WHA is a founding member of a newly-organized national coalition that is demanding that future Medicare payments reward value. The group also believes that health reform initiatives must include a value-based payment component. The VALUE COALITION includes hospital association leaders from about a dozen states including Washington, Oregon, South Dakota, Montana, Minnesota, Iowa, Virginia and Maine. Several of those states have key members on the Senate Finance Committee, a key Congressional group that will be marking up a reform bill later in the month.

"We agree with President Obama that ‘the biggest thing we can do to hold down costs is to change incentives of a health care system that (today) equates expensive care with better care,’" said WHA President Steve Brenton. "Our proposal (www.wha.org/financeanddata/pdf/valueCoalitionProposal7-7-09.pdf) will reward hospitals providing services in hospital referral regions (HRRs) that have lower overall Medicare spending per beneficiary than the national average. The proposal also provides an additional reward based on performance on current quality measures."

Although the Obama Administration and some members of Congress have touted the reduction of variation in spending and the reward of exemplary performance as a "must get done" component of health reform, proposals to date have been disappointingly silent in addressing any specific approach.

"The VALUE COALITION initiative creates a catalyst for engaging lawmakers like Ron Kind (D-La Crosse) and Senators Feingold and Kohl who are on record supporting address of the value-based incentive approach," Brenton noted.

The Value Coalition uses the Dartmouth Atlas (www.dartmouthatlas.org/interactive_map.shtm) as the data source for Medicare spending by hospital referral region and clinical process measures as displayed on the CMS Web site "Hospital Compare" (www.hospitalcompare.hhs.gov/Hospital) for the quality component of the annual incentive plan.

This week the American Hospital Association, the Catholic Health Association and the Federation of American Hospitals announced they had reached an agreement with the Obama Administration and the Senate Finance Committee on a "framework" for reimbursement concessions totaling $155 billion over 10 years and other key changes that could help achieve national health care reform. The agreement was officially announced at the White House on July 7 with Vice President Joe Biden and leaders from the respective groups.

"For several years, the AHA Board has prioritized health reform and coverage for all, paid for by all. These goals catalyzed the development of the Health for Life framework, an ambitious set of objectives achievable only through the hard work, sacrifices and heavy lifting of all stakeholders," said William Petasnick, Immediate Past Chair of the American Hospital Association and President/CEO of Wisconsin’s Froedtert & Community Health.

"This week, hospital leaders joined Vice President Biden to announce our commitment to contribute to the achievement of health reform. By committing to participate, we can play a meaningful role as health reform policies are developed and deployed. We can’t do it alone; our efforts can only affect change if all major stakeholders, including congressional leaders and those in the White House, make similar commitments to ensure our success."

The $155 billion agreed to by the three hospital associations is achieved primarily through the following:

• Reducing Medicare update factors over the 10 years ($103 billion)
• Reducing DSH payments, phased in during years 2015-2019 ($50 billion)
• Reducing payments for avoidable hospital readmissions ($2 billion)

"Now for the first time, coverage for all is within our nation’s reach, as the agreement based upon the Finance Committee proposal will cover 95 percent of all Americans," the three groups said in a joint statement. "Make no mistake that hospitals will do our part to get virtually every American covered. The reductions of $155 billion over 10 years in the framework are substantial, are linked in part to increased coverage and cannot go any deeper without damaging hospitals’ ability to care for their communities."

The agreement also seeks to address other key provisions, including delivery system reforms like value-based purchasing and bundling of payments.

Log on to www.aha.org for more information.

September 23-25, 2009
Grand Geneva Resort, Lake Geneva

The 2009-2011 Wisconsin State Budget, 2009 WI Act 28, makes changes to Wisconsin’s medical record access statute, § 146.83, Wis. Stats. The Governor signed Act 28 into law on June 29, 2009. The effective date for the changes is July 1, 2009.

The most significant changes to the health care access statutes include:

• A new requirement to provide copies of patient health care records in an electronic format upon request
• A new statutory fee schedule for copies of medical records

WHA has prepared a summary of the current requirements given the changes made in Act 28. That summary, and the relevant excerpt of Act 28, can be found at www.wha.org/legalAndRegulatory/act28WHAcopyfeesummary7-09.pdf and www.wha.org/legalAndRegulatory/act28excerpts2009.pdf or in the Legal and Regulatory section of the WHA Web site.

The Department of Health Services’ Division of Quality Assurance (DQA) warns that their ability to respond timely to construction and remodeling project plans has been affected by current vacancies, orientation of new staff, increased mandatory federal workload, and the high volume of construction plan submittals. According to DQA, mandatory state employee furloughs over the next biennium also will affect engineer availability.

Because of the staff shortage, DQA has prioritized its responsibilities as follows:

• Mandatory surveys
• Plan reviews
• Construction inspections

DQA engineers are scaling back "onsite" construction inspections. In general, priority construction inspections will focus on installations of final finishes (ceiling and walls) and again when the facility is ready for the final occupancy inspection. Construction inspections for smaller remodeling projects may be handled via paper submittals to the assigned DQA engineer.

Event: Hear directly from CMS and CGI Federal, Inc, Wisconsin’s Recovery Audit Contractor
Date: Tuesday, August 11
Time: 1 - 4 p.m.
Options: Attend in person at the American Family Education Center in Madison
- or -
Attend via teleconference
Cost: No cost but pre-registration is required

We used to say "What is good for General Motors is good for the country." Now it’s more like: "What is good for the baby boomers is good for the country."

This huge generation is aging and becoming more frequent patients at health facilities. The tremors of this shift will hit our country for the next 20 years.

I am an aging "cheesehead" and proud of it. I know Wisconsin’s famous beer, cheese and brats all too well.

But I am lucky. My primary care physician, a workplace wellness program and life event whacked me on the head. And this dose of personal health reform has led to overdue lifestyle changes.

I hope I will stay on track.

Multiply my story by millions of fellow cheeseheads and you see the bigger challenge.

Our workforce is getting older. Older workers are more likely to consume more health care as age and habits catch up with us. Poorer health, at any age, makes us less productive at work and increases our use of sick days.

This costs employers more, which makes employers less competitive, which means fewer jobs for us and for our kids.

A recent report from the Council of Economic Advisors to President Barack Obama drives home this point: "Slowing the growth in health care spending from 6 percent a year to 4.5 percent would have enormous benefits for the economy. It would create as many as 500,000 jobs a year and increase annual income for a family of four by $2,600."

No amount of "health care reform" can fix our own behaviors. We must work to reduce the amount of care our system needs to deliver. We must get serious about doing what we can to get and stay healthy. We need to do this as individuals, workplaces and communities.

Many workplaces are working to help employees make healthier decisions. Employees are more likely to make healthier choices when workplace policies promote health and reduce risk of disease. Employee wellness committees are key to work site success. All of us are more likely to respond when we hear clear expectations and are part of deciding how they can be met.

Thrive, a collaborative economic development enterprise for eight counties in southern Wisconsin, is sponsoring a new approach to workplace wellness. Three dozen major health care organizations have developed a bold plan to improve the health of the region’s workforce. They are starting with themselves.

By 2011, the target is for those employers with formal wellness programs to experience a 10 percent improvement in employees choosing a healthier lifestyle. The goal is to eat more fruits and vegetables, be more physically active and low to no alcohol and tobacco use. The five-year goal is for 60 percent of the workforce to be at a healthy weight.

We can fight the recession with our health.

The Vice Chair of the Wisconsin Senate Committee on Health, Human Services, Insurance and Job Creation says health care reform will occur, but it will be an "evolution not a revolution." State Senator Kathleen Vinehout (D-Alma) made the comment to a group of area health care representatives—including Tomah Memorial Hospital, Tomah Health Care Center, Gundersen Lutheran and Franciscan Skemp—during a legislative briefing organized by the Tomah Chamber of Commerce on July 9.

"It’s great to have our elected officials so available to discuss the legislative landscape while working together to provide quality health care," said Tomah Memorial Hospital CEO Phil Stuart, also a member of the Wisconsin Hospital Association (WHA) Board of Directors.

Vinehout was joined by fellow Democrat, State Representative Mark Radcliffe of Black River Falls. Both Vinehout and Radcliffe stressed the need to put ‘politics as usual’ aside and find common ground to "fix the system."

"No changes on any issue, including health care, will take place until there are changes (in Madison)," said Radcliffe, who serves on the Assembly Committee on Aging and Long-Term Care. He predicted the change will be a "long term process."

The two lawmakers also addressed the need to work with federal officials to ensure state programs are successful. "The first step is to have a common vision," Vinehout explained. "Then we need to take steps to change the steps in the incentive system."

Vinehout also praised the WHA for working with her to help "identify the problems" and "work toward solutions."

It’s last call for nominations for the 2009 Global Vision Community Partnership Award, presented by the WHA Foundation. Nominations must be received no later than 5 p.m. on July 15. Nomination forms can be found on the WHA Web site at www.wha.org.

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.

For more information about the Award, contact Jennifer Frank at jfrank@wha.org or 608-274-1820.

On July 1, 2009, the Centers for Medicare & Medicaid Services (CMS) released a display copy of the Proposed Rule for the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2010.

According to the Proposed Rule, CMS estimates a physician fee schedule update of minus 21.5 percent (a cut) for 2010. Medicare Physician Fee Schedule rates are updated annually based on a formula that includes the application of the sustainable growth rate (SGR). The formula has resulted in negative updates since CY 2002, but Congress has enacted legislation each year to avoid the negative updates.

Importantly, CMS proposes to make a number of changes—including refining practice expenses, eliminating payment for consultation codes, increasing the payment rates for the Initial Preventive Physical Exam, revising the treatment of malpractice premiums, and reducing payments for certain high-cost imaging services—that will result in increasing payments to primary care providers by between 6 and 8 percent (before taking into account the proposed update and other proposed changes to the fee schedule).

CMS also proposes to:

• Implement provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) involving cardiac rehabilitation services, pulmonary rehabilitation services, and kidney disease patient education services
• Implement a MIPPA requirement that (beginning January 1, 2012) suppliers of the technical component of advanced imaging services be accredited by designated accreditation organizations (AO) and use quality standards developed by the AOs
• Implement changes to the Physician Quality Reporting Initiative (PQRI) and E-Prescribing Incentive Program for CY 2010

In addition, CMS proposes removing physician-administered drugs from the definition of "physician services" in the Proposed Rule for purposes of computing the SGR in all future years. CMS does not expect this change to impact the fee schedule update for 2010. However, CMS believes that it would reduce the number of years in which physicians are expected to experience a negative update.

CMS has also released a Fact Sheet highlighting the Proposed Rule changes to the Physician Quality Reporting Initiative (PQRI) and E-Prescribing Programs. Key changes in the proposed rule for Calendar Year 2010 would:

• Add 22 individual PQRI measures and six measures groups for reporting
• Implement MIPPA provisions that would enable group practices to qualify for a 2010 PQRI incentive payment
• Add an electronic health record-based reporting mechanism to promote the adoption and use of EHRs

CMS will be accepting comments on the Proposed Rule until August 31, 2009. The Proposed Rule is scheduled to appear in the Federal Register on July 13, 2009. See the Proposed Rule for instructions regarding the submission of comments.

The 2009 Nominating, Awards and Bylaws Committee will meet in August to consider nominating a WHA Chair-Elect, three At-Large members for the WHA Board, and candidates for the Trustee Award and Distinguished Service Award (information on these two awards can be found in the weekly packet and the WHA Web site at www.wha.org/about/pdf/2009awardscall.pdf)

WHA members interested in being considered for an At-Large WHA Board seat or the Chair-Elect position should contact either WHA President Steve Brenton at sbrenton@wha.org or WHA Nominating Committee Chair Ken Buser at Ken.Buser@wfhc.org.

Nominating Committee members for 2009 are:

• Ken Buser, President/CEO, Wheaton Franciscan Healthcare, Racine - Chair
• Sandy Anderson, President, St. Clare Hospital & Health Services, Baraboo
• Tom Bayer, COO, St. Vincent Hospital, Green Bay
• Faye Deich, RN, MS, Assistant Administrator/CNO, Sacred Heart Hospital, Eau Claire
• Sue Ela, EVP & President, Aurora Metro Region, Milwaukee
• Barb Peickert, CEO, Hayward Area Memorial Hospital, Hayward
• Terri Richards, Executive Vice President, Saint Joseph’s Hospital, Marshfield
• Bill Sexton, CEO, Prairie du Chien Memorial Hospital, Prairie du Chien
• Steve Brenton, CEO, WHA, Madison

Top of page

Ministry Health Care President and CEO Nick Desien announced that Brian Kief, Ministry Health Care’s Northern Region CEO has been selected to succeed Mike Schmidt as president of Saint Joseph’s Hospital in Marshfield. Schmidt, who has been president since 1993, recently announced plans to retire in January 2010.

Kief received his bachelor of arts degree from the University of Wisconsin-Madison and his master’s in health care administration from the University of Minnesota. In 1995 he joined twin cities-based Allina Health System. Returning to Wisconsin in 2002, Kief joined Ministry Health Care as president of Howard Young Health Care. In 2006, he was named Northern Region Chief Executive Officer. In this capacity, he has been accountable for Ministry’s four Northern Region Hospitals—Eagle River Memorial Hospital, Howard Young Medical Center, Sacred Heart Hospital, and Saint Mary’s Hospital. Keif is a member of the WHA Board of Directors.

Kief will begin his transition on September 8 and plans to assume full responsibilities as president on January 4, 2010.

Six hospitals from Wisconsin were named to the 2009 Most Wired list:

• Aurora Health Care - Most Wired
• Holy Family Memorial Medical Center - Most Wired Small and Rural
• Saint Clare’s Hospital, Weston - Most Wired
• Spooner Health System - Most Wired Small and Rural
• ThedaCare, Inc. - Most Wired
• UW Health Partners Watertown Regional Medical Center - Most Wired Small and Rural

"As the health reform debate continues, it’s clear that IT will play an even more important role in the health system of tomorrow," says Rich Umbdenstock, president and CEO of the American Hospital Association (AHA). "Most Wired hospitals help illustrate IT in action—improving efficiency, quality and safety of care while helping to control costs."

The following are potential gaps in traditional first-party coverage.

• Data is not considered tangible property. Coverage is triggered by a named peril that does not include viruses or hacking. There is also a requirement for "direct" physical loss or damage.
• The bodily injury and property damage protection to third-parties provided by commercial general liability coverage does not address the key exposures of data breach trends in health care, which include:
• Protected Health Information (PHI) theft linked to benefits and treatment fraud
• Breaches by third-parties for whom hospitals are liable, which account for 30 to 40 percent of all breaches
• Custody of patient financial information
• Custody of other’s intellectual property, drug discovery, clinical trials, informatics-based research

Over the last 10 years, insurance providers have responded with increasingly sophisticated products to react to these data breach exposures. They can be customized to fit the size of any organization and most exposures. Coverage includes third-party and first-party coverage for:

• Indemnity and expenses of privacy injury for private actions
• Defense of privacy regulatory actions
• Public relations expenses, including the duty to notify and credit monitoring cost
• Damage to or disruption of other’s data
• Network extortion
• Network damage from malicious software and hacking
• Related business interruption and extra expenses

It may seem counterintuitive that at the same time your organization is looking for ways to cut expenses, you consider purchasing a policy to protect against security breaches of the information you are responsible for protecting. However, as the economic recession continues, the greater the hardship is on people with the loss of jobs and health insurance.

Technological advances are being made, making it easier for those with bad intent to perpetrate a crime, and governmental laws and regulations to put more pressure on businesses to prevent and respond to data breaches. Now may be just the time to consider cyber coverage to protect against a major loss at your facility.

Sam is elderly and a severe diabetic. In January 2009 he had to put the love of his life into a nursing home. It was a painful time for him, and then, four weeks later his beloved wife passed away. Sam was despondent and felt he had nothing to live for so he stopped treating his own illness. Complications from his diabetes resulted in his coming to St. Mary’s Emergency Department, incurring a large out-of-pocket expense. Sam was further distraught at the financial stress since his only income was from Social Security. This is not the life he had imagined for his golden years.

He worried about the balance due on his bill. When Sam returned to St. Mary’s to meet with a patient financial representative to pay the balance he arrived in tears and feeling weak. The patient services representative could see how upset he was, so she took him to the cafeteria, bought him a meal and ate lunch with him. After lunch she helped him fill out the paperwork for a community care application to cover the remaining balance on his emergency room bill. Sam felt incredible relief and now had a reason to hope again.

Since then Sam is doing better, managing his own health, his grief and he has come back to St. Mary’s to thank the staff for their kindness. If Community Care had not been there for him, his health and life would have certainly continued to deteriorate.

A new event geared to men—and the women who love them—took place at Park Falls High School. On Sunday, March 1, more than 150 men participated in the Flambeau Hospital Foundation’s first Men’s Sport and Health Expo offered in Northcentral Wisconsin.

The hospital foundation’s mission is to support the vision of the hospital "improving the health and well being of the people in the community. This event perfectly accomplished the mission while offering a fun and relaxed atmosphere," stated Jane Bentz, Flambeau Hospital Foundation coordinator.

"We all know if you combine sports with something, you have a winning combination. We wanted to draw the men for health screens, what a better way than to bring in a featured speaker about sports," stated Dr. Scott Carpenter, Flambeau Hospital Foundation Board member and ER/urgent care medical director.

Featured speaker at this event was Jerry Markbreit, a four-time Super Bowl referee, who became one of the greatest officials ever to work in the NFL. His presentation topics were "Be the Best You Can Be" and "Highlights of an NFL Referee Career."

Other highlights of this event included free health screenings for:

• Balance
• Blood Pressure
• Body Mass Index (BMI)
• Heart Risk Assessment
• Dental information
• Flexibility
• Feet
• Glucose (blood sugar)
• Grip strength
• Hearing
• Oxygen
• PSA
• Spine
• Vision

Free CPR training was offered in half-hour sessions. All participants in the CPR training received a free "CPR Anytime for Friends and Family" kit.

There were two health presentations offered by Marshfield Clinic emergency physicians;

Dr. Maurice Murphy and Dr. Scott Carpenter, "Wilderness Survival Tips" and "Health Screenings for Men," including depression and substance abuse.

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