July 6, 2012
Volume 56, Issue 27
Brenton, Size Present "The State of Health Care in Wisconsin" at Rural Conference
"Wisconsin is in a better position to respond to health reform than most states"
In what has become one of the most popular sessions at the Wisconsin Rural Health Conference, on Friday, June 22, Wisconsin Hospital Association President Steve Brenton and Rural Wisconsin Health Cooperative Executive Director Tim Size discussed the "State of Health Care in Wisconsin."
Brenton pointed out that Wisconsin has a reputation for delivering high quality, high value health care, most recently confirmed by the federal Agency for Healthcare Research and Quality that placed Wisconsin second in the nation based on scores across more than 150 measures. The state was also ranked in the top quartile for the high performance of its overall community health system by the Commonwealth Health Foundation.
"Wisconsin is a high health care quality state, which delivers value to our patients, our employers and to insurers," Brenton said. "In the future, we know we will need to do more with less, but we’re in a better position to respond to health reform than most states because of our early efforts to be more efficient, improve quality, and to meet our patients’ expectations."
Wisconsin is in better shape budget wise than many states. While the Medicaid budget shortfall is a constant concern, providers here did not experience the huge payment cuts and coverage reductions that other states are implementing, most notably, in Illinois. There, an eight-month delay in payments to hospitals is not unusual, and more than 200,000 Medicaid recipients in Illinois have lost coverage.
Brenton said in addition to the cuts expected in the process to reduce the deficit, hospitals are facing $2.6 billion in cuts through 2019 to pay for health reform coverage. In addition, there are hundreds of billions in cuts related to deficit reduction that have been enacted and proposed by both parties.
Rural health is particularly vulnerable, according to Size, because for the first time in decades rural health funding is facing unprecedented attacks. Workforce shortages, particularly physicians, will be a challenge for rural hospitals. Jobs are an important issue for rural hospitals, because according to Size, for every rural primary care physician, another 23 jobs are created, and if a rural hospital closes, it constitutes a four percent tax loss of community income.
The bottom line, Size said, is rural America is affected by where health care dollars are spent and rural communities are hurt badly when policy and politics ignore the local economic impact of rural health.
The good news is rural training tracks are making a comeback as funding has helped boost interest among hospitals. This should, according to Size, help attract and keep physicians in rural practices.
Top of page (7/6/12)
Ten Wisconsin hospital leaders will be in Washington, DC on July 30-31 to advocate in favor of extending two provisions that expire in late September—the Medicare Dependent Hospital (MDH) program and Low Volume Adjustment (LVA). Fifteen Wisconsin hospitals are impacted by these provisions and many plan to participate in the National Rural Health Association’s (NRHA) "March for Rural Hospitals" in DC. Partnering with the Rural Wisconsin Health Cooperative (RWHC) and NRHA on this trip is part of WHA’s comprehensive "Protect Hospital Care" advocacy campaign, the goal of which is to fight back against further Medicare and Medicaid payment erosion.
"Many rural patients across Wisconsin are fortunate enough to have hospital-based care provided right in their own communities," said WHA President Steve Brenton. "The Wisconsin Hospital Association will continue to aggressively work to protect that hospital care."
The MDH program was created to support small rural hospitals for which Medicare patients make up a significant percentage of inpatient days or discharges. An MDH must have fewer than 100 beds and must meet certain Medicare patient thresholds. Unless extended by Congress, the MDH program expires on September 30. Wisconsin has four MDH hospitals.
The LVA payment was created to better account for the relationship between cost and volume and helps level the playing field for low-volume providers and also sustains and improves access to care in rural areas. Unless extended by Congress, it, too, expires on September 30. Wisconsin has 10 hospitals that receive LVA payments.
While in DC, hospital leaders, WHA and RWHC will meet with Members of Wisconsin’s Delegation to urge these provisions be extended in order to protect rural hospital care. Additionally, the WHA supports bipartisan legislation—The Rural Hospital Access Act of 2012 (S. 2620, H.R. 5943)—which reauthorizes both the MDH program and extends the LVA adjustment for one year through September 30, 2013. To date, Representative Reid Ribble (R-WI 8th) has cosponsored this legislation.
Top of page (7/6/12)
The Wisconsin hospitals state political action funds fundraising campaign has raised $108,304 to date from 152 individuals. This puts the 2012 campaign at 43 percent of the goal to raise $250,000 by the end of the year. If the goal is reached, it will be the highest total ever raised.
So far individuals are contributing an average $713, which is up $101 from this same time last year. The campaign is also ahead of last year’s pace in terms of total dollars raised by $4,500.
Of the total contributors, 23 percent are members of the Platinum Club who have contributed $1,500 or more so far to the 2012 campaign.
All individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. Thank you to the 2012 contributors to date who are listed below. Contributors are listed alphabetically by contribution category.
The next publication of the contributor list will be in the July 20 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.
|Contributors ranging from $1 to $499|
|Ashenhurst, Karla||Ministry Health Care|
|Bair, Barbara||St. Clare Hospital & Health Services|
|Biros, Marilyn||SSM Health Care-Wisconsin|
|Bowers, Laura||SSM Health Care-Wisconsin|
|Brenholt, Craig||St. Joseph's Hospital|
|Brenton, Andrew||Wisconsin Hospital Association|
|Coil, Joseph||St. Clare Hospital & Health Services|
|Culotta, Jennifer||St. Clare Hospital & Health Services|
|Dahl, James||Fort HealthCare|
|Dalebroux, Steve||St. Mary's Hospital|
|Dettman, Amy||Bellin Hospital|
|Dufek, Nancy||Memorial Medical Center - Ashland|
|Facey, Alice||St. Clare Hospital & Health Services|
|Garibaldi, Isabelle||Wheaton Franciscan Healthcare - All Saints|
|Groskreutz, Kevin||St. Joseph's Hospital|
|Halida, Cheryl||St. Joseph's Hospital|
|Hieb, Laura||Bellin Hospital|
|Hill, Nick||St. Joseph's Hospital|
|Hocker, Sara||Holy Family Memorial|
|Hoege, Beverly||Reedsburg Area Medical Center|
|Holub, Gregory||Ministry Door County Medical Center|
|Hueller, Julie||Wheaton Franciscan Healthcare|
|Jelle, Laura||St. Clare Hospital & Health Services|
|Kepchar, Dennis||Ministry Health Care|
|King, Steve||St. Mary's Hospital|
|Klay, Lois||St. Joseph's Hospital|
|Krause, Carolyn||Meriter Hospital|
|Lachecki, Therese||Memorial Medical Center - Ashland|
|Lampman, Sandra||St. Mary's Hospital|
|Larson, William||St. Joseph's Hospital|
|Lynch, Sue||Mayo Health System - Franciscan Healthcare|
|Marcouiller, Don||Memorial Medical Center - Ashland|
|Margan, Rob||Wisconsin Hospital Association|
|Mason, Paul||Wheaton Franciscan Healthcare - All Saints|
|Maurer, Mary||Holy Family Memorial|
|Nguyen, Juliet||Sacred Heart Hospital|
|O'Hara, Tiffanie||Wisconsin Hospital Association|
|Olson, Bonnie||Sacred Heart Hospital|
|Olson, Keri||St. Clare Hospital & Health Services|
|Ose, Peggy||Riverview Hospital Association|
|Peiffer, Susan||Sacred Heart Hospital|
|Penczykowski, James||St. Mary's Hospital|
|Pennebecker, Allen||Ministry Saint Michael's Hospital|
|Platt-Gibson, Melanie||St. Clare Hospital & Health Services|
|Quinn, George||Wisconsin Hospital Association|
|Reinke, Mary||Aurora Health Care|
|Richbourg, Mary||Sacred Heart Hospital|
|Rocheleau, John||Bellin Hospital|
|Roethle, Linda||Bellin Hospital|
|Roundy, Ann||Columbus Community Hospital|
|Rudolph, Wade||Sacred Heart Hospital|
|Sanicola, Suzanne||Columbia St. Mary's Columbia Hospital|
|Saunaitis, Tamara||Meriter Hospital|
|Schaetzl, Ron||St. Clare Hospital & Health Services|
|Schraufnagel, Patricia||Memorial Medical Center - Ashland|
|Schwartz, Mary||St. Clare Hospital & Health Services|
|Sheehan, Heather||Hayward Area Memorial Hospital and Nursing Home|
|Sio, Tim||Wheaton Franciscan Healthcare - All Saints|
|Slomczewski, Constance||Wheaton Franciscan Healthcare - All Saints|
|Statz, Darrell||Rural Wisconsin Health Cooperative|
|Steevens, Alan||St. Clare Hospital & Health Services|
|Stelzer, Jason||St. Clare Hospital & Health Services|
|Sullivan, Anne||Memorial Medical Center - Ashland|
|Swanson, Kerry||St. Mary's Janesville Hospital|
|Tapper, Joy||Milwaukee Health Care Partnership|
|Teigen, Seth||St. Mary's Hospital|
|Tuttle, Kathryn||Memorial Medical Center - Ashland|
|Walker, Troy||St. Clare Hospital & Health Services|
|Woleske, Chris||Bellin Psychiatric Center|
|Wysocki, Scott||St. Clare Hospital & Health Services|
|Zeller, Brad||Hayward Area Memorial Hospital and Nursing Home|
|Contributors ranging from $500 to $999|
|Banaszynski, Gregory||Aurora Health Care|
|Byrne, Frank||St. Mary's Hospital|
|Canter, Richard||Wheaton Franciscan Healthcare|
|Carlson, Dan||Bay Area Medical Center|
|Clough, Sheila||Ministry Eagle River Memorial Hospital|
|Dietsche, James||Bellin Hospital|
|Heifetz, Michael||SSM Health Care-Wisconsin|
|Hymans, Daniel||Memorial Medical Center - Ashland|
|Johnson, Charles||St. Mary's Hospital|
|Just, Lisa||Aurora Medical Center in Hartford|
|Kerwin, George||Bellin Hospital|
|Larson, Margaret||Mercy Medical Center|
|Lewis, Gordon||Burnett Medical Center|
|Mantei, Mary Jo||Bay Area Medical Center|
|Miller, Jim||Children's Hospital and Health System|
|Nelson, Dave||SSM Health Care-Wisconsin|
|Richards, Theresa||Ministry Saint Joseph's Hospital|
|Rickelman, Debbie||WHA Information Center|
|Roberts, Paula||Children's Hospital and Health System|
|Russell, John||Columbus Community Hospital|
|Samitt, Craig||Dean Health|
|Schafer, Michael||Spooner Health System|
|Selberg, Heidi||HSHS-Eastern Wisconsin Division|
|Shabino, Charles||Wisconsin Hospital Association|
|Stuart, Philip||Tomah Memorial Hospital|
|Talley, Barbara||St. Clare Hospital & Health Services|
|Taplin Statz, Linda||SSM Health Care-Wisconsin|
|VanCourt, Bernie||Bay Area Medical Center|
|Warmuth, Judith||Wisconsin Hospital Association|
|Zenk, Ann||Ministry Saint Mary's Hospital|
|Contributors ranging from $1,000 to $1,499|
|Anderson, Sandy||St. Clare Hospital & Health Services|
|Britton, Gregory||Beloit Health System|
|Buck, Catherine||Froedtert Health|
|Court, Kelly||Wisconsin Hospital Association|
|Deich, Faye||Sacred Heart Hospital|
|Francis, Jeff||Ministry Health Care|
|Frank, Jennifer||Wisconsin Hospital Association|
|Herzog, Mark||Holy Family Memorial|
|Hilt, Monica||Ministry Saint Mary's Hospital|
|Kosanovich, John||Watertown Regional Medical Ctr|
|Mattes, Dan||Wheaton Franciscan Healthcare|
|Natzke, Ryan||Marshfield Clinic|
|Roller, Rachel||Aurora Health Care|
|Tempelis, Eric||Gundersen Lutheran Health System|
|Westrick, Paul||Columbia St. Mary's Columbia Hospital|
|Contributors ranging from $1,500 to $1,999|
|Alig, Joanne||Wisconsin Hospital Association|
|Barney, Steven||SSM Health Care-Wisconsin|
|Bloch, Jodi||Wisconsin Hospital Association|
|Boese, Jennifer||Wisconsin Hospital Association|
|Clapp, Nicole||Grant Regional Health Center|
|Coffman, Joan||St. Joseph's Hospital|
|Eichman, Cynthia||Ministry Our Lady of Victory Hospital|
|Gorelick, Marc||Children's Hospital and Health System|
|Grasmick, Mary Kay||Wisconsin Hospital Association|
|Harding, Edward||Bay Area Medical Center|
|Levin, Jeremy||Rural Wisconsin Health Cooperative|
|Mettner, Michelle||Children's Hospital and Health System|
|Meyer, Daniel||Aurora BayCare Medical Center in Green Bay|
|Potter, Brian||Wisconsin Hospital Association|
|Stanford, Matthew||Wisconsin Hospital Association|
|Wallace, Michael||Fort HealthCare|
|Contributors ranging from $2,000 to $2,999|
|Brenton, Mary E.|
|Erwin, Duane||Aspirus, Inc.|
|Jacobson, Catherine||Froedtert Health|
|Kachelski, Joe||Wisconsin Statewide Health Information Network|
|Leitch, Laura||Wisconsin Hospital Association|
|Merline, Paul||Wisconsin Hospital Association|
|Neufelder, Daniel||Affinity Health System|
|Normington, Jeremy||Moundview Memorial Hospital & Clinics|
|Pandl, Therese||HSHS-Eastern Wisconsin Division|
|Sanders, Michael||Monroe Clinic|
|Sexton, William||Prairie du Chien Memorial Hospital|
|Starmann-Harrison, Mary||Hospital Sisters Health System|
|Woodward, James||Meriter Hospital|
|Contributors ranging from $3,000 to $4,999|
|Borgerding, Eric||Wisconsin Hospital Association|
|Fish, David||Hospital Sisters Health System|
|Size, Tim||Rural Wisconsin Health Cooperative|
|Turkal, Nick||Aurora Health Care|
|Contributors $5,000 and above|
|Brenton, Stephen||Wisconsin Hospital Association|
|Tyre, Scott||Capitol Navigators, Inc|
WHA Behavioral Health Task Force Identifies Coordination as Key Challenge
Top of page (7/6/12)
The Wisconsin Hospital Association’s Behavioral Health Task Force, chaired by Bellin Health CEO George Kerwin, met Monday, July 2 to discuss a range of WHA mental health policy efforts. The task force also began development of a follow up to their 2010 white paper.
The Task Force spent a significant portion of the meeting performing an environmental scan of changes to the behavioral health landscape, including a review of other states’ efforts. The group noted Iowa’s 2011 mental health system reforms, which reorganized its 99-county mental health system into a new system where care is delivered locally, but managed at a regional level according to new statewide standards.
Access to care and provider shortages remain key challenges identified by the Task Force, as was the need to remove barriers to better care coordination and integration of services for individuals with behavioral health needs.
The Task Force noted that new value-based payment models, such as Accountable Care Organizations under the Affordable Care Act and mental health medical homes proposed by the Wisconsin Department of Health Services, offer intriguing benefits to improve the treatment of individuals with behavioral health needs at a lower cost. However, the Task Force expressed concern that without policy reforms focused on care coordination and integration, Wisconsin’s fragmented mental health delivery system may make any benefits of such payment model reforms illusory.
WHA also provided the Task Force with an update on its 2013 behavioral health legislative initiatives. Chief among those initiatives is the Mental Health Care Coordination Bill, which would remove barriers to care coordination by allowing treating providers to share patient records, other than psychotherapy notes, with other treating providers. Individual Task Force members agreed to work locally on engaging their patients and their families on the importance of this bill, and to continue to gather individual stories on how this bill could improve outcomes for individuals with mental illness in their hospital and clinics.
The Task Force received an update on new discussions with CMS to provide guidance on interactions between EMTALA and Wisconsin’s emergency detention law procedures, as well as on two Wisconsin Legislative Council study committees on emergency detention and implications for Alzheimer’s care following the Helen E.F. Supreme Court decision.
Top of page (7/6/12)
So the Supreme Court of the United State has finally ruled on the ACA. I know of only one person who came close to predicting this outcome (and she is WHA’s general counsel). After a week of settling dust, the full extent of the ruling’s political and policy complexity is coming into focus—and it would humble Rube Goldburg. It’s a web-like apparatus, and pushing one policy button here pops another up over there, making cohesive analysis difficult and knee-jerk reaction easy. WHA is striving for the former as we continue to analyze the impacts of the decision on Wisconsin.
In that effort, we remain well served by our Access and Coverage Principles. Adopted in late 2006, they could have been crafted yesterday. With the Court placing critical decisions in states’ hands, these principles will guide WHA’s advocacy efforts with the decision makers:
Indeed, thoughtful and objective consideration is imperative for a leader state like Wisconsin, where we are already accomplishing much of what the ACA touts for the rest of the country. But hasty rejections and declarations similar to what we’ve seen from other states could close the door on opportunities for a leader state like ours. The immediacies and absolutes of politics should not trump pragmatism and preparation.
Wisconsin has an enviable and hard-earned record of superior, highly accessible care—attributes proclaimed equally by Democrats and Republicans and achieved prior to/without the ACA’s enactment. With the ACA upheld, WHA believes Wisconsin’s policy leaders must be strategic and objective, leveraging elements of the ACA to strengthen our high quality/high coverage status.
To that point, here’s our take on just two of the decisions the ACA places in the hands of Wisconsin policymakers:
Medicaid Expansion: The Court gave states the option of accepting big federal funding (up to 100 percent of the cost) to expand Medicaid to people earning up to 133 percent of the federal poverty level (FPL). But in Wisconsin, our criteria for many categories of eligibility well exceeds 133 percent of the FPL and today we have 1,176,932 people enrolled (the highest it’s ever been in Wisconsin and roughly 20 percent of Wisconsin’s population)—the result of bipartisan, Wisconsin-specific program expansions under Governors Thompson and Doyle. And last year, Governor Walker and the Legislature put $1.3 billion in new funding into Medicaid—an unprecedented commitment to the safety net at the same time neighboring states divest and slash enrollment. Wisconsin has already extended Medicaid coverage to many who would gain it via the ACA, which makes for complicated policy choices.
According to Kaiser, there are 205,000 people (childless adults making <133 percent FPL) in Wisconsin who would qualify for coverage under the ACA’s Medicaid expansion. Assuming that is accurate, at least 25,000 of these people are currently covered under Wisconsin’s existing, but frozen, Medicaid Core program at a budgeted cost of $56 million GPR. For this population, it seems clear Wisconsin would benefit by taking the expansion deal if the feds would pick up most or all of the cost Wisconsin is currently bearing.
A handful of Governors have indicated they will reject federal money to expand their Medicaid programs. So far, Wisconsin is not one of them, since Wisconsin is covering more people through Medicaid than most states. Our leaders are confronted with the difficult question of whether to expand to the potentially eligible population (205,000 people according to Kaiser). It is a choice that will hinge on unclear rules, including how much federal funding will be available for this population, the rising uninsured rate in hard hit parts of Wisconsin, and the paramount notion (at least for WHA) of preserving employer-sponsored coverage.
Whether that is an accurate accounting of the choices remains to be determined, but the point is: policymakers must look through the political maelstrom, objectively assess the advantages, and leverage opportunities for proactive states like Wisconsin. I have my own concerns about the ACA but, now that it’s been upheld, the result cannot be fewer people with coverage and more cost-shifting in Wisconsin.
Insurance Exchanges: This question is simpler to ask: Will Wisconsin administer a (federally-approved) Wisconsin exchange or will the federal government take over? Under the upheld ACA, exchanges go online in 2014, but states must demonstrate operability of an exchange by 1/1/13 or the feds will operate it for them. Some see little difference between a federally-approved state-run exchange and a federally-run exchange. Governor Walker says Wisconsin will wait to move on the exchanges until after the November elections. If the elections don’t go as hoped, that leaves less than two months to design and stand up a Wisconsin-run exchange that will meet federal approval—a tall order.
Regardless of the Court’s decision or the outcomes of the November elections, WHA supports the creation of an insurance exchange in Wisconsin that operates within a free market construct, encourages a plurality of insurers thus fostering robust competition—and that is shaped and operated by the state of Wisconsin. It remains to be seen whether Wisconsin will be allowed to run this type of an exchange, but we won’t know unless we try.
Wisconsin will also have to decide whether it will move its Medicaid population that is >133 percent FPL off Medicaid and into the exchanges as individuals, purchasing federally subsidized individual policies commercial carriers. From a state budgeting perspective, this seems like a no brainer. For providers, it seems equally slam dunk—why wouldn’t we swap Medicaid reimbursement for commercial insurance reimbursement? But even that decision comes with logistical and sustainability complications that must be weighed (but this column is already too long).
Having said all this, we also know the future is far from resolved. While the Court found a way to declare the law constitutional, not even Justice Roberts can find a way to declare it popular with voters. The ruling, despite its seeming finality, was the second round in what is shaping up to be a three-round bout. The third round will come in the November elections, where the ACA is now guaranteed to be a top issue and when the playing field for what, if anything other than full implementation, happens next will be determined.
Of one thing I am certain—at the final bell, Wisconsin will continue to be well served by its hospitals and health systems.
Top of page (7/6/12)
The Department of Health Services (DHS) has again revised its projections of the estimated savings needed in order to avoid ending this biennium with an overall Medicaid program deficit. The latest projections show a $148.9 million state funding (GPR) shortfall, not including estimated savings from previously-announced program reforms. With the addition of the savings from these reforms, DHS estimates it is on track to keep expenditures within the level budgeted in the 2011-13 Biennial Budget Act (Wisconsin Act 32).
The $148.9 million figure is higher than the projection released last March of $82 million. The higher figure can be attributed largely to the addition of funds necessary to lift the Family Care cap, as well as state funding needed to offset a small change in the federal match rate for the Medicaid program for 2013. While these new costs are built into the shortfall estimate, projected savings from a number of reforms are not. In particular, Smith notes that the projections do not include:
After accounting for the above items, the estimated shortfall is $43.8 million GPR. Further, in the letter, Secretary Smith says that with the added savings expected from implementing plans for savings in the long-term care program, DHS will be "on course to remain within the Act 32 budgeted level."
News that the Department appears on track to avoid a deficit in the Medicaid program is certainly welcome. However, WHA will continue to carefully monitor the estimated savings needed this biennium to keep Medicaid solvent, as well as the details behind the shortfall estimates.
The full letter from Secretary Smith to the Joint Finance Committee co-chairs can be found at: www.wha.org/medicaid/DHSmedicaidreportJFC-7-2-12.pdf.
Top of page (7/6/12)
A lack of potable water to a hospital could affect a hospital’s ability to respond in an emergency. That is why the Wisconsin Hospital Emergency Preparedness Program (WHEPP) seated a State Expert Panel on the Management of Water Emergencies to developed guidelines and a template that hospitals could use to assess their water usage and create an emergency plan. Following the release of these guidelines, WHEPP funded a few emergency well pilot projects around the state to establish the utility of these back-up wells.
The success of those pilots led to WHEPP funding emergency well for 25 hospitals across Wisconsin. WHEPP has invested over $2 million in supporting this important piece of infrastructure over the past three years. The wells project coordinator, Hilde Perala, WHEPP Region 1 project manager, said the program has plans to fund seven more hospital emergency well projects by June 30, 2013. These facilities are already identified and have received approval from the Wisconsin Dept. of Safety & Professional Services (formerly WI Dept. of Commerce.)
"WHEPP funds and technical support have allowed our hospitals to achieve a higher level of preparedness than would have been possible without the program," according to WHA’s Mary Kay Grasmick, WHEPP liaison. "We’ve been able to leverage the knowledge and the funding in ways that improve our patient care every day, not just in a crisis."
Top of page (7/6/12)
This week Rep. Reid Ribble sat down with close to a dozen hospital leaders from Ministry Health Care and Affinity Health Care to discuss the Supreme Court’s recent ruling on the health care reform law, the Patient Protection & Affordable Care Act (PPACA). At the PPACA Roundtable were Dan Neufelder, Travis Andersen, Bill Calhoun, Christine Griger among others leaders from Ministry Health Care and Affinity Health Care in the Fox Valley.
During the roundtable the group discussed the PPACA decision’s impact on state health exchanges. Affinity CEO Neufelder was able to provide Rep. Ribble with insight into how an exchange would interact with Affinity’s regional health plan, Network Health Plan.
"We have a competitive health insurance market in Wisconsin," said Neufelder. "There needs to be as much competition as possible [in the Exchange]. We want to be able to compete."
The group went on to discuss the Medicaid provisions, including how Wisconsin had already expanded its Medicaid program prior to enactment of PPACA. Other topics covered included primary care, Medicare payment cuts under PPACA and Medicare’s out-dated reimbursement model, which pays for volume over value.
"You’re penalized," said Ribble. "We have to find a way to reward value."
Top of page (7/6/12)
The Transforming Care at the Bedside (TCAB) team at Mercy Hospital and Trauma Center in Janesville has focused on spreading TCAB throughout the hospital. Last year, the TCAB team showed WHA’s Judy Warmuth, vice president of workforce, the progress they had made working with the housekeeping and dietary staff on patient care improvements. This year, the team demonstrated how the TCAB work had spread within nursing.
"This team has done an impressive job of involving other nursing units and other departments in their efforts to improve patient care," said Warmuth. "The goal is to spread patient care improvements to all parts of the hospital."
For its falls project, the TCAB team used a visual measure of their progress in the form of a six-foot paper tree. A leaf is added to the tree every day without a fall. When a fall occurs, all the leaves are removed. Unit staff and staff from other departments watch the tree, comment on success and work to reduce falls to ensure that the leaves remain.
The team has focused on ensuring that necessary equipment is available, white board information for patients and families is current, and staff has ready access to instructions on how to set up infrequently used equipment. The team regularly reports to the hospital shared governance council.
Warmuth is conducting site visits with all TCAB teams this summer. A new group of hospitals will be invited to join the TCAB program this fall.
Top of page (7/6/12)
Do you know a great country doctor? If so, he or she may qualify as the 2012 Country Doctor of the Year. Sponsored by Staff Care, Inc., a national health temporary physician staffing firm and a company of AMN Healthcare, the Country Doctor of the Year Award honors the spirit, skill and dedication of America’s rural medical practitioners.
Nominations for the 2010 Country Doctor of the Year Award will be accepted for physicians who practice in communities of 20,000 or less and who are engaged in such primary care areas as general practice, family practice, internal medicine, and pediatrics. Anyone can nominate a physician, including hospital or medical group executives, co-workers or family members, and all stories or anecdotes about the physician’s practice are welcomed.
Past recipients of the award have received national news coverage. In addition, Staff Care provides the award recipient with two weeks of complementary locum tenens physician coverage, a service valued at $10,000.
Nomination forms can be downloaded from the Country Doctor of the Year Award Web site at www.countrydoctoraward.com, or call Staff Care at 800-685-2272 for a nomination form. Completed nominations must be received no later than October 15, 2012.
Top of page (7/6/12)
Hospitals are well aware of the critical role they have in protecting public health. Whether it is working with public health agencies to develop protocols and responses to pandemic flu outbreaks, teaching children proper hand-washing techniques or educating people about how to live with chronic conditions, Wisconsin hospitals partner with key stakeholders to improve the health status of their communities.
Tomah Memorial provides hand washing hygiene
Tomah Memorial Hospital (TMH) teaches school age children the importance of good hand washing with the help of a special friend. Staff from the hospital’s Community Outreach Department team up with TMH’s "Scrubby Bear" to inform children how to wash their hands. Scrubby was created by TMH Community Outreach for the presentations to Tomah area elementary schools.
Community Outreach Health Educator Kasey Bloom said in addition to learning the proper way to wash their hands, kids learn what germs are, why they should cover their mouth when they cough or sneeze, and a special song to help them remember how long to wash their hands.
"Scrubby has made many visits to elementary students over the years, but his message is always the same−washing your hands helps you stay healthy so you can play and do the things you want to do," Bloom explained.
Scrubby’s favorite time to make a visit is in the fall, right before the flu season starts. "It’s important for kids to learn the message of washing hands early to prevent the spread of the flu and other illnesses. Hopefully it’s a habit that they carry with them forever," Bloom added.
Tomah Memorial Hospital
Children’s Hospital of Wisconsin project helps improve immunization rates
Children’s Hospital of Wisconsin’s initiative to increase vaccination rates of children throughout Wisconsin has resulted in measurable improvements in vaccination rates. Children’s committed to the multiyear project in early 2010.
Since the project’s launch, each of the four participating programs at Children’s has seen an average increase of 18 percent in immunization rates for the children they serve.
Children’s is committed to improving access to vaccinations in the regions it serves.
"It is the vision of this health system to help the children we serve to be the healthiest in the nation," said Peggy Troy, MSN, RN, president and CEO of the health system. "This initiative is an important step toward achieving that goal because immunizations are one of the best ways to keep children healthy."
Project leaders first focused on incorporating the Wisconsin Immunization Registry into the vaccine verification process. Harnessing that information in their ongoing work to increase the percentage of Children’s patients, staff and their families who are up to date on their immunizations proved very successful.
In late 2011, Children’s offered its first series of mobile immunization clinics in the community, during which 149 children and 132 adults were vaccinated against the flu and other diseases. The clinics, funded through a $50,000 grant from the Brewers Community Foundation, were held at four Milwaukee sites.
In July, an immunization clinic staffed by the Milwaukee and Wauwatosa health departments will open within Children’s to serve patients and their families. Children’s will provide the facilities and equipment and pay for staff salaries.
"Children’s Hospital is uniquely positioned to help increase immunization rates in our community," said Troy. "Our health system has a high level of physician engagement. We also have a network of entities in addition to the hospital−our primary care clinics, a health plan and our social service agencies−that reach many children in the community. These entities work together to achieve measurable results. We are well positioned to set a standard on immunization rates that all other communities in the nation will aspire to achieve."
Children’s Hospital of Wisconsin, Milwaukee
Living well with diabetes support
We could all use a friendly face and helping hand when our health care needs take us down a new and challenging road. Monroe Clinic Diabetes Support Group is a free program where people can find both professional advice and understanding support, as its members travel together on the path to diabetes management.
"The Diabetes Support Group helps me keep myself on track, while I learn how other people with diabetes cope with the same problems I am facing," said Marilyn, a patient in her early 70s who was diagnosed with Type 2 diabetes in 2010.
The group is coordinated by the diabetes education team, which includes dietitians, nurses, physicians, specialists, and certified diabetes educators. It meets monthly and features experts who speak on a variety of topics with real life applications, from cooking tips to foot care. Attendees can bring a friend or support person, and membership is also open to all community members — not just Monroe Clinic patients.
Not only does Marilyn find fresh inspiration at the meetings, but it helps her maintain her long-term goals as time passes. With helpful resources like Monroe Clinic’s Diabetes Support Group and her own commitment to healthy eating and exercise, Marilyn has effectively managed her diabetes, and her latest lab results show her blood glucose levels are now in the normal range.
"It’s a good refresher of information I’ve learned during my diabetes education classes after I was diagnosed. I also enjoy getting ideas for meals and new recipes," said Marilyn.
Monroe Clinic, Monroe
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