August 9, 2013
Volume 57, Issue 32

Severson Tells WHA Council of Need to Eliminate Mental Health Treatment Barriers
Council discusses Wisconsin’s superior worker’s comp system

As a physician, Rep. Erik Severson, MD (R-Star Prairie) is familiar with the challenges that doctors face in providing mental health services in rural areas. Those first-hand experiences give him a unique, and informed, perspective in his role as chair of the Speaker’s Task Force on Mental Health. Severson also chairs the Assembly Health Committee.

Speaking at the WHA Public Policy Council meeting August 6, Rep. Severson invoked some of his own experiences as an emergency room physician at Osceola Medical Center to illustrate his point about the need for HIPAA harmonization. The purpose of HIPAA harmonization is to remove barriers in Wisconsin law that hinder care coordination for individuals with a mental health diagnosis--barriers that do not exist under the federal HIPAA privacy and security law. Severson said that individuals with mental illness face a stigma that has been put in place “by having laws that treat individuals as well as their records differently, as if we are trying to hide something.”

Under current law, the heightened barriers on physician access to mental health records for treatment purposes make it more difficult for physicians and health care providers at his hospital to treat individuals who are concurrently being treated for mental illness, especially when the treating psychiatrist is not immediately available. “The Speaker’s Mental Health Task Force has heard about the need for HIPAA harmonization over and over again,” Severson said.

Severson discussed other issues before the Speaker’s Mental Health Task Force, including recognizing the significantly different challenges of providing mental health services in urban and rural settings, the need to address workforce and access shortages and the need to review the 72-hour hold processes. Severson described the process for taking the Task Force’s recommendations and transforming them into bills to be introduced in the Assembly.

Severson stated his commitment to modernizing outdated and eliminating duplicative hospital regulations. He recalled his Committee’s hearing on the current state hospital regulation, DHS 124, and emphasized the Assembly’s goal of reducing the administrative burden caused by unnecessary and antiquated regulations. 

Severson went on to discuss in general terms the role that government should play in the health care industry. Severson opined that hospitals, clinics, and doctors—and not politicians—are going to have to figure out what is best for patients. As a result, Severson said that he is generally opposed to legislative efforts to mandate various treatments or modes of treatment when these efforts represent an unwarranted intrusion of government into the hospital/physician and patient relationship.

“Once you crack open that door, there comes a point where a bureaucrat is running your hospital or clinic,” said Severson.

A recent informational hearing on worker’s compensation at the Capitol prompted WHA Executive Vice President Eric Borgerding to share with Severson, as chair of the Health Committee, that Wisconsin providers deliver some of the highest quality care in the country to injured workers with overall medical costs that are lower than most states.  Wisconsin also shows lower utilization of medical procedures within the Workers Compensation program than in many other states. 

State legislative issue briefing

Following Severson, Eric Borgerding updated the Council on what occurred in the state budget related to enrollment changes in Medicaid. Borgerding reviewed the Board-adopted position on Medicaid expansion and specifically identified the advocacy outcomes associated with each portion of the position. 

Changes made to the budget bill occurred entirely at the Joint Committee on Finance, the Legislature’s budget-writing committee. The Committee voted for several WHA-backed changes to the Governor’s proposed budget that would provide some assistance in the event that Wisconsin’s federally-run health insurance exchange is not functional and lower-income individuals fail to access and maintain coverage in the exchange. The Committee voted to re-establish the Medicaid Disproportionate Share Hospital (DSH) program, which would provide assistance to hospitals that have high Medicaid utilization. Borgerding further explained that the Joint Committee on Finance enacted an “off ramp” that will halt the transition of Medicaid enrollees into the exchange if there is not a qualified health plan offered in that county.  The “off ramp” was part of the WHA Board-adopted position that supported a thoughtful transition to subsidized coverage for certain current Medicaid enrollees.

Borgerding said WHA staff did extensive work on navigator and non-navigator assister regulations, including licensing and registration requirements. WHA‘s objective was to ensure that any regulations for enrollment assisters would not become an obstacle for enrolling individuals into the exchange, especially for those that would be disenrolled from the Medicaid program.

The Council discussed the recent investment of $5 million in graduate medical education (GME) in the state budget. WHA Vice President of Government Relations Kyle O’Brien said the Joint Finance Committee adopted all of WHA’s proposed changes to the bill, which lifted the $50,000 per hospital cap for new residency grant dollars in existing residency programs. The bill established a new cap of $225,000 per hospital and $75,000 per residency slot. After receiving feedback from hospitals and residency programs, WHA recommended to the Committee that funding be shifted to provide $3.5 million over the biennium for the creation of new residency program consortia and $1.5 million for new residency slots in existing residency programs.  WHA is working with DHS to implement the grant programs as quickly as possible.

WHA staff, members, testify at worker’s compensation hearing

WHA Senior Vice President and General Counsel Laura Leitch briefed the Council on recent developments in the Legislature relating to worker’s compensation, including an informational hearing held July 31 by the Assembly Committee on Labor and the Senate Committee on Labor and Judiciary. Leitch said that the clear message that emerged from that hearing was that Wisconsin’s worker’s compensation system is among the best in the country, providing real value for Wisconsin employers’ premium dollars. Testimony provided at the hearing showed that Wisconsin has a lower average claims cost compared to much of  the country and has the lowest average worker’s compensation premium rates among the border states. Importantly,  Wisconsin’s lower than average medical costs per episode of care provided to injured workers drive exceptional outcomes, including workers who have better recoveries; have a shorter-than-typical duration of temporary disability, meaning they return to work faster;  are more satisfied with the care they received; and have better access to excellent care. Leitch said the program’s stakeholders are working on improvements to the program that will reduce costs, including those costs related to administrative inefficiencies, while protecting the program’s strong record.

WHA proposes seven mental-health related bills

WHA recently submitted a set of seven statutory proposals to the Speaker’s Mental Health Task Force to reform elements of Wisconsin’s mental health laws that build upon WHA’s March testimony to the Task Force. WHA Vice President of Policy & Regulatory Affairs and Associate General Counsel Matthew Stanford said the seven proposed bills were developed over the summer with the input of WHA’s Mental Health Task Force. In addition to HIPAA harmonization, the bill proposals include reforms to emergency detention processes; funding efforts to improve mental health access using savings generated from HIPAA harmonization; clearer alignment between emergency detention-related responsibilities and authorities of health care providers; creating a trauma system-like structure to differentiate different types of emergency detention facilities in order to better ensure Wisconsin has an appropriate range of emergency detention services available; and, enabling rulemaking to create data-driven reports on county performance in providing core mental health services to facilitate more informed future discussions as to how to best ensure that the mental health system is meeting Wisconsin’s needs.

WHA engages with key health insurance exchange stakeholders

WHA Senior Vice President of Policy & Research Joanne Alig provided the Council with an update on the work that WHA and its members are doing on enrollment assistance. Alig explained to the group that the WHA Enrollment Action Council has been formed to provide leadership for WHA members around patient enrollment into new coverage options that will be available through the health insurance exchange and Medicaid. Alig said that WHA continues to be engaged on this issue with policymakers, including the federal Department of Health and Human Services (HHS), the state Office of the Insurance Commissioner (OCI), and DHS. Representatives from each will be participating in an August 14 WHA webinar and elaborating on their respective roles in enrollment assistance.

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Wisconsin Among Best States in the Nation for Reducing Readmissions
Physicians play key role

Wisconsin hospitals continued to perform well under a policy that is in its second year of implementation by the Centers for Medicare & Medicaid Services (CMS). An analysis published by Kaiser Health News showed that 42 of the 66 Wisconsin hospitals (64 percent) that are eligible for the CMS readmissions program  will receive no penalty and that the average penalty of those that were penalized was .18 percent, far below the national average penalty of .38 percent. The provision, enacted under the Affordable Care Act (ACA), penalizes hospitals for “excessive” Medicare readmissions. The maximum amount a hospital could be penalized is 2 percent for Medicare payments starting October 1, 2013 – September 30, 2014. The penalty focuses on patients who return to a hospital, up to 30 days after their discharge, because of complications.

“Wisconsin hospitals have been focused on reducing readmissions and their hard work is paying off,” according to WHA President Steve Brenton. “The good news for Wisconsin is that we have among the lowest rates of readmitting patients to the hospital in the country.”

Many hospitals in Wisconsin are reporting that they have cut readmissions by one-half or more, a fact that is reflected in the CMS data.WHA has been sharing readmission reduction success stories in Valued Voice over the past few weeks. Read them here:

“We prove again and again in Wisconsin that we are absolutely committed to providing the best, safest care in the country,” said WHA Chief Quality Officer Kelly Court.

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Political Action Fundraising Nears Halfway Mark

Totals to the 2013 Wisconsin hospitals state political action funds fundraising campaign continue to climb.  Nearing the halfway mark, the campaign has raised more than $127,000 from 169 individuals. This puts the 2013 campaign at 49 percent of the goal to raise $260,000 by the end of 2013.

To date, individuals are contributing an average $812, ahead of last year’s average of $702 and well above the 2011 average of $575. Of the total contributors so far, 47 are members of the Platinum Club (PC) who have contributed $1500 or more to the 2013 campaign, which is also ahead of the 2012 PC membership pace.   The median contribution is $500.

While the 2013 campaign is ahead in the average individual amount contributed and PC membership, the campaign is behind 53 contributors and $25,000 behind the pace of last year’s record-breaking year.

All individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. Thank you to the 2013 contributors to date who are listed on page 8. Contributors are listed alphabetically by contribution amount category.  The next publication of the contributor list will be in the August 23 edition of Valued Voice.  For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Contributors ranging from $1 to $499
Ambs, Kathleen St. Mary's Janesville Hospital
Ashenhurst, Karla Ministry Health Care
Bair, Barbara St. Clare Hospital & Health Services
Bayer, Tom St. Vincent Hospital
Bergmann, Ann Spooner Health System
Boson, Ann Ministry Saint Joseph's Hospital
Breeser, Bryan Aurora Medical Center Summit
Brenny, Terrence Stoughton Hospital Association
Brenton, Andrew Wisconsin Hospital Association
Calhoun, William Mercy Medical Center
Capelli, A.J. Aurora Health Care
Cardinal, Lori Agnesian HealthCare
Casey, Candy Columbia Center
Censky, Bill Holy Family Memorial
Coniff, Barbara St. Joseph's Hospital
Connors, Lawrence St. Mary's Hospital Medical Center
Cormier, Laura Bellin Hospital
Culotta, Jennifer St. Clare Hospital & Health Services
Dahl, James Fort HealthCare
Dalebroux, Steve St. Mary's Hospital
Ferrigno, Sandra St. Mary's Hospital
Fielding, Laura Holy Family Memorial
Furlong, Marian Hudson Hospital & Clinics
Gille, Larry St. Vincent Hospital
Granger, Lorna Aurora Health Care
Guffey, Kerra Meriter Hospital
Hafeman, Paula St. Vincent Hospital
Halida, Cheryl St. Joseph's Hospital
Hardy, Shawntera Hudson Hospital & Clinics
Hieb, Laura Bellin Hospital
Hockers, Sara Holy Family Memorial
Hofer, John Bay Area Medical Center
Jelle, Laura St. Clare Hospital & Health Services
Jensema, Christine HSHS-Eastern Wisconsin Division
Jensen, Russell St. Mary's Hospital
Johnson, Charles St. Mary's Hospital
Josue, Sherry St. Mary's Hospital
Karuschak, Michael Amery Regional Medical Center
King, Steve St. Mary's Hospital
Klay, Lois St. Joseph's Hospital
Klein, Tim Holy Family Memorial
Knutzen, Barbara Agnesian HealthCare
Lange, George Westgate Medical Group, CSMCP
Larson, William St. Joseph's Hospital
Lepien, Troy St. Mary's Hospital
Martin, Nancy Ministry Saint Michael's Hospital
Maurer, Mary Holy Family Memorial
Natzke, Kristin Marshfield Clinic
Nguyen, Juliet Sacred Heart Hospital
O'Hara, Tiffanie Wisconsin Hospital Association
O'Keefe, Robert
Oland, Charisse Rusk County Memorial Hospital and Nursing Home
Olson, Bonnie Sacred Heart Hospital
Ose, Peggy Riverview Hospital Association
Ott, Virginia St. Joseph's Hospital
Palecek, Steve St. Joseph's Hospital
Pavelec-Marti, Cheryl Ministry Saint Michael's Hospital
Penczykowski, James St. Mary's Hospital
Reinke, Mary Meriter Hospital
Rocheleau, John Bellin Hospital
Roundy, Ann Columbus Community Hospital
Schaetzl, Ron St. Clare Hospital & Health Services
Schubring, Randy Mayo Health System - Eau Claire
Simaras, James Wheaton Franciscan Healthcare
Statz, Darrell Rural Wisconsin Health Cooperative
Stelzer, Jason St. Clare Hospital & Health Services
Teigen, Seth St. Mary's Hospital
Thornton, Eric St. Mary's Janesville Hospital
Walker, Troy St. Clare Hospital & Health Services
Westrick, Paul Columbia St. Mary's Columbia Hospital
Whitinger, Margaret Agnesian HealthCare
Woleske, Chris Bellin Psychiatric Center
Wolf, Edward Lakeview Medical Center
Wymelenberg, Tracy Aurora Health Care
Wysocki, Scott St. Clare Hospital & Health Services
Yaron, Rachel Ministry Saint Clare's Hospital
Contributors ranging from $500 to $999
Bablitch, Steve Aurora Health Care
Borgerding, Dana
Carlson, Dan Bay Area Medical Center
Dewitt, Jocelyn
Dietsche, James Bellin Hospital
Dolohanty, Naomi Aurora Health Care
Dube, Troy Chippewa Valley Hospital
Freimund, Rooney Bay Area Medical Center
Gullingsrud, Tim Hayward Area Memorial Hospital and Nursing Home
Hinner, William Ministry Saint Clare's Hospital
Houlahan, Beth
Hyland, Carol Agnesian HealthCare
Jacobson, Terry St. Mary's Hospital of Superior
Joyner, Ken Bay Area Medical Center
Krueger, Mary Ministry Saint Clare's Hospital
Larson, Margaret Mercy Medical Center
Lewis, Gordon Burnett Medical Center
Mantei, Mary Jo Bay Area Medical Center
May, Carol Sauk Prairie Memorial Hospital
Mulder, Doris Beloit Health System
Nelson, James Fort HealthCare
Pollard, Dennis Froedtert Health
Quinn, George Wisconsin Hospital Association
Richards, Theresa Ministry Saint Joseph's Hospital
Rickelman, Debbie WHA Information Center
Rocole, Theresa Wheaton Franciscan Healthcare
Rohrbach, Dan Southwest Health Center
Russell, John Columbus Community Hospital
Schafer, Michael Spooner Health System
Selberg, Heidi HSHS-Eastern Wisconsin Division
Shabino, Charles Wisconsin Hospital Association
Stuart, Philip Tomah Memorial Hospital
Swanson, Kerry St. Mary's Janesville Hospital
Thurmer, DeAnn Waupun Memorial Hospital
Van Meeteren, Bob Reedsburg Area Medical Center
VanCourt, Bernie Bay Area Medical Center
Worrick, Gerald Ministry Door County Medical Center
Contributors ranging from $1,000 to $1,499
Britton, Gregory Beloit Health System
Dexter, Donn Mayo Health System - Eau Claire
Heifetz, Michael SSM Health Care-Wisconsin
Huettl, Patricia Holy Family Memorial
Hymans, Daniel Memorial Medical Center - Ashland
Kerwin, George Bellin Hospital
Martin, Jeff Ministry Saint Michael's Hospital
McKevett, Timothy Beloit Health System
Natzke, Ryan Marshfield Clinic
Roller, Rachel Aurora Health Care
Sanders, Robert Children's Hospital of Wisconsin
Turkal, Nick Aurora Health Care
Contributors ranging from $1,500 to $1,999
Alig, Joanne Wisconsin Hospital Association
Anderson, Sandy St. Clare Hospital & Health Services
Bloch, Jodi Wisconsin Hospital Association
Boese, Jennifer Wisconsin Hospital Association
Byrne, Frank St. Mary's Hospital
Clapp, Nicole Grant Regional Health Center
Coffman, Joan St. Joseph's Hospital
Court, Kelly Wisconsin Hospital Association
Eichman, Cynthia Ministry Our Lady of Victory Hospital
Francis, Jeff Ministry Health Care
Frank, Jennifer Wisconsin Hospital Association
Grasmick, Mary Kay Wisconsin Hospital Association
Harding, Edward Bay Area Medical Center
Lepore, Michael Wheaton Franciscan Healthcare
Levin, Jeremy Rural Wisconsin Health Cooperative
Meyer, Daniel Aurora BayCare Medical Center in Green Bay
Millermaier, Edward Bellin Hospital
Potter, Brian Wisconsin Hospital Association
Sanders, Michael Monroe Clinic
Sexton, William Prairie du Chien Memorial Hospital
Stanford, Matthew Wisconsin Hospital Association
Wallace, Michael Fort HealthCare
Warmuth, Judith Wisconsin Hospital Association
Contributors ranging from $2,000 to $2,999
Brenton, Mary E.
Desien, Nicholas Ministry Health Care
Duncan, Robert Children's Hospital of Wisconsin
Gage, Weldon Children's Hospital of Wisconsin
Herzog, Mark Holy Family Memorial
Jacobson, Catherine Froedtert Health
Kachelski, Joe Wisconsin Statewide Health Information Network
Kammer, Peter The Kammer Group
Katen-Bahensky, Donna
Kief, Brian Ministry Saint Joseph's Hospital
Leitch, Laura Wisconsin Hospital Association
Little, Steve Agnesian HealthCare
Mettner, Michelle Children's Hospital of Wisconsin
Neufelder, Daniel Affinity Health System
Normington, Jeremy Moundview Memorial Hospital & Clinics
O'Brien, Kyle Wisconsin Hospital Association
Oliverio, John Wheaton Franciscan Healthcare
Pandl, Therese HSHS-Eastern Wisconsin Division
Starmann-Harrison, Mary Hospital Sisters Health System
Woodward, James Meriter Hospital
Contributors ranging from $3,000 to $4,999
Borgerding, Eric Wisconsin Hospital Association
Size, Tim Rural Wisconsin Health Cooperative
Contributors $5,000 and above
Brenton, Stephen Wisconsin Hospital Association
Tyre, Scott Capitol Navigators, Inc

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13 Insurers Applied to Offer Individual Insurance Coverage in the Exchange
No information released about geographic service areas or rates

On August 6, the Wisconsin Office of the Commissioner of Insurance (OCI) made public the insurance companies that have submitted applications to participate in Wisconsin’s insurance exchange.  No information was provided in the release about the geographic service area for each plan or the rates that might be offered through the exchange. 

According to OCI, 13 insurers have requested their plans to be certified as a qualified health plan (QHP) in the individual market, and nine insurers have requested to participate in the SHOP exchange.

Below is a list of all of the health insurers that have submitted rate and form filings to OCI.

Individual Market Insurance Companies

Small Employer Group Market Insurance Companies

To view the press release:

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DHS to Host Webcast Trainings

As reported last week in Valued Voice, DHS will be hosting BadgerCare Plus webcast training for partners, health care providers and other interested parties on the 2014 BadgerCare Plus policy changes that were included as part of the biennial budget.

The webcast will be held on Monday, August 12 at 10 a.m., and can be accessed at this link: 

DHS has indicated that the webcast will also be taped and archived for individuals who are unable to tune in on August 12.

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Guest Column: Institute of Medicine Concludes Studies on Geographic Variation

By: Brian Vamstad, Legislative Policy Analyst, Gundersen Health System

Recently, the Institute of Medicine (IOM) concluded a series of studies aimed at providing policy recommendations that address geographic variation in health care spending and geographic adjustment policies in Medicare payment. In their final publication, “Variation in Healthcare Spending: Target Decision Making, Not Geography,” the IOM concluded: “Geographic variation in spending and utilization is real, and not an artifact reflecting random noise; it persists across geographic units and health care services and over time.” Overall, the work performed by the IOM failed to shed any new light on the issue of geographic variation in health care spending and utilization, or offer new insights on moving toward a system of value-based care.

Numerous authorities, most notably the Dartmouth Atlas, confirm geographic variation persists in the U.S. health care delivery system.  High health care spending patterns continue in parts of the country, such as Texas and Florida, while the upper Midwest and certain other regions rank among the lowest in health care spending. The IOM conclusions of “unexplained” health care spending variation continue even after applying risk adjustment criteria.  Despite evidence of geographic variation, the most specific recommendation from the IOM in the final report is a recommendation that the Centers for Medicare and Medicaid Services (CMS) not develop value-based payment policy based on geography, but instead focus on value at the provider-level.  In making this recommendation, the IOM argues that the majority of health care decisions are made at the provider level, not by geographic units.

The Healthcare Quality Coalition (HQC) continues to be steadfastly focused on promoting value-based health care policy in the Medicare program. The HQC is disappointed in the final outcome of the IOM studies, which fail to provide new information on the issue of geographic variation, and is currently developing legislation aimed at bolstering value-based programs for hospitals and physicians that reflects a full picture of value—cost and quality.

The IOM was initially charged with a series of studies on geographic variation and geographic adjustment policy following enactment of the Affordable Care Act (ACA). In the series of prior studies, the IOM analyzed Medicare’s geographic adjustment policy, whereby physician payment is adjusted for geography according to criteria based on estimated costs of practice. In the preceding reports, the IOM recommended better and updated data sources for geographic adjustment policies to improve payment accuracy for doctors and hospitals.

Recommendations from the series of reports are now being assessed by CMS, and could influence future policy development in the annual hospital and physician payment rulemaking cycles.  

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High Value Health Care—Wisconsin’s Competitive Advantage
Flambeau Hospital Experiences No Patient Falls in 10 Months

A concentrated effort to reduce patient falls in the Flambeau Hospital in Park Falls is paying off. Over the past 10 months, the hospital has not had even one patient fall. The “Falls Team” credits their success to the support from administration and a formalized approach to quality improvement that they implemented with assistance from the WHA Partners for Patients staff.

Early identification of patients who are at a high risk for falling is not new. What is new was a decision by the Flambeau Falls Team to take a more structured approach to reducing falls. By collecting and analyzing patient fall-associated data, the team noticed that most of the falls were occurring as patients were getting out of bed. That led to the purchase of several low-to-the-floor beds equipped with exit alarms.

“Our administration’s support has enabled us to have the resources that we needed to purchase the equipment and be given the time that is required to develop and implement a hospital-wide falls education program,” said Elizabeth Schreiber, RN, director of patient care services, who is leading the project. “As a result, we have an engaged nursing staff that are very committed to keeping our patients safe.”

The collaborative relationship that was fostered between nursing and therapies that was not previously in place also contributed to their success.

“What Flambeau Hospital has accomplished in regards to falls prevention is nothing short of exceptional,” according to Tom Kaster, WHA quality improvement advisor, who recently visited the hospital. “Their decision to bring the therapy department into the falls team was brilliant. The combination of including the therapists and providing early ambulation to their patients played a major role in their amazing success. Their story is one that can help hospitals in Wisconsin learn how to improve their falls rates.”

Flambeau’s falls prevention initiative also incorporated the following strategies to provide a multifaceted approach:

   Patient and family education to help identify falls risks at home;

   Functional assessment therapy sessions that allow patients to actually perform activities at their own pace in their room or simulated environment which highlights deficits that were not evident during daily nursing care; and, 

   The adoption of the WHA “Color Safety” Standardization Program, which uses a yellow wristband to identify patients at a high risk for falling.

The Flambeau staff has taken advantage of the resources that are available through the WHA Partners for Patients initiative. The sharing of best practices and availability of WHA staff to support, encourage and consult with members were mentioned by the team as making “a big difference.”

“Reducing falls is a journey with constant need for attention and improvement. The relentless pursuit of identifying risks is essential and staff ownership is critical to success of this and any process improvement program,” according to Schreiber. “We are fortunate to have staff dedicated and focused on the safety of our patients which makes this journey much easier and enjoyable.” 

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Murphy, Bujak to Headline WHA Fall Leadership Summit

The annual WHA Leadership Summit, scheduled September 19 in Pewaukee, features a variety of nationally-known presenters who will focus on practical leadership tools and techniques needed to stay ahead of the changes in health care.

Bob Murphy, a nationally-known operations leader with the Studer Group, is a keynote presenter. Murphy will share strategies to convert new behaviors into hardwired skills within your organization that will boost patient, employee and physician satisfaction.  Dr. Joe Bujak, a popular national speaker and author, will discuss ways to engage physicians in support of organizational goals. Jamie Haeuser, senior vice president of operations for Woman’s Hospital in Baton Rouge, will focus on refining persuasion and influencing skills. Dr. Elizabeth Holloway, professor of psychology at Antioch University, will introduce a systematic approach to preventing and mitigating the effects of the toxic behaviors impacting patient safety, professional retention and team collaboration.

For those interested in continuing education, the WHA Leadership Summit has been approved for nursing contact hours, long-term care administration credits, continuing medical education, and ACHE Face-to-Face education credits. For all continuing education credit information, as well as a full agenda and online registration, visit:

A block of rooms has been reserved for WHA at Country Springs Hotel for the evening of September 18. Take advantage of the group rate and make your reservation in the WHA block by calling 262-547-0201 by August 28.

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Medicare PPS Resources Available Through WHA Website

It seems as if CMS is releasing information almost weekly this time of year about the many different prospective payment system (PPS) rules that are updated that impact Wisconsin’s PPS hospitals. As a reminder, WHA offers several different resources to help PPS hospitals understand and prepare for the yearly payment rule changes. These valuable resources are updated frequently by WHA staff and are available on the WHA website and include:

• Comprehensive rule summaries along with the federal register link to the rule itself. That information can be found at  (select the specific PPS rule from the list on the left hand side of the page).

• Hospital specific fiscal analysis of the projected impact of the PPS rules. Hospital Medicare services analyzed include inpatient, outpatient, home health, psych, rehab, etc. and can be found within a few weeks after the PPS rule is announced, on the new WHA member portal. More information on signing up and logging into the hospital specific reports portal can be found at

We hope you will take advantage of these WHA member-only resources. For more information or if you have any questions, please contact Brian Potter at .

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Wisconsin Hospitals Community Benefits: Acute, Chronic and Communicable Disease Prevention and Control

Hospitals are well aware of the critical role they have in protecting public health. Whether it is working with public health agencies to develop protocols and responses to pandemic flu outbreaks, teaching children proper hand-washing techniques or educating people about how to live with chronic conditions, Wisconsin hospitals partner with key stakeholders to improve the health status of their communities.

All Saints Heart Failure Clinic helps keep patients out of the hospital

Michael Kinzinger was short of breath when he first visited the Wheaton Franciscan Healthcare – All Saints Emergency Department. He was quickly admitted to the hospital and began receiving treatment for heart failure. A few months later, he again returned to the All Saints Emergency Department – this time for a kidney stone and an aortic aneurysm.

Based on his medical history, Michael was referred to All Saints’ Heart Failure Clinic, which is led by Dr. Kaye-Eileen Willard. The clinic is helping to manage what has become a fast-growing and very costly chronic disease. As more patients survive heart attacks, they have a high risk of developing complications as a result of weakened heart muscles. The clinic’s goal, according to Dr. Willard, is to keep people like Michael healthy and out of the hospital.

The Heart Failure Clinic has been a godsend for Michael. Uninsured, the clinic connected him with a financial counselor who helped him secure financial assistance through Wheaton’s Community Care program. Karen Murillo, a Nurse Practitioner in the Heart Failure Clinic, sees Michael on a regular basis and coordinates his care for the management of his pacemaker, coronary artery disease, and other pulmonary issues.

"Everyone who I encounter at the Heart Failure Clinic is helpful," Michael said. "They take care of everything related to my heart health. Having access to this clinic is keeping me out of the Emergency Department."

Wheaton Franciscan Healthcare - All Saints

Efforts to address a growing community health concern

Since 2003, Aurora Health Care has underwritten a community health assessment of the West Allis/West Milwaukee service area every three years, conducted in partnership with our local health department. The most recent survey conducted in 2012 revealed an increase in adults reported having diabetes, from six percent (2003) to 10 percent (2012). Why was this a concern to Jan Mittelstadt, a dietitian and diabetes educator at Aurora West Allis Medical Center? According to the Centers for Disease Control & Prevention, chronic conditions such diabetes can result in health complications, compromised quality of life and burgeoning health care costs. Diabetes can lead to other serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations.

One of the keys to addressing this issue is to educate community members about how to prevent or properly manage diabetes. Recently, Jan presented to a group of 30 community members about diabetes prevention and control. The presentation took place in the community at First United Methodist Church of West Allis (FUMCWA). There, Jan was able to discuss the difference between diabetes and pre-diabetes, associated health implications, emphasize diabetes self-management, and provide resources to aid individuals in the self-management process.

The next step to help our community members with diabetes management is to provide access to care. Not only did Jan provide a list of resources and handouts to those who attended the diabetes presentation, but she also informed them that FUMCWA is a location that has an Aurora Health Care parish nurse. Pat Shapiro, a parish nurse who also serves as a diabetes educator, is able to ensure that people dealing with health challenges, including diabetes, receive the appropriate level of care, support, and referrals they need to maintain optimum health status and independence. Pat has been the parish nurse for FUMCWA for many years and is skilled at promoting health within the faith community. She responds to parishioners’ questions and concerns about diabetes-related medications, blood pressure and nutrition. Most importantly, Pat is a familiar face who is able to provide comfort and reassurance to those struggling to manage this chronic condition, which can make all the difference.

Here’s one great example of how an established relationship with a parish nurse can avert a diabetes-related crisis:

On a previous visit to her physician’s office, Addy, who is a 79-year-old single woman, had blood sugar counts that were noted to be out of control. Her physician, who works out of Aurora West Allis Medical Center, also noted that Addy did not keep her appointment for a follow-up visit. Concerned about her, he asked Pat to make a home visit. While there, she was able to assess Addy’s insulin vial and determined it was defective. Pat then guided Addy through the process of contacting her pharmacy, which replaced the vial, reassessed her insulin preparation technique, and communicated her findings to Addy’s physician. Because of Pat’s relationship with Addy as her parish nurse, she was able to help Addy get her blood sugar under control once again without it escalating to an emergency situation.

Aurora West Allis Medical Center

Submit community benefit stories to Mary Kay Grasmick, editor, at

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