January 28, 2011
Volume 55, Issue 4

Quality Improvement Act Now Law
Updated peer review statutes will advance collaboration, drive health care improvement

In a fitting finale to an eventful first month of the new legislative session, Governor Walker put his signature on Special Session Senate Bill 1 (SS SB 1) this week, a broad tort reform bill that includes long-sought after improvements to Wisconsin’s antiquated peer review statutes.

SS SB 1 was introduced, heard and voted on by two legislative committees, passed both houses of the Legislature and signed by Governor Walker in a mere 22 days—an unequivocal testament to its priority with the new administration and legislative leadership.

WHA staff worked closely with the Walker Administration and key legislators and their staff to craft the bill and respond to misleading claims, false statements, and misinformation about the proposal. WHA also organized and led what grew into a large and diverse coalition of over 30 interested health care provider and purchaser and patient safety groups that strongly supported the bill, now 2011 Wisconsin Act 2.

"We commend Governor Walker and legislative leaders for their commitment to improving the quality of health care in Wisconsin, understanding what it takes to get that done," said WHA executive vice president Eric Borgerding. "With this new law, hospitals and other providers across the state will be able to better collaborate, share best practices, and work together to improve quality. This is exactly what we need to keep Wisconsin among the nation’s leaders in health care quality."

Legislative backers of the proposal were united in their support.

"One of the goals of the legal reform bill is to improve our health care system by encouraging more participation by physicians and other medical professionals in the peer review process," said Senator Rich Zipperer (R-Pewaukee). "A more robust peer review system will increase the quality of care, while driving down costs at the same time. This is vital in our efforts to work for better outcomes for patients."

Representative Samantha Kerkman (R-Powers Lake) agreed. "One of the goals of the Quality Improvement Act was to ensure better information-sharing among various providers and enhancing safety among patients. In the long run, I believe that such a measure could help deter the rising costs of health care."

Representative Erik Severson, MD (R-Star Prairie) added, "By passing tort reform, we have kept peer review a learning tool for doctors rather than a potential lawsuit. This is a step in the right direction towards improving the quality of health care offered to the people of Wisconsin."

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WHA Offers Community Benefits Reporting Refresher Webinar February 28

For five consecutive years, 100 percent of Wisconsin’s hospitals have collected and publicly reported community benefits information. While all hospitals have completed the WHA survey, many continue to have questions about what can be counted, how to assign dollar values to non-material contributions, and how to integrate the WHA survey into the processes they may already have set up to collect this data. In addition, the IRS Form 990 Schedule H regulations for hospitals became mandatory in 2010.

On February 28, WHA is hosting a no-cost webinar designed as a refresher for those who complete the WHA community benefit survey. Those who are new to the role will also benefit from participation. During the webinar, examples of "what counts" and where/how to include the activity in the on-line Lyon’s CBISA software will be discussed, along with a review of Schedule H, as all hospitals will need to include Schedule H reporting with their 990. A discussion focused on the most effective ways to share your community benefit stories with your community will be led by WHA’s Vice President of Communications, Mary Kay Grasmick.

Online registration is available for this event at: https://www.signup4.net/Public/ap.aspx?EID=11WC10E&TID=o9G4aXpgrPKcbLic%2bPJB0A%3d%3d. There is no cost to participate, but pre-registration is required. For questions about this webinar, contact Lisa Littel at llittel@wha.org or 608-274-1820.

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Wisconsin Hospital CEOs Present Kind With National Rural Award

This week Wisconsin Congressman Ron Kind (La Crosse) received the National Rural Health Association’s "Legislator of the Year" award for his continued commitment to rural health issues. Prairie du Chien Memorial Hospital’s CEO Bill Sexton and retired hospital CEO Harold Brown presented Kind with this award in Washington, DC.

Other Wisconsin representatives attending the ceremony were: Tim Size, executive director, Rural Wisconsin Health Cooperative (RWHC); Gerald Worrick, CEO, Ministry Door County Medical Center; Jeremy Levin, RWHC; John Eich, Wisconsin Office of Rural Health; Byron Crouse, M.D., Associate Dean for Rural and Community Health/UW, and Jenny Boese, Wisconsin Hospital Association.

"Today there are more than 1,300 Critical Access Hospitals across the United States and 59 in the state of Wisconsin. Twenty-three of those are in Congressman Kind’s 3rd District," said Sexton in presenting the award. "As my good friend Tim Size says, ‘Ron has always been there when we needed him.’ Ron, thank you for all you’ve done for rural Americans."

While in DC for the award ceremony, Wisconsin hospital representatives took the opportunity to meet with Wisconsin’s Congressional Delegation to discuss rural health care issues on the horizon.

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President’s Column: Historic Week for Health Care as Legislature Enacts Important Initiatives that will Enhance Coverage and Accelerate Clinical Performance Improvement

In just a few short days the new Wisconsin Legislature enacted key Walker Administration initiatives that will advance health coverage and accelerate clinical performance improvement throughout the Badger State.

On a bipartisan vote, lawmakers extended state tax exempt status to individually-funded HSA contributions, removing the state from the sorry ranking of being among a handful of holdouts that still tax HSA contributions. The new law is a boon to employees of small businesses that have chosen HSA-type health plans for their coverage. WHA has had such a plan in place for five years as a way of encouraging employees and their families to have some "skin in the game" when it comes to utilizing services. Average annual premium increases have dipped 50 percent since 2005 without increasing total out-of-pocket costs.

The HSA legislation had passed previous Legislatures only to be vetoed by Governor Jim Doyle. WHA has historically supported the legislation because the coverage and shared cost features of the proposals are fully consistent with WHA’s health reform principles.

The Legislature also enacted an omnibus tort reform measure that includes WHA’s Quality Improvement Act (QIA). This was the third try for the QIA, which since 2005 has passed the Assembly three times and the Senate twice. The bill was vetoed once by Governor Doyle and will soon be signed by Governor Walker.

The QIA significantly expands peer review protections beyond the walls of an individual hospital and recognizes the fact that hospitals, physician clinics, and integrated health systems must be able to work together in order to improve performance and implement best practices. The legislation brings Wisconsin’s peer review law into the modern era of health care integration and collaborative performance measurement. Until this week it has been a shameful fact that although Wisconsin is a national leader in quality health care, we’ve been a national laggard on protecting peer review discussions from being "discovered" by the plaintiff’s bar.

The new QIA law also maintains medical errors as a matter for civil, not criminal, court, an important point that drew fire from trial attorneys who vigorously but unsuccessfully attacked the legislation. Kudos to the legislators who waded through plaintiff’s bar hysteria and misinformation and to WHA staff for their yeomen efforts on this very necessary legislation.

It’s been a great two weeks for Wisconsin health care and the patients we serve. Enactment of these proposals allows us to advance and accelerate our many efforts to improve the health of our communities.

Steve Brenton

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Grassroots Spotlight:  Ministry Door County Medical Center Hosts Congressman Reid Ribble

On a cold Saturday morning, Ministry Door County Medical Center (MDCMC) welcomed Congressman Reid Ribble for a meeting with a handful of health care executives. The meeting was organized by MDCMC president Jerry Worrick, a friend of the Congressman.

The purpose of the meeting was to sit down with the Congressman for a detailed nuts-and-bolts discussion of how the health care system works and how providers are paid by the government for Medicare and Medicaid services. For nearly two hours, the group of leaders engaged in a lively discussion ranging from the history of Medicare to the health care reform law.

Joining Worrick for the meeting with Congressman Ribble were Ministry colleagues Sheila Clough, president of Howard Young; John Ceelen, senior director of strategic projects and Karla Ashenhurst, director of government affairs. Other health care colleagues attending the meeting were Travis Andersen, president of Affinity St. Elizabeth’s Hospital; Ed Harding, president of Bay Area Medical Center in Marinette; and Heidi Selberg, vice president of strategy/advocacy at Hospital Sisters Health System/Eastern Wisconsin Division. Steve Brenton, president of the Wisconsin Hospital Association, made a special trip from Madison to share in the discussion.

The group also had the opportunity to meet Marc Savard, the Congressman’s point person on health care issues. Savard will work out of the Green Bay and Appleton offices for the Congressman. The group also provided Congressman Ribble with a health care handbook including current and historic information on health care from a provider’s perspective.

This meeting is yet another example of hospitals taking the initiative to develop all-too-important relationships with their legislators. WHA encourages you to follow Ministry’s example and meet with your newly elected or incumbent legislators about priority hospital issues. Contact WHA’s Jenny Boese at 608-268-1816 or jboese@wha.org if you need assistance.

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ACOs, Physician Alignment Highlighted at WHA Physician Leadership Conference

Physician leaders must represent both clinical and managerial interests, and each year at the WHA Physician Leadership Development Conference, presenting faculty from the American College of Physician Executives (ACPE) focus on important leadership skills that help physician leaders to move beyond their clinical training and take a new approach to managerial decision-making and problem solving. There is still time to register for the sixth annual WHA conference, scheduled March 11-12, 2011 at The American Club in Kohler.

This year’s conference will focus on the following topics. "Physician Performance Management: A Path to Business and Clinical Excellence" will be presented by Marty Martin, PsyD, MPH, on Friday, March 11. The session will focus on:

"Building the Accountable Care Organization: Physician and Hospital Alignment" will be presented by Todd Sagin, MD, JD, on Saturday, March 12. That session will focus on:

Consider attending this event as a group, including not only your physician leaders, but also yourself, as a chance to accompany and host your physician leaders and have some informal, one-on-one discussion with each of them. A ‘host’ registration option is available at a discount to those who do not need CME credit. This conference is a proven, in-state option for leadership development training by nationally-recognized faculty, at about one-half the cost of national programs, with less travel expense and less time out of the hospital and away from practice.

A full conference agenda and online registration are available at www.wha.org/education/PhysicianLeadership.aspx. For more information on registration, contact Lisa Littel at 608-274-1820 or email llittel@wha.org.

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WHA Foundation to Co-Sponsor Wisconsin Health Literacy Summit

The WHA Foundation is co-sponsoring the 4th Biennial Wisconsin Health Literacy Summit in Madison April 12-13, 2011. This event will feature Keynote Speaker Richard H. Carmona, M.D., M.P.H., FACS, a number of distinguished plenary presenters and 36 breakout session options within five conference tracks: health care providers, adult literacy providers, patient education, vulnerable populations and organizational change.

The Summit is presented by Health Literacy Wisconsin, a division of Wisconsin Literacy, Inc., and Wisconsin Research and Education Network (WREN) with support from Gundersen Lutheran, the Wisconsin Hospital Association Foundation, and other sponsors.

A pre-Summit workshop, "Creating Reader-Friendly Materials for Patients" will be held April 10-11, also in Madison, with Audrey Riffenburgh, MA, president of Plain Language Works. Health Literacy Missouri, Wisconsin Literacy, Inc. and other members of the Health Literacy Regional Network will also host a pre-Summit meeting, "World Cafe: Models for Launching Health Literacy Efforts" the afternoon of April 11.

CME and CEU credits will be available for physicians and nurses attending the Summit. For more information visit www.healthliteracywisconsin.org/events.jsp.

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WHA Education:  Webinar to Focus on Legal Issues for Managing Pharmaceutical Waste

The Environmental Protection Agency (EPA) currently regulates the disposal of hazardous pharmaceutical waste under the Resource Conservation and Recovery Act’s (RCRA) hazardous waste generator regulations. These rules can be complex and cumbersome depending on the size of a health care facility. EPA has announced that many facilities may be struggling with RCRA compliance, and consequently, EPA appears to have stepped up inspections and enforcement in the health care sector. However, later in 2011, EPA is likely to finalize its Universal Waste rule for pharmaceutical waste, which is meant to simplify management of hazardous pharmaceutical waste and reduce the regulatory burden on health care facilities as it relates to hazardous waste.

On March 7, WHA is offering a webinar focused on the new Universal Waste rules for managing pharmaceutical hazardous waste and the key components of (RCRA) rules that apply to managing hazardous pharmaceutical wastes. Hospital facilities directors, maintenance officers, environmental health and safety officers, and COOs are encouraged to participate in this 60-minute webinar to learn how to prepare for the implementation of the new Universal Waste rules when they are promulgated.

The webinar "Legal Issues for Management of Pharmaceutical Waste" will be offered to WHA members on March 7, by Duncan Moss, Joy Schnackenbeck and Tom Shorter, attorneys with Godfrey & Kahn, S.C. You can register online at: https://www.signup4.net/Public/ap.aspx?EID=11WP10E&TID=X97tLNxWrPwiexvL5A1MbA%3d%3d. For registration questions, contact Lisa Littel at llittel@wha.org or 608-274-1820.

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The WHA Quality Center Calendar for 2011 is Now Available

Back by popular demand, a monthly slate of Improvement Forum webinars for QI managers and nurse leaders are ready for your calendar. In 2010, an average of 40-50 hospitals per month registered for these 30-minute webinars on a variety of topics. Feedback from these participants contributed directly to the development of the topics for this year. The year kicks off on February 24 with an overview of new functionality and content available on the WHA Quality Center Web site. Presenters Stephanie Sobczak and Jill Hanson of WHA will also share other opportunities for hospital participation in the coming year. Several member-requested features will be highlighted.

Topics for the WHA Improvement Forum webinar series:

What’s New in the Quality Center

Quality & Meaningful Use                             Culture Change for Safety’s Sake – Part 3

Root Cause Analysis                                   Culture Change for Safety’s Sake – Part 4

Failure Mode & Effects Analysis                   What is "Waste" and What Can We Do About It?

Culture Change for Safety’s Sake – Part 1     Moving the HCAPHS Dot

Culture Change for Safety’s Sake – Part 2     Process Mapping Made Easy

New this year, guest speakers will share their expertise and present several of the topics. Quality and Meaningful Use will be reviewed by Beth Dibbert of the Rural Wisconsin Hospital Cooperative. Dibbert recently co-authored a white paper focusing on what "meaningful use" means for quality measurement. Kelly Court, chief quality officer of WHA and WCHQ, will present a best practice approach for incorporating Root Cause Analysis and Failure Mode Effect Analysis for incident review. In addition, a four-part series focusing on a practical method for unit-based culture change will be the focus over the summer.

A Calendar of Events is available at www.wha.org/2011QualityCenterCalendar.pdf.

Aligning Forces for Quality is supported by the Robert Wood Johnson Foundation, through a grant to the Wisconsin Collaborative for Healthcare Quality. In Wisconsin, Aligning forces for Quality is a joint project by the Wisconsin Collaborative for Healthcare Quality, Wisconsin Hospital Association, and other organizations.

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Wisconsin Hospitals Community Benefits: Uncompensated Care/Free Clinics

Fear of a bill should never prevent a patient from seeking care at a Wisconsin hospital. Wisconsin hospital charity care programs provided $226 million to more than 700 patients a day in 2009. 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 Care

A couple moved to Wisconsin, got married, and after they got back from their honeymoon, the husband got very sick and ended up hospitalized at Columbus Community Hospital. While they did not have insurance coverage at the time of his visits, they were actively searching for personal health insurance. To complicate the matter, they both are working at reduced wages from what they were making while living out of state, they do not get health benefits through their employer, nor could they afford what turned out to be a $30,000 hospital bill! We worked with them on Community Care and were able to grant them an 88.8 percent reduction in their bill.

They are very grateful for what Columbus Community Hospital was able to do to help them out in their time of need.

Columbus Community Hospital, Columbus

New hope for military couple amid growing challenges

When Brittany’s husband, Tyler, came back from military deployment, he was not the man she married. After serving with his military unit in Honduras a couple years ago, Tyler returned home angry, depressed and prone to combat flashbacks and panic attacks.

Doctors diagnosed the 21-year-old with post traumatic stress disorder. Over several months, he wound up in the emergency room three times. Physicians sent him twice to the Fond du Lac County Acute Psychiatric Unit for treatment.

"With all the medications they ended up putting him on, they counteracted and he started having suicidal thoughts," Brittany, 21, said.

Months later when Tyler finally came home, things were looking better for him. But the couple’s medical bills were rapidly reaching $10,000. The couple couldn’t find a financial assistance program that accepted military members.

Then Brittany had her own health scare. "I ended up having a heart problem. Doctors don’t really know what happened, my heart just stopped beating," she said.

When Brittany awoke at New London Family Medical Center, physicians gave her paperwork for ThedaCare’s Caring Hearts Financial Assistance Program. The charity-care program not only accepted the military couple but has since relieved them of nearly $15,000 in medical bills. Brittany said without ThedaCare’s help, the financial stress and worry could have taken a much harder physical and mental toll on the couple.

"It feels like a weight has been lifted off my shoulders. If I didn’t have it, I’d go crazy with trying to figure out how we’re going to pay for it," she said.

Tyler follows up with his physicians each month, something that might not be possible without Caring Hearts.

"He’s finally turning back into the person he used to be," Brittany said. "I’m really thankful there’s a program out there if you don’t have the resources to get insurance through your job or even the military, to support you in the hard times."

New London Family Medical Center, New London

Jill’s Story

Jill has suffered from hypertension for years; however, with no health insurance she could not afford paying out of pocket for a primary caregiver and medications. When she was at health fairs or church events, however, she often passed the free blood pressure screenings because she did not want to know about a problem she couldn’t treat. One Wednesday afternoon, at her local food pantry, she gave in to the pressure of the student nurses conducting screenings and had her pressure taken. True to form, it was high enough at 149/100 to make the students scramble for their instructor.

This time, however, treatment was offered. Columbia St. Mary’s Community-based Chronic Disease Management (CCDM) Clinic at New Life Food Pantry offered an immediate nursing assessment, lab testing and an assessment by a nurse practitioner who prescribed medication that was given to Jill that day. Jill was also provided nutritional and lifestyle education to help her improve her hypertension.

After some time at the clinic, Jill had further medical issues that the clinic was not able to address so she and the clinic’s social worker worked together to get Jill on GAMP, the county health insurance program. Finding a primary medical provider who accepted GAMP coverage was just one step Jill has made to take control of her health. Even though her primary medical treatment continues at the GAMP-funded provider, Jill returns to CCDM to participate in the cooking demonstrations the clinic offers. Jill came to a recent cooking demonstration to sample the vegetable stir fry and to show off her 122/82 blood pressure, that is due, in large part, to the CCDM clinic and HWPP funding.

Columbia St. Mary’s, Inc., Milwaukee

Submit community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

Read more about hospitals connecting with their communities at www.WiServePoint.org.

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