The economy continues to take a toll on Wisconsin hospitals as margins deteriorate, while charity care and bad debt continue to climb. That is according to a new statewide survey released this week by the Wisconsin Hospital Association.

The survey confirms that Wisconsin hospitals, not unlike other industries, are being greatly impacted by the recession. As some of the largest employers in the state, hospitals are an integral part of the economic and physical health of the communities they serve.

"As Wisconsin hospitals struggle in an ailing economy, the ripple effect continues to be felt throughout the state," according to WHA President Steve Brenton. "No one can predict how long the recession will last, but as job losses in our communities continue to mount, hospitals are faced with an increasing demand for charity care while bad debt is mounting as more patients are unable to pay for the care they receive," he added.

Patient volume decreased in roughly two-thirds of the 80 hospitals that responded to the survey. Inpatient admissions are down as well as elective procedures. The dip in volume is a potential indication that individuals are delaying care as family budgets tighten and/or health care coverage is less generous or lost altogether.

Charity care and bad debt are up in 70 percent of the hospitals that responded, with nearly a quarter reporting a "significant" increase. As uncompensated care costs mount, nearly 70 percent of the hospitals saw a drop in their total margin; nearly 50 percent reported a "significant decrease."

As a result of the decrease in revenue, hospitals have implemented a number of changes to reduce costs. Of the 80 hospitals that responded to the survey, three-quarters said they have cut administrative costs, while nearly half have reduced staff or have laid workers off since September 2008. About 40 percent told WHA that they have adopted lean management initiatives, taken measures to improve efficiencies in managing their supply chain, implemented salary or wage cuts or delayed capital expenditures. About 20 percent reported cuts in services.

"Even in the face of extraordinary economic pressures, hospitals continue to deliver on their primary mission to maximize access to services, make health care affordable, and continue to provide good paying jobs in all regions of our state," Brenton added.

The 2009 Wisconsin Rural Health Conference, scheduled June 17-19 in Wisconsin Dells, will focus on two of the biggest issues identified by hospital executives in a recent WHA member survey – the economy and its effect on the future of health care, and improving hospital/physician relationships.

Nationally-known economist and futurist Lowell Catlett, PhD, will present an enlightening and entertaining perspective on the economy and its effect on the future of health care during the opening keynote session. The closing presentation by Tray Dunaway, MD, is one of several sessions that will focus on building a positive working relationship between physicians and the hospital.

This year’s conference will again offer the popular governance education track, offering board of trustee members and their CEOs three sessions focused on health care reform, board accountability requirements and trustee recruitment and selection.

The annual Wisconsin Rural Health Conference is a great way for hospital executives, leadership staff and trustees to take advantage of great education, right in your backyard, at a fraction of the travel and registration costs of out-of-state events.

A full event agenda and registration information will be available in the Friday Packet and online at www.wha.org soon.

The American Recovery & Reinvestment Act of 2009 (ARRA), Public Law 111-5, was enacted February 17, 2009 and includes billions of dollars for hundreds of programs. The ARRA’s stated goals are to jumpstart the economy, create or save jobs and build the foundation for long-term economic recovery. To do so, the ARRA includes $787 billion worth of tax incentives, tax cuts, and funds for programs or payments, many of which impact the health care sector.

How these new programs and projects will roll-out and what dollars will be available through the federal government, state government or local government has been the subject of many questions. This Toolkit paper can help and it provides a broad overview of the ARRA’s major health care provisions, a synopsis of the Health Information Technology incentive payments and privacy provisions, and serves as a portal to additional resources.

I often hear from our members that nursing leadership positions are difficult to fill. Positions that were once very attractive promotions for staff nurses have become some of the most difficult to fill in hospitals. One reason for this change is that nurses are often encouraged to seek advancement in clinical knowledge and skills and to move into positions where they use advanced practice and/or prescriptive authority. The majority of graduate nursing programs in Wisconsin focus on these roles. There has been very little attention given to generating interest among nurses to pursue health care leadership, management and administrative roles.

This issue, identified by the WHA membership, led the Association to create a nurse leader program that would help foster interest in and enthusiasm for leadership roles among nurses. WHA, supported by funding from the WHA Foundation, has sponsored three nurse leadership programs that have reached 200 nurses.

That was the first step. Now, the next big step has been taken by the Wisconsin Organization of Nurse Executives (W-ONE) and the Wisconsin Center for Nursing (WCN). These two organizations launched the Wisconsin Nurse Leader Academy. The purpose of the Academy is the same as WHA’s—to develop nurse leaders for the future.

The Academy’s first offering, a four-day conference for new and aspiring nurse leaders, was held in March. Twenty-nine nurses from around the state came together for the first two days of learning, sharing and collegiality. The Academy was fortunate to have Janet Krecji, associate professor, Marquette University College of Nursing and Robert Wood Johnson Foundation executive nurse fellow, along with Shelly Malin, director, advanced practice nursing and research, Children’s Hospital of Wisconsin lead the conference. Participants were enthusiastic, highly complementary of the initial session, and pleased to have been offered insight and assistance with the most complex components of leadership in the health care environment.

W-ONE and WCN plan to offer this program on a regular basis. They are also preparing to expand the Wisconsin Nurse Leader Academy to include mentoring, support, and short programs for nurse leaders in all types of health care facilities in Wisconsin.

As a representative of WHA, I have been a member of the planning process for both the Nurse Leader Academy and this first conference. It has been exciting to be a part of this important work. W-ONE, an all volunteer organization, has assumed a very important role in providing leadership in the development of nurse leaders in Wisconsin, and we applaud them for this great effort.

We are on the way….

The potential roles of medical homes and retail-based clinics in Wisconsin’s health care system were discussed at an Evidence-Based Health Policy Project (EBHPP) symposium April 7 in Madison. Experts considered their impact on primary health care in the movement toward an accountable health system that improves outcomes and reduces costs.

Presenters at the symposium included: Barbara Starfield, MD, PhD and professor at Johns Hopkins Bloomberg School of Public Health; Lowell Keppell, MD, chairman of the board of the Wisconsin Academy of Family Physicians; and Ken Berndt, director of development for Bellin Health’s FastCare retail-based clinics.

The patient-centered medical home (PCMH) is defined as a model of care delivery based on an ongoing personal relationship with a physician, according to the American Academy of Family Physicians.

Keppel said having a usual source of care is associated with a greater likelihood that people receive appropriate and preventive care that leads to better outcomes and lower costs. He said the benefit of a medical home is that a practice-based care team takes collective responsibility for a patient’s ongoing care, coordinated across care settings and multiple disciplines. While there are currently no PCMH-recognized practices in Wisconsin, there is significant interest according to Keppel.

In discussing retail clinics, Berndt cited a 2007 Commonwealth Fund study where two-thirds of Americans said they have a difficult time getting medical care on nights, weekends and holidays. Access is a big reason for the popularity of retail care clinics, according to Berndt.

Beyond access, Berndt said FastCare is differentiated by the well-defined scope of clinical services it offers, which are limited to simple acute conditions and preventive care. Integration with Bellin Health System allows for easy referral to physicians for comprehensive care, necessary when symptoms exceed the scope of service. This system, along with its convenient setting, acts as a vehicle to improve connections with patients and engage those who may not have a primary care provider. FastCare follows the American Academy of Family Physicians guidelines for retail clinics, ensuring high quality services, Berndt said.

Starfield said studies show areas with better primary care have better overall health outcomes. She also listed lower costs and greater equity in health as reasons why primary care is so important. But challenges remain in improving primary care, Starfield said, including avoiding unnecessary specialty care and moving from diseased-focused to patient-focused health care.

While improved access and reduced health care costs were viewed as common goals and benefits, each of the presenters emphasized the need for primary health care delivery to be closely linked to an established, integrated, comprehensive care system.

Several legislators were in attendance, including Rep. Jon Richards (D-Milwaukee), chair, Assembly Committee on Health and Health Care Reform and Rep. Chuck Benedict (D-Beloit), chair, Assembly Committee on Public Health.

Wisconsin Medicaid Director Jason Helgerson also participated in the discussion and said there is significant interest in improving access to primary care. He said a remaining open question is whether primary care needs to be redefined.

The EBHPP is a partnership between the UW Population Health Institute, UW-Madison’s La Follette School of Public Affairs, the Wisconsin Legislative Council and the UW School of Medicine and Public Health. The Project seeks to advance Wisconsin’s health by connecting lawmakers, researchers, and others in the public and private sector. The goal is to provide policymakers with high-quality information for evidence-based decision-making and involve and apply UW faculty research and teaching activities to state public policy issues.

St. Nicholas Hospital welcomed Congressman Tom Petri, who represents the 6th Congressional District, for a visit in late March.

An important topic of discussion was health care reform. Cong. Petri shared with hospital leaders that he and others in Congress have heard from many about this topic. The three recurring issues are: high-quality and low-cost health care, and universal coverage. Petri said there may be ways to provide several of these but finding a plan to include all three will be difficult.

Petri felt the health care industry should continue moving forward with electronic medical records because of its potential impact.

"This is the way of the future," Petri said of electronic medical records. "The savings for electronic file sharing are considerable, and the quality of care will be improved because there will a reduction in mistakes."

State Representative Jerry Petrowski met with leaders and staff at Ministry Health Care-Saint Clare’s Hospital in Weston February 27. During the three-hour in-depth visit, Rep. Petrowski was particularly impressed by the Telemedicine ICU (VISCU). He had an opportunity to meet dozens of employees while visiting this entirely digital hospital and congratulated the hospital team for their hard work on quality and cost effectiveness. Additionally, the group discussed health care workforce concerns.

William E. Bestor, president/CEO of Community Memorial Hospital, Menomonee Falls, will retire effective July 1, 2009, following a 32-year tenure. Bestor served as the organization’s president for 8 ½ years, previously serving as its chief operating and financial officer.

"Bill Bestor embodies servant leadership," said William Petasnick, Froedtert & Community Health president/CEO. "He created an environment in which others were given opportunities to grow professionally and excel in their roles."

"During my career at Community Memorial, I have attained my goal of providing leadership in support of the hospital’s mission to provide high-quality patient care in a first-class facility," said Bestor. "I am proud of the many accomplishments of our current and former staff, medical staff, volunteers and boards to improve the quality of life for the communities we serve. Community Memorial is a very special organization with individuals who practice ‘relationship-centered care’ every day with great empathy and teamwork."

During his tenure with Community Memorial, Bestor was instrumental in many significant developments and partnerships that advanced the quality and breadth of local health services in northern Waukesha County and Washington County.

"Bill has always been a leader who has led from his heart, and his passion for Community Memorial has been a driving force for our organization," said Dennis Pollard, chief operating officer of Froedtert & Community Health and a member of the executive team at Community Memorial. "We have all benefited from his mentorship and dedication to meeting the needs of our patients."

Bestor has provided valuable leadership to the Wisconsin Hospital Association, having served on the Association’s Board of Directors as well as on the Boards of both WHA Financial Solutions and the WHA Information Center Board of Advisors. Bestor also served several terms on the WHA Finance Council.

The American Recovery and Reinvestment Act of 2009 (ARRA) provides for premium reductions and additional election opportunities for health benefits under the Consolidated Omnibus Budget Reconciliation Act of 1985, commonly called COBRA. Eligible individuals pay only 35 percent of their COBRA premiums and the remaining 65 percent is reimbursed to the coverage provider through a tax credit.

The ARRA mandates that plans notify certain current and former participants and beneficiaries about the premium reduction by April 18, 2009.

The Department of Labor created model notices to help plans and individuals comply with these requirements. Each model notice is designed for a particular group of qualified beneficiaries and contains information to help satisfy ARRA’s notice provisions.

Twice in the last year, Luther Midelfort Oakridge-Mayo Health System in Osseo offered senior citizens learning sessions to enhance their knowledge in areas of most concern for their age group. Two providers spoke to the group recently about osteoporosis and arthritis, and the occupational therapy department provided the group with hands-on lessons on fall prevention.

"We feel this group of community members is important for us to focus our community benefit outreach efforts on," said Mike Ryan, Luther Midelfort Oakridge administrator. "It’s amazing to see how appreciative those in attendance are as they are actively involved in the sessions we’ve provided for them and participate by asking questions during the sessions," he added.

Each session lasted about 1.5 hours and included a lunch provided to the participants by Luther Midelfort Oakridge dietary staff.

As Wisconsin’s largest mental health provider, Rogers Memorial Hospital is keenly aware of the need for greater accessibility of mental health services.

The beginning of this decade was a hard time for mental health care in Milwaukee County. Many providers were pulling out of Milwaukee County; some were downsizing—some outright closing.

When County leadership put out the call for private hospitals to help the county bring behavioral and mental health care to its constituency, Rogers Memorial Hospital was there. Rogers Memorial provides over 4,300 Wisconsin Medicaid days a year, bringing quality, intensive care to as many of our community’s people as possible.

Through partnerships with Milwaukee County, the Medical College of Wisconsin, Children’s Hospital of Wisconsin, Froedtert and Community Health, and Columbia St. Mary’s, Rogers Memorial has become a regional provider. Rogers Memorial and its partners provide 45 percent of the inpatient behavioral health care services in Wisconsin.

Rogers Memorial’s partnerships avoid costly duplication of services by providing medical hospitals more direct access to our mental health treatment programs as well as our assistance in expanding their in-house mental health services. Most importantly, it provides the community with convenient access to both medical and mental health care.

At the ribbon cutting for the 2008 addition at Rogers Memorial - Milwaukee, Martha S. Rasmus, president and CEO of Mental Health America of Wisconsin, said: "I applaud Rogers in having the facility here in West Allis, but also being part of the community seeking to integrate mental health care into primary health care settings."

"One cannot have a healthy community, unless one is dealing with all aspects of health care, particularly mental health. With this facility, Rogers reached out to the Milwaukee community to meet the needs of children, teens, adults and older adults with mental health and substance abuse issues," said William Petasnick, president and CEO of Froedtert Hospital and the Froedtert and Community Health System.

For Tara Wilhelmi, the Dane County Early Childhood Initiative program—and its partnership with St. Mary’s Hospital—has been a lifesaver.

In 2005, she found herself in a difficult financial situation—unemployed due to illness. She was looking for help.

This mother of four, with a fifth on the way, walked into a "Joining Forces for Families" (JFF) office on Madison’s Allied Drive. JFF is a community-based service that helps families address basic human needs. Her pregnancy made her a candidate for Early Childhood Initiative (ECI), a home visitation and employment program in Dane County.

Wilhelmi applied and was accepted. She was soon matched with St. Mary’s Hospital, where she works to register new patients.

"I love working at St. Mary’s," says Wilhelmi, who is also pursuing a degree in counseling psychology from the University of Wisconsin-Madison. "The people I work with are very supportive and they encourage me."

St. Mary’s partnership with ECI is based on the program’s alignment with two of the hospital’s core values: compassion ("we reach out with openness") and community ("we cultivate relationships that inspire us to serve"), says Linda Taplin Statz, regional vice president of human resources.

"We were inspired by ECI’s efforts," she says. "And we were particularly impressed by their focused coaching to help applicants prepare for employment."

The ECI program is expanding, as is St. Mary’s interest in continued partnership. In addition to the program’s work along Allied Drive, services will extend to families in the South Bird Street/Park Circle neighborhood in Sun Prairie, and the Hammersley and Russett Roads area on Madison’s southwest side.

"The program has been a win-win," says Statz. "We’re looking forward to future placements."

For years Pierce Sherrill, MD, has been Aurora BayCare Medical Center’s physician-representative to the Brown County Tobacco-Free Coalition. He attends monthly meetings and supports initiatives such as TATU (Teens Against Tobacco Use). He also addresses tobacco-use disparities among minorities and public-assistance populations (especially WIC families). He provides tobacco-prevention education in schools and universities, and provides expertise for advancing Wisconsin Smoke-Free Workplace legislation.

In 2006, Dr. Sherrill conducted an air-quality study of Green Bay City Hall to see if smoke from the smoking lounge was leaking into other workplaces. The final result was that City Hall went smoke-free. He collaborated with representatives from the Cancer Society to lobby the Press-Gazette’s editor, which resulted in a softening of the paper’s editorial position opposing a smoke-free workplace law, and wrote an op-ed piece that was published in the paper.

In the context of occupational medicine, Dr. Sherrill gives smoking-cessation talks to workers and helps employers see how supporting their efforts to quit pays dividends in terms of lower cost, less absenteeism, and overall better health. A reformed smoker himself, Dr. Sherrill says, "I can talk the talk because I’ve been there, and I know how hard it is to quit."

His most current project is with the Coalition’s Youth Coordinator involving origami, which Dr. Sherrill knows a little something about. The project will recruit middle and high school students to fold 1,400 paper cranes to display in public to represent how many people die each day from tobacco-related illnesses. The project includes of a disproportionate number of black, yellow, brown and red cranes to show how tobacco addiction affects minorities.

Dr. Sherrill continues to write to legislators, attend legislative and gubernatorial listening sessions, and work with other agencies such as CTRI (Wisconsin’s Centers for Tobacco Research and Intervention). CTRI brings evidence-based data on smoking intervention to state physicians, and sponsors a free Tobacco Quit Line to assist smokers who want to quit.

St. Joseph’s Hospital also has a free emergency medical information "what to do" chart that carefully outlines steps to take in minor medical emergencies. First published more than 25 years ago, the chart is updated every two years and contains dozens of simple, concise measures to take for medical emergencies such as burns, cuts, fractures and sprains, bites, choking and many more. The chart also allows space for local emergency telephone numbers. Thousands of the charts have been provided free of charge to area businesses, civic groups, schools and individuals.

Scholarships
The Partners of St. Joseph’s Hospital present six, $1,000 scholarships to individuals who are enrolled or accepted in a health-related field of study. Recipients are selected based on field of study, academic record, financial need and demonstrated desire to succeed. Scholarship dollars are raised by the Partners through their various fundraisers and from memorials presented to honor Partner members.

Baldwin Area Medical Center (BAMC) has sponsored an American Cancer Society (ACS) Relay for Life Team since 1998. Starting out small, we raised $1,700 our first year. Since then, not only the team, but the totals have grown to a high in 2007 of $12,100. That year BAMC was honored at the ACS Leadership Conference in October for being one of 94 teams out of 3,700 in the Midwest Division to raise over $10,000. To date, the BAMC team has raised more than $75,500 for the fight against cancer.

Cancer can strike anyone. But because of the ACS and events like the Relay for Life, cancer can now be fought with a high degree of hope. With every 1 percent equating to roughly 5000 people, cancer deaths have been decreasing by an average of 2.1 percent each of the last few years. Research funded by dollars raised continues to find new treatments in this battle.

BAMC has been a strong and consistent supporter of these efforts for the past 11 years. They have sponsored the team of volunteers and allowed them to have fundraising events within the facility. The past two years, BAMC has been a corporate sponsor as well. Our community is also a strong supporter, coming to our external events with great enthusiasm. One of the best feelings comes when accepting a donation the person says "Oh, it’s for the Relay. Keep the change!" Since every penny helps, "thank you" is a phrase heard quite often.

Aurora Medical Center-Oshkosh (AMCO) is a sponsor of Drop Zone, an after-school program held on Tuesdays and Thursdays from 3:15 to 5 p.m. Drop Zone is a place where kids are "dropped off" to burn off some of their after-school energy before going home to dinner and homework and be rewarded for good behavior. For school-age children, Drop Zone offers organized activities in a safe environment, free to YMCA members, and offered to children on a day pass.

Drop Zone is a supervised program that offers floor hockey, ice-skating, T-ball, flag football, crafts, dodge ball and team-building activities. Drop Zone averages between 12 and 20 children for every after-school session. The program is so beneficial that AMCO will continue its commitment for this coming year.

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

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