Southeast Wisconsin Hospital Rate Increases Lower than National Average Hospitals doing a tremendous job without heavy-handed regulatory approach

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1 December 16, 2011 Volume 55, Issue 48 Southeast Wisconsin Hospital Rate Increases Lower than National Average Hospitals doing a tremendous job without heavy-handed regulatory approach A study released this week found commercial payment level and operating cost increases in southeast Wisconsin were significantly less than the national average. The study, conducted by Milliman and released by the Greater Milwaukee Business Foundation on Health (GMBFH), found that the average southeast Wisconsin hospital commercial payment levels increased about 34 percent (4 percent annually) from 2003 through This increase was 40 percent lower than the 57 percent total increase in the national hospital component of the Consumer Price Index (CPI) for the same period. The increase in individual health system hospital commercial payments from 2003 through 2010 ranged from 14 percent to 62 percent. Only one area health system had an aggregate increase greater than the Hospital CPI from 2003 through The report shows a couple important things that southeast Wisconsin hospitals and hospital systems are doing a tremendous job of retooling and refocusing to deliver high quality, high value, patient-focused care, according to WHA Executive Vice President Eric Borgerding. And, they are doing it without the heavy-handed, government-centered regulatory approach we are seeing in other so-called reform states like Massachusetts. Second, given how health insurance premiums affect labor costs, Borgerding said the state s leaders should be touting Wisconsin s health systems as an economic development tool. Led by our hospitals, Wisconsin is transforming the way care is delivered, and as a result providing some of the best health care value in the country, Borgerding added. This should become a key element of Wisconsin s economic development portfolio as we seek to attract and retain non-health care private sector jobs to Wisconsin. Borgerding said the results of the GMBFH study also underscores how important the hospital tax has become in stabilizing Medicaid reimbursement and preventing cost-shifting from spinning out of control at the same time enrollment in Medicaid programs is skyrocketing. Insurance Exchange, Medicaid Waiver, Physician Shortage Top Board Agenda Board approves action steps to address physician shortage Glancing over a publication shared with the WHA Board at their December 15 meeting in Madison called Results, WHA Chair Nick Turkal remarked that the Association was able to accomplish a lot over the past year. While all the results were commendable, he said there were two that warranted special note: WHA s ability to quickly form a good working relationship with the new Administration and the leadership role that WHA assumed in addressing the physician shortage. The physician report is getting a lot of attention, and stakeholders are enthusiastic about working with us to help address this issue in Wisconsin, Turkal said. We have a foot planted in the here and now, and a foot planted in the future on how we will address physician workforce needs. WHA President Steve Brenton recognized Dr. Turkal for chairing the Association in (continued on page 2) Board Chair: Nick Turkal, MD, President/CEO, Aurora Health Care Editor: Mary Kay Grasmick, VP Communications - mgrasmick@wha.org 5510 Research Park Drive P.O. Box Madison, WI P ( ) F ( )

2 Continued from page 1... Insurance Exchange, Medicaid Waiver, Physician Shortage Top WHA Board Agenda Nick s leadership over the past 12 months was a key reason that we were able to accomplish so many of our 2011 goals, Brenton said. WHA s Board is a catalyst for setting our strategic direction and our officers are key partners with staff in working to achieve meaningful outcomes. President s Report: Wisconsin Hospitals Spared Major Medicaid Cuts Board approves committee rosters; WHA introduces new Leadership Summit Brenton recognized the efforts of the Board and of the WHA staff in producing outstanding results in In the extremely difficult political and economic environment that will surely be one for the record books, Brenton said Wisconsin was one of the few states to not enact major provider Medicaid reimbursement cuts. I understand that only New York and California put more new money into their Medicaid programs than did Wisconsin and those are huge states, Brenton said. The Governor has been criticized for some of his difficult budget decisions; however, those of us that know what has happened in other states can appreciate what a significant commitment he made to Wisconsin s health care safety-net program. Brenton also noted that WHA has made incredible strides in engaging member hospitals in efforts to accelerate quality improvement. WHA will be signing a contract with CMS to become a Hospital Engagement Contractor (HEC). In that role, WHA will work with up to 90 hospitals to accelerate quality improvement through collaboration and sharing of best practices. Brian Potter, WHA senior vice president, presented the WHA Information Center 2011 results and the 2012 budget to the Board for their approval. Potter stated that 2011 was a very successful year for WHAIC with some significant increases in data sales due to interest in data for health reform and quality research activities. The strong 2011 results allow for a 2012 budget that includes no data fee increases, and the dedication of new resources for potential new quality reporting activities and to rewrite the WHA Board Recognizes Turkal, Olson, Grundstrom, Worrick WHA President Steve Brenton presented service awards to several Board members. WHA Chair Nick Turkal, MD, president/ceo of Aurora Health Care, was recognized for serving as Board Chair in Brenton thanked Turkal for his leadership over the past year. Turkal commented that it was a wonderful opportunity for him personally and professionally to chair the Association. He noted that he enjoyed the opportunity to get to know the board Steve Brenton, left, recognized Nick Turkal, members better and that WHA is for his leadership as WHA Chair in a great Association organized to provide strong member support. Steve Brenton presented a service award to David Grundstrom recognizing him for his time on the WHA Board. Jerry Worrick (not pictured) was also recognized for his service. Board members David Olson, chief strategy officer at Froedtert Health; David Grundstrom, chief administrative officer at Flambeau Hospital, Park Falls and Jerry Worrick, president/ceo at Ministry Door County Medical Center were also recognized for their service to WHA. Olson has served on the Board since 2003 and was Chair in Grundstrom has been on the Board since 2005, and Worrick has served several Board terms and he was an AHA Delegate. Worrick was WHA Chair in The Valued Voice -- Page /16/11 (continued on page 8)

3 President s Column Health Care Cost News Brings Holiday Cheer for SE Wisconsin Purchasers But will the Grinch steal Christmas? Health care costs in southeast Wisconsin are rising at rates substantially below the national average according to a study released this week by the Greater Milwaukee Business Foundation on Health (GMBFH). And hospital efforts to reduce operating expense growth are at the center of the study s findings. The study, conducted by two well-respected independent consulting organizations Milliman and Mercer found that during the eight-year period between , hospital rates in SE Wisconsin increased an average 34 percent compared to a 57 percent increase in the hospital component of the CPI. The study also found that day-to-day hospital operating expenses during a nine-year period ( ) increased by only 17 percent. That number is dwarfed by the 28 percent increase in the Hospital Producer Price Index during that same period. And a similar national benchmark measure produced by CMS increased by 37 percent. Several Milwaukee business leaders were at the December 14 rollout of the study and commented positively on the cost trending. (The study results) shows that hospitals and the medical community hospitals and the medical community are definitely working to reduce costs. are definitely working to reduce costs, said Ron Dix, a recently retired executive of Badger Meter who now serves as executive director of the GMBFH. The trend is in the right direction. Almost one decade ago, Milwaukee business leaders were complaining that commercial premiums were 55 percent higher in SE Wisconsin than other Midwest cities. That differential is now in the single digits. The study also confirmed the importance of the hospital tax in moderating Medicaid cost shifting. That tax, enacted in 2009, increases Medicaid payments to SE Wisconsin hospitals by more than $100 million annually. SE Wisconsin hospital leaders should be commended for this strong and independent confirmation that operating expense reductions make a difference in moderating health care cost increases. Unfortunately, this good news comes at a time when federal lawmakers seem prepared to complicate cost control efforts significantly by enacting new Medicare hospital payments cuts from a program that already pays less than 80 cents on the dollar. Steve Brenton President this good news comes at a time when federal lawmakers seem prepared to complicate cost control efforts significantly by enacting new Medicare hospital payments cuts, from a program that already pays less than 80 cents on the dollar. WHA Physician Leadership Development Conference The American Club, Kohler *** March 9-10, 2012 Early Bird Registration: Register by January 20 to Qualify The American Club Hotel Room Reservation Cut-Off: February 16 More information and online registration can be found at: The Valued Voice -- Page /16/11

4 WHA Hosts Legislative Briefing at Capitol WHA s physician workforce report continued to garner a great amount of interest and dialogue this week at a WHA-sponsored briefing at the State Capitol December 14. George Quinn, WHA senior policy advisor, and Chuck Shabino, MD, WHA senior medical advisor, were joined by Executive Vice President Eric Borgerding for a one-hour presentation on the main elements of the report. Wisconsin Eye videotaped the briefing, and it can be viewed at: Eric Borgerding; Chuck Shabino, MD; George Quinn More than 35 people attended the WHA legislative briefing on Dec. 15. Questions from the very attentive audience, which included Rep. Janet Bewley (D-Ashland), Rep. Eric Severson, MD, (R- Star Prairie), Rep. Donna Seidel (D-Wausau), and Jeff Mursau (R-Crivitz), Department of Safety and Professional Services secretary Dave Ross, staff from legislative offices, the Department of Health Services, the Legislative Fiscal Bureau and Legislative Reference Bureau, focused on how to expand, accredit, and fund more residency and clinical opportunities in Wisconsin. Several staffers also asked what could be done to get more Wisconsin students interested and accepted into one of the state s two medical schools. Quinn and Shabino explained that Wisconsin must bring nearly 800 physicians into the state every year to fill positions created by physicians who retire, cut back their hours, or relocate to other states. The report warns that unless Wisconsin can bring at least 100 new physicians to the state, in addition to the 800 they bring in now, there will be a deficit of more than 2,000 physicians by The briefing was hosted by Senators Galloway and Shilling and Representatives Seidel and Severson. Borgerding noted in his introduction that the briefing was A true bipartisan effort, and exactly what we will need to address the many nonpartisan aspects of health care policy going forward, not least of which is the looming physician shortage. WHA has met with several legislative leaders on this issue and will continue using the Physician Workforce Report and this week s briefing to keep a focus on building the momentum and action steps needed to address Wisconsin s looming physician shortage. (See related story in the WHA Board coverage in this issue of The Valued Voice.) WHA Participates in WI EYE-sponsored Physician Workforce Panel Discussion WHA s physician workforce report was the featured topic on a Newsmakers program December 8 produced by Wisconsin Eye. George Quinn, WHA senior policy advisor, was joined by Robert Golden, MD, Dean of UW School of Medicine and Public Health; Timothy Bartholow, MD, chief medical officer for the Wisconsin Medical Society; and Tim Size, executive director of the Wisconsin Rural Health Care Cooperative. All four health care experts agreed that the problem is quickly growing worse and critical care gaps will soon emerge if changes are not made. View the Wisconsin Eye Newsmakers program at: Wisconsin Eye, is a fully digital broadcast production technology that serves their audience via both television and the Internet. The mission of Wisconsin Eye, in part, is to provide unfettered access to the actions of state government and to the full range of forums, activities, and participants throughout Wisconsin that constitute community and public life in Wisconsin. The Valued Voice -- Page /16/11

5 UWSMPH Rural Residency Assistance Program Reports to Joint Finance Funded by the assessment on Wisconsin s Critical Access Hospitals, Byron Crouse, MD, director of the Wisconsin Rural Physician Residency Assistance Program (WRPRAP), recently presented the program s annual report to the Joint Finance Committee. The report said that WRPRAP has made progress toward its long-range goal of creating more residency training positions in smaller communities to build the future medical workforce required in underserved rural areas. The report is available at: According to the report, WRPRAP awarded four grants for the fiscal year and two for Grants were issued in all three categories of their funding: Rural Training Track/Resident support; sponsorship of a rural rotation; and education development projects. Considerable attention has been focused on creating awareness of funding options to eligible potential grantees. The WRPRAP is moving from concept to action in its intent to facilitate the development of rural residency rotations and new programs that will help us train more physicians in Wisconsin and subsequently, keep them here, said Chuck Shabino, MD, WHA senior medical advisor. WRPRAP issued a Request for Proposals (RFP) to encourage development of new residencies or rural training tracks or to add additional resident positions to existing programs. They will be reviewing the proposals soon and WHA will have more to report on WRPRAP s progress in this area. WHA Behavioral Health Task Force Tackles Emerging Policy Initiatives WHA testifies on Assembly bill 327 WHA s Behavioral Health Task Force met on December 13 and discussed a range of mental health policy developments and initiatives. The Task Force also identified a goal to review and update in 2012 its findings and recommendations developed in 2009 and early A significant portion of the meeting was devoted to discuss and find solutions to hospital liability concerns related to county approval of WHA s Behavioral Health Task Force emergency detentions and conflicts between federal EMTALA law and Wisconsin s emergency detention law. The Task Force discussed ongoing efforts by WHA staff to work with the Wisconsin Counties Association and other stakeholders to find solutions to these concerns. Collaboration was also a major theme of the meeting, as the Task Force discussed the parameters for a new Statewide Emergency Detention Collaboration Council jointly proposed by WHA and the Wisconsin Counties Association. The Task Force provided input on draft purposes, goals and multi-stakeholder membership for the Council. A first meeting of the Council is anticipated in early 2012, and the Council s primary purpose will be to identify best emergency detention practices and to advocate for the implementation of those practices. The Task Force also raised questions about Assembly Bill 367, a bill that would amend provisions of Wisconsin s emergency detention law governing law enforcement responsibilities. The Task Force was particularly concerned about possible unintended consequences that could result in significant delays for patients in need of an emergency detention in hospital emergency departments. (continued on page 8) The Valued Voice -- Page /16/11

6 House Approves over $440 Million in Cuts to Wisconsin Hospitals Bad debt, hospital outpatient cuts included in Middle Class Tax Relief Act On Friday, December 9, legislation called The Middle Class Tax Relief and Job Creation Act of 2011 was released by U.S. House Republicans. On December 13, that legislation passed the House by a vote. Wisconsin s House Members voted along party lines: Republicans Duffy, Petri, Ribble, Ryan and Sensenbrenner voting in support; Democrats Baldwin, Kind and Moore voting against. The legislation is part of a year-end tax and unemployment package that also includes a two-year fix for physician payments (the SGR) under Medicare. The legislation would cut more than $17 billion in hospital funding nationwide, and WHA estimates cuts to Wisconsin hospitals at $440-$480 million. I would like to express our opposition to hospital cuts being discussed in conjunction with any number of year-end bills Congress is considering, said WHA President Steve Brenton in a letter sent December 8 to the Wisconsin Congressional Delegation. We know these bills could include a fix to the physician sustainable growth rate (SGR), which we continue to strongly support, but WHA firmly believes hospital payments should not be an offset for such action. Wisconsin hospitals are already bracing for an approximate $2.6 billion in reimbursement reductions over the next 10 years from cuts under the health care reform law as well as an additional two percent Medicare cut should the sequester process remain unchanged. This two percent sequester reduction is estimated to be another $1 billion for Wisconsin hospitals. The two largest cuts to hospitals in the legislation are: Hospital Outpatient Department Payments cap total hospital outpatient payments for evaluation and management services to the rate physicians would be paid for providing these services in their offices; and, Medicare Bad Debt Payments reduce hospital bad debt payments from 70 percent down to 55 percent over three years. Unfortunately, each of these proposals are yet more reimbursement changes put forth that will negatively impact Wisconsin hospitals hospitals that are already paid less than cost for treating Medicare patients, are facing billions in Medicare payment reductions over the next decade and continue to be some of the highest-quality, cost-efficient providers in the nation, Brenton said in closing. The legislation, HR 3630, includes other non-health care related provisions and must still pass the U.S. Senate where it is expected to have a tougher time. RAC Demand Letter Process to Move to MACs Jan. 1, 2012 Beginning in January 2012, Medicare administrative contractors (MACs) will assume responsibility for sending Recovery Audit Contractor (RAC) demand letters to providers under a policy change announced earlier this year by the Centers for Medicare & Medicaid Services (CMS). The change was in response to hospital concerns, which have been expressed since the start of the RAC program, over delays and other problems with the demand letter process. Because many hospitals and systems have established separate RAC-related addresses, the Wisconsin Hospital Association, the American Hospital Association and others have asked for CMS to direct the MACs to allow hospitals (continued on page 7) The Valued Voice -- Page /16/11 Reminder: Receive Regular RAC Updates by Joining WHA RAC Contacts Group To stay up to date on RAC-related issues, such as this change in the demand letter process, WHA reminds hospital RAC teams, CEOs and other senior leaders that they can receive regular RAC updates by joining our free RAC group. To be added to this group, please contact WHA s Jenny Boese at jboese@wha.org.

7 Continued from page 6... RAC Demand Letter Process to Move to MACs Jan. 1, 2012 to request RAC-related letters to continue to be sent to these addresses. Unfortunately, the AHA announced this week that the CMS said it is not able to accommodate this request. Therefore, the MACs will send all RAC-related letters to the current address they have on file. CMS has modified the normal MAC demand letter, however, to include an R before the letter number as a means of helping providers see it is a RAC-related claim as well as having added some additional text. A sample of that revised demand letter can be found at: This is a significant change to the RAC demand letter process; therefore, it will be important for those handling RAC-related letters to talk with those currently receiving MAC correspondence. You will want to ensure a process is in place for hospital departments that receive MAC correspondence to distribute the RAC-related demand letters to the appropriate staff. Value of Strategic Planning for ICD-10 Readiness Webinar Jan. 18 A basic mantra of experienced scuba divers is plan your dive and dive your plan. Undertaking the ICD-10 transition is just as risky for your organization; therefore, you need to plan your transition and transition with a plan. On January 18, WHA is offering a webinar to share lessons learned from other providers who have developed an ICD-10 transition plan and the key points that should be in each organization s strategic plan for ICD-10 readiness. Attendees will learn who and what disciplines need to be involved in the transition team; what your timeline should look like based on where you stand today; and what should be included in your plan for beyond October This webinar is one of a four-part webinar series focused on helping hospital executives and their ICD-10 team leaders understand the magnitude of the ICD-10 implementation, the financial and clinical impact of the transition on your organization, and be better prepared for on-time implementation. The four sessions include: Budget Development and Budget Review for ICD-10 Readiness An audio recording of this November 16 session is available for purchase. Understanding Reimbursement Changes and the Financial Impact of the ICD-10 Transition An audio recording of this December 14 session is available for purchase. The Value of Strategic Planning for ICD-10 Readiness January 18, 2012 ** 12:00 PM 1:00 PM CST Assessing Your Vendors for ICD-10 Readiness February 15, 2012 ** 12:00 PM 1:00 PM CST A team can register for the full four-part webinar series (for a discounted fee) or for individual sessions. An audio recording of each presentation is available to registered attendees at no extra cost to share at a more convenient time with ICD-10 transition team members who are unable to participate on the scheduled dates. A full brochure describing the four sessions and online registration are available at: SignUp4.com/ICD10Impact The Valued Voice -- Page /16/11

8 Memorial Medical Center, Neillsville, Seeks CEO Memorial Medical Center (MMC) of Neillsville is seeking a chief executive officer. MMC is an independent Critical Access Hospital with a strong balance sheet, three years of solid financial results, demonstrated growth, and excellent improvements in patient satisfaction and quality. MMC is a modern, well-equipped 25-bed acute care hospital, with an attached 15-resident occupancy assisted living facility, a home health agency, a provider-based rural health clinic on campus and two provider-based rural health satellite clinics. Applicants should have a bachelor s degree in business or healthcare administration, or finance. A master s degree in health care administration or a related field is preferred. A minimum of five years of progressive senior-level experience in a health care setting with experience in facility operations is also required. This position is also posted in the WHA Job Bulletin at Qualified applicants should submit their CV/resume to Tammie Zarak, director of human resources, Memorial Medical Center, 216 Sunset Place, Neillsville, WI or tzarak@memorialmedcenter.org. Cont d from page 5... WHA Behavioral Health Task Force Tackles Emerging Policy Initiatives WHA expressed these concerns in testimony at a hearing on Assembly Bill 367 bill on December 15, and is working specifically with the Chiefs of Police Association to resolve the concerns. As a result of these concerns and concerns raised by other stakeholders, the bill s authors are also inviting all interested stakeholders to meet in early January to resolve concerns. A copy of WHA s testimony can be found at: In addition, the Task Force also discussed and was supportive of efforts to amend Wisconsin s mental health records statute to remove statutory barriers to better coordination of care between primary care and mental health care providers. Continued from page 2... Insurance Exchange, Medicaid Waiver, Physician Shortage Top WHA Board Agenda WIPOP online data collection program to be compliant with the upcoming conversion to ICD-10. The Board approved the WHA council and committee rosters for Brenton recognized Phil Stuart, CEO, Tomah Memorial Hospital for chairing the WHA Workforce Council for the past four years. New Board member, Nicole Clapp, president/ceo, Grant Regional Health Center, will chair the Workforce Council in The Board also approved the 2012 WHA Foundation Board of Directors. Wisconsin Health Insurance Exchange: WHA Outlines Employer, Consumer Options It s the million dollar question: Will Wisconsin employers stop providing health insurance coverage and send their employees to the health insurance exchange? How will consumers use an exchange? Joanne Alig, WHA vice president of payment, policy and reform provided the WHA Board with a comprehensive overview of how an insurance exchange could work in Wisconsin, and a view on how consumers and employers might respond in this new environment given the incentives, the penalties and subsidies that are included in the health care reform law. Every state is required to establish a federally-approved exchange for individuals and small businesses or the federal government will take over. Alig said currently, 96 percent of employers with 50 or more employees offer health insurance, while 35 percent of employers with fewer than 50 employees offer it. Individuals (continued on page 9) The Valued Voice -- Page /16/11 What is a health insurance exchange? According to AHA, It is a marketplace for individuals and business to purchase private health insurance. The one-stop shopping concept will allow individuals to get information about their insurance options and enroll in their choice of plan.

9 Continued from page 8... Insurance Exchange, Medicaid Waiver, Physician Shortage Top WHA Board Agenda must purchase insurance through the exchange to be eligible for a subsidy. Small businesses must offer insurance through the exchange for all of their employees to receive a tax credit. Businesses with fewer than 50 employees will not be penalized for not offering coverage. Alig said studies indicate that nationally up to one third of employers will drop employee health insurance. A Wisconsin-specific survey conducted by HC Trends indicated that 22 percent of the small business employers here are likely or very likely to drop coverage in The penalties are insufficient to incent employers to offer or not drop coverage, according to Alig. However, there are recruitment and retention considerations that could influence that decision. Turkal commended Alig on an excellent presentation, one that will continue to be revisited over and over in Wisconsin in the year ahead. Alig will make a presentation on the exchange at an upcoming meeting at Wisconsin Manufacturers and Commerce. CMS Approves Portions of DHS Waiver Request; Next Round of Recalls Coming Up WHA Executive Vice President Eric Borgerding updated Board members on recent activity around the Department of Health Services (DHS) Medicaid reform package. On December 9, the federal Centers for Medicare and Medicaid Services (CMS) sent a letter to DHS indicating that its full review of the DHS Medicaid reform package would require additional time and analysis and would not be completed by the end of the year. A key dynamic was set up by the state budget act: either DHS receives approval for a waiver to make changes to eligibility and enrollment in Medicaid or, if the waiver is not approved by December 31, 2011, DHS would have to reduce the eligibility income limit for the program to 133 percent of the federal poverty level for non-pregnant, non-disabled adults. CMS made it clear in their letter that they would not be able to approve the waiver in full by the December 31 deadline. DHS Secretary Dennis Smith quickly responded to CMS with a letter saying that he believes there is enough time in 2011 to reach agreement and work through all the remaining issues. If the waiver is not approved by December 31, 2011, DHS estimates that it would have to cut enrollment in Medicaid by 53,000 people. If the waiver, which including income-based premiums and cost sharing, is approved, DHS estimates as many 64,000 individuals will likely leave the program. In its letter, CMS indicated that it is prepared to approve three items included in the DHS proposal, but only for non-pregnant, non-disabled adults and at higher income levels than proposed by DHS. The approved changes include: 1. Application of a premium for enrollees (excluding children) above 133 percent of the federal poverty level (FPL) and who have access to employer-sponsored coverage for which the premium is less than 9.5 percent of the enrollees income. 2. A premium not to exceed 5 percent of household income for non-disabled, non-pregnant adults with income above 150 percent of FPL; 3. A 12-month lock out period for re-enrolling in Medicaid eligibility for the adults who fail to make a premium payment. In addition, CMS approved the DHS request to end coverage for recipients 10 days after they receive a notice, rather than waiting until the end of the month to terminate eligibility. In its letter to DHS, CMS indicates that all of the items above could be implemented without an MOE waiver. This is because the Patient Protection and Affordable Care Act (PPACA) allows states to reduce (continued on page 10) The Valued Voice -- Page /16/11

10 Continued from page 9... Insurance Exchange, Medicaid Waiver, Physician Shortage Top WHA Board Agenda the income eligibility limit for non-disabled, non-pregnant adults to 133 percent FPL, or make targeted eligibility restrictions for such adults. However, the State would have to certify that it has a budget deficit. Further, the changes would require an amendment to Wisconsin s current BadgerCare Plus demonstration. In order to obtain final federal approval, DHS would have to submit a budget deficit certification as well as additional budget documentation. If DHS submits the documents, CMS commits to completing the steps needed to reach agreement on these policies by the end of the year. Medicare Cuts Could Have $4 Billion Impact in Wisconsin The atmosphere in Washington is anything but merry as Congress struggles to pass a bill to deal with the nation s debt. Brenton warned that Medicare cuts are on the table to pay for a temporary fix of the physician payment problem as well as a temporary moratorium on Social Security payroll taxes. Those cuts along with other enacted Medicare reductions could have a $4 billion impact in Wisconsin over the next ten years. It is a very bad situation, Brenton said. Hospital Medicare Cuts Wisconsin Hospitals Timeline PPACA $2.6 Billion FFY Massachusetts Wage Index $100 Million FFY % Sequester $960 Million 1/1/13-12/31/22 HR 3630 $482 Million 1/1/12-12/31/21 Total: $4,142 Billion Brenton said WHA has joined a coalition with 25 other states to develop a bill to specifically address a provision that boosted hospital Medicare payments in Massachusetts at the expense of Wisconsin and dozens of other states. More Senators Face Challenges In addition to Governor Scott Walker, four state senators could face recall elections. So far, recall committees have registered that are targeting Senate Majority Leader Scott Fitzgerald (R-Juneau), Sen. Terry Moulton (R-Chippewa Falls), Sen. Pam Galloway (R-Wausau), and Van Wangaard (R-Racine). Recall supporters have until January 16 to collect the required number of signatures to trigger a recall election. Board Approves WHA Implementation Plan to Address Physician Shortage The WHA physician workforce report, 100 New Physicians a Year, which provides a framework to begin addressing the physician workforce shortage, received an enormous amount of attention when it was released November 29. George Quinn, WHA senior policy advisor, presented the five main issues and the action steps that he and WHA Senior Medical Advisor, Chuck Shabino, MD, proposed the Association take in 2012 to continue to move the issue forward. The issues and the steps they recommended, which received Board approval, are as follows: 1. Expand graduate medical education a. Create a WHA working group that will inventory existing programs, survey 3rd and 4th year students and final year residents, and facilitate WHA member efforts to create new residency positions and programs. (continued on page 11) The Valued Voice -- Page /16/11

11 Continued from page 9... Insurance Exchange, Medicaid Waiver, Physician Shortage Top WHA Board Agenda 2. Increase the number of Wisconsin medical school graduates a. Establish regular conversations with the Deans of Wisconsin s two medical schools and any future medical schools regarding their plans to increase enrollment and increase the proportion of Wisconsin residents admitted. 3. Focus on tuition and tuition-related debt as incentives to attract and retain physicians a. Advocate for restoration of MCW tuition assistance and survey hospital/physician groups regarding current debt forgiveness programs. 4. Anticipate and facilitate changes in care delivery a. Survey members regarding current and future team-based care delivery models and work with the WHA Workforce Council regarding supply/demand for advance practice providers. 5. Provide an infrastructure and the ongoing financial support that is required to sustain the future scope of the Wisconsin Council on Medical Education and Workforce and facilitate and support collaborative medical education and training initiatives. Following their presentation, Brenton said, This is our top priority going in to We have the template and a tremendous amount of interest in this issue. WHA Council Reports Audit and Investments: Greg Britton, chair of the committee, reported on their recent meeting. The group met with the new partner in charge of the 2011 WHA audit. The WHA audit will occur in February, and the results will be presented to the WHA Board at their April meeting. Britton also reported on the presentation given by WHA s investment firm on the investment results for He stated that returns were consistent with benchmarks, and the WHA portfolio continues to be managed according to the investment policy set forth by the committee. Finance and Payment: Brian Potter said the co-author of the WHA/UW-Extension hospital economic report, Prof. Steve Deller, presented at the last meeting, focusing on the tools that were created to develop a local report. ICD-10 and 5010 readiness issues were also discussed. Council members mentioned some significant problems that they are experiencing with the dominant claims clearinghouse vendor in Wisconsin due to their system conversion to Potter advised the Board that preparation for ICD-10 and 5010 conversions need to include plans for potential cash flow disruption, including establishing lines of credit. This is especially important since things outside of a hospital s control, such as having to rely on vendors, can cause billing and payment problems. Public Policy: Eric Borgerding reported strong attendance at the last meeting. Prof. Deller also presented at this meeting. Discussion focused on Medicaid and the DHS proposals that were submitted to CMS. Dan Schwartzer, deputy insurance commissioner, also spoke at the meeting and briefed the group on the insurance-related elements of the health reform law. Borgerding said several other pieces of legislation were also covered. Medical and Professional Affairs: Kelly Court brought a recommendation forward from the Council to add central-line associated blood stream infections to CheckPoint, which the Board approved. Court said CMS will add CLABSI to Hospital Compare in 2013, but the data will be out of date and by posting it to CheckPoint, the data will reflect current rates much more closely. The Valued Voice -- Page /16/11

12 Charity Care Wisconsin Hospitals Community Benefits Fear of a bill should never prevent a patient from seeking care at a Wisconsin hospital. Wisconsin hospital charity care programs provided $232 million to more than 700 patients each day in The stories that follow illustrate the deep commitment and continuing concern that hospitals have to their patients to ensure they receive the care they need regardless of their ability to pay. Caring Hearts program helps couple in need When Tom and Jan Marks started receiving medical bills last year following Tom s unexpected surgeries and hospital stays, Jan would send a small check with a note saying it was all they could provide. We live on Social Security and that s it, said Jan, 66, of New London. Once things like rent and bills are paid with the Social Security check, it doesn t leave a lot, said Jan. All these outstanding medical bills were bogging us down, stressing us out, she added. Luckily, the couple was approved for ThedaCare s Caring Hearts Financial Assistance Program, which has relieved the Marks of more than $3,200 worth of medical bills. That was like quite a weight lifted off our shoulders, definitely, said Tom, 67, who also has Cirrhosis of the liver. Without that we would be getting some nasty phone calls by now. Last March, Tom hit his hand, which caused an infection in his blood stream to collect in that one area. He required three surgeries in a 24-hour period and a lengthy stay at New London Family Medical Center, where he received continuous antibiotics. He then had physical therapy to regain the use of his hand. Last December, Jan was diagnosed with Atrial fibrillation, which added more medical bills. And she recently had a stent put in her leg. Jan praises the care she and her husband have received through ThedaCare. We got some excellent care and without it we wouldn t be where we are today, she said. Having Caring Hearts on their side has been a God send to us. ThedaCare, Appleton At the end of the road? Perhaps not Courage is difficult to find in these hard times, and finding it became very complicated for a 52 year-old Two Rivers man. He was rushed into the Emergency Department at Aurora Medical Center in Two Rivers with complaints of severe headaches. Sadly, test results revealed that his pain stemmed from brain cancer. The doctor gave the patient some hope that the cancer was still in the early stages and that treatment and preventive measures could be pursued. He was left to cry alone in the patient room for a while, until a financial counselor arrived. Overcome with fear and worry, the patient told the financial counselor, I am at the end of the road. He was uninsured, unemployed and living with a friend temporarily. But the financial counselor would not hear of it and immediately addressed the situation. She helped the patient apply to Aurora s Helping Hand financial assistance program and was pleased to learn that he qualified for a 100 percent discount for three months of care and treatment. In addition, the financial counselor assisted the patient with the government program called Foodshare for food stamps, as well as on-going medical assistance throughout the course of his chemotherapy. Aurora Medical Center in Two Rivers Failure is not an option Failure is not an option to a proud, 50 year-old man fighting for his health. He was admitted to Aurora St. Luke s Medical Center with pneumonia, chronic pancreatitis, acute kidney failure and emphysema, among other health issues. An inpatient for 26 days, he was no longer able to work due to his chronic health problems. Facing one medical setback after another, he was extremely fearful to see his medical bills. A hospital financial counselor reviewed all of the possible payment options, but the patient was ineligible for any of The Valued Voice -- 12/16/11 (continued on next page)

13 Wisconsin Hospitals Community Benefits (continued) the entitlement programs. Despite his pride, and as a last resort, he agreed to apply for the Aurora Helping Hand financial assistance program. Upon the day of discharge, the financial counselor walked into his room and handed him the medical bill totaling $293,542. When the patient saw the bill, he almost fainted. The financial counselor could not conceal his smile as he told the patient, It s 100 percent covered by the Aurora Helping Hand program. It was positively the best news the patient received since he was diagnosed. However, the patient needed future treatment. With help from the financial counselor, the patient applied for Social Security Disability, which was denied, but is being appealed. He continues to receive medically necessary treatment at Aurora St. Luke s Medical Center and has recently been approved for Aurora s financial assistance for an extended period. Aurora St. Luke s Medical Center, Milwaukee Bruce Smith Over the years, Bruce Smith of Balsam Lake had problems with depression, high blood pressure, high cholesterol, and diabetes. He has been going to St. Croix Regional Medical Center (SCRMC) for his health care for a number of years. In 2005, Smith was laid off from a well-paying job he d had for some years, which also provided good health insurance coverage. It wasn t a mass layoff or a plant closing, Smith explained. In fact, I was laid off, along with four other men, because of our health problems. One fellow had skin cancer, two others had diabetes, and another had Parkinson s Disease. They just got rid of us, I guess, because of our health problems. Smith and his wife have had no coverage since the layoff. I haven t been able to find a good job since my layoff, he said, and being on unemployment...obviously I can t afford the premiums. Even if a company would insure me, my wife and I could never afford the costs. And again, if we had the money, no one would take me, either, since I have pre-existing conditions: hypertension, high cholesterol, and diabetes. Mr. Smith has qualified for Community Care, a program through which we will forgive his medical debt for the dates he is eligible, explained SCRMC Patient Advocate, Brenda Bonetti. In addition to Community Care, he is eligible for chronic care for his chronic medical problems/needs. This program allows him to come in on a regular basis to have his medications refilled and so on, Bonetti continued. The provider he sees does not receive payment for the visit. For Mr. Smith, it s a free visit, but it also helps our medical center by not having to pay a provider for those maintenance needs. These programs have been such a big help for me, said Smith. I used to receive samples of the medications I need at no cost, but some legal change by the U.S. government prevents them from doing that now. Through community care, Smith s quarterly appointments with his doctor and his lab tests are taken care of. Without these programs, well, frankly, I d probably be dead. I wouldn t be able to see a doctor or pay for the medicines I need, especially for my diabetes. Brenda has helped me quite a bit, and she s been very, very good to work with, Smith continued. She s done a great job letting me know what programs and help I m eligible for. She s even tried to get me into some county programs, too, but I just don t qualify for them. St. Croix Regional Medical Center, St. Croix Falls Rebuilding her life Rebuilding a new life, said J.M., repeatedly. It was all she wanted. A single, 44 year-old Milwaukee woman who worked hard all her life, she owned a home, lived alone and she rarely shed a tear in front of anyone. After she received a pink slip from her employer and was told that she was let go, her life crumbled right before her eyes. In order to make ends meet, she withdrew money from her pension fund, and that fund was quickly exhausted. That is when her health began to deteriorate. She started coughing and vomiting fresh blood. She continued to let the condition go in hopes that it would stop on its own, but the day came when she totally collapsed on the floor. When she woke up, she found herself in the Emergency Department at Aurora St. Luke s South Shore diagnosed with hematemesis. J.M. was met by Leslie Thomas, financial counselor, to discuss her payment options. Leslie reported, The patient was in tears when I went to see her in the patient room. After I explained the Aurora Helping Hand financial assistance program to her, she was so happy at the possibility of receiving some help. J.M. told Leslie the reason she put off going to the hospital was because she did not have health insurance and had no money. However, through the Helping Hand program, J.M. was approved for 85 percent assistance. The patient was able to rest well and begin focusing on her recovery and building a new life. Aurora St. Luke s South Shore, Cudahy Submit community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org. Read more about hospitals connecting with their communities at The Valued Voice -- 12/16/11