February 22, 2013
Volume 57, Issue 8

Medicaid, Physician Workforce, Quality Lead WHA Board Meeting Agenda

The list of current issues that face Wisconsin health care leaders is daunting. Medicaid, however, was clearly top of mind for WHA Board members when they met February 21 in Madison.

WHA Executive Vice President Eric Borgerding told the Board that there were no real surprises when the Governor officially released his budget February 20. In a series of stops across the state over the past couple of weeks, the Governor executed what Borgerding described as a "slow rolling" of key elements in his budget, including his plan for the Medicaid program and physician training and education. (See coverage of the Governor’s address in this issue of The Valued Voice).

When the Supreme Court ruled that Medicaid expansion was optional, not mandatory, WHA re-activated its Medicaid Reengineering Group (MRG) and started what would prove to be an intense process to analyze and model Medicaid expansion options, well in advance of the Governor’s announcement.

The MRG recommended, and the WHA Board later adopted, a position of lifting the enrollment cap on childless adults with income up to 133 percent of the FPL and carefully transitioning the remaining Medicaid population into health insurance exchanges.

More than four years ago, with bipartisan support and long before enactment of the Affordable Care Act (ACA), Wisconsin sought and received approval from the federal Centers for Medicare and Medicaid Services (CMS) to expand coverage to childless adults with income up to 200 percent of the FPL (BadgerCare Core), but only at the usual 40 percent state/60 percent federal cost-sharing formula.

"The Medicaid Reengineering Group looked at every aspect of Medicaid expansion, including insurance exchanges," according to Borgerding. "Exchanges are an integral part of the Medicaid plan that is in the budget, but there is a great deal of uncertainty, doubt from even DHS Secretary Smith about whether the exchanges will be ready, and growing concern from providers that exchanges will translate into coverage for vulnerable populations. The risk here is more uninsured, more uncompensated care in our hospitals and clinics, and more cost shifting to Wisconsin employers."

The Governor’s budget will now go the Joint Finance Committee and then on to the State Legislature. Borgerding said that over the next four months WHA will work constructively with the Walker Administration and state legislators to build on the Governor’s proposal and enact coverage expansion in the most cost-effective way for Wisconsin’s patients, providers and employers.

"There will be much debate on this issue, with valid opinions on both sides, but at the end of the day, in this time of uncertainty, we cannot have fewer people with coverage and more uncompensated care," according to WHA President Steve Brenton. (See Brenton’s Budget Report Card in this issue of The Valued Voice).

WHA 2013 Goals Address Association Priorities; Gov. Includes WHIO Funding in Budget

Brenton presented and the Board approved the 2013 WHA strategic goals and initiatives which address the Association’s high-level priorities in the coming year. The Governor included funding in his budget for several of WHA’s top priorities, including undergraduate and graduate medical education, mental health coordination and the Wisconsin Health Information Organization (WHIO).

The Governor’s budget proposal includes $5 million over the next two years to fund the development of a business plan and timeline that will allow WHIO to acquire Medicare data to create a two-tiered data mart. Brenton said the funding will help accelerate public reporting of physician-level information. Provider organizations are able to identify episodes of care and the related resources.

"This is a very exciting opportunity that will help us continue to push the health care value agenda in Wisconsin," Brenton said. "And we are on the ground floor of making this happen."

Fiscal Cliffs, Debt Ceiling and Deficit Reduction: What is Next?

Brenton said the ACA is taking $2.6 billion from prospective payment system (PPS) hospitals over the next decade. That, he says, is just the starting point. Congress passed the Budget Control Act 18 months ago to increase the debt ceiling, but as March 1 approaches, so does the chance of the two percent across-the-board cuts, unless Congress takes action—which at this point seems unlikely, according to Brenton. The two percent Medicare cuts will impact all providers, including critical access hospitals.

Congress continues to be unable to agree on a permanent physician payment fix, which is continuing to fuel a troubling trend as hospitals take cuts to fund at least part of the SGR "fix." And the fiscal cliffs are not ending soon. The next one is March 1, then on March 27 and again on April 15. All require money, and until the fiscal issues are resolved, hospitals remain vulnerable to the two percent across-the-board payment reductions.

WHA has held Washington DC fly-ins related to the "Protect Hospitals" campaign, and it has kept a constant drumbeat of grassroots activity going both in the Congressional home districts and in Washington. The Congressional meetings continue next week with a WHA-sponsored fly-in to Washington, DC.

Physician Support Key to Success in Expanding GME

WHA’s report, "100 Physicians a Year: An Imperative for Wisconsin" outlines a plan, and offers solutions, for meeting the state’s demand for physicians. This year, according to George Quinn, WHA senior policy advisor, WHA will move forward on a number of efforts that align with the recommendations in the report.

Quinn said WHA will initiate and lead a broad-based advocacy agenda aimed at increasing the number of medical school graduates in Wisconsin and expanding GME. Governor Walker included funding in his budget which aligns with the recommendations in the WHA physician workforce report that helps to address the physician workforce shortage. The funding will:

WHA will also provide members with information and education on GME, starting with a webinar February 26. (See story below) But perhaps most importantly, WHA will work with other stakeholders to encourage physician engagement, a critical element to the future success of GME efforts. Physicians need information and resources to help them make the decision on whether they would be willing to teach new medical school graduates.

Quinn said WHA will initiate a study of the future health care delivery system, the results of which could help build consensus around changes that are needed in medical school curriculum that promote a team-based approach to medicine.

Hospitals in WHA Partners for Patients Initiative Make Progress, but Data Submission Lags

The 108 hospitals working with the WHA Partners for Patients initiative are accomplishing their goals and helping Wisconsin reach the national aims to reduce readmissions by 20 percent and reduce harm by 40 percent.

Hospitals that are submitting data and participating in the improvement webinars are showing excellent results, which proves the Partners for Patients methodology is working. However, only about half of all hospitals are submitting data or working to improve on each initiative. Many hospitals in Wisconsin are already better than the national average on much of the improvement work. However, Kelly Court, WHA chief quality officer, said that without data it is hard to get a true reflection of Wisconsin’s high health care quality.

"We’ve already been the state to envy. Wisconsin delivers high-quality, high-value health care, but we can’t prove it without data," Court explained. "Right now, we are lagging behind in submitting the necessary documentation to CMS so when we are compared to other states, we lack the "proof" that shows we’re among the best in the nation for these conditions."

With the "first wave" of work almost completed, Court asked Board members to encourage their quality managers to submit data on all of their applicable topics and to sign up for additional projects now as a new scope of work will start soon.

Court reminded Board members to register for the WHA Partners for Patients Mid-Year Event, "Catch the Wisconsin Wave," March 12-13 in Wisconsin Dells. Don Berwick, MD, who is well known for his expertise in quality improvement, will keynote the event. He is always an inspirational leader for front-line nurses, quality managers, and health care leaders who are committed to delivering high quality, safe care to their patients. Registration is still open at: http://events.SignUp4.com/13PFP031112.

Council and Task Force Reports

Medical and Professional Affairs – Kelly Court, WHA: The Council discussed two physician-related issues at their February 7 meeting. The Pharmacy Examining Board established a prescription drug monitoring program January 1, 2013. Pharmacies and anyone that dispenses controlled substances or Tramadol, directly to patients, must enter information into an online database, beginning April 1, 2013. Approved users will be able to access the data beginning in June.

The Council reviewed a proposal by the Medical Examining Board (MEB) that would change the requirements for obtaining a physician licensure in Wisconsin. The Council is supportive of the proposal to increase the number of years of completed residency to more than one year. Changes to MED-10 are also being proposed by the MEB regarding the definition of patient abandonment. WHA is working closely with the Wisconsin Medical Society to seek amendments to the MEB’s proposed language, and both organizations are advocating for a definition that is more consistent with national standards.

Rural Health Council – Ed Harding, president/CEO, Bay Area Medical Center, Marinette: Harding reminded Board members that the 2013 Rural Health Conference will be held June 26-28 in Wisconsin Dells. The Council is currently working on the conference agenda, which will include a keynote session by Quint Studer and Wisconsin-focused case studies.

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Walker Introduces State Budget, Highlights $343 Million Income Tax Cut
Includes Medicaid changes, investments in GME and mental health services

On February 19, Governor Scott Walker delivered his second budget address to a joint session of the Wisconsin Legislature. The Governor highlighted his proposed income tax cut, which amounts to $343 million, realized by lowering the bottom three marginal tax rates and by cutting taxes by an estimated $1.7 billion over 10 years. The tax cut would likely be around $100 a year for a dual-income family with each member making $40,000 a year. The Governor made a bold commitment by saying that he would like to reduce taxes every year he is in office.

Governor Walker used his address to propose, what he considers, entitlement reform to the state’s Medicaid program. As previously announced, Governor Walker’s budget address continued forward with his proposal to lift the enrollment freeze on BadgerCare Core to those under the poverty line. The proposal also moves all other individuals on Medicaid above the poverty line into federal facilitated health insurance exchanges on January 1, 2014. The proposal would also modify the BadgerCare Core benefit design so that it would be compliant with federal mandates as established under the Affordable Care Act. 

The Governor’s proposals related to graduate medical education (GME) align with WHA’s high-priority goal to increase the future supply of Wisconsin’s physicians, especially primary care practitioners. The address specifically highlighted four University of Wisconsin School of Medicine and Public Health (UWSMPH) medical students participating in the Wisconsin Academy for Rural Medicine (WARM). In his medical education and GME package, the Governor increased funding in the WARM and Training in Urban Medicine and Public Health (TRIUMPH) programs by $1.5 million to expand those programs to admit and educate more students. Graduates of the WARM and TRIUMPH programs are specifically trained to practice in rural and urban settings. So far, there have been 13 graduates of the WARM program with 62 percent now in primary care residencies. Nearly 70 percent of the WARM students are still in Wisconsin.

The budget speech also highlighted the importance of establishing an effective framework for mental health services delivered across the state. The Governor said that nationally, mental illness costs at least $193 billion a year in lost earnings and that only half of the adults with serious psychological distress receive the services they need. The Governor noted that he has made the largest commitment of state funding to mental health services in 30 years.

WHA has had a mental health task force in place since 2008 to identify regulatory, workforce and funding barriers that stand in the way of delivering accessible and well-coordinated behavioral health care. The mental health care system is facing serious challenges, and finding solutions is a top WHA priority.

The Governor said funding will be used in the following ways:

WHA staff is currently analyzing the Governor’s 1,093-page budget. The State Legislative Fiscal Bureau analysis of the budget proposal is expected within the next few weeks, as well. A brief of the Governor’s budget is here: www.doa.state.wi.us/debf/pdf_files/bib1315.pdf.

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WHA, WCMEW to Congress: GME Essential to Meeting WI Physician Shortage

On February 13, the Wisconsin Hospital Association, in conjunction with the Wisconsin Council on Medical Education and Workforce (WCMEW) traveled to Washington, DC specifically to discuss graduate medical education (GME) with Wisconsin’s Congressional Delegation. Potential reductions to Medicare GME payments have been proposed in the past and continue to be discussed by Congress as potential means for federal fiscal savings.

"Ensuring Wisconsin can meet our physician capacity needs in the future is important to everyone," said WCMEW Chair Dr. Chuck Shabino. "I think the diversity of WCMEW members represented in DC on this trip demonstrates to Wisconsin’s Members of Congress the importance of GME payments to our state."

Each year Wisconsin imports 600 physicians into Wisconsin in order to meet current patient access needs. "Right now that’s my concern, having enough doctors," said U.S. Senator Ron Johnson when Shabino relayed this statistic to him during the group’s meeting with Johnson in DC.

In 2011, WHA analyzed the state’s future physician needs based on demographics, implementation of health reform and an aging physician workforce and determined Wisconsin would need another 100 doctors per year through 2030. Since 2011, WHA has been aggressively working with many stakeholders like WCMEW to position Wisconsin for that future.

The group discussed with legislators the many innovative advancements already occurring in Wisconsin, such as the Medical College of Wisconsin’s (MCW) expansion into Green Bay and Wausau. However, the success of the MCW expansion will depend on an adequate number of resident training sites in these communities. One key element to ensuring residency sites will be through maintaining federal Medicare GME payments.

"If Congress were to cut indirect medical education payments by 60 percent and cap direct medical education payments, Wisconsin hospitals would lose upwards of $775 million," said Dr. Kenneth Simons, interim senior associate dean for academic affairs and associate dean for graduate medical education and accreditation at the Medical College of Wisconsin. "This proposed level of reduction would absolutely decimate our efforts to have adequate residency training sites here in Wisconsin and negatively impact our ability to provide care to those most in need."

U.S. Senator Tammy Baldwin said, "I certainly don’t think this [GME payment cuts] is the area to focus on. It’s cutting off the nose to spite the face."

Medicare has traditionally paid a portion of the cost of physician education, also known as graduate medical education. However, as Congress continues looking for fiscal savings, GME has been targeted for significant reductions.

During the meeting with Cong. Sean Duffy, who represents a largely rural district, the Rural Wisconsin Health Cooperative’s Tim Size explained the concern with GME cuts on rural areas. "With an aging population, there is a need for more services, plus there’s the impact of health reform and then you factor in that we’re a net importer of doctors now," began Size. "From a rural perspective, it’s even worse in rural areas if GME is cut."

Dr. Byron Crouse, UWSMPH’s Associate Dean for Rural & Community Health added, "We’ve already seen [residency] programs close in Wisconsin. This issue is real now."

In addition to meeting with Wisconsin’s Congressional Delegation, several individuals also met with professional staff for the U.S. House Committee on Ways & Means’s Subcommittee on Health.

Participants in the February 13 trip included: Dr. Kenneth B. Simons and Kathy Kuhn of the Medical College of Wisconsin; Dr. Byron Crouse of the University of Wisconsin School of Medicine & Public Health; Dr. Jake Bidwell, Aurora Health Care; Dr. Paul Wertsch, Wildwood Family Clinic of Madison; Tim Size, Rural Wisconsin Health Cooperative; Rick Abrams and Chris Rasch, Wisconsin Medical Society; Jon Sender, UW Hospital & Clinics; Paula Roberts, Children’s Hospital of Wisconsin; Maureen McNally, Froedtert Health; Michael Heifetz, SSM & Dean, Madison; Dr. Chuck Shabino, George Quinn and Jenny Boese, Wisconsin Hospital Association.

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President’s Column: Walker Budget — A Report Card

Here’s a quick report card on health-related initiatives included in Governor Scott Walker’s Biennial Budget.

Physician Workforce Initiative — The Governor proposes to spend almost $20 million to develop new infrastructure necessary to educate and train primary care physician providers. Money will help the Medical College of WI (MCW) build new satellite campuses in Green Bay and Wausau, expand family residency programs, grow the WARM and TRIUMPH programs, and provide money for hospital consortia that can develop new outstate residency programs. GRADE: A+

WHIO—Health Care Transparency Initiative — The Governor proposes funding of as much as $5 million to accelerate current public reporting and performance improvement initiatives. While the money is something of a placeholder for a yet to be developed plan, the investment will almost certainly fast track statewide public reporting at a physician group level. WHA, WMS and the WCHQ have been working with providers, purchasers and payers for years to advance clinical performance improvement. Public reporting has been a WHA and WCHQ hallmark for almost a decade. The new commitment of public funds to deploy WHIO—a robust all payer claims data repository—in ways that will engage providers and consumers has the potential to help transform provider delivery and payment reform. GRADE: A

Mental Health — Governor Walker proposes to spend $29 million over the biennium to tackle longstanding mental health treatment issues including new capacity at Mendota Mental Health Institute and added community-based care capacity. Mental health advocates laud the funding proposals. Additionally, Assembly Speaker Robin Vos has created a legislative task force to examine additional initiatives that can complement the Governor’s recommendations and be added into the budget later this summer. This is an auspicious start for an issue that’s been largely ignored for too long. GRADE: B+

MEDICAID — The Governor’s budget fully funds the "cost to continue" projected spending for the biennium, not a small issue given the history of underfunding Medicaid or using one time dollars to expand the program. The Governor also took what’s been described as a "middle ground" position regarding coverage expansion—lifting the childless adults cap to 100 percent FPL but not increasing overall eligibility to 133 percent as permitted in the ACA. WHA’s position is coverage expansion to 133 percent and we will continue to pursue that position over the next few months. In these uncertain times, hospitals that are the ultimate care safety net can’t afford to see the ranks of uninsured grow, especially when already allocated federal money is available to fully fund new coverage. GRADE: Incomplete.

Steve Brenton

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Journal Sentinel Editorial: Walker’s Medicaid plan falls short for the poor
Higher costs to the state, perhaps fewer insured, and uncompensated care for hospitals make it a poor choice.

The Milwaukee sentinel by Journal/Sentinel, Inc. Reproduced with permission of JOURNAL/SENTINEL, INC. in the format Post on the Internet via Copyright Clearance Center

Scott Walker - against Obamacare before he was for it.

We’re not sure whether that will be the governor’s next campaign slogan—or someone else’s.

The governor believes he has found a politically palatable solution that allows him to turn down billions of dollars in federal assistance for Medicaid coverage through the Affordable Care Act, yet still claim to increase coverage for the state’s poor.

Walker’s proposal is innovative—perhaps even brilliant politically. But is it good policy? We don’t think so. The full Medicaid expansion under Obamacare remains the better choice, and we urge lawmakers to protect the poor by either accepting that or making changes to the administration’s proposal.

Walker’s plan to shuffle thousands of needy people between insurance plans will cost the state more and result in fewer insured than if he had simply accepted federal money available for Medicaid expansion under the ACA. Out-of-pocket costs for those forced from Medicaid may force them to do without coverage, and that could place a greater burden on the state’s hospitals.

The governor’s plan would force about 87,000 adults now in the Medicaid program onto the new federal insurance exchanges. That will make way for about 82,000 additional people to receive Medicaid who do not now qualify. Walker claims his plan will allow 224,600 more people to receive coverage, compared with 252,700 if the state had accepted full expansion, though his administration has not explained how it arrived at those numbers. The Legislature and federal officials must OK the plan.

Under the ACA, the federal government will pay 100% of additional Medicaid costs for three years and 90% thereafter. In that scenario, Wisconsin could tap $4.38 billion in federal money through 2020, according to a preliminary estimate by the state’s nonpartisan Legislative Fiscal Bureau. In other words, the state would be money ahead if it adopts full expansion under Obamacare.

But Walker, long an opponent of Obamacare, is among a group of Republican governors who have chosen to reject the additional federal aid. The concern of Republican governors is understandable: Medicaid is a huge line item in their budgets. President Barack Obama has claimed the ACA won’t explode the federal deficit, but that’s only true if states pick up a share of the costs of the program over time. With a budget-cutting drumbeat in Washington, D.C., it’s reasonable to worry that the federal government won’t always pay 90% of Medicaid costs and might push more of the burden onto states.

But we take the view of Bob Laszewski, an insurance industry analyst and longtime critic of Obamacare. He noted last week that the same argument can be made to oppose any federal matching program. "Then don’t take highway money. Don’t take education money," he told the Journal Sentinel.

We see clear signs of electoral politics in the Walker proposal: When he runs for re-election in 2014, the governor can argue that he expanded coverage. If he has higher aspirations, he can argue two years later that he rejected Obamacare, which would play well in Republican primaries.

Walker and Dennis G. Smith, the state secretary of health services, tout the low premium cost for those forced into the federal exchanges—$19 a month for a single person whose income puts her at the federal poverty line ($11,490 this year). But that doesn’t include out-of-pocket costs allowable under Obamacare. Those costs are capped at about $2,000 a year for people with very low incomes, but that’s a huge percentage of annual income when you are making less than $12,000.

Reacting to Walker’s plan, the Wisconsin Hospital Association, which favored full expansion of Medicaid, expressed this concern in a statement: "There will be much debate on this issue with valid opinions on both sides, but at the end of the day, in this time of uncertainty, we cannot have fewer people with coverage and more uncompensated care."

And yet that’s exactly what will happen if the poor either cannot navigate the exchanges or cannot afford the policies they find there.

As Laszewski and others have noted, the exchanges were not designed for people who were eligible for Medicaid. "They’re designed for middle-class people who can afford deductibles and co-pays," he said.

We’re also concerned about the quality of coverage. Will the same comprehensive benefits offered under Medicaid be available on the lowest tier of health plans on the exchanges?

And there’s this: Walker is, in effect, taking credit for increased coverage that will flow from his plan, when in fact it’s Obamacare, which he despises, that is responsible. But we don’t expect a thank-you note from the governor’s office to land in the mailbox at 1600 Pennsylvania Ave. anytime soon.

Walker’s plan is certainly better than an outright rejection of Medicaid expansion without providing anything else for the poor. But we’re skeptical that it will accomplish what he claims. While we, too, have concerns about Obamacare—particularly its cost—the state would be better off to accept the federal help and enact a full expansion of Medicaid. We urge the Legislature or the federal government to set this right.

Find this article at: www.jsonline.com/news/opinion/walkers-medicaid-plan-falls-short-for-the-poor-bi8plgq-191485001.html.

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Advocacy Day 2013: You Won’t Want to Miss It!
Hospital advocates tell of their overwhelming support for event

The reviews are in, and this is what attendees said about last year’s WHA Advocacy Day event.

"The day is invaluable. It gives great clarity to the issues that face our hospitals and our communities."

"Enlightening experience."

"My first time attending. Was surprised by the number of people there!"

"Keynote was excellent."

"The greatest benefit is reinvigorating the advocacy spirit in us."

These quotes mirror what our surveys have told us over the years—that the vast majority of attendees rate the event extremely high. In fact, when WHA specifically asked whether the event successfully educated and engaged attendees on important hospital issues, an overwhelming 92 percent said "yes!"

That’s why you won’t want to miss this year’s event, slated for April 23 at the Monona Terrace Convention Center in Madison. Register today at: http://events.SignUp4.com/13AdvocacyDay0423.

Advocacy Day 2013 includes a great line-up. With the state budget process unfolding concurrently with Advocacy Day, the ever-popular state legislative panel will provide insight into budget deliberations and other pending health care issues of importance. David Rehr, PhD, noted national association leader and adjunct professor for George Washington University, will keynote the event. Rehr is the author of The Congressional Communications Report, the largest, most in-depth study of grassroots advocacy and lobbying practices and how they are received by Congress. Plus, Governor Scott Walker is invited to present the luncheon keynote address. [And there may even be another guest speaker, too, but it’s too early to tell.]

After a legislative issues briefing in the afternoon, attendees will then be able to go to the State Capitol, only two blocks away, to meet personally with their legislators or staff. This is the most important aspect of Advocacy Day—putting knowledge about hospital issues into advocacy action.

Make sure you have an impact in Madison on April 23. Register yourself and your hospital team today, including senior leaders, trustees and volunteers for this important event. Online registration is available at http://events.SignUp4.com/13AdvocacyDay0423.

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Register Today for Partners for Patients "Catch the Wisconsin Wave" Event
March 12-13, 2013 *** Wisconsin Dells

National caliber keynote speakers to include:

Leaders and staff from all Wisconsin hospitals and health systems are invited to attend this important event. There is no cost to attend, but pre-registration is required. Register today at: http://events.SignUp4.com/13PFP031112.

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HIRSP Authority Federal Plan Enrollment Suspended Starting March 1

Health insurance leaders and community advocates in the state are urging uninsured Wisconsinites with health issues to apply for federal Pre-Existing Condition Health Plans before an enrollment suspension begins March 2.

Federal government officials broke the news about the suspension to state administrators of the federal plan during a phone call on Friday. They indicated this was necessary because of concerns that the funding for the program could be insufficient. Current Federal Plan members are not affected by this change and their coverage continues to be in effect.

"We were quite surprised to have that happen at this point so early in the year," said Amie Goldman, CEO of the HIRSP Authority, the agency responsible for administering the federal program in Wisconsin.

"In Wisconsin we feel that the program has been well managed...so we are of course disappointed," Goldman added.

While there are 135,000 national enrollees, Wisconsin makes up just more than 2,000. Since the beginning of 2013, HIRSP has received an average of 79 applications per week for federal Pre-Existing Condition Insurance Plans.

Goldman noted that while some states have gone over their allocated budgets, the program in Wisconsin is currently under budget.

Some of these applicants may still be eligible for a state-level plan, also administered by HIRSP. These state plans are not affected by the enrollment suspension. However, those who do qualify for a state plan could face significantly higher premiums than those associated with the federal program. Those with pre-existing conditions would also face a six-month waiting period before their medical coverage begins.

"I’m glad that in Wisconsin we have a state risk pool that can be there as a safety net, albeit it’s not a perfect substitute," Goldman said.

Goldman encouraged anyone who thinks they may be eligible for the federal program to enroll on HIRSP’s website as quickly as possible before the March 1 deadline. She stressed that any application received by 11:59 p.m. on the 1st of March would be reviewed for eligibility.

HIRSP was created in 1979 to help insure Wisconsin residents who are unable to get health insurance through work or traditional channels and those that have been denied insurance due to pre-existing conditions. Benefits plans are administered by WPS, one of Wisconsin’s largest health benefits providers and the only statewide not-for-profit insurer.

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Overview of New HIPAA Regulations Focus of March 5 Webinar

On March 5, WHA is offering a 75-minute webinar, "From HITECH to High Risk: HIPAA Compliance after the Omnibus Rule," scheduled from 12 to 1:15 pm.

It has been more than a decade since the HIPAA Privacy Rules were finalized, but on January 17, 2013, the US Department of Health and Human Services (HHS) released an omnibus final rule comprised of four HIPAA-related final rules.

This session will provide participants with an overview of the new HIPAA regulations; highlight key changes and deadlines, including changes to the rules regarding fundraising and marketing; and provide recommendations for implementation, including required changes to Business Associate Agreements, Notices of Privacy Practices and other policies and practices.

Register for this webinar today at http://events.SignUp4.com/13HIPAA0305.

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Learn Basics of Graduate Medical Education at Feb. 26 Webinar

Based on member requests and in line with WHA’s physician workforce agenda goals for 2013, WHA is offering a no-cost webinar focused on the basics of Graduate Medical Education (GME) for its member hospitals.

The webinar, "What Hospitals Should Know About graduate medical education," is scheduled from 1 - 2:30 pm on February 26. There is no cost to participate in this webinar, but pre-registration is required. You can still register at http://events.SignUp4.com/13GME0226.

Hospital CEOs and other hospital leaders who are involved in a current residency program or may be involved in a future residency program should plan to attend. If you cannot attend the webinar, please click on http://events.SignUp4.com/13GME0226, and choose the option to receive an audio recording and handouts from the presentation to view at your convenience.

Direct questions about the content of this session to Dr. Chuck Shabino at cshabino@charter.net. If you have registration-related questions, contact Lisa Littel at llittel@wha.org.

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Nurse Leaders and Managers Encouraged to Attend WONE Annual Convention

The Wisconsin Organization of Nurse Executives (WONE) will host its annual convention for nurse leaders and managers on April 3-5 in Stevens Point. With a focus on its theme of "A Mission to Care, the Vision to Lead," the convention will open with a keynote presentation from Cy Wakeman, a well-known thought leader advocating a revolutionary new approach to leadership.

The agenda also focuses on a variety of other topics including a legislative update, examining new models of care being utilized in Wisconsin, lessons learned from computerized physician order entry (CPOE) implementation, managing an aging workforce, recognition of and strategies to address lateral violence and bullying in nursing, and quality reporting for critical access hospitals. The convention will also include opportunities to network with other nurse leaders and managers. A full convention brochure is included in this week’s packet and available online, along with online registration, at http://events.SignUp4.com/13WONE.

The convention will be held at Holiday Inn Hotel & Conference Center in Stevens Point. Anyone who has responsibilities for leading and managing RNs will benefit from the educational agenda and is welcome—you do not need to be an RN or a member of WONE to attend. For registration questions, contact Lisa Littel at 608-274-1820 or email llittel@wha.org.

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WHA Staff Continues Partners for Patients Site Visits

WHA staff continues site visits to hospitals participating in the Partners for Patients initiative. Stephanie Sobczak, WHA quality improvement manager, spent time with the quality improvement staff and team leads at Prairie du Chien Memorial Hospital, where the discussion centered on the readmissions improvement, and how Prairie du Chien Memorial Hospital might become involved in a community-based coalition to improve care transitions for residents of Crawford County.

Sobczak also met with several clinical department leads, the quality staff and chief nursing officer at Columbus Community Hospital. After a presentation on the Quality Center website and the 2013 Partners for Patients work, discussion was held on how Columbus could be involved in new initiatives during 2013.

Calumet Medical Center in Chilton hosted Sobczak and Travis Dollak, WHA quality coordinator, for a half-day workshop combining information on Partners for Patients and to orient new staff on Transforming Care at the Bedside (TCAB), which Calumet launched last September. In attendance was the hospital’s Lean Six Sigma coach who confirmed the TCAB approach aligned well with the hospitals Lean program. The new TCAB team members participated in a "snorkel" using an opportunity to improve communication with physicians. "The Calumet team came up with some great ideas in a very short timeframe," noted Sobczak.

Dollak reviewed the upcoming "Catch the Wisconsin Wave" Partners for Patients event on March 12 & 13, which staff from Calumet, Columbus, and Prairie du Chien will be attending.

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Wisconsin Hospitals Community Benefits: Access to High Quality Health Services

Hospitals do what they can to move health care services out of the clinical setting into the heart of the community. Community health screenings and education classes help raise awareness of steps that individuals can take to improve their health. When people learn more about how their lifestyle decisions affect their health, they make changes that ultimately lead to better health, which raises the health status of the entire community.

New fund and health fair helps local children living with Autism

Autism affects 1 in 88 children, and more children will be diagnosed with autism this year than with AIDS, diabetes and cancer combined. Autism is the fastest growing serious developmental disability in the United States. There is no medical detection or cure; its presence is growing at an overwhelming rate, and the families affected by autism struggle to provide the quality care their children need because of the staggering costs and lack of insurance coverage. To help, the Mercy Foundation created the Autism Support Fund (ASF), which provides financial resources to families affected by Autism Spectrum Disorder in Walworth County. Resources are used toward social skills classes, sensory and safety equipment, respite care and more.

"The Life Empowerment Open (L.E.O.) [and the Push-Walk-Ride (P.W.R.) Event] were great ways to kick off fundraising for our newly-created ASF. The ASF will allow us to address the needs of families of autistic children within Walworth County," said Jennifer Johns, development director, Mercy Foundation. "Our goal is to create opportunities and provide programming for these children and their families."

Since its inception in 2007, the L.E.O. event has grown to be Walworth County’s largest one-day fundraising events of all time. Last year, the P.W.R. and L.E.O. events joined forces to raise more money for organizations in Walworth County that serve its special needs population. This year, 200 people traveled the one mile route, 320 played golf and 540 guests attended the dinner and auction. The two-day event raised over $125,000 for ASF. In addition, Mercy provided hundreds of free screenings at the health fair following the P.W.R. event.

The Mercy Foundation will continue to raise funds to support and grow the ASF and will manage the funds, making sure our families and children suffering with ASD have access to the quality, comprehensive and passionate care they so desperately need and deserve. The ASF was created with Mercy’s motto in mind: With all our heart. With all our mind. We are very grateful for all of the event participants, their kind hearts and generosity toward families of children who are living with Autism in the Walworth community.

Mercy Health System, Lake Geneva, Wisconsin

Gundersen Lutheran dermatologist offers free skin cancer screenings for 4+ decades

Gundersen Lutheran Health System’s mission focuses on improving the health of the communities it serves. With skin cancer being the world’s most common cancer (one in five Americans will develop it), Gundersen Lutheran believes strongly in providing education and screening for skin cancer.

In the 1970s, the American Academy of Dermatology started a program for member dermatologists to offer free skin cancer screenings across the country. Gundersen Lutheran dermatologist Stephen Webster, MD, understood the life-saving implications of early detection and has been committed to offering free screenings to the general public ever since.

Every May, Dr. Webster together with Gundersen Lutheran and other local dermatologists, offer free skin cancer screenings for the general public with suspicious skin lesions. To say the demand for free screenings is high would be an understatement. They generally fill within three to four hours of being open for appointments. In addition, he works cooperatively with local worksites (employers pay a nominal fee) to offer free screenings to their employees. At the annual Midwest Farm Show held in La Crosse, Wis., Dr. Webster sees patients on a walk-in basis for two days straight. He also sees patients at numerous health fairs, Gundersen Lutheran regional clinics and local non-profit organizations dedicated to preventing and eliminating cancer. There is never a short line.

Dr. Webster has screened approximately 3,000 community members throughout his career. Now retired from the Gundersen Lutheran Dermatology department, he continues his screening efforts through Gundersen Lutheran’s Business Health department.

For every 10 to 15 people screened, Dr. Webster says at least one person typically has a skin lesion—cancerous or pre-cancerous—that requires follow-up. By avoiding waiting lists and costly clinic appointments, Dr. Webster’s commitment to prevention has helped save hundreds of lives by getting them medical attention before it is too late and reducing healthcare disparities. Patients are so appreciative of the free service; some even cry tears of relief when they find out a mole or skin spot is benign.

Gundersen Lutheran Health System, La Crosse

Aurora parish nurse provides medical guidance

Aurora Health Care parish nurses are in the community regularly, providing free blood pressure screenings and education. Through their work, the nurses develop many relationships with members of the community who have limited access to health care. When a person is struggling to manage a chronic condition, comfort and reassurance coming from a familiar face can make all the difference. For Betty, that familiar face belongs to Patty, a parish nurse at a church on Milwaukee’s south side.

One Sunday morning, Betty was upset when she arrived to church to meet with Patty for a blood pressure (BP) check. Patty asked Betty, "What’s wrong?"

Betty replied, "I have a new doctor managing my blood pressure and he put me on a new medication that is making me sick."

Betty has been struggling to manage her high blood pressure for several years but her previous medication had been working well for the past year. When her doctor changed her medication, it threw Betty off. She felt sick and had other distressing symptoms. Instead of telling her doctor about what she was experiencing, she took herself off the medication. Initially, she felt better but after a few days without the BP medication, she felt tired and had a persistent headache.

After listening to Betty’s story, Patty explained to Betty that the fatigue and headache she were a sign that her BP is not under control. Patty then explained to her that stopping the medication without informing her doctor puts her at risk for more severe medical issues like stroke or heart attack. Betty agreed to contact her doctor in the morning and to go to Emergency Department if symptoms of stroke or heart attack occurred.

The following week at the BP clinic, Betty greeted Patty with a smile and informed her that after she had an open discussion with her doctor, he put her back on her old medication. She is currently symptom-free. Betty is grateful that Patty was there to provide her with sound advice that helped her avoid a potential medical emergency. Betty continues to visit her parish nurse, Patty, regularly for BP screenings.

Aurora Health Care, Milwaukee

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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