September 30, 2011
Volume 55, Issue 37


WHA and RWHC Send Joint Letter to Hill Opposing CAH Cuts
Federal deficit talks continue looking at Medicare, Medicaid reductions to hospitals

In advance of Wisconsin hospital representatives traveling to Washington, DC to participate in the American Hospital Association’s (AHA) federal deficit advocacy day on October 4, Wisconsin Hospital Association (WHA) President Steve Brenton and Rural Wisconsin Health Cooperative (RWHC) Executive Director Tim Size sent a joint letter to Members of Wisconsin’s Congressional Delegation outlining concerns over proposals that impact small, rural Critical Access Hospitals (CAHs).

"Of primary concern to WHA and RWHC are proposals that seek to eliminate or rollback the CAH designation," the letter read. "Most recently, the President proposed eliminating CAH designation for hospitals less than 10 miles from the next nearest hospital. Regardless of whether it is full repeal of CAH status or eliminating CAH status for some hospitals, the result will be significant job losses and reduced access to health care for our most vulnerable citizens."

Earlier this year the Congressional Budget Office (CBO) released a report titled, Reducing The Deficit: Spending and Revenue Options. One of the CBO’s options for savings was elimination of the Critical Access Hospital (CAH) designation. The President then proposed a package which included two options targeting CAHs. Those are: Reduce payments from the current 101 percent of reasonable costs to 100 percent; and, Eliminate CAH designation for hospitals less than 10 miles from the next nearest hospital. The WHA estimates eight Wisconsin hospitals could be at risk of losing CAH status under the latter provision.

"During a time when our economy continues to sputter, hospitals are not only a health care mainstay but an economic engine in communities spanning the state," Brenton and Size said in their letter. While proposals eliminating certain CAHs may result in a small amount of short-term "savings" to the federal deficit….[it] would devastate rural Wisconsin communities."

Additionally, WHA estimates the one percent reimbursement reduction to Wisconsin’s 59 CAHs would equal approximately $4 million annually. The WHA and RWHC continue to be concerned by this proposal and others that advocate reduced CAH reimbursements.

"We ask that you continue your strong support for the hospitals in your district by contacting your leadership as well as members of the Joint Select Committee on Deficit Reduction in opposition to these and other cuts to Medicare/Medicaid. Hospitals have already contributed their fair share," the letter closed.

WHA, RWHC along with nine Wisconsin hospital leaders will be in Washington, DC on October 4 for the AHA advocacy day fly-in. Attendees will discuss Medicare and Medicaid cuts targeting hospitals.

Read a copy of the WHA, RWHC joint letter at: www.wha.org/RibbleLetterCAH9-29-11.pdf.

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Wisconsin, Others Ask the Supreme Court to Review PPACA

Attorney General J.B. Van Hollen announced this week that Wisconsin joined 25 other states requesting that the U.S. Supreme Court address the constitutionality of the Patient Protection and Affordable Care Act of 2010 (PPACA), the federal health care reform law. The U.S. Court of Appeals for the Eleventh Circuit affirmed a Florida district court’s decision striking down as unconstitutional PPACA’s individual mandate, but upheld the remainder of the law as being severable from the unconstitutional provision. The states’ petition asked the court to review the ruling that the law was severable. The petition also argued that the law’s Medicaid expansion provision upheld by the Eleventh Circuit should be invalidated.

The White House announced that the federal government also had filed a petition in the U.S. Supreme Court requesting review of the Eleventh Circuit decision. The government’s petition challenges the ruling on the individual mandate. If upheld, the mandate would require nearly all citizens, by 2014, to buy health insurance or pay a penalty.

Regarding its request, the U.S. Department of Justice said, "Throughout history, there have been similar challenges to other landmark legislation such as the Social Security Act, the Civil Rights Act, and the Voting Rights Act, and all of those challenges failed. We believe the challenges to Affordable Care Act [PPACA]—like the one in the Eleventh Circuit—will also ultimately fail and that the Supreme Court will uphold the law."

Announcing the states’ request, Attorney General Van Hollen said, "Wisconsin expects the Supreme Court will take this case, affirm the lower courts’ decisions on the individual mandate component of the health care law, and validate our position that ObamaCare is an unconstitutional power grab by the federal government that tramples States’ rights."

The State’s petition is available here: www.doj.state.wi.us/news/files/Petition-(FINAL)-20110928.pdf. The federal government’s petition is available here: www.wha.org/legalandregulatory/US_DOJ_Request.pdf

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WHA, WMS Argue Requiring Medicaid Rates in Liability Cases Reduces Access to Care
Brief filed in Circuit Court

The Wisconsin Hospital Association and the Wisconsin Medical Society this week jointly filed a friend of the court brief in a Racine County Circuit Court case in which the Court is asking whether providers should be required to accept Medicaid rates in a personal injury action or whether they are entitled to their usual and customary rates.

Guy DuBeau, a partner with Axley Brynelson, wrote the brief on behalf of WHA and the Society. In the brief, DuBeau first points to the plain language of the Wisconsin Administrative Code that gives providers a choice of how to pursue collection: they may elect to bill Medicaid for the services provided or they may seek payment by joining the recipient’s personal injury claim. The Code necessarily contemplates that health care providers are entitled to receive their usual and customary charges out of personal injury proceeds or else that choice, including choosing to accept the risk inherent in joining an injury claim, would be meaningless.

The amici also argue that limiting health care providers to the Medicaid rate would reward tortfeasors at the expense of providers, which is bad public policy. "Providers who willingly accept Medicaid patients recognize and accept the need to provide care to the least fortunate in society," said DuBeau. "But limiting recovery to the Medicaid rate in personal injury cases would create a whole new class of patients for which health care providers would, in actuality, lose money by treating. Those costs would not just disappear; they would have to be made up somewhere else."

The brief warns that requiring providers to accept the Medicaid rates in personal injury cases would ultimately increase the cost of, and reduce access to, health care. "For every additional time a health care provider has to take on a patient on which they will lose money, that much of the costs will have to be shifted to paying customers. Health insurance will have to pay more, and health insurance premiums will be forced up. When that occurs, health insurance becomes that much more out of reach for some customers." The brief summarizes, "In short, our state, both through its Legislature and court system, has recognized that it is bad public policy to unduly increase the costs of delivering health care because to do so will ultimately deny some citizens access to that care. To not fully consider the burden on society occasioned by raising the cost of delivering health care is dangerous public policy and dangerous precedent."

Watch The Valued Voice for more information on this important case.

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Guest Column: Wisconsin Hospitals Fundraising Campaign 2011 Update
By David Olson, 2011 Advocacy Chair

As Chair of the 2011 Advocacy Committee, I wanted to update you on the progress of the 2011 Fundraising Campaign for the Wisconsin Hospitals State Political Action Committee and Conduit. Before I do that however, I want to discuss the 2011 campaign goal.

As it has done in each of the last nine years, the Advocacy Committee decided to again set a higher campaign goal for 2011. Thus, at its first meeting earlier this year, we determined the 2011 goal should be to raise $250,000.

Even though 2011 is traditionally a non-election year, the Committee strongly believed an active and vigorous fundraising campaign was necessary to begin to replenish fund balances following record disbursements from the State PAC and Conduit to candidate campaigns in 2010.

A robust campaign made even more sense to the Committee once we learned that 2011 would really turn out to be an election year, with nine State Senate recall elections occurring around the state this summer. These unprecedented elections resulted in additional disbursements that the Committee was not expecting at the beginning of the year.

As a result, and with the 2012 elections approaching, the Advocacy Committee believes that it is even more important that the Campaign meet its $250,000 goal for 2011, and is even more committed to working to ensure that that goal is met.

I also want to extend my personal thanks to the 333 individuals listed at the end of this article that have made a contribution to the Wisconsin Hospitals State PAC or Conduit in 2011. I want to especially thank individuals affiliated with WHA, as they have will have contributed more than $30,000 by the end of this year, with an average personal contribution of $1,200.

I also invite you to take a look at a snapshot of the 2011 campaign’s progress to date below and let me know as your Advocacy Committee Chair if you have any questions.

To Date:

If you would like more information about the 2011 Campaign, please contact WHA’s Jodi Bloch at 608-217-9508 or Jenny Boese at 608-268-1816.

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WHA Attends Health Insurance Exchange Listening Session

Wisconsin Hospital Association representatives Joanne Alig, WHA vice president for payment policy & reform, and Laura Leitch, WHA senior vice president and general counsel, attended a Health Insurance Exchange Listening Session in Chicago on September 26. The session was hosted by the federal Department of Health and Human Services’ Region 5 and Region 7 offices, and was open to stakeholders by invitation only.

Stakeholder organizations, including state hospital associations, listened to presentations from several federal officials working on different areas of the provisions of the Patient Protection and Affordable Care Act (PPACA) related to health insurance exchanges. The presentations focused on several sets of proposed rules released this past summer, which cover a broad range of topics such as Exchange governance, network adequacy, risk adjustment mechanisms, Medicaid eligibility and enrollment, and eligibility for the premium tax credits. Formal written comments on the proposed rules are due to the U.S. Department of Health and Human Services at the end of October.

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Care Transitions Connection
November 2, 2011

Kalahari Resort, Wisconsin Dells

Register by October 12 for Early Bird Discount - $95 per person
Final cut-off for hotel reservations: October 12

Brochure and registration information can be found online at http://events.SignUp4.com/CareTrans11-2.

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Department of Health Services Releases Reform Initiatives

Today, the Department of Health Services (DHS) sent a letter to the Joint Finance Committee describing 39 proposals designed to help the State achieve approximately $500 million in savings in the next two years.

Earlier this week, the Department had launched a website to provide information about each of its reform initiatives. Information about the DHS cost savings proposals had slowly been released through the website this week, but the full listing of reform ideas was revealed just today in the Joint Finance Committee letter.

Savings are described across four different categories of reform – eligibility, benefits, service delivery, and payment. There also is a form included on the site for stakeholders to submit comments directly to DHS about the initiatives. WHA is currently reviewing the proposals for impacts on hospitals and hospital systems. Watch for more information in next week’s Valued Voice.

This spring, WHA’s Medicaid Reengineering Group (MRG), chaired by WHA Board member Nick Desien, developed recommendations that would help the Administration find savings in the Medicaid program. At a recent WHA Public Policy Council meeting, Brett Davis, the State’s Medicaid Director, complimented the WHA MRG for assisting the Department in the process of identifying cost savings and efficiencies in the Medicaid program (see August 5, 2011 Valued Voice article).

The Department’s Medicaid reform website can be found at www.dhs.wisconsin.gov/MAreform.

The letter from DHS to the Joint Finance Committee can be found here:  www.dhs.wisconsin.gov/MAreform/PacketJFC9.30.11.pdf.

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Webinar Series Focuses on Successful ICD-10 Transition Strategies for Hospitals

Two years and counting…is your hospital on its way to ICD-10 implementation by the October 1, 2013, deadline? Do you have a strong plan, team and timeline in place to get you to declare yourself "ICD-10 ready" in time? Beginning in November, WHA is offering a monthly four-part webinar series focused on helping hospital executives and their ICD-10 team leaders understand the magnitude of the ICD-10 implementation, the financial and clinical impact of the transition on your organization, and be better prepared for on-time implementation.

The four sessions will focus on budget development and review, reimbursement changes and the financial impact of ICD-10 on hospitals, the value of strategic planning for ICD-10 readiness, and assessing your vendors for their readiness. No matter where you are on the planning timeline, participation in this series will be an important part of your transition process—both to give you the jumpstart your organization might need or as a double-check to ensure your team hasn’t overlooked something important yet obscure.

All hospital executive leaders, chief financial officers and staff, physician and nurse leaders, coding managers and other ICD-10 team leaders and members are encouraged to participate in this webinar series, or any of its individual sessions, and participate as a team. A full brochure describing the four sessions is included in this week’s Friday packet, and online registration is available at http://events.SignUp4.com/ICD10Impact11-12. An audio recording of the presentation will be available to registered attendees at no extra cost, to share with ICD-10 transition team members who are unable to participate on the scheduled dates.

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ICD-10 Impact on Technology Focus of Nov. 3 Webinar

In addition to affecting your coders, your revenue cycle and your physicians, the ICD-10 transition will significantly impact every aspect of technology in use by most hospitals. On November 3, WHA is offering a one-hour webinar to review the impact ICD-10 will have on IT systems and expose what most vendors are not talking about concerning their compliance. It will highlight the pitfalls to avoid by revealing details that vendors may choose not to disclose, including pricing, testing and third-party add-ons. The impact that this conversion will have on your existing HIM system will also be discussed, along with hidden costs of the conversion.

All hospital HIM leaders and other ICD-10 team members are encouraged to participate in this important webinar. More information and online registration are available at: http://events.SignUp4.com/OperationalICD1011-3.

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HIRSP and WHA Partner to Offer Free Educational Seminars

The Health Insurance Risk-Sharing Plan (HIRSP) and WHA are partnering to offer free educational seminars across the state on the HIRSP state and federal plans. HIRSP offers health insurance to Wisconsin residents who either are unable to find adequate health insurance coverage in the private market due to their medical conditions or who have lost their employer-sponsored group health insurance.

During the two-hour course, attendees will find out how to help uninsured patients, learn the basics of HIRSP health insurance, discover the differences between the HIRSP state and HIRSP federal plans and more. Attendees will also receive training materials and an overview of the HIRSP website, documents and applications to help explain HIRSP benefits and eligibility criteria to someone who needs health insurance. Hospital billing office staff and financial counselors will find it helpful as they work to connect patients with coverage plans.

Available sessions are:

Thursday, October 20, 2pm - 4pm in La Crosse
Stony Creek Inn
3060 South Kinney Coulee Road, Onalaska

Friday, October 21, 10am - Noon in Eau Claire
Community Auditorium at Sacred Heart Hospital
900 West Clairemont Avenue, Eau Claire

Friday, October 28, 10am - Noon in Madison
St. Mary’s Hospital Conference Room, Bay 6
(Ground Level)
700 South Park Street, Madison

Friday, October 28, 2pm - 4pm in Madison
St. Mary’s Hospital Conference Room, Bay 6 (Ground Level)
700 South Park Street, Madison

Wednesday, November 2, 10am - Noon in Milwaukee
DeWitt Ross & Stevens Metro Milwaukee Office
13935 Bishop’s Drive, Brookfield

Wednesday, November 2, 2pm - 4pm in Milwaukee
DeWitt Ross & Stevens Metro Milwaukee Office
13935 Bishop’s Drive, Brookfield

Thursday, November 3, 9am - 11am in Racine/Kenosha
Wheaton Franciscan Healthcare All Saints
1320 Wisconsin Avenue, Racine

Tuesday, November 8, 10am - Noon in Stevens Point
Oak Room at Ministry Health Care
2501 Main Street, Stevens Point

Thursday, November 17, 10am - Noon in Appleton
D.J. Bordini Center
5 Systems Drive, Appleton

Thursday, November 17, 2pm - 4pm in Green Bay
Hotel Sierra and K.I. Convention Center
333 Main Street, Green Bay

Friday, November 18, 9am - 11am in Sheboygan
Maritime Insurance Group
832 Niagara Avenue, Sheboygan

To register for a session near you, email your name, phone number, hospital name, address and preferred session date and time to info@hirsp.org.

For more information on the HIRSP program, visit http://hirsp.org.

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Wisconsin Hospitals Community Benefits: Healthy Growth and Development

Early growth and development have a profound effect on health across the life span. Developmental disabilities can often be mitigated if they are detected early. Every week in Wisconsin almost 100 infants are born with low birth weight, and about six percent of those will die before their first birthday. Hospitals are striving to decrease infant mortality by providing pre-conception and inter-conception care to those affected by poor birth outcomes.


Helping new parents begin the journey of a lifetime

After giving birth, most new mothers and babies are given the chance to rest while hospital staff sees to their comfort, meals and health care needs. For those first days, nurses, physicians and visitors come and go, fussing over the baby and offering proud parents advice and encouragement. Suddenly, the day arrives when the new family makes the transition from hospital bed to real life. It can be exciting and celebratory to welcome that precious, little person into their new home. But it can also be overwhelming when suddenly there is no call button to push and no nurse stationed just down the hall.

As Abby* prepared to take her baby boy home from Monroe Clinic’s family birth center, she was surprised her nurse invited her to return in several days for a follow-up assessment. This was her second child, but it was the first time she delivered at Monroe Clinic and was offered this type of service.

"Before, when we left the hospital after giving birth, my baby was not seen until six weeks later by a health care provider," Abby said. "This time, it was very reassuring to come back and know everything was ok. I was even able to ask questions I had about circumcision care."

The purpose of Monroe Clinic’s follow-up assessment is to provide new mothers—and fathers—a chance to return to the family birth center two or three days after discharge and meet with members of the nursing staff. They check mothers’ and babies’ vital signs and offer a physical assessment.

"We can check to see if a cesarean incision is healing properly, if there are any breastfeeding problems or if a little one is dealing with jaundice. We ask questions about nutrition, rest and indications of post-partum depression. And we listen to and address any concerns the parents may have," explained family birth center coach Marsha Lindh, RN, BSN.

The assessment is offered at no cost to parents, ensuring finances are not a barrier to the support they need to successfully adjust to home life with a newborn. Marsha explained the visit also helps bridge the gap between discharge and follow-up appointments that typically occur weeks or even months later.

"It addresses issues that weren’t present during the hospital stay and answers questions parents didn’t know to ask. Breastfeeding, sleep concerns and healing progress vary and may change dramatically once the family is home. This is especially important for moms who do not have a strong support network of friends and family, as these issues can quickly affect the mother’s and baby’s well-being."

If the assessment reveals any concerns or risks, the nurse checks immediately with the patient’s physician to ensure the mother and child receive the proper care. The nurses also encourage parents to offer feedback during the visit about their care during their hospital stay, which can reinforce effective services and identify opportunities for positive change.

*name changed to protect patient privacy

Monroe Clinic, Monroe


Traveling the long miles for quality service

Navigating through complexities and almost constant changes in her life, Roberta Walsh keeps finding her way back to Milwaukee’s Aurora Sinai Medical Center.

Roberta was a Milwaukee resident until she moved to Racine, Wisconsin six years ago. The 27-year-old single mother of five is six months pregnant and will soon be expanding her family. She receives Social Supplement Income for disability, Title 19 medical assistance and food stamps through the FoodShare program. She has been a participant in the Women, Infants and Children (WIC) nutrition and education program at Aurora Sinai Medical Center since August 2002.

Although Roberta lives in Racine, she is willing to travel the long miles to Milwaukee because of the wonderful experience she’s had in the past – both with the hospital-based WIC program and for her medical care.

As Roberta puts it, "This place is a safe haven for me. Everyone makes me feel at home. I am not judged by any of the staff because I am a young mom. I am treated with dignity and respect."

Roberta has a high-risk pregnancy that requires weekly progesterone injections, bi-weekly ultrasounds and meetings with a neurologist. Logistic Transportation, funded through the Title 19 program, provides low cost transportation for her when she has medical appointments.

"They pick me up right in front of my house and as soon as my appointment is over, they pick me up on time. Everything is made so convenient for me," said Roberta.

"I try to schedule all of my appointments on the same day so I can get the most out of each trip. The staff at this hospital understands my situation and has made it possible for me to do that. Not too many hospitals would do that for their patients," Roberta continued.

She is a strong advocate for breastfeeding. Roberta breast fed all five children and plans to continue with her sixth child.

Tonya Temple, a nutrition counselor for the Aurora WIC program, educates Roberta on the basic food group pyramid and creative ways to help her children eat healthy. Roberta has experimented with adding tuna to mac and cheese to round out the nutrition for her kids. "Tonya told me as long as I add a variety of foods from the pyramid, my kids will be alright."

Roberta also learned a creative way to encourage her son to eat vegetables. "My five-year-old loves peanut butter, but did not want to eat any vegetables. I gave him a celery stick and showed him to spread the peanut butter on it. Now it has become his favorite snack," said Roberta.

The Aurora WIC program also provides farmers’ market vouchers to participants as a way for them to include fresh and locally grown vegetable and fruits. Roberta makes good use of the vouchers.

Roberta cannot say enough about the difference the hospital-based WIC program is making in her life.

Aurora Sinai Medical Center, Milwaukee


Bringing Baby Home Online Express: Because people are busy

With work, prenatal visits with the doctor and labor and delivery classes, for many expectant parents the biggest barrier to obtaining all the information and training they need is not having enough time to schedule yet another class.

So Aurora’s Women’s Pavilion is now offering Bringing Baby Home Online Express.

The online express class was designed to respond to the busy schedules and lifestyles of expectant parents. The coursework combines web-based instruction with one condensed classroom session and was developed for pregnant women and their partners to be taken in the 6th or 7th month of pregnancy, and for adoptive parents as well.

In the online session, participants navigate through written content at their convenience, which they access through Aurora’s website. When they attend the condensed class they are able to further their knowledge (and confidence!) by engaging in hands-on demonstrations provided by the hospital’s Child-Life Specialist or Registered Nurse instructor. Topics covered include:

Aurora West Allis Medical Center


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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