April 5, 2013
Volume 57, Issue 14

Informed Consent Bill Circulating for Legislative Co-sponsors
"Representative Ott’s and Senator Grothman’s bills are tremendously important"

Representative Jim Ott and Senator Glenn Grothman circulated for legislative co-sponsors companion bills that would address the Wisconsin Supreme Court’s recent Jandre decision. The Wisconsin Hospital Association met with many legislators and staff this week encouraging support for the bills.

The bills would clarify that a physician, prior to treating a patient, must 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.

In meetings with legislators, WHA highlighted that four of the seven Supreme Court justices in Jandre disagreed with the current direction of the court in informed consent cases and expressed concern that the court was expanding the law of informed consent beyond its original scope and purpose. WHA noted that Justice Roggensack called the lead opinion in Jandre "breathtaking" in the potential scope of its reasoning. Justice Prosser observed, "Nearly three decades have passed since the adoption of [the informed consent statute. Much has changed in the intervening years."

Commenting on the circulating companion bills, WHA Executive Vice President Eric Borgerding said, "Representative Ott’s and Senator Grothman’s bills are tremendously important if Wisconsin is to avoid the outcome recently predicted in an informed consent case of an increase in defensive medicine and increased health care costs because of a plethora of unnecessary tests and procedures." Borgerding emphasized, "Wisconsin hospitals and health systems are dedicated to providing high-quality, high-value health care to their patients. The bills would remove an unnecessary roadblock to that goal by establishing a reasonable, clear, and effective informed consent statute in Wisconsin."

WHA and other health care organizations have been working with the legislators to address this important issue.

Take two minutes to tell your legislator to co-sponsor this important legislation. 

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Assembly Committee Spotlight on DHS 124
"Wisconsin hospital regulations have been frozen in time"

The Assembly Health Committee this week held a public meeting on administrative rules related to health care. Representative Erik Severson (R-Star Prairie), the Committee chair, led the discussion related to DHS 124, the state administrative rule for hospitals. This Committee hearing was part of the state Assembly’s "Right the Rules" project, which has the goal of reviewing every section of the Administrative Code. Wisconsin Department of Health Services (DHS) Deputy Secretary Kevin Moore and Division of Quality Assurance Administrator Otis Woods were the invited speakers.

Moore explained that DHS is moving forward to reform DHS 124. The Administration released the 2013 Wisconsin Regulatory Review Report, which highlighted DHS 124 as a rule that is "outdated, duplicative, and confusing for health care operators because of contradictory state and federal regulations." In calling for the modernization of DHS 124, the Report noted, "This modernization will reduce hospital regulatory compliance costs and confusion." (See January 25, 2013 Valued Voice.)

Chair Severson and the committee members asked Moore and Woods a series of questions related to various outdated provisions in DHS 124. Chair Severson opined that some changes might be addressed more effectively through a statutory change.

After the hearing, WHA said in a statement, "WHA is pleased the Wisconsin Department of Health Services and Chair Erik Severson and the Assembly Health Committee are making smarter regulations for hospitals in Wisconsin a priority. Streamlining our state hospital regulations makes sense. All hospitals must meet the comprehensive Medicare Conditions of Participation with their nearly 400 pages of interpretive guidance. Beyond the Medicare regulations, over 80 percent of Wisconsin hospitals demonstrate their strong commitment to excellent patient care by voluntarily being held to the even stricter standards of the accrediting agencies."

WHA Executive Vice President Eric Borgerding noted, "While the Medicare regulations and the accreditation standards have attempted to keep pace with or set the pace for health care quality standards, the Wisconsin hospital regulations have been frozen in time, reflecting the very different health care environment of the 1980s." Borgerding continued, "We applaud this effort and look forward to working with the Administration, DHS leaders, and the Legislature to improve health care quality and value via a more efficient regulatory structure."

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New Legislator Profile: Sen. Rick Gudex (R-Fond du Lac)

A series of interviews with newly-elected legislators, by Mary Kay Grasmick, editor

Senator Rick Gudex may be a newcomer to the Wisconsin State Senate, but he has years of experience in public office. Gudex began his career in government at the early age of 29 when he was elected Mayor of Mayville. He also served on the Eden Village Board and in 2011, was elected to the Fond du Lac City Council.

Gudex’s quest to grow Wisconsin’s economy by creating a pro-business climate is driven at least in part by his background as a production manager at a manufacturing firm in Fond du Lac. He understands the key role that Wisconsin’s high-quality, high-value health care has in attracting—and keeping—business and industry.

"If I’m looking to locate a business, I will look at the quality of schools, the community’s attitude toward business, and the quality and affordability of health care," Gudex said. "Our health care systems in Fond du Lac and Oshkosh are partners with business. Everyone in the community needs to work together on economic development, and health care is a huge part of job creation."

Reducing the duplication among state, local and federal rules is one of Gudex’s top priorities. This will, according to Gudex, not only help to create the pro-business climate that is so necessary to attract industry to the state, but it also helps to improve the efficiency of state government.

Gudex sees hospitals as important partners. "I view hospitals as a resource; if I have a question, I know I can call them for help," he said.

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U.S. Rep. Paul Ryan to Keynote WHA Advocacy Day
Over 500 registrations already; Register your hospital groups today

U.S. Representative and former Republican Vice Presidential Candidate Paul Ryan will keynote WHA Advocacy Day on April 23, 2013 in Madison. A full 500 are already registered for this year’s event and over 750 are expected on April 23. It’s still not too late to register your hospital group. Log on to http://events.signup4.com/13AdvocacyDay0423.

Ryan is serving his eighth term in the U.S. House of Representatives. He is the chair of the House Budget Committee and a senior member of the House Ways and Means Committee, which has jurisdiction over tax policy, Social Security, health care and trade laws. Whatever the perspective on Ryan’s Path to Prosperity proposals to address the nation’s fiscal issues, his ideas have forced a national fiscal discussion, and attendees will have the opportunity to hear that perspective at Advocacy Day.

Advocacy Day’s other keynote will be David Rehr, PhD, noted national association leader and adjunct professor for George Washington University. Rehr will provide insight into the study of grassroots advocacy and lobbying and how those are received by Congress. With the state budget process unfolding concurrently with Advocacy Day, the ever-popular state legislative panel will provide insight into budget deliberations and other pending health care issues of importance. In the afternoon, attendees will be able to go to the State Capitol, only two blocks away, to meet personally with their legislators or staff on these important health care issues. Our luncheon ceremony will feature Department of Health Services Secretary Kitty Rhoades.

Don’t miss this premier event. Register today at: http://events.signup4.com/13AdvocacyDay0423.

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Ministry Health Care Joins Ascension Health

Effective April 1, Ministry Health Care and two other regional health systems that comprised the Marian Health System have joined Ascension Health. Marian Health System reached an agreement with St. Louis-based Ascension Health Alliance, parent organization of Ascension Health. Ascension Health is the largest Catholic and largest nonprofit health system in the nation.

The other health systems are Via Christi Health in Kansas, an affiliate of Ascension Health since 2007, and St. John Health System in Oklahoma. Marian Health System was founded by the Sisters of the Sorrowful Mother in 1989.

Ministry has a presence throughout Wisconsin and Minnesota with 15 hospitals, 46 clinics and nearly 12,000 employees. Recently, Ministry Health Care assumed sole sponsorship of Affinity Health System located in northeast Wisconsin.

"We are pleased to become part of Ascension Health. This relationship will support and enhance Ministry’s efforts in delivering high-quality patient care in the communities we serve," said Nick Desien, president and CEO of Ministry Health Care. "This affiliation joins Ministry and our two sister systems in Marian into Ascension Health, an innovative organization with a like-minded commitment to our mission, our communities, as well as a focus on providing safe, holistic, person-centered care."

"Ascension Health Alliance and the health systems of Marian, including Ministry Health Care, share a common mission of serving all with special attention to those who are poor and vulnerable," said Anthony R. Tersigni, EdD, FACHE, president and CEO, Ascension Health Alliance. "We also share a commitment to providing spiritually centered, holistic care and advocating for a compassionate and just society through actions and words. This joining together is another expression of our ongoing commitment to strengthen Catholic health care."

"We’re excited to welcome Ministry Health Care and the other health systems of Marian to our national health ministry," said Robert J. Henkel, FACHE, president and CEO, Ascension Health. "Adding their strengths and expertise to those of Ascension Health creates a combined ministry that is even better able to live our mission of serving all and to position ourselves to meet the needs of our communities."

Nick Desien, in addition to his role as president and CEO of Ministry Health Care, has agreed to also serve as Ascension Health Ministry Market Leader for Wisconsin, Kansas and Oklahoma. As Ministry Market Leader, Desien will provide leadership, support and direction to the Health Ministries in these three states, sharing accountability for their strategic positioning and operational performance.

Ministry Health Care is the second health care ministry of Ascension Health in Wisconsin, joining Columbia St. Mary’s in the greater Milwaukee market. Columbia St. Mary’s operates four hospitals and 62 clinics serving families in Milwaukee, Ozaukee, Washington and Sheboygan counties and has been a ministry of Ascension Health since its founding in 1999.

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President’s Column: Member Survey, Big Win for Health Plans and WI CAHs

Please take a few minutes to answer our survey questions. We will make sure that you receive a detailed overview of the results in a couple of months. If you have any questions regarding the member survey, feel free to contact Jennifer Frank at 608-274-1820 or email jfrank@wha.org.

One of the takeaways here is that Medicare Advantage plans are hugely popular with seniors—who vote—because they provide benefits above and beyond the basic program. Unlike hospitals, health plans can threaten to leave the Medicare program—and that’s just what they did. That’s an advocacy tool we’ll never have. But this week’s decision must be used as an example in our meetings with federal lawmakers as additional cuts are on the table later this year. Health plans don’t provide care, hospitals and doctors do.

But that’s not true in Wisconsin where all but one CAH have been reporting that same data on CheckPoint for years with scores that stack up well with larger hospitals. And CAH participation in our ongoing Partners for Patients projects is almost 100 percent, with outstanding progress being made to reduce infections and hospital-acquired conditions.

Steve Brenton

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Collaboration, Community Needs and Challenges Discussed at Mental Health Task Force

Clinicians from ThedaCare, Affinity Health System, Marshfield Clinic, Gundersen Lutheran Health System, and Rogers Memorial Hospital shared stories of their efforts and challenges to meet community needs for mental health services during the Speaker’s Task Force on Mental Health March 27 in Neenah.

Collaborative efforts to meet identified community needs was a common theme.

The story of the formation of Catalpa Health to provide mental health services to children and adolescents was one highlight of the Task Force meeting. In 2011, a community needs assessment for the Fox Valley identified a community need to focus on children’s mental health. In response to that need, ThedaCare, Affinity Health Care, and Children’s Hospital of Wisconsin began a strategic planning process to take the next step in addressing that community need. That process led to those three organizations partnering to form Catalpa Health.

"Three competing health systems saw a need in the community and decided the best thing for the community was to collaborate," said Dr. Mark Rovick, a psychiatrist at Catalpa Health. "In a time when many health systems throughout the country have closed their mental health services due to unsustainable reimbursements, our three founders decided mental health care was such a critical need that it needed to be addressed in a new way."

Patti Jo Severson from Gundersen Lutheran Health System also talked about their efforts to work with local partners to improve mental health in the La Crosse area, including partnerships with county government, their local NAMI chapter, and local law enforcement to help provide education related to mental illness.

"Ongoing collaboration is one of the strengths of our community and institution," said Severson. She also highlighted Gundersen Lutheran’s advocacy to include mental health, which had been missing from county public health plans.

Collaboration between health systems and county mental health agencies was a highlight of Marshfield Clinic’s joint presentation with the Human Service Center (HSC), a multi-county community service agency for Forest, Oneida, and Vilas Counties.

"HSC, as the sole public behavioral health provider for a large geographic area, believes that working in collaboration with the area’s health care system is not only a significant opportunity for improvement of services, but vital to our long-range strategic planning," said David Bast, executive director of HSC.

Health care systems’ commitment to serving communities’ mental health needs

Jean DeKeyser, executive director for behavioral health, ThedaCare, discussed efforts over the past decade that ThedaCare has made to provide measurably better value to individuals in need of mental health services in their community.

Guided by the ThedaCare Improvement System, DeKeyser explained that "ThedaCare Behavioral Health has dramatically improved our access to mental health from six weeks to less than five days for non-urgent care, and same day access for urgent care and increased customer satisfaction with our overall care delivery by 32 percent."

DeKeyser also described a major remodeling project on ThedaCare’s Adult Inpatient Unit at Theda Clark Medical Center.

"We included patients and families in our planning teams. We wanted to understand how they look at privacy, respect, and exceptional quality. We know that providing a therapeutic environment is key to our patients’ recovery."

Integrating mental and physical health was also important to their continuing strategy. "We are focused on integrating our care delivery into our primary care clinics, where we are aligning around the phrase ‘no health without mental health,’" said DeKeyser. "It’s with this body of work that we have the most opportunity to improve our care delivery through the Mental Health Care Coordination Bill."

Affinity Health Care’s efforts to serve their communities’ mental health needs were shared by Affinity’s Chief Medical Officer Dr. Larry Donatelle, and Director of Behavioral Health Sue Jungen.

Dr. Donatelle discussed Affinity’s expansion of its inpatient child and adolescent psychiatry unit from 13 to 17 beds, but also noted that "demand is greater than the supply for services in the community and state." Dr. Donatelle also described Affinity’s addition of case managers for mental health services into their emergency departments to aid in the alignment of resources available in the community and to prevent future hospitalizations.

Challenges to better address communities’ and patient’s mental health needs

The sustainability of the current model to provide mental health care was a concern repeated throughout the Task Force hearing.

"Current reimbursement rates for mental health services are a barrier and do not cover the cost for delivering care," said Dr. Alpa Shah, chair of the Department of Psychiatry and Behavioral Health for Marshfield Clinic. "The current fee-for-service model reimburses for face-to-face patient care. However, good patient care goes beyond the face-to-face visit. Significant resources and personnel are required and allocated to manage patient calls, crisis between visits, and for care coordination with various community agencies."

Dr. Rovik from Catalpa Health expressed a similar concern about the financial sustainability of mental health services.

"Obviously one of the biggest concerns we have is that financially, what we are doing right now is not sustainable," said Dr. Rovik. "What we end up doing is siphoning money off of other services. We can’t bill enough to cover the costs of providing these services to our kids."

Dr. Stephanie Eken, medical director of the Child Center at Rogers Memorial Hospital talked about shortages of psychiatrists, particularly child psychiatrists.

"There is a serious shortage of child and adolescent psychiatrists," said Dr. Eken. "Rural Wisconsin has a serious shortage of child and adolescent psychiatrists and even in major metropolitan areas such as Madison and Milwaukee, it can take six months to get a child into an outpatient child and adolescent psychiatrist."

Regulatory barriers were also highlighted, particularly, barriers to integration and coordination of care between primary and mental health providers in Wisconsin’s mental health records statute that do not exist for other medical specialties. (See the March 29, 2013 Valued Voice for additional discussion of this barrier and how the HIPAA Harmonization/Mental Health Care Coordination can address this barrier while preserving key confidentiality of psychotherapy notes.)

Identifying solutions to update Wisconsin mental health policy

In its testimony to the Task Force, WHA identified a number of unique policy-based challenges to Wisconsin’s mental health system and offered a road map of actions that the Task Force should take to begin addressing those challenges. A key part of that road map includes steps that the Task Force should take to set in motion an evaluation of whether Wisconsin’s county-based public mental health system should be reformed into a regional system to reduce access disparities and improve efficiencies.

Those challenges and recommended steps to address those challenges can be found in WHA’s testimony to the Task Force.

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2013 Wisconsin Medicaid EHR Incentive Now Available

On April 1, the Department of Health Services (DHS) began accepting applications for Medicaid EHR Incentive Payments for Program Year 2013. Per federal regulations, the Program Year 2013 for hospitals includes the dates between October 1, 2012, and September 30, 2013. The last day to apply for a Program Year 2013 incentive payment for hospitals is December 31, 2013.

In two separate Forward Health Updates, DHS has also announced technical changes to the EHR Incentive Program for hospitals and eligible professionals. The technical changes include changes that narrow the program exclusion for ‘hospital based’ physicians, expands the definition of a patient encounter for purposes of determining an eligible professional’s Medicaid volume eligibility, modifies the cost report data submission process for eligible hospitals, and expands eligibility for children’s hospitals.

The announcements were made in April 2013 ForwardHealth Updates 2013-21 and 2013-22, titled "Information for Program Year 2013 Regarding the Wisconsin Medicaid Electronic Health Record Incentive Program for Eligible Professionals" and "Information for Program Year 2013 Regarding the Wisconsin Medicaid Electronic Health Record Incentive Program for Eligible Hospitals," respectively.

The Forward Health Updates can be found at www.forwardhealth.wi.gov/kw/pdf/2013-21.pdf and www.forwardhealth.wi.gov/kw/pdf/2013-22.pdf. DHS has also revised and updated their Medicaid EHR Incentive Program website, which can be found at www.dhs.wisconsin.gov/ehrincentive.

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Wisconsin Hospitals Community Benefits - Physical Activity

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.

UW Health Partners WRMC partners with Watertown Police Department to host "Run from the Cops"

With a goal of making community fitness accessible to all, UW Health Partners Watertown Regional Medical Center (WRMC) partnered with the Watertown Police Department to double participation in "Run from the Cops," a community run/walk event for all ages and fitness levels.

In preparation for the run, WRMC brought in Suzy Favor Hamilton to jump start a free 12-week community training program designed to encourage those who had never completed a 5K race. The program provided training guidance and group motivation for beginner, intermediate and advanced runners. Many of the training teams formed during the program continue to work out together today.

"Our goal was to get 100 new faces to run or walk the race this year," said Stefanie Spilde of WRMC’s Wellness Works. That goal was met, as the run welcomed more than 500 participants, setting an attendance record.

"The health of the region served by WRMC is in decline," said John Kosanovich, WRMC chief executive officer. "As the region’s health care provider, we look for opportunities to reduce obesity and heart disease by inspiring healthy living throughout our community. ‘Run from the Cops’ is a great way for us to make community fitness fun."

"Run from the Cops" is a unique fitness event where participants get the opportunity to literally (and legally) run from the "Cops." Race winners are awarded donut hole trophies.

In addition to the adult run/walk, a one-mile children’s race follows a race of local mascots.

UW Health Partners Watertown Regional Medical Center, Watertown

Ministry leads community wellness initiatives

Health care is changing, and fast. Ministry Door County Medical Center in Sturgeon Bay is working to address changes brought on by several factors, including the advent of the Affordable Care Act, more patients with high-deductible insurance, and the growing realization that our country spends a great deal of resources managing chronic disease. The answer to all three challenges seems to be the same: wellness.

"We have a newfound and very strong commitment to community-wide wellness," says Matt Luders of Ministry. "We realize that we need to use more resources to keep people well and help prevent the onset of chronic disease." Ministry has launched several new initiatives to help meet this goal, including working with local workforces, schoolchildren and their own employees.

In 2012, Ministry partnered with the YMCA and Sturgeon Bay schools to create the Keeping It Real program. The program provides nutrition education and physical activity to help school staff lose weight, improve key health indicators such as blood pressure and cholesterol, and develop long-term plans to maintain healthy habits. The program has now expanded to serve all five school districts in the county. Kim Gordon, a Southern Door employee who is the head of the school’s Wellness Committee, helped coordinate the program at her school. "Across the board, participants lowered their numbers like cholesterol and weight. At the end of 12 weeks, every single person in the program noticed that they were much stronger," she reports. Keeping It Real has been so successful that Ministry is planning to tailor the program and offer it to the business community.

Ministry’s efforts also include providing support to school districts as they revamp their menus to align with new, stricter nutritional standards. Their partnership with Algoma schools helped the small district adapt to the new requirements and begin providing better food choices for students. "It’s really hard for small schools like ours, who have no dietician on staff, to deal with the new rules," says Gail Haack, business manager at Algoma schools who also serves as food service director. "Ministry has been absolutely wonderful to us, sending in a dietician to help us revamp our menu and work with our cooks."

Gina Newton, the Ministry dietician who helped Algoma, is looking forward to National Nutrition Month in March. "We realized that although schools are providing healthier options, kids are not always eating their fruits and vegetables," she says. So in the month of March, Ministry will pay to have one parent from every Door County family accompany his/her child to eat school lunch. "Good nutrition really has to start with parents," says Newton. In addition to the "take a parent to lunch" project, Ministry is planning some creative incentive programs to encourage kids to eat their fruits and veggies.

Ministry also supports schools by providing onsite nursing and physical therapy services in schools. Southern Door’s new school nurse was brought in through Ministry, who also provided funds to help build a hiking trail around the school forest, and supported the development of concussion management and strength and conditioning programs for student athletes.

Southern Door Superintendent Patti Vickman is enthusiastic about Ministry’s contribution to her community. "Beyond providing therapy and other services, over the years MDCMC has provided many programs and sponsorships, including dental care for families in need, support for the Southern Door Family Center, auditorium program sponsorship, and much more," she says. "When the district needed support for new football helmets to keep our students safe or someone to provide energy to new ideas from the district’s Partners in Health committee, Ministry was right at the table - engaged, involved, and inspiring us to dream more."

Ministry puts their belief in wellness at the forefront with their own employees. In addition to on-site exercise classes, smoking cessation classes, and mandatory flu vaccines, Ministry’s own wellness initiative means that they subsidize employee membership to the local YMCA. In turn, the YMCA matches those funds. "We believe it’s important to invest in the wellness of our own employees, but we also hold people accountable, requiring that they use the Y at least eight times a month to receive the benefit," says Luders.

The world of health care will continue to change and evolve, but Ministry Door County Medical Center is staying ahead of the game, one healthier person at a time.

Ministry Door County Medical Center, Sturgeon Bay

Submit community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

Read more about hospitals connecting with their communities at www.WiServePoint.org.

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