July 5, 2013
Volume 57, Issue 27
2013-15 State Budget Signed into Law
Governor Walker signed the 2013-2015 Wisconsin state biennial budget into law June 30. The budget bill, which is required to be passed by June 30 of every odd-numbered year, spends roughly $68 billion, including over $750 million of state funds in the Medicaid program over the next two years. In Wisconsin, the Governor has the ability to eliminate words and sentences in the budget through the "line-item veto"—a very significant power that allows him to change the budget as passed by both chambers of the Legislature. Walker signed this year’s budget June 30, 2013, the last day before the budget was to go into effect July 1, 2013 (the start of the new state fiscal year). The Governor included some line-item vetoes but none directly affecting changes in Medicaid eligibility or any of WHA’s other priorities.
The budget bill signed by Walker maintains eligibility changes to the state Medicaid program that would disenroll nearly 100,000 individuals earning more than 100 percent of the federal poverty level (FPL) beginning January 1, 2014. Those coming off Medicaid will need to connect with coverage through the federal insurance exchange. The budget also opens up Medicaid eligibility for another roughly 100,000 people earning below 100 percent FPL on January 1, 2014.
While the Legislature maintained and the Governor approved these eligibility changes (which were originally proposed by Governor Walker in February), the Governor also approved important new Disproportionate Share Hospital (DSH) program funding added to the budget by the Legislature. Roughly $73 million was included for DSH to alleviate a potential increase in uncompensated care over the next two years. DSH funding helps offset uncompensated care for those hospitals that take on higher numbers of Medicaid or uninsured patients. Wisconsin has historically used the DSH program very little and, prior to this budget bill, was one of the few states in the country to not have a robust, hospital-focused DSH program.
The Governor also maintained a WHA-backed "off-ramp" that would halt the Governor’s plan to reduce eligibility in Medicaid if the insurance exchange is not ready by October 15, 2013 or a health plan is not offered in a particular county. This WHA-supported contingency provision was added to the budget bill by the Legislature. The Governor’s veto message also recognized that Wisconsin faces a physician shortage. The Governor reiterated his initial proposal for new residency dollars, arguing that it would help to bolster Wisconsin’s health care workforce and provide needed funding to improve access to primary care. Governor Walker inserted $5 million to help establish new residency program consortia and provide new residency opportunities in existing programs for underserved specialties.
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The Rural Health Conference is the Wisconsin Hospital Association’s biggest, and arguably, most popular conference. This year was no exception with nearly 400 attendees, including a large number of hospital trustees, gathering in Wisconsin Dells June 26-28. While the conference is packed with excellent presentations on the most pertinent issues in health care, one of the most popular presentations continues to be "The State of Health Care in Wisconsin" by WHA President Steve Brenton and Rural Wisconsin Health Cooperative Executive Director Tim Size.
Reimbursement topped the list of challenges that Brenton said will face WHA members during the implementation of health reform and as Congress grapples with balancing the federal budget. In the past, rural and critical access hospitals (CAHs) have been spared, but in the latest round of budget battles, nothing is safe.
Health insurance exchanges ranked highest among several issues that Brenton referred to as the "known unknowns." The affordability of coverage, the number of plans available, and the technological challenges that are implicit in implementing a "fully-functional" statewide online exchange could pose unique problems in rural areas. Brenton said the exchange could present an opportunity to connect former Medicaid patients with commercial coverage, some for the first time. WHA has developed an education and advocacy plan to assist hospitals with issues related to the exchange. Interest in this subject is high among WHA members as a recent WHA-sponsored webinar on exchanges drew more than 400 participants. Brenton said that is just the first of many education opportunities that WHA will host on the topic in the months ahead.
Size and Brenton reported that progress is being made on the critical issue of addressing the impending physician shortage. A key element to keeping physicians in Wisconsin is to provide more clinical training opportunities, which are starting to be developed and expanded as new funding sources become available.
Amidst all this change, trustees continue to play a vital role in bringing the voice of the community into the hospital board room.
"Wisconsin is nationally recognized for delivering high-quality, high-value care," according to Brenton. "But our providers know they can do more. They are continuously striving to set an even higher standard of patient care while increasing efficiency and driving down costs. We can thank our local hospital governing boards for their expertise and guidance as we continue to strive for excellence."
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The Wisconsin Hospital Association recognized three highly-regarded rural health care leaders for their advocacy and community leadership June 28 at the Wisconsin Rural Health Conference in Wisconsin Dells.
WHA President Steve Brenton presented "Lifetime Achievement Awards" to Dan Hymans, president, Memorial Medical Center, Ashland; Phyllis Fritsch, president/CEO, Upland Hills Health, Dodgeville, and to Stan Gaynor, president/CEO, Black River Memorial Hospital. In presenting the awards, Brenton recounted the trio’s many accomplishments and contributions to not only the local community, but to the entire state.
"These three individuals always put patients first, and as true rural health care advocates, believe that everyone in Wisconsin—no matter where they live—should have access to great care, close to home," Brenton said.
All served the Association in various capacities over their long careers in Wisconsin. Hymans was WHA Board chair in 1996, while Gaynor served on the WHA Board for several years and Fritsch participated on several committees.
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The Obama Administration is delaying health care reform’s employer mandate until 2015 to give businesses another year to prepare for this requirement.
Under the Affordable Care Act (ACA), employers with 50 or more workers are required to provide health coverage to their workers or pay a penalty. The mandate was scheduled to begin in 2014. The delay of part of the ACA represents the Administration’s response to widespread complaints from businesses that the reporting requirements were too complex, and they asked for more time to comply with them.
The mandate for individuals to obtain health insurance or pay a penalty is still scheduled to go into effect in 2014.
WHA is offering a member forum on the ACA’s employer shared responsibility provisions on July 25. For more information or to register, go to http://events.SignUp4.com/13HotTopics0725.
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Children’s Hospital of Wisconsin advocates—the Rieder family—traveled to Washington, DC recently to meet with Wisconsin’s Congressional Delegation (pictured with Rep. Mark Pocan.) They also met with Representatives Reid Ribble and Paul Ryan; Steffany Stern, Legislative Director to Rep. Gwen Moore; Travis Robey, Deputy Chief of Staff to Rep. Ron Kind and Senator Tammy Baldwin.
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The state Department of Health Services (DHS) announced that they will be hosting town hall listening sessions throughout the state to discuss eligibility changes to the state’s Medicaid program. These listening sessions are part of the approval process for the BadgerCare Plus Demonstration Project Waiver. This version of the Waiver will contain changes to Medicaid eligibility that have been included as part of the 2013-2015 biennial budget act.
The Department will be hosting three separate town hall sessions:
Wednesday, July 10, 2013 – 11 am to 1 pm
Eau Claire – Chippewa Valley Technical College – Health Education Center, 615 Clairemont Ave.
Thursday, July 11, 2013 – 11 am to 1 pm
Milwaukee – Radisson Milwaukee West – 2303 North Mayfair Road
Green Bay – Green Bay Kroc Center (Walnut/Oak Rooms) – 1315 Lime Kiln Road
Comments can also be submitted online, by fax or regular mail. Participants who are unable to attend the meetings in person may view the meeting online. For more information on how to submit comments or watch the meetings online, go to: www.dhs.wisconsin.gov/badgercareplus/waivers.htm.
The actual waiver can be viewed here on the Department of Health Services’ website: www.dhs.wisconsin.gov/badgercareplus/pubs/BadgerCare%20Plus%20Demonstration%20Project%20Waiver%20Application.pdf.
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Clinical alarm fatigue is a highly visible and extremely complex patient safety concern. In April 2013, The Joint Commission released a sentinel event alert calling for hospitals to work harder to address medical device alarm safety and fatigue, as well as including alarm management as a proposed National Patient Safety Goal for 2014.
In order to help hospitals address this complex issue, WHA is offering a three-part audio conference series to examine the impact of clinical alarms on patient safety and evaluate opportunities for improvement that are within a hospital’s control. Participants will hear from nationally-respected experts in the field of alarm safety as they share innovative and successful approaches to reduce alarm fatigue and improve patient safety. Participants will leave with a better understanding of the issue and actionable next steps to improve alarm management.
Part one of the series, "Alarm Management Challenges and Opportunities," will be offered July 23, and will examine the underlying causes of alarm fatigue, the challenges many hospitals experience and opportunities for improvement. Part two of the series, "Alarm Management Strategies," will be offered August 6, and will discuss specific, actionable and practical strategies for addressing alarm safety issues. Part three of the series, "Technology Solutions for Improving Alarm Management," will discuss various technologies as well as their potential benefits, challenges and successful implementation.
For more information on this audio conference series or to register, visit: http://events.SignUp4.com/13ClinicalAlarmSafety.
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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.
Community Dental Clinic served nearly 4,500 in 2012
"Saving the world one tooth at a time," is the Community Dental Clinic’s unofficial motto. While clinic staff does not intend to save the world with good dental care, they have been changing lives in south central Wisconsin.
Located in Fort Atkinson, the clinic provides discounted dental services to the people of Jefferson County with limited or no dental insurance. In addition, the health professionals, staff, and volunteers educate patients about the importance of oral hygiene to prevent future problems.
The Community Dental Clinic was dreamed up in 2005 in response to the growing number of people in Jefferson County without reasonable access to dental care. Since the clinic did not qualify for federal funding, it was decided that it would be established as a "safety net" clinic. Through grants from the Wisconsin Medical College and Delta Dental, a vacant clinic in a Fort HealthCare facility was renovated to hold six treatment rooms and house state-of-the-art dental equipment. Fort HealthCare’s annual contribution for rent forgiveness is valued at $60,000.
Much of this wouldn’t be possible without the volunteer staff. In 2012, the clinic had 654 hours of work from volunteer dentists and 151 hours of work from volunteer hygienists. However, the clinic is always looking for volunteers, regardless of their experience in the dental field.
Financial support has been crucial for the clinic’s success. In addition to the in-kind support provided by Fort HealthCare, the Jefferson County Health Department, United Way of Jefferson and North Walworth Counties, United Way of Watertown, Wisconsin Dental Association, and Watertown Memorial Hospital have also been consistent sponsors of the clinic’s mission.
The clinic has gained an additional 1,000 patients each year since 2010, treating 4,417 patients in 2012. Clinic Director Barb Morrison Gudgeon says the clinic receives 5-10 calls each day from new patients and provides services to 35-40 patients daily. Services include: examinations, routine cleanings, filings and restorations, extractions, treatment of abscesses, and oral hygiene education.
To be eligible for treatment at the Community Dental Clinic, individuals or families must have an income at or below 200 percent of the Federal Poverty level and have no dental insurance. Or, prospective patients must be eligible to receive dental insurance through Medical Assistance.
Fort HealthCare, Fort Atkinson
Kids are smiling brighter thanks to Children’s Hospital of Wisconsin
Often, oral health care is thought of second to traditional medical care, but dental problems can lead to bigger health issues. In fact, one in three Wisconsin children are living with untreated dental decay—the most preventable chronic disease in the United States. Children and youth with special health care needs are twice as likely to have unmet dental needs. Children’s Hospital of Wisconsin is committed to providing children with the best care—including dental care—because we want our kids to be the healthiest in the nation.
To help accomplish this vision, Children’s Hospital of Wisconsin and Children’s Health Alliance of Wisconsin (Alliance) are working to raise awareness of the importance of children’s oral health. We have provided information and guidance to children and families who need it most.
The Alliance has trained frontline educators, community health navigators and outreach specialists with information and techniques to guide families through the oral health care system. The Alliance is working with community leaders to ensure they understand the burden poor oral health places on at-risk populations. Additionally, these leaders can help families navigate the system, creating greater access to oral health care providers.
Children’s Hospital is working with Milwaukee Public Schools (MPS) to implement the "Smile Smarts" program, the American Dental Association’s oral health curriculum. Students in kindergarten through third-grade in eight elementary schools participate in the program. By providing valuable educational resources in these schools, our teams are working to ensure oral health education continues in years to come. Each school has an oral health kit, which includes hands-on materials to enhance the learning process. Seven of these schools participate in a dental sealant program. More parents are consenting to dental sealants for their kids due to better communication and a more organized outreach.
Two schools, Hopkins Lloyd Community School and Clarke Street, work with the Metcalf Park Dental Clinic at the Next Door Foundation to care for students with severe oral health issues. In many cases, these children receive care quickly for painful and risky oral health issues. One student presented with what appeared to be an infection or abscess in his tooth requiring immediate care. The Next Door Foundation and MPS social workers worked together to ensure the student was treated the same day.
Through dental care and other treatment efforts, Children’s Hospital hopes to reduce the burden on our community and enhance the well-being of children and their families.
Learn more at www.chawisconsin.org.
Children’s Hospital of Wisconsin, Milwaukee
Ministry Door County Medical Center provides dental care access to those in need
The problems affecting children’s dental health are severe. Dental care is the single greatest unmet need for health services among children. Tooth decay is the most common childhood disease, affecting nearly 60 percent of children. For some it’s getting worse: 80 percent of dental disease in children is concentrated in 25 percent of children from poor families who face disproportionately high barriers to getting care. The consequences can be devastating to those from low-income and minority households.
Some problems may be intractable. This one is not. Located in Sturgeon Bay, the Ministry Door County Medical Center (MDCMC) Dental Clinic is a non-profit facility that has been providing free oral health care to youth throughout Door and Kewaunee Counties since 1999. It is the only dental facility in the area that accepts Medical Assistance, Badger Care or children who have no insurance and no dental home. The clinic is staffed by three general dentists with clinic costs underwritten by MDCMC and grant funding. More than 900 children were served by the Dental Clinic in 2011.
The dental clinic provides a dental home to a very diverse group of young patients between the ages of two and 18 from throughout the region and is connected to many local organizations. The facility receives referrals from the Door County Social Services and Health Department and from the Hispanic Resource Center. The clinic sees 90 percent of the children from the Headstart program and also gets many referrals from the schools. Although only 1.6 percent of the people residing in Door and Kewaunee Counties are Hispanic, nearly 20 percent of all clinic visits come from the area’s large Hispanic population, many of whom speak little or no English. The clinic uses two interpreters to connect with this population.
The clinic has treated many children who have been traumatized from not having dental care. Recently, a girl of eight was treated who had not ever been to a dentist. Her mother had called and said she was in pain. Clinic staff cleaned her teeth, took x-rays and did an exam. She had been to the ER and was on antibiotics, and due to a cancellation, clinic staff saw her the next day and extracted a six-year molar. The clinic has her on scheduled appointments for her other 10 decayed teeth.
With the MDCMC’s commitment to the poor, the dental clinic is now seeing adult patients two days a month who have an emergency situation as well as clients of the Community Programs who have mental health issues. In 2012 the clinic saw a large number of individuals that had emergency dental needs. A high percentage of these were clients of community programs. The others were screened and referred by the Social Service Department at MDCMC. One of these patients had to have all of his remaining teeth extracted due to the extensive infection in his mouth. The next adult dental clinic is scheduled for early August when the clinic is scheduled to see about 15 clients. Currently there is a waiting list for the next clinic.
The Ministry fund has been able to fulfill over 1,900 requests for assistance, and over $200,000 has been gifted since the fund was created in 1999. This year alone, the fund has gifted $17,000 for uninsured adults needing emergency dental care.
Ministry Door County Medical Center, Sturgeon Bay
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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