May 24, 2013
Volume 57, Issue 21



WHA Offers Webinar on Health Insurance Exchange Implementation, June 13 & 18

In an effort to keep members informed on the most current information available related to Wisconsin’s health insurance exchange implementation, WHA is offering a member forum June 13, with a repeat session offered June 18.

During the forum, participants will receive a high-level update via webinar on key implementation timeframes and some of the most significant outstanding issues with the health insurance exchange. In addition, the role of navigators and other assisters will be discussed, including clarifying the current federal regulations, recent developments for state licensure and registration and how hospitals fit into this process.

CEOs, COOs, CFOs, financial counselors and billing/collection managers will benefit most from participation; however, please make others in your organization aware who need to know more about exchange implementation in Wisconsin. Additional webinars on this topic will be available later this summer and fall and will include more detailed information as it becomes available.

There is no cost to participate in this member forum, but pre-registration is required. Register at http://events.SignUp4.com/13HealthInsExchange061318. If you cannot participate in one of the live webinars, there is an option to request an audio recording.

If you have questions about the content of this session, contact Joanne Alig at jalig@wha.org. If you have registration questions, contact Lisa at llittel@wha.org.

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Hospital Site Tour a New Addition to Annual Rural Health Conference

Attendees at this year’s Rural Health Conference have a new option—a guided bus and walking tour of Reedsburg Area Medical Center (RAMC), a 25-bed critical access hospital with some interesting and innovative continuum of care options for its community residents. This tour is a great way for hospital staff and trustees to experience another rural hospital setting in person and ask questions of the staff on-site.

Roundtrip transportation will be provided. The bus tour will include the RAMC campus and its Ridgeview Heights Independent Living retirement community. Walking tours, led by the RAMC senior management team, will include highlights of the hospital, surgery center, specialty center and the Reedsburg Area Senior Life Center, which includes both assisted living and long-term care.

There is no cost for registered conference attendees to participate in the hospital site tour, but pre-registration is required and limited to the first 50 hospital staff or trustees. The 2013 Wisconsin Rural Health Conference is scheduled June 26-28 at the Kalahari Resort. For more information on the hospital site tour or the overall conference, visit http://events.SignUp4.com/13Rural. Questions about the conference can be directed to Jennifer Frank at jfrank@wha.org or Lisa Littel at llittel@wha.org.

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Prescription Drug Monitoring Program Now Accessible to Dispensers and Prescribers

The Wisconsin Prescription Drug Monitoring Program (PDMP) database now has reports from 1,646 dispensers and almost four million records, according to a report presented to the Pharmacy Examining Board (PEB) at their May 15 meeting.

Chad Zadrazil, a policy analyst with the State of Wisconsin Department of Safety & Professional Services (DSPS), said individuals who dispense medications directly to patients have been submitting data since April 2 of this year on all reportable medications dispensed since January 1, 2013. With the large amount of data now in the database, the PDMP will move to the next step, which is to allow eligible prescribers and dispensers to access the information. This will be particularly useful in Wisconsin hospital emergency departments that may see patients who do not have a readily-accessible medical history. More information, along with instructions on how to access the database, is available on the PDMP website: http://dsps.wi.gov/Default.aspx?Page=cccf5c16-98f8-41c6-8906-ce29763de6c4.

The PEB also reviewed and took action on several changes to the administrative rules related to pharmacy. The Board plans to revise and update its rule (PHAR 7) around the practice of pharmacy and has already started to work on rules related to electronic prescriptions and requirements for pharmacy technicians.

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HIRSP Plan Expected to Close at End of Year
Guaranteed coverage and national reinsurance pool key to decision

On May 15, the Wisconsin Legislature’s Joint Committee on Finance voted to include in the biennial budget language to sunset the HIRSP program. The language approved by the Committee establishes the last day of coverage for HIRSP and HIRSP Federal Plan members as December 31, 2013 unless the federally-run health insurance exchange in Wisconsin is not accepting applications at that time. The exchange is expected to begin accepting applications on October 1, 2013 for private, guaranteed coverage effective January 1, 2014.

A key factor in the decision is a new requirement for guaranteed issue in the private market beginning January 1, 2014. HIRSP was created in 1979 and offers health insurance to Wisconsin residents who generally are unable to find adequate coverage in the private market due to their medical conditions. Guaranteed issue in the individual market as required under the Affordable Care Act (ACA) beginning January 1, 2014 means that HIRSP members, regardless of their health status, will now have access to commercial insurance.

On January 1, the new reinsurance program authorized under the ACA intended to stabilize the new markets is also expected to be implemented. Merging HIRSP members into the commercial market at the same time that the reinsurance program begins is necessary to mitigate premium increases. HHS has recently determined that, rather than a reinsurance program that distributes funds on a state level basis, insurers would have to contribute to a national reinsurance fund and could only become eligible for reinsurance payments when its claims costs exceed the national "attachment point." Coordinating the transition of HIRSP members with the reinsurance program is important to prevent reinsurance monies being paid by Wisconsin insurers and their members from being transferred to other states’ insurance markets.

Moving HIRSP members to the commercial market will eliminate the special HIRSP provider discounts and insurer assessments long used to supplement HIRSP members’ premiums to support the plan. For providers, it is also important to know that all claims must be submitted within 90 days of the program’s coverage end date. The HIRSP Authority will be sending notices to HIRSP members and will be communicating with providers. The HIRSP Authority will also post information on its website at www.hirsp.org.

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Guest Column: CHNAs: Why, What, When and How
David J. Edquist, von Briesen & Roper, s.c.

Community Health Needs Assessments (CHNAs) were the topic du jour at WHA’s Community Benefits Conference May 21 in Wisconsin Dells. Many of the questions, and many of the answers, are addressed in the latest guidance issued by the Internal Revenue Service on April 5, 2013.

The 2010 Affordable Care Act imposed new obligations on nonprofit hospitals claiming exemption from taxation under § 501(c)(3) of the Internal Revenue Code. These new conditions are found at IRC § 501(r), and include requirements on financial assistance policies, billing and collection practices, and other billing limitations, as well as CHNAs. Up until now, hospitals have been relying on IRS guidance in the form of an interim rule published in July 2011; the 2013 proposed regulations update and replace the 2011 interim rule.

Conference attendees learned how the 2013 proposed regulations addressed a number of hospital concerns regarding the 2011 interim rule. For example, IRS now proposes that CHNAs and related Implementation Strategies (IS) need only focus on significant, rather than all, health needs. The proposed regulations simplify the process of obtaining input from public health departments and underserved, low-income and minority populations, as well as the documentation of that input. Hospitals may now prepare a joint CHNA and IS with collaborating hospitals in certain circumstances, relieving them from the obligation to prepare separate documents for each collaborating entity. The IRS also proposes to excuse noncompliance with non-willful and non-egregious omissions so long as the hospital takes prompt corrective action and (in certain circumstances) discloses the omissions; the IRS clarified, however, that more serious violations could result not only in excise taxes but also the imposition of facility-level income taxes and potentially the loss of 501(c)(3) status.

While sensitive to hospital concerns, the IRS also addressed recommendations of community watchdogs that sought greater transparency and accountability. The 2013 proposed regulations envision a "feedback loop" between hospital and community by requiring hospitals to make widely available their last two CHNAs, rather than only the most recent CHNA; to make paper copies publicly available for inspection at no charge; and to accept and take into account written public comments on the most recent CHNA and IS. In order to foster greater accountability, IRS proposes that each IS will not only identify plans for addressing health needs, but also describe the anticipated impacts of those actions and how the hospital will evaluate those impacts. Hospitals would also need to report in their Form 990 on what actions were taken during the previous taxable year to address the needs identified in the CHNA, or explain why actions were not taken.

While a significant number of hospitals represented at the May 21 conference already have completed their first CHNA under § 501(r), others are still in process. Given that the 2013 proposed regulations offer relief in some areas while imposing new burdens in others when compared to the 2011 interim rule, the question naturally arises as to which guidance this latter group should follow going forward. Hospitals can no longer rely on the 2011 interim rule after October 5, 2013, but hospitals finalizing CHNAs before that date actually have the ability to rely on either the 2011 interim rule or the 2013 proposed regulations. This saves hospitals from a major re-write of their CHNAs that are nearing completion, while also allowing hospitals the option to incorporate some of the flexibility in this most recent guidance.

The IRS will continue to accept public comments on the proposed rules until July 5, 2013. Hospitals may continue to rely on these proposed regulations until six months after the date that the IRS publishes final or temporary regulations in the Federal Register.

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Grassroots Spotlight: Sen. Julie Lassa Visits Tomah Memorial Hospital

State Senator Julie Lassa (D-Stevens Point) spent time this week at Tomah Memorial Hospital.

She was able to meet with individuals at the hospital and share her thoughts on legislation pending in the State Capitol in Madison as well as hear from hospital leaders on important issues.

Among issues discussed with hospital leaders were the current state budget as well as Assembly bill 139.

On AB 139, hospital officials shared information on why this legislation is needed in order to address the Wisconsin Supreme Court’s Jandre decision.

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Health Information Essential to Driving Hospital Quality Improvement Activities

Two members of the WHA quality team presented at the Wisconsin Health Information Management Association (WHIMA) conference in Madison May 16. WHA’s Stephanie Sobczak, quality manager, and Tom Kaster, quality improvement advisor, explained the important role health information managers have in quality improvement activities in their hospitals.

"In roles where your main task focuses on developing and maintaining heath information systems as well as abstracting data, having a perspective of how the information generated is used to improve the outcome of direct patient care is invaluable," according to Kaster. "WHA’s presentations brought to light the true foundations of quality improvement and how essential the work of the WHIMA members is to helping improve the efficiency and quality of care in Wisconsin."

Debbie Rickelman, vice president of the WHA Information Center and a WHIMA member, said, "Health information management professionals play a significant role in quality improvement activities. Some have chosen a specific career track in quality while many others contribute to quality improvement by integrating data accuracy and completeness in their daily workflow."

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Hospital Teams Present CHNA Activities at WHA Community Benefit Seminar

Teams representing hospitals and public health departments from across Wisconsin presented their progress and in some cases, their final reports, at the WHA Community Benefit Seminar May 21 in Wisconsin Dells. The WHA meeting was held in conjunction with the Wisconsin Public Health/ Wisconsin Association of Local Health Departments and Boards annual conference.

David Edquist, a shareholder with von Briesen & Roper law firm in Milwaukee, provided the keynote address. Edquist reviewed the IRS proposed regulations released April 2013. He identified several new items contained in the April guidance. See Edquist’s guest column above.

Several WHA member hospitals presented at the seminar on the topics of collaboration/community engagement, community health needs assessment, and community health program implementation.

WHA has collected and reported Wisconsin hospital community benefit data for more than seven years. The hospital participation rate is 100 percent in the voluntary survey that WHA uses to collect data. Mandy Ayers, WHA director of administration, provided a brief update on the types of activities and services that are included in the survey and that are reported, in aggregate, by WHA. The survey closes at the end of the month, and a report will be issued by WHA in early fall.

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Moving Into Implementation: Resources to Guide Your Work
By: Julie Hladky, Community Health Improvement Plans & Processes (CHIPP) Research and Support Specialist, Wisconsin Association of Local Health Departments and Boards (WALHDAB)

Many hospitals in Wisconsin are now completing their community health needs assessment and moving into implementation. A recent survey of community benefits contacts in Wisconsin showed an interest in information about evidence-based strategies, evaluation methods and specific high priority topics. This article outlines valuable resources that address those needs.

General Implementation Guidance

The first place to turn for guidance on best practices in the implementation of the CHNA is the Wisconsin Guidebook on Improving the Health of Local Communities (www.walhdab.org/NewCHIPPResources.htm). This tool brings together national guidance in an easy-to-use format with links to further resources. Also at that site are two additional implementation tools: Template Implementation Plan: A Tool for Focused, Collaborative, Effective Action; and Objectives with Focus: A Pick List of Sample Objectives for Effective Implementation. Finally, County Health Rankings and Roadmaps offers and archives a series on top-notch, one-hour webinars including topics such as evidence-based strategies and evaluation.

Evidence-Based Implementation Strategies

There will be many ideas generated in your community about how to tackle the priority health issues. It is best to choose approaches that have a proven track record. Here are two excellent sources that list evidence-based or promising practices for community health interventions:

You can search either site based on the priorities selected by your community to find ideas for implementation strategies in various settings and a rating of the evidence to support those strategies.

Evaluation Methods

Although the final analysis and dissemination of the results of your work happen at the end of the community health improvement cycle, designing the evaluation needs to happen early. It is important to define process measures to track if you are completing tasks and short- and mid-term outcome measures to see if you are on track and to share your early successes. For more guidance on designing your evaluation plan, see:

Physical Activity and Nutrition Resources

In addition to the two lists of evidence-based approaches above, there are very helpful materials for local strategy development at the website for WiPAN, the Wisconsin Partnership for Physical Activity and Nutrition, including specific prevention approaches for health care settings.

Alcohol Related Resources

A few key resources that outline effective strategies for the prevention of alcohol misuse:

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Member News: Schnedler Named President/CEO of Upland Hills Health, Dodgeville

Lisa Schnedler has been named president/CEO of Upland Hills Health in Dodgeville. Schnedler will replace current President/CEO Phyllis Fritsch, who is retiring in July after a 44-year association with Upland Hills Health.

Schnedler currently serves as the CEO/administrator at Van Buren County Hospital and Medical Clinics in Keosauqua, Iowa. She has been in this leadership role for the past 23 years and is responsible for the overall operations of the hospital and six rural health clinics. Schnedler also holds the title of corporate director of strategic planning for the SMP Health System, which is the health system that manages Van Buren County Hospital. Before becoming the Van Buren County Hospital CEO, she worked for Jewish and Barnes Hospitals in St. Louis, Missouri.

Schnedler received her bachelor of science degree from the University of Missouri - Columbia and her master’s of healthcare administration from the University of Minnesota. She is a Fellow in the American College of Healthcare Executives.

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In Memoriam: Ken Creswick 1923-2013
Former WHA award winner and board member; president, Cuba City/Platteville hospitals

Kenneth W. Creswick passed away on May 16, 2013 in Chandler, Arizona.

Born in Dubuque, Iowa, Mr. Creswick attended the University of Dubuque. He enlisted the Marine Corps in 1942, during which time he spent a year at Notre Dame for officer training before going on active duty as a Second Lieutenant in the South Pacific and China until his discharge in 1946. He received his bachelor’s degree from the University of Dubuque in 1947.

Ken worked at the Eustice Lumber Company until 1956, at which time he joined the newly-opened Cuba City Medical Center as an assistant administrator and shortly became the administrator of the hospital and clinic. He served in that capacity until 1981 when he became president of the newly formed merger of the Cuba City and Platteville hospitals and the two nursing centers. He was instrumental in forming the Cuba City Area Rescue Squad in order to save ambulance service in the area. He became an EMT and member of the Rescue Squad. Ken retired from Southwest Hospital in 1989 but continued to serve on the Board of Directors until 1998.

"Ken was a strong leader and advocate for ensuring that rural communities had access to the best care, close to home," said WHA President Steve Brenton, who had an opportunity to work with Ken when he served on the WHA Board. "Wisconsin is known for leadership and innovation and Ken embodied both of these qualities." In 1979 Ken received the WHA Outstanding Hospital Administrator of the Year award.

Ken’s achievements include working with rural hospitals in Southwest Wisconsin to form the Rural Wisconsin Hospital Cooperative (now Rural Wisconsin Health Cooperative) (RWHC) and the HMO of Wisconsin.

"Ken saw the opportunity for rural hospitals to work together, long before most others," said Tim Size, executive director of RWHC. "We all stand on the shoulders of those who come before–Ken gave me the opportunity and support to work at RWHC for which I will ever be grateful."

Services will be held in Cuba City at Haudenshield Funeral Home on June 29 at 11 a.m. Memorials may be made to the Cuba City Area Rescue Squad.

The staff at WHA extends their sympathy to Ken’s family and friends.

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Wisconsin Hospitals Community Benefits – Adequate and Appropriate Nutrition

Nutrition counseling is an important aspect of the service that hospitals provide within their communities. Whether it is offering classes that focus on weight loss or promoting better health, or nutrition education for people who are diabetic, Wisconsin hospitals offer hundreds of free classes that stress the importance of a nutritional, well-balanced diet on overall health. Hospital employees also help deliver Meals on Wheels and they organize and participate in food drives to benefit local food pantries.


500 Club® helps people eat healthier

One of our biggest concerns—and challenges—is influencing healthier lifestyles in people in the communities we serve. Gundersen Health System’s Nutrition Therapy department, in an effort to combat the disturbing obesity trend, developed the innovative 500 Club® program—now in its 30th year.

The physician-endorsed 500 Club® is a healthy eating program coordinated by Gundersen registered dietitians. They work with food retailers—locally and nationally—to help consumers make smarter, healthier food choices. The 500 Club® members include grocery stores, restaurants, quick-service counters, take-and-bake businesses, delis, even convenience stores and vending machine companies.

To take the guesswork out of selecting healthier, great-tasting food, consumers only have to look for the green 500 Club® logo on food products at dozens of area locations. The 500 Club® "stamp of approval" means the selection contains approximately 575 calories or less, and is controlled in fat.

"The 500 Club® is meant to be a tool in making the healthy choice, an easy identifiable option. It goes beyond simply listing calories and fat; our meal combinations show consumers how to put together a balanced meal when eating out," states Jennifer Larson, RD, administrative director of Nutrition Therapy, Gundersen Health System. "Because of the importance of the mission of the 500 Club®, the program is free for members and consumers alike. The only commitment is to enjoy a healthier lifestyle."

500 Club® for Kids is also offered at select 500 Club® member restaurants. This program helps children and parents make nutritious choices when dining out. 500 Club® for Kids menu items don’t focus on calories but instead offer healthier side selections such as fruit and vegetables.

Snack healthier, too. In area vending machines, the 500 Club® logo (or green "pushers") identifies snack items that are approximately 200 calories and 8 grams of fat per serving.

Visit 500-club.org to see a listing of all Gundersen Health System 500 Club® members and to learn more.

Gundersen Health System, La Crosse


Growing a network for community nutrition

A local church planted a seed for the Albany Sustainable Agricultural Education Center, approaching Albany Downtown Revitalization Committee with the concept of offering fresh produce in the school cafeteria and the local food pantry.

With the eager support of many community partners, that seed has grown into a community-wide initiative focused on improving childhood and family nutrition while using locally-grown produce.

The Albany School is currently working with the program to establish a sizable garden, involving not only its agriculture and science departments, but art, technology and business students as well. From painting signage to building a shed to outlining future plans, there is plenty of activity and momentum.

Monroe Clinic is one of the community supporters of the Albany Sustainable Agricultural Education Center.

"Monroe Clinic is providing information on nutrition and wellness programs and has involved the Green County Health Department and the Healthy Kids Healthy County Coalition as partners in the garden program," explained Edward Maksym, program organizer and member of the Albany School Board and Downtown Revitalization Committee.

"Working with a number of health agencies in Green County as our partners, we are aiming for better childhood nutrition, healthier family meals, a local food source, and fresh produce for the food pantry. We may eventually be able to establish a local farmers market," said Mr. Maksym.

Monroe Clinic, Monroe


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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