Competitive Wisconsin, Inc. on October 9, 2012 released its report Be Bold 2: Growing Wisconsin’s Talent Pool. The report offered strategies and recommendations to ensure a match between the workforce needs of state employers and the skills and knowledge of Wisconsin workers.

Health care was identified as one of five critical job sectors in Wisconsin. The report included a forecast of supply and demand. Health care, like other sectors, was predicted to have a significant shortfall in appropriately-prepared workers by 2016 with an increasing shortfall in 2021. The report emphasized the need for real-time information about the skills that employers require and the importance of preparing potential workers that can fill those jobs.

Judy Warmuth, WHA vice president, workforce development, participated in the committee that advised the process. According to Warmuth, "Good data is the key to a future with the appropriate workforce. A proactive approach to matching the workforce to both current and future jobs requires a clear understanding of the current situation and accurate predictions for future needs. Educators and employers can work together when they have this strong base of knowledge for planning, strategy and action."

"WHA is pleased the report highlights talent development and acquisition as essential tools of economic development. Wisconsin offers high value, high quality health care," according to Eric Borgerding, executive vice president, WHA. "But to maintain this status into the future, we need a well-trained workforce available to our hospitals. WHA agrees with the focus of the study, which is to ensure economic growth for Wisconsin."

The report identified current workforce issues including the aging of the workforce, a talent mismatch, lack of a statewide workforce focus and lack of current data. These all point to the need for the statewide workforce strategy proposed in the report. BE BOLD 2: Growing Wisconsin’s Talent Pool contains operational recommendations targeted at achieving eight strategic goals. The goals, along with the rest of the report, can be found at www.competitivewi.com.

The Be Bold 2 report, which follows the release of Tim Sullivan’s The Road Ahead: Restoring Wisconsin’s Workforce Development, will soon be followed by a report from the Governor’s College and Workforce Readiness Council.

"The timing and grouping of these powerful reports indicates that Wisconsin is serious about addressing today’s and tomorrow’s workforce issues," said Borgerding.

Workforce remains a high priority at WHA, which has long been concerned with maintaining an adequate hospital workforce and has annually produced a report on the hospital workforce in Wisconsin. The latest report, with a focus on difficult-to-fill positions and emerging hospital workforce issues and trends, will be released in November.

A group of respected health care policy thought leaders, led by former HHS Secretary Mike Leavitt (he followed Tommy Thompson during the last Bush Administration), shared their versions of an ideal health care future last week in Washington D.C. The building blocks of that future are very much in place right now in Wisconsin.

Leavitt, along with top Clinton health staffer Chris Jennings, conservative "free market" commentator Jim Capretta and the National Business Group on Health’s Andy Webber agreed that:

• The coming "fiscal cliff" and bipartisan thirst for budget deficit reduction is the leading driver of health reform (not the ACA).
• Tomorrow’s delivery system will be highly integrated and must be able to go "at risk" in contracting with public and private payers.
• Insurance Exchanges will survive November 6 as they are needed to at least partially address small group and individual market issues.

The group called out six specific competencies that will be required of "integrators" if they are to be successful in managing risk:

• The ability to alter physician and patient behavior (move away from fee-for-service mindset).
• A brand name (marketing).
• The ability to aggregate lives and address population health.
• The ability to take financial risk.
• A geographic footprint.
• Business intelligence (data).

The policy leaders also noted that ongoing provider and payer consolidation will escalate in the near term.

The group agreed that Medicare’s future is driving the environment. And that’s because future Medicare payment will change dramatically—either due to a move to premium support—or—due to staggering Medicare cuts possibly overseen by an Independent Board. In either case, Medicare revenues for providers are likely to flatline for the foreseeable future.

For those who are either policy wonks or interested in possible scenarios that may play out post-November 6, check out www.healthreformbracketology.com, a fascinating guide predicting the status of ACA provisions under various election scenarios. The site is sponsored by Secretary Leavitt’s organization—The Leavitt Group.

Steve Brenton
President

The WHA quality team is continuing their trek around the state to visit all of the hospitals participating in the Partners for Patients initiative. Travis Dollak, WHA quality coordinator, recently visited three hospitals in the central part of the state. The site visits give hospitals a chance to share their great work and identify ways they can improve even faster.

The WHA Partners for Patients initiative is working well, according to the hospitals that Dollak visited. It provides structure to the improvement work that is going on across the state.

"The work these hospitals are doing to improve patient safety, the number of people involved in the projects and their relentless focus is impressive," said Dollak.

A summary of each of Dollak’s hospital visits follows:

Ministry St Clare’s Hospital, Weston
Ministry St. Clare’s Hospital has demonstrated a strong culture of safety and reducing patient harm by participating in five initiatives as part of Partners for Patients. At a recent Grand Rounds more than 40 individuals attended and were provided updates on the different improvement efforts taking place. Each improvement team has made efforts to get other front-line staff involved as demonstrated by more than 60 individuals participating in generating ideas to reduce future adverse events.

Ministry St Michael’s Hospital, Stevens Point
Ministry St. Michael’s Hospital is focused on reducing patient falls. The "falls team" is very engaged in graphing and analyzing data over time. They have a number of interventions going on at the senior level (new beds with alarms) and the front line (velcroing cords to prevent patients from tripping), and are interested in site visits. The team contributed to Partners for Patients by sharing a VTE risk assessment tool. They also used the staff safety assessment survey to get staff engaged and received over 40 responses.

Aspirus Wausau Hospital, Wausau
Aspirus Hospital has been focusing efforts on reducing Catheter Associate Urinary Tract Infections. A robust team including RN charge nurses and infection preventionists are leading the team. At a recent meeting, other unit leaders have joined the team to better understand the recommendations for catheter insertion and removal. The group has already found a number of opportunities for improvement and is planning a number of small tests of change. They are looking for ways to engage more frontline staff as they continue to focus on process measures to drive improvement.

WHA again this year is working with RC Healthcare on our wage index improvement project. This is a major WHA commitment and member benefit aimed at helping hospitals accurately report data in their cost reports which is used to calculate the hospital wage index, a key component of Medicare payment for PPS hospitals.

As the kickoff to this year’s wage index improvement project, WHA and RC Healthcare will be offering a wage index education webinar on October 24 at 10 am. This program will provide important information on the wage index correction process. Over the years, this engagement, which is provided as a member service, has resulted in substantial corrections of various hospital data errors or FI adjustment errors and has been critically important to maintaining the integrity and accuracy of the wage index for hospitals located in Wisconsin.

New topics covered by this year’s webinar will include the new Worksheet S-3 format with a comparison to the old format and preparation instructions. Pension reporting guidelines which were discussed last year will be covered to answer any questions hospitals may have in preparing the form. Current wage index impact of the occupational mix survey submitted July 1, 2011, findings during the audit and appeals process, and CMS proposals to Congress for wage index reform will also be discussed during the webinar. All wage index revisions need to be submitted by early December 2012.

PPS hospital members are encouraged to participate. More detailed information about the upcoming webinar was recently emailed to hospital CFOs.

While the education component of the wage index improvement project is important, it is only one piece of the overall effort. RC Healthcare also identifies a wage index contact at each hospital and then either visits or makes individual phone calls to each facility as they work on wage index reporting issues. These additional proactive efforts have led to more accurate reporting and increased reimbursement to Wisconsin hospitals

RC Healthcare also helps hospitals prepare the occupational mix survey which is an additional adjustment factor used to modify Medicare PPS rates. Through several rounds of occupational mix survey submissions, RC Healthcare has educated Wisconsin hospitals on how the survey works and how it should be completed.

If you have questions about WHA’s Wage Index Improvement Project, contact Brian Potter at WHA at bpotter@wha.org or 608-274-1820.

Memorial Health Center (An Aspirus Partner) in Medford has become the first health care organization in Wisconsin to receive Pathway to Excellence recognition from the American Nurses Credentialing Center (ANCC). The Pathway to Excellence Program® recognizes health care organizations for positive practice environments where nurses excel. Ninety hospitals nationwide have been recognized as Pathway to Excellence facilities, with Medford being the first and only Wisconsin hospital to achieve the goal.

Kaaron Keene, vice president, Patient Care Services at Memorial Health Center (MHC) is pleased with the designation. According to Keene, "MHC is committed to nurses, to what nurses identify as important to their practice, and to valuing nurses’ contributions in the workplace. This designation confirms that nurses working here know their efforts are supported."

The Pathway to Excellence designation is granted for three years and may be renewed. An organization earns or renews the Pathway to Excellence designation via a thorough review process. Applicants conduct a review process to fully document the integration of those standards in the organization’s practices, policies and culture. Pathway designation can only be achieved if an organization’s nurses validate the data and other evidence submitted, via an independent, confidential survey.

"Memorial Health Center is to be congratulated for being the first in Wisconsin to achieve recognition status from Pathway to Excellence," said Judy Warmuth, vice president of workforce development, WHA. "They join 13 Wisconsin hospitals that have also been recognized by the ANCC as part of the Magnet Hospital Program."

The Hermes Monato, Jr. Prize of $2,500 is awarded annually for the best rural health paper. It is open to all students of the University of Wisconsin (any campus). Students are encouraged to write on a rural health topic for a regular class and then to submit a copy to the Rural Wisconsin Health Cooperative as an entry by April 15.

Previous award winners as well as judging criteria and submission information are available at: www.rwhc.com/Awards/AnnualMonatoEssay.aspx.

Patrick T. Hammer, president & chief executive officer (CEO) of Rogers Behavioral Health System, recently announced the promotions of Paul Mueller, CAPSW, from chief operating officer to CEO of Rogers Memorial Hospital—and Gerald Noll from chief financial officer (CFO) of the Hospital to executive vice president (EVP) and CFO of the entire System.

As new CEO of the Hospital, Mueller provides the leadership necessary for evaluating and making recommendations to help improve the hospital’s administrative, clinical, marketing, financial and environmental operating systems. His primary emphasis will be to enhance the hospital’s ability to deliver high-quality care as the number of individuals and families who seek help at Rogers Memorial Hospital continues to grow.

As the new EVP and CFO of the System, Noll will provide leadership for the financial oversight and development of the System’s five key corporations, which include Rogers Memorial Hospital; Rogers Memorial Hospital Foundation, Inc.; Rogers Partners in Behavioral Health, LLC; Rogers Center for Research and Training; and Rogers InHealth. Noll’s primary emphasis will be on cost analysis, revenue cycle, financial due diligence, land/building acquisitions, as well as financing and construction management for the System.

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.

George’s story

It was during a very low point in George’s life that Reedsburg Area Medical Center (RAMC) was able to provide much needed financial relief.

George had been a loyal employee all of his working years, with one industrial company in town. Now, when health problems were overwhelming him, he discovered that his deductibles were so high he couldn’t afford some of the procedures he had scheduled. Due to a rough economy, his employer had been downsizing and changed insurance companies many times, saddling George with deductibles that were beyond his ability to pay.

That’s when RAMC’s Charity Care offered him just the relief he was looking for. After meeting with very helpful staff to get his application approved, he was able to get in very quickly for the radiology procedure he needed.

George says, "RAMC was there for me when I had nowhere else to turn. I seriously didn’t think I was going to be able to have the procedures that I needed, and I felt very lost. I’m very grateful that this program is in place to help people just like me."

"You listened with your ears and your heart."

A word of thanks can go a long way to any caregiver at Aurora West Allis Medical Center knowing that they have given their best to assist every patient and their family. Take the case of Mr. R.B. He was a hard-working citizen, but when the ownership of the company he worked for switched, he was unable to afford its new health plan and was left uninsured. Mr. R.B. was healthy at that time.

However, he later became ill, and to further complicate matters, he was diagnosed with a chronic skin condition, one that required many skin grafts. When financial counselor Sandy Malloy learned of this man’s situation, she immediately set out to help him.

"I met with Mr. R.B. and his mother frequently to discuss their financial situation. At that time he was still able to work part-time," Sandy explained.

"I went out of my way to help this family because, despite his chronic condition, this proud gentleman still tried to work part-time to help out his family. Eventually, his doctor told him he could no longer do so, as his condition got so bad. I know that Mr. R.B. is a hard worker and a fighter."

Sandy continued: "I worked with our Wound Care Specialist, Mike, as well as our financial department, enabling Mr. R.B. to receive a 100 percent discount through Aurora’s Helping Hand financial assistance program for the services he needed. And now, going forward, he is with BadgerCare Core."

Soon thereafter, Sandy received a card from the family expressing their deep appreciation.

"Dear Sandy, We have now had a few days to try to process the incredible news you gave us on Monday and it is still impossible to find the words to express our gratitude and our extreme good fortune in just knowing you. We have gone over every word you said to us countless times and still can’t believe it. You smiled when you said you were just doing your job, but you did so much more. You changed our lives. You listened with your ears and your heart. We will never be able to repay you for your tireless work and your kindness. You, your family, and everyone you love will forever be in our hearts and prayers. You are an amazing woman. Thank you, R.B. & Mom."

Charity care helps family in need

A husband came in for financial counseling while his wife was in St. Mary’s ICU on a ventilator. A counselor performed a detailed review of his situation. He had recently lost his job due to having to be away from work to care for his two young sons (while his wife was hospitalized) and be at her side at the hospital. This also meant loss of his health insurance. The counselor was able to determine that his family qualified for the hospital’s charity program. The review also determined that his health insurance could be reinstated through a cobra agreement with a small amount of financial assistance, which the hospital did. This resulted in his wife’s hospital bills being coved by health insurance, and any out-of-pocket balances resolved by the approved charity. These actions also facilitated her transfer to the only local long-term care facility that accepts ventilator patients, which meant he and his boys would not have to travel to visit each day.

Through the whole process you could see the toll this was taking on him physically and emotionally. He commented to the financial counselor that he would be unable to provide Easter baskets to his sons this year. The department manager worked with the hospital’s service recovery program and was able to approve a small gift card for the local Wal-Mart. This was presented to him on the day of his wife’s discharge, two days before Easter. His face immediately lit up and you could see his demeanor change. He tearfully hugged the financial counselor and thanked everyone at St. Mary’s Hospital for truly caring for his whole family in their time of need.

Patient shown dignity and compassion

When Kathleen went to the Emergency Department at Wheaton Franciscan - St. Joseph with pain from a bowel obstruction, she was quickly admitted to undergo surgery where she would soon learn that she also had stage four colon cancer. The 52-year-old began cancer treatment immediately under the care of Dr. Norwood Anderson.

Initially, Kathleen had medical insurance through her employer. Forced to retire due to her illness, she lost her insurance.

"Everyone in Dr. Anderson’s office was so kind, generous and supportive," said Kathleen. "My social worker, Claire Siebold, hooked me up with financial counselor Donna Semons who helped me to fill out the forms and apply for Community Care."

Kathleen was approved for Community Care to cover most of her costs.

"By the grace of God, Wheaton Franciscan Healthcare helped me get on a payment plan that is doable and with the dignity and compassion that made me feel safe. The Community Care program has taken a huge weight off my shoulders," said Kathleen.

Kathleen received the much needed assistance through the time of her death in May 2011.

When a loved one struggles

A 21-year-old man came to the Emergency Department at Aurora Sheboygan Memorial Medical Center and was diagnosed with paranoia and mental health issues. The financial counselor who met with the patient had a difficult time trying to communicate with him because he did not want to talk with anyone, not even the doctors and nurses, let alone a non-clinical caregiver.

After the financial counselor paid two separate visits to the patient, she discovered that the patient’s mother and sister had visited him that day. She was able to track them down to obtain information needed to process an Aurora Helping Hand application.

The patient’s mother confessed, "We are extremely concerned about accumulating hospital bills because he is uninsured. We have nowhere to turn for help."

Upon processing the information the family provided, the financial counselor was able to inform the patient and his family that a 100 percent discount would be provided for the medical attention he needed.

When the patient’s family heard the great news, his mother rushed back to the financial counselor to express her appreciation. She later sent in a note which reads in part:

"Thank you for your kindness with helping my family with the hospital bills. You will never know how difficult it is living with a son who is constantly paranoid about everything. I am so grateful that my son will receive the treatment he needs."

Read more about hospitals connecting with their communities at www.WiServePoint.org.

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