May 6, 2011
Volume 55, Issue 18


Policy and Politics Collide in Unsettled Wisconsin Political Environment

The upheaval in the political environment continues to complicate the legislative and policy debate in Madison. In his presentation to the WHA Board at their April 28 meeting in Madison, WHA Executive Vice President Eric Borgerding said nothing is "typical" as it relates to the legislative session or in the debates around the state budget.

"The focus has been on the politics, but the reality is we have extremely significant policy issues that must be addressed," Borgerding said.

At the time of the Board meeting, there were eight announced recalls in the Senate and the recount in the Supreme Court race was still in process. These were just two of the factors influencing the state budget process and other policy matters in Madison.

Wisconsin Governor Scott Walker included $1.3 billion in general purpose revenue (GPR) to the Medicaid Program in his FY 11-13 budget to shore up the program’s finances. The Governor told the crowd gathered for WHA’s Advocacy Day April 27 that, unlike other states, he is not balancing the Medicaid budget by cutting provider payments because that just amounts to a "hidden tax" on employers and other payers.

The Medicaid budget is not out of the woods however, as a $500-$600 million shortfall remains. WHA is currently meeting with the Department of Health Services (DHS) as the Department looks for ways to increase the cost effectiveness and efficiency of care in the Medicaid program. DHS plans to recommend program changes and will seek federal waivers, state plan amendments and administrative rule changes that will allow them to implement modifications to the Medicaid program.

WHA created a new task force, the Medicaid Reengineering Group (MRG), to identify savings and study any recommendations that emerge from DHS. (See related story in this issue of The Valued Voice.)

Ministry Health Care President/CEO Nick Desien chairs the new Task Force.

"Our job is twofold—to come up with ideas on our own and also to respond to recommendations that are coming out of the Department," according to Desien.

The Task Force represents a broad range of WHA members, and by applying the WHA-adopted Medicaid principles, has narrowed their focus to four major issues: pay for performance, care management, benefits options, and eligibility and enrollment issues.

"Medicaid must be preserved for our most vulnerable citizens, those who have no other options for coverage," Borgerding said. "For example, there are children enrolled in BadgerCare from families with annual incomes over $220,000, and it’s perfectly within the rules. Those families are paying a Medicaid-based premium for that coverage, a premium derived from reimbursing health care providers at Medicaid rates that are well below what it costs them to provide care—costs that are shifted to others. No one can think that makes sense. Medicaid is a safety net and more than ever must be preserved for those who truly have nowhere else to go."

If Wisconsin does not receive federal waivers and the necessary approvals to implement the changes identified by DHS, Borgerding explained, the eligibility requirements for Medicaid will need to roll back to 133 percent of the federal poverty level (FPL) on July 1, 2012.

While enrollment reductions in the Medicaid program are not on the immediate horizon, co-pays are being discussed for those who are at 185 percent of the FPL and both co-pays and premiums are being considered for those that are at 200 percent of the FPL.

Hospitals Will Feel Medicare Cuts in FY2012

For the second year in a row, PPS hospitals will see a reduction in Medicare reimbursement. In FY2012, hospitals are in line for a 0.55 percent decrease. WHA President Steve Brenton shared these details:

While there will be a +2.8 market basket increase, and a +1.1 wage index correction, those increases will be more than offset by the -1.2 productivity cut, a -0.1 market basket decrease, and the -3.15 behavioral offset, for a grand total of a 0.55 DECREASE in Medicare reimbursement in FY2012.

"As the number of Medicare beneficiaries continues to rise, combined with the aging of our population, the fact that we are seeing provider cuts as we face economic uncertainty is cause for alarm," Brenton said. "As a state that delivers value and high quality to the Medicare program, we cannot continue to sustain these cuts and expect our providers to continue to absorb them without reducing services."

Brenton said WHA is actively engaged in conversations with Wisconsin’s congressional delegation to ensure they understand the impact that continued cuts will have on Wisconsin’s health care delivery system.

Deficit Reduction Replaces Health Reform as Major Theme in Washington

Reporting on a recent trip to Washington to attend the AHA annual meeting, Brenton said DC politics are starting to reflect the strong sentiment and worry among voters around the issue of burgeoning federal spending.

"The health reform theme in Washington has been replaced by one of deficit reduction as the public begins to fear the consequences that an economic meltdown driven by the national deficit could have on the local, national and world economy," Brenton said.

Brenton said it is "astonishing" that every hour of every day, the nation’s deficit grows by $188 million. No amount of tax increases will fix the budget when debt is piling up at that rate, he added. While no one supports the trajectory that the national deficit is taking, politics begin to diverge on how to address the problem.

There are discussions at the federal level of transforming Medicare into a premium-supported program in ten years, as well as turning Medicaid into a block grant program. Both are worthy of discussion, Brenton said.

Hospital Supporters Advocate for Medicaid at 2011 Advocacy Day Capitol Visits

WHA staff will continue to run impact analysis and develop member and legislative communications aimed at sharing information about Medicaid-related issues. In addition, Borgerding said, WHA encouraged Advocacy Day participants who visited with their legislators while they were in Madison to share their local perspectives on health care issues—including the impact of provider cuts that affect "dual eligibles"—those patients that qualify for both Medicaid and Medicare.

"We asked the more than 450 advocates who met with their legislators to focus on Medicaid during their meetings," Borgerding said. "But we also touted the community and economic benefits of having a hospital in our community. Nearly one-third of our legislators are new to Madison and we need to let them know the tremendous impact that hospitals have in our communities and on our state. Advocacy Day provides the perfect opportunity to share that message." (See Advocacy Day in Review in the packet or view it at: www.wha.org/pubArchive/special_reports/2011AdvocacyDayReview.pdf)

Member Survey Reveals WHA is Meeting - in fact, Exceeding! - Expectations

The results of the latest WHA membership survey are in, and they showed that WHA is meeting or exceeding member expectations in all categories. WHA President Steve Brenton walked the Board through the results and said the survey identifies members’ most important expectations and then measures how well WHA is doing in meeting those expectations to ensure that members are receiving the value they expect to receive from their membership. The survey benchmarks Wisconsin’s performance to that of other state hospital associations.

Hospital CEOs that participated in the survey indicated that reimbursement, physician workforce issues and health reform are their top concerns. The survey showed that members feel WHA is effective in helping them address their key issues and priorities. In fact, Brenton said, WHA’s ratings in that regard were nearly perfect, with an overall score of 98 percent.

Brenton said there were nearly no gaps in satisfaction ratings, however, in the future, he said, "Our direction and goals must focus on maintaining the kind of value that is demonstrated in these scores in what will be an increasingly difficult environment for our member hospitals."

Brenton also acknowledged that the hard work that WHA staff put in helped make the 2011 Advocacy Day the most successful—and the largest with over 750 attendees—in the Association’s history. Board members agreed, and several shared examples of how important it is to engage hospital volunteers and employees in advocacy efforts.

Board Nominations

The Board approved nominations of the following individuals to councils or committees:

2011 WHA Nominating and Bylaws Committee:

David Olson, Executive Vice President, Columbia St. Mary’s, Inc., and President, Columbia St. Mary’s Hospital, Ozaukee (Chair)

Steve Brenton, President, WHA

Greg Britton, President/CEO, Beloit Health System

Ken Buser, President/CEO, Wheaton Franciscan Health Care – All Saints, Racine

Faye Deich, RN, MS, COO, Sacred Heart Hospital, Eau Claire

Bob Fale, President, Agnesian HealthCare, Fond du Lac

Terri Richards, Executive Vice President, Ministry-Saint Joseph’s Hospital, Marshfield

Mike Schafer, CEO/Administrator, Spooner Health System, Spooner

Bill Sexton, CEO, Prairie du Chien Memorial Hospital, Prairie du Chien

Wisconsin Hospitals Issue Advocacy Council, Inc.:

The Board approved the nomination of Mark Taylor, President/CEO, Columbia St. Mary’s, Milwaukee

Audit and Investment Report

The results of the recently-completed financial audit were presented by Board member Greg Britton, chair of the WHA Audit and Investment Committee. Britton reported that the 2010 audit report received an unqualified opinion, which is the best opinion given by an audit firm. There were no audit adjustments to the financial statements reported by management and the auditors had a lot of positive comments about staff assistance with the audit process. Motion to adopt the audit report was approved.

Britton also reported on the committee’s review of WHA investment performance. He stated that WHA assets were being invested according to the investment policy and the various portfolio investments were performing at or above industry benchmarks.

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WHA Medicaid Reform Group Discusses Pay-for-Performance

On April 29, the WHA Medicaid Reengineering Group (MRG) held its third of five planned meetings. The group, which is comprised of member CEOs and CFOs, was created to study various aspects of the Wisconsin Medicaid program and develop recommendations for and reaction to Medicaid reforms being developed by the Walker Administration and Legislature.

This week’s meeting focused on a new pay-for-performance program the Department of Health Services (DHS) plans to implement in the next biennium. Under the program, 1.0 percent of base funding would be withheld from hospital base rates, and hospitals would have the opportunity to earn funds back based on its scores for specific measures related to the fee-for-service Medicaid population.

The WHA Quality Measures Team, led by WHA Chief Quality Officer Kelly Court, helped to develop a set of measures that met certain guiding principles.

"We want to be proactive in helping the Department develop measures that are linked to medical evidence," said Court. "It is also important that outcomes be within the control of the hospital and that the program not add to the hospitals’ measurement burden."

The MRG reviewed the recommendations from the Quality Measures Team, which focused on eight potential measures in four areas: general inpatient care including readmissions; appropriate ER usage; maternity indicators; and mental health indicators. In addition, the MRG considered the payment methodology associated with the pay-for-performance program.

At its next meeting, the MRG will review and finalize its recommendations on the pay-for-performance measures and methodology. It will also begin discussion on care coordination in Medicaid.

"Care coordination will be one of our most significant issues," said Nick Desien, CEO of Ministry Health Care and chair of the MRG. "We have an opportunity to offer ideas, but also recognize some of the challenges for hospitals in developing appropriate care management programs for the Medicaid fee-for-service population."

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New Legislator Profile: Sen. Tim Cullen (D-Janesville)

A series of interviews with newly-elected legislators, by Mary Kay Grasmick, editor

As a former Secretary of the Wisconsin Department of Health in Gov. Tommy Thompson’s administration and top executive at Blue Cross, Senator Tim Cullen (D-Janesville) has been keeping his eye on the Medicaid program for years. Now the program is grappling with the costs associated with providing health care coverage for nearly one in five people in Wisconsin. When asked how best to control the rising costs of the program, the Senator said he believes the answer lies in more effectively managing care.

"There is a rule of thumb in the Medicaid program that about 20 percent of the people consume nearly 80 percent of the resources," according to Cullen. "While the Medicaid program has had some success in getting the healthier people into some type of managed care, there now needs to be a serious effort to get more of the chronically ill and elderly people that are in Medicaid into some type of managed care and get away from the fee-for-service environment."

If costs can be reduced overall in the Medicaid program, Cullen feels the program will have the resources required to fulfill its role as a health care safety net program for Wisconsin’s most vulnerable citizens.

Health insurance exchanges, which are included in the federal health reform law, could become a venue for Wisconsin citizens to purchase cost-effective health care coverage. Governor Walker recently established the Office of Free Market Health Care. With direction from the Department of Health Services and the Office of Commissioner of Insurance, the Office is charged with ensuring that Wisconsin maintains a competitive health insurance market that is consumer driven and is based on free market principles.

"If there is any hope of being successful, my view is to set the exchange up in a way that is similar to how federal employees select their health insurance," Cullen said. "Basically, federal employees receive a booklet that has a list of carriers in their area that they are eligible to receive care from, and they can find information about the carriers through the federal government."

In conversations recently with DHS Secretary Dennis Smith, Sen. Cullen said he shared his ideas on health insurance exchanges.

"I think that kind of model would work if you don’t want to create something that will frighten people (with its complexity)," Cullen added. "If people don’t have knowledge, they will shy away from it. The most important piece is there would need to be state involvement in what plans are offered through the exchange."

Transparency is a key component to making the exchange work. Cullen said it won’t work to develop a model that pushes consumers in a direction to make health care decisions without providing them with tools to evaluate the cost and quality of health care providers. He credits Wisconsin hospitals with moving more quickly toward health care transparency than other providers. Just 10 to 15 years ago, information on the price and quality of hospital care was not available, as it is now on WHA’s PricePoint and CheckPoint Web sites (www.WiCheckPoint.org and www.WiPricePoint.org).

"The old model of an employer offering health care plans and you pick one is basically gone for most people and it is not coming back," he added.

A strong opponent of the recently-proposed concealed carry legislation, Cullen said he will vote against it and will vote to modify it any way that he can. When asked if he would support not allowing weapons in hospitals, Cullen said it "makes 100 percent sense to not allow weapons in hospitals…it makes 100 percent sense (to not allow them) everywhere."

"I don’t want someone walking into a hospital with a concealed weapon, or in a grocery store for that matter," he added.

As it has in the past, WHA supports an amendment to the legislation that would prohibit concealed firearms from being carried in hospitals and clinics. The legislation now pending would allow private property owners, including hospitals and clinics, to decide for themselves if concealed firearms are allowed on their property. WHA believes this is a step in the right direction.

The 67-year-old Senator, who came out of retirement because of his passion for public service, said his top priority is economic development and he said he has a good relationship with the Governor and current administration on issues related to Wisconsin’s economy.

"I worked hard to save the GM plant in Janesville and we were not successful," he said. "It makes me want to do something for the economy because Rock County has been hit so hard."

Cullen sees the structural deficit as being the biggest challenge to restarting Wisconsin’s economy.

"Businesses want to look at locating in states that have their fiscal house in order," according to Cullen.

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2011 Wisconsin Hospitals State PAC and Conduit Campaign Begins

The 2011 Wisconsin Hospitals State PAC and Conduit Campaign kicked off the beginning of April. Just one month into it the Campaign has raised more than $55,000.

This year the campaign goal is $250,000 and aims to increase the number of participants during this dynamic political environment.

Watch for individual contributors’ names to be published in the next edition of The Valued Voice. For more information or to see if you have made your 2011 contribution yet, contact Jodi Bloch or Jenny Boese at 608-274-1820.

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WHA Input Results in Faster Processing of New Nurse Licenses

The Department of Regulation and Licensing (DRL) says processing of requests for new nurse licenses will be faster than last year because of changes that were requested by WHA.

"A timely response from DRL is critically important to our members," said Judy Warmuth, vice president, workforce development. "We commend DRL and its leaders for their focus and responsiveness. They have a firm grasp on this issue and its importance, not only to health care, but to our workforce and economy."

May and June are very busy months in DRL’s credentialing division. In addition to many other occupations, graduates from more than 30 Wisconsin nursing programs will graduate and apply to take their licensure exam and obtain a license. This surge of applications has, in the past, resulted in delayed responses with graduates unable to start new positions in hospitals until their applications were processed by the DRL and temporary licenses are in hand.

At WHA’s request, DRL has implemented changes that have markedly shortened the licensure process. It has been rumored that this year staffing reductions at DRL would mean a return to long response times. In a meeting with WHA, Domingo Leguizamon, division administrator, and Kris Hendrickson, credentialing supervisor, both of the Division of Professional Credential Processing, stated that staffing for this important function has actually been increased. They expect that graduate nurses who have completed all the requested documentation will have a response from the division quicker than last year.

DRL is interested in hearing member concerns and has worked to respond to those concerns by improving their processes. If you continue to have issues, or if new issues arise, contact Judy Warmuth at 608-274-1820 or jwarmuth@wha.org. WHA will continue to provide feedback to DRL.

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Hospital VBP Program Final Rule Released by CMS

The Centers for Medicare and Medicaid Services (CMS) has released a final rule establishing the Medicare hospital inpatient value-based purchasing (VBP) program. This final rule strays very little from CMS’ original proposal, despite numerous comments for change from the industry.

The Affordable Care Act (ACA) of 2010 mandates that CMS implement an inpatient hospital VBP program, a pay-for-performance program that will link Medicare payment to the quality performance of acute care hospitals paid under the Inpatient Prospective Payment System (IPPS).

Hospitals’ quality performance, as evaluated by CMS under the final rule, will affect Medicare inpatient fee-for-service payments to hospitals beginning October 1, 2012 (federal fiscal year (FFY) 2013). CMS has also set forth rules for future program years and will continue to do so in future rulemaking.

As required by the ACA, a pool of funds to be redistributed to hospitals based on quality performance under the VBP program will be created by reducing Medicare IPPS payments for all participating hospitals—a 1.0 percent reduction in FFY 2013, increasing by 0.25 percent each year until the reduction reaches 2.0 percent for FFY 2017 and thereafter.

The hospital VBP Program is one of several delivery system reforms that will affect Medicare inpatient fee-for-service payments to hospitals in the coming years. CMS is also mandated to implement payment policies for hospital readmission rates (beginning FFY 2013) and for hospital-acquired condition (HAC) rates (beginning FFY 2015).

More information on the VBP rule is available through the WHA Quality Center Web site at www.whaqualitycenter.org/Reports.aspx. Users of the Value Based Purchasing score estimator template will be notified directly when the latest version is made available to WHA.

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Connecting With Our Communities: Froedtert Health Community Memorial Hospital, Menomonee Falls

This interview with Dennis Pollard, Chief Operating Officer, Froedtert Health, is part of a series of articles that WHA is featuring in The Valued Voice that demonstrate the important benefits that Wisconsin hospitals bring to their communities in the areas of economic development, community health and wellness, and in ensuring access to high quality, affordable health care.

President Dennis Pollard is confident in Froedtert Health Community Memorial Hospital’s readiness to respond to health care reform. Pollard, who is also chief operating officer of Froedtert Health, said the system is focused on several efforts to respond to challenges such as reimbursement constraints, access to capital and creating a safe environment for patients. "Many of the advances we are making to prepare for health reform will be beneficial to our patients and communities even if federal health reform is modified," Pollard said. "We know that care will need to be more coordinated and cost-effective regardless of the legislative specifics."

Froedtert Health’s strategies to meet these challenges include: cost structure redesign, population management and care coordination, optimizing investments in information technologies such as the EPIC electronic health record and quality improvement infrastructure. For example, cost structure redesign is achieved throughout the system by eliminating redundancy and process variation and broadly applying concepts such as Lean throughout the organization.

Froedtert Health is also focused on clinical integration as the system partners with other independent health systems to achieve significant improvements in the quality of care and address issues of cost and access, Pollard said. Clinical integration involves greater information sharing across providers. For example, different provider groups may work together to tackle a single condition like diabetes or to build a common framework for the management of critically ill patients. Froedtert Health has partnered with like-minded organizations such as Bellin Health in Green Bay to jointly operate a virtual ICU using the technologies of the eICU.

CMH’s Contribution to Community Health

Community Memorial Hospital strives to achieve the "Triple Aim" as described by the Institute for Healthcare Improvement – to improve the health of the population, enhance the patient care experience and reduce the per capita cost of care. Many of the advances we are making to prepare for health reform will be beneficial to our patients and communities even if federal health reform is modified. We know that care will need to be more coordinated and cost-effective regardless of the legislative specifics.

"In 2010 our extensive community outreach efforts addressed these objectives, through contribution of services and other resources totaling $8,221,483," Pollard said.

The Community Outreach Health Clinic was established by Community Memorial Hospital in 2000 to provide quality, affordable health care to the growing number of uninsured and underinsured in the hospital’s service area. In the years since it opened, the clinic has seen a steady increase in patients as community awareness grows, confirming the need for reliable, low-cost medical care in Waukesha, Washington and northwest Milwaukee Counties. In 2010, the clinic served more than 2,400 people, an 18 percent increase over 2009.

In addition to providing the clinic to meet the healthcare needs of our community, Community Memorial assessed and evaluated the overall health needs within the hospital’s service areas in southeast Wisconsin. This community health needs assessment guides initiatives that fill service gaps for people with disproportionate unmet health needs. Past needs identified and served through the assessment include access to transportation, mental health services and chronic disease management.

"We’re also improving the health of our communities through Froedtert Health’s Workforce Health initiative, which works with area employers to promote employee wellness," Pollard said. The program is a cost-effective approach to meet area employers’ needs by combining the expertise and services of a regional health system: Froedtert Hospital, staffed by Medical College of Wisconsin physicians, Community Memorial Hospital, St. Joseph’s Hospital in West Bend and the Froedtert Health Medical Group with clinics throughout southeast Wisconsin.

As further demonstration of CMH’s commitment to the health and safety of the community it serves, Community Memorial’s Emergency Department, a Level III trauma center, serves as a medical resource hospital for fire departments from Menomonee Falls, Germantown, Lisbon, Lannon and Richfield, providing care direction and education to emergency responders.

Community Memorial Hospital’s Local and Regional Role in Economic Development

As one of the top 10 largest private sector employers in Waukesha County, Community Memorial Hospital is a major contributor to the economic health of the Village of Menomonee Falls and the County. The estimated economic impact on the local community is $207 million. Community Memorial Hospital has 1,432 staff and employs 264 Village of Menomonee Falls residents and 553 Waukesha County residents. In addition, the hospital employs 132 Germantown residents and 501 Washington County residents.

Innovation and Improvement Help Lower Health Care Costs

Community Memorial is committed to using innovation and improvement to help lower health care costs, starting with hospital-wide Lean projects, according to Pollard. For example, an image management system called PACS was installed as part of a process improvement effort. Radiology technologists are able to quickly review images on the system without the need to wait for or manage printed film. The radiologist can select an image off the work list and begin dictating the report into a voice recognition system, which transfers the text to the EPIC system. If a patient or outside provider requests copies of the images, staff are able to quickly burn the exams to a CD, rather than printing film. This provides considerable cost savings as film is expensive. Overall, PACS has provided a more efficient workflow in the department which provides the radiologists fewer interruptions, the ability to read more exams per day and quicker turn-around time for the reports.

Community Memorial’s Surgical Unit has been selected to participate in the Aligning Forces for Quality Transforming Care at the Bedside program. Nursing and frontline staff at Community Memorial will work together with other hospitals across Wisconsin to lead efforts to improve the quality and safety of patient care by piloting and testing new innovations at a local and community level. Community Memorial will improve the quality and safety of patient care, increase the vitality and retention of nurses and frontline staff, engage and improve the patient’s experience of care and improve the effectiveness of the entire care team.

In September 2009, the Froedtert Health senior leadership commissioned the Community Division Operations Committee to facilitate collaboration, efficiency and standardization between St. Joseph’s Hospital and Community Memorial Hospital. The Community Division Operations Committee was challenged to identify and prioritize community division departments and programs for integration. Emphasis was placed on the efficient use of resources and staff, quality outcomes and physician, staff and patient satisfaction. This new organizational structure took effect July 1, 2010 and integrates operations across key functions within the community division and leverages talent within system leadership.

What do you see as CMH’s greatest accomplishment in the community?

"Since it opened 47 years ago CMH’s greatest accomplishment has been its ability to deliver on its original and ongoing mission – to meet the comprehensive and evolving healthcare needs of the community. As the community has grown and its health-related demographics have evolved, so has CMH. Originally created as a 64 bed hospital serving Menomonee Falls, CMH is now a 234 bed regional medical center with key clinical centers in trauma, mental health, comprehensive cardiovascular care; and a Cancer Center affiliated with the Froedtert & Medical College of Wisconsin Cancer Network. Created from the vision of community leaders nearly 50 years ago, CMH is most proud of its ability to sustain the partnership and support of local residents and business leaders; and for their recognition that CMH is an asset that enhances the quality of life for the communities it serves."

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Grassroots Spotlight: Legislators Visit Aurora-Manitowoc County

Aurora Medical Center in Manitowoc County hosted two legislators on Monday, May 2. State Senator Frank Lasee (R-Bellevue) and State Rep. Andre Jacque (R-Bellevue) met with representatives of Aurora Health Care. The group toured the Intensive Care Unit (ICU) where they received a demonstration of the e-ICU technology. Other topics discussed included the implementation of a hospitalist program and its impact on quality of care and physician recruitment. Discussions also touched on the Patient Centered Medical Home program piloted at Aurora Two Rivers Clinic as well as other health care trends.

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Call for Nominations: 2011 Global Vision Community Partnership Award
Nominations due to WHA Foundation by July 15

Honor one of your hospital’s community health projects by nominating it for a 2011 Global Vision Community Partnership Award, presented by the WHA Foundation.

This competitive grant award is presented to a community health initiative that successfully addresses a documented community health need. The Award, launched by the WHA Foundation in 1993, seeks to recognize and support ongoing projects that support community health.

Any WHA hospital member can nominate a community health project. The project must have been in existence for a minimum of two years and must be a collaborative or partnership project that includes a WHA member hospital and an organization(s) within the community. The official call for nominations for the 2011 Award is included in this week’s packet.

Nominations are due July 15, 2011. Nomination forms can also be found on the WHA Web site at www.wha.org/about/globalvision.aspx. For more information about the Award, contact Jennifer Frank at jfrank@wha.org or 608-274-1820.

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Concealed Carry Bills Circulated for Co-sponsorship
Employers could restrict employees; Business owners could post their facilities

Two versions of legislation that would allow the carrying of concealed weapons went out for co-sponsorship this week.

The "Personal Protection Act," authored by Representative Jeff Mursau (R-Crivitz), would enable Wisconsin citizens to carry concealed weapons through a licensing system. The other, dubbed "The Right to Carry" and authored by Senator Pam Galloway (R-Wausau), would provide the same ability without a licensing system, also known as "constitutional carry."

In concealed carry bills introduced in previous legislative sessions, WHA has supported amendments that prohibited individuals from carrying concealed weapons into hospitals and health care facilities. WHA believes allowing concealed weapons in hospitals could jeopardize hospitals’ ability to provide a safe patient care environment.

Hospitals contain highly combustible materials and equipment. An accident with a weapon, concealed or exposed, could easily cause an inadvertent catastrophic event. Hospitals are also where patients and families often face traumatic or emotionally devastating situations. Compounding these difficult times by allowing weapons in hospitals is both unnecessary and counterproductive to the mission of a hospital.

Language included in both of the bills circulated this week 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. WHA views these provisions as a step in the right direction.

Hearings on the bills are planned for next week. WHA continues to analyze the details of the proposals to gauge their impact on hospitals and their related facilities.

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Helping Others Motivates, Inspires Health Care Employees
WHA recognizes 48 hospital employees for dedication to patients

The Wisconsin Hospital Association Health Care Employee Pride Program this week recognized 48 individuals for their dedication to their career, service to patients in their hospitals and their contribution to meeting the health care needs of their community. Each person honored submitted an essay describing why they entered the health profession. The reasons they gave were deeply personal and reveal the type of individual that seeks a health career.

Judy Warmuth, WHA vice president, workforce development, said many people decide on a health care career after a relative, close friend, or they personally, are treated for a chronic or life-threatening illness.

"Early encounters with a nurse, physician or other health care professional during a personal illness or that of a family member can profoundly influence a person’s career choice, or in some cases, trigger a career change later in life," Warmuth said. Several of the employees described how they had tried other careers, only to find their "true calling" in health care.

"Health care today offers people an opportunity to work in a high-tech, yet high-touch, environment. By showcasing the personal stories of health care employees, we are able to share the rewards of choosing a career serving others," according to WHA President Steve Brenton.

The essays may be viewed at www.wha.org/workForce/pdf/2011pridebook.pdf. A list of this year’s honored employees is below.

Affinity Medical Group-Heart and Lung Center, Appleton
Molli Warga, RN, Registered Nurse

Aspirus Wausau Hospital, Wausau
Lisa Breaman, RN, Registered Nurse

Aurora Medical Center, Grafton
Tera Denk, RN, Registered Nurse

Aurora Medical Center of Manitowoc County, Two Rivers
Paula Shimulunas, RN, Registered Nurse

Aurora Psychiatric Hospital Campus, Wauwatosa
Kristine Besharat, Massage Therapist

Aurora Sheboygan Memorial Medical Center, Sheboygan
Graceanne Forsyth-Krajna, Cardiac Rehabilitation Coordinator

Aurora St. Luke’s Medical Center, Milwaukee
Nancy Naus, RN, Registered Nurse

Berlin Memorial Hospital, Berlin
|Shirley Frost, RN, MSN, Director of Education

Black River Memorial Hospital, Black River Falls
Jennifer Ekern, Financial Services Representative

Calumet Medical Center, Chilton
Dawn Hammen, RN, Registered Nurse

Columbia St. Mary’s, Milwaukee
Jill Drury, Pharmacist

Divine Savior Healthcare, Portage
Jacquelyn Maki, RN, Nurse Supervisor

Franciscan Skemp Healthcare, La Crosse
Gloria Royer, Facilities Operations Supervisor

Froedtert Hospital, Milwaukee
Dana Kasprzak, RN, BSN, Registered Nurse

Gundersen Lutheran Health System, La Crosse
Heidi Westedt, Medical Assistant

Memorial Health Center - An Aspirus Partner, Medford
Katherine Ecker, Occupational Therapist, Registered

Memorial Medical Center, Ashland
Debra Ollanketo, Patient Education Coordinator

Memorial Medical Center, Neillsville
Linda Wright, Patient Services Clerk

Mercy Health System, Milton
Samantha Colby, Mercy Options Behavioral Health Medical Assistant

Mercy Medical Center, Oshkosh
Shary Radley, Service Representative

Mile Bluff Medical Center, Mauston
Jo Peterson, Pharmacy Technician

Ministry Door County Medical Center, Sturgeon Bay
Lucy Groth, Radiology Technologist

Ministry Eagle River Memorial Hospital, Eagle River
Janet Yoder, RN, Quality Specialist

Ministry Home Care-Hospice Services, Rhinelander
Melissa Houg, Volunteer/Community Outreach Coordinator

Ministry Howard Young Medical Center, Woodruff
Colette Skon, Health Unit Coordinator, Emergency Dept.

Ministry Our Lady of Victory Hospital, Stanley
Linda Klapperich, Patient Financial Services Manager

Ministry Sacred Heart-Saint Mary’s Hospitals, Rhinelander
Jenna Reil, Patient Accounts Representative

Ministry Sacred Heart-Saint Mary’s Hospitals, Tomahawk
Pamela Truog, Medical Transcriptionist

Ministry Saint Joseph’s Children’s Hospital, Marshfield
Michael Litrenta, RN, Registered Nurse

Ministry Saint Michael’s Hospital, Stevens Point
Mary Pagel, RNC, Organizational Development Specialist

Monroe Clinic, Monroe
Leslie Schmidt, Marketing Specialist - Business Development

Osceola Medical Center, Osceola
Greg Schuer, Laboratory Manager

Sacred Heart Hospital, Eau Claire
Mary Ellen Bliss, Administrative Assistant

Spooner Health System, Spooner
Susan Quigley, Activities Director

St. Clare Hospital/Meadows, Baraboo
Barb Opatik, RN, Registered Nurse

St. Croix Regional Medical Center, St. Croix Falls
Janise Skow, Patient Access Associate

St. Elizabeth Hospital, Appleton
Thelma Ortiz, Environmental Associate 1

St. Joseph’s Hospital, Chippewa Falls
Charlotte Sloan, RN, Registered Nurse - Hospice

St. Mary’s Hospital Medical Center, Green Bay
Connie Fink, People Services Consultant

St. Nicholas Hospital, Sheboygan
Darrell Elmer, Biomedical Engineer

St. Vincent Hospital, Green Bay
Elizabeth Waerzeggers, Pediatric Physical Therapist

Stoughton Hospital, Stoughton
Jeanne Duncan, Physical Therapist

Tomah Memorial Hospital, Tomah
Elaine Stecker-Kochanski, RN, Registered Nurse - Hospice

UW Health Partners Watertown Regional Medical Center, Watertown
Erica Krainz, CNA, EMT, Patient Care Partner

UW Hospitals and Clinics, Madison
Donna Rayho, Senior Health Information Management Specialist

Vernon Memorial Healthcare, Viroqua
Carol Kraabel, CNA, Certified Nursing Assistant

Waupun Memorial Hospital, Waupun
Margaret Miller, RN, Registered Nurse

Wheaton Franciscan Healthcare - St. Joseph Hospital, Milwaukee
Jeanne Endres, RN, Registered Nurse III

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WCHQ Receives $1.3 Million RWJF Grant to Continue Quality Improvement Efforts
WHA member hospitals key partners in "pioneering efforts" to improve care

The Robert Wood Johnson Foundation this week announced that the Wisconsin Collaborative for Healthcare Quality (WCHQ) was awarded a two-year extension of the Aligning Forces for Quality Grant. WCHQ is one of 16 organizations across the United States that has been designated as an Aligning Forces for Quality community, and has been participating in the initiative since 2007.

"We are delighted to continue bringing together healthcare providers, purchasers, patients, and consumers to improve care in Wisconsin," said WCHQ President/CEO, Chris Queram. "Working in partnership, we can identify ways to make significant improvements and build systems that work better for everyone."

The Wisconsin Hospital Association has been a key partner with WCHQ since 2008 in bringing the resources of the AF4Q grant to hospitals.

Stephanie Sobczak, WHA’s manager of quality improvement, and project manager for hospital initiatives said, "The AF4Q grant funding has allowed our hospitals to participate in key collaborative improvements, and learn evidence-based approaches from experts and colleagues from around the U.S."

She cites the recent launch of Transforming Care at the Bedside as an example of this approach. In addition, important improvements in infrastructure, such as the WHA Quality Center, have been funded by grant dollars.

"RWJ will challenge Wisconsin to raise the bar in the next two years and improve collaboration within the health care settings, and across our communities," says WHA and WCHQ Chief Quality Officer Kelly Court. "For example, reducing preventable readmissions and improving care transitions for all patients is important work that involves all aspects of the health care system, and directly impacts cost."

Anne F. Weiss, MPP, team director and senior program officer at the Robert Wood Johnson Foundation, called the Aligning Forces communities "models of health care improvement."

"The community organizations working on this effort have pioneered ground-breaking concepts that are also being explored through federal reform and have attracted bipartisan support, such as physician performance reports, patient-centered medical homes, and of late, payment reform," according to Weiss. "In this next phase, communities will continue to make measurable improvements in quality by placing greater focus on increasing the value of health care delivered."

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Register Now for May 11 Community Needs Assessment Webinar

Congress recently mandated that hospitals develop a community health needs assessment and implementation strategy as part of the new health care reform provisions. Community health needs assessments were added to IRS Form 990, Schedule H and they will need to be completed by every hospital starting in tax years beginning after March 23, 2012.

WHA has teamed up with Julie Willems Van Dijk from the UW Population Health Institute to offer an informational webinar to help Wisconsin hospitals in their needs assessment planning process and to ensure that they are aware of the available tools and resources. Willems Van Dijk has extensive experience in the research, development and implementation of community health needs assessments.

The webinar is set for Wednesday, May 11, 2011 from 9 – 10:00 a.m. There is no cost for WHA member hospitals to participate in this webinar, but pre-registration is required. Register for this event online at http://events.SignUp4.com/CommunityNeedsAssessment.

Individuals completing Form 990, Schedule H, individuals involved with public health and community work, and individuals involved with community benefits should plan to participate.

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Governance Education a Highlight of Annual Rural Health Conference
June 15-17, The Osthoff Resort, Elkhart Lake; Make Hotel Reservations by May 23

Each year, attendee evaluations tell us that the Wisconsin Rural Health Conference is the premier forum statewide for examining the issues that impact small and rural hospitals most, offering networking opportunities with colleagues, your leadership team and your Board of Trustees. We encourage you to make attendance for yourself, your senior leaders and your trustees a priority.

An annual highlight of the conference agenda is the popular governance education track. This year, trustees and their administrative leaders in attendance have the chance to focus on health care reform, a board’s role in quality improvement, and how health care payments are changing to reward high quality and low cost. In addition, sessions on meeting the challenges of the rural physician shortage; preparing your hospital for the ICD-10 coding transition, including improved physician documentation; and the impact of the new NLRB appointments on union organizing in Wisconsin health care organizations are planned.

The 2011 conference will also include a mock Board meeting of the fictional "Badgerland Memorial Hospital" moderated by governance expert Cindy Fineran and featuring personalities from real Wisconsin hospitals. This Board first met together as part of the 2008 Wisconsin Rural Health Conference, and some of those same personalities will be back at the Board table. This current Board will focus on the struggles involved with understanding how health reform and the Patient Protection and Affordable Care Act (PPACA) will impact their hospital and community. This fun and lively session is surely a not-to-miss session for trustees, CEOs and senior leaders alike.

Be sure to make your hotel reservations as soon as possible but before the deadline date of May 23. Due to a race at Road America, it is very likely that NO hotel rooms will be available to conference attendees after that date. It is recommended that you make your hotel reservations immediately to avoid problems.

This year’s event is scheduled June 15-17 at The Osthoff Resort in Elkhart Lake. Full conference information and online registration are available at http://events.signUp4.com/Rural.

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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.

Aurora Walkers Point Community Clinic understands – and helps

The link between obesity and depression belongs on the list of chicken and egg scenarios—which comes first? But there is no question that being overweight is a tremendous source of dissatisfaction, depression and frustration for Americans – in addition to being an impediment to good health.

Losing weight is tough work and so is battling depression. Dealing with chronic physical health issues and pressing economic challenges further complicates the matter.

The clinicians at Aurora Walker’s Point Community Clinic (AWPCC) understand. They know that higher quality lives are produced by focusing on all the factors that contribute to health and partner with their patients to address them all. They know that creating supportive population-based environments that promote healthy behaviors encourages, motivates and enables individuals to lose weight and sustain their progress with better nutrition and daily moderate physical activity for at least 30 minutes.

Juanita is one of their shining stars.

Age 45, this 5’ 1" mother of five weighed in at 220 pounds when she came to the clinic, struggling with chronic neck and shoulder pain. She had spiraled into depression as well. When she came to AWPCC on and off for a year to be seen for her physical issues, she would meet with Leslie, the psychologist, readily admitting to her diminished self-esteem for not being able to make good decisions for herself.

Initially, Leslie recognized that Juanita needed time to reach a decision to make the major commitment to lose weight. But in time, Leslie recognized that certain readiness emerging in Juanita. Despite resistance at first, Juanita eventually began to believe it herself. And so she committed.

Melissa is the prevention specialist and community health educator who met with Juanita to address her weight and nutrition.

"We started with an achievable initial goal," Melissa explains. "Juanita wanted to get to 200 pounds."

As Juanita began her one-on-one coaching with Melissa, she agreed to check in with the Leslie weekly to maintain the progress she was making emotionally. And it paid off. Embracing her own inner resources and the resources available to her at AWPCC, Juanita lost 10 pounds within the first month. Achieving this success lifted her spirits and gave her the incentive to claim a more ambitious long-term goal: to drop all the way down to 140 pounds.

"Together we agreed that losing one pound per week would be reasonable in working toward that long-term goal," Melissa explains. "Because of her initial success, Juanita became even more determined. She inhaled the educational components and did her homework on the subjects of exercise and nutrition. She took advantage of our cardio and weight training classes and pursued the mind-body connection through alternative modalities available at CORE/el Centro (a strategic partner housed on the same floor as the clinic), such as massage and body movement classes. She kept dropping pounds and once her shoulder improved, she joined the gym at the nearby United Community Center to work out on her own," Melissa continued.

"Now, after eight months, she is within nine pounds of her long-term goal, with improvements in her blood pressure, as well," Melissa reports.

Even more remarkable, Juanita has become a more emotionally healthy and vibrant person. Fueled by her newfound success and self-empowerment, you will find her out in the community, taking interest in everyone who is struggling with weight and depression, encouraging them to believe in themselves and their ability to lose weight as she did.

Aurora Health Care, Milwaukee/Aurora Walkers Point Community Clinic

VMH Living with Loss Grief Support Group comforts family members

Grief is the normal and natural response to the loss of someone or something important to you. It is a natural part of life. Grief also makes room for thoughts, behaviors, feelings and beliefs that those experiencing it might consider abnormal or unusual.

Vernon Memorial Healthcare’s (VMH) ongoing Living with Loss Grief Support Group helps individuals sort out the overwhelming mental anguish and range of emotions that often occur with the death of a loved one. David Swasko, VMH’s grief support group facilitator, says each support group meeting begins with a half hour informative session followed by a time for sharing that allows participants to be with and relate to individuals who have had similar experiences.

"A burden shared is a burden lightened," he explains. Newcomers to grief support are made to feel as comfortable and welcome as possible. The group, offered through the Vernon Memorial Hospice Program, meets on the first and third Mondays of every month from 10:00 a.m. - noon in the Vernon Memorial Hospital community rooms. It is offered at no charge to clients whether their loved one was cared for by hospice or not.

Eldoris Ekern of rural Viroqua knows firsthand about grief and the comfort she felt when she began attending VMH’s Grief Support Group meetings shortly after her husband Raymond’s unexpected death on December 22, 2004. Ekern recalls that it was a tough Christmas that year. She had never been a part of any type of support group before, nor had she ever felt that she needed to be. When she saw the January meeting of the Living with Loss Grief Support Group listed in the Foxxy Shopper she decided to attend. That’s where she first met David Swasko and suddenly found herself a regular attendee at the twice a month meetings. She recalls wishing that the meetings were offered on a weekly basis.

Ekern said, "The meetings offered me the opportunity to pour out my feelings to other individuals who were experiencing the same feelings---denial, disbelief, anger, depression, fear, and reality."

While Ekern said she is blessed with a loving and supportive family, she didn’t want to overburden them with her emotions. "I cannot say enough good about the group," Ekern said.

She enjoys passing on her experience in the hope that others will find the comfort and friendships that she did. Ekern attended Grief Support Group meetings regularly for close to four years. She occasionally checks back in with the group and always feels welcome. Ekern said she created some lasting friendships by being part of the group. A circle of friends still gather for birthdays, holidays and a summer picnic or two. They are all able to acknowledge that they have faced a significant loss and that the loss and the person who is gone matters and affects their lives.

Vernon Memorial Healthcare, Viroqua

Healing among the "porch dwellers"

By Bill Mullooly, St. Ben’s Clinic Social Worker

During the summer at Columbia St. Mary’s (CSM) St. Ben’s Clinic, a small group of people, mostly women, set up camp on our front porch. They start to gather, setting up their beds after the clinic has closed and are always gone in the morning before the clinic opens. They keep the porch very clean and sometimes ask me for a broom. The group is generally made of our current and former patients who choose not to stay in the shelters for various reasons. They respect the clinic and the staff who works here and as you walk to your car late at night, you know you don’t have to worry because they are looking out for you.

The other day one of the "porch dwellers" named Kelly brought a woman into the clinic. She told me Mary had come to the porch a week ago and needs help. Mary looked very weathered and exhausted and her long gray and white hair had not been washed in a while. When I asked Mary how I could help, she told me her story of being evicted from a house where she was renting a room. She did not want to contact her family because she was embarrassed. She kept saying, "I’m just tired and need to rest."

As our conversation progressed, I learned Mary also deals with mental health issues involving anxiety and depression. I also found out she had insurance through the state. I asked Mary if she was interested in going to Columbia-St. Mary’s (CSM) Inpatient Behavioral Medicine Center to rest and get back on the right track. She was concerned about being locked up and I explained it was voluntary and she could leave when she wanted. After a few phone calls, she was off to CSM in a taxi and I was off to see my next patient.

I received a call a few hours later from Mary and she was crying. "This place is so peaceful," she said, "I can finally get some rest and put things back together." I said to her I was so happy she found some peace. I asked her if I could do anything else for her and she said, "Yes, tell the ladies on the porch that I am doing OK and am grateful for all they did for me." I said, "Sure, I can do that for you Mary, and stop by whenever you’d like."

St. Ben’s Clinic is a place of healing and I was moved by the love, concern and support our patients showed this weary traveler out on our front porch.

Columbia St. Mary’s, Inc., Milwaukee

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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