May 27, 2011
Volume 55, Issue 21


JFC Completes Work on Medicaid
No cuts to hospital rates; Hospital supplemental Medicaid payments preserved

This week the Joint Finance Committee (JFC) wrapped up its work on the Medicaid portion of the state budget, approving many proposals included by Governor Walker, but also placing their stamp on the bill by including significant modifications.

An omnibus motion, introduced by Committee Co-Chairs Rep. Robin Vos (R-Burlington) and Sen. Alberta Darling (R-River Hills), summarizing the Republican-controlled Committee’s intent passed on a 12-4 party-line vote. The motion, which included several items of interest to hospitals, highlighted the Committee’s efforts at addressing the significant challenges faced by the Medicaid program.

Medicaid Funding

The Committee increased Medicaid base funding by $98.6 million all funds (meaning state, federal and other sources of revenue combined) over the 2011-13 biennium—an increase of nearly eight percent over the $1.3 billion Governor Walker had included in additional funding for Medicaid in his budget bill.

Also adopted were more conservative enrollment assumptions for Medicaid, which WHA advocated for, along with an additional $56 million all funds over the biennium to reflect revised projections of Medicaid enrollment growth. The changes are significant and welcome as the original budget proposal had projected a considerable drop to Medicaid enrollment and its associated funding.

No Hospital Rate Reductions

The MA provisions approved by Joint Finance do not include a reduction in hospital Medicaid rates, consistent with the budget bill submitted by Governor Walker. The Walker Administration has underscored its commitment not to cut hospital reimbursement rates during the coming biennium and has consistently raised concerns over the impact of cost shifting on Wisconsin employers (see "Medicaid Provider Reimbursement Cuts—Not an Option Here" in 4/29/11 issue of The Valued Voice).

During Committee deliberations, Co-Chair Vos also stated that it was not the Governor’s or the Committee’s intent to cut provider reimbursement rates in the budget.

"In the past the avenue that was left was rate reduction…just cut all of the providers, and they’ll just have to eat it. That is clearly not the intent of Governor Walker. I’ve had conversations with him about it (and) it clearly is not the intent of this Committee," Vos said. "We do not think the answer to solving the Medicaid problem is to just chip away at how much we are paying those who choose to provide the service. That’s the wrong answer."

"While we are concerned about the future of the Medicaid program in the current fiscal and economic environment, we applaud the work of Joint Finance to not only hold the line on hospital reimbursement rates, but to inject nearly $100 million of additional funding into the program," said WHA’s Eric Borgerding. "The new dollars will help provide a cushion should the economic turnaround or pending program reforms not produce the savings in Medicaid that are anticipated. It was a prudent move by the Committee, as was choosing not to pass Medicaid costs on to struggling employers by cutting hospital reimbursement rates."

Medicaid Cost Reduction Measures/Reforms

The Committee agreed with the Governor and adopted his proposal for DHS to use various, but yet-to-be-specified, changes and reforms to find an estimated $466 million (all funds) in savings over the biennium in the Medicaid program. While not a new proposal, the Committee agreed on the amount that Governor Walker has said will be found through the targeted reforms under development by DHS.

To this end, the WHA member Medicaid Reengineering Group continues to develop recommendations on how to reduce costs and improve care in Medicaid (see related story in this issue of The Valued Voice).

The Committee also adopted a number of welcome transparency and legislative oversight provisions supported by WHA, such as requiring DHS to obtain approval from the JFC for any changes to the Medicaid program that will require a federal waiver or a change to the Medicaid state plan amendment. DHS will also be required to submit quarterly reports to JFC on any implemented changes, including:

Medicaid Payments for Medicare Part A Services (Dual Eligibles Reimbursement)

While WHA had advocated for its removal, the Governor’s proposal to eliminate Medicaid’s payment of Medicare hospital co-payments and deductibles for "dual eligibles" (amounting to approximately $15 million in FY2012 and $21.5 million in FY2013 all funds) was also approved by the Committee. However, an analysis by the Legislative Fiscal Bureau includes positive news of DHS’ confirmation of WHA’s belief that roughly 70 percent of the reduction is a recoverable cost through Medicare, significantly minimizing the impact of this provision.

All Hospital Medicaid Supplemental Payments Preserved

Nearly every hospital in Wisconsin receives some degree of the nearly $35 million annually paid by the state in the form of seven different supplemental hospital Medicaid payments. Early in the budget process, all of these supplemental payments were targeted for elimination as a budget reduction measure. But due to early efforts by WHA and our members, and as a result of this week’s action by the JFC, all of the supplements have been preserved.

Other Non-Medicaid Provisions

As previously reported (see May 20 Valued Voice story on copy and newborn screening fees for more information), the JFC adopted two WHA-initiated and supported amendments not related to Medicaid. The previously approved amendments will:

Next Steps

JFC leaders have indicated their intent to complete the Committee’s work on the budget by the end of next week. Once approved in its entirety, the budget will move from there to the Assembly for consideration and possible amendments before moving to the Senate. Identical versions are required to pass both houses before the budget can be forwarded on to Governor Walker for his consideration, possible line item veto and signature, which is expected to happen in mid- to late-June.

WHA will continue to provide Valued Voice updates on the state budget as they become available.

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WHA Medicaid Reform Group Continues to Address Care Coordination Challenges
New report quantifies number on Medicaid that might have other insurance options

On May 26, the WHA Medicaid Reengineering Group (MRG) met to continue to discuss care coordination issues in the Medicaid program. After hearing from a series of guest speakers at its last meeting on the possible challenges and opportunities to better manage care in the Medicaid program (see May 20 Valued Voice article), the group turned its attention to developing specific care management recommendations.

"Care management and coordination for the entire Medicaid population is important," said Nick Desien, President/CEO of Ministry Health Care and chair of the MRG. "We need to be able to address the barriers to more effective coordination of care both for the fee-for-service Medicaid population and for the high percentage of Medicaid recipients enrolled in Medicaid HMOs."

Members agreed that a key challenge is in understanding that the current low reimbursement level in the Medicaid program does not incent over-utilization by providers. To reduce utilization requires a coordinated effort that also includes patient education and engaging patients in behaviors that improve their health status.

The MRG also noted the importance of bringing together providers, HMOs and the state to share data and develop shared strategies around care management. In its overall administration of the Medicaid program, the state has a critical role to play in helping all parties to identify where improvements can be made.

"The state is already engaged in ‘care coordination’ by way of the fact that 75 percent of all Medicaid recipients are enrolled in Medicaid HMOs," said WHA Executive Vice President Eric Borgerding. "That necessarily narrows the potential scope of care coordination to the remaining fee-for-service population, but that doesn’t mean the state shouldn’t be doing a better job with the 75 percent that are enrolled in HMOs. This issue has become a focus for the MRG."

Discussion also centered on the use of health homes or medical homes for the Medicaid population, and in particular for patients with behavioral health conditions. The MRG recognized that long-term fundamental changes to the behavioral health system and infrastructure are needed to implement and sustain any long-term care coordination benefits in the area of behavioral health However, it is important to continue to seek short-term care management opportunities for this high need population.

"Care coordination can result in significant savings for targeted fee-for-service populations as well as for those in managed care," said Joanne Alig, WHA’s vice president, payment policy & reform. "However, it must be properly structured, targeted and incentivized."

At its next—and last—meeting, the MRG will discuss whether and how benefits could be modified in the Medicaid program.

UW report finds many on Medicaid have other coverage options

The UW Population Health Institute has recently released a number of reports about the BadgerCare Plus Program. Of note are some of the findings in the report that suggest private insurance coverage is being "crowded out" by Medicaid, including:

All of the reports can be found on the UW Population Health Institute Web site at: http://uwphi.pophealth.wisc.edu/healthPolicy/badgerCarePlus.htm.

DHS pursuing "crowd out" reforms

In addition to the care coordination theme discussed above, the WHA Medicaid Reengineering Group recently developed recommendations focusing on eligibility and enrollment, including policies to prevent "crowd out" of employer-sponsored or other forms of private health insurance by the Medicaid program. WHA believes Medicaid is a safety net and should be reserved for our most at-risk citizens who have no other options for coverage.

In line with those objectives, the Wisconsin Department of Health Services has indicated it will develop new Medicaid polices aimed at preserving Medicaid for the most needy as a component of a larger strategy to reduce Medicaid spending during the 2011-13 biennium.

"In addition to making the coverage provided to working families more comparable to employer-sponsored insurance, eliminating the incentive to choose Medicaid over private health insurance options, the department will implement reforms to reduce the crowd-out of private health insurance," DHS stated in materials compiled to support Governor Walker’s budget legislation. "The Medicaid program was created to act as a safety net for individuals without access to health care coverage."

DHS estimates reducing "crowd-out" will save the state over $32 million during the coming two years.

"We recognize that there is a big difference between removing people from the Medicaid program based on whether they are above or below a federal poverty index and making sure that those who remain on Medicaid have no other options," said Borgerding. "We support efforts to reduce the Medicaid rolls through mechanisms that do not leave people uninsured, but instead keep them in affordable private coverage. We look forward to reviewing what DHS puts forward in this important area."

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Political Action Spotlight: Political Action Fundraising Campaign Update - 31% of Goal

The Wisconsin hospitals state political action funds fundraising campaign has raised $77,108 from 129 individuals whose average contribution is $597. In the last two weeks, the campaign has raised almost $10,000 more and added 26 additional contributors. This puts the 2011 campaign at 31 percent of the $250,000 monetary goal.

According to WHA’s Jodi Bloch, "The earlier start to this year’s campaign seems to be paying off, as the 2011 Campaign has raised almost $35,000 more as compared to this same time last year."

Individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. 2011 contributors to date are listed below. Contributors are listed alphabetically by contribution category. The next publication of the contributor list will be in the June 10 edition of The Valued Voice.

For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Contributions ranging from $1 - 499

Alstad, Nancy         Fort HealthCare

Ashenhurst, Karla         Ministry Health Care

Ayers, Mandy         Wisconsin Hospital Association

Bablitch, Steve         Aurora Health Care

Bailet, Jeffrey         Aurora Health Care

Beall, Linda         Hudson Hospital & Clinics

Boudreau, Jenny         Wisconsin Hospital Association

Braunschweig, Jennifer         Gundersen Lutheran Medical Center

Byrne, Frank         St. Mary’s Hospital

Campbell-Kelz, Nancy         Aspirus Wausau Hospital

Casey, Candy         Columbia Center

Clark, Renee         Fort HealthCare

Connor, Michael         Aurora Health Care

Dahl, James         Fort HealthCare

Decker, Michael         Divine Savior Healthcare

DeRosa, Jody         St. Mary’s Janesville Hospital

Devermann, Robert         Aurora Medical Center in Oshkosh

Dolohanty, Naomi         Aurora Health Care

Donlon, Marcia         Holy Family Memorial, Inc.

Evans, Kim         Bellin Hospital

Facey, Alice         St. Clare Hospital and Health Services

Fielding, Laura         Holy Family Memorial, Inc.

From, Leland         Beloit Health System

Furlong, Marian         Hudson Hospital

Grohskopf, Kevin         St. Clare Hospital and Health Services

Halida, Cheryl         St. Joseph’s Hospital

Hieb, Laura         Bellin Hospital

Hockers, Sara         Holy Family Memorial, Inc.

Holub, Gregory         Ministry Door County Medical Center

Jelle, Laura         St. Clare Hospital and Health Services

Keene, Kaaron         Memorial Health Center - An Aspirus Partner

Klay, Lois         St. Joseph’s Hospital

Klein, Rick         Aurora Health Care

Laird, Michael         Froedtert Health St. Joseph’s Hospital

Lange, George         Westgate Medical Group, CSMCP

Margan, Rob         Wisconsin Hospital Association

Marquardt, Amy

Maurer, Mary         Holy Family Memorial, Inc.

McNally, Maureen         Froedtert Health

Merline, Karen

Niemer, Margaret         Children’s Hospital and Health System

O’Keefe, James         Mile Bluff Medical Center

Olson, Bonnie         Sacred Heart Hospital

Ose, Peggy         Riverview Hospital Association

Penczykowski, James         St. Mary’s Hospital

Peters, Kenneth         Bellin Hospital

Petonic, Mary Frances         Meriter Hospital

Potts, Dennis         Aurora Health Care

Priest, Geoffrey         Meriter Hospital

Proehl, Sheila         Hudson Hospital

Radoszewski, Pat         Children’s Hospital and Health System

Reinke, Mary         Aurora Health Care

Rickelman, Debbie         WHA Information Center

Roller, Rachel         Aurora Health Care

Samitt, Craig         Dean Health System

Schaefer, Mark         Froedtert Health

Schafer, Michael         Spooner Health System

Scieszinski, Robert         Ministry Door County Medical Center

Stanford, Cynthia

Tapper, Joy         Milwaukee Health Care Partnership

Tews, Carol         Memorial Medical Center - Neillsville

VanDeVoort, John         St. Joseph’s Hospital

Walker, Troy         St. Clare Hospital and Health Services

Worrick, Gerald         Ministry Door County Medical Center

Yaron, Rachel         Ministry St. Clare’s Hospital

Zeller, Brad         Hayward Area Memorial Hospital and Water’s Edge

Contributions ranging from $500 - 999

Anderson, Sandy         St. Clare Hospital and Health Services

Carlson, Dan         Bay Area Medical Center

Clough, Sheila         Ministry Health Care’s Howard Young Medical Center

Court, Kelly         Wisconsin Hospital Association

Dietsche, James         Bellin Hospital

Eckels, Timothy         Hospital Sisters Health System

Frank, Jennifer         Wisconsin Hospital Association

Grundstrom, David         Flambeau Hospital

Heifetz, Michael         SSM Health Care-Wisconsin

Kerwin, George         Bellin Hospital

Lewis, Gordon         Burnett Medical Center

Mantei, Mary Jo         Bay Area Medical Center

Mohorek, Ronald         Ministry Health Care

Nelson, James         Fort HealthCare

Russell, John         Columbus Community Hospital

Schoof, Susie         Essie Kammer Consulting Group

Selberg, Heidi         HSHS-Eastern Wisconsin Division

Shabino, Charles         Wisconsin Hospital Association

VanCourt, Bernie         Bay Area Medical Center

Westrick, Paul         Columbia St. Mary’s, Inc. - Milwaukee

Wolf, Edward         Lakeview Medical Center

Zenk, Ann Ministry         Sacred Heart Saint Mary’s

Contributions ranging from $1,000 - 1,499

Alig, Joanne         Wisconsin Hospital Association

Boese, Jennifer         Wisconsin Hospital Association

Borgerding, Dana

Brenton, Mary E.

Britton, Gregory         Beloit Health System

Duncan, Robert         Children’s Hospital and Health System

Hahn, Brad         Aurora Health Care

Harding, Edward         Bay Area Medical Center

Hilt, Monica         Ministry Saint Mary’s Hospital

Kerschner, Joseph         Children’s Hospital and Health System

Kosanovich, John         UW Health Partners Watertown Regional Medical Center

Levin, Jeremy         Rural Wisconsin Health Cooperative

Loftus, Philip         Aurora Health Care

Mettner, Michelle         Children’s Hospital and Health System

Morgan, Dwight         Aurora Health Care

Normington, Jeremy         Moundview Memorial Hospital and Clinics

Olson, David

Potter, Brian         Wisconsin Hospital Association

Robertstad, John         ProHealth Care - Oconomowoc Memorial Hospital

Size, Tim Rural         Wisconsin Health Cooperative

Stanford, Matthew         Wisconsin Hospital Association

Troy, Peggy         Children’s Hospital and Health System

Wallace, Michael         Fort HealthCare

Contributions ranging from $1,500 - 1,999

Bloch, Jodi         Wisconsin Hospital Association

Coffman, Joan         St. Joseph’s Hospital

Eichman, Cynthia         Ministry Our Lady of Victory Hospital

Grasmick, Mary Kay         Wisconsin Hospital Association

Herzog, Mark         Holy Family Memorial, Inc.

Olson, Edward         ProHealth Care

Starmann-Harrison, Mary         SSM Health Care-Wisconsin

Turkal, Nick         Aurora Health Care

Warmuth, Judith         Wisconsin Hospital Association

Woodward, James         Meriter Hospital

Contributions ranging from $2,000 - 2,499

Fish, David         Hospital Sisters Health System

Kachelski, Joe         Wisconsin Statewide Health Information Network

Leitch, Laura         Wisconsin Hospital Association

Merline, Paul         Wisconsin Hospital Association

Neufelder, Daniel         Affinity Health System

Pandl, Therese         HSHS-Eastern Wisconsin Division

Contributions ranging from $2,500 - 2,999

Borgerding, Eric         Wisconsin Hospital Association

Contributions ranging from $3,000 - 3,999

Erwin, Duane         Aspirus Wausau Hospita

Contributions ranging from $4,000 - 4,999

Contributions $5,000 +

Brenton, Stephen         Wisconsin Hospital Association

Tyre, Scott             Capitol Navigators, Inc.

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Joint Finance Committee Votes to Pay Back Patient Compensation Fund

Reps. Warren Petryk (R-Eleva) and Tom Larson (R-Colfax) and Sen. Alberta Darling (R-Milwaukee) this week introduced and the Joint Committee on Finance passed a new budget adjustment bill that, among other things, would pay back the money the state owes the Injured Patients and Families Compensation Fund (IPFCF).

The 2007-2009 Wisconsin State Budget used $200 million from the IPFCF to balance the state’s books. The Wisconsin Supreme Court held that the transfer was unconstitutional. The new bill includes $235 million to pay back the IPFCF, including principal and interest.

The bill also increases Medicaid payments in the current fiscal year to take advantage of a higher federal matching rate that expires on July 1, 2011. As part of last year’s Medicaid rate reform efforts, the Medicaid program had pushed the June payment owed to health maintenance organizations into July, which is part of the next biennium’s budget. The proposed bill would reverse that decision. The bill also reduces the funding "lapse" required as part of the 2009-2011 Wisconsin State Budget and eliminates the savings associated with state employee health insurance and retirement contributions that were part of Act 10, which was voided today by a Dane County judge based on an open meetings law violation (an appeal is expected).

The nonpartisan Legislative Fiscal Bureau last week reported that state revenue was likely to increase by $636 million more than originally estimated over the next two years. "The updated revenue projections from the state’s Fiscal Bureau were certainly welcome news, but they weren’t a blank check," said Rep. Larson. "We must do the prudent thing and first take care of our responsibilities like Wisconsin families do each and every day."

Supporting the bill, Governor Walker said, "The time has come to act responsibly and pay our bills. For too long decisions related to the state’s finances were only made with the short-term consequences in mind—this action shows the Legislature is serious about governing with the next generation in mind and laying the foundation for sustained economic growth."

During the Joint Finance Committee’s debate on the bill, Committee Co-Chair Rep. Robin Vos (R-Burlington) emphasized, "We are paying back with interest the Injured Patients and Families Compensation Fund." He continued, "For once we are trying to say we are going to pay bills when they are due."

The full Assembly and Senate are expected to vote on the new Budget Adjustment Bill the week of June 6.

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President’s Column: Member Survey Results - Part 2

Last week, this column began discussing the results of a member survey conducted in February.

That column revealed that member’s most challenging current issues are: Reimbursement; Physician Workforce; and Health Reform Implementation.

So how do members perceive WHA "effectiveness" in helping members with those top issue priorities?

The conclusion was unanimous: 100 percent of surveyed executives said that WHA’s effectiveness is either good or excellent, up 8 percent from the 2008 survey and the top performer in the peer group.

And in rating the Association’s overall performance, 100 percent of survey respondents also described performance as either good or excellent with 88 percent choosing excellent.

WHA members were also asked to rate their perception of the Association based on a variety of topics including "clout" as a political advocate, quality of professional staff, presenting a "unified voice" and leadership in policy development. All scores topped 90 percent excellent/good with several being at 100 percent.

Particularly gratifying is perception of WHA’s clout as an advocate (100 percent), its ability to present a unified voice on behalf of a diverse membership (98 percent), and quality of staff (100 percent).

Next week, we will conclude our review of the 2011 member survey by looking at the Association’s perceived value.

Steve Brenton
President

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Final Chance to Register for Wisconsin Rural Health Conference
June 15-17, The Osthoff Resort, Elkhart Lake

Register today for the 2011 Wisconsin Rural Health Conference, scheduled June 15-17, in Elkhart Lake. This annual conference is the premier statewide forum for examining the issues that impact small and rural hospitals. Attendees will learn from presenting experts and from each other as they collaborate on innovative models for rural health care delivery.

This year’s conference will feature Dr. Joe Bujak, a nationally-known speaker and author on the topics of physician relationships, clinical quality and patient safety, and leading and managing transformational change. Focusing on the conference theme of "A Call to Action: Maintaining Steady Ground in Unsteady Times," Dr. Bujak, author of the book "Leading Transformational Change: The Physician-Executive Partnership," will focus on the relationship among a hospital board, its administration and its physicians, and the impact issues such as health reform, generational differences, changing technology, and payer, regulator and patient expectations have on those relationships.

This year’s conference will again have the popular governance education track, offering attendees sessions focused on strategically adapting to health reform, the role of governance in quality improvement, and the concept of value-based payment and how it may impact rural providers.

The annual Wisconsin Rural Health Conference is a great way for hospital executives, leadership staff and trustees to take advantage of quality education. Attend as a team and take advantage of the opportunity to talk about issues rural providers face.

A full agenda and online registration are available at http://events.signUp4.com/Rural.

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As Pharmaceutical Shortages Deepen, Wisconsin Hospitals Feel the Pain

Wisconsin hospitals have not been spared from the impact of the global pharmaceutical shortage. WHA receives reports from member hospitals almost daily that indicate the amount of resources—both human and financial—that hospitals devote to procuring vital patient medications are soaring, with no end in sight.

"The pharmaceutical environment we are working in now requires a tremendous amount of resources," Greg Weber, MS, RPh, director of pharmacy supply chair for Aurora Health Care and member of the Wisconsin Pharmacy Examining Board. "You need to be proactive, use multiple wholesalers, and monitor your stock."

Communication with practitioners is key, according to Weber. "The practitioners and nurses delivering the care need to know what is happening. If a change is necessary in a drug concentration because of a recall or shortage, it requires a great deal of communication."

While the number of drug shortages was "unprecedented" in 2010, Weber said 2011 will be even worse. When one manufacturer stops making a drug, others are often not able, or willing, to increase production to meet demand. While disruptions in the vaccine supply chain are not uncommon, hospitals have not experienced such pervasive, across-the-board shortages in even more common drugs, such as morphine, and drugs used in cancer treatment, or more recently, a shortage of electrolytes.

In response, Weber said Aurora is using more direct ordering, and using more than one wholesaler. In the clinics and hospitals, a physical inventory is taken sometimes twice a day and stock is moved around to ensure that hospitals and clinics have access to a "day’s supply" of the drugs they commonly use.

The pharmaceutical buyers are often the first to notice that they cannot get a drug. At that point, Weber said his team moves in to investigate further, but "it is really the people on the front line that find out first there is a shortage."

Weber said they stress that health care practitioners conserve limited resources.

"We work through scenarios. If we can’t get enough of a drug, we look at conservation measures," Weber said. "If a drug that is in short supply is being used for other things, and if there is an alternative to it, we ask our practitioners to cut back and conserve it. We ask that they use the drug in the most appropriate place and where there are no really acceptable alternatives that are equally as therapeutic."

The drug shortages are appearing without warning, so even the best resource, which Weber cites as the American Society for Health System Pharmacists (ASHP.org); has a difficult time keeping up to date. An additional resource are the "Guidelines for the Triage of Patients," (www.wha.org/disasterPreparedness/pdf/EthicGuidelinesTriagePatients_8-08.pdf), developed by the State Expert Panel on the Ethics of Disaster Preparedness in cooperation with WHA, the Wisconsin Hospital Emergency Preparedness Program, and the Wisconsin Division of Public Health.

"There is no indication in anything that I have read that this will end anytime soon," according to Weber. "While there are alternatives to most drugs, they can be more expensive, or potentially less desirable for patient care."

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WHA Annual Awards: Call for Nominations
Distinguished Service, Trustee and ACHE awards presented this fall

Nominations are now being accepted for WHA’s annual Distinguished Service Award and Trustee Award, as well as for the ACHE Early Career Healthcare Executive Award and Senior-Level Healthcare Executive Award. These important awards recognize those who display leadership, dedication and professionalism to their community or the Association.

WHA will recognize the award winners at the 2011 Annual Convention in September. You may know someone in your region, in your hospital or on your Board of Directors who deserves such an honor. You now have an opportunity to nominate them for one of these annual awards:

Distinguished Service Award is presented to a senior health care executive who has made an exemplary commitment to WHA, his/her hospital, and the communities he/she serves.

Trustee Award honors a trustee of a WHA member organization who has made an exemplary commitment to his/her community and to the organization on whose board he/she serves.

ACHE Awards - Early Career Healthcare Executive Award and Senior-Level Healthcare Executive Award nominations should be sent to Mark Hamilton, FACHE ACHE Regent, Wisconsin Vice President, Ambulatory Services University of Wisconsin Hospital and Clinics 600 Highland Avenue, H4/822, Madison, WI 53792.

Administrators, trustees, senior managers, nurse leaders, volunteers and others are encouraged to review the criteria for the awards and consider nominating someone to receive one of these honors.

The deadline for submitting nominations is July 25. Details about the nomination process and criteria for nomination can be found in the annual awards brochure included in this week’s packet and on the WHA Web site at www.wha.org/about. For more information, contact Sherry Collins or Steve Brenton at WHA, 608-274-1820.

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Senate Committee Advances Concealed Carry Legislation
‘Constitutional Carry’ bill passes on party-line vote

As expected, proposals that would allow Wisconsin citizens to carry concealed weapons are beginning to quickly move through the Legislature.

This week the Republican-controlled Senate Committee on Judiciary, Utilities, Commerce, and Government Operations chaired by Sen. Rich Zipperer (R-Pewaukee) passed an amended version of Senate Bill (SB) 93 that would allow for the carrying of concealed weapons without a license on a 3-2 party-line vote. Also known as ‘constitutional carry’, the bill is authored by Sen. Pam Galloway (R-Wausau).

Amendments in the bill would allow individuals to get an optional license for concealed carry in other states that allow it, prohibit concealed carry while in municipal court rooms, and allow the optional licenses to be suspended by a judge.

In the Assembly, Assembly Bill (AB) 126 that would allow eligible individuals to carry a concealed weapon after obtaining a license, authored by Rep. Jeff Mursau (R-Crivitz), has already had a hearing. A committee vote on that bill is expected as early as next week.

As previously reported (see story in May 13, 2011 Valued Voice), language included in both proposals allows private businesses, including hospitals and clinics, to "post" their facilities and prohibit the carrying of concealed weapons. Similarly, employers could prohibit their employees from carrying a concealed weapon in the course of their employment. However, neither bill would allow prohibiting keeping a weapon in a private vehicle in a parking lot.

In testimony, WHA pointed out that the ability for hospitals to prohibit the carrying of concealed weapons is especially important because of the unique nature of their facilities. (The testimony can be viewed at www.wha.org/AB126AssemblyCriminalJustice.pdf.)

WHA also raised a concern about the bills lacking any language related to training requirements and the ability to carry a concealed weapon. The Assembly is believed to be discussing including language related to training in AB 126. A committee vote there is scheduled for June 2.

As with other legislation, an identical version of a concealed carry bill will need to pass both houses of the Legislature before it could be forwarded on to Governor Walker for his consideration.

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Private Sector Cost-Saving Initiatives Focus of UW Population Health Briefing

On May 25, the University of Wisconsin Population Health Institute held a briefing entitled "Private Sector Employer Innovations in Health Care Financing and Delivery." John Torinus, CEO of Serigraph and author of The Company that Solved Health Care, and George Kerwin, president and CEO of Bellin Health, spoke about their organizations’ success in reducing health care costs.

Torinus presented "The Serigraph Prescription," where he described his firm’s approach to containing employee benefit costs. He listed five behavior changes needed for reform: how employees utilize medical services, how they purchase care, how they live their lives for personal health, how they follow regimens for chronic diseases, and how they relate to doctors. Serigraph’s health benefit features a consumer-driven health plan, incentives to use primary care, and a center of value platform for elective procedures. Torinus said that his firm’s health benefit costs are 40 percent below the national average.

Kerwin outlined his health system’s approach to helping employers deal with their health care costs. Bellin Health utilizes the "Triple Aim Journey," which starts with leadership and listening to develop a culture of wellness, designs a data-driven system for decision-making, and engages individuals in their own health—all leading to lower costs and higher levels of wellness. A key success factor is making access to primary care as easy as possible. Bellin’s approach has led to significant cost savings and improved satisfaction for its employer clients.

More information on the briefing can be found at: http://uwphi.pophealth.wisc.edu/healthPolicy/ebhpp/events.htm.

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New Chief Nursing Officers Participate in Orientation at WHA

Nurse leaders from 12 WHA-member organizations participated in an orientation sponsored by the Wisconsin Organization of Nurse Executives (W-ONE) and the Wisconsin Hospital Association (WHA). The 12 chief nursing officers in attendance received a high-level briefing on the specifics of statutory, policy and clinical practice in Wisconsin. The expectations of the Board of Nursing, along with information on impaired professionals and reporting requirements were also reviewed.

Along with Judy Warmuth, WHA vice president of workforce, other WHA staff that presented to the group were: Kelly Court and Stephanie Sobczak reviewed WHA’s involvement in activities related to quality improvement; Mary Kay Grasmick related information on how to work with the media and WHA’s role in assisting members with emergency preparedness; and Jenny Boese discussed the nurse leaders role in facilitating grassroots advocacy. Alternative models of care delivery and the use of assistive personnel in nursing were also discussed.

W-ONE President Peggy Haggerty, Columbus Community Hospital, and Membership Chair Doris Mulder, Beloit Health System, welcomed the group and outlined W-ONE’s organizational structure, strategic goals and invited participants to become active members.

This is the second year the orientation program has been held in Madison. Participants have been enthusiastic about the program content, the opportunity to meet others new to the CNO role and the chance to discuss Wisconsin practice issues.

W-ONE and WHA plan to offer a nurse leader orientation for new CNOs annually. Contact Judy Warmuth, jwarmuth@wha.org or 608-274-1820.

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CMS Releases Medicare IPF PPS Payment Rule for 2012

The Centers for Medicare and Medicaid Services (CMS) has released the rate year (RY) 2012 final payment rules for the Medicare Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS). The final rule updates IPF payment rates and policies and implements provisions of the Affordable Care Act (ACA) of 2010.

As part of the rule, CMS finalized its proposal to modify the annual update period for the IPF PPS from a rate year (July 1 through June 30) to a federal fiscal year (October 1 through September 30). Therefore, the IPF PPS payment rates and policies implemented by CMS will be effective for a 15-month period from July 1, 2011 through September 30, 2012.

Payment Rate Updates: CMS’ rate updates, along with a budget neutrality adjustment, result in a federal per diem base rate of $685.01 and an electroconvulsive therapy (ECT) per treatment rate of $294.91 for RY 2012 compared to $665.71 and $286.60 respectively, for RY 2011, a 2.9 percent increase.

The IPF payment rates will be updated for RY 2012 as follows:

  • Plus 3.2 percent: CMS is updating Medicare IPF PPS payment rates during the 15-month 2012 RY by a market basket of 3.2 percent. If CMS did not extend the 2012 IPF PPS rate year by three months, the final update for a 12-month RY 2012 would be 2.8 percent.
  • Minus 0.25 percentage points: Offsetting the market basket is an ACA-mandated pre-determined reduction of 0.25 percentage points.
  • Minus 0.05 percent: CMS is proposing to decrease the IPF payment rates by 0.05 percent to ensure the budget neutrality of the payment system based on changes to the wage index.

Labor Share and Wage Index: CMS adopted its proposal to rebase and revise the market basket used to update payment rates under the IPF. Based on these changes, CMS is decreasing the labor-related share of the federal rates from 75.400 percent for RY 2011 to 70.317 percent for RY 2012. As proposed, CMS will use the most recent hospital wage index, the federal fiscal year 2011 pre-rural floor and pre-reclassified hospital wage index, under the IPF PPS for RY 2012.

Outlier Payments: CMS will increase the outlier fixed dollar loss threshold amount by 15.2 percent, from $6,372 for RY 2011 to $7,340 for RY 2012. This threshold increase would reduce the number of cases eligible for outlier payments.

Resident Cap Used for the Teaching Adjustment: CMS is finalizing its proposal to adopt a change to the full-time equivalent (FTE) resident cap used to calculate the IPF PPS teaching adjustment. The change will permit an IPF’s residency cap to be temporarily increased when an IPF trains displaced residents due to a closure of an IPF or a closure of an IPF’s medical residency training program(s). The temporary increase would be resident-specific and would only apply to the displaced resident(s) until the resident(s) completes training. This change would be effective for cost reporting periods beginning on or after July 1, 2011. A similar change was recently adopted under the Inpatient PPS and proposed under the Inpatient Rehabilitation Facility PPS.

Patient and Facility Level Adjustments: CMS will retain the current patient and facility level adjustments under the IPF PPS for RY 2012. CMS notes in the final rule that it anticipates updating these adjustment factors in the next rulemaking cycle.

The IPF PPS final rule was published in the May 6 Federal Register. A copy can be found at: www.gpo.gov/fdsys/pkg/FR-2011-05-06/pdf/2011-10562.pdf.

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Wisconsin Payment Reform Initiative Renamed "Partnership for Healthcare Payment Reform"

The Wisconsin Health Information Organization (WHIO) Board and the Wisconsin Payment Reform Initiative (WPRI) Steering Committee endorsed renaming WPRI to the "Partnership for Healthcare Payment Reform (PHPR)," a change necessitated because the acronym—WPRI—was already in use by another organization. The new name reflects the fact that the Partnership’s work has relevance to providers, payers and employers that have a presence both within and outside of Wisconsin.

Along with the name change, PHPR has adopted a mission statement:

The Partnership for Healthcare Payment Reform supports the voluntary engagement of Wisconsin’s diverse health care stakeholders in assessing, designing, testing and implementing innovative, comprehensive approaches to health care payment reform in order to improve the quality and affordability of health care in Wisconsin and advance the health status of Wisconsin residents.

PHPR has also adopted a set of values that characterize the work of this initiative:

Collaboration: We rely on shared sense of purpose among participants

Openness/Transparency: Communicate learnings, engage all parties

Patient Centeredness: Payment reform should enhance patient experience of care

Synergy: PHPR will provide relevant, Wisconsin-based leadership, building on national trends

Evidence-based: Use data to select high value projects; assess promising practices

Continuous Learning: Our understanding of what best supports value in health care continues to evolve

Impact: Pilot approaches that are both replicable and scalable

Finally, this rebranding exercise provided the opportunity to ask some of the payer, provider, and purchaser volunteers why they are participating in PHPR design work, and why they might choose to participate in PHPR pilots. The volunteers said they find value in PHPR because:

  • It provides an opportunity to align incentives among payers
  • Pilot participation will allow purchasers to maximize their purchasing strategies
  • The work is collaborative in nature and builds on Wisconsin’s health care assets and tradition of collaboration
  • PHPR is committed to shared learning; organizations believe they will derive new insights from their participation
  • PHPR is committed to quality, not just cost effectiveness
  • PHPR pilots will provide participants with the opportunity to test "what we know we have to do"
  • Participants are engaged because of their sense of responsibility/duty to maintain a sustainable health care system

Letters of commitment from several organizations planning to participate in the acute care pilot have been submitted. Letters of commitment regarding the chronic care pilot are expected in the next 1-2 weeks.

For more information or to discuss pilot participation, contact Karen Timberlake, PHPR Director, at 608-268-1802 or ktimberlake1@gmail.com.

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ICD-10 Implementation Could Delay Cash Flow, Increase Administrative Costs

The ICD 10 impact on health care finance was one of the topics discussed at the WHA ICD-10 Task Force at their meeting in Madison May 26. Debbie Rickelman, senior director of the WHA Information Center, cited comments made at a recent national HIMSS ICD-10 HIMSS webinar by Tyson McDowell, CEO, Benchmark Revenue. McDowell said payer readiness will vary. Payers will most likely be technically compliant but they may adjust adjudication rules regularly as they absorb the details of ICD-10. This will cause cash flow delays and higher administrative costs. McDowell noted payers may be more diligent to assume miscoding which may increase the denial rate. He further noted (as many others have) that there are many competing initiatives that are distracting providers from ICD-10 planning and preparation. A few of these initiatives include EMR implementations, meaningful use, and ARRA. McDowell’s viewpoint is that of all these initiatives, ICD-10 carries the largest risk to financial health and many providers are not allocating sufficient resources to the ICD10 implementation. The HIMSS presentation, including McDowell’s comments, is available at www.himss.org/content/files/ICD10PlayBookSlides.pdf.

The Task Force, which includes representatives from the Rural Wisconsin Health Coop, Wisconsin Health Information Management Association, the Wisconsin Medical Society, the Office of Rural Health, WEA Trust, Sauk Prairie Memorial Hospital and the WHA Information Center, also discussed several educational opportunities and tools available to providers at all levels of their organizations. Several Task Force members said hospitals are finding the implementation timelines of great concern. Although, the two timelines recommended by AHA and AHIMA are very similar and, if followed, lead providers to readiness and accuracy of data on October 1, 2013.

Link to timelines:

www.ahacentraloffice.com/ahacentraloffice/files/PDF2010/CEOBriefingI-10.pdf

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_048737.pdf

Other activities underway by the Task Force and its collaborators include a menu of ICD-10 offerings that may be available to hospitals with fewer than 50 beds via a SHIP grant, regional physician documentation training for facility services, a webinar for physician leaders designed to assist with training the physician workforce on ICD-10, and a session at the August Office of Rural Health meeting addressing the financial impact of ICD-10. In addition, WHA will be offering a series of business-related ICD-10 webinars in July and August.

Direct Task Force related questions to Debbie Rickelman at the WHA Information Center at drickelman@wha.org or call 608-274-1820.

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Wisconsin Hospitals Community Benefits: Mental Health and Mental Disorders

Mental disorders vary in severity and in their impact on people’s lives. The symptoms can be severe and extremely destructive, causing immeasurable suffering for the patient and their families. Hospitals see an ever-increasing number of patients seeking treatment for mental disorders in their emergency departments. Hospitals that can offer inpatient treatment generally operate this service at a loss. With a disturbing shortage of mental health professionals, hospitals will continue to partner with each other and their communities to meet the growing demand for these services.

When the topic is diabetes, and no one wants to talk

We all know that support groups play an important role in helping individuals who are managing a chronic illness. Participants learn from invited guests who provide educational programs and many like to speak up to ask questions or share their experiences. But for people who are shy and uncomfortable about speaking in front of others, support groups can be a bit intimidating – at least at first.

Nola Hardy, RD, CD, who facilitates the monthly diabetes support group at the Aurora Health Center in Marinette, understands. Attendance ranges from 25 to 35 participants, and always there is someone new. To make it easier for newcomers to the group, she recently led a Conversation Maps class.

Conversation Maps are a teaching tool to generate dialogue between patients and educators. Like good old-fashioned board games, this "tool" consists of a roll-out map and a deck of cards containing questions that prompt participants to begin problem-solving together. As they answer questions and move progressively through the map, participants find themselves discussing the diabetes basics, the relationship between diabetes and nutrition, the value of monitoring and using the results, and, in so doing, they begin to fully appreciate how managing diabetes can improve their lives and prevent a whole of host of problems.

Nola’s first experience in using the Conversation Maps with the support group happened to be the time that Mrs. X attended. Mrs. X was diagnosed with diabetes four years earlier and had been in denial ever since. Having seen the notice about the support group in the local paper, she decided to check it out, even though she had not taken medication in months, missed her last two doctor appointments, and had not used her meter at home to test herself.

The Conversation Map proved to be so effective in stimulating conversation that Mrs. X became not only an active participant in the group dynamics, but she made an appointment to meet with the diabetes educators to get herself back on track with a care plan.

Aurora BayCare Medical Center, Green Bay

Upland Hills Health Hospice holds grief support group

Many times when a loved one departs, the family and friends that remain are puzzled with questions, can suffer depression or anxiety, or feel that they are alone in the pain they are suffering. The Upland Hills Hospice staff believes that although the memories of a loved one will always remain and it is difficult to go on without them, sharing thoughts and feelings with others about the grief that accompanies such a loss may allow joy to be a part of life again.

To that end, Upland Hills Hospice hosted a free, four-session grief support group. The group focused on education about grief and how to best normalize the grieving process. In addition to this, participants were able to share memories of departed loved ones and their experiences, thoughts, and feelings about grief.

"We felt that it was important for people to know they are not alone if they are experiencing grief caused by the loss of a loved one and that the feelings of distress that accompany such a loss are a normal part of the grieving process. Sharing those feelings with others can allow a sense of happiness to return, and we wanted to provide that with these sessions," stated Elyssa Goldberg, certified social worker for Upland Hills Hospice.

Upland Hills Health, Dodgeville

A Walk to Remember

More than one out of every four pregnant women in the United States experiences an infant loss through miscarriage, ectopic pregnancy, stillbirth, or newborn death. Such a death is unexpected and often shatters the lives of parents, family, and caregivers, leaving these individuals experiencing a wide range of emotions including shock, helplessness, guilt, and grief.

As a means of providing support to those touched by the tragic death of an infant, Memorial Health Center coordinated its 11th annual "A Walk to Remember." This event is dedicated to the memory of infants lost during pregnancy or infancy. It includes a 30-minute walk/opportunity for reflection, a brief memorial, and time for discussion and emotional healing.

Memorial Health Center – An Aspirus Partner, Medford

Aurora Psychiatric Hospital’s Kradwell School

Aurora’s Kradwell School, located on the campus of Aurora Psychiatric Hospital, provides a full range of academic courses for Kindergarten through 12th grade students who are unable to succeed in a mainstream school setting due to medical or behavioral health difficulties.

Aurora provides in-kind operational support to this unique school valued at more than $275,000 annually, as well as capital expenditures for furniture, equipment and computers. During the 2009/2010 school year, 153 students from 27 different school districts were served by 14 teachers at Kradwell. The Aurora Health Care Foundation provides scholarship funding.

One student’s story

It is difficult to imagine how a troubled student with a grade point average of 1.3 who could not succeed at two different high schools could ever have a chance at turning it all around. Well, meet Janie.

Janie came to Kradwell School at the end of her sophomore year from a high school where her attendance was poor, she did no homework, and she had a general lack of focus to complete tasks. Janie’s parents decided to enroll her in Kradwell’s summer school program to see if any improvement could be made.

That summer, Janie earned two credits and liked the individualized teaching style, as well as the small school atmosphere. Her parents elected to keep Janie at Kradwell. Over the next two years, she flourished: she liked coming to school; her grades improved; she was happy. Both academically and personally, Janie was enjoying success, earning a 3.1 grade point average and helping others through jewelry and soup sales, all proceeds going for scholarship. In her Economics class, she raised enough money to buy a cow for Africa, demonstrating her compassion for social issues.

Janie graduated from Kradwell on June 10, 2010, having completed her final semester with an added responsibility – an internship in the communication center at Aurora Psychiatric Hospital, to get real-world experience before leaving secondary school. Through this maturing process, a sensitive and caring young adult has emerged who can move forward with confidence to her next endeavor.

Aurora Psychiatric Hospital, Wauwatosa

Caring to help those facing a loss

Children learn to cope with the loss of a loved one in Agnesian HealthCare’s Grief Relief Program.

Reyna Jimenez and Berenice Carbajal were just seven and 10 years old when their grandmother died in 2007. Both girls – especially Reyna – were close to their grandmother, says Elba Carbajal, the girls’ mother.

Reyna and Berenice were having difficulty expressing their feelings about the loss of their grandmother. Elba saw that a Grief Relief program designed to support children and families grieving the loss of a loved one was being initiated, and contacted Sister Joyann Repp, the bereavement coordinator, for more information.

"Grief Relief’s mission is to provide a safe place where children, teens and their families can grieve openly, sharing their experience and moving through the grief process in a supportive environment of their peers," Repp says.

Elba and her girls were some of the first participants in the program. Two years later, they still attend Grief Relief every Monday evening.

"My kids love going," Elba says. "It’s helped me too. The more I talk about it, the less I cry."

Agnesian HealthCare, Fond du Lac

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

Read more about hospitals connecting with their communities at www.WiServePoint.org.

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