June 7, 2013
Volume 57, Issue 23

JFC Maintains Gov’s Medicaid Plan, Adopts WHA-Backed Implementation Trigger
Committee also provides funding for hospital uncompensated care

On a 12-4 party line vote, the Legislature’s Joint Finance Committee on June 4 approved Governor Walker’s eligibility changes to Medicaid. The Governor’s plan moves all non-elderly, non-disabled adults above 100 percent of the federal poverty level (FPL) off Medicaid on January 1, 2014, effectively requiring those individuals to seek coverage on the federal health insurance exchange or become uninsured. The Governor’s proposal also expands coverage to all adults with income below 100 percent FPL by lifting the current Medicaid enrollment freeze for childless adults.

"Governor Walker should be applauded for putting together health care reform that gives us certainty in how we deal with this issue," said Committee Co-Chair Senator Alberta Darling (R-River Hills).

A motion offered by all four Democrats on the committee that would have set Medicaid eligibility at 133 percent of FPL was defeated on a party line vote of 4-12.

"By far the most important part of this motion is adoption of the proposal by the federal government to expand our Medicaid population to 133 percent of the federal poverty line," said Representative Jon Richards (D-Milwaukee) in referring to the Democrats’ motion. "That would be a huge benefit for thousands of people in Wisconsin…people who are often working full time jobs for not much pay."

On January 30, 2013, based upon the recommendation of the WHA Medicaid Reengineering Group (MRG), the WHA Board of Directors endorsed setting Medicaid eligibility for all adults at 133 percent FPL and using federal funding provided under the Affordable Care Act to cover the cost of coverage expansion.

Over the ensuing four months, WHA led an extensive lobbying effort in support of coverage expansion to 133 percent FPL. Despite premiums being subsidized in the exchange, WHA highlighted many concerns with low-income individuals making between $11,500 and $15,300 a year transitioning off Medicaid into purchasing coverage in the still very much under construction federal health insurance exchange.

In a memo to the Joint Committee on Finance, WHA reiterated its support for coverage expansion and suggested various options for implementation, including a two-year sunset after exchanges have had a chance to get up and running. In the memo and in its extensive lobbying efforts, WHA also underscored member concerns over increased uncompensated care resulting from reliance on the federal exchange for low-income coverage.

"Wisconsin’s hospitals are the health care system’s safety net. They serve all who come though their ER doors, whether they are covered by employers’ insurance, Medicaid or have no insurance at all," WHA said in a June 3 memo to the Joint Finance Committee. "We are, in a sense and unfortunately, the insurance program for the uninsured. This is why WHA supports Medicaid expansion to 133 percent FPL and why we will work closely with all stakeholders to make transition into the exchange as successful as possible. It is also why we support recreating the DSH (Disproportionate Share Hospital) program as a way to buffer against spikes in uncompensated care hospitals across the state could experience."

Though the Joint Finance Committee did not support WHA’s Medicaid recommendations, the Committee did adopt a provision recreating a DSH program in Wisconsin for the 2013-15 biennium. While nearly every state in the country has a DSH program, Wisconsin had been without one since 2008. Under the provision adopted by the Committee, over the next two years hospitals will be eligible to receive nearly $75 million in enhanced Medicaid reimbursement through DSH. Currently, Wisconsin’s Medicaid program reimburses hospitals at 65 percent of cost.

"We think it is appropriate to provide that lifeline (DSH)…that when people go into emergency rooms uncompensated, we protect our hospitals," said Joint Finance Committee Co-Chairman Rep. John Nygren (R-Marinette) in supporting the DSH provision. "Not just our big hospitals, but hospitals throughout the state."

The Joint Finance Committee also voted to add a trigger mechanism into the budget bill, recommended by WHA, which would allow the state to suspend Medicaid eligibility changes if the exchange is not functioning. If the federal exchange is not operational across the state or within certain counties, DHS would maintain current Medicaid eligibility levels across the entire state or within a particular county.

"To preserve a sound health care safety net, WHA supports setting Medicaid eligibility at 133 percent of the federal poverty level (FPL) for adults…we believe this remains the best course for Wisconsin to ensure coverage for our lowest income populations while allowing for a cautious transition into reform," said WHA’s Eric Borgerding in a statement soon after Tuesday’s vote. "We are pleased that the Joint Finance Committee approved new funding for the Disproportionate Share Hospital (DSH) program as a means of recognizing the impact changes to Medicaid, coupled with uncertain exchange implementation, could have on Wisconsin’s safety net hospitals in the near future. Almost every other state has a DSH program—so should Wisconsin."

"In the weeks ahead, we will continue working with policymakers to attain the best possible, most achievable results for Wisconsin hospitals and their patients," Borgerding said. "In the months ahead, we will also work closely with our members, the Wisconsin Department of Health Services, the Wisconsin Primary Health Care Association and other statewide partners to facilitate and encourage enrollment in the health insurance exchange and safety net coverage through Medicaid."

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Apology Legislation Passes Assembly Health Committee
Bill moves forward to full Assembly

The Assembly Health Committee moved legislation forward June 4 that would allow health care providers to express a statement of apology or condolence without the fear that the statement could be used in a civil action as evidence of liability or admission against interest. The bill provides that a statement, gesture, or conduct that expresses apology, benevolence, compassion, condolence, fault, liability, remorse, responsibility, or sympathy to a patient or the patient’s relative or representative would not be admissible into evidence in any civil trial or administrative hearing regarding the health care provider as evidence of liability or admission against interest.

The author of the bill and Chairman of the Health Committee, Rep. Erik Severson, MD (R-Star Prairie), offered an amendment that would expand the type of proceedings covered by the bill to include disciplinary proceedings, mediation and arbitration. The amendment also would limit the bill’s provisions to statements, gestures, or conduct made before the commencement of a civil action or certain other proceedings.

In written comments to the Assembly Health Committee last week, Charles Shabino, MD, chief medical officer at WHA said, "This bill would encourage open conversation among providers, patients, and families, encouraging a better resolution of unfortunate events. Statements of concern by all providers involved in patient care can allow the patient, family, and provider to move toward solution and resolution. These positive outcomes are more difficult to achieve when there are barriers to good communication."

The legislation passed (7-4) on a party line vote and is now available for consideration by the full Assembly.

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WHA Supports Expansion of Primary Care Provider Public Reporting

Jo Musser, CEO of the Wisconsin Health Information Organization (WHIO), presented WHIO’s plan to publicly report data on quality and resource use for Wisconsin primary care providers at the WHA Medical and Professional Affairs meeting June 6 in Madison. The plan, supported by WHA, includes reporting on primary care physician practices with three or more providers, beginning later this year.

The initial reporting will include clinic site-level results for practices that meet minimum sample sizes. This expansion of health care transparency in Wisconsin will include simple ratings that are easy for consumers to understand, paired with more detailed reports that are available to the providers to guide improvement. Extensive consumer testing is planned for the website, along with a detailed communication plan to all affected physician groups. Physician groups will have access to the site and data for at least three months prior to the public release to allow time to develop a good understanding of the data.

"This initiative aligns with WHA’s strategic plan to focus on transparency and consumer engagement and to our commitment to help build a high-value delivery system," said WHA President Steve Brenton.

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Wisconsin Hospitals Make Progress on Preventing Early Elective Deliveries

The Council on Medical and Professional Affairs reviewed Wisconsin’s progress on eliminating early elective deliveries at its June 6 meeting. These early deliveries have a higher incidence of medical complications for the newborns and add unnecessary cost. The most effective method of reducing these deliveries is through implementation of a "hard stop policy," which prevents a scheduled cesarean section or medical induction before 39 weeks gestation. The national goal is for all birthing hospitals to have a rate less than three percent. Close to 30 hospitals have worked with WHA, through the Partners for Patients project to implement this policy and achieve the three percent goal.

"Wisconsin hospitals are making great progress to improve the value of obstetrical care in our state, by implementing these policies that will ensure safer and more cost-effective care," according to Kelly Court, WHA chief quality officer.

Hospital-specific rates for these early deliveries will be available on CheckPoint in 2014.

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Register Today for the 2013 Wisconsin Rural Health Conference
Kalahari Resort, Wisconsin Dells *** June 26-28, 2013

2013 Keynote Speakers: Todd Linden and Quint Studer

More information and online registration available at http://events.signUp4.com/13Rural

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Grassroots Spotlight: Local Legislators Visit Ministry Good Samaritan Health Center

Ministry Good Samaritan Health Center recently hosted State Senator Tom Tiffany and State Representative Mary Czaja for a legislative question and answer session. This meeting was held shortly after both facilities participated in the Wisconsin Hospital Association’s Advocacy Day held April 23 in Madison. The visit was part of an ongoing effort to continue the dialogue with elected officials on important issues affecting the health care industry in the communities served by Ministry Health Care.

While in Merrill, Senator Tiffany and Representative Czaja learned how issues like Medicaid reimbursement and the economy are impacting operations. They also introduced them to the important role Ministry Good Samaritan plays as a critical access hospital.

"We are happy to share with our elected officials some of our success stories in improving quality and lowering costs," said Ministry Good Samaritan President Mary Krueger. "It’s important that they know the vital role our facility serves for the Merrill community and people of Lincoln County."

As noted in the story above, Ministry Health Care attendees were some of the 900 hospital advocates from across the state who attended WHA’s 2013 Advocacy Day on April 23. Log onto WHA’s Facebook page to see more than 75 photos from this event. Make sure you "Like" WHA’s page so you can stay up to date on information and initiatives.

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Hospital Foundation Workshop Offered August 13

On August 13, hospital foundation directors, their board members and hospital executives are invited to attend a one-day workshop entitled "Prescription for Success: A Workshop for Hospital Foundations."

Due to 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.

Back by popular demand, communication and fundraising strategist Lori Jacobwith will lead an interactive session focused on tools and techniques to better engage your foundation’s board in its fundraising efforts. In addition, attorneys Monica Hocum and Leia Olsen with the law firm of Hall, Render, Killian, Heath & Lyman, P.C. will take a deeper dive into HIPAA, its newest rules, and how they affect your foundation’s ability to communicate with your hospitals’ patients.

This workshop will be held Tuesday, August 13 at the Best Western Hotel in Plover. To view the full day’s agenda and to register, visit http://events.SignUp4.com/13Foundation.

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WICD-10 Provides Updated Industry Resources

The Wisconsin ICD-10 Partnership (WICD-10) recently updated their website (www.wicd10.org) with the goal of providing more current sources for health care industry partners involved in the transition from ICD-9-CM to ICD-10-CM/PCS. New features include an assessment tab for any organization that has not started their implementation, or one that simply needs to add some structure to the process. Business operations, coder and physician education, internal and external testing, regulation, and information about the partners are additional sections of the website that provide timely information.

"We only have 15 months left to prepare for the October 1, 2014 implementation," said Debbie Rickelman, vice president of the WHA Information Center and co-facilitator of the WICD-10 Partnership. "All stakeholders, including providers, payers and vendors need to work collaboratively to make the best use of this time. Hopefully the information on the website will help partners stay on task."

WICD-10 recently restructured their workgroups to better meet the needs of the health care community and named facilitators for each workgroup. The workgroups and their facilitators include: WICD-10 website resources, Rickelman; Business Operations led by Sheila Goethel, RWHC; Coder and Physician Education led by Susan Summerfield, WHIMA; Internal and External Testing co-led by L.J. Tanner, Group Health Cooperative and, Tina Schrader-Berte, a consultant for Leading Age WI.

Rickelman said hospital and health system leaders will find the assessment and business operations sections of the website helpful. She added that the WICD-10 workgroups will continue to update resources and the groups welcome suggestions.

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AHA Presents Triple Aim Strategies to Integrate Behavioral Health in Primary Care

The American Hospital Association’s Section for Psychiatric & Substance Abuse Services, and Hospitals in Pursuit of Excellence (HPOE) is offering a 60-minute webinar on Triple Aim Strategies to Integrate Behavioral Health in Primary Care Thursday, June 27, 2013, at 2pm CDT.

During the webinar, Robin Henderson, PsyD, director of government affairs and executive director of the Central Oregon Health Council at St. Charles Health System in Bend, Oregon and Benjamin Miller, PsyD, assistant professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine will describe how better integration of physical health and mental health is the embodiment of the Triple Aim.

Focusing on improving health behaviors, this webinar will describe what integrated care is at the primary care level and how it can improve Triple Aim outcomes at the clinic and system levels. Dr. Robin Henderson will describe the Health Integration Projects, a community-based regional effort to bring the Triple Aim goals of improving quality of care and the patient experience. Dr. Benjamin Miller will provide details on the work of the National Research Network’s Collaborative Care Research Network, as well as research examining mental health and primary care integration. There will be time for questions and answers.

This webinar is available free of charge, but advance registration is required. Click here to register. If you have any questions, please contact hpoe@aha.org.

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AHA Participates in White House Conference on Mental Health

On June 3, 2013, President Barack Obama and Vice President Joe Biden hosted a National Conference on Mental Health at the White House as part of an effort to "launch a national conversation to increase understanding and awareness about mental health." Conference participants included AHA President and CEO Rich Umbdenstock and Paul Summergrad, MD, chair of the AHA’s Section Council for Psychiatric and Substance Abuse Services and psychiatrist-in-chief at Tufts Medical Center, who shared information on creative steps hospitals are taking to increase awareness and improve access to mental health services. Umbdenstock also encouraged AHA members to raise awareness of mental health in their communities, and said "adequate support from Medicare and Medicaid is essential if hospitals are to continue offering the array of services their communities have come to expect and depend on."

Umbdenstock also stressed the importance of the Mental Health Parity and Addiction Equity Act, noting, "A final rule is needed to prevent health plans from applying pre-authorization requirements to mental health and substance abuse benefits, among other issues." As part of the White House initiative, the Department of Veterans Affairs plans to convene local mental health summits with community partners to help address the needs of veterans and their families. The administration also announced a new consumer website, www.mentalhealth.gov, offering tools and information on mental illness and how to get help if needed.

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Member News: Douglas Named CEO of Memorial Medical Center, Ashland

Jason T. Douglas has been appointed CEO of Memorial Medical Center (MMC) and Regional Enterprises Incorporated in Ashland, replacing Dan Hymans who will be retiring this fall after more than 20 years of service. Douglas is anticipated to start in late summer.

Since July 2005, Douglas has served as CEO of Mercy Hospital and Healthcare Center in Moose Lake, MN. During this time, he has transformed the culture to one built on much stronger collaboration and participation in decision-making, and takes great pride in the various initiatives he has led to improve and transform care delivery during his tenure with Mercy. The hospital has just broken ground on a $38 million construction project that will add 75,000 square feet of new space along with the renovation of 40,000 square feet. Douglas was successful securing funding through a USDA Office of Rural Development grant for much of this project. Prior to this, he served as CEO of the Sibley Medical Center and Clinics in Arlington, MN, Compliance Manager of Allina Hospitals and Clinics at United Hospital in St. Paul, MN, and Director of Cardiopulmonary Services/Corporate Compliance Officer at York General Hospital in York, NE.

Douglas received his MHA at the University of Minnesota, Minneapolis and a BS in respiratory therapy from Methodist College in Omaha, NE.

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Wisconsin Hospitals Community Benefits: Mental Health and Mental Disorders

Mental disorders vary in severity and in their impact on people’s lives. The symptoms can be severe and extremely destructive, causing immeasurable suffering for the patient and their families. Hospitals see an ever-increasing number of patients seeking treatment for mental disorders in their emergency departments. Hospitals that can offer inpatient treatment generally operate this service at a loss. With a disturbing shortage of mental health professionals, hospitals will continue to partner with each other and their communities to meet the growing demand for these services.

Free depression screenings

Bellin Health’s contributions to the community include providing health care at a free or reduced charge to those in the community who are unable to pay, are medically underserved or uninsured. This includes joint ventures and innovative programs that support health care in areas that would otherwise be underserved.

Many community residents are directly affected by mental illness. Estimates are that 1 in 4 adults experiences a mental health problem in any given year and 1 in 17 adults lives with serious, chronic mental illness.

Bellin Health recognizes that mental illnesses are medical illnesses and provided free depression screenings during Mental Health Awareness Week in October. The week is designed to educate the public about depression symptoms and treatment and offer individuals a chance to be screened for depression.

The 30-minute free and confidential screenings asked participants to complete a written questionnaire or fill out an online screening form. Therapists then scored and reviewed the completed document and discussed the findings with the participant. Those in need of treatment were directed to appropriate services within the community.

The free depression screenings were offered at Bellin Psychiatric Center in Green Bay, as well as at the Bellin Health Family Medical Centers in Manitowoc and Oconto.

Bellin Psychiatric Center, Green Bay

Depression and suicide: a dangerous duo on college campuses

College campuses across the country are filled with students who have contemplated or considered suicide. In fact, in 2012, USA Today reported that one in 12 college students has a "suicide plan." This means they have considered how or when they would perform suicide if the situation arises. This is a startling number.

Beloit Health System’s Counseling Care Center works with a local college to educate and train many campus groups including students, resident assistants (RAs), and even parents.

"Our therapists are there in a variety of capacities," informs Greg Ammon, director of counseling care at Beloit Health System. "Although some of our services are contracted, others are provided as pro-bono. We provide depression screenings in the school cafeteria, offer education to students at health fairs and classes to new RAs, present to psychology classes and even host a new student/parent workshop."

Information that is shared includes warning signs, suicide awareness, risk factors and actual role playing activities.

"Several RAs have thanked us, saying they learned what to do in a crisis situation and how to help a student who comes to them with warning signs," states Molly Polyock, therapist for Beloit Health System. "Students have said ‘I remembered what you said about not promising to keep a secret if I feel they need help,’ or ‘You taught me to ask the right questions.’"

"It is a very scary topic for students and RAs, and I really work with the RAs to alleviate their own fear and anxiety so they are able to think clearly," she adds.

"The American College Health Association’s March 2013 newsletter talks about depression among college students," stated Polyock. "It states that 45 percent of all students surveyed reported feeling very sad at some time, 86 percent felt overwhelmed, 81 percent exhausted and 57 percent lonely. Some experts indicated the rate of depression among college students in the U.S. is between 2.5 and 14 percent. This is a high number of students we are trying to reach."

The Counseling Care Center at Beloit Health System has made a strong commitment to help this at-risk group. In addition to their college involvements, they also offer community outreach to local high schools when needed. In 2012, they offered a free presentation to parents of high school students called "Parents Connecting with Teens," where suicide awareness was covered. They recently received a grant to learn some of the newest and most effective suicide prevention models.

Beloit Health System, Beloit

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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