January 23, 2015
Volume 58, Issue 3

Population Health, Behavioral Health, Delivery Redesign Focus of Planning Grant

The Statewide Value Committee (SVC), a group representing health care providers, purchasers, payers and state government, met January 20 to plot strategy around implementing a major Center for Medicare and Medicaid Innovation grant designed to accelerate Wisconsin-based health care innovation.

The $2.5 million, one-year planning grant will be used to design a blueprint for an even larger implementation grant in 2016. Top priorities include: 1) population health improvement, 2) behavioral health, and 3) delivery redesign. Additional areas of focus intended to support the top priorities include HIT/HIE, value measurement and new payment modeling.

Former Wisconsin Health Information Organization Director Julie Bartels will direct the project. WHA-related representatives serving on the SVC include former WHA President Steve Brenton, Bellin Health CEO George Kerwin and Monroe Clinic Chief Medical Officer Mark Thompson. Wisconsin Medical Society and Wisconsin Collaborative for Healthcare Quality leaders are also involved with the project. Department of Health Services Secretary Kitty Rhoades is a project lead.

"The grant funding provides a real opportunity to accelerate health care value by focusing on new opportunities that will continue to transform Wisconsin health care," said WHA Senior Policy Advisor Steve Brenton. "It’s also exciting to see this shared private/public sector strategy—something that’s been an historic dynamic and has worked so well for Wisconsin."

WHA members interested in more information about the project can access this link: www.wha.org/pdf/WisconsinModelDesignAwardExecutiveSummary.docx. Members interested in being involved in one of the workgroups that will be established to identify and develop initiatives are encouraged to contact WHA staff. The behavioral health work will be led by Matthew Stanford, WHA general counsel. WHA Senior Vice President Joanne Alig will lead delivery (and payment) redesign. Kelly Court, WHA chief quality officer, will lead measurement development work, and Mary Kay Grasmick, WHA vice president, communications, will coordinate population health work.

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Medicaid In The Spotlight
Wisconsin’s hidden health care tax

Our January 9 "Spotlight" talked about Wisconsin’s historically low Medicaid/BadgerCare reimbursement rate, second lowest in the nation. In Wisconsin, that means a full 35 percent of a hospital’s actual cost of care to a BadgerCare beneficiary goes unreimbursed by the State, which then creates a "hidden health care tax."

For 2013 alone, Wisconsin’s hidden health care tax was $960 million. This is the amount that hospitals are not paid, which is then shifted onto employers and employees in the form of higher health care premiums/costs. The State Legislature should stem the "hidden health care tax" by addressing Wisconsin’s Medicaid reimbursement.

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WHA Submits GME Comment Letter to Congressional Committee

The Wisconsin Hospital Association recently submitted comments to the U.S. House of Representatives Committee on Energy & Commerce regarding the future of Medicare’s graduate medical education (GME) program. WHA’s comments were in response to a request for comments by Health Subcommittee Chair Rep. Joe Pitts and Ranking Member Rep. Frank Pallone.

WHA’s letter highlighted the ongoing work in Wisconsin to address future physician capacity needs, including aggressive multi-stakeholder efforts. Further, the letter stressed the importance of maintaining Medicare’s GME payments as key to the success of those initiatives.

"We are committed to proactively trying to meet our state’s physician and health professions capacity needs, but cannot do so without continued federal GME funding," the letter read, which was submitted by WHA President/CEO Eric Borgerding. "Reductions in GME funding will result in the loss of residencies at the very same time our nation’s physician capacity needs are expanding."

The importance of ongoing federal GME funds was one of four recommendations put forth by WHA. Within that recommendation, however, WHA also suggested increased transparency and federal coordination of the GME program would also provide value to the program. Other recommendations included providing states with additional flexibility in GME requirements, providing a pool of additional dollars for innovative GME models, and working to ensure medical school graduates and residents are prepared for the future of health care delivery.

"Wisconsin should be proud of the proactive work being undertaken by hospitals, health systems, medical schools and the government to address our state’s future capacity needs," said Borgerding. "We ask Congress to continue its historic commitment to GME so that we may all be successful going forward."

Read WHA’s full comment letter at: www.wha.org/pdf/2015-EC-GMECommentLetter.pdf.

Read the original Energy & Commerce request for comment at: http://energycommerce.house.gov/sites/republicans.energycommerce.house.gov/files/letters/20141208GMELetter.pdf.

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Guest Column: Community Members Impact Health Care through Volunteering
By Tammy A. Behnke, CAVS, MS, 2014 President,
Wisconsin Association of Directors of Volunteer Services (WADVS)

In Wisconsin, thousands of volunteers support their local hospital and health care systems by contributing their time and skills. In the challenging health care industry, these community members who chose to donate their time and talents to hospitals and health care systems are a vital component in enhancing the patient experience.

An academic study found that for every $1 spent to recruit, train, and manage volunteers, hospitals derive $6.84 in value. Proactive volunteer programs are moving beyond standard reporting of number of volunteers and hours volunteered to report on topics such as the positive impact volunteers have on patient satisfaction scores and on reducing the incidence of falls.

Depending on the volunteer program, there is a potential of 16 touch points where a customer in a health care system may interact with a volunteer, who then creates an experience. Volunteers influence efforts around employee engagement, quality, safety and productivity. These community members are the voice of the community and serve as ambassadors for the hospital. Volunteers can help build awareness in the community of state and federal issues that can have an impact on the local hospital. Many volunteers are actively engaged in advocating in support of their community hospitals through Wisconsin Hospital Association programs like "HEAT" and events like Advocacy Day. Find out more about how volunteers can make a difference in these programs at: www.wha.org/heat-grassroots-advocacy.aspx and http://events.signup4.net/15AdvocacyDay0428.

Community members serving as volunteers are an important asset to the Wisconsin health care delivery system. Those who hold director of volunteer services positions and members of the Wisconsin Association of Directors of Volunteer Services are honored to work with the dedicated community volunteers who commit their personal time and resources to helping Wisconsin continue to be one of the best states in the country for health care.

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WHA-Led Transforming Care at the Bedside Project Plans for the Future

The third group of WHA member hospitals that have a hospital department enrolled in the WHA-led Transforming Care at the Bedside (TCAB) project have completed nearly one year of their 18-month commitment. TCAB is one of WHA’s most popular and successful quality improvement initiatives.

TCAB is a nurse-led hospital program that engages frontline staff to work together to identify, pilot, test and adopt new practices over an 18-month period. Participating nurses will then share their successes and lessons learned with other hospitals across the country.

"As Wisconsin and the nation look at improving care, it is important that we provide local models of reforms that are good for everyone," said Stephanie Sobczak, WHA manager of quality improvement. "Wisconsin hospitals’ participation in this program demonstrates that we are committed to being a leader to improve patient care and increase efficiency to produce better outcomes."

On March 5, the hospital teams will convene in Wisconsin Dells to share best practices at an all-day workshop.

As in past years, WHA is offering a guest program to any member hospital that has not yet participated in TCAB, but would like a chance to see what it is about. There are a limited number of guest slots available. Interested hospitals are invited to send an individual, leader or staff person to the March 5 event and experience the one-day workshop along with a currently participating hospital.

There is no fee to attend. Travel and lodging costs are the responsibility of the attendee. To register one guest for the March 5 TCAB MidPoint Event use this link: http://events.SignUp4.net/2015TCAB3Midpoint.

WHA Hosts "TCAB: The Next Generation" Workshop March 6

Based on positive member feedback from past TCAB participants, WHA is exploring the idea of providing assistance with spreading TCAB from the pilot units through the entire hospital, or across a system. To design value-added next steps for TCAB, WHA is hosting a one-day workshop for TCAB-experienced nurse leaders. The workshop will be facilitated by two of the original grant writers, Betsy Lee and Jane Taylor. Nurse managers and chief nurse officers are encouraged to participate. There is no fee to attend. Travel and lodging costs are the responsibility of the attendee. To register for the March 6 "TCAB: The Next Generation" workshop, go to http://events.signup4.net/15TCABChallenges0306.

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Grassroots Spotlight: Rep. Kooyenga Visits Wheaton Franciscan-Elmbrook Memorial, Meets With Area Hospital Leaders

State Rep. Dale Kooyenga met with local hospital leaders at Wheaton Franciscan - Elmbrook Memorial Hospital. During his visit to the hospital, leaders discussed how Wisconsin’s BadgerCare program impacts the metro Milwaukee area.

WHA Board Chair Letter to Editor
Renew and improve Medicaid DSH program

On January 20, the Green Bay Press Gazette ran a letter to the editor from WHA Board Chair Therese Pandl, CEO of Hospital Sisters Health System-Eastern Wisconsin Division. Pandl’s letter highlighted the importance of renewing and improving Wisconsin Medicaid’s disproportionate share hospital (DSH) program.

"Our hospitals stand ready to serve all members of our community," Pandl stated. "However, to serve the poorest member of our community, Wisconsin hospitals are reimbursed significantly below the cost of providing that care."

Pandl’s letter went on to discuss the "cost-shift" that results from Medicaid underpayment and that the Governor and State Legislature should take action to help address this problem.

Find at: www.greenbaypressgazette.com/story/opinion/readers/2015/01/19/state-renew-medicaid-reimbursement-program/22025507/ 

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WHA Information Center Reports 17.8% Increase in Hospital Outpatient Glaucoma Visits

Glaucoma is more common in older adults, and with the population of Wisconsin aging, the diagnosis of and treatment for glaucoma is on the rise.

According to the WHA Information Center, from July 2013-June 2014, glaucoma was recorded as the primary reason for diagnosis or treatment on 15,973 hospital outpatient clinic or ancillary service visits, which is a 17.8 percent increase over the previous period (July 2009-June 2010). In addition, there were 3,555 outpatient surgery visits, 66 emergency room visits and nine inpatient stays related to glaucoma. These services were provided from July 2013-June 2014 in Wisconsin hospitals and ambulatory surgery centers.

Glaucoma is a group of diseases that damage the eye’s optic nerve and can result in vision loss and blindness. However, serious vision loss can be prevented with early detection and treatment. Some people, listed below, are at higher risk for the disease, including:

For more information, go to the National Eye Institute of the National Institute of Health: https://www.nei.nih.gov/health/glaucoma/glaucoma_facts

Data provided by the WHAIC (www.whainfocenter.com)

The WHA Information Center is dedicated to collecting, analyzing and disseminating complete, accurate and timely data and reports about charges, utilization, quality and efficiency provided by Wisconsin hospitals, ambulatory surgery centers and other health care providers.

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MCW Awarded Grant to Pilot Child Psychiatry Access Project
Pilot will fund collaborative child psych services not currently reimbursed

Department of Health Services Secretary Kitty Rhoades announced that the Medical College of Wisconsin (MCW) has been awarded a $1 million grant to pilot a Child Psychiatry Consultation Program (CPCP) in Milwaukee County and in 15 counties in northern Wisconsin.

"Appropriately treating mental health issues at an early age will help prevent and avoid more costly interventions later in life," said Rhoades. "This program will help children have better access to the mental health services they need by allowing a child psychiatrist from MCW to provide consultation to the child’s primary care provider."

The grant will provide funding for consultations provided by MCW mental health providers to pediatricians in the pilot region that are designed to help pediatricians better manage children with mild to moderate mental health problems. Historically, despite the value added by the mental health professional, such consultations have not been a reimbursable service to the mental health professional.

"The Child Psychiatry Consultation Program is one example of innovative approaches to mental health care delivery and payment that are seeking to better align payment systems with more efficient and high quality care delivery models," said WHA General Counsel Matthew Stanford. "Such innovative payment models for mental health care are even more important given Wisconsin’s critical shortage of both child and adult psychiatrists."

In addition to the consult services, MCW through the pilot grant will also host training programs for primary care providers of children and adolescents to increase understanding of child behavioral health issues, diagnosis and treatment.

"We have a shortage of child psychiatrists in Wisconsin, and nationwide, and primary care providers are often uncomfortable diagnosing psychiatric illnesses, and often reluctant to prescribe psychotropic medications to their patients without guidance or input from a mental health specialist," explained Jon Lehrmann, MD, the Charles E. Kubly Professor and Chair in Psychiatry and Behavioral Medicine at MCW. "This program will provide education, community linkage and referral, and a specialized ‘safety net’ to pediatricians and primary care providers to confidently treat children’s mental health disorders."

The CPCP grant will serve children and youth in Milwaukee County and in 15 counties in northern Wisconsin, including Ashland, Bayfield, Florence, Forest, Iron, Langlade, Lincoln, Marathon, Oneida, Portage, Price, Sawyer, Taylor, Vilas and Wood counties.

Funding for the CPCP was created through Act 127 in response to recommendations from the Speaker’s Task Force on Mental Health.

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Member News: Troy Elected Chair of the Children’s Hospital Association Board

Peggy Troy, president and CEO of Children’s Hospital Wisconsin, started her year-long term January 1 as chair of the Children’s Hospital Association Board of Trustees. Troy’s 40 years in health care began as a bedside nurse and has progressed through a variety of leadership roles.

"I look forward to serving as chair of the Children’s Hospital Association Board of Trustees and working with my fellow board members," said Troy. "It’s so important that we work together to protect the unique needs of children, especially those with complex medical conditions. This is a great opportunity to advocate for all children in order to improve access to quality care. We are the voice for more than 220 children’s hospitals across the country and collectively, we can protect, improve and advocate for the health of the children we serve."

In 2009, Troy became president and CEO of Children’s Hospital of Wisconsin and she serves on the WHA Board of Directors.

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Member News: Herman, MD, Begins New Role as Essentia Health CEO

David C. Herman, MD, is the new chief executive officer for Essentia Health. Herman comes to Essentia from Vidant Health, an integrated health system in eastern North Carolina. Before that, he worked at the Mayo Clinic from 1988 to 2011, where he was a professor of ophthalmology. He has more than 20 years in health care leadership and continues to practice as an eye specialist.

Herman received his medical degree from Mayo Medical School in Rochester, Minnesota, and completed his residency at the Mayo School of Graduate Medical Education. He completed a fellowship in ocular immunology and uveitis from the National Eye Institute at the National Institutes of Health in Bethesda, Maryland. He also has a master’s degree in medical management from the University of Texas at Dallas.

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