The Robert Wood Johnson (RWJ) Foundation announced a major new investment in Wisconsin and 13 other community-based programs around the country as part of an unprecedented $300 million initiative to spearhead health quality improvements through regional collaboratives.

The initiative, described as the most ambitious ever funded by the Foundation, launched June 5 at an event held at Monona Terrace in Madison. Representatives from the Foundation participated through videoconferencing. After their remarks, speakers from the organizations that are participating in the grant, including the Wisconsin Hospital Association, the Wisconsin Collaborative for Healthcare Quality, the Coalition of Wisconsin Aging Groups, and the Wisconsin Healthcare Purchasers for Quality, offered local perspectives.

Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation, said the effort is aimed at improving health care "at the ground level to create lasting change." The Aligning Forces for Quality initiative’s new emphasis is on the acute care setting as well as reducing disparities. It builds on the work already in place in the 14 communities selected for the program. These communities demonstrated the ability to bring diverse parties together to improve health care quality. According to the Foundation, Wisconsin and the other programs chosen are already positioned to make fundamental and cutting-edge changes—models that can then be shared with other states.

According to Lavizzo-Mourey, the Foundation will provide an "unprecedented level of resources, training, and expertise to bring together patients, health care providers and payers to turn proven practices for improving quality into real results" that will lift the overall quality of health care, reduce racial disparities and provide models for national reform.

Michelle Larkin, RN, MS, JD, senior program officer at RWJ, who spoke in Madison, said the Foundation chose Wisconsin because it "already had significant public engagement" in its quality efforts and it is a recognized national leader in quality.

WHA President Steve Brenton said, "Wisconsin’s quality initiatives are provider-led with the active participation of many partners, including the Wisconsin Collaborative for Healthcare Quality (WCHQ), MetaStar, the Wisconsin Medical Society, and all our hospitals and health systems. We have made a real and lasting investment so we can advance what we do and continue to aspire to lead nationally."

WHA Chair Ken Buser said the Association is particularly excited that a key component of this grant is aimed at engaging nurses and nurse leaders even more deeply in quality improvement activities.

"Nurses at the unit level are at the best vantage point for identifying opportunities for improving patient care. Thanks to the Robert Wood Johnson Foundation, we will now be able to more fully exploit an existing angle on quality improvement, which is to encourage nurses to ask themselves, ‘Are we doing the right thing and, are we doing things right’ in every aspect of patient care," according to Buser.

Buser added that a quality-focused culture requires an all-encompassing approach that integrates improvement concepts into all elements of the hospital—from the Board of Directors, physicians, nurses and housekeeping.

Wisconsin hospitals are already highly committed to quality improvement. Over the last several years, as the science of quality improvement has advanced, our mission has become to embed quality into every patient encounter. We are very grateful to the Robert Wood Johnson Foundation for the resources that will move us closer to our goal while raising the bar on health care quality even higher in Wisconsin.

WCHQ President and CEO Chris Queram told the group, "We are excited to be selected for this initiative, as we believe that bringing all parties together—those who get care, give care, and pay for care—will drive real improvements."

Gary Kuhnen from the Coalition of Wisconsin Aging Groups emphasized the role of the health care consumer, which is another aspect of the initiative. "Patients seek care that is safe, efficient and effective. That requires that we work in partnership with our physician. I need to ask questions and learn how to manage my condition," he said.

Employers are also at the table, as emphasized by Julianna Olson, Chrysler Corporation’s health initiatives director. She said Chrysler is dedicated to making positive investments in the health of their employees and in the wider community. It is Chrysler’s goal, according to Olson, to attain high quality health care at a reasonable cost, which is, "value to us."

"Legislators and everyone has a role in this issue. We believe that we have made headway on this issue and we are at the downward slope on addressing it. However, the work of Aligning Forces will help my company and all employers understand the ‘value equation’ in their health care purchases," Olson added.

WHA staff members Dana Richardson, vice president, quality initiatives, and Judy Warmuth, vice president, workforce, will coordinate all the Association’s Aligning Forces activities related to acute care quality improvement projects and disparities.

On June 5, two of the state’s largest health care organizations jointly announced their support for a resolution aimed at improving patient safety by working to eliminate nine of the most serious adverse events that can occur in hospitals.

The Wisconsin Hospital Association Board of Directors approved and the Wisconsin Medical Society endorsed a resolution that recognizes that while patient safety is the highest priority in health care, serious errors do occur. The resolution includes a list of nine serious adverse events, for example, wrong site surgeries and leaving a foreign object in a patient following surgery, and requests that hospitals not seek payment from patients or insurers for hospital care made necessary because of these events.

Wisconsin is among a small, but growing, number of states to take this voluntary action.

"This resolution sends a strong message to our communities that we are serious about patient safety. All of our hospitals are actively engaged in improving both the safety and quality of care they provide with a goal of driving errors out of our health care system," said WHA President Steve Brenton. "Wisconsin consistently ranks at the top of national quality ratings because our health care providers are dedicated to providing the best possible care."

"Patient safety and access to high quality care are top priorities for physicians across Wisconsin, which is why we support this resolution and look forward to working with hospitals in this effort," said Wisconsin Medical Society CEO Susan Turney, MD. "We are extremely proud of the care we deliver, and this is one more way we can improve health care in Wisconsin."

The resolution covers nine rare serious adverse events and is based on nationally-accepted definitions provided by the National Quality Forum. The list includes:

• surgery on wrong body part
• surgery on wrong patient
• wrong surgical procedure
• retention of foreign object
• air embolism-associated injury
• infant discharged to wrong person
• artificial insemination w/ wrong donor
• incompatible blood-associated injury
• any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances

The new resolution builds on a series of initiatives launched in Wisconsin over the past four years aimed at increasing health care transparency. In 2004, Wisconsin became the first state to voluntarily report ten measures related to hospital quality, a list that now includes nearly 50 measures (www.wiCheckPoint.org). The following year, WHA launched the PricePoint program that displays charge information for every hospital in Wisconsin (www.wiPricePoint.org).

Concern about the turnaround time it takes for a physicians to obtain a Wisconsin license prompted Steve Brenton and Judy Warmuth of the Wisconsin Hospital Association (WHA) and Dr. Susan Turney and Mark Grapentine of the Wisconsin Medical Society (WMS) to meet Tuesday, June 3 with officials from the Department of Regulation and Licensing (DRL). The group discussed existing concerns to identify solutions for the prolonged time delays for physicians to obtain a Wisconsin license. Prior to the meeting, WHA and WMS had provided DRL Secretary Celia Jackson with a letter outlining concerns from members of both organizations.

Larry Martin, executive assistant to Secretary Jackson began the meeting by acknowledging that the concerns around customer service, accuracy and timeliness were accurate and in need of attention from the department. He outlined actions already taken to improve the department’s performance. First, temporary staff has been transferred to physician licensing. This staff will be replaced by permanent staff with the beginning of the state fiscal year on July 1. Second, at the next meeting of the Medical Examining Board, Cathy Pond, Department director for credentialing, will present a list of items intended to streamline the licensing process. These items include policy, rule and statutory requirements for licensure which are redundant or add no value to the process. Her request will be for the Board to agree to the deletion of some or all of these items. Tom Ryan, bureau director at the Department, pointed out that some of these items are included as an expectation of the Federation of State Medical Boards, but that the Federation is also reviewing those expectations.

The Department members present expressed concern about staffing levels within the department, especially as new licensed groups have been added by the Legislature and as the number of licensees within every occupation has grown dramatically. The department has attempted to offset this increased workload by enhanced use of Web-based information and renewal, but is still not able to meet licensees’ expectations for the timely opening of mail, posting to the Web site and review of documents. WHA and WMS asked the department to propose standards for these processes which could be used as benchmarks and to offer a report within six months of progress against those standards.

The meeting ended with an agreement to meet again in six months to analyze progress, evaluate benchmarks and discuss additional strategies. Overall, WHA and WMS staff were satisfied with the proactive efforts identified by DRL leadership but agree that follow up will be necessary.

Hearings on proposed changes to HFS 129, the rule that regulates certified nursing assistants, are set at four Wisconsin locations. The amended rule would expand the number of classroom hours required for training to 120 hours, and the number of clinical hours to 32.

The proposed amendments to the rule do not include a note or flag on the registry if an investigation is pending on a nurse aide, as requested by WHA. WHA requested that DHFS include this change because it would assist employers as they recruit and interview potential nurse aide applicants. WHA will again ask for this addition to the registry in its testimony at the hearing.

The hearing notice and a plain language analysis of the rule can be found at: https://apps.dhfs.state.wi.us/admrules/public/Rmo?nRmoId=988#initialRulesProposed

Contact Judy Warmuth at WHA (jwarmuth@wha.org or 608-274-1820) with other concerns/issues that members have with this rule change.

• The Robert Wood Johnson Foundation (RWJ) grant award announced this week validates two central themes that have been at the core of private sector led performance improvement initiatives in Wisconsin: 1) The state is a recognized national leader in ongoing efforts to improve quality through public reporting, and 2) Those efforts are coordinated and highly collaborative.

The RWJ $1 million, three-year commitment to Wisconsin through its Aligning Forces for Quality initiative represents a special emphasis on the acute care setting that is designed to improve care by engaging nurse leaders in the care improvement process and also identifying ways to better engage consumers in making informed choices about their health care.

WHA and the Wisconsin Collaborative for Healthcare Quality (WCHQ) are partnering on the special project which will directly involve WHA staff nurse leaders—Dana Richardson and Judy Warmuth. Look for future Valued Voice articles that will track programming and opportunities for members made possible by this significant RWJ resource commitment.

• As reported in last week’s Valued Voice, our 2008 political fundraising is off to an auspicious start with over $85,000 raised in the first few weeks of the campaign. This year’s goal is $210,000—a record level that would have been considered a "stretch goal" just a few years ago. Remember that Jodi Bloch (608-274-1820) and Jenny Boese (608-268-1816) are available to answer your questions and provide special help as you support this very necessary advocacy effort.

• Last week’s Valued Voice included an annual awards announcement and brochure that can be used by members to nominate individuals to be considered for the WHA Distinguished Service Award, the WHA Trustee Award, and the ACHE Young Healthcare Executive Award. These special and highly competitive awards will be presented to 2008 recipients at WHA’s Annual Convention this fall in Green Bay. Awards information is also available on a special link that can be found at www.wha.org/about/pdf/2008awardscall.pdf.

Steve Brenton
President

The Wisconsin Department of Health and Family Services Division of Quality Assurance (DQA) has notified its licensees that it is now conducting the required four-year renewal of licensee background checks.

In May, the Centers for Medicare & Medicaid Services (CMS) reported that Medicare Recovery Audit Contractors (RACs)—entities tasked with identifying government overpayments and underpayments—collected $980 million in overpayments from Medicare providers during fiscal years 2005-2008 as part of a five-state demonstration project. The majority of those dollars were recouped from the nation’s hospitals.

Although the American Hospital Association (AHA) is urging CMS and Congress to make significant changes to the RAC program, the AHA and Wisconsin Hospital Association are advising hospitals to prepare for RAC reviews now. RAC review will begin in some states as early as this summer and may come to Wisconsin by January 2009. All hospitals, including Critical Access Hospitals, are subject to RAC review. In fact, RACs may look at claims dating back to October 1, 2007, so claims at your hospital are already being impacted.

To assist hospitals, WHA’s RAC Task Force, chaired by Divine Savior Healthcare’s CEO Michael Decker, created a workgroup that is developing a white paper to provide insight on how hospitals can prepare for these RAC reviews, such as assembling an internal team to implement process improvements to reduce RAC vulnerabilities, self-audits to identify risks and related best practices. Once RAC audits begin, hospitals should internally track any and all RAC activity to minimize financial risk and ensure timely response to the RAC requests. An internal tracking system will help monitor the status of claims in order to preserve appeal rights.

In response to the lack of data and information provided by CMS and the RACs on the impact the program is having on the nation’s hospitals, the AHA has created RACTrac, a Web-based survey that will ask hospitals to report on a quarterly basis on their RAC experience. This information will be used to educate the field, CMS and Congress on changes needed to the program. AHA is also creating an Excel template to help hospitals track these denials. The Excel template will be available online, along with other tools, when RACTrac goes live later this summer (www.AHARACTrac.org).

RACTrac will collect the following types of data but will only release data in aggregate where appropriate:

• Number of claim denials and total dollars associated with over payments and underpayments;
• Service areas where overpayments are being identified (inpatient, outpatient, rehab etc.);
• Reasons for claim denials cited by the RACs;
• Number of appeals filed and the dollars associated with those appeals; and
• Quantifying administrative burden and costs by hours of staff dedicated to managing the RAC process and dollars paid to consultants.

The Division of Quality Assurance has established a new intake system for complaints against a caregiver, agency, or DQA regulated facility. In addition to the current system in which individuals with complaints are directed to contact a DQA regional office via telephone or mail, DQA has added two options: Internet submissions and a toll-free telephone number. The Internet form for submitting a complaint is available at the following site: http://dhfs.wisconsin.gov/bqaconsumer/HealthCareComplaints.htm. The toll-free complaint telephone number is 1-800-642-6552.

Bob Beaverson is a new member of the quality department, recently joining WHA as director of quality systems. Beaverson brings with him 17 years of IT experience in the insurance industry with three years focusing on health/life. In his position at WHA, Beaverson will oversee the technical development of CheckPoint, provide support to the Maryland Quality Indicator Program, and several new quality initiatives.

"We are very pleased to welcome Bob to our staff. He has a strong background in information system and Web site development, which will help us advance our transparency agenda," said Dana Richardson, WHA’s vice president of quality.

Beaverson received his education from UW Milwaukee and other certifications specific to IT through UW Madison and MATC.

Tom Li joins WHA as software developer

Tom Li is a new member of the quality department, recently joining WHA as Software Developer. Li brings with him six years of IT experience in the programmer/analyst industry. In his position at WHA, Li will provide technical support to CheckPoint and other quality related systems.

"We are very pleased to welcome Tom to our staff. He has a strong programming background, which will help us advance our quality agenda," Dana Richardson said.

Li received his bachelor’s degree from Fudan University in Shanghai, China and a master’s degree in computer science from Marycrest International University in Davenport, IA.

Glenna Orsbin joins WHA Information Center as senior data analyst

Glenna Orsbin is the newest member of WHA Information Center, recently joining WHA as Senior Data Analyst. A graduate of Carroll College in Waukesha, Orsbin will be responsible for ensuring the integrity of discharge data collected quarterly from hospitals and ambulatory surgery centers. She is also responsible for producing ad-hoc and custom reports for internal and external customers as well as coordinating production of four annual publications. She reports to Julie Callies, WHA Information Center Director.

"We are very pleased to welcome Glenna to our staff. She brings 15 years of solid experience as a data analyst. We’re always looking to increase our efficiency, and Glenna will play a key role in helping us produce more complete, accurate and useful data for our customers and for the general public," Callies said.

On August 15, the Wisconsin Chapter of ACHE is offering the full-day, Category I education program "Physician Relations—Achieving Physician/Hospital Partnerships: The Clinical Institute Model" in Wisconsin Dells.

Participants of the program will learn to assess a range of physician/hospital partnership options, understand the strategic and tactical components necessary to create a clinical institute, discuss how clinical institutes can improve the quality of care, and describe the positive financial rewards for both physicians and hospitals in clinical institutes.

This program has been developed and is presented locally by the Wisconsin Chapter of ACHE. The American College of Healthcare Executives has awarded 6 Category I (ACHE education) credit hours to this program. To receive credit, your name MUST appear on the sign-in sheet.

The full conference brochure with registration information is available online at www.ache-wi.org. For more information, contact Thomas Shorter at 608-284-2239 or tshorter@gklaw.com. For registration questions, contact Sherry Collins at 608-274-1820 or email scollins@wha.org. Registration is limited to 40 people.

The Wisconsin chapter of the Healthcare Financial Management Association (HFMA) recently awarded its first scholarships to eligible college students pursuing degrees in accounting, business, economics, public policy, public health or a related degree. The scholarships were designed to recognize the contributions of those who work in the health care field, provide networking opportunities for students who may be interested in health care finance as a career, and to make a difference in health care’s future.

Recipients of $2,000 scholarships and HFMA student memberships are Wendy Canon of New Glarus, who is working toward a BS in healthcare management, and Wendy Schultz of De Pere, who is pursuing her MBA. The following Student Honorees will receive HFMA student memberships: Rebecca Burmaster, Mauston; Joe Jensen, Madison; Joseph Lieungh, Milwaukee; Elena Poznakhirina, Madison; and Sally Schlehlein, Madison.

For more information, call Carol May at 608-741-5651.

John Russell began his new role as administrator of Boscobel Area Health Care on April 21, 2008. Russell’s most recent position was chief financial officer at Blackhawk Healthcare LLP, where he served as acting CFO for three rural health care facilities. He also served as team leader in the due diligence, acquisition, and turnaround of critical access hospitals.

Russell holds a Bachelor of Business Administration in Accounting from the University of Wisconsin, Eau Claire. He is a Certified Public Accountant and has extensive experience providing consulting services, financial audits and operational reviews of health care providers.

Sometimes it’s a conversation over dinner that sparks an idea for a unique contribution to a community. In 2006, University of Wisconsin Hospitals and Clinics was in the midst of an organization-wide technology refresh of its computers. At the same time, employee Nick Berigan from Information Technology Services was hearing over the dinner table each night from his partner, a teacher for the Madison Metropolitan School District (MMSD), how students and teachers in the school were struggling to make do with outdated computer systems. Armed with this knowledge, Nick suggested an idea which has grown into an organizational commitment to get surplus technology resources from the hospital into the hands of students in our schools.

Because of the private nature of information that may have been stored on these computers, it took an added commitment and diligent work by the ITS department, to ensure any and all information was stripped from the systems. But with the expertise of the ITS staff, and the support of hospital administration, UW Hospitals and Clinics was able to give more than 300 used computers to the MMSD, with another 300 earmarked for donation at the end of the fiscal year. UW Hospitals and Clinics found a productive way to manage its surplus equipment, and schools and students throughout the district have access to updated technology and tools to further their education.

Affordable and accessible oral health care for the elderly and low-income families in Northwest Wisconsin has just been improved thanks in part to efforts of St. Joseph’s Hospital and Chippewa Falls 2010, a health community initiative sponsored by St. Joseph’s Hospital, in bringing a new state-of-the-art dental facility to Chippewa Falls. The new Marshfield Clinic Chippewa Dental Center is now open, serving the thousands of people on a waiting list for affordable dental care.

St. Joseph’s Hospital became involved in the effort six years ago when reports of emergency department visits for oral health care increased.

"People were coming to the emergency department of the hospital to relieve severe tooth pain, blatantly showing us an unmet need in our community," says Rhonda Brown, healthy communities specialist at St. Joseph’s Hospital and coordinator of Chippewa Falls 2010: Achieving a Healthier Community. "We soon discovered thousands of people were on a waiting list for affordable dental care in our community."

Lead by Ray Myers, assistant administrator at St. Joseph’s Hospital and Chippewa Falls 2010, the Oral Health Community Initiatives of Chippewa County was created to explore multiple options to improve access. In the meantime, St. Joseph’s Hospital assisted a rural health dental clinic by providing expanded space and renovations in the former Convent.

Several grants and collaborations paved the way to bring a federally qualified dental center to Chippewa Falls. Myers and Brown helped form the Chippewa County Dental Foundation, Inc., a non-profit foundation, which was able to secure funds to build a state-of-the-art dental facility, which has ten operatories and space for several dental specialists. Marshfield Clinic Health Center partnered with the group to bring the dentists, oral surgeons, staff and services to the center.

The Chippewa County Dental Foundation, Inc. continues its work towards awareness, education and prevention of oral health issues. For more information on the Foundation, contact Rhonda Brown at 715-726-3647.

Sonja McLaughlin is thankful Hospice Touch of Tomah Memorial Hospital saved her and her family. The Adams County village of Arkdale teacher’s aide said the she and her son were literally touched by an Angel after her husband lost a battle with cancer.

"We were devastated that no one could help us, but when Hospice came and when Valerie (Hospice Registered Nurse Valerie Kuehl) arrived at our door it was like an Angel was sent to us," McLaughlin explained. "They always gave us hope and encouraged us to pray and deal with each day."

Even though the program has never generated enough revenue to cover the direct expenses associated with running it, Tomah Memorial Hospital continues to support it as an important component of the continuum of care offered to patients.

"As a non-profit, it’s important for us to offer services because of community need, not because of the revenue they generate," explained TMH Chief Financial Officer Joseph Zeps. "With an annual operating budget of around $1.4 million, Hospice Touch is one of the largest examples of this type at Tomah Memorial."

Earlier this month, the hospital’s Board of Directors approved the establishment of a permanent endowment to provide donors with a mechanism to make a gift that will continue to benefit individuals, families and community by providing financial assistance to Hospice Touch and its programs.

"We established the program as a way to better reflect donor intent and allow for more planned giving in addition to the episodic giving that they enjoyed," TMH Chief Executive Officer Phil Stuart said. "The program allows for planned giving and perpetuity for hospice and related programs."

Hospice Touch provides end of life care through facilities in Tomah, Mauston and Adams-Friendship. The original program was formed in 1992. Annually it provides services to about 150 people, while touching the lives of hundreds each year.