June 6, 2014
Volume 58, Issue 23
WHA Legislative Briefing Increases Policymakers’ Knowledge of Wisconsin Quality Initiatives
Vukmir: "We all have a stake in protecting Wisconsin’s high-quality, high-value health care."
The legislative session ended a few short weeks ago, but that doesn’t mean that work behind the scenes in the State Capitol has come to a stop. More than 60 legislative leaders and their staff members attended a legislative briefing sponsored by the Wisconsin Hospital Association June 3 to gain a deeper understanding of and appreciation for the quality improvement work that is taking place in hospitals across the state.
"We all have a stake in protecting Wisconsin’s high-quality, high-value health care," Sen. Leah Vukmir said in her introductory comments. "High quality health care means that we have fewer hospital readmissions, fewer infections and people get back to work quicker here than nearly every state in the nation. I think we should hold our heads high when we hear that statistic."
Vukmir, along with Sen. Jon Erpenbach, Rep. Erik Severson and Rep. Sandy Pasch were acknowledged for their support of the capitol briefing.
WHA Executive Vice President Eric Borgerding and WHA Chief Quality Officer Kelly Court helped the policymakers and their staff understand how sound public policy can promote higher quality, safer care. Alternatively, excessive or burdensome regulation can stifle it. Fortunately, according to Borgerding, the last legislative session demonstrated that Wisconsin legislators are committed to creating a policy and regulatory environment that promotes high-quality patient care, and supports the caregivers who are delivering that care. Borgerding provided the following examples:
The 2011 Institute of Medicine Report Set the Stage for Quality Improvement
While the Institute of Medicine (IOM) 2011 report, "Crossing the Quality Chasm" delivered some rather dismal news, it also set the stage for quality improvement work by more clearly defining "quality." IOM identifies the six aims of quality as ensuring that care is:
Court and Borgerding provided multiple examples of how WHA’s quality-related work aligns to the six IOM aims.
"WHA’s quality strategy is to position Wisconsin hospitals and health systems ‘ahead of the curve’ using improvement collaboratives, public reporting and supportive public policy so we can be a leader state and provide the highest quality of care possible to our patients," Court said. "All of this ends up making a difference for every patient, but it’s also what propels us as a state to get the results we get and how we stack up in the country. We are constantly looking for what keeps Wisconsin ahead and how we stay there."
Wisconsin hospitals are among the most collaborative in the country, meaning that once they try and successfully implement a strategy that increases quality or safety, they share it with other hospitals. That raises the bar for quality statewide, which in turn has helped elevate Wisconsin in national rankings. It also helps hold down health care spending.
"Our members’ commitment to improving quality has not only decreased the number of readmissions, infections and falls in our hospitals, but it has reduced health care costs by an estimated $46 million in Wisconsin," Borgerding said.
Hospitals Share Their Improvement Stories
Quality improvement is a top priority for Wisconsin hospitals and WHA. While Borgerding and Court provided a statewide perspective on the impact of high quality in Wisconsin, two of WHA’s members brought the story closer to home.
Joanne Jackson, administrator of quality at Amery Regional Medical Center, and Gail Ostrander, chief performance improvement officer at HSHS Eastern Wisconsin Division, took the audience to the front lines of patient care. Ostrander and Jackson both said how their involvement with WHA’s Partners for Patients program has been invaluable to their improvement work over the past two years.
"Our goal is to surpass our patients’ expectations and deliver the highest quality care possible," according to Jackson.
Ostrander said their approach to quality is to inspire a sense of ownership among frontline care givers, and then give them the tools and knowledge they need to improve patient care. "It is not just what we do to improve quality, it is how we do it that has really driven our results," Ostrander said.
Why Quality Matters
Wisconsin is ranked among the top states in the nation by federal agencies, non-governmental organizations, and highly-respected research organizations alike. But, why does quality matter?
"It is obvious why it matters to our patients. But the position we occupy with high quality and high value is something we should exploit from an economic development perspective. We believe that it is a strong asset for our state and a ‘Wisconsin advantage,’" according to Borgerding.
Borgerding noted that high-quality care and the public policy necessary to enable and promote it has strong bi-partisan support.
"Our state leaders know the value of promoting a strong health care delivery system," Borgerding said. "Legislators from both parties know that health care is an important economic development tool as we promote our state, and with your help, it is an asset that we will continue to promote in every community to keep us moving forward."
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The first WHA members-only Health Law Manual webinar held June 5 on the topic of "consent" drew nearly 200 participants. Presented by Heather L. Fields and Nicole S. Rosen from the law firm of Reinhart Boerner Van Deuren, the education event covered topics related to medical treatments and procedures, refusal to consent and advance directives.
The presentation of the WHA Consent Manual was the first of nine webinars that WHA and partner law firms will make available exclusively to WHA members through the fall. WHA members are encouraged to register for any or all of the other eight webinars in the series. Sign-up information may be found at http://events.SignUp4.net/HealthLawManual. Attorneys in attendance may earn CLE credit.
The Health Law Manuals are available for WHA members to view and download at www.wha.org/healthLawManual.aspx. WHA members who would like to access the Manuals should contact email@example.com to request a username and password. For more information, contact Andrew Brenton, WHA assistant general counsel, at firstname.lastname@example.org or 608-274-1820.
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Mental health issues touch nearly every family. As a member of the Speaker’s Task Force on Mental Health, Rep. Paul Tittl realizes that he may not know all the questions yet, or have the answers, but that has not stopped him from tirelessly pursuing solutions that will connect those who seek help with the services they need.
"One of the accomplishments of my first term that I am most proud of is my service on the Speaker’s Task Force on Mental Health," Tittl said during a recent WHA interview. "It was probably one of the greatest enlightenments that I have had over my ten years of public service. What I really learned about mental health is the realization that there are a lot of people dealing with the issue—individually or as a family member—and we want to help them reach out and get the help that they need."
Tittl has worked closely with WHA on its mental health agenda to understand both the provider and patient perspective. He said during the next legislative session and over the summer, work will continue on the mental health legislative agenda. His plan is to bring stakeholders together to learn how to better connect people to the help they need in their community and across Wisconsin.
"I think it is essential if you are working on a health care issue that you involve the people in the field who are delivering the services and that you are talking with them on a regular basis so you can understand the obstacles that they face with government regulation," he said.
Tittl is not unfamiliar with the toll that chronic illness has on a person and their family. He battles rheumatoid arthritis on a daily basis.
"It is very important that patients connect to treatment. It can make a difference in their life and in their longevity, while also saving money because they do not become more ill or disabled and require an even higher level of care," Tittl said. "I understand chronic illness and the pain and suffering it can cause. It is one of the reasons I am so interested in health care issues."
On the subject of economic development, Tittl is quick to point out the importance of health care to the state’s economy.
"Health care is right up there with schools and taxes. People want to locate a business or move to an area where they have reasonable taxes, good schools and high-quality health care," he said. "Employers want accessible, convenient health care for themselves and their employees."
And all employers, including hospitals, deserve a regulatory environment that is as simplified as possible, which is why Tittl strongly supported reforming hospital regulations.
"Anytime you reform regulations, a lot of people understand the benefit because as business owners themselves, they know that when the regulatory process is streamlined and updated, it also can create and save jobs," Tittl said.
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Patient care starts at the bedside, so it only makes sense that quality improvement efforts should begin with front-line nurses. The WHA Transforming Care at the Bedside (TCAB) project is engaging nurses and front-line staff to improve the quality and safety of patient care on medical and surgical units, intensive care and long-term care units in hospitals.
TCAB was one of several WHA quality initiatives highlighted in the legislative briefing delivered June 3 in the State Capitol (see story on page 1).
Jodi Johnson, WHA vice president, workforce and clinical practice, recently visited three hospitals’ nursing units that are participating in TCAB to learn how they applied it in their respective settings.
The TCAB team at Mile Bluff Medical Center shared that their biggest win occurred when they were only three months into TCAB. They have seen an increase in staff engagement and enthusiasm, with positive support from their CEO. The staff of the medical-surgical unit are sharing their progress as well as displaying their quality data. The team will continue its activity with a focus on the amount of time spent with patients, which will include placing needed supplies at the bedside.
Staff at Columbus Community Hospital (CCH) has made strides by using lean principles to reorganize their supply room, which saves time and steps for both front-line and central supply staff. The TCAB team also redesigned their white boards to improve communication to patients and families. Another project improvement shared during the site visit included signage outside patient rooms that indicated whether the patient wanted to be involved in bedside report. Johnson said the CCH TCAB team has done a fantastic job of engaging both staff and patients.
Excellent outcomes was the highlight of the site visit at Calumet Medical Center, which boasted a 30 percent increase in the time nurses spent at the bedside. Visual management tools and transparency of the data collected during TCAB has bolstered team vitality. The TCAB team is expanding their activities to the emergency department where they will focus on pain management.
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Jenna Hanson joined WHA as education coordinator June 2. Hanson comes to WHA from Northern Illinois University where she worked in the admissions office supporting all aspects of the university’s recruitment efforts, including assisting in the planning, marketing and implementation of recruitment events.
"We are excited to welcome Jenna to the WHA team," said Jennifer Frank, WHA vice president of education. "She will be a valuable addition to the education department and will be a wonderful representative of WHA at our various education offerings throughout the year."
Hanson holds a bachelor’s degree in Chinese and international studies from the University of Wisconsin-Madison. Hanson can be reached at email@example.com or 608-274-1820.
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As WHA improvement advisers complete their spring site visits, they found the information that they personally gathered from the hospitals to be extremely valuable in building a body of knowledge statewide from which all hospitals can draw.
"WHA encourages hospitals to share improvement strategies during our monthly webinars, but there is never enough time to hear from everyone," according to Travis Dollak, WHA improvement advisor. "The site visits with hospitals that are participating in the WHA Partners for Patients program are always helpful. The four hospitals I visited this spring shared an incredible list of strategies that are helping them maintain momentum in their improvement work. I would have never gained all this information through the monthly webinars."
Four hospitals that have not limited their focus to clinical best practices, but are focused on building a collaborative culture for improvement, are described below.
Bay Area Medical Center (Marinette)
Bay Area Medical Center (BAMC) has been an active member of the WHA Partners for Patients collaborative the past three years and continues to expand. BAMC has actively focused on falls and readmissions as two of their biggest opportunities for improvement. They also continue to expand their efforts to reduce "harm across the board." Evidence of their expansion, and one driver of success, has been their visual management. Led by Chief Nursing Officer Rooney Freimund, the quality and infection prevention departments have increased their use of visual management. The team has actively been using multi-purpose display posters. Not only do the posters remind staff of best practices, but they provide feedback on the number of days since their last event. This has helped the team to continue to reduce falls, while sustaining good results in central-line associated blood stream infections, catheter-associated urinary tract infections and surgical site infections.
Riverside, Shawano, and New London Medical Centers (Waupaca, Shawano and New London)
Riverside Medical Center in Waupaca, Shawano Medical Center and ThedaCare Medical Center-New London are three critical access hospitals in the ThedaCare system. Dollak visited with staff in Waupaca, then moved on to New London where members of the quality improvement team from Shawano joined them.
"If you ask them, they would be modest and say they have a lot of work to do, but I believe these three hospitals have taken collaboration—both internally and externally—to a new level," according to Dollak after he met with all three hospitals.
Dollak started the day by attending Riverside Medical Center’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) meeting, where the team reviewed their patient satisfaction scores. The leaders of this group have worked to develop a culture that moves staff beyond feeling defensive about the data to one that supports working together to use the data for improvement.
New London and Shawano have developed the same culture of collaboration within their improvement systems. Staff are working together to reduce falls and readmissions, and finding new ways to get patients and families more involved in their care. When asked about how they get so many departments working together, Barb Neumann, quality coordinator at New London, said, "A strong culture is critical to improvement. We continuously look for people in our organization who have the passion for patient safety and improvement work. We then train for skill through the use of our internal resources and by taking advantage of the trainings offered by IHI, HRET and WHA through the Partners collaborative."
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WHA Mental Health Issues Manual
Presented by Reinhart Boerner Van Deuren s.c.
Thursday, June 26 ** 12:00-1:30 pm
This webinar series is complimentary for WHA hospital and corporate members, but pre-registration is required.
More information and online registration are available at http://events.SignUp4.net/HealthLawManual
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Hospital foundation directors, their board members and hospital executives are invited to attend "Prescription for Success: A Workshop for Hospital Foundations" August 7 in Rothschild. With the partnership and support of the Wisconsin Office of Rural Health (WORH), the Wisconsin Hospital Association (WHA) and the Rural Wisconsin Health Cooperative (RWHC), this workshop is available at no cost to hospital and hospital foundation staff; however, pre-registration is required.
Betsy Chapin Taylor, award-winning author, speaker and consultant on health care philanthropy with more than 15 years of experience as chief development officer and foundation president in various health care organizations, will lead the workshop. She will facilitate interactive sessions that will identify the various levers to enhance a foundation’s performance; strategies to identify and engage your key allies; and build a resonant case for support by conveying the human impact of your foundation’s work with powerful and emotional mission storytelling.
The Hospital Foundation Workshop will be held Thursday, August 7, at Stoney Creek Hotel & Conference Center in Rothschild. A workshop brochure is in this week’s packet. Online registration is now available athttp://events.SignUp4.net/Foundation14.
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CMS Rates ICD-10 Test Week as ‘Successful’
The Centers for Medicare & Medicaid Services (CMS) accepted 89 percent of test claims from a representative sample of health care providers, clearinghouses and others during ICD-10 test week in March, the agency announced last week. CMS said the March test did not identify any issues with ICD-10 claims processing by the Medicare fee-for-service system, noting that many testers intentionally included errors to ensure those claims would be rejected.
Testers submitted more than 127,000 claims, with some regions reporting acceptance rates as high as 99 pecent, CMS said. Clearinghouses, which submit claims on behalf of providers, were the largest group of testers, submitting half of all test claims. The Department of Health and Human Services (HHS)expects to release an interim final rule soon with an ICD-10 implementation date of October 1, 2015. Providers and others can submit test claims for acknowledgment any time before the implementation date. Submitters should contact their local Medicare Administrative Contractor for more information, but may want to delay acknowledgment testing until after October 6, 2014, when Medicare updates its systems. The agency expects to release details about 2015 end-to-end testing for ICD-10 soon.
In other ICD-10 related news, the Workgroup for Electronic Data Interchange (WEDI) developed an "aggressive transition roadmap" in a June 4 letter addressed to HHS. WEDI called for several actions, including:
WEDI convened an ICD-10 Emergency Summit to collect stakeholder input and generate the roadmap to guide payers and providers toward the unofficial new deadline of October 1, 2015.
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The arrival of sunny days and warmer temperatures means summer fun will be in full swing. Too much sun, however, can be dangerous. Use sunscreen and wear a hat to help prevent overexposure. The Centers for Disease Control offers good advice: www.cdc.gov/cancer/skin/basic_info/prevention.htm.
According to data gathered by the WHA Information Center, 10,074 surgeries were performed in 2013 in Wisconsin hospitals or freestanding ambulatory surgery center for malignant skin cancer removal. There were more than 8,385 visits to a hospital outpatient department for evaluation or treatment of the same condition.
Enjoy the summer, but be safe in the sun.
* Data provided by the WHAIC (www.whainfocenter.com)
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Lisa Grill Dodson, MD, has been named campus dean of the Medical College of Wisconsin (MCW)-Central Wisconsin. Dodson will provide leadership and management of MCW’s new campus in Central Wisconsin, which expects to welcome its first students in July 2016.
Dodson is currently the director of the Oregon Area Health Education Center, a position she has held since 2006. She also is associate professor of family medicine at Oregon Health & Science University in Portland.
As campus dean of MCW-Central Wisconsin, Dodson will serve as the primary liaison for health system and academic partners, which are the key elements of the immersive teaching model of the medical education program. Academic partners include Northcentral Technical College, the University of Wisconsin-Marathon County, the University of Wisconsin-Marshfield/Wood County and the University of Wisconsin-Stevens Point, which will provide teaching faculty, curriculum and student resources. MCW-Central Wisconsin’s teaching facilities will be located at Aspirus Wausau Hospital and Northcentral Technical College.
Dodson also will work with health system partners in the program to identify physician preceptors and clerkship directors, and to advocate for and support an increase in graduate medical education positions. Campus health system partners are Aspirus, Inc., Marshfield Clinic, Ministry Health Care, Riverview Hospital and the Tomah VA Medical Center.
Further, she will collaborate with MCW-Central Wisconsin’s Community Advisory Board with regard to the implementation of the community-based medical education program, monitoring of achievement of program goals, enhancement of program visibility and support, and development of community relationships and backing.
Dodson practiced family medicine for seven years in the frontier community of John Day, Oregon, where she and her partners trained medical students and residents. Upon returning to the OHSU in 1999, Dodson became clerkship director for the Rural and Community Health Clerkship, during which she developed the Oregon Rural Scholars Program.
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Mark Kehrberg, MD, chief medical officer of Ministry Health Care and Affinity Health System, received the 2014 Healthcare Administrator Award, presented by the Association for Professionals in Infection Control and Epidemiology (APIC).
The award is given annually to a member of a health care facility’s executive team who has made infection prevention and control a top priority throughout the facility.
APIC noted that Kehrberg established an organizational culture that enables and supports infection prevention efforts. He has supported and encouraged the use of best practices including policies for central line-associated bloodstream infections (CLABSI), surgical site infections and vaccination compliance.
Under his leadership, Ministry Health Care raised the employee influenza vaccination compliance rates from 70 percent in the 2011-12 influenza season to 89 percent in the 2012-13 season and 94 percent in the 2013-2014 season.
Additionally, through his active involvement in the central line team and unwavering support of best prevention practices, Affinity’s St. Elizabeth intensive care unit has not experienced a CLABSI in 15 months. Kehrberg has supported the investment in the purchase, deployment, and implementation of surveillance software that has helped to transition the hospital’s policy of infection control to that of infection prevention.
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