April 12, 2013
Volume 57, Issue 15
Assembly, Senate Committees Hold Hearings on Bills to Address Jandre Case
The Assembly Committee on Judiciary and the Senate Committee on Judiciary and Labor held nearly simultaneous public hearings April 11 on one of WHA’s top priorities, legislation that would address the Wisconsin Supreme Court’s recent decision in Jandre v. Wisconsin Injured Patients and Families Compensation Fund. The Assembly and Senate companion bills (AB 139/SB 137), which were authored by Representative Jim Ott and Senator Glenn Grothman and have 33 co-sponsors, would require a physician to inform his or her patient about the availability of reasonable alternate medical modes of treatment and the risks and benefits of those treatments. The bills would establish the "reasonable physician" standard as the legal standard a physician must meet when informing his or her patient. The "reasonable physician" standard requires disclosure of information that a reasonable physician in the same or similar medical specialty would know and disclose under the circumstances.
WHA’s testimony emphasized that Wisconsin hospitals and health systems are dedicated to providing high-quality, high-value health care to their patients. WHA noted that defensive medicine, the logical outcome of the Court’s Jandre decision, works against value-based health care. Rep. Jim Ott expressed concern in his testimony that controlling case law has gone beyond the governing statute, making physicians essentially strictly liable for bad results even though they were not negligent in the care and treatment of their patients.
Attorney Mike Van Sicklen, Foley and Lardner, who argued Jandre before the Supreme Court, observed that, "as interpreted by the lead three-justice opinion by the Supreme Court in Jandre, Wisconsin’s informed consent duty is the most extreme in the country. With this bill, patients wouldn’t lose their claim for misdiagnosis, they just wouldn’t have two kicks at the same issue through informed consent." After describing the informed consent standard in the Jandre lead opinion, Guy DuBeau, an attorney with Axley Brynelson and author of the amicus brief filed by WHA, Wisconsin Medical Society, and the Wisconsin Chapter of American College of Emergency Physicians in Jandre, said, "That is simply an unachievable standard." DuBeau continued, "Any physician who tried to meet that standard would be practicing what is called defensive medicine and would not be able to deliver care effectively."
Howard Croft, MD, a practicing emergency physician and two-time president of WACEP, gave the committee a glimpse into the day-to-day practice of an emergency physician and explained the current unrealistic burden that makes the bill necessary. "Passage of this bill will not weaken patient’s rights, but will instead serve to strengthen the bond between doctors and their patients." Croft continued, "By resetting our burden to a ‘reasonable’ standard, I will be able to focus my efforts on caring for my patients to the best of my abilities."
A copy of WHA’s testimony is available here: www.wha.org/pdf/WHAtestimonyJandre4-11-13.pdf
Senate Bill 137 is available here: https://docs.legis.wisconsin.gov/2013/related/proposals/sb137.pdf
Assembly Bill 139 is available here: https://docs.legis.wisconsin.gov/2013/related/proposals/ab139.pdf
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Only $54 million nationally, and just $830,000 for all of Wisconsin, will be available to help an estimated 497,388 people in Wisconsin connect with health insurance coverage in the exchange when open enrollment begins this October. These were the funding amounts for navigators announced on April 9 by the federal Department of Health and Human Services (HHS).
After at least a two-month delay, HHS finally released its request for proposals seeking entities to act as "navigators"—a new term coined by the ACA—to help people select a health plan in the federally-facilitated insurance exchanges. All insurance exchanges are required to award grants to navigators who will in turn provide information to consumers about health insurance, the exchange, and the availability of premium tax credits. Navigators are seen by many as a crucial link in helping people obtain coverage in the exchange.
Unfortunately, the small amount of funding allocated to Wisconsin falls far short of what is needed to fund a robust navigator program that will be successful in helping connect people with coverage.
"Health care providers are concerned about the development of the exchange and how effective it will be in connecting people with coverage, especially those at the lowest income levels who may be moving out of Medicaid eligibility," said WHA’s Eric Borgerding. "The news that there is federal grant funding for only 10 or so navigators statewide to assist in this massive undertaking is the latest indication that those concerns are well founded."
Consistent with federal rules, the grant application released by HHS would award grants to at least two entities, one of which must be a community and consumer-focused nonprofit organization. Ineligible for grants are: health insurers or their subsidiaries; associations that include members of, or lobby on behalf of the insurance industry; or entities that receive any direct or indirect consideration from any health insurer in connection with enrollment of individuals or employees into health plans.
Navigator entities will be required to facilitate the selection of a health plan in the exchange, providing fair, accurate and impartial information. They will have to maintain expertise in the insurance exchange, provide information about the Medicaid program to consumers, and conduct public education as well. Navigator staff would be required to complete up to 30 hours of an HHS-developed training program, and pass an exam.
Grant proposals are due to the federal government by June 7, and the grant awards won’t be made until August 15. That leaves little time for an entity to hire staff, meet federal and possible state training and certification requirements in time for the expected October 1 open enrollment period.
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Hospital leaders testified at multiple hearings the week of April 8 as the State Legislature’s budget-writing Joint Finance Committee (JFC) heard public testimony on the state budget in cities across the state.
"Amidst unprecedented uncertainty surrounding health care financing and delivery, it is essential to ensure stability while pursuing gradual and sound reform," said Reedsburg Area Medical Center President Bob Van Meeteren at the JFC hearing in Wisconsin Dells. "I and my fellow hospital CEO counterparts believe the best route to achieving this goal is to provide Medicaid coverage to those earning as little as $15,300 per year while proceeding cautiously in transitioning low-income populations onto the exchange."
At a packed hearing at Lambeau Field in Green Bay, Hospital Sisters Health System-Eastern Division Vice President Heidi Selberg testified before the Joint Finance Committee about the importance of Medicaid coverage in the state budget.
"We would like to encourage the Legislature to consider amendments that improve the Governor’s proposal regarding Medicaid by maintaining safety net health coverage for our low income citizens," Selberg began. "We believe that setting Medicaid eligibility at 133 percent of the federal poverty level is the best way to cover the most people for the state of Wisconsin."
The comments did not focus solely on Medicaid, as leaders touted other positive health provisions included in the Governor’s budget in their testimony.
"Governor Walker’s budget bill includes several positive health care initiatives, including new state funding for Medicaid, graduate medical education and behavioral health," said Van Meeteren. Selberg added her support for important dollars to assist the Medical College of Wisconsin’s efforts to educate more future physicians at their two new campuses in Green Bay and Wausau.
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Beginning with the litany of administrative inefficiencies in the Wisconsin Worker’s Compensation program and an invitation to worker’s compensation insurance carriers to come into the 21st century, Connie Kinsella, vice president, revenue cycle for UW Health, responded to proposals from labor and management at the Worker’s Compensation Advisory Council (WCAC) meeting the week of April 8. Joining Kinsella were practitioners representing other stakeholder organizations, including Theodore Gertel, MD, Lynn Steffes, PT, DPT, and Jeff Wilder, DC.
The WCAC started negotiating this legislative session’s "agreed-to bill" in March when labor and management representatives exchanged their initial proposals for this session’s bill. Both sides proposed reductions in reimbursement for health care services provided to injured workers. (See March 15, 2013 Valued Voice.) Negotiations continued the week of April 8 with much of the attention on management’s proposal to limit reimbursement for health care providers and practitioners to 175 percent of the Medicare rate.
Commenting on the proposal to limit reimbursement, Kinsella emphasized that their proposal would establish a reimbursement level well below commercial health insurance rates for a program that is far more costly to administer. Noting that worker’s compensation carriers, on average, pay their claims after 70 days, a period 10 times longer than Medicaid and more than twice as long as the 30-day period allowed for health insurance claims, Kinsella described the anachronistic paper-based worker’s compensation payment system.
"If we want to reduce costs in the worker’s compensation system without harming access to care, we must take a broader look at costs." Kinsella continued, "We can talk about changing reimbursement levels, but those changes must be made in concert with systemic changes that address the costly and burdensome paper chase, or access to care will be affected."
Kinsella explained that one of the other proposals, limiting reimbursement for surgical implants to 10 percent over the invoice price, would be like requiring a grocery store to mark the invoice price on every item in the store. "It would be an added administrative burden to an already inefficient program in order to receive payment that would not even cover the cost of care."
In his remarks, Dr. Gertel stressed that, given the program hassle, many of his colleagues would avoid accepting new worker’s compensation patients.
WHA has established a work group of interested members to evaluate the WCAC proposals and provide meaningful responses with a goal of improving the worker’s compensation system and protecting the injured workers’ access to excellent health care. The next WCAC meeting is scheduled May 14, 2013 in Madison.
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With still over a week before WHA’s Advocacy Day, registrations are over 750 with more coming in every day! Attendees at Advocacy Day will hear from a great line-up of speakers, including the always valuable bipartisan legislative panel discussion. This year attendees will hear about important state budget and health care issues from the following confirmed legislative panelists:
State Senator Joseph Leibham (R-Sheboygan)
Senator Leibham, Republican, represents the 9th Senate District. He serves on the powerful budget-writing Joint Finance Committee, which is currently debating the state’s biennial budget bill. Leibham was first elected to the State Assembly in 1998 and then elected to the State Senate in 2002. He has served as President Pro Tempore, Minority Caucus Chair, Assistant Minority Leader and Majority Caucus Vice Chair.
State Senator Jennifer Shilling (D-La Crosse)
Senator Shilling, Democrat, represents the 32nd Senate District. She serves on the powerful budget-writing Joint Finance Committee, which is currently debating the state’s biennial budget bill. Shillling was first elected to the State Assembly in 2000 and served there for 10 years until winning her Senate seat in a special election in 2011. She was reelected in 2012.
State Representative Peter Barca (D-Kenosha)
Representative Peter Barca, Democrat, represents the 64th State Assembly District. Most notably, Barca is the Assembly Minority Leader, and serves on the powerful Assembly Organization and Rules Committees. Barca was first elected to the State Assembly from 1984 to 1992 then served in the U.S. Congress from 1993-94. He has been reelected to the State Assembly since 2008.
State Representative Jeff Stone (R-Greendale)
Representative Jeff Stone, Republican, represents the 82nd Assembly District. He was first elected to the State Assembly in a special election in 1998. He has been reelected every since. Stone currently serves as the vice-chair of the Assembly Health Committee and the chairman of the Small Business Development Committee. He also serves on the Assembly Committees on: Jobs, Economy, and Mining; Transportation; and Ways and Means.
Advocacy Day attendees will also hear from morning keynotes U.S. Congressman Paul Ryan and Dr. David Rehr as well as luncheon keynote Wisconsin Department of Health Services Secretary Kitty Rhoades.
Advocacy Day takes place on April 23 in Madison at the Monona Terrace. There is still time to register for this important event and participate in the very-important legislative appointments in the afternoon. By going on legislative visits, you’ll join with over 450 attendees who will take the hospital message to the halls of the State Capitol on important health care issues.
If you have yet to register yourself or your hospital contingent, do so today. A complete program and online registration for 2013 Advocacy Day on April 23 in Madison are available at http://events.signup4.com/13AdvocacyDay0423.
For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or email@example.com.
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On April 10 President Obama released his Fiscal Year (FY) 2014 budget that includes multiple cuts to Medicare and Medicaid, many of which are aimed at providers.
"While the President’s proposal does cancel the automatic sequester, including for Medicare, at the same time it is proposing cuts of almost $400 billion to Medicare and Medicaid," began WHA President Steve Brenton. "Regardless of the political party proposing cuts, this continued ratcheting down on payments without recognition of the high-value, high-quality care being provided in states like Wisconsin is unacceptable."
Some of the Medicare payment reductions included in the President’s FY 2014 budget are:
With respect to Medicaid, the President’s budget does not include previously offered proposals to reduce Medicaid provider tax thresholds. However, his FY 2014 budget does include some adjustments to the Medicaid DSH program, resulting in savings of $3.6 billion nationally.
Many of the proposals listed above have been included in previous budgets or deficit reduction proposals. WHA continues to advocate strongly against them when Wisconsin hospitals and health systems are already seeing billions of dollars of cuts under the Affordable Care Act and the automatic sequester among others. Learn more about how you can help "Protect Hospital Care" for your hospital at: www.wha.org/protect-hospital-care.aspx.
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As a reminder, one executive at each member hospital and health system has been invited to complete the WHA membership survey. If you received that invitation, please complete the survey by April 25. It will only take 10 minutes of your time, but the feedback is essential to tee up the future priorities of the Association.
We currently have a 20 percent response rate. Please know that member participation in the 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. This is your opportunity to rate WHA’s effectiveness and value. Please take full advantage of it and provide your feedback. If you have any questions about the survey, contact Jennifer Frank at firstname.lastname@example.org or at 608-274-1820.
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Leaders of Chippewa Valley area government, first responders, schools, and health care providers briefed legislators and others April 4 on the progress and shared benefits of the CINC initiative, a Community Area Network (CAN) first begun in 1999. Sen. Terry Moulton (R-Chippewa Falls), Rep. Kathleen Bernier (R-Chippewa Falls), and Rep. Warren Petryk (R-Eleva), were among those in attendance.
The CINC is an association of local government agencies, schools, and health care providers that have pooled their resources to build a shared private network among the association members. The CINC formally organized as an association operating under Chapter 184 of the Wisconsin Statutes. Members of CINC include Sacred Heart Hospital and St. Joseph’s Hospital of the Hospital Sisters Health System (HSHS) and the Mayo Clinic Health System – Eau Claire
CINC members explained that by pooling their resources they were able to achieve economies of scale to build and use the network more quickly and generate shared savings for both taxpayers and health care providers. Sharing resources made more sense for the community than building separate private networks the CINC leaders said.
Presenters during the briefing also discussed how the community has benefited from health care participation in the CINC. For example, because CINC-member first responders and hospitals are both connected to the CINC’s shared private high-speed network, first responders to a health emergency are able to remotely send real-time health telemetry data directly to and from a hospital emergency department. First responders have praised this functionality which has also enabled some patients delivered by first responders to bypass the emergency department and go straight to surgery.
CINC members also discussed the limitations of the shared high-speed CINC network. They explained that the CINC network is not an internet provider, but is dedicated for bi-directional, point-to-point electronic communications among CINC members. In order to communicate outside of the CINC network, CINC members must procure their own internet and phone services from other companies.
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The Department of Health Services (DHS) announced its intent to award a contract to Medical Transportation Management, Inc. (MTM) to manage non-emergency medical transportation services for certain Medicaid and BadgerCare Plus members. MTM will replace LogistiCare as the state’s non-emergency medical transportation services manager.
No date has been set for when services will transition from Logisticare to MTM. In the meantime, health care providers and patients should continue to schedule non-emergency medical transportation services for Medicaid and BadgerCare Plus members through Logisticare.
Upon issuance of this intent to award, the Department will begin to negotiate the final contract terms with MTM. The implementation date of which MTM will begin to manage non-emergency medical transportation services for Medicaid and BadgerCare Plus members will be determined as a part of the contract negotiation process.
DHS has also indicated that the contract with MTM will include new service provisions based on feedback from stakeholders, including requirements for online reservation and complaint functionality and liquidated damages provisions for failing to meet minimum service levels.
For more information, see DHS’s press release at: www.dhs.wisconsin.gov/News/PressReleases/2013/041113.htm.
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Health care leaders from north central Wisconsin met April 9 to discuss creating a local health care workforce Alliance. The program was sponsored by the North Central Wisconsin Workforce Development Board and Centergy.
Hospital human resource professionals from Riverview Hospital Association, Aspirus, Ministry Health Care and the Marshfield Clinic were present, along with a variety of other types of provider facilities. Representatives from area technical colleges, UW Colleges, Rasmussen College, the Wisconsin Department of Administration and the North Central Wisconsin Workforce Investment Board also participated. There was consensus from the group that collaboration was necessary for the future of the region.
WHA Vice President Judy Warmuth described the current health care employment, the importance of workforce data and discussed the need for workforce planning. She also outlined the work being done in other parts of the state.
Health care workforce alliances, including those in the Fox Valley, La Crosse, Lake Shore, Southern Wisconsin and Milwaukee, are working to ensure that an adequate future health care workforce is available to care for Wisconsin residents. These alliances have been successful in finding regional strategies to address the most important health care workforce issues for their members.
"Each of these alliances has identified regional issues and have prioritized their work to ensure that they are addressing their areas’ most pressing concerns," Warmuth. "These groups have helped facilitate collaboration and action toward ensuring that Wisconsin has a workforce in place to meet the demand for care now and in the future."
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Partners of WHA, Inc., the non-profit, volunteer service organization affiliated with WHA, raised and donated over $2.23 million to hospitals throughout the state for needed equipment and other capital projects in 2012. This was accomplished through over 500 separate fundraising activities.
In addition, Partners of WHA members volunteered 1.4 million hours of service to Wisconsin hospitals in 2012, as reported by Sue Lynch, president of Partners of WHA. The financial value of a hospital volunteer’s time has been estimated nationally at $22.14 per hour (based on 2012 figure for national value of volunteer time). At that rate, the Partners of WHA volunteers donated a total value of $30.9 million of time and services to Wisconsin hospitals and health systems during 2012. Partners of WHA also awarded over $468,000 through 473 scholarships to both traditional and non-traditional students seeking health care-related degrees in 2012.
Partners of WHA is comprised of over 10,000 volunteers and auxilians at 77 Wisconsin hospitals. Founded in 1951 as Wisconsin Hospital Association Auxiliaries, Partners emphasizes volunteer service and participation in grassroots advocacy, public policy and community health education, and health career programs for Wisconsin hospitals. Additionally, Partners promotes leadership development offering resources and educational seminars to local hospital volunteer and auxiliary groups, and shares information on successful community health education initiatives, advocacy and fundraising activities and trends on volunteerism through a variety of channels, including its annual fall convention and quarterly newsletter, Reaching Out.
If you are interested in your hospital’s volunteer and/or auxilian group joining the statewide Partners of WHA organization, visit www.partnersofwha.org, or contact Jennifer Frank, WHA’s liaison to Partners, at 608-274-1820 or email@example.com.
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Physical activity is a preventive factor for many adverse health conditions, such as heart disease, stroke, high cholesterol, depression, and bone and joint disease. In communities across Wisconsin, hospitals are dedicating resources and doing what they can to encourage people of all ages to stay active.
Mayo Clinic Health System is helping Menomonie-area families become more active.
Mayo Clinic Health System has a long-standing commitment to the health and well-being of the community. An example of this commitment is the health promotion program known as Wellness ROCKS.
Wellness ROCKS, which stands for Reaching Our Communities’ KidS, is a community-based wellness program designed to involve area children and their families in physical activity and nutrition.
"Our tagline is ‘making the healthy choice the easy choice,’" says Tina Tharp, community education supervisor, Education, at Mayo Clinic Health System – Red Cedar in Menomonie.
A community needs assessment led to Wellness ROCKS’ formation in late 2009. Among its findings, the survey identified a need for additional support and resources to reduce childhood obesity, a rapidly increasing, yet preventable, problem affecting an estimated 12.5 million U.S. kids and teens. Wellness ROCKS aims to combat the condition by offering a wide array of healthy lifestyle programming. From family cooking classes to physical activities, such as bowling, disc golfing, sledding and snowshoeing, Wellness ROCKS provides something for everyone in multiple locations throughout the region and at no cost to participants.
Supportive local businesses and grants provided the primary funding for Wellness ROCKS in the beginning, while Mayo Clinic Health System – Red Cedar now largely funds the program.
Wellness ROCKS focuses on children but offers events for entire families, too.
"Take a roller-skating event. The parents are welcome to come and skate with the kids, because we want them to find fun activities they can do together," Tharp says, noting that if parents are physically active and eat healthy, it’s likely their children will follow suit. "We want to get the whole family moving," she says.
The supporting organizations’ generosity allows many community members to engage in outings that may have been out of reach otherwise, notes Sara Carstens, director, education.
"All Wellness ROCKS events are free of charge," Carstens says, crediting Tharp, who oversees the Wellness ROCKS program, for helping ensure that events are free and open to all. "Rollerskating, iceskating, all of those different activities that families may have not otherwise tried because of the cost — this program makes it financially possible for people to do it. And, I think, more importantly, it builds a sense of community around being healthy, as events bring families together."
Wellness ROCKS participation has grown every year since the program’s inception. More than 7,600 people attended the 112 events offered in 2012.
Whatever the subject matter, sessions are typically well attended. In some instances, event registrations have closed early because of high demand, Tharp says.
"It depends on the event, but we’re usually pretty happy with our attendance," she says.
"The program has been so well received by the community," Carstens says. "I think it’s been a great opportunity for our organization to reach out to and engage the community and to do something that’s really meaningful. It’s just going to grow."
Mayo Clinic Health System-Red Cedar, Inc., Menomonie
Kids for Running
As a community-based health care system in Green Bay, Bellin Health has a rich tradition of promoting a sense of community, spanning more than 100 years. That tradition continues today through numerous events and activities including athletic training services for local school sports programs and hosting the Bellin Run, one of the largest 10K runs in the U.S.
You can’t miss participants in the Kids for Running program during the Bellin Run. The grade schoolers make up groups of varying size wearing brightly colored T-shirts as they travel more than six miles through the streets of Green Bay and Allouez each June.
The Bellin Run is the grand finale, the culmination of 12 weeks of training that teaches healthy habits to future generations. They train at their schools with the help of volunteer coaches, trainers and supporters, following an easy-to-use training plan provided by the program.
Each year, the Kids for Running program draws thousands of youngsters in grades three through eight from schools in Wisconsin and Michigan’s Upper Peninsula region. With more than 2,700 Kids for Running participants in 2011, there have been an estimated 17,300 students and trainers involved since the program’s inception in 2005.
Kids for Running is a great way to help kids get active, no matter their performance level or socio-economic status, and help them to understand the importance of fitness and wellness in their everyday lives.
Bellin Health, Green Bay
Submit community benefit stories to Mary Kay Grasmick, editor, at firstname.lastname@example.org.
Read more about hospitals connecting with their communities at www.WiServePoint.org.
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