June 12, 2015
Volume 59, Issue 23

WHA Board Hears How Wisconsin Hospitals Drive Quality Improvement
WHA staff reviews progress, previews changes in CMS penalty programs

The proof that Wisconsin hospitals and health systems are focused on and committed to improving the quality of patient care is evident in the national results. WHA Chief Quality Officer Kelly Court provided an overview of several national quality ratings and programs at the WHA Board meeting June 11 in Madison. Court also described WHA’s continuing efforts to assist members with this important work. 

Wisconsin is the second most highly-rated state in the country based on the quality of its health care according to the federal Agency for Healthcare Research and Quality (AHRQ). Wisconsin had the second best overall health care quality measure score among all 50 states, second only to New Hampshire, across more than 200 measures that AHRQ used to evaluate health care performance. (See www.wha.org/nr5-2-15ahrq.aspx.)

As the Centers for Medicare and Medicaid Services (CMS) ramps up their pay-for-performance programs, quality has an increasing effect on Medicare reimbursement. In the current federal fiscal year (FFY) Value Based Purchasing (VBP) program, the Readmission Reduction Program and the Hospital-Acquired Condition Program have a combined possible penalty of 5.75 percent. WHA closely tracks how member hospitals are doing in these programs and works to align improvement projects to these topics. The VBP program is gradually increasing the amount of weight given to patient outcomes and efficiency, which is an area where Wisconsin excels. In the current federal fiscal year, the statewide payback percentage for VBP was 117 percent for a total of $3,563,300. The number of hospitals that are receiving bonuses instead of penalties is increasing over time.

The Readmission Reduction program penalties topped out at three percent this year. As CMS adds clinical conditions to the program, it will become even more challenging for hospitals to avoid a penalty. The most recent conditions added include chronic obstructive pulmonary disease (COPD) and hip and knee replacements. In FFY 2014, the cumulative statewide penalty for excessive readmissions was $947,000. This amount jumped to $5,555,000 in FFY 2015, with over $4,500,000 of the penalties being driven by readmissions for patients who had a joint replacement. 

“This creates an opportunity for Wisconsin to focus our readmission work on joint replacement patients,” according to Court.

The CMS Hospital-Acquired Condition (HAC) penalty was new in FFY 2015. This program penalizes the 25 percent of hospitals in the nation that have the worst scores for hospital-acquired infections and an aggregate patient safety indicator. Of the 65 eligible Wisconsin hospitals, 18 received the one percent penalty in this first year. 

“WHA uses the results of these national programs, along with input from hospital quality leaders across the state to prioritize the quality projects we will work on with our members,” according to Court. “Our goal is to preserve Wisconsin’s status as a high-performing state and to help members maximize their potential in these pay-for-performance programs.” 

Court said WHA has submitted an application with CMS to continue the Hospital Engagement Network (HEN) to reduce readmissions and hospital-acquired harm. However, WHA’s improvement work with members has continued absent the CMS funding. Currently, hospitals are working with WHA to decrease readmissions, sepsis mortality, clostridium difficile infections and patient falls. These clinical topics are being augmented by an additional focus on enhancing the ability to more fully engage patients and families in their care. 

“We are hopeful the CMS funding will restart this summer. The work we are doing now has continued the momentum we created in the HEN, which will help position all of our members for even better patient outcomes,” said Court. 

When WHA knows if it has received the CMS funding, all members will be notified and given an opportunity to participate in WHA’s Partners for Patients initiative. 

WHA Prepares for Supreme Court King v. Burwell Decision 
As the country waits for the Supreme Court to issue a decision in the King v. Burwell case, WHA continues to meet with state legislators and members of Congress to ensure they are aware of the potential impact it would have on the 166,000 people at risk of losing their insurance in Wisconsin. 

WHA President/CEO Eric Borgerding shared the possible scenarios that could play out depending on the high court’s decision. He said the average monthly premium in Wisconsin with the tax credit now in place is $125 per month. Without the tax credit, the average premium would increase to $440 per month. 

While one can only speculate on how the Court will rule, Borgerding said WHA is preparing a multi-pronged strategy that will be triggered by the outcome of the decision. 

WHA Advance Work, Grassroots Activities, Prove Valuable in State Budget Process
Borgerding and Kyle O’Brien, WHA senior vice president, government relations, summarized recent action on the 2015-2017 state budget bill as it relates to WHA’s legislative priorities. O’Brien highlighted action by the Joint Finance Committee (JFC) to make the Medicaid Disproportionate Share Hospital (DSH) program an ongoing appropriation, which is a top priority on WHA’s 2015 legislative agenda.

O’Brien also highlighted other WHA lobbying efforts that resulted in action by the JFC, which included:  “Over a year’s worth of advocacy groundwork on DSH has certainly paid off in this budget,” said O’Brien. 

He noted that while the current budget situation has been challenging for most advocacy organizations, the collaborative work between WHA’s government relations team and member organizations has produced significant and notable results for Wisconsin hospitals and health systems in this budget cycle. 

“This agenda was accomplished through an advocacy plan developed and implemented by WHA’s internal team working side-by-side with our external partners. We worked very closely with our members as we used a combination of targeted strategic grassroots and direct lobbying,” said Borgerding. “This task would have been much more difficult without the leadership of Governor Walker reauthorizing the program in his proposed budget. In addition, several Joint Finance Committee leaders, including Sen. Darling, Rep. Nygren, Sen. Vukmir and Rep. Knudson, were the strong voices in support of Wisconsin’s Medicaid DSH program. And they were joined by all four Democrats on the Committee who also supported making DSH permanent. We are very grateful for this ongoing, bipartisan support from our state policymakers.”

The JFC is expected to take final action in the coming weeks before the full Legislature is expected to begin its debate on the budget later this month. The budget bill, after passing both houses of the Legislature, must then move to the Governor’s desk for any partial vetoes and his signature.

Another significant piece of legislation heavily supported by WHA is also advancing. Matthew Stanford, WHA general counsel, said the interstate physician licensure compact, which was one of the issues hospital supporters encouraged their local legislators to support at in-Capitol meetings held in conjunction with the WHA Advocacy Day April 28, has been introduced with 70 co-sponsors. 

“The number of legislators who signed on in support of the physician licensure compact is a testament to the true impact of WHA’s advocacy day and the effectiveness of the in-Capitol meetings,” according to Borgerding. “This year, especially, the number of our attendees who took the time to meet with their legislators was impressive. When 650 hospital supporters converged on the State Capitol, legislators really took notice. The hospital groups who went on the meetings knew their issues and were effective, passionate citizen lobbyists for their community hospitals.”

Council Reports
Council on Workforce Development: The Council heard presentations on WHA’s quality programs and a presentation of workforce issues with certified nursing assistants. Chair Nicole Clapp and the Council expressed an interest in assisting human resource directors to engage a broader number of hospital staff in this work. The Council heard a workforce report that built awareness of how competitive the market is for entry-level health care workers. 

Council on Finance and Payment: Council Member John Russell presented the report on behalf of Chair Steve Little. Kyle O’ Brien presented an update on the state budget, while WHA Senior Vice President Joanne Alig discussed the National Association of Insurance Commissioners' work to address network adequacy.

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Wisconsin Hospitals Conduit & State PAC Campaign Surpasses Halfway Mark

The 2015 Wisconsin Hospitals Conduit and State PAC fundraising campaign continues on a strong trajectory toward the goal to raise just over $270,000 by the end of the year. So far the campaign has raised more than $138,000 and surpassed the halfway mark at 51 percent of goal. In the last two months, the campaign has taken in over $60,000 and is $50,000 ahead of last year’s pace at this time.

The number of individuals who have already contributed stands at 147, and 49 of those are members of the Platinum Club having contributed $1,500 or more so far in this year’s campaign. Individual contributions to date are averaging $940, but contributions range from $20 - $5,000 plus. 

All individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. Special thanks to the contributors to date who are listed below alphabetically by contribution amount category. The next publication of the contributor list will be in the June 26 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Contributors Ranging from $1 - $499  
Anderson, Phil Sacred Heart Hospital
Appleby, Jane Aurora Health Care
Ballentine, Anne Wheaton Franciscan Healthcare
Brenny, Terrence Stoughton Hospital
Cardinal, Lori Agnesian HealthCare
Carter, Shane Aurora Medical Center - Oshkosh
Clark, Renee Fort HealthCare
Collins, Sherry Wisconsin Hospital Association
Colman, Gerard Aurora Health Care
Cormier, Laura Bellin Hospital
Culotta, Jennifer St. Clare Hospital & Health Svcs
Dux, Larry Froedtert & MCW Community Mem. Hosp
Feeney, John Community Health Network, Inc.
Freitag, Vanessa                       Our Lady of Victory Hospital
Hafeman, Paul St. Vincent Hospital
Hamilton, Mark UW Hospitals and Clinics
Harrington, Kathleen Mayo Health System - Eau Claire
Jelle, Laura St. Clare Hospital & Health Services
Klay, Chris St. Joseph's Hospital
Knutzen, Barbara Agnesian HealthCare
Leschke, John Mercy Medical Center
Lynch, Sue Mayo Health System - Franciscan HC
McArdle, PeggyAnn Agnesian HealthCare
McMeans, Scott Holy Family Memorial
Mercer, Carla Reedsburg Area Medical Center
O'Hara, Tiffanie Sundial Software
Peiffer, Susan Sacred Heart Hospital
Roundy, Ann Columbus Community Hospital
Schubring, Randy Mayo Health System - Eau Claire
Selle, Ginger St. Clare Hospital & Health Services
Statz, Darrell Rural Wisconsin Health Cooperative
Swanson, Kaitlin HSHS-Eastern WI Division
Tapper, Joy Milwaukee Health Care Partnership
Theiler, Brian Gundersen Tri-County Hospitals & Clinics 
Walker, Troy St. Clare Hospital & Health Services
Werkheiser, Cindy Monroe Clinic
Wheeler, Susan St. Nicholas Hospital
Whitinger, Margaret Agnesian HealthCare
Wold, Gwen Amery Regional Medical Center
Contributors Ranging from $500 - $999  
Bagnall, Andrew St. Nicholas Hospital
Bailet, Jeffrey Aurora Health Care
Bard, Jeffrey Aurora Medical Center - Oshkosh
Dexter, Donn Mayo Health System - Eau Claire
Dicus-Johnson, Coreen Wheaton Franciscan Healthcarel
Dolohanty, Naomi Aurora Health Care
Ericson, Allen Froedtert & MCW St. Joseph's Hospital Campus
Frangesch, Wayne Wheaton Franciscan Healthcare
Furlong, Marian Hudson Hospital & Clinics
Golanowski, Marie Aurora St. Luke’s Medical Center
Graul, Mark Children’s Hospital of Wisconsin
Gustafson, Andy SSM Health Care-Wisconsin
Hanson, Gail Aurora Health Care
Heaney, Dwight Fort HealthCare 
Jacobson, Terry St. Mary’s Hospital of Superior
Jensema, Christine HSHS-Eastern Wisconsin Division
Kingston, Mary Beth Aurora Health Care
Kirsch, Jennifer Gundersen Health System
Lange, George Westgate Medical Group, CSMCP
Larson, Margaret Mercy Medical Center
Latta, Richard Godfrey & Kahn, SC 
Lindberg, Steve Mayo Clinic Health System - Red Cedar
Mohorek, Ronald Ministry Health Care
Nelson, James Fort HealthCare
O’Day, Thomas Godfrey & Kahn, SC
Oland, Charisse Rusk County Memorial Hospital
Ose, Peggy Riverview Hospital Association 
Quinn, George Wisconsin Hospital Association
Reardon, Brian Hospital Sisters Health System
Roesler, Bruce The Richland Hospital
Rozenfeld, Jon St. Mary’s Hospital - Madison
Rude, Nels The Kammer Group
Seitz, Verna ProHealth Care, Inc.
Selberg, Heidi HSHS-Eastern Wisconsin Division
Shabino, Charles Wisconsin Hospital Association
Shorter, Tom Godfrey & Kahn, SC
Simaras, Jim Wheaton Franciscan Healthcare
Stuart, Philip Tomah Memorial Hospital
Teigen, Seth St. Mary’s Hospital 
Van Meeteren, Bob Reedsburg Area Medical Center
Yaron, Rachel Ministry St. Clare’s Hospital
Zenk, Ann Ministry St. Mary’s Hospital
Contributors Ranging from $1,000 - $1,499  
Ashenhurst, Karla Ministry Health Care
Bloch, Jodi Wisconsin Hospital Association
Brenton, Andrew Wisconsin Hospital Association 
Connors, Larry St. Mary's & St. Vincent Hospital
Cullen-Schultz, Jeannie JP Cullen & Sons
Just, Lisa Aurora Health Care-South Region
Kerwin, George Bellin Hospital
Killoran, Carrie Aurora Health Care
McCawley, Thomas Beloit Health System
Punzenberger, Lindsay Children’s Hospital of Wisconsin 
Rickelman, Debbie WHA Information Center
Roller, Rachel Aurora Health Care
Rush, Steven Wisconsin Hospital Association
Sato, Thomas Children’s Hospital of Wisconsin
Schafer, Michael Spooner Health System
Swanson, Kerry St. Mary’s Janesville Hospital
White-Jacobs, Mary Beth          Black River Memorial Hospital
Wolf, Edward Lakeview Medical Center
Contributors Ranging from $1,500 - $1,999  
Boese, Jennifer Wisconsin Hospital Association 
Clapp, Nicole Grant Regional Health Center 
Court, Kelly Wisconsin Hospital Association 
Decker, Michael Divine Savior Healthcare 
Frank, Jennifer Wisconsin Hospital Association 
Grasmick, Mary Kay Wisconsin Hospital Association 
Harding, Edward Bay Area Medical Center
Kammer, Peter The Kammer Group
McKevett, Timothy Beloit Health System
Natzke, Ryan Marshfield Clinic 
Nauman, Michael Children's Hospital of Wisconsin
Olson, David Froedtert & The Medical College of Wisconsin
Russell, John Columbus Community Hospital 
Schulze, Connie Ministry Health Care 
Sexton, William Crossing Rivers Health Medical Center
Sheehan, John UW Hospitals and Clinics
Wallace, Michael Fort HealthCare
Contributors Ranging from $2,000 - $2,999  
Alig, Joanne Wisconsin Hospital Association
Anderson, Sandy St. Clare Hospital & Health Svcs
Duncan, Robert Children's Hospital & Health System
Herzog, Mark Holy Family Memorial
Hilt, Monica Ministry St. Mary’s Hospital
Jacobson, Catherine Froedtert & The MCW 
Kachelski, Joe WI Statewide Health Info Network 
Leitch, Laura Hall Render
Levin, Jeremy Rural Wisconsin Health Cooperative 
Lewis, Gordon Burnett Medical Center 
Mettner, Michelle Children’s Hospital of Wisconsin 
Pandl, Therese HSHS-Eastern Wisconsin Division
Meyer, Daniel Aurora BayCare Medical Ctr Green Bay
Potter, Brian Wisconsin Hospital Association
Potts, Dennis Aurora St. Luke’s Medical Center
Sanders, Michael Monroe Clinic 
Sliwinski, Ron UW Hospitals and Clinics
Stanford, Matthew Wisconsin Hospital Association
Troy, Peggy Children’s Hospital of Wisconsin
Contributors Ranging from $3,000 - $4,999  
Boatwright, Damond SSM Health Care-Wisconsin
Little, Steve Agnesian Health Care
Neufelder, Dan Ministry Health Care
Normington, Jeremy Mercy Medical Center
O’Brien, Kyle Wisconsin Hospital Association
Size, Tim Rural Wisconsin Health Cooperative
Standridge, Deb Wheaton Franciscan Healthcare
Starmann-Harrison, Mary  Hospital Sisters Health System
Turkal, Nick Aurora Health Care
Contributors Ranging from $5,000+  
Borgerding, Eric & Dana   Wisconsin Hospital Association
Brenton, Stephen Wisconsin Hospital Association
Tyre, Scott Capitol Navigators, Inc.

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President’s Column: Shutting Down the Medicare Cash Machine

For the past few years, Congress and the President have developed a disturbing and costly habit—cutting provider Medicare reimbursement to pay for the latest cobbled-together spending package or policy priority. It feels a lot like Medicare providers have become an ATM machine, and Congress has our PIN number. It is a seemingly painless practice that has grown out of control. 

In fact, since 2010, Congress and the President have hit the health care ATM in Wisconsin for some $4 billion worth of reimbursement cuts—and that’s just hospitals. Our physicians have also taken damaging hits. That is a massive number, comprised of a series of nicks and cuts that singularly, and at the time, “aren’t so bad” or “could have been worse.” But WHA has been keeping tally of these trips to the ATM, and making sure our Congressional delegation is aware of the tab. 

The latest example of this health care financed shell game comes from, of all places, international trade legislation. On May 22, the U.S. Senate adopted a trade package that includes extending the Medicare sequestration cuts (aka HOSPITAL AND PHYSICIAN MEDICARE REIMBURSEMENT CUTS) to fund international trade policy...not coverage expansion or even Medicare payment reform
...international trade policy

Closing the sum-sufficient, multi-purpose health care ATM machine has been a top WHA advocacy priority for the past five years, but it’s not an easy place to make progress. Unlike, say, fixing the SGR or reforming out-of-control RACs, shuttering the Medicare ATM is one of those less tangible advocacy targets that requires constant and long-term focus, and consistent doses of nagging and badgering. The most recent examples of the latter came in May when WHA staff and members went to Washington to specifically lobby our delegation to reject the sequester extension included in the trade package. Those visits were preceded by a letter to our House delegation reiterating WHA’s strong objection to sequester extension. 

That sustained effort is starting to yield results. The first sign came in March when Congress passed, in bipartisan fashion, the SGR fix. WHA lauded the action, in large part because it rejected heaping more cuts onto health care as an SGR fix pay-for. 

Today there is even better news on this long-term WHA advocacy target. As I write, the House is poised to act on a trade package without the Medicare sequester extension/reimbursement cuts. Stripping out the sequester extension comes in direct response to objections from the provider community over continuing to rely on provider Medicare cuts to pay for any and all matters.

Assuming all goes well in the House, the trade package, sans the sequester extension, must still be adopted in the Senate, and WHA will be urging Sens. Baldwin and Johnson to follow the House’s lead. While the outcome is uncertain, one thing is clear, we are making progress in closing down the Medicare ATM machine

Eric Borgerding,
WHA President/CEO

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Nygren Joins WHA Physician Leaders Council for Opioid Abuse Strategy Discussion

Rep. John Nygren (R-Marinette) joined the WHA Physician Leaders Council as a special guest June 11, as the Council continued its discussion of policy and practice strategies to combat the increase in heroin and opioid abuse in Wisconsin. Nygren has been a key legislative leader and partner in working to address these issues in Wisconsin. During the hour-long dialogue, several issues and recommendations were discussed:

Council Chair Chuck Shabino, MD, WHA chief medical officer, thanked Nygren for his insights and continuing dialogue with WHA on this important issue to physicians, hospitals and health systems. Shabino said the Council will continue to follow and discuss prescription opioid medication issues at future meetings. 

The Council also continued its discussion of the Wisconsin Medical Society’s Physician Professional Satisfaction Survey that began during the Council’s April meeting. Donn Dexter, MD, chief medical officer of the Wisconsin Medical Society, shared a draft of the Society’s White Paper results from the survey and indicated that a final version would be completed and published soon. The survey was designed to measure the current state of Wisconsin physician’s professional satisfaction as well as identify both satisfiers and dis-satisfiers.

The next meeting of the Physician Leaders Council will be September 16.

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