May 8, 2015
Volume 59, Issue 18
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Advocacy Day Legislative Panel Shares Thoughts on Health Care Workforce
A popular feature of the WHA Advocacy Day event is the legislator panel. Held this year in Madison April 28 with nearly 1,100 hospital supporters in attendance, four legislators shared their thoughts on a variety of issues.
Here is Part 2 of a two-part article featuring the four legislators’ responses to a number of questions related to WHA’s key legislative priorities.
Legislators participating on the panel were: Sen. Sheila Harsdorf (R-River Falls), Sen. Jen Shilling (D-La Crosse), Rep. Joe Sanfelippo (R-West Allis) and Rep. Peter Barca (D-Kenosha). Eric Borgerding, WHA President/CEO, moderated the panel.
Borgerding: In the next ten years we could see the worst potential nursing shortage in our history. We have employees who have been on a waiting list for more than a year to get into a nursing program. This is an important question because the nurse is playing a greater role in delivering primary care and in team-based care. (This was a question submitted by the audience).
Shilling: We need to make sure we know the opportunities and challenges, and we have a lot of nurses who will be retiring. CNAs, hard to fill these positions—move into a job and continue with their education. We need to make sure when we have rungs on the career ladder, we need to pay attention to them when it comes to wages.
Sanfelippo: For the next decade or so I read that we will have 10,000 people a day retiring. We will have a decrease in the supply of health care workforce and an increase in demand for care. We need a collaborative effort to open the channels and create more supply. We need to work with medical colleges and other institutions to create the space and start getting into our classrooms in high school and let the kids know about the rewards of a health care profession. But it starts with creating the capacity for more education opportunities.
Barca: It is a question of supply and demand. The aging population is going to increase demand for care—no one can retire! Seriously, addressing the skills gap issue across the board is vital. The #1 issue that business owners want addressed is the skills gap. We should address this. There has not been enough done in face of the magnitude of the issue. We had a nursing crisis in the 80s. It is more complicated than you could imagine. You have to have the space, faculty and equipment, and we need a tighter partnership between the public and private sector. We need a blue ribbon commission on this, bring together educators and health care providers, because it is clear we need to ramp up.
Harsdorf: We need to make sure we have the opportunities to be trained as, for example, CNAs. It is why we created the Fast Forward program. It puts state resources into connecting employers with technical colleges. Last session, I introduced a bill….that addressed an issue related to CNAs from other states who want to come to Wisconsin, but need more education credit. So we created a bridge program to help them. We also have an issue with physicians, the shortages there are staggering, as well. (The Legislature and the Governor) have done a number of things. We have expanded the number slots available to medical residencies, and Gordy Lewis, the CEO in Grantsburg, asked me and Rep. VanderMeer to introduce a bill related to the interstate physician licensure compact. We are hoping we can get this through this session to streamline the process for licensing physicians in our state. We have 10,000 physicians in our state who practice in other states. It will streamline the process and make it easier to license physicians who want to practice in our state.
Shilling: This legislation is coming from both houses, and it is good public policy. I want to highlight that these were bipartisan bills in both the Senate and Assembly. Working with leaders from the Assembly, we passed the HIPAA Harmonization bill, we passed the CNA “Bridge” bill, and now we are working on the licensure compact. We talked about it in Sparta, because we are neighbors to both Iowa and Minnesota. These are examples of common-sense legislation that come forward from both houses and it is good public policy no matter what side of the political spectrum you are on. It is making a difference in all our communities.
Borgerding: Thank you, Sen. Shilling, I was actually going to note the fact that so much of the progress on health care made in the last session—and it is a long list—was done in a bi-partisan way. Some of that legislation was championed by WHA. Not only did we get the bills passed and signed into law, but we are equally proud of the fact that it was done in a bi-partisan fashion.
Mark your calendars for the 2016 WHA Advocacy Day scheduled March 30 at Monona Terrace in Madison.
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President’s Column: 1,100 as 1
It’s been over a week since WHA’s 2015 Advocacy Day program, and there’s still a buzz in the air from what was another record setting day. Nearly 1,100 Hospital advocates from as far north as Superior, WI, and as far south as Springfield, IL, converged on Madison to attend what has become a “must see” premier Wisconsin health care event. Most impressive, it is a gathering dedicated to one thing—Advocacy.
This year’s Advocacy Day program was my 17th, and for each I’ve had the true privilege of standing at a podium, which affords a humbling perspective on a growing, proud and committed assemblage—one that has nearly tripled in size since 2005.
To be sure, there is much to be proud of when it comes to Wisconsin health care, the recent AHRQ and CMS rankings being just the latest examples. But in my opinion, the best example of Wisconsin’s high-value health care system is the dedication and commitment of those who care about it, believe in it, improve it, work in it, volunteer in it, defend it—and come to Madison to stand up for it.
I speak on behalf of the entire WHA team in saying how tremendously proud we are to represent Wisconsin health care, and to have been part of the 1,100 who came to Madison last week and spoke as one.
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Hospital Leaders, WHA in Washington, DC
King vs. Burwell, 340 B and Medicare cuts discussed
More than 15 hospital and system leaders along with the Wisconsin Hospital Association (WHA) were in Washington, D.C. this week to meet with members of Wisconsin’s Congressional Delegation and their staffs. Hospital leaders were in Washington, D.C. in conjunction with the American Hospital Association’s Annual meeting.
On the agenda for Hill meetings: finding an adequate solution in the event of an adverse ruling in the U.S. Supreme Court case of King vs. Burwell.
“High-quality health care is one of Wisconsin’s greatest assets, and protecting it must be our lawmakers’ top priority,” said WHA President/CEO Eric Borgerding. “Great quality care, like we have in Wisconsin, is not of much value if access to that care is diminished, and when it comes down to it, access is what is at stake in the King v. Burwell case.”
In addition to the impact of a King vs. Burwell decision on Wisconsin, other issues discussed included the importance of the 340 B drug program. This program was created by Congress to help “stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.”
Hospitals across Wisconsin—rural and urban—provided members of Congress examples of how the 340 B program has allowed their facilities to extend their services to more patients. Just two of the examples included how Wheaton Franciscan Healthcare in Milwaukee provides preventive care to low-income patients and how rural HSHS St. Clare Memorial Hospital in Oconto Falls provides remote pharmacy dispensing services to rural patients in areas without a local pharmacy.
The group also thanked those members of Congress who voted in support of repeal of the Sustainable Growth Rate (HR2) earlier this spring. However, they also reminded Congress that Wisconsin hospitals and health systems continue to see billions in cuts, including additional reductions under HR2. The group then expressed strong concerns with another Medicare cut (sequester increase in FY 2024) that has been recently included in a trade bill pending in Congress. Borgerding sent a formal letter in April to House Ways & Means Committee Chairman Paul Ryan to express opposition. Read the letter at: www.wha.org/pdf/RyanTPASequester4-22-15.pdf.
“We appreciated meeting with our members of Congress and their staffs during our time in D.C.,” said Therese Pandl, WHA Board chair and president, HSHS Eastern Wisconsin Division. “We were able to discuss the importance of the 340 B program and the need to pass legislation to correct the 96-hour rule. We also reminded our Delegation that Wisconsin’s hospitals and health systems are already seeing over $4 billion in Medicare payment reductions, so any additional cuts truly disadvantage our high-performing state.”
Individuals on Capitol Hill included: Therese Pandl, Ed Harding, Dan DeGroot, Scott McMeans, Elizabeth Cliffe-Kucharski, Lindsay Punzenberger, Tim Size, Lori Harding, Bonnie Olson, Diane Westbrook, Cindy Hermel, Sherry Jelic, Eric Borgerding, Mary Starmann-Harrison, Joan Coffman, Jerry Worrick, Brian Reardon, Tim Eckels and Jenny Boese.
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Grassroots Spotlight: Hudson Hospital Hosts Rep. Knudson, Area Hospital Leaders
Discuss Medicaid and the state budget
Rep. Dean Knudson met with area hospital leaders recently at Hudson Hospital. The group was able to spend significant time while at Hudson Hospital discussing key health care issues. Top of mind was poor Medicaid reimbursement rates and the need for longer-term stability in these rates. To that end, leaders highlighted how the Disproportionate Share Hospital program was providing some assistance to close to 100 hospitals statewide and that making that program permanent would help provide more fiscal stability.
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Grassroots Spotlight: Lt. Governor of Wisconsin Visits Westfields Hospital & Clinic
Tours Cancer Center of Western Wisconsin, a collaboration between six area CAHs
On May 6, Westfields Hospital & Clinic welcomed Lt. Governor Rebecca Kleefisch to their campus for a tour of the Cancer Center of Western Wisconsin. Kleefisch spoke of her triumph over colon cancer and saw firsthand the work being done at the Cancer Center, which provides both medical and radiation oncology treatment for those with cancer.
The Cancer Center is a unique model of care made possible through a collaboration between six neighboring rural hospitals to bring care closer to patients in rural communities. The hospitals are Amery Hospital & Clinic, Baldwin Area Medical Center, Hudson Hospital & Clinic, Osceola Medical Center, St. Croix Regional Medical Center of St. Croix Falls and Westfields Hospital & Clinic, New Richmond.
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WHA Facilitates Multi-stakeholder Conversation on Health Care Workforce
As demand for “front-line” caregivers increases, shortage impacts care across all settings
The shortage of certified nursing assistants (CNAs) and other front-line caregivers affects not only Wisconsin’s hospitals and clinics, it also impacts skilled nursing facilities (SNF), assisted living facilities and other community-based care centers. The WHA Workforce Council, chaired by Nicole Clapp, president/CEO, Grant Regional Health Center, Lancaster, discussed how partnering with those delivering care outside of the hospital setting can benefit all Wisconsin residents and health care consumers.
John J. Vander Meer, director of communications for Wisconsin Health Care Association and Wisconsin Center for Assisted Living (WHCA/WiCAL) presented the recent findings from their report. The report addresses a multitude of factors that impact the availability of CNAs in Wisconsin. Vander Meer cautioned that hospitals and other health care worker employers should no longer consider the “hospital down the street or in the adjacent county” as their primary competition in hiring from the scarce pool of employees. Instead, Vander Meer warned that fast food establishments and national chain stores are oftentimes vying for the same entry-level worker. This new competition often offers a higher starting salary than health care employers, tuition reimbursement and paid personal time off.
Steven Rush, WHA vice president for workforce and clinical practice, echoed Vander Meer’s concerns.
“In my 30 plus years in nursing, I cannot remember a time when we weren’t discussing the shortage of front-line caregivers, namely CNAs. With the aging population in Wisconsin, the chronic shortage has once again become more acute,” Rush said. “This is a big issue to tackle. WHA will continue to work with other stakeholders to address this growing problem.”
Vander Meer offered that a good example of a common goal is preventing hospital readmissions. Evidence suggests that the rate of avoidable rehospitalizations can be reduced by improving care coordination at the interfaces between care settings. Vander Meer reports that there is a direct link between the level and quality of care and the number of well-trained caregivers in skilled nursing facilities. Since many elderly patients are discharged directly from a hospital to a SNF or assisted living facility, the likelihood of patients “bouncing back” to the hospital increase as the number of CNAs in those facilities decrease, according to Vander Meer.
Stephanie Sobczak, WHA manager, quality improvement, presented to the Council important work the WHA quality department has engaged in regarding the “Partnership for Patients,” an initiative of the Affordable Care Act (ACA). A provision of the ACA allotted funding to speed the implementation of evidence-based patient safety practices in U.S. hospitals. Hospitals across Wisconsin have been very engaged in these programs. Yet, there is much more work to do to achieve the national patient safety goals.
Sobczak related to the Council members the vital importance of broad engagement of caregiving staff and how WHA’s quality programs are designed to achieve this.
“Although hospitals have expert staff dedicated to quality, the scope of this work is growing quickly and it isn’t possible for just two or three people to champion the change and manage the work,” according to Sobczak.
Sobczak asked for Council members’ input as to the feasibility of engaging front-line staff in these improvement initiatives. Members shared a few strategies for de-centralizing the improvement work but acknowledged the significant challenge of providing time during the work day to trial and implement changes.
“The staff who deliver care must be closely involved in order to efficiently ‘hard-wire’ patient safety practices in their work—that is central to reducing preventable harm,” said Sobczak.
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Medicaid Underfunding Creates Real Costs to Hospitals, Burdens Employers
While one can argue semantics on whether it is “price” shifting or “cost” shifting, no matter what it’s called, Wisconsin’s Medicaid reimbursement to hospitals—the second worst in the nation—is creating a shortfall that is approaching a billion dollars in Wisconsin.
Peter Garner, MPH, vice president and health systems analyst at BSG Analytics, joined WHA Senior Vice President Brian Potter in a panel discussion focused on Medicaid cost shifting held May 5 at Monona Terrace in Madison. Rep. Joe Sanfelippo, chair of the Assembly Health Committee, welcomed legislators, academics and representatives from a number of health-related organizations to the event. in addition to Garner and Potter, panelists included; Austin Frakt, PhD, assistant professor of health policy and management at Boston University School of Public Health, and Stephen Zuckerman, co-director of the Health Policy Center at the Urban Institute.
“State underfunding in the Medicaid program creates real costs to hospitals that become a burden to other payers and to the state’s employers,” according to Potter.
Potter noted that Medicaid has expanded over the past decade. The program now covers 20 percent of Wisconsin’s population, and it is a growing segment of hospitals’ business.
“Wisconsin hospitals and health systems have been good partners with the state in ensuring that patients, regardless of their ability to pay, have access to high-quality, high-value and accessible care,” Potter said. “Hospitals are also investing in the future by supporting workforce training for physicians and other health care professionals, and by continuing to make investments in primary care access.”
Garner described Wisconsin’s health care environment as “dynamic and complex,” but one where integration is driving higher quality and value, not price.
“Wisconsin has multiple insurance companies, and competition among hospitals, so we have a market economy on both the insurance and hospital side,” according to Garner.
Garner said hospital margins are essential if hospitals are to have the ability to meet their missions of service to the community and “margins allow hospitals to drive quality improvement and lower health care costs.” He also pointed out that the usual laws of supply and demand don’t apply to health care.
“In health care, much of the price is regulated and consumers don’t have a lot of ‘direct’ choice in where they receive services. Patients end up in the hospital because they have to be there, they don’t have a choice,” Garner said. “And, perhaps most importantly, if a consumer cannot afford the price, the hospital still provides the product.”
The Medicaid and Medicare programs “tell hospitals what they are going to pay them,” Garner said. That creates a problem for Wisconsin hospitals and health systems when both the Medicare and Medicaid programs fail to cover the cost of caring for the patients in those programs.
“There are more Medicare and Medicaid patients, the payer mix is deteriorating, and more and more unhealthy people have health care insurance,” Garner said. “Plus, let’s not forget that our personal health has a huge impact on health care prices for everyone.”
Frakt presented several conflicting theories on cost-shifting. He also cautioned that cuts to providers can decrease access to care and impact quality, especially in the Medicaid program. That was also supported by a study presented by Zuckerman that compared Medicaid access in 10 states. While Wisconsin was not in the study, Zuckerman pointed out that Medicaid patients here have better access to physician services.
In the end, the panelists agreed that regardless of the terminology used to describe underpayments, the implications can be problematic when government does not cover providers’ costs, and can impact health care costs, quality and access.
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Rural Health Conference Featured Speakers Focus on New Health Care Economy
The featured speakers for the 2015 Wisconsin Rural Health Conference include Andrew Cohen of Kaufman Hall and Jane Sarasohn-Kahn of THINK-Health. Each will focus on unique aspects of the changing health care economy and how rural providers can prepare themselves to meet the changing expectations from insurers, employers and consumers.
Cohen is senior vice president for Kaufman Hall, providing strategic planning advisory services to health care providers. His expertise lies in health care reform, value-based contracting, payer relations, growth strategy and population-driven demand. Cohen will examine the changing health care business model, from hospital-centric sick care to community-centric health care, and provide practical tips for rural providers to navigate this changing environment.
Sarasohn-Kahn is a health economist, advisor and author of the Health Populi blog, covering the intersection of health policy, economics and technology. In 2014, she was named one of 15 influencers shaping digital health, one of 50 public health blogs worth connecting with, and one of 100 Twitter accounts to follow. Sarasohn-Kahn will discuss rapidly-advancing care technology, growing consumer engagement and empowerment through mobile health apps and personal health/wellness wearables, the rise of retail health care, and how it will all disruptively innovate health care in Wisconsin.
Join your colleagues in Wisconsin Dells, June 17-19, to hear these two premier keynote speakers and more. A full agenda and online registration are available at http://events.SignUp4.net/15Rural.
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Call for Nominations: 2015 Global Vision Community Partnership Award
Nominations due to WHA Foundation by July 15
Honor one of your hospital’s community health projects by submitting a nomination for a 2015 Global Vision Community Partnership Award, presented by the WHA Foundation.
This competitive grant award is presented to a community health initiative that successfully addresses a documented community health need. The Award, launched by the WHA Foundation in 1993, seeks to recognize and support ongoing projects that support community health.
Any WHA hospital member can nominate a community health project. The project must have been in existence for a minimum of two years and must be a collaborative or partnership project that includes a WHA member hospital and an organization(s) within the community. The official call for nominations for the 2015 Award is included in this week’s packet.
Nominations are due July 15, 2015. Nomination forms can also be found on the WHA website at www.wha.org/global-vision-comm-partnership.aspx. For more information about the Award, contact Jennifer Frank at firstname.lastname@example.org or 608-274-1820.
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Pollack Named President/CEO of the American Hospital Association
The American Hospital Association’s (AHA) Board of Trustees announced Rick Pollack as the next president and chief executive officer of the national group representing America’s hospitals and health systems. A 32-year veteran of the AHA, Pollack will succeed Richard J. Umbdenstock, who announced his retirement in November and will retire at the end of 2015.
Since 1991, Pollack has served as AHA’s executive vice president for advocacy and public policy responsible for the development, implementation and management of the association’s advocacy, representation and public affairs activities, which have been cited by numerous national publications as one of the most influential and effective lobbying organizations in Washington. He will become the 11th person to hold the top post in the association’s 117-year history.
“Rick brings the right mix of skills to this role. His effective advocacy combined with his passion and commitment to the mission of hospitals and the men and women who work there will serve the association well,” said AHA Chairman Jonathan B. Perlin, MD, PhD, who is president of clinical services and chief medical officer of the Nashville-based HCA. “He will build on the many strengths of the past and ably lead the association into the future.”
WHA President/CEO Eric Borgerding said Pollack has the experience to lead, and has earned the trust and respect of his member organizations.
“I am very pleased to see Rick move into the top spot at AHA,” Borgerding said. “Rick’s experience and skills in government relations, and in leading AHA’s advocacy team, will serve us all well. Choosing Rick to lead our national association underscores the continuing commitment to strong advocacy, which is exactly what our industry needs in these dynamic times.”
Pollack will become the AHA’s president and CEO in September. A Brooklyn native, Pollack, 59, started his professional career in 1977 as a legislative assistant to U.S. Rep. David Obey of Wisconsin. He left Capitol Hill to become a lobbyist with the American Nurses Association. He went on to join the AHA’s Washington Office, where he has been a member of the association’s advocacy team, initially serving as associate director for legislation, and then vice president for federal relations and deputy director of the D.C. office before becoming executive vice president.
Pollack holds a bachelor’s degree in political science and communications from the State University of New York’s College at Cortland. He earned a master’s degree in public administration from the American University in Washington, D.C.
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Conference to Improve Maternity Care
The Wisconsin Chapter of the American Academy of Pediatrics, the Department of Health Services and the Wisconsin Breastfeeding Coalition is sponsoring an event, “Primary Care Provider’s Role in Improving Maternity Care Practices in Wisconsin,” scheduled June 9 at The Madison Concourse Hotel. This event is aimed at physicians and primary care providers who work with mothers and infants. It will examine issues related to maternity care from preconception through postpartum and will shed light on ways providers can better collaborate with community partners. Speakers will include Dr. Jennifer Thomas, as well as panel presentations representing hospitals from across Wisconsin. Attendees will hear updates on the Baby Friendly Hospital Initiative, Neonatal Abstinence Syndrome, and Postpartum Depression.
This event will be an opportunity for providers to learn about the status of maternity care practices in the state and about ways to make positive changes. Attendees will come away with useful information to improve their own medical practices, as well as to take back to their organizations. CMEs will be available. Event information can be found on the WIAAP website and online registration is now open.
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WCHQ, DHS, Metastar Sponsor Statewide Quality Improvement Event
The Wisconsin Collaborative for Healthcare Quality (WCHQ), in partnership with the Wisconsin Department of Health Services (DHS) and MetaStar will hold a Statewide Quality Improvement Event June 16 from 9 a.m. – 3 p.m. at the Monona Terrace Convention Center in Madison.
Topics covered during this event will include:
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