The WHA Board at their April 17 meeting approved a resolution that recommends all Wisconsin hospitals that use color-coded alerts to standardize the colors they use. Dana Richardson, WHA vice president, quality, reported that many states are standardizing the colors they use to communicate patient information and risks. Late last year, the WHA Board created a task force to study the issue. Richardson said ten statewide organizations, including the Wisconsin Medical Society, HOPE of Wisconsin, the Madison and Milwaukee Patient Safety Collaboratives, the Wisconsin Division of Public Health, the Wisconsin Association of Homes and Services for the Aging, and representatives from ten Wisconsin hospital and health systems, served on the task force.

"We are aware of variation within our hospitals on how they alerted their staff to patient safety conditions. Given that physicians, nurses and other care providers practice in more than one organization, and we transfer patients from hospital to hospital it is imperative from a patient safety perspective to have a standard for color alerts," Richardson said.

Richardson said not all hospitals use color to indicate a safety alert, but for those that do, the colors should be standardized. The colors hospitals are recommended to use are:

Patient identification – white or clear
DNR – Purple
Allergy – Red
Fall - Yellow

The goal is to achieve 100 percent voluntary use of the colors listed above by March 1, 2009 among hospitals that use color-coded alerts.

Richardson also indicated that there are two statewide wristbands—one for do not resuscitate (DNR) and a new gray wristband for multiple casualty tracking by EMS. The State of Wisconsin DNR only applies to community and emergency services. The state requires hospitals to re-evaluate DNR status upon admission. Hospitals may cover, but cannot remove, the state-issued DNR wristband.

President’s Report

WHA President Steve Brenton thanked Board members who recently attended the AHA Annual Meeting in Washington DC. He noted that Governor Doyle attended the Wisconsin dinner held in celebration of Bill Petasnick’s investiture as chairman of the American Hospital Association. Brenton noted Petasnick’s formal remarks relative to his vision going forward. "The AHA is in good hands with Bill at the helm, especially at a time when the debate over health care reform is about to take center stage," said Brenton.

While in Washington, Brenton said several Wisconsin hospital leaders had an opportunity to meet with Governor Doyle just prior to Doyle’s meeting with the Department of Health and Human Services on the BadgerCare Plus Childless Adults initiative. Brenton said the Governor is looking to WHA to help advance this initiative. Read more at www.wha.org/governmentRelations/pdf/2008dcBadgercare.pdf.

"This proposal provides meaningful health reform by improving coverage. At the end of the day, we believe it will receive approval because it is not an entitlement program, it finances itself, and it fits well with other waiver requests that have been approved by the Bush Administration," according to Brenton.

In other business the Board approved the membership of the 2008 Nominating and Bylaws Committee, chaired by WHA’s Immediate Past Chair Bob Fale.

Advocacy

WHA Senior Vice President Eric Borgerding reviewed the past legislative session, which was overwhelmingly consumed by state budget negotiations, leaving little time for other issues. Borgerding said the Quality Improvement Act (QIA) continues to be a priority for WHA. Last year the QIA made it all the way to Governor’s desk before meeting his veto pen. This year, a far more succinct bill—AB 863 —was drafted and supported by WHA along with 36 other health care and business organizations. It passed the Assembly on a strong bipartisan vote, but disappointingly was not taken up by the Senate. The only group opposing the QIA, and which continues to stand in the way of these important reforms, is the Wisconsin Academy of Trial Lawyers.

Three transparency bills were introduced, but none passed. Wisconsin’s hospitals are recognized leaders in transparency, and during development and debate of the proposals, WHA was sought out as a credible and valued resource.

"That is a nice position to be in. It’s the result of the proactive positioning we have taken with public reporting, as demonstrated with CheckPoint (www.wiCheckPoint.org) and PricePoint (www.wiPricePoint.org)," Borgerding said. "We felt hospitals were in a good position to comply with any of these bills and as a result, were able to work cooperatively with the authors. WHA embraces transparency."

Hospital Assessment

Since the February WHA Board teleconference, the state budget situation did indeed deteriorate. Wisconsin is facing a projected budget deficit of over $600 million shortfall by June 30, 2009 (the end of the current biennium). That requires action on the part of the Governor because each fiscal year must end with a balanced budget. The Governor introduced, as expected, his version of a budget repair bill meant to balance the budget over the biennium, which included the much-improved hospital assessment.

Borgerding reported that in addition to WHA, support for the assessment has grown and now includes major business groups Wisconsin Manufacturers and Commerce and the Metropolitan Milwaukee Association of Commerce.

"We are hopeful the assessment will be a part of a budget compromise and are working toward that end," Borgerding said. "But we will make Medicaid reimbursement a priority in 2008, regardless of what happens in with the budget adjustment bill. We are on the radio with ads now, and will be talking very publicly about Medicaid, what has and has not been done to address cost-shifting, and its impact on health care costs for the next several months," Borgerding added.

Recovery Audit Contractor Program

Recovery Audit Contractor (RAC) Task Force Chair Mike Decker reported that the Task Force will direct their efforts in three areas in preparation for the Recovery Audit Contractor Program:

1. Legislative. Keeping members informed on legislation related to RACs.

2. Preparation for RAC audits. Including member communications and education.

3. RAC Relationship. Develop a strong relationship with the RAC vendor.

Decker said WHA is currently designing an education program for member hospitals. "We need to stay engaged and begin education now," Decker remarked. He said the audits will go back to Medicare admissions beginning in October 2007.

Wisconsin Council on Medical Education and Workforce

Quinn and WHA Senior Medical Advisor Chuck Shabino, MD, both of whom serve on the Wisconsin Council on Medical Education and Workforce (WCMEW), described the work of the Council to date for the Board (see related story on page 1). WHA Board member Sandy Anderson commented that the Wisconsin Academy for Rural Medicine just selected 13 students that will start medical school in the fall. Her concern is that there are not a sufficient number of rural residency programs. She identified funding as a key issue. Dr. Turkal commented that there needs to be more flexibility built into residency programs, including additional training tracks, but said that the national accrediting organizations are an impediment.

Council Reports

Finance Chair Tom Bayer reported on the efforts of the Hospital Assessment Workgroup. The workgroup’s mission was to arrive at a consensus regarding the appropriate hospital revenue to be used as the basis for the hospital assessment. Bayer said that the workgroup used several principles in deciding which services should be included: the data used should be timely, well defined, verifiable, and comparable. It should also recognize basic hospital services while eliminating material items like professional fees, exempt units and other services that make the data less comparable and fair when used as an assessment tool. The Board accepted the recommendation of the workgroup to use Medicare Cost Report Worksheet C (with modifications) as the basis for the assessment.

Rural Health Council Chair Bill Bruce circulated the registration materials for the Rural Health Conference. Board member Dave Grundstrum said he has found the trustee education at this conference very valuable and he said hospitals should encourage their trustees to participate.

A new Web site designed to attract more physicians to Wisconsin was unveiled at the Wisconsin Council on Medical Education and Workforce (WCMEW) meeting April 15. WHA staff created the site at WCMEW’s request and is still under construction. The Web site, www.DocJobsWis.org, targets physicians who were trained in or have an affiliation with Wisconsin but are now practicing outside the state. The site provides a single-source job posting for hospitals and clinics seeking physicians and allows physicians to post their resumes and look for career opportunities.

The Council offered suggestions and comments for the site. They also recommended holding a focus group of medical students and residents to determine when and how they make decisions on where they will locate their practice, and what resources they seek out on the Internet and elsewhere to help them make that decision. WHA is working with WCMEW Chair Carl Getto, MD to recruit participants for the focus group.

The Wisconsin Medical Society is in the process of surveying Wisconsin medical directors and physicians for WCMEW to determine:

• Current number of physician vacancies
• Recruitment time cycle for providers
• Physician relocation plans
• Impact of physician shortage on clinical services
• Future need for physicians

The survey, completed by approximately 2,000 physicians to date, will supply much-needed data that will facilitate more accurate workforce planning in the future. Nancy Nankivil from the Medical Society said the response rate from medical directors has been low thus far, and additional efforts need to be made to increase the response rate. Chuck Shabino, WHA senior medical advisor, said he will make some contacts among medical directors and attempt to improve the response rate from that group.

WCMEW member Byron Crouse, MD, reported that the Wisconsin Academy of Rural Medicine admitted 13 more students who will start the program in the fall. The program has been successful in attracting top-notch students who are interested in practicing medicine in rural settings. WHA will have a more detailed story on the WARM program and profiles of the new students in an upcoming issue.

Join your rural colleagues on the beautiful shores of Elkhart Lake for this year’s Wisconsin Rural Health Conference, June 18-20 at The Osthoff Resort.

This annual event is the forum for examining issues that impact small and rural hospitals, networking with colleagues, and bonding with your team of senior staff and trustees.

This year’s event will take full advantage of The Osthoff Resort’s beautiful setting on Elkhart Lake. As an alternative to the golf outing, one-hour sailboat cruises will be offered Wednesday afternoon, thanks to WHA Corporate Champion C.G. Schmidt. Plan to bring your families and guests to the Wednesday evening dinner on the shores of Elkhart Lake, with lots of family activities planned, including a bonfire, horse and carriage rides, a steel drum band, paddle boats and hydro-bikes, and more. Plan to join your colleagues for the Thursday evening race-themed reception and dinner, in the spirit of Road America in Elkhart Lake, for a great meal, networking, a chance to visit corporate member exhibitors, and some friendly competition.

This year’s theme is "Living Great Leadership." WHA encourages you to make attendance for yourself, your senior staff and your trustees a priority, taking advantage of the opportunity to talk about similar issues and challenges rural health care providers face while trying to "live great leadership" both inside and outside the hospital each day.

On April 14, 2008, the Centers for Medicare & Medicaid Services (CMS) released its hospital inpatient prospective payment system proposed rule for fiscal year 2009. In the rule, CMS announced a mandated market basket update of 3.0 percent for hospitals that report data for 30 selected quality measures. Hospitals not submitting data would receive a 1.0 percent update. The rule proposes to expand the number of required quality measures to 72 in FY 2010. Some of the proposed measures have been endorsed by the National Quality Forum and adopted by the Hospital Quality Alliance, however, many have not.

CMS also proposes several changes to the method used to compute the hospital wage index. In addition, the proposed rule would expand the post-acute care transfer policy as it relates to transfers to home with the provision of home health services to within seven days of discharge to home instead of three – a cut of $50 million to hospitals in FY 2009. Comments on the proposed rule will be accepted until June 13. A final rule will be released by August 1, and the policies and payment rates will take effect October 1.

WHA will provide a more detailed analysis of the proposed rule in the coming weeks.

On April 7, the IRS released its first draft of the instructions for completing the redesigned 2008 Form 990. The draft instructions are open to public comment until June 1.

The redesigned 2008 Form 990, released by the IRS five months ago, represents the first major overhaul of the form in nearly 30 years. It contains a new "snapshot" summary page, an 11-page core form, and 16 supplemental schedules requesting detailed governance, management and financial information. Although the new form was designed to increase clarity (for both the filer and the IRS) and to better reflect how a modern tax-exempt entity operates, the December release did not include a set of instructions. The scope of many of the questions asked on the new form was left in question.

The wait is now over. According to the IRS, the draft instructions include a number of tools "intended to provide specific and clear guidance for completing the core form and each schedule." The draft includes separate instructions for each schedule, and a new sequencing list that helps organizations complete the form in the correct order. Perhaps most important, the draft and its glossary of 176 key terms provides new definitions for terms that are essential to complete and accurate reporting.

While many of the parts are applicable to tax-exempt Wisconsin hospitals, Schedule H is of particular interest since it is specific to hospitals. The instructions for Schedule H provide two key definitions that apply to hospitals: 1.) "Hospital" is defined as a facility that is, or is required to be, licensed or certified in its state as a hospital, regardless of whether it is operated directly by the organization or indirectly through a disregarded entity or joint venture taxed as a partnership. 2.) "Facility," for purposes of the hospital definition, includes a campus (or component thereof), building, structure, or other physical location or address at which the organization provides medical or hospital care, including a hospital, outpatient facility, surgery center, urgent care clinic, or rehabilitation facility, whether operated directly by the filing organization or indirectly through a disregarded entity or joint venture taxed as a partnership.

In addition, the instructions educate organizations on how to make certain calculations for charity care and community benefits and provide worksheets for such calculations. In addition, the instructions clarify how Medicare bad debt is defined and reported. It should be noted that organizations are only required to file Part V (Facility Information) of Schedule H for 2008. The IRS is also specifically seeking comments regarding how organizations should report the cost of Medicaid, provider taxes and other uncompensated expenses.

All tax-exempt organizations are encouraged to carefully read the 990 instructions to understand what types of organizational policies and procedures should be implemented and what types of information must be collected and kept track of to adequately prepare and complete the redesigned Form 990. The IRS will accept comments to the instructions through June 1, 2008. Organizations should submit comments to the IRS regarding remaining ambiguities or items of concern via email to Form990Revision@irs.gov or by mail at the following address:

Internal Revenue Service
Draft 2008 Form 990 Instructions, SE:T:EO
1111 Constitution Ave., NW.
Washington, DC 20224

Links to the instructions and the redesigned Form 990 can be found on the IRS website for charities and nonprofits (www.irs.gov/charities/index.html).

Governor Jim Doyle’s proposed BadgerCare Plus Childless Adults Initiative represents something almost unique in the current political environment—a health reform proposal that can and should be supported by all stakeholders committed to expanding access and coverage with an eye toward containing rapidly increasing health care costs. There are significant features of this plan that should please just about everyone regardless of their current footing on the political spectrum.

The Childless Adults Initiative, included but not funded in the recent state budget legislation, represents the second phase of the Doyle Administration’s effort to ensure that 98 percent of Wisconsin residents have access to affordable health insurance. Phase 1 is the hugely successful BadgerCare Insurance for All Kids Initiative that has already enrolled tens of thousands of children since its inception on February 1, 2008. Phase 3 is a Small Business Plan currently under development.

The Childless Adults Initiative is aimed at providing basic coverage to 80,000 chronically underinsured, low income adults who are heavy users of health services—often through the hospital emergency department. To be eligible for the program, an individual must have been without health insurance for at least 12 months. Of note, this is not an entitlement program but is intended to use state and federal Medicaid dollars for sustainable funding.

Key aspects of the program:

• Care is provided through HMOs that will be tiered based on quality measures.
• The basic benefit package is less generous than standard Medicaid coverage…focusing on primary care and prevention.
• A preliminary health needs assessment and annual physical are mandatory for participants.
• Cost sharing, based on income, is built into the plan design.

Doyle Administration officials have requested a federal waiver that, once approved, will ensure that federal dollars already allotted to Wisconsin (Medicaid Disproportionate Share Hospital funding) are available to fund the program. Some of those dollars are currently used to pay for the Milwaukee County General Assistance Medical Program (GAMP) whose enrollees will be transferred into Childless Adults coverage.

Importantly, this new initiative aligns well with WHA’s health reform principles (www.wha.org/financeAndData/pdf/accessprinciples.pdf). It’s a creative approach that focuses on early diagnosis and prevention for a fragile population whose current service pattern is episodic and largely without a health care home. WHA has already encouraged members of the Wisconsin Congressional Delegation to support the waiver request, and we look forward to continuing to partner with the Doyle Administration and other supporters to position this plan as the centerpiece of Wisconsin Health Reform.

Steve Brenton,
President

The Centers for Medicare & Medicaid Services in the next few weeks will release a final report on the overall outcome of the Medicare recovery audit contractor demonstration, the AHA reported today. Following the report, the agency plans to announce the permanent RACs for the nationwide rollout. According to CMS, the permanent RACs will conduct outreach and education efforts prior to starting claims audits. Congress in 2006 made the program permanent and required CMS to operate RACs in all 50 states by 2010. RACs review old Medicare claims and receive a percentage of the improper payments they identify – both overpayments and underpayments. For information on how to prepare for the RAC program and the legislative campaign to slow down the national rollout, visit www.wha.org.

The Wisconsin Chapter of ACHE is presenting a workshop entitled, "Reinventing Customer Service in Health Care: Lessons Learned from the Best" on June 20, following the adjournment of the Wisconsin Rural Health Conference.

Organizational survival relies on health care leaders with the vision, determination and courage to test various methods of enhancing the customer experience. Customer (both internal and external) expectations are being set by other industries. Hospitals can implement initiatives that help organizations achieve outstanding patient and staff satisfaction results, increase market share and decrease costs. Initiatives include helping caregivers and staff to move to a more customer-centric mentality and method and make the health care facility an exciting and rewarding place to work using the Baptist Institute’s Customer Service and Organizational Excellence Program and the implementation of fundamentals using the Disney Institute approach.

The presenting panel will include Kristin Baird, president of Baird Consulting, Inc., who will act as moderator; Terry Brenny, CEO of Stoughton Hospital, and Nicole Clapp, CEO of Grant Regional Health Center.

The conference will be held at the conclusion of the Wisconsin Rural Health Conference, on Friday, June 20, 2008, from 10 - 11:30 a.m. at The Osthoff Resort in Elkhart Lake. There is no cost to register for this event, but pre-registration is requested. A brochure with registration form is included in this week’s packet and on the Web site at www.ache-wi.org. Online registration is available as well.

This program has been developed and is presented locally by the Wisconsin Chapter of ACHE. The American College of Healthcare Executives has awarded 1.5 Category I (ACHE education) credit hours to this program.

For more information on the program content, contact Donald Davis at 262-544-3267 or donald.davis@med.ge.com. For registration questions, contact Lisa Geishirt at 608-274-1820 or email lgeishirt@wha.org.

Q: What prompted you to become a grassroots advocate?

McMeans: After being in Wisconsin for just over two years, I saw that there are many challenges that Wisconsin health care providers have faced and will be facing over the next several years. It will be very important for our organization to stay informed and connected using grassroots efforts.

McMeans: My first efforts came in the form of a letter writing campaign. Getting other management and physicians to understand critical issues and taking action is a very important way for our legislative representatives to learn how issues can affect our patients and our local communities.

McMeans: Through correspondence with our state legislative representatives, I know that our communication with them had an impact on how they positioned themselves with issues concerning health care.

McMeans: Using an organized strategy like HEAT allows Holy Family Memorial to efficiently and effectively address issues that are important to our organization and community without losing focus on giving high quality health care to our patients.

Q: Any success stories you’d like to share about engaging your fellow employees in grassroots?

McMeans: Getting positive responses from management and physicians about being informed of the issues and an opportunity to voice their opinion is a great indicator of the success of the HEAT program.

McMeans: While a new grassroots program in an organization takes time to gain traction, it is important to sustain the efforts by keeping them visible and easy to use. Over time, people will find their need to get involved and the grassroots program will gain one more voice for the cause.

If you would like to get involved with HEAT (Hospitals Education & Advocacy Team), contact Jenny Boese, WHA’s vice president of external relations and member advocacy, at 608-268-1816 or email jboese@wha.org.

As many of you are aware, Governor Jim Doyle signed 2007 Wisconsin Act 102 into law on March 13, 2008. The new law created section 50.375 of the Statutes, effective March 28, 2008.

Section 50.375 requires hospitals to provide a victim of sexual assault with specific information, and upon the victim’s request, emergency contraception. Hospitals that fail to comply with these requirements are subject to a forfeiture of not less than $2,500 or more than $5,000 for each violation.

The Department of Health and Family Services is responsible for ensuring that hospitals comply with the requirements of section 50.375, and is authorized to directly assess forfeitures for violations of the law.

The Department of Health & Family Services/Division of Quality Assurance is sending this information to all hospitals and asking all hospital administrators to inform their staff of their responsibilities under the new law.

The law requires a hospital that provides emergency services to a victim of sexual assault to do all of the following:

• Provide the victim with medically and factually accurate and unbiased written and oral information about emergency contraception and its use and efficacy.
• Orally inform the victim of her option to receive emergency contraception, her option to report the sexual assault to a law enforcement agency, and any available options for her to receive an examination to gather evidence regarding the sexual assault.
• Immediately provide emergency contraception to the victim upon her request, in accordance with instructions approved by the federal Food and Drug Administration. If the medication is taken in more than one dosage, the hospital shall provide all subsequent dosages to the victim for later self administration.

The law requires a hospital that provides emergency care to ensure that each hospital employee who provides care to a victim of sexual assault has available medically and factually accurate and unbiased information about emergency contraception. No hospital is required to provide emergency contraception to a victim who is pregnant, as indicated by a pregnancy test.

The complete text of the new law can be found at the following link: www.legis.state.wi.us/2007/data/acts/07Act102.pdf

Thank you for your attention to this matter. If you have any questions about this information, please contact Cremear Mims, director, Bureau of Health Services at (608) 264-9887 or (414) 227-4556.

Finding ways to recruit young people into the health care profession is crucial for providing health care services in the future. The Bureau of Health Professions projects that the number of health care jobs will need to grow significantly to meet tomorrow’s health care demands. That trend is especially applicable in rural areas.

About nine years ago, Burlington High School surveyed its graduates to determine if something was missing in their education that limited their post-secondary experience. The students frequently indicated that an anatomy/physiology course was needed to assist those pursuing positions in the health care field.

The hospital responded by assembling a team of Aurora Health Care professionals that included physicians, nurses, laboratory technicians, and other departments, such as respiratory therapy, imaging, quality and education and business development, to partner with and develop a course for Burlington High School that combines both observation and hands-on activities. Students enrolled in the anatomy & physiology class are able to access the hospital lab where they perform their own urinalysis, perform individual respiratory testing, and observe surgeries in the hospital’s operating rooms.

The involvement of physicians and professional staff is an integral part of the program, as they also go to classes at the high school and share knowledge and experience about specific topics the students are studying. The Aurora physicians and other health professionals share their personal stories of how they became interested in health care, the educational paths they took, and highlight what opportunities exist in the field today. The students are provided job descriptions and salary structures to help gain a better understanding of their field of interest.

Since the program’s inception, nearly 250 students have participated.

For some patients, returning home from the hospital following surgery or illness or from an extended care facility following recuperation may pose some difficulties. They may need short-term assistance with meal preparation, light housekeeping, running errands, and transportation, or they may just need someone to visit them.

To assist these patients, Interfaith Volunteer Caregivers and Black River Memorial Hospital have developed a new Home Safe & Sound Program to assist people to successfully transition home.

The program begins before a person is discharged. Interfaith staff and facility discharge planners work closely with the person requesting this service, their family members and their medical team to coordinate services to ensure everything is in place when they go home.

Non-professional services are provided by trained Interfaith volunteers for up to four weeks after a person returns home. Services will depend on volunteer availability and may include transportation to medical appointments or grocery shopping, light household chores, running errands, preparation of light meals, reassuring telephone calls or friendly visiting.

Sauk Prairie Memorial Hospital & Clinics’ (SPMHC) Board of Directors has named Larry Schroeder chief executive officer (CEO). Schroeder has served as interim CEO since October 2007 and as chief operations officer for SPMHC since 1998.

Schroeder earned his master’s degree in Health Services Administration from the University of Michigan’s School of Public Health. He is a Fellow of the American College of Healthcare Executives and is board certified. He serves on the governing boards for the Sauk County Health Center and Home Health United.

"Sauk Prairie Memorial has always provided exceptional service to our patients, families and communities. There is much work ahead as we develop our exciting new future; with the tremendous community support this hospital enjoys, we’ll be able to meet these challenges," said Schroeder. "I am honored to lead an incredibly caring and capable staff that is truly dedicated to providing the highest quality health care."

ThedaCare Chief Medical Officer and Sr. Vice President Dean Gruner, MD, has been named by the Board of Trustees to succeed John Toussaint, MD, as president and CEO, effective immediately. Dr. Gruner, 53, has been chief medical officer of ThedaCare and senior vice president of physician services since 2003. He has served in multiple leadership positions with ThedaCare or its affiliates since it was founded as Novus Health Group in 1987. He previously served as chief medical officer of both ThedaCare and the former Touchpoint™ Health Plan.

Gruner received his undergraduate degree in chemistry and psychology from St. Olaf College in Minnesota, and his medical degree from the University of Minnesota Medical School. He completed his residency in family practice at St. Michael Hospital in Milwaukee. Gruner earned a masters degree in medical management from the Tulane University School of Public Health and Tropical Medicine in New Orleans, La., in 2001.

"My challenge as CEO, and one I relish, is casting a wider net and engaging everyone—our employees, our independent physicians, our patients, business leaders and the community at large, in eliminating waste and errors to deliver real value in health care," Dr. Gruner said.

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