March 28, 2014
Volume 58, Issue 13

HHS Extends Enrollment Deadline for Consumers "In Line" for Coverage
Former Medicaid recipients have until May 31 to enroll in exchange

With the March 31 exchange open enrollment deadline just days away, the Department of Health and Human Services (HHS) issued new guidance March 26 that will give consumers extra time to complete their application and enrollment if they are "in line" to sign up for coverage on the exchange. High traffic on the website in the days leading up to the deadline could prevent consumers from completing their application, according to HHS.

While HHS did not say how long the extension will last, CMS will process paper applications received by April 7. These consumers will have until April 30 to select a plan with coverage effective May 1. Individuals applying online or over the phone must attest that they tried to enroll in coverage through either the Health Insurance Marketplace or the state Medicaid agency, either online or over the phone, by March 31, 2014, and didn’t complete enrollment in marketplace coverage because of a problem. CMS lists the specific problem areas in guidance for consumers and assisters (see

Under prior rules, CMS has implemented special enrollment periods—separate from this extension for individuals who were "in line"—for certain qualifying life events such as having a baby. However, consumers who receive a special enrollment period for being "in line" by March 31 will be able to claim a hardship exemption from the shared responsibility payment for the months prior to the effective date of their coverage, because they will be treated as if they had enrolled by the March 31 deadline.

As a reminder, April 1 is the first date of coverage for childless adults with income up to 100 percent of the federal poverty line ($11,670 in annual income). At the same time, as many as 75,000 parents and caretakers with income above the poverty line will be disenrolled from Medicaid. While significant efforts have been underway to connect these individuals with coverage through the exchange marketplace, it is still too early to tell how many of those expected to lose Medicaid have enrolled in coverage in the exchange. Losing coverage in the Medicaid program also counts as a qualifying event, so these individuals will have a special enrollment period through May 31.

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WHA Hosts Inaugural RAC Summit
WHA releases Wisconsin-specific RAC survey data

The Wisconsin Hospital Association (WHA) hosted its inaugural RAC Summit March 26. The day-long program was well received and well attended by 100 hospital leaders, finance, compliance and audit-related professionals from close to 50 hospitals of all sizes across the state. The event provided an educational and valuable networking opportunity for those involved in the audit process.

"Audit-related programs will continue into the future, and WHA will continue to work to educate our hospitals and systems on audit-related policies and programs through Summits like this," said WHA Executive Vice President Eric Borgerding. " WHA will also continue to be an aggressive advocate for you and your hospitals, particularly in Washington, DC, on audit program improvements."

As a member benefit, Jenny Boese, WHA vice president, external relations & member advocacy, released data from WHA’s first ever Wisconsin-specific RAC survey. The 15-question survey had a 57 percent response rate (74 hospitals of all sizes and areas of the state). Several key take-aways from the survey include:

The rest of the day included presentations from Wisconsin’s Medicaid RAC, HMS, and Wisconsin’s Medicare Administrative Contractor, NGS, and allowed for a lively question and answer session.

Larry Hegland, MD, chief medical officer for Ministry Saint Clare’s Hospital, The Diagnostic and Treatment Center, and Ministry Good Samaritan Health Center as well as System Medical Director for Recovery Audit and Appeals Services, provided insight into the role of physician advisors.

During the afternoon, attendees heard tips on surviving (and winning!) in the RAC appeals process from Karen Stoll, manager of payer services and recovery audit for Wheaton Franciscan Healthcare, and Catlin Scheppler, recovery audit and appeals nurse analyst for the recovery audit and appeals department of Ministry Health Care.

Rounding out the day’s sessions was Ronald Hirsch, MD, vice president of the regulations and education group for Accretive Physician Advisory Services. Hirsch provided a cornucopia of information on all things RAC and audit related.

Hospital members interested in learning more about WHA’s RAC survey may contact Jenny Boese at or 608-268-1816.

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WHA, RWHC Launch Quality Manager "Residency" Program

Health care quality professionals from 32 Wisconsin hospitals participated in the first in-person session of the new Quality Residency Program March 21. Sponsored by the Wisconsin Hospital Association (WHA) and the Rural Wisconsin Health Cooperative (RWHC), the program is designed to build on the skills that quality managers who are new to their position bring to the hospital’s quality department.

"Quality improvement is so integral to Wisconsin hospitals that a new manager can feel overwhelmed if they do not have access to the support and additional training that is required to help them be successful the first couple of years on the job," according to Beth Dibbert, quality consultant at RWHC. "This two-year program is designed to help bridge those gaps."

The focus of the first in-person session of the program, held at WHA headquarters in Madison, was learning how to make quality fit within the strategic context of the hospital and developing strategies for being successful in the fast-paced quality environment. Michelle LaFleur from Gundersen Health System, Rita Schara from Reedsburg Area Medical Center and Marie Wiesmann from Fort HealthCare shared their personal strategies for success.

"The managers all have the foundation they need to be successful. With the program, we want to provide those who are new to the position an opportunity to network with others and learn from one another to foster the type of collaboration that enables high performance," said Kelly Court, WHA chief quality officer. "The excitement and audience participation at this first event demonstrated to us as sponsors that this program is going to be rewarding to all of us in terms of what we will learn together."

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Congress Passes SGR "Patch"
Legislation includes one-year ICD-10 delay

Though aggressive efforts have been made this year to finally repeal the much-maligned Sustainable Growth Rate (SGR) under Medicare’s physician reimbursement system, the $130-180 billion estimated cost of a permanent fix continues to confound Congress. Instead of moving forward with full repeal, this week Congress approved legislation to “patch” the SGR for another year, until March 31, 2015. 

Physicians had faced a 24 percent payment cut without Congressional action. Under the package, physicians will see a 0.5 percent increase through the end of this year (Dec. 31, 2014) and a 0 percent increase from January 1, 2015 - March 31, 2015. The House of Representatives approved the legislation on voice vote. The Senate approved the bill by a 64-35 vote with both Wisconsin senators voting against. 

While the legislation did not include major hospital cuts and included important Medicare “extender” policies for rural hospitals, it did, unexpectedly include a year-long delay of ICD-10. The ICD-10 delay caught most by surprise and stops what has been significant progress by hospitals and health systems to go live with the new coding system. 

Provisions impacting physicians and hospitals in the legislation would: 

·         Provide no permanent fix to SGR, while providing a 0.5 percent increase in reimbursement for CY 2014.  

·         Delay implementation of ICD-10 until October 1, 2015  

·         Extend various Medicare policies including Medicare Dependent Hospitals, low-volume adjustment, therapy caps, Work GPCI and ambulance add-on payments through April 1, 2015.

·         Delay the “two-midnight” rule an additional six months, through March 31, 2015.

·         Delay Medicaid disproportionate share hospital (DSH) payments cuts one year (until 2017) but then extends the cuts out an additional year (to FY 2024).

·         Adjust application of the Medicare sequester in FY 2024.

·         Create a value-based payment for skilled nursing facilities based on individual SNF performance on a hospital readmission measure (October 1, 2018).

·         Provide for some technical corrections to long-term care hospitals (LTCHs) site-neutral payment policy to clarify that only Medicare fee-for-service discharges will be used to calculate the LTCH discharge payment percentage, and establishes an exception to the LTCH moratorium.

·         Require CMS to use private payer rate information to reform Medicare payment rates for clinical labs.


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WI ICD-10 Summit Draws Hundreds as Congress Proposes a Delay (Again)
Congress’s proposed delay would cost hospitals, systems millions of dollars

More than 200 people participated in a three-day ICD-10 Summit March 17-19 co-sponsored by the Wisconsin Hospital Association, the Wisconsin Medical Group Management Association and the Wisconsin Medical Society. While physicians, medical coders, HIM directors, practice managers, nurses and quality managers immersed themselves in preparing for and implementing ICD-10, Congress threw a wrench into that progress this week when it unveiled legislation to "patch" the Sustainable Growth Rate (SGR) formula for physician reimbursement. That legislation unexpectedly included a year delay in ICD-10, pushing implementation off until October 1, 2015 (see related SGR article above).

"Wisconsin is ready for ICD-10 implementation," said WHA President Steve Brenton. "It is unfortunate, and an indication of dysfunction in our nation’s capitol, that this important issue has been caught up in partisan wrangling in Congress."

At the Summit, Michelle Graham, MD, MME, FAAFP, vice president of medical affairs at Wheaton Franciscan Healthcare, explained how health care organizations can engage and prepare physicians for ICD-10. Graham recognized the importance of clinical documentation in the success of ICD-10 but noted, "Documentation is not the reason we went to medical school. Documentation is the thing we have to do, not what we want to do, so please help us do it better."

Kim Charland, RHIT, CCS, senior vice president clinical consulting, Panacea Healthcare Solutions, Inc., focused on the current ICD-10 environment and highlighted nine areas for providers to focus on in the next seven months, which included: 1) Address documentation, 2) Create or expand the clinical documentation improvement role, 3) Physician education, 4) Coder training and productivity, 5) Dual coding, 6) Review financial impact by specialty, 7) End-to-end testing, 8) Systems, and 9) Develop a strong contingency plan.

Debbie Rickelman, vice president, WHA Information Center, shared her research on how ICD-10 will impact some of the quality measures and other types of reporting.

"All the ICD-10 related enhancements that affect the quality measures will contribute to the Triple Aim—improving the experience of care, the health of a population and reducing the per capita cost," according to Rickelman.

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Legislative Panelists Confirmed for Advocacy Day, April 16
The countdown begins: register your hospital contingents today

Advocacy Day 2014 is less than three weeks away and already close to 600 registrations are in. Make sure your hospital is well represented at this premier event. Attendees always appreciate the informative and popular legislative panel discussion. This year our bipartisan panel includes legislators from key, influential committees.

Confirmed panelists are: Sen. Alberta Darling (R-River Hills) and Rep. John Nygren (R-Marinette) who are the Senate and Assembly co-chairs of the state’s powerful budget writing committee, the Joint Finance Committee. They will be joined by Rep. Cory Mason (D-Racine) who serves as one of two Assembly Democratic appointees to the Joint Finance Committee. Sen. Julie Lassa (D-Stevens Point), ranking member of the Senate Committee on Economic Development and Local Government, will round out the panel. The panel will give attendees in-depth insight into the issues facing our state.

In addition, Advocacy Day 2014 will have a great lineup of speakers, including morning keynote and nationally-known pollster Larry Sabato, professor of politics and director of the University of Virginia’s Center for Politics ( and creator of the website and weekly e-newsletter, "Sabato’s Crystal Ball." Luncheon keynote Governor Scott Walker is also confirmed.

Attendees will head to the State Capitol to meet with their legislators or legislative staff in the afternoon. These legislative visits are important and make a strong statement about how employees, trustees and volunteers care deeply about their local hospital and that they’re willing to take action to protect them. When you register for Advocacy Day, make sure to select the legislative visits option to ensure your voice is heard.

Please make Advocacy Day a priority again this year by joining your peers in Madison April 16. A brochure and registration information available online at:

For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or For registration questions, contact Lisa Littel at or 608-274-1820.

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Wisconsin Hospital Teams Collaborate to "Transform Care at the Bedside"

Teams from 15 hospitals joined the Wisconsin Hospital Association March 19-20 in Wisconsin Dells to launch the third cohort of Transforming Care at the Bedside (TCAB). TCAB is a framework that hospitals can use to improve quality patient care by engaging front-line staff. WHA has facilitated the TCAB work in Wisconsin for the past three years. WHA’s role as project convener serves to support hospital teams by providing opportunities for education through monthly webinars, promoting networking among the teams, and by compiling and reporting data.

The initial kick-off is the first step in the 18-month project. The event in the Dells familiarized the teams with improvement methods and models that will support the change they want to see on their units. The event brings the newly-formed teammates together and provides an opportunity for team bonding as well as networking with teams from other hospitals.

See full coverage of and photos from the TCAB Cohort 3 Kickoff Event at

Transforming Care at the Bedside (TCAB) is a project of Aligning Forces for Quality, which is supported by the Robert Wood Johnson Foundation, through a grant to the Wisconsin Collaborative for Healthcare Quality. In Wisconsin, Aligning Forces for Quality is a joint project of the Wisconsin Collaborative for Healthcare Quality, Wisconsin Hospital Association, and other organizations.

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Fast Facts from the WHA Information Center

March is brain injury awareness month.

According to data collected by the WHA Information Center (WHAIC), in the first three quarters of 2013 there were 2,922 inpatient admissions for treatment of traumatic brain injury in Wisconsin, 10,271 emergency room (ER) visits and 703 observation visits for the same diagnosis. The top three reasons for these traumatic brain injuries are unspecified falls; falls from slipping, stepping or stumbling; and falls from stairs or steps.

March is also the month that cancer groups, hospitals, and communities focus attention on preventing, treating and curing colorectal cancer. In the first three quarters of 2013 there were 2,944 inpatient admissions for cancer of the colon or rectum, 3,007 outpatient surgery visits, 678 ER visits, 361 observation visits, and 26,413 other hospital visits (lab, x-ray, etc.).

According to a large, long-term study published in 2013 from the Harvard School of Public Health, 40 percent of all colorectal cancers might be prevented if people underwent regular colonoscopy screening.

Data provided by the WHAIC (

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Governor Enacts Additional Mental Health Reforms
More mental health bills expected to be signed soon

On March 27, Governor Walker signed into law two additional mental health bills governing emergency detention and inpatient treatment of minors. The laws become effective March 29.

2013 Wisconsin Act 158 ("Act 158") makes various changes to Wisconsin’s statutes governing involuntary commitment and emergency detention for individuals that are a danger to themselves or others due to mental illness, drug dependency or developmental disability.

For health care providers, the most notable changes include:

The text of Act 158 and a summary of the bill can be found at and

2013 Wisconsin Act 161 ("Act 161") makes various changes to Wisconsin’s statutes governing the inpatient mental health treatment of minors. Specifically, Act 161 does the following:

The text of Act 161 and a summary of the bill can be found at and

Watch The Valued Voice in the coming weeks for announcements regarding WHA educational opportunities and guidance regarding these new mental health bills as well as others expected to be signed yet this spring.

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UW Population Health Institute Releases Latest County Health Rankings
Hospitals find Rankings provide valuable data for CHNA Process

As hospitals develop their community health needs assessments, many have found value in using the County Health Rankings. The new rankings (see, released March 26, provide a starting point for a conversation about community health.

While the data in the rankings is helpful, Julie Willems Van Dijk, deputy director of the Rankings report for the UW Population Health Institute, offers a note of caution on comparing county rankings.

"It’s important not to put too much weight on small changes in the rankings from year to year," according to Willems Van Dijk.

The County Health Rankings team synthesizes health information from a variety of national data sources. Most of the data used are publicly available at no charge. The Rankings measure vital health factors, including high school graduation rates, obesity, smoking, unemployment, access to healthy foods, the quality of air and water, income, and teen births in nearly every county in America.

Across Wisconsin, hospitals are playing a vital role in improving population health. WHA continues to work closely with the UW Population Health Institute to develop and share resources and tools with member hospitals and health systems that will enable hospitals to not only meet the requirements for developing and implementing a health assessment, but to improve the efficiency, effectiveness and overall value of the process and the outcome in Wisconsin communities.

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WI Center for Nursing Annual Conference Focus on Improving Community Health

The Wisconsin Center for Nursing (WCN) will hold its annual conference for nurses, health care leaders, educators and students May 19 in Appleton. The theme is "Improving the Health of Wisconsin Communities," and the conference keynote speaker is Diana Mason, presenting the role of health care to improve the health of diverse communities in Wisconsin. The conference also focuses on the impact of accountable care in Wisconsin, building sufficient and competent nursing workforce to serve persons with mental illness, initiating nurse-led clinics and fostering nurse leaders.

The conference will also include opportunities to network with health care leaders and nurses at all levels. A conference brochure is available online at and online registration at

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