March 6, 2015
Volume 59, Issue 9

U.S. Supreme Court Gives Another Review of the Affordable Care Act 

On March 4, the U.S. Supreme Court heard oral arguments in a potentially landmark case, King v. Burwell. The plaintiffs’ case hinges on the interpretation of seven words in the Affordable Care Act: “exchange established by the state under 1311,” and the decision will have implications for those Wisconsinites who are receiving subsidies to purchase health insurance coverage through Wisconsin’s federally-facilitated exchange. 

The question is whether tax subsidies are available to anyone who purchases coverage in an exchange, regardless of whether the exchange was set up by state or federal government. The Internal Revenue Service issued regulations saying they are available to anyone. The plaintiffs say those five words—“exchange established by the state under 1311”—mean they are not. 

An intriguing dialogue occurred during the oral arguments, leaving speculation as to how the Supreme Court might rule in this case. Justice Ginsburg questioned whether the plaintiffs have standing to bring the case forward in the first place, and if not, the case should be dismissed. Justice Kennedy suggested that if the plaintiffs are correct, states would be coerced to create their own exchange or send their insurance markets “into a death spiral.” He went on to remark that there is a constitutional problem with the case if the Supreme Court adopts the plaintiff’s view that tax subsidies are only available in state-run exchanges. Very few questions or comments came from Chief Justice John Roberts, who wrote the critical decision in the Supreme Court case on the ACA nearly three years ago. 

With a decision not expected until late June or early July, continued uncertainty in the health care markets is of concern. A decision in favor of the plaintiffs would remove the availability of the subsidy, but would not relieve health insurance plans of their obligations and requirements for guaranteed issue. It is unclear what this new insurance market would look like without available subsidies. 

In the meantime, federal Department of Health and Human Services (HHS) Secretary Silvia Burwell has stated the Administration currently has no definitive plan should the Supreme Court rule in favor of the plaintiffs. Rep. Paul Ryan in an Op Ed March 2 in the Wall Street Journal outlined a GOP plan that would, among other things, include subsidies for anyone purchasing private coverage and allow states flexibility to opt out of coverage mandates. At the state level, in a hearing March 3, Secretary Kitty Rhoades indicated the state would work with federal partners and will offer up suggestions on what should happen. (See related story below). 

Wisconsin’s hospitals and health systems have spent significant amounts of time and resources assisting patients and members in their communities to sign up for coverage in the exchange. The latest figures from HHS show nearly 206,000 people in Wisconsin have coverage through the exchange, and nearly 90 percent are eligible for subsidies—that’s about 183,000 people who would be directly impacted by a decision in favor of the plaintiffs. 

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State Agencies Brief Joint Finance Committee on Governor’s Budget
DHS Secretary Rhoades says state will work with feds if subsidies disappear

The Legislature’s powerful budget writing committee, the Joint Finance Committee, met with agency leaders March 2, 3 and 4 to hear about the Governor’s proposed budget and answer questions from Committee members. Wisconsin’s Department of Health Services (DHS) Secretary Kitty Rhoades testified before the Committee for more than two and a half hours, largely discussing Medicaid coverage in Wisconsin and changes to the state’s long-term care programs, Family Care and IRIS. 

Rhoades talked about the Governor’s “bold change” in the 2013-2015 budget to provide Medicaid coverage for all those living below the poverty line. She said Gov. Walker has provided “all Wisconsin residents with access to affordable health coverage.” Rhoades said the state Medicaid program will end up “in the black” at the end of this fiscal year.

After the Secretary’s testimony, Sen. Luther Olsen (R-Ripon) asked Rhoades if the state has considered a contingency plan if the US Supreme Court’s King v. Burwell decision eliminates subsidies for individuals enrolled in a federal insurance exchange, like Wisconsin. The Secretary said that her agency “will be working with our federal partners, because it’s a federal program that has to be fixed. We will offer up our suggestions and what we believe should happen.” 

Olsen said that it may be a problem created by the federal government, “but it’s our citizens.” Rhoades continued, “We will work with [the federal government] to make sure that they get it fixed right.”

Rhoades went on to talk about how the Governor’s budget makes significant changes to the Family Care program, dubbing it “Family Care 2.0.” The Governor’s plan expands Family Care to all 72 counties and depends on entities that can manage and pay for all types of services, including long-term care, primary care and acute care services. Rhoades highlighted changes to personal care service benefits in Medicaid, stating that the Governor’s proposal would require an independent assessment for personal care services to accurately assess the amount of services each person needs.

Family Care currently operates under eight regional Managed Care Organizations (MCOs), serving over 50,000 people in Wisconsin who need long-term care. Rhoades told the Committee that the current MCOs would find it challenging to integrate primary care and acute care into their contracts.

“What happens if there are only two statewide, or if there is only one?” asked Rep. Dean Knudson (R-Hudson). “We have been through this before—you will remember the Obamacare exchange was going to have plenty of providers, and then we had counties where that actually wasn’t the case.”

Rhoades said she is confident there will be multiple insurers participating in the program. She said that if DHS only had one insurer or they didn’t have the right capacity statewide, DHS would need to look at alternatives. 

Rep. Dale Kooyenga (R-Brookfield) asked Rhoades about savings associated with wrapping primary and acute care services into the Family Care benefit, instead of keeping them as a Medicaid card service. While the Secretary stated that plans for programmatic changes can only be developed after the budget is passed and DHS has authority to implement the program, Kooyenga raised concerns with budgeting savings without knowing additional details. He asked the Secretary to provide more information as it becomes available.

Sen. Leah Vukmir (R-Wauwatosa), a new member of the Joint Finance Committee and Chair of the Senate Health Committee, asked what DHS would do if they experience a budget shortfall in the next biennium. Rhoades said DHS developed multiple efficiencies after the 2011-2013 budget to reduce overall Medicaid expenditures. Rhoades said they have not been able to implement all of those items yet, due to workload and technology issues, but they want to get those efficiencies in place to avoid any cuts to provider rates, benefits and eligibility.

Sen. Jon Erpenbach (D-Middleton) asked Rhoades about changes to the BadgerCare Plus program for childless adults, including requirements that they pay premiums, require a health risk assessment and limit BadgerCare eligibility for only 48 months. Rhoades responded to Erpenbach’ s questions with a similar answer each time, saying that the budget outlines the vision for the state, but DHS would have to negotiate with the federal Centers for Medicare and Medicaid Services (CMS) to determine what these policies would ultimately look like. The budget does not identify those changes specifically, but requires DHS to request the authority to implement changes to the federal government.

“We don’t have a specific plan,” said Rhoades. “It’s not in my drawer, you have to build a waiver with CMS.” 

Knudson said, “There is discomfort that we would leave all parts of [the changes to BadgerCare Plus] to you.” He continued by asking Rhoades if she would be “comfortable putting some limits on DHS’s proposed changes legislatively where it would say you were allowed to go up to X percent of income, or X dollars per month so we would know ahead of time.” 

Rhoades responded by reminding the Committee she reports to them on a quarterly basis.

Olsen asked Rhoades about changes to reimbursement for Wisconsin’s federally-qualified health centers (FQHCs), which would reduce FQHC reimbursement from 100 percent of cost down to a federal prospective payment system (PPS) rate. Olsen discussed the need in his district for the work that FQHCs do, especially related to dental access in the Medicaid program. When Olsen asked if the Secretary was open to negotiation, Rhoades indicated that she was willing to work with the FQHCs on the provision.

The Joint Finance Committee will now hold four public hearings across the state where they will take feedback and testimony from the public. Between March 18 and 26, the Committee will meet in Brillion, Milwaukee, Rice Lake and Reedsburg. WHA government relations staff expect voting to begin the week of April 6 and conclude by the end of May.

See Secretary Rhoades’ testimony here:

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New Legislator Profile: Rep. Adam Jarchow (R-Balsam Lake)
Jarchow Supports Gov’s Budget, Fair Worker’s Compensation System for Providers

Hospitals in Rep. Adam Jarchow’s district in northwest Wisconsin are appreciative of the time he spends learning their issues, but just as important, Jarchow is interested in knowing more about the challenges facing hospitals. So much, in fact, he is taking a proactive approach to the King v. Burwell case, which was at the top of the news March 4 when WHA Valued Voice Editor Mary Kay Grasmick interviewed the first-term legislator. 

“I would encourage the folks in the health care community to keep an eye on the King v. Burwell case and to share their ideas on how we as legislators can deal with the situation that arises if the Court rules in favor of the plaintiffs,” Jarchow said. 

Jachow understands the challenges that hospitals face, including reimbursement shortfalls created when government programs do not cover the cost of the care. A supporter of the Governor’s budget, Jarchow says he believes the Disproportionate Share Hospital (DSH) program is needed.

“Do we need hospitals in my relatively rural area of the state? If you answer yes to that question, then you should also support making sure they have sufficient funding,” Jarchow said. He said he is open to discussions about making DSH a permanent line item in the state budget, rather than being up for reauthorization every two years as it is currently.

As an attorney who for the past decade has specialized in transactional law, contracts and business-related work in his practice, Jarchow is very aware of the problems businesses face when laws and regulations are poorly drafted. 

“I understand how important it is to all businesses, including hospitals, that we have good clear unambiguous laws for them to follow,” Jarchow said. 

Creating a positive climate for business has also been an important part of Jarchow’s experience. As a member of the Polk County Economic Development Corporation, he knows health care is an important factor in a business’s decision to expand or locate in a community. 

“It is not possible to attract new business or expansion without a really good health care system because no mom or dad wants to be in a position where they have an injured or sick child and they have to drive them to the Twin Cities; and, no business owner wants to have an injured or sick employee and have no one in the community that can care for them,” he said. 

And while he has not seen a Worker’s Compensation bill draft this session, Jarchow said he hopes the business and health care communities can come together and find a solution that everyone can agree on. 

“We want to have a low-cost, strong Worker’s Compensation system in Wisconsin, and we want to make sure the health care providers are being treated fairly,” according to Jarchow. 

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Guest Column: Making a Difference through Project SEARCH
By Therese Pandl, WHA 2015 Board Chair and President/ CEO, Hospital Sisters Health System, Eastern Wisconsin

On Tuesday, February 24, we welcomed Gov. Scott Walker at HSHS St. Vincent Hospital in Green Bay to announce the expansion of Project SEARCH to the greater Green Bay community. Project SEARCH is a one-year transitional program for students with intellectual disabilities during their last year of school eligibility. The program promotes the ability of students to function in a competitive work environment, attempting to align capabilities with job needs.

At HSHS Eastern Wisconsin, we view Project SEARCH as a mutually-beneficial program, which transforms both the student and hospital colleagues through the relationship. HSHS core values of respect, care, competence and joy are reinforced with this program, consistent with our culture.

The program was developed at Cincinnati Children’s Hospital Medical Center in 1996. Since then it has grown to over 300 sites throughout the world with more than a dozen active sites in Wisconsin. Project SEARCH is coming to Green Bay through a partnership with HSHS St. Vincent Hospital, Bellin Health, ASPIRO, CESA 7, Green Bay area high schools and the Wisconsin Department of Workforce Development-Division of Vocational Rehabilitation. Through an application process, up to 12 students will be chosen to receive training and education through classroom instruction and internships at HSHS St. Vincent Hospital and Bellin Health. 

The program will begin in fall for the 2015-2016 school year. Students will work in a variety of departments, including office settings, equipment sterilization, labs and more. We have had more departments offering to accept students than there are positions available.

HSHS St. Vincent Hospital is proud to be collaborating in this very important community effort. By joining together we can truly make a difference in the lives of these students.

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WHA Joins Multi-State, Multi-Organization Letter in Support of ICD-10

WHA joined more than 20 health care organizations across 14 states in a letter to key members of Congress urging no further delays with the ICD-10 implementation date of October 1, 2015. The letter signatories are comprised of 130 hospitals and 1,475 clinics in 14 states with nearly 20,000 providers and over 260,000 support professionals.

“To our surprise and disappointment, Congress acted to delay ICD-10 implementation for another year—until October 1, 2015—through a provision inserted into the Protecting Access to Medicare Act of 2014,” the letter read. “The original compliance date was finalized over six years ago…Our organizations have invested substantial time and financial resources in preparing for roll-out of ICD-10 by the mandated deadline…To delay implementation again would cause a great deal of waste and create unnecessary expense.”

The letter added that moving forward with ICD-10 will help support quality improvement efforts and create a more efficient, sustainable health care system. It does so by updating the current platform (ICD-9) which is over 30 years old, outdated and inconsistent with current medical practice. ICD-10 conversion allows “better support for care management, quality measurement and analytics,” which is “critical to quality improvement efforts.”

WHA continues to strongly advocate to Congress in support of the scheduled October 1, 2015 implementation date. Read the letter at:

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Guest Column: Madison College, Partners Deliver Hands-on Health Career Exploration
By Morna K. Foy, president, Wisconsin Technical College System

Do you remember trying to figure out your career interests? Like me, you may know a young person or two who are engaged in that important process right now.

A number of partners in Dane County recently collaborated to address a pressing need for meaningful career exploration in the health care sector. The result is the “Health Immersions Class.”
The class is a pilot sponsored by the Dane County School Consortium and presented by Madison College. Students from McFarland, Monona Grove, and Sun Prairie high schools meet for three hours each Wednesday evening at the college’s new, state-of-the-art health education facility.

College staff and instructors provide an introduction to the career field, including first-hand knowledge of duties, work environment, employment trends, wages and benefits. What really sets this experience apart, however, is that the remainder of each class is dedicated to hands-on career exploration. This includes both skills instruction and an opportunity for the students to immediately apply those skills. 

I recently had an opportunity—along with Madison College President Jack Daniels and Sharon Wendt, director of career & technical education at the Wisconsin Department of Public Instruction—to join the class and learn about the work of a respiratory technician (RT). I was impressed that the high school students, who had already had an RT session, were the ones providing instruction as I tried my hand at intubation and blood draws on a human patient simulator.

The students have been, or soon will be, exploring other potential health careers like nursing, radiography, occupational or physical therapy, medical coding, EMT/EMS, dental hygiene and others.

“We had to do something differently,” Diane Kraus, coordinator of the Dane County School Consortium, shared with the group. The goal was simple, she said: give students the information and experiences to make better informed college and career choices, knowing that’s difficult if simply reading a course or program description. The concept was to “test drive” more than 20 health occupations programs.

Kraus found enthusiastic partners for the initiative in Dr. Mark Lausch, Madison College’s dean of health education, and Sheila Hibner, school-to-career coordinator at Monona Grove High School. It takes vision, planning, collaboration and resources to develop and deliver the type of hands-on career exploration offered in the Health Immersions Class. Having seen it in action, I’d say they’re on to something. Others agree, as this concept is garnering interest in other program and geographic areas.

This effort is closely linked to the technical colleges’ career pathways approach, which focuses on employer partnerships, career exploration and planning, the opportunity for high school students to earn college credit and “stackable” college credentials and industry-based certifications.

Career exploration and pathways require active and engaged employer partners, like you. To begin exploring a partnership like this in your area, contact Ann Westrich, the Wisconsin Technical College System’s career prep coordinator, at

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Gov. Walker Touts WI Health Care as Economic Asset During WMC Business Day 
Highlights need for rural residencies 

During remarks at the Wisconsin Manufacturers & Commerce’s Business Day event held March 4 in Madison, Gov. Scott Walker touted Wisconsin’s health care as an economic asset to the state and highlighted the importance of rural residencies. 

“I think sometimes we overlook the fact that the quality of health care in the state is—measurably one of the highest levels of any state in the country—an asset to us….Just like having good roads, good power supply, you need to have quality health care…All those things tie together,” Walker said. 

Walker also indicated that, like Wisconsin’s power system and transportation infrastructure, he “includes health care as a part of that [statewide] infrastructure.” 

During extended remarks about workforce and workforce development initiatives, Walker indicated the state needs to do more with investing in human capital through workforce development. One specific area he highlighted was the role health care workforce plays in this respect, especially rural residencies. 

“Health care and making sure that, particularly in rural parts of the state of Wisconsin, that we have not only more primary care positions and other health care positions…but also in making it easier for our hospitals and health care systems around the state to have more residencies.” Walker added that having rural residencies makes it “more likely to keep those primary care physicians and others we’re teaching in those locations where they add value, not only to their employer but to those communities.”

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Veteran Journalist Tucker Carlson Keynote Speaker at Advocacy Day, April 28 

Make plans today to come to Madison on April 28 to experience Advocacy Day 2015 and get an insider’s view on Washington, D.C. from keynote speaker Tucker Carlson. Carlson is a nationally-known veteran journalist and political commentator who will offer a candid, up-to-the-moment look at today’s political climate and the 2016 race to the White House.

Each year, the WHA Advocacy Day event grows both in number of attendees and in the impact made on our legislators in Madison. Advocacy Day is one of the best ways your hospital employees, trustees and volunteers can make an important, visible impact in the State Capitol. Help make the 2015 Advocacy Day event a great success by registering today at

The highlight of Advocacy Day is always the hundreds of attendees who take what they’ve learned during the day and then meet with their legislators in the State Capitol in the afternoon. During Advocacy Day, the State Legislature will be in the thick of determining the state’s biennial budget bill. This means Advocacy Day attendees have the opportunity to meet personally with their legislators or legislative staff to advocate for policies that keep Wisconsin hospitals and health systems strong so they can continue to provide high-quality, high-value care.

Join over 900 of your peers from across the state at Advocacy Day 2015 on April 28. A brochure is included in today’s packet and online registration is available at

For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or For registration questions, contact Jenna Hanson at or 608-274-1820.

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Webinar Focuses on Whistleblower Claims, Workplace Privacy, OSHA

On March 20, WHA is offering the third of a three-part webinar series focused on timely and relevant labor and employment issues for all health care providers. The upcoming session will address whistleblower claims, social media and workplace privacy laws, and OSHA compliance. The session will be presented by attorneys from the labor and employment practice of Reinhart Boerner Van Deuren s.c. 

A full description of this session, as well as online registration, can be found at:

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. 

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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RWJF Funds Wisconsin Center for Nursing “Future of Nursing” Work

The Wisconsin Center for Nursing, Inc., co-lead for the Wisconsin Action Coalition, has received a second round of funding from the Robert Wood Johnson Foundation (RWJF) for a State Implementation Program (SIP) grant to implement the Institute of Medicine’s Future of Nursing report recommendations. 
The award follows the successful first round of activities: Taking the LEAD for Nursing in Wisconsin: Leadership, Educational Advancement, & Diversity. 

The award for the second project, Wisconsin Nursing LEADs the PACC: Partnerships in Action for Community Care, will extend from February 1, 2015 through January 31, 2017. This project will continue the Center’s work in nursing leadership, academic progression and diversity. The project will also feature a new focus area dedicated to employer-educator partnerships to develop team-based community care models, particularly specialty areas such as behavioral health.

For further information or questions related to the Wisconsin project, contact Judith Hansen, executive director, Wisconsin Center for Nursing, at 414-801-6877 or

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National Patient Safety Week – March 8-14
Patient safety is a priority for Wisconsin hospitals 

Patient safety is the number one priority for every hospital in the country. In Wisconsin, hospitals have been working together with the Wisconsin Hospital Association (WHA) to eliminate unintended complications or unexpected patient responses to treatment. 

This year during National Safety Week March 8-14, the National Patient Safety Foundation is raising awareness of the important role that patient and family engagement in health care can play in improving outcomes. Building the patient perspective into the care process requires new structures and focus. The WHA Partners for Patients initiative is helping health care systems develop this focus. WHA is partnering with hospitals to advance this important work. New strategies hospitals are implementing include:

• Creating patient and family advisory councils;
• Using patient and family advisors to provide input and feedback to improve care systems;
• Building “always events” as a way for health care organizations to set clear patient safety and interaction expectation and ensure they are “always” performed; and,
• Improving health literacy.

WHA has partnered with Health Literacy Wisconsin to help hospitals improve the clarity of their communications with patients. The WHA Foundation is supporting the Health Literacy Conference March 14-15 in Madison. For more information about this summit, visit Take advantage of an early bird discount by registering before March 17. Register at

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Fast Facts from the WHA Information Center: March is Brain Injury Awareness Month

More than two million people sustain a traumatic brain injury (TBI) each year. According to the Centers for Disease Control and Injury Prevention, the leading causes of TBI are:

• Falls (35.2%) 
• Motor vehicle-traffic crashes (17.3%)
• Struck by/against events (16.5%) 
• Assaults (10%)

According to the WHA Information Center, Wisconsin hospitals recorded 18,538 visits in their emergency rooms, had 5,273 hospital admissions, and reported 8,461 visits in other hospital outpatient settings related to traumatic brain injuries. 

Data provided by the WHAIC (

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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Member News: UnityPoint Health CEO Leaver Announces Retirement in 2016
Board Names EVP and Chief Strategy Officer Kevin Vermeer as successor

UnityPoint Health President and Chief Executive Officer (CEO) Bill Leaver announced that he will retire in January 2016. UnityPoint Health’s Board of Directors named Executive Vice President and Chief Strategy Officer Kevin Vermeer as Leaver’s successor after a transition planning process. 

Leaver has served as president and CEO of UnityPoint Health, formerly known as Iowa Health System, since January 2008. He joined the organization in 2003, serving as president and CEO of Rock Island, Ill.-based Trinity Regional Health System, an affiliate of UnityPoint Health. Leaver has more than 35 years of executive health care experience. 

During his time with UnityPoint Health, Leaver guided the organization through tremendous change in the industry. He was instrumental in the system’s growth and expansion beyond the state of Iowa to western Illinois and southern Wisconsin (Meriter-UnityPoint Health), and championed the UnityPoint Health brand transformation to connect all sites of care.

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Member News: Riverview Finalizes Affiliation with Aspirus

Riverview Hospital Association is a member of the Aspirus health system. After four months of approvals, due diligence and collaboration, leaders from both entities signed documents that made the Wisconsin Rapids hospital part of Aspirus, Inc., a not-for-profit health care system based in Wausau, Wisconsin. 

The alliance achieves two significant benefits to the community: 

1. An even more robust Riverview Hospital, backed by the resources of a strong regional health system.
2. A new foundation endowed with more than $100 million to serve the health and the general needs of the Wisconsin Rapids area for years to come. 

Aspirus President/CEO Matthew Heywood said Riverview is a tremendous addition to the Aspirus family. 

“Riverview has a long, proud history of serving this community with excellence and compassion,” he said. “We hope to build on that legacy by investing in the workforce and enhancing the services available locally.” 

Like other Aspirus hospitals, Riverview will remain active locally, and will be guided by a separate board of directors with strong local representation.

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