January 6, 2012
Volume 56, Issue 1
89 Hospitals Commit to WHA Quality Initiative
“Partners for Patients” continues to grow
In a state where hospitals are nationally known for delivering
high quality patient care, nearly 90 hospitals have committed to work together to
raise the bar on quality even higher. The count is expected to continue to climb as WHA staff
works with several hospitals that have expressed an interest in joining the new
WHA is working with AHA on a national project sponsored by the
Centers for Medicare and Medicaid Services that has two goals:
patients from getting injured or sicker. By
the end of 2013, preventable hospital-acquired conditions would decrease by 40
percent compared to 2010.
patients heal without complication. By
the end of 2013, preventable complications during a transition from one care
setting to another would be decreased so that all hospital readmissions would be
reduced by 20 percent compared to 2010.
“Having at least 89
Wisconsin hospitals collaborating means that WHA’s work on improvement can
expand greatly,” said Kelly Court, WHA’s Chief Quality Officer. “Our
hospitals were the first in the nation to voluntarily report quality measures,
which led to hospitals sharing best practices, and now we will be taking WHA’s
quality initiatives to a whole new level with statewide quality collaboratives.”
WHA will be part of the largest Hospital Engagement Network in
the nation by working closely with the Health Research and Education Trust (HRET),
an affiliate of the American Hospital Association (AHA), which currently
involves 33 states and over 1,800 hospitals. HRET’s Hospital Engagement
Network will help identify solutions already working to reduce health care
acquired conditions, and work to spread them to other hospitals and health care
Hospital Engagement Networks will work to develop learning
collaboratives for hospitals and provide a wide array of initiatives and
activities to improve patient safety. They will be required to conduct intensive
training programs to teach and support hospitals in making patient care safer,
provide technical assistance to hospitals so that hospitals can achieve quality
measurement goals, and establish and implement a system to track and monitor
hospital progress in meeting quality improvement (QI) goals.
will be broadening its improvement opportunities for hospitals and increase
staffing to provide direct consultation to hospital-based QI teams.
For information on the Partnership for Patients, visit: www.healthcare.gov/partnershipforpatients. To see the list of participating hospitals, visit www.wha.org/partnersforpatients.aspx. To enroll in the project, contact Kelly Court, WHA, email@example.com or 608-274-1820.
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Medicaid Budget Forecast Shows Improvement
Medicaid Shortfall Now Estimated at $92.3 Million GPR
The Department of Health Services (DHS) has revised its projections of the estimated savings needed in this biennium in order to keep the Medicaid program in the black. In September, DHS estimated a Medicaid shortfall of $219 million in state GPR funding. New projections have the shortfall at just under $93 million.
A letter dated December 30, 2011 from DHS Secretary Dennis Smith to the co-chairs of the Legislature’s Joint Committee on Finance, outlined reasons for the revised figure, including:
It is unclear whether the new projections account for higher-than-expected costs from lifting the Family Care enrollment cap, a move announced by Governor Walker last week. Smith cautions that the change represents only two percent of state funding in the program for the biennium, and indicates the Department will continue to closely monitor expenditures. He also notes that it is important to continue to pursue the reforms announced in September.
While WHA is awaiting important details and data related to the savings, the information is welcome news as it relates to the short-term stability, and hopefully long-term solvency, of Medicaid. The information also comes as the result of new, WHA-backed quarterly Medicaid reporting and transparency measures that were adopted as a part of the 2011-13 state budget (2011 Wisconsin act 32).
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A series of interviews with newly-elected legislators, by Mary Kay Grasmick, editor
Rep. Warren Petryk celebrated his first anniversary as a member of Wisconsin’s Legislature quietly in his State Capitol office. It’s quiet now, but he recollected the eventful first year has really strengthened his resolve to serve his constituents in Northwestern Wisconsin and the citizens of Wisconsin.
"My top priority is creating a good job climate in Wisconsin, and hospitals have a huge role to play in creating that environment," according to Petryk. "A healthy community follows the health of the business community. Better jobs. Better health."
Petryk said hospitals in his area—the Chippewa Valley—are major employers. People come into the area because they are being employed by a hospital. Beyond creating jobs and economic activity on their own, Petryk said, hospitals are major partners and major players when the discussion turns to economic development and attracting new businesses to the area.
"There is this positive attitude on the part of hospitals and the people they employ—from top to bottom—a sense of ‘team spirit’ to contribute to building a strong economy in our area," Petryk said.
Recognizing the importance of maintaining the strength of the health care economy, Petryk said the elimination of red tape and bureaucratic hurdles that interfere with patient care and a hospital’s ability to care for their patients is one of his goals.
"When I see the stacks of regulations on health care providers or any other business, I always feel there needs to be a better balance in the field of health care between how we can be more innovative and responsive to patients and improve efficiencies. We can’t improve how care is delivered if care providers are being stifled with too much paperwork," Petryk said. "We need to repeal outdated laws and update others to streamline some processes while still protecting patients."
Petryk believes that patient protection can be preserved with a common sense approach to regulation and tort reform and an open dialogue that keeps the lines of communication open and creates a partnership between regulatory agencies and the health care industry.
The sustainability of Medicaid as a safety-net program remains a concern. Petryk noted that for the first time in the state budget "real state dollars" replaced past practices of using stimulus dollars and one-time fixes to fund Medicaid.
"We want to make sure that the safety net is there for the people that really need it, but the balance is to very carefully screen people and realize that there are some that do not qualify," he said. "We face an uphill battle in trying to create efficiencies in an ‘over-bloated’ system. The Medicaid program started out with good intentions, but it has become the 800-pound gorilla in the room. DHS has done a good job with finding efficiencies and helping those that truly need help. My goal with Medicaid is to continue to find efficiencies in how care is delivered and to hold down costs."
Petryk was a key supporter in the effort to preserve federal funding for rural broadband projects through WiscNet. Like others, he believes that access to affordable, high speed internet is critical in rural areas.
"Hospitals in my district are vested in WiscNet because it has helped them make great strides in their ability to communicate with their own physicians and with other hospitals," he said.
Petryk said he recognizes and appreciates WHA’s advocacy efforts and its ongoing commitment to improve the quality of health care.
"I am so impressed with the quality and accessibility of health care in Wisconsin," Petryk said. "My goal is to truly not take us backward but to be a partner to building strong, healthy communities that are poised to sustain themselves well into the future."
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In a recent announcement, the Walker Administration indicated that they believe the federal government has met the statutory requirements necessary for an agreement related to the Department of Health Services’ (DHS) Medicaid waiver application. DHS, therefore, is currently not planning an across-the-board reduction in the income limit for eligibility in the Medicaid program.
A provision in 2011 Wisconsin Act 32 required DHS to seek a waiver from the federal government to implement eligibility and enrollment changes that are more restrictive than were in place when the federal health care reform law was passed. If the waiver was not approved by December 31, 2011, Act 32 required DHS to reduce the eligibility income limit to 133 percent of the federal poverty level (about $29,700 per year for a family of four) for non-pregnant, non-disabled adults, consistent with the Medicaid cost savings measures authorized in PPACA—the federal health care reform law. If implemented, the change in the income limit would have resulted in an estimated 53,000 individuals becoming ineligible for the program.
The Walker Administration submitted the waiver application in November. The Centers for Medicare & Medicaid Services (CMS) sent a letter to DHS last month indicating that it is still reviewing the entire waiver request, but was prepared to approve some of DHS’s initiatives. These include: a new affordability test for employer-sponsored insurance, increasing premiums to up to five percent of family income, and extending the period of ineligibility when the premium isn’t paid. CMS approved these changes only for non-pregnant, non-disabled adults and, with respect to the affordability, for those at higher income levels than originally proposed by the state. CMS also said that the state could end eligibility closer to the date after a person was determined ineligible, rather than waiting until the end of the month.
"CMS’ approval of a number of our reforms enables us to avoid cutting back on eligibility, which is good news," Department spokesperson Beth Kaplan told Tim Stumm of Wisconsin Health News. "The Governor and Secretary Smith have said publicly that this was the goal. We continue to work with CMS on approval of other reforms that are good public policy to help ensure that the program is sustainable now and in the future."
DHS is continuing to negotiate with the federal government on state plan amendments and the waiver requests.
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The National Labor Relations Board (NLRB) delayed until April 30 the requirement that employers subject to the National Labor Relations Act, including most hospitals and health systems, post a notice informing employees of their rights under the Act. The NLRB had previously delayed the effective date and agreed to the additional postponement at the request of the federal court in Washington, D.C. The court is hearing a legal challenge regarding the rule. Under the rule, failure to post a notice may be an unfair labor practice and in some circumstances may toll the statute of limitations for filing unfair labor practice charges against an employer. A copy of the notice is available here: www.nlrb.gov/sites/default/files/documents/1562/employee_rights_fnl.pdf
In other NLRB news this week, President Barack Obama announced the recess appointments of three new NLRB members. Obama appointed Deputy Labor Secretary Sharon Block, union lawyer Richard Griffin, and NLRB counsel Terence Flynn, giving the five-member Board a full contingent for the first time in more than a year. Republican members of Congress and other organizations questioned the legality of the recess appointments.
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Take advantage of an early bird discount by registering today for the 2012 WHA Physician Leadership Development Conference. The discount pricing is available to individual physicians and hospital teams until January 20. This annual conference is for new, potential and seasoned physician leaders, and will be offered by WHA on Friday, March 9 and Saturday, March 10, at The American Club in Kohler. Registration information is included in this week’s packet, and online registration is available at: http://events.SignUp4.com/12PLD.
Each year, attendees express the value of attending the conference as a team—physician leader and management leader—allowing for invaluable informal, one-on-one conversation and team building during the event. This opportunity is once again available at the 2012 conference, with a special "host" registration option available to those hospital representatives/management leaders who would like to accompany their attending physicians to the conference but do not need the CME credit.
Professional leadership training to your new or seasoned physician leaders continues to be a need in Wisconsin hospitals, so for 2012, consider WHA’s proven, in-state option for physician leadership development training, offering high-quality education at about one-half the cost of the national programs, with less travel expense and less time out of the hospital and away from practice.
This popular conference offers nationally-recognized faculty to assist in developing physician leadership skills and facilitating the transition of your physicians from clinicians to physician leaders. Physician leaders must represent both clinical and managerial interests, and each year at this event, presenting faculty from the American College of Physician Executives (ACPE) focuses on important leadership skills that help physician leaders to move beyond their clinical training and take a new approach to managerial decision-making and problem solving.
ACPE is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. ACPE designates this educational activity for a maximum of 12 AMA PRA Category 1 Credits.TM Physicians should only claim credit commensurate with the extent of their participation in the activity.
The full conference brochure with registration and resort information is included in this week’s packet. For more information on registration, contact Lisa Littel at 608-274-1820 or email firstname.lastname@example.org.
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A four-part webinar series for senior leaders and their ICD-10 implementation teams
The next session is January 18: Strategic Planning for ICD-10 Readiness
Follow-up sessions include:
An audio recording is available of the November 16 session – ICD-10 Budget Development/Review, and of the December 14 session – Understanding the Financial Impact of ICD-10.
A full brochure and online registration are available at http://events.SignUp4.com/ICD10Impact11-12
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The Centers for Medicare & Medicaid Services (CMS) named 73 individuals from a pool of 900 health care professionals for the agency’s Innovation Advisors Program, an initiative in which trained leaders will test new delivery models in their organizations and communities.
The initiative, launched by the CMS Innovation Center in October 2011, will help health professionals deepen skills that will drive improvements to patient care and reduce costs. After an initial orientation phase, Innovation Advisors will work with the CMS Innovation Center to test new models of care delivery in their own organizations and communities. They will also create partnerships to find new ideas that work and share them regionally and across the United States.
Funding for this initiative was made possible by the Affordable Care Act.
Those individuals from Wisconsin named as Innovation Advisors are:
These individuals will:
"It is an honor and a testament to the dedication to health care quality in our state to have five of our quality leaders named to the Innovation Advisors Program," said Kelly Court, WHA’s chief quality officer. "We all look forward to learning more from these key individuals."
More information about the Innovation Advisors Program, including a fact sheet and list of participants and their home organization, can be found at:http://innovations.cms.gov/initiatives/innovation-advisors/index.html.
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 in 2010. 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.
An ill-fated swim
Kathleen Swenson jumped off her daughter’s houseboat last summer expecting to have a refreshing swim and some relief from the heat. What she actually got was a badly fractured ankle and shin when her foot hit a shallow rock. Her surgery required 13 screws and two plates to hold the bones together. She was told to place no weight on the injured leg for three months. "Fortunately, my daughter and mom were able to help," Swenson remembers, "and it seemed that the pain was even worse as it was healing."
Recently unemployed and without health insurance, Swenson didn’t know what to do. "I couldn’t go back to work because I couldn’t stand for any period of time nor could I walk at all!"
Swenson contacted St. Croix Regional Medical Center’s financial assistance staff and gave them her financial information. "Thanks to SCRMC’s community care program, the medical center paid for everything—just over $22,000," Swenson said. "Honestly, I don’t know what I would have done without their financial help. I had no other options. Period!
St. Croix Regional Medical Center, St. Croix Falls
A letter from a grateful Community Care patient
"I would like to thank everyone involved with the Community Care program for the financial support for my surgery. Without the help I received from Community Care, this operation would not have been possible.
I was lucky to have such a great surgeon and the great nursing staff to help me recover. Since my operation I have been free of the pain that I experienced before and now have more peace of mind I need to live a healthy life.
After receiving such a great gift I only hope that I can return the favor to someone else someday."
- A grateful patient at Aspirus Wausau Hospital
Aspirus Wausau Hospital
Homeless with nowhere to go
A life can go unnoticed when a person is homeless. But not to a financial counselor at Aurora Sheboygan Memorial Medical Center who kept tabs on the life of a 52 year-old Sheboygan man who is divorced, homeless, uninsured and in need of care.
Over time, the man had pancreatitis, liver problems and broken knees.
When he arrived in the hospital’s emergency department, the financial counselor met with him again.
"I have been working with this patient for over five years," she explained. "He had accumulated many bills but never responded to any of the financial counselors except me. He always kept me posted on his status."
This time she was able to assist him with completing the application for Aurora’s Helping Hand program to pay off his bills.
When the patient learned the application was accepted, he sent a simple, but sincere, thank you note, which read: "Thank you so much for all your help through the years. I am just glad that my bills are finally paid off."
Although the financial counselor offered to assist the patient with temporary housing, he refused that service and explained he would stay at a friend’s house instead.
Aurora Sheboygan Memorial Medical Center
It all works out for the best
The emergency department (ED) at Aurora Medical Center in Oshkosh was a safe and familiar environment for a 19-year-old pregnant teen. She was a soon-to-be single mother, unemployed and uninsured, who lived with her parents. It was her third visit to the ED. The first two visits were for abdominal pain, but this time, she had come to the hospital to deliver her baby.
Financial Counselor Jon Hanna met with the patient in her room to provide resources and to discuss payment options. After he assessed her financial situation, Jon sprang into action to assist with an express enrollment for the BadgerCare Plus Program. The patient and baby were immediately approved for BadgerCare Plus coverage.
Jon explained, "Prior to her pregnancy, she had two outstanding medical bills related to ED visits that were left unpaid, which BadgerCare Plus Program does not cover." For that, Jon assisted the patient in applying to Aurora Helping Hand Patient Financial Assistance Program.
Jon noted, "It was a great relief to her when she received the news that she was eligible for a 100 percent discount through the Aurora Helping Hand Patient Financial Assistance Program. The patient was extremely grateful."
"Baby and mom are doing well," he added.
Aurora Medical Center in Oshkosh
Community Care Program
Mark and Enid are self-employed milk truck drivers with private insurance. Their insurance has a high deductible and high premium. Mark became very ill. He was diagnosed with Lyme disease after several physician visits. His physician recommended IV treatments which are very costly. Mark and Enid had an out-of-pocket maximum of $2,500 for outpatient visits. While Mark was ill and unable to drive, the couple was forced to hire a driver to service their clients. In addition, they lost income.
The couple was extremely grateful for Vernon Memorial Healthcare’s (VMH) Community Care Program. VMH provides various levels of financial assistance to those who are unable to pay for health care services. Financial assistance is available to individuals who do not have the ability to pay their full obligation as determined by qualification criteria. The amount of the aid will take into account each individual’s ability to contribute to the cost of his or her care.
Mark and Enid qualified for a reduction in their medical bill. Mark continues to recover and is once again able to work and enjoy life.
Vernon Memorial Healthcare, Viroqua
We all need somebody to lean on
An unexpected trip to the ER followed by four days in the hospital left Georgia in a financial panic. Due to her health condition, she had not been working and had no insurance. The resulting bills were too much to take on.
"It was a time when I just needed someone to say, ‘Don’t worry, I’ve got your back,’" Georgia said.
Even with such hope, she did not expect what followed: St. Mary’s forgave the entire amount owed for her hospital stay. Though still making payments on the doctors’ bills, the debt relief allows Georgia to focus on living a healthy life. It’s now her turn to provide the leaning post for others, namely her children and grandsons.
"Now that I’m healthy, I can be the grandmother that my daughter always knew I could be."
St. Mary’s Hospital, Madison
SPMHC’s Community Care helps those in need
Sarah* knew if she didn’t have surgery, the mass in her abdomen could continue to grow. The dull pain that wouldn’t go away served as a constant reminder.
"But I didn’t have insurance, and I was very concerned about the cost," said Sarah.
A friend suggested she talk to the billing office at Sauk Prairie Memorial Hospital & Clinics (SPMHC) before further tests or surgery.
"I met with Dawn and she was extremely respectful and nice," said Sarah. "She helped me apply for the Community Care program."
SPMHC’s Community Care program helps patients who are financially unable to pay their medical bills. Sarah found out she qualified for the program and could start preparing for surgery, looking forward to a day without pain.
* Name changed to protect patient confidentiality.
Sauk Prairie Memorial Hospital & Clinics, Prairie du Sac
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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