March 2, 2012
Volume 56, Issue 9
Joint Finance Committee to Schedule Hearing on Medicaid Waiver Changes
In a memo dated February 24, the Department of Health Services (DHS) officially advised the Legislature’s Joint Finance Committee of modifications to the Medicaid waiver proposal, which was previously approved by the Committee last fall. Democrats on the Committee immediately requested a hearing on the changes, and have asked for DHS Secretary Dennis Smith to attend the hearing. The co-chairs of the Committee have formally notified Secretary Smith that a hearing will be scheduled to review the request, although a hearing date has not yet been announced.
After initial approval by the Committee, DHS has been in negotiations with CMS, which has resulted in changes to the policy regarding premiums. Originally plans were for premiums to be charged to adults and children in families with income above 150 percent of the federal poverty level ($34,575 for a family of four). The premium amount would have been equal to five percent of the family’s income. Under the new policy, premiums would be applied to adults only (not to children) in households with income above 133 percent of the federal poverty level ($30,657 for a family of four). The premium amount would be on more of a sliding scale, and would be between 3 percent and 6.3 percent of household income.
To read the memo from DHS to the Joint Finance Committee, go to:www.wha.org/Data/Sites/1/medicaid/JFC2-27-12.pdf.
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Hospitals Showcase TCAB Efforts to Improve Patient Quality, Safety
The 16 hospitals participating in the Wisconsin Transforming Care at the Bedside (TCAB) project gathered for a "mid-point" meeting February 28 in Wisconsin Dells. Led by the Wisconsin Hospital Association, the TCAB meeting brought more than 100 front line nurses and nurse leaders together for a day of learning, sharing and inspiration. The hospitals were asked to report on one of their improvement projects in a display themed around a destination in New York City—Broadway, Yankee Stadium, a classic hot dog stand, to mention just a few. The displays became a focal point where participants could talk to the nurses involved in the project, ask questions, and collect a card that explained the project and provided contact information for the presenting hospital. At the end of the day, all attendees had created a reference "ring of knowledge" that they could take back to their hospital comprised of these cards.
While it was a light-hearted theme, the progress that was reported by the Wisconsin hospitals at the meeting is making a serious difference in the quality and safety of patient care. Jane Taylor from the Institute for Healthcare Improvement commended Wisconsin for the dedication that hospitals have to quality improvement. She explained the processes that hospitals can use to spread improvement from one unit to another, and emphasized that it is not possible to either spread, or sustain, improvement without the acknowledgement by hospital leadership that the improvement project is a key strategic initiative of the organization.
Olmsted Medical Center in Rochester, Minnesota, was an early adopter of TCAB. Sheri Peters, and nurse from Olmstead deeply involved in TCAB, quoted the president of the hospital as saying, "We will work to reduce the variation in our clinical processes, not increase it. Important byproducts of this effort include making the best use of the time of our clinicians and support staff, reducing costs, and achieving better quality results."
The Wisconsin TCAB project is being led by Stephanie Sobczak, WHA quality manager, and by Judy Warmuth, RN, PhD, WHA vice president of workforce.
"The teams, utilizing the TCAB tools, have developed solid processes that can be replicated from unit to unit, from hospital to hospital, for improving care to patients and improving hospital quality indicators," according to Sobczak. "The TCAB teams are reporting reductions in patient adverse events, improved care outcomes, lower costs, and as we witnessed at the meeting, they are having fun, as a team, doing this work. The energy and vitality of these teams filled the room today. When nurses feel empowered to suggest, test, and implement change, it gives them a whole new perspective on their role in the hospital."
Warmuth, who conducted 18 TCAB site visits, is an enthusiastic TCAB supporter. "As a nurse, this is such an exciting event. Over the past year, these teams have implemented ideas, some very small, some much larger in scope that change the practice of nursing with the goal of safer, better, less expensive care for their patients," Warmuth said. "When unit staff are empowered to examine their work and create change, they make a measurable difference for all."
For a list of hospitals participating in TCAB visit: www.wha.org/transformingcare.aspx.
TCAB is a project of Aligning Forces for Quality, which is supported by the Robert Wood Johnson Foundation, through a grant to the Wisconsin Collaborative for Healthcare Quality. In Wisconsin, Aligning forces for Quality is a joint project by the Wisconsin Collaborative for Healthcare Quality, Wisconsin Hospital Association, and other organizations.
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On February 28, the federal Centers for Medicare and Medicaid Services (CMS) hosted a national webinar updating hospitals on critical dates during this first year of implementation of the new Value-Based Purchasing (VBP) program. In preparation for the actual performance reports and incentive adjustment expected this coming fall, CMS is now providing hospitals a simulated "dry run" report.
The simulated report is intended to help hospitals understand more about the VBP program and the scoring methodology for fiscal year 2013. The simulated report uses a different performance time period from what will be used to compute actual hospital VBP scores later this year, so it does not indicate how well a hospital will actually perform. Hospitals should now be able to access their hospital-specific simulated report on their My QualityNet page.
The official reporting period that will be used as the basis for the first payments under the VBP program began July 1, 2011 and will end March 31, 2012. CMS will provide hospitals with their estimated 2013 incentive adjustment by August 1, 2012, and the actual incentive adjustment by November 1.
A slideshow presentation from CMS provides more detailed information about the hospital VBP program including the criteria for hospitals being excluded from the VBP program, the scoring methodology, critical dates and milestones for 2013 through 2015, and how to re-activate your MyQualityNet page if needed.
The recent CMS presentation, along with other materials on the VBP program can be found under the "Reports" section of the WHA Quality Center website at www.whaqualitycenter.org/Reports.aspx.
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WHA released two surveys this week that are aimed at gathering information and data that will help the WHA Task Force on Graduate Medical Education (GME) understand the current GME environment.
The WHA Task Force on Graduate Medical Education was formed following the WHA report "100 New Physicians a Year: an Imperative for Wisconsin" to act as a catalyst for expansion of GME in Wisconsin. Experience has shown that the best predictor of where new physicians will practice is the location of their residency training. Graduates of medical schools in Wisconsin who also do their residency training in Wisconsin have an 85 percent probability of staying in Wisconsin to practice.
"The combination of a physician attending a medical school in Wisconsin and completing a Wisconsin-based residency program dramatically increases the likelihood they will practice in Wisconsin," according to George Quinn, WHA senior policy advisor. "So it is critical for the WHA Task Force to collect data to aid in developing recommendations that will increase the chances of that happening."
WHA developed two assessment surveys that are currently in circulation. The first survey is of Wisconsin hospitals/health systems of their perspectives regarding GME, including past experiences, current level of participation, future interest, barriers and opportunities. The second survey is aimed at residency program directors with the intent of assessing the current training environment, challenges facing current programs and opportunities and barriers to expansion.
The Task Force asks that hospitals/health systems complete a survey and that they encourage their affiliated residency program directors to participate in the residency program survey. If you have not received links to the survey, contact Shannon Nelson at WHA, firstname.lastname@example.org or 608-274-1820.
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Q: What made you decide to attend Advocacy Day the first time? What did you think of this event?
Dietsche: I thought it was important to have leadership representation from our organization to support the health care issues that we are advocating for on behalf of the residents of our community. I also wanted to develop a relationship with our local representatives to assist in having them understand the financial issues that health care organizations are dealing with in trying to be able to provide care to our local community.
I thought the event provided an excellent forum to clearly understand the issues that we as providers are facing as a state. I believe the WHA does a tremendous job of developing an easy to understand way of communicating the message to our legislators.
Q: As a CFO of a hospital, why do you think it’s important to meet/talk with legislators at Advocacy Day (and throughout the year)?
Dietsche: I think it is good that we meet face to face with our legislators. It is important to provide some background for the issues we face in the industry. Legislators are faced with attempting to become knowledgeable about issues in many industries, and it is important that we be a resource to them to accelerate their understanding of a very complex industry.
Q: Would you recommend other CFOs attend Advocacy Day this year? Why?
Dietsche: I would recommend it. The WHA Advocacy Day program always has a great keynote speaker who speaks about relevant issues. We typically have had a presentation from our current governor who talks specifically about health care issues facing our state. In the years I have attended there has been a legislative panel that answers questions on relevant health care issues. Finally, we are provided with a briefing on current issues being addressed by WHA and are given an easy to use communication packet as we meet with our local legislators.
Q: Any last thoughts or comments about the value of this event to you personally, or to hospitals?
Dietsche: I think the WHA does a fantastic job of organizing issues and speaking points about relevant issues facing our industry. Typically they take very complex topics and boil them down to talking points that make it much easier to explain to others outside our industry.
Advocacy Day 2012 will be held April 24 at Monona Terrace in Madison. To register, go tohttp://events.SignUp4.com/AdvocacyDay12.
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National Rural Health Association Joins Effort to Repeal Wage Index ‘Manipulation’
Cites provision’s ‘devastating impact’ on small, rural hospitals
The Coalition of America’s Hospitals, of which WHA is a founding member, announced that the National Rural Health Association (NRHA) has officially joined its efforts to reverse the adverse national impact of Section 3141 of the Affordable Care Act (ACA).
"NRHA is pleased to join this important coalition fighting to end the manipulation of the wage index," explained Alan Morgan, CEO of NRHA. "Because, if no action is taken, hospitals around the nation could lose billions of dollars, and such a loss will have a disproportionate and potentially devastating impact on small, rural hospitals. It is an outrage that this blatant manipulation is allowed to continue."
Twenty-one state hospital associations, along with NRHA, are seeking to "fix" the Wage Index Manipulation. A January 18 letter from the Coalition asked President Obama to address the issue as part of his future budget proposal. The Massachusetts "windfall" will cost Wisconsin hospitals about $10 million annually.
"Our Coalition is seeking administrative address as opposed to aggressively lobbying Congress at this time given the importance of concentrating on stopping pending Medicare cuts," according to WHA President Steve Brenton. "The field must concentrate on one issue at a time right now, and the magnitude of another round of hospital cuts demands our full attention."
Tom Bell, president/CEO of the Kansas Hospital Association, speaking on behalf of the Coalition, commented, "We are thrilled to add NRHA’s support to the nationwide groundswell against Massachusetts’ actions. Based on this endorsement (NRHA’s) plus the early support expressed by bipartisan members of both the House and Senate, we are quite hopeful that Congress will address this matter before tens of millions of dollars are siphoned away from hospitals across America."
The issue was publicly raised in late February in the Senate Finance Committee during questioning of Health & Human Services Secretary Sebelius by the panel. It has also come up several times privately with senior Administration officials. The announcement by NRHA is one more building block underscoring the momentum the Coalition is generating.
The National Rural Health Association is the nation’s preeminent leader on rural health matters with a membership of more than 20,000 members, whose sole charter is unwavering leadership on rural health issues.
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On February 28, the Assembly Committee on Aging and Long Term Care approved Senate Bill (SB) 380—a bill that would lift the Family Care enrollment cap—with an amendment that would actively require Joint Finance Committee (JFC) approval before the program could be expanded.
Prior to the implementation of the program cap in last year’s state budget, the Family Care program could be expanded to new counties under a 14-day "passive" approval by the Joint Finance Committee. This meant that expansions could be approved without the committee ever holding a hearing. Under the amendment, the Joint Finance Committee must hold a hearing and actively approve any expansions. The amendment does not include any timeline for JFC to take action.
In proposing the amendment, Committee Chair Representative Dan Knodl (R-Germantown), said, "It’s the cruelest thing in the world to provide people with benefits and assistance that we can’t pay for."
A version of the bill that did not include the amendment was unanimously passed by the Senate on February 14.
The amended bill is now available for scheduling for a vote by the full Assembly and would need to be concurred by the Senate before it could be sent to Governor Walker for his consideration.
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Affinity Health System, Children’s Hospital of Wisconsin and ThedaCare announced February 28 their creation of Catalpa Health, a new organization formed to provide seamless, community-based and collaborative outpatient pediatric mental health services to children and adolescents in the Fox Valley.
"The current approach to providing mental health services for children and adolescents in the Fox Cities is not optimal," said Daniel E. Neufelder, president and CEO of Affinity Health System. "Our current model is fragmented with limited access to care and not financially sustainable. It was time to think differently about our collective approach to care."
A 2011 study by community stakeholders, including the United Way, local chambers of commerce, and others confirmed a need for the Fox Valley communities to focus on children’s mental health, and in February 2011, Neufelder along with Dean Gruner, MD, president and CEO of ThedaCare and Peggy Troy, president and CEO of Children’s Hospital of Wisconsin, formed a committee to lead a strategic planning process to take the next step in addressing the community’s pediatric mental health care needs. The process led the committee to form Catalpa Health, a stand-alone entity that will provide outpatient services including individual and group therapy, psychological and neuropsychological testing, medical management (psychiatry) and prevention services for the local public schools.
"It was clear from the start we needed to create a single, unified entity to provide the full continuum of pediatric mental health services," said Dr. Gruner. "Catalpa Health is our response to the desire to find better ways to serve the mental health care needs of children in the Fox Valley."
"We set lofty goals, and we believe we can achieve them," said Troy. "We are absolutely committed to increasing the number of children and adolescents whose behavioral/mental health care needs can be served. Catalpa Health will allow us to improve access to all levels of mental health care, eliminate duplication and improve operational effectiveness and create tighter connections with schools and community agencies."
This is not the first time that Affinity, ThedaCare, and Children’s Hospital of Wisconsin have collaborated to address pediatric mental health needs. The three systems also collaborated to open the Fox Valley Children’s Mental Health Center in January 2009.
"Access to mental health services, especially mental health services for children, is a problem in many communities throughout Wisconsin," says WHA President Steve Brenton. "The efforts of Affinity, ThedaCare, and Children’s Hospital of Wisconsin to collaborate to provide pediatric mental health services is a commendable example of Wisconsin health systems working together to address community needs."
A board of directors for Catalpa Health has been named. There are three board members representing each of the three partners and one from each organization must be a community member. Board members to date include:
Catalpa Health will employ approximately 21 providers and 15 support staff. Staff will come together in shared facilities in the Appleton and Oshkosh areas in the late summer and they will become employees of Catalpa Health effective January 1, 2013. A facility search is also currently being conducted and it is expected Catalpa Health will be fully operational by January 1, 2013.
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Since 2002, the Wisconsin Hospital Association has sponsored the Health Care Employee Pride Program to recognize the dedication of Wisconsin’s health care workforce. The Pride Program gives employees the opportunity to share why they love their career of service to others, while giving the Association an opportunity to honor their contributions to their hospital, community and profession.
A designated leader from administration, human resources, public relations or patient care from WHA member hospitals is asked to coordinate the program. Employees are encouraged to submit to the hospital a one-page essay, poem or story that explains why they chose to work in health care. From those essays, a committee at the hospital will pick one employee to represent their hospital and forward that person’s essay to WHA. WHA will send the hospital representative a certificate and pin to present to their honoree in May, and will also post the essays on the WHA website at that time.
Pride Program materials are available on WHA’s website at www.wha.org/pride-program.aspx. For more information, contact Shannon Nelson at email@example.com or Mary Kay Grasmick at firstname.lastname@example.org, or call 608-274-1820.
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A teen arrives in the emergency department by ambulance following a terrible car accident. A child receives head injuries while bicycling without a helmet. A woman walks into the emergency department with injuries inflicted by an abusive spouse. These are stories of pain and tragedy that hospital personnel see all too often. Injury is the most under recognized major public health problem facing the country and it is the leading cause of death in people ages 1 to 44 in Wisconsin. Wisconsin hospitals devote significant resources to reduce the number of intentional and unintentional injuries that occur in the communities they serve.
Project Ujima: Breaking the cycle of violence
Jonathan is a happy 18-year-old who loves hanging out with friends, going to the mall and playing football. In 2009, Jonathan was the victim of an armed robbery and was shot seven times. He was in critical condition when he arrived at Children’s Hospital of Wisconsin. His sister LaHelen had received care at Children’s for asthma and Lupus, so it was a hospital his family trusted.
While doctors worked to save Jonathan’s life, his family began participating in Project Ujima, a program that helps victims of violent crime overcome the trauma they experienced through counseling and case management. Project Ujima taught them how to overcome the tragedy, prevent further victimization and end the cycle of violence. Today, Jonathan is a healthy college student who just finished his freshman year.
Watch his mother, Jackie, share their story: www.chw.org/display/PPF/DocID/47575/Nav/1/router.asp
Project Ujima is a community program – the only one of its kind in the state – committed to helping those who are victimized by violent crime through individual, family and community intervention and prevention strategies. Services include crisis intervention and case management, social and emotional support, youth development and mentoring, and mental health and medical services.
Specifically, Project Ujima addresses the needs of youth victims of violence who come to Children’s Hospital of Wisconsin’s Emergency Department/Trauma Center by providing treatment, which promotes physical and psychosocial recovery, and by linking victims at the time of discharge to community-based organizations in order to provide long-term psychosocial intervention.
Project Ujima also provides services to adult crime victims. (See www.chw.org/display/PPF/DocID/44329/Nav/1/router.asp.)
Since it began more than 15 years ago, more than 4,500 victims and their families have been helped, reducing the number of repeat victims.
Children’s Hospital of Wisconsin, Milwaukee
Summer programs geared toward child safety
Each summer, Aspirus Wausau Hospital and Safe Kids Wausau Area host Splash Into Safety, a water safety program for children. During the program, kids between the ages of five and 14 learn about boating safety, life jacket safety, deep water safety, reach and throw assists, wading assists and hypothermia safety.
Children who participate in the program receive a free life jacket and a free family swim follows the event.
This year, Aspirus and Safe Kids also partnered with the General Motors Foundation to provide education about the dangers of leaving children alone in cars in hot weather. The Never Leave Your Child Alone in a Car program unites coalition partners to share prevention tips with parents and caregivers to address the dangers to children in vehicles.
The program includes demonstrations at community events as well as tip sheets and posters that are handed out at child care centers, hospitals, police and fire stations.
Aspirus Wausau Hospital
Aurora Sexual Assault Nurse Examiner program
A Sexual Assault Nurse Examiner (SANE) at Aurora Lakeland Medical Center is on-call seven days a week, 24 hours a day. A SANE conducts examinations with a special understanding of emotional and physical trauma that is present after a sexual assault. The nurse gathers medical forensic evidence that may be useful in court. A SANE assists victims with many concerns, including evaluation and treatment of sexually transmitted infections and pregnancy risk.
In 2011, Aurora Lakeland Medical Center treated 60 victims of sexual assault. The program is offered at nearby Aurora hospitals, including Aurora Medical Center in Kenosha which treated 110 patients, and 40 patients received treatment at Aurora Memorial Hospital of Burlington.
SANE Saskia Lodder at Aurora Lakeland Medical Center began her nursing career at an emergency department (ED) in Los Angeles as a staff registered nurse. Ten years ago, Saskia relocated to Wisconsin to work as a SANE and later was promoted as coordinator.
The SANE program is an extension of Saskia’s experiences in the ED. She was always interested in forensic nursing. Saskia explains, "After participating in the SANE training, I began to understand the sensitive dynamics of sexual assault, as well as the healing process from victim to survivor. It is difficult to fill a SANE position. Besides being highly specialized, a SANE needs to function in an unbiased manner."
In addition to Saskia’s role as a SANE coordinator, she is a public speaker on education and prevention of sexual assault. Saskia also is a member of a collaborative community response team addressing sexual assault issues.
"The hardest case for me is helping a patient who was date raped. The date-rape drug is very powerful because the patient does not remember anything. The patient becomes incoherent and suffers a profound loss of control. Unfortunately, the drug is detrimental to our purposes because it dissipates quickly, making it difficult to collect evidence of any illegal substance," Saskia explained.
"Witnessing a patient’s transformation from confusion, shame and sadness to making positive choices makes every minute of my role worth it. Without the SANE program, victims of sexual assault within our community would not have the safe haven and support that our program provides," said Saskia.
Aurora Lakeland Medical Center, Elkhorn
Fifty-eight students learn to be responsible babysitters
The Babysitting Clinic, which is sponsored by Black River Memorial Hospital and Partners of Black River Memorial Hospital, was held June 22-24 at the Black River Falls Middle School. There were 58 students who participated from the Black River Falls, Hixton, Alma Center, Humbird, Merrillan, Granton, Melrose, Taylor, and Sparta areas. The clinic trains students to be responsible, creative, and safety-conscious babysitters. The eight-hour clinic was open to any student who had completed the 6th grade.
Professionals from the hospital, community, Partners of Black River Memorial Hospital, fire department, and sheriff’s department donated their time and expertise to teach these classes. Classes included: "Guidelines for Sitters," "Fire Safety," "Bathing Infants and Toddlers," "Dressing Infants," "Feeding Infants," "First Aid," "Responding to Emergencies, Rescue Breathing, and Choking Intervention," "Safety and Legal Responsibilities," and "Babysitting Kits." After students completed the exam on the final day, they had the opportunity to ask questions of a panel of parents from the community. The panel also shared its experiences with babysitters and what their expectations are.
This very educational, no-cost program was sponsored by Black River Memorial Hospital and the Partners of Black River Memorial Hospital. Funding was also in part from a Lunda Charitable Trust grant.
Black River Memorial Hospital, Black River Falls
Submit community benefit stories to Mary Kay Grasmick, editor, at email@example.com.
Read more about hospitals connecting with their communities at www.WiServePoint.org.
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