June 28, 2013
Volume 57, Issue 26

WHA Urges Governor to Approve DSH
Exchange enrollment key to reaching Gov’s coverage pledge

With Governor Walker contemplating changes he will make to the state budget via his veto, this week WHA urged him to approve the $73 million Disproportionate Share Hospital (DSH) program inserted into the budget by the Legislature.  Walker will reveal which items he approves and which he vetoes June 30 when he signs the budget bill into law.

“No matter how well planned or executed, transitioning currently covered populations into the exchange comes with risk, and could result in increases in uncompensated care,” WHA Executive Vice President Eric Borgerding wrote in a letter to Governor Walker on June 26 urging him to approve the DSH proposal.  “Recognizing these concerns, the Legislature amended (the budget bill) to reestablish the Medicaid DSH program … This is welcome recognition of the challenges that will confront Wisconsin’s safety net hospitals during the transition to the federal exchange.”

WHA also urged Walker to closely scrutinize forthcoming state rules regulating exchange navigators and assisters.  The Legislature inserted the new rules, which come on top of yet-to-be developed federal navigator rules, into the state budget in May (see May 17 issue of Valued Voice).

“Part of the success in reaching your goal of reducing the number of uninsured (by 225,000 people) will rest on the work of assisters, whether navigators, certified application counselors or other individuals   who are assisting with enrollment for low income populations,” WHA stated in the same letter to Governor Walker. “Please ensure that these new state-level regulations avoid unnecessary duplication, complexity and administrative expense and do not impede the ability of assisters to provide meaningful services to those applying for coverage through the exchange.”

The letter to Walker also included support for WHA-backed provisions that were added by the Joint Finance Committee for an “off ramp” of the proposed Medicaid eligibility changes. The “off ramp” provisions included in AB 40 would maintain current Medicaid eligibility standards should the exchange be nonoperational on January 1, 2014. Further, if a qualified health plan (QHP) is not available via the exchange in a particular county, childless adults under 100 percent would become eligible for Medicaid and those currently on Medicaid would not be disenrolled in that county.  Once the Department determines that a QHP is offered in the county, then those non-elderly, non-disabled adults between 100 percent and 200 percent FPL would be disenrolled.  WHA expressed the importance of this provision as a sound contingency plan to the Governor’s proposed Medicaid eligibility changes.

WHA also conveyed its strong support for the $5 million in new funding that was included in the budget for expanded residency training slots and creation of new residency programs.  These important funding initiatives were included by Governor Walker in his version of the state budget in February (see February 22 issue of Valued Voice), but slightly tweaked by the Legislature to shift more funding into hospital residency grants.  The change is supported by WHA.

See next week’s Valued Voice for a recap of developments with these and other key WHA-supported provisions included in the state budget.

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HHS Exchange Education, Outreach Effort Offers Little Information

The Department of Health and Human Services (HHS) unveiled a toll-free line and launched a revised website June 24 aimed at helping consumers and small business owners understand the new health insurance exchanges. A WHA review of these resources indicates that HHS is in the very preliminary implementation stage, with nothing yet available that consumers can act upon. HHS indicated it will be mid-September before benefit plans are available for consumers to view and to find how much the plans will cost.

HHS hosted a teleconference to provide information about their new resources and to promote their use in driving enrollment among the uninsured this fall.  The teleconference found, though, that there are still many more questions that will need to be answered before the exchange open enrollment begins October 1. Several callers had questions about a variety of topics ranging from how income is counted to details on the small business exchange (also known as SHOP), that could not be addressed over the call. 

The Wisconsin Hospital Association (WHA) has raised and continues to raise concerns about whether the insurance exchanges will be fully functional October 1 and whether consumers will have enough information to enroll in coverage.  The exchange enrollment process is critical as the Wisconsin Department of Health Services (DHS) begins to implement the Governor’s 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 for benefits beginning January 1, 2014. This means that roughly 1,400 people per day will need to be enrolled between October 1 and December 15, to avoid any gaps in coverage.

It’s an ambitious endeavor, and one that is making WHA members and others quite nervous, according to WHA Executive Vice President Eric Borgerding, given that the success of the Governor’s plan is largely tied to the exchanges. 

Despite strong commitments by DHS, 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.

“Hospitals emergency departments could become the defacto insurance plan for thousands of low income adults and families,” according Borgerding. “That dynamic is bad for our patients, our hospitals and for everyone who feels the bite of cost shifting from uncompensated care.”

There was much interest among the more than 400 WHA members who participated in a recent Association-sponsored webinar about how and when consumer information about the exchange would be available. Below are links to the resources that HHS has released: 

HHS toll free hotline number is:  1-800-318-2596
HHS website for the Exchange is: https://www.healthcare.gov/
HHS press release:  http://www.hhs.gov/news/press/2013pres/06/20130624a.html

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Learn Latest on Health Insurance Exchange at WHA Member Forum August 14

WHA will host 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’s 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 the latest  information available 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. DHS Medicaid Director Brett Davis 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 through a webinar, the Member Forum will take place Wednesday, August 14, from 9:30-11 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.

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AHA Urges Congress Not to Cut Hospital Emergency Preparedness Funds

Hospital emergency preparedness funding has taken a hit over the past few years – a situation that the American Hospital Association (AHA) says could lead to hospitals not having the resources they need to be fully prepared for a disaster.  

In an advertorial placed in the Wall Street Journal June 25, AHA advocated for “reasonable” funding of hospital emergency preparedness. Hospitals in Wisconsin and across the country develop and implement preparedness plans to care for victims of natural and other disasters that occur in their communities. But “[w]hile preparedness pays,” AHA President/CEO Rich Umbdenstock, said in the ad, “it also costs. Providing emergency care around the clock demands constant staffing of the emergency department and much more—laboratory, radiology, pharmacy, surgical services, general and intensive care units, labor and delivery.”

Wisconsin hospitals and hospitals in other states likewise “invest in communications and emergency power systems, purchase personal protective gear, build decontamination units and stockpile medical supplies.” Umbdenstock pointed out that funding from the federal government for hospital emergency preparedness has declined by almost 30 percent over the past decade and that this decline, compounded by decreasing Medicare and Medicaid reimbursements, may severely curtail hospital emergency preparedness in Wisconsin and beyond. Umbdenstock urges policymakers to consider preparedness an investment “that must be nurtured and grown over time” by providing reasonable funding now.

In Wisconsin, WHA works in partnership with DHS on preparedness through the Wisconsin Hospital Emergency Preparedness Program (WHEPP).

“WHEPP funding has helped our hospitals invest in life-saving supplies, equipment and training that are critically important to ensure that we can respond quickly and appropriately when disaster strikes in our communities,” said WHA President Steve Brenton.

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High Value Health Care—Wisconsin’s Competitive Advantage

High quality, high value health care is a hallmark in Wisconsin. Hospital systems are improving quality, increasing efficiency and delivering value to employers and residents in their communities. Hospitals have been working with WHA in a focused initiative to reduce readmissions. This week, we feature the work of Vernon Memorial Hospital in Viroqua.

Vernon Memorial Hospital Cuts Readmission Rate Nearly in Half

With assistance from the WHA Partners for Patients program and by attending the Statewide Transitions of Care Coalition* (STOCC) workshops last fall, Vernon Memorial Hospital (VMH) in Viroqua has reduced their rate of hospital readmissions from 3-4 percent in 2012, to 1-2 percent now.  The hospital hosted STOCC’s first Community Coalition Workshop.

According to VMH Director of Quality and Compliance Sue Sullivan, the workshop helped caregivers understand their local system of care, identify gaps and understand how navigating transitions looks from the patients’ perspective.  Vernon County used a multi-stakeholder approach led by VMH to improve the transition of care when patients are transferred from one entity to another. VMH hosted several discussions and planning sessions with area nursing homes, home care and hospice, County Unit on Aging, Western Wisconsin Cares and Vernon County Health Services.

“We recognized early in the process that there are multiple issues related to a patient moving from one place to another so we began a discussion on what could be done to improve the process and prevent the patients from being readmitted to the hospital,” Sullivan said.

Preventing readmissions is a complex process, since any number of factors can lead to a hospital readmission after discharge.  For many years, hospitals have been continuously working on improving their discharge processes, simplifying patient handouts, and ensuring patients are clear about their self-care upon leaving the hospital. However, a number of factors outside the walls of the hospital can influence if a patient must return. These factors might include confusion with medications once the patient arrives home, problems getting to a clinic or pharmacy, or patients not recognizing a serious change of symptoms. 

Hospitals are not able to solve these types of issues independently, according to Stephanie Sobczak, WHA quality manager and co-lead of the Statewide Transitions of Care Coalition.  The system of care in the patients’ community can have an effect on their ability to stay out of the hospital.  Sobczak said this is particularly true in rural areas.  In addition, providers across the spectrum, such as nursing homes and primary care clinics, are being held to new standards – mainly driven by the Centers for Medicare and Medicaid Services.  Rural hospitals, such as Vernon Memorial, are discovering the benefits of working across the care continuum with other provider organizations.

Sullivan said the group determined communication issues were at the top of the list. VMH is developing a universal tool for each organization within the county to use when transitioning patients. Each organization is identifying what information they need when receiving or transferring a patient to another setting. 

VMH started a readmissions group that discusses their internal discharge planning process on a regular basis. The hospital pharmacy has increased the number of patients who receive complete medication reconciliation on admission and prior to going home, and the hospital pharmacy also communicates to external pharmacies to make them aware of medication changes.

Patients also receive a call from a nurse within 48 – 72 hours after they are dismissed from the hospital to ensure they understand the discharge instructions.

*The Statewide Transitions of Care Coalition started in 2012 is co-led by WHA and MetaStar.  Representatives also include LeadingAge Wisconsin, Wisconsin Health Care Association, WI Department of Health Services, the Greater Wisconsin Agency on Aging Resources, Wisconsin Collaborative for Health Care Quality and several other organizations.  

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Reedsburg Area Medical Center Hosts First-Ever Rural Conference Site Tour

For the first time, the Wisconsin Rural Health Conference  offered an option to tour a local hospital, and Reedsburg Area Medical Center (RAMC) was proud to be the first hospital to open its doors to attendees.

The tour included stops at Ridgeview Heights Independent Living retirement community, the Reedsburg Area Senior Life Center, the Reedsburg Area Medical Specialty Center & Surgery Center, the Fusch Community Center, the emergency room  and a walking tour of the RAMC campus. 

“We are really proud of our organization, from our acute care services to our commitment to meet the needs of the elderly in our community through our residential living and long term care facility,” according to RAMC President Bob Van Meeteren.    “We believe in providing services that align with the continuum of care from birth to end-of-life, and we think it is important   that our residents can receive that care close to home and family.”

During a tour of their specialty clinics, Van Meeteren said RAMC brings a broad range of specialists into their hospital to ensure that patients can receive the care they need in their community. That raises the health status of the community, and keeps economic benefits in Reedsburg as well. 

“We bring health care providers to Reedsburg instead of sending Reedsburg out of town to the providers,” Van Meeteren said.

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St. Joseph’s Hospital Honored Nationally for Improving Community Health

The American Hospital Association announced that St. Joseph’s Hospital’s Chippewa Health Improvement Partnership is being awarded for its collaborative efforts to improve community health with the 2013 American Hospital Association NOVA Award. The Association will present the award at a ceremony during the Health Forum/AHA Leadership Summit on July 27 in San Diego.

Only five hospital programs throughout the country will receive the prestigious award this year. Others include programs in Maine, Kentucky, Indiana and Michigan.

“We are pleased to honor this year’s AHA NOVA winners for their collaborative efforts to improve health and wellness,” said AHA President/CEO Rich Umbdenstock. “Working together, hospitals and like-minded community organizations are providing valued and compassionate programs and addressing vital health care needs.”

Chippewa Health Improvement Partnership is an area-wide initiative responding to the health, environmental, social and economic needs of people of all ages. With the goal of improving overall health and quality of life, CHIP has successfully established a federally-qualified dental and oral health care center, provided automated external defibrillators in public venues and helped to establish an open door clinic that offers free medical and mental health care.

“Being named a recipient of the prestigious AHA NOVA award is a humbling honor,” said Rhonda Brown, Chippewa Health Improvement Partnership director. “It brings community health to the forefront and reinforces that Chippewa Health Improvement Partnership has been on the right track.”

Chippewa Health Improvement Partnership has successfully improved food security in the area and increased community awareness of sweetened beverages as part of its goal to lower childhood obesity. The community partnership directed a falls prevention program for the elderly in addition to advance directive education and end of life planning, just to name a few. St. Joseph’s Hospital is the primary funding source for CHIP although local, state and federal grant monies are actively sought and successfully secured.

Established in 1993, the AHA NOVA Award recognizes hospitals and health systems for their collaborative efforts toward improving community health.

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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.

Charity care recipient grateful

Since beginning at Reedsburg Area Medical Center (RAMC) in 1996, Lori has always gone above and beyond for the patients she encounters each day in her role as a collections coordinator.  *Jill, a recipient of RAMC’s Charity Care program, shared that it was because of Lori’s helpfulness that she and her husband were able to make it through yet another winter.

 “Thank you so much for helping us with the medical bills. We had no way of paying for all of them. It’s nice to know that there are people like you out there that can help.  We are very thankful Lori, that you made this happen for us.  You really blessed us.  Thank you so much!”

 As part of RAMC’s mission, we are committed to ‘going beyond the expected’ in providing our top-notch care to everyone, regardless of their ability to pay. Lori’s commitment to this mission is just another example of how our employees take our mission to heart.

*=name changed for privacy

Reedsburg Area Medical Center

From community clinic to hospital for medically necessary treatment

A physician at Aurora Walker’s Point Community Clinic referred a 60-year-old male to Aurora St. Luke’s Medical Center (ASLMC) with a diagnosis of “pleural effusion of unknown etiology.”  The clinic was unable to successfully treat the issue, and the patient’s condition was worsening rapidly.

At ASLMC the patient was seen by pulmonology and thoracic specialists for a STAT evaluation, delay of which, according to the referring physician, “would likely result in demise.”

The patient, a former schoolteacher who had been laid off a few years ago and had been unable to obtain gainful employment since that time, had been working for temp agencies and in other low paying part-time jobs.  At the time of admission he was working in a bakery getting only minimal hours at minimum wage with no insurance.

The patient did not meet criteria for BadgerCare or Medicaid and could not afford HIRSP insurance.  With the help of the hospital’s financial counselor, he applied for Aurora’s Helping Hand Patient Financial Assistance Program.  His application was approved expeditiously due to the urgent medical need outlined by the referring physician. The patient was approved for a 100 percent discount and continues to receive the treatment he needs at ASLMC.

Aurora St. Luke’s Medical Center, Milwaukee

Wheaton Franciscan Healthcare lends a hand to new Wisconsin resident

When Rosann lost her job, she decided to move to Wisconsin to be closer to family. She applied for BadgerCare, and during two and a half years on the waiting list, Rosann developed medical conditions that needed attention.

Realizing that her issues could not be delayed any longer, Rosann sought care at Wheaton Franciscan Healthcare – All Saints including testing for blood clots and treatment for high blood pressure. While receiving treatment, Rosann heard that Wheaton offers a program called Community Care that provides free or discounted health services to those who qualify. 

With the help of her doctor, Rosann met Jill Barbian, a financial counselor with Wheaton, who helped her apply to the program.

“Jill must deal with so many people every day,” said Rosann. “But whenever she was with me, she made me feel so important.”

Rosann did not think her condition was severe enough to qualify for the program but hoped for the best. To Rosann’s surprise, her application was accepted, and Wheaton provided care with no out-of-pocket costs for her.  

“I really appreciate Jill’s help. There was no question that I would ask that she couldn’t answer,” said Rosann. “She really belongs working with people and helping them.”

Wheaton Franciscan Healthcare – All Saints, Racine

Community Care

A 64-year-old woman was diagnosed with Ovarian Cancer in the spring of 2011.  She was a widow, and she was working to support herself. Unfortunately, she was unable to return to work during her oncology treatment.  She was drawing wages from short-term disability and her Social Security.  However, this was not enough to allow her to meet her financial needs.

As a result, the patient was unable pay her Cobra premium(s).  St. Vincent financial counselors assisted with not only obtaining financial assistance through the hospital’s community care program, but also paid her Cobra premiums to support her ongoing health care needs.

Sadly the patient passed away, but had frequently expressed gratitude for the assistance she received.

St. Vincent Hospital, Green Bay

ThedaCare hospitals end gut ache for Shiocton man

For a long time, Keith Olson of Shiocton had been plagued with severe stomach aches. “All of a sudden one day I just couldn’t take it,” he said, recalling his trip to the emergency room.  

Olson, 48, was diagnosed with ulcerative colitis, which is hereditary but can be triggered by stress. Over the year, Olson required five surgeries, some extensive, including a recent visit in May. One of his intestines broke open and more issues kept happening. He has  been in and out of facilities like Appleton Medical Center, Theda Clark Medical Center and New London Family Medical Center.

 Olson said during his first surgery, doctors thought he would not make it. He had been in a coma for a short time. Then he had to spend a couple months in the hospital and learning how to walk again.

 Olson knew the medical bills would soon pile up, and being unable to work, he worried how he would pay them. While in the hospital, a nurse told Olson about ThedaCare’s Caring Hearts Financial Assistance Program.

 “We got the forms, and we filled them out,” he said. “To my surprise, they came through. They would help me up to 100 percent.”

 His medical bills were at $3,500 and climbing. He has been living off his 401K, which has helped cover living expenses. He has also filed for state disability but has been turned down. He hopes to appeal.

 “I don’t know if I’m going to get any help of any kind,” he said. “If I don’t get help, I’m going to lose my house, the car.”

 Without the help from Caring Hearts, Olson knows he would have already lost his home and car.

 “That’s where the Caring Hearts came in,” he said. “They saved me the extra bills.”

 He is glad the program is available to those in need. “It’s an incredible program,” he said. “They’ve never not done what they said they were going to do. It’s been flawless.”

ThedaCare, Appleton

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