May 11, 2012
Volume 56, Issue 19
Wisconsin Hospitals in DC to Talk With Congressional Delegation
Bob Van Meeteren receives AHA "Grassroots Champion" award
Close to two dozen hospital representatives traveled to Washington, DC May 6-8 for the American Hospital Association’s Annual Meeting and the Wisconsin Hospital Association’s annual day on Capitol Hill.
One of the big issues hospital leaders discussed with Wisconsin Members of Congress was their continued push to provide health care "value"—high quality, cost-efficient care—to their patients and to Wisconsin. A recent report issued by the Commonwealth Fund on health care system performance backed this up and was cited as yet another example of why states like Wisconsin continue to lead the way nationally. The report tracked 43 performance measures in each of 306 mutually-exclusive local health care regions across the country. Several Wisconsin communities, including Appleton, Green Bay, La Crosse, Madison, and Neenah ranked in the top 10 percent of all local areas while all Wisconsin communities ranked in the upper (top 25 percent) quartile of states.
With this context, hospital leaders also expressed concerns with the potential that Congress will again propose hospital payment cuts later this year, as it wrestles with how to deal with the physician payment fix, looming sequester cuts, and the debt ceiling among other issues.
"Wisconsin hospitals have been aggressively pushing quality improvement, patient safety initiatives and cost efficiencies," said WHA President Steve Brenton. "Should Congress propose additional hospital payment cuts later this year, it penalizes those very hospitals held up as national leaders."
During their meetings, hospital representatives discussed the recently-released Inpatient Prospective Payment System rule and its continuation of a flawed policy manipulating the hospital wage index. Unless addressed, this hospital wage index change will swing billions of dollars away from 43 states, including Wisconsin. While there are larger issues that must be addressed with the wage index, WHA believes this manipulation must be fixed as quickly as possible and is working with a coalition of other state hospital associations to do so.
WHA and hospital leaders met personally with Sen. Kohl and Reps. Duffy, Kind, Petri and Ryan and met with staff for Sen. Johnson and Reps. Baldwin and Sensenbrenner. WHA thanks these members and their staff for their time.
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WHA staff and Wisconsin hospital quality managers joined hospital quality leaders from around the country at the Partnership for Patients, AHA/HRET Improvement Leader Fellowship in Chicago April 30 and May 1. Wisconsin was not the largest state by population represented, but with 55 participants, it did have the second highest number of hospital quality leaders present—evidence of Wisconsin’s continuing commitment to hospital quality improvement.
The Improvement Leader Fellowship is designed to build improvement and safety capacity at the hospital level. In addition to presentations from national leaders in health care quality, the participants were able to enhance their knowledge on measuring harm and learn more about the science of improvement with a focus on the Institute for Healthcare Improvement’s Plan-Do-Study-Act model.
Kelli Eklof, RN, clinic administrator at Burnett Medical Center in Grantsburg said this about the event:
"The fellowship was a wonderfully-organized quality improvement event that will assist Burnett Medical Center’s efforts in creating care improvements and quality outcomes for our patients. Every single presenter provided necessary data to build appropriate projects that will help us to reduce patient harm through preventable readmissions and early elective inductions. Not only were the presenters tremendously knowledgeable—they were also able to share data in a manner that held the interest of the participant, allowing it to really sink in. Overall, the first two days of this fellowship were outstanding—thanks!"
Participants will meet in August and again in November to continue their learning and collaboration with peers throughout the U.S., all in an effort to improve patient safety in hospitals nationwide.
The Partnership for Patients is a public-private partnership that intends to help improve the quality, safety and affordability of health care for all Americans. The aim is to reduce inpatient harm by 40 percent and readmissions by 20 percent in the 10 targeted areas:
"Our hospital leaders are to be commended for their commitment to quality improvement and for committing the time and resources that this endeavor requires," said Kelly Court, WHA chief quality officer. "In the end, our hospitals and communities will benefit from safer, more affordable, higher value care."
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On May 9, CMS released a proposed rule requiring higher Medicaid payments for primary care services provided by certain physicians. The new provision, required by the Patient Protection and Affordable Care Act (PPACA) would take effect for calendar years 2013 and 2014.
The new policy requires states to pay Medicare rates for primary care services. Medicare payment rates are generally higher than state Medicaid rates, so the policy is seen as an increase for primary care physicians. States would have to pay either the Medicare rates in effect in CY2013 and CY 2014, or the Medicare rate in effect in 2009, whichever is greater. The federal government will fund the entire difference between the Medicare payment amount and the Medicaid rate in effect on July 1, 2009. The policy applies to services under both FFS and managed care.
Primary care physicians with a specialty designation of family, general internal and pediatric medicine would qualify for the new payments, as would related subspecialists. The increase is not limited to physicians in these categories who are Board certified, but states would have to verify the eligibility of non-Board certified physicians through a review of the physician’s practice characteristics. The increase would also be applied to nurse practitioners and physician assistants who are providing services "under the supervision of a physician."
CMS proposes that the increase be limited to physicians who, as Medicare providers, would be reimbursed using the Medicare physician fee schedule. Thus, physicians delivering primary care services at federally-qualified health centers (FQHCs) and rural health centers (RHCs) are not eligible for the increased payments because they do not use the Medicare physician fee schedule.
The proposed rule lays out specific procedure codes eligible for the new payment, including evaluation and management (E&M) procedure codes and some vaccine administration codes. Other codes are also included, such as those for new and established patient comprehensive preventive medicine codes.
The payment change is limited to calendar years 2013 and 2014. Some have raised concerns about a temporary increase which would leave states in the position of reducing payments in 2015 or struggling to continue their funding without the federal match.
WHA continues to evaluate the rule to determine the impact in Wisconsin, especially in light of new payment policies implemented by the Medicaid program in the past year, including a reduction in Part A cost sharing for dual eligible recipients, and a recent reduction in the physician reimbursement rate for certain services provided in a hospital setting.
The proposed rule is available at:www.wha.org/Data/Sites/1/medicaid/PrimaryCarePaymentsProposedRule5-2012.pdf. Comments are due 30 days after publication in the Federal Register. The expected publication date is May 11.
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CMS Releases Final Rule Updating the Medicare Conditions of Participation
Part of effort to reduce unnecessary, obsolete, and burdensome regulations
The Centers for Medicare & Medicaid Services (CMS) this week released its final rule that updates the Conditions of Participation (CoP) for hospitals, including critical access hospitals (CAHs). Hospitals must meet the CoP to participate in Medicare and Medicaid. The Obama Administration proposed the rule as part of its effort "to reduce unnecessary, obsolete, and burdensome regulations."
CMS estimates that annual savings to hospitals related to the reduced regulatory burdens in the final rule could exceed $900 million in its first year. The final rule was developed through a retrospective review of existing federal regulations called for in Executive Order 13563 to "modify, streamline, or repeal" regulations that impose unnecessary burdens, including those on hospitals and other providers that must comply with requirements through Medicare. According to CMS, the final rule takes into consideration recommendations from hospitals, members of Congress, patient advocates, and others. A copy of WHA’s comments on the proposed rule is available here: www.wha.org/Data/Sites/1/reimbursement/WHAcommentsCAH-CoPReforms12-22-11.pdf.
The final rule includes the following and other changes:
A copy of the final rule updating the CoP and CMS’s responses to the comments it received will be published in the May 16 Federal Register and is available here: www.ofr.gov/OFRUpload/OFRData/2012-11548_PI.pdf.
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The goal of WHA’s public reporting initiatives has always been to provide consumers with information that they can use to better understand their health care choices. Since 2005, Wisconsin hospitals have led the country in the amount of information they share about the quality and cost of the care they provide.
In line with that continued commitment, WHA is pleased to announce that outpatient radiological procedures have been added to WHA’s PricePoint website (www.WiPricePoint.org). PricePoint currently serves as a transparency pricing website for inpatient, outpatient surgery, emergency department and urgent care facility charges.
The new outpatient data represents groups of radiological procedures that include magnetic resonance imaging and angiography, mammography, digestive radiology, ultrasound, PET scans, bone densitometry, CAT scans, and a few other radiology procedures.
The addition of this data was prompted by requests from consumers and providers for more information on hospital outpatient services, particularly those related to imaging. We believe this is incited by the volume of individuals with high-deductible health insurance policies combined with the number of individuals without insurance who are paying for outpatient services out-of-pocket.
As part of the development process for additions to PricePoint, WHA convened a group of WHA Information Center (WHAIC) hospital data users, a WHAIC vendor and representatives from the Wisconsin Department of Health Services. In partnership with 3MTM, WHAIC used the 3MTM Enhanced Ambulatory Procedure Groups (EAPGS). The 3MTM EAPGs are a classification system for all types of outpatient services that use the procedure, rather than diagnosis, as the initial classification variable.
After receiving feedback from the WHA workgroup, WHAIC provided each hospital a sample of their data using the EAPG format. This step allowed an opportunity for awareness, education and adjustment in reporting for a few hospitals.
The WHA Information Center will update the radiological procedure information on a quarterly basis—the same frequency used for other PricePoint updates. The first publication of this data on PricePoint includes services provided in the first two quarters of 2011. More outpatient data groups will be added over time based on feedback from providers and users of the information.
The health care environment is changing for the public. High deductibles and co-payments are becoming common, and as they are required to spend their own money first, consumers will be paying much more attention to the quality, safety and price of their medical services.
Thanks to a commitment to transparency that started in 2005, Wisconsin hospitals are more than ready for the new wave of consumerism.
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The American Hospital Association (AHA), in partnership with WHA, awarded Bob Van Meeteren, President/CEO of Reedsburg Area Medical Center with the "Grassroots Champion" award for Wisconsin. Grassroots champions were honored at a breakfast event held during the AHA Annual Meeting in Washington, DC on May 8.
As an award honoree, Van Meeteren was recognized for his exceptional leadership in generating grassroots activity on important hospital and health care issues.
"Bob has been a great grassroots asset in delivering the hospital message to his elected officials," said WHA’s Vice President of External Relations & Member Advocacy Jenny Boese. "Whether traveling to Madison or Washington, DC to meet personally with his legislators or submitting a letter to the editor in the local paper, Bob is always ready to speak up on behalf of his hospital and patients. He is well deserving of this award."
The Grassroots Champion Award was created by AHA to recognize 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 hospitals and patients.
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Ten Wisconsin communities will soon be testing new tools and resources to determine the value that they lend to the community health needs assessment process. The Community Health Improvement Plans and Processes (CHIPP) Infrastructure Project (see sponsoring organizations below) launched a request for proposals to identify 10 pilot sites.
Twenty-one sites applied for the pilot opportunity. Applicant communities included hospitals, local health departments and a UW-Extension as lead agencies. The applications were reviewed by CHIPP staff and a review panel of project partners, that included representatives from public health, the University of Wisconsin School of Medicine and Public Health, and the Wisconsin Hospital Association.
The ten communities reflect a mix of rural, urban, and various levels of health as measured by the County Health Rankings project. It is the mix of these sites that is the key to the success of the pilot effort. For instance, having sites that are "advanced" or that have "excellent" partnerships is as important as having sites that are "beginners" or have "struggling" partnerships.
The ten selected pilot communities include:
As a whole, the ten sites reflect the following mix:
Starting in summer 2012, these communities will begin piloting a set of tools and resources. Baseline information will be collected first, and technical assistance through a Healthy Wisconsin Leadership Institute (HWLI) team will be available throughout the life of the 18-month project. Mandy Ayers, a community benefit specialist at WHA, is a member of one the teams and her expertise will be available to all WHA members as a resource.
Information about the project, including summarized information on CHIPP best practices, is currently available on the Wisconsin Association of Local Health Departments and Boards (WALHDAB) website, www.walhdab.org/SpecialProjects.htm.
For more information about this project, contact Mary Kay Grasmick at WHA, firstname.lastname@example.org
or 608-274-1820, or Julie Hladky, CHIPP Research and Support Specialist, at Julie.email@example.com
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Register Now for the Partnership for Healthcare Payment Reform Summit
There is still time to register for the Partnership for Healthcare Payment Reform Summit, June 20, 2012, at the Milwaukee Marriott West. The summit is a showcase of innovative efforts in health care payment reform. It will provide updates on payment reform initiatives and highlight progress and learnings from other leading payment reform work.
Chief executive officers, chief medical officers, chief financial officers, contracting, operations and data leads, and others responsible for leading past, present and future payment redesign projects are encouraged to attend.
Highlights of the program include:
Full information on the Summit and registration information is at: http://events.SignUp4.com/PHPR12.
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Hospital Sisters Health System Division – Eastern Wisconsin announced that Larry Connors will now serve as the common chief operating officer (COO) for both St. Mary’s Hospital Medical Center and St. Vincent Hospital in Green Bay.
Connors, who has 27 years experience in Catholic health care administration, has been with St. Mary’s Hospital Medical Center since 1993 and has served as the hospital’s COO for the last five years. In his newly-expanded role, he will succeed Tom Bayer at St. Vincent Hospital uniting the two hospitals under a common COO. Bayer has been appointed senior vice president of regional development. In his new position, he will grow relationships with regional partners to improve access to specialty health care in outlying communities.
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Nutrition counseling is an important aspect of the service that hospitals provide within their communities. Whether it is offering classes that focus on weight loss or promoting better health, or nutrition education for people who are diabetic, Wisconsin hospitals offer hundreds of free classes that stress the importance of a nutritional, well-balanced diet on overall health. Hospital employees also help deliver Meals on Wheels and they organize and participate in food drives to benefit local food pantries.
Roberts couple moves beyond dieting to successful, sustained weight loss
This certainly wasn’t their first attempt at weight loss. John and Kristi Kurkowski of Roberts may even have considered themselves dieting experts. The problem was, they were still overweight.
Kristi was, in fact, on a diet when she spotted a brochure for Healthy Habits for Life, one of several classes, seminars and support groups that Hudson Hospital & Clinics offers members of the community to support lifestyle changes for optimal health. She took the brochure home to her husband, John.
"I thought it sounded interesting and could help us," Kristi says. "John was all for it."
One of the first things John and Kristi learned when they started the 12-week group program in November was that they didn’t need a diet; they needed a lifestyle change, starting with the basics of cooking and exercise.
Under the guidance of registered dietitian Brittany Willard, the Kurkowskis met weekly with other program participants to learn, share ideas and support each other. Willard also completed comprehensive evaluations of each participant to determine his or her metabolic rate and establish safe and realistic milestones for losing weight.
That individual assessment was critical to her success, Kristi says. "So many other diets and programs I had tried were based on an average person. But I didn’t fit into the ‘average’ mold. My metabolic rate was much lower, and I don’t need as many calories as I was eating with other diets."
John, a longtime Hudson High School physical education teacher, says he appreciated the program’s sensibility and credibility. "I’m a very detailed guy. I liked that the Healthy Habits for Life program made sense. It didn’t feel like a diet."
It helped, Kristi says, that Willard was always energetic, upbeat and nonjudgmental. "I could be honest with her. She didn’t judge, no matter how much someone had to lose."
And they have lost a lot of weight. To date, John has shed 21 pounds, and Kristi, 33 pounds. Kristi is buying new belts to cinch in her newly loose clothing, with plans to buy smaller clothes in the future when she’s met all her weight-loss goals.
Willard says she’s grateful the Healthy Habits for Life program helped the Kurkowskis succeed. "They were really eager to learn; so motivated and excited. Their kids got involved at home and, as a couple, they were really supportive of each other."
Hudson Hospital & Clinics
Sacred Heart Hospital offers health and wellness education to area youth
More than 1,000 second-graders from 22 area schools in Eau Claire County came to Sacred Heart Hospital April 2-4, 2012, for the hospital’s 34th Annual Pediatric Health Fair. The event is sponsored by Sacred Heart’s Center for Healthy Living with the assistance of Volunteer Partners. The health fair was originally designed as a way to orient children to possible hospital departments they might visit. However, in the past five years, the event has been redesigned to teach children about the importance of making healthy choices and adopting healthy habits at a young age. The fair encompasses the whole "body, mind and spirit" of children and stresses prevention and education on how to stay healthy.
The success of this program is due to the dedicated work of all those involved: hospital nurses and professional staff, local health professionals, Sacred Heart’s Safe Kids program, and law enforcement officers.
"If we can start teaching the importance of these safety messages at a younger age, hopefully the children will develop healthier habits that stick with them throughout adolescence and into adulthood," commented Paula Pater, Safe Kids Coordinator, Center for Healthy Living.
Students visited eight different stations during the health fair:
1. Sacred Heart Pediatrics (Hand Washing)
2. Eau Claire Police Department and Center for Healthy Living (Internet Safety)
3. Cardiac Rehabilitation (Importance of Exercise)
4. Sacred Heart Nutrition (Healthy Eating)
5. Officer Kyle Roder, Eau Claire Police Department (Bullying)
6. Linda Bohacek, Dental Hygienist (Sugar Content of Beverages)
7. Sacred Heart Safe Kids (Bike and Helmet Safety)
8. Dr. Turner, Pediatric Dentist (Dental Health)
As a way to carry what the children learned back to the classroom, each student is encouraged to draw a picture of their favorite station. These pictures are returned to the hospital and one child from each classroom is chosen as a winner. The student, their family, teacher and principal are invited to an awards ceremony on May 14 at which they are recognized for their drawing. There is a short slide show explaining to the adults what the fair was all about and the children are given a certificate, bike helmet or t-shirt. They are then able to take their award-winning art work home to share with others.
Sacred Heart Hospital, Eau Claire
Submit community benefit stories to Mary Kay Grasmick, editor, at firstname.lastname@example.org.
Read more about hospitals connecting with their communities at www.WiServePoint.org.
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