June 1, 2012
Volume 56, Issue 22

Hospital Teams Praise WHA Quality Initiative
Amazing focus and energy…to meet improvement goals"

Following extremely successful launch events in Madison and Eau Claire earlier this month, the 108 hospitals participating in WHA’s Partners for Patients initiative are submitting their work plans to WHA and laying the groundwork for related activities in their hospitals.

A WHA follow-up survey completed by the more than 300 attendees that participated in one of the kick-off events showed overwhelming praise for how well the event was organized and for the keynote speakers, which included Maulik Joshi, Dr. P.H., president, HRET, and senior vice president of research at AHA, and Chris Goeschel, assistant professor and the director of strategic development and research initiatives for The Quality and Safety Research Group in the Johns Hopkins School of Medicine. More importantly, participants felt that the event helped prepare the teams for their hospital’s improvement initiative.

When asked how confident they were to begin working on their improvement area, more than 60 percent of the teams said they are "very confident," and nearly 20 percent of the teams have already started their work.

One area identified by attendees for improvement was that they felt they needed a better understanding of outcome and process measures for each initiative as well as the data submission requirements. WHA’s quality improvement advisors are currently working with hospitals to help with measures, reporting and to finalize their work plans.

"There was an amazing amount of energy and a very focused approach to quality improvement exhibited by the participants at the kick-off events," according to WHA Chief Quality Officer Kelly Court. "I am confident that Wisconsin will meet the national goal set by the Centers for Medicare and Medicaid Services to reduce hospital readmissions by 20 percent and to decrease hospital-associated harm by 40 percent."

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Register Now for Rural Health Conference
Hotel Reservations Due by June 6

Register today and plan to join your colleagues at the premier statewide forum for examining the issues that impact rural hospitals most, the 2012 Wisconsin Rural Health Conference. As a reminder, to ensure a reservation and to receive the special conference rate, hotel reservations need to be made by June 6. Due to other large area events, it is very likely that no hotel rooms will be available after that date. It is recommended that you make your hotel reservation immediately to avoid any issues.

Nationally-known health care governance and leadership expert Jamie Orlikoff will open this year’s conference, and he will identify the challenges and opportunities confronting rural health care providers and offer practical strategies to keep executive leaders and trustees ahead of the demanding curve of change. This keynote session will be followed by a variety of breakout sessions, including the popular track focused on health care governance.

The always popular "State of Health Care in Wisconsin" presentation by WHA President Steve Brenton and Rural Wisconsin Health Cooperative Executive Director Tim Size is included on this year’s agenda, as well as a closing session by internationally-known health care futurist Ian Morrison. Morrison will close the conference by sharing his insights on the political, economic and strategic context of change in health care; and providing strategic insight on how rural organizations can flourish in the future as they work to improve the health of their communities, one patient at a time.

This year’s conference is scheduled June 27-29 at The Osthoff Resort in Elkhart Lake. Online registration and full conference information are available at http://events.signUp4.com/12Rural.

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New Legislator Profile: Rep. Evan Wynn (R-Whitewater)
A series of interviews with legislators, by Mary Kay Grasmick, editor

Health care is a top priority for Rep. Evan Wynn. Throughout the state budget debate, Wynn said he remained concerned about two things: ensuring that senior citizens and the very young could access the health services they needed and provider reimbursement.

"One of the most important things that government does is ensure that vulnerable populations have access to health care," according to Wynn.

"When there are limited dollars, you have to set priorities. My number one priority is making sure that we take care of those that cannot take care of themselves, especially senior citizens and the very young," Wynn said. "I will cut other programs before I look at cutting health services."

He believes the Medicaid program is on the right track, but provider reimbursement rates are an issue that concerns him.

"If the reimbursement rate to hospitals and doctors is too low, that only gives doctors and hospitals the choice of cost-shifting these costs to others, or to stop seeing those patients," Wynn said. "The reimbursement rate to health care providers really worries me."

Wynn recognizes the value that the hospital brings to his community and to area employers in terms of creating a healthy community, and with that, a healthier workforce.

"In the past, we have focused on treating the ill. Now we know we need to focus on wellness because that will lower the cost of doing business. And a lot of wellness and community health outreach programs are sponsored by hospitals" he said. "Fort HealthCare sponsors many programs in the community that help keep people healthy. It saves employers health care costs, and it’s a vital economic development tool to attract new employers to move into our area."

Wynn is concerned that state laws and regulations are lagging behind the practice of modern medicine.

"Bureaucracy moves slower than medicine does," Wynn said. "We need to do something about keeping up with the speed of medicine and be more adaptable to changes in medical practice."

Wynn is familiar with health care workforce issues as a member of the Assembly Colleges and Universities Committee and, closer to home, because both his wife and his daughter are in nursing school.

"I have seen firsthand the shortage of seats in the technical schools and in the colleges for nursing," he said. "To get into nursing school, most require that you go through a certified nurses aid program. There is a backlog of students trying to get into those programs before they get into nursing school. There need to be more seats for quality students to go to school and create capacity in a way that does not ‘water down’ the training."

Wynn noted the problem with finding nursing instructors. "There are a lot of reasons for the shortage; pay is one. The other is that nurses like to be with patients," he said. "It is an issue we really need to look at because of the aging population."

With a distinguished 22-year military career behind him, Wynn has found that training to be a valuable resource in his legislative work.

"On any issue, there are always people on both sides, so you need to weigh each side of the issue based on what was best for the state," Wynn explained. "From my experience in the military providing security for VIPS while I was in Iraq, I had to make multiple decisions based on the intelligence reports that I had. Sometimes I had to make a decision on the spot. I have learned then, and I know now, how to make a decision, and if I determine later on with more information that it was wrong, I will correct it."

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Alig Named Senior Vice President, Policy and Research

Joanne Alig, formerly WHA’s vice president of payment policy and reform, has been promoted to the position of senior vice president, policy and research. Alig will develop and direct strategies, analyses, proposals and responses to hospital and health system payment issues and health care reform. Alig will also play a key role in WHA’s analysis and policy development efforts on both federal and state budgets and reform activities, the Medicaid state plan, other legislation and WHA initiatives.

"The promotion reflects both outstanding individual performance and teamwork," said WHA Executive Vice President Eric Borgerding. "The new position underscores the principle role research and analysis play in advocacy and, increasingly, in the broader function and growing scope and purpose of WHA and its affiliates."

Alig started her career in the Wisconsin Legislative Fiscal Bureau. Most recently she was a project associate with Deloitte Consulting. Her prior experience also includes serving as the senior policy director at the Wisconsin Association of Health Plans and the Department of Health Services, Division of Health Care Financing where she was director of the Bureau of Eligibility Management.

"Joanne is a part of what continues to be one of the strongest, most knowledgeable and experienced association teams in Madison—WHA," Borgerding added.

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WHA Submits Comments on Newborn Screening Fee Rule

In 2010, the State Laboratory of Hygiene Board approved an astonishing fee increase of 57 percent for newborn screening cards. Responding to member concerns about the fee increase, WHA initiated and successfully supported a budget amendment that requires the fees to be set by administrative rule. This process allows for more transparency and for public input at each step.

Birth hospitals fund the newborn screening program through their purchase of the cards. The cost covers testing as well as the diagnostic, dietary and all follow-up care for patients with congenital disorders. Hospitals bear additional costs relating to obtaining and managing the screening information, but for the almost 50 percent of births covered by the Medicaid program, no additional revenue is billed or collected for these costs.

In February, WHA wrote a letter to DHS Secretary Dennis Smith commenting on the resulting draft rule. Last week, WHA offered formal comments on the final rule version. This final version sets the fee at its current level of $109.

In her comments, Judy Warmuth, WHA vice president of workforce, requested that DHS explore options for long term financial support of the program. The birthrate (and the sale of cards) is declining in Wisconsin and at the same time, program costs continue to escalate. WHA asked that the Department work to assure that the program was reasonable and sustainable.

Comments and testimony will be summarized and the rule will be forwarded to the Legislature for a final review. See WHA’s testimony at www.wha.org/data/sites/1/rules/WHAnewbornScreeningFeeRuleTestimony5-25-12.pdf.

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President’s Column: June 5—All Eyes on Wisconsin

Ultimately, this election should be determined by voters discerning which candidate will do the best job creating an environment in which private sector jobs will grow and flourish. All of the important services that state government provides, from education to health care to public safety, are better positioned and sustained if Wisconsin enhances its desirability as a state that is a favorable venue for JOBS. And the very best way to address Wisconsin’s Medicaid budget, of course, is to migrate beneficiaries into commercial coverage by way of employment that provides family-sustaining benefits.

Steve Brenton

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Drug Shortage Legislation Moves Through Congress

Both the U.S. House and U.S. Senate have overwhelmingly passed similar legislation in recent days reauthorizing the Prescription Drug User Fee Act (PDUFA). Within PDUFA are important provisions to help address critical drug shortages. While similar, the two versions of the legislation—HR 5651 and S. 3187—must still be reconciled.

To help alleviate drug shortages, the legislation includes various reforms, such as: requiring manufacturers to notify the FDA in advance if there will be a discontinuance or interruption in the supply of a drug; codifying the FDA’s authority to more quickly approve manufacturer applications to make drugs that are in short supply; lifting caps set by the Drug Enforcement Administration on narcotic ingredients to ensure sufficient supply for vital anesthesia, pain management and other critical uses; and improving communication with providers and patients as to the reason for and length of potential shortages. The legislation also creates a user fee program that will help speed FDA approval of generic drugs.

"Hospitals have taken action to reduce the impact of shortages on patients, including increasing inventories, buying alternative drugs and training clinical staff on how to deal with drug shortages," said American Hospital Association President Rick Umbdenstock. "This new legislation will help ease the strain that hospitals across the country have faced in dealing with shortages."

Earlier in May, the White House expressed support for the Senate legislation, indicating "S. 3187 also enhances the tools available to the Food and Drug Administration to address drug shortages."

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Wisconsin Hospitals Community Benefits: Mental Health and Mental Disorders

Mental disorders vary in severity and in their impact on people’s lives. The symptoms can be severe and extremely destructive, causing immeasurable suffering for the patient and their families. Hospitals see an ever-increasing number of patients seeking treatment for mental disorders in their emergency departments. Hospitals that can offer inpatient treatment generally operate this service at a loss. With a disturbing shortage of mental health professionals, hospitals will continue to partner with each other and their communities to meet the growing demand for these services.

Summit helps create mental health coalition to increase access

Like many places in Wisconsin, Fox Cities residents in need of mental health services often have difficulty finding and accessing resources they need and navigating the system. A one-day mental health summit held in March brought together more than 150 people, including mental health service providers, primary care providers and officials from local schools and law enforcement agencies, to brainstorm ideas on how to improve access and navigation.

The idea for the summit came from a "plunge" sponsored by the Appleton Medical Center and Theda Clark Medical Center-led Community Health Action Team (CHAT) that looked at the issues facing people with mental health as well as alcohol and other drug abuse issues, said Mary Downs, executive director of ThedaCare Behavioral Health.

"Substance abuse – especially alcohol abuse – is definitely an issue in this area, and by coming together, we identified ways we can better link people to the help they need," she said. "In many cases, the substance abuse covers up another problem."

The summit generated several ideas on how the community can improve access to mental health services, said Downs, adding it was essential to have members of the law enforcement agencies involved. "They are a piece of the puzzle that’s often missed," she said.

At the summit, attendees seized on an idea presented by the Tarrant County-Fort Worth Mental Health Connection about creating a coalition to streamline mental health care in the community, Downs said.

"We walked away creating a coalition to connect various organizations to each other so that wherever someone shows a need for mental health services – whether it’s at a school, the legal system or primary care provider – they will be directed to the help they need," she said.


Teen Screen

Each year in Fond du Lac County, teen suicides account for 8.4 percent of all suicides compared to the state’s 11.4 percent. According to the Wisconsin Department of Health and Family Services report, suicide is the second leading cause of death for youth and third in the nation.

To help trim this alarming statistic, in 2005 staff at Aurora Health Center Fond du Lac partnered with the Fond du Lac School District to establish the nation’s first Columbia University TeenScreen® program in a clinic setting to address the concerns of teen suicide. TeenScreen is a computerized national mental health and suicide risk-screening program for youth. The program is designed to identify risk factors associated with depression, anxiety, alcohol, substance abuse and suicide.

Psychotherapists Greg Henderson and Stephanie Owen, both with Aurora Health Care Fond du Lac, have been volunteering their clinical expertise to the TeenScreen Program since its inception.

Greg says, "Teen depression and suicide are treatable and possible to prevent once identified. There is a sense of relief from the teens who participate that someone has taken the time and interest to listen and provide hope. I believe there is no greater reward than being part of a team that provides interventions to save a life and to create a brighter future for the teen."

Currently, the TeenScreen program is offered to all ninth grade students throughout Fond du Lac County in both private and public high schools. Screening takes place in schools or at Aurora Health Care Fond du Lac if the student prefers a more private setting. Aurora doctors have screened over 700 youth for mental health concerns and connected over 70 students with needed services since 2005.

Aurora Health Care

Suicide a serious problem; SCRMC offers free support group

"Although it may be surprising and hard to accept," said St. Croix Regional Medical Center (SCRMC) psychologist Patricia Fettes, PhD, "suicide is a serious problem in Polk County, just as it is across our state." Among those who’ve taken their life recently are a young father, a young mother, two students from one high school, and an 11-year old.

"Many people who are feeling suicidal cannot take steps to get help on their own," Fettes explained, "which makes suicide prevention a community issue." Action must start with involvement by parents, family, friends, colleagues, teachers, health care providers and clergy, she pointed out. "Suicide is preventable," Fettes emphasized, "But only if all of us acknowledge that it’s a threat in our community and, most importantly, take action!"

Every 17 minutes someone is left to make sense of it (suicide). A new support group is now meeting every other Tuesday at St. Croix Regional Medical Center which is open to adolescents and adults grieving a loss because of suicide. Facilitated by SCRMC Counseling and Psychological Services, the group meets from 6:30-8:30 PM in the Glacier Conference Room in the lower level of the hospital.

For more information, call 715-483-0243 or visit: www.mentalhealthpolk.org.

St. Croix Regional Medical Center, St. Croix Falls

Caring to lend a helping hand

Agnesian HealthCare and the American Cancer Society help female cancer patients recover their self-esteem.

Agnesian HealthCare’s Journeys: a health resource center began offering the Look Good…Feel Better® program three years ago, in conjunction with the American Cancer Society. The free program helps women with cancer learn skin care and make-up techniques to overcome the appearance-related effects of chemotherapy and radiation.

"When you’re going through different types of treatment, your skin and hair change," says Carla Witkowski, a women’s health consultant at the Agnesian Health Shoppe. "Some women get very dry skin. Their hair falls out. They lose their eyebrows."

Tricia O’Callaghan, a cosmetologist at Benessere Salon, guides participants through mini-makeovers based on the participants’ needs and desires. The results are amazing.

"I see women walk through the door feeling very sad and frumpy, almost like their inner dignity has been taken away," says O’Callaghan. "But by the end of the night, they want to call someone and go out."

Agnesian HealthCare, Fond du Lac

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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