In response to the potential for a pandemic flu outbreak, the Wisconsin Department of Health Services (DHS) has requested assistance from the Wisconsin Hospital Association to ensure all Wisconsin residents have access to medical care for symptoms related to H1N1 influenza virus, even if they do not have health insurance.

Today, WHA staff met with Medicaid Director Jason Helgerson and DHS staff to immediately develop a plan that would ensure uninsured and undocumented citizens have access to medical care and medications to treat the virus. The concern is that if uninsured or undocumented residents seek care solely in emergency departments, emergency departments’ available resources could be quickly overwhelmed and slow response time for patients that are critically injured or ill. WHA and DHS are developing a plan to establish a safety net of care statewide for these patients, in close coordination with Wisconsin hospitals.

Most hospitals in Wisconsin are reporting spikes in call volume in the emergency department and clinics. Patients who call the hospital and report flu-like symptoms are being directed to contact their primary care physicians. As is always true, hospital visitors that are sick are being asked to not visit patients.

Wisconsin is among the most prepared states in the nation when it comes to handling a potential pandemic flu outbreak, according to Governor Jim Doyle. On April 30, the Governor declared a public health emergency after two new probable cases of flu were reported in the state. Among other measures that are triggered by his Executive Order, it will speed the delivery of anti-viral medications to the public. The order also gives public health officials the resources they need to "respond to the challenges."

For the latest information on the flu, go to www.pandemic.wisconsin.gov. WHA has also established a Web page at www.wha.org, click on H1N1 Influenza at the top of the page. WHA staff are available to answer member questions related to the H1N1 influenza at 608-274-1820.

In the early hours of this morning (May 1), the Joint Finance Committee (JFC) took action on the proposed 2009-2011 budget for the Department of Regulation and Licensing (Department). Approved were 17 positions to support the regulatory and licensing functions of the Medical Examining Board (MEB). These positions are for the purpose of granting licenses and completing investigations in a more timely manner. Temporary staff for peak application times was also approved.

In addition, proposed fee increases to be effective this renewal cycle were reduced for all licensed occupations. Rep. Robin Vos (R-Racine) made the final motion, noting that WHA has expressed concerns about turnaround times for investigations and licensure.

This is another step toward improved service from the Department that WHA has been working on for nearly a year. Meetings with the Department, continued contact with staff and information to legislators have provided the impetus for improvements already made with additional improvements to come from increased staffing.

In this very tight budget year, it is a great success to have increased staffing and support to a department of state government.

WHA’s efforts on this issue have been driven by member concerns and complaints. At this point, member concerns about licensing times have been greatly reduced. WHA remains very interested in hearing about service levels from the Department, both compliments and concerns. Contact Judy Warmuth, vice president, workforce at 608-274-1820 or jwarmuth@wha.org with your comments.

In other JFC action, a motion by Sen. Judy Robson (D-Beloit) passed to create and support a biennial survey of the nurse workforce. Funding for the survey would come from a $4 surcharge on nursing licenses. This nursing survey will greatly increase the accuracy and timeliness of nurse workforce planning efforts.

Last week the JFC approved a WHA-supported provision to restore funding to the Wisconsin Poison Center (WPC). The WPC provides toll-free, instant access for Wisconsin families and health care providers to the best emergency poison control information available. The WPC saves lives and it also saves Wisconsin patients and their employers millions of dollars annually in avoided and reduced health care costs.

Six out of 10 hospitals nationally are seeing a greater proportion of patients without insurance coming through their emergency departments, according to a new survey released April 26 from the American Hospital Association (AHA). At the same time, nearly half of hospitals reported they have cut staff. Recent employment information from the Bureau of Labor Statistics confirms that hospital employment is no longer growing and that the number of mass layoffs for hospitals reported in February was more than double what it was a year ago.

The majority of hospitals reported that fewer patients are seeking inpatient and elective services; however, many hospitals are seeing more patients covered by Medicaid and other public programs for those in need. Need for hospital-subsidized services such as clinics, screenings and outreach is increasing even as charitable contributions are down for many hospitals.

"Today’s findings signal what many of us in health care are concerned about: people put off care when they lose their job, which can complicate health care issues for many down the road," said AHA President and CEO Rich Umbdenstock. "At the same time, the fact that hospitals are cutting staff challenges the notion that hospitals are recession-proof."

The national survey found that the economy is affecting hospitals, with nine in 10 hospitals making cutbacks to help weather the economic storm. At the same time, more than one in five hospitals reported reducing services their community depends on, such as behavioral health programs, post acute care, clinics and patient education.

"Community need for care remains high and in these tough times, communities turn to their local hospital," Umbdenstock said. "Hospitals are walking a tightrope, trying to balance the growing needs of their communities with today’s economic challenges."

Despite taking these steps, the majority of hospitals are seeing a moderate or significant decline in their financial health in 2009 versus the same period in 2008. Many hospitals are struggling to make ends meet with over 40 percent expecting losses in the first quarter of 2009, jeopardizing their mission of caring for their communities. The majority of hospitals reported fewer patients are seeking inpatient hospital care or elective care, further shrinking the resources hospitals rely on to meet the health needs of their communities. Financial measures such as days cash on hand that are important to creditors are slipping. If key measures fall below a certain level, creditors can require immediate repayment of borrowed money.

Nearly all hospitals report that their ability to borrow funds to make improvements is getting worse or remains challenging. In a December AHA survey, many hospitals reported that it was significantly more difficult or even impossible to access tax-exempt bonds and other sources of capital to make improvements. Nearly eight of 10 hospitals have stopped, postponed or scaled back projects such as facility upgrades as well as clinical and information technology planned or already in progress.

The AHA survey results closely follow those of a WHA survey completed in February that found patient volumes decreased in roughly two-thirds of the 80 Wisconsin hospital and health systems that responded to the survey. The decreases were across both the inpatient and outpatient settings. Wisconsin hospitals also reported sharp increases in charity care and bad debt as job losses mounted and health insurance was not available.

Two Wisconsin health care leaders shared their concerns about the impact the economy is having on patients and on their communities with media representatives from the American Hospital Association at the AHA Annual Meeting. Former AHA Chair Bill Petasnick, president/CEO, Froedtert & Community Health, referenced the key role that hospitals play in the local economy as employers and health care providers. In spite of the considerable economic challenges, Petasnick urged hospitals to "move forward and continue our vital mission in the community."

Frank Byrne, president, St. Mary’s Hospital, Madison, told AHA that they are seeing patients delay care, either because they do not have insurance, or because they are afraid to be away from their job for any length of time for fear of their employer realizing, "they are not needed." Byrne said charity care applications are up and patients are arriving at the hospital sicker as they have delayed seeking care.

WHA President Steve Brenton was interviewed by AHA for a radio news release. Brenton said even as the economy is taking its toll on hospitals and physician practices, the "historic community benefits provided by hospitals continue."

Over a dozen hospital representatives, led by WHA Chair and Spooner Health System CEO Mike Schafer, traveled to Washington, DC this week to join hundreds of their peers at the American Hospital Association’s Annual Meeting and day on Capitol Hill. On the top of the list of issues discussed with Wisconsin Members of Congress were health care reform and the Employee Free Choice Act (EFCA).

"Our hospital leaders were on message regarding the need for shaping a health care reform initiative that recognizes the strengths of Wisconsin’s delivery environment," said WHA President Steve Brenton. "Our lawmakers clearly understand this issue, as well as the importance of an outcome that is arrived at with bipartisan participation and support."

Hospital representatives took the opportunity to reinforce the efforts Wisconsin hospitals have taken to increase quality, transparency and demonstrate value, such as highlighting strong support for covering childless adults under the BadgerCare Plus program and continued commitment to CheckPoint and PricePoint initiatives.

Additionally, they highlighted Wisconsin’s continued top pier ranking (#1 in 2007, #2 in 2008) for quality as determined by the national Agency for Healthcare Research and Quality, and significantly lower Medicare enrollee reimbursement costs when compared nationally, as documented by the Dartmouth Atlas of Health Care.

"Even though Wisconsin brings great news about what we have been able to accomplish through our hospitals’ proactive, collective efforts," said WHA Executive Vice President Eric Borgerding, "One issue central to any health care reform discussion should be how to address primary physician shortage. In the end, access to coverage will not equal coverage itself."

Hospital representatives also reiterated strong opposition to the Employee Free Choice Act (or "card check") legislation pending in Congress. EFCA would effectively eliminate the secret ballot vote in union organizing, require mandatory binding arbitration and increase penalties on businesses only.

St. Joseph’s Hospital CEO David Fish Receives "Grassroots Champion" Award

The AHA in partnership with WHA awarded David Fish, chief executive officer of St. Joseph’s Hospital in Chippewa Falls, with the "Grassroots Champion" award for Wisconsin during a breakfast presentation held during the AHA Annual Meeting in DC on April 28. As an award honoree, Dave Fish was recognized for his exceptional leadership in generating grassroots and community activity in support of a hospital’s mission.

"Dave Fish truly exemplifies a Grassroots Champion," said WHA’s Vice President of External Relations & Member Advocacy Jenny Boese. "He is in regular contact with his legislators, encourages others to do likewise, annually brings 50 individuals to WHA’s Advocacy Day event, and has always been a strong advocate for his hospital, employees, patients and community."

The Grassroots Champion Award was created by AHA to recognize those hospital leaders who most effectively educate elected officials on how major issues affect the hospital’s vital role in the community and who are tireless advocates for the hospital and its patients.

"We depend upon strong voices like yours to help tell the story of hospitals as cornerstones of the communities they serve," said Rich Umbdenstock, AHA president and CEO. "This award is a small token of our appreciation for your hard work and dedication to improving health and health care in America."

WHA congratulates David Fish on this well-deserved award.

The Recovery Audit Contractor (RAC) program’s impact on providers must be monitored and addressed at the national level to ensure adherence to Medicare policy, assess its implications for broader policy issues such as medical necessity, and measure the true impact of RACs on the provider community and the Medicare program as a whole. To this end, the American Hospital Association is launching RACTrac, a survey to track and summarize the impact of RAC activity on individual hospitals nationwide. Data collection will begin this fall. RACTrac is FREE to all hospitals, regardless of whether you are an AHA member. The Wisconsin Hospital Association will encourage all Wisconsin hospitals to participate.

To help educate the hospital field on RACTrac, AHA will hold a free webinar on the use of the tool which will be held on May 6. To register, go to https://www1.gotomeeting.com/register/520770921.

Once RAC audits begin, providers will need to internally track any and all RAC activity to minimize financial risk and ensure timely response to the RACs to avoid technical denials. An internal tracking system will help providers monitor the status of claims in order to preserve appeal rights on every claim that is identified as an overpayment.

Therefore, the AHA created a free companion claim-level Excel tool to help hospitals internally track their RAC audits. This tool is available on the AHA Web site at no cost to both members and nonmembers of the AHA. Using the tool will also allow you to upload your RAC activity into the RACTrac survey. For more information on RACTrac and the Excel tool, go to www.aha.org/aha/issues/RAC/ractrac.html.

The RAC program, designed to identify Medicare overpayments and underpayments, is slated to begin in Wisconsin as early as August 1, 2009. Wisconsin’s RAC is CGI who recently revealed their new RAC Web site, http://racb.cgi.com.

The Federal Trade Commission (FTC) announced yesterday that it is delaying enforcement of the new "Red Flags Rule" until August 1, 2009 to give organizations covered by the rules more time to develop and implement written identity theft prevention programs.

"Given the ongoing debate about whether Congress wrote this provision too broadly, delaying enforcement of the Red Flags Rule will allow industries and associations to share guidance with their members, provide low-risk entities an opportunity to use the template in developing the programs, and give Congress time to consider the issue further, " FTC Chairman Jon Leibowitz said.

Under the rule, financial institutions and creditors with covered accounts must have identity theft prevention programs to identify, detect, and respond to patterns, practices, and activities that could indicate identity theft. The rule applies to financial institutions and creditors, including non-profit and government entities, that defer payment for goods and services. Hospitals are likely to meet the rule’s broad definition of "creditor," requiring them to develop a written identity theft prevention program.

The American Hospital Association’s Web site has more information available about the rule, including a sample policy that hospitals can use as a first step in developing their written identity theft program. The AHA material is available at www.aha.org/redflags.

This week the U.S. Senate Finance Committee unveiled a 48-page "policy options" paper on Medicare payment reform, which the Committee immediately began discussing behind closed doors on April 28.

The policy paper released this week includes options to:

• Establish a hospital value-based program (VBP). The VBP would go beyond payment for reporting on quality measures to payment for actual performance on those measures.
• Link payment to quality outcomes for home health, skilled nursing facilities and physicians.
• Establish quality reporting programs for inpatient rehabilitation facilities and long-term care hospital providers.
• Reduce hospital readmissions by creating national readmission rate benchmarks for the top eight conditions with the highest volumes/rates of readmission. Reduce payment to Medicare inpatient prospective payment system hospitals for readmissions above certain established thresholds.
• Bundle payments of IPPS hospital services and post-acute care services with 30 days of hospital discharge. Post-acute payments include home health, skilled nursing facilities, rehab hospitals and long-term care hospitals.
• Explore various options to address the Medicare physician payment formula.
• Consider health information technology incentive payments for nurse practitioners and physician assistants.
• Consider options to establish a long-term/permanent framework to set national priorities for comparative clinical effectiveness research.
• Promote nursing home transparency (require disclosure of ownership, accountability measures, etc.).
• Redistribute unused GME slots to increase access to top primary care/generalist physicians and promote more flexibility in residency training programs.
• Consider establishing a national health workforce commission to advise on health care workforce policy and make recommendations.
• Changes to Medicare Advantage (linking payment to quality, more efficient payment structure, payment for chronic care management).
• Establish a Chronic Care Management Innovation Center.
• Promote Medicare program integrity through options to combat fraud, waste and abuse.

WHA will continue to urge Wisconsin Members of Congress to consider all that Wisconsin hospitals have done voluntarily and proactively to promote quality, transparency and access to coverage as part of their Medicare reform deliberations. WHA will continue to review and provide comment, where appropriate, on these proposals as they move forward in Congress.

Paul Markgren, 75, passed away April 29 at Heritage Manor in Rice Lake. A well-known leader in Wisconsin health care, Paul served as administrator at Cumberland Hospital for nine years after which he became administrator at Menomonie Memorial Hospital. In 1969, he relocated to Madison to complete his college degree. While in Madison, he became assistant director of the Wisconsin Hospital Association under then-director Warren Von Ehren. In 1972, Paul was named director of the Northwest Comprehensive Health Planning Agency in Hayward that served the northernmost 12 counties of Wisconsin.

In 1975, he joined Lakeside Methodist Hospital in Rice Lake, which later became Lakeview Medical Center, where he served as administrator for nearly two decades. Paul is credited with being a driving force to build a new hospital that opened in 1978.

The staff at WHA send their deepest condolences to Paul’s family and friends.

Funeral services are at 2 p.m. Saturday at Bethany Lutheran Church in Rice Lake. Visitation is 4-8 p.m. Friday at Appleyard’s Home for Funerals and for one hour prior to services Saturday at the church.

A project aimed at improving stroke care in rural Wisconsin has received national attention. At its national conference, the American Heart Association recognized the Wisconsin Rural Hospital Stroke Improvement Project as a successful national model for improving stroke education and treatment in rural areas.

The following 19 rural Wisconsin hospitals participated in the Project that was supported by the Wisconsin Hospital Association and the American Stroke Association with funding from the Wisconsin Office of Rural Health:

1. Agnesian HealthCare, Fond du Lac

2. Black River Memorial Hospital, Black River Falls

3. Oconto Hospital and Medical Center, Oconto

4. Community Memorial Hospital Inc., Oconto Falls

5. Divine Savior Healthcare, Portage

6. Fort HealthCare, Fort Atkinson

7. Ministry Health Care - Good Samaritan Health Center, Merrill

8. Grant Regional Health Center, Lancaster

9. Langlade Hospital – An Aspirus Partner, Antigo

10. Memorial Hospital of Lafayette County, Darlington

11. Memorial Medical Center, Neillsville

12. Moundview Memorial Hospital & Clinic Inc., Friendship

13. Riverview Hospital Association, Wisconsin Rapids

14. Ministry Health Care – Sacred Heart-St. Mary’s Hospital, Rhinelander

15. Spooner Health System, Spooner

16. St. Joseph’s Hospital, Hillsboro

17. Stoughton Hospital, Stoughton

18. Waupun Hospital, Waupun

19. Westfields Hospital, New Richmond

The hospitals worked in teams to identify methods that could be used to build the infrastructure necessary to deliver excellent stroke care, develop protocols for treating stroke patients, and standardize stroke care-related processes.

"This Project was successful in bringing rural hospitals together to improve the level of care they provide in their communities," according to Dana Richardson, WHA vice president, quality initiatives. "However, the most important element in stroke care starts with a family member or co-worker recognizing the signs of stroke and seeking immediate medical care," she added.

Stroke is the third leading cause of death in Wisconsin. In the hospital, the early recognition and application of appropriate medical care is critical to improving patient outcomes. For family members and care givers, it is important to identify the signs of a stroke and seek immediate medical attention.

Glacier Canyon Lodge in Wisconsin Dells

The Wisconsin Chapter of Healthcare Financial Management Association is holding its Spring Program at the Stone Harbor Resort in Sturgeon Bay from May 20 to 22.

Ford Titus of ProHealth Care will kick off the conference with a presentation on the current challenges facing Wisconsin’s health care leaders. He will be followed by WHA President Steve Brenton, who will share his insights on the impact of various state and federal health care reform initiatives on Wisconsin. These presentations will assist the attendees to identify potential legislation and what it could mean for the industry as well as developing organizational strategies for positioning tomorrow’s health care delivery.

In another session, an expert panel will discuss the arguments being used by local, state and federal tax authorities, attorney generals, consumer advocates and plaintiffs class action lawyers to challenge the charitable nature and tax-exempt status of hospitals, systems and other nonprofit and exempt health care organizations.

Other sessions will include an overview of preparing the Medicare cost report and provide strategies to optimize reimbursement, strategies for integrating physicians into service line options, tools for improving the accuracy of the patient access process and strategies for applying lean sigma in redesigning hospital patient placement staffing.

To view the brochure, go to www.hfmawi.com/programs/spring2009brochure.pdf. The cost of the entire 1 & 1/2 day program is $225 for HFMA members and $275 for non-members and includes breakfast, lunch, dinner on Thursday, and breakfast on Friday. A single day rate is also available.

For more information, contact Program Chair Brian Stephens at stephenb@dcmh.org.

The Hospital Sisters Health System (HSHS) named Therese B. Pandl president and CEO of the Hospital Sisters Health System’s Eastern Wisconsin Division. Pandl is also named as president and chief executive officer of St. Mary’s Hospital Medical Center and St. Vincent Hospital in Green Bay. The Hospital Sisters Health System (HSHS), based in Springfield, IL, sponsors three hospitals in Eastern Wisconsin – St. Nicholas in Sheboygan, and St. Vincent and St. Mary’s in Green Bay. The Eastern Wisconsin Division covers 11 counties in Wisconsin and upper Michigan.

Pandl is currently executive vice president and chief operating officer of Columbia St. Mary’s, a large hospital system in Milwaukee. She will be succeeding James G. Coller, who has served HSHS for over 25 years, most recently as president of the Eastern Wisconsin Division. Coller will retire in February, 2010, and will continue to serve HSHS as a senior advisor until that time.

Pandl will assume her duties in mid-June.

Pandl earned her Master of Business Administration Degree from the University of Wisconsin-Milwaukee in 1992, and earned a Master of Nursing Degree from the University of Washington, Seattle in 1979. She was a Commonwealth Fund Nurse Executive Fellow from 1990 - 1992. She began in health care after earning a Bachelor of Science Degree in Nursing in 1976. She currently serves on the Board of Directors of Horizon Homecare and Hospice, the Columbia College of Nursing and the Business Advisory Council of Cardinal Stritch University. She is a Fellow in the American College of Healthcare Executives, and is active in several other professional and community organizations.

Aurora Parish Nurses are central figures in the churches they serve, combining faith with nursing to provide a vital link to people in need in all stages of life. During the first six months of 2008, Aurora Parish Nurses made direct contact with 8,495 parishioners, served 9,608 people in group settings, conducted health screenings for 5,837 people and assisted 420 with completing Advance Directives.

Aurora Parish Nurses are also health counselors who listen and respond to health concerns of individuals and their families. Concerns such as medications, blood pressure, nutrition, weight control and end-of-life issues are everyday matters.

Pam is an Aurora Parish Nurse who received a call from a woman who reported that her husband was sleeping too much. She paid them a home visit the very same day. It was immediately apparent the husband had previously suffered a stroke. It was also apparent that caretaking was taking its toll on the wife, who was doing her best but losing the battle.

Pam arranged a doctor’s appointment for the husband to be seen by a physician the very next morning. But when she checked on his status in the afternoon, she learned that the wife had cancelled the appointment. Such are the realities of parish nursing.

The next day, with Pam’s skillful and compassionate assistance, the husband was admitted to the hospital for a work-up and found also to be in late stages of cancer.

Pam helped in arranging hospice care so he could spend his remaining weeks of life in comfort and with dignity. She then turned her attention to the wife, who was facing an incalculable loss. Pam arranged for mental health support services and got her enrolled in a new prescription drug plan to pay for medications she needed. Most importantly, she comforted and prayed with the wife, counseling her all the way through the stages of bereavement, and continues to monitor her medical, emotional and mental health needs.

Shoppers will find new a new look at the children’s play area and medical information kiosk, both sponsored by Luther Midelfort at Oakwood Mall.

The play area theme is Luther Midelfort’s Oakwood Forest, complete with a Chippewa River bridge, oak tree, Mayo One helicopter and a medical tent.

The medical information kiosk has an open concept, allowing people to walk in and view videos and find health information. Consumers also can look up information on a computer that accesses Luther Midelfort and Mayo Clinic Web sites.

"We are proud that the play area and kiosk bring healthy activity and health information to the public in a community setting," said Dr. Randall Linton, Luther Midelfort’s president/CEO.

As access to health care for the uninsured continues to be a national concern, a coalition of dedicated volunteers in Watertown is working to ensure that local residents without health care coverage aren’t denied that access. Backed by professional and financial resources from UW Health Partners Watertown Regional Medical Center, the community recently opened a free clinic to meet the needs of the growing uninsured population.

When Dr. John Basarich, a UW Health Partners Watertown Regional Medical Center family practitioner, voiced his long-standing interest in developing health care solutions for the underinsured, the organization supported him in seeking out a partnership with the Watertown Public Health Department to address this need. The two entities recognized that this would have to be a community-wide effort and formed a committee as part of the Dodge-Jefferson County Healthier Community Partnership (DJHCP). Comprised of health care professionals, business leaders, educators and public health officials, the committee identified access to health care as a true community need and delved into the issue of providing health care to underserved individuals.

The committee began discussions in early 2005. At the time, the focus of the committee was on creating access to health care and gaining community-wide support for the initiative. The partnership operated under the mission statement, "We strive toward providing improved access to health care in the Watertown area with the focus on identifying populations that are in need and the available resources. We will coordinate the compassion and caring of the people of our area to create solutions and build a healthier community."

In order to subsidize its enterprise, the DJHCP requested funding from UW Health Partners Watertown Regional Medical Center’s community health fund, which was granted in October of 2005. After researching many different models throughout the United States and surveying Watertown area providers, the committee determined that a free clinic model would best serve the local community.

The creation of the Watertown Area Cares Clinic (WACC) was truly a community effort. UW Health Partners Watertown Regional Medical Center donated professional expertise, start-up funds and a commitment to pay the facility’s rent for three years. A location at Watertown’s Health and Wellness Center was secured, and many contractors and local businesses donated their skilled time and material to the construction of the clinic.

Thanks to the determined efforts of community volunteers and the steadfast support of Watertown Area Health Services and the Watertown Public Health Department, the WACC saw its first patients on May 20, 2008. In its first two months, the clinic served more than 100 patients. Staffed mostly with volunteers, the clinic has been successful in using an Electronic Health Record to ensure continuity of care with UW Health Partners Watertown Regional Medical Center. Local providers regularly donate their time to the effort, which has become a true community-wide accomplishment.

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

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