June 22, 2012
Volume 56, Issue 25

Federal Agency Ranks Wisconsin High in Health Care Quality
Patients can be glad they live in Wisconsin"

The Federal Agency for Healthcare Research and Quality (AHRQ) released data June 22 that confirms Wisconsin’s reputation as a leader in health care quality. Wisconsin ranked second highest in the nation in overall health care quality scores based on 171 measures that AHRQ used to evaluate health care performance.

In fact, Wisconsin was edged out of the top spot by Minnesota by a mere one tenth of a percent as the top performing state in the country based on health care quality.

"Patients can be glad they live in Wisconsin where we consistently deliver some of the best, safest care in the country," according to Kelly Court, chief quality officer at the Wisconsin Hospital Association. "In Wisconsin, health care providers work collaboratively to raise the bar on clinical quality and achieve these superior results."

"High quality care is a Wisconsin economic and competitive advantage," said WHA President Steve Brenton. "Better quality means better value, not only for our patients, but also for our employers and it helps make Wisconsin more attractive to business. Like roads and utilities, quality health care should be touted as a Wisconsin advantage—a key element of our economic infrastructure."

Since the health reform bill was signed into law, WHA has been working with a national coalition comprised of hospitals, health systems, hospital associations and physician groups to work with policymakers on both sides of the aisle in Washington DC to help reform the health care delivery system in a way that rewards states that provide high quality, low cost health care.

"The report is another indication that our reimbursement system should move toward paying for the quality and value of health care, not for the quantity of procedures, tests and services that are prescribed for a patient," according to WHA President Steve Brenton.

AHRQ ranks the quality of a state’s health care system from weak to very strong. Wisconsin’s strongest performance measures are related to care provided by hospitals, home care agencies and in physician clinics. Patients in Wisconsin who are being treated for cancer, respiratory disease or chronic conditions, such as diabetes and heart disease, are getting better care here than they would receive in other parts of the country.

"Quality health care means doing the right thing, at the right time, in the right way, for the right person—and having the best possible results. Wisconsin hospitals are always working to improve quality and sustain it," according to Court. "This report confirms that our efforts to improve quality are moving Wisconsin in the right direction. We continually strive to increase the value of health care to our patients, employers and payers."

According to AHRQ, its State Snapshots Web tool (http://statesnapshots.ahrq.gov) helps state health leaders, researchers, legislators and consumers understand the status of health care quality in individual states, including each state’s strengths and weaknesses. AHRQ’s annual State Snapshots is based on data drawn from more than 30 sources, including government surveys, health care facilities and health care organizations.

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Wisconsin Medical Society
CEO Abrams Addresses WHA Board Members
"Wisconsin’s health care delivery and payment system is a national model"

After being in the state just a few months, Wisconsin Medical Society Chief Executive Officer Rick Abrams told the WHA Board at their meeting in Madison June 21 that he is clearly impressed by what he has seen as he has toured the state and visited with health system and physician leaders.

"You have created, and you are still creating, a very exciting future of health care delivery and payment, that, quite frankly, is a model for the rest of the country," Abrams said. "And it’s not just doctors and hospitals thinking about it. It’s payers and all of us working on it together."

Compared to his prior work on the East Coast where conflict was more common than cooperation, Abrams said, "Words like partnership and collaboration are not just ‘words’; they are activities in Wisconsin."

Abrams, who has a law degree from Seton Hall, has 25 years of experience in health policy and also has expertise in federal and state health-related issues, specifically in how those issues impact physicians. He cited end-of-life-care and advance care planning, two connected but distinct issues, as being very high priorities for him both on a personal and professional level.

"It’s not an issue of less care or no care; the right care is the issue," he said. "If you provide the right kind of care at the end of life, it can also be the most cost effective care, too."

Abrams said the Society is determined to overturn the Jandre case, a decision by the Wisconsin Supreme Court that he said took him by surprise.

"If we took the name, ‘Wisconsin Supreme Court’ off that decision as I read the opinion, I would have thought I was back in New York," Abrams said. "That decision turns on its head the historic legal principle of informed consent. Not only did they blow the doors off, but they did not provide a road map on how a doctor should respond."

Abrams said it is a high priority to work with WHA and "do the homework and make a convincing argument" to overturn the case.

The WHA physician workforce report, "100 New Physicians a Year: An Imperative for Wisconsin" was, according to Abrams, an excellent report, "chock full of data." He said the physician workforce issue is one that he looks forward to working on with WHA, as training and retaining physicians are critical to Wisconsin’s health care future.

President’s Report

WHA President Steve Brenton welcomed new Board member Susan Edwards, president/CEO of ProHealth Care. Edwards represents WHA’s Southeast Region.

Brenton provided a summary of the latest news out of Washington, noting that all eyes are on next week’s expected Supreme Court decision on PPACA. WHA is considering the effects of the decision, whether the entire law is upheld or struck down, or whether individual mandate is struck and other parts of the law remain. Brenton reminded members that the law required $2.6 billion in Medicare cuts to Wisconsin hospitals to pay for the reform. He also noted that it is fair to say that if the entire law is struck down, it will take weeks or even months to sort out the full ramifications. WHA will be in communication with members about the decision and will be hosting a town hall meeting in early July.

Brenton also discussed the potential for significant cuts to hospitals, related to deficit reduction. Looming before us are four major issues, most of which will come to a head on January 1, 2013. These are: the two percent across-the-board cut (the "sequester"), the end of the physician payment fix, the need for a new deficit ceiling, and the lapse in tax cuts.

In order to find savings, everything is on the table, and there are concerning policies being discussed for critical access hospitals (CAHs), rural hospitals, as well as other PPS hospitals. Issues include the CAH mileage requirements, bad debt, graduate medical education, and DSH to name a few. In addition, hospitals are faced with the sunset of special provisions for Medicare dependent hospitals, low-cost county hospitals, and the low volume adjustment. WHA is involved in strategies to extend these provisions.

Brenton told members that WHA is very engaged in order to "minimize our exposure in a very difficult budget environment, regardless of the outcome of the November elections." WHA will be working with AHA on a variety of messages and has developed its own "Protect Hospital Care" plan specific to Wisconsin. This is a comprehensive, multi-pronged strategy to help educate and mobilize hospital leaders and advocates against payment cuts.

Brenton proved a mid-year review of the WHA goals noting that steady progress was being made in all areas. WHA Chair-elect Dan Neufelder previewed the WHA Board Planning Session and said discussion will focus on issues related to graduate medical education and physician workforce.

WHA Partners for Patients Work Begins

WHA Chief Quality Officer Kelly Court told Board members that the WHA Partners for Patients quality improvement initiative continues to gain momentum as hospitals have submitted their work plans to WHA. Each of the 108 WHA member hospitals submitted a customized work plan, which will also serve as a vehicle for hospital CEOs to know which areas are priorities for their quality improvement leaders. Court said more than half of the hospitals have indicated they will work on reducing readmissions, which is a key focus of the initiative.

The WHA Partners for Patients initiative is part of a national effort sponsored by the Centers for Medicare and Medicaid Services (CMS) to decrease hospital readmissions and hospital-associated harm. In Wisconsin, 127 hospitals—98 percent—are participating, which is among the highest participation levels in the country.

Borgerding Reviews WHA Priority Issues

WHA Executive Vice President Eric Borgerding said WHA staff is already starting to plan for the 2013 -14 legislative session. Among the issues he identified for attention in the upcoming session are Medicaid and the state budget, the potential implementation of the Patient Protection and Affordable Care Act (PPACA), Wisconsin’s physician shortage, the Jandre court decision, collateral source, mental health care coordination/HIPAA, EMTALA conflicts with Chapter 51 and emergency detentions, regulatory streamlining, and efforts to address various aspects of employment law.

WHA Summer Candidate Education "Road Trips" Start Soon

With the recall elections now over, Borgerding provided an environmental scan of the political landscape and a preview of the key upcoming elections. With the newly-redistricted legislative districts in place for this fall’s election, and several open seats with new candidates from both parties, this summer promises to be one of the busiest campaign seasons of the last decade. Borgerding said members of the WHA government relations team will be meeting with candidates in the upcoming races both before and after Wisconsin’s primary election, which has been moved up to August 14.

WHA’s goal is to hold more than 70 targeted meetings with candidates over the next few months to educate them on the Association’s priority issues such as Medicaid, the value of health care in Wisconsin, the physician workforce shortage and the impact of federal Medicare cuts.

While state legislators have no control over the federal cuts to Medicare funding, Borgerding said they need to have an awareness of how these cuts will affect Wisconsin hospitals so legislators understand that if they propose changes in the state Medicaid program, hospitals are also dealing with major cuts at the federal level.

The Health Care Value Campaign

Borgerding said in the interim period before the Legislature resumes, WHA is developing an education campaign targeting the business community. In the past, WHA has developed tools to help member hospitals quantify the economic impact that they had on their communities. While that remains an important message, Borgerding said WHA is starting to focus on growing the non-health care economy because of the importance that family-sustaining jobs with good benefits has on the overall health of the community and on individual’s ability to have the benefit of private health insurance.

It starts with a conversation around economic development and the role that high quality, accessible health care has in attracting and retaining business in Wisconsin.

"We want to inject health care quality and value into the economic development equation," Borgerding said. "Quality plays a huge role in producing better outcomes, keeping employees healthy, returning them to work sooner, and increasing productivity for employers here. The business community should view access to high quality health care the same way they think of utilities, roads and other parts of Wisconsin’s economic infrastructure."

Borgerding cited two recent examples where value was a key message, starting with Governor Walker’s keynote address at WHA’s Advocacy Day April 24. More recently, WHA was invited to provide testimony before the Assembly Health Committee on the importance that health care value has to Wisconsin’s future economic growth.

"It doesn’t matter how the Supreme Court rules on the PPACA; we know that Wisconsin health care leaders are already focused on a new future and are shaping, not waiting for, reform," Borgerding said. "We are moving in the right direction."

WHA GME Task Force Sees Input from Program Directors as "Essential"

George Quinn, WHA senior policy advisor and Chuck Shabino, MD, WHA senior medical advisor, reported that progress is being made toward increasing rural training opportunities for physicians through the Wisconsin Rural Physician Residency Assistance Program (WRPRAP).

Quinn said on June 25, WHA is bringing the residency program directors together with the deans of Wisconsin’s two medical schools to discuss issues related to recruitment of Wisconsin medical school graduates to Wisconsin-based residency programs. In a discussion led by Shabino, Task Force members reviewed the draft meeting agenda and agreed that input from the directors of the existing GME programs is essential to solving the state’s physician workforce shortage.

WHA Council on Medical & Professional Affairs

Karen Timberlake, director of the UW Population Health Institute, presented at the May 3 meeting of the Council on Medical & Professional Affairs. She summarized the work the Institute is doing to study and improve Wisconsin’s population health and the role that hospitals have in that work. Shabino provided an update on the GME Task Force previously described in this story, while Mary Kay Grasmick, WHA vice president, communications, updated the Council on hospital emergency preparedness activities in the state.

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Key Health Care Leaders Participate in Healthcare Payment Reform Summit

On June 20, the Wisconsin Partnership for Healthcare Payment Reform (PHPR) hosted an impressive array of health care leaders from across Wisconsin to share lessons learned from a variety of payment reform projects in Wisconsin. PHPR Director Karen Timberlake noted that reform efforts are beginning to branch out, and the day’s events provided ample evidence of efforts aimed at transforming the health care payment system.

PHPR is an initiative of the Wisconsin Health Information Organization (WHIO). As WHIO Board chair, WHA President Steve Brenton set the tone for the day in his opening remarks, commenting on the spirit of collaboration that sets Wisconsin apart from the other states in the nation. Others echoed this sentiment throughout the day.

PHPR is a unique mix of health care providers, payers, employers and consumers dedicated to tackling the complex challenge of providing quality care, while reforming the overall health care payment structure. The summit featured presentations on the PHPR pilot programs in the areas of bundled payments for total knee replacements and diabetes care. Presentations also included progress on the Medicare pilot projects. Panelists included CEOs, CFOs, medical directors, and representatives from Meriter Hospital, Anthem Blue Cross Blue Shield, UW Health, Bellin-ThedaCare Healthcare Partners, Dean, WCHQ, and others.

Key themes and lessons learned emerged throughout the day. Many of the panelists identified the need to ensure physician engagement in payment reform initiatives. Others discussed the relationship between payer and provider, noting that trust and communication are key elements in developing agreements around new payment models. Many speakers commented on risk mitigation, with some noting the importance of patient communication, engagement, and compliance as important in the risk mitigation strategy.

WHA continues to work on many aspects of implementing reform in Wisconsin. This summit shows that Wisconsin providers are continuing to develop new models and approaches to care and payment that provide value through quality improvements and cost reductions.

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WHA Hosts WI Health News Roundtable: Health Reform after the Supreme Court

Four of the state’s leading hospital and health system CEOs will discuss health reform in Wisconsin and the impact of the U.S. Supreme Court’s historic decision during a Wisconsin Health News lunch panel sponsored by the Wisconsin Hospital Association. The roundtable luncheon will be on July 26 from 11:00 am – 1:00 pm at the Madison Club.

The Supreme Court is expected to rule on the law in late June, a historic decision certain to reverberate across the national health care industry for years to come. But what will the impact be in Wisconsin, where fundamental, value-focused payment and delivery reform was well underway prior to the passage of the federal health reform law? The four health care leaders will provide valuable insight on the impact, if any, of the decision on their organization, and the pace and scope of health care reform in Wisconsin.

Panelists include Dean Health System President/CEO Dr. Craig Samitt, Marshfield President/CEO Dr. Brian Ewert, ThedaCare President/CEO Dr. Dean Gruner, and Mayo Clinic Health System–Eau Claire President/CEO Dr. Randy Linton. WHA Executive Vice President Eric Borgerding will moderate the panel.

Space is limited. Register by visiting: https://events.r20.constantcontact.com/register/eventReg?oeidk=a07e5zw7h8wc8394ed2&oseq=.

For more information contact Tim Stumm at Wisconsin Health News at 608-216-8898 or tstumm@wisconsinhealthnews.com, or Eric Ostermann at Badger Bay Management at 920-560-5610 or eric@badgerbay.co.

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Gov. Walker Announces UW System Flexible Degree Option
Holds press conferences at hospitals in Weston, Green Bay and Madison

Wisconsin Governor Scott Walker made three stops at hospitals across the state June 19 to announce the launch of a new revolutionary online degree model for the University of Wisconsin (UW) System. Walker held press conferences at Bellin Health in Green Bay, Ministry Saint Clare’s Hospital in Weston, and UW Health in Madison.

Today’s economy demands more educated workers at a time when attaining that education is becoming more difficult, and Wisconsin residents need more flexible, affordable opportunities to pursue degrees in fields like health care. Joined by UW Colleges & Extension Chancellor Ray Cross and UW System President Kevin Riley, Walker announced the "UW Flexible Degree" college option, which will use online instruction and other innovative methods to deliver the competencies that students need at an affordable price.

The unique self-paced, competency-based model will allow students to start classes anytime they like and earn credit for what they already know. Students will be able to demonstrate college-level competencies based on material they already learned in school, on the job, or on their own, as soon as they can prove that they know it. By taking advantage of this high quality, high flexibility model, and by utilizing a variety of resources to help pay for their education, students will have new tools to accelerate their careers. Working together, the UW System, the State of Wisconsin, and other partners can make the same quality UW college degree significantly more affordable and accessible to substantially more people.

"This new model for delivering higher education will help us close the skills gap at an affordable price to get Wisconsin working again," said Governor Walker. "As states across the country work to improve access and affordability in higher education, I am proud to support this exciting and innovative University of Wisconsin solution.

"We are proud of the collaborative work that has gone into this proposal, and we look forward to working with the Governor, the Legislature, faculty, employers, and others to make Wisconsin the leading innovator in higher education," said UW System President Kevin Reilly. "We’ve set the stage for this in recent years with efforts to expand transfer policies, enabling students to more easily move college credits from one UW campus to another or from another school into the UW System."

Judy Warmuth, WHA vice president of workforce, applauded the Governor’s announcement.

"A well-educated workforce is a benefit to everyone in Wisconsin," Warmuth said. "All employers, including health care employers, will benefit from a larger pool of educated workers."

UW System expects to make this program available online to students by as soon as fall of this year.

"It’s no secret that today’s new generation of health care workers are in high demand while increasing numbers of consumers test our ability to care for them," said Ministry Saint Clare’s President Mary Krueger. "This is another initiative that we support to expand opportunities for new students as well as current members of our workforce looking to accelerate their careers."

Donna Katen-Bahensky, president/CEO of UW Hospitals and Clinics, said, "Many of our staff members at UW Hospitals and Clinics are focused on continual improvement. As most of us can appreciate, furthering your education can be a challenge when you need to juggle work and family. It is wonderful the UW System is creating a program that creates the flexibility to allow more people the opportunity to pursue a great UW education."

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Wisconsin Hospitals Community Benefits: Oral Health

Wisconsin hospitals share a common mission to improve their community’s health status, which includes oral health care, an area often neglected because people cannot afford dental work. Lack of proper dental care can lead to a myriad of other health problems. Those with severe tooth pain often end up in hospital emergency rooms for pain relief. By increasing access to dental services for those who cannot afford it, hospitals are not only improving the overall health of their communities, but also decreasing the burden on their emergency departments.

Celebrate Smiles

Tooth decay is a common chronic illness among children in the United States, despite being almost entirely preventable. Painful tooth decay and oral diseases, if untreated, could be a root to more health and emotional problems.

Nan Peterson, Director of Child Health Advocacy at American Family Children’s Hospital at UW Hospital and Clinics, says, "Good oral health is essential to overall health and well-being of our children. Untreated tooth decay affects a child’s ability to learn in the classroom, their ability to eat comfortably, to speak, and their self-esteem and social relationship."

This past year, American Family Children’s Hospital partnered with Access Community Health Centers, Madison Metropolitan School District, some county school districts and Public Health of Madison of Madison and Dane County to launch the "Celebrate Smiles" initiative with the Ronald McDonald Care Mobile Program. This school-based program provides preventive and restorative oral health care to the children who reside within Dane County.

Children from lower income households are more vulnerable to oral disease because they are less likely to make visits to dentists than higher-income families. "The target population for the Celebrate Smiles project is schools with the highest free/reduced lunch program statistics," Peterson explains.

Jeff Poltawsky, Vice President for American Family Children’s Hospital, says, "This collaborative model with many community partners works to lessen the disparities and improve access to preventive services for children in our community, using a best practice, school-based, model of care."

"We are seeing many more children with the school-based, prevention model," says Peterson. "All children are screened at a school. Children who need prevention services (sealants, fluoride varnish) or restorative services can receive proper care."

Children may also receive more comprehensive care and treatment. Peterson explains, "If the Ronald McDonald Care Mobile moves on to the next school before services are done, children can obtain the rest of their treatment at Access Community Health Centers."

This past school year, the Celebrate Smiles initiative screened 3,541 students at nine schools and provided preventive or restorative care to 3,999 teeth within the mouths of 996 elementary school-age children. This charity care program enables children without insurance to receive treatment at no cost. Peterson says, "American Family Children’s Hospital is grateful to the Ronald McDonald House Charities for its ongoing support of this program."

For the 2011-2012 school year, Celebrate Smiles expects to increase its reach of elementary schools within Dane County by 50 percent, providing more children with the skills for improved oral health, breaking the cycle of decay, and lessening the burden of oral health for young children.

University of Wisconsin Hospitals and Clinics, Madison

Healthy Smiles for Wood County

The Healthy Smiles for Wood County program has been sealing the cracks at schools for the past 11 years. Not the cracks in the sidewalks, but in the pits and grooves of second grader’s teeth.

Ministry Saint Joseph’s Hospital, in partnership with the Wood County Health Department and local dentists, have been providing dental screenings, referrals and sealant placement to second grade students in the county for more than a decade.

Tooth decay is the most common childhood disease affecting nearly 60 percent of children nationally. Closer to home in Wood County, 64 percent of children screened by Healthy Smiles last year were found to have experienced tooth decay. Poor dental health and untreated tooth decay can lead to pain, infection and tooth loss. Toothaches can prevent children from getting a good night’s rest, eating or speaking properly, or learning in school.

Poor dental health affects disadvantaged children at a much higher rate: 80 percent of childhood dental disease is concentrated in 25 percent of kids, primarily those from low-income and minority households. Here in Marshfield, we are fortunate to have local dentists who will see Medicaid-enrolled families that have difficulty accessing dental care. But due to the downturn in our economy, plus the significant increase in Medicaid enrollment with the BadgerCare Plus program, more Wood County families are finding it difficult to afford or access dental care.

The Healthy Smiles for Wood County program is just one avenue to combat this trend. Because of generous local and state funding and committed local partnerships, Healthy Smiles has been able to increase its services over the past several years. Healthy Smiles has expanded since its inception and last year screened 1,000 children, providing sealants and/or fluoride varnish to more than 400 children. Healthy Smiles attributes its success to the fact that services are provided at school where the parents can give permission for their children to participate without having to take time off from work, eliminating transportation and appointment scheduling barriers.

Dental sealant placement can prevent tooth decay for seven to ten years. Healthy Smiles, side-by-side with the dental community, will continue to work to keep the cracks sealed in our kids’ teeth.

Ministry Saint Joseph’s Hospital, Marshfield

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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