May 29, 2015
Volume 59, Issue 21
WHA CheckPoint Program Adds All-Cause Readmission Measure
WHA’s hospital quality reporting website continues to expand to include new information valuable to hospitals and consumers. On May 29, WHA added a new all-cause readmission measure to CheckPoint.
Many hospitals are working to decrease readmissions for all types of patients. Current measures typically only include readmissions to the same hospital or for a single payer. The new CheckPoint measure, which was developed by the WHA Information Center (WHAIC), tracks readmissions between Wisconsin hospitals and includes patients from all payer sources. The measure excludes patients who were likely to have planned readmissions, using the Centers for Medicare and Medicaid (CMS) algorithm. The Wisconsin Office of Rural Health helped fund the development of the new measure.
The readmission measure will include the most recent four quarters of data supplied by WHAIC (7/1/2013 - 6/30/2014). Hospitals have been reviewing their data in preview format for several quarters and using the data to augment their readmission reduction efforts.
"Access to the hospital discharge data provides Wisconsin hospitals with the unique opportunity to have the data necessary for this robust measure. This gives us a more accurate picture of our overall readmission rates in the state," according to Kelly Court, WHA chief quality officer. "We continue to see work on readmissions as the most common improvement project hospitals are working on to improve quality and reduce costs."
Since 2004, CheckPoint has given consumers a snapshot of Wisconsin hospitals’ performance in key areas. Today, 127 acute care Wisconsin hospitals and some specialty hospitals are publicly reporting data on more than 80 measures to the CheckPoint program. This information can be used to see how often each hospital provides recommended care for patients with certain conditions or the progress hospitals have made toward national patient safety goals. Consumers can use the information to compare how different hospitals perform, while hospitals can use the data to benchmark their progress toward national quality and safety goals.
"Public reporting has advanced and accelerated quality improvement. It is certainly a factor in Wisconsin being consistently ranked as one of the top states in the country based on the quality of our health care," according to Court. "The information on CheckPoint helps consumers make informed decisions about their hospital care and engages Wisconsin hospitals in early quality improvement."
Click here to access the new measure.
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On May 27, the Joint Committee on Finance continued to amend the pending state budget bill, including scaling back proposed changes to the state’s high-performing Worker’s Compensation program.
The proposed state budget would have split up the Worker’s Compensation program, moving it entirely out of the Department of Workforce Development (DWD), and sending adjudication functions to the Department of Administration (DOA) while moving the rest of the program to the Office of the Commissioner of Insurance (OCI).
Insurance companies, insurance agents and Wisconsin Manufacturers and Commerce supported splitting the program, including the move to OCI. WHA took no position on shifting adjudication functions to DOA, but opposed moving the rest of the Worker’s Compensation program to OCI.
On May 27, the Joint Committee on Finance approved shifting adjudication functions to DOA, but deleted the proposal to shift the bulk of the Workers’ Compensation program to OCI.
WHA recognizes that Wisconsin’s Worker’s Compensation is one of the best in the country—a message carried to the Capitol by 650 hospital and health system advocates during last month’s WHA Advocacy Day—and believes it should remain in DWD.
Return-to-work statistics in Wisconsin’s Worker’s Compensation program beat nearly every other state in the nation. Wisconsin’s injured workers are much more satisfied with the care they receive, resulting in lower utilization of medical services and less overall litigation in the program. In fact, a 2014 story in Governing magazine highlighted two manufacturers that moved their business from New York to Wisconsin because Wisconsin’s Worker’s Compensation costs were "far cheaper" than what they experienced in New York.
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The 2015 Wisconsin Hospitals Conduit and State PAC annual fundraising campaign is off to its best start with 139 individuals contributing nearly $132,000. The campaign is at 49 percent of the goal to raise $270,000 by the end of the year.
Individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. The campaign is off to a very strong start, thanks to the contributors who are listed below. Contributors are listed alphabetically by contribution amount category. The next publication of the contributor list will be in the June 12 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.
|Contributors Ranging from $1 - $499|
|Anderson, Phil||Sacred Heart Hospital|
|Appleby, Jane||Aurora Health Care|
|Ballentine, Anne||Wheaton Franciscan Healthcare|
|Brenny, Terrence||Stoughton Hospital|
|Cardinal, Lori||Agnesian HealthCare|
|Carter, Shane||Aurora Medical Center - Oshkosh|
|Clark, Renee||Fort HealthCare|
|Collins, Sherry||Wisconsin Hospital Association|
|Colman, Gerard||Aurora Health Care|
|Cormier, Laura||Bellin Hospital|
|Culotta, Jennifer||St. Clare Hospital & Health Svcs|
|Dux, Larry||Froedtert & MCW Community Mem. Hosp|
|Feeney, John||Community Health Network, Inc.|
|Freitag, Vanessa||Our Lady of Victory Hospital|
|Hafeman, Paul||St. Vincent Hospital|
|Hamilton, Mark||UW Hospitals and Clinics|
|Harrington, Kathleen||Mayo Health System - Eau Claire|
|Jelle, Laura||St. Clare Hospital & Health Services|
|Klay, Chris||St. Joseph's Hospital|
|Knutzen, Barbara||Agnesian HealthCare|
|Leschke, John||Mercy Medical Center|
|Lynch, Sue||Mayo Health System - Franciscan HC|
|McArdle, PeggyAnn||Agnesian HealthCare|
|McMeans, Scott||Holy Family Memorial|
|O'Hara, Tiffanie||Sundial Software|
|Peiffer, Susan||Sacred Heart Hospital|
|Roundy, Ann||Columbus Community Hospital|
|Schubring, Randy||Mayo Health System - Eau Claire|
|Selle, Ginger||St. Clare Hospital & Health Services|
|Statz, Darrell||Rural Wisconsin Health Cooperative|
|Swanson, Kaitlin||HSHS-Eastern WI Division|
|Tapper, Joy||Milwaukee Health Care Partnership|
|Theiler, Brian||Gundersen Tri-County Hospitals & Clinics|
|Walker, Troy||St. Clare Hospital & Health Services|
|Werkheiser, Cindy||Monroe Clinic|
|Wheeler, Susan||St. Nicholas Hospital|
|Whitinger, Margaret||Agnesian HealthCare|
|Wold, Gwen||Amery Regional Medical Center|
|Contributors Ranging from $500 - $999|
|Bagnall, Andrew||St. Nicholas Hospital|
|Bailet, Jeffrey||Aurora Health Care|
|Bard, Jeffrey||Aurora Medical Center - Oshkosh|
|Dexter, Donn||Mayo Health System - Eau Claire|
|Dicus-Johnson, Coreen||Wheaton Franciscan Healthcarel|
|Dolohanty, Naomi||Aurora Health Care|
|Golanowski, Marie||Aurora St. Luke’s Medical Center|
|Graul, Mark||Children’s Hospital of Wisconsin|
|Gustafson, Andy||SSM Health Care-Wisconsin|
|Hanson, Gail||Aurora Health Care|
|Heaney, Dwight||Fort HealthCare|
|Jacobson, Terry||St. Mary’s Hospital of Superior|
|Jensema, Christine||HSHS-Eastern Wisconsin Division|
|Kingston, Mary Beth||Aurora Health Care|
|Kirsch, Jennifer||Gundersen Health System|
|Lange, George||Westgate Medical Group, CSMCP|
|Larson, Margaret||Mercy Medical Center|
|Latta, Richard||Godfrey & Kahn, SC|
|Mohorek, Ronald||Ministry Health Care|
|Nelson, James||Fort HealthCare|
|O’Day, Thomas||Godfrey & Kahn, SC|
|Oland, Charisse||Rusk County Memorial Hospital|
|Ose, Peggy||Riverview Hospital Association|
|Quinn, George||Wisconsin Hospital Association|
|Reardon, Brian||Hospital Sisters Health System|
|Roesler, Bruce||The Richland Hospital|
|Rozenfeld, Jon||St. Mary’s Hospital - Madison|
|Rude, Nels||The Kammer Group|
|Seitz, Verna||ProHealth Care, Inc.|
|Selberg, Heidi||HSHS-Eastern Wisconsin Division|
|Shabino, Charles||Wisconsin Hospital Association|
|Shorter, Tom||Godfrey & Kahn, SC|
|Simaras, Jim||Wheaton Franciscan Healthcare|
|Stuart, Phil||Tomah Memorial Hospital|
|Teigen, Seth||St. Mary’s Hospital|
|Van Meeteren, Bob||Reedsburg Area Medical Center|
|Yaron, Rachel||Ministry St. Clare’s Hospital|
|Zenk, Ann||Ministry St. Mary’s Hospital|
|Contributors Ranging from $1,000 - $1,499|
|Ashenhurst, Karla||Ministry Health Care|
|Bloch, Jodi||Wisconsin Hospital Association|
|Brenton, Andrew||Wisconsin Hospital Association|
|Connors, Larry||St. Mary's & St. Vincent Hospital|
|Cullen-Schultz, Jeannie||JP Cullen & Sons|
|Just, Lisa||Aurora Health Care-South Region|
|Kerwin, George||Bellin Hospital|
|Killoran, Carrie||Aurora Health Care|
|Punzenberger, Lindsay||Children’s Hospital of Wisconsin|
|Rickelman, Debbie||WHA Information Center|
|Roller, Rachel||Aurora Health Care|
|Rush, Steven||Wisconsin Hospital Association|
|Sato, Thomas||Children’s Hospital of Wisconsin|
|Schafer, Michael||Spooner Health System|
|Swanson, Kerry||St. Mary’s Janesville Hospital|
|White-Jacobs, Mary Beth||Black River Memorial Hospital|
|Wolf, Edward||Lakeview Medical Center|
|Contributors Ranging from $1,500 - $1,999|
|Boese, Jennifer||Wisconsin Hospital Association|
|Clapp, Nicole||Grant Regional Health Center|
|Court, Kelly||Wisconsin Hospital Association|
|Decker, Michael||Divine Savior Healthcare|
|Frank, Jennifer||Wisconsin Hospital Association|
|Grasmick, Mary Kay||Wisconsin Hospital Association|
|Harding, Edward||Bay Area Medical Center|
|Kammer, Peter||The Kammer Group|
|McKevett, Timothy||Beloit Health System|
|Natzke, Ryan||Marshfield Clinic|
|Russell, John||Columbus Community Hospital|
|Schulze, Connie||Ministry Health Care|
|Sexton, Bill||Crosssing Rivers Health Medical Center|
|Sheehan, John||UW Hospitals and Clinics|
|Wallace, Michael||Fort HealthCare|
|Contributors Ranging from $2,000 - $2,999|
|Alig, Joanne||Wisconsin Hospital Association|
|Anderson, Sandy||St. Clare Hospital & Health Svcs|
|Duncan, Robert||Children's Hospital & Health System|
|Herzog, Mark||Holy Family Memorial|
|Jacobson, Catherine||Froedtert & The MCW|
|Kachelski, Joe||WI Statewide Health Info Network|
|Leitch, Laura||Hall Render|
|Levin, Jeremy||Rural Wisconsin Health Cooperative|
|Lewis, Gordon||Burnett Medical Center|
|Mettner, Michelle||Children’s Hospital of Wisconsin|
|Pandl, Therese||HSHS-Eastern Wisconsin Division|
|Meyer, Daniel||Aurora BayCare Medical Ctr Green Bay|
|Potter, Brian||Wisconsin Hospital Association|
|Potts, Dennis||Aurora St. Luke’s Medical Center|
|Sanders, Michael||Monroe Clinic|
|Sliwinski, Ron||UW Hospitals and Clinics|
|Stanford, Matthew||Wisconsin Hospital Association|
|Troy, Peggy||Children’s Hospital of Wisconsin|
|Contributors Ranging from $3,000 - $4,999|
|Boatwright, Damond||SSM Health Care-Wisconsin|
|Hilt, Monica||Ministry St. Mary’s Hospital|
|Little, Steve||Agnesian Health Care|
|Neufelder, Dan||Ministry Health Care|
|Normington, Jeremy||Mercy Medical Center|
|O’Brien, Kyle||Wisconsin Hospital Association|
|Size, Tim||Rural Wisconsin Health Cooperative|
|Standridge, Deb||Wheaton Franciscan Healthcare|
|Starmann-Harrison, Mary||Hospital Sisters Health System|
|Turkal, Nick||Aurora Health Care|
|Contributors Ranging from $5,000+|
|Borgerding, Eric & Dana||Wisconsin Hospital Association|
|Brenton, Stephen||Wisconsin Hospital Association|
|Tyre, Scott||Capitol Navigators, Inc.|
State Insurance Regulators Addressing Network Adequacy
Top of page (5/29/15)
For the past year, the National Association of Insurance Commissioners (NAIC) has been working toward a model state law that would address consumer, provider and insurer concerns about network adequacy.
The implementation of the insurance exchange two years ago shed new light on insurer networks and highlighted the difficulty many consumers have in obtaining information from their insurance plan about differences between in-network and out-of-network providers and their associated cost sharing.
While the federal government has been issuing guidance regarding the insurance exchange, Medicaid and Medicare, state insurance regulators see it as their role to monitor and enforce insurance rules, including around network adequacy. To that end, the NAIC established a group to update their 1996 model act on the topic. Wisconsin’s, J.P. Wieske, legislative liaison & public information officer for the Wisconsin Office of the Insurance Commissioner, is chairing the group.
The NAIC’s model law has not been updated for nearly two decades. The final product will be the result of several weekly and bi-weekly meetings involving dozens of interested parties since last year including provider, consumer and insurer representatives. The goal is to create a model act that allows for state flexibility should states seek to implement their own state network adequacy law.
All stakeholders appear to express the same goals of ensuring there is sufficient choice of providers, care is easily accessible, and there is certainty of when care is being provided in or out of network. However, stakeholders differ on how those goals should be achieved. The latter point—whether care is provided in or out of network—has been of particular concern to the NAIC insurance regulators working on the model act. More specifically, over the course of the group’s conversations, and particularly in the past two weeks, the group has indicated concerns about the ability of consumers to understand whether practitioners working in the hospital are in or out of network. On May 28, the group agreed to keep provider-sponsored language that the access plan submitted by health plans to the state insurance regulator should contain a number of items, including a description of the insurer’s process for monitoring access to certain practitioners at the insurer’s participating hospitals. Providers had argued that insurers are not diligent in their attempts to contract with practitioners at their in-network hospitals, such as for physician specialist services in the emergency room, anesthesiology, radiology, hospitalist care and pathology/laboratory services. Insurers, however, feel that the burden should be on providers to know and communicate who is in an insurer’s network and ensure that certain practitioners are part of the insurer’s network. A recommendation by America’s Health Insurance Plans (AHIP) that would have placed the burden on providers was rejected by the insurance regulators.
WHA continues to listen and participate in the NAIC calls on a regular basis. WHA will provide an update on the NAIC work at the Rural Health Conference in June and will continue to provide information as the NAIC wraps up their work on the draft model act later this summer.
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The state’s budget-writing Joint Committee on Finance voted May 27 to remove provisions of the Governor’s budget changing the state’s long-term care program, Family Care and IRIS. The Committee instead adopted a lengthy set of changes that would establish the framework for a revised Medicaid long-term care program. The plan would establish new integrated health agencies (IHAs) in at least five different regions throughout the state, requiring multiple IHAs in each region. The IHAs would then provide Medicaid-funded long-term care consumers with long-term and acute care services, including a self-directed care option for enrollees.
According to the proposal, the Department of Health Services (DHS) would be required to report back to the Finance Committee prior to April 1, 2016 with a summary of the proposed waiver request by DHS to implement the changes noted above. The Committee would have the authority to approve or disapprove the plan, without changes. The amended language also requires DHS to consult with stakeholders and the public prior to developing the final waiver request.
The proposal would also require that DHS seek a change to the state’s long-term care waiver which would expand the current Family Care program statewide beginning January 1, 2017 or a later date determined by DHS. Currently, eight out of Wisconsin’s 72 counties do not operate a Family Care program and instead rely on legacy waiver programs, like the Community Integrations Program (CIP) and the Community Options Program (COP). DHS would have the authority to eliminate these programs once a county has made Family Care available to all eligible residents in that county.
The proposal would maintain existing Aging and Disability Resource Centers (ADRCs) across the state, but require DHS to assess the responsibilities of these agencies and ensure that no duplication is occurring with current DHS procedures.
The proposal was adopted by a 12-4 vote, on party lines. Democrats on the Committee expressed their opposition to the plan and offered up their own motion which deleted the Governor’s proposal and maintained the current Family Care and IRIS programs. The Democrat’s version failed to pass the Committee on a 4-12 vote.
To see a copy of the Republican budget motion that passed, go to: www.wha.org/pdf/motion513.pdf.
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The Centers for Medicare & Medicaid Services (CMS) released a proposed rule that would "modernize" the Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations. The rule, which is the first major update to Medicaid managed care regulations in more than a decade, is intended to better align them with existing commercial, Marketplace and Medicare Advantage regulations.
Insurers have already expressed their concerns with the provision of the rule that would require medical loss ratios for Medicaid managed care plans. The proposed rule also specifies the minimum factors a state must consider in developing network adequacy standards for Medicaid managed care and proposes that states would have to establish time and distance standards for specified provider types. The proposed rule also covers quality measures, external quality review, and certain beneficiary rights and protections. The proposal would implement best practices identified in existing managed long-term care services and support programs, require states to develop a Medicaid managed care quality rating system for health plans, and permit managed care flexibility for enrollees aged 21 to 64 in short-term inpatient or sub-acute institutions for mental disease (IMDs). Finally, CMS would strengthen its requirements on state standards and practices for monitoring managed care plans.
WHA will perform a thorough review of the rule and will submit comments. The rule can be found here. Comments on the proposed rule are due July 27.
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Wisconsin Attorney General Brad Schimel recently met with leaders from Affinity and Ministry Health Systems to talk about challenges local communities are facing with substance abuse and behavioral health. Schimel talked about his appreciation of the health care community’s willingness to work on issues like opioid and heroin addiction. Providers at the meeting talked about the challenges of working with patients who are addicted to opioids and some strategies to better manage the patient’s condition.
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Recently U.S. Rep. Glenn Grothman visited with Howard Croft, MD, and toured the emergency department at HSHS St. Nicholas Hospital in Sheboygan.
During Grothman’s time at the hospital, Dr. Croft and hospital President Andy Bagnall discussed federal hospital requirements, such as EMTALA, along with policy changes that seek to move Medicare payments toward value, such as contained in the recently-enacted repeal of the Sustainable Growth Rate. They also discussed Wisconsin’s track record of providing high-quality, high-value care.
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More information and online registration are available at: http://events.signUp4.net/15Rural
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The Department of Workforce Development’s (DWD) Office of Skills Development (OSD) released $8 million on May 14 in Grant Program Announcements (GPAs) under Gov. Scott Walker’s Wisconsin Fast Forward (WFF) initiative. One of the nine targeted workforce sectors is health care. Employers are encouraged to submit innovative and collaborative customized worker training grant applications. Criteria used to determine Round 4 investment categories included a comprehensive analysis of pressing workforce demand that included skilled worker labor market employment projections and immediate worker training needs of employers. Grant awards will be announced no later than 60 days from the application deadline of 5 p.m. on August 20, 2015. Grants for health science and health care related occupations will range from $5,000 to $400,000 each.
Wisconsin Fast Forward program funding is subject to the state’s biennial budget approval. Round 4 GPA and application details, dates for informational webinars about the application process, and the grant application can be accessed on the grant program page.
Round 3 of Walker’s WFF program was quickly approved with overwhelming bipartisan support from lawmakers in 2013 to address the skills gap through a $15 million investment in grants to employers for customized skills training to fill current job openings and ongoing skill requirements. WFF has awarded 145 grants to provide in-demand worker training to nearly 13,800 workers and more than 300 businesses to date. View intent to award summaries here.
WHA encourages its members to identify regional training opportunities and to connect with workforce partners to develop plans for Round 4 applications. Past WHA member awardees include:
Contact OSD for more information or assistance.
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According to the WHA Information Center, in 2014 there were 78 inpatient admissions and 2,933 hospital outpatient visits (2,206 of those in the emergency room) in Wisconsin hospitals due to a bicycle-related injury. Forty two percent of the total visits occurred in children ages 5-14, 18 percent in young adults ages 15-24, and 22 percent in adults ages 45 and older. Men accounted for 69 percent of those visits.
For more information: www.cdc.gov/HomeandRecreationalSafety/Bicycle.
Data provided by the WHAIC (www.whainfocenter.com). The WHA Information Center is dedicated to collecting, analyzing and disseminating complete, accurate and timely data and reports about charges, utilization, quality and efficiency provided by Wisconsin hospitals, ambulatory surgery centers and other health care providers.
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