Already grappling with the Herculean task of filling a nearly $6 billion deficit in the state budget, the job became even harder for lawmakers and the Governor this week with the news that the deficit could exceed $7 billion.

Governor Doyle delivered the sobering news at a Capitol press conference May 7, at which he described the magnitude of the problem and challenge facing state lawmakers.

"Here in Wisconsin we are facing tougher choices than ever about what level of state services we can sustain at a time when people need them most," Doyle said. "I am fighting to protect the middle class, education, public safety and health care. These are my priorities. I don’t believe that we as a state will ever move forward unless we protect what is really important."

Rumors of a billion-plus dollar increase in the deficit, and actions that could be taken to address it, have been swirling around the Capitol for the past several days. The Legislature’s Joint Finance Committee temporarily suspended its work on the state budget this week while awaiting the potentially "game changing" news from the Governor.

Doyle did outline several steps he is proposing to address the new budget figures, including:

• Mandatory furloughs of eight days per year for all state employees. While the Governor cannot be furloughed, he will return pay for eight days per year to the state.
• Deeper cuts to state government spending that will reach at least five percent and include layoffs.
• A roll back of the two percent pay increases for state employees that were to be effective in June.
• Directing all state agencies to review all service contracts to reduce personnel costs.
• No new taxes.

As previously reported in The Valued Voice, and prior to the May 7 announcement, Medicaid had been targeted for a $140 million reduction over the 2009-11 biennium. Discussions with lawmakers and the Administration had focused on avoiding cuts to provider payments to the greatest extent possible, but at press time, the complete impact of the new deficit figures on Medicaid was unclear.

"An already very difficult budget has just become significantly more so," said WHA Executive Vice President Eric Borgerding. "Through some hard work and setting the right priorities, Wisconsin has been able to avoid the massive cuts in funding and eligibility for Medicaid that we are seeing in other states—and for good reason. In tough economic times, preserving the health care safety net should be a top priority."

Unlike most other state spending, dollars spent on Medicaid attract a significant amount of matching federal revenue. Thus, cutting Medicaid not only jeopardizes access to vital health care services, but leaves potentially hundreds of millions in Wisconsin’s fair share of federal health care dollars unclaimed.

"Medicaid is a state/federal partnership, meaning each $1 cut from Medicaid will result in the loss of another $1.91 in federal matching revenue," Borgerding said. "In other words, cutting $100 million means giving up nearly $200 million in federal matching dollars. These are the types of difficult decisions now confronting the Legislature and Governor."

The Legislature will likely resume its deliberations on the budget bill next week and is sure to offer up its own ideas on how to address the deficit. It is anticipated that the state budget will be signed into law sometime in late June or early July.

The Wisconsin Hospital Association (WHA) is leading a statewide initiative to eliminate central line-associated blood stream infections (CLABSI) and is inviting all member hospitals to participate in the newly-formed collaborative. Dana Richardson, WHA vice president, quality initiatives, is leading the collaborative with funding from the WHA Foundation.

The "CUSP: Stop BSI" collaborative is a national-state-hospital initiative that leverages the experience of the Johns Hopkins Quality & Safety Research Group, the Michigan Health & Hospital Association Keystone Center, Health Research and Education Trust (HRET), and hospitals from 28 states over three years. Hospitals participating in the collaborative will have access to education, strategies, benchmarks and lessons learned from hospitals throughout the U.S. Additional hospital-acquired infections may be addressed based on participating hospitals time and interest.

Each year, 250,000 cases of CLABSI occur in U.S. hospitals with 18 percent of those cases resulting in death. In addition to the hardship this causes the patient, physicians and hospital staff, CLABSIs account for $3 billion in excess health care costs per year. The good news is that CLABSI are often preventable, and the science and methods are available to prevent them.

On May 6, HHS Secretary Kathleen Sebelius called on hospitals across America to commit to reduce CLABSI in Intensive Care Units by 75 percent over the next three years. Research indicates that these infections strike hundreds of thousands of surgical patients and the percentage of patients acquiring these infections has steadily increased over the past six years. According to Richardson, "Hospital acquired infections have risen to the top of the radar screen for consumers, policymakers, payers and providers. Although Wisconsin hospitals have made strides in reducing these infections, we now have the opportunity to further advance this focus by joining forces with national experts and sharing lessons learned to overcome barriers. Through other WHA-led collaborative projects, Wisconsin hospitals have demonstrated their ability to respond to similar challenges over the past three years. We are confident this project will also lead to changes that will improve health outcomes for patients and reduce unnecessary costs."

WHA has completed two of three informational webinars on the collaborative, with the last one scheduled May 13 from 9-10 a.m. The deadline to register for the BSI collaborative is June 26, 2009. An enrollment brochure is included in this week’s packet and is available online at www.wha.org.

To learn more about this project, contact Dana Richardson at dirchardson@wha.org or at 608-274-1820. To register for the May 13 webinar or to enroll in the collaborative, contact Brian Competente at bcompetente@wha.org or at 608-274-1820.

On May 7, the Wisconsin Hospital Association recognized 76 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. The reception, dinner and awards ceremony was held at the Kalahari Resort in Wisconsin Dells. About 275 people attended the event.

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.

Kathy Guenther, a registered nurse at Black River Memorial Hospital, offered encouragement to those learning a new career. "In this economy, for many people, it will be a year of change and I wonder how many will return to school and find employment within the health care system. For those that think they can’t do it, yes, you can if you really want to. It certainly isn’t easy, but well worth it in the end. Each and every day, I leave my job having learned something new from working with an incredibly expert team of professionals. It is never dull or boring and always meaningful.

Judy Warmuth, WHA vice president, workforce, along with Mary Beth White-Jacobs from the Wisconsin Organization of Nurse Executives (W-ONE), and Angie Hupf from the Wisconsin Society of Healthcare Human Resources Administration (WSHHRA) presented the awards.

Warmuth said many people decide on a health career after a relative, a close friend, or they personally, were 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.

The fact that hospitals offer secure jobs with family-sustaining wages and benefits makes them desirable choices for employment, according to WHA President Steve Brenton. But training, recruiting and retaining a workforce large enough to meet the growing demand for health care is a constant challenge for hospitals and other health care providers. (See WHA’s most recent workforce report at: www.wha.org/workForce/workforce_report.aspx.)

"Our health care employees reflect the demographics of the general population – and many are nearing retirement. Our hospitals are planning now to fill the positions they will vacate in the not-so-distant future. And as we continue to see more chronic and age-related illnesses in our communities, it will require an even larger and highly-skilled workforce to meet the growing demand for care," Brenton said.

"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," Brenton said. The essays are posted at www.wha.org.

Below is a list of the 2009 Pride Program honorees:

Agnesian HealthCare, Fond du Lac
Barb Van Egtern, Employment Specialist

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

Aurora Health Center, West Bend
Peggy Hays, Physician Assistant

Aurora Medical Center, Oshkosh
Marta Hoch, Manager, Medical Staff Services

Aurora Medical Center, Hartford
Lynn Reynolds, RN, Emergency Department

Aurora Medical Center, Two Rivers
Berdie Maigatter, Patient Access Representative

Aurora Sheboygan Memorial Medical Center, Sheboygan
Jody Keil, IS Training Specialist

Aurora Sinai Medical Center, Milwaukee
Gloria Jackson, Patient Transporter

Aurora St. Luke’s Medical Center, Milwaukee
Jeffrey Klister, RN, 4KLM Dept.

Aurora St. Luke’s South Shore, Cudahy
Stacy Wilson, RN, Registered Nurse

Aurora West Allis Medical Center, West Allis
Patricia Celek, RN, Certified Diabetes Educator

Baldwin Area Medical Center, Baldwin
Sarah Anton, Certified Nursing Assistant

Beaver Dam Community Hospital, Beaver Dam
Alicia Madigan, Exercise Physiologist - EKG/Cardiopulmonary

Bellin Hospital, Green Bay
Lindsay Hintz, RN, Team Facilitator

Berlin Memorial Hospital, Berlin
Connie Belter, Telecommunications Operator

Black River Memorial Hospital, Black River Falls
Kathy Guenther, RN, Registered Nurse

Burnett Medical Center, Grantsburg
Julie Andersson, Physician Assistant

Children’s Hospital of Wisconsin, Milwaukee
Debra Martin, Lead Specialty Pharmacy Technician

Columbia St. Mary’s, Glendale
JoAnne Arndt, Clinical Nurse 2

Columbus Community Hospital, Columbus
Michele Hein, Accounting Specialist

Community Memorial Hospital, Oconto Falls
Jennifer Patzer, Patient Financial Advocate

Divine Savior Healthcare, Portage
Kendra LaCrosse, Occupational Therapist

Flambeau Hospital, Park Falls
Barbara Koch, RN, Home Health and Hospice

Fort HealthCare, Fort Atkinson
Florence Falk, LPN, Licensed Practical Nurse

Franciscan Skemp Healthcare, La Crosse
JoAnne Damaschke, RN, CNRN - Neurosurgery

Froedtert Hospital, Milwaukee
Mary Jo Burgoyne, Clinical Nurse Specialist

Gundersen Lutheran Health System, La Crosse
Rebecca Berg, Medical Assistant

Hayward Area Memorial Hospital, Hayward
Jaime Harris, Business Office Receptionist

Hudson Hospital, Hudson
Lindsay Rees, CNA, Certified Nursing Assistant

Lakeview Medical Center, Rice Lake
Kathleen Evertsen, Patient Registrar, Admitting

Langlade Hospital, Antigo
Theresa Clark, Cancer Center Receptionist

Luther Midelfort Northland, Barron
Brittany Homer, Massage Therapist

Luther Midelfort Oakridge, Osseo
Stacey Connell, Nursing Assistant

Luther Midelfort-Mayo Health System, Eau Claire
Kurt Ellis, Lead - Clerical Medical Imaging

Memorial Health Center, Medford
Nicole Buehler, RN, Registered Nurse

Memorial Hospital of Lafayette County, Darlington
Michelle Edwards, Medical Coder

Memorial Medical Center, Ashland
Theresa Hoyles, Registered Dietitian

Memorial Medical Center, Neillsville
Philan Susa, CNA, Certified Nursing Assistant

Mercy Health System, Janesville
Janet Schlegel, RN, Case Manager

Mile Bluff Medical Center, Mauston
Rhonda R. Larson, RN, Director of Cancer Care Nursing

Ministry Health Care - Good Samaritan Health Center, Merrill
Nancy Johnas, RN, Registered Nurse

Ministry Health Care - Howard Young Medical Center, Woodruff
Patrick Baker, Respiratory Care Practitioner

Ministry Health Care - Saint Clare’s Hospital, Weston
Kris Contois, Housekeeper I

Ministry Health Care - Saint Joseph’s Hospital, Marshfield
Kelly Friesen, RN, Registered Nurse

Ministry Health Care - Saint Mary’s Hospital, Rhinelander
Kathy Van Ryen, RN, Nurse Manager

Ministry Health Care - Saint Michael’s Hospital, Stevens Point
Jared Davis, Physician Recruiter Specialist

Monroe Clinic, Monroe
Linda Sangrene, Contract Management Specialist

Orthopedic Hospital of Wisconsin, Glendale
Mark Ahrens, Diagnostic Services Director

Osceola Medical Center, Osceola
Dody Lunde, RN, Lead RN, Oncology Infusion Services

Red Cedar Medical Center, Menomonie
Kristine Brekke, Mail Clerk

Ripon Medical Center, Ripon
Ann Soda, RN, Registered Nurse

River Falls Area Hospital, River Falls
Shauna, Knott, Wellness Coordinator

Riverview Hospital Association, Wisconsin Rapids
Kelly, Akkerman, Employment Coordinator

Sacred Heart Hospital, Eau Claire
Diane Zakopyko, RN, Registered Nurse

Sauk Prairie Memorial Hospital & Clinics, Prairie du Sac
Kathryn Murphy, Employee Health Practitioner

Shawano Medical Center, Shawano
Terri Reuter, Cafeteria Aide

Southwest Health Center, Inc., Platteville
Kari Pace, RN, Registered Nurse

Spooner Health System, Spooner
Diane Neste, Social Worker

St. Clare Hospital & Health Services, Baraboo
Judy Hannaford, Director, Alcohol and Drug Counselor

St. Joseph’s Community Health Services, Hillsboro
Kevin Dean, Emergency Services Coordinator

St. Joseph’s Hospital, West Bend
Suzanne Yanke, RN, Registered Nurse

St. Joseph’s Hospital, Chippewa Falls
Catherine Kromrie, RN, Service Area Coordinator

St. Mary’s Care Center, Madison
Suzanne Dungan, Activities Coordinator

St. Mary’s Hospital, Madison
Lauren Pallin, Administrative Supervisor, Nursing

St. Mary’s Hospital of Superior, Superior,
Jane Cain, Surgical Technician

St. Nicholas Hospital, Sheboygan,
Jon Paquette, Chaplain

St. Vincent Hospital, Green Bay
Patty Bekkers, RN, Outpatient Renal Dialysis

Stoughton Hospital, Stoughton
Lori Larsen, RN, Registered Nurse

The Richland Hospital, Inc., Richland Center
Lisa Clary, RN, BSN, Clinical Coordinator

Tomah Memorial Hospital, Tomah
Margie Weber, RN, Registered Nurse

University of Wisconsin Hospitals and Clinics, Madison
Elinor Gbedey, Scheduler Senior

Upland Hills Health, Dodgeville
Sherry Wenzel, RN, Emergency Room RN

UW Health Partners Watertown Regional Medical Center, Watertown
Holly Brom, RN, Registered Nurse

Vernon Memorial Healthcare, Viroqua
Eric Thunstedt, Exercise Physiologist - Clinical

Veterans Administration Medical Center, Tomah
Susan Schmitz, RN, Registered Nurse

Wild Rose Community Memorial Hospital, Wild Rose
Denise Reilley, Administrative Assistant

Legislative leaders announced agreement this week on a statewide smoking ban proposal covering all workplaces that would go into effect July 5, 2010. The compromise was agreed to by smoking ban supporters and the Tavern League of Wisconsin after several modifications were included. The bill is set for a vote in both houses of the Legislature next week.

WHA voiced support for a strong, statewide smoke-free law in a memo to lawmakers this week. The memo cited the devastating effect tobacco has on the health of those that use it and those around them, as well as the cost of treating chronic disease caused by tobacco use – including in the state’s Medicaid program.

Long-time smoking ban advocate Senator Fred Risser (D-Madison), the main Senate author of the proposal called the law inevitable and said, "The sooner we pass it, the sooner we start saving lives and saving the state money." Main Assembly author Representative Jon Richards (D-Milwaukee), chair of the Assembly Health and Health Care Reform Committee, called the bill a compromise that brought Democrats and Republicans together and said the law is a major step forward for Wisconsin.

WHA has long supported tobacco-free efforts. In 2004, WHA partnered with the University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) to ensure that hospitals had proper protocols to help patients quit smoking. WHA’s CheckPoint program, which publicly reports information related to hospital quality and safety efforts, www.wiCheckPoint.org, includes measures related to hospitals’ tobacco intervention efforts.

In 2006, the WHA Board recommended that all hospitals go tobacco-free throughout their campuses. Through diligent effort, hospital leadership and staff made the recommendation a reality and now, 100 percent of Wisconsin’s acute care hospitals are tobacco free campus-wide.

Besides the delayed start date, among the other changes that helped broker the compromise were exemptions for outdoor smoking patios, cigar bars and tobacco retailers, and modifications to the fines imposed for violations.

Local smoking ban provisions that relate to outdoor areas would remain effective only until the new statewide ban goes into effect.

Register by May 15 for the annual Wisconsin Rural Health Conference and take advantage of the special early bird discounted registration fees. This year’s conference is a great way for hospital executives, leadership staff and trustees to take advantage of great education, right in your backyard, at a fraction of the travel and registration costs of out-of-state events.

This year’s conference is scheduled June 17-19 at the Kalahari Resort in Wisconsin Dells. Register now to take advantage of the special deals, and book your hotel now as well, to ensure the special Rural Health Conference group rate.

Growing hospital concerns about the "public plan (government) alternative" component of the Obama Administration’s anticipated health reform legislation intensified this week with the unveiling of the proposed CMS inpatient PPS rule for FY2010.

The proposed rule freezes hospital payments by reducing the already inadequate annual inflation update (hospital market basket) by 1.9 percent. This cut is rationalized by CMS as a "behavioral offset"…an action that takes back dollars that hospitals are currently overcharging Medicare by upcoding patient bills. CMS claims that hospital coding practices do not reflect real changes in case-mix, a charge loudly refuted by the hospital field and at odds with declining aggregate Medicare margins both nationally and in Wisconsin.

AHA is protesting the proposed market basket number—2.1 percent—as inadequate and low by historic standards. Last year’s adjustment was 3.6 percent. The coding adjustment, on top of the inadequate inflation increase, results in a de facto payment freeze for Medicare admissions beginning October 1.

The CMS rule also eliminates Indirect Medical Education (IME) payments for teaching hospitals at a time when the physician workforce issue is universally recognized as a top tier challenge and concern for the nation’s hospitals and clinics. Who will take care of the millions of new patients that will be "covered" under the reform plan?

The Medicare capital payment update is also whacked for all PPS hospitals due to the previously discussed coding adjustment. This dynamic comes at a bad time for those who are hoping that hospital construction and equipment spending will lead the nation out of the current recession.

The sum total of cuts found in the CMS Inpatient Payment rules amount to tens of billions of dollars over the next decade. Add to that to the additional billions in "savings" proposed within the Administration’s budget initiative (readmission penalties, payment bundling and value-based purchasing) and one envisions a pretty bleak financial picture for the nation’s hospitals that seem to be at the epicenter of federal budget slashing.

Why is this CMS rule a harbinger for health reform? Because the public (government) plan alternative may look a lot like Medicare and be subject to the same annual budgetary pressures that rationalize the type of cuts described in this column. If the new program ultimately "crowds out" millions who are currently privately insured, the resulting impact on hospitals, physicians, the larger health care workforce as well as suppliers and vendors will be dramatic.

Steve Brenton
President

In order to reduce expenses as mandated by Governor Doyle due to the state budget deficit, Dean Robert Golden, MD, School of Medicine and Public Health has recommended closing the Clinical Laboratory Sciences/Medical Technology (CLS/MT) program. WHA has expressed concern about the impact that decision will have on Wisconsin’s health care workforce.

In a letter to UW Madison Chancellor Biddy Martin, WHA President Steve Brenton, noted that "Medical technologists are a key component of the workforce and access to laboratory services is critical to Wisconsin’s health care delivery system. Our concern about closing this program is based upon the following information:

• WHA routinely surveys its members to obtain information on difficult to fill positions. In 2007, the most recent data available, the vacancy rate for medical technologists in Wisconsin hospitals was 8.7 percent compared to the vacancy rate for registered nurses of 8.9 percent. Much attention has been paid to RN vacancies, while the vacancy rate for medical technologists is very similar but much less visible. The number of nursing programs in Wisconsin is growing. It is alarming that the number of programs preparing medical technologists is declining.

• Medical technologists are among the oldest workers in the hospital workforce. Twenty-five percent of these professionals are more than 55 years of age. This means that a large proportion of these workers will retire in the near future, which will create more vacancies and make it more difficult to fill open positions.

• Health care programs often struggle to find good clinical learning opportunities for students. There are currently five accredited medical technology degree programs in the state of Wisconsin. This proposal would reduce that number and leave none in the Madison area, where many opportunities for clinical experience now exist.

• Wisconsin is struggling with loss of industry and jobs, but health care has positions and is still expected to grow. Graduates of medical technology programs are finding jobs when other program graduates in Wisconsin may not be able to do so."

WHA urged Martin to reconsider the decision to close this program. Additionally, if the reason for recommending closure was—as stated—a lack of fit with the mission of the School of Medicine and Public Health, WHA suggested that the CLS/MT program be allowed to move, along with its funding, to another home within the Madison campus.

"It is WHA’s understanding that all of this year’s graduates of the program have jobs. Closing a program that creates needed health professionals, all of whom can find jobs in this difficult economy, is not a logical or sensible move. Further, in an era when health care demands of an aging population are increasing, decreasing the supply of this important component of the health care workforce will reduce access and increase the difficulty that Wisconsin hospitals encounter in filling these important clinical positions," Brenton stated.

Providing testimony at a legislative hearing moved Stoughton Hospital’s Kristi Hund from a passive observer in the legislative process to an active grassroots advocate.

"Testifying was a great experience for me," said Hund. "I should have done it earlier and will do it again whenever I have the opportunity."

Kristi’s testifying experience was an exceptional one. She provided testimony in opposition to Senate Bill 108, legislation prohibiting a health care facility from using mandatory overtime. The companion bills, Senate Bill 108 and Assembly Bill 152, are authored by Senator Judy Robson and freshman legislator Rep. Sandy Pasch.

Hund testified from two perspectives—a (former) staff nurse who had been mandated to stay to care for patients and a (current) nurse executive responsible for staffing an entire hospital and its patients.

"As a former staff nurse and current nurse leader, I have a hands-on knowledge of both sides of the issues," she said. "I knew I needed to provide these perspectives to committee members, so it was easy to speak about this topic and share my expertise."

Always interested in public policy, Kristi reads WHA’s Valued Voice newsletter, stays abreast of current events and has contacted her legislators in the past. She is also active in the nursing roundtable at the Rural Wisconsin Health Cooperative and the Wisconsin Organization of Nurse Executives.

She recently added professor to her public policy resume, teaching a course for Upper Iowa University on the topic. But, it was testifying before the Senate Health Committee that she believes helped her truly influence the development of public policy.

"As a first time testifier, I appreciated the coaching and support I received from WHA staff Judy Warmuth and Jenny Boese. Their encouragement and guidance made all the difference," said Hund. "So much so, I’ve told my peers how painless it was and encouraged them to testify if they ever have the opportunity."

Do you have a great grassroots story to tell HEAT? Contact Jenny Boese at 608-268-1816 or email jboese@wha.org so we can spotlight you.

A continuing highlight of the annual Wisconsin Quality & Safety Forum, the Project Showcase will once again allow attendees to share information about their current quality and safety improvement initiatives, in a poster board format, as part of the 2009 Forum.

A project submission brochure for the 2009 Wisconsin Quality & Safety Forum is included in this week’s packet and on WHA’s Web site at www.wha.org. Examples of projects eligible for submission include those that enhance organization-wide improvement culture and structure; are undertaken to improve quality or safety of care; and demonstrate how quality improvement practices are utilized in an organization. Submitted projects will be included on a special Quality & Safety Forum Web site.

Showcase projects submissions will only be accepted via completion of the on-line submission form at www.wha.org/QSFshowcase. The online form is now available, and all submissions are due to WHA, via the online form, by July 1, 2009. For questions about project submission, contact Brian Competente at 608-274-1820 or bcompetente@wha.org.

WHA will be preparing more analysis on all of these rules in the coming weeks. The complete rule summaries will be posted on the WHA Web site at www.wha.org/financeAndData/reimbursement.aspx.

The Centers for Medicare & Medicaid Services issued a hospital inpatient and long-term care prospective payment system proposed rule for fiscal year 2010 that would decrease average inpatient payments by 0.5 percent. The proposed rule includes an initial market-basket update of 2.1 percent for those hospitals that submit data on quality measures; hospitals not submitting data would receive a 0.1 percent update. However, the rule then proposes a cut of 1.9 percent to eliminate what CMS claims is the effect of coding or classification changes the agency says do not reflect real changes in case-mix. This proposed 1.9 percent cut is a prospective cut for FY 2010 and beyond – in total, cutting billions of dollars. When coupled with the lower-than-usual market basket and other policy changes, the average decrease in payments would be 0.5 percent.

The rule is currently posted at www.federalregister.gov/OFRUpload/OFRData/2009-10458_PI.pdf.

Proposed rule would cut SNF payments by 1.2 Percent in FY 2010

The Centers for Medicare & Medicaid Services proposes to reduce Medicare payments to skilled nursing facilities by a net 1.2 percent, or $390 million, in fiscal year 2010, according to a proposed rule to be published in the May 12 Federal Register. CMS proposes a 2.1 percent market basket update for the SNF prospective payment system for FY 2010, which would be offset by a 3.3 percent reduction resulting from a recalibration of the case mix index used to adjust for a patient’s severity of illness. CMS said the recalibration is intended to set payments to the levels intended in 2006, when the agency expanded the SNF PPS payment classification system. The agency will accept comments on the proposed rule through June 30.

The Centers for Medicare & Medicaid Services issued a proposed rule updating inpatient rehabilitation facility payment rates for fiscal year 2010. The proposed rule recommends a market basket update of 2.4 percent as well as raising the IRF outlier threshold to $9,976, which would increase IRF payments by $150 million from 2009 levels. In addition, CMS proposes to begin including Medicare Advantage patients in its assessment of compliance with the "60% Rule," which would require IRFs to assess this additional group of patients. CMS also issued, in a separate document, draft revisions to the IRF criteria in the Medicare Benefit Policy Manual, and will accept comments on those revisions via email at MBPMComments@cms.hhs.gov. Comments on the proposed rule and IRF criteria will be accepted through June 29. A final rule will be issued by August 1, with provisions that take effect October 1.

Dependent eligibility audits are a hot topic. The high return on investment has helped this cost containment strategy become a central point of discussion between many advisers and their clients. While audits can be extremely effective, it’s important for employers to be aware of some of the most common mistakes that can send these projects off track.

Don’t ignore the fact that you have ineligible dependents: Most employers would like to believe that their benefit plan does not incur the extra cost burden of ineligible dependents. However, as employers of all sizes and from a wide variety of industries have found, ineligible dependents are a problem that every employer must address. Most employers who have not conducted an audit can expect between 5 percent and 8 percent of their dependents to be ineligible.

Don’t scrimp on communications efforts: Effective communication with employees is critical to the success of a dependent eligibility audit. Early communication will not only help the employees understand the process, but will also help lower the number of "non-responders." Employers should open up many different channels of communication, including email, fax and call centers for employees who need help with the process.

Don’t rush it: During a dependent eligibility audit, an employer will face unique situations that require a well thought out and standardized position. Time spent up front considering how these situations will be addressed will lead to a more successful project.

Don’t ignore the details: Details always matter. However, when handling sensitive issues, details take on an even higher level of importance. A simple detail like co-branding the first letter that is sent to employees with the name of the employer and the name of the vendor performing the audit will go a long way toward making the project successful. Employers should also try to use letters that have the dependents for each employee listed on the form. Sending out blank forms for the employee to fill out will not help catch ineligible dependents that the employee doesn’t realize are still on the plan.

Don’t ignore applicable laws: Employers should pay close attention to any laws that will impact their dependent audit project. Employers also need to carefully consider COBRA and how they will integrate this into their projects.

Don’t forget about the future: After an employer goes through a dependent eligibility audit, they must consider how they will address ineligible dependents. Many employers use a dependent eligibility audit as a signpost to tighten up their existing documentation requirements for enrolling dependents. In addition, some employers perform audits on a quarterly or annual basis for new dependents. These follow-up audits are a good way to ensure that an employer’s benefit plan does not continue to carry ineligible dependents.

Boscobel Area Health Care gave away 50 helmets at the Grant County Fair to area youth and adults.

"Pediatric safety has been a big priority for us this year," says Emergency Room Nurse Manager Amy Franklin. "A bike helmet is a simple piece of equipment that can make a big difference in preventing serious injury."

Boscobel Area Health Care decided to give out bike helmets at the fair because of the great response they received at their open house in April, where they gave helmets to 150 children.

"It feels great to see children around the community wearing them," said Franklin.

Pediatric injury prevention has been identified as a community benefit goal for the 2008-2009 year, says Community Relations Coordinator Mary Sprosty.

"We are pulling all of our smaller community benefit efforts into a larger, more comprehensive plan with defined goals and outcomes. This year we will focus on preventing pediatric injury through programs focusing on bike helmet and car seat use," says Sprosty.

Sprosty said Boscobel Area Health Care has partnered with local schools and police departments to carry out these efforts. The three organizations will sponsor a bike safety day, community car seat checks, and educational programs at the school.

Aspirus Wausau Hospital announced it is donating 2 acres of land near the hospital to The Women’s Community, Inc.

The Aspirus Wausau Hospital Board of Directors recently approved the donation of the parcel of land located at the corner of Hilltop and 32nd Ave., for The Women’s Community to build a new, 20,000-square foot facility.

"There is a real need in our area for the invaluable services The Women’s Community provides," said Duane Erwin, President and CEO of Aspirus Inc. "We carefully evaluated this opportunity and recognized that their mission aligns very closely with that of our own Women’s Health program, and they share Aspirus’ commitment to serving our community’s health needs."

The Women’s Community, currently located at 2801 N. 7th St. in Wausau, provides specialized services and resources 24 hours a day to people in central Wisconsin affected by domestic violence, sexual assault and unemployment. It is a private non-profit organization, funded by federal, state, and local grants and community contributions.

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