April 25, 2014
Volume 58, Issue 17

Registration Now Open for 2014 Wisconsin Rural Health Conference, June 18-20, Elkhart Lake

Join your colleagues at The Osthoff Resort in Elkhart Lake for the 2014 Wisconsin Rural Health Conference, June 18-20. This annual event is the forum for examining the issues that impact small and rural hospitals, networking and collaborating with colleagues, and bonding with your team of senior staff and trustees.

Each year, WHA’s Council on Rural Health acts as the planning committee for this conference, and again this year, they have crafted an interesting and diverse education agenda. The opening keynote speaker is Stephen Klasko, MD, examining the most significant changes expected in health care by 2020 and strategies for rural health providers to stay a step ahead of those transformations. Klasko is president and CEO of Thomas Jefferson University and Thomas Jefferson University Health System in Philadelphia. Previously, he was the CEO of USF Health and the dean of the Morisani College of Medicine at the University of South Florida, where he implemented an entrepreneurial-academic model, developing partnerships among the colleges of medicine, nursing, public health, physical therapy and biomedical science.

The Rural Health Conference will also include the popular state and federal legislative update co-presented by Rural Wisconsin Health Cooperative Executive Director Tim Size and WHA President Steve Brenton. In addition, the Council identified a variety of pertinent concurrent session topics, including several specific to hospital governance.

The annual Wisconsin Rural Health Conference is a good way for hospital executives, leadership staff and trustees to take advantage of great education, close to home, at a fraction of the travel and registration costs of out-of-state events. The conference agenda and online registration are available now at http://events.SignUp4.net/14Rural.

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CheckPoint Adds Two New Birth Measures: EED and Newborn Testing Turnaround Times
Hospitals now voluntarily report 92 quality measures

Two new birth measures related to early elective deliveries (EEDs) and newborn screening turnaround times were recently added to the CheckPoint website, bringing the total number of hospital quality measures that are voluntarily reported on the site to 92.

Early Elective Deliveries: The first measure shows the percent of babies born prior to 39 weeks who were being delivered early at the request of the mother or for provider reasons. When babies are born before 39 weeks gestation they are at higher risk for complications related to breathing and eating. National and Wisconsin statistics, prior to 2012, indicated that there was an increasing trend of babies less than 39 weeks being delivered electively. These babies are also at higher risk for needing care in a neonatal intensive care unit, which adds unnecessary cost to their stay.

Wisconsin hospitals are reversing this trend by educating patients about the risks to the baby so they don’t request an early delivery and by implementing a "hard stop" policy that prohibits an early delivery unless there are appropriate clinical indications. Wisconsin hospitals have reduced early elective deliveries by 78 percent since mid-2012. The newly-reported data on CheckPoint shows the state composite rate for 2013 is now at 5.1 percent.

Newborn Screening Turnaround Times: All newborns in the state of Wisconsin are tested for 44 uncommon, but very serious, disorders. The testing process starts in the hospital with hospital personnel drawing a blood sample from the infant 24-48 hours after he or she is born. Five drops of blood are placed on a newborn screening program "blood card" that is sent to the State Lab of Hygiene. The lab then runs tests on the blood samples to screen for the 44 disorders. If they find that one of the tests is abnormal, the lab director contacts the physician and if necessary, works with the physician to start treatment.

Timely identification of these conditions and initiation of treatment can be critical to the health and well-being of a newborn. A standard that has been set is for cards to arrive at the lab within four days of collection. Prior to a series of media stories that began in 2013, Wisconsin hospitals did not have data on how quickly the blood samples were getting to the state lab for testing. WHA worked closely with the state lab to develop monthly quality reports for each hospital. Hospitals received the first report in January.

"Hospitals worked quickly and effectively to eliminate any delays that were occurring. This is a perfect example of Wisconsin hospitals reacting in a positive way when they are made aware of a potential patient safety problem," according to Kelly Court, WHA chief quality officer.

Hospitals are now measuring and sharing their results with the public on CheckPoint to ensure they maintain the high standard for timely transport of these blood samples. The data that is now available on CheckPoint shows that 99.7 percent of hospital samples made the four-day cutoff during the first quarter of 2014.

Both of these new measures can be found on the Birth Measures Report on CheckPoint at www.wicheckpoint.org/report_topic_BirthRatings.aspx.

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Guest Column: Health Advocates Inform and Challenge Lawmakers
By Senator Kathleen Vinehout (D-Alma)

"YOU are the reason why we were so successful…" Eric Borgerding of the Wisconsin Hospital Association told the health advocates. "You are extremely effective in communicating with and educating your legislators on local health care issues."

Recently over 800 health advocates traveled to Madison. Some 65 western Wisconsin advocates met with Senator Moulton, staff and I to discuss the challenges facing hospitals. And they shared their passion for caregiving and healing.

Health leaders face new challenges with the passage of the Affordable Care Act (ACA). Leaders from Durand, Black River Falls, and Whitehall shared a frustration with the new health law. "There’s not a good model for rural hospitals," one administrator told me.

"We need a rural model where we all work together—schools, nursing homes, the county, Western Dairyland."

"We need to get back to primary care: education, nutrition, parenting—including health care of children. We must really get on that side of it." There’s a real need—and real cost savings—in preventing health problems.

"Think about the mom whose child has an ear infection coming to the emergency department (ED) at 2:00 am. By law, the hospital must treat the patient. The doctor must do a health assessment. But this isn’t the best place for the mom or the child. She really needs parent education to help her with common childhood illnesses. She may not get that in the ED. For everyone—including those on Medicaid—this is a very expensive way to care for the child."

"Hospitals are still getting paid for crisis care and a single event," another administrator said. "Yet we are trying to provide the patient with the right care, at the right time and the right place. The system doesn’t always pay for this."

Sometimes the hospital finds such value in a different way of providing care, they invest in a new program without reimbursement. An example is the Transitional Nurse Program, which employs a full-time nurse who travels to patients’ homes and helps people adjust to living with a chronic condition.

Little things like grocery shopping can be a real challenge for a newly-diagnosed diabetic. Getting expensive antibiotics right away to a man just discharged with pneumonia can mean the difference between getting well and another hospital stay.

Ending up back in the hospital is something hospital leaders very much want to avoid. And for good reason: patient readmission within 30 days is often considered a preventable failure. To encourage hospitals to prevent readmissions the ACA set new federal rules. In most circumstances, hospitals will no longer be paid by Medicare for readmission of a patient who was admitted less than 30 days prior.

A Chippewa Valley finance director told me, "There is an important connection between the hospital and the nursing home. If the nursing home doesn’t do its job, the hospital is penalized." This is the case when a patient is readmitted from a nursing home.

During our vigorous discussion of challenges facing nursing homes, I shared some of the conversation I recently had with several area nursing home administrators. The administrators said homes experienced a 14 percent cut in Medicare rates. They talked about how the state pays hospitals and nursing homes well below their cost to care for patients. Facilities cost shift by covering Medicaid patient costs with money from other patients. Federal Medicare cuts now make this much more difficult.

The hospital leaders called the underfunding ‘the hidden health care tax’ because private insurance patients pay higher premiums to cover these losses. The advocates challenged lawmakers to better fund Medicaid. This is a big ask of lawmakers who know health care is the largest and fastest growing part of the state budget.

Health leaders were eager to engage lawmakers in new ideas and outside the box solutions. This engagement is vital, especially because few lawmakers can keep up with the complex, fast changing world of health care.

Thank you to all those hospital volunteers, trustees, leaders, doctors, nurses and other professionals for your work. Your continued advocacy is critical as the state struggles to balance budget realities with preserving high-quality health care and improving access.

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WHA Behavioral Health Legislative Priority Signed into Law
Gov. Walker signs emergency detention reforms into law

On April 23, Gov. Scott Walker signed Assembly Bill 488 into law as Wisconsin Act 340. This WHA legislative priority, authored by Rep. John Jagler (R-Watertown) and Sen. Paul Farrow (R-Pewaukee), modifies Wisconsin’s three-party petition process to help families find a way to get court-ordered treatment for their loved ones before they come to harm or harm others. Joining Walker, Jagler and Farrow at the bill signing were Columbus Community Hospital President/CEO John Russell, St. Mary’s Hospital (Madison) Psychiatric Medical Director Matt Sager, MD, and WHA Vice President Government Relations, Kyle O’Brien.

Currently, family members and health care providers may file a "three party petition" in which three people, one of which has personal knowledge of the individual’s dangerousness, makes a sworn petition to a judge to order involuntary care. A recent series in the Milwaukee Journal Sentinel highlighted a problem with the current process by saying that the petition is not "guaranteed to go before a judge. County lawyers can refuse to file the petition, saying they don’t think the reasons listed meet the legal standards."

The Act sets forth a collaborative approach between families and county corporation counsel that provides families an opportunity to have a court review a three-party petition for involuntary care, while maintaining county corporation counsel’s role in drafting and filing the petition and representing the interests of the public in the process. Formerly, the petition could only move forward if the county corporation counsel agreed with the petition. If the county corporation counsel disagrees with the petition, Act 340 now requires county corporation counsel to proceed with filing the petition under limited appearance if the petitioners would still like to pursue the petition. The Act also specifies that a court shall review a three party petition within 24 hours, excluding weekends and holidays. Under current law, no timeline is provided for review.

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President’s Column: WHA Advocacy Day Now Epitomizes WHA’s Advocacy Clout

As WHA Board Chair Ed Harding noted in greeting the crowd, "This is an impressive view!" That sentiment was reinforced by Governor Walker at the noon luncheon when he commented on the large turnout and focused on "the many positive things happening (because of community health care initiatives) in the state of Wisconsin."

Steve Brenton

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Hospital Leaders Meet With Sen. Ron Johnson
Discuss Medicare cuts, high value care

Fifteen hospital leaders from Southeastern Wisconsin met with U.S. Sen. Ron Johnson at Wheaton Franciscan-Elmbrook Memorial Campus in Brookfield. The meeting with Johnson was requested to express the growing frustration health care leaders have with repeated Congressional attacks on Medicare reimbursements.

Host Debra Standridge, president of Wheaton Franciscan’s north market, kicked off the meeting by providing context for Johnson around the cuts Wisconsin hospitals and health systems have taken to date—some $4 billion in reimbursement cuts already.

Wisconsin’s high-value care was highlighted during the discussion. However, there is a deepening concern that Washington DC’s failure to address important issues will create uncertainty in the Medicare program and result in burdensome regulatory issues, especially the Two Midnight Rule.

"Senator Johnson listened intently to our group’s comments and opinions, and shared his own frustrations regarding incoherent government directions," said WHA President Steve Brenton. "It was especially gratifying to hear Senator Johnson reject further Medicare provider cuts as a strategy to pay for other programs like a permanent physician payment ‘fix.’"

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WHA Workforce Council Discusses Impact of Legislation

At their April 24 meeting in Madison, the WHA Workforce Council discussed the impact of 2013 Wisconsin Act 236, the legislation that reforms Wisconsin hospital regulation, signed into law earlier this month. Laura Leitch, WHA senior vice president and general counsel, discussed next steps in the DHS 124 reform process.

Jodi Johnson, WHA vice president, workforce and clinical practice, reviewed the human resource-related bills, including the Time Keeper Requirement, Wisconsin Act 286, signed into law April 16 and effective April 18, which no longer requires an employer to keep record of the hours of employment of an exempt employee who is not compensated on an hourly rate bases. This is a big win for WHA members, since it decreases the tedious work to track time of certain employees.

Lastly, the CNA Bridge Program bill was signed into law April 23, which aides certified nursing assistants who have successfully completed a training program no less than 75 hours and passed a competency test (inclusive of bordering states: Minnesota, Michigan, and Iowa) to complete a DHS approved bridge program of 45 hours to meet the 120 hour requirement to practice in Wisconsin. Neighboring facilities of these bordering states can work with potential employees to meet the bridge requirements and meet workforce needs.

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TCAB Cohort 2 Teams Finish with Improvement Across the Board

The 24 Transforming Care at the Bedside (TCAB) teams that launched in September 2012 (Cohort 2) recently completed their 18-month journey. The teams demonstrated improvement in each of the four TCAB pillars: safety, efficiency, teamwork, and patient-centered care. Teams were required to submit data every month covering each of these pillars. Every TCAB team improved in at least two areas of focus during the collaborative. Safety was improved as 15 of the 24 teams achieved a 20 percent improvement in their chosen area of preventable harm. The incidence of falls with injury was reduced in Cohort 2 with an estimated 98 serious falls avoided at a savings of $392,000. Results also showed that 18 of 24 teams had significant improvement in measured team vitality. Likewise, 13 of the 24 teams measurably improved their efficiency by achieving a benchmark of 60 percent of nurses time spent at the bedside.

Teams also met monthly via webinar during which they shared their experiences and ideas with each other, as well as learned new techniques for improving care. According to TCAB Project Manager Stephanie Sobczak, "As a group, Cohort 2 teams were really engaged in learning. The monthly calls were a lot of fun, since I could start the conversation with a few key questions and the teams would take over and interact with each other. This shows by the spread of ideas among the teams."

Credit for success also goes to the nursing leadership in each hospital—the unit managers and nurse executives—who provide the team with support, resources and guidance. Jodi Johnson, WHA vice president, workforce and clinical practice, says, "You can’t overstate the importance of the nurse leaders’ role in ensuring a TCAB effort is impactful and ‘sticks.’ We teach nurse leaders that there is a balance between being too hands-on and too hands-off. How that balance is maintained is a learning opportunity for managers and executives as well as staff," according to Johnson.

Additionally, WHA staff benefits from each cohort by conducting their own cycles for improvement. Learning from TCAB has helped shape the structure of the Partners for Patients projects and resources, and likewise WHA continues to learn from each new cohort better ways to teach and engage teams of front-line staff.

What is next for the teams in Cohort 2? "We always welcome teams to stay engaged by attending the monthly webinars, or using the TCAB resources on the Quality Center website. Ultimately, time will tell if teams use what they learned in TCAB to fundamentally transform their thinking about improvement and help their hospitals navigate the demand for continuous improvement."

Seven hospitals have chosen to enroll different units in Cohort 3 to enhance the spread of TCAB.

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