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June 5, 2009
Volume 53, Issue 22
Effects of Economic Downturn Reflected in Preliminary Fiscal Survey Results
Uncompensated Care up 18 Percent; Total Margins down 60 Percent
Preliminary financial results for Wisconsin hospitals in Fiscal Year 2008 show that they were not immune from the effects of the ongoing economic downturn. And the picture may get worse before it gets better.
With all acute-care hospitals’ FY 2008 fiscal surveys submitted, Wisconsin hospitals’ aggregate total margin is down more than 60 percent from Fiscal Year 2007. At the same time, uncompensated care jumped more than 18 percent, with most of the change attributable to a large increase in bad debt. Total charity care and bad debt for Fiscal Year 2008 exceeds $1 billion in charges for the first time ever.
"Uncompensated care can be seen as a barometer for the overall economy," said WHA President Steve Brenton. "These numbers show that hospitals are the ultimate health care safety net when the economy suffers."
Brenton noted that as hospitals close the books on Fiscal Year 2008, it is possible that Fiscal Year 2009 results will be worse.
"More than half of all Wisconsin hospitals have a fiscal year that ends on or before September 30, so the 2008 fiscal survey information as a whole probably doesn’t capture the full effect of the current economic downturn," he said.
Overall patient volumes were relatively stable in 2008 compared to 2007. However, Brenton pointed out that the distribution of patients has changed, with growth in government-pay and uninsured discharges and corresponding reductions in volumes for privately-insured patients.
"This is particularly true with emergency-department discharges, which are sometimes a leading indicator of emerging health care trends," he said.
In the fourth quarter of 2008, nearly three of every five ED encounters not resulting in an admission was a government-pay or uninsured patient.
"This changing payer mix points to the critical need to expand Medicaid eligibility and improve Medicaid reimbursement," Brenton said.
AHA, Health Care Organizations Submit Cost-Containment Strategies to Obama
AHA provisions include quality and patient safety measures
In fulfillment of the hospital field’s May 11 commitment to the Obama Administration to develop concrete ideas to reduce the rate of growth in health care spending, the American Hospital Association (AHA) and five other national health care organizations submitted their cost-containment strategies to the White House this week. The other organizations include the American Medical Association, America’s Health Insurance Plans, Pharmaceutical Research and Manufacturers of America, Advanced Medical Technology Association, and the Service Employees International Union.
The AHA outlined specific actions hospitals can take immediately, as well as longer-term initiatives, to improve patient safety and quality while reducing costs. The recommended actions reflect many of the promising initiatives already underway in hospital organizations and leadership from the field. Several recommendations were drawn from work with strategic partners such as the Agency for Healthcare Research and Quality and the Institute for Healthcare Improvement.
Overall, the AHA outlines the goals of its "Hospitals in Pursuit of Excellence Campaign" as:
Facilitate hospital and health system performance improvements that have meaningful quality improvement and associated cost savings;
Further the use of known best practices, initially in the areas of infection prevention and patient safety and expanding over time into other areas;
Facilitate the sharing of best practices among hospitals, health systems and national, state, regional and metropolitan hospital associations; and
Demonstrate the commitment of the hospital field to achieve these improvements.
The following focus areas are referenced by the AHA that hospitals may initially begin work on:
Reduce surgical infections and complications
Reduce central line-associated blood stream infections (CLABSI)
Reduce methicillin-resistant Staphylococcus aureus (MRSA)
Reduce clostridium difficile infections (c diff)
Reduce ventilator-associated pneumonia (VAP)
Reduce catheter-associated urinary tract infections
Reduce adverse drug events from high-hazard medications (e.g., anticoagulants, narcotics, opiates, insulin, sedatives)
Reduce pressure ulcers
The AHA also identified longer-term cost-containment strategies that will be pursued, as evidence, tools and nationally-endorsed measures emerge. Those include:
Improving Care Coordination – Focus in particular on the discharge process and care transitions.
Implementing Health Information Technology (HIT) – Focus on leadership and clinical strategies to effectively implement HIT.
Promoting Efficient Resource Utilization – Promote palliative and hospice care through the use of advanced directives and best practices.
Preventing Patient Falls – Further the implementation of effective fall prevention programs and use of fall risk assessment tools.
Improving Perinatal Care – Promote best practices to improve perinatal care and reduce birth trauma and complications.
Reducing Supply Costs – Create a more efficient and transparent purchasing environment, including greater alignment of hospital and physician incentives, greater product standardization and other measures.
The recommendations are consistent with many of the quality efforts already under way in Wisconsin, said Wisconsin Hospital Association President Steve Brenton. "WHA looks forward to working with AHA and our members to advance this important performance improvement agenda," Brenton said. "We are already engaged in working on several of these quality improvement priorities and anticipate rapid adoption of additional patient safety activities."
For example, Wisconsin hospitals have participated in collaborative learning projects to reduce surgical site infections and other complications of surgery. Hospital specific performance on these national measures is reported on CheckPoint (www.wiCheckPoint.org). Current statewide improvement initiatives include the Wisconsin Pressure Ulcer Coalition project, the MetaStar MRSA project and the upcoming WHA CUSP: STOP BSI project.
Access AHA’s full letter, including measures submitted by the other five health care organizations, online at www.wha.org/financeAndData/pdf/letterPresident6-1-09.pdf.
President’s Column: Gundersen Lutheran Communication Absolutely a "Must Read"
A letter this week from Gundersen Lutheran CEO Jeff Thompson, M.D., to Senate Finance Committee members (www.wha.org/financeAndData/pdf/gundersen5-29-09.pdf) absolutely nails a series of fundamental issues that must be addressed in national health reform legislation. But due to highly-charged regional political differences, these issues may be tossed aside in the haste to get something done later this summer.
The communication asks Congress to recognize longstanding Medicare payment disparities, noting that "Wisconsin, Minnesota and Iowa are ranked in the top quartile for having the best quality health care in the country" while "having some of the lowest reimbursement rates in the nation." The letter presses Congress to "reward quality and efficiency, rather than quantity," but also notes Congress’ failure to tackle the issue in the past.
Dr. Thompson’s letter also notes that "rural physician shortages place access to care at risk." Thompson refers to a long list of current and possibly future payment issues (SGR formula, pending medical education subsidy cuts and inadequate physician shortage area bonus payments) that serve to undermine address of the shortage.
Finally the letter urges "support for payment for the use of advance care planning tools for the chronically ill in their last two years of life," noting success in Western Wisconsin in engaging clinicians and patients in advance directives.
The Gundersen Lutheran correspondence includes actionable recommendations that align with the issue themes, including advancing a value-based payment methodology developed by the Mayo Health System (www.wha.org/financeAndData/pdf/mayo5-20-09.pdf) that can meaningfully reward value rather than providing incentives for quantity.
This communication aligns with themes that WHA has raised regarding the need to "fix" an already broken payment system as part of a larger health reform strategy. This is especially necessary given the likelihood that a government plan alternative that looks a lot like Medicare will be a central pillar of legislation that will be pushed by the Obama Administration. And we can’t rely on our national associations to advance advocacy positions that pit one region of the nation against another region. That’s an understandable reality but certainly shouldn’t preclude the upper Midwest from weighing in with our Congressional Delegations.
Steve Brenton
President
Grassroots
Spotlight: Congressman Kagen Visits Howard Young Medical Center
Holds Listening Session on Health Care
Congressman Steve Kagen, MD (8th Congressional District), hosted a listening session on May 26 at Ministry Health Care’s Howard Young Medical Center in Woodruff to address the future direction of health care. Cong. Kagen is in his second term in the House of Representatives and is a well-known allergist in the area.
Attending the listening session were Stewart Watson, MD, CEO of Ministry Medical Group, Ministry Health Care Northern Region CEO Brian Kief, and Howard Young President Sheila Clough. They were joined by other members of the Howard Young Health Care leadership team and community members.
During the 90-minute session, Kagen outlined his plans to reform health care and shared his 10-point "Essential Elements of Health Care Reform." He then fielded questions from audience members for nearly an hour.
This listening session was the third in two years for Kagen at a Ministry facility, and, he used the opportunity to note his appreciation for Ministry Health Care. Rep. Kagen originally spent time at Howard Young Medical Center in 1973 as a third-year medical student.
Do you have a grassroots story to share? Let us know by emailing jboese@wha.org .
Call for Nominations: 2009 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 2009 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 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 2009 Award is included in this week’s packet.
Nominations are due July 15, 2009. Nomination forms can also be found on the WHA website at www.wha.org/about/globalvision.aspx. For more information about the Award, contact Jennifer Frank at jfrank@wha.org or 608-274-1820.
Workforce Bills Introduced in State Legislature
A bill that would call for the collection of workforce-related data from nurses was introduced in the Wisconsin Assembly June 2, 2009. Assembly Bill 293, which emerged from the Legislative Council’s Special Committee on Building Wisconsin’s Workforce, sets an expectation that workforce data would be collected at the time the nursing license is renewed. The work necessary to collect this information would be performed jointly by the Department of Regulation and Licensing and the Department of Workforce Development.
Planning for an adequate future nursing workforce in Wisconsin has been complicated by the fact that the actual number of nurses working in Wisconsin, how many hours they work, and how many jobs they hold is unknown. As a member of the Committee that drafted the bill, Judy Warmuth, WHA vice president of workforce, is enthusiastic about the collection of this data.
"If you cannot accurately describe the nursing workforce in Wisconsin, you are essentially guessing whether the supply of nurses will meet the future demand for their services. The data collected from nurses would facilitate statewide nurse workforce planning that would enable hospitals and other organizations to more adequately prepare for the future," according to Warmuth.
Several other licensure-related bills were also introduced. SB 115 would change the dietitian credential from a certificate to a license; AB 275 would move the Physical Therapy Board, currently an affiliated board of the Medical Examining Board, to independent status; and AB 267 /SB 184R would create licensure for radiographers.
The budget bill, (AB 75) at this time, still includes the addition of FTEs in the Department of Regulation and Licensing. WHA has been supportive of this increase as more timely complaint investigation and licensure are critical needs for WHA members.
WHA Community Benefit Survey Closes
Requests for charity care climb in community hospitals
While the final numbers are not
in yet, WHA expects once again to see 100 percent of Wisconsin’s hospitals
report their community benefits to the Association. For the fourth year in
a row, more than 130 hospitals responded to the survey that collects information
related to programs and activities that meet the health, social and economic
needs in the communities they serve. Again this year, WHA used the
Community Benefit Inventory for Social Accountability (CBISA) tool to collect
the data in response to member requests. WHA held a seminar in March to
acquaint the community benefit contact people with the collection tool.
According to Mandy Ayers, WHA
director, administration, “This is WHA’s second year working with the CBISA
tool. The tool allows hospitals to track community benefits real time as
they are providing the services to their communities. CBISA added features
to the tool, which will assist our hospitals in preparing for the IRS 990
Schedule H which takes effect in 2010.”
While the survey is now closed,
WHA is actively soliciting stories about hospitals activities related to charity
care and community services, such as health screenings, free clinics, dental
programs, and other services.
“This year we expect to see
an increase in services that hospitals have provided to their communities since
we know from the Fiscal Survey data that charity care has climbed due to the
economy,” according to Mary Kay Grasmick, WHA vice president, communications.
“Many of the stories submitted for the annual report so far illustrate the
difficulties that people have faced as they have lost their jobs and insurance.
Hospitals truly are the health care safety net in the communities they serve.”
The deadline for submitting stories for consideration in the 2009 WHA Community Benefit Annual Report is July 31, 2009.
Call for Nominations for WHA Annual Awards
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 Young 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 2009 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 Young Healthcare Executive Award is presented to a member of the American College of Healthcare Executives under the age of 40 who has shown exceptional professional development. Nominations for this award should be sent to Mary Hansen, Berlin Memorial Hospital, ACHE Young Healthcare Executive Award, 225 Memorial Drive, Berlin, WI 54923.
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 17. 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/awards.aspx. For more information, contact Sherry Collins or Steve Brenton at
WHA, 608-274-1820.
Final Chance to Register for the 2009 Wisconsin Rural Health Conference
Kalahari Resort, Wisconsin Dells *** June 17-19, 2009
More information and on-line registration is available at www.wha.org.
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.
Community Benefits: Spooner Health System, Spooner
Clinical site for nursing students
Sixteen nursing students completed a nursing clinical experience at Spooner Health System.
Jean Kissack, Wisconsin Indianhead Technical College (WITC) Instructor, has been teaching nursing students for 20 years. Jean states, "I enjoy having clinical at Spooner Health System because staff members are so willing to show the students new things. The hospital and nursing home being connected is also an advantage when we have eight students who each plan to take two to three residents or patients."
Students are given the opportunity to observe and participate in the roles and relationships of the various levels of health care personnel. They learn how to care for patients with an acute or chronic illness and observe in Dialysis, Surgery and the Emergency Room. We continue to collaborate with WITC to provide clinical experiences for persons in training for EMT (Emergency Medical Technician), CNA (Certified Nursing Assistant) and RN (Registered Nurse). We also collaborate with the College of St. Scholastica to provide clinical experiences for the RN program.
"I have found Spooner Health System to be a wonderful place to grow as a student and as a nurse. The staff has been encouraging as well as nurturing in my growth from CNA to RN. The transition from student to working RN has been both rewarding and fulfilling... I owe many thanks to the great RNs who have nurtured me along the way!" - Faith E.
Community Benefits: Fort HealthCare, Fort Atkinson
Fort HealthCare donates to Rainbow Hospice inpatient facility campaign
Recently, the Fort HealthCare board of directors authorized support of the Rainbow Hospice Inc., capital campaign with a donation valued at approximately $250,000. Rainbow Hospice intends to build an inpatient hospice facility on donated land located on Highway 26 just north of Interstate 94 in Johnson Creek.
Construction plans call for a fully-equipped 12,000 square foot eight-bed inpatient facility to be built on a wooded hilltop. The facility will provide care and comfort to patients with terminal illnesses and their families. Architectural renderings show creatively designed, large rooms built to accommodate patient and family needs including space for mementos, pictures and reminders of home. Expansive windows look out onto a serene, wooded setting with view of trees, gardens and natural life. A large gathering room with a warm fireplace, attractive dining room, intimate living room, chapel and playroom for children will allow families to visit often and stay longer.
The facility will be built to with an eye toward future expansion and current hospital construction codes specific to housing patients requiring sophisticated palliative care and complex medical interventions. With the recent donation of property, the estimated cost of the project has been greatly reduced to approximately $3.6 million. Construction is slated to begin in 2009 with completion occurring in 2010.
Fort HealthCare has a long-standing relationship with Rainbow Hospice, an organization that began in 1990 with a dedicated group of volunteers. As Rainbow Hospice volunteers began to realize the great need for hospice care in the area, Fort HealthCare and other organizations such as St. Vincent de Paul, Watertown Regional Medical Center, the United Way and Tomorrow’s Hope stepped in to provide funding and other resources. In addition to many years of financial support, Fort HealthCare has provided ongoing guidance with two staff members serving on the Rainbow board of directors.
Today, Rainbow Hospice Care provides service to patients throughout the Fort HealthCare service area including all of Jefferson County and surrounding counties such as Dodge, Dane and Walworth. Patients appropriate for hospice care are those with a life expectancy of 12 months or less. The demand for hospice care remains great as indicated by the current average daily census of 66 patients, a figure that has nearly doubled in the past year alone
"Fort HealthCare’s support of the proposed inpatient facility is important for many reasons," says Michael Wallace, president and CEO of Fort HealthCare. "There is a real need for a specially designed facility for persons who are terminally ill and who, for a variety of reasons, can no longer be cared for at Fort Memorial Hospital or at home. Rainbow has been an exceptional partner and resource for us in these situations. The new hospice facility will provide an additional option that is sorely needed.
"Our terminally ill patients who can’t remain in the hospital nor can be adequately served at home will now have a state-of-the-art facility built especially for their medical needs and the emotional needs of their families", he added. Families seeking inpatient hospice care currently must transfer their loved ones out of the area to facilities in Oconomowoc, Waukesha or the Madison area.
Rainbow President and CEO Karen Carrig oversees a staff of 39 full-time and part-time employees, who embrace the philosophy of teaching families how to care for their loved ones in addition to "doing" for the patient. Services offered include bereavement, dietary, homemaker, hospice aide, medical, nursing, occupational therapy, patient/family companion, physical therapy, social services, speech pathology, and spiritual and other counseling. Last year, 70 volunteers helped Rainbow Hospice serve patients.
Hospice is a special type of care intended for people who have been diagnosed with a life- limiting illness (12 months or less to live). It is based on a concept called palliative care, which means that the primary objectives are to keep the patient comfortable and with a heightened sense of dignity despite the need for intensive medical intervention. Comfort is achieved via the aggressive treatment of symptoms related to the terminal diagnosis whether that is pain, respiratory distress, nausea, vomiting, diarrhea, anxiety or other symptoms.
According to Carrig, the goal of hospice care is to ensure patients’ remaining days are a life of quality. Hospice care is provided by an interdisciplinary group of doctors, nurses, aides, social workers, chaplains, volunteers and bereavement coordinators. At the center of this team’s focus is the patient and his or her family. Staff focuses on providing quality of life and compassionate care for patients, as well as support for the needs of caregivers.
"It is important to understand that the emphasis in hospice is placed on caring, not curing and, in most cases, care is provided in the patient’s home. That being said, many patients are best cared for in an inpatient setting due to limited ability of family to supplement care provided by hospice staff, complex medical issues or simply the desire to be cared for outside the home," Carrig explained.
Submit hospital community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.