June 10, 2011
Volume 55, Issue 23

WHA’s Medicaid Advisory Group Reviews 2012 Draft Base Rates for Hospitals

The WHA Medicaid Advisory Group (MAG) received the 2012 draft base fee-for-service hospital rates in a meeting with staff from the Wisconsin Department of Health Services (DHS) on June 7.

Brett Davis, administrator of the Wisconsin Medicaid Program, Curtis Cunningham and Krista Willing from DHS, and Matt Sorrentino, a DHS consultant from Public Consulting Group, presented the methodology used in determining the inpatient and outpatient rates for all hospitals. They presented a step-by-step explanation of the factors that affect rate development including wage index, capital, medical education, rural adjustments, and outlier payments. DHS applied the factors and calculated the new rates using the most current claims and cost report data available to DHS.

WHA Senior Vice President Brian Potter noted, "We are also glad to see that, during this difficult budget, DHS has not implemented base rate reductions for hospitals. We appreciate the work that goes into developing these rates, and the process set up with the Medicaid Advisory Group so that hospitals can better understand how the rates are calculated."

No changes were made to the payment methodology for hospitals (including Acute Care, CAH and Psych hospitals), with the exception of increasing the trim points, which affects when a claim becomes eligible as an outlier payment. DHS also will pay labs based on a maximum fee schedule when it settles lab claims for FY 2011. Overall the base rate for inpatient PPS hospitals increased from 2011. DHS projects Medicaid fee-for-service utilization to decrease for all hospitals.

Hospital specific rate sheets will be sent to each hospital at the beginning of July. Hospitals will have 60 days to appeal. DHS also indicated that staff is willing to discuss rates with individual hospitals.

In addition, DHS announced that it will not be moving to an APC system for Medicaid outpatient reimbursement on December 1, 2011, as previously planned. However, it will continue to explore APCs and other methodologies like the Enhanced Ambulatory Payment Grouping System (EAPG) for outpatient rate setting.

DHS will send draft Inpatient and Outpatient State Plan Amendments to hospitals by June 14. Hospitals are encouraged to provide feedback to DHS and communicate potential changes or suggestions prior to and during the next Medicaid Advisory Group meeting on June 21. Topics for the June 21 meeting will include the pay-for-performance measures for 2012 and 2013 and details of the state plan amendment DHS intends to submit to CMS.

Materials from the June 7 meeting, along with other information about the Medicaid Advisory Group can be found on the WHA Web site at: www.wha.org/financeAndData/MAG.aspx.

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Guest Column: Accountable Care – Where Do We Go from Here?
By Nick Turkal, MD, WHA 2011 Board Chair

Monday (June 6) was the deadline for public comment on proposed regulations for the operation of accountable care organizations (ACO). Federal health reform legislation designed ACOs as a way to encourage health care providers to share cost savings and improve clinical quality and overall patient health.

The Wisconsin Hospital Association member hospitals have been working for years to reform health care, so we appreciate the challenges the Centers for Medicare & Medicaid Services (CMS) faced in developing the proposed ACO regulations.

However, I have strong reservations about how this well-intentioned concept is going to be rolled out. As they stand, the regulations are counterproductive to health systems’ ability to deliver on the promise of accountable care.

I’m not alone in my concerns. A good number of health system CEOs and policy experts agree that these proposed regulations need serious reworking.

I say this as a strong believer in the need for fundamental health care reform. The rules CMS proposed missed out on truly transforming health care from a fee-for-service system to one that pays for performance. CMS also was overly restrictive on how accountable care organizations could work in the marketplace.

Accountable care is central to creating meaningful health care reform. We are already spending enough on heath care in the United States to deliver high quality, consistent care to every American. We do not need to spend more. The current growth in health care costs is economically unsustainable.

Let’s develop accountable care rules that:

These proven practices include those developed through Premier’s Hospital Quality Incentive Demonstration and QUEST projects. Over 30 months, QUEST saved 25,235 lives and $2.85 billion in costs among 157 U.S. hospitals. If all hospitals in the country achieved similar results, an estimated additional 64,000 lives and $23 billion could have been saved, meeting the dual goals of enhanced care and reduced costs without excessive regulation or rapid movement to capitation.

At the risk of sounding as if the Wisconsin Hospital Association and its members have it all figured out, we know we are far from perfect. We are, however, committed to continually improving quality and health care cost efficiencies. We are optimistic health care can be reformed and we want to be part of the effort.

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New Legislator Profile:Rep. John Klenke (R-Green Bay)

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

When Rep. John Klenke visits hospitals in his area, he is struck by the significant amount of write-offs they take as a result of providing charity care and inadequate reimbursement from Medicaid and Medicare.

"It’s an unsustainable business model," Klenke, a former finance executive with Schneider National, Inc. observed. "Hospitals know they can’t ask the business sector to shoulder the financial burden (for underpayments)."

Klenke, a Republican from Green Bay serving his first term in the State Assembly, advised hospitals to "be more vocal" and express what they know is right about the direction that overall health policy is taking at both the state and federal level. Hospitals, he suggested, should continue to "lead the way" on discussions about health policy.

"We need hospitals to be part of the conversation and the solution because we know we can do better than our current system, but we can’t do better if we can’t have an objective dialogue about the problem," Klenke said. "If we continue to push hospitals toward write-offs, we will end up with terrible results for everyone."

Klenke believes Medicaid should be a safety net program and serve those that are "truly needy," but an element of personal responsibility should be built in. He is a strong proponent of consumer-driven health care, which he says creates an awareness of what care costs. Klenke said the Medicaid program should provide access to certain services for free, but recipients that can pay should be responsible for a co-pay.

"We know we cannot keep providing an unlimited amount of medical services for free or the demand will quickly outstrip the supply," he said. "Our health care system is second to none, but there is a limit to our resources."

An advocate of private sector solutions and a smaller role for government, Klenke said he hopes that the health care exchanges will enable more competition among insurers by allowing health insurance to be sold across state lines. He also pointed out the innate unfairness of government mandates on health insurance coverage for the private sector, which do not apply to public sector insurance plans.

"Government makes rules that apply to the private sector, and then they say it ‘doesn’t apply to us,’" according to Klenke. "We need to stop doing that. It ruins the integrity of government, diminishes people’s trust, and verifies to the public that government is not working for them."

Klenke is one of several new legislators being regularly profiled in The Valued Voice.

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Assembly Passes "Bill to Pay the Bills" and Restores Patient Compensation Fund

This week the Assembly approved a bill to pay back the money the state owes the Injured Patients and Families Compensation Fund (IPFCF). Assembly Bill (AB) 148 recently received unanimous approval from the Joint Finance Committee (JFC). (See May 27 Valued Voice article.) Last week, the JFC also voted to include the bill’s language in the 2012-13 Biennial Budget.

The 2008-2009 Wisconsin State Budget used $200 million from the IPFCF to balance the state’s books. The Wisconsin Supreme Court held that the transfer was unconstitutional. The new bill includes $235 million to pay back the IPFCF, including principal and interest.

"The patient’s compensation fund is a critical element of a stable medical liability insurance market that is necessary to attract and retain needed health care practitioners to the Wisconsin," according to WHA President Steve Brenton. "We are very pleased that Governor Walker and the State Assembly recognize the importance of restoring money that was taken from the fund in 2008."

The bill also increases Medicaid payments in the current fiscal year to take advantage of a higher federal matching rate that expires on July 1, 2011. As part of last year’s Medicaid rate reform efforts, the Medicaid program had pushed the June payment owed to health maintenance organizations into July, which is part of the next biennium’s budget. The proposed bill would reverse that decision. The bill also reduces the funding "lapse" required as part of the 2010-2011 Wisconsin State Budget and eliminates the savings associated with state employee health insurance and retirement contributions that were part of Act 10. This week, the Wisconsin Supreme Court heard arguments relating to an appeal of a Dane County judge’s decision to void Act 10. The judge found that when passing Act 10, a committee of the Legislature violated the open meetings law, making the law voidable.

The Senate is expected to take up AB 148 next week.

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WHA Outlines Concerns with CMS Proposed ACO Rule
Rule fails to provide correct incentives and infrastructure

WHA has submitted comments in response to CMS’s proposed rule for implementing Accountable Care Organizations (ACOs). In the letter, WHA indicated that it supports the concept of ACOs as a promising idea with the goal of attaining the highest quality and most efficient care for Medicare patients.

WHA emphasizes, however, that the rule, as proposed, will not encourage participation because it fails to ensure that the right incentives and infrastructures are in place, care management is enhanced, and regulatory oversight is not too prescriptive or burdensome. Specifically, it fails to provide for:

In the letter, WHA outlined its concerns regarding the proposed rule and recommendations for improvements.

Shared Savings

Assignment of Beneficiaries

Quality Measures

Governance, Marketing, and Other Operating Requirements

Rural Beneficiaries and Providers

• CMS should encourage participation by rurally-developed ACOs by:

o Implementing a flat one percent minimum savings requirement for all ACOs

o Allowing small/rural ACOs a greater share in first-dollar savings

o Providing up-front capital to engage small and/or rural ACOs

If you have any questions, contact George Quinn, senior vice president, at 608-274-1820, or gquinn@wha.org.

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President’s Column: New Study Predicts Massive Migration to Insurance Exchanges in 2014

A new study released this week predicts 30 percent of private employers will move their patients into publicly-subsidized insurance exchanges created in the Accountable Care Act (ACA) in 2014. The report, featured in the publication McKinsey Quarterly, June 2011, was based on a survey of 1300 employers that found 30 percent saying they "definitely" or "probably" will stop offering coverage after 2014. Most disturbingly, the survey found that among companies most familiar with the laws, mandates and regulations, 60 percent plan to actually end coverage.

The findings of this new report are at odds with the Congressional Budget Office (CBO) claims of a year ago that were used by the Obama Administration and Congressional supporters when passing the bitterly-contested legislation. At that time, it was largely envisioned that the state-level exchanges would primarily serve currently uninsured small employers and low income individuals. But this new survey data is based on interviews of real business owners and human resources staff who will actually make the bottom-line decisions a couple of years from now. Many are beginning to believe that publicly subsidized exchanges may be a low-cost alternative to employer-sponsored health care, even with the $2,000 annual per employee penalty for dropping coverage.

The impact on government, providers and consumers of a migration to state-level exchanges of the magnitude suggested in this report will be staggering.

For government, the economics of a stampede to publicly-subsidized coverage may well mean that the projected costs of ACA are far less than the looming reality. How will the new expense be paid in an era of budget deficit reduction?

For consumers, the promise that "you can keep the coverage you now have" will be little more than "bait and switch" political rhetoric.

For providers, the movement of millions of commercially insured (in some cases) to heavily-regulated insurance exchanges may have real economic consequences. Remember the fight over the public option? Look at the current "cost crisis" and its heavy-handed focus on provider payment in Massachusetts for a reality check on this one.

WHA’s health reform principles strongly support retention of employer-based health benefits. This new report raises real concerns that this important principle may be undermined. As we work with the Walker Administration and state lawmakers to develop Wisconsin’s Free Market Insurance Exchange, this issue must be front and center of our advocacy position.

Steve Brenton

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Political Action Spotlight: Political Action Fundraising Campaign Update - 36% of Goal

The Wisconsin Hospitals PAC and Conduit fundraising campaign has raised more than $12,000 in the last two weeks from 17 individuals bringing the campaign total to date at $89,337 from 146 individuals whose average contribution is $612. Two months into the campaign, this puts the 2011 campaign at 36 percent of the $250,000 monetary goal. Last year at this time, the campaign raised $64,000 and by year’s end, a total of 601 individuals raised just over $235,000.

2011 contributors to the Wisconsin Hospitals PAC and Conduit to date are listed on page 10. Contributors are listed alphabetically by contribution category. The next publication of the contributor list will be in the June 24th edition of The Valued Voice.

For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Contributions ranging from $1 - 499

Alstad, Nancy         Fort HealthCare

Ashenhurst, Karla         Ministry Health Care

Ayers, Mandy         Wisconsin Hospital Association

Bablitch, Steve         Aurora Health Care

Bailet, Jeffrey         Aurora Health Care

Beall, Linda         Hudson Hospital

Boudreau, Jenny         Wisconsin Hospital Association

Braunschweig, Jennifer         Gundersen Lutheran Medical Center

Byrne, Frank         St. Mary’s Hospital

Campbell-Kelz, Nancy         Aspirus Wausau Hospital

Casey, Candy         Columbia Center

Clapp, Nicole         Grant Regional Health Center

Clark, Renee         Fort HealthCare

Cooksey, Patricia         Hudson Hospital

Connor, Michael         Aurora Health Care

Dahl, James         Fort HealthCare

Decker, Michael         Divine Savior Healthcare

DeRosa, Jody         St. Mary’s Janesville Hospital

Devermann, Robert         Aurora Medical Center in Oshkosh

Dolohanty, Naomi         Aurora Health Care

Donlon, Marcia         Holy Family Memorial, Inc.

Elliott, Roger         St. Joseph’s Hospital

Evans, Kim         Bellin Hospital

Facey, Alice         St. Clare Hospital and Health Services

Fielding, Laura         Holy Family Memorial, Inc.

From, Leland         Beloit Health System

Furlong, Marian         Hudson Hospital

Geid, Janice         St. Joseph’s Hospital

Grohskopf, Kevin         St. Clare Hospital and Health Services

Halida, Cheryl         St. Joseph’s Hospital

Hieb, Laura         Bellin Hospital

Hockers, Sara         Holy Family Memorial, Inc.

Holub, Gregory         Ministry Door County Medical Center

Jelle, Laura         St. Clare Hospital and Health Services

Keene, Kaaron         Memorial Health Center - An Aspirus Partner

Klay, Lois         St. Joseph’s Hospital

Klein, Rick         Aurora Health Care

Kuehni-Flanagan, Tracy         St. Joseph’s Hospital

Laird, Michael         Froedtert Health St. Joseph’s Hospital

Lange, George         Westgate Medical Group, CSMCP

Margan, Rob         Wisconsin Hospital Association

Marquardt, Amy

Maurer, Mary         Holy Family Memorial, Inc.

McNally, Maureen         Froedtert Health

Merline, Karen

Mulder, Doris         Beloit Health System

Niemer, Margaret         Children’s Hospital and Health System

O’Keefe, James         Mile Bluff Medical Center

Olson, Bonnie         Sacred Heart Hospital

Ose, Peggy         Riverview Hospital Association

Palecek, Steve         St. Joseph’s Hospital

Penczykowski, James         St. Mary’s Hospital

Peters, Kenneth         Bellin Hospital

Petonic, Mary Frances         Meriter Hospital

Potts, Dennis         Aurora Health Care

Priest, Geoffrey         Meriter Hospital

Proehl, Sheila         Hudson Hospital

Radoszewski, Pat         Children’s Hospital and Health System

Reinke, Mary         Aurora Health Care

Rickelman, Debbie         WHA Information Center

Roller, Rachel         Aurora Health Care

Samitt, Craig         Dean Health System

Schaefer, Mark         Froedtert Health

Schafer, Michael         Spooner Health System

Scieszinski, Robert         Ministry Door County Medical Center

Stanford, Cynthia

Tapper, Joy         Milwaukee Health Care Partnership

Tews, Carol         Memorial Medical Center - Neillsville

VanDeVoort, John         St. Joseph’s Hospital

Walker, Troy         St. Clare Hospital and Health Services

Worrick, Gerald         Ministry Door County Medical Center

Yaron, Rachel         Ministry St. Clare’s Hospital

Zeller, Brad         Hayward Area Memorial Hospital and Water’s Edge

Contributions ranging from $500 - 999

Anderson, Sandy         St. Clare Hospital and Health Services

Bjork, Tanya

Bultema, Janice

Carlson, Dan         Bay Area Medical Center

Clough, Sheila         Ministry Health Care’s Howard Young Medical Center

Court, Kelly         Wisconsin Hospital Association

Dietsche, James         Bellin Hospital

Eckels, Timothy         Hospital Sisters Health System

Frank, Jennifer         Wisconsin Hospital Association

Garcia, Dawn         Sacred Heart Hospital

Grundstrom, David         Flambeau Hospital

Heifetz, Michael         SSM Health Care-Wisconsin

Huettl, Patricia         Holy Family Memorial, Inc.

Kerwin, George         Bellin Hospital

Lewis, Gordon         Burnett Medical Center

Mantei, Mary Jo         Bay Area Medical Center

Mohorek, Ronald         Ministry Health Care

Nelson, James         Fort HealthCare

Nelson, Nanine         ProHealth Care

Oberholtzer, Curt         Bay Area Medical Center

Russell, John         Columbus Community Hospital

Schoof, Susie

Selberg, Heidi         HSHS-Eastern Wisconsin Division

Shabino, Charles         Wisconsin Hospital Association

Swanson, Kerry         St. Mary’s Janesville Hospital

VanCourt, Bernie         Bay Area Medical Center

Westrick, Paul         Columbia St. Mary’s, Inc. - Milwaukee

Wolf, Edward         Lakeview Medical Center

Zenk, Ann         Ministry Sacred Heart Saint Mary’s

Contributions ranging from $1,000 - 1,499

Alig, Joanne         Wisconsin Hospital Association

Boese, Jennifer         Wisconsin Hospital Association

Borgerding, Dana

Brenton, Mary E.

Britton, Gregory         Beloit Health System

Duncan, Robert         Children’s Hospital and Health System

Francis, Jeff         Ministry Health Care

Hahn, Brad         Aurora Health Care

Harding, Edward         Bay Area Medical Center

Hilt, Monica         Ministry Saint Mary’s Hospital

Kerschner, Joseph         Children’s Hospital and Health System

Kosanovich, John         UW Health Partners Watertown Regional Medical Center

Loftus, Philip         Aurora Health Care

Mettner, Michelle         Children’s Hospital and Health System

Mohorek, Ronald         Ministry Health Care

Morgan, Dwight         Aurora Health Care

Normington, Jeremy         Moundview Memorial Hospital and Clinics

Olson, David

Potter, Brian         Wisconsin Hospital Association

Robertstad, John         ProHealth Care - Oconomowoc Memorial Hospital

Stanford, Matthew         Wisconsin Hospital Association

Troy, Peggy         Children’s Hospital and Health System

Wallace, Michael         Fort HealthCare

Contributions ranging from $1,500 - 1,999

Bloch, Jodi         Wisconsin Hospital Association

Coffman, Joan         St. Joseph’s Hospital

Eichman, Cynthia         Ministry Our Lady of Victory Hospital

Grasmick, Mary Kay         Wisconsin Hospital Association

Herzog, Mark         Holy Family Memorial, Inc.

Kammer, Peter         Essie Consulting Group

Levin, Jeremy         Rural Wisconsin Health Cooperative

O’Brien, Mary         Aurora St. Luke’s Medical Center

Olson, Edward         ProHealth Care

Starmann-Harrison, Mary         SSM Health Care-Wisconsin

Turkal, Nick         Aurora Health Care

Warmuth, Judith         Wisconsin Hospital Association

Woodward, James         Meriter Hospital

Contributions ranging from $2,000 - 2,499

Fish, David         Hospital Sisters Health System

Kachelski, Joe         Wisconsin Statewide Health Information Network

Katen-Bahensky, Donna         UW Hospital and Clinics

Leitch, Laura         Wisconsin Hospital Association

Merline, Paul         Wisconsin Hospital Association

Neufelder, Daniel         Affinity Health System

Pandl, Therese         HSHS-Eastern Wisconsin Division

Size, Tim         Rural Wisconsin Health Cooperative

Contributions ranging from $2,500 - 2,999

Borgerding, Eric         Wisconsin Hospital Association

Contributions ranging from $3,000 - 3,999

Erwin, Duane         Aspirus Wausau Hospital

Contributions ranging from $4,000 - 4,999

Contributions $5,000 +

Brenton, Stephen         Wisconsin Hospital Association

Tyre, Scott         Capitol Navigators, Inc.

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Joint Finance Committee Amends Senate Concealed Carry Bill
Licensing, training provisions added

Legislation that would allow Wisconsin citizens to carry concealed weapons continued to advance this week as the Joint Finance Committee (JFC) approved an amended version of Senate Bill (SB) 93, authored by Senator Pam Galloway (R-Wausau).

Among the changes, approved on a 12-4 partisan vote, the Republican-controlled JFC added provisions requiring individuals interested in carrying a concealed weapon to be licensed and to provide proof of firearm training.

Language already included in the bill allows private businesses, including hospitals and clinics, to "post" their facilities and prohibit the carrying of concealed weapons. Similarly, employers could prohibit their employees from carrying a concealed weapon in the course of their employment.

While the bill still would not allow prohibiting keeping a weapon in a private vehicle in a parking lot, language included in the amendment clarifies that business property could be posted, including parking lots.

The bill could be voted on by the Senate as early as next week. While a concealed carry bill is also making its way through the Assembly, it is believed the changes made by the JFC include language that can be supported by the majority of members in that house. Governor Walker has also indicated his support for concealed carry legislation.

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Grassroots Spotlight: HSHS Hospitals Host Elected Officials 
Sen. Moulton Visits St. Joseph’s Hospital, Chippewa Falls
Cong. Kind Visits Sacred Heart Hospital, Eau Claire

Recently State Senator Terry Moulton (R-Chippewa Falls) returned for a visit to the hospital where he had previously worked for 17 years in hospital administration.

While at the hospital, Moulton provided staff with an update on legislative activities in Madison and heard from staff about important hospital issues.

Moulton toured the hospital’s new emergency services area, radiology services area and St. Joseph’s Center for Wound Care and Hyperbaric Medicine.

This visit continues St. Joseph’s Hospital’s commitment to hosting area legislators and building those important legislative relationships.

Cong. Kind at Sacred Heart Hospital, Eau Claire

Congressman Ron Kind (D-3rd Congressional District) visited Sacred Heart Hospital in Eau Claire, Wisconsin and toured the hospital’s intra-operative MRI Smart OR surgical suite. Kind also had time to talk with various hospital leaders during his visit.

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Rep. Brooks Shadows at Mile Bluff Medical Center

Mile Bluff Medical Center President & CEO James O’Keefe hosted State Rep. Ed Brooks this week for a shadow day at the hospital. Shadow days are a grassroots initiative launched by WHA to have elected officials experience firsthand what it takes to run a hospital in today’s health care environment. This is the fifth shadow day hosted by a hospital CEO this year.

During his time at Mile Bluff, Brooks visited their dialysis unit and learned how important it is that dialysis services are available in the local community. He also spent time with Dr. Rodney Malinowski, a general surgeon, and he had an opportunity to discuss the importance of having an electronic medical records system.

"I was very impressed with the staff and facilities at Mile Bluff," said Rep. Brooks. "My job shadow experience gave me insight into how these professionals make the complexity of their jobs invisible to patients and their loved ones. They are a wonderful resource to the community," Brooks said.

Throughout the day Rep. Brooks talked with O’Keefe and the hospital leadership team about hospital operations.

"The entire staff at Mile Bluff Medical Center and I were pleased to have Representative Ed Brooks visit our facility. I personally enjoyed getting to know him and the front-line staff members appreciated having the opportunity to show him some of the important work they do for our patients and the community each and every day," O’Keefe said. "We look forward to having him visit again in the future."

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AHA Comments on Proposed Inpatient Rule For FY 12
Strongly disagrees with flawed CMS policy on behavioral offset

In May the Centers for Medicare & Medicaid Services (CMS) released a proposed rule for inpatient prospective payment system (PPS) fiscal year (FY) 2012 hospital payments. That proposed rule includes significant cuts for hospital payments due to the continuation of a flawed CMS policy—referred to as the "behavioral offset" or "coding offset"—which for FY 12 is estimated to reduce hospital payments nationwide an estimated $6.3 billion and Wisconsin hospital payments some $50 million.

The CMS policy is in response to implementation of the Medicare severity diagnosis-related groups (MSDRGs) several years ago, which CMS claims hospitals are upcoding under, and therefore, warrants payment reduction. The American Hospital Association, WHA and many others opposed CMS policy when it was proposed under the FY 2011 PPS rule and continues to strongly oppose its continuation now under the FY 2012 proposed rule

This week the AHA submitted comments on the proposed FY 12 rule and provided its own analyses that indicate that much of the change CMS found from moving from DRGs to MSDRGs is actually the continuation of historical increases in the case mix index (CMI), not the effect of documentation and coding changes due to the implementation of MSDRGs. AHA is urging CMS to use a more appropriate methodology to estimate documentation and coding changes—one that takes real case-mix changes into account. WHA agrees and will be commenting on this proposed rule in the coming days.

If implemented as proposed, for FY 2012, this policy would cut hospital payments by 6.05 percent, or $6.3 billion, and would create substantial volatility in inpatient PPS rates for the next two years. Together with other policy changes in the PPS rule, this cut would cause FY 2012 payments to decrease by 0.55 percent on average, or $498 million total, compared to FY 2011 payments.

Additionally, in its comment letter on the FY 2012 PPS rule, the AHA also expresses concerns about the measures proposed for the Hospital Readmission Reduction Program, which begins in FY 2013. CMS proposes to use the three currently reported 30-day readmission measures for heart attack, heart failure and pneumonia. The statute directs CMS to exclude from the measures readmissions that are unrelated to the prior discharge or that are planned; however, the current measures exclude only a very limited set of planned readmissions and, thus, do not meet the statutory requirement.

The AHA strongly disagrees with CMS’ proposal and believes the agency has ignored Congress’ intent that the measures be modified to explicitly exclude unrelated and planned readmissions. The AHA urges the agency to instead conduct a study to thoroughly determine the common reasons for planned readmissions, as well as determine a subset of readmissions that are unrelated to the initial admission for the relevant conditions. In the interim, CMS should take steps to improve the existing measures, such as adjusting for patient characteristics beyond age, gender and medical diagnosis.

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Key Federal Advisory Body Recommends Delay of Stage 2 Meaningful Use
Concerns remain that recommended Stage 2 MU standards are inflexible and problematic

The Health Information Technology Policy Committee’s (Policy Committee) recommended on Wednesday that the Department of Health and Human Services (HHS) delay compliance with Stage 2 EHR meaningful use rules for one year. In a draft letter to the National Coordinator for Health IT at HHS, the policy committee notes that the current schedule for Stage 2 compliance "poses a nearly insurmountable timing challenge" for those who attest to meaningful use in 2011.

"With the anticipated release of the final rule for Stage 2 in June, 2012, it would require EHR vendors to design, develop and release new functionality, and for eligible hospitals to upgrade, implement and begin using the new functionality by the beginning of the reporting year in October of 2012," states the letter.

Because of delays in promulgating Stage 2 rules and a risk for early participants in the Medicare incentive program of losing incentive payments due to those delays, many hospitals have been choosing to wait at least until at least FY2012 to begin participation in the Medicare incentive program.

Under current rules, hospitals that receive a Medicare meaningful use payment in FY 2011 are required to meet Stage 2 meaningful use beginning October 1, 2012 or the hospital loses its Medicare incentive payment for FY 2013. However, if the Policy Committee recommendation were adopted in rule, such hospitals could wait until October 1, 2013 to meet Stage 2 meaningful use. Under current rules and the Policy Committee recommendation, hospitals that receive a Medicare meaningful use payment in FY 2012 are currently not required to meet Stage 2 meaningful use until October 1, 2013.

The Policy Committee also made its final recommendations on Stage 2 meaningful use standards. The final recommendations contain little change from its initial recommendations released earlier this year.

WHA, with the help of WHA’s HIT Task Force, submitted comments on the initial recommendations in February and raised concerns that the recommendations reverted back to an inflexible "all or nothing" approach to meaningful use where hospitals would be required to meet at least ten new functionality requirements (a total of over 30 requirements). Last week, the American Hospital Association sent an additional letter to the Policy Committee reiterating these concerns.

The Policy Committee’s recommendations to the HHS National Coordinator for Health IT represent the first official step toward the development of Stage 2 meaningful use rules. Official proposed rules from HHS, and a second opportunity for comments, are not expected until at least later this year. Final rules are now not currently anticipated before June 2012.

Links to the Policy Committee’s Stage 2 meaningful use recommendations can be found here: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__policy_past_meetings/1814

WHA’s comment letter can be found at www.wha.org/WHAhitpcMUcommentLetter.pdf.

AHA’s June 6 letter can be found at: www.aha.org/aha/letter/2011/110608-let-fishman-hit.pdf.

Contact Matthew Stanford at mstanford@wha.org with questions.

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WHA/AHA Encourages Wisconsin Hospitals to Complete Drug Shortage Survey

This week WHA sent all hospital pharmacy managers a brief AHA-generated survey aimed at quantifying the degree and severity of drug shortages. AHA had previously sent the survey to their member CEOs attention, but WHA worked with AHA staff to allow us to redirect the survey to hospital pharmacy managers.

The information gathered from hospitals will be extremely helpful to AHA in their national advocacy efforts related to the severe shortage of drugs. The Food and Drug Administration reported a record number of drug shortages across all classes of drugs.

"This issue is of significant concern to hospitals and health systems as drug shortages have had serious consequences for patient safety, quality of care and access to therapies," AHA President and CEO Rich Umbdenstock said in a letter accompanying the survey. "Shortages also are costly to hospitals and health systems in terms of staff time and other resources needed to manage the shortages, and the increased cost of buying off-contract and alternative drugs."

The user name and password required to complete the survey can be obtained from WHA by emailing Mary Kay Grasmick, mgrasmick@wha.org or Judy Warmuth, jwarmuth@wha.org. The email to pharmacy managers was sent by Judy Warmuth and it contains the link to the AHA survey. If you have questions about the survey, contact either Warmuth or Grasmick at 608-274-1820, or email.

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Call for Nominations: 2011 Global Vision Community Partnership Award
Nominations Due to WHA Foundation by July 15

Honor one of your hospital’s community health projects by nominating it for a 2011 Global Vision Community Partnership Award, presented by the WHA Foundation.

This competitive grant award is presented to a community health initiative that successfully addresses a documented community health need. The Award, launched by the WHA Foundation in 1993, seeks to recognize and support ongoing projects that foster community health.

Any WHA hospital member can nominate a community health project. The project must have been in existence for a minimum of two years and must be a collaborative or partnership project that includes a WHA member hospital and an organization(s) within the community. The official call for nominations for the 2011 Award is included in this week’s packet.

Nominations are due July 15, 2011. Nomination forms can also be found on the WHA Web site at www.wha.org/about/globalvision.aspx. For more information about the Award, contact Jennifer Frank at jfrank@wha.org or 608-274-1820.

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Transforming Care at the Bedside Site Visit: Beloit Health System
Innovation, vitality drive patient care improvement

Evidence of changes that are being created by the Transforming Care at the Bedside (TCAB) Project team is everywhere at Beloit Health System. A TCAB display is even visible in the lobby—a signal to the employees and the community that Beloit Health System is committed to this staff-led project to improve patient care.

An enthusiastic team from the Multi-Care Center (MCC) met with Judy Warmuth, WHA vice president for workforce and clinical leader for the Wisconsin TCAB project. Team members talked about the current and planned projects, data collection, measurement and the impact of unit activity and changes on the care team.

"Our strategy was to start with small projects that would be highly visible," according to Mary Marino, director of medical/surgical/oncology. "Team members started working on ideas while we were still at the kickoff meeting in Wisconsin Dells. They kept up the momentum when we returned to MCC."

Additional team members were recruited and the group now meets routinely to plan unit improvements. The entire team participated in the site visit.

Questions about involvement of departments other than nursing, keeping enthusiasm high and involvement of patients and families were posed by Warmuth as part of the visit. Warmuth recommended that the team consider how they would spread changes beyond MCC and how to sustain the transformation upon completion of the 18-month project.

Site visits are a required component of participating in the Transforming Care at the Bedside (TCAB) Wisconsin project. Warmuth will visit all 18 medical-surgical units and report on actions and initiatives designed to improve patient care and nurse involvement. Beloit Health System bravely committed to being the first participating hospital to be visited.

Staff from the Robert Wood Johnson National Program Office plan to join Warmuth for some of the visits. The purpose of the site visit is to 1) Ensure that TCAB teams have successfully launched and 2) Assess and offer any assistance from WHA that could enhance project success.

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Senate Approves Van Meeteren for WHEFA Board Appointment

This week the Senate confirmed the appointment of Bob Van Meeteren, CEO at Reedsburg Area Medical Center, 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.

Van Meeteren, whom WHA recommended for the appointment, was nominated by Governor Walker to fill a vacant seat on the WHEFA Board with the term expiring July 1, 2013.

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Wisconsin Hospitals Community Benefits: Oral Health

Wisconsin hospitals share a common mission to improve their community’s health status, which includes oral health care, an area often neglected because people cannot afford dental work. Lack of proper dental care can lead to a myriad of other health problems. Those with severe tooth pain often end up in hospital emergency rooms for pain relief. By increasing access to dental services for those who cannot afford it, hospitals are not only improving the overall health of their communities, but also decreasing the burden on their emergency departments.

Meeting the dental needs of Manitowoc County

Over the past decade, the problem of dental care access for persons on Medicaid has been documented through various Manitowoc County Community Health Assessments. The northeast region of Wisconsin is the second most critical in the state for dental care needs as demonstrated by these statistics: caries history (55.4 percent), untreated decay (26.1 percent), and early and urgent treatment needs (25 percent).

As a result, Healthiest Manitowoc County 2020, a community-based initiative seeking to make positive changes in the health status of Manitowoc County, has identified "dental health and access to care" as one of its top six health priorities.

Slow and steady progress has been made during the past ten years through local initiatives, a limited federally-funded grant, and multiple collaborative local efforts.

The most recent developments include a United Way Venture Grant dedicated to initiate comprehensive adult dental services, the expansion of the previously existent kids dental programs, and the formation of a new non-profit corporation in July, 2010, known as Healthy Teeth, Healthy Communities of Manitowoc County. This governing entity is responsible for the full "family" of dental programs which is now being offered for low-income residents.

The need for dedicated office space became more apparent. Responding to this community need, Holy Family Memorial supports Healthy Teeth, Healthy Communities of Manitowoc County by economically housing their dental clinic within its network buildings providing four operatory rooms and space for its administrative offices. Since this clinic’s opening date of July 1, 2010, over 3, 200 individuals have been seen.

Holy Family Memorial, Inc., Manitowoc

Sina’s story

In 2008, Sina didn’t have much to smile about. Living in Madison without friends or family, she found herself without a home or a job.

Determined to only move forward, Sina connected with various organizations to secure housing and help her re-enter the workforce. A case worker at the YWCA noted that Sina never smiled and would often turn her head away while talking. Sina admitted that she was losing teeth. She hid her mouth and did not speak up because she was embarrassed by the gaps from missing teeth. Not only was she embarrassed, Sina also had a great deal of pain.

The staff at the YWCA connected Sina to a program at Meriter’s Max Pohle Dental Clinic known as Smiles for Success. Smiles for Success assists women returning to the workforce by providing cosmetic dentistry services aimed at improving smiles and increasing self-confidence.

Meriter staff explained to Sina that the program was a time commitment. Smiles for Success could take a long time and require many appointments. Sina recalls, "I was ready to do this. It was a long process – but it was worth it."

Sina’s teeth were in poor condition and needed to be pulled. The staff at Meriter made sure that Sina had temporary teeth before any other teeth were pulled. "The staff really took care of me. I never walked around without teeth."

After working hard for years, Sina’s life was firmly on the right path. She had a job and better housing. But, her new permanent teeth and new smile gave her so much more. "Now – when I walk in to a room and I smile, I know that the whole room lights up!"

Sina’s new smile helped her get a job as the Front Desk coordinator at Joining Forces for Families in Madison. She confidently greets each person when they arrive and nearly all comment on her smile. "Well, I have a lot to smile about!"

Not only does Sina have a beautiful smile, she is also without pain. "I can chew! I can even eat steak!," Sina laughs. "But more than anything, Smiles for Success and Meriter have been a miracle for me. My life is changed. I am a whole woman now."

Meriter Hospital, Madison

Protecting smiles with mouth guards

The Gundersen Lutheran Department of Dental Specialists, in conjunction with the La Crosse area YMCA, offers sports participants the chance to have custom-made mouth guards for a minimal charge.

Dental Specialists staff members take mouthguard impressions during special Saturday clinics. The charge for the mouth guards is $20, a significant savings compared to most custom mouth guards costing $100 to $150. Participants can choose from a variety of colors for their mouth guards, even in their favorite teams’ colors.

This special offering encourages participants in all sports and levels of competition to wear properly-fitted mouth guards to avoid the risk of injury to their teeth. Mouth guards help cushion blows that might otherwise cause broken teeth and injuries to the lips, tongue, face or jaws, which can cost thousands of dollars to treat. Ready-made or stock mouth guards sold in stores do not fit as well and are not as comfortable so they may not be worn as often as they should be.

The program has been well received. In 2010, Gundersen Lutheran held four clinics; two in the spring and two in the fall to accommodate seasonal athletes. We crafted 345 mouth guards in 2010, more than doubling the total from five years ago. In the past eight years, we’ve custom-crafted more than 1,800 mouth guards to protect the smiles and dental health of athletes in our service area.

Gundersen Lutheran Health System, La Crosse


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

Read more about hospitals connecting with their communities at

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