October 25, 2013
Volume 57, Issue 42
GME Conference Focuses on Starting, Sustaining Medical Education Opportunities
Governor says GME investments will attract, keep doctors in Wisconsin
One of WHA’s top priorities is to increase the supply of physicians, especially in primary care. More than 70 hospital and health system leaders and senior decision makers involved in the process of evaluating and implementing graduate medical education (GME) programs attended a one-day conference October 24 in Neenah sponsored by the Wisconsin Council on Medical Education and Workforce (WCMEW). The conference addressed a number of the key components involved in starting and sustaining community-based GME opportunities. John Raymond, MD, president/CEO of the Medical College of Wisconsin, and Dean Robert Golden, MD, UW School of Medicine and Public Health, discussed the role that academic medical centers and community teaching hospitals have in creating clinical experiences in more rural settings. WHA members Mark Thompson, MD, chief medical officer, Monroe Clinic, and Andy Anderson, MD, senior vice president, academic affairs, Aurora Health Care, explained how GME fits into a hospital’s strategic plan.
"It is gratifying to see how much progress we have made over the past year in implementing the recommendations that were introduced in WHA’s physician workforce report," said WHA Senior Medical Advisor Chuck Shabino, MD. "Our members and physician leaders are fully engaging in their own communities to gather the resources that are required to implement a successful GME program. This conference helps put us another step closer to our goal of ensuring that our hospitals and health systems can meet the current and future demand for medical care."
As Wisconsin hospitals and health systems develop and expand GME opportunities in their communities, they can count on the strong support of Governor Scott Walker.
"One of my biggest priorities is to increase the number of doctors and dentists in Wisconsin, particularly in rural areas. We know that more than 85 percent of the students from Wisconsin who attend medical school here and complete a residency in-state will stay here to practice medicine," the Governor said in a video message to the conferees. "The grants program that was funded in the state budget is just one way that my administration and the Legislature are demonstrating our commitment to ensuring that you have the resources you need to create education and clinical opportunities for our future physicians."
The Governor said the state is investing nearly $23 million into improving access to health care for Wisconsinites in rural and impoverished urban areas through medical training programs and rural medical residency grant incentives. He knows that a strong health care delivery system is an economic development asset.
"Making sure we have enough talented doctors, dentists and health care workers in the state, particularly in less-populated areas, directly affects the quality of life for people who live here, and it also has a big impact on the economy," according to the Governor. "Much like good schools, business owners consider a strong health care system a key factor in deciding where to locate and expand."
WHA Executive Vice President Eric Borgerding recognized the Governor and State Rep. John Nygren (R-Green Bay) at the conference for their leadership and support of GME in the state capitol.
"Gov. Walker and Rep. Nygren have been strong champions of GME and helped us secure grant funding throughout the state budget process," Borgerding said. "It was the Governor’s initiatives in the state budget, earmarking $23 million for increased medical school education and hospital training capacity that have given our efforts in Wisconsin a welcome boost."
Watch for more in-depth coverage of this conference in the November 1 issue of The Valued Voice.
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On October 22, the Assembly Committee on Health held a public hearing on 12 bills recommended by the Speaker’s Task Force on Mental Health. The Committee began by hearing a WHA legislative priority, AB 453—the Mental Health Care Coordination Bill. The bipartisan bill’s authors are Rep. Severson (R-Star Prairie) and Pasch (D-Shorewood), and Sens. Vukmir (R-Wauwatosa), Carpenter (D-Milwaukee) and Shilling (D-La Crosse). Forty-three legislators from both parties are co-sponsors of Assembly and Senate companion bills.
"This bill removes statutory restrictions on psychiatrists and other mental health providers from coordinating a patient’s care with the patient’s other treating providers that has resulted in less coordinated, less integrated, and more costly care for individuals with mental illness," said WHA’s Matthew Stanford in verbal testimony before the Committee. "AB 453 will improve the health outcomes for individuals with mental health needs by updating Wisconsin law to be consistent with modern integrated approaches to medicine."
In his testimony before the Committee, Dr. Rick Hafer, vice-chair of the Psychiatric Department for UW Health reinforced the point that AB 453 is about improving patient care. "I observe the daily disadvantages of the current separation of medical from mental health records," said Dr. Hafer. "I’m also keenly aware that with the proposed changes the quality of health care delivery will improve. The current system does not ‘protect’ patients, but actually makes them more vulnerable."
AB 453 provides important protections by maintaining existing special confidentiality for ‘psychotherapy notes,’ as well as patient rights to request restrictions on the disclosure of health information, Stanford also noted in his remarks.
Assembly Bill 451 – Creation of a process to challenge a county denial of an emergency detention recommended by a treating provider
WHA also testified on Assembly Bill 451, a bipartisan bill that would empower families and treating health care providers to help an individual with mental illness receive necessary involuntary emergency stabilization if they believe the person is an imminent danger to themself or others.
Under current law, an individual with mental illness may be temporarily detained to receive emergency stabilizing care if the person evidences a danger to themself or others. However, county crisis agencies must approve such temporary detention. If the county agency denies the detention, the county is not required to provide rationale to family members or treating providers on why they denied the detention. Also, family members or treating providers have no venue of recourse to challenge this decision.
Dr. Matt Sager, St. Mary’s Hospital (Madison) Department of Psychiatry Chair, testified in support of AB 451 and provided examples of the difficult position psychiatrists and their patients are put in when there is no ability to quickly challenge a county’s decision to deny an emergency detention recommended by a treating psychiatrist.
"Wisconsin isn’t the only state that I have practiced in. I don’t know the history of why physicians don’t have the ability to be involved in the process in Wisconsin," said Dr. Sager. "This fear that there will be this glut of unsubstantiated emergency detention has not been proven in other states."
Since its inception in 2008, members of WHA’s Mental Health Task Force have expressed concerns that under current law, there is no mechanism for treating health care providers to independently challenge a decision by law enforcement or a county crisis agency to deny such emergency, temporary detention for a patient that the treating provider believes meets the clinical and legal criteria for emergency detention.
WHA’s 2010 Behavioral Health Task Force White Paper noted that, "While the problem is not statewide, for those hospitals that are facing emergency detention problems, the concerns are very real."
"WHA supports this bill, because it gives families and treating health care providers an ability to challenge a decision by a county crisis agency to not approve and initiate a temporary, emergency, involuntary treatment for a mentally ill individual that the health care provider believes is a danger to themselves or others," Stanford said at the public hearing.
WHA testimony on other mental health bills
WHA also provided testimony this week on the following bills:
Copies of WHA’s written testimony and the bills can be found at www.wha.org/mentalhealth.aspx.
To see the 2010 WHA Behavioral Health Task Force White Paper, go to: www.wha.org/Data/Sites/1/behaviorhealth/bhtf-whitepaper.pdf.
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The week started with an announcement by President Obama about the federally-facilitated health insurance exchange. Reactions to the message were mixed, but further reports indicate that the insurance exchange website still is not functioning for the vast majority of Americans and Wisconsinites that have tried to access it. Few have gotten through the full application process and successfully enrolled in a qualified health plan. The federal government has not released exact numbers, but has indicated it has brought in top IT experts to assist in fixing issues with site. WHA continues to monitor the process.
New Data on Medicaid Recipients
In the meantime, more information has been released on the number of current Medicaid recipients that could be disenrolled from the program beginning January 1, 2014, under the changes included in the biennial budget act (2013 Wisconsin Act 20). The most recent information indicates that statewide, approximately 77,500 current Medicaid recipients are expected to be disenrolled in January, based on data currently on file with the Department of Health Services (DHS). DHS has also released county-level data for this population and for the adults currently on the Core plan waiting list. This information can be found at: www.wha.org/exchangemedicaidenrollment.aspx
Agent List Now Available
The state’s Insurance Commissioner’s office (OCI) has posted a list of agents who have completed the OCI-required training on Medicaid/BadgerCare Plus, and who have agreed to be available to help with enrollment into the exchange marketplace. The list was created by OCI and is housed on their website. It is sorted by county of service. The list can be accessed here: http://ocidev.wi.gov/healthcare_reform.htm#badgercare-ce.
Upcoming Medicaid Trainings
The Wisconsin Department of Health Services (DHS) in collaboration with Covering Kids and Families, the Wisconsin Primary Health Care Association and local partners will be hosting a series of in person regional trainings to provide comprehensive overview of Medicaid/BadgerCare policies for 2014, and overview of the changes to the Medicaid/BadgerCare application, best practices when working with the Exchange Marketplace, and other key updates. In particular the training will cover the November 18 expected updates to the Medicaid Program’s ACCESS system to allow newly-eligible Medicaid/BadgerCare members to apply directly for Medicaid/BadgerCare coverage which would begin January 1, 2014.
As space for each session is limited, DHS requests advance registration. A list of the trainings and link to register can be found here under Medicaid Training: www.wha.org/stateLevelTrainingEvents.aspx.
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On November 7, WHA will offer another members-only webinar focused on the most current information available on the implementation of the health insurance exchange in Wisconsin. This Member Forum will include the most up-to-the-minute information available about the implementation of and access to the exchange in Wisconsin.
The webinar "A 30-Day Check-Up on the Health Insurance Exchange in Wisconsin" will take place Thursday, November 7, from 1 - 2 pm, and is intended for WHA hospital and corporate members only. There is no cost to participate in this member-only forum, but pre-registration is required. Register online at http://events.SignUp4.com/13HCExchange1107. If you cannot participate in the live webinar, there is an option to request an audio recording.
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On November 8, WHA is offering a webinar that will focus on what hospitals and physician practices should know when they are considering including dual coding as part of the ICD-10 transition plan. Topics will include:
The concept of dual coding, or coding the same patient health record in both ICD-9-CM and ICD-10-CM/PCS, should be considered as one of several steps to prepare for the ICD-10 transition. Dual coding has the ability to provide the information needed to reduce the financial impact of ICD-10.
Chief financial officers, ICD-10 transition team leaders and members, coding managers and others considering the inclusion of dual coding in their ICD-10 transition plan should attend. More information and online registration is available at: http://events.SignUp4.com/13ICD10Coding1108. ICD-10 teams are encouraged to register.
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Nurses are always seeking ways to spend more time at the patient’s bedside. The nurses on the Progressive Care Unit at St. Elizabeth Hospital in Appleton found one way to spend more time with patients. This initiative developed after the unit learned about Transforming Care at the Bedside (TCAB) from Chief Nursing Officer Tom Veeser.
The staff provided ideas to improve patient care and communication with a focus on bedside report. Team leads shared best practice and evidence-based literature with the staff prior to going live with bedside report. As they moved toward the implementation of bedside report, team leads each took a small group of nurses and did one-on-one coaching to discuss the new report process and what to expect during the transition.
"A key to successful implementation with our initiatives has been transparency, openness, and having face-to-face time with the team to share ideas and dialogue," said Alison Schneller, team lead.
Patient Care Manager Jenny Genke agrees, stating, "TCAB has empowered the front-line staff to make positive changes in the workplace while knowing they have full support from management."
Prior to implementing bedside report, the team expressed the shift change process was fragmented, duplicative and unorganized. After implementing the changes, the unit reported excellent results. The average nurse time at the bedside improved from 41 percent prior to bedside report to 69 percent after bedside report implementation as measured by an observational time study (measurements were taken May 2013 and September 2013). Overtime was reduced from 3.9 percent to 3.4 percent from August 2012 to August 2013, and staff turnover was reduced from 8.3 percent to 2.6 percent from August 2012 to August 2013.
The Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) results illustrate the success the team has achieved with their TCAB project. On the HCAHPS measure related to communication with nurses, the measure related to whether nurses explained things understandably increased from 64.5 percent to 75 percent.
The benefits of this change are many. "Patients are involved in the discussion of their care, and bedside report addresses safety by ensuring no crucial information is missed from one shift to the next," said Stephanie Sobczak, WHA quality manager. "And most importantly, nurses and patients have more time to interact."
The Progressive Care Unit at St. Elizabeth Hospital found that the WHA TCAB program is a powerful improvement tool. "The ideas and collaboration between the hospitals involved in the TCAB cohort as well as expertise and knowledge shared from the WHA staff is unparalleled," said Larissa Smage, team lead. "Data drives improvement efforts, and TCAB helps front-line staff understand the importance of data collection and metrics that matter."
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Caring for an elderly relative can be a full-time job. Balancing both financial and everyday care needs can often feel impossible, especially when the caregiver begins to experience a serious medical condition of his or her own. Here is one woman’s story:
Jill is a 51-year-old single woman with no children. She lives with her elderly mother who requires constant care due to multiple health concerns. Jill is her mother’s primary caretaker, as her father passed away years ago, and her only brother lives out of state. After caring for her mother during the day, Jill works part-time in the evenings as a server at a small local diner that does not offer its employees medical insurance.
Last year, Jill noticed that she was feeling an unusual amount of fatigue and realized she has been drinking water more often than usual but still felt thirsty. One day, while working her late shift at the diner, Jill’s head began to pound. She took some over-the-counter headache medication but it did not seem to help. Suddenly, she started to sweat and her vision became blurred. Unsure of what was going on, she had a friend take her to the Emergency Department (ED) of Aurora Medical Center Summit where the physicians determined she was experiencing a diabetic attack. Unaware she had diabetes, Jill was shocked at her diagnosis.
Informed of her new diagnosis, combined with her role as a caretaker and her inability to get insurance coverage through her employer, the social worker in the ED referred Jill to the financial counselor. Upon meeting with the counselor, Jill discovered that she was eligible to apply for the Aurora Helping Hand Patient Financial Assistance Program. After providing the completed application and the supporting documents to the financial counselor, she was approved for a 100 percent discount on her hospital bills.
Jill knows that she has a long road of learning ahead of her to learn all she needs to know about managing her diabetes, but she is determined. Proper management will help keep her from requiring another visit to the ED in the future. Aurora Helping Hand played a key role in her ability to get back on the road.
Aurora Medical Center Summit
Patient receives financial help from Grant Regional Health Center’s Community Care Program
Having experienced a mild heart attack in 2011, Thomas knew the pain in his chest was more serious this time around a year and a half later. At only age 51, he didn’t expect to have this condition bring his busy lifestyle to a crashing halt. He was transported by rescue squad to Grant Regional Health Center where lifesaving measures were put into action.
"I know the value of having a hospital close by in our rural community," Thomas explains. "It was a close call," he remembers. "It’s not something you can just wait and see what happens." Thomas was then air-lifted to a Madison hospital where he underwent surgery including three stints. Remarkably, he was home within 72 hours and back to work within three weeks.
Tom is employed by a local feed company, so he had some insurance, but the coverage was minimal. Given the fact that he was worried about the cost of emergency care and a hospital stay, he was encouraged to apply for assistance through Grant Regional’s Community Care Program. After reviewing his financial situation, Grant Regional Health Center forgave 100 percent of the charges incurred for his emergency care – totaling $5,000.
"I know how lucky I was to have prompt, experienced medical care close to home. They helped through a very difficult time –and for that, I’m very grateful to Grant Regional Health Center."
Grant Regional Health Center, Lancaster
You can’t put a price on peace of mind
Imagine the anguish you might feel if you needed a medical test or treatment that you could hardly afford. No one should live in such uncertainty.
For years, making ends meet was difficult, let alone finding disposable income to cover health insurance costs. As her opportunities and options diminished, she had no choice but to drop health insurance—all the while a mysterious lump was developing on one of her breasts. Scared and desperate, she sought help.
This 49-year-old woman came to the Mercy Regional Breast Cancer team in May 2013, after a referral from the Wisconsin Well Woman Program (WWWP), short-term medical assistance that provides preventive health screening services to women with little or no health insurance. Shortly after the results from her mammogram came back, it was quickly determined she needed a breast MRI to diagnose the problem. Since WWWP does not cover MRI services, one of the Center’s new breast health navigators advocated and investigated any and all options so this patient could get the quality health care she deserved. After exhausting all possible leads, Mercy forgave her entire screening balance due, using part of its recent grant funding offered by Susan G. Komen. Luckily, the results from the MRI showed she was cancer free. Mercy was fortunate to not only to help her get the care she needed, but also give her the good news we all hoped for.
In 2012, Mercy received a $150K grant from Susan G. Komen for its efforts to reach and direct low-income and minority populations. Mercy used some of the funds to hire two breast health patient navigators to coordinate community breast health education, awareness, treatment, access to care, translation services, rehabilitation, case management and counseling in an effort to increase breast cancer screening rates among uninsured and under-insured African American and Hispanic women in Rock County.
But it’s not just about treatment; it’s about feeling good enough to carry on through your treatment journey.
Mercy Regional Cancer Center also selects ten of its patients to participate in Mercy’s Journey to Health program at Mercy Cardiac Fitness Center. The program allows breast cancer patients the exercise and nutrition benefits to help them feel better through the treatment process. The membership is fully funded by community support from events like Paint the Rink Pink and other Mercy Foundation events.
Mercy Health System provided almost $40 million in uncompensated care and free services in 2012. What we strive to give, however, are the things that cannot be measured. Health care is mission-driven, and our mission is healing those who need us most.
Mercy Health System, Janesville
Submit community benefit stories to Mary Kay Grasmick, editor, at email@example.com.
Read more about hospitals connecting with their communities atwww.WiServePoint.org.
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