April 15, 2011
Volume 55, Issue 15

WHA Medicaid Reform Group Holds Second Meeting

On April14 the WHA Medicaid Reengineering Group (MRG) held it’s second of at least four planned meetings. The group, which is comprised of member CEOs and CFOs, was created to study various aspects of the Wisconsin Medicaid program and develop recommendations for/reaction to Medicaid reforms being developed by the Walker Administration and the Legislature.

This week’s meeting focused on issues related to eligibility and enrollment. Future issues include pay for performance, program benefits, and care coordination.

"It is clear there are changes coming to the Medicaid program from both Madison and Washington," said Nick Desien, CEO of Ministry Health and chair of the MRG. "We don’t want to simply react—we need to be at the table with ideas and input; that’s what this process is about."

The MRG is scheduled to meet at least three more times through May. Their work is guided by a set of policy principles that include:

  1. Financial incentives that are based on patient outcomes must be tied to the ability to affect the outcome.
  2. The administrative burden and cost of any recommendation must be recognized and balanced against the benefit of the recommendation.
  3. Decreases in eligibility and enrollment changes should be targeted to individuals and families that have other coverage options.
  4. To the extent they are able, consumers should share directly in the financial responsibility for covering the costs of their health care needs and engaging in behaviors that improve their health care status.
  5. Program benefit options should preserve core services.

"These are complex issues that require a high degree of engagement," said WHA Executive Vice President Eric Borgerding. "We appreciate the willingness of members to commit the time it takes to not only attend, but to prepare for these substantive meetings."

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2011 Wisconsin Rural Health Conference
A Call to Action – Maintaining Steady Ground in Unsteady Times

Join your colleagues at the beautiful Osthoff Resort on the shores of Elkhart Lake for this year’s Wisconsin Rural Health Conference, scheduled June 15-17. This annual event is the forum for examining the issues that impact small and rural hospitals most, networking with colleagues, and bonding with your team of senior staff and trustees.

The 2011 conference will feature keynote speaker Dr. Joe Bujak, a nationally-known speaker and consultant on hospital, physician and board of trustee relationships. He will focus on ways to assess physician opinion, engage physicians in support of organizational goals and create mutually beneficial relationships.

In addition, this year’s conference will again offer the popular governance education track, offering board of trustee members and their CEOs sessions focused on health care reform, a board’s role in quality improvement, and how health care payments are changing to reward high quality and low cost.

This year’s event will take full advantage of The Osthoff Resort’s beautiful setting on Elkhart Lake. Plan to join your colleagues at the Wednesday evening welcome reception for networking and a chance to visit corporate member exhibitors. Register to bring your families and guests to the Thursday evening dinner on the shores of Elkhart Lake, for a great meal, networking, and the relaxing sounds of the steel drum band.

The annual Wisconsin Rural Health Conference is a great way for hospital executives, leadership staff and trustees to take advantage of great education, right in your backyard, at a fraction of the travel and registration costs of out-of-state events. Make sure to register by June 1, and make your hotel reservations as soon as possible but before the deadline date of May 23. Due to a race at Road America, it is very likely that no hotel rooms will be available to conference attendees after that date. It is recommended that you make your hotel reservations immediately to avoid problems.

The full conference brochure with registration information is included in this week’s packet and is available online at www.wha.org.

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Wisconsin Hospitals in DC to Talk With Congressional Delegation
Mary Starmann-Harrison Receives AHA "Grassroots Champion" Award

Over a dozen hospital representatives were in Washington, DC this week at the American Hospital Association’s Annual Meeting and day on Capitol Hill. On the top of the list of issues discussed with Wisconsin Members of Congress were Medicaid provider taxes and Medicaid flexibility for the state.

"With a current $1.8 billion Medicaid deficit in Wisconsin, any changes to the Medicaid program at the federal level will significantly impact Wisconsin hospitals," WHA President Steve Brenton said.

Brenton was referring to proposed changes to Medicaid provider taxes, as espoused by President Obama and the Federal Deficit Commission.

"Limiting or eliminating a state’s ability to use provider taxes will directly impact Wisconsin’s Medicaid program and hospitals," said Brenton. "The trickledown effect will be reduced access for the patients who need this safety net program, increased emergency room visits, higher levels of uncompensated care and increased cost shifting onto employers."

In further discussing the Medicaid program, hospital representatives asked for Members of Congress to support more flexibility under current Maintenance of Effort (MOE) restrictions on states. Current MOE provisions under the health reform law do not allow states much flexibility in adjusting their Medicaid programs. Hospital representatives indicated some level of flexibility would be far better than eliminating tens of thousands of low income individuals from the program.

Hospital representatives also took the opportunity to alert legislators to the level of resources (staff and capital) being used to implement and adopt Electronic Health Records (EHR) in order to meet meaningful use requirements and apply for electronic health record incentive payments. WHA highlighted this issue because some in Congress are proposing to roll back unused stimulus dollars, including already promised incentive payment dollars.

WHA staff continues to believe attending the AHA Annual Meeting and spending a day on the Hill visiting Wisconsin’s Congressional delegation is an important element of its overall advocacy program.

Mary Starmann-Harrison Receives AHA "Grassroots Champion" Award

The AHA, in partnership with WHA, awarded Mary Starmann-Harrison, past president & CEO of SSM Healthcare-Wisconsin and current president & CEO of Hospital Systems Health System (which includes five Wisconsin hospitals), with the "Grassroots Champion" award for Wisconsin. Grassroots champions were honored at a breakfast event held during the AHA Annual Meeting in DC on April 12. As an award honoree, Mary was recognized for her exceptional leadership in generating grassroots activity on important hospital and health care issues.

"Mary is one of those individuals with whom you truly enjoy working," said Jenny Boese, WHA’s vice president of external relations & member advocacy. "She is energetic, innovative and when she commits to something, you know it will be done. Mary is well deserving of this award."

The Grassroots Champion Award was created by AHA to recognize hospital leaders who most effectively educate elected officials on how major issues affect the hospital’s vital role in the community and who are tireless advocates for hospitals and patients.

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Health Information Leaders Meet in Baltimore for ICD-10 Summit

Over 500 health information professionals met in Baltimore April 11-12 to discuss the strategies and tactics for industry success related to ICD-10 implementation. The participants included provider, payer, and regulatory agency representatives. The lead sponsor of the event was the American Health Information Management Association (AHIMA) with several cosponsors including the American Hospital Association. Bonnie Cassidy, MPA, RHIA, FAHIMA, FHIMSS, 2011 AHIMA president, stated the by June 2011, providers and payers should have completed organizational awareness training, established an executive leadership strategy including a budget through 2013, performed an impact assessment, conducted a system inventory, completed a comprehensive gap analysis, established a timeline, determined a plan for training and management of contractual changes, and continued ongoing organizational management of the 5010 electronic claim form.

Karen Trudel, director, Office of E-Health Standards and Services, CMS, emphasized the relationship between ICD-10 and other health care initiatives and regulations. She noted Version 5010 of the electronic claim form is a prerequisite to ICD-10, while the HITECH Act and the Affordable Care Act have overlapping timelines with ICD-10 and will be affected by ICD-10 operations. The integration of these health care initiatives is an opportunity to leverage ICD-10 implementation to improve effectiveness.

A summary of the presentations from the summit are available at http://journal.ahima.org/icdsummit.

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President’s Column: "Counterproductive and Asinine"

"These rules are counterproductive and asinine!" That’s the harsh assessment of the proposed Accountable Care Organization (ACO) rules made by a senior state hospital association leader at an AHA Washington meeting/briefing last Sunday morning. His non-nuanced comments were met by thunderous laughter and applause from colleagues who had just listened to a somewhat rosy AHA staff analysis of new regulations—regulations that are supposed to encourage hospitals and physicians to reduce unnecessary Medicare spending by "sharing" savings gained by more efficiently managing the care of Medicare patients.

Q. Where does one begin to describe the stunning flaws littered throughout these rules?

A. Well, how about the fact that Medicare beneficiaries will be assigned retrospectively to the ACO? And how about the fact that the ACO will be prohibited from discouraging Medicare patients from getting their health care from providers outside the ACO network? Imagine the challenge of managing risk with those dynamics in play.

The ACO provisions were considered an important tool within ACA that providers would embrace to either begin—or in some cases accelerate—integration and new clinical approaches to better align payment and delivery. But unless dramatically deconstructed and rehabilitated…ACOs may end up being an expensive boondoggle. And did I mention that the average expense likely to be incurred in starting up an ACO will approach $2 million?

The proposed rule, according to AHA and others, also fails to provide adequate Stark, Anti-Kickback, CMP, and anti-trust expectations and "safe harbors" needed to support clinical integration by independent hospitals and physician groups that want to jointly manage risk while remaining independent. The rules also fail to reward ACOs that manage risk in traditionally low spending areas of the country (WI, IA, MN, etc.) by including a national component in the benchmark used to determine "shared savings." So all of the hard work in communities like La Crosse, Madison and Appleton that went on prior to 2010 goes unrewarded. Sound familiar?

WHA staff is working on comments associated with the proposed rules. AHA is doing the same. But given past experience, the notion that major changes will be forthcoming is unrealistic. Hospitals and physicians looking for integration "training wheels" won’t likely find them here. And organizations looking for a vehicle to manage Medicare risk may need to seek other pathways.

Steve Brenton

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Worker’s Compensation Advisory Council Begins Biennial Negotiations
Management proposes to cut provider reimbursement

The Worker’s Compensation Advisory Council (WCAC) this week started negotiating this legislative session’s Worker’s Compensation bill. As previously outlined in the Valued Voice, the WCAC voting members include five representatives of "labor" and five representatives of "management." Worker’s Compensation insurer representatives are nonvoting members but sit at the WCAC table. Three health care provider organizations are nonvoting "liaisons" to the WCAC: WHA, the Wisconsin Medical Society, and the Wisconsin Chiropractic Association. After the WCAC unanimously approves an "agreed to" bill, the Wisconsin Legislature traditionally passes the bill without amendment.

After opening remarks by the new secretary of the Wisconsin Department of Workforce Development, Manny Perez, the labor and management representatives exchanged proposals, both of which will be available on the WHA Web site. The management proposal includes several provisions that would affect hospitals and other health care providers. Management would cap reimbursement for health care services at one standard deviation above the mean rather than the current 1.4 standard deviations. The proposal likely would affect reimbursement for trauma care and other services provided to the most seriously injured workers. The management proposal also would allow employers to direct care to the providers of the employer’s choice for the first 90 days of treatment. Management proposes codifying the current treatment parameters to create a presumption for determining necessity of treatment.

WHA and the other provider liaisons will work with the WCAC to improve the proposed changes to the Wisconsin Worker’s Compensation system. The WCAC intends to complete its work on the "agreed to" bill by August 2011. If the WCAC meets its timeline, the bill will be introduced in the Legislature in September 2011. Watch The Valued Voice for more information as the WCAC’s negotiations continue.

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Advocacy Day Surges Past 600, Close to 400 Will Meet With Legislators
Final days to register for this premier event, http://events.SignUp4.com/AdvocacyDay

The Wisconsin Hospital Association’s Advocacy Day event topped the 600 mark again this year and is closing in on 700 registrations! Close to 400 of those attendees are planning to take the hospital message to the halls of the State Capitol during this important legislative advocacy day. If you have yet to register yourself or your hospital contingent, please do so today. Advocacy Day is scheduled April 27 in Madison at the Monona Terrace.

Jim VandeHei is the featured keynote speaker at Advocacy Day. He is co-founder and executive editor of Politico, the highly influential political newspaper and web site that Washingtonian magazine recently hailed as a "media phenomenon." 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. Close to 400 attendees are already planning on visiting with their legislators or staff, but it is not too late for more to do so. Hospitals 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 those to the Medicaid program, will impact Wisconsin hospitals.

Make sure to register for Advocacy Day now. There are only a few days left before this important event. The full brochure and online registration are available at http://events.SignUp4.com/AdvocacyDay.

For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org.

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Grassroots Spotlight: Rep. Petri Visits Moundview Memorial Hospital & Clinics

U.S. Representative Tom Petri visited Moundview Memorial Hospital & Clinics on Monday, April 11, where he met with the hospital’s management team to discuss rural hospital health care issues and concerns.

"We shared with Rep. Petri some of the difficult decisions our hospital has had to make in recent years, including discontinuing service lines which ultimately decreased the hospitals expenses by 20 percent and helped return us to profitability," said Jeremy Normington, CEO at Moundview. "We also discussed the impact that the state and federal budget proposals may have on our hospital.

"With budget challenges, an increasing number of baby boomers retiring, and ever changing technology needs, health care is a continuously evolving industry," said Normington. "Any opportunity we have to educate our legislators about health care in Wisconsin will help them to make more informed decisions on behalf of our hospital and community."

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CMS Announces "Partnership for Patients" Initiative

This week Health and Human Services Secretary Kathleen Sebelius announced the Partnership for Patients, a new national partnership that HHS says will help improve care and lower costs over the next three years. Sebelius said the Partnership’s goal is to reduce costs to the Medicare program by about $50 billion over the next ten years, a move that is expected to result in billions more in Medicaid savings.

In a statement, AHA President/CEO Rich Umbdenstock applauded the Secretary for bringing stakeholders together—consumers, doctors, hospitals, federal and state regulators and other payers—in an effort to strengthen the health care system for all patients.

HHS announced it would invest up to $1 billion in federal funding, made available under the Affordable Care Act. $500 million of that funding was made available through the Community-based Care Transitions Program. Up to $500 million more will be dedicated from the Centers for Medicare & Medicaid Services (CMS) Innovation Center to support new demonstrations related to reducing hospital-acquired conditions. The funding will be invested in reforms that help achieve two shared goals:

  • Keep hospital patients from getting injured or sicker
  • Help patients heal without complication

The Partnership will target all forms of harm to patients but will start by asking hospitals to focus on nine types of medical errors and complications where the potential for dramatic reductions in harm rates has been demonstrated by pioneering hospitals and systems across the country. These nine areas of initial focus include:

  • Adverse Drug Events (ADE)
  • Catheter-Associated Urinary Tract Infections (CAUTI)
  • Central Line Associated Blood Stream Infections (CLABSI)
  • Injuries from Falls and Immobility
  • Obstetrical Adverse Events
  • Pressure Ulcers
  • Surgical Site Infections
  • Venous Thromboembolism (VTE)
  • Ventilator-Associated Pneumonia (VAP)

In coordination with stakeholders from across the health care system, the CMS Innovation Center is planning to use up to $500 million in additional funding to test different models of improving patient care and patient engagement and collaboration in order to reduce hospital-acquired conditions and improve care transitions nationwide. These collaborative models will help hospitals adopt effective interventions for improving patient safety in their facilities.

Many Wisconsin hospitals have already been working hard to improve in the areas covered in this new program according to WHA Chief Quality Officer Kelly Court. Court also added that WHA will be seeking additional details such as how hospitals can become involved, potential new measures and links to reimbursement. As soon as more details are released they will be communicated to hospital executives and quality leaders.

For more information about the Partnership for Patients, visit www.HealthCare.gov/center/programs/partnership. For a fact sheet on today’s announcement, visit www.HealthCare.gov/news/factsheets/partnership04122011a.html. For more information about the Community-based Care Transitions Program funding opportunity, visit www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1239313.

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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.

Community members put their heart n’ sole in walking

If she doesn’t get her morning walk, Patricia Holstein of Eau Claire says she doesn’t feel like herself.

Thankfully, even in a long Wisconsin winter, Patricia and her husband, Gary, have somewhere warm and dry to walk for free. The Holsteins participate in Heart N’ Sole — a frequent walker program at Oakwood Mall in Eau Claire. Luther Midelfort - Mayo Health System sponsors the program to emphasize community health and wellness.

The Holsteins have participated in the mall walking program for many years. Almost every morning, the couple walks about four and a half laps around the mall — the equivalent of three miles. They were inspired to start walking after participating in one of many cardiovascular screenings at Luther Midelfort.

Patricia and Gary walk to relieve stress, keep active and stay in shape as they get older. Since joining the walking program Gary’s health has improved enough so he no longer needs two of his blood pressure medications. "If I didn’t walk, I would have to take more medications," Gary says. The program has not only benefited their health, but they have made many friends as well.

"Participating in this program has helped me do some of the things I did when I was younger," Gary says. "I am inspired to keep active when I see others who are older than me walking."

Currently, 150 walkers are registered in the walking program. Walkers are encouraged to keep track of how far they walked each day by recording it on a card kept at the Luther Midelfort kiosk. When the card has been completed, walkers are entered into a drawing for a $25 mall gift card.

"The Heart N’ Sole walking program is a great way for people to get their exercise and meet new friends. I hear many comments about the friendships formed while walking," says Becky Hilson, a Luther Midelfort employee responsible for coordinating activities at the mall. "We are happy to sponsor this program; our numbers have steadily increased each year."

Luther Midelfort has partnered with Oakwood Mall since 1998 to provide health care information to shoppers. A free-standing kiosk was installed in the mall where shoppers can pick up health information, view videos of physicians and other health care providers and check their blood pressure.

Every Thursday, a health care professional is available to check blood pressures and answer questions. Health fairs are offered several times a year as well. Cholesterol and blood sugar screenings often are provided as well as department-specific information and health talks.

Luther Midelfort - Mayo Health System, Eau Claire

"Healthy Kids" Program Sponsored by Reedsburg Area Medical Center

Reedsburg Area Medical Center is excited to sponsor a program to help fight childhood obesity called Healthy Kids. This comprehensive program is designed to educate children and their families about nutrition, food choices, exercise and activities to promote a healthy lifestyle. The three-week courses are offered in two sessions, one for kids entering grades 1-3 and the other for grades 4-6.

Healthy Kids is open to all area children who will be entering grades 1-6 in the next school year and is held at a local elementary school. Each year the program is held in July for 3 weeks, on Monday, Wednesday and Fridays from 8 a.m. – 10 a.m. for grades 1-3 and from 12:30 p.m. – 2:30 p.m. for grades 4-6. There is a parents/family night held beforehand for registration.

Each day the kids have the opportunity to do fun activities and exercise in a group setting. Healthy snacks are provided each day and all kids receive a Healthy Kids t-shirt.

The three-week program is $20, including a t-shirt and snacks. Scholarships are available to those who are not able to afford the fee. Reedsburg Area Medical Center promotes this program through fliers in all the schools and by handing out information in their Butterfest parade, in early June.

Reedsburg Area Medical Center, Reedsburg

Energy for Life

Energy For Life is a program unique to Aurora West Allis Medical Center that was developed in 2006. Community partners include the West Allis/West Milwaukee School District, the Wisconsin Athletic Club and the American Heart Association. The goal of the program is to increase physical activity and improve nutritional choices among fifth grade students in six elementary schools located in the West Allis/West Milwaukee School District. Each year, the program reaches between 360-400 students. The goal is accomplished by providing students with monthly educational offerings throughout the year provided by clinical staff of Aurora West Allis Medical Center and Aurora Medical Group.

The program is introduced to students in November, and they complete pre-test to assess their knowledge of health and nutrition. Every 5th grade student at each school takes the test. They then see an American Heart Association video that encourages healthy lifestyle choices. The video emphasizes the benefits of physical activity and the perils of junk food and smoking, which are crucial areas of emphasis.

After a holiday break in December, the curriculum portion of the program kicks off in January with an Aurora dietician who visits the classrooms bringing intriguing props: various foods and vials of fat and sugar that are utilized in an interactive, engaging presentation. Students learn how to read nutrition labels, and through a worksheet activity they learn how to add up the calories in a typical meal.

Two weeks later, an exercise specialist visits the classroom to continue on the key learning theme of food consumption and its relationship to energy and strength. The exercise specialist teaches squats, push-ups and lunges and encourages students to keep up with the exercises throughout the month.

In February, an Aurora family practice physician comes to the classroom with a full-sized plastic skeleton to teach students about the musculoskeletal system and explain how important it is to keep bones and muscles healthy. Two weeks later, an exercise specialist returns and students learn cardio-vascular exercises, including running and jumping.

In March an Aurora RN meets with the classes to instruct students on healthy ways to deal with everyday stresses, such as hurt feelings, bullying and fighting. A yoga instructor from the Wisconsin Athletic Club joins in to teach and demonstrate stress-release poses and stretches to relieve tension.

In April, an interactive presentation by the American Heart Association and an Aurora Community Education Coordinator covers the health hazards of cigarette smoking. Together they teach strength and cardiovascular exercises for students to maintain peak heart/lung health.

Aurora West Allis Medical Center

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

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

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