July 22, 2016
Volume 60, Issue 29

Wisconsin Health Care Maintains Rank among Best in Nation
Has ranked in the top 4 states 9 of the last 10 years

Wisconsin continued to hold its place as one the best states in the nation based on the quality of its health care. 

According to the federal Agency for Healthcare Research and Quality (AHRQ), Wisconsin is the third most highly-rated state in the country, with overall health care quality scores that closely followed Maine and Massachusetts. The rankings are based on close to 200 measures that AHRQ uses to evaluate health care performance. 

“The AHRQ rankings are a national validation of what we know here; Wisconsin’s local and regional health systems are delivering some of the best care in the country,” according to Wisconsin Hospital Association President/CEO Eric Borgerding. “Across the continuum of care, in rural and urban settings, we are maintaining consistently high performance, while striving to set even higher standards of care. It is that combination of performance and commitment to be better that makes Wisconsin a perennial leader.”

Wisconsin has shown consistently high performance since AHRQ started the state rankings in 2006. As AHRQ has evolved the rankings to include more health care sectors and new measures, Wisconsin’s performance ranking has seen little change. 

“The consistency from year to year is important,” says Kelly Court, WHA chief quality officer. “This demonstrates that health care is well coordinated and delivered as an entire system across the state. It also shows that Wisconsin providers continue to evolve as health care changes, and they focus on improving important aspects of the care they provide.” 

The AHRQ quality measures are compared to achievable benchmarks, which are derived from the top-performing states. AHRQ measures health care quality in three different contexts: by types of care (such as preventive, acute, or chronic care), by settings of care (such as hospitals, nursing homes, home health or hospice), and care by clinical area (such as care for patients with cancer or respiratory diseases). They also report measures by race and ethnicity.

Wisconsin scored higher than the national benchmarks on 50 percent of the 200 measures. Areas of strong performance include care for acute and chronic conditions, as well as preventive care. The state also shows consistently high performance in the area of care coordination, which includes measures for coordination of care between health care settings and the patient.

While Wisconsin shows strong overall performance in most areas of care, there is still work to be done related to health care equity. When measures are segmented by race and ethnicity, the performance is just average. The data indicates that blacks and Hispanics may not be getting adequate care for their chronic conditions that result in avoidable hospitalizations. 

“WHA members are working with community partners and aligning their quality improvement goals to address health care equity issues,” Court said. 

Access the full AHRQ report here: https://nhqrnet.ahrq.gov/inhqrdr/state/select.

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Senators Act on WHA-Backed Rural Recommendations
WHA’s Court co-chaired NQF Committee that developed the recommendations

Co-chairs of the bipartisan U.S. Senate Rural Health Caucus expressed support for the recommendations of the National Quality Forum’s (NQF) Rural Health Committee to integrate rural providers into Medicare quality improvement programs. Members of the caucus sent a letter to U.S. Department of Health and Human Services Secretary Sylvia Burwell urging the agency to include rural providers in Centers for Medicare and Medicaid (CMS) quality measurement and improvement programs. Caucus members Al Franken (D-MN) and Heidi Heitkamp (D-ND) have also introduced a bill that includes language that would legislate many of the NQF recommendations.

Wisconsin played an important role in the development of the NQF committee recommendations. Kelly Court, WHA chief quality officer, co-chaired the committee and Tim Size, executive director of the Rural Wisconsin Health Cooperative, participated as a member. The report produced by this committee outlines the challenges rural and small-volume providers have with current CMS quality programs. The report also includes recommendations that would address the need for development and use of rural relevant measures, flexibility to choose measures that reflect the types of services provided, consideration of smaller patient populations, and use of a phased approach that would eventually require participation of rural hospitals and providers in CMS programs.

The actions being taken by members of the U.S. Senate are consistent with the insight WHA President/CEO Eric Borgerding provided to CMS acting administrator Andy Slavitt in June during an invitation-only discussion on MACRA implementation (see The Valued Voice article at www.wha.org/pubarchive/valued_voice/WHA-Newsletter-6-17-2016.htm#1). Borgerding, who was joined at the meeting by Monroe Clinic Chief Medical Officer Dr. Mark Thompson, highlighted the need for an increased focus on rural providers. Additionally, the NQF recommendations were discussed by Borgerding, Court and Size personally with CMS Deputy Administrator Sean Cavanaugh when he traveled to Wisconsin in 2015 to visit several rural hospitals to better understand how high-value care is delivered in rural settings

“Rural hospitals and providers are essential to our health delivery system by ensuring that high-quality care is accessible in every region of Wisconsin,” according to Court. “WHA is very pleased to see the U.S. Rural Health Caucus act on these important recommendations that will help our rural members measure and continue to improve the quality of the care they provide patients in communities across the state.”

A copy of the NQF Rural Health Committee report can be found at www.qualityforum.org/Publications/2015/09/Rural_Health_Final_Report.aspx.

Read the Burwell letter at: www.wha.org/pdf/BurwellSenateletterruralhealth7-14-16.pdf.

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WI Scores High on Commonwealth Report on Local Health System Performance

A newly-released report by the Commonwealth Fund placed Wisconsin among the best states for local health system performance, with several communities here ranking in the top-quintile nationally .

Appleton ranked 5th highest in the nation among the 306 U.S. communities included in the report, with Madison (13th), La Crosse (15th) and Green Bay (19th) scoring in the top quintile. Wausau, Neenah, Marshfield and Milwaukee ranked in the top quartile. Milwaukee topped more than 231 health care markets across the country.

“Wisconsin’s excellent performance on this scorecard is not a surprise given the high degree of care integration in our state and the continuing commitment of our hospitals, health systems and care providers to quality improvement,” according to WHA President/CEO Eric Borgerding. “Our hospitals and health systems are closely aligned with physicians, long-term care facilities, home health and often health plans to ensure that care is coordinated across settings. This not only leads to better quality care, but also better outcomes and ultimately better value for the dollars we spend on health care.”

The Commonwealth Fund Scorecard on Local Health System Performance assesses the state of health care from 2011 through 2014. Using the most recent data available, the Scorecard ranks 306 regional health care markets known as “hospital referral regions” on four main dimensions of performance encompassing 36 measures. There are five measures of hospital care and a mix that includes nursing home, ambulatory and population health.

“One measure that showed significant improvement was readmissions, which aligns with the work that WHA has been doing with members over the past four years through our Partners for Patients project,” according to Kelly Court, WHA chief quality officer.

Court said readmissions and the hospital safety composite score, which was included in the Commonwealth Scorecard, are reported in WHA’s CheckPoint program.

While the report speculates that federal and state policies may be required to “address socioeconomic inequities and ensure that all communities have equal opportunities to improve,” the report also says the Scorecard is an indication that “community and local delivery system leaders across the country are already demonstrating the power of innovation and collaboration to promote health.”

“Every hospital and health system in the state is collaborating with community partners to raise the health status of Wisconsin’s residents,” Borgerding said. “Wisconsin providers are not waiting for changes in the reimbursement system that recognize and pay for prevention, they are already helping people to stay well and avoid encounters with the health care system, which will create heathier communities that will attract economic development in our state, as well.” 

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Telemedicine Subcommittee Announces MED 24 Ready for Full MEB Board Review

At their July 20 meeting, the Wisconsin Medical Examining Board (MEB) telemedicine subcommittee discussed the latest version of MED 24, the rule overseeing telemedicine practice by physicians. 

As previously reported in The Valued Voice, the MEB group recently shifted focus from an earlier Iowa model to a much more streamlined Florida model. Steven Rush, WHA vice president, workforce and clinical practice and lead staff for WHA’s Telemedicine Task Force, has worked closely with WHA’s task force and is finalizing comments and suggestions for revisions. The next steps for the MEB will be for the full board to review the latest draft at either the August or September meeting and then schedule a public hearing in October. The WHA Telemedicine Task Force has provided several suggestions for additional revisions, and those will now be incorporated into a revised draft. 

“I’m quite pleased with the process to date on this issue, but there is more work to do,” said Rush. “I think we’re getting close to a version that will be fully endorsed by WHA and the Telemedicine Task Force.” 

For more information, contact Rush at 608-274-1820 or srush@wha.org.

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Wisconsin Delegation Sends Letter to CMS on Mixed-Use Space

Led by bipartisan U.S. Reps. Ron Kind (D) and Reid Ribble (R), Wisconsin’s Delegation sent a letter to the Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt about concerns over varying interpretations by CMS regional offices on the issue of shared/mixed-use space. 

“We are writing today to express our deep concerns with what seems to be the Centers for Medicare & Medicaid Services (CMS) regional offices increasingly restrictive review and approval of shared space/mixed-use sites, especially those where the provider-based and non-provider-based locations share the same suite,” the Wisconsin Delegation letter read.

The letter goes on to ask Slavitt to utilize a recently created rural-focused CMS council to review the issue.

“In early February you unveiled the establishment of a CMS Rural Health Council to work across the entire agency to oversee our work in three strategic priority areas. We believe that the shared space/mixed-use issue would be a primary issue for this Council’s review and exploration as it relates to both the access and economics of providing health care to all Americans in rural settings,” continued the Delegation letter. “We would also urge a discussion between the Council and rural hospitals to discuss the practical implications and potential solutions to these adverse interpretations….” 

In addition to U.S. Reps. Kind and Ribble, Wisconsin Members who signed onto this letter to Slavitt include: U.S. Senators Ron Johnson and Tammy Baldwin; U.S. Reps. Mark Pocan, Sean Duffy, Jim Sensenbrenner, Glenn Grothman and Gwen Moore. (Speaker Paul Ryan, due to his leadership position, does not traditionally sign onto letters.)

“The Wisconsin Hospital Association and Rural Wisconsin Health Cooperative have raised this issue with Wisconsin’s Delegation previously and greatly appreciate U.S. Reps. Kind and Ribble spearheading this Delegation letter. We appreciate Wisconsin’s Delegation urging CMS to ensure its policies recognize the realities of rural health care,” said WHA President/CEO Eric Borgerding. 

Read the full letter at: www.wha.org/pdf/2016CMS_Mixed_Use_Space7-13.pdf.

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MEB Approves Final Version of Opioid Prescribing Guidelines

ACT 269, one of several pieces of legislation in Rep. John Nygren’s (R-Marinette) Heroin Opioid Prevention and Education (H.O.P.E) package allows the Medical Examining Board (MEB), the Podiatry Affiliated Credentialing Board, the Board of Nursing, the Dentistry Examining Board, and the Optometry Examining Board to issue guidelines regarding best practices in prescribing controlled substances for persons credentialed by the Board who are authorized to prescribe controlled substances. The MEB guidelines address opioid prescribing, and do not include recommendations on other controlled substances such as stimulants and benzodiazepines. 

The new guidelines, available at www.wha.org/pdf/WisOpioidPrescribingGuidelineDraft7-2016.pdf, are based largely on the Centers for Disease Control and Prevention (CDC) guidelines. A plan for widespread dissemination and use has yet to be fully discussed by the MEB, but broad dissemination was encouraged. 

For more information contact Steven Rush, WHA vice president, workforce and clinical practice, at 608-274-1820 or srush@wha.org.

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WHA Seeking Nominations for 2017 Board, Including Two Physician Leaders

Nominations are now being accepted for a WHA chair-elect, at-large members, two new physician leader at-large positions for the WHA Board and candidates for the Trustee and Distinguished Service Award..

You may know someone in your region, in your hospital or on your Board of Directors who deserves such an honor. You now have an opportunity to nominate them for one of these annual awards:

Administrators, trustees, senior managers, nurse leaders, volunteers and others are encouraged to review the criteria for the awards and consider nominating someone to receive one of these honors. Information on these two awards can be found on the WHA website at www.wha.org/award-program-information.aspx.

The Nominating Committee will also make recommendations on new WHA Board members. Of particular note, in 2017 we will be adding two new board seats designated for WHA member physician leaders. Candidates for the physician leader positions must be actively employed by or designated representatives of WHA member hospitals or health systems. Ideal candidates will occupy a senior clinical leadership position and have responsibility for strategic direction and oversight of medical affairs. 

Please submit nominations for both the awards and WHA Board of Directors no later than Friday, August 19

WHA members interested in being considered for or nominating an At-Large WHA Board seat or the Chair-Elect position should contact either WHA President/CEO Eric Borgerding at eborgerding@wha.org or WHA Nominating Committee Chair Therese Pandl at therese.pandl@hshs.org.

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Rottmann Named COO of WISHIN

Steve Rottmann has joined the Wisconsin Statewide Health Information Network (WISHIN) as its new chief operating officer (COO). As COO, Rottmann will be responsible for leading all business operations, developing and implementing strategic initiatives, managing customer and vendor contracts and assisting with marketing and sales initiatives.

“Steve brings many assets to WISHIN, including forward-thinking leadership and strategic planning,” says WISHIN CEO Joe Kachelski. “His experience in IT, especially his most recent position in a post-acute-care setting, will be valuable as WISHIN explores new opportunities and grows our community health record.”

Rottmann previously worked as the director of information technology at Oakwood Village, an organization that provides long-term care, acute care, rehabilitation, memory care and independent living services to aging adults in the greater Madison area. Prior to his position at Oakwood, he served in various IT roles at the Beaver Dam Unified School District, Badger Bank and Farmers & Merchants State Bank.

Rottmann has a Bachelor of Science degree in strategic management of information systems from Cardinal Stritch University. He also served in the United States Army as a telecommunications sergeant (E-5), providing leadership to soldiers in combat during Operation Enduring Freedom in Afghanistan. 

WISHIN is a not-for-profit organization dedicated to improving the health of individuals and communities in Wisconsin. WISHIN has developed infrastructure, technical services and policies to facilitate the electronic sharing of clinical data on an EHR-neutral basis to ensure that medical records can be shared automatically and prospectively, improving clinical decision-making and reducing administrative time and expense on both ends of the transaction. 

WISHIN Pulse, WISHIN’s community health record, includes clinical data on more than 3.8 million patients in Wisconsin, spanning 185 million patient events across nearly every county in the state.

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New Victim Advocate Law Takes Effect August 1 
Impacts on ERs explained in April WHA Act summary

Act 351 formalizing roles and access of victim advocates for victims of sexual assault and sexual abuse takes effect August 1. The new law includes a new notification requirement for hospital emergency departments when they see a patient who is a suspected victim of sexual assault or abuse. 

Additional details about the law and impacts on hospitals can be found in WHA’s Legislative Act Summary section of the WHA members-only portal. The WHA summary for Act 351, along with summaries of several other new laws passed last session, were released in April through email and The Valued Voice

All of the WHA Act Summaries can be found in the WHA Member Only portal, which is accessible by clicking the “WHA Member’s Only” icon located on the home page at wha.org. Once in the WHA member portal, the summaries can be found in the dropdown menu under the “General” tab. This section of WHA.org is a secure location and requires a first-time user to obtain a username and password. If you do not have a member account, go to members.wha.org and click on “Register” to create an account. If you have questions about how to register, contact Tammy Hribar, thribar@wha.org or 608-274-1820.

If you have questions about Act 351 and its requirements and impacts on hospitals, contact Matthew Stanford, WHA general counsel, at mstanford@wha.org or 608-274-1820.

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Maximum Medical Record Copy Fees Adjusted Upward for Inflation

The maximum fees that health care providers may charge under State law for providing health care records have been upwardly adjusted by 1 percent through June 30, 2017 to account for inflation. This inflation adjustment follows from a WHA-championed change to the medical record copy fee statute in the 2011-13 state budget; under this statute, fees approximate the costs to produce copies and are adjusted every year in line with the Consumer Price Index (CPI).

The July 1, 2016-June 30, 2017 schedule of permissible medical record copy fees can be found on WHA’s website at www.wha.org/pdf/2016_DHS_public_notice_annual_adjustment_to_fees.pdf. Notwithstanding the adjusted fees, special provisions regarding copy fees for Medicaid recipients and social security disability and supplemental security income appeals and eligibility determinations still apply; those provisions can be found under s. 146.83(1f) of the Wisconsin Statues: http://docs.legis.wi.gov/statutes/statutes/146/83.

For additional information, contact Matthew Stanford, WHA general counsel, at mstanford@wha.org or 608-274-1820.

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New Lab Testing Information Available on WHA Zika Web Page

On July 22, WHA received a memorandum from Jeffrey P. Davis, MD, Wisconsin’s chief medical officer and state epidemiologist for communicable diseases at the Wisconsin Department of Health Services (DHS), Division of Public Health (DPH). In the memorandum, now posted on www.wha.org, Dr. Davis discusses recommendations on laboratory testing for Zika virus infections.

To help our members respond to requests for information from their clinical staff and patients, WHA has dedicated a page to Zika in its emergency preparedness resources at www.wha.org/zika.aspx. This Zika webpage contains Davis’ memorandum as well as other useful items, including a Zika virus planning resource guide.

WHA will continue to monitor this issue and post links on the resource page to outside news sources that we believe will be helpful in keeping our members informed on this emerging public health issue.

Direct questions related to Zika to Steven Rush, WHA vice president, workforce and clinical practice, at srush@wha.org or 608-274-1820.

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