June 24, 2011
Volume 55, Issue 24

Final Budget Decisions Rest with Governor
Swift action expected as fiscal year draws to a close; WiscNet provisions complicate final legislative discussions

With legislative approval wrapping up late last week, Wisconsin’s 2011-13 Biennial Budget was sent to Governor Scott Walker for his consideration and possible line-item. The Governor is expected to sign the budget in the next few days as the current fiscal year ends June 30. The process began when Gov. Walker introduced his budget bill back in early March.

As previously reported in the May 27 Valued Voice, the Joint Finance Committee (JFC) approved many of the proposals included by Gov. Walker in the Medicaid portion of the budget, but also placed their stamp on the bill by including significant modifications.

The JFC increased Medicaid base funding and adopted more conservative enrollment assumptions for Medicaid to reflect revised projections of Medicaid enrollment growth. The changes are significant and welcome as the original budget had projected a considerable drop to Medicaid enrollment and its associated funding. The changes were also approved by the Legislature.

As they were in the bill first introduced by Governor Walker, hospital Medicaid rates remained intact and in fact are increasing (see related story about WHA Board meeting). Also included in budget language passed by lawmakers were additional reporting requirements for the Department of Health Services (DHS) as they develop various, yet-to-be specified changes and reforms for the Medicaid program to find an estimated $466 million (all funds) in savings over the biennium.

WiscNet Issue Complicates Final Legislative Budget Approval

One of the last budget items settled related to WiscNet, a public-private organization that provides its members with high-capacity, affordable broadband in areas of the state where this access was previously unavailable. In areas where some level of broadband is available, it remains cost-prohibitive, especially for the high capacity needs of health care and telemedicine.

Wisconsin was recently awarded over $30 million in federal matching grants to expand broadband access in rural parts of the state and several WiscNet pilot projects are underway including in such areas as Eau Claire, Platteville, Wausau and Superior. Local community partners, including hospitals, have also invested or pledged millions of dollars in matching funds.

For hospitals and health care providers, fast and accurate patient diagnosis is critical to providing high-quality and safe patient care, especially in medical emergencies. These diagnoses often include the latest in digital scanning and imaging technologies that create large medical image files.

WiscNet facilitates expanded access to fast, dependable and affordable transmission of these medical images from where they are taken to where they can be diagnosed in areas of the state where access to this high-capacity is limited or cost prohibitive.

Provisions included during final budget deliberations by the JFC would have turned back Wisconsin’s federal funding for rural broadband efforts and prevented UW from participating in WiscNet, potentially crippling cost-effective access to high-tech patient diagnostic capabilities in rural areas. Hospital Sisters Health System’s (HSHS) Sacred Heart Hospital in Eau Claire and St. Joseph’s Hospital in Chippewa Falls were among those spearheading an effort that helped form a coalition of concerned rural legislators.

Legislators that sought changes to the JFC language included Senators Terry Moulton (R-Chippewa Falls), Pam Galloway (R-Wausau), and Sheila Harsdorf (R-River Falls) and Representatives Howard Marklein (R-Spring Green), Warren Petryk (R-Eleva), Tom Larson (R-Colfax), Kathy Bernier (R-Chippewa Falls), Roger Rivard (R-Rice Lake), John Murtha (R-Baldwin), Tom Tiffany (R-Hazelhurst), and Travis Tranel (R-Cuba City).

WHA circulated a memo to all legislators asking for the WiscNet provisions to be removed from the budget (see www.wha.org/governmentRelations/pdf/RemoveWiscNetBudgetProvisions6-13-11.pdf).

The Assembly ultimately agreed to amended language that allows Wisconsin’s federal funding to continue for WiscNet broadband projects already underway, but requires JFC approval for any new projects. The Legislative Audit Bureau must also prepare a financial and performance evaluation audit of the use of broadband services by the Board of Regents that examines issues of statutory compliance, competition, cost shifting, financing, collaboration, and access to broadband services.

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Medicaid, Health Reform, State Budget Top WHA June Board Agenda

With the state budget sitting on the Governor’s desk awaiting his signature, and as state legislators begin a well-earned summer break, WHA staff remains actively engaged in advocacy efforts in both Madison and Washington, D.C.

ACO Rules Disappoint, Discourage Providers

WHA President Steve Brenton called the Board’s attention to two letters drafted by WHA staff that were sent to the Centers for Medicare and Medicaid Services (CMS) regarding the recently-released Accountable Care Organization (ACO) rules.

Brenton said the ACO rules are extremely disappointing because it was believed they would be the "crown jewel" for incenting care coordination that would lower costs and improve quality. Instead, the rules are deeply flawed. Among the issues identified by WHA:

  • The savings formula sets the hurdle too high for attaining incentive payment,
  • The sharing percentage to providers is too low and it does not reward health systems that already provide efficient care.
  • The American Hospital Association estimates the cost to start an ACO to be well in excess of $10 million.
  • The benchmark should be adjusted for those health systems already performing at efficient levels.
  • The number of quality measurements—65—is unnecessarily high. WHA suggested that CMS select a smaller number of measures that are likely to improve quality rather than the broad approach suggested in the proposed rule.
  • Beneficiaries should be assigned prospectively so the health system can identify the patients and design care management plans and monitor those patients’ health status.

Providers in rural areas are at a particular disadvantage as it relates to scale, according to Brenton. CMS should change the rules to encourage and foster participation in rural-developed ACOs.

"While WHA strongly supports the ACO program goals, substantial changes are necessary to make the program attractive to potential participants and viable in the long run," Brenton said. "In the meantime, Wisconsin providers are moving ahead with their own innovative models which will foster care coordination, reduce costs, and improve quality."

First IOM Report Targets Payment Equality, Adequacy and Value-related Issues

A new report from the Institute of Medicine (IOM) concluded that the Medicare program should use more accurate data for adjusting pay rates based on where hospitals and physicians are located. While the report indicates the data is flawed, Brenton said, it does not specify how it can be fixed.

The report is the first of three planned by an IOM committee that is studying price variations caused by Medicare geographic adjustments. The next report will focus on variation relative to geographic disparities and how they should be taken into account in a value-based approach. That report is not expected to be out until 2012.

ICD-10: Will Wisconsin Be Ready?

WHA has created a new task force to help identify issues hospitals will encounter as they prepare for implementation of ICD-10. Member preparedness for the change is uneven at this time, but hospitals are aware of the issue, and WHA is working with a number of collaborators to help ensure that members have the training and the resources they need to implement ICD-10.

A board member mentioned that the technical colleges do not seem to be ramping up and training an adequate number of coders. WHA Executive Vice President Eric Borgerding mentioned that WHA has started a list of hospital CEOS that serve on technical college boards and that they can be provided with information on the issue to share at the local tech board level.

Legislature Adjourns; WHA Advocacy Effort Shifts Gears

The State Capitol has almost returned to normal as the Legislature stands adjourned, and Gov. Walker prepares to sign what proved to be a hotly-debated state budget.

WHA Executive Vice President Eric Borgerding explained to Board members that Wisconsin’s Medicaid providers are in much better shape than their counterparts in other states that have seen Medicaid payments slashed. Early on, Gov. Walker said there would not be across-the-board provider payment cuts, and he and the Legislature followed through on that promise.

There are now nearly 1.2 million people in the Medicaid program with a projected cost in state fiscal year (SFY) 2012 of $6.9 billion. Gov. Walker provided $1.3 billion to backfill the $1.8 billion Medicaid deficit in the 2011-13 budget, while the Legislature added another $100 million in funding, $56 million of which will likely be used to cushion unexpected increase in caseload, a move strongly advocated by WHA. According to Borgerding, inpatient hospital base payment rates will actually increase in SFY12 by nearly six percent—one of the first base payment increases in many years.

"These are extremely challenging times for Wisconsin, and while there are many details and reforms still to be worked out in the coming months, Medicaid is clearly a priority," Borgerding said. "As states around the country are slashing Medicaid enrollment and reimbursement, we are pleased this budget preserves this crucial safety net and recognizes that cost-shifting is not the way to pay for Medicaid."

While WHA’s public policy team had "boots on the ground" in the State Capitol throughout the state budget debate, it will now shift gears and focus even more attention on activities within the Department of Health Services (DHS) related to Medicaid reform.

WHA created two Medicaid groups that have met regularly to discuss program-related issues and to form recommendations.

The WHA Medicaid Reengineering Group (MRG) was formed to develop recommendations to share with DHS that are aimed at reforming Medicaid to deliver care more efficiently and to preserve the Medicaid safety net. The MRG tackled four major issues: eligibility and enrollment, pay-for-performance, care coordination and benefit options.

Key discussions at their last scheduled meeting June 22 surrounded options for limiting or reducing benefits in the Medicaid program, and the effect such changes could have on uncompensated care.

"Making benefits more like commercial insurance could result in savings to the program. However, limiting benefits could also have a significant impact on patients and hospitals in terms of access to care for patients and possible increases to uncompensated care, both of which could exacerbate cost-shifting," said Nick Desien, CEO of Ministry Health and chair of the MRG. "Benefit options should preserve core services, and proposals to modify or reduce benefits should be accompanied by a thorough impact analysis."

Desien expressed his appreciation to WHA staff for their "outstanding" work. In addition to Borgerding, WHA Vice President of Payment Policy and Reform Joanne Alig and WHA Senior Vice Presidents Brian Potter and Laura Leitch staffed the Medicaid task forces.

The second WHA Medicaid Group—the WHA Medicaid Advisory Group (MAG)—met June 21 with DHS to finalize 2012 rates for hospitals. On June 7, the MAG received the draft base fee-for-service hospital rates (see June 10 Valued Voice article). Materials from the MAG meetings can be found on the WHA Web site at www.wha.org/financeAndData/MAG.aspx.

Borgerding said no additional across-the-board changes were made to hospital rates since the June 7 meeting. DHS staff sent the draft Inpatient and Outpatient State Plan Amendments to hospitals on June 14. These documents do not yet include changes from the 2011-2013 biennial budget, which is expected to be signed by the Governor in Green Bay June 26. Once the budget is signed, DHS will make additional changes to the State Plan Amendments, and hospitals will be given the opportunity to review those changes.

Additional topics discussed at the MAG meeting included projections of hospital assessment payments for 2012, and an overview of the new pay-for-performance initiative, which is still under development. It is clear that DHS took into account several of the recommendations from the WHA Medicaid Reengineering Group in developing its pay-for-performance programs, but some details about the initiative are still under development. DHS expects to have one more meeting of the MAG over the summer to further discuss the pay-for-performance measures and associated payment methodology.

In other budget-related items, Borgerding said the Legislature restored most of the supplemental EACH payments. They also repealed the medical record copy fees enacted at the behest of the plaintiff’s bar two years ago, and substituted a more appropriate, WHA-backed fee schedule that will also annually be adjusted for inflation. Changes were also made to the fee-setting process for newborn screening tests, another change spearheaded by WHA in the state budget bill.

Most unexpectedly was a move to eliminate WisNet and return the $36 million ARRA grant for broadband expansion into rural areas of Wisconsin. WHA was brought into the fight late, according to Borgerding, but became the lead interest group opposing the elimination of the grant and was directly involved in a compromise reached during the final stages of budget bill negotiations.

WiscNet is a multi-partner, public/private consortium that has invested heavily in building broadband infrastructure, including the type of high-capacity data transfer technology needed for telemedicine applications, in areas of the state where other affordable options have not been readily available. The two-year delay will allow a study of the issue to determine if other telecommunications providers come forward to economically build accessible broadband infrastructure that meets the technological demands of health care in rural areas of Wisconsin.

WHA Council Report

Council on Medical and Professional Affairs: Kelly Court

At the last MPA meeting, the Wisconsin Poison Center updated the Council on its work and the financial challenges they are facing. The Poison Center, which is funded in part by Children’s Hospital and Health System, said about 25 percent of their calls are from hospitals, a service that is held in high regard by providers. The staff also takes a considerable amount of calls from the public, which they report helps avoid unnecessary emergency department utilization by providing information.

The Council also heard a report on ICD-10 implementation and the important role that physicians have in ensuring a successful transition.

Lastly, Court said work is starting in Wisconsin to better understand disparities—work that starts with collecting accurate data, which begins with training the patient registration staff.

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Political Action Fundraising Campaign Update - $100K Mark Surpassed

The Wisconsin hospitals state political action funds fundraising campaign has raised more than $24,000 in the last four weeks bringing the campaign total to date to $101,037 from 164 individuals. This puts the 2011 campaign at 40 percent of the $250,000 monetary goal. Last year at this time, the campaign raised $88,487 from 115 individuals so both the total amount and number of individuals participating is up this year from last year at this same time.

Individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. 2011 contributors to date are listed below. Contributors are listed alphabetically by contribution category. The next publication of the contributor list will be in the July 8 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Contributions ranging from $1 - 499

Alstad, Nancy         Fort HealthCare

Ashenhurst, Karla         Ministry Health Care

Ayers, Mandy         Wisconsin Hospital Association

Bablitch, Steve         Aurora Health Care

Bailet, Jeffrey         Aurora Health Care

Banaszynski, Gregory         Aurora Health Care

Beall, Linda         Hudson Hospital

Boudreau, Jenny         Wisconsin Hospital Association

Braunschweig, Jennifer         Gundersen Lutheran Medical Center

Brenny, Terrence         Stoughton Hospital Association

Byrne, Frank         St. Mary’s Hospital

Campbell-Kelz, Nancy         Aspirus Wausau Hospital

Casey, Candy         Columbia Center

Clapp, Nicole         Grant Regional Health Center

Clark, Renee         Fort HealthCare

Connor, Michael         Aurora Health Care

Cooksey, Patricia         Hudson Hospital

Dahl, James         Fort HealthCare

Decker, Michael         Divine Savior Healthcare

DeRosa, Jody         St. Mary’s Janesville Hospital

Devermann, Robert         Aurora Medical Center in Oshkosh

Dolohanty, Naomi         Aurora Health Care

Donlon, Marcia         Holy Family Memorial, Inc.

Elliott, Roger         St. Joseph’s Hospital

Evans, Kim         Bellin Hospital    

Facey, Alice         St. Clare Hospital and Health Services

Fielding, Laura         Holy Family Memorial, Inc.

From, Leland         Beloit Health System

Furlong, Marian         Hudson Hospital

Giedd, Janice         St. Joseph’s Hospital

Govier, Mary         Holy Family Memorial, Inc.

Grohskopf, Kevin         St. Clare Hospital and Health Services

Groskreutz, Kevin         St. Joseph’s Hospital

Halida, Cheryl         St. Joseph’s Hospital

Hemes, Jim

Hieb, Laura         Bellin Hospital

Hockers, Sara         Holy Family Memorial, Inc.

Hoege, Beverly         Reedsburg Area Medical Center

Holub, Gregory         Ministry Door County Medical Center

Jelle, Laura         St. Clare Hospital and Health Services

Keene, Kaaron         Memorial Health Center - An Aspirus Partner

Klay, Lois         St. Joseph’s Hospital

Klein, Rick         Aurora Health Care

Kuehni-Flanagan, Tracy         St. Joseph’s Hospital

Laird, Michael         Froedtert Health St. Joseph’s Hospital

Lange, George         Westgate Medical Group, CSMCP

Margan, Rob         Wisconsin Hospital Association

Marquardt, Amy

Maurer, Mary         Holy Family Memorial, Inc.

McNally, Maureen         Froedtert Health

Merline, Karen

Muellerleile, Steven         Westfields Hospital

Mulder, Doris         Beloit Health System

Niemer, Margaret         Children’s Hospital and Health System

O’Keefe, James         Mile Bluff Medical Center

Olson, Bonnie         Sacred Heart Hospital

Ose, Peggy         Riverview Hospital Association

Page, Alison         Balwin Area Medical Center

Palecek, Steve         St. Joseph’s Hospital

Penczykowski, James         St. Mary’s Hospital

Peters, Kenneth         Bellin Hospital

Petonic, Mary Frances         Meriter Hospital

Potts, Dennis         Aurora Health Care

Priest, Geoffrey         Meriter Hospital

Proehl, Sheila         Hudson Hospital

Radoszewski, Pat         Children’s Hospital and Health System

Rambo, Kari         Hudson Hospital

Reinke, Mary         Aurora Health Care

Rickelman, Debbie         WHA Information Center

Roller, Rachel         Aurora Health Care

Samitt, Craig         Dean Health System

Schaefer, Mark         Froedtert Health

Scieszinski, Robert         Ministry Door County Medical Center

Sheehan, Heather         Hayward Area Memorial Hospital and Water’s Edge

Stanford, Cynthia

Tapper, Joy         Milwaukee Health Care Partnership

Taylor, Steve         Beloit Health System

Tews, Carol         Memorial Medical Center - Neillsville

Van Meeteren, Bob         Reedsburg Area Medical Center

VanDeVoort, John         Sacred Heart Hospital

Walker, Troy         St. Clare Hospital and Health Services

Worrick, Gerald         Ministry Door County Medical Center

Yaron, Rachel         Ministry St. Clare’s Hospital

Zeller, Brad         Hayward Area Memorial Hospital and Water’s Edge

Contributions ranging from $500 - 999

Anderson, Sandy         St. Clare Hospital and Health Services

Bjork, Tanya

Bukowski, Cathy         Ministry Eagle River Memorial Hospital

Bultema, Janice

Carlson, Dan         Bay Area Medical Center

Clough, Sheila         Ministry Health Care’s Howard Young Medical Center

Court, Kelly         Wisconsin Hospital Association

Dietsche, James         Bellin Hospital

Eckels, Timothy         Hospital Sisters Health System

Frank, Jennifer         Wisconsin Hospital Association

Garcia, Dawn         St. Joseph’s Hospital

Grundstrom, David         Flambeau Hospital

Guirl, Nadine         ProHealth Care

Heifetz, Michael         SSM Health Care-Wisconsin

Huettl, Patricia         Holy Family Memorial, Inc.

Johnson, Patricia         Hayward Area Memorial Hospital and Water’s Edge

Kerwin, George         Bellin Hospital

Lewis, Gordon         Burnett Medical Center

Mantei, Mary Jo         Bay Area Medical Center

Mohorek, Ronald         Ministry Health Care

Nelson, James         Fort HealthCare

Nelson, Nanine         ProHealth Care

Oberholtzer, Curt         Bay Area Medical Center

Russell, John         Columbus Community Hospital

Schafer, Michael         Spooner Health System

Selberg, Heidi         HSHS-Eastern Wisconsin Division

Shabino, Charles         Wisconsin Hospital Association

Swanson, Kerry         St. Mary’s Janesville Hospital

VanCourt, Bernie         Bay Area Medical Center

Westrick, Paul         Columbia St. Mary’s, Inc. - Milwaukee

Wolf, Edward         Lakeview Medical Center

Zenk, Ann         Ministry Sacred Heart Saint Mary’s

Contributions ranging from $1,000 - 1,499

Alig, Joanne         Wisconsin Hospital Association

Boese, Jennifer         Wisconsin Hospital Association

Borgerding, Dana

Brenton, Mary E.

Britton, Gregory         Beloit Health System

Duncan, Robert         Children’s Hospital and Health System

Francis, Jeff         Ministry Health Care

Hahn, Brad         Aurora Health Care

Harding, Edward         Bay Area Medical Center

Hilt, Monica         Ministry Saint Mary’s Hospital

Kerschner, Joseph         Children’s Hospital and Health System

Kosanovich, John         UW Health Partners Watertown Regional Medical Center

Loftus, Philip         Aurora Health Care

Martin, Jeff         Ministry Saint Michael’s Hospital

Mettner, Michelle         Children’s Hospital and Health System

Mohorek, Ronald         Ministry Health Care

Morgan, Dwight         Aurora Health Care

Normington, Jeremy         Moundview Memorial Hospital and Clinics

Olson, David

Potter, Brian         Wisconsin Hospital Association

Robertstad, John         ProHealth Care - Oconomowoc Memorial Hospital

Sexton, William         Prairie du Chien Memorial Hospital

Stanford, Matthew         Wisconsin Hospital Association

Troy, Peggy         Children’s Hospital and Health System

Wallace, Michael         Fort HealthCare

Contributions ranging from $1,500 - 1,999

Bloch, Jodi         Wisconsin Hospital Association

Coffman, Joan         St. Joseph’s Hospital

Eichman, Cynthia         Ministry Our Lady of Victory Hospital

Grasmick, Mary Kay         Wisconsin Hospital Association

Herzog, Mark         Holy Family Memorial, Inc.

Kammer, Peter         Essie Consulting Group

Levin, Jeremy         Rural Wisconsin Health Cooperative

O’Brien, Mary         Aurora St. Luke’s Medical Center

Olson, Edward         ProHealth Care

Starmann-Harrison, Mary

Turkal, Nick         Aurora Health Care

Warmuth, Judith         Wisconsin Hospital Association

Woodward, James         Meriter Hospital

Contributions ranging from $2,000 - 2,499

Fish, David         Hospital Sisters Health System

Kachelski, Joe         Wisconsin Statewide Health Information Network

Katen-Bahensky, Donna

Leitch, Laura         Wisconsin Hospital Association

Merline, Paul         Wisconsin Hospital Association

Neufelder, Daniel         Affinity Health System

Pandl, Therese         HSHS-Eastern Wisconsin Division

Size, Tim         Rural Wisconsin Health Cooperative

Contributions ranging from $2,500 - 2,999

Borgerding, Eric         Wisconsin Hospital Association

Desien, Nicholas         Ministry Health Care

Contributions ranging from $3,000 - 3,999

Erwin, Duane         Aspirus Wausau Hospital

Contributions ranging from $4,000 - 4,999

Contributions $5,000 +

Tyre, Scott         Capitol Navigators, Inc

Brenton, Stephen         Wisconsin Hospital Association

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Governor Expected to Sign Concealed Carry Bill Soon
Legislature approves licensing, training provisions

This week legislation that would allow Wisconsin citizens to carry concealed weapons cleared its final legislative hurdle when the Assembly approved the bill on a bi-partisan 68-27 vote. The proposal passed the Senate on a bi-partisan 25-8 vote last week and has been forwarded to Governor Walker, who is a concealed carry supporter.

As previously reported, important language in the bill allows private businesses, including hospitals and clinics, to "post" their facilities and prohibit the carrying of concealed weapons. Similarly, employers could prohibit their employees from carrying a concealed weapon in the course of their employment.

The bill does not allow prohibiting keeping a weapon in a private vehicle in a parking lot, but clarifications were made to ensure that business property could be posted, including parking lots.

In the coming weeks, look for additional information and a WHA webinar on how to comply with what will soon be Wisconsin’s new concealed carry law.

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IRS Makes Reporting on New Tax-Exempt Requirements Optional

The Internal Revenue Service (IRS) recently announced that reporting on the new tax-exemption requirements for hospitals will be optional for tax year 2010. Part V Section B of the 2010 Schedule H addresses the new Section 501(r) requirements under the Patient Protection and Affordable Care Act, including community health needs assessment, financial assistance policy, billing and collections, and charges for medical care. According to the agency, the section will be optional for tax year 2010 to give the hospital field "more time to familiarize itself with the types of information the IRS will be collecting related to compliance with section 9007…and to address any ambiguities arising from the extensive revisions of the form and instructions."

The IRS invited comments to improve the clarity and reduce the burden of reporting. AHA, WHA, nine other state and metropolitan hospital associations, Healthcare Financial Management Association, and VHA, Inc. recently urged the IRS to "act with dispatch to withdraw and reissue the form, improve the instructions and issue clear and usable guidance." The form creates onerous and redundant reporting requirements, goes beyond the statute’s requirements, and was issued without a proper notice and comment period, the associations said.

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New Non-Emergency Medical Transportation Management System for Medicaid Recipients Begins July 1
Hospital discharge planners should be aware of a new hospital-specific FAQ on changes

Effective July 1, 2011, the Department of Health Services (DHS) will implement a new transportation management system that will coordinate non-emergency medical transportation (NEMT) services for most, but not all, Medicaid and BaderCare Plus members. DHS has contracted with LogistiCare Solutions, LLC, (LogistiCare) to provide NEMT management services. The changes will not affect emergency transportation or the transport of patients that need medical care during transportation.

WHA staff has worked with LogistiCare and DHS to address hospital specific questions about the changes. As a result, LogistiCare has created a FAQ specifically for hospitals that describes key changes to the transportation management system for Medicaid. A copy of that FAQ can be found at: www.wha.org/WisHospitalsFAQs6-2-11.pdf. Additional information about the program can be found at https://facilityinfo.logisticare.com/wifacility/Home.aspx and https://www.forwardhealth.wi.gov/kw/pdf/2011-24.pdf.

LogistiCare and DHS have previously sent additional information to hospitals and providers about the changes, including:

Key facts about the upcoming changes include:

Questions about LogistiCare and the July 1 changes should be directed to either Bob Harrison at LogistiCare (roberth@logisticare.com) or Greg DiMiceli (gregory.dimiceli@wisconsin.gov) at DHS. Matthew Stanford (mstanford@wha.org) and Judy Warmuth (jwarmuth@wha.org) at WHA are also available if you have further questions.

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Federal Deficit Talks Heat Up: Provider Taxes, Program Cuts Potentially in the Mix
We need you to "turn up the HEAT"

Congress is wrestling over how to address the national debt, with action on the debt ceiling needing to take place by August 2. Contained within the various proposals Congress is discussing are potentially drastic cuts to Medicare and Medicaid, including a roll-back or possible elimination of state provider assessments.

Cuts to Medicaid and Medicare could come in any number of forms, including across-the-board program cuts or arbitrary limits to federal spending levels. This week the American Hospital Association and other groups released a study done by The Lewin Group that estimates the negative impact of certain arbitrary triggers or caps. Among the study’s findings are that hospitals could see an estimated $704 billion in cuts over the decade and Medicaid, Medicare would see a combined $1.6 trillion in cuts.

"Our public programs, Medicaid and Medicare, already pay hospitals and physicians far less than the costs of providing patient care," said WHA President Steve Brenton. "The message to our federal lawmakers should be a resounding…‘enough’s enough’!"

In addition to these proposals are other more targeted cuts to the Medicare and Medicaid programs. Of most concern is an issue that continues to be on the table—limiting or eliminating a state’s ability to use provider assessments, like Wisconsin’s successful hospital assessment. If this proposal were to move forward in Washington, it could dramatically impact Wisconsin hospitals and our state’s safety net program.

Currently Wisconsin’s Medicaid program covers more than 1.1 million people, meaning one out of every five Wisconsin residents is a Medicaid recipient. Wisconsin’s hospital assessment has significantly helped stabilize Medicaid funding in the program and minimize the impact of the recession on hospitals and patients. Proposals being discussed that reduce a state’s ability to use provider assessments like that in Wisconsin will result in lower funding and even more pressure to cut Medicaid, jeopardizing services to the most needy.

Additional proposals being floated are: cuts to Graduate Medical Education; cuts to Medicare bad debt; and changes to Medicaid’s matching rate.

Details are slim on all of these items and there is much uncertainty in the debt ceiling discussions as a whole; however, WHA continues to engage hospitals on this issue. In our efforts to do so, WHA will be scheduling meetings between hospitals and their Members of Congress during the month of July, and will send a grassroots HEAT alert in the coming days. Also, the American Hospital Association will be hosting a Washington DC fly-in on July 13. Please contact Jenny Boese at jboese@wha.org or 608-268-1816 if you will be participating in this event.

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Presentations at the 2011 Rural Health Conference:
Rural Residency and Rotation Programs: The Nuts & Bolts

Wisconsin hospitals are not waiting for someone else to solve the physician shortage problem. They are addressing it head on by creating—and funding—rural residencies.

It is a well-known fact that physicians tend to stay in the community where they complete their residency. That usually means they are completing their training in a large, urban area. But several Wisconsin hospitals are putting considerable resources into developing a residency program in their own hospital in an effort to keep physicians in the community.

Two rural hospitals shared their experiences with residency programs at the Wisconsin Rural Health Conference June 16.

"We want the very best for the people that live in our community," said Sandy Anderson, president of St. Clare Hospital and Health Services in Baraboo. "That is why this residency program is a passion."

While the costs of supporting a rural residency are high, there is a financial benefit in the fact that if a physician is retained through the program, it eliminates recruitment costs downstream. Another benefit for both the hospital and for the physician is they can build a practice panel while they are still a resident.

The strengths of the program have been the willingness of the community to be seen by the residents, the commitment of the physicians and program coordination staff, and the support of the hospital. In the area of improvements, there is a need for the medical schools to increase the visibility of rural practices, and more rural training sites are necessary to meet the demand for these opportunities.

Anderson identified two threats to the success of the rural residencies: Health reform and the impact it could have on the ability of hospitals to support training in rural areas, and students in medical school being "steered" toward urban programs and into specialty and subspecialty programs.

Jim Damos, MD, is the head of the rural residency training track in Baraboo. He said family medicine is the "champion" of rural placement. Rural communities, in his opinion, have been "left behind" as specialties have grown.

"The concept of having rural residencies is to train physicians in ‘laboratories’ similar to where they will work in the future," according to Damos. "We feel prolonged rural exposure challenges resident physicians to think differently than they would if they were working in an environment without numerous specialists."

While there are numerous advantages for physicians in the rural residencies, what is in it for the established physicians that are training the new crop of doctors?

"It is an opportunity to mentor the new generation," according to Neil Bard, MD, Richland Medical Center. "We are there to help them ‘test drive’ what they have been taught at the university under direct supervision."

Bard said physicians like working with the residents because they not only can teach, but also learn, from the new physicians and maintain a connection to UW Madison. The residents can help with routine work, such as patient histories, hospital rounds and call. The disadvantage to participating physicians is it can sometimes be "extra work" in an already busy day, and some residents need much more time and assistance than others.

Overall, however, Bard was quick to point out that the residency program is popular among the physicians that participate in it, and "our physicians stay in the community because they like to train other doctors."

All presenters agreed that even if there is not an opening on the medical staff immediately available when a physician completes the rural residency, they are more likely to come back when a position does become open because of the connection they have with the medical staff, the hospital, and the community.

The Rural Physician Shortage: Meeting the Challenge

While it’s an attractive location for a physician to set up a practice, Wisconsin continues to import most of its physicians because we are not retaining those that train in this state. It’s a problem that WHA’s George Quinn and Chuck Shabino find very alarming.

"Think of the consequences that a physician shortage will have on our state," Quinn said. "Each year we fall farther and farther behind. We need to have 20 percent more physicians practicing in our state than we have today just to stay even with the demand for care."

The number of physicians that will stay in Wisconsin to practice is dependent, in large part, to where they do their residencies. Quinn said it is critical that Wisconsin increase the number of residencies that are open to Wisconsin medical school graduates. Another move that could increase the number of physicians practicing in Wisconsin is to accept more students into Wisconsin’s medical schools that have been raised here. Currently, only about half the students in Wisconsin’s medical schools are from the state.

Quinn and Shabino shared statistics with the audience that will be included in the next WHA physician supply report, all of which illustrated that actions must begin now to build an adequate physician workforce for tomorrow.

One program that was funded by the rural hospital assessment has the potential to help bring physicians into and support them in rural areas. Bill Schwab, MD, is director of the Wisconsin Rural Physician Residency Assistance Program. The aim of the program is to establish and expand physician residency positions in rural areas by helping to support administrative costs, resident salary expenses and help fund preceptor payments. The program encourages hospitals to set up an eight-week rural rotation in a clinic or hospital that is staffed by physicians that admit patients to a rural hospital.

"We want to facilitate the development of new rural residency experiences by providing funding or technical support for innovation in rural residency experiences," Schwab said.

Shabino said the residents and physicians that are teaching them are both seeing the benefit. "We are giving the residents unique and excellent content that exceeds what they can get in their traditional settings," Shabino said. "Then, the other benefit is we produce a more satisfying work experience for our physicians in rural areas that have a part in teaching. They, in turn, then have an opportunity to recruit those new physicians into their practices."

WHA Presents Peickert Lifetime Achievement Award

As CEO of Hayward Memorial Hospital, Barbara Peickert always put the patient first. That dedication to and passion for providing high quality health care is just one of the many traits that made Peickert an exceptional health care leader. Peickert is retiring after 25 years of service to the hospital.

The Wisconsin Hospital Association presented a "Lifetime Achievement Award" to Peickert last week at the Wisconsin Rural Health Conference held in Elkhart Lake. In presenting the award, WHA Executive Vice President Eric Borgerding recounted her many accomplishments and contributions to not only the local community, but to the entire state.

"Throughout her career, the dignity and care of hospital patients and nursing home residents has always been the cornerstone of her leadership," according to Borgerding. "Barb is first and foremost an advocate for, and expert in, clinical care excellence."

Peickert received a BSN in Nursing from the University of Minnesota. She worked at the U of M as a staff nurse in the transplant and dialysis units, as clinical director of the Masonic Cancer Hospital at the University and as Associate Director for Inpatient Services during her 14 years there. In1980, the family moved to Ashland when Peickert accepted the Director of Nursing position at Memorial Medical Center. She continued to work in Ashland until 1986 when Hayward Area Memorial Hospital was purchased by Regional Enterprises, Inc., the parent company of the Ashland facility. At that time, she accepted the opportunity to serve as CEO of the Hayward facility.

Peickert served two terms on WHA’s Board of Directors as well as fulfilling leadership roles in many other civic organizations including the Hayward Development Corporation and the Hayward Rotary Club. Barb and her husband Lanny have three children, Ann Marie, Ross and Ryan.

"A hospital CEO must be committed, intelligent, and able to make difficult decisions and be flexible enough to pitch in and tackle any challenge that may arise," Borgerding said. "While there are many rural CEOs that fit that job description, there is only one Barb Peickert. She is an original."

RWHC Recognizes Quinn at Rural Health Conference

Tim Size, executive director of the Rural Wisconsin Health Cooperative, recognized WHA Senior Vice President George Quinn’s contributions to the field of rural health. Presenting the award at the Rural Health Conference June 16 on behalf of RWHC members, Size described Quinn as a "champion for rural hospitals since day one."

Size commended Quinn for his work involving rural hospitals, rural health care, hospital finance, Medicare & Medicaid, regulatory matters, quality improvement and reporting, and workforce issues.

"A common thread through all of these issues is George’s ability to work with people, to understand what the numbers mean, and then develop the strongest advocacy position," Size said.

Quinn was instrumental in getting Critical Access Hospital status implemented in Wisconsin. He was also responsible for the two "Who Will Care for Our Patients" reports about the mal-distribution and shortage of physicians in Wisconsin. Quinn is now leading a task force for the WHA Board of Directors that many believe will lead to WHA and others calling for a radical change and expansion of the physician supply in Wisconsin.

"George, you set the standard for common sense and effectiveness; you are leaving top-notch successors at WHA but you will be missed," Size said in closing.

Quinn announced he will retire in July, but he will continue to work with the Association on a consulting basis.

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Grassroots Spotlight: Hospitals Hosting Legislators
Rep. Sean Duffy talks Medicare, national budget at St. Joseph’s Hospital (Chippewa Falls)

Medicare and the $14.3 trillion budget shortfall were on the mind of Rep. Sean Duffy (R-7th Congressional District) as he met with some 20 members of St. Joseph’s Hospital (Chippewa Falls) Advocacy Committee recently.

"There is no dispute from Democrats or Republicans. The trajectory (of Medicare) is unsustainable," Duffy told the crowd. "We have Baby Boomers that are about to retire."

"We have real issues with how we are going to deal with Medicare," he said. "We’re trying to secure Medicare, save it, protect it."

Duffy said he proposes that people who are 55 and older would keep Medicare, and people who are 54 and younger would pay a portion, similar to a health insurance premium, which is run through the Medicare Premium Support program. With that, Duffy said there will be many providers.

Duffy met with St. Joseph’s Hospital President and CEO Joan M. Coffman, took a brief tour of the hospital’s Emergency Services Area, Wound Care and Hyperbaric Medicine and Radiology, and then was the guest speaker during the hospital’s Advocacy Committee meeting.

Rep. Ribble at Shawano Medical Center

Rep. Reid Ribble (R-8th Congressional District) toured Shawano Medical Center and talked with staff about health care and other issues.

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Member News:
Agnesian HealthCare Announces Change in Leadership: Fale to retire; Little appointed CEO

Robert Fale will retire as president/CEO of Agnesian HealthCare effective February 1.

Agnesian’s board of directors has appointed Steven N. Little, executive vice president, as the new chief executive officer effective January 1, 2012.

Little joined Agnesian HealthCare as chief financial officer in 2003 and became the system’s executive vice president in 2010. He is on the board of the Fond du Lac Area Association of Commerce and is past president of the Fond du Lac Family YMCA. Little earned a Bachelor of Science degree in business administration/accounting and is a certified public accountant.

Froedtert Health and Froedtert Hospital Appoint Senior Leaders

Bill Petasnick, president and CEO of Froedtert Health and Froedtert Hospital, announced that effective July 1, Catherine Jacobson, executive vice president of finance and strategy for Froedtert Health, will be promoted to president of Froedtert Health; and Cathy Buck, executive vice president and chief operating officer of Froedtert Hospital, will be promoted to president of Froedtert Hospital. Petasnick will continue to serve as the chief executive officer of Froedtert Health.

"My focus will turn to the long-term development needs of the health system, physician integration, fundraising and advancing health care reform at the national and state levels," Petasnick said.

As president of Froedtert Health, Jacobson will assume responsibility for the overall operations of the health system. She will also continue to oversee long-term strategic and financial planning efforts at the system level. Jacobson came to Froedtert Health in 2010 after 14 years with Rush University Medical Center in Chicago, where she guided the organization through long-term strategic planning while building innovative partnerships with other health care providers and insurance companies.

Cathy Buck, RN, as president of Froedtert Hospital, will be responsible for the financial, quality and service goals of the organization, working in partnership with Medical College of Wisconsin physicians. Buck will work directly with the Froedtert Hospital board of directors in developing community benefit strategies to improve the health status of eastern Wisconsin region residents served by the academic medical center. Buck has served in progressive leadership capacities at Froedtert Hospital since 1983, pioneering numerous patient safety and quality improvements. She has served as executive vice president and chief operating officer since 1999.

Westfields Hospital Names New CEO

Steven Massey has been appointed president and chief executive officer of Westfields Hospital in New Richmond, effective August 1.

"Steve is a highly-respected leader with extensive experience in the financial side of health care," said Jeff Redmon, Westfields Hospital board chairman. "As we conducted our executive search, it was important to us that we find someone who was very familiar with the western Wisconsin region."

Massey was previously the chief financial officer at Osceola Medical Center for nearly three years. He has also held positions with Fairview Health Services and Allina Hospitals and Clinics.

Massey earned a bachelor of science degree in finance from Missouri State University and a master’s of healthcare administration from the University of Minnesota.

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Wisconsin TCAB Project Featured in Nursing Matters
Warmuth visits Osceola Medical Center, Holy Family Hospital, and Meriter Hospital

In a very short time, the 18 hospital units participating in the Transforming Care at the Bedside (TCAB) have organized their efforts and started to move forward.

WHA’s Judy Warmuth has been conducting site visits at each of the units. The major purpose of the site visits is to assure that each team has successfully launched TCAB on their unit. Warmuth reports this week on three more visits she conducts, each of which continues to prove that the TCAB teams are showcasing their actions and making progress on the quest to improve care at the bedside.

Each of these teams-with leadership support-has successfully launched and created improvements for patients and staff. Site visits will continue through the summer.

The current issue of Nursing Matters contains a story about Wisconsin’s TCAB initiative, written by Warmuth and Stephanie Sobczak, WHA’s quality improvement manager (see www.wha.org/nursingMattersJuneJuly2011.pdf). It will become a regular feature in Nursing Matters, highlighting Wisconsin teams and their successes.

Warmuth’s site visit reports follow:

Osceola Medical Center

A public launch announcing participation in TCAB and a visible presence for staff members, patients and visitors is an expectation of TCAB participation. Visible bulletin boards like this one in Osceola create interest in the project, encourage other units and departments to participate and show the public how the units is committed to quality. This team has found a simple way to measure the distance that patient’s ambulate and has begun a pilot of nurse/physician rounding.

Holy Family Hospital in Manitowoc

The team at Holy Family Hospital used the snorkel approach to identify areas for improvement to give everyone the chance to raise ideas, propose solutions and participate in TCAB efforts. The amount of creativity and a large number of good ideas—big and small—mean that staff is engaged in improvement. This team has new strategies for keeping patient rooms organized and clear and now offers (with the help of their volunteers) a warm lavender-scented washcloth to patients at bedtime.

Meriter Hospital has two units participating in TCAB

Med/Surg unit: The largest unit in the project, 6 Tower has initiated charge nurse huddles, started to work on bedside shift report and revamped (stealing shamelessly from their friends on 8T) the supplies and organization of their nurse servers.

Ortho/Neuro: A quick win for this unit on 8Tower was commodes for every patient room, a great improvement for their specific population. They have also moved their emesis bags, worked on room organization, and will start on new strategies for assuring that patients are ready for discharge.

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Wisconsin Hospitals Community Benefits: Oral Health

Wisconsin hospitals share a common mission to improve their community’s health status, which includes oral health care, an area often neglected because people cannot afford dental work. Lack of proper dental care can lead to a myriad of other health problems. Those with severe tooth pain often end up in hospital emergency rooms for pain relief. By increasing access to dental services for those who cannot afford it, hospitals are not only improving the overall health of their communities, but also decreasing the burden on their emergency departments.

Diane’s story

Diane Patterson, 52, works only part time, receives an income under 200 percent of poverty levels and has no dental insurance. She began experiencing severe pain in one of her lower molars and did not know where to go for help. A friend told her to call the 211 @ IMPACT help line, and she learned of urgent-care services at Seton Dental Clinic, sponsored by Columbia St. Mary’s (CSM).

When Patterson first came to the clinic, the dentist, Dr. Charles Kosowski, D.D.S., told her she had a blood pressure of 160/110—too high to have the painful tooth extracted. She was surprised: "I never knew I had high blood pressure, but it does run in my family." Patterson was referred to the Columbia St. Mary’s Community-based Chronic Disease Management Clinic (CCDM) for a medical evaluation, with instruction to return to Seton when her blood pressure was under control.

Three weeks later, Patterson came back to Seton, presenting documentation from CCDM to show that her blood pressure was now being treated and monitored. She was grateful for the care she received at the CCDM Clinic, saying, "I went to the one at 205 East Concordia. I never will forget that address; they have been so good to me. I get my blood-pressure medicine for free!"

Patterson was given an appointment with Dr. Kosowski right away and, with a blood pressure reading in the normal range, had the painful tooth extracted. "That doctor is so nice; everyone has been so nice," she said.

Then, despite just having had a tooth extracted, she flashed the biggest smile that she could.

Columbia St. Mary’s, Inc., Milwaukee

FCCHC offers dental services to underserved residents

Historically, access to oral health services has been a significant challenge for underserved residents in the Fox Valley, as few dental providers are able to cost-effectively treat Medicaid and uninsured patients. Wisconsin ranks in the bottom five states nationally for the amount of money allocated to its dental Medicaid program. In 2008, less than 20 percent of Medicaid/Badger Care recipients were able to receive dental services and the access issues for uninsured individuals are even more significant.

The statistics supporting the oral health needs in the Fox Valley communities are grim. Without action, the downward slide of dental services to the poor will accelerate. The Fox Cities Community Health Center (FCCHC), located in Menasha, Wis., added dental services in early 2009 after recognizing the decline in access to oral health in the area. The FCCHC dental department had over 4,200 visits in the first year.

In order to meet the growing needs of better access to dental services, in early 2011 the FCCHC moved its dental clinic to an office location allowing for more patients to access services. Since the new clinic location, it is up 80 visits per month, now averaging 1,000 visits per month.

The FCCHC, a community-initiated, non-profit organization, originally formed in 1997 with strong ties to local health systems, public health departments and the university system. This "free clinic" was created through a partnership of Affinity Health System and ThedaCare in response to the closure of state-funded county voucher programs for medical care. The FCCHC maximized local charity care programs and provided free care to uninsured patients.

In 2004, FCCHC was funded as a Community Health Center and Health Care for the Homeless program, the only combined program in the state of Wisconsin. Today, the in-kind and financial support of Affinity Health System and ThedaCare are an important partner in providing care. In the Fox Valley area, there continues to be a lack of coordinated, comprehensive primary and preventive care for individuals facing financial, cultural and linguistic barriers. FCCHC is the only safety net clinic in the area, providing necessary primary and preventive services to more than 7,000 individuals that otherwise would not have access to care.

The mission of FCCHC is to create a vibrant community through health care access and quality service delivery to the underserved. FCCHC offers primary care, preventive dental care and mental health services at the main facility in Menasha, Wis., in the heart of the tri-county service area of Winnebago, Outagamie and Calumet County. Additional primary care, case management, and AODA services are provided through the center’s Healthcare for the Homeless Program at the regional emergency shelter in Appleton. All fees are based on a sliding fee ranging from $20-$80 depending on monthly income and family size; however, no one is turned away for ability to pay.

FCCHC has significant experience providing primary care services to the community’s most at-risk population and is the only non-profit organization providing these services in the Fox Valley area. FCCHC has maximized collaborative relationships with local health systems, public health departments and other community service agencies, allowing FCCHC to concentrate on filling gaps in service and providing services to individuals with the greatest needs. FCCHC has grown considerably since its inception, resulting from the community’s investment in FCCHC and its ability to respond to the emerging health care needs of the community.

Affinity Health System

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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