January 18, 2013
Volume 57, Issue 3

WHA Letter to Hill Outlines Fiscal Cliff Law Impact
Ongoing tally of hospital cuts keeps adding up

As Congress faces debt ceiling deliberations in the coming month, WHA President Steve Brenton wrote all members of Wisconsin’s Congressional Delegation regarding the impact to Wisconsin hospitals of the recently enacted American Taxpayer Relief Act of 2012 (ATRA).

Unfortunately, the ATRA continued along the path of cutting hospital payments in order to fund other providers or programs. In this instance, hospitals nationally will see a $10.5 billion reduction to offset the costs of the Medicare physician payment patch.

"With respect to the ATRA’s Medicare inpatient coding cut, WHA estimates it will reduce payments to Wisconsin hospitals by $161 million over four years," said Brenton. "This reduction is on top of an estimated $2.6 billion in reductions [over 10 years]. Wisconsin hospitals are seeing under the Affordable Care Act, another potential $1 billion in reductions under sequester [over 10 years], and a $55 million Medicare bad debt cut our hospitals saw in February 2012 under the Middle Class Tax Relief & Job Creation Act.

Congressional District

WI Impact of ATRA Inpatient Coding Cut

CD 1 - Ryan

-$15.6 million

CD 2 - Pocan

-$30 million

CD 3 - Kind

-$16.8 million

CD 4 - Moore

-$40 million

CD 5 - Sensenbrenner

-$17 million

CD 6 - Petri

-$10.5 million

CD 7 - Duffy

-$14.7 million

CD 8 - Ribble

-$16 million

Statewide Impact

-$161 million

While WHA supports fixing the physician reimbursement formula, it does not support cutting hospital payments to do so. "For highly integrated states like ours," Brenton added, "this approach is short-sighted and harms the very nature of our state’s high-value health care delivery system."

According to the American Hospital Association, hospitals nationally have been cut $250 billion since 2010 to pay for other laws, programs or providers. In Wisconsin the estimated impact of these cuts to hospitals over 10 years is $3.6 billion.

"We believe there is a better approach and ask Congress to look at ways to incent higher value care in Medicare. We believe high value states like ours are already proving it can be done and demonstrating that we have been saving the Medicare program dollars for years," said Brenton. "Should any additional hospital cuts be discussed….[they] should take into account the proven track record of high value providers like ours."

The letter also expressed appreciation for the extension of important Medicare payments, including the Medicare Dependent Hospital (MDH), Low Volume Adjustment (LVA) and physician work geographic adjustment factor.

"Without the extension of the LVA and MDH, 15 Wisconsin hospitals would have seen an estimated $13 million cut in 2013 alone," began Brenton. "WHA and the impacted hospitals appreciate Congressional commitment to extending these important payments for our more rural, non-critical access hospitals. We also appreciate the extension of the physician work geographic adjustment factor for an additional year. Failure to extend this would have cost Wisconsin providers millions of dollars."

Read WHA’s full letter at: www.wha.org/pdf/whafiscalclifflaw_kind1-16-13.pdf.

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Wisconsin Joins 21 States to Stop Massachusetts Medicare Windfall
Hospitals here will lose $9.4 million while Massachusetts gains $350 million

The Wisconsin Hospital Association is one of 21 state hospital associations that have joined forces to fight back a provision in the health reform law that gives Massachusetts hospitals hundreds of millions of dollars in bonus payments—at the expense of nearly every other state in the country.

According to WHA, hospitals here will lose $9.4 million per year due to the manipulation of Medicare’s complex reimbursement formulas. That loss is on top of the more than $2.6 billion in Medicare payment cuts WHA estimates hospitals already face under provisions enacted in the health reform law and another $1 billion in Medicare cuts under mandatory, across-the-board reductions known as sequester.

"What I am outraged about is that high-value, high-quality Wisconsin hospitals in communities across the state will lose millions because of a calculated approach to manipulating arcane rules and regulations," said WHA President Steve Brenton. "It’s just not right to dock hospitals in 41 states to give very few states a windfall."

That is why a coalition of 21 states has come together seeking to reverse this windfall, sometimes referred to as the "Bay State boondoggle." The issue is expected to come up again in Congress as early as February during debt ceiling and entitlement reform discussions.

In addition, proposed legislation has already been discussed with some in Congress, including potential scenarios like a "claw back," taking back the money Massachusetts has received in the last two years, or trimming future collections, said Dan Boston, a health care lobbyist representing the coalition of 21 hospital associations.

The saga was set in motion when one hospital in Nantucket, Massachusetts reclassified the type of hospital it was for Medicare reimbursement purposes. The action taken by the Nantucket hospital then artificially inflated the rest of the state’s Medicare reimbursements. The dramatic shift in payments nationally was only seen after Senator John Kerry (D-MA) negotiated the inclusion of an amendment into the health reform law, which moved hospital wage reimbursements from a fixed state-based amount to a fixed national amount. That means that one state’s "boon" comes at the expense of other states.

Massachusetts is by far the largest beneficiary, seeing a $367 million increase in FY 2012 and another $256 million in FY 2013. California is next in line but sees only half as much money. On the other side are many Midwest states who are hit hard, with Wisconsin, Illinois, Iowa, Minnesota and Michigan losing money to offset the Medicare payment increases in Massachusetts (see table below).

Annual Gain

(in millions)

Annual Loss

(in millions)













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Bill Introduced Implementing WHA Mental Health Task Force Recommendation
Emergency Detention Special Committee completes its work with four bills introduced

The Wisconsin Joint Legislative Council on January 16 voted to introduce as legislation a bill draft that would implement the WHA Mental Health Task Force’s recommendation to include hospital representation on county 51.42 Boards that guide policy regarding county mental health services, including emergency detention services. That bill draft was among three other bill drafts introduced by the Joint Legislative Council and developed by the Special Committee on Review of Emergency Detention and Admission of Minors Under Chapter 51.

George Kerwin, CEO, Bellin Health and chair of WHA’s Behavioral Health Task Force, and Dr. Gina Koeppl, regional director of Ministry Health Care-Northern Region’s Behavioral Services, served as hospital representatives on the Special Committee, which also included legislators, law enforcement, county human services providers, county corporation counsel, and mental health consumer representatives.

To foster better coordination of and collaboration on county mental health services, the introduced legislation would require hospital, law enforcement, and consumer representation on each county’s mental health services board.

"Regular and active collaboration and coordination between county agencies, law enforcement, hospitals, and consumers is necessary to best provide consistent, appropriate emergency detention services," said Kerwin. "This bill will ultimately help to improve the outcomes for individuals with emergency mental health needs throughout the state by providing a formal framework for county-level collaboration and coordination on emergency detention and other mental health services policy issues."

The Joint Legislative Council also introduced as legislation a bill draft from the Special Committee that would remove various barriers to voluntary admissions of minors for psychiatric treatment, as well as a bill draft that would create a pilot program to assist individuals in correctional facilities to obtain health benefits upon release.

In addition, the Joint Legislative Council also introduced a bill containing multiple changes relating to Wisconsin’s emergency detention law. The Joint Legislative Council discussed addressing in the standing legislative committees two technical issues in the bill draft that were identified by WHA that may make it more difficult for individuals to receive needed treatment. WHA looks forward to working with legislators on these issues as the bill moves through the regular committee process.

The introduction of the Special Committee’s bill drafts by the Joint Legislative Council culminates the work by the Special Committee to identify changes to Wisconsin’s emergency detention laws that have broad stakeholder support.

"Mr. Kerwin and Dr. Koeppl have been participating on the Emergency Detention Special Committee for almost two and a half years and during that time have been outstanding advocates for improving patient outcomes by reforming outdated laws that have resulted in a fragmented mental health system in Wisconsin," said WHA President Steve Brenton. "WHA and hospitals throughout the state are truly grateful for their volunteer efforts and expertise on this complex issue."

Additional information on the newly-introduced bills, including summaries, past WHA correspondence with the Special Committee, and a history of the development of the bills can be found here: http://legis.wisconsin.gov/lc/committees/study/2012/12CH51/index.html.

WHA’s memo to the Joint Legislative Council regarding the bills can be found here: www.wha.org/pdf/WHALetter-ch51StudyCommitteebills1-15-13.pdf

Contact WHA’s Matthew Stanford at mstanford@wha.org or 608-274-1820 if you have any questions.

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HHS Releases Omnibus Final HIPAA Rule

On January 17, the U.S. Department of Health and Human Services (HHS) released an omnibus final rule comprising of four HIPAA-related final rules. The 563-page omnibus final rule can be found at: www.ofr.gov/(X(1)S(bomb3tr1qcowvjftprcgpqtv))/OFRUpload/OFRData/2013-01073_PI.pdf.

The first of the four final rules finalizes the July 14, 2010 proposed rule that made modifications to the HIPAA Privacy, Security, and Enforcement Rules that were mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act. This final rule, among other items, addresses business associate compliance and liability, addresses use of protected health information for marketing, fundraising, and sales purposes, expands individuals’ rights to receive electronic copies of health information, enables the restriction of disclosures to health plans for treatment paid out of pocket in full, makes changes to the provision of notice of privacy practices, and modifies requirements to facilitate research and child immunization.

The other three final rules incorporate the increased and tiered civil monetary penalty structure, replaces the "harm" threshold in the 2009 breach notification final rule with a new objective standard, and finalizes a prohibition on health plans from using or disclosing genetic information for underwriting purposes.

The final omnibus rule will be published in the Federal Register on January 25 and will take effect March 26. However, compliance with most of the rule’s provisions will not be required until September 23.

WHA will continue to digest the new omnibus rule and provide updates as needed in future editions of The Valued Voice.

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CAH Method 2 MDs Now Eligible for Medicare EHR Incentives

Physicians providing services in outpatient departments of critical access hospitals who submit bills using the optional "Method 2" billing approach are now eligible to participate in the Medicare Electronic Health Record (EHR) incentive Program according to a new fact sheet released by CMS.

Under Method 2 billing, a critical access hospital bills Medicare for physician services on behalf of the physician, and these physician services are submitted on the UB-04 form rather than on the Form 1500. This created confusion for CMS, and resulted in CMS improperly designating Method 2 physicians as "hospital-based" physicians ineligible for EHR incentives when such physicians were not in fact "hospital-based."

CMS is now implementing system changes that will enable Method 2 physicians to participate in the Medicare EHR Incentive Program this year. However, these physicians cannot submit attestations until January 2014.

For more information on this change, see CMS’s fact sheet here: www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CAH_Method_II_Participation_FactSheet.pdf.

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WHA Physician Leadership Development Conference
The American Club, Kohler *** March 8-9, 2013

Early Bird Registration ENDS Today – Friday, January 18

Register at: http://events.SignUp4.com/13PLD

Make hotel reservations at The American Club before February 14.

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WHA Posts 2013 Wisconsin Health Care Employee Pride Program Toolkit

The Wisconsin Hospital Association is now offering hospitals an opportunity to customize the Employee Pride Program to meet local needs.

The program encourages WHA member hospitals to invite their employees to express themselves in an essay and tell others why they chose a health occupation. The Pride Program gives employees the opportunity to share why they love their career of service to others, while giving hospitals an opportunity to honor their employees’ contributions to their hospital, community and profession.

This year, WHA encourages hospitals to coordinate the Pride Program locally, choose an honoree to be recognized, and decide within your organization how you’d like to recognize your employee or employees. WHA has modified the materials to a more local angle and posted them at: www.wha.org/pride-program.aspx. The toolkit includes instructions, a poster and sample press release.

For more information contact Shannon Nelson at snelson@wha.org or Mary Kay Grasmick at mgrasmick@wha.org, or call 608-274-1820.

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Medical Surgical Nursing Units Report TCAB Progress

Reports from hospitals participating in Transforming Care at the Bedside (TCAB) continue as WHA staff complete site visits. Each hospital unit that is participating is visited twice during the project and asked to report on initiatives and activities conducted by the team.

The TCAB team at Mayo Clinic Health System in Eau Claire kicked off their project with a snorkel on "how to reduce hunting and gathering work of nurses." From that exercise, they found some quick wins. They now keep a supply of pillows in each room, increased the number of persons that could access medications, reduced travel time to ice machines and packaged isolation kits. They also have larger projects from this snorkel that include standardization of supplies in patient room cabinets and a new process for obtaining IV pumps for patients.

Team communication is a second focus for this unit with a large number of staff. A staff newsletter is one of their latest improvements.

At Spooner Health System, the TCAB team has implemented a quiet zone in front of the Pyxis machine. They have also created a safe zone at the entry to isolation rooms with a mockup of the process in the nursing report room. This group places a sign indicating "small test of change" to alert staff when they are working on a new idea.

To save steps gathering materials for new patient admissions, the team has created an admission cart that can remain outside the room that saves time and steps during each admission. Instituting hourly rounding is a next step for this team.

Hayward Area Memorial Hospital’s TCAB team started with an easy win by packaging a "fall kit" that included the materials necessary when fall precautions are required by a patient. This team’s first snorkel was "how to improve management of patients’ pain." One strategy they will use is an informational brochure for patients and families provided on admission outlining goals for assessing and managing pain while in the hospital. A second snorkel has been conducted on use of a white board in patient rooms.

This team is also working on team communication and has created a newsletter with the name "Connected." Access to supplies, such as blood pressure cuffs, is a work in progress, and the team has a planning day to create a strategy for bedside report.

The Wisconsin TCAB initiative is an 18-month project that will end March 2014. Participants will each be expected to outline a plan to sustain the project after that date. Transforming Care at the Bedside is a WHA project funded through the Wisconsin Collaborative for Healthcare Quality by the Robert Wood Johnson Foundation.

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Wisconsin Hospitals Community Benefits: Free Clinics

Where do you go when you need a doctor and you don’t have insurance? More and more hospitals are establishing free clinics to serve those who do not have a "medical home." Every effort is made to connect patients with follow up care and even help them obtain the medical supplies or prescription drugs that they need.

Luck and magic help asthma disappear

It might have been (bad) luck that landed Mary at a free asthma clinic in Madison but she claims it was magic that gave her a new lease on life.

Mary has suffered from asthma for nearly 50 years. During those five decades, her condition was never controlled, and breathing was always a struggle. To add insult to injury, her meager fixed income put expensive medications at the bottom of the priority list.

In January 2008, Mary was visiting Madison from her home in Neillsville, about three hours to the northwest. A severe asthma attack put her in St. Mary’s Hospital for three days, and a staff member recommended she visit the free Dean & St. Mary’s Neighborhood Asthma Clinic. Through free medication and education provided at the clinic, Mary has been able to keep her asthma under control – so much so that she calls the clinic "magic." She further believes the clinic saved her life. Thanks to trips with family to visit grandchildren in Madison, she has become a regular patient at the clinic.

"I never used to be so healthy," she explains, adding that she feels better now than she did 20 years earlier. "My friends ask me all the time what I’ve done, and I tell them I go to the Magic Clinic in Madison."

St. Mary’s Hospital, Madison

A place to turn for help

What would you do if you were sick, scared and had nowhere to turn to receive the medical attention that you are in dire need of? Millions of Americans do not have insurance coverage and struggle every day because proper health care is not available to them. At Mercy, we lend a helping hand to our local communities by providing services for those in need who cannot afford it. The Janesville Community Health Center (JCHC) at Mercy Clinic South is a place where patients receive primary health care services at a reduced rate and low-cost prescription drugs through a federal drug program. This clinic is located within Mercy Clinic South and is fully staffed by 26 family medicine physicians—residents and faculty alike. JCHC provides quality health care services for Medicaid, underinsured and uninsured patients in Rock County. Eligible persons can receive primary care at a reduced rate (a sliding fee scale based on income) and discounted prescription drugs. In each calendar year, nearly 4,300 are served.

When medical problems suddenly arise, it can become a very serious and frightening time for those uninsured and needing individuals. Jane, a recent patient at Janesville Community Health Center, said her experience as a tough but very grateful one. Jane says it was never easy for her to see a doctor because of long-term financial constraints, but, when headaches and high blood pressure started in January of this year, she knew it was time something needed to be done. She turned to the Janesville Community Health Center for help before her health worsened.

"It is a great thing to have a place that will take care of you if you do not have the money," said Jane. "I was very scared to ask for help, but it has been such a god-send to be able to turn to Mercy for help."

She says one of the best aspects of her care is that she receives financial assistance to help pay her medical bills. Jane would like to thank everyone, from the bottom of her heart. "Without Mercy and the Janesville Community Health Center, I’m not sure where I’d be today."

Mercy Health System donates over $32 million in uncompensated care and free services every year. What we strive to give, however, those are the things that cannot be measured. Health care is mission-driven, and our mission is healing those who need us most.

Mercy Health System, Janesville

Gundersen Lutheran extends care through St. Clare Health Mission

It is a painful reality that millions of Americans are without health insurance, keeping many from seeking health care. The La Crosse area is no exception. Fortunately, help is available through St. Clare Health Mission in La Crosse, supported in part by Gundersen Lutheran (www.gundluth.org).

"St. Clare Health Mission provides free basic health care to people who are uninsured but are not eligible for medical assistance," explains Chad Thurman, MD, a Family Medicine doctor at the Gundersen Lutheran – Onalaska Clinic. He—like so many other Gundersen Lutheran physicians, physician assistants, residents, nurses, pharmacists, social workers, lab technicians and support personnel—has volunteered his medical services at the Mission for several years.

"Serving at St. Clare is the right thing to do. There is a growing demographic of people who don’t qualify for government-paid health insurance and can’t afford private insurance," Dr. Thurman says. "The Mission is their safety net. For me, it is very rewarding to help the community in this way."

The Mission sees a wide range of people for a variety of health issues from asthma, abdominal pain and diabetes management to psychiatric care. According to Dr. Thurman, they’re seeing more young people—recent college graduates—who haven’t been working long enough to afford or qualify for health insurance. If not for St. Clare Health Mission, many of these patients would go without health care and medication or would be receiving their health care via emergency rooms—one of the most costly ways to provide health care and puts extra stress on already-overburdened emergency rooms.

St. Clare is open for walk-in care two evenings a week. In addition, many Gundersen Lutheran board-certified specialists in areas such as cardiology, surgery, orthopaedics, pain medicine, gynecology, gastroenterology and others are available for scheduled patient appointments at the clinic.

There’s also an evening Continuity Clinic and Prevention Clinic to care for those with chronic medical conditions. Those clinics are run by students along with their preceptors. They provide nutrition counseling, diabetic education, smoking cessation, foot care and specialty medical care.

Since it began in 1993, dedicated and compassionate volunteers from both of La Crosse’s health care organizations have cared for more than 15,500 patients during more than 64,000 visits. The Mission serves people of Houston, La Crosse, Monroe, Trempealeau and Vernon Counties in Wisconsin and relies almost exclusively on volunteer services and donated equipment, supplies, pharmaceuticals and money.

Gundersen Lutheran Health System, La Crosse

The Bread of Healing Clinic

The Bread of Healing Clinic is a free clinic whose mission is to provide basic medical care to the uninsured. With the support of Aurora Sinai Medical Center and other grants, the clinic is open four half days each week at Cross Lutheran in Milwaukee, where an average of 300-350 patient visits are completed monthly. Two additional Bread of Healing Clinic sites are opened to accommodate an additional 50 patient visits monthly. In total, the Bread of Healing clinic provides medical care to more than 1,500 people annually who do not have medical insurance.

C.M. is a patient of the clinic who knows all too well how difficult it is for an uninsured person is to find medical care. She had developed a painful lump on her back but was only working part-time and had no medical insurance. She was so grateful to find help at the Bread of Healing Clinic. After much effort, the staff of Bread of Healing was able to locate and refer C.M. to a surgeon who diagnosed her with a rare and aggressive form of cancer called Dermatofibrosarcoma Protuberans (DFSP). There is only about one case per million annually. The surgeon removed the tumor for C.M., free of charge. Without the clinic’s surgeon referral, C.M. believes the tumor would still be growing, and it would be difficult if not impossible for her to keep working.

"It should be enough to say Bread of Healing saved my life, but there’s so much more. They attended to my body, heart, and soul. That is what makes them an amazingly effective, friendly, and life-saving medical clinic."

– C.M., grateful patient & friend to Bread of Healing Clinic

Aurora Sinai Medical Center, Milwaukee

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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