February 13, 2015
Volume 58, Issue 6
WHA Report Shows Hospital Quality Improvements Reduce Cost, Improve Care, Increase Value
Wisconsin hospitals provided better care to 9,000 patients, avoided more than $87 million in health care costs
Wisconsin hospitals’ efforts to improve quality are reducing health care costs in the state, improving patient care and saving lives.
That is according to a new report from the Wisconsin Hospital Association (WHA) that documents the progress hospitals made in 2014 to reduce avoidable hospital readmissions, decrease infections and prevent medication errors.
The 108 hospitals working with WHA over the past three years estimate that they have improved care for over 9,000 patients and avoided more than $87 million in health care costs in Wisconsin. Those results do not reflect the results of 32 additional hospitals in Wisconsin that are working with other improvement groups.
“Wisconsin hospitals are demonstrating measurable and sustained progress toward improving care by adopting best practices, sharing what they have learned, and working in teams,” according to WHA Chief Quality Officer Kelly Court. “We still have work to do, but we have the improvement processes, determination and support to move us closer.”
One area that is particularly important to patients is the prevention of hospital-acquired infections. Central line-associated blood stream infections (CLABSIs) are among the most serious and often lead to extended stays in the Intensive Care Unit or place a patient at risk of death. Since 2008, Wisconsin hospitals have reduced CLABSIs by 71 percent by standardizing best practices and with real-time monitoring.
Another infection that is common, catheter-associated urinary tract infections (CAUTIs), has also been a focus for improvement activities. The key to reducing CAUTIs is adherence to best practices for catheter insertion, as well as early identification of when a catheter is no longer needed, according to Court. Hospitals have driven down CAUTIs by 20 percent statewide. Court said work will continue in 2015 to bring CAUTI rates even lower.
Preventing patients from returning to the hospital after discharge has been a special area of emphasis. About eight percent of Wisconsin patients are readmitted for further treatment of their original condition, or as a result of a complication or a new problem. The reasons for a readmission vary greatly, and it is one of the hardest outcomes for hospitals to improve.
The complexity of the issue requires strong partnerships with patients and with other health-related organizations in the community. These partners include nursing homes, home health and public agencies that provide services to patients who are elderly or disabled.
For the past three years, WHA has worked with state leaders from a variety of organizations that have a stake in reducing readmissions. Together, this group helped launch 22 community coalitions across the state. These coalitions can be as small as one hospital, to regions with three or four hospitals and many other health care providers in the same community. All are focused on working together to provide patients and their families the support they need when patients are transitioned to a new care setting or back to their homes.
Hospitals are also working to reduce adverse drug events. Any mistake with a medication has the potential to cause harm; however, a special group of medications used in hospitals are more likely to cause harm if there is a dosing error, and the harm they cause is more likely to be serious. WHA is partnering with the Pharmacy Society of Wisconsin (PSW) to help hospitals improve processes for administering these medications, including accurately calibrating doses and carefully monitoring and evaluating the patient’s condition after he or she receives the medication. Hospitals working on this initiative have seen a 43 percent reduction in adverse drug events related to insulin and anticoagulants.
WHA President/CEO Eric Borgerding said the Association is committed to helping hospitals and health systems expand and accelerate their quality improvement work with education and on-site support.
“Hospitals have made a lot of headway, but there is still a long road ahead to meet, and then exceed, the high standards of care that are a hallmark in Wisconsin,” according to Borgerding. “Our work with our member hospitals will continue to include cultivating community partnerships to ensure smooth transitions among various health care settings, engaging patients and families in their care, and publicly reporting key quality measures and pricing information. Our goal is to always be recognized as one of the best states in the nation based on the quality of our health care.”
As hospitals improve the quality of care, patient outcomes are better, and unnecessary costs to patients and purchasers of health care services are reduced.
“High-quality, high-value health care is what sets Wisconsin apart from other states,” Borgerding said. “Hospitals and health systems will continue to pursue clinical excellence, guided by the dedicated and caring health care professionals and support staff who put patients first.”
Wisconsin is already a national leader in health care transparency, including publicly reporting both quality results (WiCheckPoint.org) and price information (WiPricePoint.org). Hospitals have embraced transparency and know how to leverage this type of reporting to drive improvement in their organizations.
WiCheckPoint.org is a source for information on infections, birth information, heart and stroke-related care, mortality, patient satisfaction and many other topics. Today, 127 hospitals report 80 hospital quality measures on the site. The website averages 3,000 visits each month.
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The DSH program was needed to alleviate concerns about those previously on Medicaid not taking up coverage in the exchange. As the chart
above illustrates, those concerns were real. While DHS projected that 93 percent of disenrolled Medicaid enrollees would take up private commercial or exchange coverage, we now know that only 54 percent actually did. This low take-up rate underscores the continued need for DSH. WHA thanks Governor Walker for including DSH in his upcoming budget, and we encourage the Legislature to support and improve upon this program.
Medicaid In The Spotlight: Wisconsin’s DSH Program
WHA’s past “Spotlights” highlighted Medicaid program underfunding, which has led to unreimbursed costs for hospitals in the amount of an annual $960 million “hidden health care tax.” These facts coupled with changes to Medicaid eligibility under the past state budget necessitated re-establishing a program in Wisconsin known as the Disproportionate Share Hospital (DSH) program. Here’s why DSH was and is still necessary…
As Wisconsin transitioned individuals onto and off of Medicaid, the Wisconsin Department of Health Services (DHS) projected 93 percent of individuals moving off of Medicaid would sign up for coverage in the health insurance exchange. This is called the “take-up” rate.
The DSH program was needed to alleviate concerns about those previously on Medicaid not taking up coverage in the exchange. As the chart above illustrates, those concerns were real. While DHS projected that 93 percent of disenrolled Medicaid enrollees would take up private commercial or exchange coverage, we now know that only 54 percent actually did. This low take-up rate underscores the continued need for DSH. WHA thanks Governor Walker for including DSH in his upcoming budget, and we encourage the Legislature to support and improve upon this program.
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WHA, Hospital Leaders to Travel to D.C. March 19 for AHA Fly-In
Congress has many issues on its plate this spring, including addressing the Sustainable Growth Rate (SGR) by a March 31 deadline, which requires hospitals and health systems to continue to speak up in D.C. That is why the Wisconsin Hospital Association (WHA) and hospital leaders will participate in a March 19 Washington, D.C. fly-in being hosted by the American Hospital Association.
While in D.C., WHA and hospital leaders will discuss the SGR and how arbitrary Medicare cuts, whether to academic medical centers or small critical access hospitals, disadvantage high-value states like Wisconsin. Participants will also discuss support for ICD-10 implementation, support for the 340B program and other issues while meeting with Wisconsin’s Congressional Delegation.
If you are interested in participating in the March 19 Washington, D.C. fly-in, contact Jenny Boese, WHA vice president, federal affairs & advocacy, at email@example.com or 608-268-1816.
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Register Today for 2015 Advocacy Day
April 28, 2015 *** Monona Terrace, Madison
Make an impact in Madison for your hospital by attending Advocacy Day
April 28. Register yourself and your hospital team today, including your senior leaders, trustees and volunteers for this important event.
Online registration available now at http://events.SignUp4.net/15AdvocacyDay0428
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Work Comp Council Lauds Program with “National Reputation” for Efficiency
Management and labor reps tout work comp system, express concerns with changes
The Wisconsin Worker’s Compensation Advisory Council, an advisory committee to the Legislature comprised of five members of management and five members of labor, met February 10 and discussed changes to the Worker’s Compensation program proposed by Governor Scott Walker in the biennial budget bill. Council members expressed concerns about the impact these changes would have on Wisconsin’s program that provides benefits more efficiently and at a more reasonable cost than other states, according to Council members.
“Wisconsin’s Worker’s Compensation program enjoys a national reputation for efficiently delivering quality benefits to injured workers at a reasonable cost to employers,” said a resolution offered up by management representatives. The resolution went on to state that the Council would like to “ensure that the proposed changes to the divisions…do not result in a diminution in the level of services and protections that all stakeholders enjoy under the current system.”
Department of Workforce Development (DWD) Secretary Reggie Newson released a memo to DWD Worker’s Compensation Division employees that Governor Walker would like to model Wisconsin’s program after states such as Texas and Florida, who have transitioned worker’s compensation programs from workforce development agencies over to insurance regulatory agencies. Governor Walker’s proposal moves hearing and appeals functions over to the Department of Administration and the rest of the state’s Worker’s Compensation program over to the Office of the Commissioner of Insurance. The proposed changes do not appear to impact reimbursement levels for medical services provided in the program.
Labor representative Stephanie Bloomingdale questioned the changes, by asking how these states’ systems are better than what is experienced in Wisconsin. The Wisconsin State Journal reported that “the nonpartisan Worker’s Compensation Research Institute found Wisconsin’s system is cheaper, injured workers return to work sooner and fewer employees hire lawyers than many other states.”
WHA continues to monitor the changes proposed to the state’s Worker’s Compensation program as the budget bill goes through the legislative process. Last session, the Worker’s Compensation Advisory Council proposed legislation that implemented a fee schedule for medical services in the state’s Worker’s Compensation program. WHA, along with a large coalition of medical providers, was able to stop the legislation in the State Capitol. It was the first time since World War II that a Worker’s Compensation Advisory Council bill did not pass through the state Legislature.
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President’s Column: WHA Report Documents Progress and Commitment to Quality Improvement
This week, WHA released its second annual report on the progress Wisconsin hospitals have made toward a common goal of delivering the best care possible to their patients. The WHA report, “Wisconsin Hospitals: Collaborative Partnerships for Better Quality,” shows how hospitals are reducing infections, preventing medication errors and misuse, decreasing avoidable readmissions and combating sepsis, to name just a few of the areas included in the report.
A strength in Wisconsin, and a trait that sets us apart from other states, is the willingness of our hospitals to collaborate across settings, putting competitive interests aside to share best practices they have successfully incorporated into their care settings. That attribute, along with the fact that Wisconsin was one of the first states in the country to voluntarily publicly report hospital quality-related data, has accelerated our quality improvement activities.
Hospitals are using evidence-based best practices, collecting data and participating in national and statewide programs, such as the WHA Partners for Patients initiative or the WHA-led Transforming Care at the Bedside project (TCAB) to not only help them refine their quality improvement processes, but also to help them create the cultural changes that are necessary to foster and sustain high-quality care.
In health care, value is driven by achieving the desired outcome at an affordable cost. As hospitals improve patient safety and decrease readmissions, for example, they are eliminating unnecessary costs to patients and purchasers of health care. Over the past three years, hospitals working with WHA have provided better care to over 9,000 patients and avoided $87 million in costs. These results are limited to the 108 hospitals that worked with WHA in 2012-2013 and 95 hospitals in 2014. It does not include additional patients and cost savings that 32 Wisconsin hospitals achieved working with improvement partners other than WHA.
Hospitals have made a lot of headway, and are committed to both setting and meeting the high standards of care that are a hallmark in Wisconsin. That work will continue to include cultivating community partnerships to ensure smooth transitions among various health care settings, engaging patients and families in their care and publicly reporting key quality measures and pricing information on WHA’s CheckPoint and PricePoint websites.
WHA is committed to helping its member hospitals and health systems expand and accelerate their quality improvement work with education and on-site support. But our commitment doesn’t stop there. Our legislative and regulatory advocacy agenda focuses on advancing public policy that enables our members to deliver superior quality, high-value care. The passage of the WHA-supported landmark Quality Improvement Act is just one example of the Association’s advocacy agenda aligning with quality to ensure hospitals can share best practices and continuously improve their clinical performance.
This report reflects one point in time in our journey toward excellence. The data shows how far we have come, but we know many challenges lie ahead in our quest to deliver the best health care possible to the residents of Wisconsin.
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State Assembly Leaders Meet with Hospitals in Green Bay
State Assembly Majority Leader Jim Steineke (R-Kaukauna) and State Assembly Joint Finance Committee Co-Chair John Nygren (R-Marinette) met with close to a dozen hospital and physician leaders from northeastern Wisconsin on February 9. The meeting was hosted by Aurora BayCare Medical Center.
The roundtable discussion was an opportunity for legislators to hear directly from hospitals in the region about issues pending in the state budget bill, which is currently before the Joint Finance Committee.
The group had in-depth discussions about how inadequate Medicaid reimbursement for hospitals creates a “hidden health care tax” on Wisconsin employers who provide insurance coverage to their employees. The group discussed how the State Legislature could help address this hidden health care tax by improving the Medicaid Disproportionate Share Hospital program proposed in Governor Walker’s budget and making targeted investments in Wisconsin’s Medicaid program. Therese Pandl, HSHS-Eastern Division President/CEO, and Ed Harding, Bay Area Medical Center President/CEO, both told these legislative leaders how poor Medicaid reimbursement impacts employers in their communities.
Dan Meyer, Aurora BayCare Medical Center CEO, also brought up concerns that he has with the upcoming King vs. Burwell U.S. Supreme Court case that argues that those enrolled in federal exchanges (like Wisconsin) cannot receive a subsidy. If this decision goes the way of King, it could impact those in Wisconsin enrolled in the federal health insurance exchange who receive insurance subsidies. In Wisconsin, these subsidies amount to roughly a 70 percent reduction in premium. Meyer said a Wisconsin solution to this problem may be necessary.
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Walker Administration Makes Changes to Leadership at DHS, DSPS
Governor appoints DHS Deputy Secretary Kevin Moore to Medicaid Director
Governor Walker announced several significant changes to leaders in his Administration on February 9, including changes to leadership at the state Department of Health Services (DHS) and the Department of Safety and Professional Services (DSPS).
Former DHS Deputy Secretary Kevin Moore was shifted to run the Division of Healthcare Access and Accountability within DHS, a position also commonly known as the state’s Medicaid director. Moore was also the executive assistant (now called assistant deputy secretary) under former Secretary Dennis Smith. Moore has served in the Walker Administration for over four years.
Other changes to the Governor’s Administration include:
Kelly Court, WHA chief quality officer, co-chaired a recent National Quality Forum (NQF) Rural Health Measures Committee meeting. The Committee is providing guidance to NQF, who will be developing recommendations for the Centers for Medicare and Medicaid Services (CMS) on how to mitigate challenges of performance measurement for rural and low-volume providers. The work is being done in the context of possible inclusion of rural providers in future pay-for-performance programs that currently do not include rural providers. The committee members, which include Court and Tim Size, executive director of the Rural Wisconsin Health Cooperative, represent providers and stakeholders from the hospital and ambulatory sectors.
The challenges and guidance the committee provided to NQF staff focused on the following areas for consideration by CMS:
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GAO Releases ICD-10 Report to the U.S. Senate Committee on Finance
Congressional Hearing Panel advises no more delays in ICD-10 implementation
A panel of witnesses representing providers, payers, health information technology experts and researchers told lawmakers this week it is time to move ahead with implementation of the ICD-10 coding set, with Kristi Matus, chief financial and administrative officer, Athena Health saying, “It’s time to pull the trigger or pull the plug.”
House Energy and Commerce Health Subcommittee Chairman Joe Pitts (R-PA) said he believes the Centers for Medicare and Medicaid Services (CMS) should move forward with the planned October 1, 2015 implementation rather than delay again. Ranking Member Gene Green (D-TX) agreed. Implementation was originally scheduled for October 2011.
Witnesses testified to the Subcommittee that additional delays would be unfair to those who have invested in upgrading to ICD-10 and would require costly retraining as well as postpone the benefits of a more precise coding system for the U.S. that has been accepted by the rest of the world. Six of seven witnesses advocated for the planned implementation schedule, with only one opposed. Committee members generally agreed that the implementation should occur as planned after two administrative and one legislative delay.
William Terry, MD, an Alabama urologist, said the majority of physicians in private practice are unprepared, and he questioned whether the new coding system will be an improvement for patients. Edwin Burke, MD, who practices internal medicine in rural Missouri, replied that his small practice of four primary care providers installed ICD-10 seamlessly with the help of an HIT vendor. Burke explained that ICD-10 specificity does help with patient care, noting, for example, there are more specific codes for asthma. Selection of a specific code serves as an improved method of communicating the patient’s condition to his colleagues (and himself) to follow-up with the patient for continued appropriate treatment.
On February 6, the Government Accountability Office (GAO), released a report to the Committee on Finance, U.S. Senate on CMS’s Efforts to Prepare for the New Version of the Disease and Procedure Codes. The report notes CMS has taken multiple steps to help prepare covered entities for the transition, including developing educational materials and conducting outreach. The agency reported the Medicare FFS claims processing systems have been updated to reflect ICD-10 codes, and it is not yet known whether any changes might be necessary based upon the agency’s ongoing external testing activities. (The January 2015 testing results are scheduled to be available to the public in a few weeks.) CMS has also worked with the states to help ensure their Medicaid systems are ready for the ICD-10 transition, but in many states, work remains to complete testing by the transition deadline.
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Free ICD-10 Training for Small Practice Physicians and Managers, May 6
WHA has teamed up with the Wisconsin Medical Group Managers Association (WMGMA), the statewide ICD-10 partnership (WICD-10) and CMS to offer free ICD-10 training to physicians and practice managers.
“Road to 10: A Small Physician Practice’s Route to ICD-10” will be offered May 6, 2015, from 1:00-3:00 p.m. at Tundra Lodge in Green Bay, in conjunction with the WMGMA Annual Conference.
Designed for physicians and practice managers, this free educational session will offer background and strategies on ICD-10 implementation so small physician practices will understand the business imperative around implementing ICD-10. The presentation will include discussion of the basics, differences, and benefits of ICD-10; and will explore common codes, primers for clinical documentation, and clinical scenarios all broken out by specialty. In addition, attendees will have the opportunity to create a customized action plan, personalized by specialty and practice details.
Register today at http://wmgma.site-ym.com/events/event_details.asp?id=596393&group.
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Carbon Monoxide Leak at Theater Prompts Casualty Event at Flambeau Hospital
Wisconsin Hospital Emergency Preparedness Program (WHEPP) facilitates good outcome
Scene - critical access hospital (CAH) late in the night with limited staff deals with disaster using numerous means of communications along with assistance of other hospitals.
A team effort by providers, staff, administrators and numerous resources helped Flambeau Hospital navigate through an emergency response after carbon monoxide sickened theater patrons on February 2 in Park Falls.
Approximately 150 people were watching a movie when several people became ill. Emergency responders came to the theater and within minutes—because of the close proximately of the theater to the hospital—the hospital was seeing numerous patients with carbon monoxide symptoms. Several more came to the hospital later after seeing messages on Facebook about needing medical attention if you were having symptoms and were in attendance at the theater.
A mass casualty event was activated by a computer program called Send Word Now, a web-based communication tool that allows hospitals to provide mass notification to hospital associates of an event. Funding for this program was provided by WHEPP.
Eighty-seven hospital employees left their families and homes to respond to the alert. Thirty one patients were treated at Flambeau Hospital, six were transported to facilities of a higher level of care and three were admitted overnight. Plans in place that night included using Ministry Connect (securing ground, air and private plane transport) and the hospital opened up the Incident Command Center. All communication tools including computers, radios, education and training were provided by WHEPP.
“Preparation, training, and hard work came together to have this potentially chaotic situation handled with professionalism and calmness. There is a potential for anxiety during an event like this, but with the education and support from WHEPP, the hospital was prepared to deal with the situation. We also have community-wide training events, tabletop and functional exercises, and disaster plan reviews. All of these education pieces made this event seamless,” stated Jane Eaton-Nyman, director of organizational integrity and member of Region 2 WHEPP.
A “hotwash” of the mass casualty event—observed strengths and areas of opportunity—was held February 9.
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WisHHRA Annual Conference for Human Resource Professionals, April 15-17
The Wisconsin Healthcare Human Resource Association (WisHHRA) will host its annual conference for health care HR professionals April 15-17 at Glacier Canyon Lodge at The Wilderness Resort in Wisconsin Dells.
The 2015 conference will focus on developing leaders with a keynote session by Cy Wakeman, a national keynote speaker, consultant, author and trainer who focuses on reality-based leadership. Wakeman will focus on strategies for becoming a leader who is able to quickly see and accept the reality of any situation and capitalize on the opportunities each situation presents. In addition, this year’s conference will also include the popular annual legal and legislative update sessions, as well as several best practice and case study sessions, allowing attendees to learn from their peers.
Anyone who has human resource responsibilities in a health care organization will benefit from the educational agenda and is welcome to attend. In addition, the program has been submitted to HR Certification Institute for continuing education/recertification credit.
The full conference brochure is included in this week’s packet and online registration is available at http://events.SignUp4.net/2015WisHHRA. For registration questions, contact Jenna Hanson at 608-274-1820 or email firstname.lastname@example.org.
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Webinar Focuses on WI Caregiver Law, Background Checks and Effective Handbooks, February 20
On February 20, WHA is offering the second of a three-part webinar series focused on timely and relevant labor and employment issues for all health care providers. The upcoming session will focus on the Wisconsin Caregiver Law, background checks, managing impairment issues, and effective employee handbooks. The session will be presented by attorneys from the labor and employment practice of Reinhart Boerner Van Deuren s.c.
An additional webinar focusing on other labor and employment issues will be offered March 20. Webinars can be taken as a full series or individually. Full descriptions of each session, as well as online registration, can be found at: http://events.SignUp4.net/2015LaborEmployWebSeries.
Health care human resources professionals, hospital and health system in-house counsel and others interested in learning more about these important labor and employment issues should plan to participate. Attendees are encouraged to participate in this webinar series as a team, to gather and learn together through one, low-cost registration. While attendees are encouraged to attend all three sessions, the option exists to register for individual sessions as well.
Each session has been approved through the HR Certification Institute for 1.5 HR General recertification credit hours toward PHR, SPHR and GPHR recertification.
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23rd Annual $2,500 Rural Health Prize - June 1 Deadline
The Hermes Monato, Jr. Prize of $2,500 is awarded annually for the best rural health paper. It is open to all students of the University of Wisconsin (any campus) as well as those who will be recent graduates at the time of submission.
Students are encouraged to write on a rural health topic for a regular class and then submit a copy to the Rural Wisconsin Health Cooperative as an entry by June 1.
Previous award winners as well as judging criteria and submission information are available at www.rwhc.com/Awards/AnnualMonatoEssay.aspx.
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Member News: Richland Hospital Names Roesler New Chief Executive Officer
Richland Hospital Board Chair Dennis Hamilton announced February 11 that Bruce Roesler will be the next chief executive officer at The Richland Hospital, Inc. beginning March 9, 2015.
Roesler is a member of the American College of Healthcare Executives and is active in the Iowa Hospital Association (IHA). He previously served as district chair for his hospital’s IHA district and he has served as a member of the IHA’s Legislative and Advocacy Council.
Most recently, he was the president and CEO at Mercy Medical Center in New Hampton, Iowa for more than seven years. Mercy Medical Center is a system-sponsored, integrated provider-based family medical clinic and critical access hospital with over 100 full-time employees. Prior to his experience at Mercy Medical Center, Roesler served as president and CEO at Avera Marshall Regional Medical Center in Marshall, MN; as senior vice president of professional services at Riverview Hospital Association in Wisconsin Rapids, WI; and as administrator and CEO at St. Joseph’s Hospital in Arcadia, WI.
Roesler earned his BS degree in Business Administration from University of Wisconsin – La Crosse and his master’s degree in Hospital Administration at University of Minnesota in Minneapolis, MN.
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