February 12, 2010
Volume 54, Issue 6
WHA Establishes Member Medicaid Advisory Group
WHA has created a new member Medicaid Advisory Group to interact more directly with the Department of Health Services (DHS) on Medicaid issues. The new committee will provide timely input into the many medical assistance (MA) topics that are in play throughout the year. The group is comprised of members representing all areas of the state and various disciplines within each organization. It will be chaired by Jim Woodward, CEO, Meriter Hospital in Madison.
In 2009, the state passed a hospital assessment program, with the help of WHA, which significantly improved Medicaid payments to Wisconsin hospitals. This new program has dramatically changed the Medicaid landscape with regard to payment methodologies, complexity and the desire for more transparency, an increased need to be more involved in state plan amendments, the changing role of managed care, technical CMS issues like the Medicare upper payment level and actuarial soundness, and a myriad of other MA topics.
The list of Medicaid issues has grown substantially over the past two years with additional major developments like the CAH assessment and the creation of a new Medicaid Basic plan program in the works for 2010. WHA will take a comprehensive and focused approach to actively manage this list. A single point of focus is necessary because there are many interrelated issues. The new Medicaid Advisory Group will be integral to that focus.
DHS staff has agreed to monthly meetings with the new WHA Medicaid Advisory Group as a way to increase transparency and to include more input from the hospital industry into the many Medicaid issues that require action throughout the year.
The first meeting of the group with DHS staff will occur in early March.
Top of page
In 2009, the Wisconsin Division of Public Health (DPH) in collaboration with the Wisconsin Hospital Association and MetaStar responded to a Center for Disease Control and Prevention (CDC) grant opportunity to create a Healthcare Associated Infections (HAI) Prevention program in Wisconsin. The $979,000 grant will be used to first address HAIs in the hospital setting, but will be extended to include ambulatory surgery centers, long term care facilities and dialysis centers if additional funding becomes available in the future.
"All Wisconsin hospitals support infection control functions aimed at detecting and preventing infections within their organization," according to Dana Richardson, WHA vice president of quality initiatives. "The infusion of this funding at the state level will facilitate progress toward a comprehensive surveillance and prevention model in Wisconsin that leverages the resources and expertise of multiple organizations."
DPH created the Wisconsin HAI Multidisciplinary Advisory Committee to oversee the project, with membership from the Department of Health Services, state quality improvement organizations including WHA, and infection control professionals from multiple hospitals and health systems. In November, the committee began to develop a statewide HAI prevention plan with measurable two and five year goals.
Key elements of the plan include:
Surveillance and Reporting – Statewide standardized HAI surveillance is necessary to measure baseline and progress to HAI reduction goals. To accomplish this, hospitals will be requested to begin voluntary reporting of HAI information to the CDC National Healthcare Safety Network (NHSN). DPH will offer education and other technical support to hospitals as they make this transition to the NHSN system.
Prevention – The Wisconsin HAI prevention plan will leverage two existing collaborative improvement projects in the state and add one new focus area.
CUSP: STOP BSI – The WHA CUSP: STOP BSI project is part of the first national quality improvement collaborative lead by the Johns Hopkins Quality and Safety Research Group, the Michigan Health and Hospital Association Keystone Center, and the American Hospital Association Health Research and Education Trust. The three-year project to reduce central-line associated blood stream infections (CLABSI) includes hospitals from 28 states with additional states entering the project in 2010. Currently 24 Wisconsin hospitals are participating in the collaborative. The CUSP: STOP BSI project includes practice improvement strategies to reduce central line associated blood stream infections and improve the culture of safety at the unit level. Under the HAI Prevention Project a minimum of seven additional hospitals will be invited to enter the project in May-June 2010.
MRSA Prevention Project – At this time, 14 Wisconsin hospitals are participating in the MetaStar collaborative to reduce methicillin-resistant staphylococcus aureas (MRSA) infections funded through the CMS 9th Scope of Work. This project will expand to include six additional hospitals.
SSI Prevention Project – A new surgical site infection prevention project will be initiated in 2010 aimed at infections contracted during hip and knee procedures. A minimum of ten hospitals will be recruited to participate in this collaborative.
HAIs have been identified as one of the top ten causes of death in the United States despite more than 40 years of infection control practices in individual health care organizations. In addition to the morbidity and mortality associated with HAI, the cost associated with their treatment is staggering and viewed by many as waste in the health care system. For example, the average added cost of treating an ICU patient that contracts a central-line associated infection is $42,000.
"We know that many health care providers in Wisconsin have focused their efforts on reducing and preventing infections, but there is always more that can be learned and shared that will help us address this serious problem," said Seth Foldy, MD, Wisconsin State Health Officer. "This new partnership will enhance our efforts to increase patient safety."
Top of page
At a meeting in Edgerton, Sen. Judy Robson and Rep. Kim Hixson learned firsthand how Medicaid cuts will affect health care in rural areas. Hospital leaders at the meeting voiced their concern that the CAH Medicaid reimbursement cut effective January 1 will negatively impact access to some critical medical services now offered in their communities. The state’s 2009-2011 budget provision calls for the Wisconsin Department of Health Services to cut Medicaid payments to CAHs by $18 million, or 10 percent across the board. The Edgerton group discussed possible options to the 10 percent cut, including creation of a new assessment for CAHs modeled after the program now in place for PPS hospitals. The cut permanently changes CAH reimbursement from 100 percent to 90 percent of cost, a reversal of state policy never approved by the Legislature.
"In my opinion, it seems quite counterproductive to cut payment to health care providers when even more people are in need of health care assistance, especially given ‘the great recession’ that the country and the State of Wisconsin are in the midst of," said Jim Pernau, CEO, Edgerton Hospital and Health Services. "Many critical access hospitals are already struggling to stretch very limited financial resources to meet the increasing need to provide care to a growing Medicaid population."
In addition to Pernau, Edgerton Hospital Board Chair Dorothy Gunderson and board member Sue Larson attended the meeting with Sen. Robson and Rep. Hixson. They also emphasized the heavy toll the recession is taking on rural communities. Over the past year, charity care has risen 24 percent, bad debt has climbed 14.5 percent, and nearly half of rural Wisconsin hospitals either lost money or barely broke even in 2008. Every person who arrives at a Critical Access Hospital is cared for, regardless of personal or financial circumstances.
Over the past few weeks, more than 30 of these meetings have occurred between CAHs and their elected representatives.
Top of page
The Assembly and Senate Health Committees debated a new health care program for low-income adults without dependent children this week. Known as BadgerCare Plus Basic, the plan offers limited benefits and is designed for people who are on the waiting list for the BadgerCare Plus Core Plan.
As previously reported, the waiting list for the Core Plan is the result of overwhelming interest in that program; 63,000 people are enrolled in the Core Plan causing the Department of Health Services to suspend enrollment in order to comply with federal "budget neutrality" requirements. The Basic Plan will allow persons on the waiting list for the Core Plan to have access to a minimal form of coverage until space becomes available in the Core Plan. The waiting list is now up to 25,000 people with thousands of applications pending review. An average of 1,500 application requests have been received each week since the waitlist began on October 9, 2009.
In written testimony (www.wha.org/governmentRelations/pdf/basicTestimony2-11-10.pdf) on Assembly Bill (AB) 697 and Senate Bill (SB) 484, WHA recognized Wisconsin’s laudable record of providing health insurance coverage for its citizens, noting that Wisconsin has the second highest percentage of insured residents in the country and, according to DHS, 98 percent of Wisconsin residents have access to coverage. WHA also noted that Wisconsin’s hospitals have played a key role in helping achieve that status. The Disproportionate Share Hospital program and funding from the hospital assessment allowed expansion of Core beyond Milwaukee to the rest of the state.
Specifically addressing the Basic proposal, WHA commended the Governor for continuing to seek innovative means of extending health coverage to the uninsured, especially to those who would otherwise have no (or no better) options. WHA reaffirmed its support of a balanced public/private approach to expanding coverage. While supporting Basic in concept, WHA stressed that the new program must be designed and implemented as a temporary safety net for those who genuinely have no alternatives.
WHA expressed concern that the current Basic proposal lacks key details and leaves too many important decisions outside the purview of the Legislature.
Another concern expressed by WHA was that Basic, as proposed, would cap provider reimbursement rates at no more than Medicaid rates. The Senate Health Committee amended the proposal to require reimbursement rates under the program to be at least Medicaid rates, except for Federally Qualified Health Centers (FQHCs) and hospital outlier payments. The Senate amendment also requires the Department of Health Services to report quarterly to the Joint Committee on Finance information related to the solvency of the Basic program and any changes in premiums, benefits, and provider reimbursement rates implemented by DHS. The bill passed on a party-line vote.
WHA continues to be concerned that eligibility verification process for the Core Plan and the Basic Plan will not ensure that space in those programs is reserved for those who have no or no better alternatives and could "crowd out" employer sponsored health insurance. WHA will continue to work with the Legislature and the Administration to find ways to address the issue of access to affordable health care.
Having passed out of committee, SB 484 is available for scheduling for a vote before the full Senate. No further committee action has been scheduled on AB 697. Identical versions of the proposal will need to pass both houses before it can be forwarded on to Governor Doyle for his consideration.
Top of page
The Chicago Tribune last week labeled it "a disastrous decision." The Illinois Supreme Court’s 4-2 ruling that scuttled that state’s five-year-old cap on medical malpractice awards was further described as creating a "health care crisis" that will be almost impossible to "fix."
When the Wisconsin Supreme Court narrowly voted to overturn this state’s non-economic damages cap in 2005 its primary argument was that the dollar amounts were inadequate. The Illinois Supreme Court’s decision found that the caps violated the state constitution’s separation-of-powers clause. In other words—the Legislature shouldn’t be telling the courts what to do. The significance of this ruling means that the Illinois Legislature can’t revisit the cap dollar thresholds (like Wisconsin) but instead would need to amend the state constitution—a most difficult task. Importantly, a dozen other Courts across the country have repudiated the separation-of-powers argument.
The Tribune editorial last week noted that the Illinois Legislature "acted appropriately to a crisis" in 2005, a time when medical malpractice premiums were skyrocketing because "insurers were afraid to do business here." Malpractice coverage was "especially egregious for doctors in riskier specialties such as obstetrics and neurosurgery." Access to care, especially in rural Illinois, became a huge issue, thus prompting a rare display of bi-partisan agreement. That disappeared last Wednesday when the decision broke along partisan lines (the four Democrats voted to overturn the law and the two Republican justices voted in the minority).
Wisconsin is blessed with a relatively favorable and balanced tort environment, the foundation of which is the Injured Patients and Families Compensation Fund and fair limits on non-economic damages that prevent runaway jury awards. The tort environment has been an important recruitment tool for a state that must import physicians in order to adequately staff our hospitals and clinics.
The lesson to be learned from Illinois—Supreme Court elections matter.
A further lesson to at least be argued is the need to nationalize tort reform as part of a larger health reform measure, something that the majority in Congress has failed to do because of the strong hand of the trial bar. One national study found that tort reform could save the nation $54 billion in medical costs due to reduced defensive medicine costs over the next decade. That’s real money that could help pay for coverage expansion. And adding meaningful tort reform to a comprehensive initiative might garner Republican support for what has been a partisan effort.
Top of page
Still Time to Register
Reminder: Deadline for special room rate at The American Club: February 19
For more information and online registration go towww.wha.org/education/physicianleadership.aspx
Transparency Proposal Passes Assembly Committee, Gets Hearing in Senate
Hospital outpatient clinic charges bill also approved
This week the Assembly Health Committee unanimously approved a significantly modified bill that seeks to increase the amount of information health care providers and insurers disclose to health care consumers. A similar proposal, with the shared goal of providing patients and consumers with more information for making informed decisions about their health care, also received a hearing in the Senate.
On a 13-0 vote, the committee approved an amended Assembly Bill (AB) 614 from Representative Jon Richards (D-Milwaukee) that requires health care providers (non-hospitals) to provide upon request and at no cost to a patient the median billed charge information for their top 25 presenting conditions, as identified by DHS.
As previously reported, providers must create a document that lists for those conditions: 1) the provider’s median billed charge; 2) reimbursement rate information for Medicare; and 3) the average allowable payment from 3rd-party payers. Providers must also make available to consumers any quality data reported to a health care information organization such as the Wisconsin Health Information Organization (WHIO) or the Wisconsin Collaborative for Healthcare Quality (WCHQ) for the top 25 presenting conditions.
Because of the WHA Information Center’s PricePoint and its existing publicly available reports using hospitals data reported under Chapter 153 of the Wisconsin Statutes, hospitals are defined and treated separately in this legislation from other providers.
Using data already available through PricePoint, hospitals would be required to list in a single document, and provide upon request and at no cost to a health care consumer, "median billed charge" information for the 75 most frequently provided inpatient stays and the 75 most frequently performed outpatient surgery procedures– assuming no complications – for the four most recently reported quarters.
The document also would include average allowable payment information from Medicare and private, third-party payers for the same top 75 stays and procedures. WHA successfully lobbied to remove Medicaid payment information.
Due to amendments secured by WHA, hospitals will be able to comply with the above requirements through information they are already required to provide to the WHA Information Center (WHAIC). The lists can be compiled for hospitals by the WHAIC. In fact, PricePoint currently posts the top 25 by hospital.
Each hospital must prominently display a statement informing consumers they have the right to receive a copy of the top 75 document from hospitals and a good faith estimate from their insurers or self-insured health plans of the consumer’s total out-of-pocket cost according to the consumer’s benefit terms.
AB 614 also requires that if a hospital has publicly reported quality data, they are required to make that data available. Due to an amendment secured by WHA, hospitals will be able to comply with this requirement through the information they already provide to WHA and that is currently made available on CheckPoint.
In front of the Senate Health Committee, WHA’s Executive Vice President Eric Borgerding testified in support of a similarly amended proposal, Senate Bill (SB) 418 from Senator Jim Sullivan (D-Wauwatosa).
"Because of our long-standing proactive stance on transparency we believe hospitals are well positioned to comply with this legislation," Borgerding told Committee members. "This bill, as amended, will allow hospitals to capitalize on the existing technology and infrastructures of PricePoint and CheckPoint to place more data into the hands of consumers."
SB 418 does not include a quality transparency component and executive action has not yet been scheduled.
WHA worked closely with Sen. Sullivan and Rep. Richards to amend the proposals to increase price transparency for health care consumers while minimizing the additional administrative burden created by expanding the availability of that information.
Identical versions of the bills will need to pass both the Senate and Assembly before they can be forwarded on to Governor Doyle for his consideration.
Hospital outpatient clinic charges bill passes committee
Also this week, the Assembly Public Health Committee passed an amended AB 207 relating to patient notification of hospital clinic charges. Committee Chair Rep. Chuck Benedict (D-Beloit) is the bill’s author.
The bill was adopted on a 4-3 party-line vote, with Democrats Benedict, Pasch, Dexter and Bernard-Schaber voting yes and Republicans Strachota, Vukmir and Newcomer voting no.
WHA and several member hospitals worked with Rep. Benedict and his staff on various details of the bill and were appreciative that many hospital-suggested modifications were incorporated. While WHA did not take an official position on the bill, it was significantly modified from its initial language. Some outstanding questions remain however, relating to notification requirements and how to best address repeat or follow up appointments. Republican objections were focused on these concerns.
At the hearing on AB 207, WHA noted that individually, hospitals strive to be as clear and open as possible with patients about services and charges and in the area of transparency, Wisconsin hospitals are already leading by example. By publicly posting pricing information on the PricePoint Web site (www.wiPricePoint.org) and quality measures on the CheckPoint Web site (www.wiCheckPoint.org), Wisconsin hospitals continue to show they are dedicated to providing consumers useful information for making sound decisions about their health care.
In short, and as amended, the bill requires a health care facility or health care provider to orally notify a patient, if an appointment is made over the phone, that they may receive a charge for clinic services in addition to a charge for provider services, which may be on a separate bill. If a patient makes an appointment electronically, the same notification must be provided in writing or electronically within 24 hours of receiving the appointment request.
This notification is not required if one of the following applies: a) Within the 12 months immediately preceding the patient’s request for the appointment, the health care facility or health care provider provided the patient notification for the same services as above; or b) Before the patient requested the appointment, the health care facility or health care provider provided the patient notification as above for the same services, and the patient had a visit for the same services within the 12 months immediately preceding the patient’s request for the appointment.
The bill requires a health care facility or health care provider, upon request of a patient and before the end of the second business day after the request is made, to provide a good faith estimate of the charge for clinic services.
The bill also requires every disability insurance policy and every self-insured health plan to disclose all of the following in any policy, plan, or certificate of coverage:
AB 207 now becomes available for scheduling for a vote before the full Assembly.
Top of page
This week the multi-state Healthcare Quality Coalition (Coalition), of which the Wisconsin Hospital Association (WHA) and many other Wisconsin providers are members, wrote President Barack Obama to urge continued action toward a value-based payment system based on quality and efficiency. The letter was signed by 31 providers and organizations representing 16 states.
"As nationally-recognized providers, we believe that health care costs are financially unsustainable and that the current payment system does not incentivize quality care," the letter read. "Costs are largely driven by a system that pays based on volume. It is further driven by regionally variable service utilization and performance. Action must be taken to address payment reform to properly incentivize quality care."
The House and Senate versions of health care reform passed late last year both include important provisions to incentivize value in Medicare payment reforms. The Coalition’s letter this week comes amidst continued discussion of health care reform proposals by Congress and the Obama Administration.
"Regardless of the legislative path, a core component of any true health care reform package must be transforming the current payment system from one that rewards volume to a new system that rewards value," continued the letter. "This is vital if we are to continue to meet the needs of patients today and the patients of tomorrow. We stand ready to work with you and your Administration to make this change possible..."
In addition to WHA, the letter was signed by the following Wisconsin providers and organizations: Affinity, Allina, Aurora, Bellin, Dean, Essentia Health, Gundersen Lutheran, Hospital Sister Health System, Marshfield Clinic, Mayo, Ministry Health Care, Prevea Health, SMDC Health System, Theda Care, Rural Wisconsin Health Cooperative and the Wisconsin Medical Society.
Read the text of the letter online atwww.wha.org/governmentRelations/pdf/HQCvalueLetter2-11-10.pdf.
Grassroots Spotlight: Riverview Hospital Hosts Sen. Julie Lassa
Senator Julie Lassa visited Riverview Hospital in Wisconsin Rapids on February 5 to seek hospital representatives' input on topics including mandatory overtime for health care workers and health care quality reporting. Hospital staff also briefed Lassa regarding Riverview's status on electronic medical recordkeeping and community benefit services which the hospital provides area residents for little or no cost.
Top of page
Chief executive officers and chief medical officers from WHA member hospitals have been invited to participate in a day-long working session focused on creating the foundation for future health care payment and delivery in Wisconsin.
"A small group of Wisconsin health care and business leaders have been working to identify key issues and options to implement payment reforms, which will encourage and pay for value in health care," said WHA President Steve Brenton. "This Summit, scheduled April 6 in Waukesha, will bring others to the table to take this very critical discussion to the next level. Ideas and solutions generated from this Summit may provide the basis for health care reimbursement strategies to support improved value in health care for all stakeholders."
Brenton also emphasized the importance of having key health care executives at the Summit. "This is a strategic session requiring the participation and wisdom of thought-leaders of the highest level of influence and know-how to reap the greatest results." Invitations were sent to all WHA hospital CEOs and CMOs on February 10.
Harold Miller from the Center of Health Care Quality and Payment Reform, and Karen Timberlake, Secretary of the Wisconsin Department of Health Services, will open the session and provide context for the work. Then, workgroups will delve into how to make health care reimbursement reform a success for Wisconsin and a model for the nation.
In addition to WHA, the Summit is sponsored by the Wisconsin Collaborative for Healthcare Quality, the Wisconsin Medical Society, the Wisconsin Health Information Organization, ThedaCare Center for Healthcare Value, and the Greater Milwaukee Business Foundation on Health.
Space is limited and seats will be filled on a first-come first-serve basis. A brochure is in this week’s packet, and you can register online at www.wha.org/education/paymentReform4-6-10.aspx. For registration questions, contact Lisa Littel at 608-274-1820 or via email firstname.lastname@example.org.
WSHHRA Annual Conference for Human Resource Professionals, April 7-9
The Wisconsin Society for Healthcare Human Resource Administration (WSHHRA) will host its annual conference for human resource professionals April 7-9 at The Osthoff Resort in Elkhart Lake.
The 2010 conference will focus on embracing change and will open with a keynote session presented by nationally-respected speaker Chip Madera. Madera will explore the cycle of change and typical responses to change, as well as share practical communication techniques to foster acceptance and flexibility and motivational techniques for helping people through changing times.
This year’s event includes the important and highly-rated annual HR legislative and legal updates, along with sessions focused on using social media for HR, leadership development, and four best practice sessions from Wisconsin hospitals. The conference will also include a roundtable discussion session, allowing attendees to discuss issues and exchange ideas with their peers.
Anyone who has human resource responsibilities in a health care organization will benefit from the educational agenda and is welcome to attend. Attendance is not limited to current WSHHRA members. An "early bird" discount is available for registrations received by March 15, and group discounts for three or more from the same facility are also available. In addition, the program has been submitted to HRCI for continuing education/recertification credit.
The brochure and registration form are included in this week’s packet and on the WSHHRA Web site at www.wshhra.net. For registration questions, contact Lisa Littel at 608-274-1820 or email@example.com.
Top of page
Since 2002, the Wisconsin Hospital Association has sponsored the Health Care Employee Pride Program to recognize the dedication of Wisconsin’s health care workforce. This year the program will once again encourage WHA member hospitals to invite their employees to express themselves in an essay and tell others why they chose a health occupation. The only change to the program is WHA will not be hosting a banquet for all the honorees. All other aspects of promoting and recognizing the individual Pride honorees will remain unchanged.
The Wisconsin Health Care Employee Pride Program is based on the fact that the decision to work in health care is often made for personal and compelling reasons. The decision to stay in health care is often tied to the same reasons, along with the desire to help others live healthier lives. The Pride Program gives employees the opportunity to share why they love their career of service to others, while giving the Association an opportunity to honor their contributions to their hospital, community and profession.
A designated leader from administration, human resources, public relations or patient care from WHA member hospitals is asked to coordinate the program. Employees are encouraged to submit to the hospital a one-page essay, poem or story that explains why they chose to work in health care. From those essays, a committee at the hospital will pick one employee to represent their hospital.
The Wisconsin Hospital Association, along with the Wisconsin Society of Healthcare Human Resources Administration and the Wisconsin Organization of Nurse Executives, is proud to sponsor the Wisconsin Health Care Employee Pride Program.
Pride Program materials are available on WHA’s Web site at www.wha.org/workforce/pride_2010.aspx. Don’t miss this opportunity to participate in the 2010 Pride Program. For more information contact Shannon Nelson at firstname.lastname@example.org or Mary Kay Grasmick at email@example.com, or call 608-274-1820.
Top of page
The Wisconsin Department of Public Health (DPH) and the Department of Quality Assurance are in the process of mailing requests to complete a short survey to a sample of facilities in Wisconsin that hold CLIA certification. The purpose of this survey is to collect information about the current status of the clinical laboratory workforce. The data collected from this survey will be used to project needs for Wisconsin’s future clinical laboratory workforce. If your lab is selected to participate in this survey, you will receive a mailing this month, directing you to a secure Web site. Your participation in this short survey will be much appreciated.
This survey of selected laboratories is part of a grant entitled "Collaborative Response to the Growing Wisconsin Health Workforce Crisis." Partners include the Wisconsin Department of Workforce Development, Governor’s Select Committee on Healthcare Workforce, the Health Workforce Data Collaborative subcommittee, the Wisconsin Medical Society, the Wisconsin Center for Nursing, Rural Wisconsin Health Cooperative, and the DPH, Workforce Development and Primary Care programs. The program is funded by the Medical College of Wisconsin Healthier Wisconsin Partnership Program.
Laboratorians are among the oldest employee groups in Wisconsin hospitals. Strong data is necessary to determine statewide needs and to encourage educational programs to build capacity to meet those needs. It is critical that invited hospitals complete the survey to ensure that educated workers are available to meet those future needs.
If you have questions, contact Nancy McKenney, RDH, MS, director of workforce development, Wisconsin Department of Health Services atNancy.McKenney@dhs.wisconsin.gov.
WHA Financial Solutions: Where Are Participants in Their 401(k) Recovery?
(From Solutions Spotlight, included in this week’s packet.)
Both the mainstream press and reports from 401(k) vendors lead us to conclude that participants’ 401(k) accounts either have, or are nearing, pre-recession levels. That said, the mixture of both relief and disbelief that plan sponsors are experiencing needs be somewhat tempered. As with most issues, the "devil is in the details."
The Vanguard Group recently reported that 60 percent of their plan participants had the same, or higher, account balances in September 2009 as they did in September of 2007 (near the market peak). Of the remaining 40 percent with lower balances, most were less than 20 percent below their peak value. Both Fidelity and Prudential (among other vendors) reported similar findings. On the surface, this information may be difficult to believe. While true that the "market" has rebounded substantially since its low point in Q1 2009 (the S&P 500 rebounded approximately 68 percent between March 9 and December 31 of 2009), it is still down roughly 25 percent from its peak in October of 2007.
However, the reports of participant account recovery are in fact accurate. First, the reality is that many 401(k) accounts are relatively small. The national average account balance, prior to the market downturn, was estimated at around $50,000. The smaller the account balance the greater the impact of new contributions (employee and employer) on the recovery of the account balance. EXAMPLE: Assume an "average" participant with an account balance of $50,000. The participant contributes $8,000 and receives an employer match of $4,000. Those amounts, in addition to investment growth experienced in 2009, serve to come very close to compensating for the losses experienced during the recent recession.
That said, plan sponsors should recognize that all participants will not have had similar experiences. Participants with higher account balances are likely still looking to recover losses incurred during the downturn of the market. Ultimately deferrals drive the success of the participant’s drive towards a healthy retirement.
To discuss strategies for increasing the average deferral percentage of your plan participants, contact Forrest Ross at WHA Financial Solutions firstname.lastname@example.org.
Wisconsin Hospitals Community Benefits – Uncompensated Care
Mr. D’s story
As a teen, Mr. D. was diagnosed with Crohn’s disease, a lifelong inflammation of the intestines that can lead to other chronic health problems such as fissures and narrowing of the intestines. This disease requires good preventive care and frequent monitoring to avoid scarring and life-threatening intestinal blockages.
Mr. D. Said, "I’ve had Crohn’s disease since I was 18 years old. It’s a tough disease to manage but I’ve done it for 32 years. In order to stay healthy I need to have a colonoscopy once every year to keep ahead of problems related to Crohn’s." He continued, "Over the years the costs for care have risen incredibly. Colonoscopies have tripled in cost and the drugs I have to take to manage this condition are also very expensive. I stopped taking one of the drugs because I could not afford it, and the doctor helped me find another drug that was less expensive."
In January 2009, Mr. D. was laid off from his job as a plumber. He said, "The construction industry is slow so we were all laid off. I’ve not had health insurance now or in the past because I work for a small employer, and they cannot afford to offer health insurance to their employees. I’ve tried to get insurance on my own, but no one will insure me with Crohn’s disease. It’s tough, really tough. I worry about going bankrupt."
Mr. D said, "St. Mary’s has been wonderful; they were able to provide colonoscopies for me for the past few years through a charity program—this is life-saving for me! I could never afford this on my own. My doctor says it’s a necessity so that he can monitor what’s going on; we’re trying to prevent having surgery—which would completely wipe me out financially. It’s unbelievable what St. Mary’s has done for me, I don’t know what I’d do otherwise —it’s a God-send!"
St. Mary’s Hospital Medical Center, Green Bay
Fight for life became fight for financial health
Overwhelming debt can be as indiscriminating as cancer – it can happen to anyone. Dennis and Mary Smith* of Hudson know both conditions all too well these days.
When the Smiths moved from Apple Valley, Minnesota six years ago, they were a healthy, two-income family enjoying a home they had built in Hudson. Dennis was an attorney who worked as an independent contractor in downtown Minneapolis. Mary had a full-time career as a representative for a national company in the medical field.
As they settled into their new home, Dennis started experiencing unbearable neck and shoulder pain and unexplained deteriorating health. The Smiths were aggressive in pursuing the cause of the pain and consulted with innumerable specialists in several states, including a neuro-spine specialist. It wasn’t until a friend, a registered nurse from California specializing in cancer and transplants, visited them in 2007 and told Mary she believed Dennis was deathly ill. Within a few days, they were back at the oncologist’s office asking for more tests and, a week later, received a confirmed diagnosis that it was kidney cancer.
"It was an insidious onset of his health problems," said Mary. "Our friend was the guardian angel that literally saved Dennis’ life."
The past six years have been exhausting trying to diagnose Dennis’ illness, and the most recent, life-threatening battle against his kidney cancer, included a grueling year-long chemotherapy regimen requiring many infusion sessions and other tests at Hudson Hospital & Clinics.
Prior to 2006, the Smiths were able to manage the costs of Dennis’ many proposed treatment plans and medications. Medical insurance provided through Mary’s employer paid all medical and procedure costs except co-payments ($15.00 for a doctor visit, $35.00 to see a specialist, $75.00 for an ER visit, and no co-payment for laboratory and other screening tests.) However, in 2007, she was informed that her plan was being modified and that insurance coverage was changing from a co-payment plan to an 80/20 plan; the Smiths were now responsible for 20 percent of all Dennis’ medical costs – every physician or specialist appointment, test and procedure.
"That’s when it became unmanageable," said Mary.
And that’s where Charlene Barnes, the hospital’s patient financial services representative, entered the picture.
"I told her ‘we don’t qualify for anything,’" said Mary, who was trying to deal – calmly – with a growing mountain of debt while concerned that her own anxiety and fear would further burden her husband of 22 years. "Charlene said, ‘Yes, I can help.’"
With Barnes’ assistance, the Smiths were able to manage their past-due debt and establish a payment plan for new medical costs.
"Talking about finances is difficult at any time," said Mary. "But Charlene is a compassionate, caring and considerate person. At no time did she make me feel uncomfortable or embarrassed to discuss our financial crisis."
Barnes said many families find themselves struggling with medical costs. For many years now, she said, insurance premiums, co-pays and deductibles have risen for nearly everyone.
"People get caught up in trying to balance getting well and paying the bills," said Barnes. "In an average case, chemotherapy drugs can cost $35,000. It’s like adding insult to injury."
Did the Smiths think they’d ever find themselves in the position of overcoming a mountain of debt? "Never," said Mary. "I would like to say thank you to Hudson Hospital & Clinics and to Charlene Barnes, in particular, for her compassionate generosity on behalf of the hospital."
*Name changed for confidentiality
Hudson Hospital & Clinics, Hudson
Help is out there
Jimmie White had not been to the doctor in years. But when he became violently ill in April, his nephew took him to the Wheaton Franciscan Healthcare – All Saints Emergency Department in Racine.
White had refused to go to the doctor himself because he did not have health insurance and was concerned he would not be able to pay for his care. While at the hospital, Jimmie learned from Financial Counselor Elizabeth Masik of Wheaton Franciscan Healthcare’s Community Care program which provides care to those who qualify.
"He sent in the paperwork and he got 100 percent approved, which surprised us," recalled Jimmie’s sister, Shirley Johnson, who is caring for her brother. "We had no idea there was a way for him to get help like this."
Jimmie then returned to the hospital for a battery of tests and learned that, among other problems, he was suffering from throat cancer. He is scheduled to begin treatment soon.
"Without the help he got from the program at the hospital, he would never have gone back for the tests," Johnson said. "We’re very grateful."
Wheaton Franciscan Healthcare – All Saints, Racine
How Aurora’s Helping Hand and the Well Woman Program is bridging the gap
Each year, many women without insurance or in financial hardship are able to receive a free mammogram through the Wisconsin Well Woman Program (WWWP), which happens to have a local coordinator located at Aurora West Allis Medical Center (AWAMC). The guidelines to qualify for the free screening and diagnostics require a woman with demonstrated financial needs be 35 years of age or older. The Wisconsin Well Woman Program also is a resource for women whose findings are positive.
A young married woman with no children was diagnosed with breast cancer at the age of 32. She and her husband did not have health insurance. She turned to WWWP for help, but because of her age, she did not qualify for the Wisconsin Well Woman Program nor Well Woman Medicaid or any other Medicaid program. The WWWP program coordinator referred her to the Aurora Helping Hand Patient Financial Assistance program at AWAMC. She was accepted and the hospital covered this patient’s surgery and treatment.
When she needed to have a follow up mammogram two years later, the young woman was three months away from turning 35, the age at which she would become eligible for the Wisconsin Well Woman Program and Well Woman Medicaid. A special case approval to grant access to the Well Woman Medicaid program was filed on the young woman’s behalf by the WWWP coordinator. Her case was approved and she was enrolled into Well Woman Medicaid. Since then, Well Woman Medicaid has helped Kristina receive follow up care, medication and reconstructive surgery.
Aurora West Allis Medical Center, West Allis
Top of page