August 29, 2014
Volume 57, Issue 35

Hospital Workforce Reflects Wisconsin’s Aging Trend
Hiring remains flat, but retirements loom

Hiring in hospitals has remained flat since the recession; however, it could pick up in the near future as baby boomers who postponed retirement plans begin to leave the workforce.

While the economy has caused many employees to put their retirement plans on hold, hospitals across the state are putting strategies in place to ensure they have a workforce to replace those that are leaving. In some key hospital patient care positions, nearly a quarter of the employees are over age 55 according to data collected by the WHA Information Center (WHAIC).

Almost 20 percent of the registered nurses working in hospitals and 35 percent of the laboratory technologists are more than 55 years of age, according to WHAIC. Hospital pharmacists are also older with 22 percent over 55 years old. Occupational and physical therapists are still among the youngest workers in the hospital. However, 19 percent of respiratory therapists fall within the 55 and older age bracket.

"Hospitals have made accommodations for older employees in the workforce, but time will eventually win out, and the more experienced employees, including nurses, will leave the workforce," according to Jodi Johnson, WHA vice president, workforce and clinical practice.

Hiring has remained relatively flat in hospitals since about 2008, according to the WHAIC annual hospital personnel survey. As older employees delay retirement and work shifts to the outpatient unit, hospitals have had less need to hire new employees. However, hospitals are factoring a tightening of the nursing workforce into their workforce strategic plans as retirements over the next decade are expected to outstrip hospitals’ ability to hire experienced nurses. The current statewide vacancy rate for nurses is 6.8 percent, a slight increase from 6.0 percent in 2011.

"While some nurses over age 55 may be in the workforce for another decade—and that may seem like a long time—we have to take into consideration that it takes two to four years for a nurse to complete his or her education," Johnson said. "We must remain vigilant in our workforce planning activities and continue to work with the education community to ensure that we are training the next generation of workers to meet the rising demand for care."

At present, the challenges of workforce planning focus on preparing a workforce that has the right skills and competencies needed to function in a new care environment that is based on a patient-centric, team-based care model.

"Current and accurate data is an essential element of workforce planning. WHAIC collects data on 33 key positions in Wisconsin hospitals," said WHAIC Vice President Debbie Rickelman. "It is a service and capability that hospitals value as they prepare today to meet the workforce needs of tomorrow."

The WHAIC specializes in providing data to health care organizations, consumers, payers and policymakers to help guide and inform their decisions. WHAIC annually collects personnel data from all hospitals in the state.

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WHA Health Law Manual Webinar: Record Retention, Patients’ Rights

WHA will continue its months-long complimentary webinar series on September 11 from 12-1:30 p.m. with a presentation of the "WHA Record Retention Manual and WHA Patients’ Rights, IRB, HIV & Other Miscellaneous Issues Manual." This webinar will cover the recommended minimum time periods for retaining various health care records and documents as well as statutory provisions regarding the proper disposal of medical records. The webinar will also discuss patients’ rights protections set forth in the Medicare and Medicaid Conditions of Participation and skilled nursing facility requirements and in Wisconsin statutes and regulations governing hospitals and nursing homes. It will further address specific informed consent issues, including consent to participate in clinical research, consent for HIV testing, and disclosure of test results.

WHA members are encouraged to register for this webinar as well as any or all of the other webinars in the series. Registration and more information about each of the remaining webinars in the series may be found at Attorneys in attendance may earn CLE credit.

This webinar will be presented by Katherine A. Kuchan and Stephane P. Fabus of the law firm of Hall Render Killian Heath & Lyman.

The Health Law Manuals are available for WHA members to view and download at WHA members who would like to access the Manuals should contact to request a username and password.

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New Legislator Profile: Rep. John Spiros (R-Marshfield)
A series of interviews with newly-elected legislators, by Mary Kay Grasmick, editor

Rep. Spiros Believes Balance is Needed in Wisconsin Worker’s Compensation System

Rep. John Spiros is relatively new to the state capitol, but he is familiar with many of the issues the Legislature will face when they take their seats in January. As vice president of safety and claims at Roehl Transport, Spiros is well versed in Wisconsin’s Worker’s Compensation Program. And while he can name a number of areas of the program that should be reformed, he does not believe that a fee schedule that was proposed during the last session is the answer.

"I would like to see everyone get on the same page and come up with one solution," Spiros said. "I don’t like it when government comes in and says, ‘you have to do it this way’ and the question remains, ‘why?’ The fee schedule, from my perspective, is not the target that I have—there are other areas that we need to get right."

For starters, he believes that a more balanced system for both employer and employee would benefit the program.

"The program now seems to be slanted more toward employees," he said. "Employees need to be forthright about pre-existing conditions when they apply for a job. We need to be absolutely sure that the injury that produces the worker’s compensation claim occurred while they were on the job."

As a freshman legislator last session, Spiros is pleased he was able to see eight of his bills pass.

"From my standpoint, it was important that I was active and not sitting on the sidelines," he said. "I think the thing I am most proud of is that I was able to work across the aisle."

Spiros is committed to working hard for his community and for the state. One of his priorities is to ensure Wisconsin is creating a climate that promotes business and job growth.

"If we tighten down things from a business sense today, we can make sure Wisconsin is open for business tomorrow," according to Spiros. "There is still work to be done, such as cutting red tape and making sure Wisconsin’s business climate is healthy, but we are getting there. In my role, as both an employee of a Wisconsin business and as a legislator, I can see it from both sides. I see the effects of what happens in the capitol, and I live it every day. I see what hurts business and what helps us."

What does hurt business is cost-shifting Medicaid costs.

"I look at the charts and see that Wisconsin Medicaid payments are 65 percent of cost—that creates shortfalls. It is something we have to look at in the next session," he said. "We put money into the last state budget to help hospitals that see a lot of Medicaid patients. That was a good step that we have to continue."

Familiar with the health care organizations in central Wisconsin, Spiros noted how well the health systems work together in his area.

"There is not an endless amount of money for health care, so it is always good to see health systems collaborate, which makes new technology available and also helps to control costs," he added. "Efficiency is huge in business, and it is equally as important in health care. How can we be more efficient while providing the best care at the best cost? That is the goal."

Spiros made a point of thanking WHA and his health care constituents for helping to educate him on the issues. His wife is a nurse, so he is familiar with some of the issues facing health care, but he quickly adds that his door is always open.

"Education is important. We have a lot of new lawmakers from diverse backgrounds. We don’t understand how everything works; we want to learn," Spiros said. "Don’t be afraid to educate us. I will always make the time to meet with those who can help me better understand an issue."

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340B Program Updates: Orphan Drug Ruling, Recertification

This week the U.S. District Court for the District of Columbia allowed the Department of Health & Human Services (HHS) and the Health Resources & Services Administration (HRSA) interpretive guidance on the 340B "orphan drug" discounts to stand. Orphan drugs are used for treating rare diseases, but HRSA has allowed providers to purchase those drugs at a discount if used for treating other conditions separate from the original rare drug designation.

HRSA’s orphan drug exclusion policy applies to critical access hospitals, sole community providers, rural referral centers and free-standing cancer hospitals. This final ruling relates to the lawsuit filed by the Pharmaceutical Research and Manufacturers of America (PhRMA) against HHS seeking to stop the policy and subsequent discounts on orphan drugs.

The Wisconsin Hospital Association also wants to remind providers that the deadline for recertification under the 340B program is September 10. HRSA has sent 340B authorizing officials user names and passwords that they can use to log into the 340B database and certify that the information on file is correct. Authorizing officials also will be asked to decertify any sites that have closed or are otherwise no longer eligible or participating in the program. HRSA is required to recertify annually all participating covered entities enrolled in the 340B program to ensure they are appropriately listed on the 340B database and that covered entities remain compliant with the 340B program requirements.

Questions or information on recertification can be obtained by contacting the 340B prime vendor program, Apexus, at 888-340-2787 or

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DHS to Change Presumptive Eligibility Process for Qualified Hospitals

The Department of Health Services (DHS) is making changes to the presumptive eligibility (PE) process that qualified hospitals can use to temporarily enroll individuals in BadgerCare Plus. The initial PE process for qualified hospitals was temporary, and the long-term solution will be in place September 29, 2014. To provide necessary training to qualified hospitals, DHS has scheduled regional training sessions to explain the new PE process. Training is mandatory for qualified hospital staff who will be utilizing this process.

Registration for the trainings is required prior to attending the in-person training sessions, but not for the webcast. Information about how to register for the trainings will be included in a ForwardHealth Update that will be issued in September. For planning purposes, below are the dates and times of the in-person trainings and webcast.

Please note that the training dates below are for qualified hospitals only and will fulfill the training requirements needed for qualified hospitals to utilize the PE process.



Date and Time

Holiday Inn South
4751 Owen Ayres Ct
Eau Claire WI 54701

September 15, 2014
Check-in — 1:00 p.m. to 1:30 p.m.
Training — 1:30 p.m. to 4:00 p.m.

Rural Wisconsin Health Cooperative
880 Independence Lane
Sauk City WI 53583

September 17, 2014
Check-in — 9:30 a.m. to 10:00 a.m.
Training — 10:00 a.m. to 12:30 p.m.

Holiday Inn
150 S Nicolet Rd
Appleton WI 54914

September 22, 2014
Check-in — 1:00 p.m. to 1:30 p.m.
Training — 1:30 p.m. to 4:00 p.m.

Wheaton Franciscan Healthcare – Wauwatosa
5th Floor Conference Center, Rooms 5B & C
201 North Mayfair Road
Wauwatosa, WI 53226

September 22, 2014
Check-in — 1:00 p.m. to 1:30 p.m.
Training — 1:30 p.m. to 4:00 p.m.

Howard Johnson Inn
2101 N Mountain Rd
Wausau WI 54401

September 25, 2014
Check-in — 1:00 p.m. to 1:30 p.m.
Training — 1:30 p.m. to 4:00 p.m.

Online Live Webcast

October 2, 2014
10:30 a.m. to 12:00 p.m.

In addition, for other health care providers and community partners who are not qualified hospitals, there will be training via webcast September 23, 2014. Information about the webcast for community partners and other health care providers will be announced through a partner email update and be posted to the Department’s website at

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AHA Submits Comments on Proposed OPPS Rule for CY 2015

AHA submitted a comment letter August 27 to the Centers for Medicare & Medicaid Services on its proposed rule for the calendar year 2015 outpatient and ambulatory surgery center prospective payment systems. The letter urges the agency to carefully reconsider its proposed methodology of creating a Healthcare Common Procedure Coding System modifier to track services furnished in off-campus, provider-based hospital outpatient departments. It also recommends changes to the implementation of its new set of claims-level comprehensive ambulatory payment classifications to ensure that it does not negatively and disproportionately impact certain types of hospitals that have specialized case mixes. In addition, AHA opposes CMS’s proposal to require a physician order for all inpatient admissions as a condition of payment under the agency’s general rulemaking authority, noting the agency cannot use its general authority to require a physician order for every inpatient admission when the Medicare statute itself requires an order only for extended inpatient stays. The letter also provides comment on CMS’s proposals related to: modification of the current process for accepting new and revised Common Procedural Terminology codes; changes to the inpatient-only list; payment for ED services; changes to the proton beam radiation therapy policy; and changes to the outpatient quality reporting and ASC quality reporting programs.

AHA will submit separate comments on CMS’s proposal for partial hospitalization program policies and payments. Comments on the proposed rule are due to CMS September 2.

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CMS Announces Acknowledgment Testing for ICD-10

There will be three different testing weeks leading up to the implementation date for ICD-10, the Centers for Medicare & Medicaid Services recently announced. (See

While submitters may acknowledgement-test ICD-10 claims at any time through implementation, the ICD-10 testing weeks have been created to generate awareness and interest, and to instill confidence in the provider community that CMS and the Medicare Administrative Contractors are ready and prepared for the ICD-10 implementation.

CMS lists the testing weeks as follows:

The testing is designed to validate providers’ ability to meet "technical compliance and performance processing standards" during implementation, according to CMS.

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Wisconsin Society for Healthcare Risk Management Fall Conference

The Wisconsin Society for Healthcare Risk Management (WSHRM) invites hospital risk managers, quality improvement and safety managers and staff to attend the 2014 WSHRM Fall Conference "The Evolution of Claims and Litigation." The conference will be held September 18-19 at the Glacier Canyon Lodge at the Wilderness Resort in Wisconsin Dells. This year’s conference will focus on trends and emerging risks in hospital and physician professional liability and will include speakers from leading health care liability insurance brokers, carriers and consultants, and panelists from Wisconsin health systems. Presentations on claim litigation and defense include "The Reptilian Approach to Litigation," and "Pearl and Dart: Strategies for Claims and Risk Management." The conference will conclude with an update on legislative and court actions that impact health care providers and an update from the Injured Patients and Families Compensation Fund.

This event will be submitted to the American Society for Health Care Risk Management (ASHRM) for CEU credit and to the Wisconsin Bar Association for CLE credit.

The agenda and registration information can be found at

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Fast Facts from the WHA Information Center
September is National Newborn Screening Awareness Month

September is Newborn Screening Awareness Month. In 2013, 66,289 babies were born in Wisconsin hospitals*. Wisconsin screens nearly 65,000 babies each year for one of the 44 disorders detected in the blood. For more information go to

* Data provided by the WHAIC (

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