September 7, 2012
Volume 56, Issue 36


A Look at Obama, Romney Health Care Plans
WHA provides side-by-side comparison

To help hospitals digest the competing plans for reforming the country’s health care system, the Wisconsin Hospital Association (WHA) developed a quick side-by-side comparison of the Obama-Biden Administration’s Affordable Care Act (ACA) and the Romney-Ryan health care reform plan.

The analysis provides key information about each plan’s position on major issues such as Medicare and Medicaid financing, the Independent Payment Advisory Board (IPAB), and the Sustainable Growth Rate among others.

Of interest is how each plan seeks to control costs in government programs. Obviously under President Obama, the ACA would continue, while Governor Romney would seek to repeal the ACA.

Both plans seek to limit the growth in Medicare. Governor Romney would do this through a defined contribution payment to beneficiaries, which would be designed to control costs through competition. Under the ACA, the IPAB would make recommendations to control program costs, but is prohibited from increasing enrollee cost sharing or otherwise modifying program eligibility and benefits to control those costs.

The plans also differ in their approach to the Medicaid program. Governor Romney has supported providing federal funds through a block grant to states, giving states greater flexibility and control over their programs. The ACA gives states enhanced federal funding for expanding Medicaid programs, and includes various demonstration projects for state Medicaid programs, but does not fundamentally change financing for the Medicaid program. (However, in separate proposals, President Obama has previously supported restructuring the matching arrangement for states.)

"We believe an informed debate about these plans should be encouraged," said WHA’s Joanne Alig, senior vice president of policy and research. "As hospitals can only expect continued fiscal pressures under state and federal budgeting, we must understand how each plan positions Medicare and Medicaid for future sustainability."

In addition to providing a high-level look at how each plan treats major issues, the analysis also indicates WHA’s positions and principles on each topic.

View the comparison at: www.wha.org/data/sites/1/finance/ACAvsRomneyRyanPlans.pdf.

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State Reports Higher than Expected Revenue Collections
Announcement is good news as deficit remains in Medicaid

On September 5, the Wisconsin Department of Revenue (DOR) reported Fiscal Year 2012 (FY12) general purpose revenue figures that exceeded predictions from earlier this year. Preliminary figures show general purpose revenue (GPR) tax collections increased 4.7 percent in FY12 to $13,514.6 million. The report covers the state fiscal year ended June 30.

The numbers are 0.9 percent ($126.6 million) higher than DOR’s May 2012 estimate. Under state law, half of the money goes into the state’s rainy day fund, which the Legislative Fiscal Bureau (LFB) indicates will bring the total in that fund to $125.4 million. The other half will go toward the state’s bottom line according to LFB.

While the DOR report does not take into account any expenditure changes that may arise, the LFB says if projected costs are not exceeded, the state will end the current two-year budget with a surplus of $274.1 million. DOA’s annual fiscal report, which includes expenditures and final accounting, will be released by October 15.

"These positive revenue numbers are very encouraging, but expenditures must also be counted," said DOA Secretary Mike Huebsch. He added, "…fiscal stewardship does not take a break. As state agencies prepare their biennial budget requests, we will ensure that agencies continue to be fiscally responsible, while providing the best possible services to our citizens."

While the overall revenue picture is positive, WHA continues to monitor the Medicaid budget. Back in July, DHS reported to the Joint Finance Committee revised projections of the savings needed in order to avoid ending this biennium with an overall Medicaid deficit. At that time, DHS Secretary Smith said while there remained an estimated program shortfall of $43.8 million, with the added savings expected from implementing plans for savings in the long-term program, DHS will be "on course to remain within" the current budgeted level.

"This is great news for Wisconsin, especially when you look at what is happening in states around the country," said WHA Executive Vice President Eric Borgerding. "Here, that budget is being balanced, and it’s been done without gutting safety net programs like Medicaid. We still have some work to do in Medicaid—reimbursement rates for hospitals and physicians are still far too low, but we are headed in the right direction, and this revenue news helps."

(See related story at www.wha.org/pubArchive/valued_voice/vv7-6-12.htm#6).

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Upcoming WHA Hospital Listening Session: U.S. Rep. Tom Petri

On the heels of a very successful "Hospital Listening Session" with U.S. Rep. Reid Ribble hosted by St. Mary’s Hospital in Green Bay, the Wisconsin Hospital Association will be holding a similar event September 18 at Holy Family Memorial in Manitowoc featuring U.S. Rep. Tom Petri.

"WHA has been very focused on connecting our hospital and health system members with timely opportunities to directly interact with their elected officials at both the state and federal levels," said WHA’s Executive Vice President Eric Borgerding. "From Telephone Town Halls to in-district listening sessions and meetings at WHA member facilities, we continue placing the highest priority on bringing our member advocates together with their elected leaders."

The Hospital Listening Sessions along with WHA’s Telephone Town Halls have been a mainstay over the past year as a means for WHA to educate and motivate hospitals on important issues. Those have included:

Additional events are also in the works with U.S. Rep. Sean Duffy among others.

The WHA Hospital Listening Sessions are intended for WHA members only. They are free, but registration is required. Register for our upcoming September 18 event with Cong. Petri at: http://events.SignUp4.com/12GRListeningSession0918.

Contact WHA’s Jenny Boese at jboese@wha.org with questions.

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Maximum Medical Record Copy Fees Adjusted Upward for Inflation
First automatic adjustment under WHA-championed law

The maximum fees that health care providers may charge under State law for providing health care records have been upwardly adjusted by 1.5 percent through June 30, 2013 to account for inflation. This is the first such inflation adjustment under the new medical record copy fee statute championed by WHA and enacted in the 2011-2013 budget last year.

Under the old copy fee statute, the fees health care providers could charge were significantly less than the cost to actually produce the copies, while under the new copy fee statute, the fees approximate the costs to produce copies and are adjusted every year in line with the Consumer Price Index (CPI).

The new schedule of permissible medical record copy fees can be found on WHA’s website at www.wha.org/data/sites/1/legal/2012copyFeeAdjustment.pdf, or in the Wisconsin Administrative Register No. 679 at: http://docs.legis.wisconsin.gov/code/register/2012/679b/register.pdf. Notwithstanding the adjusted fees, special provisions regarding copy fees for Medicaid recipients and social security disability and supplemental security income appeals and eligibility determinations still apply; those provisions can be found under s. 146.83(1f) of the Wisconsin Statues: http://docs.legis.wi.gov/statutes/statutes/146/83.

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President’s Column: A Case of Health Care Value

Bellin Health’s partnership with local employers represents a commitment to delivering value, a theme that WHA is pursuing as an essential Wisconsin economic development strategy. The article also notes that Bellin Health and ThedaCare are partnering on an ACO Pioneer Medicare model, a risk-sharing opportunity to align payment with delivery focused on outcomes.

The group wants to mimic a Massachusetts law that sets a state cap on health care spending at something at or under the average rise in state wages. The idea is to quickly force feed a dramatic change in payments away from FFS and toward payment bundles around episodes of care. Major public and private payers would "negotiate" payments with hospitals and physician groups. State-level boards (similar to ACA’s Independent Advisory Board) would monitor spending growth and take action when targets aren’t met. The nature and extent of that action isn’t known, but in Massachusetts, "budget-busting providers will be required to file plans—laying out how they’ll amend their spendthrift ways."

But the non-partisan Congressional Budget Office (CBO) begs to differ, noting on several occasions that massive Medicare spending cuts are used to finance ACA coverage increases, not address Medicare’s looming fiscal cliff. And that those cuts, largely taken from providers, "will not enhance the ability of the government to pay for future Medicare benefits."

Steve Brenton
President

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Hospitals and Health Systems Support the Guard and Reserve (ESGR) Program

At the WHA Summit in Madison on Friday, September 21, military representatives from the Employer Support of the Guard and Reserve (ESGR) program will be present as WHA President Steve Brenton signs an employer statement in support of the Guard and Reserve. We are also making this opportunity available to you. If you would like to sign a Statement of Support at the Summit, WHA staff will take a photo and provide a news release that you can share with your media and hospital employees. If you are interested, email WHA’s Elizabeth Schumann at eschumann@wha.org, and she will take care of all the details.

The Statement of Support is the cornerstone of the ESGR program’s effort to gain and maintain employer support for the Guard and Reserve. The intent of the program is to increase employer support by encouraging employers to act as advocates for employee participation in the military. Supportive employers are critical to maintaining the strength and readiness of the nation’s Guard and Reserve units.

Employers signing a Statement of Support make the following commitments to their employees:

To check to see if your organization has signed a letter of support, go to: www.esgr.mil/Employers/Statement-of-Support.aspx and select Wisconsin from the drop-down list.

To fill out the form and submit your Statement of Support online, go to: www.esgr.mil/Employers/Statement-of-Support/Form.aspx.

For more information contact Elizabeth Schumann at eschumann@wha.org or call 608-274-1820.

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CMS’s New Therapy Caps Process for Hospital Outpatient Departments

As WHA has previously alerted hospitals to, legislation enacted earlier this year temporarily extends to the hospital outpatient department setting (HOPDs) therapy caps and the exceptions process for physical, occupational and speech-language pathology therapy services. The caps/exceptions process will be in place for HOPDs from October 1-December 31, 2012. Critical access hospitals are excluded.

The Centers for Medicare and Medicaid Services (CMS) is rolling out the process in the following phases:

  • Phase I Oct 1, 2012 to December 31, 2012

  • Phase II Nov 1, 2012 to December 31, 2012

  • Phase III Dec 1, 2012 to December 31, 2012

  • See which phase your facility is in by logging onto https://data.cms.gov/dataset/Therapy-Provider-Phase-Information/ucun-6i4t. (If your NPI is not listed, you are in Phase 3.)

    This week CMS held an open door forum on the new manual medical review process covering topics such as insight on covered services, plan of care, and documentation of services, including good and bad examples of the latter. Access the CMS PowerPoint for this Open Door Forum online at: www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/Downloads/090512TherapyClaimsSlides.pdf.

    Additional resources and information on the therapy caps and exceptions process are the following:

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    Memorial Medical Center’s Hymans, Whiteaker, Set to Retire

    Dan Hymans, president/CEO, and Les Whiteaker, vice president/CFO of Memorial Medical Center (MMC) and its parent company Regional Enterprises Incorporated (REI), have formally announced their plans to retire. Hymans will officially retire on October 1, 2013. Whiteaker will drop to part-time on January 1, 2013 and officially retire on September 1, 2013.

    "Dan and Les have played a vital role to establishing MMC as a state-of-the-art, quality health care center," said Matt Anich, president of the MMC Board of Directors. "We appreciate their commitment to work with the Board through this important transition time and are confident they will leave MMC positioned for success under the new administration." Hymans came to MMC in 1992 while Whiteaker started in 1973.

    Hymans is a highly-regarded health care and community leader and an advocate for rural hospitals. He was WHA Chair in 1996 and, in total, gave nearly a decade of service to the Association. From 1999-2002, Hymans was Wisconsin’s representative to the American Hospital Association. In addition, he participated in the WHA Task Force on Access and Coverage, the WHA Foundation Board, Executive Committee and on the Nominating, Awards and Bylaws Committee.

    Of his retirement, Hymans said, "I have had the privilege of working with an extraordinary Board of Trustees, generous volunteers and wonderful medical staff in a community I’m proud to call home. I know the hospital is being left in great hands, not only because of them but because of the strong staff that works at MMC."

    Whiteaker echoed a similar sentiment, "Every day I have the pleasure of working with employees committed to providing the best care possible in a community they love. While I am excited for this next chapter of my life, I will miss the day-to-day interactions with staff and the rest of the incredible regional medical community."

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    Member News: Ministry Health Care’s Parent Organization Signs Memorandum of Understanding with Ascension Health Alliance

    Marian Health System, parent organization of Ministry Health Care, announced September 5, 2012 a memorandum of understanding (MOU) has been signed with Ascension Health Alliance of St. Louis, the nation’s largest Catholic and non-profit health system. Ministry Health Care is one of three regional health systems sponsored by Marian Health System, founded in 1989, included in the MOU.

    The MOU includes the three Marian regional health systems sponsored by the Sisters of the Sorrowful Mother: Via Christi Health in Wichita, Kansas; Ministry Health Care; and St. John Health System in Tulsa, Oklahoma.

    Ministry Health Care has a presence throughout Wisconsin and Eastern Minnesota with 15 hospitals, 46 clinics and nearly 12,000 employees. Most recently, Ministry Health Care assumed sole sponsorship of Affinity Health System located in Northeast Wisconsin.

    Over the next several months, the organizations will pursue the development of a definitive agreement and begin due diligence. If an agreement is reached, Ministry Health Care would become a regional ministry of Ascension Health and the Sisters of the Sorrowful Mother would share a leadership role of Ascension Health with four other religious congregations.

    "By joining these other religious congregations, the Sisters of the Sorrowful Mother have the opportunity to ensure Catholic health care in the United States is strong and vibrant now and into the future. A relationship with Ascension Health brings many benefits to Ministry, including greater access to capital, economies of scale and best practices, a connection to an innovative organization recognized for high level performance with a commitment to growing and diversifying and the backing of a strong, national health care system," said Nick Desien, president and chief executive officer, Ministry Health Care.

    "Ascension Health Alliance and the health systems of Marian Health share a common goal of serving all with special attention to those who are poor and vulnerable," said Anthony R. Tersigni, EdD, president and chief executive officer, Ascension Health Alliance. "This step is part of an ongoing effort to strengthen Catholic health care in the U.S. The systems are all committed to serving the community and advocating for the common good."

    Ministry Health Care would become the second health care ministry of Ascension Health in Wisconsin joining Columbia St. Mary’s in the greater Milwaukee market. Columbia St. Mary’s, with $750 million in annual operating revenue, operates four hospitals and 62 clinics serving families in Milwaukee, Ozaukee, Washington and Sheboygan counties and has been a ministry of Ascension since 1999.

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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.

    Young mother-to-be finds support for high risk pregnancy at Women’s Outpatient Center

    When Kalia Yang discovered she was pregnant with twins, she was a little uneasy. She had suffered two previous miscarriages and she knew she was going to have to do some things differently if she wanted a better outcome.

    "Because of my history, I was very concerned," said the 22-year-old mother-to-be.

    A relative referred her to the Wheaton Franciscan – St. Joseph Women’s Outpatient Center in Milwaukee that specializes in providing prenatal care to women in high risk situations. The center provides a wide range of obstetric and gynecological services from general wellness checks and screenings to advanced treatments for a variety of conditions.

    So far, Kalia said, it has made all the difference. "I have received so much more support from the Women’s Outpatient Center than any other clinic I’ve been to in the past. I’ve learned how to take better care of myself and how to be more independent."

    Kalia was coached on nutrition and the importance of breastfeeding, and she is enrolled in classes on providing a safe sleep environment and proper use of a car seat. She has also received much needed support in her effort to quit smoking, a habit she was not able to break during her prior two pregnancies. Though no doctor has told Kalia that smoking was the cause of her miscarriages, Kalia was motivated to stop smoking the minute she found out she was pregnant again.

    "The babies don’t like the smell of smoke," she said, while gently stroking her stomach.

    So far, giving up the addictive habit has been successful. But Kalia worries about whether she can sustain the effort once the babies are born. "I’ve had a few friends who started smoking again after their babies were born because of the stress," she said.

    That’s where the Women’s Outpatient Center’s "First Breath" program comes in, said social worker Anne Janisch. The smoking cessation program is just one of many resources available to women who come to the center. Mothers-to-be learn not only about the dangers of smoking and second-hand smoke, but they also learn how to recognize and cope with certain triggers that can derail their efforts to quit.

    But Kalia’s concerns went beyond her health. Her high-risk pregnancy forced her to quit her job and temporarily suspend her education at Milwaukee Area Technical College, which left her with concerns about insurance and finances. Janisch was able to put her in touch with state resources, and she now has coverage for her care.

    "I’m just so happy that the Women’s Outpatient Center is here," Kalia said.

    Wheaton Franciscan – St. Joseph, Milwaukee


    SCRMC hosts free Mom and Baby Expo

    The St. Croix Regional Medical Center (SCRMC) Birthing Center, also known as "The Birth Place," hosted its first annual free "Mom and Baby Expo" with everything "baby" all in one area in the Riverbend Conference Center in St. Croix Falls. Over 90 participants attended the Saturday morning event, held from 9 to noon.

    Attendees viewed all kinds of information, including infant massage, maternal and child health information, fitness for moms, ages and stages information, pampering for mom, "make your own baby food" demonstrations, cloth diaper sales, trendy baby gear, breastfeeding products, baby weight checks, pregnancy and infant photography, local baby crafters, free infant CPR basics, and car seat safety checks (with advance registration). Names were entered for door prize drawings once their passport form was completed and submitted. Featured were local activities for families with children such as early childhood family education, and the Family Resource Center, and light refreshments were served.

    Participants were thrilled the event was free, access was easy, and requested that the next expo have longer hours.

    St. Croix Regional Medical Center, St. Croix Falls


    Fees waived on family classes for better access to health education

    For years, Monroe Clinic Clinical Education has offered an array of "Family Series" classes for new and expectant parents. The classes offer families valuable health and safety information on childbirth preparation, infant CPR, breastfeeding and tips on helping siblings adjust to having a baby at home.

    "Hundreds of parents and families take advantage of these classes each year, but we wanted to ensure we were reaching as many people as possible who might benefit from this support. We didn’t want cost to ever present a barrier," said Vicki Coffey, director of Women Services at Monroe Clinic.

    In 2011, Monroe Clinic stopped charging for group classes. Now, parents and caretakers can attend classes like "Lifesaver Baby" or "Big Brothers/Big Sisters" free of charge. To make sure the community is aware of the programs, information and class dates are noted on Monroe Clinic’s newsletter and website, with information given directly to expectant mothers at Monroe Clinic and the Green County Health Department.

    In 2011, over 340 participants attended the free classes, and during the first six months of 2012, professional caregivers and health educators have reached nearly 200 parents and family members.

    As one participant of the "Lifesaver Baby" recently commented, "I learned so much and feel better about scary situations."

    "If waiving these fees prevents one child from a health or safety threat, it will be worth it," said Vicki.

    Monroe Clinic, Monroe


    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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