October 2, 2015
Volume 59, Issue 39

State Lawmakers Circulate Bipartisan Mental Health Reform Legislation
Borgerding: “Providers are coming to the table”

A bipartisan group of Wisconsin lawmakers circulated a bill to their colleagues September 29 that would authorize nearly $1 million in state funding for Medicaid pilot projects that test alternate payment models for care coordination and psychiatric consultations. The legislation, introduced by Rep. Mary Czaja (R-Irma), Sen. Leah Vukmir (R-Wauwatosa), Rep. Deb Kolste (D-Janesville) and Sen. Janet Bewley (D-Ashland) would also authorize $30,000 a year to go to the development of a mental health bed tracking program to take a statewide, near real-time inventory of open inpatient psychiatric beds.

In a memo to their colleagues, the four legislators said that Wisconsin has some of the best health care in the nation but noted there is more to be done to serve individuals suffering from mental illness.

“As a state, we cannot reform care delivery and lower utilization without testing alternative models,” said the legislators. They continued by saying these “pilot programs will help us understand what we can do to improve care in Wisconsin.” 

“We are grateful for the bipartisan leadership shown by both rural and urban state lawmakers on this important piece of legislation,” said WHA President/CEO Eric Borgerding. “The pilot programs in this bill will demonstrate how health care providers are coming to the table with innovative care coordination solutions that will lead to better care for those suffering from mental illness, better use of resources and lower costs in our Medicaid program.”

The first pilot would use approximately $1.5 million in state and federal funds to make payments to integrated health systems that provide comprehensive, coordinated care to patients with chronic mental illness. The pilot period would be three years, and a provider would be required to target a Medicaid population of high volume or high intensity users of non-behavioral health medical services with significant or chronic mental illness. Providers awarded a pilot project would need to submit interim and final reports analyzing utilization and expenditures of the target population versus a control population.

The second pilot would allocate $500,000 to encourage consultations between psychiatrists and other health care providers for individuals with mild to moderate mental illness and physical health needs. Similar to the first pilot, recipients would need to file interim and final reports with the Wisconsin Department of Health Services (DHS) analyzing the performance of the pilot project. This pilot program would also span a period of three years.

DHS would have the authority to develop the pilot projects and make awards to eligible health care providers under criteria specified in the legislation.

Finally, the legislation would authorize funding to create an online mental health bed tracking system in Wisconsin, modeled after a similar program currently operated in Minnesota by the Minnesota Hospital Association. The program would be voluntary and would provide information on the number of available child, adolescent, adult and geriatric inpatient psychiatric beds available at the time the hospital reports the information. This information would benefit health care providers, including emergency department staff, who are attempting to locate an available inpatient bed for a patient in need of psychiatric services.

The legislators are asking their colleagues in the Senate and Assembly to sponsor the legislation and plan to formally introduce the bill after October 9. Following formal introduction, the bill moves to standing committees in the Legislature for public hearings and committee votes.

For more information, see a copy of the legislators’ memo, a copy of the bill draft and WHA’s memo to lawmakers asking them to sponsor the legislation. If you have questions about this legislation, contact WHA General Counsel Matthew Stanford at mstanford@wha.org or WHA Senior Vice President, Government Relations, Kyle O’Brien at kobrien@wha.org

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Guest Column: Post ICD-10 Operations: Top Metrics to Watch in the First 30 Days
By Debbie Rickelman, Vice President, WHA Information Center

Congratulations to all Wisconsin hospitals and health systems as you work through the first few days of ICD-10 implementation. Hopefully, all the preparation has paid off, and you are now actively working (somewhat successfully) in a production environment. Anecdotal feedback indicates Wisconsin hospitals are generally ready. 

WHA Board Chair Therese Pandl, president/CEO, HSHS Eastern WI Division, notes, “We are in good shape, although there are always minor details. Our awesome ICD-10 project director has done a great job preparing our system.”

It is important to remember the vision for ICD-10 was that the clinical story for patients will be told much more specifically using the new codes. We will have more discrete information about the health of our population. Predictions are that long-term opportunities for quality reporting, research, health policy and value-based payment will surface over time. However, first we need to focus on operational issues such as claims payment, cash flow, coder productivity/accuracy and physician documentation.

Anything can happen when so many internal and external stakeholders are involved, even for those organizations that have done extensive testing and training. Health care providers and their staff who work collaboratively within their organizations to report and address snags will benefit immediately. The next 30 days is a critical time to use an established mechanism for reporting issues so your organization does not have a landslide of complications down the line. 

Some key performance indicators to watch for include:

As with all performance metrics, the goal is to identify struggles early on while they are manageable. More than one hospital CFO has had nightmares about the historic 5010 claim format transition. Let’s learn from that and be on top of our game. 

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Federal Fiscal Deadlines Approach
Medicare reimbursement cuts should not be Congress’ ATM

Running right up to the deadline, on September 30, Congress passed and the President signed into law a Continuing Resolution that funds the federal government through December 11. This stop-gap measure leaves Congress a few months to try to negotiate a larger two-year budget, address the impending debt ceiling and other fiscal issues. 

With this scenario facing Capitol Hill, the Wisconsin Hospital Association (WHA) will be on guard against any arbitrary Medicare cuts that could be in the offing. Cutting Medicare reimbursements for hospitals and health care systems to help pay for a budget deal or to fund other fiscal priorities is unacceptable. 

As always, WHA will engage our membership in helping us advocate to our Congressional members that they should protect Wisconsin’s high-value, high-quality providers, not hurt this asset with any additional cuts. One recent example where our advocacy efforts were successful was fighting back when Congress proposed using Medicare cuts to fund a portion of a trade package deal earlier this year. Another example was how Congress adroitly addressed repealing and replacing the Sustainable Growth Rate without devastating cuts to hospitals or health care systems. Hospitals engaged on both these issues, and it made a difference. 

WHA will continue to encourage Congress to reward value and quality in Medicare, but we will strongly oppose arbitrary cuts. Stay tuned over the next several months as the federal fiscal situation unfolds. We may need to engage your help in protecting Wisconsin hospitals and health systems. 

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In-Depth: 340B Proposed Guidance
WHA encourages review of definition of patient, other provisions 

In late August, the Health Resources and Services Administration (HRSA) released its long-awaited proposed guidance on the federal outpatient drug discount program known as 340B. Interested parties may comment on the proposal until October 27. The Wisconsin Hospital Association (WHA) intends to provide comments after full review and input from its membership. 

The proposed guidance contains provisions related to a variety of 340B program areas, but some of the biggest changes largely revolve around the new six-part criteria established under the “definition of a patient.” HRSA proposes that a six-part criteria be met for a patient on a “prescription-by-prescription or order-by-order basis.” Those six criteria are as follows:

  1. Individual receives health care services at a hospital or outpatient facility that is registered and listed in the 340B public database. Further, HRSA adds that an individual who receives initial care at a 340B-covered entity but then receives follow up care at a non-340B site would not be considered an eligible patient for that follow-up care. Affiliation arrangements with a covered entity are not sufficient to establish patient eligibility.
  2. Individual receives care from a provider that is either employed by or is an independent contractor for the hospital such that the hospital may bill for services on behalf of the provider. HRSA indicates faculty practice arrangements and locum tenens, for example, would suffice, but having privileges or being credentialed would not be sufficient to establish eligibility.
  3. Individual receives a drug that is ordered or prescribed by the hospital’s provider as a result of care provided by that provider (this relates back to criteria #2). HRSA specifically states that if dispensing or infusion of a drug is the only health care received, then that does not qualify. 
  4. Individual’s health care is consistent with the scope of the federal grant, project or contract. (This requirement would largely not apply to hospitals.)
  5. Individual is classified as an outpatient when the drug is ordered or prescribed. (This means it must be billed as outpatient, cannot be prescribed at inpatient discharge, etc.)
  6. The individual’s patient records are accessible to the covered entity and the hospital can demonstrate it is responsible for the patient’s care. HRSA adds that the records must be auditable and establish provider-patient relationship resulting in 340B drug being ordered, etc. 
HRSA’s guidance also includes several other provisions WHA would like to highlight: WHA encourages 340B covered entities to review the full guidance and provide the Association with any areas of potential concern. Review the proposed guidance at: www.gpo.gov/fdsys/pkg/FR-2015-08-28/pdf/2015-21246.pdf

Questions or comments should be directed to Jenny Boese, WHA vice president, federal affairs & advocacy, at 608-268-1816 or jboese@wha.org.

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KEPRO Provides Overview of New Two-Midnight Review Process

On September 30, KEPRO, one of the quality improvement organizations newly tasked with handling reviews of the two midnight short stay policy, hosted its first webinar detailing their review process. KEPRO is beginning to bring this process online, and issues are still being discussed between KEPRO and the Centers for Medicare & Medicaid Services, but here are some general highlights of what providers should expect. 

Finally, organizations may designate a contact person to receive communications from KEPRO for short stay reviews. Hospitals should use this form to designate a point of contact.

KEPRO’s slidedeck from this week’s webinar can be accessed here. KEPRO two midnight information may be accessed at www.keproqio.com/twomidnight

For additional information, contact WHA’s Jenny Boese at 608-268-1816 or jboese@wha.org.

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UW Sponsors Conference on Opioids in the Management of Chronic Pain 

The launch of a new public opioid awareness campaign in Wisconsin (http://doseofrealitywi.gov) has raised interest in professional education among health care practitioners. A conference sponsored by the UW School of Medicine and Public Health, School of Pharmacy, and the School of Nursing will focus on “Opioids in the Management of Non-Malignant Chronic Pain,” and will be held November 11 at the Madison Marriott West Hotel in Middleton. 

The 2015 Madison Fall Institute will provide pharmacists, nurses, physicians and other interested health care practitioners with updates on the management of non-malignant chronic pain with a focus on safe practices for opioid use. Health care professionals who interact with or manage patients prescribed with opioids for treatment of non-malignant chronic pain are encouraged to attend. Share program information with colleagues/associates who may have an interest in the theme and topics.

More information, including an agenda and registration information, is available here. The registration fee is $135 ($175 after October 14) and fee includes all instruction, processing of CE credit, and lunch. 

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Recent Developments in Meaningful Use

CMS Says Hardship Exceptions Available for Having Switched EHR Vendors
In an encouraging move, the Centers for Medicare and Medicaid Services (CMS) announced last week that hospitals and doctors that have switched certified EHR technology vendors and are accordingly unable to meet the meaningful use requirements of the Medicare and Medicaid EHR Incentive Program may apply for a hardship exception to avoid a payment adjustment.

CMS Urged by Congress to Finalize the Stage 2 Rule and Postpone Stage 3 Rule
Meanwhile, Congress has called on the federal Department of Health and Human Services (HHS) immediately to adopt the proposed modifications to the Stage 2 meaningful use requirements and also to refrain from finalizing the requirements for Stage 3. Sens. John Thune (R-SD) and Lamar Alexander (R-TN), chairmen of Senate committees with jurisdiction over health information technology, urged HHS in a September 29 letter to finalize a 90-day reporting period for 2015 and more reasonable patient engagement measures for Stage 2, as well as to evaluate experience of Stage 2 before finalizing Stage 3 reporting requirements. This letter comes a day after a bipartisan group of 116 U.S. Representatives, including Wisconsin Rep. Glenn Grothman, urged HHS in a separate letter to “pause” the Stage 3 rulemaking process. The House members stated that HHS should “incorporate the lessons learned from Stage 2 into Stage 3” but that “[t]his is not possible at present because a minority of providers have achieved Stage 2 and because the Stage 2 modifications rule has yet to be implemented.”

Congress’s call to HHS echoes comment letters WHA submitted to the federal agency earlier this year, wherein WHA encouraged CMS to finalize portions of the Stage 2 rule that support high-quality, low-cost health care and to postpone finalizing the Stage 3 rule until CMS has evaluated the experience of Stage 2 and accelerated the availability of mature standards to support meaningful use requirements in accordance with clinical needs. Both rules were transmitted to the Office of Management and Budget on September 3, the final step before being finalized and published.

View CMS’s hardship exception announcement, the Thune-Alexander letter and the letter from the U.S. Representatives.

For additional information, contact Andrew Brenton, WHA assistant general counsel, at abrenton@wha.org, or Matthew Stanford, WHA general counsel, at mstanford@wha.org, or 608-274-1820.

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WCMEW to Host Team-Based Care Summit on November 12

The Wisconsin Council on Medical Education and Workforce (WCMEW) is hosting a one-day event focused on designing and advancing team-based care. Team-Based Care Summit 2015: Transforming Concepts into Reality will be held November 12 in Appleton and registration is now open at http://events.SignUp4.net/15TBC1112.

The Summit will begin with an opening keynote session focused on improving population health through team-based care. A plenary session will examine payer perspectives on team-based care. Breakout sessions will focus on using metrics as a guide for team-based care; provide a how-to guide to managing workflows, protocols and team member roles; ways to leverage learners in existing or developing teams; and measuring the outcomes of a team’s impact. 

Registration is now open for this event. For information, including the day’s agenda, visit: http://events.SignUp4.net/15TBC1112. Registration questions can be directed to Jenna Hanson at jenna.hanson@wha.org or at 608-274-1820.

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Deadline Extended: Poster Showcase Submissions for WCMEW Team-Based Care Summit

Health care teams are invited to submit a project to be showcased as a poster display at the second annual Wisconsin Council on Medical Education and Workforce (WCMEW) Team-Based Care Summit. Poster showcase submissions are due by October 16.

The Summit is scheduled for November 12 at the Radisson Paper Valley Hotel in Appleton, and the agenda will include time for a poster showcase, allowing teams to learn from and network with one another. Projects focused on the following topics will be considered for poster displays:

To submit, please complete the form located at: http://events.SignUp4.net/15TBCPosterShowcase by October 16.

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WHA’s Grasmick Presented WHPRMS 2015 Professional Excellence Award

The Wisconsin Healthcare Public Relations & Marketing Society (WHPRMS) awarded WHA Vice President of Communications Mary Kay Grasmick the 2015 Professional Excellence Award. The award was presented to Grasmick at the WHPRMS Annual Conference October 1 in La Crosse.

The WHPRMS Professional Excellence Award is given to a WHPRMS member who has demonstrated innovation in the practice of strategy development, enhancement of health care marketing/PR professional credibility, and exceptional personal qualities and leadership abilities.

WHA President/CEO Eric Borgerding said, “Mary Kay is a dedicated advocate for health care across Wisconsin, a trusted professional among her public relations and communications colleagues. She is proud of the high quality care this state is known for and always eager to tell the Wisconsin health care story in new and impactful ways. The WHA team is very happy for Mary Kay, and proud that our colleague is receiving this well-deserved honor and important recognition from her peers.” 

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OB Simulation Training Scholarships Available to Hospitals 
Priority deadline: October 9

Five simulation labs across the state have partnered with the WHA Foundation to offer hospitals hands-on experience in a variety of OB simulations. The WHA Foundation has granted funding to provide scholarships for interdisciplinary OB teams to participate in OB clinical simulation training at these labs, in an effort to provide hospitals greater access to simulation-enhanced learning environments.

To apply for an OB Clinical Simulation Training scholarship application, visit the WHA Foundation webpage at: www.wha.org/whaFoundation.aspx.

Priority submission deadline for scholarship applications is October 9, 2015, with notification by October 23. Regular submission deadline is December 1, with notification by December 4. A maximum of 20 scholarships will be awarded, so hospitals are encouraged to apply as soon as possible. 

This is an excellent opportunity for hospitals who might have limited access to high fidelity OB simulation. The training will include up to eight hours of clinical simulation exercise, staff to assist the hospital OB team in the identification and development of appropriate scenarios, debriefing after simulation completion and materials for the hospital to take back to their facility to share with colleagues. The actual training must take place between November 1, 2015, and October 31, 2016. 

Direct any questions to Jennifer Frank at jfrank@wha.org.

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Update: Partner Trainings Regarding Enhancements to ACCESS 

The Department of Health Services (DHS) will host trainings in October for community partners regarding enhancements being made to ACCESS October 24, 2015. ACCESS will be updated with new features that will expedite application processing for applicants. For some applicants, these new features will allow additional online data matching to minimize the need for additional verification and for a small number of applicants, it could mean they are able to get an immediate eligibility determination. This new, immediate eligibility determination is referred to as real-time eligibility. The MyACCESS tool is also being enhanced to allow existing members to apply for additional programs through a streamlined process—Add a Program. 

DHS will hold six in-person trainings around the state and one webcast. Dates, times, and locations of the trainings are listed below. Please note the corrected date for the La Crosse training is October 22


Green Bay
Tuesday, October 6, 2015, 1:00 – 2:30 p.m.
Northeast Wisconsin Technical College, Room SC128 (Executive Dining Room)
2740 West Mason Street, Green Bay, WI 54307

Thursday, October 8, 2015, 10:00 – 11:30 a.m.
Goodman Community Center, Evjue Room D
149 Waubesa Street, Madison, WI 53704

Wednesday, October 14, 2015, 2:30 – 4:00 p.m.
Wisconsin Indianhead Technical College – Ashland
2100 Beaser Avenue, Ashland, WI 54806

Chippewa Falls
Thursday, October 15, 2015, 1:00 – 2:30 p.m.
Chippewa County Courthouse, Lower Level – Room #003
711 North Bridge Street, Chippewa Falls, WI 54729 

Wednesday, October 21, 2015, 1:00 – 2:30 p.m.
Medical College of Wisconsin, HRC Auditorium
8701 Watertown Plank Road, Wauwatosa, WI 53226

La Crosse -Session 1
Thursday, October 22, 2015, 10:30 a.m. – 12:00 p.m.
La Crosse County Health and Human Services Building, Basement Auditorium
300 4th Street North, La Crosse, WI 54601

La Crosse- Session 2
Thursday, October 22, 2015, 1:00 – 2:30 p.m.
La Crosse County Health and Human Services Building, Basement Auditorium
300 4th Street North, La Crosse, WI 54601

Will be available on Friday, October 23, 2015
A link to the webcast will be available on the ForwardHealth Community Partners webpage.

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DHS Releases Public Health Profiles for State, County, Public Health Regions

Hospitals and health systems that are working with their communities to identify health priorities will find a new resource from the Department of Health Services (DHS) helpful. 

Public Health Profiles are published annually by DHS, and they provide concise health and demographic information about each county in Wisconsin. Detailed demographic information is available in the following categories: deaths, births, income and workforce data, and motor vehicle and injury rates, among others. The profiles also include data related to hospitalizations by cause, age group, and cost. DHS used data collected by the WHA Information Center to populate the profiles. 

The WHA Information Center collects, analyzes and disseminates complete, timely and accurate reports about charges, utilization and quality provided by Wisconsin hospitals, ambulatory surgery center and other health care providers. 

The county profiles are available at: https://www.dhs.wisconsin.gov/stats/pubhealth-profiles.htm.

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October is Breast Cancer Awareness Month

Breast cancer is the second most common cancer (behind skin cancer) and second leading cause of cancer death (exceeded only by lung cancer) among women in the U.S. About 1 in 8 (12%) women in the U.S. will develop invasive breast cancer during their lifetime.

The American Cancer Society estimates about 40,290 women in the U.S. will die from breast cancer in 2015. According to the WHA Information Center’s most recent four quarters of data, (April 2014 – March 2015) there were 540 inpatient admissions, 7,514 outpatient surgeries, and 54,548 other hospital outpatient visits for the diagnosis or treatment of female breast cancer. 

The WHA Information Center is dedicated to collecting, analyzing and disseminating complete, accurate and timely data and reports about charges, utilization, quality and efficiency provided by Wisconsin hospitals, ambulatory surgery centers and other health care providers.

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