April 1, 2011
Volume 55, Issue 13

New Bill Addresses FY11 Medicaid Shortfall
WHA calls for quick passage

New legislation introduced this week would fully fund the growing FY11 deficit in Medicaid and, if enacted, will prevent the program from running out of money sometime in May.

The new legislation, Special Session Senate Bill 12 and Special Session Assembly Bill 13, includes the fiscal items that were dropped from Governor Walker’s first budget adjustment bill. The legislation provides $176.5 million to fund the Medicaid program in the current biennium, some $24 million more than when Governor Walker introduced his first bill to fix the deficit on February 15. With the additional funds, the Medicaid budget would be fully funded until the end of the current biennium, which ends June 30, 2011, without making cuts to enrollment or provider payments. The primary source of the funding used to fill the deficit comes from refinancing state debt, which is expected to generate $165 million this fiscal year.

Addressing the FY11 Medicaid deficit, without cuts to enrollment or reimbursement, is one of WHA’s top priorities in the young 2011-12 session. Earlier this year the WHA Board of Directors approved a set of principles to guide the Association’s Medicaid advocacy efforts. Principle number one is "Fully funding the FY11 Medicaid budget without enrollment or payment cuts." Others include:

"The Medicaid provisions included in Special Session SB 12 / AB 13 are consistent with these principles, and we urge you to pass this important legislation," said WHA Executive Vice President Eric Borgerding in a March 31 letter to the Legislature. "Prompt passage of this measure will preserve Wisconsin’s health care safety net for FY11 and avoid negative and immediate consequences."

The Legislature is expecting to take up the funding bills sometime next week.

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Accountable Care Organization Proposed Rules Released
Other Agencies Release Related ACO Information

This week the Centers for Medicare & Medicaid Services (CMS) released long-awaited proposed rules for Accountable Care Organizations (ACOs). To coincide with the release, multiple other agencies—including the Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG), the Department of Justice (DOJ) in conjunction with the Federal Trade Commission (FTC), and the Internal Revenue Service (IRS)—also issued legal policy statements regarding ACOs.

HHS is required under the Patient Protection and Affordable Care Act (PPACA) to establish the ACO program. Under the rule, an ACO refers to a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that will work together to coordinate care for no less than 5,000 assigned Medicare beneficiaries. ACOs would share in savings with the Medicare program if quality and cost objectives are met. The ACO program is voluntary and requires a three-year agreement from participating providers. ACOs are scheduled to be effective January 1, 2012.

Under the proposed rules, two types of risk models are provided for ACOs. The first is a "one-sided" risk model, which allows an ACO to pursue fee-for-service Medicare payment with shared savings for the first two years, and then requires the ACO to assume risk for shared losses in the third year. The second model is a "two-sided" risk model, which requires ACOs to share savings and losses for all three years. CMS believes this approach would have the advantage of providing an entry point for organizations with less experience with risk models while also providing an opportunity for more experienced ACOs that are ready to share in losses to enter a sharing arrangement that provides a greater share of savings, but at the risk of repaying Medicare a portion of any losses.

The proposed rule also requires ACOs in year one to collect and submit data on 65 quality measures in five quality domains: patient experience of care, care coordination, patient safety, preventive health and at-risk populations. In future years ACOs will have to reach certain benchmarks on these measures.

The 429-page proposed rule will be published in the April 7 Federal Register; a display copy is available at www.ofr.gov/OFRUpload/OFRData/2011-07880_PI.pdf.

Other agencies also releasing information this week are:

CMS will accept comments on the proposed ACO rule through June 6. The DOJ/FTC will accept public comments through May 31, and the IRS will accept public comments through May 21.

Watch for more details in future Valued Voice newsletters as WHA continues its review of the proposed rule.

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New Legislator Profile: Rep. Howard Marklein (R-Spring Green)

A series of interviews with newly-elected legislators, by Mary Kay Grasmick, editor

Rep. Howard Marklein’s (R-Spring Green) ten years of experience on the Fort HealthCare Board of Directors was good preparation for his term in the Legislature.

"Howard was an excellent Board member at Fort HealthCare," according to Fort HealthCare CEO Mike Wallace. "He took the time to listen and become informed about the issues facing our organization. He brought an insightful and calming perspective to difficult issues and was always very skillful in making sure all viewpoints were heard."

Facing a daunting hole in the Medicaid budget, Marklein understands that controlling costs in the program is crucial. His hospital board experience, along with his background as a certified public accountant, has made Marklein very aware of the impact that government underpayments to Medicaid providers have on hospitals and how those unpaid costs are shifted to the private sector.

"I have a meeting set up with DHS to better understand the model, but I know we can’t keep spending money in the program like we are," Marklein said. "We need to develop solutions that are sensitive to the needy, but are cost effective."

Marklein says when costs are shifted, the private sector pays for it—the same people who are already working and paying for their own care.

"We have done a poor job for a long time in shifting costs to other taxpayers," Marklein said.

Also related to his experience as a hospital board member, Marklein expressed deep concern about the future of Wisconsin’s medical malpractice environment, and is "absolutely" concerned about the future composition of Wisconsin’s Supreme Court.

"I had a physician as a client a few years ago who left Wisconsin for another state, but once there, found the medical malpractice climate was making it extremely difficult for him to practice in that state because the insurance premiums were just impossibly high," Marklein said. "His was a story where he returned to Wisconsin because he appreciated our medical malpractice environment."

As a consumer himself, Marklein said he wants an ample supply of qualified physicians in our state. Medical malpractice caps on non-economic damages are one way to assure that Wisconsin can attract, and retain, physicians.

"Having served on a hospital board, I have seen the damage that a malpractice suit has on both the institution and on the individual. It is tragic," he said. "Good physicians are sometimes sued for things that they did not have a part of, and I’ve seen it take a toll. It subconsciously affects the way they practice and promotes defensive medicine, which drives up the price of health care for everyone."

Marklein sees an important role for hospitals in creating jobs in the Badger State. He believes that a focus on prevention, not just treatment, is critical.

"I would like to see more hospitals reach out to private sector employers and provide some non-traditional solutions to health care issues, such as contracting with a physician to come into their facility and provide care on site," he said. "It can drive down costs because it improves access to care and health issues could be identified early. It’s a win-win for both the health care provider and the company."

Marklein lists his two biggest priorities as a new legislator as balancing the state budget and getting the state’s fiscal house in order. With an accountant’s attention to detail, he has reviewed the audit reports of the State of Wisconsin and found "the trajectory of our spending is not sustainable."

"We need to make the tough decision to fix that glide path. I have looked at the Governor’s proposed budget and the fact that we are not adding to the deficit is a win-win for taxpayers," according to Marklein. "We are not digging the hole any deeper, and we’re spending less money that we did in the prior biennium for the first time for a very long time. That’s a win."

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DHS Begins Medicaid Listening Sessions

This week the Department of Health Services (DHS) began holding a series of listening sessions around the state to receive input on efficiencies and cost-savings related to Medicaid. The first session was held March 30 at Chippewa Valley Technical College in Eau Claire.

DHS says ideas from the sessions "… will help the department develop plans aimed at improving overall consumer care, streamlining program delivery and ensuring long-term sustainability."

In a letter delivered to DHS Secretary Dennis Smith and Deputy Secretary Kitty Rhoades (www.wha.org/DHSListeningSession3-30-11.pdf), WHA President Steve Brenton said the Association is anxious to work with the department to find sound and reasoned savings.

Brenton discussed the well-known challenges facing the Medicaid program, including the 300,000 new enrollees since 2007 and the over $450 million in GPR that was taken out of the program during this time of rapidly-escalating enrollment, replaced by one-time and limited-duration funding sources. Brenton described these types of funding sources as an unsustainable financing approach.

The principles that guide WHA’s Medicaid advocacy efforts were also highlighted in the letter.

Brenton praised the Administration for pursuing changes and reforms aimed at preserving the Medicaid safety net, rather than resorting to enrollment reductions seen in other states, and for seeking ideas from patients and providers.

WHA looks forward to working with the Administration and the legislature to develop sound changes to the Medicaid program.

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Register Today for WHA Advocacy Day, April 27

There’s still time to register yourself, your senior leadership team, your trustees and your volunteers for this year’s WHA Advocacy Day event, scheduled April 27. Advocacy Day is free of charge and takes place at the Monona Terrace in Madison.

As always, WHA has a great line up of speakers, including morning keynote Jim VandeHei, co-founder and executive editor of Politico, the highly-influential political news outlet. With a close-up view of what really happens in Washington, VandeHei will bring a frontline journalist’s insight and insider knowledge of Congress and the White House to Advocacy Day attendees.

The highlight of Advocacy Day is always the hundreds of attendees who take what they’ve learned during the day and put that into action by meeting with their legislators in the State Capitol in the afternoon. With the Capitol only a scant two blocks away (transportation will be available), you can speak up on behalf of your hospital by meeting with your legislators or their staffs. In these difficult budget times, hospital representatives need to meet with their legislators and make sure they are telling them about the value they provide to their communities and how program changes, like to the Medicaid program, will impact Wisconsin hospitals.

Join more than 650 of your peers from across the state at Advocacy Day 2011 on April 27. Register today. A complete program and online registration are available at http://events.SignUp4.com/AdvocacyDay. A printed copy of the Advocacy Day 2011 brochure is also included in this week’s Friday Packet. For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org. For registration questions, contact Lisa Littel at llittel@wha.org or 608-274-1820.

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Guest Column: Core Competencies in the New Era: A Final Reflection
By William Petasnick, CEO, Froedtert Health

Note: The Guest column below is an excerpt from an article – "It’s Time to Get on With the Work at Hand" (www.wha.org/TimeToGetOnWithTheWork.pdf) authored by William Petasnick, CEO, Froedtert Health and former AHA and WHA Chair(s) for the Journal of Health Care Management. Much of the article focuses on the importance of clinical integration as a tool for independent providers to align common strategies.

Health care reform has set the stage for the development of innovative approaches to improve the organization and delivery of health services at local and regional levels. Health care reform also brings significant uncertainty. Do not wait for clarity around the new legislation and related regulation and policies; waiting dramatically increases the risk of failure.

Health systems that excel in this emerging environment will be those that focus on quality and enhancing the patient care experience, are clinical innovators, have the ability to integrate care across the continuum, and are fiscally sound. As providers, we place a high value on technical expertise and standard protocols. To succeed in the future, we need to similarly embrace creative solutions that expand and improve our ability to share expertise and protocols. Successful health care systems need to continually evolve and relearn in response to our dynamic environment.

Universally recognized truths remain amid the uncertainty. Payments will decrease; we can and should manage costs down and restructure care delivery, even without knowledge of the exact amount and timing of payment cuts. Tolerance for fragmentation of care will continue to fall; we should build collaborative partnerships inside and outside of our organizations now to support the enhanced communication and coordination necessary to serve patients in the future. We don’t need the federal government to tell us that fragmentation is detrimental; we know it from our own experience as patients. Adjusting to regulatory details will be easier if we are already moving forward. It’s time to get going.

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Rep. Van Roy Shadows at St. Mary’s Hospital Medical Center

Recently St. Mary’s Hospital Medical Center (Green Bay) COO Larry Connors hosted State Rep. Karl Van Roy for a shadow day opportunity.

"I’m grateful for Rep. Van Roy’s interest in health care and his willingness to spend time learning about the challenges we face. It’s important in these challenging times to forge positive relationships with our local representatives," said Connors. "I found the opportunity to share information with Rep. Van Roy about health care and St. Mary’s in particular to be meaningful and rewarding."

WHA initiated shadow days in 2010 and continues to see how valuable these are in helping hospital CEOs convey to legislators what it takes to run a facility in today’s health care environment.

During Rep. Van Roy’s time at St. Mary’s he spent time in the emergency department (ED). The ED physicians were able to discuss how Medicaid reimbursement is becoming more prevalent in the ED, and how that is impacting the ability to attract and retain physicians. Van Roy spent time in the Cancer Center and learned how advances in technology are improving quality of life and extending life for many cancer patients. He spoke with a nursing supervisor and reviewed staffing grids, and he saw St. Mary’s roof garden and other efforts that led to St Mary’s receiving Project Greenhealth’s Environmental Leadership Award. Finally, he was able to hear from the Hispanic health educator on unmet health care needs in the area.

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Transforming Care at the Bedside Launch Draws Large Attendance
Wisconsin third Aligning Force for Quality state to host TCAB

Wisconsin’s Transforming Care at the Bedside (TCAB) initiative launched March 23-25 in Wisconsin Dells with more than 130 WHA members participating in the education event. Supported by Wisconsin’s statewide participation in an Aligning Forces for Quality (AF4Q) grant, 18 medical-surgical units from 16 Wisconsin hospitals began an 18-month improvement strategy. Directed and lead by nurses and other direct care givers, the goals of TCAB are to address and improve:

Hospitals sent teams comprised of the chief nursing officer, unit level manager and two or more staff nurses. Teams learned about quality processes, heard examples of successful staff-driven improvement efforts from around the country and practiced leadership skills. Every team left the three-day event with a ‘plan in hand’ for implementing activities on their own unit.

"The beauty of TCAB is that quality becomes practical in the hands of bedside nurses who are given the tools to conduct small tests of change, then adapt, adopt, or abandon those tests until an innovation becomes a new way of doing things," according to Judy Warmuth, WHA vice president, workforce.

The 18 TCAB units are also charged with spreading their improvement strategies to the entire hospital.

Experienced faculty from across the country shared their TCAB stories along with evidence of improvement and best practices they have implemented or invented. Jennifer Osterbauer, a nurse from Hudson Hospital, brought a local flavor to the faculty as Hudson was one of four Wisconsin hospitals that had participated in an earlier national TCAB collaborative.

Wisconsin is the third AF4Q community to launch its TCAB project. Minnesota led the way and Western New York began its project in January. Next in line are Maine, Oregon and New Mexico. Representatives from each state were present at the Wisconsin event.

"We are looking forward to seeing what innovative approaches our teams come up with through the TCAB experience," says WHA’s TCAB Project Manager, Stephanie Sobczak. "This will be a lot of fun while at the same time we will improve the quality and safety of patient care in Wisconsin."

Hospital teams left the kick-off energized to be part of a national program lead by caregivers designed to improve all aspects of medical-surgical unit performance.

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Wisconsin Hospitals are Ready to Respond and Protect Their Communities
New WHA report showcases hospitals preparedness activities

Hospitals have always been crucial to a community’s ability to respond to an emergency. Whether it is flooding or a flu pandemic, Wisconsin hospitals stand at the ready. The community looks to the hospital not only for medical care, but as a "safe haven" and coordination point when disaster strikes.

This week’s packet includes a copy of a report that WHA prepared with support from Dennis Tomczyk, director of the Wisconsin Hospital Emergency Preparedness Program (WHEPP). The report features hundreds of quotes from Wisconsin hospital emergency preparedness coordinators, safety officers, and regional preparedness experts. The report is also posted to the WHA Web site: www.wha.org/disasterpreparedness/pdf/WHEPPreport2011.pdf.

"The progress we have made in emergency preparedness since the events of 9/11 show what is possible when hospitals work together toward a common goal and a commitment to strengthen preparedness in their community, the region, and in our state," according to WHA President Steve Brenton.

Tomczyk describes the WHEPP as a peer-to-peer program, "designed by hospitals for hospitals."

"Our leadership groups have met monthly since 2002, and they represent all sizes of hospitals and all ranges of medical disciplines," Tomczyk said. "Their time and expertise, as well as the federal commitment to fund and implement their recommendations, have made Wisconsin one of the nation’s more disaster-ready states."

This report showcases how the dedication of individuals and their hospitals, with the support of WHEPP and the Wisconsin Division of Public Health, have strengthened emergency preparedness throughout the state. While progress has been made, emergency preparedness is an ongoing process of continuous improvement. When disaster does strike, Wisconsin’s health care professionals will know how to respond in the best possible way to protect the communities they serve—their core mission.

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New Hospital Outpatient Rates in Effect for HIRSP Program
Selected services to be paid according to statewide fee schedule

The Health Insurance Risk-Sharing Plan (HIRSP) is implementing a new reimbursement approach for selected hospital outpatient services, effective April 1, 2011.

Hospital outpatient services billed under 33 specific revenue codes will be paid according to a statewide fee schedule. All other hospital outpatient services will continue to be paid at the existing discount off billed charges.

The affected revenue codes and maximum fees for each CPT code can be found online at www.hirsp.org/provider.

HIRSP is Wisconsin’s health insurance program for medically uninsurable individuals who do not have access to employer-sponsored health insurance. The program currently covers about 20,000 members.

Joe Kachelski is WHA’s representative on the HIRSP Authority Board of Directors. Questions about HIRSP can be directed to him at jkachelski@wishin.org.

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Workforce Alliances Present at Workforce Council, Group Reviews IOM Report

In some parts of Wisconsin, employers and educators have formed alliances to assure that a sufficient number of health care workers are available to meet the current and future demand for workers. Each group is doing good work, but without necessarily knowing what the other groups are doing.

Three of these Alliances presented at the March 22 meeting of the WHA Workforce Council in Madison. Several members of the Council also serve on these Alliances, facilitating communication among the groups, which is a good fit with the role of the Council. Council members presented the following reports:

Southern and South Western Regional Workforce Alliance. WHA’s Judy Warmuth and Rural Wisconsin Health Cooperative’s JoAnne Preston described several of this group’s projects, including an online resource map, which Preston demonstrated. Council member Jan Bultema, senior vice president, human resources at University Hospitals and Clinics, is the past president of this Alliance, and Nicole Clapp, CEO, Grant Regional Medical Center is the new chair. Clapp is also a member of WHA’s Workforce Council.

Fox Valley Health Care Workforce Alliance. Council member Linda Mingus, director, human resources, Aurora Medical Center-Oshkosh, guided the group through the FVHCA Web site including discussion of the region-wide standardized process for student clinical placements and the job shadowing project. The Web site can be found at www.fvhca.org.

Lakeshore Health Care Alliance. Council member Carrie Penovich, director clinical and support services, Aurora Medical Center, Two Rivers, described past and current activities of this Alliance including the Health Career Academy and current initiatives aimed at entry level workers in the home and nursing homes. The Web site for that Alliance is www.lshca.org.

The Council reviewed the recommendation in the Institute of Medicine’s report on the "Future of Nursing" related to the educational preparation of registered nurses and nurse residency programs. The Council also provided input to Warmuth about the current nurse practitioners and physician assistant supply and demand in Wisconsin hospitals. Warmuth will share that information with education program leaders as she meets with them across the state.

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Member News: Columbus Hospital Names New CEO

John Russell, administrator at Boscobel Area Health Care since 2008, has accepted the position of president and chief executive officer at Columbus Community Hospital.

Russell comes to Columbus Community Hospital with nearly 20 years of experience in the health care arena. Much of his career has focused on critical access hospitals, as he is the former chief financial officer for an organization that specialized in returning struggling critical access hospitals to success, both financially and culturally. Russell was also a consultant to health care facilities across the western half of the United States. His expertise in consulting and reimbursement led him to become a nationally-recognized speaker on these topics.

Russell will assume his role at Columbus Community Hospital on May 3.

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Member News: Governor Nominates Van Meeteren for WHEFA Board Appointment

Governor Scott Walker has nominated two WHA recommendations for appointments to the Wisconsin Health and Educational Facilities Authority (WHEFA) Board. WHEFA has been providing capital financing assistance for health care institutions since 1979. Its charter has also been expanded over the years to include the issuance of bonds for educational and non-profit research facilities.

Bob Van Meeteren, CEO at Reedsburg Area Medical Center, has been nominated to fill a vacant seat on the WHEFA Board with the term expiring July 1, 2013. Because he filling a vacant seat, rules allow Van Meeteren to begin serving immediately, although Wisconsin Senate confirmation is required.

As CEO at Reedsburg Area Medical Center, Van Meeteren oversees a diverse healthcare facility that includes a critical access hospital, a skilled nursing facility, a 50-bed long-term care senior life center and a 24-apartment assisted living facility. Van Meeteren’s experience includes practical knowledge of WHEFA, having worked with them on debt refinancing issues and tax-exempt bonds. He has an undergraduate degree and an MBA in Health Services Administration from the University of South Dakota.

Nominated for re-appointment to WHEFA was Tim Size, executive director of the Rural Wisconsin Health Cooperative (RWHC). Size is a long-time WHEFA Board member, having first been appointed by then-Governor Thompson in 1988. Size’s current appointment expires July 1, 2011. His new term would expire in 2018.

Size, who helped begin RWHC in 1980, is currently the longest serving member of WHEFA. He is well known in Wisconsin, having been active in a variety of roles since 1974. With the upcoming retirement of WHEFA’s executive director, Size will bring continuity to WHEFA operations.

WHA recommended each of these individuals for appointments because of their diverse and well-developed knowledge across a broad skill set. This knowledge will make them valuable assets as WHEFA works to fulfill its mission of assisting all eligible borrowers in obtaining and maintaining access to the broadest range of low cost, private capital market funding possible.

Required Senate confirmation for both nominees is expected in the next several weeks.

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Community Memorial Hospital, Oconto Falls, Seeks CEO

Community Memorial Hospital seeks an experienced health care executive for the position of chief executive officer at their facility located in Oconto Falls. This rare opportunity comes with the retirement of the hospital’s current chief executive. Community Memorial Hospital is a 25-bed Critical Access Hospital with six primary care clinics.

Successful candidates for the hospital CEO position will have at least five years of acute care hospital senior leadership experience, along with an open, friendly and approachable demeanor and excellent communication skills. In addition, candidates should have a successful track record of physician recruitment and retention, enjoy a high level of community involvement, and demonstrate a keen awareness of the hospital’s market along with the vision and leadership to ensure a successful future for the organization. Prior hospital CEO experience is preferred, and Critical Access Hospital experience is also desired. A Bachelor’s degree in business or healthcare administration is needed; a Master’s degree is preferred, or completion within five years of hire. Fellow status in ACHE is also desirable. To apply for this position, send your resume to: Community Memorial Hospital, 855 South Main Street, Oconto Falls, WI 54154, Attn. Human Resources Department. For further information contact Trisha Brown at trishabr@cmhocontofalls.org or 920-846-3485 or visit www.cmhospital.org.

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Guest Column: Workplace Wellness–from Slogan to Reality
by Tim Size, Executive Director, Rural Wisconsin Health Cooperative, Sauk City

When I used Google to search on the Internet for the word "wellness," the first response was Wellness® - Healthy Dog and Cat Food. "See what our customers say about our quality healthy dog and cat food and discover the difference WELLNESS® all natural pet food makes."

I don’t believe that most of us care more about our pets than ourselves. If we could buy human wellness in a can once a week, we’d clean out the stores. But aging houses and bodies share the need for sweat equity. I know from experience, easier said than done.

I also am pretty sure that none of us gets out of here alive. And sooner or later all of us will face tough challenges to our health that diet and exercise and attitude will do little to change. But what we do, for most of us most of the time, makes a huge difference in how well we enjoy the trip.

There are numerous carefully crafted definitions of "wellness." For me, it simply means feeling healthy. The challenge is how do we each make it happen? What incentives at work and home are most effective in helping us to engage in our own health over the long run? I don’t know the answers for you, just that these are the right questions. Google "wellness tips" and you’ll bypass pet food to many organizations with practical advice.

Every year there is an endless series of National This or That Week or Month for every body part and cause. The "skip over ads" button on my remote protects my quality couch time so I am not much distracted. But as an early baby boomer, the "joys" of an aging body continue to remind me I can’t take health for granted. My only regret is that I wish I had figured it out 20 years earlier.

Hopefully fewer people will make my mistake. Something is changing in our country. Wellness the slogan is starting to become a mainstream reality. Or at least it is something more of us are trying for and with more support. Employers are beginning to think about employee wellness. For those of us fortunate to have a job, too much time is spent at work to restrict wellness to after hours.

More of us now know that our health is too important to expect someone else to fix it after we run it down. And we all know we have less money to pay for repairs. Most employers care about the people they work with, day after day. But they also are beginning to understand that an investment in wellness can have a real payback to the organization, whether for profit or non-profit.

Employers are changing because the benefits are becoming clearer, according to a recent study release by the American Hospital Association, "A Call to Action: Creating a Culture of Health."

This year, join me in dropping the donut at work and getting off the couch at home.

The first week in April is National Workplace Wellness Week, sponsored by the American Heart Association. AHA believes worksite wellness programs are critical to addressing our nation’s soaring healthcare costs, rising obesity rates and increasing prevalence of chronic disease. A comprehensive program should include tobacco cessation and prevention, physical activity, stress management/reduction, early detection/screening, nutrition education, weight management, training in CPR, AED, First Aid and cardiovascular disease prevention. For more information visit www.americanheart.org/workplacewellness.org.

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Population Health Institute Releases 2011 County Health Rankings
Data useful in developing community health needs assessment plan

The University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation released the 2011 County Health Rankings March 30. This report is a valuable resource for hospitals as they develop their community health needs assessment.

WHA is working closely with Julie Willem Van Dijk, RN, PhD, associate scientist/community engagement lead at the University of Wisconsin Population Health Institute, to develop tools that will be helpful to hospitals as they develop a plan for their own communities.

In a recent column in WHA’s Valued Voice, Willems Van Dijk encouraged hospitals to review the County Health Rankings data as a first step. The Take Action section of the County Health Rankings website provides links to numerous resources to guide your assessment process.

The County Health Rankings are the most comprehensive report of its kind to rank the overall health of nearly every county in all 50 states by using a standard way to measure how healthy people are and how long they live. The Rankings illustrate that where we live, learn work and play influences our health and how long we live.

Ozaukee County has the healthiest residents in Wisconsin and Menominee County is the least healthy county in the state, according to the 2011 County Health Rankings.

Wisconsin’s five healthiest counties are:

The five counties in the poorest health are:

• Ozaukee

• Menominee

• St. Croix

• Adams

• Washington

• Marquette

• Waukesha

• Milwaukee

• Taylor

• Jackson

The healthiest of Wisconsin’s 72 counties are largely suburban counties near the city of Milwaukee and on the border with the Minneapolis-St. Paul metropolitan area with the exception of Taylor County; the least healthy counties are primarily located in rural areas of central and northern Wisconsin with the exception of Milwaukee County, the state’s most urban county, in the southeast.

"The Rankings help county leaders see what is affecting the health of local residents," says Dr. Patrick Remington, associate dean for public health at the University of Wisconsin School of Medicine and Public Health. "Leading a healthy lifestyle is much easier if you live in a healthy community - such as one that has access to quality early childhood education programs, access to healthier foods or has created more opportunities for physical activity."

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Save The Date: Wednesday May 11 – Community Needs Assessment Webinar

As you may be aware, Community Health Needs Assessments have been added to IRS Form 990, Schedule H and will need to be completed by every hospital starting in tax years beginning after March 23, 2012.

WHA recognizes a need for additional training on Community Health Needs Assessments. WHA has teamed up with UW’s Julie Williems Van Dijk to hold an informational webinar on Wednesday, May 11, 2011 from 9:00a.m.-10:00a.m. Van Dijk received a grant to work with Wisconsin hospitals and public health to implement community health needs assessments by bridging the gap.

Individuals completing Form 990, Schedule H, individuals involved with public health and community work, and individuals involved with community benefits should plan to participate.

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Upland Hills "Goes for the Gold" and Sees Employee Flu Vaccination Rate Climb

As she compared the employee influenza vaccination rates from 2009-2010 to the current flu season, Maria Leary, RN, infection prevention employee health coordinator at Upland Hills Health in Dodgeville, was pleasantly surprised.

"We saw a pretty significant jump in our rate, from 81 percent last year, to 87.5 percent this year," according to Leary. Upland Hills has been a member of the Department of Health’s "80% Club" for several years.

Leary believes the increase this year is the result of the attention generated last year during the H1N1 outbreak. She also credits their participation in The Joint Commission’s influenza campaign this year, which brought a new element into her local effort.

"The Joint Commission’s Flu Vaccination Challenge provides a lot of new resources that we found helpful this year," according to Leary. "It gives you ideas on best practices, and you receive recognition for attaining various levels of employee immunization rates."

There are three levels to The Joint Commission’s challenge: bronze is a 75 percent employee immunization level or more; silver is 85 percent and better; and gold is 95 percent or more. Upland Hill’s campaign theme was, "Going for the Gold."

Support from administration is important, according to Leary. CEO Phyllis Fritsch lends her voice to the campaign with messages from administration that encourage employees to protect themselves and their patients from influenza. Nursing administration also supported the efforts with nursing house supervisors and emergency department staff providing immunizations for night and weekend staff.

Leary said for the past four years, Upland Hills has required a signed declination statement from employees that refuse the vaccination. This year, the form had to be picked up at and returned to the employee health office. She said this enables her to meet with the employee and discuss their concern about the vaccine or reason for refusing it. Before signing the declination, the employee is required to read the educational materials. The most common reason employees give for not getting a flu shot?

"Some people say they have never received the flu shot because they have never had influenza," she explained. "For others, it is a personal choice that they just don’t like vaccinations in general."

Leary said she has found that the younger staff members are more apt to decline the flu vaccination than their more seasoned colleagues, perhaps because it has not become a routine. No matter the reason, Leary said by December 15, all employees were required to either receive the vaccination or sign a declination form, or they were removed from the schedule.

Leary said it is not "necessarily popular" but it enables the hospital to reach its goal of having every employee finish the flu vaccination process before the flu season begins.

"In health care it’s about more than just you," Leary said. "Getting the flu shot is important to you, your patient, and your family."

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Wisconsin Hospitals Community Benefits: Physical Activity

The increasing rates of obesity among adults and children are raising concerns because of the dire implications on American’s health. In communities across Wisconsin, hospitals are dedicating resources and doing what they can to encourage people of all ages to lose weight and stay active.

The Living Well Series

For many, living well requires a little extra help and support, and the Aurora West Allis Medical Center provides it through a 12-month program. The year-long series includes educational classes and an on-site program coordinator who helps participants make the lifestyle and behavior changes necessary to prevent diabetes, reduce risk of cardiovascular disease and maintain weight to achieve optimal health for a lifetime.

The program is divided into two phases for which participants can enroll separately. The first phase consists of three months of weekly meetings and a three-month gym membership to the Wisconsin Athletic club. The second phase is a nine-month maintenance program with biweekly meetings for two months, then monthly meetings.

For women unable to make two six-month commitments, the Aurora Women’s Pavilion teams up with the Karen Yontz Center and provides no shortage of alternatives to help women achieve optimal health through the life span. One example is a six-week course to improve women’s cardiovascular fitness, balance, core strength and muscle tone. Instruction is provided at individual and group exercise stations to provide the participants with the experience of interval training.

Aurora West Allis Medical Center

"Motivating People to Move"

Monroe, Wis. event offers inspiration and ideas for healthier living

Good health practices don’t always originate in the doctor’s office. Sometimes they begin in a high school parking lot under the instruction of an enthusiastic man and his Nordic walking poles.

On March 22, 2010, Monroe Clinic and The Swiss Colony partnered to host a community presentation in Monroe, Wis. The two-part event, called "Motivate Monroe to Move!" featured Robert Sweetgall, a motivational speaker with a passion for active living. Marcey Sink, Monroe Clinic community health education coordinator, and Tracey Meier, The Swiss Colony human resource manager, worked closely together to organize the event that would attract and inspire the community to approach an active lifestyle with a fresh perspective.

"When it comes to healthy living, Sweetgall walks the walk and talks the talk. The man radiates with energy, and it’s motivating just to be in the same room with him," said Sink.

The first portion of the event focused on the activity of Nordic walking and took place in the parking lot of Monroe High School. Robert split the crowd of 50 into smaller groups, teaching them various ways to use the Nordic walking—or Exerstrider®—poles, then he organized relay races that allowed the participants to put their newfound skills to work.

The second part of the evening took place inside the school’s auditorium, where a larger audience of 120 people listened as Robert shared his personal story of his trek across the United States and offered those in attendance advice on making positive changes in their health and lifestyles.

Among those in attendance for both presentations was Janice Everson of Monroe, who came with her husband, Dennis. While the Eversons were inspired by Robert’s story of his walk across America, they particularly enjoyed the earlier Nordic walking demonstration.

"Robert gave us several demonstrations of different ways that we could use the poles, and then we each tried what he had just demonstrated. We divided into groups and had races against the others," said Janice. "We really enjoyed seeing Robert put the poles in motion and show us how to use them."

The Eversons enjoyed the demonstration so much, they both purchased their own poles, which they have grown comfortable using during walks.

While "Motivate Monroe to Move!" offered area residents an evening of hands-on fun and information, the overall objective went deeper. According to the U.S. Department of Health and Human Services, 37 percent of adults report they are not physically active, and only three in 10 adults get the recommended amount of physical activity.

The resulting situation is a local and national example of how doing nothing is actually doing something—something dangerous and damaging to the lives of American adults and children. Diabetes, heart disease and obesity are at epidemic levels, and these serious illnesses are striking younger populations more than ever before.

"Monroe Clinic and The Swiss Colony are the community’s two largest employers. So these statistics aren’t just statistics. They’re the people who make up our workforce, our patients and customers, our communities, and our children," said Sink. "These statistics are also proof that it’s time to get creative and look for new ways to integrate physical activity into our lives. Hopefully, events like ‘Motivate Monroe to Move!’ can offer a fresh and exciting perspective on exercise. And if one person embraces a healthier lifestyle because of this event, then it’s a success."

Monroe Clinic, Monroe

Door Weigh to Family Health program

Door County Memorial Hospital in partnership with the Door County YMCA offers their community a unique wellness program opportunity for families.

Door Weigh to Family Health is a program created by a team of professionals from both Door County Memorial Hospital and the YMCA with the intent to take initiative against a growing problem in this country—childhood obesity. Rates of childhood obesity are sky rocketing and Door County is not benign from this epidemic. Door Weigh to Family Health is a multidisciplinary 12-week parent/child class which meets weekly. Classes are lead by a registered dietitian, social worker and physical fitness instructor. Each week, parents and kids together practice ways to increase daily activity and set achievable eating and exercise goals. Children learn exercises designed for their weight levels and families enjoy menu plans with nutritious kid-tested recipes. Parents learn positive ways to coach children to make healthier lifestyle choices. Each class is filled with fun and learning. Kids are referred from their doctor, nurse, school nurse, school counselor or other friends and family who have experienced the program. The main focus is fun, although, in all that fun they are learning about nutrition, making healthier food choices, increasing physical activity and feeling better about themselves. Kids age 6-18 are invited to join, although at least one parent is required to attend with the child.

Several life changes have been made by the families who have participated in Door Weigh to Family Health. Parents report their kids’ physical education teachers notice increased participation in P.E. class. Other remarks from parents are; "We eat out less," "We cook healthier meals and plan our meals more often," "We eat more fruits and vegetables." Parents state they catch their kids reading food labels, and more importantly, they are found making healthier food choices. Kids comment they look forward to class and have fun while parents notice their kids are learning through the games they play without even realizing it. Parents themselves feel the benefit as the whole family is encouraged to make changes and get healthy together.

Door Weigh to Family Health began in February 2008. Plans to continue this program are underway with discussion regarding expanding the program out into the county schools or after school programs. So far, Door Weigh to Family Health has helped improve the lives of about 30 families (approximately 100 people) in our community. Ultimately touching the lives of many more kids/families is our hope and goal.

Ministry Health Care’s Door County Memorial Hospital, Sturgeon Bay

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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