June 3, 2011
Volume 55, Issue 22

WHA Emphasizes Patient-Provider Communication in "Apology Bill" Testimony
Shabino: "Does it make any sense to inhibit folks from showing emotion and being sincere?"

WHA Senior Medical Advisor Chuck Shabino, MD, provided compelling rationale to legislators in support of AB 147—the "Apology Bill"—when he testified on behalf of Wisconsin’s hospital and health systems before the Assembly Health Committee June 1 in Madison.

AB 147, and its Senate companion SB 103, would protect statements of apology by health care providers or administrators to patients and families from being used against them in a lawsuit. Both bills received public hearings this week.

"We lose that opportunity to be able to speak from the heart and help ourselves—as care providers—and to the families through the grieving process," Shabino told members of the Assembly Health Committee. "We also lose the ability to identify opportunities to improve, and we lose the ability to embrace the families in the whole understanding of what has occurred."

AB 147 was introduced by Representatives Erik Severson, MD (R-Star Prairie) and John Nygren (R-Marinette), while the companion bill in the Senate—SB 103—was introduced by Senator Pam Galloway, MD (R-Wausau).

"This bill creates an atmosphere where health care providers can show empathy with a patient and the patient’s family," Rep. Severson said in his testimony at the Assembly hearing. "It will improve communication between patients and providers and improve overall health care in Wisconsin."

When a health care outcome is not what was planned or expected, a heartfelt statement of concern or apology can be very helpful for all involved. However, in Wisconsin those statements can be used as evidence in a lawsuit, making health care providers and administrators less willing to communicate with patients and families at times when communication is crucial.

In his testimony, Shabino further explained that the inability to share their own emotions with patients and families because they fear their words could later be used against them, "crushes the spirit of our best caring professions—the spirit of caring—because they are not allowed to express themselves."

"We don’t want to shirk our duties in terms of accountability; we simply want to be able to speak confidently and not have to script our responses in these times of crisis," Shabino said.

During discussion on the proposal at the June 2 hearing before the Senate Judiciary, Utilities, Commerce, and Government Operations Committee, Senator Galloway agreed, adding, "The first thing we have to think of in these situations are the needs of the patient and their family."

Testifying at that hearing, Paul Merline, WHA vice president, government affairs, urged committee members to "… support this bill and advance the open and honest communication between health care providers and their patients that results in the best possible health care environment."

"Passing the Quality Improvement Act earlier this year was a key element in WHA’s agenda to bring common sense reform to Wisconsin law, changes that will encourage, not squelch, open communication among health care providers," said WHA’s Eric Borgerding. "AB 147 and SB 103 are the next step and will lead to better quality of care through discussion and collaboration. We commend the authors and co-sponsors of this important, common sense legislation. It’s long overdue."

Committee action on the bills is expected soon.

WHA’s testimony is available at www.wha.org/governmentRelations/pdf/WHAtestimonyAB147.pdf.

A video of Shabino’s testimony is here: www.wha.org/2011ApologyBillShabino6-1.wmv.

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One More Week to Register for the 2011 Wisconsin Rural Health Conference
The Osthoff Resort, Elkhart Lake *** June 15-17, 2011

More information and online registration is available at http://events.signUp4.com/Rural

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New Non-Emergency Medical Transportation Management System for Medicaid Recipients Begins July 1
Hospital discharge planners should be aware of a new hospital-specific FAQ on changes

Effective July 1, 2011, the Department of Health Services (DHS) will implement a new transportation management system that will coordinate non-emergency medical transportation (NEMT) services for most, but not all, Medicaid and BaderCare Plus members. DHS has contracted with LogistiCare Solutions, LLC, (LogistiCare) to provide NEMT management services. The changes will not affect emergency transportation or the transport of patients that need medical care during transportation.

LogistiCare has developed a FAQ specifically for hospitals that describes key changes to the transportation management system for Medicaid. A copy of that FAQ can be found at: www.wha.org/WisHospitalsFAQs6-2-11.pdf. Additional information about the program can be found at https://facilityinfo.logisticare.com/wifacility/Home.aspx and https://www.forwardhealth.wi.gov/kw/pdf/2011-24.pdf.

LogistiCare and DHS have previously sent additional information to hospitals and providers about the changes, including:

Key facts about the upcoming changes include:

Questions about Logisticare and the July 1 changes should be directed to either Bob Harrison at Logisticare (roberth@logisticare.com) or Greg DiMiceli (gregory.dimiceli@wisconsin.gov) at DHS. Matthew Stanford (mstanford@wha.org) and Judy Warmuth (jwarmuth@wha.org) at WHA are also available if you have further questions.

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President’s Column: Members Rate WHA Value High

The last couple of columns have looked at the results of a member survey conducted early this year.

We first identified member issue priorities (Reimbursement, Physician Workforce and Health Reform Implementation) and then looked at member perception of WHA performance.

This final column will look at how members perceive the VALUE of WHA membership—defined in terms of the financial and human capital that members invest in WHA programming.

This year, 95 percent of members described WHA’s value as either being good or excellent, with 72 percent choosing "excellent."

When it comes to survey trending, the most notable finding is the fact that an increasing number of members are rating WHA’s value as excellent. In fact, the score jumped from 58 percent in 2008 to 72 percent in 2011.

Finally, WHA’s 2011 "excellent" ranking is the top score among states surveyed by SatisfactionWorks, our survey vendor.

Our challenge going forward is pretty simple—continue to meet and exceed member expectations by helping to get results on the issues that matter.

Steve Brenton

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IOM Releases First in Series of Medicare Geographic Adjustment Reports
"System could be vastly improved"

This week the Institute of Medicine (IOM) released the first in a series of three reports analyzing and addressing Medicare geographic payment adjusters. The study, Geographic Adjustment in Medicare Payment Phase I: Improving Accuracy, is the result of efforts by the Healthcare Quality Coalition, of which WHA and many Wisconsin providers are members, and Congressman Ron Kind who sought to raise the issue of Medicare reimbursements disparities. In the press briefing releasing the IOM report’s release, it was stated that "the system could be vastly improved," and the report states that putting all the recommendations into effect would equal a "significant change." WHA will continue to analyze this technical report in order to determine potential impacts for Wisconsin hospitals.

This Phase I report is the first in a series that focuses on accuracy and technical assessments of data sources related to the hospital wage index (hospitals) as well as the geographic practice cost index (physicians). Two additional reports in this series are expected—one this summer and a final report in 2012.

Geographic adjustments to Medicare payments are intended to accurately and equitably cover regional variations in wages, rents, and other costs incurred by hospitals and individual health care practitioners; however, many exceptions exist. The committee indicates the high levels of exception suggest the mechanisms underlying the adjustments are inadequate.

The IOM committee is, therefore, recommending fundamental changes to the data sources and methods the program uses to calculate the adjustments in order for those payments to be more accurate. The report recommends 11 actions that could be taken to improve payment accuracy under four subject areas: labor markets, hospital wage index, smoothing labor markets, and the geographic practice cost index.

In general, the recommendations include moving to a single source of wage and benefits data, changing to one set of payment areas and labor markets, and expanding the range of occupations included in the index calculations. The IOM also recommends developing a new source of data on the cost of office rent and applying the hospital wage index for facilities other than acute-care hospitals.

The IOM indicates that all combined, the recommendations would lead to improvements in payment accuracy. Access further details and the full report at: www.iom.edu/geographiadjustment.

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AHA Reopens Schedule H Project for Tax-Exempt Hospitals

The American Hospital Association is encouraging hospitals to participate in the AHA "Mock H" project. Mock H is a tool designed to help tax-exempt hospitals complete the Form 990, Schedule H.

The AHA has been working with tax-exempt specialists at Ernst & Young to collect and analyze Schedule H forms filed with the Internal Revenue Service to pinpoint weakness in the form and advocate for necessary changes. AHA is reopening the project to allow tax-exempt hospitals that file on a fiscal year basis to participate in this project. Through September 15, 2011, hospitals that submit a copy of their filed Schedule H at the project’s secure Web site will receive a concise benchmark report summarizing the responses of similar hospitals to questions such as the amount of un-reimbursed Medicaid expenses. No participant’s name or identifying information will be disclosed as part of any feedback or report.

To participate in the Mock H project, go to the following site: https://survey.ey.com/ScheduleHProject.

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Hayward Area Memorial Hospital Seeks CEO

The Board of Directors of Hayward Area Memorial Hospital is seeking a new CEO due to the impending retirement of its long-time and highly-regarded leader Barb Peickert.

The CEO will take responsibility for Hayward Area Memorial Hospital, a 25-bed Critical Access Hospital, as well as Water’s Edge, which consists of a new 50-bed long-term care center and a 20-unit assisted living facility. All entities are on one campus and interconnected. The application deadline is June 15.

For more information, contact Ed Edwards at 630-215-3437 or email edsearch@aol.com.

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Member News: Ripon Medical Center Affiliates with Agnesian HealthCare

With a goal of expanding access to primary care and advanced health care services to the community, leaders at Ripon Medical Center (RMC) and Agnesian HealthCare (AHC) came together on May 31 to sign official papers for a full affiliation.

The signing means that as of June 1, 2011, Ripon Medical Center is now a member of Agnesian HealthCare joining Agnesian HealthCare Enterprises (the retail arm of AHC), Consultants Laboratory, Fond du Lac Regional Clinic, St. Agnes Hospital, St. Francis Home and Waupun Memorial Hospital.

Both the RMC and AHC Boards of Directors approved a definitive agreement in May that allowed the linkage to move forward.

The Ripon City Council also endorsed this partnership between the two health care organizations as did the Foundation for Ripon Medical Center.

"We are very pleased to welcome Ripon Medical Center to Agnesian HealthCare," says Robert Fale, AHC president and chief executive officer. "Our common goal to serve our communities with the finest health care close to home with compassion and respect will lead us together into the future."

"Pooling our talents, skills and resources through this affiliation secures quality health care close to home for the residents of our community," comments Joan Karsten, interim RMC chief executive officer. "This opportunity strengthens health care for our patients and the extended communities we serve while allowing for local governance for our community hospital. We could not be happier about this affiliation with Agnesian HealthCare."

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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.

Smart Smiles and Seton Dental Clinic - Jaylaen’s story

Jaylaen, a seven year-old at O.W. Holmes Elementary, is destined to become a star. His confident smile proves it. However, just a few months ago his smile did not feel so confident. Jaylaen’s teeth were very sensitive, especially when he drank cold water. This was because Jaylaen had three cavities on his primary molars. Thankfully, Jaylaen’s mom signed him up for Columbia St. Mary’s (CSM) Smart Smiles, a school-based oral hygiene program, where Jaylean received a cleaning, two sealants, and two fluoride treatments. His mom also took advantage of the referral to CSM’s Seton Dental Clinic and brought Jaylaen to dental appointments where he had all three of his cavities filled. Thanks to this work done by Smart Smiles and Seton Dental Clinic, Jaylaen can flash his movie star smile anytime.

Not only did Jaylaen receive oral health care from the Smart Smiles and Seton Dental Clinic staff, he learned about preventive oral health and smart eating habits that help him keep his smile healthy. Jaylaen learned to always brush his teeth when he gets up in the morning and brush again before he goes to bed. He likes that now his teeth feel smooth and clean. When asked about his favorite part of the dental treatment, Jaylaen exclaimed, "the glasses!" Jaylaen was referring to the neon-colored, 80’s style sunglasses used to protect his eyes from debris and ultra-violet light during the dental procedures. To Jaylaen, the sunglasses were an important part of the transformative experience he felt during these dental procedures. The sunglasses added to his new image—a confident young man with a bright smile and shining future. Jaylaen’s new smile is proof that someday he will be a star.

Columbia St. Mary’s, Inc., Milwaukee

Promoting good oral health and access to dental care in Lincoln County

When times are tough, oral health often gets neglected. In fact, the Make Your Smile Count Survey in 2009 in Wisconsin found that 20 percent of third-graders had untreated tooth decay.

Ministry Good Samaritan Health Center and the Merrill Area Healthy Lifestyle Network (MAHLN) have come together to launch a communitywide initiative to promote good oral hygiene and assist those with dental expenses they cannot afford.

MAHLN is a collaboration of citizens, businesses, agencies and civic groups that focus on enhancing community environments and promoting increased awareness and practice of healthy lifestyles.

Oral health issues are nothing new in Merrill as approximately 360 dental related visits to Ministry Good Samaritan Health Center Walk In and Emergency Departments each year. Other recent studies demonstrate an association between gum disease and heart disease, diabetes and strokes.

Through a grant from the Ministry Good Samaritan Foundation plus contributions from the Ministry Good Samaritan Employee Advised Fund, dental toolkits were created for all second- and third-grade students in Merrill schools and distributed by MAHLN member organizations and volunteers.

Merrill Area dentists and hygienists have joined the effort to provide the education component in classrooms, demonstrating how to brush and floss correctly. Each student also receives a dental kit with a toothbrush, toothpaste, flossers, brushing timers and toothbrush covers.

"By the time children turn 8 to 9 years old, they are able to become more independent in their own oral care," said Vicky Rice, hygienist at OakPark Dental. "Up to this point, they often do not have the coordination to reach all of their teeth and need parental assistance. With permanent teeth coming in at this age, it is crucial that these kids learn the correct techniques."

In addition to the dental tools, oral health calendars were included in the toolkits. Each person was encouraged to mark the calendar as a reminder to brush the teeth a minimum of twice a day and floss each night before bed.

"With studies showing that repeating a skill for 21 days creates a habit, it is hoped that with parents’ supervision and reminders to continue these habits, kids will continue to perform them for a lifetime," said Dr. Mark Mehlos, a retired dentist from Merrill.

Parents received information on brushing and flossing techniques and the impact of sugar and acids on the teeth, for example:

    • Flossers, like toothbrushes, can be reused if they are rinsed off and dried between uses.
    • Avoid brushing teeth for one hour after drinking soda or other acidic foods. Although this might sound counter-intuitive, acidic foods soften tooth enamel and leave it prone to damage if brushed too soon.
    • Individuals need to brush all surfaces of their teeth for a minimum of two to three minutes each session.

"We are pleased with the excitement and motivation of the students during the educational sessions," said Carol Crevier, coordinator of Community Health and Wellness at Ministry Good Samaritan Health Center. "Hopefully, with the support of parents, we will see a turn-around in dental emergencies and poor oral hygiene in Merrill."

In addition, with the support of the B.A. and Esther Greenheck Foundation, the Ministry Good Samaritan Health Center Foundation in 2010 launched the "Tooth Fairy Fund," which assists Lincoln County residents who have no means to pay for oral health care.

Those who present through the Emergency or Walk-In Department’s at Ministry Good Samaritan and qualify for services are referred to Bridge Community Dental Clinic with a voucher from the "Tooth Fairy Fund."

Ministry Good Samaritan Health Center, Merrill

Healthy Smiles

With child dental decay on the rise, Columbus Community Hospital teamed up with a local dentist office, Columbus Family Dental, and the Columbus and Fall River School Districts to present Health Smiles Day, dedicated to providing dental care for qualifying students in 5-year-old kindergarten to second grade.

Columbus Community Hospital donated over 24 hours of staff time, as well as materials to coordinate the event through the production of a survey to parents, notification to those qualifying, scheduling of the appointments, refreshments for the event, and follow up surveys to both those who participated and those who qualified and did not participate.

A total of 24 children qualified and self-identified for the program, held March 25. Of those 24 children, eight participated in the Health Smiles Day. The children received a cleaning, a dental exam including x-rays, a plan of care, and a dental kit. Some children also received sealants and fillings if needed.

Columbus Community Hospital is currently investing additional staff time in collecting the data from the follow up surveys and meeting with the local dentist office to coordinate a second Healthy Smiles Day in the fall at the beginning of the school year.

Columbus Community Hospital

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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