March 25, 2011
Volume 55, Issue 12



WHA’s Medicaid Advisory Group Begins 2012 Rate Setting Process
Medicaid Program and Funding Changes in the Proposed Biennial Budget Discussed

The WHA Medicaid Advisory Group (MAG) held its first meeting in 2011 with staff from the Wisconsin Department of Health Services (DHS) was held March 22 at the DHS offices in downtown Madison. The major focus of the meeting was DHS’s presentation of Medicaid program and funding changes included in the Budget Adjustment Bill and the Governor’s Biennial Budget Bill. This set the stage for upcoming MAG meetings when hospital rates for rate year 2012 will be discussed.

Brett Davis, administrator of the Wisconsin Medicaid Program, Jim Johnston and Curtis Cunningham from DHS, and Matt Sorrentino, a DHS consultant from Public Consulting Group, took the advisory group through the overall funding included in the biennial budget for the Medicaid program. Davis explained that although the Governor’s budget provides an infusion of $1.3 billion in general purpose revenue (GPR) into the Medicaid program, there is still a projected cost-to-continue shortfall of $500 million GPR. The Department explained options for achieving savings in Medicaid, including possible changes to program eligibility and enrollment, achieving health care efficiencies, and changes to the Family Care and SeniorCare programs.

For hospitals, the proposed fee-for-service budget—including base inpatient and outpatient payments, access payments, and supplements—is projected to decrease by just over four percent in each year of the biennium. DHS staff indicated that the budget includes no increase for intensity. WHA staff continues to work with DHS to understand the underlying assumptions related to the hospital funding change, including caseload projections.

"While we appreciate the information shared by the Department, it is critical that hospital base rates are supported and we will continue to work with DHS to clarify the base funding pool for hospitals," noted WHA Senior Vice President Brian Potter. "We are glad to see that DHS is continuing the MAG meetings this year so that there is transparency in how the rates are calculated for our members."

A critical part of the upcoming rate-setting process involves new pay-for-performance measures. For 2012 and 2013, the Administration is proposing holding back 1 percent of each hospital’s base rate, which the hospital will have the opportunity to earn back if performance measures are met. DHS staff said that they are just beginning to develop the pay-for-performance criteria and requested input from hospitals. Hospital representatives noted that measures need to be tied to outcomes that are appropriately in the control of the hospital. WHA staff will work with member hospitals to recommend appropriate measures to DHS.

In addition to the pay-for-performance measures, DHS is seeking input on a variety of topics, including eligibility and enrollment changes, health care efficiency suggestions, and care management.

"I am impressed with programs that hospitals already have in place that are designed to improve the coordination of care," said Davis. Davis asked hospitals for ideas for additional models, particularly models that would address mental health and AODA costs.

DHS also presented policy issues for the FY12 rate-setting process, including modifying trim points, reviewing how the budget is set for critical access hospitals versus acute care hospitals, moving to the ambulatory payment classification for outpatient rates, and paying labs on the maximum fee schedule. Each of these policy issues will be discussed in more detail at the April 20 Medicaid Advisory Group meeting.

Please note that future meetings of the MAG will be open meetings and publicly noticed by the Department. Materials from the March 22 meeting, along with all presentation items from last year’s meetings and other information about the Medicaid Advisory Group can be found on the WHA Web site at: www.wha.org/financeAndData/MAG.aspx.

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A Nurse Leader Perspective: The Value of WHA’s Advocacy Day
An interview with Peggy Haggerty, Columbus Community Hospital

Every year some 650 individuals from hospitals across the state converge on Madison for the Wisconsin Hospital Association’s annual Advocacy Day. At Advocacy Day individuals learn about important issues and then meet with their legislators in the State Capitol. Advocacy Day often coincides with legislative happenings in the Capitol, such as public hearings and/or floor votes on important hospital issues. In the following Q&A, Peggy Haggerty, vice president, patient care services, Columbus Community Hospital, shares her views on the value of Advocacy Day and how she was able to turn her attendance into action.

Q: Why do you think it’s important for nurse leaders to attend WHA’s Advocacy Day?

Haggerty: This is a great opportunity to hear about health-related issues that impact patient care or the organizations in which we work. There are educational sessions for part of the day, which includes an overview of the governmental issues nationally that impact the states, as well as state-level issues. As a nurse leader, it is imperative we are aware of the legislative issues we may be faced with and become involved in sharing how legislation impacts our organizations and patient care. We have an obligation to educate legislators about the health care environment. As part of Advocacy Day, we have the opportunity to meet with our legislators and express our views related to legislation impacting our organizations. Our presence makes a statement.

Q: You may remember several years ago Advocacy Day coincided with a public hearing on legislation banning the use of mandatory overtime. Hundreds of Advocacy Day attendees were able to be at that hearing and express opposition, including you. Can you give us your thoughts about that day?

Haggerty: This was a great experience, not ever having testified before. This was an issue that would have a serious impact on a critical access hospital as well as other larger hospitals. Ultimately, this bill would impact patient care. It was imperative to share our side of the story so that the legislators understood this was not an issue that could be generalized to hospitals across the state. Testifying why I was against this bill helped educate legislators on the impact this bill would have on our patients. Engaging the Wisconsin Organization of Nurse Executives and nurses from our hospitals to either write testimony or to testify allowed for our concerns to be heard. I had several staff nurses who wrote their testimony and were prepared to testify. In addition, my outpatient director testified along with me, which was also her first experience. As a result, she has expressed interest in participating in the future when possible. This experience made me realize the importance of having my voice heard as a nurse leader.

Q: Personally and professionally, what do you think is the value of Advocacy Day?

Haggerty: Personally, Advocacy Day is energizing because of the education that is part of this day. In addition, I am able to connect with many of my colleagues across the state who are also in attendance. Networking is always a positive outcome for these types of venues. Plus it always is a wonderful experience to go to the Capitol for the legislative visits and to observe some of the legislative sessions – this is very educational.

Professionally, this day brings together many individuals who are interested in what is happening legislatively and how that impacts our organizations. It also provides various perspectives on issues. Finally, it is a time when we, as nurse leaders/professionals can have our legislators’ attention to present our views on those issues impacting our organizations, either positively or negatively. This is a day that provides nurse leaders from across the state an opportunity to be politically active and be heard.

Q: If you could say one thing to other nurse leaders about Advocacy Day, what would it be?

Haggerty: I would strongly encourage every nurse leader to participate in this day to become better informed, better educated, and to be part of the legislative visits and or process, if not to testify or talk with your legislators to at least experience it with a colleague who has had this experience previously. It is an excellent opportunity to see our government in action.

As nurse leaders, we are the experts and we need to share our expertise to better educate those who are not in health care on issues that impact patient care and the organizations we serve. It is always a great experience.

Make sure you and your hospitals are assembling your Advocacy Day contingent. A complete program and online registration are available at http://events.SignUp4.com/AdvocacyDay. For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org. For registration questions, contact Lisa Littel at llittel@wha.org or 608-274-1820.

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New Legislator Profile: Sen. Pam Galloway, (R-Wausau)
A series of interviews with newly-elected legislators, by Mary Kay Grasmick, editor

As a surgeon, Pam Galloway, MD (R-Wausau) understands firsthand how critically important a favorable medical malpractice climate is in attracting physicians to practice in Wisconsin. In 2002, Galloway and her husband, who is also a physician, relocated their medical practices from Ohio to Wausau to escape the medical malpractice crisis in that state. It was when Wisconsin’s medical malpractice environment was threatened that Galloway said she first became politically active. That, along with a deep concern that she felt as she witnessed Wisconsin’s deteriorating fiscal conditions and then-Governor Jim Doyle’s raid on the Injured Patients and Families Compensation Fund, caused her to decide to run for the State Legislature.

Restoring Wisconsin’s fiscal health is at the top of Galloway’s priorities. As she reviews the state budget, she is looking carefully at changes in the Medicaid program that could help improve its long-term economic position.

"I think we need to look carefully the expansion in Medicaid that have taken place among non-disabled, non-pregnant adults and consider rolling the eligibility levels back to 133 percent," Galloway said.

Galloway also said co-pays and premiums and other cost-sharing measures should be considered, but her hope is that as the economy improves, Wisconsin residents can connect to employer-based insurance policies.

Galloway is one of the co-authors of the WHA-supported "apology" bill, which will be introduced in the Legislature soon. The bill would protect statements of apology, condolence, compassion and sympathy, as well as other expressions of empathy by a health care provider to his or her patient.

"Sometimes an apology is a way of starting the healing process, and physicians should not be afraid to offer an apology for fear it will be used against them in a court of law," "This bill is important because I don’t think something a physician says to their patient should be used against them in a court of law," Galloway said.

Her home district is never far from her mind. "I want the state budget to be the best as it can be for my district, even as we face potential cuts to shared revenue," Galloway said. The concept of splitting UW-Madison off from the UW-System is an issue she is watching carefully to ensure that her district is not negatively impacted by that move.

Galloway is interested in exploring the concept of a "council" of small businesses that brings together smaller businesses to enable them to form a pool for the purpose of purchasing discounted health insurance.

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Ribble Visits WHA Headquarters

Congressman Reid Ribble visited the Madison offices of the Wisconsin Hospital Association March 22 in his continued efforts to understand how health care issues pending in Congress will impact hospitals.

"Having Cong. Ribble and his staff join us at the WHA offices was an important opportunity for us to discuss issues like Medicaid, Medicare and health reform that will impact hospitals across the state," said WHA President Steve Brenton.

During the meeting Brenton discussed several issues related to the Medicaid program, including the current Medicaid deficit and how flexibility will be needed from federal requirements in order to fully address it. Additionally, staff discussed how Wisconsin hospitals were moving forward with adopting and implementing Electronic Health Records (EHR) in order to meet "meaningful use" requirements as well as become eligible for EHR incentive payments.

"I am always impressed by Cong. Ribble’s desire to hear from his hospitals as well as the Wisconsin Hospital Association," closed Brenton. "We look forward to working with him in the future."

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IRS Releases Revised Schedule H and Instructions
"Vastly expands paperwork"

The Internal Revenue Service (IRS) last month released a revised Schedule H with Instructions, and announced a mandatory three-month extension for filing IRS Form 990 for certain filers. (See February 25, 2011 edition of The Valued Voice) The IRS directed all filers with "hospital organizations" that have filing due dates before August 15, 2011 not to file before July 1.

The IRS has amended Part V of Schedule H to incorporate into Form 990 the requirements of the recently enacted Internal Revenue Code Section 501(r), which includes the new standards for exemption from federal income taxes for hospitals. The American Hospital Association has noted that the new Schedule H vastly expands the paperwork required of hospitals beyond what the statute requires. In particular, Section V.B. requires responses to 21 questions, most of which have multiple sub-questions on behalf of each of the hospital’s licensed facilities.

The seven questions regarding community needs assessment are "optional" for the 2010 filing. The Instructions explain that 501(r)(3) does not impose community health needs assessment requirements until tax years beginning after March 23, 2012. AHA notes that the rest of Part V.B. is not marked "optional," but the questions are not applicable to hospitals whose 2010 fiscal year began before March 23, 2010. AHA emphasizes that the newly revised 2010 Schedule H Part V.B. is entirely optional for calendar year filers and for filers whose fiscal year began January 1 through March 23, 2010.

Go to the following links for the revised Schedule H: www.irs.gov/pub/irs-pdf/f990sh.pdf and the Instructions at www.irs.gov/pub/irs-pdf/i990sh.pdf.

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President’s Column: Happy Birthday…CheckPoint!!!

Seven years ago next week, the WHA unveiled our CheckPoint initiative (www.WiCheckPoint.org), thus becoming the first state in the nation to embrace voluntary, hospital-specific, public reporting of clinical quality and safety performance measures. The statewide effort was led by former WHA Board Chairs Ken Buser and Chuck Shabino, MD, under the able direction of former staff member Dana Richardson. The initiative was and continues to be enthusiastically supported by WHA members across the state of Wisconsin.

Today, 128 Wisconsin hospitals, including 60 Critical Access Hospitals, report over 100 process and outcomes measures (see below). Importantly, the longevity of CheckPoint has enabled us to track improvement over time for publicly-reported measures. Documented improvements have been consistent and universal. The axiom, "if you measure it and report it you will improve it" is certainly true.

Measure Category

Measure Count

Measure Examples

CMS/Core Measures

27

Heart Attack, Heart Failure, Pneumonia, SCIP

Perinatal/Birth Measures

25

Facilities, Education, Delivery Rates

Surgical Infection Prevention

22

Hip Surgery, Colon Surgery, CABG

Mortality Rates

15

Illness and Procedure Related Rates

Patient Satisfaction

10

Clean Room, Recommend Hospital

Error Prevention Project

4

Site Marking, Procedure Verification

WHA’s Board-directed strategy is to align with (and in many cases lead) identified national improvement priorities. During the second quarter of 2011, new stroke measures will be reported and in early 2012, new CheckPoint reporting will include hospital-acquired conditions (HAC), hospital-acquired infections (HAI) and readmission rates. And WHA’s Quality Center (www.whaqualitycenter.org) has emerged as a "go to" hub for statewide health care improvement activity, thus assisting members to identify best practices and excel at aligning with anticipated pay-for-performance initiatives.

Much has happened in the past seven years including: the emergence of CMS’ HospitalCompare Web site; the ongoing commitment of larger hospitals, health systems and physician clinics to support the Wisconsin Collaborative for Healthcare Quality’s (WCHQ) ambulatory-focused public reporting efforts; the Wisconsin Health Information Organization’s (WHIO) all claims data repository; and cutting-edge efforts by the WMS to help physicians understand, using WHIO data, the variation in resources used in similar episodes of care.

As an organization representing members that are increasingly organized as integrated delivery providers, WHA has placed a strong emphasis on working with physician leaders, many of whom are active in WCHQ. Our plan is to harmonize and partner with like-minded organizations to maximize efficiencies and advance common goals going forward.

Special recognition to WHA’s Chief Quality Officer, Kelly Court and her fine staff—Jill Hanson, Stephanie Sobczak and Geoff McAlister—for their outstanding work.

Steve Brenton
President

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Save the Date: Wisconsin Rural Health Conference
"A Call to Action: Maintaining Steady Ground in Unsteady Times"

June 15 – 17, 2011

The Osthoff Resort, Elkhart Lake

Watch for more information in the coming weeks

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WHA/RWHC ICD-10 Survey Results

Results from 57 WHA member hospitals were received in response to the Wisconsin Hospital Association/Rural Wisconsin Healthcare Cooperative ICD-10 survey which was sent to executive leadership and health information directors and managers. The 57 responses represented 69 hospitals as some respondents were from hospital systems. Forty-four percent of the responses were from critical access hospitals.

Areas that were assessed include general awareness of the Final Rule related to ICD-10, assignment of responsibility for leading the transition, an inventory of 12 functional areas in the hospital and their related state of ICD-10 planning and preparedness, budget planning, and identification of areas where hospitals would participate if WHA/RWHC offered assistance.

In terms of general awareness, the results show hospitals are generally aware (98 percent); however, only 26 percent state their medical staff is aware of the transition that will occur. Most hospitals have assigned the responsibility for leading the transition (79 percent) but, 44 percent of hospitals have not convened a cross-functional steering committee to identify systems affected and to assign tasks and responsibilities to carry out the necessary changes. Most hospitals have budgeted for some aspects of the ICD-10 transition. The greatest emphasis has been on education and training. Fewer hospitals responded that they have budgeted for temporary or contract staffing, additional software or software upgrades, or for the additional staff time needed to prepare for and implement the transition.

The highest volume of requests for assistance from WHA/RWHC are in the following areas—medical staff education on documentation, a Web page on the WHA Web site dedicated to ICD-10 resources, intense coder training 6-9 months prior to ICD-10 implementation, coder education on the structure and unique features of ICD-10, and identification of key transition tasks and objectives. WHA has convened a task force with representatives from other organizations to identify resources and tools to help hospitals with the change to ICD-10. The first meeting was held March 22 at WHA.

More information regarding the survey results are available at the WHA ICD-10 Web page at www.wha.org/financeanddata/icd_10.aspx. WHA and the task force will continue to add resources to the Web page.

Contact Debbie Rickelman, RHIT, senior director, WHAIC, with questions regarding the survey or posting of additional resources, at drickelman@wha.org.

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WHA Welcomes New Employee James Cahoy

Jim Cahoy recently accepted the position of database administrator (DBA) with the WHA Information Center. Cahoy will assume the DBA responsibilities for collection and dissemination of hospital and free-standing ambulatory surgery center data. He will also assist in the installation, maintenance and upgrades of WHA Information Center’s hardware and software technologies.

Cahoy brings more than 20 years of computer technology experience and has a proven commitment to serving customer needs. He holds a bachelor’s degree from the University of Northern Iowa in mathematics with computer science emphasis. Prior to coming to WHA, Cahoy worked for over 11 years with the American Cancer Society on their administration and database design.

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Three Wisconsin Health Care Systems Share Innovations in Care Delivery at National Conference

Three Wisconsin health care systems—Aurora Health Care, Bellin Health and ThedaCare—were recently recognized for innovations that that improved individuals’ experience of health care, improved the health of the population, and lowered health care costs—the Triple Aim.

Their work is featured in the March issue of Health Affairs along with 13 other national organizations, ranging from health care systems to health plans and other health initiatives. The15 organizations presented their initiatives at Health Affairs’ Innovations across the Nation in Health Care Delivery conference held last December and they demonstrated that there are clear commonalities and common-sense strategies underpinning their success. At the same time, it is clear that change is hard and challenges remain. The profiles in the March issue of Health Affairs describe what these innovators have achieved despite myriad constraints, such as fragmented delivery systems and flawed payment structures, and suggest what could be accomplished if these constraints were eliminated.

The abstract of Aurora’s presentation is printed below, with permission from Health Affairs. The abstracts for Bellin and ThedaCare appeared in the March 11 issue of The Valued Voice (www.wha.org/pubArchive/valued_voice/vv3-11-11.htm#4). A link to Aurora’s full article follows the abstract.

Aurora Health Care: Using Teams, Real-Time Information, And Teleconferencing To Improve Elders’ Hospital Care

SYSTEM:
Aurora Health Care, a not-for-profit, integrated delivery system consisting of 15 hospitals, 155 clinics, and 1,600 employed physicians in eastern Wisconsin.

KEY INNOVATION: Acute Care for Elders Tracker, a computerized data tool to improve care for hospitalized elderly patients. It provides multidisciplinary teams with real-time information on each patient’s health risks and allows teams to customize treatment plans. Another innovation, e-Geriatrician, makes geriatricians available through teleconferencing to consult with staff at hospitals lacking their own geriatricians.

COST SAVINGS: None to date.

QUALITY IMPROVEMENT RESULTS: Published data show that at one Aurora hospital, the percentage of patients receiving urinary catheters decreased from 26.2 percent to 20.1 percent. (Such catheters are sometimes used inappropriately in US hospitals and nursing homes for patients who have difficulty using the toilet independently, rather than for accepted medical indications such as monitoring urine output.) The share of patients receiving consultations for physical therapy increased from 27 percent to 39.1 percent. Unpublished administrative data show that across the Aurora system, 1,716 fewer older patients received a urinary catheter in 2010 compared with 2007.

CHALLENGES: Getting multidisciplinary teams to meet daily to review cases using data from the acute care tracker; persuading some physicians to accept input from other team members; enlisting support from some hospitals’ senior leadership; spreading use of tracked data to clinic and home care settings; and persuading information technology companies to develop similar data tools for widespread use.

Click here to view the full Health Affairs article: www.wha.org/HealthAffairs-Aurora3-2011.pdf

Copyrighted and published by Project HOPE/Health Affairs as Using Teams, Real-Time Information, And Teleconferencing To Improve Elders’ Hospital Care, by Harris Meyer, Health Affairs, 30, no. 3 (2011):408-411.

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Quality Officers, Others Participate in WHA’s Quality Improvement Act Webinar
"QIA allows providers to redouble their efforts to improve quality"

The recently enacted "Quality Improvement Act," which was part of a larger tort reform package introduced by Governor Walker as the first bill of a special legislative session, was the subject of a Wisconsin Hospital Association webinar last week. The webinar featured Kelly Court, WHA’s chief quality officer, and Tom Shorter, an attorney with Godfrey Kahn. Over 100 hospital quality officers, legal counsel, and executives participated in the webinar.

Court and Shorter provided a brief history of the efforts, led by WHA and including a broad coalition of health care providers, business groups, and patient advocates, to update the important quality improvement statutes. Court and Shorter outlined the changes to the health services review, or "peer review," statute; and discussed the physician duty to report.

"Talking to people around the state who are focused on improving the efficiency and effectiveness of health care, it’s clear that hospitals are anxious to take their improvement programs to the next level," observed Shorter. "Learning about the newly-available tools is an important step."

"The Quality Improvement Act allows health care providers to redouble their efforts to improve the quality and efficiency of the care they provide to their patients," observed Court. "The great participation in this webinar and in other quality improvement programs highlights that this is truly a priority of our members."

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Health Care Administrative Professionals Conference, May 20

WHA’s annual one-day conference for executive assistants and other administrative support staff from hospitals will be held May 20 at the Grand Lodge by Stoney Creek in Rothschild. This year’s agenda will focus on methods to improve your efficiency in taking and drafting meeting minutes, an update on state and federal legislation that affects health care in Wisconsin, as well as strategies for dealing with difficult people. Attendees will leave with practical solutions to issues faced on a daily basis.

This program is designed for executive and administrative assistants, business office managers, and other support staff in hospitals and other health care settings. A brochure is included in this week’s packet. Online registration is available at http://events.SignUp4.com/HC-Administrative

Please pass the brochure on to the valued administrative support professionals in departments throughout your organization. For registration questions, contact Lisa Littel at 608-274-1820 or email llittel@wha.org.

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Fale Will Represent Wisconsin on AHA’s Regional Policy Board

Former WHA Chair Bob Fale, president, Agnesian HealthCare in Fond du Lac, will represent Wisconsin on the AHA Regional Policy Board (region 5). Fale succeeds Mary Starmann-Harrison, who recently relocated to Illinois to serve as president and CEO of the Hospital Sisters Health System (HSHS).

Fale has chaired a number of WHA committees and task forces, and he has served as the alternate delegate to the AHA-RPB for the past two years.

There are nine Regional Policy Boards (RPBs) that meet three times a year to foster communication between the AHA, its members, and state hospital associations. The RPBs provide input on public policy issues considered by the Board of Trustees, serve as an ad hoc policy development committee when appropriate, and identify needs unique to a region and assist in developing programs to meet those needs.

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Wisconsin Hospitals Community Benefits: Injuries and Violence

A teen arrives in the emergency department by ambulance following a terrible car accident. A child receives head injuries while bicycling without a helmet. A woman walks into the emergency department with injuries inflicted by an abusive spouse. These are stories of pain and tragedy that hospital personnel see all too often. Injury is the most under recognized major public health problem facing the country and it is the leading cause of death in people ages 1 to 44 in Wisconsin. Wisconsin hospitals devote significant resources to reduce the number of intentional and unintentional injuries that occur in the communities they serve.

St. Vincent Hospital offers SANE program

Statistics report that 1 in 3-4 females and 1 in 6 males will be assaulted in their lifetime and 80 percent of the victims are assaulted by someone they know.

St. Vincent Hospital in Green Bay committed to the Sexual Assault Nurse Examiner (SANE) program several years ago by sending nurses from its emergency department (ED) for the specialized SANE training. While launching the program in the ED was a logical place to begin, it was not necessarily the best situation for either the hospital emergency patients or sexually assaulted victims.

Typically the exam and evidence collection process for a SANE victim takes three to six hours. Taking an ED nurse away from the emergency department for that period of time posed staffing and patient care concerns. As the hospital leadership studied the program they realized there was a substantial need in the community for the program and resolved to find a better way to deliver the service.

In 2004, the St. Vincent Hospital SANE department officially began as a 24/7/365 program. It is located near the ED but is a separate service caring for both pediatric and adult patients. Within 30 minutes of receiving a page, the (SANE) nurse on call reports to the hospital. This quick response time helps reduce the victims’ wait time and anxiety.

In addition to working with victims, SANE nurses are also active in the community offering educational programs to many social service agencies, children’s services, schools, and other health care facilities. They also provide training sessions with the Sexual Assault Center and offer presentations to the NWTC Law enforcement candidates to help candidates better understand the victims’ situation and feel more comfortable in their role as law enforcement officials.

The St. Vincent Hospital SANE program is part of the Brown County Sexual Assault Response Team (SART). The hospital is dedicated to the SANE program and the people it serves by partnering with the local medical community, law enforcement agencies, and other health care facilities to ensure those affected by violence are treated with respect and dignity.

St. Vincent Hospital, Green Bay

A Sexual-Assault Nurse Examiner (SANE) describes her role

Life-shattering crimes bring patients to Aurora’s Sexual Assault Treatment Center (SATC), where they wait in a private waiting area so that they do not have to be in the presence of others.

I walked in to meet a thin young woman in her early 20s – "Heidi." She was tearful and curled up on the recliner. I choose my words carefully when I’m working with sexual assault patients.

"Hi, Heidi. My name is Eve. I am a specially trained nurse who takes care of people after they have been hurt," I explained.

Discussing their sexual assault is one of the most difficult things our patients have to endure.

I made sure Heidi was as comfortable as possible and asked if she needed a blanket or was having any pain. She reported a "massive headache." I asked if she wanted medication to help with the pain and she said yes.

In the back of my mind while caring for patients is forensics. As a SANE I think about possible evidence that needs to be collected.

She gave me permission to collect evidence. I talked Heidi through each step. Following an assault, patients startle easily to noise or movement. Moving next to them without warning can cause increased anxiety. I want the patient to feel that each action is an informed choice. With each small question they answer, and the decision they make, they are taking back some control.

I gave Heidi medication for her headache. I knew that she had been seen in the E.D. and received medications for nausea and pain prior to coming to SATC. Her loss of memory, her nausea and headache all pointed to the possibility that she might have been under the influence of something other than alcohol. I was thinking about the possibility that she may have been drugged. Drug-facilitated sexual assault can be especially challenging for a patient because they have no recall. They can’t even trust their own memory because the drugs have erased it. Often even if specimens are collected from the patient, the drugs used have already metabolized out of their system before the patient even presents for care.

I provided Heidi with options of care. She chose the care plan that was best for her. She said the idea that she could have been assaulted was so horrible that she could not tolerate being examined. Heidi, and patients like her, feel guilty that they have not provided enough evidence. I told her she was making the right choices for herself and her body and that she was in control of each choice she made.

After she was discharged Heidi continued to utilize our 24-hour crisis line when she needed to talk. Our crisis counselors assess for trauma-related symptoms and determine how the patient is coping. The crisis line and follow-up provide a bridge for the patient from the initial crisis to long-term needs.

We partner with The Healing Center, where Heidi utilized group and individualized counseling, art therapy and body work to rebuild her life. As each survivor does, Heidi reported both good and bad days. She worked hard to heal from this trauma and supports other patients who come through SATC by donating much-need items.

Aurora Sinai Medical Center, Milwaukee

SANE nurses provide needed care for youngest sexual assault victims

Victims of sexual assault, including the youngest victims, find a compassionate and safe environment at St. Joseph’s Hospital’s Emergency Care Center, which has four specially-trained Sexual Assault Nurse Examiners (SANE) available 24 hours a day. The SANE program began in 1998 at St. Joseph’s Hospital and added pediatric services (patients 12 years old and younger) in 2007. Three of the SANE nurses have additional pediatric training.

In 2009, St. Joseph’s Hospital saw 25 sexual assault patients, five of whom were pediatric patients, some only a few years old. SANE nurses take on the challenges of treating the physical and emotional wounds of sexual assault, which seem particularly horrific when the victim is a child.

"It’s surprising that we saw five. It’s really sad. Any time we get called in to see a child it’s very hard," said Nicole Beisbier, RN, SANE-A. She noted that the average age for victims of sexual assault in Wisconsin is 15.

Expanding the program to include pediatric patients meant that children from the area could now find compassionate and safe care close to home. Their families would not have to travel outside the area for care during a frightening and traumatic time.

Sexual assaults are acts of violence where sex is used as the weapon. SANE nurses, who are available 24-hours-a-day, conduct a thorough medical exam and collect forensic evidence. They identify and document injuries, maintain chain-of-evidence and provide expert witness testimony in a court of law. Reporting of child sexual assault is mandatory.

The nurses also understand the physical, emotional and legal aspects of sexual violence, knowing that the victim’s initial care is critical to recovery.

SANE nurses also work closely with area agencies, and regularly speak to students and community groups. "There definitely is more awareness of the needs of sexual assault victims. We work a lot with Washington County, West Bend, Germantown law enforcement and other agencies. In recent years, I’ve been amazed at how compassionate officers are, especially with these little patients," Nicole said.

Nicole is a member of the Washington County Sexual Assault Response Team and Community Coordinated Response, a team of 20 people from various agencies who work with victims of domestic violence and sexual assault. Nicole chairs the Sexual Assault Victim Services subgroup.

Nicole said she feels the education provided by the subgroup and the SANE nurses is making a difference. As one student wrote on her evaluation form, "I never would have known what to do. Now I know."

St. Joseph’s Hospital, West Bend

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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