June 8, 2012
Volume 56, Issue 23
Governor Walker Prevails Against Recall Challenge
Three of four senators facing recall win; fourth race yet to be called
Culminating nearly a year and a half of heightened partisanship and a sharply condensed campaign season with near constant political messaging, Governor Scott Walker (R) defeated Milwaukee Mayor Tom Barrett (D) in what became the most expensive political race ever in Wisconsin. With his victory, Walker became the only governor in United States history to survive a recall challenge.
In a race that garnered national and international attention, Walker’s final margin of victory was 53-46 percent, close to the margin seen in some polls released in the closing days of the campaign, and nearly identical to the 52-45 percent margin found in the most recent Marquette University Law School poll of likely voters. The winning margin was slightly larger than the 52-47 percent Walker victory over Barrett in the 2010 election.
While the recall elections were driven by reaction to Walker’s controversial proposals to limit public employee collective bargaining and change public employee union requirements, campaign issues ultimately focused on Wisconsin’s economic environment and job creation.
In his election night speech, Walker said it was time to bring Democrats and Republicans together.
Also winning her recall challenge was Lieutenant Governor Rebecca Kleefisch (R) who defeated Democrat Mahlon Mitchell, a Madison firefighter and union president. The race was the nation’s first-ever recall election of a lieutenant governor. Kleefisch won by a 53-47 percent margin.
Majority control of the Senate remained in limbo this week as Senate Republicans won three of the four recall challenges they faced, while the outcome of the fourth remained undetermined.
In the 13th Senate District, current Senate Majority Leader Scott Fitzgerald (R-Juneau) defeated challenger Lori Compas (D) 58-41 percent.
In the 23rd Senate District, Senator Terry Moulton (R-Chippewa Falls) defeated challenger, former State Representative Kristin Dexter (D) 57-43 percent.
In the 29th Senate District, Representative Jerry Petrowski (R-Marathon), who entered the race when incumbent Senator Pam Galloway (R-Wausau) decided to retire, defeated current State Representative Donna Seidel (D-Wausau) 61-39 percent.
But as of press time, the race in the 21st Senate district had yet to be called where former State Senator John Lehman (D-Racine) leads incumbent Senator Van Wanggaard (R-Racine) by only 779 votes. Wanggaard defeated Lehman in the 2010 election.
Should Lehman be named the winner, and absent a recount, majority control in the Senate would shift to Democrats by a 17-16 margin at least until January 2013 after this fall’s general election. But with Governor Walker retaining his seat and Republicans in control of the Assembly, little additional legislative activity is expected before the end of the year.
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The WHA Partners for Patients quality improvement initiative continues to gain momentum as hospitals submitted their work plans to WHA on June 5. 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 QI leaders. Two initiatives, falls reduction and catheter-associated urinary tract infections were launched through the use of webinars on June 5 and June 6, with 39 and 32 hospitals enrolled in these projects, respectively.
The webinars offered in the Partners for Patients collaborative are more interactive than previous WHA offerings. According to Stephanie Sobczak, WHA manager, quality improvement, "We really wanted to have a more ‘real-time’ feel to the content presented. Now our participants are invited to participant in live polling during the webinar. This allows the group to learn more about their colleague hospitals in terms of what processes are in use, areas of challenge, and peer feedback on the content presented in the webinars.
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, or 98 percent, of the hospitals are participating, which is among the highest participation levels in the country.
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This week the Joint Legislative Council approved membership in their recently announced Study Committees for the interim before the next legislative session that begins January 2013. Made up of both citizens and legislators, Legislative Council Study Committees work to examine major issues and recommend legislation to address potential problems and concerns.
Among the study committees approved for this interim are Special Committees on Legal Interventions for Persons with Alzheimer’s and Related Dementias and on 911 Communications. Recommendations made by WHA for membership on these committees were among those included by Legislative Council Co-Chairs Rep. Joan Ballweg (R-Markesan) and Sen. Mary Lazich (R-New Berlin) on the ballot that received final Council approval.
Kenneth Robbins, MD, medical director of the Stoughton Hospital Geropsychiatry Unit and Clinical Professor of Psychiatry, University of Wisconsin School of Medicine and Public Health, was approved as a member of the Special Committee on Legal Interventions for Persons with Alzheimer’s and Related Dementias. This committee is directed to review and develop legislation to clarify the statutes regarding guardianship, protective placement, involuntary commitment, and involuntary treatment as they apply to vulnerable adults with a dementia diagnosis who may or may not have a co-occurring psychiatric diagnosis.
Work on this committee will be especially important in light of the recent Wisconsin Supreme Court decision in the In Re Helen E.F. case that overturned a Chapter 51 mental health commitment of a plaintiff with Alzheimer’s disease exhibiting aggressive behavior and refusal of meals and medication. (See related story at www.wha.org/pubArchive/valued_voice/vv5-25-12.htm#3.)
Also approved was Tracey Froiland, emergency preparedness coordinator, ThedaCare and regional manager for the Wisconsin Hospital Emergency Preparedness Program for membership on the Special Committee on 911 Communications. This committee will study: (a) creation of a statewide entity to provide coordination and long-term planning for the system; (b) existing funding sources and projected costs of the system; (c) the training curriculum and requirements for 911 dispatch personnel; (d) establishment of a minimum 911 service standard; (e) methods to upgrade multi-line telephone system technology to enable responders to locate calls originating from large or multi-location facilities; and (f) best practices around the country for potential implementation in Wisconsin.
Because their work remains in progress, the Special Committee on Review of Emergency Detention and Admission of Minors Under Chapter 51 from last session was approved to continue. Dr. Gina Koeppl, regional director, Ministry Behavioral Health, who is a member of this committee, was also approved as a member of the Special Committee on Legal Interventions for Persons with Alzheimer’s and Related Dementias.
With majority leadership in the Senate yet to be determined because of pending results in one of this week’s Senate recall elections (see related story), the Senate membership on the Joint Legislative Council may change, but citizen membership on the study committees is expected to remain the same.
The 2012 Study Committees will work through the summer and fall with their final recommendations expected to be ready before the end of the year for potential legislation in the 2013-14 legislative session.
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On May 23, the United States Senate Committee on Finance held a hearing in Washington, DC about innovations in health care delivery. At exactly the same day and time, WHA and Wisconsin hospitals and health systems were testifying in Madison before the State Assembly Committee on Health at a hearing on efforts to transform health care in Wisconsin through improved quality and value. (See Valued Voice coverage at: www.wha.org/pubarchive/valued_voice/vv5-25-12.pdf.)
"Because we believe Wisconsin has a great record of driving innovations and value in care, we submitted our [Assembly Health Committee] testimony to the U.S. Senate Committee on Finance for its hearing record," said WHA President Steve Brenton in a letter to Wisconsin’s Congressional Delegation, accompanied by a copy of that testimony.
WHA’s testimony highlighted how Wisconsin: remains the home of national leaders and pioneering organizations in the quality and value movement; has a strong presence of integrated hospital and health systems that include employed physicians, and align toward a common goal—better outcomes; hospital and health systems have a long history of commitment to improving care and transparent reporting of results; is a leader in adopting electronic health records; hospitals are taking a page from the manufacturing sector’s book and increasingly adopting LEAN and other efficiency initiatives that focus on reengineering processes to reduce waste and improve quality; and how hospital commercial payments are also reflecting improvements in efficiency and quality.
"We continue to be proud to represent Wisconsin hospitals and health systems who have been dedicated for years to pursuing value-based care," said Brenton’s letter to Wisconsin Members of Congress. "We think Wisconsin has a great story to tell to our communities and a national audience. We hope you agree."
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The first of two 2012 election cycles is over with Governor Scott Walker re-affirmed by a vote margin exceeding his 2010 totals. Tuesday night’s outcomes that include retention of at least 3 of 4 GOP Senators facing recall set the stage for November 6. Voters now get to look forward to: a fight for control of the Wisconsin State Senate, a Presidential donnybrook in this very "purple" state, and tough re-election campaigns for two freshman Republican House members (Ribble and Duffey).
WHA’s goal in navigating this unprecedented "permanent election" political environment has been to be viewed as a relied-upon, non-partisan health care policy resource. It’s essential that our members’ health care policy priorities be positioned to matter. And those priorities include: preserving Medicaid as a fully-funded "safety net" program for our most vulnerable citizens, influencing the implementation of health reform consistent with WHA’s reform principles, and shaping an environment in which high value health care can be delivered to our communities and constituencies.
As it relates to Tuesday’s outcomes, the continuity in the East Wing of Wisconsin’s Capitol will almost certainly mean continuity in thoughtfully-developed and executed Medicaid reforms that differentiate Wisconsin from other states that are struggling to sustain their Medicaid programs. When it comes to health reform implementation, WHA is poised to act quickly following the late June Supreme Court decision to help position Wisconsin to successfully implement aspects of PPACA that may be left standing based on that decision.
Finally, look forward to participating in our upcoming (and continuing) work to engage Wisconsin’s Congressional Delegation (current and future) around issues associated with Medicare spending. As mentioned previously, we are now just five months away from being mired down in a highly-charged debate about Medicare’s future. That debate will include unprecedented potential for devastating provider cuts.
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Register today at: http://events.signUp4.com/12Rural
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Nominations are now being accepted for WHA’s annual Distinguished Service Award and Trustee Award, as well as for the ACHE early career and senior-level health care executive awards. These important awards recognize those who display leadership, dedication and professionalism to their community or the Association.
You may know someone in your region, in your hospital or on your Board of Directors who deserves such an honor. You now have an opportunity to nominate them for one of these annual awards:
Administrators, trustees, senior managers, nurse leaders, volunteers and others are encouraged to review the criteria for the awards and consider nominating someone to receive one of these honors.
The deadline for submitting nominations is August 3. Details about the nomination process and criteria for nomination can be found in this week’s packet and on the WHA website at www.wha.org/award-program-information.aspx. For more information, contact Sherry Collins or Steve Brenton at WHA, 608-274-1820.
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The Wisconsin Rural Physician Residency Assistance Program (WRPRAP), funded through an assessment on critical access hospitals in 2009, is making progress on its goal to increase rural training opportunities for physicians, according to program director Byron Crouse, MD. Any Wisconsin residency program (current or future) in family medicine, general surgery, internal medicine, obstetrics, pediatrics or psychiatry is an eligible recipient for funding.
Speaking at the WHA Graduate Medical Education Task Force meeting June 7 in Madison, Crouse said WRPRAP is actively supporting hospitals, health systems and clinics that are starting or expanding rural rotations, training tracks and rural residency programs. WRPRAP is currently supporting, through grants, several rural training programs, including Franciscan Skemp in Tomah, the Baraboo Rural Training Track, a fellowship program at Monroe Clinic and a faculty development project in Richland Center.
Crouse said the Rural Wisconsin Health Coop (RWHC) received funding to establish the Wisconsin Rural Training Track Collaborative (WRTTC). The WRTTC is a collaborative venture for developing a family medicine rural training track (RTT) and potentially other vehicles for expansion of resident training in rural communities. Partners in the collaborative will share resources and administrative functions and will operate both independently and collaboratively to complement each other’s programs and services.
The WRPRAP funding is open to all rural facilities, regardless of medical school and/or system affiliation. Crouse said that while there is some interest in developing rural rotations and training tracks in surgery, there are significant logistical issues that would need to be addressed.
Task Force members voiced their interest in exploring the possibility of creating a statewide GME coordinating council. George Quinn, WHA senior policy advisor, highlighted the need for local community involvement at both the state and local levels. Up until now, the individual community has not been considered in a statewide strategy to increase residencies. However, Quinn said the community plays an important role in facilitating the development of and sustaining medical residency programs. The stakeholder in GME includes the medical residents, local physicians as faculty, the health systems and medical schools, each of which plays an important part in GME, but none are able to do it on their own. That is why it is important for communities to consider creating consortiums to help align stakeholders in terms of resources and their needs.
Later in June, 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 Chuck Shabino, MD, WHA senior medical advisor, 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.
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The UW Population Health Institute Advisory Board met June 5 at WHA headquarters in Madison. Karen Timberlake, director of the Institute, identified the Advisory Board’s role as that of helping the Institute identify and set priorities, providing suggestions for improvement, and serving as a forum for idea and knowledge exchange among a wide variety of stakeholders. WHA President Steve Brenton is a member of the Advisory Board.
Timberlake said the Institute also wants to reach out to the business community in Wisconsin to help shape the return on employers’ investments in preventive health in both the public and private sector beyond just workplace wellness. She sees the Institute reaching out to community-led health improvement efforts to help these groups evaluate their work to determine if these programs are making a difference in the overall health status of Wisconsin communities.
The County Health Rankings are one part of the Institute’s Mobilizing Action Toward Community Health (MATCH) program. Julie Willems Van Dijk described how counties across the country have used the County Health Rankings to help inform the process of creating a community health needs assessment. WHA has worked closely with the Institute and the MATCH program to share resources that hospitals can use to complete their community health needs assessment. Willems Van Dijk emphasized the importance of local collaboration in the development of policies and programs that are aimed at improving a community’s health status.
Liz Feder, also with the Population Health Institute, said over the past few decades, communities nationwide have increasingly recognized the numerous direct and indirect impacts that both the social and built environment can have on people’s health. This recognition has encouraged local and regional governments, along with University and community partners, to begin considering how to better assess and articulate how, and to what extent, their plans and investments impact the health of the people they serve, a process that is called a health impact analysis (HIA). It is still a relatively new concept, but Wisconsin received funding to establish HIA capacity at the Wisconsin Division of Public Health, Bureau of Environmental and Occupational Health.
For more information on HIA, visit: www.dhs.wisconsin.gov/hia.
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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.
Diane P., 52, works only part time, receives an income under 200% of poverty levels and has no dental insurance. She began experiencing severe pain in one of her lower molars and did not know where to go for help. A friend told her to call the 211 @ IMPACT help line, and she learned of urgent-care services at Seton Dental Clinic, sponsored by Columbia St. Mary’s (CSM).
When Diane first came to the clinic, the dentist, Dr. Charles Kosowski, D.D.S., told her she had a blood pressure of 160/110—too high to have the painful tooth extracted. She was surprised: "I never knew I had high blood pressure, but it does run in my family." Patterson was referred to the Columbia St. Mary’s Community-based Chronic Disease Management Clinic (CCDM) for a medical evaluation, with instruction to return to Seton when her blood pressure was under control.
Three weeks later, Diane came back to Seton, presenting documentation from CCDM to show that her blood pressure was now being treated and monitored. She was grateful for the care she received at the CCDM Clinic, saying, "I went to the one at 205 East Concordia. I never will forget that address; they have been so good to me. I get my blood pressure medicine for free!"
Diane was given an appointment with Dr. Kosowski right away and, with a blood pressure reading in the normal range, had the painful tooth extracted. "That doctor is so nice; everyone has been so nice," she said.
Then, despite just having had a tooth extracted, she flashed the biggest smile that she could.
Columbia St. Mary’s, Inc., Milwaukee
Ministry Door County Medical Center assists those in need of dental care
Located in Sturgeon Bay, the Ministry Door County Medical Center (MDCMC) Dental Clinic is a non-profit facility that has been providing free oral health care to the youth of Door and Kewaunee Counties since 1999. The clinic is staffed by two general dentists and one volunteer dentist with clinic costs underwritten by MDCMC and grant funding. In total, more than 800 individuals in need were served by the MDCMC Dental Clinic in 2010.
The clinic provides a dental home to a very diverse group of young patients between the ages of two and 18 from throughout the region and is connected to many local organizations. The facility receives referrals from the Hispanic Resource Center, Door County Department of Social Services and the Door County Health Department. Although only 1.4 percent of the people residing in Door and Kewanee Counties are Hispanic, nearly 20 percent of all clinic visits come from the area’s large Hispanic population, many of whom speak little or no English. The clinic uses an interpreter from the Hispanic Resource Center or an ESL teacher to assist when there is a language barrier.
MDCMC also assists adults in the community who need emergency dental care through resources made available from employees and other donors to its Ministry Fund. Patricia B. and Tanya H., both of Sturgeon Bay, received assistance this year from the fund for emergency dental care.
Patricia tolerated mouth pain for nearly a year, until the pain started shooting straight into her ear. "I was constantly taking ibuprofen to offset the pain. It was excruciating," she said. Patricia endured the discomfort for so long because she didn’t have the finances to cover a visit to the dentist. It was then that a friend recommended that she contact Katie Graf, MDCMC Social Services.
Katie assisted Patricia and told her about the free or discounted dental care available to those in need. Patricia learned that her cracked molar needed to be pulled out, "They were very nice and gentle, and they explained the entire procedure so I wasn’t nervous about it."
Patricia remains grateful for the help and support from Ministry Door County Medical Center. "It was 100 percent awesome. I was free of pain immediately – I just can’t thank them enough."
When Tanya learned she needed to have a few teeth pulled she was nervous. Not only could she not afford a trip to the dentist, but "I was scared and worried that my front teeth would be missing." Katie Graf also helped assist her with receiving emergency dental care.
After Tanya’s front teeth were successfully removed, she then received a partial denture. "It was a great experience. They were all really nice, and I am beyond grateful for the help I received."
The Ministry fund has been able to fulfill over 1,900 requests for assistance and over $200,000 has been gifted since the fund was created in 1999. This year alone, the fund has gifted $16,000 for uninsured adults needing emergency dental care.
Ministry Door County Medical Center, Sturgeon Bay
Joining together to provide affordable dental care
After two years of exploring options, writing grants and finding staff, Karen Fabisiak of St. Vincent de Paul is happy to say that low-income residents of Sauk County and the Sauk Prairie area will now have access to basic dental care.
"So far we’ve heard from individuals that haven’t seen a dentist in years because they simply couldn’t afford it," said Fabisiak. "We’ve also heard from mothers who have children that have never had dental care because they can’t find a dentist who will accept payment from BadgerCare."
"The need is definitely there," said Fabisiak. "We just had to come together to figure out how to provide the service."
With contributions from 16 Sauk County organizations including Sauk Prairie Memorial Hospital & Clinics (SPMHC) and the Sauk Prairie Memorial Hospital Foundation (Foundation), St. Vincent de Paul’s Dental Clinic began by taking dental appointments two days each month.
SPMHC originally contributed to the cost of writing grant applications to hire a dentist for the clinic. Once a dentist was hired, SPMHC and the Foundation contributed matching gifts toward the salary of a dental hygienist.
"We were glad to join this collaborative effort to bring such a needed service to the area," said Carol May, chief financial officer at SPMHC.
The dental clinic accepts qualified uninsured or underinsured patients who are on Medicare, Medicaid and BadgerCare. Applications must be completed to determine if a patient qualifies based on income and need.
Sauk Prairie Memorial Hospital, Prairie du Sac
Submit community benefit stories to Mary Kay Grasmick, editor, at firstname.lastname@example.org.
Read more about hospitals connecting with their communities at www.WiServePoint.org.
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