March 29, 2013
Volume 57, Issue 13
Providers Across Wisconsin Call for End to Barrier to Mental Health Care Coordination
The Speaker’s Task Force on Mental Health held its second meeting on March 27 at Theda Clark Medical Center in Neenah. The Speaker’s Task Force is a bipartisan effort created to, among other things, improve coordination of care among those who treat people with mental illness. Assembly Health Committee Chairman Rep. Erik Severson (R-Osceola) chairs the Task Force, and Ranking Health Committee Member Rep. Sandy Pasch (D-Shorewood) is the vice-chair.
Over the course of five hours, health care providers shared their perspectives on a wide range of efforts and proposals to help advance recovery for individuals with mental illness.
"While beneficial progress has been made in mental health care, many individuals affected by mental illness remain disadvantaged by public policy that has led to a fragmented mental health system and barriers to modern holistic and coordinated care that integrates physical and mental health" stated Matthew Stanford, WHA vice president policy & regulatory affairs. "Important and significant changes are being made both in how health care is delivered and in society’s view on mental health; it is critical that Wisconsin’s policies keep pace."
Stanford discussed how outdated laws can actually perpetuate and institutionalize stigma. "Wisconsin’s mental health records law is one example of how public policy can perpetuate stigma and stand in the way of holistic and integrated care," said Stanford.
"That law, which predates federal HIPAA laws, not only perpetuates the stigma that mental health care is different from physical health care by requiring in practice that mental health information be separated from a patient’s physical health information in their medical record, but it also forces treating providers to make assumptions—a root cause of stigma—about an individual’s mental illness in the absence of accessible relevant information about the individual’s mental illness in the medical record," according to Stanford.
Stanford recommended that the Task Force reform Wisconsin’s mental health records law by working to enact the Mental Health Care Coordination/HIPAA Harmonization Bill that would remove statutory barriers to the coordination of care for persons with mental illness that do not exist for persons that do not have a mental health diagnosis.
Clinicians from ThedaCare, Affinity Health System, Marshfield Clinic, Gundersen Lutheran Health System, Rogers Memorial Hospital and clinicians representing the Wisconsin Psychiatric Association, the Wisconsin Medical Society, the Wisconsin Chapter of the American College of Emergency Physicians, and the Wisconsin Academy of Family Physicians all expressed similar concerns and supported efforts to have Wisconsin adopt the federal HIPAA privacy law as Wisconsin’s standard for communicating information among all treating health care providers.
"Difficulties coordinating care is another significant barrier we regularly face. HIPAA harmonization is an important area of impact in order to improve coordination," said Dr. Stephanie Eken, the medical director of the Child Center at Rogers Memorial Hospital speaking on behalf of the Wisconsin Psychiatric Association and Wisconsin Medical Society. "The inability to tie electronically to the health care system, especially to coordinate with primary care providers, undercuts our efforts in prevention, assessment and quality, and comprehensive care for our most vulnerable population."
"[Care] management of mental health patients is hindered by limited access to mental health records. This results in inconsistent, less effective and more expensive care," said Dr. Allan Mottram, representing the Wisconsin Chapter of the American College of Emergency Physicians. He added that under current Wisconsin law, important information "can be legally inaccessible to other providers, including those expected to provide emergency mental health services."
Stanford held out Hawaii’s HIPAA Harmonization law as a model for Wisconsin. That bi-partisan bill was enacted in 2012 and was supported by health care providers and consumers, including NAMI Hawaii. Stanford shared with the committee the letter of support for Hawaii’s bill from the Consumer, Family and Youth Alliance of Hawaii: "We support the streamlining of access to health records and believe that the HIPAA protections that are currently in place provide adequate protection for Hawai’i’s consumers."
One of the misconceptions about HIPAA and the HIPAA harmonization proposal is that HIPAA allows "unlimited access" to mental health information. Stanford stated that under HIPAA and the HIPAA harmonization proposal, psychotherapy notes would still remain confidential with the treating mental health provider. But, important information such as treatment plans, medication monitoring notes and summaries of progress would be available for all members of the patient’s care team. Rep. Pasch also addressed this misconception during the hearing. "The HIPAA Harmonization would never disclose the psychotherapy notes; it’s supposed to be more information but not that. Whatever you say to your therapist is private."
To help address some of those misconceptions, Stanford also testified about efforts to engage consumers to discuss removing barriers to care coordination over the past 15 months.
Although efforts to reform Wisconsin’s mental health records laws was a key focus of the testimony during the five hour hearing, WHA and WHA members also presented compelling testimony to the Speaker’s Task Force on multiple other proposals to help reform Wisconsin’s mental health system and health systems’ collaborative efforts to improve mental health care in their communities. Watch for a Valued Voice article April 5 that features excerpts from their testimony and provides more coverage of the Speaker’s March 27 hearing in Neenah.
WHA’s written testimony as well as multiple supporting materials provided to the Task Force can be found here:www.wha.org/Data/Sites/1/behaviorhealth/Speakers-Task-Force-mental-health-testimony-packet-03-29-2013.pdf.
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WHA Applauds Sen. Baldwin for Leadership on Correcting Massachusetts Manipulation
Co-sponsors legislation, budget amendment to strengthen Medicare reimbursements for WI
U.S. Senator Tammy Baldwin (D-WI) signed on as a co-sponsor to bi-partisan legislation, S. 183, the Hospital Payment Fairness Act, supported by the Wisconsin Hospital Association and 20 other hospital associations across the country. The legislation, sponsored by Senators Tom Coburn (R-OK) and Claire McCaskill (D-MO), fixes a Medicare reimbursement provision in the Affordable Care Act (ACA) that has been a windfall to Massachusetts hospitals at the expense of hospitals in other states, including Wisconsin.
"On behalf of hospitals across the state of Wisconsin, we thank Senator Baldwin for co-sponsoring this legislation. The Hospital Payment Fairness Act corrects a situation that has resulted in the annual loss of millions of dollars in Medicare payments to Wisconsin hospitals," said Wisconsin Hospital Association President Steve Brenton. "We greatly appreciate Senator Baldwin’s support for this bipartisan solution and look forward to working with her toward enactment."
In other positive action on this issue, during debate in the Senate of the 2014 budget resolution, Sen. Baldwin joined two other Senators to co-sponsor a budget amendment similar to S. 183. The amendment passed the Senate 68-31 with strong bi-partisan support. Wisconsin Senator Ron Johnson also voted in support of this amendment during Senate floor action. The provision was included in the final budget package passed early Saturday morning by the Senate.
"Wisconsin hospitals deserve a fair shake—and that means that all hospitals should have to play by the same rules. This bill evens the playing field, allowing for geographic and economic differences in our country, but ensuring no one state benefits while other states like Wisconsin pay the price," said Baldwin.
WHA thanks Senator Baldwin for her open door policy with the Wisconsin Hospital Association and other Wisconsin health care stakeholders to discuss issues like this one that impact Wisconsin hospitals, health systems and health care delivery in this state.
"I am committed to working across party lines to make the Affordable Care Act work for Wisconsin and fix what doesn’t," Baldwin said. "I am proud to support a bipartisan solution that will improve health care reform for Wisconsin citizens."
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WHA conducts a survey of the full membership about every two years, with the intention of staying aware of the members’ changing needs and priorities and getting a clear picture of what WHA should be doing to address those member priorities.
WHA will be conducting this survey again during the month of April, and I encourage you to carve out some time to provide WHA with your ratings and comments on a variety of essential topics. On April 5, one executive at each member hospital and health system will receive an invitation to complete the survey online. The survey will only take 10-15 minutes of your time, but the feedback is essential to tee up the future priorities of the Association.
Member participation in the confidential survey is critical to the success of this effort. Significant participation, followed by incorporation of survey findings into WHA’s current and future programming, can only enhance member value. The collective opinions and ratings will be reviewed by our senior management team, shared with you, and be used by the WHA Board for strategic planning later this year.
This is your opportunity to rate WHA’s effectiveness and value. Please take full advantage of it and provide your feedback.
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Close to 75 hospital leaders and hospital advocates recently participated in the latest of the Wisconsin Hospital Association’s series of "Telephone Town Halls." The event featured Assembly Speaker Robin Vos (R-Rochester) and touched on a number of important health care issues pending in the State Legislature in Madison.
"Let me thank you for this opportunity to talk to so many health care leaders across the state," said Speaker Vos in opening comments. "You should be incredibly proud of the WHA. They are highly respected in the State Capitol."
During the call, Vos touched on the state budget, Medicaid coverage, the federal insurance exchange, state funds for graduate medical education, regulatory streamlining and behavioral health among other issues.
Speaker Vos expressed concerns about federal funding for Medicaid "expansion" under the Affordable Care Act. He believes the federal government would not keep its promise to provide full funds for Medicaid, and feels that Governor Walker made a "wise decision" in declining the funding in his state budget bill and instead using state dollars to cover all those with incomes below 100 percent of the federal poverty level. Under the proposed state budget, those earning above 100 percent FPL would be ineligible for Medicaid and would instead purchase subsidized individual coverage in an exchange.
On a related matter, WHA and others have raised concerns that the exchanges will not be operating in a manner that will connect low-income populations, including those who would become ineligible for Medicaid under the proposed state budget, with affordable commercial insurance. An unintended consequence could be more people without coverage, and ultimately more uncompensated care in Wisconsin.
"We are keeping our ears open to your concerns so we don’t have more uninsured individuals showing up in your emergency rooms," Speaker Vos said in response to a related question from the audience. "I am open to language on an Exchange and not pushing individuals into this unless it works," Vos said. "If there is a way to have a ‘triggering mechanism,’ I would certainly be open to that idea."
Sandy Anderson, WHA’s immediate past Board chair and president/CEO of St. Clare Hospital (Baraboo), indicated to Speaker Vos that funds contained in the Governor’s budget regarding graduate medical education were very important to hospitals like hers. Vos responded that assuming revenue projections stayed stable that there was very good chance that those dollars would remain.
Vos also indicated strong support for addressing behavioral health issues, such as modernizing Wisconsin statutes, as well as referencing the task force he assembled on the topic.
The Wisconsin Hospital Association appreciates Speaker Vos’s time and willingness to participate in this event.
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Attend Advocacy Day on April 23 with 750 other supporters of Wisconsin hospitals and make an impact in Madison. Register yourself and your hospital team today, including senior leaders, trustees and volunteers, for this important event.
Online registration is available at: http://events.SignUp4.com/13AdvocacyDay0423
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Unfortunately, the study recommends against rewarding providers in efficient (high value) locales because individual provider variation also exists in those regions. Logic like this suggests that an outlier or two should stop payments for demonstrated value despite the overall performance of the larger team. This rationale actually encourages silo-based payment—a continuation of a FFS payment world that most argue is not sustainable.
The preliminary IOM study results don’t bode well for high-performing providers in the upper Midwest and the Northwest who were promised four years ago that the IOM effort will lead to payment incentives and rewards for delivering value instead of volume. Don’t put any money down that the final results will alter the landscape.
Meanwhile, as we place our hopes on an academic exercise, providers in states like Massachusetts and New Jersey used their political muscle to increase their Medicare payments by sneaking obscure language (the Bay State Boondoggle) into the ACA. Their Medicare payments skyrocketed at a time the rest of us are taking big hits. Those states learned long ago that relying on an IOM study to rationalize their wage index complaints would get them nowhere—far more effective to deploy legislative clout.
As it relates to this Bay State Boondoggle, a national coalition of aggrieved states, including Wisconsin, recently won the first of what will need to be several victories in an advocacy push to repeal that wage index manipulation that has already cost Wisconsin PPS hospitals almost $20 million. Special kudos to Senator Tammy Baldwin for helping lead a rare bipartisan effort described in a related story in this week’s Valued Voice.
In addition to very real concerns as to what the federal government will have up and running on October 1, other pressing challenges include: the unveiling of a 15-page eligibility form needed to qualify for Exchange subsidies, an emerging legislative debate over potentially restricting Exchange "navigators" to individuals who pass a yet-to-be-defined licensure exam, growing confusion within the employer community regarding the pros and cons of dumping current employer-based insurance, and a recent study by the national Society of Actuaries that predicts a massive increase in costs for individual policies in the new Exchanges due to a flood of sicker people taking up the new coverage. The increase for Wisconsin is predicted to be 80 percent over the first three years.
These developments and other unanswered questions underscore the wisdom of WHA’s Medicaid expansion position which cautions against quickly moving current Medicaid enrollees into a very uncertain Exchange environment.
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On March 25 State Senator Mark Miller (D-Monona) visited Stoughton Hospital. During his time at the hospital he met with hospital leaders, toured the facility and participated in a question and answer session with over 25 hospital employees.
"We greatly appreciate Sen. Miller’s willingness to visit Stoughton Hospital recently," said Stoughton Hospital President & CEO Terry Brenny. "Our staff and leaders were excited by the opportunity to meet and talk with Sen. Miller personally about issues that impact rural health care in our state."
While meeting with hospital leaders, Senator Miller was able to hear about the hospital, its commitment to the community and how issues pending in the Legislature could impact rural health care.
The importance of rural health care also came up during a question and answer session held with more than two dozen staff.
In discussing physician workforce needs, Sen. Miller indicated that Wisconsin is an attractive state for physicians to practice partly due to the state’s medical malpractice environment.
Sen. Miller took the opportunity to praise the Wisconsin Hospital Association, saying it was an important resource for policymakers in Madison.
He was also able to tour the facility during his time in Stoughton.
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The Wisconsin Hospital Emergency Preparedness Program (WHEPP), in coordination with the Wisconsin Hospital Association, is sponsoring a one-day seminar, "Risk and Crisis Communication Training," in two locations: Wednesday, April 24 in Plover/Stevens Point, and Thursday, April 25, 2013 in Madison. The seminar will be identical in content each of the two days it is being offered.
Dr. Vincent Covello, founder and director of the Center for Risk Communication in New York, will be the presenter. Covello is an internationally-recognized trainer, researcher, consultant and expert in crisis, conflict, change and risk communications.
The seminars are intended for hospital public information officers, emergency preparedness staff and others responsible for risk communications who would like to learn techniques to communicate effectively about high-concern health issues.
There is no cost for this one-day seminar, however, registration is required. To register, go to www.TRAIN.org, log in, and in the keyword or course ID box enter Course ID #1042446 or "WHEPP." (The course is titled "Risk and Crisis Communication - WHEPP.")
Note: Prior to registration, you must create an account on TRAIN, the statewide public health online training portal, if you do not already have an account. To create an account, go to www.TRAIN.org and enter the required information.
A brochure is included in this week’s packet and is available at www.wha.org/education/2013-WHEPP-crisis-training.pdf. For registration questions, contact Melissa Dittmer-Hermann, operations program associate, Emergency Health Care and Preparedness, Division of Public Health, at 608-266-9376 or email Melissa.DittmerHerrmann@dhs.wisconsin.gov.
For conference questions, contact Tracey Froiland, Region 6 WHEPP manager, at 920-427-2229 or email@example.com.
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WHA’s annual one-day conference for executive assistants and other administrative support staff from hospitals will be held May 9 at the Glacier Canyon Lodge at the Wilderness Resort in Wisconsin Dells.
This year’s program, called "Twenty Microsoft Office Timesavers," will provide tools to cut hours off of everyday tasks. Learn tips to get Outlook to do a lot of the work for you, the right way to use Word, key tools to make Excel a breeze, and ways to create dynamic PowerPoint presentations in minutes.
This program is designed for executive and administrative assistants, business office managers, and other support staff in hospitals and other health care settings. A brochure is included in this week’s packet. Online registration is available at http://events.SignUp4.com/13HCADMIN0509.
Please pass the brochure on to the valued administrative support professionals in departments throughout your organization. For registration questions, contact Lisa Littel at 608-274-1820 or email firstname.lastname@example.org.
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WHA will host a Community Benefits/Community Health Needs Assessment seminar Tuesday, May 21, 2013 from 1 - 4:30 pm in Wisconsin Dells. The seminar will focus on IRS updates, what can be counted as a community benefit, and tools that hospitals will find useful in completing and implementing their Community Health Needs Assessment (CHNA).
WHA has been working closely with the UW Population Health Institute and with the Wisconsin Association of Local Health Departments and Boards (WALHDAB) in the development of these tools. That close working relationship led us to schedule the WHA seminar the day before the Wisconsin Public Health Association (WPHA) and Wisconsin Association of Local Health Departments and Boards (WALHDAB) State Conference that will be held May 22-23, 2013.
Both conferences are beneficial to those hospitals working with their communities through the assessment and implementation stages of their CHNA.
A copy of the brochure is included in this week’s packet and is available at: www.wha.org/education/2013-community-benefit-conference-5-21.pdf. Online registration for either the WHA seminar or for the WPHA/WALHDAB conference is available at:www.wpha.org/Events/Annual-Conference-2013.
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Wisconsin Hospitals Community Benefits: Injuries and Violence
A teen arrives in the emergency department by ambulance following a terrible car accident. A child receives head injuries while bicycling without a helmet. A woman walks into the emergency department with injuries inflicted by an abusive spouse. These are stories of pain and tragedy that hospital personnel see all too often. Injury is the most under recognized major public health problem facing the country and it is the leading cause of death in people ages 1 to 44 in Wisconsin. Wisconsin hospitals devote significant resources to reduce the number of intentional and unintentional injuries that occur in the communities they serve.
Safe Communities coalition provides exercise classes to prevent injuries
Even though Ann Di Piazza has no major health complaints, she is realistic about the risks associated with aging—specifically the danger of falling and breaking bones. At 94, she is fully mobile and has no chronic issues requiring prescription medications, and she really wants to keep it that way.
That’s why she’s taking advantage of two programs offered through St. Mary’s Hospital: the Stepping On program for falls prevention and chair yoga for ongoing strength.
"It makes me stronger and I can balance better," says Ann, a retired nurse who enjoys the independence of living in her own home.
Stepping On, which is part of a wider community effort through the Safe Communities coalition, is a seven-week session that mixes practical exercises with expertise from a physical therapist, pharmacist, vision expert and community responder like a fire fighter or police officer. St. Mary’s offers the low-cost program four times a year at the hospital, with additional sessions elsewhere in the area. Many of St. Mary’s 13 parish nurse sites provide the course free of charge.
In addition to Stepping On, the parish nurse assigned to St. Patrick’s Church in Cottage Grove also offers a free weekly yoga class for members of that rural community. For Ann, the social aspect of the group is a bonus on top of the chance to strengthen her arms and legs. She has turned what she’s learned from both programs into a commitment.
"I get up at 5:30 and do my exercises. If I don’t do it in the morning, it doesn’t get done."
St. Mary’s Hospital, Madison
The Healing Center
Children, adolescents, and adults who are sexually abused may suffer a range of psychological and behavioral problems, from mild to severe, in both the short and long term, many for years after abuse has occurred. The Healing Center offers survivors of sexual abuse and assault and their families opportunities for healing through support, advocacy, and community education.
The Healing Center operates various programs and counseling groups, including those for women who experience sexual assault as adults or need to heal from a history of sexual abuse as a child. The center also provides a transition for patients receiving treatment at Aurora Sinai Medical Center’s Sexual Assault Treatment Center. The Healing Center is able to make all services available to survivors at no cost thanks to the financial support of Aurora Health Care, Aurora Sinai Medical Center, and other donors. In 2011, the staff of six was able to serve 628 survivors.
K.C. was sexually assaulted ten years ago by a man she previously considered a close friend. She never reported the incident in fear that her abuser would retaliate. Instead she spent years drowning her emotions in drinks after work, while her self-image continued to decline and her feelings of loneliness grew. K.C. is now a single mother of two daughters. She is watching her little girls grow and knows that she needs to work through the emotions of her past so that she can be an example of strength for her girls. K.C. contacted The Healing Center and within weeks started participating in support groups and one-on-one counseling sessions. Thanks to The Healing Center, K.C. no longer feels alone and has begun to heal from her past. She no longer drinks after work and spends more time teaching her daughters how to live well.
"I thought I was abnormal and defective. Meeting with women who have had similar experiences to mine makes me feel normal. My experiences with The Healing Center make me feel okay to be me."
-A Sexual Abuse Survivor
Aurora Health Care, Milwaukee
Safe Kids car seat check program provides peace of mind
Brett and Lauren Kell are the proud parents of two small children and would do anything to keep them safe. This includes regular car seat checks with Erin Donaldson, coordinator of Safe Kids Kenosha-Racine. Over the last three years, Donaldson has done at least five different car seat checks for the Kells, including inspections after Lauren was rear-ended at a stoplight.
"At first I thought ‘how hard can it be to install a car seat?’" said Brett. "But after hearing Erin’s presentation about how the straps have to be pulled a certain way and the car seat base has to set at a certain angle, I was grateful for her expertise."
In the last year, more than 230 car seat checks have been conducted through the Safe Kids program at Wheaton Franciscan Healthcare - All Saints, which leads the program in Racine and Kenosha counties. Safe Kids, established in 2001, works to prevent unintentional injuries to newborns through the age of 14 through education, awareness and advocacy on topics such as child passenger safety, fire safety, home safety, poison prevention, pedestrian safety, and water safety. All activities provided by Safe Kids are free to anyone in the community who works with or cares for children. Its partners include health care providers, fire and police services, local school districts, social service programs and community members.
Donaldson has helped the Kells install both their infant and convertible car seats, and has even made house calls when needed. "We never hesitate to call Erin. She has been a tremendous resource for us," Lauren said.
"It’s mind-blowing that this program is free," Brett added. "The education and peace of mind that Erin has given us is invaluable."
Wheaton Franciscan Healthcare – All Saints, Racine
Submit community benefit stories to Mary Kay Grasmick, editor, at email@example.com.
Read more about hospitals connecting with their communities at www.WiServePoint.org.
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