August 6, 2010
Volume 54, Issue 31


Groups Focus on Turning Wisconsin Economy Around
Hospitals playing a part in crafting new approaches

This week economic development leaders from across the state convened in Appleton to begin crafting a comprehensive strategy to improve Wisconsin’s stagnant economy. It was the first of three gatherings that are part of the 2010 Wisconsin Economic Summit Series. Each summit has a specific focus with the goal of developing strategies and recommendations that will be presented to the new Governor and Legislature after the November elections. The next stop is August 26 in La Crosse, where the focus will be on the Wisconsin state budget.

The summit series has the financial support of several organizations across the state, including WHA and Aurora Health Care, and has enlisted the help of leading Wisconsin business and economic experts, such as John Torinus, Todd Berry and Tom Still. WHA serves on the summit group’s steering committee, which is developing a package or recommendations to give to Wisconsin’s new Governor and Legislature.

Last week a coalition of organizations under the umbrella of the Wisconsin Economic Development Corporation (WEDA) released a study aimed at boosting Wisconsin’s regional, national and international competitiveness. Be Bold Wisconsin: The Wisconsin Competitiveness Study, is a comprehensive and thorough (47 pages) examination of Wisconsin’s relative economic strengths and weaknesses. The study was conducted by Deloitte and Newmark Knight Frank and includes an eye-opening benchmark analysis of how Wisconsin stacks up against a handful of states recognized as leaders in economic development.

Based on those findings, and with the goal of ranking Wisconsin in the top 10 for starting and expanding a business by 2016, the study details nine actionable and measureable recommendations, including scrapping the current, state-run Department of Commerce in favor of a more independent, solely-focused economic development organization called "Accelerate Wisconsin." The study was funded by various organizations, including significant backing by WHA. WHA also served on the steering committee that helped formulate the parameters of the study.

Before these efforts began, the Wisconsin Manufacturers & Commerce (WMC) was first out of the box with its Wisconsin Jobs 2010 agenda, which focuses on growing the Wisconsin economy through controlling Wisconsin’s state budget, encouraging more private investment and reforming our legal system. Wisconsin’s largest and most influential business organization, WMC is known for laying out a specific, policy-focused agenda and pursuing it aggressively in the halls of the state Capitol. The WMC Board of Directors includes hospital leaders from across the state.

"The bad news is we are in a prolonged recession that is bucking historical trends and will take more than keeping our fingers crossed or looking to Washington to solve," said WHA Executive Vice President Eric Borgerding, who serves on the steering committees for both the Summit Series and Competitiveness Study. "The good news is there are multiple efforts underway focused on Wisconsin not only surviving this recession, but emerging stronger with a retooled approach to economic development and a focus on the future and long-term job creation. There is consensus that Wisconsin must take a new approach—recognize our current assets and continue what we do well, but rethink where we want to be 10 or 15 years down the road and realign our policies to get there. Health care is a part of this new formula, and hospitals are involved." (See related guest column on page 3 of this issue of The Valued Voice.)

WHA’s 2010 annual convention will feature a morning session dedicated to Wisconsin’s economy and state budget situation, including a reactor panel of statewide business and opinion leaders. Learn more at www.wha.org/education/convention.aspx.

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No Relief from Coding Offset to Inpatient Payments in FFY 2011
CAH assessment provisions, opposed by multi-state coalition, also unchanged

The Centers for Medicare and Medicaid Services (CMS) has released a display version of its final rule for the federal fiscal year (FFY) 2011 Medicare Inpatient Prospective Payment System (IPPS). The IPPS final rule will be published in the August 16, 2010 Federal Register.

CMS, in the final rule, makes regulatory payment and policy changes to the IPPS and implements changes mandated by the Affordable Care Act (ACA) of 2010 and the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 ("Preservation of Access to Care Act"). Highlights of the regulatory and legislative changes to the IPPS are provided below.

Major Provisions of the Final Rule

Marketbasket Update: CMS will provide a marketbasket update of 2.35 percent for FFY 2011, which reflects a full marketbasket update of 2.6 percent minus 0.25 percentage points as mandated by the ACA.

Coding Adjustment to IPPS Payment Rates: Despite strong opposition by WHA, AHA and many other associations and hospital providers, CMS has adopted its proposal to recoup 5.8 percent of the increase in IPPS payments during FFYs 2008 and 2009. CMS contends that this 5.8 percent increase can be attributed to improved hospital coding and classification of patients, resulting from the implementation of Medicare-Severity Diagnosis Related Groups (MS-DRGs) rather than real case-mix changes due to patient characteristics and treatment patterns.

CMS will reduce both the FFY 2011 and the FFY 2012 standard payment amount by 2.9 percent to achieve the 5.8 percent recoupment. These reductions will also apply to the hospital-specific rates for Sole Community Hospitals (SCHs) and Medicare Dependent Hospitals (MDHs).

The FFY 2011 2.9 percent coding adjustment will more than offset the 2.35 percent marketbasket update to IPPS payment rates, causing hospitals to experience a decrease in their overall Medicare IPPS payments from FFY 2010 to FFY 2011.

In explaining its rationale to move forward with the coding adjustment, CMS cited the Medicare Payment Advisory Commission’s (MedPAC’s) comments that noted the coding adjustments should not be considered to be payment cuts, but rather as offsets to unintended overpayments to hospitals.

In comments on the proposed coding adjustment, WHA described numerous conceptual and technical flaws in CMS’ calculation of its coding adjustment. The general conclusion was that the CMS analysis did not fulfill the legislative mandate—it did not differentiate between case-mix increases due to changes in coding behavior and case-mix changes that reflect real changes in patient characteristics and treatment patterns. WHA argued that the CMS methodology ignored factors such as changes in patient severity (due to aging of the population, increased public health problems such as obesity levels, etc.) and changes in treatment patterns (due to the introduction of new technologies, more widespread use of existing complex procedures, increased use of outpatient surgeries, etc.).

"WHA is very disappointed in the CMS decision to move ahead with this inappropriate rate cut. The economic impact of this action to Wisconsin hospitals is over $50 million in FY 2011 and with the additional proposed cut in FY 2012 and its cumulative effects over time, these reductions by CMS will end up costing Wisconsin PPS hospitals well in excess of a billion dollars over the next 10 years," said WHA President Steve Brenton. "We will work with AHA and with members of our Congressional Delegation to seek legislative address of this outrageous action."

Consideration of Costs of Provider Taxes as Allowable Costs: Despite strong opposition from WHA and others in the hospital field, CMS is moving forward with a clarification for determining which provider taxes assessed by states may be considered allowable reasonable costs and paid under Medicare. CMS is implementing the clarification based on concerns that some provider taxes may not be "related to the care of beneficiaries" and that some, if not all, of the costs of these taxes might not be actually incurred by providers. The clarification, which could affect Medicare reimbursement to Critical Access Hospitals (CAHs) as well as other providers that are paid on the basis of their incurred reasonable costs, will require Medicare fiscal intermediaries to determine if the provider taxes are allowable on a case-by-case basis, based on reasonable cost principles.

"We are very disappointed with CMS’s complete dismissal of the concerns of rural hospitals across the country as well as those expressed in a letter to CMS signed by more than 40 Members of Congress," said WHA Executive Vice President Eric Borgerding. "We are exploring our options and next steps, and we will keep our members apprised of where things stand."

Quality Measures Used for the Hospital Pay-for-Reporting Program: To receive a full marketbasket update under the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program in FFY 2011 (FFY 2011 payment determinations), hospitals will be required to successfully report data on 45 quality measures. Forty-one quality measures have been retained from the FFY 2010 program, one measure has been retired, and four new measures have been added. The new measures include two new Surgical Care Improvement Project (SCIP) chart-abstraction measures and two new structural measures related to participation in systematic clinical database registries for stroke care and nursing sensitive care. Hospitals that do not successfully submit quality data will be subject to a 2.0 percentage point reduction to their IPPS marketbasket update—the reduction factor has not changed.

Finalizing its proposal to select RHQDAPU measures for three consecutive payment years rather than one payment year in a given rulemaking cycle, CMS has adopted RHQDAPU measures for FFY 2012 through 2014 payment determinations as follows:

CMS is not adopting its proposal to require hospitals to begin submitting all-patient volume data for the 55 MS-DRGs that relate to the pay-for-reporting program quality measures. Currently, only Medicare volumes for these DRGs are displayed on Hospital Compare. CMS agreed with comments from the hospital field that this requirement would be overly burdensome for hospitals.

CMS is not adopting its proposal to add four registry topic-based measures to the program for FFY 2013 payment determinations.

HAC Payment Policy: CMS will continue its FFY 2011 HAC payment policy, using the same 12 categories as are used in FFY 2010. CMS has added five new International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes to the Blood Incompatibility category.

Outlier Threshold: CMS will decrease the outlier threshold by 0.3 percent from $23,140 in FFY 2010 to $23,075 in FFY 2011 in order to maintain estimated outlier payments at 5.1 percent of total payments under the IPPS.

CAHs—Election of the Optional Payment Method for Payment of Outpatient Services: CMS is adopting its proposal to permit CAHs that elect to be paid for outpatient services under the "optional method" to be paid under the option on a continuous basis. Current rules require CAHs to elect the option on an annual basis. Failure to make a timely election of the preferred payment method has significant consequences because Medicare outpatient reimbursement to CAHs under the optional method provides reasonable cost payment for facility costs and 115 percent of the amount otherwise paid for professional services.

Certified Registered Nurse Anesthetist (CRNA) Services Furnished in Rural Hospitals and CAHs: CMS is adopting its proposal to modify current rules to allow hospitals and CAHs that have successfully reclassified from urban status to rural status to be eligible for payment on reasonable cost for anesthesia and related care furnished by qualified non-physician anesthetists. To qualify for reasonable cost-based payment for anesthesia and related services provided by qualified non-physician anesthetists, a rural hospital or CAH cannot exceed an annual limit of 800 surgical procedures requiring anesthesia.

ACA-Mandated Changes to the IPPS

Rural Floor and Imputed Floor Budget Neutrality Adjustment: The ACA restores the budget neutrality adjustment for the rural and imputed floors to a uniform, national adjustment, beginning with the FY 2011 wage index. This modification reverses CMS’ transition to a state-specific wage index budget neutrality adjustment. CMS will apply a budget-neutrality adjustment of 0.996641 to all wage indexes to implement this requirement.

Low-Cost County Adjustment: Beginning in FFY 2011, the ACA provides $400 million over two years to IPPS hospitals (including SCHs and MDHs, but excluding CAHs) located in counties within the lowest national quartile for total Medicare Part A and Part B spending per enrollee. Using a methodology to risk-adjust Part A and Part B Medicare spending for age, sex, and race, CMS is adopting its proposal to distribute $150 million of these funds in FFY 2011 and $250 million in FFY 2012. CMS’ methodology identifies 786 counties nationally in the lowest quartile; however, only 273 of these counties contain qualifying hospitals. Based on this analysis, the $150 million would be distributed to 416 hospitals nationally in FFY 2011. CMS will distribute the funds as annual, one-time payments during each of FFYs 2011 and 2012 through each individual qualifying hospital’s Fiscal Intermediary (FI)/ Medicare Administrative Contractor (MAC). CMS did not specify the exact timing of payments. The provision has some positive impact on several Wisconsin hospitals.

Low-Volume Hospital Adjustment: The ACA requires CMS to implement a temporary change for FFYs 2011 and 2012 that would allow more hospitals to qualify for the Medicare inpatient low-volume hospital payment adjustment. A Medicare subsection (d) hospital (general, acute care, short-term hospital), including SCHs and MDHs, can apply for the adjustment if it is more than 15 road miles from another subsection (d) hospital and has less than 1,600 discharges for individuals entitled to, or enrolled for, benefits under Medicare Part A during the fiscal year (including Medicare Advantage enrollees). CMS has modified its proposal that provided a scaled adjustment based on a range of discharges and is implementing a continuous sliding scale methodology (as mandated) that will provide payment adjustments for hospitals with less than 1,600 Medicare discharges. The provision has some positive impact on some "tweener" Wisconsin hospitals.

Wage Index Reclassifications: The ACA requires CMS to restore, for FFY 2011 and thereafter, the less restrictive FFY 2008 Medicare hospital wage index reclassification average hourly wage (AHW) thresholds. Among other criteria, current policy requires that a hospital seeking a reclassification must meet a certain AHW threshold when comparing its own AHW to the wage index area to which it seeks reclassification. The ACA modified the thresholds as follows: 84 percent for urban hospitals rather than 88 percent; 82 percent for rural hospitals rather than 86 percent; and 85 percent for a group of hospitals rather than 88 percent. Current law requires that hospitals must apply for reclassifications 13 months prior to the start of a new fiscal year. Applications for FFY 2011 reclassifications were due by September 1, 2009. The ACA did not modify the statutory application deadline for the FFY 2011 reclassifications. CMS has reviewed the hospital applications for FFY 2011 reclassifications that were received by September 1, 2009 and has identified 22 additional hospitals that will qualify for reclassification for FFY 2011 based on the new thresholds. CMS is not allowing hospitals to file new reclassification applications for FFY 2011.

Medicare Dependent Hospitals (MDHs): As required by the ACA, CMS in the final rule is extending the MDH program and the special payment rates associated with the program through September 30, 2012.

CAHs—Optional Payment Method: As mandated by the ACA, CMS will reimburse CAHs that elect the "optional method" of payment for outpatient services at 101 percent of reasonable costs for facility services rather than 100 percent as proposed by CMS in its FFY 2010 rule. CMS will also reimburse for ambulance services furnished by a CAH at 101 percent of reasonable costs if the CAH is the only provider of ambulance services within a 35-mile radius.

Preservation of Access to Care Act-Mandated Changes to the IPPS

Modifications to the 3-Day Payment Window – "72-Hour Rule:" As required by the Preservation of Access to Care Act, CMS has clarified the Medicare payment policy regarding how hospitals may bill for outpatient non-diagnostic services related to an inpatient admission (other than ambulance and maintenance renal dialysis services) provided on the day of admission or during the three days (72 hours) prior to the admission. Effective for services furnished on or after June 25, 2010, such services must be bundled for payment. Outpatient non-diagnostic services that are unrelated to the hospital inpatient stay should be billed separately under Medicare Part B; hospitals will be required to attest to the fact that the services were unrelated. The law does not change the billing of diagnostic services during this period.

Final Rule Information

The IPPS final rule will be published in the August 16, 2010 Federal Register. A display copy of the final rule is available on the CMS Web site at www.cms.gov/AcuteInpatientPPS/IPPS/list.asp#TopOfPage.

CMS has also posted a fact sheets on the final rule at www.cms.hhs.gov/apps/media/fact_sheets.asp.

CMS is accepting comments related to the 72-hour rule only. Comments on the provision are due to CMS by September 28.

WHA will be providing a final rule summary and analysis in the coming weeks.

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House to Return to Vote on FMAP Extension
Vote expected Tuesday, August 10

With the Senate passing H.R. 1586 on August 5, AHA-backed legislation that includes a six-month extension through June 2011 of Medicaid’s temporary enhanced Federal Medical Assistance Percentage (FMAP) for states, Speaker Nancy Pelosi (D-CA) has recalled the House of Representatives to take up the bill next week.

The FMAP extension contained in H.R. 1586 is scaled back from the original 6.2 percent for six months to 3.2 percent for the first additional quarter (January 2011 through March 2011) and 1.2 percent for the second quarter (April 2011 through June 2011). For the same six-month period, states with high unemployment would continue to receive the additional percentage points in funding, as they do under current law. The estimated cost for this pared-down provision is $16.1 billion (from the original $24 billion). The extension will be offset through a combination of tax increases and rescissions.

The House will reconvene Monday afternoon (August 9) and a vote is expected Tuesday. The House had included an FMAP extension in it last "jobs" bill but stripped it after objections to the cost. However, this bill is fully paid for.

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Newborn Screening Fees Jacked Nearly 60%
Hike comes with no input from hospitals or payers

The Wisconsin State Laboratory of Hygiene (WSLH) has done newborn screening blood tests for many years. As established in state statutes, under "Tests for Congenital Disorders" and the related program, the Department of Health Services (DHS) contracts with WSLH to perform the newborn tests while DHS provides diagnostic, dietary, and follow-up counseling for patients with congenital disorders. Statutory authority is also given to DHS and the WSLH to determine their charges for the test and program.

The previous fee charged by WSLH for the tests was $69.50, which included $39.50 for the panel lab fee from WSLH, and a $30 panel surcharge to fund DHS’s congenital disorders program. As of July 1, 2010, the panel lab fee has been increased $19 and the surcharge has been increased $20.50, bringing the total fee up to $109—a 57 percent increase.

Because of a lack of openness in the process to set these fees, in a letter this week to agency officials WHA has asked the fee increase be suspended until adequate input is received from hospitals and payers.

State statutes that allow some agencies to establish fees for services without going through the administrative rules process were the basis for the recent and dramatic increase in the cost of newborn screening testing.

"It is disturbing that an increase of this magnitude was proposed and approved with little effort to solicit comment from hospitals, payers, and other affected organizations," WHA Executive Vice President Eric Borgerding said in the letter. "Assuming 72,000 births in Wisconsin each year, the statewide annual increase for this program will be close to $3 million—without a vote by the Legislature, adequate public notice and comment, or input from affected organizations," Borgerding added.

The fee increase related to Medicaid patients will hit some hospitals especially hard, as nearly 50 percent of Wisconsin births are paid for by the Medicaid program. Medicaid pays hospitals far less than their cost of providing care to Medicaid patients, and those unpaid costs must be recouped through higher prices charged to everyone else. Unless the Medicaid program agrees to pay for the newborn screening charges, any increase in costs for the Medicaid patients will cause an increase in the cost of health care for all those covered by private insurance.

While agencies are allowed to establish some fees without going through the administrative rule process, "...we believe that authority comes with an obligation to actively seek public comment, especially in the case of a 57 percent increase," Borgerding said.

Because the recent fee increase for the newborn screening program was not handled in this manner, WHA is making it a legislative priority next session to bring this process under the administrative rule process subject to legislative oversight and approval.

After receiving the WHA letter, DHS and WSLH called and met with WHA. Both apologized for not seeking input from hospitals and payers and started the discussion on how to improve the process in the future. Additional updates will be provided as they become available.

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Guest Column: Wisconsin’s (Non-Health Care) Economy: A New and Necessary WHA Priority
By Eric Borgerding, WHA Executive Vice President

I don’t think it’s untoward bravado to say that WHA and its members have earned the reputation of a respected voice and relied upon resource in the halls of the State Capitol in Madison. And when one takes stock of the bushels of issues we’ve grappled with in just the last 24 months (not to mention those clearly looming on the horizon), it is hard to imagine there is extra capacity to take on more projects and priorities, especially those not directly tied to health care reform, workforce shortage, HIT, Medicare cuts or the Medicaid funding deficit. But in organizations that lead, priorities are dynamic, focus is nimble and there is always an opportunity to identify a new, seemingly outside-the-bailiwick challenge.

Case in point – statewide economic development. Hospitals have a substantial effect on the state’s economy, employing roughly 113,000 people in good paying jobs and causing over $22 billion in annual economic activity. And our top national ranking in health care is critical to the quality of life we enjoy in the Packer state. But that’s not what I’m talking about. It’s becoming increasingly clear that the often touted strengths of our health care system are tied to the "health" of our non-health care economy.

A telling illustration of this connection is the state’s Medicaid program. It should surprise no one that the roles of the Medicaid program have exploded concurrently with the recession and loss of jobs in the private sector. Medicaid enrollment has grown—nearly 40 percent in the past three years—as the number of people with employer-sponsored coverage has shrunk. The cost of our burgeoning health care safety net is reflected in both its impact on the state budget (now well over $6 billion a year, up 26 percent in just the past three years) and the increasing amount of cost-shifting from providers to employers.

However, the solution to our "Medicaid problem" is not a meat cleaver to the program’s funding in the next state budget. Massive cuts will not reduce the number of people seeking/needing care and will force the transfer of even more of the state’s unpaid Medicaid costs to private employers and employees via cost shifting (which totaled well over $700 million in 2008).

And there is more at stake here than the state budget. Wisconsin’s hospitals will not be the state’s second largest job-producing industry if the private sector continues shedding good paying jobs with employer-sponsored health insurance. We will not sustain one of the top-ranked health care systems in the country if it is increasingly financed through growing government-sponsored health care programs, such as Medicaid.

While many policymakers focus on how to get more people onto Medicaid, few are posing a more essential question: How do we get people off Medicaid? How do we reduce program costs via reductions in demand while maintaining the safety-net purpose of the program? The answer is simple, but not easy—get people working again in jobs with good pay and benefits. In other words, supplant government coverage with private sector coverage, by developing and championing policies that foster and help create good paying jobs with benefits.

Though a somewhat atypical priority for WHA, we are jumping in with both feet, lending our voice and resources to the emerging efforts to refocus the state’s economic development strategies and doing our part to advocate for policies that will create jobs in Wisconsin.

Here’s what we’ve done so far:

It’s a true but underappreciated correlation—as goes the economy, so goes health care. There has never been a better or more necessary time for hospitals to engage directly in efforts to rebuild Wisconsin’s non-health care economy.

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MEB Issues Guidance on Act 382’s Physician "Duty to Report"
MEB "acknowledges the critical importance of local peer review"

The Medical Examining Board (MEB) has released guidance concerning the new physician "duty to report." 2009 Wisconsin Act 382 created the new duty, which requires a physician who has reason to believe any of the following about another physician to submit a written report to the MEB:

A physician who reports another physician to the MEB under the Act may not be held civilly or criminally liable or be found guilty of unprofessional conduct for reporting in good faith.

The Wisconsin Hospital Association wrote a letter to the MEB asking for guidance clarifying that a physician who learns about a potentially reportable act through the peer review process does not have an individual duty to report but, instead, the physician would meet his or her reporting obligation if the peer review panel reported to the MEB. The MEB agreed with that position and included the clarification in its guidance adding, "If a majority of the panel concludes that Act 382 conditions are not met, members of the minority would have no obligation to report but would be free to do so should they think that action appropriate." The WHA letter also asked the MEB to address the reporting obligation of a physician who is treating another physician for a substance abuse, psychiatric, or other issue that might affect the patient-physician’s practice. WHA asked that the reporting duty be interpreted like the "duty to warn" under current law. The MEB guidance states that, "the critical reporting requirement applies to the presence of a current danger to the public. The physician-patient in an appropriately-monitored recovery program need not be reported."

In its guidance the MEB emphasized, "This law was initiated by an MEB, all of whose physician members participate in peer review in their own institutions and who have no intent to weaken the local peer review. The MEB acknowledges the critical importance of local peer review and encourages physicians to remain active participants in it. The MEB expects the act to strengthen statewide peer review, which is the function of the MEB."

A copy of both the WHA letter to the MEB and the MEB guidance, which is in the Wisconsin Regulatory Digest that went to all licensed Wisconsin physicians, is available on WHA’s Web site at www.wha.org under the "Legal and Regulatory" tab.

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WHA Leads Statewide CLABSI Project
Expansion allows more hospitals to participate…enrollment still open

Starting in January 2011, hospitals will be required to report to the CDC the rates that patients develop central line associated bloodstream infections (CLABSI) in the intensive care and neonatal intensive care units. The CDC estimates that patients develop more than 250,000 central line associated bloodstream infections each year while in the hospital.

Infection rate information for each hospital will be posted later that year on the federal Hospital Compare web site. During the first year of public reporting, Medicare payments will be tied to hospitals for reporting infection rates, but following that first year, the payments will be tied to meeting a certain standard for infection rates.

Hospitals participating in CMS’s pay-for-performance program, Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU), will need to use CDC’s National Healthcare Safety Network (NHSN) infection surveillance database to report central-line associated blood stream infections (CLABSI) in ICUs and NICUs. The Wisconsin Division of Public Health is leading the Healthcare-Associated Infections Prevention Project to increase NHSN enrollment within the state.

WHA is leading a statewide initiative to not only eliminate central line-associated blood stream infections (CLABSI), but also implement practices to eliminate these infections. Currently 38 Wisconsin hospitals are participating in "On the CUSP: Stop BSI." Thanks to additional funding made available by the Wisconsin Division of Public Heath, WHA is able to expand this initiative and allow more hospitals to participate in this improvement project. The specific program components include implementation of the comprehensive unit-based safety program (CUSP), and activities to measure and eliminate central line associated blood stream infections (CLABSI).

"We are beginning to see payment and quality come together in a real way," said George Quinn, WHA senior vice president. "Next year, Medicare will reduce payments to hospitals for not reporting quality data. Very soon they will begin to reduce payments for not achieving certain levels of quality."

Hospitals that participate in the BSI project will receive support from WHA including content and implementation guidance and tools needed to succeed in the project. In addition, teams have the unique opportunity to share best practices among their peers

Each participating hospital will collect and report data on specific measures and implement interventions during the course of the project. Team members should plan to participate in shared learning sessions including one face-to-face workshop each year and monthly conference calls for sharing and problem solving at no cost.

WHA will be enrolling hospitals thru August 31, 2010, with an anticipated start date of September 30, 2010. This is an 18-month project. For more information on this program, or to request an enrollment packet, contact Jill Hanson at 608-268-1842 or jhanson@wha.org.

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August 12 Webinar Features Nationally-Recognized Labor Relations Expert

On August 12, nationally-recognized labor relations expert Bruce Stickler will present a one-hour webinar for WHA member hospitals focused on National Nurses United (NNU), the national nursing labor union formed in late 2009 and currently representing 165,000 registered nurses.

Learn about the NNU’s aggressive agenda, both nationally and regionally, as well as other unions’ plans to step up their organizing strategies. In this session, learn how these actions will impact your organization and how to prepare for and respond to these challenges.

All hospital CEOs, COOs, human resource leaders, nurse executives, nursing managers and in-house legal counsel should consider participation.

This webinar is scheduled August 12, from 12 - 1 p.m. for a nominal $25 fee per connection. Please register only one person per phone line and webinar connection; however, you are welcome to gather a group of any size to listen in to the presentation.

You can register online today at www.wha.org/education/nursesUnion8-12-10.aspx. For registration questions, contact Lisa Littel at 608-274-1820 or email llittel@wha.org.

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WHA and Wisconsin Chapter of ACHE Partner to Offer Category I Session

Even during this time of tightened belts and limited education and travel for many health care organizations, ACHE members have a need to continue obtaining credit for advancement and credentialing. To help, WHA and the Wisconsin Chapter of ACHE have teamed up to offer a 3-credit Category I seminar, to take place as part of the WHA Annual Convention this September.

The session, titled "Hospital of the Future: Strategies in an Era of Health Care Reform," will be presented by Robert Reece, president of the Cambridge Research Institute and ACHE faculty member. This session will occur during the WHA Annual Convention, on Thursday afternoon, September 16, from 1:30 pm to 4:45 pm. There are a variety of registration options to meet your budget, your schedule and your need for both Category I and II credit.

In addition to the Thursday afternoon seminar, on Friday, September 17, the Wisconsin Chapter of ACHE also invites you to attend the annual chapter breakfast and meeting. Finally, a 1.5 credit Category I panel discussion will also occur on September 17, at the conclusion of the WHA Annual Convention, focused on physician integration approaches. The Friday activities are all available at no cost to chapter members.

More information is available at www.ache-wi.org. Online registration for these activities is available on the WHA Web site at www.wha.org. For registration information or questions, contact Lisa Littel at 608-274-1820 or email llittel@wha.org.

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WHA Welcomes New Employees Geoffrey McAlister and Devoin Ruffin

Geoffrey McAlister
recently accepted the position of systems analyst. McAlister will assume the responsibilities of customer support on quality applications and data sourcing.

McAlister brings with him many years of health care experience and will be an asset to serving WHA members. Prior to this role, McAlister worked at Epic Systems Incorporated. He holds his B.A. in mathematics, physics, and Asian studies from St. Olaf College, along with a teaching degree in mathematics and a M.S. in mechanical engineering from the University of Iowa.

"Geoff brings with him a combination of health care experience and strong analytical background. Most recently, he was at Epic as a technical services representative where he worked with numerous health care clients regarding their software needs, " said George Quinn, WHA senior vice president. "We are fortunate to have him with us."

Devoin Ruffin recently accepted the database administrator position with WHA Information Center. Ruffin will assume the responsibilities for the collection and dissemination of hospital and free-standing ambulatory surgery center data. He will also assist in the installation, maintenance and upgrades of WHAIC’s hardware and software technologies.

Ruffin brings more than 15 years of computer technology experience and has a proven commitment to serving customer needs. He holds an associate degree in programming analyst along with many professional certifications in systems language, databases, software and networks. Ruffin served in the military as an Army airborne ranger for 3 ½ years. Prior to that he worked with Stress Photonics and Ruffin Technologies as a consultant.

"I am excited about the opportunities this holds for Devoin to further enhance WHAIC technologies and processes for the collection and dissemination of data," said Julie Callies, director of the WHA Information Center.

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Workshop to Focus on Collaboration of Finance, Nursing Leadership & Quality to Meet Payment Reform Challenges
Save-the-date: October 19

WHA is planning a one-day workshop on October 19 to provide education and practical takeaways on topics specifically related to payment reform—and how finance and quality staff can work together to meet the challenges of payment reform. The idea for the workshop is to explore the potential impact of non-payment for adverse events, quality and value-driven reimbursement models, increasing attention on measurable improvement, and the impact on the bottom line.

Attendees will gain an understanding of the importance of the CFO/CNO/QI leader working relationship, an understanding of how quality improvement projects link to the key organizational strategies and initiatives, and practical tools to determine cost savings as a result of improved quality or patient safety. The intended audience for this workshop is quality improvement leaders, chief financial officers, and chief nursing officers—although anyone with an interest is welcome.

Mark your calendar for Tuesday, October 19. Full information, including location, will be available in late August.

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Medicaid to Implement Prior Authorization for Advanced Imaging
WHA comments on draft guidance

The Wisconsin Medicaid program will implement a new prior authorization requirement for most advanced imaging services beginning October 4, 2010. Prior authorization will be required for advanced imaging services provided in both outpatient hospital and non-hospital settings, but will not be required during an inpatient stay, when the patient is in observation status, as part of an emergency room visit, or when provided as an emergency service. Working with members of its Council on Finance, the Wisconsin Hospital Association submitted comments to the Wisconsin Medicaid program asking for additional details in the program’s draft guidance implementing the new requirement.

The draft guidance identifies the reasons for the new prior authorization requirement as the following:

Some Council on Finance members questioned the need for the new prior authorization requirement given that the very low reimbursement rates in the Medicaid program make it unlikely that many providers are ordering medically unnecessary tests. Some members were concerned that the increased administrative burden associated with the prior authorization requirement with the low reimbursement rates could cause excellent providers to walk away from the program, reducing the number of tests by reducing access to services for the Medicaid population.

In its letter, WHA asked the Medicaid program to define a number of the terms used in the draft guidance. For example, "medically urgent" and "emergency" services have very different prior authorization processes and providers need to know which process to use. WHA also questioned the timeframes outlined in the draft document. The document states that MedSolutions, the company that will administer the prior authorization program, will make a decision regarding a prior authorization request within 20 days. The draft document also states that MedSolutions is frequently able to make an immediate prior authorization determination. WHA asked for the standard on which the Medicaid program will be evaluating the performance of MedSolutions.

WHA asked the Medicaid program to monitor implementation of the requirement closely to ensure that the program was not affecting access to care. WHA also said that it will ask its members to continue to provide comments on the program throughout the implementation process. A copy of the WHA letter is available on the WHA Web site at www.wha.org/priorAuthComments8-2-10.pdf.

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Additional Federal Dollars Awarded for Rural Broadband
Wisconsin receives another $65 million to expand high-speed Internet access

As part of $1.2 billion in federal stimulus grants for broadband access announced this week, Wisconsin will receive another $65 million for 13 expansion projects around the state. Wisconsin received $25 million in an earlier round of awards last month. Additional details on these projects can be found at: www.link.wisconsin.gov/lwi/default.aspx?page=19&bhcp=1.

Included among the goals of the American Recovery and Reinvestment Act (ARRA) was the expansion of broadband access to un-served and underserved communities across the U.S. and billions of dollars were made available in the form of grants and loans to support the various infrastructure projects necessary to reach that goal.

Significant community benefits can be expected from the implementation of ultra high-speed broadband, including improved public safety services, economic development efforts, transportation and educational programming.

As previously reported in the June 18, 2010 edition of The Valued Voice, a statewide initiative is underway known as LinkWisconsin. The most significant efforts of this initiative are to map where broadband access currently is and isn’t available and to plan for where future coverage needs to be.

Among the next steps already in progress are identifying, consulting and engaging representatives from key Wisconsin stakeholders in the process. If you or members of your facility are interested in participating in efforts relating to improving broadband access across the state, contact Gary Evenson directly at gary.evenson@wisconsin.gov. Periodic regional workshops and meetings are planned.

Ongoing updates are available at www.linkWISCONSIN.org.

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WHA’s Improvement Forum for QI Managers Prove Successful

In January, WHA quality staff launched a monthly webinar series aimed at quality improvement (QI) managers, department leads, and team facilitators. The design of the 30-minute noon-time sessions is intended to introduce specific topics that relate to enhanced QI success in hospitals—both for those who may not be familiar, as well as to provide additional information and resources to those who have begun adopting the practices.

"We typically have at least 50 hospitals represented on each monthly forum," according to Stephanie Sobczak, WHA QI manager. "Often we hear from hospitals how they have used these sessions for group learning and discussion so, as intended, there is just enough information provided for hospitals to decided if the practice is needed, should be enhanced, or might be taken to their quality councils for further discussion," according to Sobczak. "This is exactly what we hoped for."

Topics have been gleaned from the 2009 QI manager survey and their specific requests for more information. So far this year, Improvement Forum topics have included project management in QI, working with resistance to change, and scorecards & dashboards. The next Improvement Forum is July 19 on the topic of "Making the Business Case for QI Initiatives." Registration is free.

The Forums are made possible through the Wisconsin Aligning Forces for Quality grant, a project of the Wisconsin Collaborative for Healthcare Quality, the Wisconsin Hospital Association and other organizations. A calendar of Improvement Forum dates and topics is located on the WHA Quality Center Web site at www.whaqualitycenter.org/Links.aspx?item=LearnOpp or contact Stephanie Sobczak, WHA QI manager, at ssobczak@wha.org or 608-268-1847 for more information.

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Wisconsin Safety Council Offers Behavioral Screening and Intervention Symposia

The Wisconsin Safety Council is offering four free, regional breakfast symposia for health care purchasers, payers and providers on behavioral screening and intervention (BSI) services. These services have the potential to lower health care costs and improve employee productivity when systematically delivered in health care settings. BSI includes delivery of evidence-based, widely-recommended interventions for tobacco use, excessive drinking, drug use, and depression, which often cause chronic illness, injury, disability and high health care utilization. At the symposia, business and health care leaders will discuss what BSI is, how BSI can be delivered efficiently in busy health care settings, and why employers should have BSI as a health care benefit for their employees.

Symposia will be offered in Neenah on August 25, Wausau on August 27, Milwaukee on September 10, and Madison on September 14. Go to www.wischamberfoundation.org/WCS/pdf/BehaviorAssessmentSymposium.pdf for more information.

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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.

Heart attack and stroke prevention screening

In recognition of the fact that this year ten million Americans will suffer from a disease they could have prevented, Rusk County Memorial Hospital offered noninvasive screening tools to the community for a minimal fee. They included:

  • Carotid Screening - Ultrasound used to detect stroke-causing plaque
  • Ankle-Brachial Index - Ultrasound used to detect Peripheral Vascular Disease in the pelvis or legs
  • Cardiac Scoring - CT scan used for non-invasive evaluation of heart vessels (minimal radiation exposure involved)
  • Abdominal Aorta Screening - Ultrasound used to detect an Abdominal Aorta Aneurysm

If a community member had a history of high blood pressure, high cholesterol, heart attack, stroke, diabetes, is over age 40 or smokes, they were invited to participate in our vascular health screening. There was no fee for the screening test(s) and only a minimal charge for the result interpretation by a radiologist. Participants received a letter regarding results of the screening within a week. Sixty-six exams were completed on the 20 people who took advantage of this offer, which is planned to be repeated in the near future.

The hospital’s goal is to help our community become healthier through the prevention of disease. By participating in the risk assessment, the participants were evaluated and provided with information to prevent a silent killer from taking control of their lives.

Rusk County Memorial Hospital, Ladysmith

‘The price was right’: Free vascular ultrasound prevents likely stroke

Laverne Falkenberg felt perfectly fine when he went with his wife to Luther Midelfort’s annual Healthy Heart Fair at Oakwood Mall in February 2009. But a simple questionnaire Falkenberg answered at the fair identified risk factors for vascular disease and prompted him to sign up for a free screening.

"I just thought it wouldn’t hurt to have it checked," said Falkenberg. "And the price was right, I suppose. It was free."

Atherosclerosis is a vascular disease in which plaque builds up in the arteries that carry oxygen-rich blood to the body. The goal at the Heart Fair was to identify community members who might be at risk for this frequently undiagnosed disease. While they may not have symptoms, they may be "moments away from a stroke or lethal abdominal aortic aneurysm," explains Dr. Steve Folz, a Luther Midelfort radiologist. "Others might be limited by circulatory disease in their legs that limits their walking and lifestyle."

Because vascular screenings require special equipment and additional time, the screening took place the following weekend at Luther Midelfort, which is accredited by the American College of Radiology. When Falkenberg arrived, the radiology team was ready to volunteer its time and tools to be sure he and more than 20 other patients had access to the best-quality ultrasounds. These noninvasive scans identify blockages in a patient’s circulatory system.

For Falkenberg, the image was clear. He had 95 to 100 percent blockage of his carotid artery and was at risk of a massive stroke. The results led to an evaluation by Dr. Thomas Carmody, a Luther Midelfort cardiovascular surgeon, and a subsequent surgical carotid endarterectomy to remove the plaque from Falkenberg’s artery.

"He didn’t have a stroke," Folz says with satisfaction. "That’s the beautiful thing — that we were able to detect his disease before anything worse happened."

In 2009, Luther Midelfort — part of Mayo Health System — provided nearly $40,000 in community benefits through vascular screenings. And in 2010, Falkenberg again attended the Heart Fair, this time encouraging others to be screened for vascular disease.

Luther Midelfort, Eau Claire

HeartAware

According to the Wisconsin Department of Health Services, heart disease is the number one cause of death in Wisconsin and stroke the number three cause of death. Both of these cardiovascular diseases can be prevented. One of the ways that Affinity Health System is targeting this important issue is to provide HeartAware, a free risk-assessment tool that assesses and identifies potential risks of heart disease.

"This free assessment tool is an excellent resource for community members concerned about their risk for heart disease due to family history or other risk factors associated with heart disease," said Jody Andropolis, RN, clinic manager, St. Elizabeth Hospital Heart, Lung & Vascular Center. "Individuals who are identified as high risk are eligible for a free lipid panel as well as a free visit with a nurse practitioner to further assess their risk factors."

Daniel Neufelder, president and CEO of Affinity Health System spearheaded the project in 2007. The 10-minute online test will tell you how many risk factors you have. If you have two or more risk factors you are eligible to receive a free screening by a cardiac clinician at the Affinity Heart & Lung Centers. You will also receive heart healthy tips for prevention and wellness. Since the program began in 2007, there have been 2,478 hits to the HeartAware questionnaire, 490 deemed at risk and 317 patients who accepted the offer and have taken advantage of the opportunity to come in for a screening.

St. Elizabeth Hospital, Appleton

Hospital helps fund stroke education

In August of 2009, it was just another summer day for Patricia Black of Darlington until she started feeling confused, had trouble walking and had a strange honeycomb like haze over her right eye. Just earlier that day, Pat had heard an ad on a local radio station describing the symptoms of a stroke and how they urged it was a medical emergency. Immediately Pat’s husband took her to the emergency room of Memorial Hospital of Lafayette County (MHLC) for treatment. Pat’s husband recalled that it took just minutes for the ER staff to recognize that she was having a stroke and to implement the appropriate testing that was needed. Pat received a CT scan right away and the quick results confirmed the outcome that Pat’s family had not hoped for. Since Pat and her husband could recall the exact time when her symptoms began and she received medical treatment within the three-hour window of opportunity, Pat was eligible for the blood clot busting drug that can reverse the devastating effects of a stroke. Pat was able to receive tpA administration at MHLC and her condition was continuously monitored as she was transferred to an urban Madison hospital.

Pat recalled "within two hours of this all, I was back to normal. Dr. Solverson and the staff of MHLC were wonderful!"

What Pat and her family didn’t realize, was that just 10 months before this happened, MHLC was awarded grant funding to expand upon their stroke education for staff and community. MHLC opted to match those funds for extras such as billboards, giveaways and the very radio ad that Pat had heard on the day of her stroke, about the importance of knowing the early warning signs and symptoms of stroke.

Pat and her family now know that without MHLC being so close to home, her medical outcome may not have been the same and it is so important to have access to the kind of quality health care the Memorial Hospital of Lafayette County can provide. They really do "treat you like family"!

Memorial Hospital of Lafayette County, Darlington

Free heart and vascular screenings

UW Health and Reedsburg Area Medical Center joined together in April of 2010 to help area residents take better care of their heart. Free screenings were offered as well as information to help reduce the risk for cardiovascular disease.

Free screenings for Peripheral Arterial Disease, commonly known as PAD were offered for those between 50 and 70 years old, this screening could help determine whether the participant was at risk for heart disease.

Blood Pressure Screenings were offered also—no registration was necessary

Opportunities were also offered to give participants a chance to talk with a UW Health Cardiologist about heart and vascular concerns during education sessions

The following educational sessions were offered: Peripheral Arterial Disease—What is it and am I at risk? presented by Mark Sasse, MD, UW Health Cardiologist; as well as Taking Charge of Your Health to Prevent Heart Disease, presented by Kjersten Busse, Clinical Nurse Specialist

It’s estimated that 10 million people are currently affected by PAD, and many may not know it. Reedsburg Area Medical Center & UW Health joined together to offer this free community event!

More information on PAD can be found by visiting www.uwhealth.org/heartandvascular.

Reedsburg Area Medical Center, Reedsburg

Edgerton Hospital offers free compression only CPR training

Sudden cardiac arrest kills 1,000 people a day in the U.S. or roughly one person every two minutes. Would you know what to do if you saw someone you love affected? Edgerton Hospital and Health Services was proud to partner with St. Mary’s Hospital, Channel3000.com and the American Red Cross to offer free compression only CPR training to the community as part of Hands on Hearts.

During this event, we had nearly 70 community members stop into our lobby for the free 15-minute training session. Our team taught these participants a skill that when performed, can mean the different between life and death. In fact, when compression only CPR is used on a victim of cardiac arrest, the chance of surviving increases three fold! If we made a difference in the lives of these 70 individuals, our time was well spent!

Edgerton Hospital and Health Services, Edgerton

Project ADAM

Just imagine ...

You’re 16, in great physical shape and enjoying some warm-up time before your cross country practice. Suddenly, after running just one lap, you feel really awful. When you go indoors to call mom for an early ride home, you drop to the floor, slip into a seizure and stop breathing.

You are a 41-year-old teacher, playing in your elementary school’s annual alumni softball game. You are proud that you’ve managed to stay in better shape than many of your friends. But, right in the middle of the game, your heart stops – and you collapse.

You are 65, watching your granddaughter’s high school basketball game. You’re applauding. You’re jumping up and shouting. You’re smiling and laughing and having loads of fun. Then you fall forward. Your heart isn’t beating, your face is blue.

These snapshots are from real experiences. Each story is about a Wisconsin resident who was saved while in a school served by Project ADAM (Automated Defibrillators in Adam’s Memory). Project ADAM began in 1999 after a series of sudden deaths among high school athletes in southeastern Wisconsin. Many of these deaths appear due to ventricular fibrillation. After Adam Lemel, a 17-year-old Whitefish Bay, Wis., high school student collapsed and died while playing basketball, Adam’s parents - Patty Lemel and Joe Lemel - along with David Ellis, a childhood friend of Adam’s, collaborated with Children’s Hospital of Wisconsin to create the program in Adam’s memory.

More than 2,000 young people have a sudden cardiac arrest every year. A person’s chance of surviving drops by 7 to 10 percent for each minute a victim has to wait before his or her heartbeat is restored. If defibrillators are used within the first few minutes of a collapse, the survival rate can be as high as 70 percent. On-site public access defibrillator programs often mean the difference between life and death, even in areas with the fastest-acting ambulance and emergency response services.

The Acevedo family of Milwaukee understands the importance of public access defibrillator programs (PAD). In January 2010, their 11-year-old granddaughter, Maria, experienced a cardiac arrest in her classroom at Milwaukee Public School’s Grant Elementary. Thanks to collaboration with Project ADAM, as well as other community partners, Grant School’s AED team was able to respond to the situation immediately by giving CPR and using their AED to shock her heart back into a regular rhythm. Marie was then taken to Children’s Hospital for further care. She now is healthy and happy. The Acevedo family remains forever grateful the school was prepared to respond appropriately.

Grant Elementary is one of the many MPS schools that developed its PAD program through funding and assistance from Project ADAM. There are more than 1,800 MPS staff members certified to use the defibrillators. Five lives have been saved at MPS schools as a result of PAD programs.

Project ADAM provides everything schools need to plan, fund and develop their program. Children’s Hospital and Health System creates and supports numerous community programs that benefit the health of our children. Project ADAM is critical in ensuring the health of our community.

Program highlights from 2009 include:

    • More than 3,000 schools across the country benefit from Project ADAM resources, including training grants, consultations and step-by-step instructions for creating and growing PAD initiatives.
    • Two new state affiliates - Alabama and Illinois - were fully indoctrinated into the program.
    • An analysis of the program’s recently-released training support video revealed a statistically significant increase in viewers’ knowledge about sudden cardiac arrest and reported willingness to respond to an emergency as a result of viewing the video.
    • Project ADAM forged a new partnership with a physician at the University of Wisconsin – Madison to study the prevalence of AEDs in Wisconsin high schools.
    • The National Institutes of Health now is helping to promote Project ADAM’s program and mission by sharing the program’s resources through their education website.
    • Most importantly, the program helped to save 15 lives (seven adolescents and eight adults) in just one year (Aug 2008 - Aug 2009).

Children’s Hospital of Wisconsin, 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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