October 28, 2011
Volume 55, Issue 41

WHA Medicaid Reengineering Group Meets on DHS Medicaid Reforms

On October 25, the WHA Medicaid Reengineering Group (MRG) met to review the package of reforms released by the Department of Health Services on September 30 (see www.wha.org/pubArchive/valued_voice/vv10-7-11.htm#1). The Group, chaired by Nick Desien, CEO of Ministry Health, reviewed several of the Medicaid program changes that will affect both hospitals and hospital systems.

"It appears the Department is working to make Medicaid benefits more like private insurance, and to reduce the cost shift," said Desien. "But more information is needed about some of their savings estimates, and we think we can make further suggestions that will help DHS refine their proposals."

As a result of comments and suggestions from the MRG, WHA staff developed final recommendations on the reform package to share with DHS. The recommendations recognize the Administration’s efforts to avoid across-the-board enrollment reductions and instead to find alternative means for finding cost savings. However, WHA also describes some of the unintended consequences of certain reform provisions on access to and cost of care, particularly in underserved areas of the state.

As part of the reform package, DHS must develop a formal waiver request to submit to the federal government. This request must be submitted to the state’s Joint Committee on Finance for review and approval. Although expected soon, at the time of this writing, the request had not yet been submitted to the Finance Committee.

Contact Joanne Alig or Eric Borgerding at 608-274-1820 to learn more.

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Joint Amicus Brief Filed in CBRF Property Tax Exemption Case
"We are asking the court to follow the public policy choice made by the Legislature"

The Wisconsin Hospital Association, Rural Wisconsin Health Cooperative, and Wisconsin Association of Homes & Services for the Aging jointly filed an amicus brief this week supporting a property tax exemption for a nonprofit Community Based Residential Facility (CBRF). The case, currently being considered by the Court of Appeals, involves Beaver Dam Community Hospitals, Inc. and Eagle’s Wings, its 22-bed CBRF.

In 2009, the hospital submitted a property tax exemption request for the Eagle’s Wings CBRF. The hospital subsequently received a property tax bill from the City of Beaver Dam and after paying the tax bill, filed a claim for refund with the City. In 2010, the hospital filed a claim in Dodge County Circuit Court "seeking recovery of the unlawful taxes levied and collected by the City." The City argued that while the CBRF is owned by a nonprofit entity, the facility is not "benevolent" and, therefore, is not exempt from property taxes. The judge issued a ruling in favor of the CBRF. The City appealed.

The Court of Appeals will decide whether the statute requires a facility licensed, certified, or registered under Chapter 50, Wis. Stats., to be not only owned by a nonprofit entity but also "benevolent" in order to be exempt from property taxes. In the joint amicus brief written by Margaret Derus and Don Millis, attorneys at Reinhart Boerner Van Deuren, WHA, RWHC, and WAHSA, said, "The Legislature has chosen to exempt property used as a Chapter 50 facility to aid these nonprofit organizations in furthering their missions. The Legislature has expressed its policy determination that these organizations and facilities provide a public benefit and will be exempt if they meet the specific criteria identified in the statute."

After filing the brief, Derus observed, "Far from being a sleepy part of the statute, the property tax exemption that is the focus of this case has been subject to numerous legislative proposals, Legislative Council, and Department of Revenue studies over the last two decades. The Legislature acted deliberately when it amended the statute. We are asking the court to follow the public policy choice made by the Legislature."

Watch The Valued Voice for more information as this case develops.

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Bill That Would Streamline Nursing Home Regulations Passes Senate
Troubling amendment that would have eliminated the QIA voted down

A proposal that would reform duplicative and outdated nursing home regulations received bi-partisan support in the Senate this week. But while voted down, a troubling amendment was introduced that would have eliminated the Quality Improvement Act (QIA) passed earlier this year.

Senate Bill (SB) 212, introduced by Senator Pam Galloway (R-Wausau) and others does not repeal any current regulations or expectations of nursing homes. Instead, and among other provisions, the proposal eliminates the potential for nursing homes to be assessed a double state and federal penalty for a single incidence of alleged non-compliance. The bill also expands the authority of the Department of Health Services (DHS) to cite federal deficiencies, in addition to state citations, as grounds for state licensure action.

WHA supports the proposal being pursued by the Wisconsin Health Care Association (WHCA), the Wisconsin Center for Assisted Living (WiCAL) and Wisconsin Association of Homes and Services for the Aging (WAHSA). A companion bill, AB 302, was introduced by Representative Dan Knodl (R-Germantown) and others in the Assembly.

During Senate floor debate, an amendment was introduced by Senators Tim Carpenter (D-Milwaukee) and Julie Lassa (D-Stevens Point) that would have abolished the QIA.

Included in the broad tort reform proposal Special Session Senate Bill 1 and signed into law as 2011 Wisconsin Act 2, the QIA included long-sought after improvements to Wisconsin’s antiquated peer review statutes. The QIA helps improve health care quality, safety, and efficiency by encouraging more and better quality improvement activity.

WHA staff worked closely with the Walker Administration and key legislators and their staff to craft the bill and respond to misleading claims, false statements, and misinformation about the proposal. WHA also organized and led what grew into a large and diverse coalition of over 30 interested health care providers and purchasers and patient safety groups that strongly supported the bill.

The amendment was defeated on a partisan 16-15 vote.

SB 212 now heads to the Assembly where a vote is expected next week.

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Physician Documentation Key to ICD-10 Success
WHA offers regional seminars focused on documentation improvement

Although there are many areas of preparation important to a successful transition to ICD-10, ensuring detailed physician documentation may be the most vital of them all. Proper physician documentation is critically important because of its direct bearing on a hospital or clinic’s revenue cycle and ability to report quality outcomes appropriately.

When WHA members were surveyed in early 2011 regarding their ICD-10 readiness and needs, 74 percent of hospital members indicated their medical staff was not aware of the final rule related to ICD-10 transition by October 1, 2013, and 74 percent indicated physician education on documentation improvement was their number one need.

Based on this member feedback, in March 2012, WHA is offering five regional, one-day seminars focused on physician documentation improvement for ICD-10, presented by Lynn Kuehn, a Certified Coding Specialist for Physicians (CCS-P) and an AHIMA Certified ICD-10-CM/PCS trainer. Hospital leaders should encourage their physician leaders, physician liaisons, clinic managers, coding supervisors and managers, clinical documentation specialists and other ICD-10 implementation team members to attend one of these regional sessions.

While appropriate documentation is currently an issue with ICD-9 coding, it will only be intensified with the detail required for proper ICD-10 coding. One key to compliance is to have physicians familiar with the new documentation requirements of the ICD-10 code set, particularly the significant differences between the current ICD-9 and ICD-10 code sets. Physicians need to understand that there are significantly more codes in ICD-10 than in ICD-9, and the codes that are used are significantly more detailed and granular, requiring more and more specific documentation to support. In addition, the ICD-10-CM codes are organized differently.

Attendees will learn how the ICD-10 regulation will affect physicians and their practices and discuss specific examples of how physician documentation impacts ICD-10 coding accuracy. In addition, Kuehn will share the information needed from the various physician specialties and why this information is vital to code assignment. Most importantly, tools for physician leaders and others on the ICD-10 team to use in supporting the physician community with the ICD-10 transition will be identified, and each attendee will receive a packet of documentation quick references developed by Kuehn for AHIMA. One quick reference document per specialty and body system will be provided.

The seminar will be offered in five regional locations:

March 13 – Country Springs Hotel, Waukesha
March 14 – Tundra Lodge, Green Bay
March 15 – Grand Lodge by Stoney Creek, Wausau
March 20 – Holiday Inn, Eau Claire
March 22 – Glacier Canyon Lodge, Wisconsin Dells

All seminars will be identical, so attendees can choose the date and location most convenient for them.

A full brochure is included in this week’s packet and online registration is available at: http://events.SignUp4.com/UnlockICD10.

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President’s Column: WHA Board Approves Health Reform Priorities

At last week’s WHA Board Meeting, members gave the nod to five health reform implementation priorities that were the topic of much discussion earlier this summer at the Board Planning Session.

1. Accelerate Performance Improvement on Clinical Quality, Safety and Cost

WHA will work on this issue through our continued partnership with organizations like the Wisconsin Collaborative for Healthcare Quality, the Wisconsin Health Information Organization and Wisconsin Medicaid staff. There’s strong agreement that activities should align with the national agenda…especially Medicare payment-related initiatives.

2. Pursue Value Agenda

Wisconsin has been in the forefront nationally of a movement to harness the power of performance improvement, delivery integration and health information technology to achieve sustainable value. Much of the effort has been directed through the Health Care Quality Coalition (www.qualitycoalition.net) and that national advocacy must continue despite likely opposition from others concerned about regional redistribution of Medicare funds.

At the end of the day, if payment isn’t aligned with value, health reform will be a failure.

3. Advance Payment and Delivery System Reform

Hospitals and physicians must align as a strategy to advance care coordination and to improve outcomes in an era of declining or static resources.

WHA will continue to support multi-stakeholder payment reform initiatives and deploy recommendations of the Medicaid Reengineering Group. The focus will be on bundled payment pilots, coordinated care initiatives and medical home models.

4. Medicare Payment Cuts


Wisconsin PPS hospitals are already on the hook to finance PPACA coverage improvements to the tune of $2.6 billion over the next decade. Now our hospitals, including CAHs, face staggering new cuts to fund federal budget deficit reduction and the needed physician payment (SGR) "fix."

Unprecedented advocacy efforts will be needed and must be sustained.

5. Wisconsin Insurance Exchange

WHA will collaborate with Walker Administration officials and the Legislature to help create an exchange that aligns with WHA’s Board-approved principles.

BOTTOM LINE: WHA’s program and advocacy efforts will accelerate market-based coverage and performance improvement and stop or minimize public program payment cuts.

Steve Brenton

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Rep. Bernier Shadows at St. Joseph’s Chippewa Falls

On October 21, State Rep. Kathy Bernier shadowed St. Joseph’s Hospital (Chippewa Falls) CEO Joan Coffman. During her time with Coffman, Rep. Bernier was able to meet personally with the senior leadership team and leaders of the radiology department, the emergency room, the wound care center and the L.E. Phillips Libertas Center.

Shadow days are a WHA initiative designed to facilitate greater understanding by legislators of what it takes to run a hospital in today’s health care environment.

Following her meetings with staff, Rep. Bernier also had the opportunity to meet with the Healthcare Advocacy Committee, providing an update on what is happening in Madison and answering numerous questions.

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Grassroots Spotlight: Cong. Ribble Visits HSHS Leaders at St. Vincent Hospital (Green Bay)

Congressman Reid Ribble met with representatives of the Hospital Sisters Health System-Eastern Wisconsin at St. Vincent Hospital on October 20.

The group discussed the work health care systems such as Hospital Sisters are doing to bend the cost curve and improve care integration, as well as the impact that proposed cuts in Medicare would have on hospitals and health systems.

"We know that Rep. Ribble’s time is precious, so we especially appreciated the time he took to meet with us," said Heidi Selberg, HSHS-Eastern Wisconsin vice president of strategy and advocacy.

"Rep. Ribble understands how Wisconsin leads the nation on controlling costs and demonstrating quality in health care. We were able to give him real-life examples of how we and others like us are working every day to improve and reform health care right here in Wisconsin."

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Budget Development/Review for ICD-10 Readiness, Webinar Nov. 16

The implementation of ICD-10 will be one of the most expensive undertakings the health care industry has ever faced. Successful implementation requires consideration of virtually every department in the hospital. Hardware, software and HIM are the obvious budget areas, but ancillary needs should not be overlooked.

On November 16, WHA is offering a webinar to explore the budgeted items that should be included in every transition plan, as well as those less obvious areas that only some facilities will need. This session is important for every hospital, both those who are working to set an appropriate budget for ICD-10 planning and implementation, and those who already have a budget set but want to ensure it covers the most appropriate needs.

Attendees will learn what areas in the hospital are impacted, the scope of education needed from executives to physicians to support staff, the operational impact in the short and long-term, what hardware and software needs exist, how to appropriately budget for physician engagement and documentation improvement, and what other budget considerations there are specific to staffing.

This webinar is part of a four-part webinar series focused on helping hospital executives and their ICD-10 team leaders understand the magnitude of the ICD-10 implementation, the financial and clinical impact of the transition on your organization, and to be better prepared for on-time implementation.

The four sessions include:

  1. Budget Development and Budget Review for ICD-10 Readiness
  2. November 16, 2011 ** 12:00 PM – 1:00 PM CST

  3. Understanding Reimbursement Changes and the Financial Impact of the ICD-10 Transition
  4. December 14, 2011 ** 12:00 PM – 1:00 PM CST

  5. The Value of Strategic Planning for ICD-10 Readiness
  6. January 18, 2012 ** 12:00 PM – 1:00 PM CST

  7. Assessing Your Vendors for ICD-10 Readiness
    February 15, 2012 ** 12:00 PM – 1:00 PM CST

A team can register for the full four-part webinar series (for a discounted fee) or for an individual session. Either way, an audio recording of each presentation will be available to registered attendees at no extra cost to share at a more convenient time with ICD-10 transition team members who are unable to participate on the scheduled dates.

A full brochure describing the four sessions and online registration are available at: http://events.SignUp4.com/ICD10Impact11-12.

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WHA Webinar November 3 Focuses on ICD-10 Impact on Technology

In addition to affecting your coders, your revenue cycle and your physicians, the ICD-10 transition will significantly impact every aspect of technology in use by most hospitals. On November 3, WHA is offering a one-hour webinar to review the impact ICD-10 will have on IT systems and expose what most vendors are not talking about concerning their compliance.

This webinar will highlight the pitfalls to avoid by revealing details that vendors may choose not to disclose, including pricing, testing and third-party add-ons. The impact that this conversion will have on your existing HIM system will also be discussed, along with hidden costs of the conversion.

All hospital HIM leaders and other ICD-10 team members are encouraged to participate in this important webinar. More information and online registration are available at: http://events.SignUp4.com/OperationalICD1011-3.

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Mercy CEO Calhoun Receives WHA Partner’s "Best of the Best" Award

William Calhoun, president of Mercy Medical Center in Oshkosh, received the "Best of the Best" 2011 Administrative Award at the WHA Partners Annual Convention in Eau Claire.

In presenting the award, Pat Freeders, chair of the Best of the Best Awards Committee, said Calhoun worked closely with both the auxiliary members and hospital volunteers to change how the organizations were structured. All volunteers are now members of one Partners organization with the state dues paid by the hospital.

Freeders also noted that Calhoun has included the volunteers in Peer-to-Peer recognition and in the Assisting Clinical Excellence awards. His commitment to understanding the duties of various volunteer jobs included a stint with the projects group learning to do needlepoint.

In his address to the group, Calhoun recognized his volunteers and the considerable contributions they make to the hospital. He projected that the $1.5 million impact of the Mercy Medical Center volunteers is representative of volunteers in the 5,000 hospitals in the nation. Volunteers nationwide provide at least $5 billion of services and donations to benefit their hospitals. He thanked all of the attendees for their dedication to excellent health care in Wisconsin.

Calhoun has been president of Mercy Medical Center since 2007. A Wisconsin native, he has 20 years of health care administration experience. He earned a bachelor’s degree in occupational therapy at UW-Madison and a master’s degree in business administration from UW-Milwaukee.

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Wisconsin Hospitals Community Benefits: Social, Economic and Educational Factors that Influence Health

There is a strong association between social and economic factors and adverse health outcomes. Low socioeconomic status, including poverty, lack of education, and other factors are strong influences on health. Wisconsin hospitals are dedicating resources and developing programs to address these issues and improve the health status of those individuals that often cannot access even basic health services.

Proyecto Salud’s community health promoters

Racial and health disparities are exacerbated during an economic spiral downward. It is especially hard for those living in the U.S. with language barriers, cultural and ethnic differences to navigate the health system.

To best serve the rapidly-growing Latino community in Milwaukee, Aurora Walker’s Point Community Clinic collaborated with CORE/EL Centro to create Proyecto Salud, a program for training community health promoters (promotoras). The mission is to create new avenues for social change and foster a community that embraces spiritual, mental and physical health.

Proyecto Salud was launched in the Latino community in the greater Milwaukee area in 2006. With proven success, the promotora training branched out into West Allis and Waukesha counties. The project was recognized by the Wisconsin Department of Health Services for "Promising Practice in 2008" and by the City of Milwaukee Health Department Commissioner’s Community "Award of Excellence" in 2009.

Proyecto Salud focuses on education for action, civic capacity building, and tackling social determinats of health. The project works to create access for the community members to be at the table when decisions concerning their health and neighborhood are being made.

Ana Paula Soares-Lynch is co-founder and director of Proyecto Salud. She is also founder of Milwaukee Health Coalition. Ana Paula notes, "Since the inception of this project, we have accomplished many levels of outcomes. I have many stories of how our community health promotras reached out to their community to advance our causes. One promotora developed specialized parenting-skills training and resources for Latino parents who have children with disabilities."

Ana Paula continued, "Another member taught courses at University of Wisconsin Madison to educate those who enter into the U.S for the very first time. A third member who had experienced major depression and was able to receive free services through the Aurora Walker’s Point Community Clinic now works as a promotora by creating focus groups to discuss depression within the Latino community. It is not easy to become a promotora. An individual must complete 12 training sessions that are related to health issues. Examples of topics range from diabetes, terminal health, immigration, food, housing and cancer prevention."

In 2009 a total of 10,947 program hours were provided to 4,352 people served by health promoter-led projects. There were 22 promotoras who volunteered 2,885 hours in 12 Milwaukee-area agencies.

"The Latino population has been growing so rapidly in Wisconsin, the program has become a ‘hybrid,’ making it even more important for organizations to create partnerships to fully understand the cultural needs," said Ana Paula.

Aurora Health Care, Milwaukee

Do you want to help a child who struggles to read?

One in every five children has a language-based learning disability. For these children acquiring basic reading and language skills becomes a constant struggle.

To ease this struggle, Memorial Health Center pediatrician Dr. Cathy Reuter, MD, FAAP, and Memorial Health Center speech therapist Michelle Granger, MS, CCC-SLP, felt it essential to arm parents and educators with techniques to help struggling readers succeed.

For the second year in a row, Dr. Reuter and Granger held a 10-week multi-sensory reading-instruction training course for area adults wishing to tutor struggling readers. This free course was sponsored by Memorial Health Center.

As a part of their "Do you want to help a child who struggles to read?" course, Dr. Reuter and Granger taught 26 participants the Orton-Gillingham multi-sensory research-based approach to teaching reading. The Orton-Gillingham approach involves using a child’s ears, eyes, and muscles to reinforce what they are learning. It has proven very effective in children who have dyslexia.

One individual stands out among the many grateful course participants. Shortly after the 10-week course began, she started using the techniques she learned to help a very important student who had been struggling with reading since first grade – her daughter. Right away she began to see positive results.

"For the past 2 ½ years [my husband and I] hoped that we could catch her up and she would love reading like her older siblings do," she says. "We are now on our way to reaching that dream."

As if improvement in her daughter’s reading ability hasn’t been rewarding enough, she says Memorial Health Center’s "Do you want to help a child who struggles to read?" course has also benefited her family in another notable way.

"There’ve been no more tears of frustration from any of us," she says.

Memorial Health Center, Medford

Health-e People aims to increase health literacy

Studies show literacy skills are a stronger predictor of an individual’s health status than age, income, employment status, educational level, or racial or ethnic group. Medication errors, excess hospitalizations, longer hospital stays, more use of emergency departments, and a generally higher level of illness – all attributable to limited health literacy – add billions in excess cost to an already strained healthcare system.

To raise awareness of health literacy and related problems, Gundersen Lutheran Health System, in collaboration with other area health and literacy organizations, helped launched a joint regional education and information project. Its mission is to support and promote literacy/life-long learning for area children and adults through members’ collaborative efforts. The project has drawn queries from health care organizations nationally.

Gundersen Lutheran Health System, La Crosse

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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