May 3, 2013
Volume 57, Issue 18


WHA-Backed Legislation Addressing Jandre Decision to Get Vote in Assembly

The full Assembly intends to vote next week on legislation addressing the Supreme Court’s Jandre decision—one of WHA’s top 2013 priorities. The Jandre decision created an unclear standard for physicians to meet when obtaining patients’ informed consent prior to providing treatment. Assembly Bill 139 addresses that by establishing a clear reasonable physician standard for physicians when providing patients with information about the risks and benefits of reasonable alternate treatment. Importantly, under the bill, a physician is not required to provide information about treatment for conditions the physician does not believe the patient has.

WHA Advocacy Day, which was held two days prior to the Assembly Committee vote, brought nearly 900 hospital leaders and volunteers Madison to learn about WHA’s priority issues and talk with their legislators about important bills, including AB 139. Hospital advocates were very effective explaining the need for the bill to their legislators—the bill passed the Assembly Committee on a 6-2 vote.

"It is apparent that recent hospital and health system advocacy efforts have effectively raised awareness of the Jandre decision and how, if unaddressed, it adversely affects health care treatment and costs in the state by encouraging defensive medicine," said Kyle O’Brien, WHA vice president of government relations. "Now is the time to remind elected officials about the importance of this legislation and ask them to support Assembly Bill 139."

The full Assembly will vote on the bill Wednesday, May 8. After approval in the Assembly, the bill will be considered by the Senate and if approved by the Senate, Governor Walker will be asked to sign the legislation, making it law.

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Advocacy Day Legislative Panel Addresses Mental Health, Physician Shortage

Mental health and physician workforce issues were two topics of conversation that were presented to a legislative panel at WHA’s Advocacy Day on April 23. Both issues are being deliberated in the Governor’s budget and the Speaker’s Task Force on Mental Health.

Sen. Joseph Leibham, (R-Sheboygan), Sen. Jennifer Shilling (D-La Crosse), Rep. Jeff Stone, (R-Greendale) and Rep. Sandy Pasch (D-Whitefish Bay) participated in the panel discussion. Nearly 900 hospital supporters were in attendance. WHA Executive Vice President Eric Borgerding moderated the panel.

The wave of demand for health care services is expected to create workforce shortages for physicians, physician assistants, advanced practice nurses and others. A WHA report quantified the physician shortage and found that Wisconsin will need 2,000 new physicians by 2030. Borgerding said WHA is pleased that the Governor included $20 million in his budget to be used to expand both undergraduate and graduate medical education. He asked the legislative panel for their opinion on the likelihood that the Legislature will maintain this important funding throughout the budget process.

"Through your advocacy, you have let us know the need is out there, particularly in the rural areas," Leibham said. "I am excited about what the Governor is proposing—putting money into the Medical College of Wisconsin and other important initiatives."

Stone said he also sees a role for the Legislature in helping to solve workforce development issues in health care.

"One of the most powerful economic engines we have in southeast Wisconsin is in medical technology and research at GE Medical, UW Milwaukee and on our health care campuses," Stone said. "It is an economic driver, so we have a vested interest in strengthening and improving the health care workforce. We also want to have a strong health care system to care for our future citizens."

"The WHA study shows a need for 2,000 new doctors by 2030. As I tour rural and federally-qualified health centers, I ask about their recruiting efforts. It is important that we partner with our universities and technical school system to identify those areas of medicine that interest people," said Shilling. "We have a role and a responsibility in helping that to happen."

Pasch said she feels the Legislature should do whatever it can to interest people to work in health care, especially in underserved areas.

Opportunities to Modernize Mental Health Policy

Borgerding described challenges health care providers face in providing modern, high-quality, accessible care for individuals with behavioral health needs and the fact that many of Wisconsin’s behavioral health laws have remained largely unchanged since the 1970s. This has resulted in frustration for providers, patients, law enforcement and local government. Borgerding asked legislators to share their thoughts specific to whether laws should be changed that would bring comprehensive reform to the system.

Leibham said he is enthusiastic about the newly-formed Speaker’s Task Force on Mental Health.

"The Legislature is ‘us.’ We have struggled with this issue as mental health conditions and treatments have changed. Our statutes and laws have not kept pace. For many years we didn’t want to talk about it. But this will move forward statutory changes," Leibham said.

Growing up in a home with mental health providers has given Stone a unique perspective.

"I have been an advocate for modernizing mental health and moving to a community–based treatment model, that has better outcomes for those who are in the mental health system," Stone said. "We can reform how those services are delivered at a local level. I was excited that the Governor made a commitment to expand funding to mental health programs in the state. I think that has the potential to rein in other costs, especially in the Medicaid program. It can strengthen the way we deliver mental health care and have a positive impact on other parts of the state budget."

Shilling voiced her concerns about the tie between Medicaid funding and the potential that cuts will have on accessing mental health services.

"Cuts to Medicaid will have an impact on those that need mental health services and therapies," according to Shilling. "We need to consider the whole patient as we look at health reform."

Shilling said the health systems in western Wisconsin are making great investments in behavioral health and she encouraged other communities to also consider mental health initiatives.

"We have come so far in our understanding of mental health, but our laws have not kept pace," Pasch said, who is vice chair of the Speaker’s Task Force on Mental Health.

The Task Force is making progress with both parties working with WHA to identify problems and find potential solutions. Pasch said she is "optimistic that this time, we can make change."

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This Week’s Happenings with the Wisconsin Health Insurance Exchange

With just five months to go before the health insurance exchange in Wisconsin is supposed to begin taking applications, deadlines continue to get extended, details continue to remain elusive, and much remains unknown about how the exchange will actually work.

Insurer Filing Deadline Delayed. On April 29, just one day before insurer applications were due to the federal government, the Centers for Medicare and Medicaid Services (CMS) delayed the filing deadline to Friday, May 3. Stating that they were responding to requests from various insurers, CMS allowed the three-day extension for insurer applications offering qualified health plans through the health insurance exchange for coverage year beginning January 1, 2014. The applications were due to the federal government for states like Wisconsin that will have a federally-facilitated Exchange. As reported in The Valued Voice over the past few weeks, once insurers file an application, the federal government and the state’s Office of the Commissioner of Insurance (OCI) will review the applications. OCI staff have indicated that in July they will announce insurers who have applied to participate in the Exchange. However, it will not be known which insurers definitely will participate in offering plans through the Exchange, and in what locations of the state, until early September when insurers must sign agreements with CMS.

CMS Call with Wisconsin Stakeholders Provides Little Information. On May 1, CMS Region V Acting Administrator, Jackie Garner, hosted a call specifically for Wisconsin stakeholders to, as the advertisement noted, "update participants on the operations and policies of the Marketplace." Unfortunately, few walked away from the call feeling that they had any better information about the Exchange operations and policies. The scripted remarks provided virtually no details about what the Exchange would look like, important timelines, or key policies needed to understand what to expect in October when the federal Exchange is supposed to be operational in Wisconsin. For nearly each and every question, callers were not given a direct answer but were told to go to the federal website. Many are disappointed and very concerned that just five months before the Exchange is supposed to be up and running, there seems to be little clarification on important policies and procedures.

Revised Exchange Consumer Application Forms Released by HHS. In response to criticism about the length of the draft ‘streamlined’ application for consumers to apply for coverage through the Exchange, HHS released three variations of the application form—one for families, one for an individual, and one for an individual who is not seeking financial assistance or tax subsidies through the Exchange. Comparing the new family application to the draft application released earlier this year reveals that most of the information to be collected is the same, but the application form itself has been rearranged to move some information into an Appendix. The previous form also had two pages for each family member’s information and had embedded enough pages for up to six family members within the basic application form. The new application still includes two pages for each family member, but the applicant will have to add pages if there are more than two family members applying. To view the forms:

Individual application: http://cciio.cms.gov/resources/other/Files/AttachmentB_042913.pdf

Individual application without financial assistance: http://cciio.cms.gov/resources/other/Files/AttachmentD_042913.pdf

Family application: http://cciio.cms.gov/resources/other/Files/AttachmentC_042913.pdf

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Register today for the 2013 Wisconsin Rural Health Conference
Kalahari Resort, Wisconsin Dells *** June 26-28, 2013

More information and online registration is available at: http://events.signUp4.com/13Rural

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WHA, Hospital Leaders in DC on Capitol Hill
Holy Family’s Scott McMeans receives AHA "Grassroots Champion" award

Wisconsin hospital leaders and the Wisconsin Hospital Association (WHA) were in Washington, DC recently for the American Hospital Association (AHA) Annual Meeting and Day on Capitol Hill. During the AHA Annual Meeting, Holy Family Memorial’s (Manitowoc) Scott McMeans received an AHA "Grassroots Champion" award. The award is given out each year by AHA to one individual in each state.

"We depend upon strong voices like yours to help tell the story of hospitals as cornerstones of the communities they serve," said Rich Umbdenstock, AHA president and CEO. "This award is a small token of our appreciation for your hard work and dedication to improving health and health care in America."

McMeans received the award for Wisconsin due to his dedication and commitment to grassroots advocacy.

"WHA is pleased that Scott was honored as a 2013 Grassroots Champion award," said Jenny Boese, WHA vice president, external relations & member advocacy. "His efforts have been exemplary this past year and have turbo-charged hospital advocates at Holy Family Memorial in Manitowoc."

While in DC, hospital leaders made certain to take the opportunity to go to Capitol Hill and meet with the majority of Wisconsin’s Congressional offices. During meetings, leaders discussed Wisconsin’s health care value and how current proposals arbitrarily reducing Medicare payments work contrary to our state’s high value efforts.

"Wisconsin providers are delivering high value health care to seniors," said WHA President Steve Brenton. "But we are concerned that hospitals have become something of a Medicare piñata—constantly being whacked with cuts that will at some point threaten access to quality care."

While on Capitol Hill, hospital leaders asked Wisconsin House members to sign onto the Medicare Audit Improvement Act, HR 1250, to address ongoing problems with programs like the Recovery Audit Contractors. While meeting with Cong. Ribble’s office, Therese Pandl, HSHS eastern division president, thanked Ribble for quickly signing onto this legislation.

Attendees also discussed legislation to address a manipulation by Massachusetts of Medicare’s arcane wage index, which is resulting in the loss of hundreds of millions of dollars annually to almost every other state, including Wisconsin. Legislation has been introduced in the Senate, S. 183, to fix this issue. Attendees thanked Senator Baldwin for helping lead efforts in the U.S. Senate on this solution and thanked Sen. Johnson for support.

Wisconsin leaders on Capitol Hill included: Mary Starmann-Harrison, HSHS (IL/WI); Sandy Anderson, SSM-St. Clare Hospital (Baraboo); Jerry Worrick, Ministry-Door County Memorial (Sturgeon Bay); Therese Pandl, HSHS-Eastern WI (Green Bay, Sheboygan); Scott McMeans, Holy Family Memorial (Manitowoc); Tim Eckels, HSHS (IL/WI); Sue Lynch, Partners of WHA; Diane Westbrook, Partners of WHA; Michael Heifetz, SSM-Dean (Madison); Jeremy Levin, Rural Wisconsin Health Cooperative; and Steve Brenton, Jenny Boese, WHA.

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CMS Proposes Medicare Inpatient Payment Rules for FFY 2014

The Centers for Medicare and Medicaid Services (CMS) has released the federal fiscal year (FFY) 2014 proposed payment rule for the Medicare Inpatient Prospective Payment System (IPPS). The proposed rule reflects the annual update to the Medicare fee-for-service inpatient payment rates and policies based on regulatory changes put forward by CMS and legislative changes previously adopted by Congress.

Among other regular updates and policy changes, the expansive rule includes proposals that would:

The rule also includes proposals that would update the quality reporting programs for cancer hospitals and inpatient psychiatric facilities and would update the payment rates and policies for long-term care hospitals.

The 1,424-page proposed IPPS rule would increase operating rates by 0.8 percent. The proposed rate increase also reflects a proposed temporary reduction of 0.8 percent required in the implementation of the American Taxpayer Relief Act to avert the fiscal cliff. The temporary reduction serves to recoup overpayments to providers from prior years as a result of a new patient classification system that better recognizes patient severity of illness. A proposed additional 0.2 percent reduction would offset projected spending increases associated with proposals regarding admission and medical review criteria for inpatient services.

The proposed rule also modifies the method for calculating disproportionate share hospital payments (DSH) to hospitals that serve a large proportion of uninsured and low-income individuals.

CMS will reduce DSH payments to 25 percent of the amount Medicare would pay under the current policy. The remaining 75 percent will be adjusted depending on hospitals’ rate of uninsured individuals and uncompensated care. The agency seeks comments on how these additional payments will be distributed.

To address concerns regarding the requirements for admission as a hospital inpatient, CMS is proposing to clarify the rules governing physician orders of hospital inpatient admissions for payment under Medicare Part A. CMS is proposing to specify in the regulations that an individual becomes an inpatient of a hospital, including a CAH, pursuant to an order for inpatient admission by a physician or other qualified practitioner and, therefore, the order is required for payment of hospital inpatient services under Medicare Part A.

CMS is also proposing to revise guidance to hospitals and physicians relating to when hospital inpatient admissions are determined reasonable and necessary for payment under Medicare Part A. CMS is specifying that hospital inpatient admissions spanning two midnights in the hospital would generally qualify as appropriate for payment under Medicare Part A. Under this proposal, Medicare’s external review contractors, including Recovery Audit Contractors (RACs) and other Medicare contractors, would presume that hospital inpatient admissions are reasonable and necessary for beneficiaries who require more than one Medicare utilization day (defined by encounters crossing two "midnights" threshold). However, CMS would presume that hospital services spanning less than two midnights should have been provided on an outpatient basis, unless there is clear documentation in the medical record supporting the physician’s order.

Under the patient safety program to be launched in 2015, and called for by the Affordable Care Act (ACA), hospitals that rank among the lowest-performing 25 percent on hospital-acquired conditions will be paid one percent less than they would otherwise be paid under the Inpatient Prospective Payment System (IPPS).

Other provisions in the proposed rule related to supporting paying for value and quality to improve patient care, include:

CMS will accept comments on the proposed rule until June 25 and finalize the rule by August 1. The agency will officially publish the proposed rule in the May 10 Federal Register. A display copy and other resources related to the IPPS are available on the CMS website at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY-2014-IPPS-Proposed-Rule-Home-Page.html.

WHA will be preparing a more thorough summary of the inpatient rule along with a hospital specific impact analysis that will be available in the coming weeks.

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Focus on CMS Confirmation, Financial Impact and Health Care’s ‘Triple Aim’ at AHIMA’s ICD-10 Summit

The Centers for Medicare and Medicaid Services (CMS) stated there will be no further delays of ICD-10.

That was the key message relayed by Denise M. Buenning, BA, MsM, deputy director of the Office of E-Health Standards and Services at CMS at the 2013 AHIMA ICD-10-CM/PCS and Computer-Assisted-Coding Summit that took place in Baltimore in late April.

"I have absolutely no reason to believe this (ICD-10) deadline will move again. The industry has invested billions of dollars in this transition, and we recognize the benefits of ICD-10 in an e-health ecosystem," Buenning said. "It would be problematic to delay or skip 10 and go to 11. The Secretary and Administrator are dedicated to seeing this implemented in 2014. I have heard nothing to think otherwise."

According to Buenning, CMS considers ICD-10 as part of the larger context of "e-health," emphasizing that ICD-10 is integrated into a health ecosystem that includes easier data sharing, interoperability, better quality measurements, better efficiencies, lower costs, and enhanced fraud and abuse detection. She emphasized the enhanced detail in ICD-10 will assist with business intelligence and determining risk factors.

Bruenning’s message dove-tailed nicely with that of Dr. Sam Ho, chief clinical officer at UnitedHealthcare, during his keynote address at the Summit.

"If health care is going to truly be reformed and improved, three areas must receive focus—improving the experience of care, improving the health of populations and reducing per-capita costs of health care. This ‘Triple Aim’ can be achieved through data collection and analysis of services received by patients—work that is aided by the implementation of the more specific and versatile ICD-10-CM/PCS code set."

If an organization is going to achieve the Triple Aim, they must have a successful ICD-10 transition, Ho noted. Organizations must understand the projected impact of ICD-10 and areas of risk in their clinical, financial, and operational performance. This is done with a risk assessment that uses data analytics to identify impact areas, and aids stakeholders to remediate issues before, during, and after ICD-10 implementation. While risks do exist, ICD-10 has great potential to help providers achieve the Triple Aim and transform health care for the better.

A provider perspective was shared by Paul Allen, RHIA, John Hopkins Health System, and Mark Dominesey, RN, BSN, MA, Sibley Memorial Hospital, in their presentation, "Frightening Scenario, or Manageable Change? Determining the Realistic Financial Impact of ICD-10 on MS-DRGs and APR-DRGs." Dominesey characterized the transition to ICD-10 as a manageable change for organizations with a documentation improvement program in place. These programs can be used to help prepare and mitigate anticipated shifts in reimbursement by continuing to improve documentation. Alternatively, he felt that hospitals that do not have a documentation improvement program may be facing a frightening situation.

Further information regarding the AHIMA ICD-10 Summit is available at: http://journal.ahima.org/category/icd-10cac-summit.

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Governor Announces New Council on Workforce Investment
Members include Wheaton health system representative

Governor Scott Walker announced the new membership of his administration’s Council on Workforce Investment, an advisory panel that will help guide efforts to advance the Governor’s comprehensive agenda to prepare workers to find jobs in the modern workforce. Workforce development is a top WHA priority.

Theresa Jones, vice president of diversity and inclusion strategies at Wheaton Franciscan Healthcare, Brookfield was selected to serve on the newly-formed Council. Other members of the Council include state legislators, local elected officials, and representatives from youth organizations, organized labor, and community-based organizations. A list of members is available at http://www.wi-cwi.org.

The Council is a federally-mandated body that advises the Governor and state Department of Workforce Development (DWD) on the allocation of federal workforce development funding. Among the duties of the Council are approving the annual Workforce Investment Act plan required of all states in coordination with Wisconsin’s 12 autonomous workforce investment boards.

Governor Walker has proposed nearly $100 million in state funding to support a sweeping workforce development agenda. The Governor has included funding in his state budget targeted at building the infrastructure that is necessary to expand education opportunities for medical students and physicians who will stay in Wisconsin and practice in rural and impoverished urban areas.

Governor Walker has proposed nearly $100 million in state funding to support a sweeping workforce development agenda, including a series of 2013-15 budget proposals as well as the recently enacted Wisconsin Fast Forward initiative, which targets $15 million in worker training funds and supports the development of a state-of-the-art labor market information system. WHA has long supported collecting health care workforce-related data to help inform the workforce planning process.

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WHA Site Visit Finds Hospitals Reducing Readmissions, Improving Safety

Wisconsin hospitals continue to focus on improving the quality and safety of the care they provide in their communities. Recently, Tom Kaster, quality coordinator for the WHA Partners for Patients initiative, visited two hospitals in northwest Wisconsin. He returned with several examples of how committed Wisconsin hospitals are to ensuring that their patients receive the highest quality care possible.

Burnett Regional Medical Center

While at Burnett Regional Medical Center, Grantsburg, Kaster met with a management team that was looking to take the next step in Partners for Patients. The team included, Heather Jensen, clinic administrator; Paulette Maday Groshens, director of nursing; Charlie Faught, chief financial officer; and, Marcia Sassen, quality coordinator. In the first wave of WHA Partners for Patients, Jensen did an outstanding job of managing the program and leading Burnett’s Improvement teams. That duty has now been passed to Sassen.

During the meeting, the group discussed Burnett’s achievements in 2012, which highlighted their successes, specifically in reducing readmissions. They are now preparing for their 2013 Partners for Patients projects.

St. Croix Regional Medical Center

At St. Croix Regional Medical Center, Kaster met with Laura Jensen, St. Croix’s vice president of patient care, and several of her project team leads. The conversation revolved around the exceptional work they were doing in regards to their adverse drug events, readmissions and OB early elective delivery improvement initiatives. Throughout 2012, St. Croix Regional built dynamic teams that have helped them drive improvement in their initiatives. Although they have made great progress, they are not satisfied and are continuing work on their 2012 initiatives as well as adding several more for 2013.

To summarize the trip, Kaster offered the following insights:

"Overall, the visits were exciting for me. At each location, the conversation was not focused on concerns for lack of resources or obstacles. It was focused on how the hospitals could do more to continue to improve their already high levels of patient safety and quality. That type of consistency of purpose is why Wisconsin hospitals are national leaders in high-quality, high-value health care."

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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.


School nurse program promotes good health

Sixth-grade students at Sabish Middle School are singing the praises of fruits and vegetables thanks to a long-term partnership between Agnesian HealthCare and the Fond du Lac School District.

"It is good to eat healthy," says student Lauren Huettl. "It is very important for a person’s overall health. I have been eating more fruits and vegetables, especially grapes and strawberries."

Jonathan Levengood agrees. "I have learned that it is good to know that fruit and vegetables are important. I like corn, broccoli and even tomatoes!"

Patti Shippee, RN, has served as school nurse at Sabish as an associate of Agnesian HealthCare. "The school nurse program offers a comprehensive health model," she says. "We are supporting the physical, emotional and psychological health of all students, and helping them to attain their highest potential for learning and development."

In her role, Shippee helps to assess students’ health needs, and then to link resources in the schools and community to meet these needs. "There is an emphasis on prevention, case finding, counseling, early intervention and remediation of health concerns, along with health education, physical education and activity, health services, nutrition services, health promotion for staff, counseling and psychological services and a safe school environment."

Learning about the importance of fruits and vegetables is just one of many activities that Shippee promotes. "I try to offer different programs to enhance the overall health practices according to need. It is my hope that offering students a contest to increase fruit and veggies will get them thinking about their overall health food choices every day. Research shows that a diet with increased fruits and veggies, along with adequate sleep and exercise, helps to improve overall health by decreasing health concerns in the future, maintaining a healthy weight, and helping the brain and body to function better in school."

Kaira Tabbert is helping to spread this message. "Eating healthy is very beneficial to a person," she says. "I’ve even gotten my friends to eat better now too."

Agnesian HealthCare, Fond du Lac


Hospital donates food to those in need

For most of us, discussion about hunger is accompanied by a vision of third world countries. The reality is one in six Americans are impacted by hunger and food insecurity. This is not a problem isolated to low-income pockets or certain regions or neighborhoods. The problem of hunger impacts adults, seniors and children from all communities throughout Wisconsin.

St. Mary’s Hospital of Superior is partnering with Second Harvest Northern Lakes Food Bank’s (SHNLFB) Food Rescue Program. The Food Rescue Program represents one growing source of food for SHNLFB. In this program, the food bank picks up any surplus perishable food from the hospitals, restaurants and retail grocery stores for distribution to qualifying meal programs. ServSafe staff and refrigerated trucks ensure the safety of the perishable food from donor to recipient. At St. Mary’s Superior, pick up of food is scheduled weekly. A variety of foods are available for donation including sandwiches, soups, hot dishes, entrees and desserts.

In 2012, St. Mary’s Superior donated 1,485 pounds of food. This resulted in approximately 1,188 meals for those in need. The Superior Boys and Girls Club and the Salvation Army benefit from donations. The food service staff at St. Mary’s Superior is proud to be able to participate in this SHNLFB program with such a direct impact on our community.

St. Mary’s Hospital, Superior


Heart healthy cooking

Each year more Americans die from heart disease than from any other cause. While this is scary news, it doesn’t mean that heart disease can’t be prevented or treated. Adopting healthy eating habits is one of the many things a person can do to help reduce his or her risk of developing or dying from the disease.

Every fall and spring, Memorial Health Center offers free Heart Healthy Cooking educational sessions for the public in an effort to help people take better care of their hearts. At these sessions, Odessa Syryczuk, RD/CDE, Memorial Health Center registered dietitian, explains how to make smart food choices from every food group, read nutrition labels to identify heart healthy foods, and set achievable health goals. A free heart healthy lunch is also served to those attending, proving that heart healthy meals don’t need to be boring or bland.

Memorial Health Center, Medford


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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