenstein, president of HC Leaders, LLC and clinical associate professor at the University of Wisconsin-Milwaukee School of Nursing.

The 15 TCAB units were educated on practices and processes to lead their respective nursing units that can potentially spread to other areas of their hospital. During the TCAB event, participants placed patients at the focal point of care to create new ideas that improve patient outcomes. Participants looked at ways to engage front-line staff through storytelling and interactive exercises that aim to define new processes within the health care setting.

"TCAB provides practical tools that can be used to empower and engage nurses at the bedside to lead innovative efforts that positively impact patient outcomes," according to Johnson.

A highlight of the TCAB kickoff was keynote speaker Barb Pinekenstein, who presented information regarding the current and prospective state of the nursing workforce in Wisconsin. The future challenges facing health care lend both urgency and perspective to the need for improving quality and ensuring safe outcomes. Nurses from St. Elizabeth Hospital in Appleton, Mayo Clinic Health System - Franciscan Healthcare in La Crosse, and Froedtert & The Medical College of Wisconsin Community Memorial Hospital campus in Menomonee Falls presented from a front-line perspective to exemplify the pillars of TCAB. Katy Tomten from Gunderson Boscobel Area Hospital and Clinics energized the participants with a presentation on improving teamwork.

"The number of ideas and creativity the participants shared with us was very impressive. I am excited to see the outcomes from this cohort," according to Sobczak.

Keeping patients and high quality care at the forefront is a hallmark of Wisconsin’s excellent health care efforts and its drive to improve the quality and value of care.

TCAB is a project of Aligning Forces for Quality, which is supported by the Robert Wood Johnson Foundation through a grant to the Wisconsin Collaborative for Healthcare Quality. In Wisconsin, Aligning Forces for Quality is a joint project of the Wisconsin Collaborative for Healthcare Quality, Wisconsin Hospital Association, and other organizations.

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Holy Family Memorial Continues Strong Effort in Year Three of Partners for Patients

Keeping staff engaged over a three-year improvement effort can be challenging. At Holy Family Memorial in Manitowoc, the quality management staff has continually supported their hospital’s efforts to sustain great results and organize teams when opportunities for improvement are uncovered.

On March 10, Travis Dollak, quality advisor with the WHA Partners for Patients project, visited with staff from Holy Family Memorial to see how they maintain such a strong presence in the Partners collaborative. Dollak found that while the quality staff organizes the work, it is the continuous involvement of front-line staff that has allowed their hospital to tackle additional patient harm issues. It has also been helpful to have the full support of the senior leadership and board of directors, particularly the board-level PI Committee who have been engaged in the improvement efforts.

Vicki Wetenkamp, administrative director of clinical and service excellence, explained why they have been successful in consistently sustained efforts across the board.

"We focus not only on outcomes, but on processes as well. Our hospital staff has worked hard to produce safe care for our patients, and it shows in terms of our patient safety rates. However, we know our processes can always be improved to better prevent future events from happening. This is why we’ve continued to organize teams to participate in Partners’ collaboratives and stay focused on sustaining or spreading our gains," said Wetenkamp.

One of the keys to sustaining efforts year after year is not allowing efforts to dissipate when a team leader moves to another area in the organization. One example of this is the Holy Family adverse drug event team. Their team leader took a new role within the organization, which greatly reduced the amount of time that she could dedicate to the team. To ensure the improvements that were made did not get lost like so many other improvement efforts, Holy Family quickly recruited a new team leader.

After the visit, Dollak had this to say about Holy Family Memorial’s efforts to sustain great results: "I was able to meet a few new team leaders, and I am very confident they will be successful in reducing patient harm. I say this for two reasons. One, they were all very engaged and knowledgeable about their initiatives. And two, Holy Family Memorial has made a significant commitment to help their team leads be successful by enrolling them in the HRET Improvement Leader Fellowship to continue to build on their quality skills."

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