September 13, 2013
Volume 57, Issue 37



Workplace Wellness Legislation Passes Senate Committee

On September 12, the Senate Committee on Agriculture, Small Business and Tourism recommended adoption of legislation that would establish a workplace wellness program for small businesses in Wisconsin. Small businesses are defined in the legislation as employers with 50 or fewer employees. The "Wisconsin Healthy Jobs Act," Senate Bill 73, authored by Senator Terry Moulton (R-Chippewa Falls) and Representative John Murtha (R-Baldwin), would allow a business to claim a credit against their taxes for three years, an amount that is equal to 30 percent of the amount paid in a taxable year in creating a workplace wellness program.

The Senate Committee adopted a substitute amendment that would change the funding mechanism from a tax credit to a grant program. The amendment would maintain a cap on the entire grant program at $3 million per fiscal year. Employers would be able to apply to receive a portion of those funds. The legislation would only be applicable to new workplace wellness programs and could not be used to offset the cost of acquiring, constructing, rehabilitating, remodeling or repairing real property. A restriction that applicants could only receive up to 30 percent of the cost of the workplace wellness program would still exist. The workplace wellness program, within small businesses, must include health risk assessments and one or more of the following programs: chronic disease prevention, weight management, stress management, worker injury prevention programs, health screenings, nutrition education, health or fitness incentive programs, vaccinations or employee physical examinations.

In a statement earlier this spring, Moulton said, "A wellness program that offers assistance in making healthier lifestyle decisions would not only contribute to heading off these potential diseases but could increase productivity and general workplace satisfaction. Improved overall fitness, mental alertness, and morale are a mutual benefit to both employers and employees. A work environment that supports and encourages good health makes sense."

The Committee unanimously supported the substitute amendment and the bill as amended. The bill now moves on to the floor of the State Senate. Similar legislation has been introduced in every legislative session since 2005, but has not been signed into law. The Assembly version of the bill is still awaiting a committee vote in the Assembly Committee on Jobs, Economy and Mining.

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Opportunities for In-Person OCI Training for Certified Application Counselors

On September 17 and 18, the state will provide on-site training for certified application counselors (CACs) who are helping consumers enroll in coverage in the health insurance exchange. On-site opportunities will be available in Sauk City, Fennimore, Eau Claire, Marshfield, and Waukesha. State law requires that certified application counselors who are assisting individuals with enrollment into exchange coverage take 16 hours of training and pass an exam. The exam must be taken separately at an approved exam location.

WHA, in coordination with the Rural Wisconsin Health Cooperative (RWHC) and Healthcare Financial Management Association, has been working to encourage the Office of the Commissioner of Insurance (OCI) to provide in-person certified application counselor (CAC) training opportunities for hospitals and health systems throughout the state. The Department of Health Services (DHS) has been working to coordinate these opportunities.

You must register to attend the training. There is no direct training cost for these events. Registration will close Monday morning, September 16.

DHS is coordinating additional training events at later dates, including opportunities in Appleton, Green Bay, and Rice Lake, among other locations. More information will be provided on WHA’s website as soon as it is available.

RWHC will be hosting OCI’s in-person training on September 17 and 18 at the RWHC office in Sauk City. Registration is limited to two participants from each facility. You can register for the RWHC site at: www.eventbrite.com/event/8249170491

The OCI in-person event will be broadcast via webinar and proctored at the following sites:

More information is provided on WHA’s website at: www.wha.org/stateLevelTrainingEvents.aspx.

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Four Health Systems Join UnitedHealthcare to Launch Accountable Care Initiative

Quality Health Solutions, Inc. (QHS), a collaborative of major Wisconsin health systems and the Medical College of Wisconsin, and UnitedHealthcare announced a new accountable care initiative that will provide coordinated care to more than 100,000 Wisconsin residents enrolled in UnitedHealthcare’s employer-sponsored health plans.

Under the new initiative, which will go into effect January 1, 2014, the 3,000 physicians and 18 hospitals comprising the five QHS members in southeastern Wisconsin (Agnesian Healthcare, Columbia St. Mary’s, Froedtert Health, Wheaton Franciscan Healthcare and the Medical College of Wisconsin) will be rewarded for effectively managing all aspects of patients’ care, providing the right treatment in the right setting at the right time.

"The scale and geographic footprint of this partnership with Quality Health Solutions will accelerate the transformation of how we pay for health care and how health care is delivered," according to Wendy Arnone, president & CEO, UnitedHealthcare of Wisconsin.

QHS will provide primary care physicians ongoing status reports on their patients, enabling them to monitor each patient’s care and to maintain their clinical information in a secure patient registry. Care providers will be eligible for payment incentives based on meaningful improvements in measures such as readmission rates, disease management and prevention, patient safety and care delivery, as well as total cost savings.

"QHS’s pioneering strategy brings competing health systems together in a new way that creates value by driving down costs for employers and increasing quality," said Catherine Jacobson, QHS board chair and president/CEO of Froedtert Health. "As UnitedHealthcare’s partner in this market, QHS care providers will use a shared clinical information platform and common quality standards to coordinate care for UnitedHealthcare’s plan participants. It is a tremendous step toward a sustainable health care system."

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Current Exchange Information to be Shared at WHA Member Forum, Sept. 17

For the most current information available on the implementation of the health insurance exchange in Wisconsin, plan to participate in the next WHA member forum, offered via webinar, September 17.

Presented just two weeks from the October 1 launch date, the member forum will provide the most up-to-the-minute information on the exchange implementation. Joanne Alig, WHA’s senior vice president for policy and research, will provide an updated report on the exchange. In addition, Lisa Olson, interim director of enrollment for Health Wisconsin and director of policy and programs for the Wisconsin Primary Health Care Association, will provide an update on the progress of the statewide strategy for exchange enrollment activities.

There is no cost to participate in this member forum, but pre-registration is required and attendance is limited to WHA hospital and corporate members. To register, visit http://events.SignUp4.com/13HCExch14Days. If you cannot participate in the scheduled webinar, the option to request an audio recording is available.

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Anthem Blue Cross and Blue Shield Announces Health Exchange Products

Anthem Blue Cross and Blue Shield announced it will offer several insurance products on the health insurance exchange when it opens October 1. The products will be connected to its "Blue Priority for Individual" focused network. Blue Priority will include Aurora Health Care, ThedaCare and Aspirus health systems, as well as select doctors, specialists and clinics.

The counties covered by the Blue Priority for Individual network are: Brown, Calumet, Dodge, Door, Fond du Lac, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, Manitowoc, Marathon, Marinette, Menominee, Milwaukee, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Taylor, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago and Wood.

The company said it will not sell individual health insurance policies outside of the counties covered by the Blue Priority for Individual network. Inside that area, Anthem Blue Cross and Blue Shield’s Individual products will be available for purchase both on and off of the federally-facilitated exchange in 2014.

Individuals with active Anthem Blue Cross and Blue Shield health insurance policies located outside of the Blue Priority network area will have the option to select a "new policy option"—which would maintain their existing network and benefits until December 1, 2014—or seek coverage from another health insurer either on or off of the exchange marketplace. These individuals will receive a letter from Anthem Blue Cross and Blue Shield outlining their options no less than 90 days before the end of their policy.

Detailed rates and product information are still pending final approval by the federal Department of Health and Human Services. Once that approval is received, Anthem Blue Cross and Blue Shield will finalize contracts with its network providers, and rate information will be available in the exchange marketplace in October.

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Last Chance to Register for WHA’s 2013 Leadership Summit
September 19, 2013***Country Springs Hotel, Pewaukee

Full agenda and online registration available at http://events.SignUp4.com/13LeadershipSummit0919

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High Value Health Care—Wisconsin’s Competitive Advantage: RAMC Finds Provider and Patient Education Lowers Early Elective Deliveries

Healthy babies are worth the wait. That is the message that the staff at Reedsburg Area Medical Center (RAMC) delivered to their OB Care team and patients in their efforts to reduce the number of early elective deliveries (EEDs).

When RAMC noticed a slight increase in inductions among patients who were not due, they found it was the result of a combination of patient demand and midwife/physician preference. The improvement team focused their efforts on two areas: reducing demand and increasing education among providers and patients. Midwives and physicians were educated about the benefits of waiting to deliver until after 39 weeks. At the same time, patients were receiving information on the benefits of the baby being born after 39 weeks, starting with the prenatal appointment and following through with them for the duration of the pregnancy. At the pre-birth conference, a poster is shared that gives the "40 Reasons for Going the Full 40." Later, the DVD "Waiting for Baby" is shown in childbirth class. RAMC also provided education in the wider community through the hospital newsletter.

The second area of focus was on reducing availability. The protocol for scheduling inductions was modified to direct staff that an induction cannot be scheduled prior to 39 weeks unless they cite one of the qualifying medical exclusions, which are listed on the request form. If the patient will not be 39 weeks and does not have a medical exclusion, staff are to call the director/assistant director to resolve the issue.

"We have had good results with the measures we have initiated. The midwives/physicians have been cooperative, and the RAMC patient safety and quality staff have been helpful in supporting the staff as they implement the new policy," according to Myra Dorow, RN, BSN, team leader.

Team member Teresa Field, RN said the Wisconsin Hospital Association Partners for Patients staff have been very helpful in providing education, materials and support to help the RAMC team promote this cause. Erin Nachreiner, RN, also is a member of the improvement team.

"Having the backing of the WHA has increased the effectiveness of this initiative," according to Dorow. "It would have been hard to accomplish this on our own."

"RAMC was one of the first hospitals in the project to get this new policy implemented, demonstrating their commitment to high-quality, safe patient care," said Kelly Court, WHA’s chief quality officer.

The RAMC team is now working to develop a plan for ongoing education for patients, staff and midwives/physicians as they continue to build community awareness to "wait for baby."

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Students Can Now Complete Hospital Requirements for Clinical Rotations Online

A web-based tool is making it easier for students to meet hospital requirements for a clinical rotation. The idea originated with the Fox Valley Workforce Investment Board (WIB) and now Southern Wisconsin WIB is piloting a similar process with schools and hospitals in Madison, to be expanded to others in the region. To make the online preparation possible, hospitals must standardize requirements and expectations for students, and those agreed-upon standards are used for all online materials. The hope is that other regions will develop similar websites that can be used by all clinical students in the state.

WHA’s Judy Warmuth, VP, workforce development, and Erin Bechen, operations director for the Workforce Development Board of South Central Wisconsin, demonstrated the website for members of the Northwest Workforce Investment Board’s Health Care Alliance September 12. The website allows student nurses to meet requirements for education regarding infection control, safety and patient privacy online, before entering the clinical facility. Expectations for immunizations and criminal background checks are posted for the student. By completing this step online, actual clinical learning can begin earlier and hospitals can reduce staff time needed for student orientation. Each clinical facility has a welcome page for students with information on dress, nametags, parking and where to report on their first day.

For more information, contact Warmuth at jwarmuth@wha.org or call 608-274-1820.

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Conference Focus on Hospital, Physician Role in Creating, Sustaining GME

Wisconsin’s ability to meet the growing demand for care hinges on having enough physicians. In-state medical residencies can be a major factor in attracting and keeping physicians. Hospitals and health systems play a key role in creating and expanding graduate medical education (GME) in Wisconsin.

Several WHA members will share their experiences with starting and sustaining a GME program at a statewide GME conference scheduled October 24 in Neenah, sponsored by the Wisconsin Council on Medical Education and Workforce (WCMEW), a collaborative of WHA and other stakeholders on physician workforce issues.

The day’s topics will include:

The conference will be held Thursday, October 24, at the Best Western Bridgewood Resort Hotel & Conference Center in Neenah. A full agenda and online registration are available at: http://events.SignUp4.com/13GME.

Direct questions on the conference, GME funding or other related activities to George Quinn at gquinn@wha.org, or Charles Shabino, MD at cshabino@wha.org.

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National Survey Reflects Wisconsin Trend: APPs/PAs in High Demand

For the seventh straight year, family physicians top the list of the most highly-recruited doctors, according to a new market review released by Merritt Hawkins, a national physician search firm and a company of AMN Healthcare. Physicians specializing in general internal medicine were second on the list.

The Review found that nationally, the demand for non-physician practitioners is increasing rapidly, a finding that was reported in the WHA 2012 workforce report. For the first time in the 20 years Merritt Hawkins has been conducting their review, physician assistants (PAs) and nurse practitioners were among its top 20 recruiting assignments.

In the 2012 WHA workforce survey, hospitals reported a 55 percent increase in the number of advanced practice professionals (APPs) they employ, a 38 percent increase in certified registered nurse anesthetists, and a 25 percent increase in PAs from 2009 to 2011. The sharp increase is attributed to a couple of factors—it is increasingly difficult to recruit primary care physicians, and evidence shows that advanced practice professionals have a positive effect on patient care.

Merritt Hawkins also noted that health facilities nationwide are gearing up for health reform and are putting primary care networks in place to care for large population groups through accountable care organizations and other integrated delivery models.

"In Wisconsin, our health care systems invest heavily in primary care providers, both physicians and increasingly advanced level practitioners, because they are often the first point of entry and are the patient’s navigators through their entire episode of care," according to WHA Executive Vice President Eric Borgerding. "This is why gauging current and anticipating future workforce needs remains one of WHA’s top priorities. The better we can predict workforce demand, the more effective our policy agenda will be in this area."

WHA will release its 2013 Workforce Report later this year. For a copy of the Merritt Hawkins 2013 Review of Physician and Advanced Practitioner Recruiting Incentives, email Kurt Mosley at kurt.mosley@amnhealthcare.com.

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Seminar Focuses on Updating Chargemaster for 2014

On November 19, WHA is offering "2014 Procedure Coding for Chargemasters," a one-day seminar focused on the 2014 reporting requirements, as well as CPT and HCPCS coding revisions and additions impacting the hospital chargemaster.

The new 2014 edition contains nearly 350 CPT changes. This seminar will cover those changes affecting a facility’s chargemaster, as well as the surgical CPT code changes assigned by HIM coding staff. In addition, the new, deleted, revised CPT and HCPCS codes, as well as the revised CPT modifiers, will be reviewed. The OPPS Final Rule’s reporting challenges will also be incorporated into each clinical area’s discussions. Suggestions for implementation and attendee comments and questions will be addressed.

Chargemaster/APC coordinators, chief financial officers, controllers, decision support managers, office managers, compliance auditors, coding staff, pharmacy directors, material managers/purchasing directors, and other directors and managers responsible for the charge generation process are encouraged to attend this event.

This seminar will be held at Glacier Canyon Lodge at the Wilderness Resort in Wisconsin Dells November 19. A brochure with registration form is included in this week’s packet, and online registration is available at http://events.SignUp4.com/13Chargemaster1119. For registration questions, contact Lisa Littel at 608-274-1820 or email llittel@wha.org.

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Member News: Jeff Meyer to Retire as CEO at Osceola

After 18 years as Osceola Medical Center’s CEO—48 years in health care—Jeff Meyer is ready to fly off into the retirement sunset. He means that literally, as he and his wife Ann will fly their airplane to St. Louis to visit relatives during his first month of retirement. Meyer will retire at the end of September.

Meyer began his journey at Osceola Medical Center in December of 1995. One of his first goals was to better integrate the physicians with the medical center—a task he said others in the organization rallied around. After seeing strong and steady growth while at the helm, Meyer’s tenure culminates with the completion of a new facility, strong partnerships and the creation of a health care campus.

In looking back at his 48 years in health care, he says the changes in technology have been incredible, from surgical equipment to computerization.

"With more patient care being delivered on an outpatient basis rather than inpatient, for example, what was once a five-day stay for having a baby is now usually two," Meyer said. "With it all, however, it really is still about taking care of people."

Meyer has a B.S. degree in history and a master’s degree in hospital administration from the University of Minnesota in Minneapolis, and a master’s degree in public administration from Northeastern University, Boston. He and his wife, Ann, have two children, Mathew and Alison.

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Wisconsin Hospitals Community Benefits - Charity Care

Fear of a bill should never prevent a patient from seeking care at a Wisconsin hospital. Wisconsin hospital charity care programs provided $232 million to more than 700 patients each day last year. The stories that follow illustrate the deep commitment and continuing concern that hospitals have to their patients to ensure they receive the care they need regardless of their ability to pay.


Tom Kariean

Tom Kariean of Shawano was diagnosed with hypertension that requires a prescription to get his condition under control.

But each time he saw a doctor, or picked up the needed medicine, the totals racked up. And Kariean, 53, is currently not making a steady income.

He was being treated in the emergency department at Shawano Medical Center when he found out about ThedaCare’s Caring Hearts Financial Assistance Program. He applied and was able to get the assistance needed to meet the medical bills piling up.

"This program has relieved me of some pressure right now," he said. "I wouldn’t know how I would pay for this. They’ve been very kind, too."

The Caring Hearts program has helped with over $10,000 in medical bills relating to a one-night stay at the hospital and numerous doctor visits. Kariean said the Caring Hearts program is a life line for those struggling. "I think it’s an excellent idea," he said. "With today’s economy, there are a lot of people who don’t work. We’re human beings. We all get sick but we still got to maintain our bodies."

Caring Hearts has relieved much pressure from Kariean, who continues to look for employment. "It’s been very kind to me and very helpful to me," he said.

Shawano Medical Center


A new start from a "Helping Hand"

Without medical care and prescription medication, persistent stomach pain, vomiting, and dehydration landed W.O. in the Emergency Department (ED) of Aurora Lakeland Medical Center multiple times. W.O. is a young man with a drive to work; unfortunately his condition prevents him from doing so. Without a job and only limited income, W.O. could not afford medical insurance.

During one of his emergency visits to the hospital, W.O. was referred to the financial counselor, Myra. After listening to his story, she explained the Aurora Helping Hand Patient Financial Assistance Program and gave him an application. He completed the form and returned it to the counselor with the required supporting documents. A few days later, Myra was able to inform W.O. that he was approved for a 100 percent discount on his hospital medical services.

In addition to receiving this "Helping Hand," the financial counselor also was able to assist him in applying for a partial pay prescription plan that makes the medications he needs to control his conditions affordable.

Relieved of the financial burden of the medical bills he accrued, and with access to medications he can afford, W.O. got a whole new lease on life.

"He has not been back to the ED," Myra says. "And that’s a good sign. Last we heard, he landed a part-time job and was really working his way back to a productive and happier life."

Aurora Lakeland Medical Center, Elkhorn


Community hospitals provide access to care regardless of ability to pay

Imelda Chavira and her husband are both employed but neither has health insurance through their employment. They feel strongly about paying for their own expenses and didn’t believe in applying for medical assistance because they both felt others needed the financial support more than they did—until Imeda was diagnosed with cancer. Chemotherapy expenses alone exceeded $120,000, not including X-ray and MRI charges.

At Westfields we believe all patients deserve to be treated with dignity, respect and compassion. And all receive the same exceptional care, regardless of their ability to pay. Our Charity Care Assistance program helps uninsured patients with verified financial need. Chavira was approved for a partial discount on her medical expenses. Thanks to medical treatment, she was in remission and feeling better.

"I applied for Medicaid, but they didn’t help me," says Chavira. "The hospital was the one that helped me."

Hospitals are vital to meeting the health care needs of the communities they serve whether it’s providing access to specialized resources such as cancer care or treatment of heart attack or stroke; providing a safety net role for all who seek emergency care, regardless of ability to pay; or providing disaster readiness and response in the case of large-scale accidents, natural disasters or epidemics.

Westfields Hospital, New Richmond


A thank-you letter

"I am sending this because I knew if I would have called to thank you, I would not have been able to speak. This hits the heart very deeply. I want to thank you with all my heart that this (Community Care assistance) happened for me…I am one who pays bills ahead of time and extra when I had it. Now it’s a complete turnaround. But it is people and organizations like yours that help make life easier. Again, thank you with all my heart. This bill being paid helped my stress go down. There are no words to say how much I appreciate this kindness and help."

-Jennifer A.

(name has been changed)

University of Wisconsin Hospitals & Clinics, Madison


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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