January 11, 2013
Volume 57, Issue 2
WHA Report Sees Sharp Increase in APP Employment in Hospitals
Vacancy rates for most hospital positions are low now, but retirements are a concern
The WHA 2012 Health Care Workforce Report released this week shows rapid growth in the number of positions being created for physician assistants (PAs) and advanced practice nurses (APNs) in hospitals that is triggering a new round of recruitment challenges. Read full report here: http://workforcereport.wha.org.
"Advanced practice nurses and physician assistants are a critical component of the patient care provided by Tomah Memorial," according to Phil Stuart, CEO, Tomah Memorial Hospital. "These professionals improve access to care, increase the speed with which we can offer care and help us ensure that the care our hospital provides is efficient and effective for our patients."
According to the WHA report, hospitals reported a 55 percent increase in the number of APNs 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 quality.
"The aging of Wisconsin’s population, combined with a growing primary care physician shortage, has created new opportunities for advanced practice health care professionals to apply their expertise in the hospital setting," according to Judy Warmuth, WHA vice president for workforce development. "Eleven years ago when WHA conducted its first hospital workforce survey, the number of these professionals directly employed by hospitals was not significant. Today, we’ve seen a significant jump, and we are confident we will continue to see this trend."
The report also found that positions that hospitals struggled to fill just four years ago, such as pharmacists and radiology technologists, are now reporting historically low vacancy rates. Only three groups employed in hospitals had vacancy rates that exceeded five percent: certified nursing assistants (CNAs), physical therapists and occupational therapists.
Certified nursing assistant positions showed the highest vacancy rate topping six percent, according to Warmuth. This higher vacancy rate is attributed to the turnover this profession experiences as nursing students typically work as CNAs while they complete a registered nursing program. Once they complete their RN degree, they move on to a new position, which creates a vacancy.
Hospitals are keeping a close eye on retirements as health care workers reflect Wisconsin’s overall aging demographics. More than 36 percent of medical technologists are older than 55 years. Their predicted retirement will create new, difficult-to-fill vacancies as there are fewer graduates statewide to step into these jobs. The second oldest group of hospital employees is pharmacists, where nearly a quarter of these professionals working in hospitals are over the age of 55.
Health care is an important economic sector in Wisconsin, supporting more than 13 percent of the non-farm jobs in the state. Hospitals employ more than 100,000 individuals, while the health care sector, which includes nursing and residential care facilities and ambulatory care centers, employs more than 300,000 people.
WHA President Steve Brenton had high praise for Wisconsin’s health care professionals.
"Our hospital employees are dedicated to providing excellent patient care, which has earned our state a national reputation as a top-performer for delivering high-quality, high-value health care," Brenton said. "Our health care attracts individuals and industries to locate in Wisconsin, and the notable high value of Wisconsin’s health care is an economic development tool for our communities."
Warmuth said the Association urges policy makers in Wisconsin’s Legislature and in the state’s colleges and universities to support policies and programs that create the capacity and incentives to meet the demand for training the highly-skilled workforce that today’s hospitals require. WHA noted in the report that workforce data collection is critical to developing supply and demand projections that support statewide planning activities.
"We must act now, in times when we are not facing critical workforce shortages, to ensure that we can compete with other states to attract a workforce that can help us meet the growing demand for medical services in Wisconsin," Warmuth said.
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Wisconsin hospitals did well in the first round of CMS penalty and bonus payments. When the penalties and bonuses from the two programs are combined, more than half of the 64 hospitals eligible for a payment adjustment received a bonus and no hospital here will receive even half of the possible two percent penalty.
The list below shows how Wisconsin ranked nationally, when compared to all 50 states.
WI National Ranking
Percent of WI hospitals that will receive a combined bonus
Percent of WI hospitals that will receive a combined penalty 13th
Average (positive) change in payment 13th
"The hard work of our health care employees and the proactive quality improvement efforts by our hospitals are showing positive results," according to Kelly Court, WHA chief quality officer. "Wisconsin hospitals have been keenly focused on quality improvement for more than a decade, and WHA is proud to be their partner. Their continuous attention to delivering high-quality, high-value care is paying off for our patients and for our communities."
Medicare will begin adjusting payments in January through the end of the federal fiscal year in September. The change to payments will be retroactively applied to the last three months of 2012. According to Kaiser Health News, the cumulative gain or loss for each facility will not be clear until the end of the fiscal year, since hospitals do not know exactly how many patients they will end up admitting and for what conditions.
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With enactment of the American Taxpayer Relief Act of 2012 last week, the Wisconsin Hospital Association (WHA) is estimating approximately $161 million over four years in payment reductions to Wisconsin hospitals under a Medicare coding offset provision.
"Wisconsin hospitals have already taken an estimated $2.6 billion in payment reductions under the Affordable Care Act, plus Congress cut millions more in 2012 to address other issues," began WHA President Steve Brenton. "Now add this new $161 million cut and potentially a billion dollar reduction as sequester takes effect in March, and the negative impact on Wisconsin’s high-value hospitals is significant."
Nationally, the law recoups $10.5 billion from hospitals for what the Centers for Medical & Medicaid Services has claimed is "upcoding" or "coding creep" when moving to the more robust MS-DRG coding system. The WHA and the American Hospital Association have continually voiced strong disagreement with CMS’ contention, and indicate instead that coding under the MS-DRG system is now more accurately representing patient acuity among other issues.
On a positive note, the new law also extends two valuable Medicare provisions impacting more than a dozen of Wisconsin’s rural, non-Critical Access Hospitals. Those provisions are the Medicare Dependent Hospital program and Medicare Low Volume Adjustment payment, which were both extended until October 31, 2013. These two payments affect 15 Wisconsin facilities. WHA estimated these hospitals would have lost an estimated $13 million in payments in 2013 without these Medicare extensions.
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Hospitals, clinics and urgent care centers are reporting a high number of patients who are seeking care for influenza-like illnesses. Hospitals that are at or near capacity are holding meetings at least once a day for a situational assessment, including a bed count and tracking patient movement within the hospital. Collaboration and communication among hospitals, nursing homes and other community organizations has proven critical to assure that patients are receiving the care they need. Some health systems are extending clinic hours into the weekend and adding providers to accommodate patient volumes in hopes of easing the strain in their emergency departments.
Every flu season, Jon Temte, MD, chair of the U.S. Advisory Committee on Immunization Practices, and professor of family medicine with the UW School of Medicine and Public Health, shares his weekly report with WHA. Temte noted in his January 11 report that the number of influenza cases continues to increase across Wisconsin. Since October 1, more than 760 individuals have been hospitalized and over 2,800 cases of influenza have been confirmed statewide. The prevalence of influenza-like illness [fever of 100 degrees F or higher and either cough or sore throat] in Wisconsin’s primary care patients is estimated to be 5.3 percent and has increased in the last week. This is likely approaching its peak level at this time. When the percent of primary care respiratory infection patients who have a recorded fever >100 degrees F rises above 5 percent, there is high correlation with influenza in Wisconsin. The current level is 5.99 percent. His report also notes that there appears to be an excellent match between the current influenza vaccine and circulating strains. Find Dr. Temte’s reports here: www.wha.org/weekly-influenza-update.aspx.
The Wisconsin Department of Health Services (DHS) held a webcast January 9, which is now available for viewing at: http://dhsmedia.wi.gov/main/Viewer/?peid=3c345502cdd246198a66e0d9ffc666351d&autoStart=true
DHS will post a question and answer document soon at: flu.wisconsin.gov. Requests for antiviral medications can be sent to: DHSStockpile@wisconsin.gov and information is updated regularly at flu.wisconsin.gov.
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A scant week after the American Taxpayer Relief Act of 2012 was enacted to avert the so-call "fiscal cliff," the Wisconsin Hospital Association (WHA) is already gearing up for multiple DC lobby days in February to fight further Medicare and/or Medicaid cuts.
Unfortunately, federal action on the fiscal cliff only addressed a portion of the nation’s fiscal problems. Within the next several months Congress must still determine how to address the debt ceiling, fund government operations and stop impending sequester cuts should they decide to do so. All of these require Congress to find additional dollars either through reducing federal spending or raising revenue/taxes.
For hospitals nationally and in Wisconsin, this means payments to graduate medical education, critical access hospital and evaluation/management codes, which have all been targeted previously, will once again become targets. WHA will continue its aggressive fight to protect hospital care during several Washington, DC fly-ins.
On February 13, WHA in conjunction with the Wisconsin Council on Medical Education and Workforce and allied organizations such as the Wisconsin Medical Society, Rural Wisconsin Health Cooperative and Wisconsin’s two medical schools, will travel to Washington, DC for a Hill fly-in focused specifically on protecting Graduate Medical Education (GME).
The American Hospital Association has announced it will host two lobby days in February: February 13 and February 26. Due to the WCMEW GME lobby day February 13, WHA will focus on the February 26 AHA lobby day if there is member interest.
For details or questions about either of these opportunities, please contact WHA’s Jenny Boese at 608-268-1816 or firstname.lastname@example.org. To learn more about how you can protect hospital care, log onto WHA’s micro-site at: www.wha.org/protect-hospital-care.aspx.
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Register now for the 2013 WHA Physician Leadership Development Conference scheduled March 8 – 9 and take advantage of the early bird discount, which ends January 18. This conference is for new, potential and seasoned physician leaders, The event will be held at The American Club in Kohler. Registration information is included in this week’s packet. Register online at: http://events.SignUp4.com/13PLD.
Past attendees say there is value in attending as a team—physician leader and management leader—which fosters valuable time for one-on-one conversations and team building. A special "host" registration option is available to hospital representatives/management leaders who would like to attend the conference but do not need the CME credit.
This popular conference offers nationally-recognized faculty that helps develop physician leadership skills and facilitates the transition of physicians from clinicians to leaders. Physician leaders represent both clinical and managerial interests. Faculty is from the American College of Physician Executives (ACPE).
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This week Congressman Sean Duffy along with several of his district staff visited Burnett Medical Center (BMC) in Grantsburg.
"It was a historic day for Burnett Medical Center," began Gordy Lewis, CEO. "This was the first visit by a Member of Congress to the facility since its founding in 1930."
During his time at BMC, Cong. Duffy was able to provide his thoughts on federal fiscal issues and hear from hospital leaders and employees about the hospital, its services and commitment to patients.
"We thanked Cong. Duffy for his strong support for Critical Access Hospitals and his engaged leadership on the issue, but shared our concerns that hospitals continue to bear the brunt of Medicare payment cuts when Congress needs funding for other programs," said Lewis.
"We urged him to look at better solutions like incenting value rather than continuing piecemeal cuts."
Other issues discussed included BMC’s progress on ICD-10 implementation. Duffy also toured the facility.
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More than 20 hospital nursing units are participating in the second Wisconsin Hospital Association Transforming Care at the Bedside (TCAB) program. Site visits to each participating unit are an important part of the program. Visits occur early in the project to offer sites the opportunity to report on project kick-off and early success. A second site visit to each unit will occur at the end of the project. First round site visits are ongoing.
The TCAB team at Aurora Sinai Medical Center reported that consolidating the communication board was a quick win. They relocated many resources so that all phone numbers, on-call lists, etc. are in a single location and easy for all staff to find. Making signage more available for staff was also an easy fix.
They have replaced the nursing supplies outside the patient rooms based on staff input on items they needed. Housekeeping has been a partner in the supply work.
The participating unit at Froedtert Memorial Lutheran Hospital is an intensive care unit. This unit’s quick win was ensuring that IV poles are available in every room. They are testing changes to the tube system on the night shift to reduce noise in patient rooms. The team is also working with the pharmacy department to review and maybe revise the process for delivering non-urgent meds which currently uses the pneumatic tube delivery system. The team has also created and tested supply baskets for patients who go into isolation after admission, which was a staff pleaser. The team asked staff to identify the most frequent missing supplies and created a small basket that sits outside of the room.
The Wisconsin TCAB initiative is an 18-month project that will end March 2014. Participants will each be expected to outline a plan to sustain the project after that date. Transforming Care at the Bedside is a WHA project funded through the Wisconsin Collaborative for Healthcare Quality by the Robert Wood Johnson Foundation.
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Through a grant from the Wisconsin Department of Health Services/Division of Mental Health and Substance Abuse Services, Mental Health America of Wisconsin (MHA) is inviting applications from eligible entities, including hospitals and clinics, to participate in a learning community around implementation of the Perfect Depression Care model developed by Henry Ford Health System (HFHS) Division of Behavioral Health Services. This model, which resulted in significant reductions in suicides among enrollees in HFHS, was a key focus of a report by the National Action Alliance on Suicide Prevention’s Clinical Care and Intervention Task Force: http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicideprevention.org/files/taskforces/ClinicalCareInterventionReport.pdf.
More information about this opportunity can be found here: www.dhs.wisconsin.gov/dsl_info/InfoMemos/DMHSAS/CY2013/imemo201301.pdf. Applications will be reviewed and awarded on a first come, first serve basis. MHA intends to finalize awards by January 31.
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Where do you go when you need a doctor and you don’t have insurance? More and more hospitals are establishing free clinics to serve those who do not have a "medical home." Every effort is made to connect patients with follow up care and even help them obtain the medical supplies or prescription drugs that they need.
Angel of Hope Clinic provides a family feel to health care for the uninsured
Thomas Rivas, 56, had been trying to piece some work together after being laid off from his manufacturing job when a series of health issues beset him – including a nagging cough, high blood pressure and the start of diabetes. With no insurance, he stopped at a community health fair, where a social worker encouraged him to go to the Angel of Hope Clinic.
The Angel of Hope Clinic is a partnership between Wheaton Franciscan Healthcare, Outreach Community Health Centers (a Federally Qualified Health Center) and Hope House of Milwaukee, a homeless shelter on Milwaukee’s near south side. Angel of Hope provides health care services for low-income individuals and is funded in part through the Wheaton Franciscan Healthcare Foundation for St. Francis and Franklin.
What Thomas finds comforting about Angel of Hope is the personalized attention and family-like feel he gets when he visits.
"It’s actually relaxing to come here," Thomas said. "I used to be afraid of getting shots. I’m not afraid now. They helped me. I’m on a better diet, and I exercise. It’s a different feeling here. It’s so good."
Nurse Practitioner Tara Seleen said patients really appreciate the care and are willing to make lifestyle changes to get healthier.
"This is my dream job," said Tara. "I love helping people in the community." Tara said that her patients aren’t simply looking for a handout. They truly want to improve their lives. Through the clinic’s educational approach to healthier lifestyles, Tara and the staff see many positive results. And their patients agree.
"We’re like family here," said Thomas, who rides his bike to his clinic appointments. "They always want to know what’s going on with you and how they can help."
Wheaton Franciscan Healthcare, Milwaukee
Free Clinic of Pierce and St. Croix Counties
The Free Clinic of Pierce and St. Croix Counties provides preventive health care, including prescription drugs, to those with nowhere else to turn. In 2011, the Free Clinic provided care to 660 patients, including 364 new patients, through a total of 2,668 patient visits, dispensing 7,187 prescriptions.
All services at the Free Clinic are provided free of charge. To qualify for services, patients must be low-income (at or below 185% of the federal poverty level) and be uninsured with no other source of care.
The clinic’s volunteer health care providers see an average of 25 patients each week on a first come, first serve basis. Follow-up services, including blood work, dressing changes, diabetes education, physical therapy and prescription refills, are provided to an additional 10-40 patients each week. When a patient has a chronic condition requiring maintenance medication, the clinic helps enroll them in a prescription assistance program.
When patients need follow-up care, the clinic works with community partners to try to arrange for the needed services. Patients are referred to and receive follow-up care from specialists like physical therapists, diabetic educators, ophthalmologists, gynecologists, dentists, surgeons and others.
The Free Clinic has leveraged many community assets and ultimately provides care on a very modest budget. In 2011, River Falls Area Hospital supported the Free Clinic by:
Acting as the employer-of-record for the three Free Clinic staff members;
Providing space for patient pre-screening on Tuesday evenings;
Providing laboratory and imaging services at cost, then covering the first $10,000 with a grant from the hospital foundation;
Working with clinic staff and volunteers to arrange for needed follow-up hospital services, then enrolling eligible patients in the hospital’s charity care program;
Providing significant in-kind staff support for the Free Clinic, including the support of the hospital’s foundation and community engagement director, who is the secretary of the Free Clinic’s board of directors.
While we have not quantified the financial impact of the Free Clinic on our hospital, we know the Free Clinic is serving many individuals who would otherwise have ended up at an emergency room, either our own or at one of the other hospitals in our region, receiving care that would ultimately be uncompensated. By providing access to primary care services, the Free Clinic is helping to meet the health care needs of our region in a way that is better for the individual patient, the broader community and the health care system at large.
River Falls Area Hospital, River Falls
Huiras Family Community Health Clinic: A healthy weight gain
A young woman came into the Huiras Family Community Health Clinic one winter night. Her chief complaint was that she was unable to eat. She weighed 110 pounds. The nurse practitioner assessed the patient and conducted multiple tests. Her weight continued to drop. By the next month, she weighed only 86 pounds. It was soon discovered that the patient was extremely hyperthyroid.
The Columbia St. Mary’s financial services staff enrolled her in the Community Care program which assists patients in paying for their medical expenses. The Huiras Family Community Health Clinic staff found her a primary care physician that prescribed her medications to relieve some of the symptoms she suffered. The patient also needed to have a thyroid uptake and scan, which was covered through Community Care. Now, months later, she has gained nearly 30 pounds and is feeling much better. The combination of the care she receives from her primary care physician and the medication the clinic provides continue to significantly improve the patient’s health. The Huiras Clinic, primary care physician’s office, and the nuclear medicine department have teamed up to provide the best possible care for this patient.
Columbia St. Mary’s Ozaukee, Mequon
Upland Hills Health supports Community Connections Free Clinic
Upland Hills Health annually supports the Community Connections Free Clinic in Dodgeville by offering laboratory tests, imaging procedures and follow-up care for the patients who receive free care at the Free Clinic. During the past year, Upland Hills Health has been involved in the care of 117 patients, including x-rays and follow-up care, without compensation. Additionally, 835 laboratory tests were performed without charge to the Free Clinic patients.
Phyllis Fritsch, administrator, says, "The local Free Clinic is a vital part of our community’s health, and Upland Hills Health is honored to be a part of providing services to the Free Clinic patients."
Upland Hills Health, Dodgeville
Submit community benefit stories to Mary Kay Grasmick, editor, at
Read more about hospitals connecting with their communities at www.WiServePoint.org.
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