August 3, 2012
Volume 56, Issue 31

Wisconsin Hospital Leaders in Washington, DC
Fight for rural hospitals

This week a dozen Wisconsin hospital leaders traveled to Washington, DC to advocate on behalf of rural hospital payments set to expire later this year. The trip was in conjunction with the National Rural Health Association’s "March for Rural Hospitals." The Wisconsin Hospital Association and Rural Wisconsin Health Cooperative led the trip as part of their cooperative efforts to protect rural hospital payments.

"Wisconsin’s rural, but non-critical access hospitals, are unique and vital to their communities," said WHA President Steve Brenton. "During the 1980s as hundreds of rural hospitals closed, Congress recognized this importance and created two payments in order to keep access to care available in rural areas."

The two payments are the Medicare Dependent Hospital program and the Low-Volume Adjustment. Both focus on hospitals that would otherwise struggle to maintain financial stability under Medicare’s fee schedule because of their smaller size and the large share of Medicare beneficiaries. Both payments expire on September 30, 2012. Wisconsin has 15 affected hospitals estimated to lose approximately $13 million in FY 2013 without these payments.

"Sixty-five percent of our patients are Medicare," said John Graf, senior vice president at UW Health Partners Watertown Regional Medical Center. "That does not give you a lot of flexibility."

"I look at these payments as fixes to a system that did not work for certain rural providers," said Fort HealthCare CEO Mike Wallace.

Hospital leaders met with 9 out of ten of Wisconsin’s Congressional Delegation or their staff to ask them to sign on to the Rural Hospital Access Act of 2012 (S. 2620, H.R. 5943) which extends both payments for another year.

"I appreciate who you are and what you do," said Sen. Herb Kohl to the hospital leaders and then immediately signed on to the legislation. "It’s tremendous."

WHA thanks Sen. Kohl and Reps. Petri, Kind and Ribble for quickly agreeing to co-sponsor this legislation and for their strong support for rural hospitals.

Wisconsin hospital leaders in DC included: Sandy Anderson, St. Clare Hospital (Baraboo); Mike Wallace, Fort HealthCare (Fort Atkinson); James O’Keefe, Mile Bluff Medical Center (Mauston); Mike Sanders, Monroe Clinic; Ned Wolf, Lakeview Medical Center (Rice Lake); Mike Decker, Divine Savior Healthcare (Portage); Carol May, Sauk Prairie Memorial Hospital (Prairie du Sac); John Graf, UW Health Partners Watertown Regional Medical Center; Scott McMeans, Holy Family Memorial (Manitowoc); John Eich, Office of Rural Health; Tim Size and Jeremy Levin, RWHC; and Jenny Boese, WHA.

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Wisconsin Hospitals and Health Systems View Physician Shortage with Urgency

The announcement by the Medical College of Wisconsin (MCW) that they plan to expand their campus into two Wisconsin communities was welcome news to the members of the Wisconsin Hospital Association. However, it also raises concern about whether there will be enough slots to place these new graduates in Wisconsin-based residencies.

Wisconsin’s ability to meet the growing demand for care and avert a looming physician shortage was the main focus at the WHA Board Planning Session held July 18-20 in Elkhart Lake. The session was led by Dan Neufelder, president/CEO, Affinity Health System, who is WHA’s incoming chair.

"In terms of importance to our member hospitals, the physician workforce issue is second only to reimbursement in terms of how deeply concerned we are about the potential impact it could have on our hospitals’ ability to meet their missions," said WHA President Steve Brenton.

The key is getting more Wisconsin students into the state’s medical schools and then connect them to an in-state residency. WHA Senior Policy Advisor George Quinn said there is a "powerful relationship" between those two factors.

"We know that students who go to a Wisconsin medical school, and then complete a residency here are 80 percent more likely to stay," according to Quinn. "MCW’s decision to expand their campus to educate medical students in Central Wisconsin and Green Bay means that students will have an opportunity to receive a superb education and then, hopefully, stay in Wisconsin and practice medicine."

Board member George Hinton, chief administrator of Aurora Sinai Medical Center in Milwaukee, says more must be done to keep students in-state.

"Once a student leaves the state to go to school, they are gone, and we will never get them back. We need to get them into one of our universities," said Hinton. "We need to have our own students in our universities and medical schools, especially students of color. It’s a huge issue across the state."

Quinn said he is optimistic that Wisconsin hospitals and health systems, in partnership with MCW, communities, business, and government—all working together—will make progress.

MCW President John Raymond, MD, is equally as confident. He said the Medical College is committed to developing new models for educating physicians.

"In my view, this is just the beginning. We are looking to expand into other communities later," Raymond said. "Two communities were ready to go now, and our plans are to matriculate the first students in 2015, with a goal of 25 per class setting. There is capacity for more, but we are concerned about quality and culture, so we think 25 is a comfortable place to start."

Raymond said the College’s vision is to develop a community-based program, steeped in the IHI "Triple Aim," with an accelerated curriculum that shaves one year off the debt burden with pre-clinical opportunities "built-in" to it. He envisions having medical, dental, pharmacy and advanced practice providers learning together. The plan is to partner with some of the University of Wisconsin’s four-year campuses to build a "critical mass" where faculty and clinical rotations could be coordinated and shared between the two institutions to avoid duplication.

The key, however, is to attract students who are most likely to stay in Wisconsin to practice medicine. The challenge is to create more residencies. But that is easier said than done. A residency program comes with a heavy administrative burden.

GME in the Community: The Kalamazoo Model

In Michigan, Borgess Medical Center and Bronson Methodist Hospital created a separate corporation, the Kalamazoo Center for Medical Studies (KCMS), that currently provides undergraduate medical education for 50 third and fourth year medical students each year from Michigan State University. In addition there are currently 192 residency positions in KCMS. The Center has its own staff, runs all aspects of the GME programs, and the two health systems share the costs, but both save resources because they can avoid duplicating the costs associated with accreditation, curriculum development, faculty and other GME-associated expenses.

According to Patrick Dyson, chairman of the KCMS Board of Directors, the collaboration between the two health systems has worked for more than 40 years because it was set up with these guiding principles:

Their successful collaboration on GME led to the creation of Western Michigan University School of Medicine, which was incorporated on January 13, 2012. A private medical school within a public university, it plans to enroll its first class of medical students this summer.

Dyson said medical education is an important driver of economic development in Kalamazoo, something that the health systems help support. In addition to the economic benefits, the program has created a recruitment pool for the health systems, especially for the hospitalist and emergency medicine needs.

Meeting the Demand for Physicians in Wisconsin

You can’t start talking to kids too early about a career in medicine, according to Byron Crouse, MD, associate dean for rural and community health at the University of Wisconsin School of Medicine and Public Health, and director of the Wisconsin Academy of Rural Medicine (WARM).

From grade school forward, there are concerted efforts to expose students to role models and ensure they are versed in the basic sciences. The UWSMPH’s WARM program recruits and admits highly-qualified students to its medical school who are from rural backgrounds and it then facilitates connecting them to in-state post-graduate training.

"WARM students’ performance in medical school has essentially equaled that of their peers and their performance on written tests and clinical exams has been neither helped nor harmed by their participation in the WARM program," according to Crouse. That addresses an initial concern that WARM students would not be as prepared for medical school.

Crouse also provided a brief report on the Wisconsin Rural Physician Residency Assistance Program (WRPRAP). He said WRPRAP is helping to support physician education in seven rural areas of the state. The plan is for the program to continue to expand. Crouse thanked WHA for taking the initiative to get funding for this important initiative.

Art Walaszek, MD, UWSMPH, described a new emergency medicine residency that is a partnership between the medical school and a community hospital, using a new source of funding that became available, to create an emergency medicine residency. Walaszek said the medical school did not have any emergency medicine graduates last year, but they will be up to 36 by 2015. Even with an expansion in the number of slots, he said Wisconsin will not be able to accommodate all the new grads interested in emergency medicine.

"The best projections are that by 2018 we will graduate more American-trained physicians than we have residency positions for and medical school graduates will not match to a residency," Shabino said.

Given the expansion of the number of graduates from the two Wisconsin medical schools, it is important that we ensure an adequate number of GME positions to train these students in Wisconsin. Shabino reminded the group that the desired outcome is retention of Wisconsin students as practicing physicians in our state. An important determinant of this is for them to do their residency training here.

Collaborations provide a mechanism for sharing the costs and resources required for a successful GME program among multiple sponsoring institutions.

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WHA Telephone Town Hall Features U.S. Rep. Kind
"You’ve contributed your pound of flesh."

This week WHA held the second in its series of Telephone Town Halls. Featured speaker U.S. Rep. Ron Kind (D-La Crosse) provided insight to roughly 75 hospital constituents on the future of government health care programs.

During his remarks on August 2, Rep. Kind discussed multiple issues facing Congress, ranging from sequestration cuts to rural hospital issues. In discussing the looming sequester due to hit in January 2013, Rep. Kind was concerned by the approximate $1 billion in Medicare spending reductions this would mean for Wisconsin hospitals over 10 years.

"From my perspective, I believe health care providers were at the table during health care reform; you contributed your pound of flesh," Rep. Kind began. "To keep going back to you now for more contributions, for more reductions in funding is unfair…."

Unfortunately, Kind said he did not see a clear path in Congress for how to deal with the sequester cuts. He also added that attention is currently focused on the defense side of the equation and expressed his concern that if defense cuts are reduced, this only puts more pressure on cutting health care programs. He reiterated that asking health care providers to continue to give more was the wrong direction to take.

Rep. Kind provided his perspective on health care reform law (ACA), indicating that though it was not perfect, he believed the status quo was unsustainable. In particular, he told of his long-time support for the ACA’s health insurance exchanges and told of his past efforts to author bipartisan legislation known as the "SHOP" Act. With respect to Governor Walker’s decision to hold off on developing a Wisconsin exchange, Rep. Kind indicated he had contacted the Governor to encourage him to move the state forward.

"What we should be doing is doing it the Wisconsin way," said Rep. Kind. "Let’s implement health care exchanges the way I think we can in Wisconsin and show the rest of the country how well it can be done."

As many hospitals in Rep. Kind’s district and on the Telephone Town Hall represent rural or Critical Access Hospitals, Rep. Kind announced that he had signed onto legislation, H.R. 5943, to reauthorize the Medicare Dependent Hospital program and Low-Volume Adjustment. This legislation was the purpose of WHA’s trip to Washington, DC earlier this week with a dozen hospital leaders. (See related article)

With respect to questions about attacks on the Critical Access Hospital designation, Rep. Kind responded, "I’ve been very protective of CAH designation for obvious reasons…it has worked well." WHA thanks Rep. Kind for his continued and repeated efforts to protect CAH status.

Other issues touched upon included Kind’s bipartisan efforts to find a permanent solution to the physician payment formula as well as encouraging providers to weigh in with him and with the Centers for Medicare & Medicaid Services on the recently released value modifier rule.

As Congress moves closer to voting on major fiscal decisions later this year, Rep. Kind expressed his desire to participate in another WHA Telephone Town Hall with hospitals. WHA will be certain to follow up on the offer and make registration details known to members.

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Political Action Fundraising Campaign Reaches 60% Mark

The Wisconsin hospitals state political action funds fundraising campaign has raised $150,539 to date from 203 individuals. This puts the 2012 campaign at 60 percent of the goal to raise $250,000 by the end of the year. If the goal is reached it will be the highest total ever raised. 2012 is a major election year as well and will likely result in record disbursements to candidate campaigns.

So far individuals are contributing an average $742, well above last year’s average by $183. The campaign is also ahead of last year’s pace in terms of total dollars raised by $18,000. Of the total contributors so far, 40 are members of the Platinum Club who have contributed $1,500 or more to the 2012 campaign.

All individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. Thank you to the 2012 contributors to date who are listed below. Contributors are listed alphabetically by contribution amount category. The next publication of the contributor list will be in the August 17 edition of The Valued Voice.

For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Contributors ranging from $1 to $499
Ashenhurst, Karla Ministry Health Care
Bablitch, Steve Aurora Health Care
Bair, Barbara St. Clare Hospital & Health Services
Beglinger, Joan St. Mary's Hospital
Biros, Marilyn SSM Health Care-Wisconsin
Bowers, Laura SSM Health Care-Wisconsin
Brenholt, Craig St. Joseph's Hospital
Brenton, Andrew Wisconsin Hospital Association
Buss, Diane St. Mary's Hospital
Censky, Bill Holy Family Memorial
Coil, Joseph St. Clare Hospital & Health Services
Culotta, Jennifer St. Clare Hospital & Health Services
Dahl, James Fort HealthCare
Dalebroux, Steve St. Mary's Hospital
Dettman, Amy Bellin Hospital
Dufek, Nancy Memorial Medical Center - Ashland
Elliott, Roger St. Joseph's Hospital
Entenmann, Kim St. Joseph's Hospital
Facey, Alice St. Clare Hospital & Health Services
Fielding, Laura Holy Family Memorial
Freimund, Rooney Bay Area Medical Center
Fuchs, Thomas St. Joseph's Hospital
Gajeski, Lynn St. Vincent Hospital
Garibaldi, Isabelle Wheaton Franciscan Healthcare - All Saints
Garvey, Gale St. Mary's Hospital
Giedd, Janice St. Joseph's Hospital
Groskreutz, Kevin St. Joseph's Hospital
Grundstrom, David Flambeau Hospital
Halida, Cheryl St. Joseph's Hospital
Hamilton, Mark
Hedrington, Brian Sacred Heart Hospital
Hieb, Laura Bellin Hospital
Hill, Nick St. Joseph's Hospital
Hinton, George Aurora Sinai Medical Center
Hockers, Sara Holy Family Memorial
Hoege, Beverly Reedsburg Area Medical Center
Holub, Gregory Ministry Door County Medical Center
Hueller, Julie Wheaton Franciscan Healthcare
Huemmer, Paul St. Mary's Hospital
Jelle, Laura St. Clare Hospital & Health Services
Jensen, Russell St. Mary's Hospital
Johnson, George Reedsburg Area Medical Center
Karow, Deborah Aspirus Wausau Hospital
Kepchar, Dennis Ministry Health Care
King, Steve St. Mary's Hospital
Klay, Lois St. Joseph's Hospital
Klein, Tim Holy Family Memorial
Krause, Carolyn Meriter Hospital
Lachecki, Therese Memorial Medical Center - Ashland
Lampman, Sandra St. Mary's Hospital
Larson, William St. Joseph's Hospital
Leonard, Mary Kay St. Mary's Hospital
Lynch, Sue Mayo Health System - Franciscan Healthcare
Marcouiller, Don Memorial Medical Center - Ashland
Margan, Rob Wisconsin Hospital Association
Maroney, Lisa
Mason, Paul Wheaton Franciscan Healthcare - All Saints
Maurer, Mary Holy Family Memorial
Meicher, John St. Mary's Hospital
Merline, Karen
Nelsen, Dean St. Mary's Hospital
Nguyen, Juliet Sacred Heart Hospital
O'Hara, Tiffanie Wisconsin Hospital Association
Olson, Bonnie Sacred Heart Hospital
Olson, Keri St. Clare Hospital & Health Services
Ose, Peggy Riverview Hospital Association
Peiffer, Susan Sacred Heart Hospital
Penczykowski, James St. Mary's Hospital
Pennebecker, Allen Ministry Saint Michael's Hospital
Platt-Gibson, Melanie St. Clare Hospital & Health Services
Quinn, George Wisconsin Hospital Association
Reinke, Mary Aurora Health Care
Reynolds, Kristen Aurora Health Care
Richbourg, Mary Sacred Heart Hospital
Rocheleau, John Bellin Hospital
Roethle, Linda Bellin Hospital
Roundy, Ann Columbus Community Hospital
Rozenfeld, Jonathan St. Mary's Hospital
Rudolph, Wade Sacred Heart Hospital
Sanicola, Suzanne Columbia St. Mary's Columbia Hospital
Saunaitis, Tamara Meriter Hospital
Schaetzl, Ron St. Clare Hospital & Health Services
Schraufnagel, Patricia Memorial Medical Center - Ashland
Schwartz, Mary St. Clare Hospital & Health Services
Sender, Jon
Sheehan, Heather Hayward Area Memorial Hospital and Nursing Home
Sio, Tim Wheaton Franciscan Healthcare - All Saints
Slomczewski, Constance Wheaton Franciscan Healthcare - All Saints
Statz, Darrell Rural Wisconsin Health Cooperative
Steevens, Alan St. Clare Hospital & Health Services
Stelzer, Jason St. Clare Hospital & Health Services
Sullivan, Anne Memorial Medical Center - Ashland
Tapper, Joy Milwaukee Health Care Partnership
Teigen, Seth St. Mary's Hospital
Thurmer, DeAnn Waupun Memorial Hospital
Turner, Sally Aurora Health Care
Tuttle, Kathryn Memorial Medical Center - Ashland
Walker, Troy St. Clare Hospital & Health Services
Woleske, Chris Bellin Psychiatric Center
Wysocki, Scott St. Clare Hospital & Health Services
Zeller, Brad Hayward Area Memorial Hospital and Nursing Home
Contributors ranging from $500 to $999
Banaszynski, Gregory Aurora Health Care
Borgerding, Dana
Brooks, Alenia Aurora Health Care
Bultema, Janice
Canter, Richard Wheaton Franciscan Healthcare
Carlson, Dan Bay Area Medical Center
Chess, Eva Aurora Health Care
Clough, Sheila Ministry Eagle River Memorial Hospital
Dietsche, James Bellin Hospital
Ewing, Thomas Aurora Health Care
Fields, Mary Aurora Health Care
Hart, Shelly Aurora Health Care
Heifetz, Michael SSM Health Care-Wisconsin
Houlahan, Beth
Huettl, Patricia Holy Family Memorial
Hyland, Carol Agnesian HealthCare
Hymans, Daniel Memorial Medical Center - Ashland
Jacobson, Terry St. Mary's Hospital of Superior
Joyner, Ken Bay Area Medical Center
Just, Lisa Aurora Medical Center in Hartford
Kerwin, George Bellin Hospital
Larson, Margaret Mercy Medical Center
Lewis, Gordon Burnett Medical Center
Mantei, Mary Jo Bay Area Medical Center
McDonald, Brian Aurora Health Care
Miller, Jim Children's Hospital and Health System
Nelson, Dave SSM Health Care-Wisconsin
Potts, Dennis Aurora Health Care
Richards, Theresa Ministry Saint Joseph's Hospital
Rickelman, Debbie WHA Information Center
Roberts, Paula Children's Hospital and Health System
Russell, John Columbus Community Hospital
Samitt, Craig Dean Health
Schafer, Michael Spooner Health System
Selberg, Heidi HSHS-Eastern Wisconsin Division
Shabino, Charles Wisconsin Hospital Association
Stuart, Philip Tomah Memorial Hospital
Swanson, Kerry St. Mary's Janesville Hospital
Talley, Barbara St. Clare Hospital & Health Services
Taplin Statz, Linda SSM Health Care-Wisconsin
VanCourt, Bernie Bay Area Medical Center
Wilk, Leonard Aurora Medical Center in Grafton
Zenk, Ann Ministry Saint Mary's Hospital
Zorbini, John Aurora Health Care
Contributors ranging from $1,000 to $1,499
Anderson, Sandy St. Clare Hospital & Health Services
Bailet, Jeffrey Aurora Health Care
Britton, Gregory Beloit Health System
Buck, Catherine Froedtert Health
Byrne, Frank St. Mary's Hospital
Court, Kelly Wisconsin Hospital Association
Deich, Faye Sacred Heart Hospital
Falvey, Patrick Aurora Health Care
Francis, Jeff Ministry Health Care
Frank, Jennifer Wisconsin Hospital Association
Garcia, Dawn St. Joseph's Hospital
Herzog, Mark Holy Family Memorial
Hilt, Monica Ministry Saint Mary's Hospital
Johnson, Charles St. Mary's Hospital
Kelch, Elaine
Kosanovich, John
Lappin, Michael Aurora Health Care
Loftus, Philip Aurora Health Care
Mattes, Dan Wheaton Franciscan Healthcare
Natzke, Ryan Marshfield Clinic
Radoszewski, Pat Children's Hospital of Wisconsin
Ricci, Anthony Aurora Memorial Hospital of Burlington
Robertsad, John ProHealth Care - Oconomowoc Memorial Hospital
Roller, Rachel Aurora Health Care
Size, Pat
Tempelis, Eric Gundersen Lutheran Health System
Westrick, Paul Columbia St. Mary's Columbia Hospital
Contributors ranging from $1,500 to $1,999
Alig, Joanne Wisconsin Hospital Association
Barney, Steven SSM Health Care-Wisconsin
Bloch, Jodi Wisconsin Hospital Association
Boese, Jennifer Wisconsin Hospital Association
Clapp, Nicole Grant Regional Health Center
Coffman, Joan St. Joseph's Hospital
Eichman, Cynthia Ministry Our Lady of Victory Hospital
Gorelick, Marc Children's Hospital and Health System
Grasmick, Mary Kay Wisconsin Hospital Association
Hahn, Brad Aurora Health Care
Harding, Edward Bay Area Medical Center
Levin, Jeremy Rural Wisconsin Health Cooperative
Maciver, Carolyn Aurora Health Care
Meyer, Daniel Aurora BayCare Medical Center in Green Bay
Postler-Slattery, Diane Aspirus Wausau Hospital
Potter, Brian Wisconsin Hospital Association
Stanford, Matthew Wisconsin Hospital Association
Wallace, Michael Fort HealthCare
Warmuth, Judith Wisconsin Hospital Association
Contributors ranging from $2,000 to $2,999
Brenton, Mary E.
Erwin, Duane Aspirus, Inc.
Jacobson, Catherine Froedtert Health
Kachelski, Joe Wisconsin Statewide Health Information Network
Katen-Bahensky, Donna
Kief, Brian Ministry Saint Joseph's Hospital
Leitch, Laura Wisconsin Hospital Association
Merline, Paul Wisconsin Hospital Association
Mettner, Michelle Children's Hospital and Health System
Neufelder, Daniel Affinity Health System
Normington, Jeremy Moundview Memorial Hospital & Clinics
Oliverio, John Wheaton Franciscan Healthcare
Pandl, Therese HSHS-Eastern Wisconsin Division
Sanders, Michael Monroe Clinic
Sexton, William Prairie du Chien Memorial Hospital
Starmann-Harrison, Mary Hospital Sisters Health System
Taylor, Mark Columbia St. Mary's, Inc.
Woodward, James Meriter Hospital
Contributors ranging from $3,000 to $4,999
Borgerding, Eric Wisconsin Hospital Association
Fish, David Hospital Sisters Health System
Size, Tim Rural Wisconsin Health Cooperative
Turkal, Nick Aurora Health Care
Contributors $5,000 and above
Bjork, Tanya
Brenton, Stephen Wisconsin Hospital Association
Tyre, Scott Capitol Navigators, Inc

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WHA is "Convener and Igniter" on Wisconsin Physician Workforce Issue

WHA Board members participated in a panel discussion at the recent WHA Board Planning Session held in Elkhart Lake, facilitated by WHA Senior Medical Advisor Chuck Shabino, MD. Four CEOs participated in the panel, and they shared their views on WHA’s role in ensuring that Wisconsin has enough physicians to meet the demand for care.

Therese Pandl, president/CEO of St. Vincent Hospital, Green Bay said she has been pleased at the interest that the physicians in the Hospital Sisters Health System (HSHS) have shown in working with the Medical College and to being preceptors to medical residents. While it impacts their productivity to some extent, Pandl said HSHS believes it has a role in helping to train new physicians in a value-based model. That model, she said, can elevate patient care and keep physicians accountable.

As to WHA’s role, "WHA should be credited as a convener and as an igniter on the physician workforce issue and GME," according to Pandl. "We must stay focused and advocate for the continuation of GME payments, which will be a huge role."

Mike Sanders, president/CEO, Monroe Clinic, also sees WHA playing a large role in state and federal GME advocacy.

"WHA can advocate on issues that cut across the state that all hospitals can benefit from, " Sanders said. "There may not be a direct benefit to all who fund it, but in a statewide approach, we can get some balance between rural and suburban."

Catherine Jacobson, president/CEO of Froedtert Health, said providers are on a "collision course" with health reform. The decision to cut Indirect Medical Education payments is in direct conflict with the need to train more physicians to meet the demand that will increase as more people gain coverage.

Jacobson said the Medical College of Wisconsin Affiliated Hospital (MCWAH) model works because it is a collaborative between the MCW and the Milwaukee health systems that provides infrastructure for and acts as the administrative body for the medical residency program.

Sandy Anderson, president, St. Clare hospital in Baraboo and current WHA chair, sees the Association’s role as one of a convener in creating more residency slots.

"If we look at the linkages that WHA has with other health associations and trade organizations, and to Wisconsin Manufacturers and Commerce, we can use those ties to connect residency training to economic development in the state," according to Anderson. "We really need to use WHA as our advocacy voice."

Without residency opportunities, Wisconsin will be at a distinct disadvantage in its quest to meet the demand for physicians.

Physician training does not need to be limited to larger cities. Nicole Clapp, president/CEO of Grant Regional Health Center in Lancaster, said she was initially concerned about hosting a rural training track, but that didn’t stop her from considering a rural rotation program. Clapp said they are currently researching the requirements for graduate medical education. Grant Regional Health Center received a grant from the Wisconsin Rural Physician Residency Assistance Program to conduct an in-depth feasibility study to determine their capacity for resident training opportunities within a critical access hospital setting.

Sanders is anxious to get started on solutions. "WHA needs to be in lead role. We need partners, but we should not wait. We should not follow. We should lead," according to Sanders. "All our membership must be on board in this effort."

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President’s Column: Defense Trumping Medicare—and the Clock is Ticking…

In the Commonwealth of Virginia, the Senate race, which is still 100 days out, sees the issue emerging as something of a fist fight with the two partisan candidates one upping each other as to who would best be able to roll back the defense cuts in a state where defense spending is a top-tier economic development issue.

Nationally, Republican candidates, pretty much across the board, are pledging support for undoing the sequester…as it relates to military and defense spending. Obama Administration Defense Secretary Leon Panetta has labeled the cuts "devastating." No similar constituency has emerged, other than provider organizations, to question the looming Medicare cuts.

The fact is that if the rest of the nation provided the VALUE that Wisconsin (add in MN, IA and SD) provides to CMS, we wouldn’t be talking about a looming Medicare spending crisis.

These Medicare add-on payments, also known as "extenders," represent alternative payment methodologies that counteract the effects of low volumes and disproportionate patient mix from a program that pays rural hospitals about 80 cents on the dollar.

Steve Brenton

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Jandre Raises Concerns that Require Address, Topinka Tells WHA MPA Council
McKeown values WHA, hospital collaboration with public health

The WHA Council on Medical and Professional Affairs heard that a priority for WHA in the next legislative session will be addressing the issues created by the Wisconsin Supreme Court’s decisions in Jandre v. Wisconsin Injured Patients and Families Compensation Fund and other informed consent cases.

WHA and the Wisconsin Medical Society, with a broad coalition of partners, will be seeking legislation that clarifies the physician’s duty of informed consent in Wisconsin. Ralph Topinka, senior vice president and general counsel at Mercy Hospital and Truama Center in Janesville and member of the joint WHA and WMS Jandre Workgroup, explained to the Council at their August 2 meeting in Madison the potential effect of the Wisconsin Supreme Court’s decisions and provided an overview of the workgroup’s efforts to craft the clarification.

Karen McKeown, administrator of the Division of Public Health (DPH), joined the Council to discuss existing and possible future intersections between the work of public health and hospitals. McKeown and the staff at DPH are thankful for the good working relationship with WHA and Wisconsin hospitals, and the existing collaboration in the areas of infection prevention, emergency preparedness and data exchange. Karen and her team continue to look for additional areas of collaboration.

The Council discussed two topics that have the strongest potential for synergy with existing WHA Partners for Patients quality improvement projects that include reducing early elective deliveries and promoting patient self-management programs to help reduce readmissions.

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CMS Releases Final FY 2013 Inpatient PPS Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) on Wednesday, August 1, issued its hospital inpatient prospective payment system (PPS) final rule for fiscal year (FY) 2013. (For information about the proposed rule, see

The final FY2013 rule overall provides for an increase of 2.3 percent on average in hospital payments nationwide when compared to FY 2012. This is up from CMS’ proposed rule which would have increased hospital payments by .9 percent average. The difference is in part due to changes in the proposed policies for documentation and coding cuts. CMS withdrew its proposed cut to inpatient payments to permanently eliminate what CMS claims is the effect of documentation and coding changes from FY 2010 the agency says do not reflect real changes in case-mix. Unfortunately, CMS continues to implement the coding cuts for 2008 and 2009.

In both the proposed and final rule, it is important to note that CMS did not factor in the expected across-the-board budget cuts of 2 percent expected to begin next January.

As in the proposed rule, Massachusetts will continue for a second year to receive a significant windfall from its "manipulation" of the rural floor policy.

The final rule implements several changes to various quality reporting programs, including the removal of a number of measures currently used in the Inpatient Quality Reporting (IQR) program effective in 2015. Changes are made to hospital acquired conditions, and to the hospital value-based purchasing program. The final rule also implements changes to the Long-Term Care Hospital, the PPS-Exempt Cancer, and Inpatient Psychiatric Facility quality reporting programs.

CMS also proposes a number of changes related to Graduate Medical Education, including the expansion of the cap-building period from three years to five years. CMS also finalizes criteria and timeframes for hospitals to retain any new resident slots it received as a result of the resident redistribution provision under ACA. CMS announces a deadline of October 29, 2012 to apply for additional residency slots coming from recently closed hospitals.

In addition, CMS finalizes their proposal to include labor and delivery bed days in the count of available beds used in the DSH and IME calculations. CMS estimates this change would decrease IME payments by $170 million in FY 2013.

Finally, the proposed rule would have imposed a retroactive and punitive policy on hospitals that had erroneously been given sole community hospital (SCH) status, or that no longer qualified for SCH status. Under the final rule, we are pleased that CMS has modified the effective date of SCH cancellations to 30 days after the Regional Office’s decision that the hospital no longer meets the SCH criteria, with an exception for cases of fraud.

What’s Next?

Watch for a more detailed analysis in the coming weeks. The final rule is expected to be published in the federal register on August 31, and the policies and payment rates will take effect October 1.

The final rule is available at:

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TCAB Visits Continue to Show Results-Oriented Success in Wisconsin Hospitals

Involving direct caregivers in care improvements is the goal of Wisconsin’s Transforming Care at the Bedside (TCAB) project. The project is nearing completion after 18 months of activity. WHA’s Judy Warmuth has been visiting the medical-surgical nursing units enrolled in the project to hear their reports and to see the progress made by these teams.

Staff at Froedtert Community Memorial Hospital in Menomonee Falls began their visit by sharing data with Warmuth showing unit improvements in seven publicly-reported measures, all now exceeding the unit-based goal of 86 percent. Team members outlined the unit changes that created the improvements. The team continues its activity with physician rounding and an ‘all about me’ patient preferences program.

The TCAB team at Beloit Health System reviewed their project successes and actions including improvements to documentation for continuous bladder irrigation (CBI), implementation of a ‘red box’ in isolation rooms and new admission and discharge folders for patients and families. The team is also directing staff involvement in unit redesign. They provide a weekly email to staff on data and results.

The excitement and energy by the TCAB Team at Boscobel Area Health Center staff was palpable as they reported on projects that included involving their hospital departments in a recycling project, and a planned expansion of TCAB activities to the clinic environment. Changes and results in team vitality were highlighted as were changes made early in the project that have been sustained.

The Transforming Care at the Bedside Project has been supported by the Robert Wood Johnson Foundation as part of an Aligning Forces for Quality project.

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WHA 2012 Leadership Summit
September 21, 2012

Marriott Hotel, Madison

Make your hotel reservations before the deadline of August 31

Brochure and registration information can be found online at

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Wisconsin Hospitals Community Benefits: Charity Care

Fear of a bill should never prevent a patient from seeking care at a Wisconsin hospital. Wisconsin hospital charity care programs provided $232 million to more than 700 patients each day last year. The stories that follow illustrate the deep commitment and continuing concern that hospitals have to their patients to ensure they receive the care they need regardless of their ability to pay.

Community Care program facilitates true patient-centered experience

Danielle is, by all accounts, a healthy young woman. She never had any hospital stays, and only scheduled clinic appointments rarely, when a health concern arose. Young and seemingly "invincible" could have described her mindset. That unexpectedly changed, however, in July 2011.

Danielle had been experiencing stomach pains off and on, lasting a few days at a time. Like many of us, Danielle would tough it out and the pain would go away. Finally, however, at the sight of her belly button protruding and blood, Danielle went to the ER. She was diagnosed with an umbilical hernia.

"The pain always went away, so I didn’t think there was any real problem. Being told I needed surgery threw me for a loop. I didn’t have extra money to pay for this, because I already had my regular bills. So now, I was stressed out about my health and how much this was all going to cost."

Shortly after leaving the Clinic, Wendy Proffitt, Patient Financial Services Supervisor, contacted Danielle. Wendy explained Memorial Medical Center’s Community Care program and asked if this was an option that Danielle would like to explore. With relief reflected in her voice, Danielle replied "Yes."

On the day of her surgery, Danielle came to Memorial early and met with Wendy to provide the required documentation.

"She was very diligent in gathering the paperwork and scheduling time to meet with me. It is gratifying to see people understand the opportunity the Community Care program offers and take the application seriously," explained Proffitt.

Feeling optimistic about the bill, Danielle focused on her surgery, trying not to be nervous.

"I remember the surgeon, nurse anesthetist, and nursing staff all meeting with me. They explained what was going to happen during surgery and what I could expect when I woke up. I remember Dawn [OR Technician] being especially nice, spending extra time to make sure I was comfortable. And Dr. Paustian was so friendly, taking plenty of time to talk with me and make me feel secure."

Since her surgery, Danielle is recovering well. She is healing normally and has been cleared to return to work -- which is really good news to Danielle.

More good news came when Wendy contacted Danielle to confirm that the Community Care program was going to pay approximately $11,470 of the total bill, leaving Danielle to pay only $25.

"I’m glad Community Care exists, that’s for sure. I mean, I never thought I would need it, but I bet no one does. And I’m grateful for the kindness of the staff too. No one talked down to me. They focused on making me feel that I was in good hands, and things would all be OK."

Memorial Medical Center, Neillsville

What financial counselors see that we never see

A 26-year-old male was experiencing shortness of breath and a sharp pain on the left side of his chest when he came to the Emergency Department at Aurora Sinai Medical Center. He was diagnosed with congestive heart failure and was admitted to the hospital for treatment. The patient was unemployed, uninsured and had no income. He and his wife had been homeless for six months, relying on shelters, as well as living with friends.

Upon recovery, Financial Counselor Della Nichols met with the couple to assist them with applying for the Aurora Helping Hand Patient Financial Assistance Program and to provide information on food pantries and other community resources.

Della recalls, "The couple looked very distressed. The wife had holes in her shoes, and the husband wore an old T-shirt. I went into our ‘emergency clothing closet’ and found a pair of shoes for the wife and a few T-shirts for her husband before they left the hospital. They accepted the shoes and T-shirts graciously."

Within days, the patient received the best news possible regarding his medical bills. He was approved for a 100 percent discount through the Aurora Helping Hand Patient Financial Assistance Program enabling him to receive the needed follow-up treatment in order to fully recover.

Aurora Sinai Medical Center, Milwaukee

Community Care recipients come from all walks of life…

In 2010, Upland Hills Health provided 1,408 people with reduced or entirely forgiven bills, based on their financial situations. A total of $462,453 was forgiven through the Community Care program. Recipients came from a variety of situations, including:

Upland Hills Health offers Uncompensated Care to our uninsured outpatients or inpatients when they present through our Emergency Department. If a patient is admitted with an inpatient status, our patient benefit specialist talks directly to the patient about our Community Care Program and helps the patient complete the application immediately if they are well enough.

Upland Hills Health, Dodgeville

Judith’s story

"I have never owed anyone in my life, and now I have this huge bill. I don’t know what to do."

This winter was particularly hard for Judith. "I knew I was sick, but I guess I didn’t know how sick." Judith explains.

She spent more than two weeks in in the hospital, including time in the Intensive Care Unit, battling bronchitis and COPD. She hardly remembers her hospital stay.

"It almost did me in. I don’t know exactly what the doctors and staff did for me but… thank goodness they knew what they were doing because they saved my life!"

As Judith was starting to feel better and think about going home, she experienced another scare – she started to worry about her bill. "I am 63 years old, and I have never owed anyone money before. I knew that I couldn’t work. How can I pay? I didn’t know what to do."

Before Judith was discharged, she met with one of Meriter’s Patient Finance Coordinators, who helped her through the paperwork for financial assistance. While this gave Judith some hope, she still worried as the bills continued to climb. "Just to get out of the hospital, I needed medication and oxygen. It was one thing after another. You know, it is hard on person to owe. It was all I could think about. I thought about selling my house. I wasn’t sure how I would live the rest of my life."

Shortly after arriving home Judith learned that Meriter forgave her entire bill. "I almost cried!" Without the stress of the bill weighing on her, Judith could focus on getting better. She can exercise a little and has made lifestyle changes to help her stay well. "I am so grateful. The staff at Meriter helped me through everything. Meriter saved my life – twice!"

Meriter Hospital, Madison

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