October 5, 2012
Volume 56, Issue 40
A Deeper Dive into the Obama, Romney Health Care Plans
WHA provides additional details on implications for hospitals
Last month, the Wisconsin Hospital Association (WHA) developed a high-level side-by-side comparison of the Obama-Biden Administration’s Affordable Care Act (ACA) and the Romney-Ryan health care reform plan (see September 7 Valued Voice). To help hospitals more fully compare the plans, WHA staff took a deeper dive into the details of each of the plans and what they might mean for Wisconsin’s hospitals.
"The plans are very different in their approach to holding down Medicare costs and financing Medicaid," said Joanne Alig, WHA’s senior vice president of policy and research. "We wanted to dig a little more to understand what each might mean for provider reimbursements, impacts on beneficiaries and recipients, and overall sustainability of these programs."
One fundamental difference between the two plans is the continuation of the Affordable Care Act (ACA). Under President Obama, the ACA would continue, while Governor Romney would seek to repeal the health reform law. The Congressional Budget Office (CBO) in a July report on the ACA projects the federal deficit would be reduced by just over $260 billion from implementation of the ACA. While provider cuts and new taxes and fees under the ACA would amount to almost $1.3 trillion, over $1 trillion of that would be used to offset the costs of insurance coverage expansion under the ACA, such as the insurance exchange subsidies. Should the ACA be repealed, cuts of about $2.6 billion over ten years to Wisconsin hospitals could be restored.
On Medicare, Governor Romney would control costs through a defined contribution payment to beneficiaries that would first be effective in 2023. Under his plan, Medicare savings would help decrease the federal deficit. By contrast, under the ACA, an Independent Payment Advisory Board (IPAB) would make recommendations to control program costs (through provider cuts only) beginning in 2015 if the rate of growth in spending per beneficiary is projected to exceed certain targets.
On Medicaid, Governor Romney’s support of a block grant program has been projected to reduce program growth by about $810 billion nationally over ten years. Given the growth that has already occurred in the Wisconsin Medicaid program, a high estimate of the Wisconsin share is about $16 billion. The impact of block grants on hospital reimbursement is somewhat unclear as it will depend upon the level of funding provided to each state, and the decisions and priorities set by each state to use its funds, appropriate additional funding, and stay within budget.
Under President Obama and the ACA, savings in Medicaid would be much less. The ACA includes reductions in Medicaid Disproportionate Share Hospital funding of about $14 billion nationwide. The ACA, however, also includes Medicaid coverage expansions that would largely be funded by the federal government. In a recent deficit reduction plan, President Obama proposed reductions in Medicaid of up to $66 billion over ten years, primarily from moving to blended match rate, and from reductions in the threshold for provider taxes. Under the plans proposed to date, the reduction in provider taxes would not affect Wisconsin hospitals because Wisconsin is already below the proposed threshold.
View the latest detailed comparison at: www.wha.org/data/sites/1/finance/RomneyRyan_vs_ObamaBiden10-5-12.pdf.
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Wisconsin hospitals made impressive improvements in reducing central line-associated health care infections (CLABSIs). CLABSI was one of the Wisconsin Hospital Association’s earliest collaboratives, led by Jill Hanson, WHA quality manager. Since the collaborative started in 2008, there has been a 67 percent drop in central line-associated infections in the 42 Wisconsin hospitals that are participating in the project.
According to a preliminary report released by the Agency for Healthcare Research and Quality (AHRQ), nationally, the CLABSI project reduced the rate of CLABSIs in intensive care units by 40 percent. It is the largest national effort to combat CLABSIs to date, according to AHRQ, which funds the project.
On October 1, Hanson was recognized for her hard work on the CLABSI project by Johns Hopkins University Armstrong Institute for Patient Safety and Quality. In a message to Hanson, Peter J. Pronovost, MD, PhD, senior vice president for patient safety and quality at Johns Hopkins Medicine, said, "You helped to advance the science, and you saved lives and changed health care forever. It brings great joy to know that we have formed a nationwide community that is making care safer for all. We are proud of all that has been achieved through your leadership and collaboration."
WHA President Steve Brenton expressed his appreciation to Hanson’s dedication, as he recognized Wisconsin hospitals’ commitment to patient safety.
"At WHA, we are proud to have leaders on our staff, such as Jill, who personally believe that our top priority in this state is delivering the highest quality, safest care possible in our hospitals," Brenton said. "We are excited to see Jill recognized for her work at a national level. She is a strong member of our quality department, and we appreciate her dedication to and skill in facilitating our health care quality improvement efforts here at WHA."
The Comprehensive Unit-Based Safety Program (CUSP) was created by a team led by Pronovost. "It is gratifying that this method has become such a powerful engine for improving the quality and safety of care nationwide," said Pronovost. "It is a really simple concept; trust the wisdom of your front-line clinicians."
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One of the highlights of the WHA’s September 28 newsletter was the coverage of the second wave of hospitals participating in the Transforming Care at the Bedside (TCAB) project (see www.wha.org/pubArchive/valued_voice/vv9-28-12.htm#4). WHA member hospitals that are currently, or have participated in TCAB last year, are reporting impressive results and seeing cultural transformation on the units that are implementing the TCAB process.
Shortly after the TCAB launch on September 26-27 in Wisconsin Dells, Kris Holmes, RN, MSN, director of medical/surgical nursing at Meriter Hospital in Madison, let WHA know that Meriter’s 6 Tower unit received an Innovative Best Practice Award from National Research Corporation (NRC). 6 Tower was one of 18 units that participated in WHA’s first TCAB project. The award was presented to a hospital that best captured and detailed a patient-centered best practice implemented in the organization that has improved publicly-reported outcomes.
Holmes said the unit council used techniques learned through WHA’s TCAB project to improve care for both patients and their families. "The work that 6 Tower did with TCAB has been so valuable. The unit is absolutely thriving, and patients are noticing," according to Holmes. "It is wonderful to hear patients describe the great care and wonderful staff. We haven’t stopped on 6 Tower—we are ‘spreading’ to all units. I want to thank you WHA for allowing us to participate (2 units) in TCAB. It really has helped to engage the staff at the bedside, and it has been delightful to watch the staff grow."
Twenty-three additional nursing units have recently joined WHA’s TCAB project, which is co-led by Judy Warmuth and Stephanie Sobczak.
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In its latest report to the Joint Finance Committee, the Department of Health Services (DHS) projects the Medicaid shortfall for this biennium at $13.8 million in state GPR funding ($35.5 million in total combined state and federal funding).
The $13.8 million amount is significantly lower than the projection released in June which showed up to $148.9 million in state GPR funding was needed to avoid a deficit in the Medicaid program. At that time, however, savings from some reform activities weren’t factored in, and DHS had stated that it appeared to be on track to stay within budget.
The new estimate includes the following:
In addition, DHS projects savings of just over $34 million GPR from the imposition of premiums on certain non-pregnant, non-disabled adults in the Medicaid program; a new policy for reviewing an applicant’s access to employer-sponsored insurance; and ending the retroactive eligibility policy. These new policies were implemented July 1, and DHS has separately announced a projected disenrollment of about 21,600 individuals as a result.
The full letter from Secretary Smith to the Joint Finance Committee co-chairs can be found at:www.wha.org/Data/Sites/1/medicaid/DHSreport-JFCoverallConditionofMedicaid10-2-12.pdf.
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President’s Column: Bipartisan Group Quietly Working to Avoid "Fiscal Cliff" and Delay Medicare Cuts
A handful of Senate Republicans and Democrats are quietly framing a proposal that might avert the "fiscal cliff" facing the nation on January 1.
Although far from a done deal, the plan may involve a $4 trillion reduction in the federal deficit over ten years achieved via: new revenues raised from an overhaul of the tax code (probably scaling back certain deductions like mortgage interest); cuts to federal programs, both defense and domestic; and savings from entitlement programs including Medicare, Medicaid and Social Security.
If it comes together late this year, the bipartisan deal may end up looking a lot like the framework of the Simpson-Bowles Budget Deficit Reduction Commission proposal (www.fiscalcommission.gov/sites/fiscalcommission.gov/files/documents/TheMomentofTruth12_1_2010.pdf), narrowly rejected two years ago by Congressional leaders who felt it went too far (Ds) or not far enough (Rs). The thinking is that in a post-election environment, with the clock ticking on a variety of painful tax increases and an across-the-board automatic sequester, a bipartisan compromise might actually work. That thinking aligns with growing concerns about the possibility of a new recession due to the shock on an already fragile economy from new tax increases and reduced spending.
Importantly, although the plan will likely identify specific budget savings numbers, the actual details as to how to achieve those numbers would be assigned to Congressional committees to work out over six months to a year.
For Medicare providers, such an approach would probably put off the two percent cut scheduled to take place in January but tee up the likelihood of new spending cuts later in the year. Also likely to be on the table is an increase in the age for Medicare eligibility—probably a slow increase from 65 to 67 over ten years or so. That idea, of course, will engender thunderbolts from AARP and other groups purporting to represent seniors.
The good news is that at least a handful of lawmakers are removing themselves from election year rhetoric and ideology. But getting this done will take some monumental heavy lifting.
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Citing a lack of federal regulations, Insurance Commissioner Ted Nickel sent a letter to U.S. Health & Human Services Secretary Kathleen Sebelius on September 28 requesting additional time to choose an Essential Health Benefits (EHB) benchmark plan for Wisconsin. Nickel asks for the deadline pushed back to at least 60 days after HHS issues final EHB regulations.
The EHB plan defines the minimum benefits that must be included in most health insurance plans sold to individuals and small businesses both inside and outside the health insurance exchange beginning in 2014. Under initial guidelines issued late last December, the federal Department of Health and Human Services (HHS) proposed giving states the option to choose one of ten plans operating in the state’s market as the EHB benchmark plan.
HHS had requested that states select their EHB plan by September 30. If a state failed to choose a plan, the default plan would be chosen by HHS as the small group market plan in the state with the most enrollees.
However, HHS has not yet issued formal regulations on the EHB. "With no EHB regulations issued to date, two days before states are to identify their EHB benchmark plans, we respectfully request that HHS not make this important decision on behalf of Wisconsin," wrote Nickel. He further noted that, "Additional time will provide for the opportunity to thoroughly review the regulations and obtain stakeholder feedback on the benchmark options available to Wisconsin."
In a forum at the State Capitol two weeks ago, HHS Region V Director Kenneth Munson indicated that 30 states were working on selecting their EHB plan. Based on various reports, less than half of all states chose their EHB by September 30.
To read the letter, go to http://oci.wi.gov/ehb-09-28-2012.pdf.
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The Leapfrog Group has mailed instructions to roughly 2,600 general acute-care hospitals to review the accuracy of their Leapfrog Hospital Safety Scores before they are publicly reported in mid- to late November.
In June, the Leapfrog Group released a scorecard assigning a letter grade for overall patient safety to more than 2,600 U.S. hospitals. The American Hospital Association (AHA) expressed concerns (see www.aha.org/advocacy-issues/letter/2012/120625-let-binder-rju-leapfrog.pdf) with Leapfrog’s initial scorecard methodology and data accuracy. In a letter to the Leapfrog Group, the AHA pointed out that hospitals are committed to transparency; in return, "all that they have asked is for assurance that the measures are truly important to the quality or safety of a patient’s care and that the data are collected and analyzed fairly and accurately. That is why we are raising concerns about the scorecard and whether it meets these important goals." The data being used by Leapfrog includes data from their survey, from CMS Hospital Compare and from the AHA Annual Survey. Since the data is not limited to just the Leapfrog survey it is important for all hospitals to participate in the preview.
In response, Leapfrog has made the data available for confidential review by hospitals until October 24.
The Leapfrog Group is a Washington-based healthcare quality-improvement group formed by large employers that assigns hospitals a letter grade—A, B, C, D or F—on performance based on 26 quality measures, covering areas such as medication safety, infection prevention and patient falls. Scores worse than a C were suppressed in the initial Leapfrog reporting; however, that will likely not be the case with the November update. AHA and WHA encourages hospitals to preview and verify the data online at www.leapfroggroup.org/data-validation/validation-login before the October 24 deadline.
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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.
Free screening event helps reduce health care disparities in La Crosse
Mi Yia Vang is 54 years old and works two jobs during the week. She says finding the time and resources for routine health care is a challenge. Adding to that challenge is the fact that she speaks little English. When Mi Yia learned about a free Hmong health fair and screening event presented by Gundersen Lutheran Health System, she was relieved to know she could access free preventive care.
Mi Yia was among 45 community members who attended the event at the Gundersen Lutheran – Onalaska Clinic in February 2012. Participants could receive free PAP smears, mammograms, prostate exams, bone density exams, and cholesterol and glucose testing. In addition, there were presentations and educational booths on topics such as cancer prevention, depression, exercise, osteoporosis, nutrition and health insurance.
"I liked that the screening event was held on a weekend," Mi Yia says. "That way, I was free to go and get my annual mammogram and PAP smear done. It is hard for me to take off to do those things during the week."
In addition, Mi Yia says the free clinic helped ease her mind. "My exams were all normal. I now know how to eat healthier, how to protect my skin better (I garden a lot!) and what I need to do to keep my bones healthy. I also liked the fact that there were many interpreters at the event to help us. Thank you so much. I wouldn’t have been able to receive these screenings and health advice if it weren’t for this free clinic."
Gundersen Lutheran Health System is part of a national network of community cancer centers—the National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP)—that focuses, in part, on reducing cancer health care disparities and improving access to the latest evidence-based cancer care close to where patients live.
Thanks to this network and more than 30 Gundersen Lutheran staff volunteers, the Hmong Health Fair and Screening Event has been a success for the past two years. In all, more than 25 mammograms, prostate exams and lab tests were conducted in 2012.
Gundersen Lutheran Health System, La Crosse
Health ed for seniors
Not too many people like to talk about touchy topics like urinary incontinence with senior citizens. But Tomah Memorial Hospital (TMH) made the topic one of the keynote presentations during their annual free Senior Health & Safety Expo held recently. It was the 14th consecutive year that TMH partnered on the event with Monroe County Senior Services, which also provided free transportation for attendees.
"We hold the event every year not only to provide information on a variety of health and safety topics, but it also gives the senior population various resources available in the area," Kasey Bloom, TMH outreach health educator said.
She said more than 30 area organizations and businesses offered displays and exhibits on a myriad of health and safety topics geared toward seniors.
Hospital staff also provided free non-fasting health screenings, including blood pressure, blood glucose, blood cholesterol, and bone density. Bloom said more than 200 seniors attended.
Tomah Memorial Hospital, Tomah
Voucher program for mammograms
The National Breast Cancer Foundation estimates over 200,000 women will be diagnosed with breast cancer and over 40,000 die each year. One in eight women either currently has or will develop breast cancer in her lifetime. If detected early, the five-year survival rate for breast cancer exceeds 96 percent. Mammograms are among the best early detection methods, yet 13 million U.S. women 40 years of age or older have never had a mammogram. Regrettably, for women who are uninsured or under-insured, preventive medicine is all too often given a back seat to other priorities.
But, thanks to the Fort HealthCare mammogram voucher program, this does not have to be the case. Eligibility includes: Any woman age 35 - 64 whose income guideline is 250 percent of the federal poverty level and is uninsured or under-insured, including high deductible or poor coverage or a woman age 40-49 who does not present with a breast symptom or family history of breast cancer.
Through a partnership with the Fort Memorial Hospital Foundation, the Jefferson County Health Department and the Rock River Free Clinic, women with little or no insurance received vouchers for free mammograms. The organization also made a concerted effort to reach its Hispanic population with bilingual posters at area restaurants, grocery stores, Literacy Plus offices, and through the Spanish language newsletter, Conexiones. Vouchers are available from any Fort HealthCare clinic and the Jefferson County Health and Human Services Department.
FortHealthCare.com/Mammo site allowed women to request an appointment online and find answers to their most frequently asked questions. More than 300 women received mammograms during the entire campaign. Even better, 15 percent of the mammography patients who scheduled appointments were new to the program.
Fort HealthCare, Fort Atkinson
Submit community benefit stories to Mary Kay Grasmick, editor, at firstname.lastname@example.org.
Read more about hospitals connecting with their communities at www.WiServePoint.org.
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