August 24, 2012
Volume 56, Issue 34


St. Mary’s Hosts WHA Hospital Listening Session with Cong. Ribble in Green Bay
"There’s no more money that we can take from hospitals."

Forty hospital leaders and advocates representing almost every hospital in Northeastern Wisconsin attended a WHA Hospital Listening Session with U.S. Rep. Reid Ribble (R-WI 8th) hosted by St. Mary’s Hospital Medical Center in Green Bay. The Hospital Listening Session was an opportunity for hospital advocates to hear personally from Ribble about health care issues pending in Congress and to ask important questions.

"I’ve tried to get to every hospital in the district to understand [health care]," said Cong. Ribble in his opening remarks. Health care "is not simple and your time here is important…The quality of health care in Northeastern Wisconsin is known across the country."

Cong. Ribble discussed his approach to being a lawmaker, citing his desire to listen, understand and see the data, so that together Congress can find pragmatic solutions that create the best results for the broadest number of people.

During the discussion, Bellin Health Chief Financial Officer Jim Dietsche asked how highly-innovative hospitals, like those in Wisconsin, can continue to innovate when all they see is the federal government cutting payments. Dietsche cited the upcoming sequester cuts due to begin January 2013. Ribble responded that he did not think the sequester cuts would occur as enacted, but be replaced by something else. However, he added that the answer to how those cuts would be altered is unknown at this time and will be impacted by the elections.

Dr. Richard Ludgin, vice president of medical affairs at Green Bay’s Aurora BayCare Medical Center, asked how Congress would deal with the upcoming cuts to Medicare physician payments under the Sustainable Growth Rate (SGR). Ribble responded he thought the SGR would, as usual, be extended temporarily until the new Congress convenes in 2013. At that time, he felt Congress would consider a longer-term fix to the SGR.

Both of these questions highlighted some of the major concerns facing hospital leaders and advocates: the federal government’s continued attempts to cut payments to hospitals. To this, the Congressman responded, "There’s no more money that we can take from hospitals."

Ribble’s answer led to a discussion on how, then, to propel government health care programs forward. From care integration to changing Medicare’s fee-for-service payment system, attendees discussed how to move from an outdated, volume-based system to a more nimble, outcomes and value-based payment system. Ribble said that under the latter, "Wisconsin wins in that scenario." Ribble mentioned that he regularly talks with his colleagues in Congress about how care is delivered in Wisconsin.

The conversation also touched on other issues including his opposition to the Independent Payment Advisory Board, his strong support for rural hospitals and how to address the shortage of primary care physicians.

WHA thanks Cong. Ribble and hospital attendees for participating in this important WHA Hospital Listening Session.

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Court of Appeals Agrees with Hospital and Amici: CBRF is Property Tax Exempt
WHA, RWHC, WAHSA filed brief in case

The Court of Appeals this week agreed with the circuit court that Beaver Dam Community Hospital’s Eagle’s Wings facility, a community-based residential facility (CBRF), is exempt from property taxes based on what the Court said was an "unambiguous statute."

Beaver Dam Community Hospital (BDCH), a nonprofit hospital, owns Eagle’s Wings, a CBRF licensed by the Wisconsin Department of Health Services to provide care to residents who require assistance with activities of daily living, but do not require the skilled level of care offered in a nursing home setting. Eagle’s Wings’ residents range in age from 70 to 98 years old. The City of Beaver Dam assessed taxes on the real and personal property used for Eagle’s Wings. BDCH paid the taxes and then filed a claim to recover the taxes from the City. The City denied the claim. BDHC appealed, arguing that Eagle’s Wings is explicitly exempt from property taxes under the statute (s. 70.11(4)(a)) as a facility licensed by DHS under Ch. 50. The City countered that the exemption cited by the hospital applies only to facilities that show benevolent use.

The statute in question provides an exemption from property taxes to property owned and exclusively used "by a nonprofit entity that is operated as a facility that is licensed, certified, or registered under ch. 50, including benevolent nursing homes…" In its brief, written by Attorney Kevin Ferguson, Hall, Render, Killian Heath & Lyman, BDHC asked the Court to "uphold the express policy decisions of the Legislature and apply the unambiguous language" of the statute. The Court, agreeing with BDCH, said, "[W]e agree with the hospital system that the City’s interpretation in not supported by the language of the statute and conclude that the only reasonable interpretation, consistent with the text of the statute, is that a nonprofit entity that is operated as a facility licensed…under ch. 50 is eligible for exemption, whether or not the facility is benevolent."

WHA, the Rural Wisconsin Health Cooperative, and the Wisconsin Association of Homes and Services for the Aging, in an amicus brief supporting Eagle’s Wings’ property tax exemption, explained that the Legislature acted deliberately when it amended the statute to include the exemption, noting its changes were comprehensive. Attorneys Margaret Derus and Don Millis, Reinhart Boener Van Deuren, filed a brief on behalf of the amici. In their brief they noted that the amendments enacted by the Legislature in 2009 "represented a culmination of nearly two decades of legislative proposals, studies by the Wisconsin Legislative Council and Wisconsin Department of Revenue, and litigation involving property tax exemptions for facilities that provide services and housing for the elderly, frail elderly, and those in need of nursing services."

The Court of Appeals concluded that the Legislature established Eagle’s Wings’ exemption through unambiguous statutory language. See a copy of the Court’s decision at the following link: www.wicourts.gov/ca/opinion/DisplayDocument.pdf?content=pdf&seqNo=86414.

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CMS, ONC Release Final Stage 2 EHR Meaningful Use Rules
Revision of PPS penalty timeline remains a concern for WHA

On August 23, the Centers for Medicare & Medicaid Services (CMS) released a final rule defining "meaningful use" of electronic health records (EHR) for Stage 2 of the Medicare and Medicaid EHR Incentive Programs. The Office of the National Coordinator for Health Information Technology (ONC) also issued a companion final rule that sets certification criteria, standards and implementation specifications for EHR technology. CMS has also posted a "fact sheet" summary of the meaningful use final rule at www.cms.gov/apps/media/fact_sheets.asp.

After an early review of the meaningful use rule, it appears that changes from the proposed rule are relatively modest. It also appears that CMS has retained its policy, first announced in the stage 2 proposed rule, that it intends to assess penalties in 2015 on PPS hospitals not based upon whether the PPS meets meaningful use in 2015 but whether it meets meaningful use in a reporting period prior to 2015. The applicable reporting period would depend on when a PPS hospital first meets meaningful use. WHA had argued in its comment letter to CMS that this policy is contrary to the intent of the HITECH Act.

"WHA is disappointed that CMS has set an unrealistic timeline and high bar for achieving meaningful use that hospitals must achieve in order to avoid penalties," said WHA President Steve Brenton. "Despite a high rate of EHR adoption in Wisconsin as measured by multiple metrics, CMS’s final rule has increased the likelihood that hospitals in Wisconsin will face additional cuts to Medicare funding in 2015."

WHA will continue to review the new rules and provide additional information and analysis in the coming days and weeks.

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WHA’s Behavioral Health Task Force Discuses the ACA and Care Coordination

WHA’s Behavioral Health Task Force, chaired by George Kerwin, president/CEO, Bellin Health System, met August 17 in Madison and worked through an agenda addressing both long-term and short-term advocacy efforts and opportunities related to behavioral health policy.

ACA Analysis and Possible Impacts on Mental Health Care in Wisconsin

Joanne Alig, senior vice president for policy and research at WHA, provided a presentation on unresolved issues relating to the Affordable Care Act (ACA), especially coverage expansion scenarios either through Medicaid expansion or new insurance subsidies that could have direct effects on the provision of mental health services in Wisconsin in particular. Alig and Matthew Stanford, vice president for policy and regulatory affairs at WHA, noted that how the ACA is implemented in Wisconsin will likely have significant impacts on future access to behavioral health services and funding for those services.

Potential ACA impacts on behavioral health access

Improving access to behavioral health services is one issue that the Task Force has focused on since its inception. If Wisconsin chooses to expand its Medicaid program and if more individuals take up private coverage given the availability of subsidies through the exchange, it is anticipated that a disproportionate number of individuals that would gain coverage under the ACA, either through Medicaid expansion or through insurance subsidies, would have behavioral health needs. Currently, the demand for behavioral health services already frequently outstrips the supply of such services. Without efforts to improve the supply of behavioral health services, this problem has the potential to worsen in Wisconsin if there is an influx of childless adults with untreated or poorly-treated behavioral health problems that currently do not have coverage but begin to seek care with new coverage under the ACA.

However, the supply-demand gap for behavioral health services has the potential to be further exacerbated if Medicaid rates stay at levels below the cost to provide care. Without improvements in Medicaid rates for behavioral health services, the supply of such services may actually decrease, as an influx of new Medicaid patients added via the ACA into psychiatric clinics and units could worsen the financial condition of psychiatric clinics and units that are already frequently operating in the red.

Potential ACA impacts on public mental health funding

Wisconsin is unique in the nation in having county government fund a significant share of public mental health services. The Task Force has previously identified differences in county levels of funding as a contributor to the disparity in county mental health services (including emergency detentions) provided across Wisconsin. However, the coverage expansions and changes to Medicaid match rates for Medicaid expansion populations in the ACA would appear to significantly reduce future county obligations for funding behavioral health services. For this reason, the Task Force identified this as a potential opportunity to reduce disparities in public mental health services provided across Wisconsin and to reevaluate the funding mechanisms and organization of public mental health services in Wisconsin.

Sharing Best Practices on Meeting Behavioral Health Needs

One goal of the Task Force has been to find new opportunities for hospitals to share initiatives and best practices that they are using to meet local behavioral health needs. By better communicating such efforts and experiences across the state, other hospitals will have an opportunity to replicate initiatives that have been successful in other communities. To help meet this goal, the Task Force discussed using WHA’s successful effort to gather and communicate hospital community benefit stories as a model for gathering and sharing hospital experiences in meeting local behavioral health needs. Hospitals can anticipate a rollout of this project from WHA in the coming months.

Behavioral Health Advocacy Update

The Task Force discussed several behavioral health-related advocacy issues that WHA and others have been working on this summer.

Removing statutory barriers to the coordination of care for individuals with mental illness by enacting the Mental Health Care Coordination Bill in the next legislative session has continued to be a goal that the Task Force, WHA, and others have been working toward this summer. The Task Force discussed the ongoing efforts of WHA, hospitals, and individual Task Force members to build support for the bill throughout the state. If you or your hospital know of one or more individuals that work in your hospital or live in your community that would be interested in helping to support the efforts to pass this bill, please share that information with WHA’s Matthew Stanford at mstanford@wha.org or 608-274-1820.

The Task Force also received an update on two Legislative Council Study Committees relating to behavioral health policy.

The Study Committee on the Review of Emergency Detention and Admission of Minors Under Chapter 51 has been ongoing since August 2010, but appears to nearing completion after making some final amendments to draft language. Kerwin and Dr. Gina Koeppl, regional director, Ministry Behavioral Health, both serve on this committee and have represented hospitals’ interests well. More information on the work of this study committee, including multiple WHA memos submitted to the study committee, can be found at: http://legis.wisconsin.gov/lc/committees/study/2012/12CH51/index.html.

The Study Committee on Legal Interventions for Persons with Alzheimer’s Disease and Related Dementias met for the first time July 31. Dr. Ken Robbins, medical director for Stoughton Hospital Gerophsyciatry, and Dr. Koeppl both serve on this committee. This study committee is largely focusing on issues related to the provision of emergency services for individuals with Alzheimer’s disease created by the Helen EF case decided by the Wisconsin Supreme Court earlier this year. Multiple perspectives were provided to the Committee during the meeting through invited testimony, including from Dr. Jerry Halverson from Rogers Memorial Hospital (also a Task Force Member). WHA also submitted a memo that can be found at www.wha.org/Data/Sites/1/behaviorhealth/WHAmemoLCSC-Alzheimers7-31-12.pdf.

WHA is creating a small work group to develop more specific recommendations to be submitted to the Committee at its next meeting. If you are interested in participating on that work group, please contact WHA’s Matthew Stanford at mstanford@wha.org or 608-274-1820.

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President’s Column: Will Increased Coverage Result in Lower Uncompensated Care? Perhaps Not

Hospital Medicare cuts are one of the largest revenue sources funding the Affordable Care Act (ACA) coverage expansions. The rationale was…"as folks gain coverage, charity care and bad debt will go down and hospitals will be a net ‘winner’ financially." Wisconsin hospitals gave up $2.4 billion over a ten-year period to pay for new Medicaid coverage and low-income subsidies that begin in 2014. Those cuts include lower inflation updates and severe cuts in disproportionate share payments (DSH).

But maybe the rationale is wrong, or at least overstated.

Consider Wisconsin’s own experience since 2006.

Medicaid enrollment increased about 350,000 from 2006-2011. But charity care continued its annual march upwards, and bad debt increased significantly as did Medicaid losses (which would be far worse but for the hospital assessment).

Some might argue that the red ink would have been worse but for coverage increases. Others will claim that high deductible plans are driving the bad debt numbers (that dynamic will NOT disappear when insurance exchanges are up and running in 2014). And some wonder just how many of the 350,000 newly-Medicaid eligible were formally covered through an employer.

Nevertheless, there can be no disagreement that the Wisconsin numbers suggest that significant public program coverage increases will hardly make uncompensated care go away, or even decrease. And that’s an important finding given the justification that went into funding ACA through hospital cuts.

Steve Brenton
President

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Grassroots Spotlight: Rep. Farrow Visits Rehab Hospital of Wisconsin

Recently Rep. Paul Farrow (R-Pewaukee) visited one of his newly-redistricted hospitals, the Rehabilitation Hospital of Wisconsin in Waukesha.

"It was a pleasure to meet Representative Farrow and to showcase the work we do at the Rehabilitation Hospital of Wisconsin," said Ann Jurenec, CEO. "As the only free-standing intensive rehabilitation facility in the state, we are in a unique position to address the specialized rehabilitative needs of individuals and their families."

Due to redistricting, Rep. Farrow now represents the hospital. During his time at the hospital, Farrow was able to meet with hospital leaders to learn more about the special role the hospital plays in the larger care continuum as well as learn about other issues facing the hospital.

"We welcome the opportunity to work with Representative Farrow in the future as we work together to meet the challenges of providing affordable, efficient and high-quality care to those in need," Jurenec said.

Ribble visits Calumet Medical Center

While back in Wisconsin during the August Congressional recess, Rep. Reid Ribble visited Calumet Medical Center in Chilton. Under redistricting, the hospital is now represented by Cong. Ribble.

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Register Now for WHA’s Inaugural Leadership Summit, September 21 in Madison

Make plans to attend the WHA Leadership Summit September 21 at the Marriott Hotel in Madison. This one-day event, which replaces the traditional WHA annual convention, will include learning, networking and peer recognition opportunities for WHA members. Attendees will receive examples of innovative and bold leadership, share actionable strategies, and gain valuable insight on ways that Wisconsin can continue to be a national leader in providing high-quality, high-value and affordable health care.

CEOs, administrators, vice presidents, CFOs, nurse executives, physician executives, department and service line managers and board of trustee members should register today at: http://events.SignUp4.com/12LeadershipSummit0921.

Be sure to make your hotel reservations at the Marriott Madison West Hotel before August 31. A block of rooms is being held for attendees for the evening of September 20. Reservations can be made by calling 888-745-2032 or 608-831-2000.

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Hot Summer Provides Opportunities to Put WHEPP Equipment to Good Use

The record-breaking heat that hit Wisconsin this summer posed many challenges, especially for organizers of outdoor sporting events. It also provided an opportunity for hospitals to put some essential emergency response equipment to use.

Participants in the Door County Sprint held July 21 and the Door County Triathlon on July 22 took advantage of the medical tent during the two-day event. Steve Schwenke, Ministry Door County Medical Center Safety Officer, said the equipment was provided to the Triathlon Medical Support Team (coordinated by MDCMC’S Tina Koyen, MS, ATC, PES, and staffed predominantly with MDCMC employees) by Ministry Door County Medical Center and were purchased through the Wisconsin Hospital Emergency Preparedness Program (WHEPP). A total of 25 cots were used (15 in the medical tent and 10 throughout the course) as well as one generator, one 48-inch fan, and for the runners to cool down, a 1,000-gallon dump tank as well as a 500-gallon dump tank. Not only did the participants benefit, but it also gave the hospital an opportunity to practice using the equipment.

"The temperatures and humidity were going to be higher than the organizers first expected, and based on the experience of some of the other races held earlier, they wanted to be ready," according to Schwenke. "Most of the visits to the medical tent were for dehydration and leg cramps, and because of preplanning, the Medical Support Team was ready for them. Those who were experiencing discomfort were treated quickly, which quite possibly prevented them from becoming more serious."

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Wisconsin Hospitals Community Benefits: Charity Care

Fear of a bill should never prevent a patient from seeking care at a Wisconsin hospital. Wisconsin hospital charity care programs provided $232 million to more than 700 patients each day last year. The stories that follow illustrate the deep commitment and continuing concern that hospitals have to their patients to ensure they receive the care they need regardless of their ability to pay.

The unexpected happens…over and over again

Sally is 49 years old and self-employed. Her husband is working part-time and therefore is not eligible for the health insurance benefit through his employer. They had looked into getting health insurance coverage on their own and found most plans to be very expensive. They were continuing their search for an affordable plan when the unexpected happened. Sally had a heart attack. She was rushed to Holy Family Memorial’s Emergency Room and from there transferred to another facility. After Sally was cleared to go back to work, the couple had so many medical bills they did not know where to turn for assistance. One of Holy Family Memorial’s Patient Financial Advisors told them about the Community Care Program in an effort to possibly help them with their emergency room visit. The Advisor also suggested they contact the other facility to inquire about their assistance programs. Unfortunately, this was not the end of Sally’s story.

Six months later, Sally was readmitted to Holy Family Memorial in need of an emergency heart catheterization. By the end of the following month, another emergency heart catheterization was needed after Sally’s follow-up stress test showed additional blockage. At this point, Sally and her husband found that they had medical bills from Holy Family Memorial alone totaling well over their annual income. How would they ever pay these bills? Holy Family Memorial was able to assist this patient and her family with nearly 100 percent Community Care assistance leaving them a more manageable personal pay balance to deal with.

Sally is still not back to full-time work and is still dealing with the side effects of what she went through. They are very grateful for the financial assistance Holy Family Memorial provided to them.

By assisting with this medical debt, Holy Family Memorial has allowed Sally the time needed to heal properly. It is hoped that she and her husband can enjoy a long and healthy life together. They are still looking into health insurance and, perhaps with a good medical check-up, will be able to get affordable health insurance in the near future.

Holy Family Memorial, Inc., Manitowoc


It could happen to anyone

A 24 year-old female came to the emergency department at the Aurora Medical Center in Grafton with a badly-sprained ankle. She was uninsured, unemployed, looking for work. The sprain was putting a serious crimp in her ability to attend job fairs and visit employment offices to fill out applications.

The patient met with a financial counselor to discuss her payment options. She explained that she was recently laid off from her employer due to downsizing of the company and received only a small amount of unemployment compensation.

The financial counselor introduced the young woman to the Aurora Helping Hand financial assistance program application. Upon full completion and evaluation, she was approved for a 100 percent discount to get the care she needed to heal completely. She is now able to focus on seeking a full-time employment with benefits.

Aurora Medical Center in Grafton


Charity care helps Amish family

An Amish family delivered their newborn (son) at their home. This was their 7th child that was born at their home. The mom & baby were transferred from Holy Family Hospital Emergency room in Manitowoc to St. Vincent Hospital in Green Bay. Sadly enough, the newborn did not survive beyond three days in St. Vincent’s NICU. The father was a self-employed carpenter and the Mother had six small children to care for under the age of 10. They were uninsured and according to their religious beliefs they chose not to apply for any government entitlement or socio-economic program and so did not have the means to cover the financial burden to the delicate and advanced care their newborn had received. They did not have modern conveniences that we take for granted, such as heat, hot water, air conditioning, a vehicle, etc. They heat their home with a wood stove, and they had a shared community garden. The community had some livestock and chickens for all of their food supply. They made their own clothes and lived without the amenities that we as a society take for granted. They were very appreciative for the charity assistance.

St. Vincent Hospital, Green Bay


Cancer patient receives free care from Wheaton Franciscan Healthcare - St. Francis

When 57-year-old Anthony Wisniewski was admitted to Wheaton Franciscan Healthcare– St. Francis, both he and his longtime girlfriend Kathy thought it was for symptoms of a stroke.

Instead, Anthony quickly learned he was suffering from fourth stage brain, liver, and lung cancer. After an 11-day hospital stay at St. Francis, he began chemotherapy at Wheaton Franciscan Healthcare’s Reiman Center for Cancer Care in Franklin.

Anthony lacked the financial means to pay for this most recent hospital stay as well as cancer treatment. That’s when Donna Semons, a financial counselor with Wheaton Franciscan Healthcare, stepped in to help.

"Donna was exceptional to work with," Kathy said. Donna encouraged Anthony to apply for Community Care, which provides free or discounted care to those in need.

Kathy said that not only was Donna wonderful, but so were the nurses and doctors that cared for Anthony during his stay at St. Francis and his treatments at the Reiman Center.

"We couldn’t have asked for anything better," she said. "The teamwork between the doctors and nurses was amazing."

While Anthony has since died, his girlfriend said he was able to spend his final months knowing he couldn’t have asked for better care from anyone or anywhere.

Wheaton Franciscan Healthcare’s Community Care program provides free or discounted care to those in need. In 2010, Wheaton Franciscan Healthcare in Southeast Wisconsin provided approximately $16.8 million in free or discounted health services to those who cannot afford to pay and who meet all criteria for financial assistance. Charity care is based on actual costs, not charges, and does not include bad debt.

Wheaton Franciscan Healthcare - St. Francis, Milwaukee


Community Care after cancer screening

Columbia St. Mary’s (CSM) is a collaborator with Susan G. Komen for the Cure in offering mammography screening for women with difficulty in accessing diagnostic services. A Komen-sponsored screening found several women who needed ongoing diagnostic services, among them Maria.

Anxious and unfamiliar with medical treatment, Maria did not speak English as her primary language. She had little support in Milwaukee—and much need for help—as she went through diagnosis and treatment for breast cancer. Although she was able to receive financial assistance through grant funding during the initial diagnostic process, she needed Community Care to fund the treatment of her disease.

CSM’s breast health advocate, Claudia Guevara, was important to Maria in her application for Community Care at CSM. Community Care was approved for Maria’s treatment, allowing her to deal with the demands of surgery and radiation therapy without the anxiety of financial problems.

Guevara continued to help Maria in understanding treatment plans, dealing with symptoms, and adjusting to the diagnosis. Through the support of Community Care and the breast health advocate, Maria completed her treatment and is healthy today. It is not often that health providers can be sure that their work saved a life, but in Maria’s case, we can be confident that her access to Community Care was indeed life-saving.

Columbia St. Mary’s, Inc., Milwaukee

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

Read more about hospitals connecting with their communities at www.WiServePoint.org.

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