November 2, 2012
Volume 56, Issue 44
Election is Days Away…What Will it Mean for Health Care in Wisconsin?
With the election just days away, WHA members will soon be asked for their opinions on what the election will mean in their communities. In the next of WHA’s series of Telephone Town Halls, join WHA President Steve Brenton and WHA Executive Vice President Eric Borgerding as they provide members a post-election analysis on the impact of the election on Wisconsin’s health care landscape.
Brenton and Borgerding will describe what the elections mean in terms of decisions that will need to be made on Medicaid, the future of health insurance exchanges and how Congress and the President may approach health reform and the federal budget deficit following the election.
Mark your calendar for either November 13 or 15 and register for the WHA Telephone Town Hall titled, "Post Election Analysis: What the Results Mean for Wisconsin Health Care" online at: http://events.SignUp4.com/12GRTOWNHALL111315. WHA Telephone Town Halls are intended for Wisconsin hospital members as a member benefit.
To date, 400 hospital leaders and advocates have participated in WHA’s series of Telephone Town Halls and Listening Session listed below.
Additional events are in progress so watch The Valued Voice for details in the coming weeks and months. For questions, contact WHA’s Jenny Boese at email@example.com or 608-268-1816.
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The Wisconsin Hospital Association 93rd Annual Meeting of the House of Delegates will be held December 17 at 9:00am at WHA Headquarters in Fitchburg, Wisconsin and via teleconference. The agenda and teleconference information will be mailed to each authorized representative of your organization. Contact Sherry Collins with questions at firstname.lastname@example.org or 608-274-1820.
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In the continuation of WHA’s series of Hospital Listening Sessions, some 60 hospital leaders and WHA HEAT advocates heard from U.S. Sen. Ron Johnson (R-WI). This WHA Listening Session was held at Holy Family Memorial in Manitowoc and attended by hospitals/systems from the eastern part of the state.
During Sen. Johnson’s prepared remarks, he focused attention on the growth of the federal budget, the nation’s federal deficit and his opposition to the health reform law (PPACA). During questions and answers, participants asked the Senator about health care issues such as impending Medicare cuts under sequester and Wisconsin’s reputation as a high value state. The following are excerpts from Sen. Johnson’s remarks.
On The Deficit/Economy:
"The first step in a 12-step program is to admit you have a problem."
"100 years ago government spending was 2 percent of GDP. In 2011 it’s now 24 percent of GDP. "If we do not structurally reform Social Security, Medicare, Medicaid, we will have a 35 percent structural deficit by 2036."
On Health Reform (PPACA)/Provider Cuts:
"You don’t bend the cost curve down by increasing taxes on providers." (referring to the various taxes on medical providers contained in PPACA)
"Obamacare dramatically increased the demand for health care but dramatically reduces supply [through cuts]."
"Individuals don’t have skin in the game….Let’s move to a system where individuals can make decisions."
On Sequester (2% Medicare Cuts Beginning Jan. 2013)
"Wisconsin really comes out on the short end of the stick [because of high levels of quality, value] when states like Florida already get two to three times more in reimbursement."
On Caring For the Poor – When asked how to right the economy, address the deficit and still care for those in need, Sen. Johnson said the following:
"Free market capitalism has lifted more individuals out of poverty than any other system…I am highly concerned about the least among us…I believe you do so by growing the [economic] pie…"
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In the growing frustration over policies from audit programs like the Recovery Audit Contractors (RACs), this week the American Hospital Association (AHA) filed suit against the U.S. Department of Health & Human Services (HHS) over a long-festering issue of "rebilling" for denied payments. At issue is the administration’s refusal to reimburse for care when the government in hindsight believes that such care could have been provided in an outpatient facility or department instead of the inpatient portion of the hospital.
"What the federal government is doing is wrong, unfair and a clear violation of federal law," said Rich Umbdenstock, president and CEO of the AHA. "Doctors and nurses provide the best care possible using their medical judgment and training. Allowing government auditors to second-guess these difficult medical decisions about where to best treat a patient years later based on a cold record and then refuse to pay for that care is indefensible."
Under the current policy, when a RAC decides care should have been provided in a setting other than the inpatient setting, hospitals are denied payment and essentially cannot rebill for the "outpatient" services they provided even though there is no dispute whatsoever that the care received was reasonable and necessary. The only dispute is whether it could have been delivered in an outpatient department instead of in the hospital.
The AHA lawsuit, which was joined by four other hospital systems, is asking the court to overrule this policy and reimburse hospitals for denied payments. Read the complaint at: www.aha.org/content/12/121101-aha-hhs-medicare-com.pdf.
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As the nation moves into the homestretch of the elections and as hospitals prepare for the "Lame Duck" session in Congress, the American Hospital Association (AHA) this week sponsored several online ads in a key political publication, Politico’s Playbook. The ads are designed to focus attention on the negative impact continued Medicare payment cuts will have on the health care sector, including hospitals and health systems.
"America’s hospitals stand ready to care 24 hours a day, seven days a week, 365 days a year...ensuring that patients have access to the care they need at the right time, in the right setting. But hospitals’ ability to maintain the kind of access to services that their communities have come to expect is threatened," the ads say.
The ads also highlight a report prepared for the AHA, American Medical Association and American Nurses Association in September by Tripp Umbach, a firm specializing in economic impact studies.
The Wisconsin Hospital Association supports the AHA’s efforts to push back against continued Medicare cuts including through the Coalition to Protect America’s Healthcare, for which WHA is encouraging financial support.
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By Jenny Boese, WHA Vice President, External Relations & Member Advocacy, and Brian Potter, WHA Senior Vice President
Overwhelming evidence shows that Wisconsin hospitals and providers take seriously their commitment to improving quality and reducing costs. From the federal Agency for Healthcare Research & Quality’s #2 ranking for Wisconsin on quality to the Commonwealth Fund ranking all Wisconsin communities in the top quartile for health system performance, Wisconsin’s track record on quality and efficiency is strong.
Unfortunately, duplicative and uncoordinated federal Medicare audit programs redirect our hospitals and health system’s vital financial and personnel resources away from areas of the health care delivery system where those could be best used. In the fiscal environment hospitals and health systems face—including billions in payment reductions already underway for Wisconsin hospitals/health systems and proposals suggesting billions more in reductions—the Wisconsin Hospital Association (WHA) has concerns with the rapid growth of these audit programs, especially Recovery Audit Contractors (RACs).
We are not alone in our concerns.
We hear regularly from our members about RAC audit processes gone awry, or worse yet, inappropriate payment denials that have led to a backlogged Medicare appeals process. Process breakdowns range from hospitals not receiving the first letter initiating RAC review to the RAC failing to meet its mandatory requirements. These obstacles inhibit our hospitals from efficiently handling RAC claims, leading to numerous calls to the RAC for status updates, missing information and beyond.
In fact, our hospitals have had to take many costly steps to deal with the RAC program since it began several years ago, including:
Thousands of hours and dollars are spent to comply with the RAC process, and the RAC program is only one in an acronym-laden audit landscape—think CERT, OIG, MIC, MIP, PERM, MAC, ZPIC….
But the trouble with the RAC program is more than a frustrating process—it also crosses into territory we believe belongs to the treating physician and the hospital—that of the medical necessity of care. Medical necessity is an increasing focus on the RACs and amounts to an auditor deciding in hindsight whether the medical care given was appropriate. These medical necessity denials are on the rise every quarter and are some of the most complex and costly cases for our hospitals. Naturally, many hospitals decide to appeal.
Data from the American Hospital Association shows that 75 percent of those appeals ultimately are decided in the hospital’s favor. Yet, this is only a snapshot of the total picture, as the bulk of all appeals are still somewhere in the appeals process. Not only is this a costly process for our hospitals, but also for the federal government, as thousands of RAC claims clog up the Medicare appeals process.
WHA and our providers support appropriate efforts to fight "waste, fraud and abuse" in government health care programs, but we believe it is important to understand that there is a cost being borne by the health care delivery system with having complex and oftentimes redundant federal audit programs.
These concerns have prompted U.S. Reps. Sam Graves (R-MO) and Adam Schiff (D-CA) to author bipartisan legislation known as the Medicare Audit Improvement Act of 2012 (H.R. 6575). HR 6575 makes much needed improvements to the RAC and other Medicare audit programs such as improving auditor performance by implementing financial penalties on them, requiring medical necessity audits to focus on widespread payment errors, and requiring a physician review for Medicare payment denials among other important provisions.
In this time of scarce federal and health care dollars, WHA asks Congress and the Centers for Medicare & Medicaid Services to reevaluate audit efforts and target them more appropriately and effectively. To that end, WHA strongly encourages Wisconsin’s Members of Congress to support audit program reforms by co-sponsoring the Medicare Audit Improvement Act.
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The WHA Council on Medical and Professional Affairs (MPA), during their November 1 meeting in Madison, heard about the Wisconsin Hospital Association’s ongoing comments to the Medical Examining Board concerning the Board’s draft proposals to update MED 10, the administrative rule that defines unprofessional conduct for physicians. Laura Leitch, WHA senior vice president and general counsel, outlined WHA’s priorities for MED 10, which include encouraging strong quality improvement programs by protecting local peer review and ensuring clear and consistent standards for physicians. (See August 17, 2012 edition of The Valued Voice.) Leitch asked the Council for input on WHA’s request to the MEB that the MEB provide a definite statement that outpatient services ordered by a physician who is licensed in another state may be provided in Wisconsin if certain conditions are met. The Council, chaired by Brad Manning, MD, agreed that those conditions should be (1) the ordering physician sees the patient in the state in which the physician is licensed and (2) the physician who issued the order remains responsible for the patient’s care.
Chris Queram, CEO, Wisconsin Collaborative for Healthcare Quality (WCHQ), provided MPA members with an overview of a project that will report WCHQ measures in a special Wisconsin insert of Consumer Reports magazine in January 2013. The 30-page insert will include data on seven ambulatory preventive health measures for all WCHQ members. The insert will also include significant editorial content on the state of quality in Wisconsin and vignettes on each participating health system. Kelly Court, WHA chief quality officer, summarized information she gathered from numerous websites that are reporting hospital quality measures and rankings. Many of the rankings are being derived from the 100+ measures hospitals are required to report to the Centers for Medicare & Medicaid Services (CMS), from Medicare claims and voluntary surveys such as Leapfrog. Court reviewed some of the challenges hospitals have with trying to keep up with all of the reporting requirements and making sense of the numerous rankings.
Matthew Stanford, WHA vice president, policy and regulatory affairs and associate counsel, provided an overview of the WHA-supported HIPAA Harmonization/Mental Health Care Coordination Bill. Passage of the bill in the next legislative session, which would remove statutory barriers to the coordination of care for individuals with mental illness, is a goal of WHA’s Behavioral Health Task Force. Stanford said at its last meeting, the Task Force discussed the ongoing efforts of WHA, hospitals, other stakeholders and individual Task Force members to build support for the bill throughout the state. Stanford told the Task Force that if they know of individuals that work in their hospitals or who live in their communities who are interested in helping to support efforts to pass this bill, share that information with Stanford at 608-274-1820 or email@example.com.
Stanford also provided an update on the Legislative Council Study Committee on Legal Interventions for Persons with Alzheimer’s disease and Related Dementias. Dr. Ken Robbins, medical director for Stoughton Hospital Geropsychiatry, and Dr. Gina Koeppl, northern region director of Behavioral Health Services for Ministry Health Care, both serve on this committee. This study committee is largely focusing on issues related to the provision of emergency services for individuals with Alzheimer’s disease created by the Helen EF case decided by the Wisconsin Supreme Court earlier this year. To address these issues, the Study Committee is in the process of drafting legislation that would make it easier for an individual to provide for admission to a hospital for psychiatric treatment through a power of attorney document, as well as legislation to create a more workable process to help individuals with Alzheimer’s disease get necessary emergency care when they need it. More information about the Committee’s work can be found at: http://legis.wisconsin.gov/lc/committees/study/2012/ALZ/index.html.
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The WHA Information Center held the first of four regional in-person training sessions November 1 in Madison. The session provided an overview of the Information Center’s 2012 accomplishments, which included the development of an updated version of the data collection software, preparation of a public-use data set on hospital outpatient ancillary services, addition of a new category to PricePoint based on hospital outpatient ancillary services using the 3M EAPG (Enhanced Ambulatory Payment Groups) methodology, and the development of an annual and fiscal survey training module and technology security enhancements.
During the session, Brian Competente, operations manager, and Cindy Case, coding, compliance and education manager, demonstrated how users can register for the new secure portal to submit and edit in the updated data collection software to receive profile and validation reports or to receive data products. Debbie Rickelman, WHA Information Center senior director, discussed the Information Center’s ICD-10 transition activities and offered WICD-10 (the Wisconsin ICD-10 Partnership) as a resource—www.wicd10.org.
"In-person training is a great way to ease our hospital and ambulatory surgical center partners into the changes we will all experience over the next couple of years," stated Rickelman. "Change is upon us, but at the Information Center, we strive to provide education and resources so we can address as many challenges as we can in a proactive way."
Additional training dates are November 7 in Rice Lake, November 14 in Green Bay, November 15 in Pewaukee, and December 4 via webinar. Hospital and ASC staff may register at www.signup4.net/Public/ap.aspx?EID=11LI12E.
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The National Labor Relations Board (NLRB) recently issued its first decisions involving employer social media policies—rulings that will set precedent for future cases. On November 28, WHA will offer a webinar focused on the hidden dangers for employers on social media use in the workplace. The use of social media increases daily and presents unique risks for employers. During this webinar, David Kern, partner in the law firm Quarles & Brady LLP, will discuss these risks and how best to manage them.
Participants will learn how to minimize liability associated with monitoring social media use by employees, how to improve your review and updates of acceptable use and social media policies, and how to better avoid risks associated with disciplining employees for use of social media.
The webinar "Social Media and the Workforce: Hidden Dangers for Employers" will be offered to WHA members on November 28 at 9:00am. Hospital human resource professionals, nurse leaders and others in management positions are encouraged to participate. You can register online at: http://events.SignUp4.com/12SocialMedia1128. For registration questions, contact Jennifer Frank at firstname.lastname@example.org or 608-274-1820.
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Alcohol and substance abuse has a devastating toll on individuals, families, and society. Armed with expertise and determination, Wisconsin hospitals are fighting the war on drugs and alcohol in their communities with counseling and services aimed at prevention and treatment.
Educating students about alcohol and other drug abuse
Children’s Health Education Center, an affiliate of Children’s Hospital of Wisconsin, offers a variety of health education online through BlueKids.org e-learning programs. The unique, interactive programs are game-based and include pre- and post-tests to engage students and improve knowledge retention.
BlueKids.org offers three e-learning programs tailored specifically to elementary and middle school students regarding alcohol and other drug abuse: Drug Defense: Get UR Facts, It’s UR Choice and It’s Up 2U.
Drug Defense: Get UR Facts, helps fourth- and fifth-graders understand the basics of alcohol, tobacco and other drugs. Students learn the negative impact drugs have on the body and how to make healthy choices in life by negotiating a variety of interactive activities, including games and puzzles.
It’s UR Choice empowers sixth-graders to make smart decisions in the midst of peer pressure situations. Students learn about the seven types of drugs (alcohol, nicotine, inhalants, prescription, over-the-counter, performance-enhancing and schedule 1 drugs) and how they impact our bodies.
The third alcohol and other drug abuse program offered by BlueKids.org, It’s Up 2U, is geared toward sixth, seventh, eighth-grade students. This program integrates critical-thinking and decision-making skills into the students’ game-based experience. It’s Up 2U includes a unique journaling component that allows students to log their experiences and thoughts throughout the program.
Connie Beaster, an educator from Richmond Elementary School in Sussex, Wis., said, "The journals are interesting and important. I think they encourage students to think critically about the problems kids face and the choices they have. Students have to justify and evaluate their journal entries."
The positive feedback from students and staff is encouraging. All three programs have considerably increased the content knowledge of the students and changed their attitudes. For example, in one Drug Defense: Get UR Facts sample of 4,895 students using the program during the 2010-11 school year, the content knowledge of the students increased from 42 percent at the pre-test, to 75 percent at the post-test.
Children’s Health Education Center invests substantial annual costs to deliver the e-learning programs it offers to schools. The small, affordable fee for schools to enroll in these programs does not cover all costs associated with the development, delivery and evaluation of the programs. While generous donors have covered some of the costs, the remaining costs are covered by the health system.
For more information about the BlueKids.org e-learning programs offered through Children’s Health Education Center, visit HealthyKidsLearnMore.com or call (414) 390-2163.
Children’s Hospital and Health System, Milwaukee
The Adult Substance Abuse Program
The road to recovery from addiction requires life-long vigilance and support. The Adult Substance Abuse Program at Aurora Psychiatric Hospital provides evidence-based therapy built on three proven treatment approaches: motivational interviewing, cognitive-behavioral therapy and community reinforcement. The program instills the hope, motivation and self-management skills needed for a successful recovery. It offers individual, group and family therapy, education, medication management and support groups that assist in the development of these skills.
Robert was in his mid-50s when he arrived at the Aurora Psychiatric Hospital Dewey Center in March 2011. He used alcohol recreationally since his early twenties and struggled with substance abuse for most of his life. Robert had periods of sobriety that always led back to relapse.
Robert had been involved in treatment programs elsewhere and wanted to stop drinking, but he was unable to do so on his own. After he was arrested for drunk driving, it was the "wake up call" he needed, and he was ready to commit to treatment.
Robert was assessed in the intake department and admitted to the partial hospital program. He participated in educational sessions, as well as family and group therapy. While in treatment, Robert developed a plan to prevent relapse, which involved creating and connecting with a support system. At this point, Robert was already several weeks sober, and he was able to recognize the severity of his addiction.
Robert made a commitment to attend a community-based support meeting every day for 90 days. He also obtained a sponsor and attended the family sessions every Saturday at Aurora Psychiatric Hospital with his wife as a supporter. Robert successfully completed the 90 days support group program and made the active decision to continue to attend the daily sessions to maintain his sobriety. He is determined to conquer his addiction and, with his well-placed support system, time and dedication, the road to recovery does not seem too far to be reached.
Aurora Psychiatric Hospital, Wauwatosa
Submit community benefit stories to Mary Kay Grasmick, editor, at email@example.com.
Read more about hospitals connecting with their communities at www.WiServePoint.org.
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