June 21, 2013
Volume 57, Issue 25

DHS: "Deadlines Will be Met"
Leaders share plans to meet coverage goal with WHA Board

With the state budget nearly wrapped up, all eyes are turning to the Wisconsin Department of Health Services (DHS) as they begin to implement the Governorís plan to cut the uninsured rate in half. Meeting this commitment hinges in large part on DHS successfully transitioning more than 90,000 people who are now in the Medicaid program to the health insurance exchange starting October 1. At the same time, an almost equal number of adults without dependents will become eligible to enroll in the Medicaid program. Altogether, under the Governorís state budget plan, more than 240,000 people currently uninsured are expected to enroll in either Medicaid or connect with and maintain coverage in the exchange.

Itís an ambitious endeavor, and one that is making WHA members and others quite nervous given that the success of the plan is largely tied to getting the exchanges up and running October 1, and enrolling more than 90,000 people who will be losing Medicaid coverage by December 31. That means roughly 1,400 people per day will need to be enrolled between October 1 and December 15 to meet the enrollment deadline for coverage starting January 1.

DHS Deputy Secretary Kevin Moore, Medicaid Director Brett Davis and Executive Assistant Andrew Hitt met with the WHA Board June 20 in Madison to discuss some aspects of the Departmentís plan to meet this challenge.

Davis admits that it is a big job, but he said DHS has been drafting a detailed transition plan for some time, and he is confident that it will lay to rest many of the concerns that hospitals have had about successfully transitioning a population that has been in Medicaid into the exchange. Davis was adamant that it will happen, on deadline. Moore is equally confident.

"This is going to be one of our largest efforts, but the deadlines will be met," according to Moore. "Our goal is to fulfill the Governorís objective to cut the uninsured rate in half."

Davis said the list of health plans that have submitted an application to HHS is not public information yet, but he is "very certain" every county will have a qualified health plan in the exchange. A number of the health plans are already working on marketing strategies and outreach efforts to Medicaid patients who will be transitioning to the exchange. The health plans are taking steps to try to ensure that former Medicaid patients have continuity of care if they must change networks or providers and are seeking ways to ensure that their clinical information and prior authorizations follow them to their new coverage.

DHS is working closely with the Office of the Commissioner of Insurance (OCI) on a comprehensive implementation plan. The outreach strategy will include meetings with hospitals and health systems, a step WHA will assist DHS in implementing. Davis told the Board that what he really wants to address is how to enroll a patient coming into the emergency department at 11:00 pm on a Saturday night, who needs care and is eligible for subsidized coverage in the exchange. In other words, how easy will it be to enroll someone who needs "spur of the moment" coverage?

Part of the answer, according to Davis, resides with the income maintenance consortiums. The state budget provides for an increase in funding for the consortia for enrollment and outreach, but "the federal government is not going to give us enough money to run this, and our thinking is that we need to control it."

The goal is a "one-touch" system, according to Davis. That is, when a person who is eligible for subsidized coverage in the exchange "comes in the door," they do not leave without being connected to a certified application counselor or navigator who can complete their application. Davis said he was encouraged that more than 70 organizations, including WHA, supported the Wisconsin Primary Health Care Associationís navigator grant application to the Centers for Medicare and Medicaid Services (CMS). He feels that level of support will help build the infrastructure statewide to reach people in even the most "challenged" zip codes.

WHA President Steve Brenton said WHA members have raised questions about the "hand off" of an enrollee from an assister, who could be in a community hospital or clinic, to a broker or navigator. Hospitals have been helping patients enroll in Medicaid for decades. However, if they do not qualify for Medicaid, hospital assisters can only go so far with helping a patient enroll in the exchange, and then the patient must either complete the enrollment online without help, or be connected with a navigator or broker who can help them complete their application.

"There may be hundreds of assisters in our community hospitals who will face a considerable road block as they try to connect patients with coverage in the exchange," Brenton said. "That issue is causing considerable consternation among our members. I know DHS needs to make this work, but OCI must address this problem before we are faced with it in our hospitals."

Under federal law, according to Davis, only brokers can give "insurance advice" and that must be clearly defined. Can the transaction with the enrollee be completed by a broker available by phone? Those are some of the issues Davis said are being explored at the agency level.

Moore said DHS has decided to replace the three lines of Medicaid coverage that are now in place with one standard plan that covers more services than the current Core or Benchmark plans. The Medicaid budget "is solid enough," according to Moore, to cover those individuals who will be newly-eligible and potentially will have many health care issues. The standard plan, which includes behavioral health coverage for all Medicaid recipients, was well received by the Department of Health and Human Services (HHS) during discussions around the waiver necessary to implement the Governorís plan for Medicaid expansion.

WHA Board members acknowledged the DHS staff for their planning efforts to conduct extensive outreach and education and for the strong commitment to expand statewide coverage. "We are all committed to making this work," noted WHA Chair Dan Neufelder.

Alleviating uncompensated care, encouraging enrollment are WHA priorities

Despite strong commitments, partnerships and best efforts, most acknowledge that connecting those coming off Medicaid with coverage and maintaining that coverage in the exchange will be a challenge. With that comes a risk for increasing uncompensated care in hospital emergency rooms (ERs) as the exchanges get up and running.

"There is a real possibility that former Medicaid enrollees, other low income patients that have not signed up for coverage in the exchange, and those that do not know they are eligible for Medicaid will show up in our ERs for care," according to Borgerding. "That is why funding was provided for the disproportionate share hospital (DSH) program in the budget. This was a positive and welcome move by the Legislature."

The new DSH program is slated to run through the 2013-2015 biennium.

With the state budget behind them, WHA staff will focus on implementation details, especially in the area of the exchange and Medicaid enrollment.

To further address the concerns about take up of coverage, WHA is making enrollment a high priority in the coming weeks. Joanne Alig, WHA senior vice president of policy & research, said the Association will assume a leadership role in helping member hospitals that want to engage in enrollment efforts. She described the WHA Enrollment Assistance Plan to the Board, which will include engaging our members, working with policymakers, including OCI and DHS, and coordination with other stakeholders throughout the state. Communication will be a large part of the overall plan.

"We had more than 400 of our members participate in our recent webinar on exchanges," Brenton said. "Clearly, there is a lack of information and with the deadlines just months away, there is a sense of urgency to communicate as much and as often as we can." WHA has two more webinars scheduled this summer (see related stories below).

In other advocacy-related news, Borgerding said the WHA-supported graduate medical education funding remained in the state budget. GME funding amounted to $5 million; $4 million will be used to establish new residency programs, while $1 million in matching grants will be available.

With the state budget on its way to the Governorís desk, Borgerding said WHA will now have time to focus on several of the Associationís other legislative priorities, including: a "fix" for the Jandre decision; work on a robust behavioral health agenda; the reform of DHS 124, which are the administrative rules that govern hospitals; and workerís compensation.

WHA Senior Vice President and General Counsel Laura Leitch said both Labor and Management have proposed changes in reimbursement for the health care services provided to injured workers. Leitch said that in discussions with Council members and other stakeholders, WHA has emphasized that any reimbursement changes must be part of broader payment reforms that address current inefficiencies in the system. The Council has requested reform proposals from provider groups by September 6.

Brenton: WHA Board Planning Session will focus on Associationís strategic plan

WHA President Steve Brenton reviewed the agenda for the July board planning session, which will focus on WHAís strategic plan. While the current plan fits the present environment quite well, Brenton emphasized that he wants to ensure that WHAís priorities continue to align with membersí key issues.

Brenton reviewed the Member Leadership Survey results. The survey helps measure WHAís performance and assesses the value that members believe they are receiving from their investment in the Association. Nearly three-quarters of WHA members who responded to the survey identified "advocacy" as the top benefit they expect to receive from WHA; and 90 percent said WHA did it "extremely well." All respondents ranked WHAís "clout" as a political advocate as excellent or good.

"The results of the survey indicate that our team is doing an outstanding job meeting and delivering on our membersí expectations. And that is at the heart of our mission," Brenton said. After advocacy, WHA members identified their key expected benefits as education and information/expertise.

Hospitalsí engagement in WHA Partners for Patients initiative continues to grow

Wisconsin hospitals were recently recognized for their outstanding efforts to reduce health care-associated infections by DHS and the state public health department. WHA Chief Quality Officer Kelly Court remarked that it is always a good place to be when others recognize your quality improvement efforts.

Court said after the WHA Partners for Patients Mid-Point Event in March, hospital quality teams felt "reinvigorated" and engagement in many of the six topics increased, including readmissions. Hospitals that are working with WHA have said that the webinars and online learning opportunities are a key factor driving their participation and success.

WHA council and task force reports:

Medical and Professional Affairs: Court said at the June 6 meeting Jo Musser presented the Wisconsin Health Information Organization (WHIO) plan to publicly report data on quality and resource use of Wisconsin primary care providers.

Wisconsin Council on Medical Education and Workforce: Chuck Shabino, MD, WHA senior medical advisor, and George Quinn, WHA senior policy advisor, reported that WCMEW will host a graduate medical education (GME) forum in the fall. Member hospitals provided enthusiasm for this learning opportunity and provided input to the agenda. The session will be aimed at senior decision makers from organizations that are thinking of expanding their present GME activities or are considering engaging in GME for the first time and they are looking at the practical applications for it in their organization. The Council expressed their concerns about the results of the last "Match Day" where the requests for residency program slots exceeded the number of positions available across the country. See full report at: www.wha.org/Data/Sites/1/pubarchive/valued_voice/WHA-Newsletter-6-14-2013.htm#1.

Top of page (6/21/13)

Assembly, Senate Pass Biennial Budget
$70 Billion budget now moves to Governor Walkerís desk

Both chambers of the Wisconsin Legislature passed the proposed 2013-2015 biennial budget this week. The budget, which was mostly amended and changed in the Committee process, saw several "technical" amendments by Republicans in the Assembly. These changes were agreed-to changes that leadership in both the Assembly and the Senate made prior to the Assembly taking up the budget on June 19.

In a surprising move, Assembly Democrats decided not to introduce the 200+ amendments they drafted and said that they would instead, "take this directly to the people of Wisconsin." In the Assembly, after finally going to the floor to debate the bill, Democrats called for a vote within a little over an hour of debate. The budget then passed that house by a vote of 55-42, with three Republicans voting against the bill.

The bill immediately moved over to the State Senate where, on June 20, Senators began debating the bill. Senate Democrats held out for nearly 12 hours of debate, offering amendments that included expanding Medicaid to 133 percent of the Federal Poverty Line. The amendment failed by a vote of 16-17, on party lines, with Senator Dale Schultz (R-Richland Center) joining the Democrats.

Finally, Democrats all objected to final passage of the bill late on June 20. This required the Senate Republicans to schedule a floor vote for 12:01 am on June 21, which was held and then allowed the Senate to pass the budget on mostly partly lines, with Schultz joining the Democrats.

The budget bill now moves on to Governor Walkerís desk. Walker may decide to make partial changes to the bill through a line-item veto, which allows him to strike certain portions of the bill before he signs it into law. Walker has indicated that he will be signing the bill into law before the beginning of the next fiscal year, which starts July 1, 2013. The Legislature could overturn any vetoes that Walker makes to the bill, with a 2/3 vote in both chambers of the Legislature, but this is highly unlikely.

Top of page (6/21/13)

Wisconsin Hospitals State PAC and Conduit Reaches 34 Percent of Goal

The Wisconsin Hospitals State PAC and Conduit fundraising campaign has raised more than $88,614 in the last two months from 114 individuals. This puts the 2013 campaign at 34 percent of the $260,000 monetary goal, which is the highest goal ever set by the annual campaign. While this number is slightly better than 2012 at this time, it is about $10,000 off of the 2011 campaignís pace where 140 individuals contributed almost $98,000 at this time.

This year so far, the individual average contribution is outpacing the averages at this same time in 2012 and 2011. This is due in part to the early number of contributors who are members of the Platinum Club, 37 individuals (32 percent of contributors to date), who have contributed $1,500 or more so far in 2013.

All individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. Thank you to the earliest of the 2013 contributors to date who are listed below. Contributors are listed alphabetically by contribution amount category. The next publication of the contributor list will be in the July 5 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Contributors ranging from $1 to $499
Ashenhurst, Karla Ministry Health Care
Bair, Barbara St. Clare Hospital & Health Services
Bayer, Tom St. Vincent Hospital
Bergmann, Ann Spooner Health System
Boson, Ann Ministry Saint Joseph's Hospital
Brenny, Terrence Stoughton Hospital Association
Brenton, Andrew Wisconsin Hospital Association
Calhoun, William Mercy Medical Center
Capelli, A.J. Aurora Health Care
Casey, Candy Columbia Center
Connors, Lawrence St. Mary's Hospital Medical Center
Culotta, Jennifer St. Clare Hospital & Health Services
Dahl, James Fort HealthCare
Ferrigno, Sandra St. Mary's Hospital
Fielding, Laura Holy Family Memorial
Granger, Lorna Aurora Health Care
Hafeman, Paula St. Vincent Hospital
Hardy, Shawntera Hudson Hospital & Clinics
Hieb, Laura Bellin Hospital
Hofer, John Bay Area Medical Center
Jelle, Laura St. Clare Hospital & Health Services
Johnson, Charles St. Mary's Hospital
Karuschak, Michael Amery Regional Medical Center
King, Steve St. Mary's Hospital
Klein, Tim Holy Family Memorial
Lange, George Westgate Medical Group, CSMCP
Maurer, Mary Holy Family Memorial
O'Hara, Tiffanie Wisconsin Hospital Association
Ose, Peggy Riverview Hospital Association
Pavelec-Marti, Cheryl Ministry Saint Michael's Hospital
Reinke, Mary Meriter Hospital
Rocheleau, John Bellin Hospital
Roundy, Ann Columbus Community Hospital
Schubring, Randy Mayo Health System - Eau Claire
Statz, Darrell Rural Wisconsin Health Cooperative
Walker, Troy St. Clare Hospital & Health Services
Westrick, Paul
Wolf, Edward Lakeview Medical Center
Wymelenberg, Tracy Aurora Health Care
Wysocki, Scott St. Clare Hospital & Health Services
Yaron, Rachel Ministry Saint Clare's Hospital
Contributors ranging from $500 to $999
Bablitch, Steve Aurora Health Care
Borgerding, Dana
Byrne, Frank St. Mary's Hospital
Carlson, Dan Bay Area Medical Center
Dietsche, James Bellin Hospital
Dube, Troy Chippewa Valley Hospital
Freimund, Rooney Bay Area Medical Center
Gullingsrud, Tim Hayward Area Memorial Hospital and Nursing Home
Hinner, William Ministry Saint Clare's Hospital
Hyland, Carol Agnesian HealthCare
Hymans, Daniel Memorial Medical Center - Ashland
Jacobson, Terry St. Mary's Hospital of Superior
Krueger, Mary Ministry Saint Clare's Hospital
Larson, Margaret Mercy Medical Center
Lewis, Gordon Burnett Medical Center
Mantei, Mary Jo Bay Area Medical Center
May, Carol Sauk Prairie Memorial Hospital
Mulder, Doris Beloit Health System
Richards, Theresa Ministry Saint Joseph's Hospital
Rickelman, Debbie WHA Information Center
Russell, John Columbus Community Hospital
Schafer, Michael Spooner Health System
Selberg, Heidi HSHS-Eastern Wisconsin Division
Shabino, Charles Wisconsin Hospital Association
Simaras, Jim Wheaton Franciscan Healthcare 
Stuart, Philip Tomah Memorial Hospital
Swanson, Kerry St. Mary's Janesville Hospital
VanCourt, Bernie Bay Area Medical Center
Worrick, Gerald Ministry Door County Medical Center
Contributors ranging from $1,000 to $1,499
Britton, Gregory Beloit Health System
Dexter, Donn Mayo Health System - Eau Claire
Kerwin, George Bellin Hospital
Levin, Jeremy Rural Wisconsin Health Cooperative
Martin, Jeff Ministry Saint Michael's Hospital
McKevett, Timothy Beloit Health System
Natzke, Ryan Marshfield Clinic
Roller, Rachel Aurora Health Care
Turkal, Nick Aurora Health Care
Contributors ranging from $1,500 to $1,999
Alig, Joanne Wisconsin Hospital Association
Anderson, Sandy St. Clare Hospital & Health Services
Bloch, Jodi Wisconsin Hospital Association
Boese, Jennifer Wisconsin Hospital Association
Clapp, Nicole Grant Regional Health Center
Court, Kelly Wisconsin Hospital Association
Eichman, Cynthia Ministry Our Lady of Victory Hospital
Frank, Jennifer Wisconsin Hospital Association
Grasmick, Mary Kay Wisconsin Hospital Association
Harding, Edward Bay Area Medical Center
Meyer, Daniel Aurora BayCare Medical Center in Green Bay
Potter, Brian Wisconsin Hospital Association
Sanders, Michael Monroe Clinic
Sexton, William Prairie du Chien Memorial Hospital
Size, Tim Rural Wisconsin Health Cooperative
Stanford, Matthew Wisconsin Hospital Association
Wallace, Michael Fort HealthCare
Warmuth, Judith Wisconsin Hospital Association
Contributors ranging from $2,000 to $2,999
Brenton, Mary E.
Herzog, Mark Holy Family Memorial
Jacobson, Catherine Froedtert Health
Kachelski, Joe Wisconsin Statewide Health Information Network
Katen-Bahensky, Donna
Kief, Brian Ministry Saint Joseph's Hospital
Leitch, Laura Wisconsin Hospital Association
Little, Steve Agnesian HealthCare
Mettner, Michelle Children's Hospital of Wisconsin
Neufelder, Daniel Affinity Health System
Normington, Jeremy Moundview Memorial Hospital & Clinics
O'Brien, Kyle Wisconsin Hospital Association
Oliverio, John Wheaton Franciscan Healthcare
Pandl, Therese HSHS-Eastern Wisconsin Division
Starmann-Harrison, Mary Hospital Sisters Health System
Woodward, James Meriter Hospital
Contributors ranging from $3,000 to $4,999
Borgerding, Eric Wisconsin Hospital Association
Contributors $5,000 and above
Brenton, Stephen Wisconsin Hospital Association
Tyre, Scott Capitol Navigators, Inc


Top of page (6/21/13)

WHA Opposes Physician Regulation in Firearms Bill
Prohibits certain discussion of firearms by physicians

On June 11, Representative Michael Schraa (R-Oshkosh) circulated the "Wisconsin Firearms Freedom Act" for co-sponsorship. The proposed legislation would, among other things, prohibit physicians from discussing certain issues related to firearms with patients. The provision seeks to regulate the medical practices of private health care providers as one component of larger firearms legislation aimed at preserving Second Amendment rights. WHA opposes this specific portion of the legislation.

Pursuant to a specific provision in the bill, a physician other than a psychiatrist would violate Wisconsin law if, in conjunction with obtaining a patientís personal information and medical history, the physician asks the patient if he/she has firearms at their home or property, or if the physician chooses not to continue to be the patientís health care provider if the patient chooses not to respond to that question. According to the Legislative Reference Bureauís analysis, violation of this provision would be a crime punishable by up to nine months in prison and a $25,000 fine.

While the bill exempts psychiatrists, WHA has informed the Legislature that many providers, not just psychiatrists, care for patients with depression or other mental illnesses and will inquire about gun ownership to develop a plan with the patient for reducing risk of suicide or other gun violence.

The proposal is modeled after the national "Firearms Freedom Act," legislation that has been proposed to create state-based protections for firearms owners. While much of the bill replicates this model legislation, the provision regulating physician practices was not included in the model Firearms Freedom Act that has been passed in eight other states across the country. That provision appears to be unique to Wisconsinís draft.

In a memo delivered to the Legislature June 18 opposing this section of the legislation, WHA noted its consistent objection to bills that put government in the position of setting medical practice rather than physicians and nurses. Referencing its opposition to legislation mandating pulse oximetry testing (SB 104/AB 111), WHA wrote "We believe we should rely on the judgment of the physicians and the nurses who are the experts in their fields to establish practice standards and should allow those standards to evolve over time through research and practice."

WHA has asked legislators not to support the bill if it continues to include the provision regulating physician practice. Several other health care organizations have also weighed-in with the Legislature indicating their opposition to the physician-related provisions of the draft legislation.

Top of page (6/21/13)

WHA Exchange Webinar Fills Information Void

The first of WHAís member forums on the health insurance exchange in Wisconsin garnered significant positive response from WHA members, with more than 400 people listening in to hear the latest on the exchange implementation.

"There is a real interest in the exchange in Wisconsin with just over 100 days to its implementation," said Joanne Alig, WHA senior vice president for policy and research. "There isnít a lot of accessible, factual information out there yet, surprisingly, and we want to make sure our members have what they need to understand potential impacts for their hospitals and systems."

WHA is stepping in to fill the void by offering a series of webinars to its members. In the first presentation, held June 13 and repeated June 18, Alig provided a high level overview of the basics of the exchange, including key issues such as benefits, penalties, tax credits and insurer timelines. She also discussed the changes in the Governorís budget in the Medicaid program, and how patients will be in transition. Some patients may lose Medicaid benefits and need to sign up for coverage in the exchange, others will be newly eligible for Medicaid as childless adults, and others will be newly eligible for private coverage through the exchange. All of this points to the need for outreach, education and assistance particularly for low income individuals and families to make sure they get signed up for coverage and maintain their coverage throughout the year.

Indeed hospitals were very engaged, and expressed high interest particularly in the discussion on navigators and certified application counselors. However, some details important for hospital planning efforts are not yet available, including federal and state government plans for outreach and education; the final rules on navigators and other assisters; and when and where training will be available. WHA expects more information to be released in the coming weeks and will work to communicate this information to our members (see related story in this issue).

WHA has scheduled two more member forums this summer. For more information, see related articles below in this issue of The Valued Voice.

Top of page (6/21/13)

Call for Nominations: 2013 Global Vision Community Partnership Award
Nominations Due to WHA Foundation by July 19

Honor one of your hospitalís community health projects by submitting a nomination for a 2013 Global Vision Community Partnership Award, presented by the WHA Foundation.

This competitive grant award is presented to a community health initiative that successfully addresses a documented community health need. The Award, launched by the WHA Foundation in 1993, seeks to recognize and support ongoing projects that support community health.

Any WHA hospital member can nominate a community health project. The project must have been in existence for a minimum of two years and must be a collaborative or partnership project that includes a WHA member hospital and an organization(s) within the community.

The official call for nominations for the 2013 Award is included in this weekís packet. Nominations are due July 19, 2013. Nomination forms can also be found on the WHA website at www.wha.org/global-vision-comm-partnership.aspx.

Top of page (6/21/13)

High Value Health CareóWisconsinís Competitive Advantage: UW Partners Watertown Regional Medical Center Reduces Readmissions 60%
Reducing Readmissions through Health Transitions Services

Patient safety is a top priority for all hospitals, but sometimes communication failures between settings during transitions of care can compromise patient safety and quality of care. Multiple studies of Medicare patients found that nearly one quarter of hospital patients experience issues during care transitions. And, an estimated 60 percent of medication errors occur during times of transitions: upon admission, transfer or discharge of a patient.

In an effort to reduce readmissions and to build a stronger bond with their patients, UW Health Partners Watertown Regional Medical Center (WRMC) made it a priority to develop a healing patient relationship that extends beyond the hospital stay. To facilitate this goal, WRMC deployed two RNs with more than 25 years of home health experience to follow up with patients after they are discharged. A clinical resource leader guides the nurses and monitors the program for quality.

Nurses usually see two to three patients per day in the home and spend additional time with follow up calls. "Home visits are extremely valuable teaching and learning opportunities. Nurses often find medication issues unknown to the hospital or to their primary care provider," says Christine Thompson, WRMC quality director. "It is very rare that an additional follow up visit is needed."

The nurses use the phone call as an assessment tool. When questions and problems arise, nurses use the WRMC electronic medical record to "task" the primary care physician. The nurse who calls the patient to follow up on the discharge instructions is usually the same person who checks in on them in their home. This helps to ensure continuity of patient care and increases patient satisfaction.

Patients at high risk for readmission are either selected to participate in the program, or if they have had the service in the past, they request it. Over a three-month period, WRMC reported none of these high risk patients were readmitted, a testament to the success of the program.

One of WRMCís Health Transitions nurses is Kathy Henze, RN. "We use patient-centered teaching to help make sure our patients fully understand their plan of care," Kathy says. "Iíve found there can sometimes be a gap in what their doctor is saying and what theyíre hearing."

"Kathy told me things I did not even realize," says Caroline Arndt, a patient who had been hospitalized with congestive heart failure in 2012. "Low sodium! I didnít realize it was that serious. I was just using less table salt. Now I realize I had to change what I was eating and I read labels on everything. You know I even found low sodium dill pickles and ketchup?"

"In 2011, prior to implementing the Health Transitions Program, our readmission rate was just over 10 percent," according Linda Holzhueter, who is leading the initiative. "In the past few months, it has been between three and four percent. On average, we have improved our readmissions rate by 60 percent."

The team at Watertown acknowledged that the assistance they received from the WHA Partners for Patients program enabled them to learn new approaches to quality improvement. They noted that the WHA-quality staff led webinars and the sharing of best practices among hospitals, an attribute that Wisconsin is known for nationally, helped them reduce readmissions and offered them the support they needed to reach their goal.

Top of page (6/21/13)

WHA Member Forum Focus on ACAís Employer Shared Responsibility Provisions

WHA will offer a members-only forum July 25 for hospital and corporate members, focused on what hospitals need to know, as employers themselves, about the Affordable Care Act (ACA) and health insurance exchanges.

Participants will receive an update on hot topics for employers under the ACA, with a focus on ACAís "pay or play" or "shared responsibility" provisions and how they impact strategy and plan design issues.

Hospital HR professionals, CEOs, COOs, and CFOs will benefit most from participation in this webinar. There is no cost to participate in this members-only forum, but pre-registration is required. Register at http://events.SignUp4.com/13HotTopics0725. If you cannot participate in the live webinar, there is an option to request an audio recording.

Top of page (6/21/13)

Member Forum Features Latest on Health Insurance Exchange, August 14

On August 14, WHA will be offering another members-only forum focused on the most current information available on the implementation of the health insurance exchange in Wisconsin. Moderated by Joanne Alig, WHA senior vice president for policy and research, this member forum will include presentations by representatives from the Centers for Medicare and Medicaid Services (CMS), Wisconsin Department of Health Services (DHS) and the Wisconsin Office of the Commissioner of Insurance (OCI).

Jackie Garner, interim regional director of HHS Regional Office V for CMS, will share information related to the implementation of the federal exchange in Wisconsin, including timelines, development of the online tool for consumers, information about the federal call centers, and other consumer assistance. Brett Davis, DHS Medicaid director, will discuss the transition of Wisconsin Medicaid recipients to the federal exchange. J.P. Wieske, legislative liaison/public information officer for OCI, will discuss the most current information available regarding insurers participating in the exchange, as well as information on training and registration for enrollment assisters.

Offered via webinar, this member forum will take place Wednesday, August 14, from 9:30-11:00 am. There is no cost to participate in this member-only forum, but pre-registration is required. Register online at http://events.SignUp4.com/13HCExchange0814. If you cannot participate in the live webinar, there is an option to request an audio recording.

Top of page (6/21/13)

Member News: Gaynor Retires After 20 Years of Service

Stan Gaynor, president and CEO of Black River Memorial Hospital (BRMH), will retire on June 28, 2013. Gaynor started at BRMH in 1993 after being the CEO for Burnett Medical Center for 13 years.

During his tenure, BRMH has experienced significant growth and organizational success. He was part of the team that lead the hospital to several awards, including Modern Healthcareís Best Places to Work, The Wisconsin Forward Mastery Award, The Jackson Groupís Laureate Award, and as a Top 100 Critical Access Hospital.

Gaynor has been involved at the state level by serving on the boards for the Rural Wisconsin Health Cooperative, the Wisconsin Hospital Association, and Shared Health Services Corporation. The community of Black River Falls has also benefited by his leadership roles with the Interfaith Caregivers, Ho-Chunk Institutional Review Board, St. Josephís Parish Council, Black River Falls Rotary Club, and as a volunteer with Employers Supporting the Guard and Reserve.

"I have enjoyed the opportunity to serve as the chief executive officer and am proud of the accomplishments of the staff," Gaynor said. "As I reflect on my years of serving the community and Black River Memorial Hospital, it is deeply satisfying to know the patients in our community will receive the best care possible."

Top of page (6/21/13)

Wisconsin Health Care Professionals Attend National Disaster Training Program

Imagine a small group of domestic terrorists attacking local infrastructure, leading to injuries and death, a disruption of daily life and instilling fear among area residents. Itís a scenario most people donít want to think about, but 134 personnel from 42 health care and hospital facilities across Wisconsin recently dealt with that scenario during an intensive, week-long training program June 10-14 at the Center for Domestic Preparedness in Anniston, Alabama.

The center provides emergency responders with the skills they need to respond to and manage incidents and is fully funded by the Federal Emergency Management Agency (FEMA) so participants can attend at no cost to their employers.

"Participating in an event like this is so valuable. It brings all of our community partners together to a state-of-the-art training facility where we can study, train, and go through these exercises," said Tracey Froiland, emergency management coordinator for ThedaCare and the Region 6 manager for the Wisconsin Hospital Emergency Preparedness Program (WHEPP). "Our community benefits from our involvement since we are gaining skills that will help us as we deal with incidents that very likely could occur in our communities."

For the Wisconsinís groupís scenario, multiple attacks on a subway system required officials to triage and treat more than 300 patients, who were portrayed by role players and manikins. Participants engaged in patient triage, patient tracking, hazmat, patient care and incident command activities during the mock disaster.

"Experience is the best teacher, and this experience was incredible," said Ron Krajnik, MD, medical director of New London Family Medical Centerís emergency department. "The hands-on training prepared us very well for a mass casualty drill. The large-scale and detail of the drill made it feel very realistic. I learned a great amount this weekópractical things I can bring back to New London. This course is a valuable experience for all hospital staff. If we ever experience a mass casualty in real life, everyone in the hospital is going to need to play a role in helping the injured."

Froiland, who organized the trip, said the training is invaluable, since itís very costly for individual communities to put on their own mock disasters. "We often donít have the opportunity to train along the entire continuum of a disaster and we received that chance in Anniston. We often train parts of it at a time, but donít have the resources to do an entire event from start to finish," she said. "Training is key. Disasters can be anything from like what we saw at the Boston Marathon to a natural disaster like the tornados in Oklahoma."

A unique part of the week is that there were three courses offered featuring only Wisconsin health care partnersówhich is a first for the center. "We did a health care leadership course that focused on using the incident command structure while keeping the hospital operational during a big event," Froiland said, "The other two courses donned Hazmat equipment in 90-degree weather while triaging and treating patients."

Megan Wilcox, ThedaCare, participated in the Anniston drill and contributed text and photos to this article.

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Wisconsin Hospitals Community Benefits: Charity Care

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

A patientís letter of thanks

"Dear Rogers Foundation,

I want to take this opportunity to extend my sincerest thanks for the grant. Within days of my arrival at Rogers, I came to the realization that I had finally found the help I so desperately needed.

When I learned my insurance provider would not cover the additional treatment, I was devastated. However, that feeling soon disappeared as I learned I was a candidate for a grant. This was a time in my life when I felt I was worth nothing. On paper, I didnít appear to be a good investment but the Foundation, with this grant, told me I was worth everything.

I am amazed that people who were relatively unknown to me would extend such a gift. The grant has been pivotal in my success so far. It not only gave me the additional treatment I desperately needed but more so, it was an endorsement in me as a person.

I am eternally grateful for what you have done!" - Phil G.

Rogers Memorial Hospital, Oconomowoc

Charity care

This story highlights one of the many Charity Care cases Bellin Health System in Green Bay regularly offers qualified patients.

Rhonda, a senior citizen living in the Green Bay area, was recently in a tight spot Ė unemployed, living on Social Security benefits and no health insurance.

Getting by day-to-day was a challenge in itself, so regularly-scheduled visits to the doctor for necessary checkups were out of the question, especially without the means to pay for the health services or medication.

"Unless you have been in a position of having no health coverage, you cannot imagine what a terrifying feeling hangs over your shoulders all the time," Rhonda said. "It is horrible to have to try resisting going to see a health care provider when you are in need because you know that the huge balances you will incur are going to drag you under as you have no means of paying them."

But Rhonda could no longer resist seeing a health care provider when she began feeling severe chest pains. The pain quickly and effectively rendered her fears of financial hardships moot as she found herself rushing to Bellin Healthís Emergency Services Pavilion for treatment.

Following the emergency room episode, the medical bills eventually came, as did Rhondaís concerns over her inability to pay them. Thatís when Bellinís Community Care program stepped in.

Community Care or charity care is offered to low-income patients that have little or no ability to pay for much-needed medical services.

"All too often we see seniors that are too young for Medicare come in with some serious health problems, as in Rhondaís case, because theyíve waited so long to see a doctor out of their inability to pay for services," said Cathy Barbeaux, a financial assistance specialist at Bellin. "Thatís where we come in. Our Community Care program is able to assist during those special cases where patients do not qualify for any other public assistance. Rhonda was one of those cases."

The charity care provided to Rhonda was a relief, a weight lifted off her shoulders.

"Your program is truly community care," Rhonda said. "I, for one, will always be so very grateful that it was there for me in my times of need. Thank you so very much."

Note: The patientís name in this story has been changed to protect patient confidentiality.

Bellin Health System, Green Bay

Mission in Action

At Langlade Hospital our mission is to heal, promote health and enrich lives. We advocate for the most vulnerable patients and act responsibly on behalf of all those we serve. This is a long-standing mission of Langlade Hospital, Aspirus and the Sisters of the Religious Hospitallers of St. Joseph.

Langlade Hospital has a program called Community Care that offers a way to ease the financial worries of patients in need of medical care that do not have a means to pay for those services. Our mission-driven organization embraces those that are in need. Read on.

Grace retired in Wisconsin a few years ago and no longer has family close by. She depends solely on friends for her transportation and emotional support. At age 70, Graceís health took a turn for the worse and she was suddenly faced with an overwhelming burden of mounting medical bills. She is on a tight budget as Social Security is her only source of income. She was in need of ongoing medical care and physical therapy and considered declining care because she was concerned about the cost and how she would pay for it. Langlade Hospital Community Care program wrote off 100 percent of the charges that were incurred at Langlade Hospital and encouraged Grace to keep her appointments and get the care that she needed. Grace sent a note to the hospital that said: "I donít know what to say! God bless everyone that helped me. Thank you from the bottom of my heart."

A few years ago, William became disabled as a result of degenerative spine disease and was no longer able to work. Shortly thereafter, he was diagnosed with cancer. Disability payments have not come through for him, and he is unsure if it will ever happen. William cashed out his 401K which has provided the only family income that he and his wife have. His wife provides full time care to William and continues to look for part time employment but in the struggling economy is having difficulty finding work. She is ineligible for unemployment so the coupleís cash reserves are exhausted. Langlade Hospital Community Care program has taken care of all hospital charges as William continues his battle with cancer and degenerative spine disease. Williamís wife wrote: "Thank you so much for your help. We are so blessed to be living in this community, where people help people. God bless the Sisters, Hospital Board and anyone who had a hand in helping us qualify for this wonderful program."

Steven was diagnosed with an aggressive cancer and was undergoing debilitating treatments. He lives with his elderly step-father and has no other family to count on. Steven had a compromised immune system and became very ill with pneumonia. He has been unable to work due to his illness, has no health insurance and his unemployment has run out. Steven worries about the cost of his chemotherapy and extensive lab work. Langlade Hospital Community Care program has taken care of 100 percent of his hospital costs. Steven writes: "I sincerely thank your organization and staff for the assistance with my bills. Our family has been economically burdened for quite some time and the help you have provided has been an unexplainable blessing."

Langlade Hospital Ė An Aspirus Partner, Antigo

Submit community benefit stories to Mary Kay Grasmick, editor, at

Read more about hospitals connecting with their communities at www.WiServePoint.org.

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