July 1, 2011
Volume 55, Issue 25

Governor Walker Signs 2011-13 Budget
Priority status maintained for state’s health care safety-net

Just over 16 weeks after he introduced his biennial budget proposal, Governor Scott Walker signed the bill that will dictate Wisconsin’s spending priorities for the next two years.

Although Wisconsin’s governor possesses the most powerful veto authority in the country, thanks to the ability to line-item veto individual budget provisions, Gov. Walker left the budget document sent back to him by the Legislature largely intact. While Gov. Walker issued only 50 vetoes on the 2011-13 budget, other governors have issued upwards of several hundred.

The commitment to the health care safety-net remained throughout the budget process. In fact, the Legislature added nearly $156 million all funds (meaning state, federal and other sources of revenue combined) to the $1.3 billion in new revenue included in the Medicaid budget proposed by the Governor. WHA strongly advocated for the increased funding, which was based in part on more conservative enrollment assumptions. During the budget negotiations, the Administration and the Legislature confirmed their commitment to maintain at least current hospital rates.

The proposal for DHS to use various, but yet-to-be-specified, changes and reforms to find an estimated $466 million (all funds) in savings over the biennium in the Medicaid program remained in the final budget, as did a number of transparency and legislative oversight provisions supported by WHA that were added by the Legislature.

Early in the budget process, all of the state’s supplemental payments made to hospitals—amounting to nearly $35 million annually—were targeted for elimination, but all of these payments were ultimately preserved.

Language that increases the fees that health care providers can charge for copies of medical records and that requires the fees for newborn screening test cards to be determined by administrative received final approval, as did language allowing Wisconsin’s federal funding to continue for WiscNet broadband projects already underway.

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Senate Committee Passes "Apology Bill"

This week SB 103—the "Apology Bill"—was approved by the Senate Judiciary, Utilities, Commerce and Government Operations Committee on a 3-2 vote.

The bill, authored by Sen. Pam Galloway (R-Wausau), along with its companion AB 147 authored by Reps. Erik Severson (R-Star Prairie) and John Nygren (R-Marinette), would protect statements of apology by health care providers or administrators to patients and families from being used against them in a lawsuit.

Voting in favor of the bill were committee chair Senator Rich Zipperer (R-Pewaukee) and Senators Galloway and Neil Kedzie (R-Elkhorn). Voting against the bill were Senators Fred Risser (D-Madison) and Jon Erpenbach (D-Middleton).

As previously reported in the June 3, 2011 Valued Voice, WHA testified in support of the bills.

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

A video of WHA Senior Medical Advisor Chuck Shabino, MD testifying is here: www.wha.org/2011ApologyBillShabino6-1.wmv.

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.

SB 103 and AB 147 will lead to better quality of care by encouraging the open and honest collaborative communication between health care providers and their patients that results in the best possible health care environment.

SB 103 can now be considered by the full Senate. A committee vote on AB 147 has not yet been scheduled in the Assembly. Identical versions of the proposal will need to pass both houses of the Legislature before it can be forwarded on to Governor Walker for his consideration.

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Guest Column: Measuring Charity Care for Financial Reporting
By Holly Pokrandt, Partner, Wipfli LLP

The financial statements are finally catching up to the Internal Revenue Service Form 990 Schedule H and the Wisconsin Hospital Association’s reporting of Uncompensated Care, Annual Fiscal Survey, and Community Benefit Survey—requiring the reporting of charity care at cost in the financial statement footnotes. This new requirement is based on Accounting Standards Update (ASU) No. 2010-23, Health Care Entities (Topic 954) Measuring Charity Care for Disclosure. This new accounting standard is effective for fiscal years beginning after December 15, 2010, and applies to all years presented in the financial statement footnotes. Prior to this new accounting standard, there was diversity in practice for the disclosure of charity care in the financial statement footnotes. Organizations were using various measurements including cost or charges forgone.

Now all entities that provide charity care are required to use direct and indirect costs as the measurement basis for disclosure purposes. Various methods can be used to determine the charity care at cost such as:

In addition to reporting the dollar amount of charity care at cost, the method selected to determine the cost will also be a required footnote disclosure in the audited financial statements.

One of the reasons for the recent shift to reporting charity care at cost is to provide more comparable data among entities that provide charity care. Since charges are established by entities using a variety of methodologies, it is difficult to use gross charges as a measurement or comparison tool. Measuring charity care at cost should be more meaningful to users of the financial statements and regulators.

In conclusion, because a health care entity does not recognize revenue when charity care is provided, ASU No. 2010-23 does not have any effect on the amount of accounts receivable or revenue reported on the balance sheet or statement of operations. Currently, the reporting of charity care at cost is required on Schedule H of the Form 990 as well as on the Wisconsin Hospital Association’s various annual surveys. In addition, the upcoming changes to the Medicare cost report schedules, in particular as it relates to the health information technology (HIT) incentive, will also require charity care reporting under a cost methodology. Fortunately, entities that provide charity care have had to deal with converting charity care to cost for the past few years. Hopefully, lessening the burden on the financial statement footnote disclosure of this newly-effective accounting standard.

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WHA 2011 Nominating, Awards and Bylaws Committee to Meet in August

The 2011 Nominating, Awards and Bylaws Committee will meet in August to consider nominating a WHA chair-elect, three at-large members for the WHA Board and candidates for the Trustee Award and Distinguished Service Award. Information on these two awards can be found in the weekly packet and the WHA Web site at www.wha.org/about/pdf/2011awardscall.pdf.

WHA members interested in being considered for an at-large WHA Board seat or the chair-elect position should contact either WHA President Steve Brenton at sbrenton@wha.org or WHA Nominating Committee Chair David Olson at Dolson6@gmail.com.

Nominating Committee members for 2011 are:

David Olson - Chair

Steve Brenton, President/CEO, WHA, Madison

Greg Britton, President & CEO, Beloit Health System, Beloit

Ken Buser, President & CEO, Wheaton Franciscan Health Care – All Saints, Racine

Faye Deich, RN, MS, COO, Sacred Heart Hospital, Eau Claire

Bob Fale, President, Agnesian HealthCare, Fond du Lac

Terri Richards, Director, Strategic Initiatives, Ministry Saint Joseph’s Hospital, Marshfield

Mike Schafer, CEO/Administrator, Spooner Health System, Spooner

Bill Sexton, CEO, Prairie du Chien Memorial Hospital, Prairie du Chien

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LogistiCare Revises Guidance to Hospitals Regarding Non-emergency Transport of Medicaid Patients

In the June 3 and June 24 editions of The Valued Voice, guidance was provided regarding the July 1 implementation of a new transportation management system coordinated by LogistiCare Solutions, LLC. LogistiCare is now modifying that guidance.

Per the June 3 and June 24 articles, hospitals were instructed that the new system would not affect non-emergency transport of patients that need medical care during transport, such as a patient that needs IV medication during transportation. However, LogistiCare informed WHA on June 29 that that instruction is "no longer correct." LogistiCare now instructs hospitals to contact LogistiCare for ALL non-emergency transportation of Medicaid or BadgerCare Plus patients, regardless of their need for medical care during transport, unless the patient is enrolled in a Medicaid HMO in Milwaukee, Waukesha, Washington, Ozaukee, Kenosha, or Racine counties, the patient has their own means of appropriate transportation, or the member is a resident of a nursing home.

A copy of the modified guidance provided in The Valued Voice as well as LogistiCare’s modified FAQ for hospitals can be found here: www.wha.org/Revised6-3-11ValuedVoiceArticle.pdf and here: www.wha.org/revisedLogisticareWisHospsFAQs6-02-11.pdf.

Questions about LogistiCare or implementation of the transportation management system to either Mary Kaminiski at LogistiCare (mary.kaminski@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: It’s Been a Good Six Months for Wisconsin Health Care

It may be difficult to appreciate given the cacophony of clanging pots and pans and trumpeting vuvuzelas in the Capitol rotunda, but it has been a terrific six months for Wisconsin health care, a fact particularly noteworthy given the massive Medicaid budget deficit that faced Governor Walker and Wisconsin lawmakers back in December.

Consider this roster of outcomes:

The caveat with all of this good news is "the rest of the story," specifically the remaining work associated with the Medicaid re-engineering work and anticipated federal Medicaid waiver. It is important that Medicaid remain a safety net program for vulnerable individuals and families and that the state’s admirable track record on coverage continue.

In addition to Medicaid, the other top WHA priority this year will be helping construct a Wisconsin Insurance Exchange consistent with the Association’s health reform principles. Initial indications from the Walker Administration suggest common ground on this front.

It has been a loud, emotionally-charged and busy first six months in Madison, filled with controversial decisions and reactions. But for now, health care has emerged in good shape, and Governor Walker and the Legislature deserve credit for making Medicaid a priority at a time when most other states, facing similar budget challenges, are doing just the opposite.

While we’re pleased with what’s been accomplished so far, next week we’ll talk about WHA’s legislative agenda for the remainder of the 2011-12 session.

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WHA Comments on Rule Requiring Influenza Vaccine
Proposal would change Medicaid/Medicare conditions of participation

This week the Wisconsin Hospital Association submitted comments to the Centers for Medicare & Medicaid Services’ (CMS) on proposed revisions to the Medicare and Medicaid Conditions of Participation (CoP) related to influenza vaccinations. Under the proposed rule, CMS would require that all hospitals at all inpatient and outpatient settings offer and, if agreed to, administer influenza vaccines to patients. While the WHA agrees that increasing the number of individuals who receive the annual influenza vaccination is an important public health goal, WHA objects to the CMS proposal and does not believe it is the most appropriate approach.

In its comment letter, Kelly Court, WHA’s chief quality officer, laid out the following points on the CMS proposal:

To read WHA’s comment letter, go to www.wha.org/CMScommentLtrWHA-Fluvaccine7-1-11.pdf

Read AHA’s comment letter at: www.wha.org/CMScommentLtrAHA-Fluvaccine7-1-11.pdf

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Grassroots Spotlight: State Rep. Janis Ringhand Tours Monroe Clinic Hospital

On May 26, State Rep. Janis Ringhand, 80th Assembly District, enjoyed a first-hand look at how Monroe Clinic is using the healing influence of nature in their new hospital.

Monroe Clinic’s President and CEO Mike Sanders and Director of Facility Services Steve Borowski guided Ringhand through Monroe’s largest and greenest building project. The rooftop gardens provide energy savings and create natural views and a healing environment. Monroe Clinic is on track to become the first LEED Silver-Certified inpatient hospital in Wisconsin. Ringhand commented on the amount of sunlight in hallways and patient rooms, views of nature and seamless joining of the new hospital to the existing clinic on all floors.

"I was impressed to learn hundreds of people, many of them Monroe Clinic staff, served on committees to ensure this hospital was built around patients’ needs while keeping a close eye on its environmental impact," said Rep. Ringhand. "They left no stone unturned. They improved work flows, added top-notch technology and created a setting designed for healing. This project will have a huge, positive impact on Monroe and the surrounding communities for years to come."

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Grassroots Spotlight: Ministry Howard Young Medical Center (Woodruff) Hosts Lieutenant Governor

Lt. Governor Rebecca Kleefisch hosted a Small Business Roundtable on June 23 at Ministry Howard Young Medical Center in Woodruff. Nearly 20 Northwoods business leaders joined hospital President Sheila Clough to share their perspective on how to Grow Wisconsin. The Lt. Governor has been tasked to help grow small businesses across Wisconsin.

In the lively and candid 90-minute discussion, business leaders shared their concerns regarding state and federal regulatory burdens keeping them from expanding and making capital investments, improvements or growth through hiring or other expansions. The community leaders recognized the importance of having a high-quality health care provider such as Ministry Howard Young Medical Center in a community when recruiting or expanding businesses.

For more information on the Lt. Governor’s small business development efforts, visit www.ltgov.wi.gov.

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Wisconsin Trauma System Participates in American College of Surgeons Assessment

The American College of Surgeons provided a consultation June 27-30 for Wisconsin’s trauma system to assess its functions, interaction with public health and other partners and to provide recommendations for improvement.

The ACS Committee on Trauma provides consultation visits, at the request of a state, regional or local authority, to assess trauma care. The purpose of the site visit is to promote sustainable effort for the improvement of statewide trauma systems. The site visit team was comprised of two surgeons, an emergency department physician, a state EMS director, and a state trauma program director.

The three-day visit involved state-level staff, volunteers and stakeholders from the trauma system, including hospital representatives from all trauma designation levels. Participants were invited to reflect on Wisconsin’s achievement of the standards as well as areas of potential improvement.

An overview of statewide assets and challenges, as well as the preliminary recommendations, were provided to the group at the end of the visit. The final report to DHS is expected in about eight weeks. The team will also create a document advising DHS on Wisconsin’s strengths and challenges with a goal of moving the trauma system forward.

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Member News: DeGroot Named New CEO at Community Memorial Hospital, Oconto Falls

Daniel DeGroot has been selected as the new chief executive officer for Community Memorial Hospital in Oconto Falls.

DeGroot is familiar with the area and the region through his previous health care administration experience in Green Bay and presently with Marshfield Clinic, Wisconsin’s largest independent group practice, where he is administrator for the West and Northwest Divisions.

In his current role, DeGroot has worked with physician leadership to create and implement strategy, enhance operational performance, and continuously improve clinical and service quality. Prior to joining Marshfield Clinic, he served as the chief operating officer for the Minneapolis Heart Institute, based at Abbott Northwestern in Minneapolis, as well as having held administrative roles in the Green Bay health care market. He has a master’s degree in Business Administration from the University of Wisconsin-Milwaukee School of Business.

DeGroot will start at CMH August 8.

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Wisconsin Hospitals Community Benefits: Alcohol and Other Drug Abuse

Alcohol and substance abuse has a devastating toll on individuals, families, and society. Armed with expertise and determination, Wisconsin hospitals are fighting the war on drugs and alcohol in their communities with counseling and services aimed at prevention and treatment.

Wheaton Franciscan Center for Addiction Recovery helps Racine mother overcome addictions

Sherrill Aukland is a vivacious, 58-year-old who lost years of her life to alcoholism and pain killer addiction. She did eventually recover – but only with the help of her five sons, the Wheaton Franciscan Center for Addiction Recovery, and Alcoholics Anonymous.

Sherry is an active, outgoing woman who abused pills and alcohol well before her divorce in 2003. Instead of feeling better, she spiraled deeper into depression and guilt. After two years of this, she recognized her decline and tried for a year to recover.

"I felt spiritually bankrupt," she said. "I was trying to get out of a bad situation but doing all the wrong things. I didn’t want to live, but I couldn’t ask for help because I didn’t want to realize I was addicted and alcoholic."

One night, she had had enough. She gathered her five boys, ages 13, 16, 18, 22 and 26. She had already been questioned by one of her sons, who had done a search on her migraine medication and learned it was addictive. She handed them the remainder of the pills, "admitted" the drinking problem they knew about, and told them she needed help. They responded quickly and firmly.

They drove her immediately to her doctor, refusing to leave until he hospitalized her. After three days, the doctor discharged her. She moved to her mother’s basement apartment, where she detoxed on her own for 10 days. Her boys searched online and found the Wheaton Franciscan Center for Addiction Recovery.

Located in Racine, the Center for Addiction Recovery is a private, comfortable site devoted to providing addictions treatment for adults. Programs include primary outpatient day treatment, morning and evening intensive outpatient, and continuing care groups.

When Sherry was strong enough, one of her sons took her to the Center. She remembers that she was asked to list her goals. One was that she would overcome her addiction to pain killers. Still not willing to admit her alcoholism; the second goal was to have a glass of wine with dinner.

Sherry went every day for a month to four hours of counseling with the Wheaton Franciscan outpatient program. In the meetings she learned about alcoholism and addiction and what these diseases do to your mind, body and spirit. She received support, guidance, and resources, and found her spiritual core again.

Sherry and her boys also attended an educational evening meeting for families at the Center. The session provided education for the boys, who learned of their increased risk for alcoholism and addiction.

Sherry took the recommendation of her Center counselor and began attending Alcoholics Anonymous (AA) meetings. She got a sponsor right off the bat, worked the steps and did everything the program suggested.

Today, Sherry is a successful landlord. She fills in at the Center for Addiction Recovery to introduce new participants to the AA program. She continues to attend AA meetings and has been sober five years as of March 2010. Her sons – her reason for living and recovering – have told her how thankful they are to have found the Wheaton Franciscan Center for Addiction Recovery and Alcoholics Anonymous. Because now they have their mom back.

Wheaton Franciscan Healthcare, Milwaukee


Trauma drill raises awareness of perils driving impaired

Caregivers at Aurora Medical Center in Kenosha partnered with two area high schools for a trauma drill to help raise awareness of the perils of driving impaired and to promote safe behaviors for students attending proms. In coordination with the Students Against Destructive Decisions (SADD) programs at Central and Wilmot High Schools, the drill involved a party where a student overdosed and students leaving the party crashed their car.

To educate students, the media department from Central High School filmed the drill and showed it to students at both schools. Following the film, students were shown the mock car accident that was set up by Town of Salem Fire and Rescue.

Aurora Medical Center treated four "patients" from the drill, which included a teenage girl whose parents received the worst news of their lives.

The drill involved a number of Kenosha County fire departments, EMS units and law enforcement agencies.

Communication and cooperation are key when situations such as these arise in real life. One of the goals of training is to make sure information is shared frequently and communication lines stay open. Training also provides caregivers with valuable experience in dealing with specific emergency scenarios. Circumstances will change rapidly, and keeping everyone in the loop can sometimes be just as challenging as dealing with the crisis at hand.

Aurora Medical Center Kenosha

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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