The Federal Environmental Protection Agency (EPA) is seeking public comment on a proposed rule published December 2 that would simplify collection and disposal requirements for hazardous pharmaceutical wastes and help ensure that "hazardous pharmaceutical wastes are properly disposed of and treated as hazardous waste."

The proposed rule would permit hospitals, clinics, and others to manage and dispose of hazardous pharmaceutical wastes as "universal hazardous waste," which currently includes hazardous wastes such as batteries, florescent light bulbs, and mercury thermometers.

For hospitals, this rule should reduce management and disposal costs for hazardous pharmaceutical wastes. The proposed rule reduces waste determination and separation requirements and reduces tracking and documentation requirements. Additionally, if enacted, the proposed rule should reduce shipment costs to disposal facilities due to the rule’s increased accumulation and storage time limits for hazardous pharmaceutical wastes and because waste haulers typically charge substantially less for shipments of universal hazardous waste compared to other hazardous waste.

Existing EPA requirements "add to the complexity and burden of managing pharmaceutical waste appropriately," according to the EPA in its notice of the proposed rule. "[G]iven the number of different pharmaceuticals generated as waste and the small volumes, the benefit [of the requirements] may not always be commensurate with the burden they impose."

This rule is not final. EPA is encouraging comments on the proposed rule by January 2, 2009. A copy of the proposed rule and commenting instructions can be found at http://edocket.access.gpo.gov/2008/pdf/E8-28161.pdf. WHA will be working with the American Hospital Association on a comment letter to EPA. For more information, contact Matthew Stanford at mstanford@wha.org or 608-274-1820.

Hospitals report that physical therapy (PT) positions are difficult to fill, a situation that is cause for alarm and action for not just the Wisconsin Hospital Association, but now the Wisconsin Physical Therapy Association (WPTA) is joining forces with WHA to help address the problem.

According to the most recent WHA Hospital Workforce Report, physical therapists and physical therapist assistants are both in short supply and in demand by hospitals. WPTA has appointed a task force to search for and recommend strategies to increase the number of therapists and assistants. The task force is particularly interested in recruiting physical therapists to work in Wisconsin hospitals. Members of the task force include representatives from Aurora Health Care, Froedtert Hospital and UW Hospitals and Clinics.

Members of the WPTA Task Force met with WHA staff to discuss how the two groups might work together to increase supply. At this meeting, problems that are fueling the current shortage were identified as follows:

• The limited number of PT and PTA programs in Wisconsin
• The rate at which PTs leave hospital employment and move to independent practice
• The rate at which graduates leave Wisconsin to practice elsewhere
• The likely increase in demand for PT services as older patients experience joint repair and replacement
• An erroneous belief by PT students that hospitals, especially small rural hospitals, are uninteresting places to practice.

WHA and WPTA agreed that collaborating on the issue would be beneficial and each group would identify actions it can take that could alleviate a shortage.

According to Judy Warmuth, WHA vice president of workforce, "This partnership has wonderful potential to define the steps and implement the actions necessary to address this critical shortage for Wisconsin hospitals. We look forward to working with WPTA to find long-term solutions that will lead to an adequate number of PTs working in Wisconsin hospitals."

Contact Judy Warmuth at jwarmuth@wha.org or 608-274-1820. Warmuth encourages member input.

WHA desires a better understanding of your changing needs and priorities and a clear picture of what we need to be doing to address those needs. To accomplish this, WHA has again contracted with SatisfactionWorks, a California-based research company, to conduct a membership satisfaction survey. This evaluation lets you provide us with your ratings and comments on a variety of essential topics, without taking too much of your time. This is your opportunity to rate WHA’s effectiveness and value. And it works, as your input in 2006 led to the development of our proactive physician workforce agenda!

One executive at each member hospital and health system will receive an invitation to complete the survey, either online or in written format. The survey will only take 10-15 minutes of your time. The collective opinions and ratings will be reviewed by our senior management team, shared with you, and be used by the WHA Board for strategic planning.

Member participation in the confidential survey is critical to the success of this effort. Significant participation, followed by incorporation of survey findings into WHA’s current and future programming, will enhance member value.

The Centers for Medicare and Medicaid Services (CMS) has released its final Outpatient Prospective Payment System (OPPS) rule for calendar year (CY) 2009. This final rule will significantly change Medicare outpatient payments and reporting requirements over the next several years.

Significant provisions of the final rule include:

Marketbasket Factor: The final CY 2009 APC rates will include a full marketbasket update of 3.6 percent for CY 2009. Hospitals that were not compliant with the outpatient quality reporting requirements will receive the marketbasket update minus 2.0 percentage points.

The conversion factor will increase from $63.694 in CY 2008 to $66.059 in CY 2009, which includes a budget neutrality adjustment of 0.1 percent.

Outliers: The outlier fixed-dollar threshold will increase from $1,575 in CY 2008 to $1,800 in CY 2009. Outlier payments are provided when the cost of furnishing a service exceeds 1.75 times the APC payment amount and exceeds the APC payment rate plus the $1,800 fixed-dollar threshold.

Quality Measures: CMS is adopting its proposal to increase the number of outpatient quality measures that hospitals must report from seven to 11 in CY 2009. Hospitals that fail to report the 11 measures in CY 2009 will receive a reduction of 2.0 percentage points to their marketbasket update in CY 2010. The four additional quality measures focus on imaging efficiency. CMS will continue to consider 18 additional outpatient quality measures for future years’ reporting.

Validation of Quality Reporting: CMS is implementing a voluntary quality data validation approach for CY 2010, beginning with encounters from January 2009, the results of which will not affect the CY 2010 payment update for any hospital.

Composite Ambulatory Payment Classification (APC) Groups: CMS is increasing the number of composite APCs from five to ten for CY 2009. Composite APCs provide a single payment when a specified combination of outpatient procedures are provided in a single patient encounter, rather than paying for each service individually. The additional five composite APCs cover multiple imaging services.

Type B Emergency Department Visits: Type B emergency departments (EDs) offer emergency level services, but are not open 24/7. Currently, these services are paid under clinic APCs. CMS is creating four new APCs for Type B ED visits. In addition, Level 5 Type B ED visits will be assigned to the same APC as Level 5 Type A visits. Based on data collected over the past few years for the Type B ED visits, CMS’ analysis shows that they are more expensive than clinic visits but less costly than an emergency visit.

The Final Rule and a more detailed summary are located on the WHA Web site at www.wha.org/financeAndData/reimbursement.aspx. Information on other Medicare and Medicaid reimbursement issues are also located at that link.

Less than one month following statewide news conferences held in Wausau, Madison and Milwaukee to showcase the report Who Will Care For Our Patients?, new national and local attention is focusing on the primary care physician crisis identified in the Wisconsin Council on Medical Education and Workforce (WCMEW) report (authored by WHA Senior Vice President George Quinn).

The front page story in the November 2008 AHA magazine H&HN focuses on "The Disappearing Primary Care Physician," and The Physicians’ Foundation has released findings from a survey of general practice physicians providing further evidence that current geographic-centered internal and family medicine physician shortages will mushroom into a primary care crisis very soon. And last Sunday, the Milwaukee Journal Sentinel ran an extensive editorial entitled "Paging New Doctors" that focused on issues raised in the WCMEW report.

Most health reform plans in play nationally and at the state level envision enrolling thousands of people who are currently uninsured in "medical homes" that are "managed" by primary care physicians. But desired outcomes based on those strategies will be undermined by the absence of infrastructure necessary to care for this new patient population. That’s exactly what is happening today in Massachusetts where thousands of the "newly insured" cannot find a primary care physician and continue to use hospital EDs as their access point for episodic care.

The WCMEW report provides a blueprint to address the physician workforce challenge  (www.wha.org/pubArchive/special_reports/2008PhysicianReport.pdf). The difficulty will be to get elected officials to see the matter as a current priority given the barrel full of other "crises" currently in play in Madison and in Washington, D.C. For too long lawmakers have relied on the private sector to subsidize the education and training of tomorrow’s physicians. Recent cuts in Madison (indirect medical education) and in Washington (Medicare funding and residency training) have demonstrated shortsightedness that all too often is the currency of the political process.

Health reform initiatives must not ignore address of adequate infrastructure necessary to care for newly "covered" patient populations. Absent appropriate "access," enhanced coverage will fail to improve patient care.

Steve Brenton
President

In a continued effort to play a small role in improving the health care workforce situation in Wisconsin hospitals, the WHA Foundation, Inc., awarded 35 scholarships, worth approximately $38,000, to health care students during the 2007-2008 school year.

This was the fifth year that the WHA Foundation has provided these scholarships. A unique twist to the Foundation scholarship program is that, unlike most scholarships, it covers tuition and book expenses for the final semester of the technical college degree program, to assist and encourage students to make that one final push toward graduation and a career in health care. Each scholarship winner is reimbursed for actual tuition and book expenses, up to $2,000.

Since the program’s inception in mid-2003, a total of 159 scholarships, worth more than $168,000, have been awarded to students of the state’s 16 technical colleges. Degrees earned include nursing, physical and occupational therapy, radiography, respiratory care, health information technology and a variety of other health care-related two-year degree programs.

In a thank you letter to the Foundation, one scholarship recipient writes, "Your support is invaluable to students such as myself who are not only busy studying, but are also busy raising families and holding down jobs. Your support has helped me make my dream come true."

Another recipient writes, "Returning to school has been difficult at times due to the investments of time and finances. Yet, to this day, I know I made the right decision because I truly enjoy my new career! … Someday, I hope to be in a position in which I may be able to donate to a scholarship fund to help others as you have helped me."

The new FMLA Final Rule becomes effective January 16, 2009, and the regulations provide new military family leave entitlements in addition to updating the regulations under the 15-year-old Act. All covered employers will need to review and revise their FMLA policies, procedures and forms between now and January 16, 2009, and make changes in order to comply with the new regulations.

WHA is offering a webinar on Wednesday, December 10, at 12 p.m., and a repeat session at 4 p.m. to focus on the recent changes and share key strategies for compliance with the new regulations. By the end of the session, you will know:

• How the new regulations may affect your employees who are in the military or who have family members in the military;
• How the Act defines "serious health condition";
• When and how an employer can contact the employee’s health care provider directly;
• What to do to bring your FMLA forms into compliance; and
• Your notice obligations.

Newly-elected Fred Clark (Assembly District 42) recently visited St. Clare Hospital & Health Services in Baraboo. Rep-Elect Fred Clark received a tour of St. Clare Hospital, discussed the hospital’s commitment to the community and heard insights into important legislative issues for the hospital.

During his tour, Rep-Elect Clark saw the hospital’s new Stereotactic Breast Core Biopsy and Digital Mammography facility. Besides U.W. Hospital in Madison, St. Clare is the only other hospital in the area to offer this minimally invasive diagnostic test, which has virtually replaced surgical intervention.

St. Clare Hospital CEO Sandy Anderson said the investment was worth it because "early diagnosis is crucial in the successful treatment of breast cancer, and these tools are essential in achieving that end."

St. Clare is committed to building legislative relationships and this recent visit is another example of that dedication.

Mark your calendar for the 2009 Health Literacy Summit, sponsored in part by the WHA Foundation, on March 31 – April 1, in Madison. The Summit will focus on continuing communication between health care professionals and adult literacy educators and the exchange of ideas on how to improve the delivery of health care to Wisconsin adults with low literacy and limited English speaking skills.

Summit highlights include a keynote address by Andrew Pleasant, author of "Advancing Health Literacy: A Framework for Understanding and Action," as well as health literacy initiatives from other states, interventions in health care settings, and the Joint Commission’s new health literacy standards.

In addition, Wisconsin Literacy is currently accepting proposals for best practice initiatives in the area of health literacy awareness or education at the 2009 Summit. Opportunities exist for both 20-minute information sessions and 80 minute workshops. Proposals are due by December 31 and can be submitted to Georgia Weier at Wisconsin Literacy at georgia@wisconsinliteracy.org.

Registration information will be forwarded when it becomes available. In the meantime, if you have questions about the Summit, contact Georgia Weier at 608-257-1655 or georgia@wisconsinliteracy.org. For more information about the WHA Foundation, contact Jennifer Frank at 608-274-1820 or jfrank@wha.org.

Sue Lynch, a volunteer at Franciscan Skemp of La Crosse, has been appointed by the American Hospital Association Board of Trustees to serve a one-year term as the chair of the AHA Committee on Volunteers. Sue Lynch served as the Public Policy Education (PPE) chair for the Partners of WHA and led the Franciscan Skemp auxiliary for eight years.

"This AHA appointment is well deserved recognition of Sue’s service and leadership, two attributes that she has so ably demonstrated during her years of active involvement in Partners of WHA," said WHA President Steve Brenton.

During her tenure as chair of the AHA Committee on Volunteers, Lynch will help provide insight and direction for volunteers and auxiliaries nationwide. The Committee plays a significant role in supporting AHA’s mission and public policy agenda, including:

• Identifying issues and policies,
• Identifying institutional practices requiring AHA’s consideration and action,
• Advising AHA on programs and services directed to volunteers and auxilians, and
• Providing AHA with a community perspective on hospital issues.

Lynch has done the same thing in Wisconsin during her time as statewide public policy education (PPE) chair of the Partners of WHA. In her role as PPE chair, Lynch worked cooperatively with WHA and its HEAT grassroots program to educate and mobilize hospital volunteers on important issues that impact Wisconsin’s community hospitals. Those efforts resulted in at least 1,000 legislative contacts in the past year alone. WHA congratulates Lynch on her appointment.

Wisconsin gets an overall health grade of B- compared to other states, according to Dr. David Kindig, professor emeritus of population health sciences and vice-chancellor emeritus for health sciences at the University of Wisconsin-Madison.

Addressing the Wisconsin Quality Steering Committee December 2 meeting in Madison, Kindig said as part of its mission to translate research into policy and practice, the University of Wisconsin Population Health Institute has prepared the Health of Wisconsin Report Card to increase understanding of the health of Wisconsin and to better characterize health disparities on a county-by-county basis.

This health grade is based on both the length and the quality of life of Wisconsin’s residents. But reporting just an average grade ignores the state’s failing health of several of its sub-groups. A health disparity grade has also been developed that breaks the state’s population down by gender, geography, race/ethnicity and socioeconomic status.

The UW’s Population Health Institute has developed a model for data collection and action in response to the report card. This model indicates there are numerous factors that influence health and health disparity across life stages. These factors are characterized into four categories: genetics, social and physical environment, public health & health care systems, and individual health behaviors. The data from the model are being used to help identify opportunities for making Wisconsin the healthiest state.

Kindig stated that Wisconsin must invest in the three categories we have control over to improve Wisconsin’s health grade. Potential policies and programs are being evaluated as a result. Any improvement in health as a result of these policies and programs will likely be measured in years rather than months.

The results of Dr. Kindig and his team’s work will be turned over for use in the development of the next State Health Plan, "Healthiest Wisconsin 2020." The two reports Dr. Kindig presented can be found at:

Health of Wisconsin Report Card 2007:
www.pophealth.wisc.edu/UWPHI/research/report_card_2007/report_card_2007.pdf#cover

Opportunities to Make Wisconsin the Healthiest State:
www.pophealth.wisc.edu/UWPHI/research/healthy/opportunities.pdf

ForwardHealth is meeting with providers in December to share updates and additional information on the implementation of ForwardHealth interChange and the provider portal. These sessions will:

• Answer common questions ForwardHealth has received from providers post-implementation.
• Provide the latest information on the implementation of the new processing system.
• Review the format of new Remittance Advices and how to read the information contained in the report.
• Share information and tips for use of the provider portal including account set-up and maintenance, enrollment verification, claims research, and submitting prior authorizations.
• Give providers the opportunity to ask questions about the new system and the functionality of the provider portal.

The dates and locations of the sessions are:

December 10:
Country Springs Hotel, Pewaukee, 2810 Golf Rd., Pewaukee, WI 53072; (262) 547-0201

December 15:
Crowne Plaza, Madison, 4402 E Washington Ave., Madison WI 53704; (608) 244-4703

December 16:
Holiday Inn-Campus, Eau Claire, 2703 Craig Road, Eau Claire WI 54701; (715) 835-2211

December 17:
The Plaza, Wausau, 201 N 17th Ave., Wausau, WI 54401; (715) 845-4341

December 17:
Holiday Inn Select, Appleton, 150 S Nicolet Rd., Appleton, WI 54914; (920) 735-9955

There will be three, two-hour sessions at each location. No registration is required; however, in order to focus the discussion, providers are encouraged to attend the session appropriate to them—professional or institutional. Session times at each location are:

• 8:00 a.m. -10:00 a.m.: Professional service providers (for those billing on the 1500 Health Insurance Claim Form).
• 10:30 a.m. -12:30 p.m.: Institutional service providers (for those billing on the UB-04 Claim Form).
• 1:30 p.m. – 3:30 p.m.: Professional service providers (for those billing on the 1500 Health Insurance Claim Form).

Top of page

Cancer. It’s a word that strikes fear in even the strongest person. But if caught early, most cancers are treatable and curable.

Affinity Health System teamed up with the American Cancer Society, ThedaCare, and the Fox Cities Community Health Center to bring free cancer screenings to individuals in the Fox Cities Community. More than 65 people participated in this annual event and received screenings, performed by medical personnel, for prostate, breast, colon, skin and oral cancers.

"With cancer, timing is everything," says Faye Kamrath, director of radiology for Affinity Health System. "By providing free screenings, we are reaching out to individuals that are either uninsured or underinsured who may not have the means for adequate preventive health care."

Individuals interested in the screenings were asked to register with Affinity NurseDirect where they were informed about each test and allotted an appointment time. During the screening, volunteers asked about the individual’s health history and any concerns.

"Each year this event continues to grow," says John Fuller, manager of the St. Elizabeth Hospital Cancer Center. "I’m glad we continue to work together to provide this much-needed service. These individuals are so appreciative."

In any given community there are children who endure health challenges so insurmountable that Hospice and Palliative Care care become the best option to enable them live out their life expectancies with as little distress as possible—with dignity and in familiar surroundings with the people they love, and who love them.

Unfortunately, many of these children are at risk of falling through the cracks because family resources for the child’s health care needs are exhausted. In such cases, families need a support system that will enable them to bring their child home from the hospital and feel confident they can manage the child’s care needs and be prepared, knowing what to expect.

Aurora Visiting Nurse Association Hospice is that support system. The Hospice interdisciplinary care team provides a continuum of care to ensure that the physical, emotional and spiritual needs of the child and the whole family are met, in keeping with the organization’s mission to provide service based on patients’ needs, not their ability to pay.

At any given time, this special team of caregivers provides care and support to as many as 12 to 15 children and their families daily under the Hospice and Palliative Care program. They are a source of great relief to families who need to have quality time together—for however much time they have. The Aurora VNA hospice team continues to sustain families with bereavement and grief support to ensure coping skills are sufficient to meet the changing needs of the family.

According to Dr. Glenn Ragalie, Hospice Medical Director for Aurora VNA Home Hospice and Aurora Zilber Family Hospice Residence, "Aurora VNA Hospice is an invaluable service for children and parents across Southeastern Wisconsin."

Howard Young Medical Center has partnered with the Lakeland Food Pantry to establish a Food Pantry Healthcare Enhancement Program. Through this program, health care professionals from the hospital and Ministry Medical Group collaborate to provide free health care screenings, education, assistance with insurance paperwork and access to a variety of services. The focus of the program is to bring health care to the Food Pantry recipients who typically find accessing health care challenging due to limited income, transportation or limited understanding of how to navigate the health care system. This program has provided blood pressure screenings, free glucose and cholesterol testing, education on nutrition and exercise, and access to social workers to assist with depression and anxiety. Hundreds of hours and thousands of dollars in health care resources have been donated to help these community members in an attempt to address health care issues before they end up in the emergency room in an acute disease state. These prevention strategies have been very successful and have reached over 200 community members monthly.

One story highlights this success. A gentleman who participated in the cholesterol screening found out he had extremely high cholesterol, a measure of heart health. Through our program we helped the gentleman register for doctor appointments, complete paperwork for our Charity Care program to cover the cost of services, and even arranged for transportation to his doctor appointments. It was all worth it the day he shared with our nurse at the Food Pantry that his cholesterol was in control and he was feeling great! Our program is making a difference, one person at a time!

With the shortage of health care workers in all areas of the health care industry, Spooner Health System decided to hold a health career fair for high school students.

Our objectives were to:

• Introduce the students to the many careers that are available in health care

• Provide the student with the opportunity to speak with staff about their personal job experiences

• Inform students of the educational requirements needed for each career and to guide them as to what courses they should take in high school

• Encourage the student to participate in our job shadowing program

The managers in all departments at Spooner Health System did a great job of creating display boards with information about each of their departments meeting the above objectives.

We also had representatives from Chippewa Valley Tech, UW Barron County, W.I.T.C. Rice Lake and Lake Superior College, Duluth, MN to inform students of their health-related education programs.

The career fair was open to the general public and current employees interested in advancing their careers. We will offer a health career fair annually with the hopes of reaching even more students.

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

Top of page