July 2, 2009
Volume 53, Issue 26
On June 26, the federal Agency for Healthcare Research and Quality (AHRQ) released data that showed Wisconsin is leading—in fact is number one—in the nation for health care quality. Wisconsin had the top overall health care quality score among all 50 states based on measures that AHRQ used to evaluate health care performance.
The AHRQ 2008 State Snapshots summarize health care quality in three dimensions: type of care (preventive, acute and chronic care), setting of care (hospitals, ambulatory, nursing homes and home health care) and by clinical areas (cancer, diabetes, heart disease, maternal and child health and respiratory disease). The 2008 State Snapshots allow users to explore whether a state has improved or worsened compared with other states in several areas of health care delivery.
Wisconsin has consistently ranked at or near the very top of AHRQ’s annual report for overall health care quality. Wisconsin ranked number one in 2006 and was second only to Minnesota in 2007. Minnesota was second to Wisconsin in the most recent rankings.
Dana Richardson, vice president of quality initiatives at the Wisconsin Hospital Association (WHA), said Wisconsin scored well on measures related to hospital, ambulatory and nursing home care with hospital and home health care showing the greatest improvement compared to baseline measures.
"Quality health care is safe care that fits the patient’s needs, is right for their illness and is given without unnecessary delays. Wisconsin health care providers continue to work diligently with their patients to improve the care that they provide in their communities," according to Richardson.
WHA President Steve Brenton said, "Wisconsin is nationally recognized as a high quality, low cost health care provider. Wisconsin is well positioned to serve as a model for national and state level health reform."
While public reporting creates a measurement tool for improvement, the next step is changing processes to ensure that the best care is provided and engaging consumers in their health.
According to AHRQ, its State Snapshots Web tool (http://statesnapshots.ahrq.gov) helps State health leaders, researchers, legislators and consumers understand the status of health care quality in individual states, including each state’s strengths and weaknesses. AHRQ’s annual State Snapshots is based on data drawn from more than 30 sources, including government surveys, health care facilities and health care organizations.
Shelly Egstad, Tomah Memorial Hospital quality/compliance director, said, "Here at Tomah Memorial, we’ve invested significant time, energy and dollars in assessing and improving quality. We have a strong belief that you can’t manage what you don’t measure, so we have voluntarily participated in the Institute for Healthcare improvement program called the 5 million lives campaign and the statewide publicly reported program called Checkpoint, as well as many of the Medicare (CMS) reporting options."
Dr. Terrance Borman, medical Director at Luther Midelfort, Eau Claire, and Dawn Garcia, director of medical affairs and quality at Sacred Heart and St. Joseph’s Hospitals in the Chippewa Valley say Wisconsin has some of the best rates of diabetes care and child immunization, but also some of the best means of coming together to care for patients.
"I think (Wisconsin) has been very progressive in the way they organize at the state level: Wisconsin Hospital Association and the Wisconsin Collaborative for Health Care Quality," according to Borman.
Governor Doyle Signs State BudgetOn June 29, Governor Jim Doyle signed the 2009-11 biennial state budget into law, marking the first time budget action has been completed prior to the start of the next biennium since 1977.
The Governor and Legislature had faced the monumental challenge of coping with an over $5 billion deficit when budget work began earlier this year, only to learn of an additional $1.6 billion shortfall in May. Wisconsin was not alone as states across the country faced unprecedented deficits, with many implementing massive cuts to hospital and provider payments as they struggled to balance their books.
A key element in the budget—an expanded hospital assessment—was left intact throughout the final process. Increased by 20 percent and maintaining the distribution formula negotiated by WHA earlier this year, the assessment allows hospitals to receive additional Medicaid payments to help address the problem of growing program enrollment.
The expanded assessment also means additional funding to help shore up the state’s Medicaid program and allow expansion of coverage to low-income, currently uninsured childless adults (BadgerCare Core Plan) to proceed statewide without delay.
Medical records and copy fee provision partially vetoed
Governor Doyle vetoed some of the most negative aspects of the medical records access and copy fee language included in a last minute amendment adopted by the Joint Finance Committee.
The new law sets the allowable per-page fee that health care providers can charge for copies of medical records below the cost of making the copies and includes no provision for future price increases. But language that would have drastically limited fees for electronic copies of records and language that conflicted with HIPAA timetables and penalties was removed.
In his veto message, Governor Doyle indicated that because the impact of some of the changes made in the budget requires further study, he is directing DHS to work in collaboration with the Wisconsin eHealth Care Quality and Patient Safety Board to evaluate alternatives and to make recommendations that can be adopted in future legislation.
Prior to the budget being forwarded to the Governor, WHA helped spearhead a major effort that sought a veto of all language relating to medical records access and copy fees. Besides WHA, the list of organizations and individuals submitting or signing on to veto request letters included:
WHA and hospital system lobbyists were also instrumental in recruiting legislative co-signers to a veto letter from Senator Dave Hansen (D-Green Bay) and Representative Jennifer Shilling (D-La Crosse). The letter ultimately included 30 Democratic legislators requesting Governor Doyle to veto the onerous provisions. Additional information about implementation of the new copy provisions will be provided in next week’s Valued Voice.
Other budget issues
As previously reported, the very problematic and heavily lobbied against joint and several liability provisions that included language relating to jury instructions and comparative negligence were removed from the final budget passed by the Legislature and did not become law at this time.
WHA also continues to track the nearly $190 million in unspecified Medicaid program cuts included in the budget (see Guest Column). Additional details will be provided as they become available.
Political Action Spotlight: Mid Way into the 2009 Campaign 46 Percent of the Goal AchievedNearly two months into the 2009 Campaign, the Wisconsin Hospitals State PAC and Conduit fundraising campaign has raised nearly $99,000 from 191 individuals, an increase of 53 individuals and $14,000 from two weeks ago when only 138 individuals had contributed a total of $85,000.
Last year, the Campaign at this same time raised just over $115,000 from 246 individuals. By the end of the 2008 Campaign, more than 600 individuals contributed and contributions increased by an average of nine percent from the previous year totaling just over $212,000.
This year the campaign goal is $213,000 and also aims to increase the number of participants by 10 percent, hoping to gain at least another 60 new individuals.
Individual contributors’ names are published below by amount categories in alphabetical order. They will be published again in two weeks. For more information, contact Jodi Bloch or Jenny Boese at 608-274-1820.
Contributions Ranging from $1 - $249
Annala, Shannon Aspirus Wausau Hospital
Arendt, Kathleen Aspirus Wausau Hospital
Banaszynski, Gregory Aurora Health Care
Beckler, Rick Sacred Heart Hospital
Bernklau, Robert Memorial Health Center
Bliven, David Aspirus Wausau Hospital
Bosio, David Aspirus Wausau Hospital
Boson, Ann Saint Joseph’s Hospital
Bowe, Cynthia Sacred Heart Hospital
Brisch, Joe Holy Family Memorial Medical Center
Brueggeman, Mary St. Joseph’s Community Health Services
Burgener, Jean Aspirus Wausau Hospital
Burtch, Sue Aspirus Wausau Hospital
Campbell-Kelz, Nancy Aspirus Wausau Hospital
Casey, Karen Columbia Center
Censky, Bill Holy Family Memorial Medical Center
Chartier, Jacklyn Aspirus Wausau Hospital
Clapp, Nicole Grant Regional Health Center
Coblentz, Kathy Jo St. Joseph’s Community Health Services
Cohen, Joan Aspirus Wausau Hospital
Collins, Sherry Wisconsin Hospital Association
Culotta, Jennifer St. Clare Hospital and Health Services
Davis, Kathleen Children’s Hospital of Wisconsin
Decker, Dawn Aspirus Wausau Hospital
DeWitt, Pamela St. Joseph’s Community Health Services
Diemer, Peggy Aspirus Wausau Hospital
Dietsch, Teresa St. Clare Hospital and Health Services
Dittrich, Peggy Memorial Health Center
Dorpat, Denice Aspirus Wausau Hospital
Draxler, Deborah Aspirus Wausau Hospital
Facey, Alice St. Clare Hospital and Health Services
Gantner, Sue Aspirus Wausau Hospital
Garavet, Scott Aspirus Wausau Hospital
Gengler, Tim Aspirus Wausau Hospital
Grohskopf, Kevin St. Clare Hospital and Health Services
Gulan, Maria Aspirus Wausau Hospital
Harter, Ellen Aspirus Wausau Hospital
Hinton, George Aurora Sinai Medical Center
Hinz, Russ Aurora Health Care
Hoege, Beverly Reedsburg Area Medical Center
Holmes, Sheri Aspirus Wausau Hospital
Hueller, Julie Wheaton Franciscan - Milwaukee
Jelle, Laura St. Clare Hospital and Health Services
Jones, Tom St. Joseph’s Community Health Services
Karow, Deborah Aspirus Wausau Hospital
Kempen, Jacob Aspirus Wausau Hospital
Krueger, Pamela Aspirus Wausau Hospital
Logemann, Tim Aspirus Wausau Hospital
Lopas, Mary Door County Memorial Hospital
Mason, Paul Wheaton Franciscan Healthcare - All Saints
Merwald, Alfred Aspirus Wausau Hospital
Mickelson, Ronald St. Clare Hospital and Health Services
Miloszewicz, Angela Wisconsin Hospital Association
Morauske, Michelle WHA Financial Solutions, Inc.
Mourey, Gerald Aspirus Wausau Hospital
Mulder, Doris Beloit Memorial Hospital
Olson, Keri St. Clare Hospital and Health Services
Plaisance, Christopher Aspirus Wausau Hospital
Powell, Stacey Sacred Heart Hospital
Prunty, Brian Aspirus Wausau Hospital
Rasmussen, Sheri WHA Financial Solutions, Inc.
Reding, Rick Aspirus Wausau Hospital
Rocole, Theresa Wheaton Franciscan Healthcare - All Saints
Roundy, Ann Columbus Community Hospital
Schade, Randy Aspirus Wausau Hospital
Schweitzer, Susan Columbus Community Hospital
Scinto, Jeanne Aspirus Wausau Hospital
Selberg, Heidi St. Mary’s Hospital Medical Center
Swanson, Kerry SSM Health Care-Wisconsin
Todd, Jeffrey Aspirus Wausau Hospital
Tryba, Jennifer Aspirus Wausau Hospital
Voelker, Thomas Aspirus Wausau Hospital
Walker, Troy St. Clare Hospital and Health Services
Wanserski, James Aspirus Wausau Hospital
Wilson, Deanna Upland Hills Health
Wojciechowski, Gary
Aspirus Wausau Hospital
Contributions Ranging from $250 - $499
Abitz, John WHA Financial Solutions, Inc.
Allison Stonebraker, Pat Children’s Hospital of Wisconsin
Andersen, Travis St. Elizabeth Hospital
Ayers, Mandy Wisconsin Hospital Association
Biros, Marilyn SSM Health Care-Wisconsin
Clough, Sheila Howard Young Medical Center
Conwell, Lisa WHA Financial Solutions, Inc.
Deich, Faye Sacred Heart Hospital
Dietrich, Dean Aspirus Wausau Hospital
Drengler, Kathryn Aspirus Wausau Hospital
Geiss, Peter ProHealth Care
Grundstrom, David Flambeau Hospital
Gutsch, Mike Southwest Health Center
Hattem, Marita Aspirus Wausau Hospital
Hessert, Peter Aspirus Wausau Hospital
Johnson, Charles St. Mary’s Hospital
Levin, Jeremy Rural Wisconsin Health Cooperative
May, Carol Sauk Prairie Memorial Hospital
McCoic, Kristie St. Joseph’s Community Health Services
McKevett, Timothy Beloit Memorial Hospital
Merline, Karen
Nelson, James Fort HealthCare
Nevers, Rick Aspirus Wausau Hospital
Olkowski, Leland Aspirus Wausau Hospital
Pinekenstein, Barbara Oconomowoc Memorial Hospital
Ross, Forrest WHA Financial Solutions, Inc.
Rowe, Jeanne Aspirus Wausau Hospital
Sczygelski, Sidney Aspirus Wausau Hospital
Spieckerman, Jill Sacred Heart-St. Mary’s Hospitals
Stout, Johni WHA Financial Solutions, Inc.
Stuart, Philip Tomah Memorial Hospital
Van Meeteren, Bob Reedsburg Area Medical Center
Voss, Mark Aspirus Wausau Hospital
Worrick, Gerald Door County Memorial Hospital
Yunk, Dennis Agnesian HealthCare
Contributions Ranging from $500 - $999
Anderson, Sandy St. Clare Hospital and Health Services
Borgerding, Dana
Braddock, Michelle WHA Financial Solutions, Inc.
Buerstatte, Gary ProHealth Care
Bukowski, Cathy Our Lady of Victory Hospital
Callies, Julie WHA Information Center
Canter, Richard Wheaton Franciscan Healthcare
Desien, Nicholas Ministry Health Care
Eddy, Lee Anne Children’s Hospital of Wisconsin
Frank, Jennifer Wisconsin Hospital Association
Gutzeit, Michael Children’s Hospital of Wisconsin
Harding, Edward Columbus Community Hospital
Heifetz, Michael SSM Health Care-Wisconsin
Huber, Mark Aurora Health Care
Kersten, Juliet Children’s Hospital of Wisconsin
Kerwin, George Bellin Memorial Hospital
Klawiter, Anne Southwest Health Center
Klimisch, Ronald Aspirus Wausau Hospital
Korom, Nancy Children’s Hospital of Wisconsin
Merline, Paul Wisconsin Hospital Association
Miller, Jim Children’s Hospital and Health System
Mlynarek, Robert Waukesha Memorial Hospital
Neufelder, Daniel Affinity Health System
Postler-Slattery, Diane Aspirus Wausau Hospital
Potter, Brian Wisconsin Hospital Association
Radoszewski, Pat Children’s Hospital of Wisconsin
Schafer, Michael Spooner Health System
Shabino, Charles, M.D. Wisconsin Hospital Association
Ship, Mark Children’s Hospital of Wisconsin
Wallace, Michael Fort HealthCare
Wolf, Edward Lakeview Medical Center
Woodward, Jim Meriter Hospital
Contributions Ranging from $1000 - $1999
Bazan, Bill Wisconsin Hospital Association
Birkenstock, Timothy Children’s Hospital of Wisconsin
Bloch, Jodi Wisconsin Hospital Association
Boese, Jennifer Wisconsin Hospital Association
Braddock, Jonathan WHA Financial Solutions, Inc.
Britton, Gregory Beloit Memorial Hospital
Chapin, Rocklon St. Mary’s/Duluth Clinic Health System
Christensen, Cinthia Children’s Hospital of Wisconsin
Duncan, Larry Children’s Hospital of Wisconsin
Dunigan, Thomas Children’s Hospital of Wisconsin
Eichman, Cynthia Our Lady of Victory Hospital
Erwin, Duane Aspirus Wausau Hospital
Gazzana, Thomas Children’s Hospital of Wisconsin
Grasmick, Mary Kay Wisconsin Hospital Association
Kachelski, Joe WHA Information Center
Karuschak, Michael Amery Regional Medical Center
Kosanovich, John Watertown Memorial Hospital
Leitch, Laura Wisconsin Hospital Association
Loftus, Philip Aurora Health Care
Mettner, Michelle Children’s Hospital of Wisconsin
Morgan, Dwight Aurora Health Care
Munson, Kenneth Children’s Hospital of Wisconsin
Niemer, Margaret Children’s Hospital of Wisconsin
O’Brien, Mary Aurora St. Luke’s Medical Center
Oldham, Keith Children’s Hospital of Wisconsin
Olson, David Bay Area Medical Center
Olson, Edward Waukesha Memorial Hospital
Reynolds, Sheila Children’s Hospital of Wisconsin
Richardson, Dana Wisconsin Hospital Association
Robertstad, John Oconomowoc Memorial Hospital
Roller, Rachel Aurora Health Care
Stanford, Matthew Wisconsin Hospital Association
Titus, Rexford ProHealth Care
Troy, Peggy Children’s Hospital and Health System
Turkal, Nick, M.D. Aurora Health Care
Warmuth, Judith Wisconsin Hospital Association
Contributions Ranging from $2000 - $2999
Brenton, Mary E.
Buser, Kenneth Wheaton Franciscan Healthcare - All Saints
Katen-Bahensky, Donna
Quinn, George Wisconsin Hospital Association
Starmann-Harrison, Mary SSM Health Care-Wisconsin
Tyre, Scott Capitol Navigators, Inc.
Contributions $3000 and up
Borgerding, Eric Wisconsin Hospital Association
Brenton, Stephen Wisconsin Hospital Association
Size, Tim Rural Wisconsin Health Cooperative
Guest Column: The Budget Bill’s Health Care HangoverThe 2009-11 biennial budget is now "on the books" (see related story), closing for the time being this most troubling chapter in the state’s fiscal history. The unprecedented fiscal challenge that was laid before Governor Doyle and lawmakers was met with a combination of tax increases and spending cuts (and some perhaps unwarranted spending increases) that few found palatable. In fact, privately many minority Republicans were grateful that the fiscal crisis was not theirs to solve given the options available.
As you might expect, the budget is a mixed bag of good and bad. "The Good" includes key health care priorities that have either been preserved or strengthened, a notable feat in this budget climate but especially given what is happening to Medicaid programs in other states. The BadgerCare Plus – Core Plan, which will provide basic health coverage for low-income, uninsured childless adults ineligible for BadgerCare, will be implemented statewide. Expansion of the Core Plan was made possible by the negotiated increase in the hospital assessment. If implemented properly, both the hospital assessment and the Core Plan should help alleviate some of the exploding levels of bad debt and charity care hospitals are currently experiencing while providing coverage to a chronically-uninsured population.
An important priority is the health care workforce, which is an almost universally ignored aspect of health care reform. In the myopic rush to achieve 100 percent coverage (Wisconsin is close to that right now, by the way, and without a massive mandate from Washington), few, other than health care providers themselves, appreciate the impact universal coverage will have on a health care system that is right now struggling to keep up with demand. "Coverage does not equal access," has been our mantra of late, conveyed to anyone willing to slow down and listen … and someone appears to be. The budget bill includes eight new FTEs within the Department of Regulation & Licensing to help expedite physician licensure and regulation. While much more needs to be done on this front, this WHA-backed nugget was spared the budget ax and will help get more desperately needed MDs through the regulatory pipeline. Now we need more in that pipeline!
There are many important details of the budget worth reviewing, but there is one critical provision that came with hardly any detail at all. The budget directs the Department of Health Services (DHS) to reduce Medicaid spending by $190 million in state funds over the 2009-11 biennium. That number is closer to $600 million when the federal Medicaid match (which will be lost) is factored in. That’s an important distinction—$190 million is the impact on the state budget, but $600 million is the potential impact on health care providers serving Medicaid patients.
Further, the cuts are unallocated, meaning the manner in which they are implemented rests solely in the hands of Governor Doyle and DHS. A plan for making the reductions is likely to come forward in the next few weeks.
The Governor has rightly touted Wisconsin’s health care record, drawing special attention to the fact that even in these tight budget times we are able to maintain health care as a priority.
"I want to thank the WHA and you for the incredible work you have done to move us forward to my goal of getting almost everybody in Wisconsin good health insurance," Governor Doyle said to the more than 600 who attended WHA’s Advocacy Day in April. "These are tough times for all of us (but) we need to do two things: protect our priorities and be careful to not move back so far that we can’t move forward when the economy picks up…People see good doctors, great nurses, wonderful hospitals that deliver high quality care. I know you go through a lot of battles, government regulations and competition, but in the big picture, we are doing it right."
Indeed, the Governor and Legislature took a laudable step forward in the budget bill by delivering on the WHA-shared goal of expanding coverage through the Core Plan. But are we now on the verge of taking two steps back? A plan that includes massive cuts to hospitals and other Medicaid providers could mean that we in fact "move back so far that we can’t move forward when the economy picks up." As we know in health care, coverage does not equal access, and $600 million in cuts simply cannot be absorbed without having a direct impact on patient access to care, regardless how much coverage they have.
Catholic Bishops and Unions put Forth Guidance Document for Organizing CampaignsThe U.S. Conference of Catholic Bishops, Catholic health care organizations and labor unions have released a document outlining a consensus between Catholic health care employers and unions on voluntary "principles for a fair and just organizing model." The document, titled "Respecting the Just Rights of Workers: Guidance and Options for Catholic Health Care and Unions" can be found at www.usccb.org/sdwp/national/respecting_the_just_rights_of_workers.pdf. Among other guidelines, the document states that it is in the best interest of workers for the union and the employer to enter into a local agreement before an organizing campaign is fully under way. The local agreement should address the subjects of "respect, equal access to information, truthful and balanced communications, pressure-free environment, fair and expeditious process, meaningful enforcement of the local agreement, and honoring employee decisions."
Within the local agreement, management would agree not to use traditional anti-union tactics or outside firms that specialize in such tactics and unions would agree to refrain from publicly attacking Catholic health care organizations.
Under the category "fair and expeditious process," the guidelines suggest that the union and employer "mutually agree that employees will make their choice through a secret ballot election, supervised by the National Labor Relations Board (NLRB) or another mutually agreed upon process (e.g., non-Board election or other method of majority verification) provided the union and employer have entered into a local agreement, and both the union and the employer are committed to avoiding lengthy hearings and delays."
This portion of the guidelines is contrary to current union support and endorsement of the Employee Free Choice Act (EFCA). This proposed federal legislation would remove the requirement for a NLRB supervised secret ballot election to determine the outcome of an organizing campaign. EFCA, once expected to move easily through congress, has been slowed down as legislators have heard concerns from many sources—including hospitals—about the need for a secret ballot process.
If implemented, this consensus document would change the face of union organizing in hospitals. In addition to agreeing to the secret ballot election, unions would no longer conduct lengthy, highly public corporate campaigns, hospitals would not involve outside parties or mandatory meetings to influence the decision of workers and both parties would share employee publications and information pieces before distribution.
Court Accepts WHA Brief in Lawsuit to Protect the FundOn June 26, 2009, the Court of Appeals accepted WHA’s amicus brief filed in the Wisconsin Medical Society (WMS) lawsuit that seeks to protect the integrity of the Injured Patients and Families Compensation Fund ("Fund"), Wisconsin Medical Society and David Hoffman, MD v. Michael Morgan. In that case, WMS argues that there was an unconstitutional taking of $200 million from the Fund, the result of a transfer from the Fund to the Medical Assistance Trust Fund, (and $200 million GPR reduction in the MATF) in the 2007-2009 State Budget. WMS’s arguments include that the transfer was (1) an unconstitutional taking of property; (2) impaired the health care providers’ contract rights in the Fund; and (3) constitutes an unlawful tax.
In its amicus brief, WHA supports WMS, arguing, "[The] removal of Fund money is an unconstitutional impairment of the State’s contractual obligations with health-care providers." The WHA brief lays out the terms of "the deal" between health care providers and the State, including the providers’ agreement to fund the Fund and, in exchange, the State’s commitment to secure the integrity of the Fund, "Here we have, on the one hand, health-care providers that have honored their obligations under the contract. Health-care providers have paid in almost $1 billion—over $951.237 million—to fund the Fund, from the Fund’s inception in 1975 to June 30, 2008." The brief continues that in removing $200 million from the Fund the fundamental aspects of the parties’ relationship under the contract were altered. In particular, the actions have (a) impaired the discretion of the managers of the Fund, (b) imperiled the finances of the Fund, and (c) imposed losses upon health care providers.
For its part, the State argues that health care providers do not have a property interest in the Fund, that the IPFCF statute creates no contractual rights on the part of providers, and that the transfer is not a tax (transfer is not "an exaction…of money, by the government, for the support of government"). WMS’s reply brief is due July 2.
RAC Outreach Date Set and New RAC Resources Posted on WHA Web SiteLater this summer, WHA will be hosting a member forum with representatives from the Centers for Medicare & Medicaid Services (CMS) and CGI Federal Inc., to present their approach to the Medicare Recovery Audit Contractor (RAC) program for Wisconsin hospitals. WHA’s Recovery Audit Contractor Forum will take place Tuesday, August 11, from 1 - 4 p.m.
This event will be available both as a live event at the American Family Education Center in Madison and via teleconference, for those unable to attend in person. Due to space and teleconference limitations, priority will be given to registrants of WHA hospital members. All non-members and corporate members will be accepted on space availability.
There is no cost to attend this Forum, either in-person or via teleconference, but pre-registration for either option is required. A brochure is included in this week’s packet, and easy online registration is now available at www.wha.org. Again, space is limited, so register early!
CGI Federal Inc. has been named as the RAC for Region B, which includes Wisconsin. The permanent RAC program for Wisconsin will include review of Medicare fee-for-service claims for inpatient, outpatient, physician, hospice, home health, and durable medical equipment provider claims paid October 1, 2007, or later.
In addition to the upcoming outreach opportunity, WHA has posted two new RAC publications on the WHA Web site. The first publication is on the RAC program overall and the second is on the RAC appeals process. Thanks to Amphion Medical Solutions for their help in developing these new resources. The papers along with other resources on the RAC program can be found at
www.wha.org/governmentRelations/rac.aspx.Top of page
CMS Issues Proposed Hospital Outpatient, ASC Rule
The Centers for Medicare & Medicaid Services earlier this week released its proposed rule updating payment policies and rates for hospital outpatient departments and ambulatory surgical centers for calendar year 2010. CMS projects that proposed payment rates under the outpatient prospective payment system would result in a 1.9 percent increase in Medicare payment for providers paid under the OPPS. Among other provisions, the proposed rule includes changes to the hospital outpatient quality data reporting program, and would establish procedures to make the data collected through the reporting program publicly available. CMS will accept comments on the rule through August 31, and plans to issue a final rule by November 1. WHA is reviewing the proposed rule and will get details to its members in an upcoming communication.
CMS Proposes 21.5 Percent Payment Cut for Physicians in 2010The Centers for Medicare & Medicaid Services earlier this week issued a proposed rule cutting Medicare payment rates for physicians by 21.5 percent in calendar year 2010. However, in anticipation of similar action by Congress, CMS proposes to remove physician-administered drugs from the annual payment update formula, which CMS projects will raise the payment update in future years. CMS also proposes reducing physician fee schedule payments for advanced imaging services in order to promote reduced utilization, and requiring certain providers of the technical component of advanced imaging services to be accredited by 2012, as stipulated in the 2008 Medicare Improvements for Patients and Providers Act. These providers include physician offices, mobile units and independent diagnostic testing facilities. The proposed rule will be published in the July 13 Federal Register, with comments accepted through August 31.
Milwaukee, Madison Hospitals Participate in Full-Scale "Red Dragon" ExerciseApproximately 3,000 soldiers from the 415th Chemical Brigade of the U.S. Army Reserve Unit, under the Pentagon Force Protection Agency, participated in full-scale exercises in Wisconsin June 17-20. "Operation Red Dragon-Homeland Defense Training Exercise" is a joint federal, state and local disaster simulation.
Exercise scenarios played out at hospitals in several counties in Wisconsin. It was the largest full-scale exercise of its kind in the United States in 2009. This is the first time in the country civilian and military personnel trained together on a major chemical decontamination exercise. Throughout the training military personnel made use of a full range of special equipment to include a system of decontamination tents and sprayers to treat "mock victims."
The Red Dragon-Homeland Defense Training Exercise tested the coordination and communication between the military and area hospitals’ abilities to respond and continue patient care in a large-scale incident. Throughout the exercise both military and civilian response units learned valuable information that will shape future protocols and procedures.
Operation Red Dragon was carried out in Milwaukee, La Crosse, and Madison.
Participating hospitals included: Aurora Medical Center Washington County, Aurora Sheboygan Medical Center, Children’s Hospital of Wisconsin, Columbia St. Mary’s Ozaukee, Froedtert Hospital, Oconomowoc Memorial, St. Agnes Hospital, Waukesha Memorial, Waupun Memorial Hospital, Wheaton Franciscan Healthcare All Saints Racine; UW Hospitals and Clinics, St. Mary’s Hospital and William S. Middleton Memorial Veterans Hospital in Madison, as well as Gundersen Lutheran in La Crosse.
Member News: Normington is New CEO at MoundviewJeremy Normington-Slay has been named CEO at Moundview Memorial Hospital & Clinics effective July 1, 2009. Normington has been serving as vice president of patient care services at Moundview since January 2008.
Normington has experience in leadership positions at two other health care organizations including St. Joseph Regional Medical Center in Milwaukee and Cherokee Regional Medical Center in Cherokee, Iowa. His education includes bachelor’s, master’s and doctorate degrees in health care-related fields and he has successfully completed the Executive Program offered by the American College of Healthcare Executives.
Community Benefits: Riverview Hospital, Wisconsin RapidsRecognizing an unmet community health care need, Riverview Hospital has established a dental clinic in Wisconsin Rapids for lower income individuals who have Wisconsin Medicaid or BadgerCare Plus insurance coverage.
The Riverview Community Dental Clinic opened in June 2009 in the dental office of a recently retired dentist. Riverview had assumed control of the former Ministry Health Care dental hygiene program at Riverview’s Lakes Area Medical Center in the Adams County Town of Rome in January 2009. Riverview expanded the program to include the services of a dentist and made the commitment to move it to a more convenient location in Wisconsin Rapids.
"The demand for these services has outstripped the capacity of dentists in our community who serve this population," said Celse Berard, president and CEO of Riverview Hospital Association. "We feel this is a natural extension of our mission to provide progressive health care to our community, as recent medical research has shown increasing links between oral health and overall health."
Studies have shown that a person’s oral health may either contribute to or be indicative of many other health conditions. These studies have shown potential links between poor oral health and cardiovascular disease, premature birth, diabetes, osteoporosis and many other conditions.
Costs to purchase, equip and operate the Riverview Community Dental Clinic were funded by Riverview Hospital, with assistance from Delta Dental of Wisconsin, the state’s leading dental insurance provider which has provided grants for more than a dozen community-based clinics across Wisconsin.
Dental care and hygiene services at the Riverview Community Dental Clinic are being provided 2-1/2 days per week initially. Patients are seen two days a week by Dr. Daniel Goeckermann, whose time is shared with a similar dental clinic in Stevens Point. Patients also see a local dentist, Dr. Robert McGrath of Mid-Towne Dental Associates in Wisconsin Rapids. Since January, Dr. McGrath had volunteered a half-day per week to provide dental services at Riverview’s Lakes location and agreed to continue in this role with the Riverview clinic in Wisconsin Rapids.
"The generosity of Dr. McGrath makes a big difference for many local families who would otherwise go without dental care," said Berard. "We’re hoping that the more convenient location in Wisconsin Rapids will attract other local dental professionals to also participate. There definitely is need in our community for a full-time clinic if we have the dentists to fill the hours."
Wisconsin Medicaid and BadgerCare Plus are Wisconsin Department of Health Services ForwardHealth programs for low to moderate income individuals and families who cannot afford or do not have access to health insurance.
Community Benefits: Beloit Memorial Hospital, BeloitHospitals typically help patients through diagnosis, surgery or treatment for those struggling with health care concerns. However, in this case, they help patients by training health care providers who will be there for them in the future.
Beloit Memorial Hospital is currently a vital partner of two local high school’s Youth Apprenticeship Program. This program allows students in their junior or senior year to earn their certified nursing assistant (CNA) license with the help of classroom and clinical study. The program, now in its 10th year, has graduated over 300 CNAs into the job market, many of whom have gone on to other essential areas of health care.
"The hospital’s participation in this community program has been critical," explains Valerie Burt, Youth Apprenticeship Coordinator for two area school systems. "The hospital has been there for us from the very beginning when we had no space, no instructors, and no supplies. They have provided classroom space, a clinical RN instructor, hospital beds and other important equipment for our Learning Lab, plus continued support."
The hospital is not reimbursed for any of these costs, but considers them a donation to the public school and the community students. Their commitment extends to providing a location and celebration for the graduates and their families. The families of these young students are amazed by the education their children are receiving and the motivation they see as a result.
Kwamesha Milsap, CNA and a graduate of the program in 2006, is one of the many success stories coming out of the high school program. "The training was so great," Kwamesha emphasizes. "It really helped me with my communication skills, relationship building, loyalty, and other patient and business skills. I knew I wanted to go into health care, like my grandma, but I didn’t know where to start. When I graduated from high school with my CNA license, I was one step ahead of my classmates. I already had a career path and a job." Kwamesha, while working as a CNA, is now going on to nursing school at Blackhawk College to continue her education.
"Partnerships within the community are essential to develop programs like these," states Bonnie Scholko, of Beloit Memorial Hospital’s Human Resources. "It’s been very rewarding to watch the students develop and see their accomplishments. Their participation in this program actually earns them both high school and college credits and they see a promising career path to point them toward a fulfilling future."
Burt closely follows the success of those graduating from the Youth Apprenticeship Program. She is proud to report that 97 percent of the graduates have stayed in the health care field, with 82 percent going into nursing. The program has grown in popularity and status with a current list of 70 students interested in the school program. The hospital is pleased to partner with such an important educational program.
Submit hospital community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.