January 4, 2013
Volume 57, Issue 1

Troubling Hospital Cuts Enacted in Fiscal Cliff Law
Important rural hospital programs extended

Both the U.S. Senate and U.S. House approved and President Obama signed into law the American Taxpayer Relief Act of 2012 in rapid succession this week, but only after heated negotiations. This week’s action temporarily averts the so-called "fiscal cliff." The Senate approved the bill 89-8 and the House by a vote of 257 to 167. Wisconsin’s two U.S. Senators, Kohl (D) and Johnson (R), voted in favor. Wisconsin’s Representatives Baldwin (D), Kind (D), Moore (D), Ribble (R) and Ryan (R) voted in favor while Reps. Duffy (R), Petri (R), and Sensenbrenner (R) voted against.

"While this most recent package of changes has several positives, including extending important rural hospital Medicare programs and stopping impending physician payment cuts," began WHA President Steve Brenton, "we are very disappointed that hospital payments continue to be targeted to pay for other providers or programs. Such cuts can only hurt high-value states like Wisconsin. Federal decision-makers would be wise to stop penalizing states and providers who have already demonstrated value in health care."

The following are a few of the law’s health-related provisions:

Over the past year, WHA has aggressively advocated for important Medicare extensions and against hospital-related cuts under WHA’s advocacy campaign, "Protect Hospital Care." Those efforts have included no fewer than five trips to Washington, DC to advocate personally with members of Congress, HEAT members sending thousands of email messages to legislators, multiple town halls and listening sessions with legislators among other activities.

WHA expects hospital payments to be targeted in the coming months as Congress still faces debt ceiling negotiations, must permanently address sequester and make other fiscal decisions. WHA will need your continued help and involvement in 2013 to make the hospital voice heard throughout these deliberations. Watch The Valued Voice, HEAT newsletters and log onto our "Protect Hospital Care" site for more information. Contact Jenny Boese at jboese@wha.org with questions on what you can to do help.

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Neufelder Begins Term as WHA 2013 Chair
Harding will chair Association in 2014

Dan Neufelder, FACHE, senior vice president of hospital operations, Ministry Health Care, assumed his new duties January 1 as chair of the WHA Board of Directors.

Neufelder has served on a number of WHA councils and task forces, most recently on the WHA Executive Committee and on the Council on Public Policy. Prior to joining Ministry, Neufelder served as president/CEO of Affinity Health System from 2006-2012; for 12 years as the executive vice president and chief operating officer of Memorial Hospital of South Bend, Indiana; 10 years with the Community Health Network of Indianapolis, with the last four of those years as the executive vice president and chief operating officer of Community Hospital East; one year with St. Vincent Hospital and Healthcare System in Indianapolis, Indiana; and five years as a health care management consultant with Ernst & Young. He has been a member of the WHA Board since 2008.

Throughout his career, Neufelder has volunteered with numerous community-based organizations with special emphasis on serving the sick and poor.

Neufelder received his bachelor’s degree from the University of Southern Indiana in 1979 and his master’s degree in business administration from the University of Indianapolis in 1989. He was the recipient of the 1997 Young Healthcare Executive of Year Award for Northern Indiana. He is a Fellow in the American College of Healthcare Executives (ACHE), and received the ACHE senior–level health care executive award in 2012. Neufelder is also a Certified Public Accountant.

Edward Harding, president/CEO, Bay Area Medical Center in Marinette, will serve as WHA’s chair-elect in 2013 and chair in 2014.

Harding joined Bay Area Medical Center in December 2010. Prior to that, he served as president/CEO of Columbus Community Hospital from 2000 to 2010. His experience also includes being vice president of strategic planning, marketing and professional services at Mercy Medical Center, Clinton, Iowa.

A WHA Board member since 2006, Harding currently chairs the Council on Rural Health and is a member of the WHA Executive Committee.

A native of Sturgeon Bay, Harding received his master’s degree from the University of Minnesota in 1990. He received his bachelor’s degree from the University of Wisconsin-Stout in 1985. He is a Fellow of the American College of Healthcare Executives and is ACHE board certified in Healthcare Planning and Managed Care.

For a complete list of WHA members who are serving on a WHA Council or Task Force in 2013, go to: www.wha.org/councilsBoardsRegions.aspx.

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DHS Reports Balanced Medicaid Budget in Recent Quarterly Report

In their latest report to the Legislature’s Joint Committee on Finance, the Department of Health Services (DHS) projects their Medicaid budget will be balanced, eliminating almost the entire deficit. According to the letter dated December 28, 2012, the projected Medicaid program deficit for this biennium is about $300,000 in state GPR funding ($750,000 when combined with federal funds).

The report is welcome news given that at the start of the biennium DHS was charged with finding nearly $500 million in savings (about $200 million in state funds) in order to avoid a deficit situation. It is also a contrast to the end of the previous biennium when the state Legislature needed to provide an additional $142 million in state funds to cover program costs.

In their previous report released in September 2012, DHS indicated that the Medicaid program still faced a budget gap of nearly $14 million in state funding. The Department faced additional challenges after the newly-released federal matching rate was announced beginning October 1, 2012, causing an estimated increase of $25 million that must be covered by state funds in this biennium. The Department realized savings because of adjustments to Family Care and PACE/Partnership capitated rate projections as well as an estimated $27.8 million in state fund savings realized for the rest of the fiscal year due to health care efficiencies.

Importantly, the report also provides information about the effects on enrollees of the new premium policy implemented July 1, 2012. Since then, DHS has required non-disabled and non-pregnant adults with incomes above 133 percent FPL to pay premiums in order to remain enrolled in the program. The report indicated that the Department is tracking attrition rates due to non-payment of premium. The latest figures indicated that 23 percent of the nearly 49,000 individuals subject to premiums did not pay their premiums even after their grace period expired.

Because premium levels for the Medicaid program mirror premiums that individuals with the same income levels would be required to pay for subsidized private coverage through the health insurance exchanges beginning in 2014, some see the Medicaid attrition rates as a test of the affordability of exchange premiums for low income families.

A link to the latest report can be found at www.wha.org/medicaid/dhsmedicaidletter-12-28-12.pdf.

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President’s Column: Lame Duck Bill a Harbinger of Difficult 2013 for Hospitals

There were a couple of positives within the much ballyhooed legislation that passed Congress earlier this week. Specifically, the bill included one-year extensions for two programs that provide extra payments for rural Wisconsin PPS hospitals that have been designated either Low Medicare Volume or Medicare Dependent Hospitals. These organizations, located in Watertown, Baraboo, Mauston, and a dozen other Wisconsin communities are often referred to as "tweeners"—too large to be critical access hospitals and too small to realize the economies of PPS payment.

The legislation also provides a 12-month "patch" that prevents a massive Medicare payment cut for physicians. This latest last minute "fix" has become something of an annual ritual, necessitated by a statutory, formula-based and convoluted physician payment system know as the SGR.

That’s about it—all other Medicare issues await the next Fiscal Cliff which will arrive on or about March 1 and largely focus on spending—as opposed to taxes. Absent action, the across-the-board Medicare payment cuts which were delayed via this legislation for 60 days take effect automatically.

Some takeaways:

Steve Brenton

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WHA Physician Leadership Development Conference
The American Club, Kohler *** March 8-9, 2013

Early Bird Registration: Register by January 18 to qualify

The American Club hotel room reservation cut-off: February 14

More information and online registration can be found at: http://events.SignUp4.com/13PLD

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Mark your 2013 Calendar for These Important WHA Events:

March 8-9: Physician Leadership Development Conference, The American Club, Kohler

April 23: Advocacy Day, Monona Terrace, Madison

June 26-28: Rural Health Conference, Kalahari Resort, Wisconsin Dells

September 19: WHA Leadership Summit, Country Springs, Pewaukee

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Transforming Care at Bedside Project Sees Results

The Wisconsin Transforming Care at the Bedside (TCAB) project, led by the Wisconsin Hospital Association, is fostering changes at the bedside and improvements in the quality and safety of patient care that participants are anxious to share. WHA’s Judy Warmuth, vice president, workforce, has been conducting site visits at the 23 nursing units participating in the TCAB project. Warmuth said the site visits serve to ensure that each team has successfully launched TCAB on their unit. Early results are promising, according to Warmuth.

The team at Aurora Memorial Hospital of Burlington has created a role of "resource nurse" on each shift with positive feedback from staff. They are also looking to relocate the automated medication dispensing machine to a common, quiet area and doing a small test of change on nurse-physician rounding. In the future, they plan to create a daily schedule for each patient.

The visit to the Clement J. Zablocki VA Medical Center in Milwaukee began with a tour of three early changes: switching the employee locker room and a supply room, reorganizing the clean supply room and developing a process for keeping unbleached linen from other linens. They also have a new "thank you" board to recognize staff for great work. The team’s next project is improving shift-to-shift reports beginning with very small tests.

The Wisconsin TCAB initiative is an 18-month project that will end March 2014. Participants will outline a plan to sustain the project after that date. Transforming Care at the Bedside is a WHA project funded through the Wisconsin Collaborative for Healthcare Quality by the Robert Wood Johnson Foundation.

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Bergmann Appointed to AHA Committee on Volunteers

The Board of Trustees of the American Hospital Association (AHA) recently appointed Ann Bergmann of Cumberland, Wisconsin to serve as Board chair for the Committee on Volunteers. The Committee on Volunteers (COV) is comprised of 15 members from throughout the United States and is the recognized body of AHA that is concerned with the role and responsibilities of organized volunteers and auxiliaries.

In addition to responsibilities for member communication and assistance in policy development, she will lead the committee on advising the Association on programs and services directed to volunteers and auxilians, will participate in AHA grassroots advocacy and policy development and help implement AHA policy and programs in hospitals and health systems.

Bergmann began this role January 1, 2013. She is currently a member of the COV Committee, past president of Partners of Wisconsin Hospital Association and serves as Partners of WHA Public Policy Education Chairperson for the Northwestern District of Wisconsin. Bergmann is a member of Partners of Cumberland Health Care.

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Wisconsin Hospitals Community Benefits: Free Clinics

Where do you go when you need a doctor and you don’t have insurance? More and more hospitals are establishing free clinics to serve those who do not have a "medical home." Every effort is made to connect patients with follow up care and even help them obtain the medical supplies or prescription drugs that they need.

Fond du Lac woman finds hope at Samaritan Health Clinic

A work injury – and Agnesian HealthCare’s Samaritan Health Clinic – may have saved Suzanne Dye’s life.

Suzanne, a Fond du Lac resident, was working as a truck driver when she injured her back at work. Her employer arranged for follow-up care, but Suzanne was completely caught off guard when she was told that one of her X-rays revealed "something" on her lungs.

"They told me that I would want to go to a regular doctor and find out what it was," Suzanne says. But she didn’t have a regular doctor, or health insurance. "I didn’t know what to do."

For a year, she struggled with the concern in her mind. She worked as much as she could and tried to save up enough money to see a doctor. "It was really hard," says Suzanne, who, by then, was experiencing significant fatigue and shortness of breath. "When I didn’t feel good, I still had to go to work."

Then an acquaintance mentioned the Samaritan Health Clinic, Agnesian HealthCare’s clinic for uninsured/low income residents of Fond du Lac and Dodge counties. The clinic seemed like an answer to a prayer. Suzanne called, filled out the necessary paperwork and burst into tears when she learned she was approved for care. "That’s how relieved I was," she says.

Suzanne quickly saw a doctor, who scheduled her for a CT scan to evaluate the questionable area on her lungs. The CT was not reassuring, so she underwent a biopsy. The spot on her lungs turned out to be cancer. Suzanne had the cancerous portion of her lungs removed at St. Agnes Hospital in late 2011 and is feeling much better today.

"If it wasn’t for the Samaritan Health Clinic, I probably wouldn’t have had the surgery done, because I couldn’t afford it," she says. "The whole thing was a God-send. If I hadn’t hurt my back, I wouldn’t have even known I had cancer. So I thank God, and then I thank God that Samaritan Health Clinic was there."

Agnesian HealthCare, Fond du Lac

"Without the Clinic, I wouldn’t be alive today"

When Kristi Mesick was diagnosed with diabetes 11 years ago, it was the beginning of a long and difficult struggle with a myriad of health problems that also included hypertension and depression. Her diabetes proved to be an extreme type that has been difficult to control, taking an increasingly severe toll on her health and ability to function.

With nearly half of all uninsured nonelderly adults suffering from a chronic condition, Kristi’s situation is increasingly typical of the 2,500 patients the Community Outreach Health Clinic at Froedtert Health Community Memorial Hospital serves each year. Patients with chronic illnesses require ongoing disease management and medications to prevent their condition from deteriorating into a crisis, benefits that are out of reach without health insurance. Patients’ weakened health often prevents them from maintaining steady employment that would offer health insurance benefits. Kristi, 46, and living with friends in Sussex, has worked at a number of jobs over the years, but recurring health issues have made permanent employment difficult to maintain.

Fortunately, Kristi found out about the Community Outreach Health Clinic at Froedtert Health Community Memorial Hospital eight years ago, and her life changed. Here she found caring, supportive people who were committed to working with her multiple health concerns and finding solutions. She gets not only regular check-ups, affordable insulin and other essential medications through the Prescription Assistance Program, but moral support and education that have helped her improve her diet and make other lifestyle changes. Kristi tests her glucose levels three times a day, adjusts her medication accordingly and is being treated for her recurring depression.

"They are wonderful people," Kristi says about Nurse Practitioner Linda and volunteer Registered Nurse Anita. "They go out of their way to help in any way they can, above and beyond what’s necessary. Without the Clinic, I wouldn’t be alive today."

Froedtert Health Community Memorial Hospital, Menomonee Falls

It takes a community

She was in her third decade when she first rang the doorbell to Shalom Holistic Health Services (Shalom), Stoughton’s free health clinic for those without health care insurance and having financial issues. She arrived at the clinic with a several-year history of substance abuse and in the phase of early recovery. She credited her recovery at that time to attendance at weekly AA meetings and a lot of prayer. Though she held a part-time job at a local fast food facility, she had bigger dreams – dreams that entailed a purpose for her life and the acquirement of a dependable health care insurance policy.

Over the course of a couple of years, Shalom became the major support for her health care needs. Through professional volunteers, she would have the continuity of care that she would not find in the local urgent care or emergency room. She and Shalom worked together through counseling sessions and psychiatric visits to improve her health. Her physical needs were met through the regular availability of volunteer doctors and nurses. She even corrected a problem with a muscle strain through physical therapy. And though prayer was already integral to her life, she further had access to pastoral counseling, a facet of health care that often goes overlooked.

After two years, our client continues in her life of sobriety and is thankful for her improved good health received through AA and the existence of Shalom. She has completed her certified nursing assistant education and is gainfully employed by an area health care facility. She is enjoying the space of apartment living. She will soon be a candidate for her employer’s health care insurance, a clear symbol to her of reaching beyond poverty.

Stoughton Hospital, Stoughton

Red Shield Free Clinic

In operation since 1992, The Salvation Army’s Red Shield Free Clinic serves the medical needs of low-income people who lack insurance. It’s the only clinic of its kind in Sheboygan County and a valuable community resource. During 2011, the clinic served 1,100 patients, an increase of 10 percent over 2010. A total of 13 physicians from Aurora Sheboygan Clinic logged 127 volunteer hours seeing and treating people who turn to the clinic for the medical attention they need.

Pam Sandee, Red Shield clinic coordinator, points out "We are very fortunate to be able to refer our most chronically ill patients to Aurora Sheboygan Memorial Medical Center to apply for Aurora’s Helping Hand Financial Assistance program. Without this program, many of our patients would be left with a big financial burden. Aurora has always been so easy for us to work with. There is an easy transfer of our patients to the hospital because we have great relationship with the staff, some of whom are volunteers at our clinic."

Many people seeking medical care at the clinic also require lab work. Red Shield patients receive a voucher to have their lab work completed at Aurora Sheboygan Memorial Medical Center, free of charge, and the hospital also assists in funding prescription medications for the clinic’s patients.

Aurora Sheboygan Memorial Medical Center, Sheboygan

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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