November 16, 2012
Volume 56, Issue 46

WHA Medicaid Reform Group Dives into Expansion and Exchange Questions

On November 14, the WHA Medicaid Reengineering Group (MRG) held its third meeting. Comprised of leaders from member hospitals, the MRG has been tackling questions around Medicaid coverage in light of the Supreme Court’s decision that the Medicaid expansion is optional for states.

This week’s meeting focused on analysis related to whether the subsidized coverage through the exchange was a viable alternative to Medicaid coverage. Understanding that it is difficult to determine whether individuals would take up coverage in the exchange, the group examined various scenarios taking into account estimates of the uninsured, and impacts on provider reimbursement including charity care and bad debt.

The group is still working on its final recommendations and will schedule an additional call in the coming weeks.

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WHA Hosts Two Post-Election Telephone Town Halls
150 leaders learn what the future holds for health care in Wisconsin

This week WHA continued its popular series of Telephone Town Halls with two live presentations of "Post-Election Analysis: What the Elections Mean for Wisconsin Health Care." Featured speakers WHA President Steve Brenton and Executive Vice President Eric Borgerding provided valuable insight to upwards of 150 hospital and health system leaders on what the election results mean in terms of decisions to be made on Medicaid, the health insurance exchanges, as well as on Congressional activities during the lame duck session and beyond.

In kicking off the Town Hall, Brenton and Borgerding provided a snapshot of the election results, including a status quo result at the federal level but reverting back to complete Republican control in the Wisconsin State Legislature. These results will have impacts on many issues, particularly implementation of elements of the President’s Affordable Care Act (ACA).

"Most importantly is the fact that the states will, in a significant way, be able to control the destiny of important provisions in the Affordable Care Act," said Brenton, referring to decisions on whether Wisconsin will expand its Medicaid program as laid out in the ACA and whether it will choose to run a state-based health insurance exchange.

With respect to ACA implementation, Borgerding went on to discuss what faces Wisconsin in the coming weeks and months, describing ACA implementation as "where worlds now collide."

"More than ever before, with the Affordable Care Act being upheld and the result of the election, we’re seeing an intertwining or an intermingling of state and federal policymaking. No better example of this is the decisions that are in front of the State of Wisconsin and our elected officials as it relates to implementing the ACA."

Borgerding provided further insight into these decisions, indicating WHA’s desire for a state-run exchange. Doing so, in WHA’s eyes, would allow the State to better preserve Wisconsin’s unique health care and insurance market strengths. Regarding the Medicaid expansion, as allowed for under the ACA, Borgerding indicated that WHA’s Medicaid Reengineering Group had already begun meeting to discuss the many issues surrounding this decision, including options such as expanding Medicaid to childless adults or moving this population into the exchange.

In looking toward the looming fiscal cliff, Brenton provided an overview of the fiscal decisions facing Congress and the President in the coming months. A few examples of these decisions include stopping a 27 percent cut in Medicare physician payments and addressing the looming across-the-board cuts to programs like Medicare among many others.

Unfortunately, there is a strong potential that hospital and provider payments may be targeted as a means to find savings for other proposals, leading Brenton to highlight the importance for hospitals to be engaged.

"All this means is that our advocacy role, your advocacy role is front and center. We have a ‘Protect Hospital Care’ campaign…with all kinds of information that provides you with the tools you need to educate and work with your legislators," said Brenton.

To learn more about these and other important hospital/health system issues, log onto WHA’s website at Watch for additional Telephone Town Halls in the coming months.

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MEB Grapples with Out-of-State Physician Orders
"Will help our patients who live and work near our state’s borders receive the same efficient and coordinated care"

The Medical Examining Board (MEB) this week continued its review of MED 10, the administrative rule that defines unprofessional conduct for physicians in Wisconsin. Prior to the November 14 meeting, the Wisconsin Hospital Association asked the MEB to consider several significant matters for Wisconsin hospitals, health systems, physicians and their patients. A copy of the WHA letter to MEB is available at

Material prepared for the meeting by MEB staff highlighted issues that the health care community believes create roadblocks to coordinated patient care. In its letter to the MEB, WHA asked the Board to clarify its position on several of the most significant issues, including the longstanding issue of orders from physicians licensed in another state. WHA explained that health care practitioners and providers have struggled with guidance from the Board of Nursing and the MEB related to orders from out-of-state physicians. WHA asked the MEB for a clear statement that outpatient services ordered by a physician who is licensed in another state may be provided in Wisconsin under the following conditions: (1) The ordering physician sees the patient in the state in which the physician is licensed; and (2) The physician who issued the order remains responsible for the patient’s care.

After discussing the issue, the MEB passed the following motion:

Aiding or abetting the practice of medicine by an unlicensed, incompetent, or impaired person or allowing another person or organization to use his or her license to practice medicine. This provision does not prohibit a Wisconsin physician or any other practitioner subject to this rule from providing outpatient services ordered by a physician licensed in another state if the physician who wrote the order saw the patient in the state in which the physician is licensed and the physician who wrote the order remains responsible for the patient.

WHA Senior Medical Advisor Chuck Shabino noted after the vote, "Wisconsin is a leader in providing efficient, high value health care. Care coordination has been a key part of that success." Shabino continued, "The MEB’s action recognizes this and, importantly, will help our patients who live and work near our state’s borders receive the same efficient and coordinated care."

The MEB intends to vote on a complete MED 10 package at its meeting in December.

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Wisconsin Health Care Value Message Reaches National Employer Market
Health care quality and value is a primary site selection consideration

WHA’s campaign to raise awareness of the high quality and value of Wisconsin’s health care is now reaching a national employer audience. An article in the latest issue of Area Development magazine entitled, "Is Healthcare Part of the Facility Location Decision?" ( says health care value should be "part of the mix" that employers consider in their primary site selection process.

The article recognizes Wisconsin for its high quality and collaborative approach to improvement, and points out that Wisconsin is among "five top states" that are consistently recognized for delivering high quality care.

"Of the more than 150 (AHRQ) measurements of care and treatment settings, these states (Wisconsin, Iowa, Minnesota, Maine and Massachusetts) are shown to out-perform other states in terms of overall access and quality of care," says Dr. Carolyn M. Clancy, director of the federal Agency for Healthcare Quality and Research.

WHA Executive Vice President Eric Borgerding believes that being a national leader in health care quality and cost is an attractive community economic development tool.

Borgerding, quoted in the article, says, "Health care costs are a key part of total labor cost for many businesses. A state like Wisconsin, through our collaborative efforts to moderate health care costs and deliver better value for health care dollars, should have a competitive edge when it comes to attracting new business operations or expansions compared to other states."

WHA will soon embark on a direct mail campaign aimed at Wisconsin employers that have more than 100 employees. WHA’s theme will continue to be: High Quality-High Value Health Care: A Wisconsin Advantage. Watch for WHA emails related to this effort that will give you a heads up when WHA is mailing to employers in your area. For more information on the campaign visit:

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President’s Column: Medicare Cuts Part of Looming Fiscal Cliff

In just six weeks, a confluence of expiring tax cuts and federal spending cuts will occur unless Congress acts in a lame duck session. The much discussed "fiscal cliff" contains two Medicare-related provisions: a looming physician payment (SGR) formula-driven 28 percent cut and an automatic two percent across-the-board payment cut for all Medicare service providers. The latter issue is part of the legislated "sequester" that features both domestic and defense spending reductions. The Congressional Budget Office has warned Congress that failure to deal with the fiscal cliff could trigger a recession.

Most observers believe that Congress will temporarily delay at least some, but not necessarily all, of the spending cuts. A temporary patch of the physician cut is a certainty. The issue is… how will that "fix" be paid for? The concern is that other Medicare providers will be slashed to fund the SGR problem—a very real example of robbing Peter to pay Paul. It also appears that addressing sequester-related defense cuts has many supporters. That’s not necessarily the case for Medicare cuts.

In the likelihood that Congress delays addressing most of the cliff until sometime later in 2013, we need to understand that additional hospital exposure to even more cuts will very much be in play. Just this week, an Obama Administration spokesman indicated "the starting point" for 2013 Congressional budget discussions will be the President’s 2011 deficit reduction plan. The plan includes: further reductions in Medicare bad debt payments, teaching hospital cuts, CAH mileage restrictions, "strengthening" IPAB, and limitations on Medicaid provider taxes. And that’s the starting point.

Given our vulnerability and all that’s at stake, active advocacy efforts will be required of all of us over the next six months. WHA’s PROTECT HOSPITAL CARE CAMPAIGN ( is a key element within our larger advocacy tool kit.

WHA previously organized a half dozen in-district meetings with House members. More are likely. We are also working with AHA on a D.C. meeting featuring Hill Visits on November 29. Contact Jenny Boese at 608-268-1816 or if you are interested in attending.

In addition to discussing the horrific financial consequences of cuts of the magnitude in play right now, we also must argue that these cuts have the potential of harming Wisconsin’s high value delivery system. And we must not forget that Wisconsin hospitals are already on the hook for $2.6 billion in cuts to pay for coverage provisions within the Affordable Care Act.

Steve Brenton

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Grassroots Spotlight: Kind Visits Ministry Saint Michaels Hospital in Stevens Point

Congressman Ron Kind (D-La Crosse) recently visited Ministry Saint Michaels Hospital in Stevens Point for the first time. Under new district boundaries, the hospital moves into Kind's 3rd Congressional District.

During his visit, Kind met with hospital and Ministry Medical Group leadership, led by Jeff Martin and Mark Fenlon, MD, respectively, as well as had an opportunity to spend time with a larger group of hospital leaders. In addition to learning about the hospital and the medical group, Kind toured select portions of the hospital, including the emergency department.

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Support Statewide Initiatives with a Contribution to WHA Foundation

Each year, the WHA Foundation supports a variety of initiatives that have statewide impact on health care in the areas of workforce development, quality and patient safety and community collaboration.

In order to continue supporting initiatives that meet its three funding priorities in 2013, the WHA Foundation officially kicked off its annual fundraising campaign this week, asking WHA hospital members to consider supporting the WHA Foundation by making a contribution this fall. Funds raised in the current campaign will be used to continue some of its most successful and long-standing initiatives, including the Global Vision Community Partnership Awards and the technical college student scholarships, and give the Foundation the opportunity to consider new initiatives for funding in 2013.

Each WHA hospital executive has received a direct appeal for the fundraising effort. A contribution form is included in this week’s packet for anyone who would like to make an individual contribution or one on behalf of your hospital.

For more information on the WHA Foundation’s annual fundraising campaign, contact Jennifer Frank at 608-274-1820 or at

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Be Involved—Join a Council or Committee

WHA is currently soliciting appointment requests from WHA members to participate in WHA councils and subcommittees. Now is your opportunity to participate on the councils that are at the forefront of identifying key policy issues for the membership and making recommendations on positions to the WHA Board.

There are five councils and one committee for which we are looking for member participation:

Additional information including council responsibilities and current member information is located at may direct questions to Sherry Collins at or 608-274-1820.

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Brenton Joins WHA’s Public Policy Department

WHA is pleased to announce that Andrew Brenton has joined the Public Policy Department as assistant general counsel. Brenton graduated from the University of Wisconsin Law School in May 2012 and received his BA from the University of Wisconsin-Madison in May 2009.

Brenton gained valuable experience in internships with the Office of Legal Counsel for Governor Scott Walker, for Wisconsin Supreme Court Justice Annette Ziegler, and the Wisconsin Department of Justice. Brenton previously assisted WHA’s legal counsel on a part-time basis prior to being hired full time.

"Andrew is a great addition to WHA’s legal and public policy team," said Laura Leitch, WHA senior vice president and general counsel. "He is smart, curious and focused. He is proving to be a valuable asset to WHA and its members."

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Hidden Dangers of Social Media in the Workplace Focus of Nov. 28 Webinar

The National Labor Relations Board (NLRB) recently issued its first decisions involving employer social media policies, rulings that will set precedent for future cases. On November 28, WHA will offer a webinar focused on the hidden dangers for employers on social media use in the workplace. The use of social media increases daily and presents unique risks for employers. During this webinar, David Kern, partner in the law firm Quarles & Brady LLP, will discuss these risks and how best to manage them.

Participants will learn how to minimize liability associated with monitoring social media use by employees, how to improve the review and updates of acceptable use and social media policies and how to better avoid risks associated with disciplining employees for use of social media.

The webinar "Social Media and the Workforce: Hidden Dangers for Employers" will be offered to WHA members on November 28 at 9:00 AM. Hospital human resource professionals, nurse leaders and others in management positions are encouraged to participate. You can register online at: For registration questions, please contact Lisa Littel at or 608-274-1820.

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Ministry Sacred Heart Hospital Recognized for Quality Achievement

Ministry Sacred Heart Hospital in Tomahawk was recognized by the Health Research & Educational Trust (HRET) November 12 for their commitment to reducing venous thromboembolism (VTE). They were one of roughly 10 hospitals out of more than 2,000 who received an award for their successful work to improve patient safety. Sue Klemm accepted the award on behalf of Ministry Sacred Heart Hospital during a recognition lunch held in Indianapolis during Hospital Engagement Network (HEN) Week.

Through the use of a simple VTE risk assessment screening tool that includes choices for prophylaxis and staff education, they have only experienced one VTE in the last 21 months. Since they began working with WHA Partners for Patients, the Ministry Sacred Heart team has continued their work to improve compliance with VTE risk assessment and initiating prophylaxis.

"Ministry Sacred Heart’s results show that when providers and staff are presented with education and simple-to-use, yet effective tools, and have the motivation to ‘do the right thing,’ they can achieve nationally-recognized results," according to Kelly Court, WHA chief quality officer.

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Wisconsin Hospitals Community Benefits: Charity Care

Fear of a bill should never prevent a patient from seeking care at a Wisconsin hospital. Wisconsin hospital charity care programs provided $232 million to more than 700 patients each day last year. The stories that follow illustrate the deep commitment and continuing concern that hospitals have to their patients to ensure they receive the care they need regardless of their ability to pay.

Community Care takes "a load off my mind…"

On Jan. 3, 2012, Larry Hoefs was without medical insurance.

That wasn’t on his mind at the moment. His diabetes-related foot ulcer brought such excruciating pain to the pinky toe of his right foot that he could no long bear it.

Needing immediate medical attention, Larry drove to Beaver Dam Community Hospital’s emergency room. Soon, doctors informed him that the ulcer was so advanced that they would need to amputate his toe. Dr. Paul Shuler successfully removed the toe the next day, and Larry needed to spend a total of seven days in the hospital.

During his recovery, Larry got to know a lot of different people, including doctors, physician assistants, nurses and therapists. He also met Liz Schliewe, a financial counselor with Beaver Dam Community Hospital (BDCH), who visited Larry to discuss his financial situation.

Thanks to Schliewe’s gentle persistence and guidance, Larry applied for and was granted Community Care through BDCH, covering Larry’s hospital bill, which included a second diabetes-related inpatient stay.

As part of the Community Care application process, Liz had Larry contact the State of Wisconsin to enroll in BadgerCare, which covered his follow-up medical costs through June 30.

"I can’t say enough for what Liz and Beaver Dam Community Hospital did for me," Larry said. "When I was going through this, I was feeling really hopeless, and when I feel hopeless, I don’t feel like doing anything. Liz really kept on me, motivated me to keep my spirits up and made sure I filled out all the paperwork properly.

"If they hadn’t provided this Community Care for me, I’d be in trouble and facing a lot of unhappy bill collectors," continued Larry. "It took a lot off my mind because I’m on disability, and I only have so much money to spend each month, and I can’t get on Medicaid until October."

In all, Beaver Dam Community Hospital provided $1,234,993 in Community Care to its patients over the past fiscal year ending June 30.

Beaver Dam Community Hospital, Beaver Dam

Not a moment too soon

S.L. had been struggling to make ends meet without a job or health insurance, and he had serious health problems that were making his tough situation even more stressful.

Julie Thomas, a financial counselor at Aurora St. Luke’s South Shore, received a call from a doctor’s office and was asked to meet with S.L. He was a 43-year-old male, unemployed, uninsured and without resources, as his unemployment checks had just ended. He was in need of surgery for kidney and lower urinary calculus, which the doctor said needed to be done the next day.

Julie noted, "He was so nervous about the surgery and the cost. He kept repeating, ‘I can’t afford this.’" Julie explained Aurora’s Helping Hand financial assistance program and instructed the patient to return with the documents that were needed for the application and approval, which he did. And the very next day the surgery was performed. The procedure made it evident that he needed two additional procedures done after the first surgery.

Julie noted, "He would call me several times a week checking on the status of his application. He was so thrilled to be approved for 85 percent coverage through the Aurora Helping Hand program.

Aurora St. Luke’s South Shore, Milwaukee

Critical access hospital’s commitment to community

John* has struggled with various medical issues for much of his adult life. Despite his struggles, he remains a positive force in northern Wisconsin.

He volunteers his time and enthusiasm to various projects to improve the quality of life for others. He’s initiated fundraising projects for the local fire department, worked on restoration projects for the historical society, served as a mentor and collaborated with 4H to beautify the community he calls home.

This commitment to community is just one reason a Memorial Medical Center Board Member intervened after John found himself in dire straits following a 2010 visit to the emergency room. John came to Memorial Medical Center in Ashland after attempting to manage excruciating head pain for several days. Given the extremity of his pain, he thought his VA insurance would cover the emergency visit versus attempting to visit a VA Clinic. After disputing the charge for more than a year, his insurance ultimately denied the charge because they deemed the visit was not an emergency.

John has minimal assets and was in no way capable of paying the $6,900 bill, so he was encouraged to apply for Community Care. Memorial Medical Center’s Community Care program assists patients who are unable to pay for hospital services. After receiving his application, Memorial Medical Center ultimately decided to forgive the bill in full.

This is one of many community members Memorial Medical Center has assisted as part of their mission to provide the health care services people need to achieve independent and productive lives.

(*Name has been changed to protect this patient’s identity.)

Memorial Medical Center, Ashland

In a high-risk situation, every minute counts

Playing sports can be risky business and resulting injuries can be devastating. Take the case of a 24 year-old Burlington man who arrived at the Aurora Memorial Hospital of Burlington’s Emergency Department (ED) with a fractured ankle. The ED physician had to refer the patient to a specialist at Aurora St. Luke’s Medical Center (ASLMC).

However, the young man was uninsured, unemployed and lived with his parents. His father was with him at that time. They were in great distress.

Financial counselor Diane Mantey met with them to discuss the situation. Diane emphasized, "After I spoke with the physician at ASLMC, the patient almost fainted. His injuries were so severe that permanent damage was at stake if he did not get immediate surgery."

Diane was able to quickly process the Aurora Helping Hand application and received an approval for the patient to go directly to ASLMC to have the surgery.

The father and son returned about a week later to see Diane personally. Diane reports, "They were very appreciative for the assistance they received from me and the Aurora Helping Hand program. I am just doing my job, but I am glad to be in a position that I can help someone who really needs it."

Aurora Memorial Hospital of Burlington

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

Read more about hospitals connecting with their communities at

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