October 21, 2011
Volume 55, Issue 40

WHA Nominating Committee Selects Dan Neufelder as 2012 Chair-Elect

Dan Neufelder, president and chief executive officer, Affinity Health System, was selected by the WHA Nominating Committee and confirmed by the WHA Board to serve as chair-elect in 2012 and WHA chair in 2013. Sandy Anderson, president, St. Clare Hospital and Health Services, Baraboo, will chair the Association in 2012. Both health care leaders have impressive records of professional and community service.

Prior to joining Affinity, Neufelder served for 12 years as the executive vice president and chief operating officer of Memorial Hospital of South Bend, Indiana; 10 years with the Community Health Network of Indianapolis, with the last four of these years as the executive vice president and chief operating officer of Community Hospital East; one year with St. Vincent Hospital and Healthcare System in Indianapolis, Indiana; and five years as a health care management consultant with Ernst & Young. He has been a member of the WHA Board since 2008.

Throughout his career, Neufelder has volunteered with numerous community-based organizations with special emphasis on serving the sick and poor.

Neufelder received his bachelor’s degree from the University of Southern Indiana in 1979 and his master’s degree in business administration from the University of Indianapolis in 1989. He is the recipient of the 1997 Young Healthcare Executive of Year Award for Northern Indiana, and he is a Fellow in the American College of Healthcare Executives, and a Certified Public Accountant.

Originally from southeastern Wisconsin, Anderson came to St. Clare from Greene Memorial Hospital in Xenia, Ohio, where she was executive vice president/chief operating officer from 1996 to 2002. In her 20 years at Greene Memorial, she held several other administrative positions. In 2002, Anderson became president of St. Clare Hospital and Health Services.

Anderson currently chairs WHA’s Health Information Technology (HIT) and State-Level Health Information Exchange Task Force. She has served on the WHA Board continuously since 2006, is a member of the Advocacy Committee, served on the WHA Nominating Committee 2004-2006 and on the WHA Physician Task Force in 2003. She has served on several state advisory councils on health care issues, and was named the American Hospital Association Grassroots Champion for Wisconsin in 2007.

Anderson earned a master’s degree in health care administration in 1989 from Central Michigan University and a bachelor’s degree in occupational therapy from UW–Milwaukee in 1981.

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WMC’s Bauer Cautiously Optimistic about Wisconsin’s Business Climate
WHA Board approves Board nominees, WHA physician workforce report

Speaking at the WHA Board meeting in Madison October 20, Kurt Bauer, president and CEO of Wisconsin Manufacturers and Commerce (WMC), told the Board that he has reason to be optimistic about Wisconsin’s business climate and that has not been the case for a long time.

"We are in a very different place now from where we started this year," Bauer said. "We were ranked worse in every category that matters to business. In business climate ratings, Wisconsin was consistently in the bottom 10."

Bauer said that business leaders are starting to see a "sea-change" as the state adopts policies and passes laws that promote business growth and economic development. As the business environment improves in Wisconsin, it will become more competitive as a state where businesses want to locate.

WMC released a study October 18 conducted by the National Chamber Foundation entitled "Growing Wisconsin," (http://www.wmc.org/PDFfiles/WMC/WMC_Growing-Wisconsin.pdf) that found Wisconsin has made dramatic progress in improving the business climate and with that, the state’s economy. The report indicated that the first half of 2011 brought with it some signs of recovery. According to the Bureau of Labor Statistics Current Employment survey data, Wisconsin ranked 19th in seasonally adjusted job growth in the first seven months of the year, with a growth rate one third higher than the national rate.

"Wisconsin is ‘open for business.’ We have backed that rhetoric by balancing the state budget for the first time in 15 years," according to Bauer. "By balancing our budget, we are in a position of being able to improve our business climate."

Bauer pointed out that for every manufacturing job, two to three jobs are created in other sectors of the economy. "It is truly the foundation of the Wisconsin economy," Bauer said. Manufacturing is the largest sector in Wisconsin, followed by government, agriculture and tourism.

The regulatory and tort climate figures prominently into a state’s ability to attract business. A comprehensive tort reform package was the first legislation taken up by the newly-seated Legislature last January. An important component of that package was the WHA-supported Health Care Quality Improvement Act (QIA). Now law, the QIA enables more cost-efficient and effective medical care through increased collaboration.

Two issues continue to evade address, and they are taxes and workforce. On the tax front, Bauer said Wisconsin taxes are still high. When it comes to the state’s workforce, Bauer said his members struggle to find workers who have the skills to fill the jobs that are open. He said there are literally thousands of manufacturing jobs that remain unfilled because employers cannot find qualified workers. Wisconsin is not alone in that struggle. Bauer said whoever fixes that problem first, "wins."

Executive Vice President Eric Borgerding reminded Bauer and the Board that hospitals have an interest in the health of the non-health care economy.

"We have a strong stake in the economy, including the success of our manufacturers who create thousands of good paying jobs," Borgerding said. "We can’t sustain our health care system on a growing Medicaid population. We need more family-supporting jobs with good benefits, and WHA will do its part to help the state get there."

Presidents Report: Board Sets Health Reform Implementation Priorities

WHA President Steve Brenton briefly reviewed the July Board planning session, which focused on two issues: the physician workforce report (described later) and health reform. At the planning session, the Board discussed the current environment and member priorities related to health reform implementation issues at the state and national levels. Members found that the WHA Access, Coverage and Cost Principles adopted by the WHA Board four years ago remain relevant in the current environment and should continue to serve as a road map for WHA priorities.

Brenton then presented the five health reform implementation themes that the Board agreed upon:

1. Accelerate performance improvement on clinical quality, safety, and cost

Through participation with the Wisconsin Health Information Organization (WHIO), the Wisconsin Collaborative for Health Care Quality (WCHQ), and in collaboration with the state Medicaid staff and other stakeholders, WHA will remain committed to measurable, focused, and coordinated performance improvement initiatives.

On a related subject, WHA Chief Quality Officer Kelly Court reported that WHA is in a good position to receive a contract from the Centers for Medicare and Medicaid Services to serve as a "hospital engagement contractor" to work with hospitals to improve the quality of care associated with ten targeted conditions. Court said WHA would recruit hospitals to work on improvement projects, similar to the work now being done by WHA staff to help hospitals reduce HAIs. If WHA is selected as a contractor, work will start shortly after the first of the year. CMS’s goal is to reduce hospital acquired conditions 20 percent and reduce readmissions by 40 percent.

"This is an important project," according to Brenton. "It is clear that our members want us to focus and align our improvement activities around national goals, especially from a payment perspective, and that is exactly what this is."

2. Pursue Value Agenda

Wisconsin has been at the forefront nationally of the movement to harness the power of transparency, delivery integration, and health information technology to achieve value…the sum of high quality and costs. Those advocacy efforts have been directed through the Health Care Quality Coalition, a group of organizations committed to ensuring that health reform implementation features a strong commitment to paying and providing incentives for high value. WHA will maintain that focus through its involvement in the Quality Care Coalition.

3. Advance Payment and Delivery System Reform

Board members agreed that delivery system and payment reforms will remain important dynamics in the coming year and successful hospitals and health systems will need to align with physicians in order to either lead or accommodate anticipated new public and commercial payment strategies aimed at improving outcomes with static or declining resources.

4. Medicare Payment Cuts

The Accountable Care Act (ACA) pays for coverage expansions by reducing Medicare payment to hospitals. WHA advocacy efforts must focus on minimizing further Medicare payment cuts associated with reforming Medicare, reducing the federal deficit, or fixing the physician payment formula (sustainable growth rate or SGR).

5. Wisconsin Insurance Exchange

WHA will collaborate with state officials and the Wisconsin Legislature to align WHA’s health insurance exchange principles with the implementation of the Wisconsin Office of Free Market Health Care. WHA’s highest priority will be to support a pluralistic insurance marketplace with accountable governance that minimizes the erosion of employer-based coverage in Wisconsin.

Board Approves Physician Report, Agrees with Action Steps to Increase Physician Supply

Wisconsin needs 100 more physicians each year or it will not be able to meet the demand for medical care of an aging population. While there is agreement that something needs to be done to train, attract and keep more physicians in the state, Wisconsin has lacked a cohesive strategy on how to make that happen.

George Quinn, WHA senior policy advisor, and Chuck Shabino, MD, WHA senior medical advisor, presented the final WHA physician workforce report and provided suggested action steps on how to expand the physician workforce in Wisconsin. They have met leadership from both of Wisconsin’s medical schools, the Wisconsin Council on Medical Education and Workforce (WCMEW) as well as many other stakeholders, and incorporated their ideas and feedback into the final report, which was approved by the Board. Quinn and Shabino will now develop a statewide implementation plan that addresses the key issues described in the report. The report will be widely disseminated later in November. Watch for more details in The Valued Voice.

Medicaid Continues to Dominate WHA Advocacy Agenda

Borgerding provided background on the Medicaid budget to date, opening with the fact that Governor Walker started his term with a $1.8 billion Medicaid deficit. Walker provided $1.3 billion to backfill the deficit, but that still left a significant funding gap that the Department of Health Services (DHS) is trying to address through its recently unveiled Medicaid reform package. WHA has been highly engaged in discussions with member hospitals and with the Administration on ways to reduce costs in the Medicaid program.

Borgerding said the 47 recommendations developed by the WHA Medicaid Reengineering Group (MRG) led by Nick Desien, president/CEO, Ministry Health Care, along with the WHA board–approved Medicaid guiding principles have positioned WHA well. WHA’s input on the Medicaid reform package, released by the Governor on September 30, has been guided by those principles, focused on ensuring that Medicaid will be a safety net for the most vulnerable citizens and will minimize cost shifting to employers from unreimbursed Medicaid costs and uncompensated care.

The Governor’s Medicaid reform package contains 39 separate proposals. The plan attempts to shrink demand for Medicaid by preserving employer-sponsored coverage. The issue is how to reduce demand for Medicaid without moving people with no other options out of the program.

"We’re continuing to review elements of the package and understand the impact," Borgerding said. "The provisions that would affect rural hospitals and FQHCs, and the greater reliance on uncollectible co-pays are of greatest concern. Other provisions that seek to streamline eligibility and enrollment, and preserve the integrity of Medicaid as a safety net are rightly focused."

Borgerding said WHA is meeting with DHS staff, legislative leaders and budget writers and the Legislative Fiscal Bureau to discuss the reform package. WHA will also submit comments on the reform package during the public comment period that ends October 24. Further, the WHA Medicaid Reengineering Group will reconvene on October 25 to consider the package.

On another advocacy front, WHA Senior Vice President and General Counsel Laura Leitch said the Worker’s Compensation Advisory Council reached a tentative agreement this week on this biennium’s Workers Compensation package. The agreement will be drafted as a bill for the Legislature to consider. Traditionally, the Legislature passes and the Governor approves the WCAC proposed bill without amendment. WHA is pleased that the agreement will require an audit of the Worker’s Compensation certified databases for provider reimbursement and that 80 percent of hospitals should not be negatively affected by the changes in the bill.

Leitch also said the Association has recently filed two amicus briefs—one on a case that will determine whether a health care provider is entitled to receive its standard fee or whether the law requires it to accept the Medicaid reimbursement rate in a personal injury action. The key issue in the second case is whether a facility licensed, certified or registered under Chapter 50 of the Wisconsin Statues, such as a CBRF, RCAC or nursing home, that is owned and operated by a nonprofit entity must be "benevolent" in order to be exempt from property taxes.

WHA Board Approves Association 2012 Budget

Brenton presented the 2012 WHA budget as forwarded for approval by the WHA Budget Committee. The budget includes funding for work on key advocacy objectives including healthcare reform, physician workforce and quality initiatives. After discussion, the Board approved the 2012 WHA budget as submitted.

The Board also approved the appointment of Brian Potter, WHA senior vice president of finance and operations to succeed George Quinn as the Association’s secretary/treasurer.

WHA Committee and Council Reports

Council on Finance and Payment – Brian Potter, WHA staff
. Guest speaker Tyson McDowell provided information related to the financial risk that faces hospitals that are not prepared for the transition to ICD-10. McDowell stressed that long term risk mitigation requires financial modeling which can help with budgeting, contract negotiations and other "what if" scenarios.

Council on Workforce Development – Judy Warmuth, WHA staff. The Council heard from SSM HR regional vice president Linda Taplin-Statz on SSM’s new flu immunization policy for employees, physicians and volunteers. She discussed the purpose of this policy and the requirements. ICD-10 was also discussed by the group.

Rural Health Council – Brian Potter, WHA staff. Potter reported that at the last Rural meeting, George Quinn presented the WHA physician report with emphasis on the challenges of recruiting physicians to rural areas.

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New Legislator Profile: Rep. Janet Bewley (D-Ashland)
A series of interviews with
newly-elected legislators, by Mary Kay Grasmick, editor

As the demand for physicians goes up, and supply declines, the ability to recruit doctors to rural areas will become an even bigger challenge. Rep. Janet Bewley is concerned about this issue, driven by her sense of commitment to the health and well-being of residents living in the 74th district.

"My first priority is to have the people of my district feel confident and secure in living in the north," Bewley said. "We desire a good quality of life and that includes good schools, clean air and water, and good health care."

Bewley believes incentives, such as loan forgiveness programs and other financial considerations, could offer some relief. But long term, she points to the University of Minnesota-Duluth’s medical school which focuses on educating doctors who will serve rural communities. In fact, in 2010, the Medical School-Duluth campus, was named #1 in the country in percentage of MDs who practice in rural areas.

The federally-qualified health centers, according to Bewley, have been helpful in connecting low income patients with a family medicine physician. However, the physician shortage combined with the fact that more physicians are going into the higher-paying specialties than into family medicine, will make recruiting a family medicine physician to Northern Wisconsin an even bigger challenge.

"Getting good family medicine doctors into rural areas might be expensive in the short run, but the long term payoff in terms of health is access to these physicians can prevent more expensive treatment," she said. "So in the long term, that investment in a physician will pay off in lower health care costs."

Bewley welcomes input from her constituents and encourages hospitals to work with her.

"I want to not only understand the needs and concerns of the patients, but also those who offer the care," said Bewley. "They are as concerned as I am in outcomes and I want to make sure that we work together."

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CMS Works to Reduce Regulatory Burden on Hospitals
"State level streamlining long overdue"

The Centers for Medicare and Medicaid Services (CMS) this week released a regulatory reform proposal that would ease the regulatory burden for hospitals. Commenting on the proposal, U.S. Department of Health and Human Services Secretary Kathleen Sebelius said, "Our new proposals eliminate unnecessary and obsolete standards and free up resources so hospitals and doctors can focus on treating patients."

The proposed rule would revise the existing Medicare Conditions of Participation ("CoP") for hospitals. In its reform package, CMS is proposing to recognize a single governing body over multiple hospitals within a health system, a change from CMS’ previous position that each hospital within a health system must have its own board; allow CAHs to provide certain services, such as diagnostic, therapeutic, laboratory, radiology and emergency services, under service arrangements; allow advanced practice practitioners to serve in an expanded role, and other changes. Concerning the expanded role for advanced practice practitioners, CMS wrote, "We especially believe these proposed changes would support efforts to provide better health care in medically underserved communities. These changes would provide more flexibility to critical access hospitals in rural areas with a limited supply of primary care and specialized providers." WHA Vice President for Workforce Judy Warmuth said, "We appreciate CMS’s efforts to address in part the health care workforce shortages through smarter regulation."

The Wisconsin Hospital Association has also been working on a hospital regulatory reform proposal. The state hospital regulations have not been updated in several decades. "State-level streamlining is long overdue," said WHA Executive Vice President Eric Borgerding. "The state hospital regulations were created originally to mirror the federal CoP. While the federal regulations have continued to evolve with health care, our state regulations have been frozen in time, becoming unnecessary, inconsistent, and obsolete."

CMS estimates that the proposed changes would save $5 billion over five years. A copy of the proposed revision to the CoP is available here: www.ofr.gov/(X(1)S(0ifbimlizkdoryd51vavts04))/OFRUpload/OFRData/2011-27175_PI.pdf.

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CMS Clarifies Process for Attesting to Meaningful Use Quality Measures

In response to concerns raised by the American Hospital Association, the Centers for Medicare & Medicaid Services (CMS) released a News Update on October 17 (see link below), clarifying the requirements for attestation to the clinical quality measures needed to meet the definition of "meaningful use" under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The clarification also addresses the documentation needed to demonstrate compliance in this area. The clinical quality measures are only one part of the attestation process.

According to CMS’s release, a hospital does not need to attest to the accuracy of its clinical quality measures generated by a certified EHR. However, the hospital does need to attest that the clinical quality measures were generated by and reported directly from certified EHR technology.

"In other words, the hospital is only attesting that [clinical quality measure information that] was put in the attestation module is identical to the output generated by its certified EHR," states the CMS release.

CMS also recommends in the release that hospitals print out or save from their certified EHR an electronic copy of the clinical quality measure report used at attestation, and that hospitals retain such copy to show its data in the event of an audit. CMS explains that upon audit, this documentation will be used to validate that the hospital accurately attested and submitted its clinical quality measures.

A copy of the full CMS release can be found here: www.cms.gov/EHRIncentivePrograms/Downloads/Meaningful_Use_Attesting_to_the_data.pdf.

If you have questions or need additional information, contact Matthew Stanford, WHA vice president, policy & regulatory affairs and associate general counsel at (608) 274-1820 or mstanford@wha.org.

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WHA Board Approves Nominating Committee Recommendations

The Nominating Committee presented their recommendations to the WHA Board on October 20. The Board voted and approved the Nominating Committees recommendations. The following individuals will serve on the WHA Board effective January 1, 2012.

Nicole Clapp
(1st term)
Grant Regional Health Center, Lancaster
    Council on Workforce Development, 2011
    WHA Financial Solutions Board, 2007-201

Peggy Ose
(2nd term)
Vice President, Patient Services
Riverview Hospital Association, Wisconsin Rapids
    WHA Board, 2010-2011

Therese Pandl
(1st term)
HSHS – Eastern WI Division, Green Bay
    Council on Public Policy, 2008-2009

Bill Petasnick
(2nd term)
Froedtert & Community Health Milwaukee
    WHA Board - 1996-2001; Chair 2000
    AHA Delegate, 2003
    Ex Officio, 2004-2008
    Unexpired Term, 2010-2011
    Executive Committee, 1999-2001
    Council on Public Policy, 1994-1999, Chair 1997-1999
    TF on Community Benefits, 2005
    TF on Access & Coverage, 2006-2009
    Nominating & Awards Committee, 1999-2001 & 2006, Chair 2001
    Advocacy Committee, Chair 2001

Mark Taylor
(Filling unexpired term)
Columbia St. Mary’s, Milwaukee
    Medicaid Reengineering Group, 2011

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Register your ICD-10 Team Today for this Important Webinar Series:
"The ICD-10 Impact on Hospitals and Transition Strategies to Meet the Deadline"

A four-part webinar series for senior leaders and their ICD-10 implementation teams

• Budget Development and Review – November 16
• Understanding Reimbursement Changes & Financial Impact – December 14
• Strategic Planning for ICD-10 Readiness – January 18
• Assessing Your Vendors for Readiness – February 15

A brochure is included in this week’s packet and online registration is available at http://events.SignUp4.com/ICD10Impact11-12

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Sen. Harsdorf Shadows River Falls Area Hospital CEO

Senator Sheila Harsdorf spent time recently with David Miller, President of River Falls Area Hospital (RFAH). In addition to meeting with Miller, Harsdorf was able to meet with the hospital’s senior leadership team and other employees throughout her visit.

During her meeting with the senior leadership team, topics discussed ranged from RFAH’s community health improvement partnerships to parent System Allina’s advanced care planning initiative as well as providing insight on the hospital’s service growth and future planning. The group also made sure to focus discussion on how RFAH is positioning itself to deal with the many challenges of impending health care reform while also continuing efforts to control cost and improve patient outcomes.

Though a federal issue, one challenge specifically highlighted to Harsdorf was how federal deficit reduction talks are targeting "critical access hospitals" (CAHs) like RFAH. CAH designation is a specific form of Medicare payment created by the federal government to help small, rural hospitals keep their doors open. With deficit reduction talks ensuing, some in DC are proposing changing how CAHs are reimbursed or outright eliminating this designation altogether.

One proposal on the table right now in DC eliminates CAH designation (and its accompanying reimbursement) for as many as eight CAHs in Wisconsin, including RFAH. In raising this issue, RFAH President David Miller wanted to help Sen. Harsdorf understand how federal proposals will impact her district as well as show that decisions she makes at the state level—such as how Wisconsin will come up with an additional $200 million in Medicaid savings, including one that could impact CAHs by reducing certain types of facility or location-based provider reimbursement—cannot be done in a vacuum.

Sen. Harsdorf was also able to join the RFAH’s volunteer group during their luncheon being held that same day.

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Grassroots Spotlight: Rep. Kind DC Legislative Director Visits Prairie du Chien

This week Travis Robey, Rep. Ron Kind’s DC legislative director, took time to travel to Wisconsin and visit several of the hospitals in Kind’s district, including Prairie du Chien Memorial Hospital.

During his visit to Prairie du Chien Memorial Hospital, Robey met with Chief Executive Officer Bill Sexton, Chief Administrative Office Skip Gjolberg and Board Chair Paul Ginkel.

They discussed a variety of issues impacting rural hospitals, including:

Robey was also able to visit other district hospitals, including Grant Regional Health Center in Lancaster.

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Legislature Approves Tax Exemption for Insurance Benefits of Adult Dependents

A bill that would extend a federal tax exemption for certain health benefits to Wisconsin state income tax received overwhelming bi-partisan support in the Legislature this week.

Senate Bill (SB) 203 authored by Senator Van Wanggaard (R-Racine) and others in the Senate, along with Representatives Pat Strachota (R-West Bend) and Steve Doyle (D-Onalaska) and others in the Assembly passed the Senate with a unanimous 33-0 vote and the Assembly by a 93-3 margin.

As previously reported (see www.wha.org/pubArchive/valued_voice/vv10-14-11.htm#4), Wisconsin and the federal government mandate that health insurance coverage be extended to adult children up to age 26. While this benefit is not subject to federal income tax because of a federal tax exemption, employers in Wisconsin are required to impute income associated with this coverage for state income tax purposes.

Wisconsin has become the only state not to exempt the benefit from state income tax.

WHA supports the proposal, as it would be a welcome fix for employers facing the significant challenge of determining the fair market value of this dependent coverage and the imputed income associated with it.

Governor Walker is expected to consider and approve the bill soon.

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Accountable Care Organization (ACO) Final Rules Released

On October 20, the federal Department of Health and Human Services (HHS) released its final rules governing Accountable Care Organizations, hailed as the keystone provision in the Patient Protection and Affordable Care Act for incenting care coordination, lowering costs and improving quality. The initial proposed rules released by HHS earlier this year were controversial, and drew significant fire from hospitals, doctors and others as unworkable. In June, WHA submitted detailed comments outlining several concerns with the proposed rules. An initial review indicates that HHS is attempting to address some of concerns, while others appear to remain.

The rules include a new "Advance Payment Model" to provide physician-owned and rural providers with start-up resources—advanced from future shared savings—to build the necessary infrastructure to participate in ACOs. In addition, the number of quality measures an ACO will be required to report and meet is reduced from 65 to 33.

The new rules also attempt to address one of the more erroneous provisions of the original proposal that would have kept patients and doctors from knowing up front which beneficiaries were included in their ACO. Under the new rules, HHS would implement a preliminary prospective assignment to allow the health system to identify patients that will likely be assigned to it, with the final assignment still to occur after the patient has had a majority of primary care visits with the ACO.

In conjunction with the release of the ACO final rule, the U.S. Department of Justice and the Federal Trade Commission issued a final Statement of Antitrust Enforcement Regarding ACOs, making important changes from their original Statement. The Office of Inspector General also issued an interim final rule with the IRS issuing a fact sheet (read more details in story below).

Regardless of whether the HHS/Medicare version of ACOs proves viable, WHA supports its goals—fostering better care coordination and achieving lower cost and higher quality over the long run. WHA continues to review the 700 page rule, and it remains to be seen if Medicare ACOs can provide the necessary financial incentives and regulatory relief that expedites achieving these goals.

WHA’s ACO comments, submitted to CMS on June 6, are available at: www.wha.org/WHAACOcomment6-6-11.pdf.

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Antitrust, Fraud and Abuse, Other ACO-related Documents Released

In conjunction with the Centers for Medicare & Medicaid Services’ release of the Accountable Care Organization final rule, the U.S. Department of Justice and the Federal Trade Commission issued a final Statement of Antitrust Enforcement Regarding Accountable Care Organizations. In an important change for hospitals, the antitrust agencies abandoned their proposed mandatory antitrust review before hospitals could even apply for the ACO program and replaced it with guidance applicable to all ACOs. The guidance said the agencies will "vigilantly" monitor complaints about anti-competitive behavior and all ACOs’ competitive conduct will be evaluated under the "rule of reason," which takes pro-competitive benefits into account. In addition, CMS and the U. S. Department of Health and Human Services’ Office of Inspector General issued an interim final rule with comment period that created five waivers, including from the Physician Self-Referral Law, the federal anti-kickback statute, the "Gainsharing CMP," and the Beneficiary Inducements CMP, that go beyond the limited protections offered in the proposed rule. The Internal Revenue Service also issued a fact sheet adding a series of questions and answers to its previous guidance.

The DOJ and FTC Statement of Antitrust Enforcement Regarding Accountable Care Organizations is available here: www.justice.gov/atr/public/health_care/276458.pdf

The OIG’s interim final rule is available at: www.ofr.gov/OFRUpload/OFRData/2011-27460_PI.pdf

The IRS’s fact sheet is available at: www.irs.gov/pub/irs-drop/n-11-20.pdf

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Last Chance to Register for "Care Transitions Connection"
A forum for hospitals, long-term care and home care to discuss care transitions improvement and reduce preventable hospital readmissions

November 2, 2011
Kalahari Resort, Wisconsin Dells

Brochure and registration information can be found online at

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"Apology Bill" Scheduled for Vote in Assembly

The "apology bill," Assembly Bill (AB) 147, introduced by Representatives Erik Severson, MD (R-Star Prairie), John Nygren (R-Marinette) and others has been scheduled for a floor vote in the Assembly next Tuesday, October 25.

Earlier this year, WHA testified at public hearings in support of the bill, which would protect statements of apology by health care providers to patients and families from being used against the provider in a medical malpractice lawsuit. (See previous Valued Voice story at: www.wha.org/pubArchive/valued_voice/vv6-3-11.htm#1.)

In its testimony to the legislative committees, WHA explained that when a health care outcome is not what was planned or expected, a heartfelt statement of concern or apology can be very helpful for all involved. However, if a provider is concerned that those statements could be used as evidence in a lawsuit, the health care provider could be reluctant to communicate with patients and families at times when communication is crucial.

WHA also testified that the apology bill would encourage better quality of care by encouraging the open and honest collaborative communication between health care providers and their patients, which results in the best possible health care environment.

A companion bill, SB 103 authored by Senator Pam Galloway, MD (R-Wausau) and others has also passed out of committee, but has not yet been scheduled for a vote in the Senate.

WHA is engaging H.E.A.T advocates on these bills.

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Brenton Shares Health Reform Message at WHPRMS Conference

Health reform: What does it mean to Wisconsin hospitals?

WHA President Steve Brenton shared his knowledge on that subject with attendees at the Wisconsin Healthcare Public Relations and Marketing Society Conference in the Dells October 14.

Brenton described health reform as presenting a mixed bag of "good and bad" for Wisconsin providers and residents. Among the favorable aspects of the health reform law cited by Brenton were:

Along with the good are the bad aspects of health reform:

The ugly side of health reform is the fact that on top of the $2.6 billion in cuts to Wisconsin hospitals, further reductions are on the horizon driven by the federal deficit.

"Deficit reduction is the ‘issue of the day’ now in Washington, and we will see a strong focus on reducing the federal deficit now through the Presidential elections in 2012," Brenton said. "It will be the prevailing issue for your organizations into the foreseeable future."

Brenton said the two percent across-the-board cut that will be triggered if the "super committee" does not find $1.5 trillion in savings could be the "preferable" route to fixing the federal budget woes, a scenario that will be played out later this year.

Brenton warned that the combination of health reform cuts and deficit reduction-related actions mean an era of flat Medicare payments for hospitals and physicians. He encouraged hospital communicators to tell their story in the community.

"Wisconsin hospitals have made significant investments in health information technology, we have some of the most integrated care in the county that is helping us reduce costs and drive up quality," Brenton said. "We have a good story to tell in our communities."

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AHA Health Reform Advocacy Message: "Enough is Enough!"

The American Hospital Association’s advocacy message is simple: Enough is enough!

Speaking at the Wisconsin Healthcare Public Relations and Marketing Society Conference in the Dells October 14, AHA Communication Strategist Jennifer Armstrong-Gay said hospitals are already absorbing $155 billion in reductions through health reform, on top of federal regulatory actions such as the Medicare IPPS coding offset, which has meant even more cuts in hospital Medicare payments. The cuts, being driven by the federal deficit, pose yet another threat to America’s already thinly-stretched "health care safety net."

"Further cuts to providers are going to start resulting in real harm to beneficiaries," Armstrong-Gay warned. "Ratcheting down provider payment is not health reform. We’re telling the Members of Congress, ‘enough is enough.’"

Armstrong-Gay encouraged communicators to share examples or "stories" that demonstrate the value hospitals provide, as well as the challenges they face, on the following themes:

For more health reform related information, visit the American Hospital Association’s website at www.aha.org.

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WHA Education: 2012 Chargemaster Updates Focus of December Seminar

On December 15, WHA is offering "Getting the Chargemaster Ready for 2012," a one-day seminar focused on the 2012 reporting requirements and CPT and HCPCS coding revisions and additions impacting your Chargemaster.

There are over 500 known CPT changes for 2012, and it is anticipated that CMS will have an equal number of HCPCS changes. As in previous years, nearly every ancillary department of the hospital will be impacted by the coding changes, and this session will focus on the requirements for updating the facility’s Chargemaster and on strategies for educating your department staff.

Chargemaster/APC coordinators, coding staff, office managers, CFOs, and others who are responsible for charge generation processes are encouraged to attend this event.

A brochure with registration form is included in this week’s packet and online registration is available at http://events.SignUp4.com/Chargemaster12. For registration questions, contact Lisa Littel at 608-274-1820 or email llittel@wha.org.

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WHA Member Hospitals Transforming Care at the Bedside

Since launching the Wisconsin TCAB collaborative in March, the 15 participating hospitals have been busy engaging front-line staff in improvement. Many of these units are working on ways to improve the patient-centeredness of the care they provide. Several U.S.-based studies have shown that acute care nurses, on average, spend less than one third of their day in the patients’ rooms. In addition, national measures of physician and nurse communication with patients indicate there is room for improvement. TCAB is giving front line staff new tools to re-think the work day and discover ways to enhance teamwork, communication and spend more time with patients.

The Nursingmatters publication is providing a vehicle for these very active units to share their journey with the rest of the state. Prairie du Chien Memorial Hospital nursing staff have piloted a solution to address these challenges with one change in a common activity in hospitals—the daily rounds. They have submitted their story to Nursingmatters, and we are pleased to share their work with you.

The article can be viewed at www.wha.org/TCABnursingMatters10-2011.pdf.

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Wisconsin Hospitals Community Benefits: Social, Economic and Educational Factors that Influence Health

There is a strong association between social and economic factors and adverse health outcomes. Low socioeconomic status, including poverty, lack of education, and other factors are strong influences on health. Wisconsin hospitals are dedicating resources and developing programs to address these issues and improve the health status of those individuals that often cannot access even basic health services.

Friends Outreach Program, Hmong Association serve minority populations

In 2001, St. Nicholas Hospital in Sheboygan began its Friends Outreach Program to offer health care services and education to underserved residents, particularly among ethnic minority populations. Shortly thereafter, the Friends Outreach Department formed a partnership with the Hmong Mutual Assistance Association to provide health information to its clients. The program’s goal continues to help participants obtain knowledge about their health care options and to actively engage in making appropriate health care choices.

The need for these services has grown as a result of the increase in the Asian population, which expanded by 128 percent from 1990 to 2007. The Hmong Association and Friends Outreach remain committed to providing clients with preventive health education and services in addition to offering other supportive services such as housing assistance, employment, interpretation and translation services, short-term counseling, and referrals.

Cher Pao Vang, the older refugee program coordinator and employment specialist at the Hmong Association, mainly serves the Hmong refugee population who arrived from Thailand from 2004 to 2006. He is responsible for coordinating the program for Hmong seniors and providing employment services to new refugees. According to Cher Pao, "Many of our refugee clients need some type of health education, and St. Nicholas Hospital serves as our health resource."

Currently, Mary Paluchniak, RN, BSN, the Friends Outreach Program development specialist, coordinates monthly health education programs for the Hmong Association. These include conducting free health screenings such as high blood pressure, blood sugar, and heel bone density in addition to health education presentations. Each fall, flu vaccines are provided at no cost. A monthly exercise class was also introduced in the spring of 2010 to promote fitness and well-being. "By working with the Hmong Association, we have the ability to concentrate our resources on activities which are relevant to the Sheboygan Hmong population and their health care needs," states Mary Paluchniak.

The ongoing working relationship between St. Nicholas Hospital and the Hmong Association has assisted many refugees in transitioning to new ways of living in a very different culture. By holding classes and offering services at the Hmong Association’s center, the Friends Outreach program assists in meeting their health care needs in a welcoming and familiar environment. This partnership mutually strengthens both organizations by providing increased knowledge for all parties and a commitment to continue and evaluate future programming.

St. Nicholas Hospital, Sheboygan

TMH devotes night to women’s health

Women certainly have a different perspective when it comes to health. That is why the Tomah Memorial Hospital (TMH) Community Outreach Department provides a special program devoted to women each year. TMH Community Outreach held its annual Women’s Health Night March 24.

More than 250 women, including Wendy Luchterhand of New Lisbon attended. "I think it’s great that all these services are provided under one roof," she said of the more than 30 informational booths and free health screenings that were offered. Community Outreach Health Educator Kasey Gegenfurtner said the evening incorporated fashion, fitness, friends, family, and financial wellness, while allowing women of all ages to feel good about themselves and find their own "fab" formula.

TMH Community Outreach has held the event for the past 12 years.

Tomah Memorial Hospital, Tomah

A gift of life – an unforgettable journey

Poverty is intimately related to health disparities. Latashia Jones of Wauwatosa has been a frequent and faithful patient at Aurora Sinai Medical Center (ASMC) and a familiar face to the Labor and Delivery Department. Latashia had a pre-term delivery at 20 weeks and lost her firstborn child. It was a tragic loss, and she never imagined having another child. But, with overwhelming support from hospital staff and her family, Latashia was able successfully deliver a baby boy, now 11 years old, and a baby girl, now eight years old, both at ASMC.

Latashia and her husband always wanted a large family and decided to have a third child. In April 2011, she had a routine ultrasound, which revealed complications. At 14 weeks she was dilating. She was admitted to ASMC to be monitored for four days. Upon discharge, Social Worker Kathy Jens introduced her to Linda Kasun, parenting nurse educator from Aurora Family Service. Linda worked with Latashia making regular home visits. Latashia’s pregnancy was considered high-risk because of prior experience in the loss of her firstborn.

Nevertheless, Latashia attended Milwaukee Area Technical College (MATC) to become a phlebotomist. But it wasn’t easy. Latashia explains:

"At 20 weeks, that’s where it all went wrong for me. I was walking uphill from MATC to the hospital for a routine doctor’s appointment and did not realize that walking promotes labor. I thought it was only cramps."

In order to prevent pre-term labor, the doctor had to inject magnesium sulfate to help the baby’s lungs. Latashia was put on strict bed rest for the remainder of her pregnancy.

"It was so hard because I had to focus on school, and I was unable to take care of my two children. They had to learn to be independent and do things for themselves," Latashia recalls.

But in the end, it was all worth it. Latashia not only received a passing grade in school, but she delivered a healthy baby girl at 37 weeks.

"I can’t thank Aurora Family Service enough for sending Linda Kasun to the rescue, and the staff in Newborn Intensive Care Unit (NICU)—the doctors, psychologists, and social workers—for not leaving me alone to face my problems. They made me feel really comfortable. They addressed all of my concerns, and my baby received the best care."

Aurora Sinai Medical Center, Milwaukee

La Feria de Salud Latina in West Allis

Aurora West Allis Medical Center teamed up with the West Allis Health Department (WAHD) to support the first Latino Health Fair organized by newly trained community health workers (promotoras) in West Allis.

Free Hepatitis A and B vaccinations for adults were provided by the health department. Hospital clinicians provided blood pressure, pulse and body mass index screenings and information about diabetes, cancer and nutrition.

According to 2010 Wisconsin Department of Public Instruction statistics, the percentage of Latino children attending West Allis/West Milwaukee Schools has increased from 3.1 percent during the 1996-1997 school year to 16.4 percent during the 2009-2010 school year.

The hospital has been a partner with WAHD to respond to the needs of the growing Latino population in West Allis and West Milwaukee. Supporting the training and work of the promotoras is a central focus. The hospital’s community benefit planning team is developing programs and venues for Promotoras to expand their outreach to the community.

Aurora West Allis Medical Center

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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