August 27, 2010
Volume 54, Issue 34
The Legislative Council Special Committee on Health Care Access met for the first time on Tuesday, August 24. The Committee, chaired by Representative Fred Kessler (D-Milwaukee) and vice-chaired by Senator Luther Olsen (R-Ripon), is directed to study potential solutions to the shortage of health care providers, particularly in rural areas and inner cities, and the adequacy of and additional funding sources for public health. The Committee is also directed to study possible state assistance to underserved areas and an expansion of Wisconsin’s capacity for training family practice physicians and nurses.
Among the 17 Committee members are Sandy Anderson, CEO of St. Clare Hospital and Health Services in Baraboo and Mary Lu Gerke, vice president/CNO for Gundersen Lutheran Health System.
"I am very pleased to participate in the Committee’s efforts to address Wisconsin’s health care access issues," Anderson said. "The similar challenges of transportation, cultural differences, educational disparities and the effects of poverty greatly impact access to health care services in both rural and urban areas and finding solutions to these challenges needs to be a top priority."
At their meeting, Committee members heard presentations from a variety of invited speakers including: Richard Cooper, MD, professor of medicine, University of Pennsylvania; Jenni Sevenich, CEO, Westside Healthcare Association, Inc.; Tim Size, executive director, Rural Wisconsin Health Cooperative; Carl Getto, MD, associate dean for hospital affairs, University of Wisconsin School of Medicine and Public Health; Kenneth Simons, MD, associate dean for graduate medical education and accreditation, Medical College of Wisconsin (MCW); and Marilyn Kaufman, PhD, RN, nursing program chair, Lakeshore Technical College.
Cooper began the presentations with a brief look back at the issue of physician shortages, recalling that in the past, the talk was about future shortages, where now the discussion has turned to the current shortfall of physicians. He described how medicine can be restructured to include as many providers as necessary to provide the best care and how to anticipate the unanticipated additional tasks of future physicians are among the biggest challenges.
While Cooper believes the need for training additional physicians is obvious, he also pointed to a political reticence to accept and act on that belief based on the thought that while America has spent more on health care, our outcomes are worse. Cooper instead pointed to the link between poverty and poor health status, an area where significant amounts are spent but outcomes are poor, highlighting that the high cost of poverty is the real problem in America.
In his concluding remarks, Cooper said that even though there is nothing in federal health care reform to expand medical education it, along with expanded physician training, needs to be high on the agenda.
From Milwaukee’s Westside Healthcare Association, Sevenich discussed the issue of health care access from an urban perspective, in particular outlining why there is an access problem, including issues related to cultural differences, fear, racism, and apathy. She also discussed several consequences of the problem including increased use of emergency rooms for primary care, chronic conditions going untreated, increased health care costs related to public program cost-shifting, and fewer minorities becoming medical providers.
Among ways to address the urban access problem, Sevenich discussed the opportunities and challenges faced by Community Health Centers and providing incentives for providers to work in urban underserved areas. She also issued a call to look at health and access to health services in broader terms, encompassing political and economic issues related to poverty, education, housing and racism.
In his presentation, Size discussed issues of health care provider supply and demand, with a primary emphasis on the rural perspective. He refuted myths about rural health and health care and described the current situation for physicians, dentists, mental health providers, advanced practice providers and other health care professionals. He advocated for the need to provide students, especial medical students, with rural exposure and experience during their educational program. He also argued for increasing the number of rural residencies for physicians.
Getto reviewed the issues raised in the 2008 Wisconsin Council on Medical Education and Workforce (WCMEW) report, "Who Will Care for Our Patients?" (www.wha.org/pubArchive/special_reports/2008PhysicianReport.pdf). Following his presentation there was discussion of Wisconsin’s malpractice environment and the need to increase residency capacity.
Simons reported that MCW is the third largest private medical school in US and is at capacity. MCW has 68 Wisconsin residents in its currently entering class. More Wisconsin residents would likely be admitted if the State of Wisconsin reinstated funding for those students.
Kaufman offered a presentation about nurse faculty shortage. She referenced the June 2007 Wisconsin Nurse Faculty Shortage Task Force Report indicating the age of current nurse faculty and the important shortage of faculty prepared at the doctoral level needed by those programs that prepare nurses at the masters and doctoral level.
"The first Legislative Council Meeting on Health Care Access was filled with presentations from various perspectives," commented Gerke after the meeting. "The wisdom, knowledge and experience on this committee surely will bring forth exciting recommendations and frameworks that we can develop over the next few years to meet the access demand and workforce shortage of health care professionals."
The next two committee meetings will both be public hearings with opportunity for citizen testimony. The Oct 1 meeting will be held in central Wisconsin and an Oct 22 meeting will be held in Milwaukee. Invited speakers may also be asked to present at those meetings.
WHA Webinars to Focus on Medicare and Medicaid EHR Incentive ProgramsIn an effort to help member hospitals strategically plan for the upcoming Medicare and Medicaid EHR Incentive Programs, WHA is offering several webinars in the coming weeks to provide high-level insights into the final meaningful use and EHR certification rules.
On September 9, WHA will present a one-hour webinar designed to help hospital leaders understand and plan for the Medicare EHR Incentive Program. The session will touch on key concerns facing hospitals as they begin short and long-term planning for meeting meaningful use, payment methodologies under the Medicare EHR Incentive Program, and the differences between the proposed meaningful use rules and the final meaningful use rules. Senior hospital leaders who are participating in the strategic planning for EHR implementation in their hospitals or health systems should plan to participate in either the September 9 webinar or the repeated offering on September 10.
On September 21, a second webinar will be offered, this time focusing on the Medicaid EHR Incentive Program. This session will focus on calculating the 10 percent Medicaid volume threshold, Wisconsin’s plans for implementing its Medicaid EHR Incentive Program, and the payment differences between the Medicaid and Medicare EHR Incentive Programs. Senior leaders of hospitals that have Medicaid volume at or near 10 percent, and who are participating in the strategic planning for EHR implementation in their hospitals or health systems should plan to participate in this program.
Online registration is now available for these programs at www.wha.org. If you have registration questions, contact Lisa Littel at llittel@wha.org or 608-274-1820.
Nominating Committee Announces WHA Board RecommendationsThe WHA Nominating Committee will present its report and recommendations for board members to be voted on by the membership at the Annual House of Delegates meeting Thursday, September 16 in Madison. The following individuals have been nominated to serve on the WHA Board of Directors.
John Oliverio
(2nd term)
President/CEO, Wheaton Franciscan Healthcare, Milwaukee
Michael Sanders
(1st term)
President/CEO, Monroe Clinic, Monroe
Jim Woodward
(filling unexpired term)
President/CEO, Meriter Hospital, Madison
A project that would standardize the requirements placed on nursing students by hospitals and other clinical facilities, offer a record-keeping system and provide some or most of the educational modules required of those students, was presented at the WHA Workforce Council meeting August 25 in Madison. Peggy Ose, past chair of the Wisconsin Organization of Nurse Executives (W-ONE), provided council members with an overview of W-ONE’s proposed "passport" project that would create a standard set of pre-clinical requirements for students. Modeled after work completed by the Fox Valley Health Care Alliance, the current practice of having each facility create and monitor a unique set of requirements would be replaced with a "passport" system. When students have met that standard set of requirements, they receive a "passport" good for the semester or year, accepted by all clinical facilities. W-ONE believes that the passport project would save hospitals, nursing programs and students’ time, money and human resources.
David Dies, executive secretary of the Wisconsin Educational Approval Board (EAB), met with the Council and explained the role of the EAB. The EAB has oversight responsibility of the for-profit educational programs located in Wisconsin. Increasingly visible in advertising and promotion, for-profit schools with health care programs advertise for certified nursing assistant, certified medical assistant, registered nurse and other courses. WHA members have asked questions about the oversight, cost, and quality of these programs and have voiced concern about the substantial loans that students in these programs may assume. There is detailed information about each program reviewed and approved by the EAB on their Web site at: http://eab.state.wi.us/default.asp.
Work continues on analyzing and reporting data collected from the Wisconsin RN Survey. The Department of Workforce Development anticipates that a one-page summary will be available in the next month. A limited amount of preliminary (and not yet public) information from that survey was shared with council members. Data from the Wisconsin Clinical Laboratory Science Workforce Survey was shared with the Council. These surveys show an aging workforce, targeted positions with vacancies and many predicted retirements. WHA personnel survey data collection is complete and will be reported in the annual Workforce Report published by WHA due out later this year.
President’s Column: Collaboration Cited as #1 Success FactorIn case you missed it, the senior vice president of performance improvement for Thomson Reuters (sponsor of the 100 Top Hospitals Program), had some nice things to say about hospitals located in the Midwestern U.S. in a recent Modern Healthcare column. And her focus was on collaboration as a model for accelerating clinical performance improvement.
Specifically, Jean Chenoweth noted that hospitals in the five highest-performing states—Michigan, Ohio, Wisconsin, Minnesota and Iowa—"have left previously high-performing states like California and Florida far behind." Chenoweth promises to "conduct research to learn more about the industry shift," but in the meantime hypothesizes that beginning in the early 2000s the states "consciously chose to collaborate rather than compete on quality." She noted that Midwestern hospital, health system and state hospital association leaders "courageously committed to collaborate on transparency and quality improvement to solve two intractable industry-wide problems: the prevalence of poor patient safety and unnecessary deaths in hospitals." That commitment, according to Chenoweth, led to the favorable separation of delivery organizations in those states from national counterparts.
Wisconsin has been at the forefront of the transparency and performance improvement movement. Organizations like WHA, WCHQ, WHIO and WMS have devoted substantial resources to efforts that have contributed to our state consistently ranking at or near the top of national quality report cards. But while the recognition is nice, it is also something of a calling to maintain and advance collaborative efforts in the future. WHA’s recent commitment to align more closely with WCHQ is just one opportunity to do just that.
The fact that national health reform legislation, at best, may only modestly reward value remains one of the biggest disappointments of the recently-concluded national debate. But that reality should not be an impediment for doing the right thing for our patients and our communities. And the notion that highly competitive organizations have agreed to collaborate on the most important thing they do is an excellent precursor as we establish future priorities.
Steve Brenton
President
Marriott Madison West Hotel, Madison
NOTE: Hotel reservation deadline extended until September 1
Conference registrations due: September 3
Brochure and registration information can be found online at
www.wha.org.Top
of page
Wisconsin Hospitals Community Benefits: Access to Primary and Preventive Health Services
Hospitals do what they can to move health care services out of the clinical setting into the heart of the community. Community health screenings and education classes help raise awareness of small, and sometimes, large steps that individuals can take to improve their health. When people learn more about how their lifestyle decisions affect their health, they make changes that ultimately lead to better health, which raises the health status of the entire community.
Program reaches isolated rural families
Thanks to the Shawano County Rural Health Initiative, 321 Shawano County farm families now have access to health care services they didn’t previously have.
Executive director Rhonda Strebel has worked with 750 individuals—35 to 40 percent of Shawano County’s farm population—including Amish families and Hispanic workers, all who live in isolated rural communities. The program gives them access to preventive care, health risk assessments, mental health services and community wellness groups.
Recently, Strebel performed a health risk assessment on a 60-year-old farm couple. Each was overweight and had elevated blood pressure, blood sugar and cholesterol levels, putting them at high risk for diabetes, hypertension and other disease. The pair committed to making drastic changes in their diets and lifestyles, and when Strebel revisited them six months later, the numbers were impressive.
"She lost 45 pounds, he lost 40 pounds, and they got it all under control just by making lifestyle changes," Strebel said. "That’s what’s really neat—to see people be excited about having these tests done and the changes they’ve made."
The Shawano County Rural Health Initiative began in 2004 as a $120,000 three-year pilot program, funded largely by Appleton Medical Center parent organization ThedaCare and the agricultural community. It has grown especially in the last year to encompass wellness groups, healthy cooking workshops and mental health services. As part of The Rural Health Initiative’s "Sewing Seeds of Hope," farm families are allowed four free counseling sessions with a ThedaCare Behavioral Health therapist who travels to Shawano County.
"All of these services are free to farm families, and it’s good to see health care providers working together to support this program," Strebel said.
She said this program is very doable in other communities. If the Rural Health Initiative receives the grant it recently applied for, the group will conduct surveys and gather evidence to share with other communities — evidence that shows the program has made a significant difference financially and in the well-being of farm families.
ThedaCare, Appleton
Partnering for a safer community
It is important for communities to have public and private entities work together to serve the best interests of its citizens. Community Memorial Hospital is committed to being a good corporate citizen and seeing Menomonee Falls thrive and grow. Menomonee Falls is their home community.
In 2009, Community Memorial donated a first aid vehicle to the Menomonee Falls Police and Fire Departments to serve as their new Emergency Services Command Center. The value of the donation was $85,000.
Community Memorial used a mobile clinic for many years to deliver first aid and other related health services in the community outside the walls of the hospital. It was decided that that the hospital could provide these same services more efficiently using a van and tents to provide services at health fairs, safety fairs and community events. The van gives a better ability to maneuver when participating at events.
Since the vehicle’s conversion to an Emergency Services Command Center, it has been used at many community functions, including a safety fair, Waukesha County drug collection, neighborhood watch events, Falls Fest, parades and other community events.
"Through the generosity of Community Memorial Hospital, our village has a valuable public safety tool that we otherwise would not have been able to afford," Menomonee Falls Police Chief Anna Ruzinski said. "The mobile command post allows both police and fire to work in a unified location and be better equipped to handle major incidents in the village. Furthermore, it serves as a base station and public relations tool allowing for public safety to be more visible at community functions."
Community Memorial Hospital, Menomonee Falls
Providing annual clinical breast exams
Judy Tjoe, MD, is a board-certified, fellowship trained surgeon who specializes in breast disease in the Aurora Breast Health Program at Aurora Sinai Medical Center. She dedicates her practice to the care, education and treatment of women with breast cancer, as well as those who have a high susceptibility to breast cancer, and has been actively involved in Dia de la Mujer Latina for four years, as well as other breast screening evens for underserved women. She recently received this note of thanks from the American Cancer Society:
Good Afternoon Dr. Tjoe:
I hope you are well. Thank you and Aurora for volunteering at this year’s Dia de la Mujer Latina event! You and your team provided 101 clinical breast exams to women who often do not have access to early detection resources. Of those screened, seven were referred for mammograms through Wisconsin’s Well Woman Program.
The importance of this screening resource was validated by the line of women waiting to enter the building before 8:00 am and the subsequent line of women patiently waiting to receive a clinical breast exam. Thank you for joining in the fight against cancer and supporting the priority to address the unequal burden of cancer experienced within the Hispanic/Latino community.
Sincerely,
Joenell Henry-Tanner, Vice President, Health Disparities
American Cancer Society, Midwest Division, Inc.
Aurora Sinai Medical Center, Milwaukee
2nd annual Men’s Sport and Health Expo held in Park Falls
An event geared to men—and the women who love them—returned to Park Falls. In March the Flambeau Hospital Foundation sponsored the 2nd Men’s Sport and Health Expo.
The hospital foundation’s mission is to support the vision of the hospital: "Improving the health and well being of the people in the community." This event highlighted a variety of recreational opportunities available in our area and blended together necessary health screenings to promote physical activity and wellness.
"The recreational industry combined with health care has proven to be a winning combination," stated Jane Bentz, Flambeau Hospital Foundation Coordinator.
The featured speaker at this year’s event was Jim Gantner, a Milwaukee Brewer second baseman from 1976-92. Gantner spent his entire career with the Milwaukee Brewers. He was part of the team that won the American League pennant in 1982. Gantner coached for several years after he retired and currently works for the Brewers organization. He spoke on "The Importance of Setting Goals." There was a wild game cooking demonstration with tasting.
New this year to the expo were kayak demonstrations, rod casting and lure demonstrations, "Ask the Docs," fueling performance – nutrition for active individuals, Pamida 3-point basketball shootout, animal health info, and smoking cessation information.
Other highlights of this event included free health screenings for:
• Balance
• Blood Pressure
• Body Mass Index (BMI)
• Heart Risk Assessment
• Dental information
• Flexibility
• Feet
• Glucose (blood sugar)
• Grip strength
• Hearing
• Oxygen
• PSA
• Spine
• Vision
Free CPR / including AED training was offered. All participants in the CPR training left with a free "CPR Anytime for Friends and Family" kit, valued at $50, to share their life-saving training with their neighbors, family and friends.
Sports information was offered on topics like four-wheeling, camping, cycling, golf swing analysis, grilling, guide services, fishing, hunting, kayaking, motor cross, aquatic programs, taxidermy and trapping.
There were health presentations offered by Marshfield Clinic emergency physicians Dr. Maurice Murphy and Dr. Scott Carpenter, "Wilderness Survival Tips," and new to the event this year was "Ask the Docs." Besides Drs. Carpenter and Murphy, Dr. Louay Danial and Nurse Practitioner Rick Anderson held a panel for the audience to ask questions anonymously.
Over 200 people enjoyed an afternoon of good information and good health. As a note, women were welcome to attend also.
Flambeau Hospital, Park Falls
Helping un- and under-insured women through free mammogram program
Findings of the Community Profile conducted by the Milwaukee Affiliate of Susan G. Komen for the Cure® – research underwritten by Aurora Health Care – reveal that women are putting off needed preventive breast cancer screenings due to economic hardships and changing health insurance plans with high deductibles insurance and high co-pays.
The free mammogram program at Aurora Lakeland Medical Center was established in 2004 to support preventive breast screening for women who have no insurance or the kind of plans with high deductibles and co-pays. Eligibility for these free services is based on proof of income and completion of a simple one-page form and costs are funded through the Aurora Foundation, which is supported by a combination of employee and community donations. The hospital’s breast care coordinators participate in community outreach events and distribute flyers to clinics and physician offices to promote availability of the program.
During 2008 breast care coordinators Aurora Lakeland Medical Center assisted 46 women through the program. Thirty-four received bilateral screening mammograms, seven had unilateral diagnostic mammograms, and four women had bilateral diagnostic mammograms. Six of the women received breast ultrasounds, and four underwent additional studies.
Aurora Lakeland Medical Center, Elkhorn
Aurora Midwifery and Wellness Center
The Aurora Midwifery and Wellness Center (AMWC) provides access to high-quality, holistic obstetrical/gynecological care to a medically underserved population of Milwaukee. Nearly 90 percent of patients ages 15-44 live in zip codes with the highest infant mortality rates—neighborhoods noted for housing insecurity, unemployment and poverty. AMWC addresses teen pregnancy, prematurity, access to quality care, interpersonal violence, risk assessment and infant mortality.
The nurse-midwives of AMWC engage in community-oriented primary care, reaching out to African-American and Latino populations in the schools. This outreach includes prenatal group visits every other week at North Division High School—and community clinics including Aurora Clarke Square Family Health Center and Milwaukee Health Services. Each nurse-midwife is community-based within Aurora’s integrated health care delivery system while remaining actively engaged in teaching and community-based participatory research projects in Milwaukee.
When combined with deliveries at all Aurora UW Medical Group Clinics as well as Milwaukee Health Services, AMWC’s deliveries result in fewer low birth weight babies for both adolescent and adult women.
Aurora Sinai Medical Center, 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.