June 14, 2013
Volume 57, Issue 24

Med School Grad Rate Outpaces Residencies
WHA, WCMEW consider options as state budget seeks to expand GME funding in state

The number of residency positions available in the U.S. has failed to keep pace with the increase in medical school class size. More than 500 medical students nationally failed to match with a residency program in the most recent "Match Day." Of the 17,487 U.S. medical school graduates, 528 do not have residency positions and thus will not be able to continue next year with their career path.

At the June 12 Wisconsin Council on Medical Education and Workforce (WCMEW) meeting at WHA headquarters in Madison, chaired by Chuck Shabino, MD, WHA senior medical advisor, members discussed issues related to Wisconsinís physician workforce, but focused much attention on residency programs.

"The 2013 National Resident Matching Program results highlighted the impact of the failure to match the increase in medical school graduates with a corresponding increase in graduate medical education (GME) (residency training positions)," according to Shabino. "This mismatch between the number of medical school graduates and residency positions means that physicians canít complete their training requirements for licensure, thus further exacerbating the physician supply shortage."

The number of applicants for first year resident positions increased over all by 10 percent, while U.S. medical school seniors applying increased by 5.8 percent, reflecting the early impact of current medical school class size and new schools coming on line. It is projected that the number of U.S. medical school graduates will increase by 2,500-3,000 over the next six years. Without a corresponding increase in residency positions, there will be qualified medical school graduates unable to pursue their careers, thus putting additional negative pressure on efforts to avoid the physician workforce shortage. This dilemma is evident in this yearís match results for U.S. medical school seniors.

The issue clearly is a lack of supply of residency positions. Of the 26,392 first year positions available this year only 61 were unfilled, virtually none of which were in primary care.

WHA has been focused on securing financial support to help expand GME efforts in Wisconsin hospitals and health systems. The Joint Finance Committee recently approved a plan by Governor Scott Walker to provide $5 million in state funds for GME initiatives in Wisconsin. The WHA-supported proposal provides significant funding for the development of new residency programs through GME consortia as well as additional dollars for specific high-need residency areas like psychiatry and internal medicine, according to George Quinn, WHA senior advisor, who discussed the state budget initiatives with the group.

Larry Pfeifer, executive director of the Wisconsin Academy of Family Physicians, said his group convened a Summit late last year with a goal to address the issues relevant to growing and sustaining the primary care workforce in Wisconsin. A key element is to interest medical students in pursuing primary care and to address some of the reimbursement equity issues that exist between primary care providers and sub-specialists.

Shabino said WCMEW and WHA staff are developing an education session on GME that will address specific issues related to the expansion of current GME programs and the creation of new opportunities. The conference is intended for hospital and health systems that have an interest in participating in existing or new GME initiatives. The session will give participants the information they need as they develop local initiatives. More information will be available later this summer.

In other business, Shabino welcomed new WCMEW member Jackie Sill, president of the Wisconsin Staff Physician Recruiters.

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Workerís Compensation Advisory Council Continues Health Care Payment Reform Discussion

The Workerís Compensation Advisory Council met June 11, continuing to consider policy options for this legislative sessionís "agreed upon bill." During this sessionís negotiations, both the management and labor representatives on the Council have pitched significant reimbursement reductions for health care services provided to injured workers. (See March 15, 2013 Valued Voice.)

As part of the Councilís public meeting, a representative of the Minnesota Workerís Compensation program explained to the Council the positive features of the Minnesota Workerís Compensation reimbursement system. She also emphasized that it is important for the Workerís Compensation reimbursement system to recognize through higher reimbursement the providersí significant administrative costs associated with the program compared to commercial health insurance. During discussions with Council members, WHA has emphasized that health care cost containment strategies must include broad payment reforms, such as prompt pay and reduced reliance on paper-based claims and prepayment reviews.

After the Council meeting, WHA Executive Vice President Eric Borgerding noted, "We will support broad reforms that improve our Workerís Compensation system, including addressing administrative inefficiencies. We have witnessed other states struggle with cost containment strategies that were not part of a real, overall reform effort. Workers in those states have seen reduced access to quality care." Borgerding continued, "Employers do not save money if cost containment does not include administrative reforms as part of a more cost effective program."

WHA, Wisconsin Medical Society, Wisconsin Chiropractic Association, and Wisconsin Physical Therapist Association continue to work with their members and the Council on system reforms. The Council will consider proposals at the next Council meeting, which is scheduled for September 17, 2013.

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New Legislator Profile: Rep. Debra Kolste (D-Janesville)

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

Free clinics have a vital role in the community, and Rep. Deb Kolste knows firsthand. As a volunteer at Health Net, a free clinic in Janesville that is supported in part by local hospitals, Kolste sees thousands of people every year who are uninsured and need medical care. Many of the patients see Health Net as their medical home.

Janesville is still recovering from the economic downturn, and Kolste said many of the patients in the free clinic never thought they would need help. Some of the jobs that they held were eliminated and replaced with temporary, part time work. That work, according to Kolste, doesnít come with health insurance. Even working full time in low paying jobs, families are barely able to make ends meet. Salaries now, compared to a few years ago, are still lagging behind; even as the unemployment rate improves, people are still struggling.

"Our patients are uninsured, and if they have insurance, they are not able to meet the co-pays and deductibles. They just want to get back to where they were," Kolste said. "Itís hard for a community to adjust when they used have a relatively high wage base, and now it is not as good. It was a big hit, and it could take us a decade to recover."

Kolste, who serves on the Assembly Health Committee, said she hopes the Legislature will expand Medicaid coverage and accept the enhanced federal match for individuals below 133 percent of FPL. As a Health Committee member, Kolste has been working on updating Wisconsinís antiquated administrative code that regulates the stateís hospitalsóDHS 124. Kolste said when the Committee started their work on the Assemblyís "Right the Rules" project, many people and groups needed to be a part of the process, and it is, "a mammoth undertaking." She hopes DHS 124 can be updated and the work completed over the next 18-24 months.

She also serves on the Speakerís Task Force on Mental Health and discussion has focused on the need to modernize Wisconsinís mental health care laws, which she termed, "archaic." WHA has led an effort to modernize Wisconsinís mental health records law and align the requirements for state records with what is allowed under federal law.

"Everything has changed over the past 20 years and the rules and regulations need to be modernized," Kolste said.

A former school board member, Kolste has held numerous leadership positions in school and community groups. She views her role as a legislator as a way to "give back to the community and voice the opinions of others who may not be heard."

"In my legislative office, we are just trying to help people who have concerns and become distraught working through the bureaucracy that sometimes confronts them," Kolste said.

Kolste, who has served on Mercy Hospitalís volunteer board, said volunteers are very effective advocates for their hospitals.

"Anytime you hear stories about real people from real peopleópeople not directly employed by hospitalsóthey can make a difference. They bring real life stories, and you have an entirely different conversation with them than if you are talking to an employee," according to Kolste. "Volunteers are often closer to the families; they see the dynamics and bring a different perspective."

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WHA Offers Webinar on ACAís Employer Shared Responsibility Provisions

In an effort to keep members informed on the most current information available related to Wisconsinís health insurance exchange implementation, WHA is offering a member-only forum on July 25 focused on what hospitals, as employers themselves, need to know about the Affordable Care Act (ACA).

During the forum, participants will receive an update on hot topics for employers under the ACA, with a focus on ACAís "pay or play" or "shared responsibility" provisions and how they impact strategy and plan design issues.

Hospital HR professionals, CEOs, COOs, and CFOs will benefit most from participation in this webinar. There is no cost to participate in this member forum, but pre-registration is required. Register at http://events.SignUp4.com/13HotTopics0725. If you cannot participate in the live webinar, there is an option to request an audio recording.

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WHA 2013 Nominating, Awards and Bylaws Committee to Meet in August

The 2013 Nominating, Awards and Bylaws Committee will meet in August to consider nominating a WHA Chair-Elect, five At-Large members for the WHA Board and candidates for the Trustee Award and Distinguished Service Award (information on these two awards can be found on the WHA website at www.wha.org/award-program-information.aspx.)

WHA members interested in being considered for an At-Large WHA Board seat or the Chair-Elect position should contact either WHA President Steve Brenton at sbrenton@wha.org or WHA Nominating Committee Chair Sandy Anderson at sandy_anderson@ssmhc.com.

Nominating Committee members for 2013 are:

Sandy Anderson, President, St. Clare Hospital, Baraboo - Chair
Steve Brenton, President/CEO, WHA, Madison
Greg Britton, President/CEO, Beloit Health System, Beloit
Faye Deich, RN, MS, COO, Sacred Heart Hospital, Eau Claire
Nick Desien, President/CEO, Ministry Health Care, Milwaukee
David Olson, Chief Strategy Officer, Froedtert Health, Milwaukee
Terri Richards, Director, Strategic Initiatives, Ministry Saint Josephís Hospital, Marshfield
Mike Schafer, CEO/Administrator, Spooner Health System, Spooner
Phil Stuart, CEO, Tomah Memorial Hospital, Tomah
Gerald Worrick, President/CEO, Ministry Door County Medical Center, Sturgeon Bay

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Last Chance to Register for the 2013 Wisconsin Rural Health Conference
Kalahari Resort, Wisconsin Dells *** June 26-28, 2013

More information and on-line registration available at: http://events.signUp4.com/13Rural

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Presidentís Column: The Exchange Must Work

We are about 100 days out from the Wisconsin insurance exchange (aka marketplace) going "live" on October 1, and the number one priority for a lot of stakeholders must be to work hard to make it successful.

Discussion and speculation about the uncertainty of exchange implementation must pivot to collaborative and proactive efforts to provide information and assistance necessary to get individuals and families covered through what at best will be a confusing situation, at least early on.

Governor Walkerís health care coverage platform aspires to place 250,000 uninsured Wisconsin citizens in either Medicaid (through expansion of eligibility to 100 percent of the FPL for low-income adults) or the insurance exchange for uninsured citizens with higher incomes. WHA will be focused on helping make the Governorís plan work.

Our single greatest priority must be on the 90,000 who will lose Medicaid coverage January 1. WHA will work with the Administration and others to 1) inform this population of their pending loss of public coverage and 2) make sure that they have access to personal assistance necessary to determine their options within the new exchange.

This will be a daunting task as continuity of coverage past January 1 will require 90,000 people to sign up and pay for first month coverage between October 1 and December 15. Thatís over 1,000 individuals a day, seven days a week. The magnitude of resources required to get this done will be astounding. But get it done is a must and now a top priority for WHA, our members and like-minded organizations.

Look for additional information as well as specific areas for involvement in the coming weeks. And weíd love to learn of your interest and ideas going forward.

Steve Brenton

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Operation Mayhem: Exercising a Decade of Preparedness Planning

"Mayhem" struck southern Wisconsin June 7 when more than 165 people participated in a disaster preparedness exercise known as "Operation Mayhem." About 30 hospitals, 19 public health departments, a community health center and a tribal clinic from 17 counties of southwestern and south central Wisconsin joined in a tabletop exercise at the Alliant Energy Center. Andrew Brenton, WHA assistant general counsel, represented the Association at the exercise.

It was 10 years ago that the first exercise of its kind occurred in the region.

The exercise scenario was based on realistic hazards identified from the Hazard Vulnerability Assessment that the region completed together in 2012 at a Wisconsin Hospital Emergency Preparedness Program (WHEPP) regional meeting. The scenario was that severe winter weather was affecting the southern region of Wisconsin, testing the abilities of the teams to set up incident command, create an incident action plan, and communicate with partners on public messages and internal situational awareness updates. The objectives for Operation Mayhem included Emergency Operations Center (EOC) coordination, utilization of emergency communications systems, health-related message coordination and public information, coordination of transportation resources and mass fatality management.

"Although the scenario is different 10 years later, many of the same challenges are still apparent today in emergency preparedness. However, the difference in the level of preparedness from 2003 until now is astonishing," according to Lori Wallman, WHEPP Region 5 Manager. "After a decade of federal funding used to enhance equipment, collaboration and preparedness planning among these community players, there is an obvious advancement in response compared to 10 years ago. It really reinforces the benefit of these organizations to participate in exercises and planning activities."

Eighteen teams, which included hospital representatives, local public health departments and state-level officials operated as individual EOCs. The "State EOC" in this exercise included the State of Wisconsin Departments of Transportation, Emergency Management, State Patrol, National Guard and Health Services. Representatives from the Wisconsin Association of Public-Safety Communications Officials and D-First, a statewide resource for fatality management, were also participants in the "State EOC." The County EOCs included medical examiners, coroners, emergency medical services, volunteer amateur radio operators and local emergency management.

The exercise was funded by the Wisconsin Hospital Emergency Preparedness Program (WHEPP) and the Public Health Emergency Preparedness Program.

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Member News: Fritsch to Retire from Upland Hills Health

Phyllis Fritsch, president and chief executive officer of Upland Hills Health, will retire after serving 34 years with the organization, including nine in her current role. Her last day is July 3.

Fritsch has served Iowa County both personally and professionally most of her life. In the early 1970s she was a member of the Board of Directors at Dodgeville General Hospital and played an integral role in the merger of St. Joseph and Dodgeville General to form Memorial Hospital of Iowa County. She was appointed interim administrator in 2004, and after serving in this capacity for more than one year, she was appointed administrator.

Fritschís commitment to provide quality health care to rural areas led to the acquisition of clinics in Highland, Montfort and Spring Green. The expanded number of physicians employed by Upland Hills Health may be attributed, in large part, to her recruitment efforts.

Knowing that to truly make an impact on the quality of health care, she would need strong support from the community itself she helped to create a Foundation so the community would have a permanent way of turning their philanthropic wishes into health care opportunities. In five short years, the assets of the Foundation were over $1 million.

Outside of her career at Upland Hills Health, she was involved with the Rural Wisconsin Health Cooperative and Wisconsin Hospital Association, and represents rural health initiatives to the National Advisory Council. She has also served on many church and community boards and is an active and energetic Kiwanis member. She is a founding member and currently vice-chair of the Iowa County Area Economic Development Corporation and is a member of the Thrive Healthcare Council.

Fritsch recently received the Dodgeville Chamber of Commerce Lifetime Achievement Award and the Rural Wisconsin Health Cooperative Rural Health Ambassador Award.

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Member News: UW Hospital and Clinics Names Head of East-Side Campus

John Sheehan has been named president of UW Health-American Center and senior vice president, University of Wisconsin Hospital and Clinics, after an extensive national search. He will assume his new role July 22, 2013.

Sheehan comes to UW Hospital and Clinics with a breadth of experience working in hospitals and complex systems. He currently serves as executive vice president/ chief operating officer at UnityPoint Health-St. Lukeís Hospital, a large community hospital with 560 beds serving northeast Iowa. He also serves as the regional vice president for UnityPoint Clinic in that region. Sheehan is the only hospital chief operating officer in UnityPointHealth with a dual role as the administrative leader for the employed physician group of 160 providers and their ambulatory practice.

Before joining St. Lukeís, he served as vice president of hospital administration at ThedaCare, a 420-bed hospital system in Appleton, Wisconsin; and at Danville, Pennsylvaniaís Geisinger Health System, a 540-bed tertiary care and teaching hospital with an academic medicine partnership with the Thomas Jefferson University. He held various roles and responsibilities including developing the nationís first rural Medicare HMO network, and serving as Geisinger Medical Center/Central Regionís vice president of operations. He started his career as vice president of operations of St. Mary-Corwin Regional Medical Center, a large community hospital in Pueblo, Colorado.

A Sun Prairie native, Sheehan is a graduate of the University of Wisconsin. He received a masterís in health care administration at St. Louis University, St. Louis, Missouri. He is a Fellow of the American College of Healthcare Executives.

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Member News: Beloit Health System Announces McKevett as New President

Gregory Britton, Beloit Health System President and CEO, recently announced the leadership promotion of Timothy McKevett, from senior vice president to president. McKevett will take over the operational responsibilities for Britton, who will retain the title of chief executive officer for the Health System. As CEO, Britton will continue his focus on Board of Trustees leadership and strengthening governance processes.

McKevett has been employed by Beloit Health System since 1985, when he served as an administrative intern while a Beloit College undergraduate student. He received his degree in Economics and Management from Beloit College and a Masters in Business Administration (MBA) from the University of Wisconsin. In addition, McKevett recently completed the Advanced Executive Program at Northwestern Universityís Kellogg School of Management.

"Timís promotion to president is a reflection of his progressive and effective leadership," according to Britton. "He has been involved in almost all areas of operation over his career and accomplished excellent outcomes." In his career at the Health System, most recently as senior vice president, McKevett has been instrumental in developing the health system into a financially strong, innovative independent health care provider.

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Wisconsin Hospitals Community Benefits: Mental Health and Mental Disorders

Mental disorders vary in severity and in their impact on peopleís lives. The symptoms can be severe and extremely destructive, causing immeasurable suffering for the patient and their families. Hospitals see an ever-increasing number of patients seeking treatment for mental disorders in their emergency departments. Hospitals that can offer inpatient treatment generally operate this service at a loss. With a disturbing shortage of mental health professionals, hospitals will continue to partner with each other and their communities to meet the growing demand for these services.

Grief Resource Group

Losing a child can be the hardest thing a parent will go through in their lives. For many, there are barriers to getting the support they need due to their location, time of day restrictions, and personal concerns. The Grief Resource Group was established by Childrenís Hospital of Wisconsin (CHW) to offer a new kind of support group to families going through this trying experience. CHW conducted research regarding the best social media platform, and created a Facebook group to meet the needs of both parents and the bereavement program. As a closed group, the bereavement coordinator is the only one who can accept new people into the group, helping to maintain the security of grieving parents and the integrity of the group. Uploaded to their page is a set of "What We Believe" guidelines, which sets expectations for group members.

Through the group, bereaved parents have the opportunity to share stories, feelings, and pictures at any time of day and receive support from others who can understand. Parents are able to message one another and the bereavement coordinator, and participate in online chats. The page also allows information about events to be spread more efficiently. The ability to share information and receive support transcends the barriers of time and space usually in place for traditional support groups.

Started in March of 2011, the Grief Resource Group now has 95 parent members. The group has truly become a place of comfort, support, and understanding. In an example of just how important the group is, parents have used it to share their fears about subsequent pregnancies before reaching out to their own friends and family. For these parents, they knew the group "would get it" more than even their closest friends would. When it comes to the logistics of dealing with a childís death, the group has been able to offer answers regarding funeral and headstone questions, and even advice when a childís Social Security number and identity are stolen.

For bereaved parents, the day-to-day moments of grief can be overwhelming. The Grief Resource Group offers a truly unique way of getting support whenever a parent needs it. As one parent said, "I just want to say that I am thinking of all the families and all the angels that have brought us together with this site and the care provided at CHW. We all know it is not easy. We all have pain. We are all in varying points of grieving. But I remind myselfÖ I have a lot to be thankful for and those kinds of positive thoughts are most important."

Childrenís Hospital of Wisconsin, Milwaukee

Gundersen Health System and La Crosse YMCA collaborate on Community Teen Center

It is an unfortunate fact that mental health care is lacking in many places. Even more so, the importance of early detection and treatment of mental health problems in youth is often overlooked. According to the National Institute of Mental Health, half of all lifetime cases of mental illness begin by age 14, where social stigmas and lack of health care access can delay diagnosis and treatment.

To combat this problem, Gundersen Health System and the La Crosse Area Family YMCA have created the YMCA Community Teen Center. With a mission of engaging youth and strengthening the community, members of this program work to address and de-stigmatize the issue of mental health in teens.

The Teen Center is a safe, tobacco, alcohol and drug-free drop-in center for all teens, grades 8-12. It offers free skill-building and recreational activities that are engaging and attractive to young people and makes use of their talents, energy and creativity.

Teens have access to a positive and safe environment to learn and develop in a healthy way. At the Center, they learn new skills, develop leadership qualities, express creativity, make new friends, learn social responsibility, get help with homework, volunteer and simply have fun.

A new part of the Teen Center, Kaitlinís Table, was created in memory of Kaitlin Mahr, the daughter of Dr. Todd and Deb Mahr. In 2007, Kaitlin lost her battle with depression and bi-polar disorder. The Mahrís wanted to do something to prevent the same tragic events from happening to other teens and families. With the support of Gundersen Medical Foundation, the Mahrs donated funds to provide a place where young people dealing with mental health issues could talk with therapists about life challenges. Kaitlinís Table provides a calm and inviting space where teens can come to talk, a library with resources on a range of health topics, and offers community outreach and educational activities.

The Teen Center program offers primary and secondary prevention strategies to strengthen teens. It provides free education and activities related to mental health and wellness on-site and in the community. Staff and volunteers are trained by a licensed mental health professional, who is available for ongoing consultation on how to identify and appropriately refer a teen who demonstrates concerns related to mental health, substance use, behavioral and social issues, or basic needs.

The number of teens using the Center is constantly growing. In 2012, the average number of teens visiting each night per month was 18. In the last three months, the number has risen to 21. This March, alone, 154 different teens visited throughout the month, with 80 attending more than once, 37 attending more than five times and 17 attending more than 10 times.

To learn more about the YMCA Community Teen Center and the free services available to teens, contact Sarah Johnson, therapist, Gundersen Behavioral Health, at (608) 775-1357 or email SJJohns1@gundersenhealth.org. You can also check out this YouTube video: http://youtu.be/KJDIEPah_SQ.

Gundersen Health System, La Crosse

Guiding young lives in a modern world

Parenting in a "plugged-in" era comes with distinct challenges that previous generations have never before faced. On March 11, 2013, Monroe Clinicís Behavioral Health team invited the community to join them in addressing these growing concerns. The event was called, "Guiding Young Lives."

"The purpose was to provide support, education, and strategies to parents in the surrounding communities," explains Courtney Stewart, LPC, Monroe Clinic psychotherapist. "In particular, one of the items on the agenda addressed the issue of how technology has changed the concerns parents have on implementing boundaries and limits for their children."

Stewart was one of three providers discussing the impact of social networking and personal electronic devices on families. They spoke about the influence of parents, as children may avoid or push parents out of their social circles, making it difficult for parents to monitor kidsí behaviors.

"We provided parents with the knowledge and support that they have the Ďrightí to place technology limits and boundaries to protect their children from exposure. In addition, we highly recommend family time where electronic devices, including the television, are not turned on so parents and children can be tuned in to one another. We stress the importance of continued open communication and to allow children to be the Ďteachersí educating their parents about them," said Stewart.

Feedback from the event was very positive. Attendees noted it helped empower them in their role as parents. Stewart said the audienceís interest has prompted the team to look at future opportunities to work with parents as they deal with new challenges and difficult questions.

"Monroe Clinicís Behavioral Health team strives to provide excellent services to parents, children, and families to educate, support, and empower them to strengthen their bonds and to function at their optimal levels," she said. "Events like this help us take these services directly to the community, where so many people can benefit."

Monroe Clinic, Monroe

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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