February 8, 2013
Volume 57, Issue 6

Governor, Assembly Speaker Release Mental Health Initiatives
WHA applauds bipartisan effort

Governor Walker and Assembly Speaker Robin Vos (R-Burlington) both released initiatives this week to address the need for additional state resources for mental health services and to continue the discussion on providing efficient and effective mental health services in Wisconsin. The initiatives released by Gov. Walker will be part of his 2013-15 biennial budget, which is set to be released during his budget address on February 20, 2013.

"Our behavioral health care system is facing serious challenges, and finding solutions is a top WHA priority," said WHA Executive Vice President Eric Borgerding in a statement commending the new initiatives.

Governor Walkerís agenda includes the following funding:

Speaker Vos announced the creation of the Speakerís Task Force on Mental Health, a bipartisan effort created to, among other things, improve coordination of care among those who treat people with mental illness. Assembly Health Committee Chairman Rep. Erik Severson (R-Osceola) will serve as the chair of the Task Force and Ranking Health Committee Member Rep. Sandy Pasch (D-Shorewood) will serve as the vice-chair.

The Speakerís Task Force consists of 11 members from both parties who will begin their work on February 27 with recommendations being sent to the Legislature in May.

In December, WHAís Behavioral Health Task Force, chaired by George Kerwin, president/CEO, Bellin Health System, released 13 specific recommendations (see www.wha.org/pubArchive/valued_voice/vv12-7-12.htm#3) for improving behavioral health care in Wisconsin. WHA believes the work of that group can serve as a resource to Speaker Vosís bipartisan Task Force.

"Since 2008, WHAís Behavioral Task Force has worked with health care leaders throughout the state to identify regulatory, workforce and funding barriers that stand in the way of delivering accessible and well-coordinated health care," said Borgerding. "We look forward to working with the Governor and legislative leaders to identify and implement solutions."

See Governor Walkerís release here: http://walker.wi.gov/Default.aspx?Page=5d4ecba7-4cd1-412c-bef1-1f388f03622c

See Speaker Vosís release at: www.wha.org/pdf/VOSmentalhealth2-6-13.pdf

See WHA Executive Vice President Eric Borgerdingís statement here: www.wha.org/pdf/WHAStmtMentalHealth2-6-2013.pdf.

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La Crosse Tribune Editorial: Walker Should Expand Medicaid

The following editorial is reprinted with permission from the La Crosse Tribune

Gov. Scott Walker will never be a fan of the Affordable Care Act. His actions and statements during the past two years certainly attest to that.

But Walker also realizes that the act is law, no matter how much he and some of his Republican colleagues dislike it. So itís time that the governor step up to the plate, hold his nose if he needs to and do what is in the best interests of Wisconsin by agreeing to expand the stateís Medicaid program.

Hereís whatís at stake. While estimates vary, expanding Medicaid in Wisconsin could impact some 200,000 citizens, including nearly 8,000 in our region. The expansion would include childless adults ages 18 to 65 with individual incomes below $15,414 a year. The federal government would fully cover the expansion cost through 2016 and then scale back to 90 percent funding by 2020.

Walker said his decision will be made when he announces his budget later this month. He is clearly concerned about how much the state will pay in the future, but states have the option to withdraw.

This much also is clear. We will pay for the costs one way or another. Many of the possible participants are people working part-time jobs that offer no health insurance coverage. If we want to expand our workforce and grow jobs in Wisconsin, we need to make sure more people have access to medical coverage.

As Dr. Laurie Logan, a family practitioner at Mayo Clinic Health System-La Crosse said during a press conference Monday (February 4), postponing health care simply puts more people into the emergency room, which is the most expensive coverage.

We also know that if Walker does not accept the expansion, the state will continue to pay for 40 percent of the coverage (the feds pay the rest) for people already covered under various programs. And new figures released Tuesday (February 5})by the Legislative Fiscal Bureau show Wisconsin could cover up to 175,000 additional people and save $66 million during the first three years.

The stateís cost for from 2016 through 2020 would be an additional $67 million, but Wisconsin would get $4.56 billion from the federal government. Thatís a pretty good return on investment and one would hopeóunder Walkerís leadershipóthat the stateís economy will grow and the number of people needing Medicaid-funded programs would diminish.

Democrats certainly are in favor of the expansion. But if the governor doesnít want to listen to Democrats, he should listen to the Wisconsin Hospital Association, the Wisconsin Medical Society and other state groups that support the expansion of Medicaid.

"There will be much debate on this issue with valid opinions on both sides," Steve Brenton, president of the Wisconsin Hospital Association told the Milwaukee Journal Sentinel. "But at the end of the day, in this time of uncertainty, we cannot have fewer people with coverage and more uncompensated care."

The governor has certainly not ignored some of the health care needs in the state. His first budget expanded Medicaid spending by $1.2 billion. But other Republican governors around the country who have been opposed to the Affordable Care Act have done the right thing for their citizens and accepted the expansion.

We hope that Wisconsin will join them. Itís our money, too.

Read at: http://lacrossetribune.com/news/opinion/our-view-walker-should-expand-medicaid/article_76ab61fe-70ab-11e2-8305-0019bb2963f4.html?cid=print

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Rep. Kind Named Chair of House Rural Health Care Coalition
Continues his strong commitment to rural health

U.S. Rep. Ron Kind, member of the House Ways and Means Committee health subcommittee, was recently selected as chair of the Rural Health Care Coalition in the House of Representatives. The caucus is a bipartisan group of over 100 members who focus on improving access to care in rural communities.

"We have some of the best rural health care providers in the country right in our own backyard," said Rep. Kind. "I am proud to have worked hard on their behalf during my time in office and look forward to the bipartisan progress we will be able to make as a coalition. I will continue to advocate for legislation that gives rural hospitals and clinics the support they need and increases access to the care they provide. Ensuring access to providers is vital to the long-term sustainability of rural communities."

This week Rep. Kind also met with Wisconsin hospital leaders in Washington, DC during the National Rural Health Care Associationís annual policy institute. Those individuals included Tim Size, executive director of the Rural Wisconsin Health Cooperative (RWHC); Jeremy Levin, director of advocacy for the RWHC; Bill Sexton, CEO, Prairie du Chien Memorial Hospital; Jim OíKeefe, CEO, Mile Bluff Medical Center in Mauston; David Hartberg, CEO, Boscobel Area Health Care; and John Eich, director of the Wisconsin Office of Rural Health, among others.

Kind discussed the importance of rural hospitals for both patient access and economic development, the potential impact of impending indiscriminate cuts on rural providers, and legislation he is authoring to provide more flexibility to rural hospitals to better care for their communities.

"On behalf of all Wisconsin hospitals, we greatly appreciate Rep. Kindís commitment to rural health care," said WHA President Steve Brenton. "As Congress continues to grapple with how to fund various fiscal requirements, Wisconsin hospitals will look to legislative leaders like Rep. Kind to protect rural hospitals and the important access to care they provide."

Rep. Kindís district is home to 17 critical access hospitals.

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WHA to CMS: Outreach, Education "Absolutely Crucial" for Exchange Enrollment
CMSís Munson joins legislators and stakeholders for roundtable discussion

This week, Senator Jon Erpenbach (D-Middleton) and Representative Jon Richards (D-Milwaukee) hosted a roundtable discussion with Director Ken Munson of the federal Centers for Medicare and Medicaid Services (CMS) about the implementation of a federally-facilitated health insurance exchange in Wisconsin as established under the Affordable Care Act. Munson is the Region V Director for CMS, covering the states of Wisconsin, Illinois, Indiana, Michigan, Minnesota and Ohio.

WHA Executive Vice President Eric Borgerding was invited by Sen. Erpenbach and Rep. Richards to participate in the discussion, along with representatives from statewide provider, insurer, and business organizations.

Munson answered questions related to all aspects of the Affordable Care Actís yet-to-be implemented exchanges, including the "federally facilitated exchange" that will be implemented in Wisconsin. Questions included regulation of insurance products and the importance of educating individuals on how to access coverage through this new exchange, especially for those who would have previously received their coverage through Medicaid.

WHA used the opportunity to underscore the need for robust outreach and enrollment efforts, especially for low-income populations who will be coming off Medicaid and into exchanges when the federal Medicaid Maintenance of Effort expires for the Medicaid eligibility.

"The outreach and education efforts for a federally facilitated exchange are going to be absolutely crucial," WHA Executive Vice President Eric Borgerding told Director Munson. "Otherwise, we will end up with a lot of uninsured people"

"I couldnít agree moreóthis is a very important point," responded Munson.

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Presidentís Column: WHA Medicaid Position Embraces Stability in Uncertain Times

WHAís Board-approved Medicaid position supports lifting the enrollment freeze for childless adults with incomes below 133 percent FPL. It also conditionally supports transitioning higher income individuals to subsidized coverage via the state Insurance Exchange once certain conditions are met. WHAís position represents a pragmatic approach that works for Wisconsin hospitals, physicians and low-income patients and families. It also is the "best" available deal, at least in the short term, for Wisconsin taxpayers.

Wisconsin hospitals today face unprecedented uncertainty given massive Medicare cuts that have already taken place, as well as a new two percent across-the-board cut that will likely occur in less than 10 weeks. That cut, known as the "sequester," will cost hospitals $100 million over the next 12 months. Anything that might worsen this already problematic environmentólike a new stream of financially indigent patients who may lose their Medicaid coverageómust be avoided.

Ultimately, a strong economy creating good paying, family-sustaining jobs with benefits is the best way to "reform" Medicaid. Medicaid should be a safety net, not a low cost alternative. Hopefully the much ballyhooed Insurance Exchange will someday be a far preferable coverage option than Medicaid, especially for providers who now see 20 cents on the dollar of costs for caring for one million plus Wisconsin citizens in ambulatory settings. But the likelihood that a functional and consumer-navigable Exchange will be up and running on October 1 meets the "slim to none" test.

WHAís advocacy position on Medicaid recognizes the fact that Governor Walker invested over $1.2 billion in the last budget biennium in the program. Other far more politically popular spending opportunities were rejected in order to sustain Medicaid. And Governor Walker will likely call for another $700 million in the coming biennium in order to pay for the programís "cost to continue." There should be no debate about the Governorís commitment to Medicaid.

Governor Walkerís Medicaid coverage decision will be known in less than three weeks. WHA will then have the opportunity to either fully support that decision or work to constructively improve the proposal as the Legislature has their say. In the meantime, WHA continues to share our Board-adopted position with stakeholders, noting that position leverages already-authorized federal funding to help provide coverage to very low income uninsured and reduce cost shifting to Wisconsin employers.

Steve Brenton

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Register Today for 2013 Advocacy Day
April 23, 2013 *** Monona Terrace, Madison

Make an impact in Madison for your hospital by attending Advocacy Day on April 23. Register yourself and your hospital team today, including senior leaders, trustees and volunteers for this important event.

Online registration available at http://events.SignUp4.com/13AdvocacyDay0423

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CMS Proposes Important Changes to the Federal Regulations for Hospitals
Increased inconsistency underscores need for state regulatory reform

The Centers for Medicare and Medicaid Services (CMS) has proposed important changes to the hospital Medicare Conditions of Participation (CoP), intending to reduce regulatory burden and promote efficiency for hospitals. According to CMS, the proposed rule would increase the ability of health care professionals to devote resources to improving patient care by eliminating or reducing requirements that impede quality patient care or that divert resources away from providing high quality patient care.

Among the changes, CMS proposes to rescind the recently adopted hospital regulation requiring that a hospitalís governing board include a member of the medical staff. CMS instead proposes to require that a hospitalís governing board periodically consult with a designated member of the medical staff, focusing the requirement on effective communication rather than dictating a particular structure. The proposed rule also contains regulatory changes stipulating that each hospital, including hospitals within multi-hospital systems, must have its own medical staff. CMS also proposed clarification to other selected requirements for hospitals, critical access hospitals, long-term care facilities, laboratories, transplant centers and other organizations.

As CMS continues to update the hospital Medicare CoP, the federal and state hospital regulations have become increasingly inconsistent. Governor Scott Walkerís Administration recognized the regulatory inefficiency created by the divergent rules in its recently-released "2013 Wisconsin Regulatory Review Report." The Report, which highlighted 218 different rules, included DHS 124 as a rule that "Öis outdated, duplicative, and confusing for health care operators because of contradictory state and federal regulations." Governor Walkerís report called for DHS 124 to be modernized in order to reduce hospital regulatory compliance costs and confusion. To modernize DHS 124, which is a priority for WHA, WHA is proposing to use Ohio and Minnesota state regulations as models. Those states rely primarily on the Medicare Conditions of Participation for hospital regulation.

CMS published the proposed changes to the CoP in the February 7, 2013, Federal Register. To see a copy, go to www.ofr.gov/OFRUpload/OFRData/2013-02421_PI.pdf.

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Partners for Patients: WHA Visits Langlade Hospital

Tom Kaster, WHA quality coordinator, recently visited Langlade Hospital in Antigo. For the first wave of the WHA Partners for Patients collaborative, Langlade Hospital has focused on venous thrombotic embolisms (VTE) and Readmissions.

"Although Langlade did a very good job with VTE, their work on Readmissions had been outstanding." Kaster said. "They have left no stones unturned." The interventions Langlade is focusing on to help reduce Readmission include:

One can easily see that Langlade is doing their due diligence to reduce readmissions. Their patients are receiving exceptional service and patient care.

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WiSHHRA Annual Conference for Human Resource Professionals, April 18-19

The Wisconsin Society for Healthcare Human Resource Administration (WiSHHRA) will host its annual conference for health care HR professionals April 18-19 at Country Springs Hotel in Pewaukee.

The 2013 conference will focus on planning for the future and will open with a keynote session by generational guru Anne Loehr. Loehr will discuss the history, traits and culture that are informing the newest generation of Americaís workforce, as well as three workforce trends every leader should know. In addition, fellow Wisconsin health care HR professional John Zorbini, member of the Governorís Council on College and Workforce Readiness, will share his experiences as a Council member, the recommendations made to the Governor, and the reasoning behind each one.

This yearís conference will also include the popular annual legal and legislative update sessions, as well as several best practice sessions, allowing attendees to learn from their peers.

Anyone who has human resource responsibilities in a health care organization will benefit from the educational agenda and is welcome to attend. In addition, the program has been submitted to HRCI for continuing education/recertification credit.

The full conference brochure is included in this weekís packet, and online registration is available at http://events.SignUp4.com/13WiSHHRA. For registration questions, contact Lisa Littel at 608-274-1820 or email at llittel@wha.org.

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Transforming Care At the Bedside Fosters Innovation, Quality Improvement

Lead by WHA, the Wisconsin Transforming Care at the Bedside (TCAB) project is fostering innovations and improvement to the quality and safety of patient care. Judy Warmuth, WHA vice president, workforce, has been conducting site visits at the 22 nursing units participating in the TCAB project. Warmuth said the site visits help to ensure that each team has successfully launched TCAB on their unit and reports that participants are anxious to share progress they have made.

The TCAB team from Froedtert Community Memorial Hospitalís medical unit offered a thank you to all members of their unit staff upon their return from the kick-off event. Their snorkel question was, "What is your ideal unit?" and they continue to get ideas from that question. Borrowing an idea from the kick-off, the team introduced a "precautions perimeter" inside isolation rooms. They did a cost savings estimate before implementation and estimate that 18 minutes are saved per day by staff. This team is also working on a medication teaching form and process for all of their patients.

Froedtert Community Memorial Hospitalís ortho/peds unit shares the medication teaching form project with their peers on the medical floor, but is also working on projects specific to their workgroup and patient population. This team did a "steps" evaluation before and after changing the materials stocked in their nurse servers. Nurses who tested the new supply model saved an average of 203 steps per hour! Their snorkel was on team vitality and the team has been asked by the CNA staff to update unit checklists. Each Community Memorial TCAB unit has a page on the hospital intranet that lists changes made by the team.

Midwest Orthopedic Specialty Hospitalís TCAB team began with a snorkel on "hunting and gathering" and has worked to have information and materials easily available for staff. Printed information has been accumulated and placed in two places at the nursing station. Restocking of room supplies has also been changed with a simple magnet to indicate when resupply is needed. The team describes their ability to think outside the box as their strength.

The Wheaton Franciscan Healthcare-Franklin TCAB team did their first snorkel on "How to Improve the Response to Patient Call Lights." Bedside report, purposeful rounding and a change to the staffing pattern are strategies they are using to improve that response. They have also worked on shift report among patient care assistants and between registered nurses and patient care assistants. They are using a parking lot strategy to organize storage rooms, and have developed a way to offer information for Eucharistic Ministers that does not interrupt nursing care.

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

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Wisconsin Hospitals Community Benefits: Access to High Quality Health Services

Hospitals do what they can to move health care services out of the clinical setting into the heart of the community. Community health screenings and education classes help raise awareness of steps that individuals can take to improve their health. When people learn more about how their lifestyle decisions affect their health, they make changes that ultimately lead to better health, which raises the health status of the entire community.

Free cancer screening saves area manís life

Don Timm, of Green Lake, says divine intervention led him to a free cancer screening 10 years ago at Agnesian HealthCare. The trip to Fond du Lac that day saved his life. An active guy nearing retirement at that time, Don, now 71, is glad to be alive.

"I was healthy and still working then," Don says. "But for some reason, when I saw the article in the newspaper promoting the free cancer screening in Fond du Lac, I told my wife I wanted to go."

Following the screening, Don was notified of the results. "The results showed that my PSA blood test for prostate cancer screening was 77 when it should be between 0-4," Don recalls. "I was directed to see my doctor."

After seeing his doctor in Berlin and learning the news he had prostate cancer, he began a decade of dealing with the disease. "My original diagnosis was a lifespan of just three to four years," Don says. "Iíve beaten those odds, and I am continuing to get excellent care now with my new oncologist Dr. (Michael) Jones at Agnesian HealthCareís cancer center in Fond du Lac."

Don is enjoying life in spite of his ongoing issues with cancer. He and his wife love to go camping and bicycling. "We go all over. I like to stay active and eat right to stay as healthy as possible. I eat a lot of fish and chicken, drink green tea and exercise a lot." Donís positive outlook on life along with a woodworking hobby has also helped him enjoy life to the fullest.

The Living Smart free cancer screening has been held annually (each spring) for the past 16 years, according to Bill Daly, Agnesian HealthCareís director of Oncology and Diagnostics.

The free cancer exams include prostate and colorectal screenings, skin cancer screenings by Agnesian HealthCare dermatologists, oral cancer screenings by local dentists and a staff review of self-breast exam methods with interested participants. All medical and dental professionals volunteer their time for the event.

"We want to stress the importance of finding a cancer in an early stage when itís more easily treated," Daly says. "But I also want to caution that this does not replace your annual visit to your doctor. We want to educate the public on the importance of seeing their health care provider on an annual basis."

Don knows all too well the importance of the cancer center and the annual cancer screenings. "If I wouldnít have gone to the free screening clinic 10 years ago, I wouldnít have known anything was wrong. I think God led me there. I wouldnít be here today if it wasnít for that. I urge everyone to go. It could be the most important thing you ever do for yourself."

Agnesian HealthCare, Fond du Lac

Ministry Good Samaritan launches Rural Outreach Program

Agriculture continues to be one of the most challenging occupations related to health and safety, yet many farm families struggle obtaining preventive medical care because of the unique demands of their profession.

These obstacles include limited access to care due to driving distance, lack of or limited insurance coverage, and long working hours.

In an effort to eliminate these obstacles, Ministry Good Samaritan Health Center is pleased to announce the launch of a Rural Outreach Program to help farm families stay healthy and prevent life-threatening illness and injuries.

This FREE program features an agri-certified registered nurse from Ministry Good Samaritan Health Center to visit a participantís home or farm with a customized visit featuring testing, education and available resources.

"We realize that for farm families, time is a major factor in the ability to seek medical care," said Anne Mathson, Ministry Good Samaritan Foundation and Community Outreach Director. "It is our hope that this convenient program will catch and prevent illness early and reduce medical expenses for farm families."

A highlight of the program is full-blood panel testing on site with quick results to aide in the early detection of heart disease, diabetes, stroke and some cancers.

Education about health issues related to improper respiratory, hearing and eye protection and proper protective clothing will be provided along with screening, education and resources for children living and or working on the family farm are an important part of the program.

Additional community support for Ministry Good Samaritanís Rural Outreach Program is provided by the Fraternal Order of Eagles-Merrill #584 and the Ministry Good Samaritan Health Center Foundation.

"We are grateful for the support of the Merrill Eagles and our Foundation for this important initiative," added Ministry Good Samaritan President Kris McGarigle. "Eighty-three percent of Lincoln County farms are operated by individual families, and we hope this will provide a level of support for the estimated one in five farmers that are uninsured."

Ministry Good Samaritan Health Center, Merrill

Live Well programming helps underserved population know their numbers

Fort HealthCare recognizes that access to essential primary care services is sometimes unavailable to those who are under-insured. In a continuing effort to increase access to care, the organization is introducing a new program that provides these individuals with baseline lab measurements, biometrics like waist circumference and body mass index, and a general health risk assessment that addresses chronic diseases and lifestyle choices. The program also provides access to tools and information needed to make necessary lifestyle changes. It is specifically targeted to benefit those with little or no insurance.

Live Well Community programming is free for eligible participants and includes, on an annual basis: a free fasting lipid panel and glucose screening (lab work), biometrics assessment, a one- hour one-on-one coaching session with a Fort HealthCare clinician, general health risk assessment, monthly Health365 e-newsletter, wellness challenges and a Cerner Health account to access personal health-related information.

The goals of the Live Well Community program are to allow participants access to basic wellness care, to introduce community members to Fort HealthCare and Cerner Health; to provide information on how to best utilize services, like when to use emergency or urgent care and when to make an appointment for primary care; to complete a Personal Heath Assessment and have results reviewed and explained by a health care professional; to provide wellness coaching to encourage healthier choices and to educate individuals about health risks associated with lab, biometric and health assessment results.

To become a member of the Live Well Community program, interested persons will receive a brochure and lab slip from a participating organization, such as Fort HealthCare Community Health & Wellness, Rock River Free Clinic, Workforce Development, Health & Human Services or other affiliated organizations. Then participants must complete a fasting lipid panel at the Fort Memorial Hospital Laboratory. Results are sent to James Martin, MD for review, and anyone with elevated risks will be contacted. A representative from Fort HealthCare Community Health and Wellness will schedule a one hour, one-on-one coaching session to perform a biometrics assessment, receive lab results, sign up for a Cerner Health account and complete the Health Risk Assessment questionnaire. Lab results will be provided at the one-on-one coaching session.

Anyone who is un- or under-insured, and can show need, will be welcome to participate in the free program.

Fort HealthCare, Fort Atkinson

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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