Valued Voice - December 30, 2011

December 30, 2011
Volume 55, Issue 50

Association 2011 "Results" Reflect Strength of Member-Staff Collaboration

Medicaid Audit Highlights Need for Better Program Management

Wisconsin Hospitals Join WHA Quality Initiative

Political Action Spotlight: Wisconsin Hospitals PAC and Conduit Campaign Raises $232,000 in a Volatile Political Year

Legislative Study Committee Supports Key WHA Behavioral Health Task Force Recommendations

President’s Column: "From the Cutting Room Floor – Good Out-takes from ‘Results’"

Medicaid Spared from Budget Lapse

Congress Passes Hospital Supported TRICARE Clarification

Wisconsin Hospitals Community Benefits: Charity Care

Association 2011 "Results" Reflect Strength of Member-Staff Collaboration
Guided by member priorities, WHA achieves commendable outcomes

Travel to an unfamiliar destination requires a road map. The same could be said for an Association.

For WHA, our members set the road map for policy decisions in Madison, Washington DC, and within regulatory agencies. Without it, the results that we achieved this year—one of the most challenging in our history—would be unattainable.

Member participation on WHA councils, task forces, and committees this year was at an all time high. It requires a commitment of time by our members that is gratefully acknowledged by the WHA staff and our Board of Directors. The work products, recommendations and motions that were heard and acted upon by the WHA Board in 2011 started as discussions of often complex issues that required expertise, experience, and vision—hallmarks of Wisconsin’s health care leaders.

The WHA 2011 "Results" are in this week’s packet and on the WHA website at:www.wha.org/pubarchive/reports/2011results.pdf. We actually couldn’t fit all the achievements that we made together with you, our members, in that eight page publication (see President’s Column on page 3). It is a nice problem to have as an organization that strives to provide membership value to Wisconsin hospitals that are dedicated to improving patient care, controlling costs, and ensuring that health care is accessible to patients in your community.

The staff at WHA is looking forward to serving our members in 2012.

Happy New Year.

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Medicaid Audit Highlights Need for Better Program Management

The Wisconsin Legislative Audit Bureau (LAB) recently completed its work on an audit of the Wisconsin Medicaid program. Auditors recommended several areas of improvement in the state’s management and oversight of the program, and the need for better data and information to evaluate program expenditures. In his response, Department of Health Services (DHS) Secretary Dennis Smith agreed to take the steps needed to increase the program’s transparency.

The audit was requested by the Joint Legislative Audit Committee in January 2011 as a result of concerns about the growth of enrollment and expenditures in the Medicaid program. The report indicates that since 2006, enrollment increased by about 38 percent, from 870,200 to 1.2 million, and expenditures grew from $5.0 billion to $7.5 billion—an increase of about 50 percent.

The report attributes the program’s enrollment growth to the economic downturn and to changes in state law that expanded eligibility. The majority of the expenditure growth is attributed to increased enrollment, but also increased reimbursement rates for some services, like hospital services.

WHA Executive Vice President Eric Borgerding, in a memo to the Joint Legislative Audit Committee, emphasized that state expenditures are only one part of the picture. It is important to consider whether those expenditures are reasonable considering the actual cost of the services being provided.

"Even with increased payments from the hospital assessment, hospitals and other health care providers overall are reimbursed for services well below the costs those providers incur to provide those services," the WHA memo states. "In 2010, WHA estimates that hospitals alone were reimbursed approximately $879 million below what it cost hospitals to provide care to Medicaid enrollees. In other words, Wisconsin’s Medicaid program paid 63 cents for every $1 worth of hospital services (at cost) it received … although annual Medicaid expenditures are currently over $7 billion, the program’s true value is actually much higher when you account for the un-reimbursed costs incurred by providers for caring for Medicaid patients."

The auditors also found limitations in the state’s accounting systems, and indicated that they spent a large portion of their efforts compiling basic information on expenditures, participation, and service costs in a useful format for policymakers. The LAB recommends that DHS submit a detailed biennial budget request, and detailed reporting of program expenditures by service category.

The report notes concerns about state contracts and vendors, as well as the lack of state resources available to manage the program. The concerns identified by the LAB highlight the need to consider simplification efforts as part of Medicaid reform activities, and to avoid adding complex new initiatives without appropriate state resources to manage them.

Finally, the auditors recommend that DHS consider the potential benefits of enrolling recipients into HMOs in a timely manner. WHA has supported efforts to better manage care for the Medicaid population. Earlier this year, the WHA Medicaid Reengineering Group submitted recommendations to DHS for better care management in the Medicaid program, including the use of medical home models, as well as more information about the care management practices currently being employed by care management vendors. This would help all stakeholders understand practices that work well and that could be replicated throughout the program.

See the WHA memo to the Joint Legislative Audit Committee in response to the audit findings: www.wha.org/Data/Sites/1/medicaid/labmedicaidaudit-whamemo.pdf

To see the full audit report, including the DHS response, go to: http://legis.wisconsin.gov/lab/CurrentReportsByDate.htm

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Wisconsin Hospitals Join WHA Quality Initiative
Join WHA’s Partners for Patients Initiative

A new WHA initiative is off to a strong start with 63 hospitals now enrolled in the new "Partners for Patients" project. Announced the week before Christmas, WHA staff has been pleased with the member response.

"Partnership for Patients" is a national initiative supported by the Centers for Medicare and Medicaid Services (CMS) aimed at reducing inpatient harm by 40 percent and readmissions by 20 percent over a three-year period in ten key areas. Through the new project, hospitals will have access to evidence-based practices, staff training and opportunities for sharing practices, as well as continued direct engagement with WHA staff.

"We’ve learned from our other successful collaboratives that even if a hospital has worked on these topics before, they find that sharing and an open dialogue with peers about improved processes can take them to a higher level of performance," according to Kelly Court, WHA chief quality officer. "Even the best performers learn that it takes a lot of diligence to hardwire best practices in patient care areas."

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, kcourt@wha.org or 608-274-1820.

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Political Action Spotlight: Wisconsin Hospitals PAC and Conduit Campaign Raises $232,000 in a Volatile Political Year

In 2011, the Wisconsin Hospitals State PAC and Conduit fundraising campaign raised $232,000 from 411 individuals. The 2011 non-election year campaign was just shy of surpassing the 2010 all-time record of $235,000.

"While we were just shy of last year’s record-breaking year, I am quite proud of the campaign’s success this year, especially given that 2011 was a non-election year when it is typically more difficult to raise contributions," said WHA Advocacy Chair David Olson.

The average contribution this year is up to an all-time high of $566. The average contribution from individuals that are hospital CEOs/presidents was more than $1,250, and one third of those individuals are members of the new Platinum Club. The Platinum Club recognizes those who have contributed $1,500 or more in a calendar year, and members are invited to special recognition events.

In addition to the start of the Platinum Club in 2011, special events designed to thank and recognize all contributors were also a large part of the 2011 campaign. Participants were invited to events such as the Wisconsin Hospitals PAC/Conduit Hospitality Reception at the Governor’s Inaugural Gala in January, a breakfast event with Politico’s Jim VandeHei in Madison in April, an evening cocktail reception at Elkhart Lake in June and a special election 2012 briefing with pollster Prof. Charles Franklin at Miller Park in early December.

Next year’s campaign effort will focus on growing the number of individuals participating in the 2012 campaign. The 2012 Advocacy Committee, chaired by outgoing WHA President Dr. Nick Turkal, will meet in early spring to help determine next year’s goal.

This year’s contributors are listed in alphabetical order by contribution amount below.

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Contributions ranging from $1 - 499
Adams, Daniel	Memorial Medical Center - Ashland
Alstad, Nancy	Fort HealthCare
Anderson, Layton	Ministry Saint Joseph's Hospital
Andritsch, Stacie	Wheaton Franciscan Healthcare
Annala, Shannon	Aspirus Wausau Hospital
Arendt, Kathleen	Aspirus Wausau Hospital
Ashenhurst, Karla	Ministry Health Care
Ayers, Mandy	Wisconsin Hospital Association
Bablitch, Steve	Aurora Health Care
Ballentine, Anne	Wheaton Franciscan Healthcare
Banaszynski, Gregory	Aurora Health Care
Barkovich, Catherine	Sacred Heart Hospital
Beall, Linda	Hudson Hospital
Beglinger, Joan	St. Mary's Hospital
Bell, Kristine	Aspirus Wausau Hospital
Bernklau, Robert	Aspirus Wausau Hospital
Biros, Marilyn	SSM Health Care-Wisconsin
Bliven, David	Aspirus Wausau Hospital
Bloom, Deborah	Sacred Heart Hospital
Boecker, Ron	Wheaton Franciscan Healthcare
Bosio, David	Aspirus Wausau Hospital
Boson, Ann	Ministry Saint Joseph’s Children’s Hospital
Boudreau, Jenny	Wisconsin Hospital Association
Braun, James	Flambeau Hospital
Braun, Michael	Aspirus, Inc.
Braunschweig, Jennifer	Gundersen Lutheran Medical Center
Brenholt, Craig	St. Mary's Hospital
Brenny, Terrence	Stoughton Hospital Association
Bryans, Richard	Sacred Heart Hospital
Burgener, Jean	Aspirus Wausau Hospital
Busch, Rebecca	Spooner Health System
Buss, Diane	St. Mary's Hospital
Calhoun, William	Mercy Medical Center
Campau, Patricia	Columbia St. Mary's, Inc.
Campbell-Kelz, Nancy	Aspirus Wausau Hospital
Hansen, Carrie	Ministry Health Care
Casey, Candy	Columbia Center
Caven, Michael	Memorial Medical Center - Ashland
Ceelen, John	Ministry Health Care
Censky, Bill	Holy Family Memorial, Inc.
Clark, Renee	Fort HealthCare
Connor, Michael	Aurora Health Care
Cooksey, Patricia	Hudson Hospital
Cox, Tamarah	Aspirus Wausau Hospital
Dahl, James	Fort HealthCare
Dalebroux, Steve	St. Mary's Hospital
Danner, Dean	Aspirus, Inc.
Decker, Michael	Divine Savior Healthcare
DeMars, Nancy	Sacred Heart Hospital
Derks, Darla	Sacred Heart Hospital
DeRosa, Jody	St. Mary's Janesville Hospital
Devermann, Robert	Aurora Medical Center in Oshkosh
Dietrich, Dean	Aspirus Wausau Hospital
Dolohanty, Naomi	Aurora Health Care
Donlon, Marcia	Holy Family Memorial, Inc.
Drengler, Kathryn	Aspirus Wausau Hospital
Drexler, Rochelle	Aspirus Wausau Hospital
Dux, Larry	Community Memorial Hospital
Dwyer, Amy	Sacred Heart Hospital
Ehn, Diane	Froedtert Health
Ela, Susan	Aurora Health Care
Elliott, Roger	St. Joseph's Hospital
Erickson, Susan	Meriter Hospital
Erickson, William	Ministry Saint Mary’s Hospital
Evans, Kim	Bellin Hospital
Evenson, Rock	Froedtert Health
Fabich, Robb	Aspirus, Inc.
Facey, Alice	St. Clare Hospital and Health Services
Fait, Jane	Ministry Saint Joseph's Hospital
Fielding, Laura	Holy Family Memorial, Inc.
Flanagan, Tracy	Sacred Heart Hospital
Freiberg, Kerry	Community Memorial Hospital
From, Leland	Beloit Health System
Fuchs, Thomas	St. Joseph's Hospital
Furlong, Marian	Hudson Hospital
Garavet, Scott	Aspirus Wausau Hospital
Garvey, Gale	St. Mary's Hospital
Gaynor, Stanley	Black River Memorial Hospital
Giedd, Janice	St. Joseph's Hospital
Gigot, Kelly	St. Vincent Hospital
Gjolberg, Skip	Prairie du Chien Memorial Hospital
Goldberg, David	Community Memorial Hospital
Govier, Mary	Holy Family Memorial, Inc.
Graul, Mark	Children's Hospital of Wisconsin
Grohskopf, Kevin	St. Clare Hospital and Health Services
Groskreutz, Kevin	St. Joseph's Hospital
Gruber, Richard	Mercy Health System Corporation
Grunwald, Patricia	Meriter Hospital
Guffey, Kerra	Meriter Hospital
Gulan, Maria	Aspirus Wausau Hospital
Gullicksrud, Lynn	Sacred Heart Hospital
Gutsch, Mike	Southwest Health Center
Hafeman, Paula	St. Vincent Hospital
Halida, Cheryl	St. Joseph's Hospital
Hamilton, Lisa	Aspirus Wausau Hospital
Hamilton, Mark
Hansen, Carrie	Ministry Health Care
Hattem, Marita	Aspirus Wausau Hospital
Heilmann, Lea	Aspirus Wausau Hospital
Hemes, Jim
Hessert, Peter	Aspirus, Inc.
Hieb, Laura	Bellin Hospital
Hill, Nick	St. Joseph's Hospital
Hockers, Sara	Holy Family Memorial, Inc.
Hoege, Beverly	Reedsburg Area Medical Center
Hofer, John	Bay Area Medical Center
Holmes, Sheryl	Aspirus Wausau Hospital
Holub, Gregory	Ministry Door County Medical Center
Hueller, Julie	Wheaton Franciscan Healthcare
Hupf, Angela	Memorial Health Center
Jelle, Laura	St. Clare Hospital and Health Services
Jensen, Russell	St. Mary's Hospital
Johnas, Nancy	Aspirus Wausau Hospital
Johnson, Charles	St. Mary's Hospital
Johnson, Joanne	St. Mary's Hospital
Keene, Kaaron	Memorial Health Center - An Aspirus Partner
Kellar, Richard	Aurora West Allis Medical Center
Kelsey Foley, Kathy	Aspirus Wausau Hospital
Kempen, Jacob	Aspirus Wausau Hospital
King, Peggy	Memorial Health Center
King, Steve	St. Mary's Hospital
Klay, Lois	St. Joseph's Hospital
Kleaveland Kupczak, Sarah	Wheaton Franciscan Healthcare
Kostroski, Sharon	Ministry Saint Joseph's Hospital
Kuehni-Flanagan, Tracy	St. Joseph's Hospital
Lachecki, Therese	Memorial Medical Center - Ashland
Laird, Michael	Froedtert Health, St. Joseph's Hospital
Lange, George	Westgate Medical Group, CSMCP
Lentz, Darrell	Aspirus, Inc.
Leonard, Mary Kay	St. Mary's Hospital
Logemann, Cari	Aspirus, Inc.
Lopas, Mary	Ministry Door County Medical Center
Lucas, Roger	Aspirus Wausau Hospital
LuCore, Patricia	Sacred Heart Hospital
Lux, Teri	Community Memorial Hospital
Magnussen, Eric	Aspirus Wausau Hospital
Marcouiller, Don	Memorial Medical Center - Ashland
Margan, Rob	Wisconsin Hospital Association
Markgraf, Janelle	Langlade Hospital - An Aspirus Partner
Maroney, Lisa
Marquardt, Amy
Marsch, Jean	St. Vincent Hospital
Mason, Paul	Wheaton Franciscan Healthcare - All Saints
Matzke, Monica	Aspirus, Inc.
Maurer, Mary	Holy Family Memorial, Inc.
McKenzie, Paula	St. Mary's Hospital
McKevett, Timothy	Beloit Health System
Meicher, John	St. Mary's Hospital
Meidl, Kathy	Ministry Saint Joseph's Hospital
Meissner, Diane	Ministry Saint Joseph's Hospital
Merline, Karen
Meyer, Jeffrey	Osceola Medical Center
Meyer, Margaret	Community Memorial Hospital
Mohr, Carol	Sacred Heart Hospital
Mourey, Gerald	Aspirus, Inc.
Mueller, Rick	Ministry Saint Joseph's Hospital
Muellerleile, Steven	Westfields Hospital
Mugan, James	Agnesian HealthCare
Mulder, Doris	Beloit Health System
Myers, Lynne	Meriter Hospital
Nakamura, Ron	Children's Hospital and Health System
Needham, Jean	Westfields Hospital
Neikirk, Jon	Froedtert Health
Nelson, Dean	St. Mary's Hospital
Nevers, Rick	Aspirus, Inc.
Niemer, Margaret	Children's Hospital and Health System
Nockerts, Steven	The Richland Hospital
Norton, Marcella	Aspirus Wausau Hospital
Ojala, Theresa	St. Mary's Hospital
O'Keefe, James	Mile Bluff Medical Center
Olson, Bonnie	Sacred Heart Hospital
Oungst, Laurie	Ministry Health Care's Howard Young Medical Center
Omdahl, Nicholas	Wheaton Franciscan Healthcare - All Saints
Ose, Peggy	Riverview Hospital Association
Osen, John	Aspirus Wausau Hospital
Page, Alison	Baldwin Area Medical Center
Palecek, Steve	St. Joseph's Hospital
Peiffer, Susan	Sacred Heart Hospital
Peck, Lori	Memorial Health Center
Pempek, Kalynn	Aspirus Wausau Hospital
Penczykowski, James	St. Mary's Hospital
Peters, Kenneth	Bellin Hospital
Petonic, Mary Frances	Meriter Hospital
Pinske, Heather	St. Mary's Hospital
Piper, Barbara	Sacred Heart Hospital
Polenz, Scott	Memorial Medical Center - Neillsville
Potts, Dennis	Aurora Health Care
Powell, Stacey	Sacred Heart Hospital
Priest, Geoffrey	Meriter Hospital
Proehl, Sheila	Hudson Hospital
Prunty, Brian	Aspirus Wausau Hospital
Quade, Steve	Ministry Door County Medical Center
Quinn, George	Wisconsin Hospital Association
Radoszewski, Pat	Children's Hospital and Health System
Rambert, Luanne	Community Memorial Hospital
Rambo, Kari	Hudson Hospital
Reinke, Mary	Aurora Health Care
Rickelman, Debbie	WHA Information Center
Roethle, Linda	Bellin Hospital
Rozenfeld, Jonathan	St. Mary's Hospital
Rubenzer, Deanne	St. Joseph's Hospital
Rudolph, Wade	Sacred Heart Hospital
Rueber, Joel	Aspirus, Inc.
Rutkowski, Jennifer	Grant Regional Health Center
Samitt, Craig	Dean Health System
Sanders, Paul	Community Memorial Hospital
Saunaitis, Tamara	Meriter Hospital
Schade, Randy	Aspirus Wausau Hospital
Schaefer, Mark	Froedtert Health
Schaetzl, Ron	St. Clare Hospital & Health Services
Schmitz, Bonnie	Agnesian HealthCare
Schraufnagel, Patricia	Memorial Medical Center - Ashland
Schroeder, Larry	Sauk Prairie Memorial Hospital
Schuelke, Susan	Community Memorial Hospital
Schulz, Janet	ProHealth Care, Inc.
Schuster, Lynn	Wheaton Franciscan Healthcare
Scieszinski, Robert	Ministry Door County Medical Center
Scinto, Jeanne	Aspirus Wausau Hospital
Sczygelski, Sidney	Aspirus Wausau Hospital
Sennholz, William	Ministry Saint Joseph's Hospital
Shapiro, David	Columbia St. Mary's Columbia Hospital
Sheehan, Heather	Hayward Area Memorial Hospital and Water’s Edge
Smith, Greg	Wheaton Franciscan Healthcare
Snow, Rachel	Aspirus Wausau Hospital
Sparks, Steven	St. Mary's Hospital
Sprengeler, John	St. Joseph's Hospital
Stanford, Cynthia
Statz, Darrell	Rural Wisconsin Health Cooperative
Stelzer, Jason	St. Clare Hospital and Health Services
Stenson, Jill	Agnesian HealthCare
Stephenson, Sean
Stine, Stephen	Aspirus Wausau Hospital
Stoffel, Julie	St. Joseph's Hospital
Stone, Stacy	Sacred Heart Hospital
Strasser, Kathy	Aspirus, Inc.
Strobel, Donald	Aspirus Wausau Hospital
Sullivan, Anne	Memorial Medical Center - Ashland
Sullivan, Gail	St. Joseph's Hospital
Swiderski, Julie	Wheaton Franciscan Healthcare
Tapper, Joy	Milwaukee Health Care Partnership
Tarantino, Jennifer	Aurora Health Care
Taylor, Steve	Beloit Health System
Tews, Carol	Memorial Medical Center - Neillsville
Tincher, Pat	Langlade Hospital - An Aspirus Partner
Tobin, Susan	Aspirus Wausau Hospital
Todd, Jeffrey	Aspirus Wausau Hospital
Turner, Sally	Aurora Health Care
Turtenwald, Robyn	Community Memorial Hospital
Tuttle, Kathryn	Memorial Medical Center - Ashland
Vakoc, Patricia	Aspirus Wausau Hospital
VanDeVoort, John	Sacred Heart Hospital
Voelker, Thomas	Aspirus Wausau Hospital
Vogt, Paula	Aspirus Wausau Hospital
Waldoch, Timothy	Froedtert Health
Walker, Troy	St. Clare Hospital and Health Services
Wanless, Kathy	Aspirus Wausau Hospital
Washburn, Juliane	Bay Area Medical Center
Watts, Susan	St. Vincent Hospital
Wipperfurth, Kay	Fort HealthCare
Witt, Heather	Aspirus Wausau Hospital
Yaron, Rachel	Ministry St. Clare’s Hospital
Zeller, Brad	Hayward Area Memorial Hospital and Water’s Edge
Zorbini, John	Aurora Health Care
Contributions ranging from $500 - 999
Anderson, Rhonda	Columbia St. Mary's Milwaukee Hospital
Andersen, Travis	St. Elizabeth Hospital
Bailet, Jeffrey	Aurora Health Care
Bayer, Tom	St. Vincent Hospital
Bukowski, Cathy	Ministry Eagle River Memorial Hospital
Bultema, Janice
Byrne, Frank	St. Mary's Hospital
Cardamone, Dr. Steve	Wheaton Franciscan Healthcare
Carlson, Dan	Bay Area Medical Center
Clapp, Nicole	Grant Regional Health Center
Clough, Sheila	Ministry Health Care’s Howard Young Medical Center
Deich, Faye	Sacred Heart Hospital
Dicus-Johnson, Coreen	Wheaton Franciscan Healthcare
Dietsche, James	Bellin Hospital
Eckels, Timothy	Hospital Sisters Health System
Frank, Jennifer	Wisconsin Hospital Association
Garcia, Dawn	St. Joseph's Hospital
Gingerich, Lisa
Granger, Lorna	ProHealth Care
Grundstrom, David	Flambeau Hospital
Guirl, Nadine	ProHealth Care
Heifetz, Michael	SSM Health Care-Wisconsin
Herzog, Sarah	Wheaton Franciscan Healthcare
Hinner, William	Ministry Saint Clare's Hospital
Huettl, Patricia	Holy Family Memorial, Inc.
Hyland, Carol	Agnesian HealthCare
Johnson, Patricia	Hayward Area Memorial Hospital and Water’s Edge
Jurenec, Anne	ProHealth Care - Rehabilitation Hospital of WI
Kersten, Juliet	Children's Hospital and Health System
Kerwin, George	Bellin Hospital
Klimisch, Ronald	Aspirus Wausau Hospital
Korom, Nancy	Children's Hospital and Health System
Krueger, Mary	Ministry Saint Clare's Hospital
Lewis, Gordon	Burnett Medical Center
Mantei, Mary Jo	Bay Area Medical Center
May, Carol	Sauk Prairie Memorial Hospital
McNally, Maureen	Froedtert Health
Nelson, Dave	SSM Health Care-Wisconsin
Nelson, James	Fort HealthCare
Nelson, Nanine	ProHealth Care
Normington, Jeremy	Moundview Memorial Hospital & Clinics
Oberholtzer, Curt	Bay Area Medical Center
Ouimet, Mary	Wheaton Franciscan Healthcare - All Saints
Pedretti, Julie	Children's Hospital and Health System
Peterson, Douglas	Chippewa Valley Hospital
Pollard, Dennis	Froedtert Health
Postler-Slattery, Diane	Aspirus Wausau Hospital
Richards, Theresa	Ministry Saint Joseph’s Children’s Hospital
Rocole, Theresa	Wheaton Franciscan Healthcare
Roller, Rachel	Aurora Health Care
Runge, Charles	Froedtert Health
Russell, John	Columbus Community Hospital
Sale, Nora	Froedtert Health
Schafer, Michael	Spooner Health System
Schneider, David	Langlade Hospital - An Aspirus Partner
Selberg, Heidi	HSHS-Eastern Wisconsin Division
Shabino, Charles	Wisconsin Hospital Association
Ship, Mark	Children's Hospital and Health System
Simaras, James	Wheaton Franciscan Healthcare
Stuart, Philip	Tomah Memorial Hospital
Schoof, Susie
Swanson, Kerry	St. Mary's Janesville Hospital
Thurmer, DeAnn	Waupun Memorial Hospital
Van Meeteren, Bob	Reedsburg Area Medical Center
VanCourt, Bernie	Bay Area Medical Center
Volpe, Joseph	Wheaton Franciscan Healthcare
Worrick, Gerald	Ministry Door County Medical Center
Zenk, Ann	Ministry Saint Mary's
Contributions ranging from $1,000 - 1,499
Alig, Joanne	Wisconsin Hospital Association
Anderson, Sandy	St. Clare Hospital and Health Services
Boland, Susan	Wheaton Franciscan Healthcare - All Saints
Bowers, Brenda	Wheaton Franciscan Healthcare
Britton, Gregory	Beloit Health System
Buser, Kenneth	Wheaton Franciscan Healthcare - All Saints
Court, Kelly	Wisconsin Hospital Association
Duncan, Robert	Children's Hospital and Health System
Edwards, Susan	ProHealth Care, Inc.
Fale, Robert	Agnesian HealthCare
Francis, Jeff	Ministry Health Care
Friberg, Deb	Columbia St. Mary's Milwaukee Hospital
Fritsch, Phyllis	Upland Hills Health
Geboy, Scott	Hall, Render, Killian, Heath & Lyman
Gunn, Veronica	Children's Hospital and Health System
Gutzeit, Michael	Children's Hospital and Health System
Hahn, Brad	Aurora Health Care
Harding, Edward	Bay Area Medical Center
Hilt, Monica	Ministry Saint Mary’s Hospital
Hymans, Daniel	Memorial Medical Center - Ashland
Karuschak, Michael	Amery Regional Medical Center
Kerschner, Joseph	Children's Hospital and Health System
Kosanovich, John	UW Health Partners Watertown Regional Medical Center
Kryda, Michael	Ministry Saint Joseph's Hospital
Little, Steven	Agnesian HealthCare
Loftus, Philip	Aurora Health Care
Martin, Jeff	Ministry Saint Michael’s Hospital
Morgan, Dwight	Aurora Health Care
Nauman, Michael	Children's Hospital and Health System
Niemer, Margaret	Children's Hospital and Health System
Radoszewski, Pat	Children's Hospital and Health System
Reynolds, Sheila	Children's Hospital and Health System
Robertstad, John	ProHealth Care - Oconomowoc Memorial Hospital
Sanders, Robert	Children's Hospital and Health System
Size, Pat
Sohn, Jonathan	Wheaton Franciscan Healthcare
Standridge, Debra	Wheaton Franciscan Healthcare
Troy, Peggy	Children's Hospital and Health System
Wallace, Michael	Fort HealthCare
Westrick, Paul	Columbia St. Mary's, Inc.
Contributions ranging from $1,500 - 1,999
Bjork, Tanya	Capitol Navigators, Inc.
Bloch, Jodi	Wisconsin Hospital Association
Boese, Jennifer	Wisconsin Hospital Association
Canter, Richard	Wheaton Franciscan Healthcare
Coffman, Joan	St. Joseph's Hospital
Eichman, Cynthia	Ministry Our Lady of Victory Hospital
Gorelick, Marc	Children's Hospital and Health System
Grasmick, Mary Kay	Wisconsin Hospital Association
Herzog, Mark	Holy Family Memorial, Inc.
Jacobson, Catherine	Froedtert Health
LePore, Michael	Wheaton Franciscan Healthcare
Mohorek, Ronald	Ministry Health Care
Normington, Jeremy	Moundview Memorial Hospital & Clinics
O'Brien, Mary	Aurora St. Luke's Medical Center
Olson, David	Froedtert Health
Olson, Edward	ProHealth Care
Potter, Brian	Wisconsin Hospital Association
Sexton, William	Prairie du Chien Memorial Hospital
Stanford, Matthew	Wisconsin Hospital Association
Starmann-Harrison, Mary	Hospital Sisters Health System
Warmuth, Judith	Wisconsin Hospital Association
Wolf, Edward	Lakeview Medical Center
Woodward, James	Meriter Hospital
Contributions ranging from $2,000 - 2,499
Borgerding, Dana
Brenton, Mary E.
Fish, David	Hospital Sisters Health System
Kachelski, Joe	Wisconsin Statewide Health Information Network
Katen-Bahensky, Donna
Kief, Brian	Ministry Saint Joseph’s
Leitch, Laura	Wisconsin Hospital Association
Merline, Paul	Wisconsin Hospital Association
Mettner, Michelle	Children's Hospital and Health System
Neufelder, Daniel	Affinity Health System
Oliverio, John	Wheaton Franciscan Healthcare
Pandl, Therese	HSHS-Eastern Wisconsin Division
Sanders, Michael	Monroe Clinic
Troy, Peggy	Children's Hospital and Health System
Contributions ranging from $2,500 - 2,999
Desien, Nicholas	Ministry Health Care
Levin, Jeremy	Rural Wisconsin Health Cooperative
Taylor, Mark	Columbia St. Mary's, Inc.
Contributions ranging from $3,000 - 3,999
Borgerding, Eric	Wisconsin Hospital Association
Kammer, Peter	The Kammer Group
Petasnick, William	Froedtert Health
Turkal, Nick	Aurora Health Care
Contributions ranging from $4,000 - 4,999
Erwin, Duane	Aspirus Wausau Hospital
Contributions $5,000 +
Brenton, Stephen	Wisconsin Hospital Association
Klein, Rick	Aurora Health Care
Size, Tim	Rural Wisconsin Health Cooperative
Tyre, Scott	Capitol Navigators, Inc.

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Legislative Study Committee Supports Key WHA Behavioral Health Task Force Recommendations

On December 19, a special legislative study committee voted to recommend legislation that would require hospital representation on county-level 51.42 mental health policy making boards and also agreed to create a committee workgroup to review and refine a WHA proposal to explicitly align Wisconsin emergency detention procedures with federal law. Both actions stem from key recommendations by WHA’s Behavioral Health Task Force.

The study committee, officially named the Special Committee on Review of Emergency Detention and Admission of Minors Under Chapter 51, is made up of legislators, health care providers, law enforcement, county human services providers, county corporation counsel, and mental health consumer representatives, and met for the first time since December 2010 to review and recommend legislation to improve emergency detention processes in Wisconsin.

George Kerwin, CEO Bellin Health Care and chair of WHA’s Behavioral Health Task Force, and Dr. Gina Koeppl, regional director of Ministry Health Care-Northern Region’s Behavioral Services, serve as hospital representatives on the Committee.

WHA Recommendation: Explicitly align Wisconsin emergency detention procedures with federal law

The study committee discussed the WHA Behavioral Health Task Force’s draft proposal to amend Wisconsin law to help ensure that hospitals would not be penalized under federal law for emergency detention related decisions made by county crisis agencies or law enforcement pursuant to Wisconsin’s emergency detention statute. Pursuant to that statute, in most situations, county crisis agencies and law enforcement have exclusive authority to make determinations regarding whether and how a mentally ill individual may be involuntarily detained under the emergency detention statute and transported for stabilization.

The study committee agreed to create a work group of the Committee to more fully discuss the proposal and to refine language drafted by legislative council attorneys at the request of Rep. Joan Ballweg.

WHA worked with Rep. Ballweg, other legislators on the study committee and other members of the study committee prior to the meeting to help educate them on this technical but important issue, and was pleased that they agreed to add the WHA proposal to the study committee’s discussion.

Stressing the need to address the situation, Dr. Koeppl said, "Hospitals need to be in a position when people do arrive on site to support a diversion to a crisis bed or other appropriate setting."

"We are trying to narrowly craft something that doesn’t create new liability for counties; enables the counties to continue to do [emergency detention] diversionary work, which we support; and meets the consumers’ needs," said Matthew Stanford, WHA vice president, policy & regulatory affairs, in testimony to the study committee.

A first meeting of the workgroup has not yet been set, though WHA anticipates that it will occur in the very near future.

WHA Recommendation: Add hospital representation to 51.42 county behavioral health policy boards.

The study committee also voted unanimously to recommend legislation to the full Joint Legislative Council that would implement the WHA Task Force’s recommendation to include hospital representation on 51.42 Boards that make policy regarding county behavioral health services. The Joint Legislative Council will now have an opportunity to introduce and sponsor the legislation.

To increase collaboration and improve care for individuals with mental illness at the county level, the WHA Behavioral Task Force recommended in its 2010 white paper that hospital representation be required on county 51.42 Boards. Counties are required to have such boards to make policy regarding the county behavioral health services, including mental health crisis services.

"The key issue is to have hospitals and law enforcement involved actively in the discussion to learn from and develop relationships with people on the board and be able to overcome some of the concerns that the committee heard in testimony last year," Kerwin told the study committee in his support of the 51.42 Board recommendation.

Senator Mary Lazich, chair of the study committee agreed. "I think this is an absolutely excellent idea to add the hospital rep and the law enforcement rep [to the 51.42 Boards]….I know from my prior experience on a human services board that that expertise would be invaluable."

Other issues

The study committee also considered 11 other reforms. Notable recommendations of the study committee included ensuring that Dane County would not become subject to special emergency detention procedures, which are now statutorily required only of Milwaukee County, once Dane County’s population exceeds 500,000 individuals; creating new limited exceptions to the statutory requirement that an individual in Milwaukee County must be evaluated for detention by the detention facility treatment director within 24 hours; and creating new limited exceptions to the statutory requirement that a probable cause hearing must be held within 72 hours of the initiation of an emergency detention.

Due to time constraints, the study committee was unable to discuss two additional draft bills regarding the creation of a mental health power of attorney statute and various reforms to the admission of minors for behavioral health treatment under s. 51.13 of the Wisconsin Statutes. It is anticipated that these issues will be taken up by the Task Force at a future meeting.

If you have any questions or input on any of these issues, please contact WHA’s Matthew Stanford at mstanford@wha.org or 608-274-1820.

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President’s Column: "From the Cutting Room Floor – Good Out-takes from ‘Results’"

Every year about this time, we produce a publication that reviews the "Results" of your Association’s work over the past 12 months. Most of you know me well enough by now to know that I appreciate brevity. Our eight-page report could have easily been 16 pages. It was a busy, productive and often challenging year. The state budget, the federal deficit, health reform implementation, physician workforce report, and issues associated with Medicare and Medicaid were enough to keep us on the "top of our game," a dynamic we’ll need to maintain in 2012.

In the space of my column this week, I’d like to highlight a few priorities that were not included in the 2011 "Results" publication, which is in our Friday packet this week:

ICD-10 Readiness – Remember when we all waited with eyes wide open for the clock to strike 12:01 AM in the year 2000? Some experts are likening the ICD-10 transition to Y2K. The hope is that it, too, will be as uneventful as that moment 12 years ago due to advanced planning and careful attention to critical implementation timelines.

Thanks to staff efforts at WHA, we have been acknowledged by our members as a valued ICD-10 educational resource, offering 22 different sessions focused on ICD-10 readiness this year. Several of my President’s columns in 2011 were devoted to "sounding the alarm" and ensuring that our members were aware of key deadlines. You can count on us to continue to stay abreast of this issue in 2012. This coming year is the critical time to activate your implementation plan full force while bringing your physicians into the fold, fine tuning your education plan, assessing managed care contracts and planning for possible threats to financial stability, and frequent communication with vendors to ensure timely and accurate system transitions.

Workforce – While the WHA physician report, "100 New Physicians A Year" received a lot of attention this past year, the health care workforce as a whole continues to be closely watched and occasionally influenced by WHA staff. In 2011, the trend of having a lot of vacant positions basically disappeared as the recession took hold. Member hospitals reported in the WHA annual personnel survey that they were experiencing the lowest vacancy rates since WHA’s first survey in 2000. In spite of the slowdown, however, hospitals reported having more than 3,000 vacant positions. WHA will release its annual workforce survey early in 2012.

Communications and Education – At the beginning of every year, WHA staff are asked to select five member hospitals and schedule on-site visits. Over the past couple of years, most of you have welcomed staff and provided them with insights that we cannot gain from emails, regional programs or even Council meetings. During the course of those visits, we heard many times over the value of WHA’s communication and education efforts. An Association is only as strong as its ability to communicate effectively on the issues that are your highest priorities. Every week, we strive to collect the latest information and report to you on issues that are critical to your success. Our special reports are designed to give our members, and oftentimes, legislators and other stakeholders, a better perspective on an issue and provide readers with the impact that it will have on Wisconsin.

We view our commitment to member education as proactively providing information that will help you meet your staff education goals. In the last year, we offered 125 webinars, 21 in-person conferences and seminars, and hosted nearly 4,200 attendees from Wisconsin hospitals. Next year, we have a full education agenda planned, with flexibility built in to address new education needs that may arise as the year rolls on.

We hope you enjoy reviewing "Results." It is a privilege to serve the hospitals of Wisconsin. We wish you a Happy New Year and thank you for your continued support of YOUR Association.

Steve Brenton,
President

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Medicaid Spared from Budget Lapse

The Walker Administration last week provided additional details concerning the "unallocated lapse" of $174 million that was part of the 2011-2013 biennial budget (2011 Wis. Act 32). The budget bill requires the secretary of the Department of Administration (DOA) to develop a plan for the discretionary lapse and submit that plan to the Legislature’s Joint Committee on Finance for review. The Medicaid program was spared from the lapse.

Announcing the lapses and confirming that the Medicaid program would not be affected, DOA Secretary Mike Huebsch wrote, "In establishing the lapse targets, specific educational exemptions were granted to school aids, higher education financial aid and technical college aids. In addition, Medical Assistance and other direct care programs at the Department of Health Services (DHS), and the Department of Children and Families’ child welfare and certain Temporary Assistance for Needy Families programs were exempted."

DOA’s plan includes a lapse of $24 million related to a performance bonus the Medicaid program received from the Centers for Medicare and Medicaid Services for simplifying their enrollment and renewal processes and increasing the enrollment of uninsured children in the Medicaid program. The $24 million bonus reportedly had not been budgeted for Medicaid expenditures and, therefore, does not increase the amount of savings, approximately $550 million, DHS must identify in the Medicaid program in its 2011-2013 budget.

Subsequently, a plan was announced to lift the Family Care cap imposed in the last budget and to expand Family Care to additional counties. The funding source for lifting the cap, estimated to be $80 million, and expanding the program to additional counties is unclear.

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Congress Passes Hospital Supported TRICARE Clarification
Without change, TRICARE patients might have had fewer health care options

"At a time when hospitals are being asked to do more with less reimbursement, it makes little sense to divert financial resources from patient care in order to satisfy administrative requirements," the American Hospital Association (AHA) told Congressional leaders considering the conference agreement on the National Defense Authorization Act (HR 1540). The legislation includes language clarifying that TRICARE network providers should not be considered subcontractors under the Federal Acquisition Regulation and other law. AHA, WHA, and other health care organizations strongly supported the clarification. Congress passed the conference agreement on December 15, 2011.

The Office of Federal Contract Compliance Programs (OFCCP) recently took the position that hospitals and health systems that serve as TRICARE providers are federal subcontractors, imposing additional burdensome and costly requirements that apply to federal contractors and subcontractors. The OFCCP’s position is contrary to the position taken by the U.S. Department of Defense, the agency charged with administering TRICARE.

AHA reminded the members of Congress that hospitals are currently subjected to a myriad of laws and regulations, including anti-discrimination regulations, that are appropriately enforced by many agencies. Some hospitals that care for TRICARE patients reportedly have had to weigh whether to continue in the program because of the increased administrative costs associated with participation. As a consequence, without the recently passed legislation TRICARE patients might have had fewer health care options available to them. TRICARE provides health care coverage for uniformed service members and their families.

On December 21, 2011, Congress sent the bill to the President for his consideration. The President is expected to approve the legislation. A copy of the enrolled bill is available here (see Section 715): http://thomas.loc.gov/cgi-bin/query/z?c112:H.R.1540:

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Wisconsin Hospitals Community Benefits: Charity Care

Fear of a bill should never prevent a patient from seeking care at a Wisconsin hospital. Wisconsin hospital charity care programs provided $232 million to more than 700 patients each day 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.

Supporting the vulnerable during difficult times

Tim, a single male in his early 20s, found himself with some health issues that interfered with his ability to perform the requirements of his employment. He needed to leave his job until his medications could be regulated and managed well enough for him to return to work safely. This process was expected to take months and Tim’s employer could not wait; they needed to fill his position.

Tim had no choice but to return to his parents’ home to live until such time that he would again be gainfully employed and able to be self-sufficient. Tim did contribute $100 per month for room and board to his parents when he was able to during this time of extended illness and recuperation. Holy Family Memorial granted Tim 100 percent assistance for his medical bills through the Community Care Program. By doing so, Holy Family Memorial assisted him on his journey back to self-sufficiency and rejoining the workforce.

Holy Family Memorial, Inc., Manitowoc

A familiar face with an all-too familiar story

Most people who are uninsured wait too long – until their pain is unbearable. Then they go to the emergency department (ED) for treatment.

One familiar face to the staff in the ED at Aurora Medical Center of Manitowoc County was admitted four times within several months. That familiar face belonged to a young woman, age 23, whose first ED visit was for dental pain due to lack of oral hygiene – a condition that had progressed into upper respiratory infections and caused her severe difficulty breathing. She was well aware that her medical bills were piling up.

The patient met with a financial counselor and revealed that she was living on her own and working part-time for an employer who does not offer health insurance for part-time employees. Luckily, she enrolled in a government program called Foodshare, which provided food stamps. Her initial thought was to work out a payment plan with the financial counselor. At that point she was encouraged to apply for Aurora’s Helping Hand financial assistance program, which provides free or discounted care to those in need. Within weeks, the patient received news that she qualified for a 100 percent discount through the Helping Hand program. In addition, the financial counselor was able to link her with the local One-Stop Job Center case manager to work with her on seeking a full-time job with health benefits.

Aurora Medical Center in Two Rivers

ThedaCare provides financial assistance

Brian Zenefski of Neenah always prided himself on paying bills on time. But when medical bills began to mount, the unemployed man worried about his future.

"More money going out than what was coming in," said Zenefski, 56, who lost his job in 2008.

Zenefski has numerous medical issues, such as a lung disease called sarcoidosis, and requires follow up treatments for asthma, his heart and prostate cancer, which was treated last year. With no money or insurance, Zenefski was not sure he could get the care he needed.

"It was getting to a point of just not go to the doctor and take my chances," he said.

ThedaCare’s Caring Hearts financial assistance program accepted Zenefski, providing $16,000 in medical assistance.

Having the assistance was a blessing, said Zenefski. "I was really happy," he said. "I did not know how I was going to take care of these bills."

Zenefski had been hesitant to accept assistance. But he knew there was no choice.

"I was just so overwhelmed," he said, noting he made as many cuts as he could to make ends meet. "I just pictured myself being out in the street. How can I get a job when my health is so lousy?"

ThedaCare, Appleton

The never-ending cycle

It was a never-ending cycle for a 54 year-old divorced female patient who was a frequent patient in the emergency department (ED) at Aurora St. Luke’s Medical Center. She had 16 inpatient admissions and five ED visits in 2010, resulting from congestive heart failure and severe diabetes. The patient initially lived alone, but eventually moved in with her adult daughter as she was unable to keep a job due to her health issues.

A financial counselor met with the patient to provide a variety of assistance options, which included an application for Aurora’s Helping Hand program. The patient’s health had deteriorated to the point that the doctor declared her presumptively disabled, and Aurora Family Services assisted with a Title 19 application. Although the patient was approved for coverage in the future, all of her previous dates of service were not covered by Title 19. The patient was approved for 100 percent coverage through Aurora’s Helping Hand program for the dates of service not eligible for coverage by Title 19. The bills, a total of nearly $190,600, were covered by Aurora’s Helping Hand program.

Aurora St. Luke’s Medical Center, Milwaukee

Once healthy Pewaukee resident caught off guard with serious infection

At age 31, Brian Matthews was young and healthy and didn’t worry much about not having health insurance. Between being in and out of work in a tough economy and trying to get a small business off the ground, the Pewaukee resident says he just couldn’t afford it. But in May 2011, Brian admits he was caught off guard when he developed a serious infection in his lower right leg. It was swollen to twice its normal size when he finally sought medical treatment at the Wheaton Franciscan – Elmbrook Memorial Emergency Department in Brookfield.

Quickly diagnosed with cellulitis, Brian was hospitalized for nearly two weeks while he underwent antibiotic treatment and two separate surgeries. He was told the condition could have been deadly at that point.

"It’s enough to be stressing over your health, and then I was worrying about the financial part and what I’d face later. I knew right away this would be expensive," Brian shared.

Fortunately, Brian was able to qualify for Wheaton’s Community Care program, which paid for 100 percent of his care. Cris Liebhauser is the Wheaton Franciscan financial counselor who assisted him with the application. She said, "When I walked into Brian’s room and saw how painful his leg looked, the first thing that came to mind was that I had to help him."

"I’m incredibly relieved and very grateful for the help. This was my first time ever needing to be in a hospital. In my case, the financial assistance really saved me. More than a month later, I’m still in outpatient treatment and I don’t know what I’d do without it."

Wheaton Franciscan Healthcare – Elmbrook Memorial, Brookfield

At the end of her rope?

Life can be challenging enough when you are unemployed and trying to make it through day by day, but imagine the struggle when a diagnosis of cancer is added to the equation.

One woman, who was unemployed and facing foreclosure on her home, had just sold valuable family memorabilia to try to save her home and also support the family. Shortly thereafter, she was diagnosed with cancer at Aurora West Allis Medical Center. Her doctor ordered tests and procedures that needed to be done as soon as possible.

Through tears she told the financial counselor, "I am at the end of my rope."

The financial counselor guided her through the application process for the Aurora Helping Hand financial assistance program. The patient received wonderful news that she was eligible for a 100 percent discount for all the procedures she needed

The financial counselor said, "Just knowing that she had a light at the end of the tunnel, someone helping her and providing her guidance, is at least one less stress in her life. I am so glad to be able to help her concentrate on the most important thing, and that is for her to fight for her life and beat that cancer."

Aurora West Allis Medical Center

Submit community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

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

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