January 7, 2011
Volume 55, Issue 1

Health Care Providers, Purchasers, Join Forces to Back Quality Improvement Act

Governor Scott Walker unveiled his special session tort reform package this week, which included a provision that will improve the quality and value of health care in Wisconsin. The provision, called the Health Care Quality Improvement Act (QIA), will put Wisconsin at the forefront of the patient safety and quality improvement movement, leading to better outcomes for patients and better health care value for employers and employees.

The Wisconsin Hospital Association was joined by a growing list of health care and business organizations in voicing their strong support for the QIA (see news release). Under the proposal, health care providers will be able to study and improve practices and, importantly, share what they learn with others without fear of those findings being used against them in a lawsuit. These changes will bolster the work of organizations—including the state’s regulatory agencies—that work to improve patient safety and health care quality.

WHA has pushed for revisions in the state’s peer review laws in two previous legislative sessions. In the 2005-2006 legislative session, WHA and a strong coalition of providers and purchasers supported a bill that would have updated the peer review laws. The bill received overwhelming bi-partisan support in both the Senate and the Assembly, receiving 29 "yes" and only three "no" votes in the Senate and passing on a voice vote in the Assembly. However, the bill fell victim to Governor Doyle’s veto pen. In the 2007-2008 legislative session, the QIA passed the Assembly committee on a strong bi-partisan 11-2 vote and again passed the Assembly on a voice vote. The Senate failed to take up the bill.

Wisconsin’s current "peer review" laws were largely enacted in the 1970s and have fallen far behind modern, integrated approaches to delivering health care. The newly-proposed QIA legislation will encourage broader participation in quality reviews by health care practitioners and professionals. Walker’s legislation will also accelerate important collaborative efforts that will improve patient outcomes.

The QIA encourages this activity by:

The Senate and Assembly judiciary committees will hold a joint public hearing on the QIA and the rest of the tort reform package on Tuesday, January 11, in Madison.

WHA President Steve Brenton praised the QIA and called it "an essential element of a special session focused on jobs because employers want the kind of high-quality health care that is the byproduct of ongoing and future efforts to constantly improve clinical care."

"This is really about value for dollars used to purchase health care," according to Brenton. "Wisconsin is already a high value health care state, and this legislation will allow us to accelerate our performance improvement efforts."

Wisconsin Manufacturers and Commerce Vice President of Government Relations James Buchen said, "WMC strongly supports the QIA because we believe it will help Wisconsin providers become more cost-efficient and improve the quality of the care delivered, increasing the overall value of the health care employers and employees purchase."

WHA issued a statewide news release on the QIA January 5 and submitted an opinion editorial to several major news outlets that was co-authored by WHA Chair Nick Turkal, MD and WHA President Steve Brenton. The op-ed appears on page 3 in this issue of The Valued Voice.

More information about the other provisions in the special session tort reform package is available on the Wisconsin Civil Justice Society (WCJS) Web site (www.wisciviljusticecouncil.org/issue-resources/2011-special-session). WCJS was organized in 2009 with the primary goal to "achieve fairness and equity, reduce costs, and enhance Wisconsin’s image as a place to live and work." WHA is a founding member of WCJS, and WHA Executive Vice President Eric Borgerding is a member of its board of directors.

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Inauguration Ceremonies Usher in New Leadership for Wisconsin
Governor, Senate and Assembly sworn in; Walker administration continues to take shape

The first week of the new year saw Scott Walker (R) sworn in as Wisconsin’s 45th governor and new republican majorities in both the Senate and Assembly take the oath of office.

In the Senate, Scott Fitzgerald (R-Juneau) takes over as majority leader, and in the Assembly, his brother Jeff Fitzgerald (R-Horicon) is now the Speaker. For the Democrats, Mark Miller (D-Monona) in the Senate and Peter Barca (D-Kenosha) in the Assembly are the new minority leaders.

Governor Walker’s administration also continued to take shape as an additional department secretary was named and key agency staff positions continued to be filled. Also among the announcements this week was the addition of Brian Hayes as Budget Director. Hayes has served as an administrative law judge, worked in DOA, and was as a legislative aide to former Assembly Speaker John Gard.

In addition to previously named secretaries, including Dennis Smith at the Department of Health Services (DHS) and Mike Huebsch at the Department of Administration (DOA) (see www.wha.org/pubArchive/friday_packet/vv12-30-10.htm#1), Walker named heads at the Department of Workforce Development (DWD), the Department of Regulation and Licensing (DRL), and the Department of Commerce and the Commissioner of Insurance.

Key staff joining Huebsch at DOA includes Deputy Secretary Cindy Archer, who formerly served under Walker in his role as Milwaukee County Executive; and Executive Assistant Jodi Jensen, previously Huebsch’s top aide in the Legislature.

Serving as Smith’s Deputy Secretary at DHS is former state representative Kitty Rhoades. Former state representative Brett Davis will spearhead the key role of Medicaid Director and Department Executive Assistant will be Kevin Moore, former long-time aide to Rhoades in the Legislature.

At DWD, Manuel "Manny" Perez is the new Secretary and has named Scott Baumbach, his Deputy. Perez has run and co-owned an employment staffing firm and was a partner at the law firm Michael Best & Friedrich.

Walker named former Superior Mayor Dave Ross Secretary for the DRL and former Secretary of the Department of Veterans Affairs John Scocos will be his Deputy. Department Executive Assistant will be John Murray, former legislative aide for Senator Dale Schultz.

At Commerce, the new Secretary is former Green Bay Mayor Paul Jadin. Deputy Secretary Mike Klonsinski is a former executive director of the Wisconsin Manufacturing Extension Partnership (WMEP) and Executive Assistant David Volz is a former legislative aide to Joint Finance Committee Co-Chair Alberta Darling.

And this week, Walker named Ted Nickel Insurance Commissioner. Former lobbyist Dan Schwartzer will be Nickel’s Deputy.

Required Senate confirmation of Walker’s cabinet choices is expected soon.

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New Majorities Mean Big Changes for Study Committees
Republicans now control chairs, committee direction

Incoming co-chairs of the Joint Legislative Council for the 2011-12 session, Sen. Mary Lazich (R-New Berlin) and Rep. Joan Ballweg (R-Markesan) moved quickly this week to change the chairs of several Legislative Study Committees that began work before the end of the 2009-10 session.

Lazich and Ballweg replace prior Joint Legislative Council Co-Chairs Sen. Fred Risser (D-Madison) and Rep. Marlin Schneider (D-Wisconsin Rapids). Schneider was not re-elected in November.

Among the leadership changes voted on by new Joint Legislative Council members:

The new chairs will now decide the direction each committee will pursue as they address their respective committee topics.

Other significant changes learned this week include the potential for Sen. Olsen to conclude work on the Health Care Access Committee at their next meeting and the cancellation of the next Health Care Reform Committee meeting previously scheduled for Monday, January 10.

Additional study committee updates will be provided as they become available.

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Governor Proposes Change in Commerce Department
Change aligns with WHA-supported recommendation in "Be Bold Wisconsin" Study

Gov. Scott Walker released draft legislation January 6 that will convert the Department of Commerce into the Wisconsin Economic Development Corporation (WEDC). The Governor believes the move is one of several necessary to restart Wisconsin’s sluggish economy and open the door for new business and job growth in the state.

The Governor’s plan is consistent with a recommendation contained in the "Be Bold Wisconsin: The Wisconsin Competitiveness Study." WHA was a member of the Study’s steering committee and also provides financial support. The Study proposed replacing the Commerce Department with a new quasi-public entity charged with crafting, delivering and overseeing Wisconsin’s economic development strategy. As a non-political advocate, the Study said the new organization would be insulated from frequent leadership, policy or strategy changes; thereby, allowing it to develop a comprehensive, targeted and statewide economic development strategy. Gov. Walker’s plan aligns closely with the plan outlined in the Study’s recommendation.

In his announcement, the Governor said the regulatory duties currently assigned to the Department of Commerce will be reviewed to determine their impact on public safety or public health before being reassigned to other agencies or eliminated. The new authority will be led by a "chief executive officer" and a 12-member board of directors. The board of directors will be comprised of the Governor, who will serve as chairman, and 11 members appointed by the Governor and confirmed by the Senate.

WHA strongly supports the drive to create jobs in Wisconsin and stimulate economic development. As a founding and on-going member of two nonpartisan, multi-stakeholder groups, including the Be Bold Wisconsin effort, WHA is actively advocating for comprehensive and specific plans for future economic development activities that focus on job creation and growth in the non-health care economy. WHA Executive Vice President Eric Borgerding participated in three economic development summits last summer aimed at spurring economic development that would help generate much-needed revenue to help address the state’s significant budget shortfall. Advocating for initiatives that will improve Wisconsin’s private sector economy is one of the top five Association priorities in 2011.

"The first step to addressing the state’s massive budget problem is to get people back to work," Borgerding said. "If people have jobs with good pay and benefits, the skyrocketing enrollment we’ve seen in the Medicaid program will begin to moderate."

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Op-Ed: QIA Strengthens, Accelerates Quality Improvement

The following editorial opinion was sent to the statewide press January 5, 2011.

Nurses, physicians and other health care professionals work determinedly to provide safe and excellent care. In Wisconsin we want to do even more; our patients deserve nothing less. That is why we support Governor Walker’s proposed "Health Care Quality Improvement Act"—legislation that will help Wisconsin health care providers deliver quality care second to none.

Health care practitioners have a long history of critically analyzing their own and their peers’ performance to improve care. Historically, groups of providers reviewed and discussed patient cases, using what they learned to improve future care. Our laws, crafted in the 1970s, encouraged this collaboration by protecting "peer reviews" from use in lawsuits. Lawmakers understood that if peer reviews could be used against a physician, nurse or other practitioner, it would discourage candid participation in quality improvement activities.

Today, robust quality improvement is more important than ever, but our laws have NOT CHANGED. Over the last several years, the risk to providers who work to improve care by cooperating with regulators or participating in their facilities’ quality improvement efforts has increased. As a result, some are reluctant to share what they have learned.

While national report cards show that Wisconsin is a national leader in delivering high quality care, our peer review laws have fallen behind other states, no longer aligning with the way modern care is delivered. Wisconsin is fortunate to have integrated health systems, hospitals and clinics anxious to work internally and with each other to research and improve practices. Through collaboration, they can make measurable strides to improve patient safety and outcomes. We can strengthen and accelerate this work by protecting those collaborative efforts. We also can encourage the good work of our regulatory agencies by protecting people who cooperate with the regulators. And we can enable more public reporting of quality and safety data.

Our patients deserve the best care possible, the primary goal of Governor Walker’s Health Care Quality Improvement Act. This forward looking and progressive initiative deserves strong support from health care providers and consumers and, most importantly, bipartisan support in the Legislature.

Nick Turkal, MD
Chair, Wisconsin Hospital Association
President/CEO, Aurora Health Care

Steve Brenton
President, Wisconsin Hospital Association

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Physician Leadership Development Conference Offered March 11-12
Take advantage of early bird discount by January 28

Take advantage of early bird discount pricing by registering today for the 2011 WHA Physician Leadership Development Conference. The discount pricing is available to individual physicians and hospital teams until January 28. This annual conference is for new, potential and seasoned physician leaders, and will be offered by WHA on Friday, March 11 and Saturday, March 12 at The American Club in Kohler. Registration information is included in this week’s packet, and online registration is available at www.wha.org/education/PhysicianLeadership.aspx.

Each year, attendees express the value of attending the conference as a team—physician leader and management leader—allowing for invaluable informal, one-on-one conversation and team building during the event. This opportunity is once again available at the 2011 conference, with a special "host" registration option available to those hospital representatives/management leaders who would like to accompany their attending physicians to the conference but do not need the CME credit.

Professional leadership training for your new or seasoned physician leaders continues to be a need in Wisconsin hospitals, so for 2011, consider WHA’s proven, in-state option for physician leadership development training, offering high-quality education at about one-half the cost of the national programs, with less travel expense and less time out of the hospital and away from practice.

This popular conference offers nationally-recognized faculty to assist in developing physician leadership skills and facilitating the transition of your physicians from clinicians to physician leaders. Physician leaders must represent both clinical and managerial interests, and each year at this event, presenting faculty from the American College of Physician Executives (ACPE) focus on important leadership skills that help physician leaders move beyond their clinical training and take a new approach to managerial decision-making and problem solving.

ACPE is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. ACPE designates this educational activity for a maximum of 11 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The full conference brochure with registration and resort information is included in this week’s packet. For more information on registration, contact Lisa Littel at 608-274-1820 or via email at llittel@wha.org.

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WHA Co-Sponsors "Business Day in Madison" on February 23
Stuart Varney and Larry Sabato provide keynotes

The Wisconsin Hospital Association joins with other organizations, including host organization Wisconsin Manufacturers & Commerce, in co-sponsoring the "Annual Business Day in Madison 2011," set for February 23 at Madison’s Monona Terrace. WHA co-sponsors and participates in Business Day as part of its overall advocacy strategy to collaboratively find policy solutions to important issues.

Keynote speakers for Business Day 2011 include Stuart Varney and Dr. Larry Sabato. Varney, host of Varney & Co., is a business and financial journalist. He will discuss the global economic crisis and what it means for America as well as how America can lead the world out. Dr. Sabato, an election analyst, is also the author of Larry Sabato’s Crystal Ball. He will discuss the U.S. Constitution and changes that could be made to restore a more productive balance between policies and government.

Invited but yet to be confirmed speakers are Governors Chris Christie of New Jersey, Governor Scott Walker and Rep. Paul Ryan.

Business Day annually brings business leaders from across the state to Madison to learn about issues impacting the business community, to meet with their legislators in the State Capitol and to network with one another. WHA will host a members-only briefing at 8 a.m. that morning.

If you plan on attending this event or need additional information, please contact Jenny Boese at 608-268-1816 or jboese@wha.org.

View the program at: www.wha.org/2011BusinessDay.pdf

Learn more or register for Business Day online at: www.wmc.org/display.cfm?ID=1027

Important Note: Business Day in no way duplicates nor takes the place of WHA’s premier legislative grassroots event, WHA’s Advocacy Day, to be held on April 27, 2011 in Madison. Some 650 hospital leaders, employees, trustees and volunteers from across Wisconsin are expected at this year’s event.

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CMS Launches Registration Web Site for Meaningful Use

Hospitals and physicians can now register for the Medicare and Medicaid electronic health records "meaningful use" incentive programs at www.cms.gov, but are not required to do so immediately, the Centers for Medicare & Medicaid Services has announced. The CMS registration Web site can be found at www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp.

There are a few things that hospitals should know before registering, according to Matthew Stanford, vice president, policy and regulatory affairs, WHA, which are:

If you have questions, contact Matthew Stanford at 608-274-1820 or email mstanford@wha.org.

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Spooner Health System Employee Flu Vaccination Rate Sets New Record – 90 Percent!
The ‘flu-light special’ and other creative approaches drive success

Spooner Health System (SHS) Infection Preventionist Jill Andrea RN has cause for celebration this flu season. For the 2010-2011 flu season, Andrea helped push SHS’s employee flu vaccination rate to 90 percent, beating last year’s record of 88 percent. How does she do it?

"I start early. Even in the summer we promote the flu vaccination during our ‘skills labs’ that are devoted to staff education," Andrea explains. "The employees are in small groups and we have an opportunity to discuss topics of importance such as hand hygiene and influenza vaccinations. We can address their concerns in a more intimate setting, well in advance of the fall flu clinics."

Andrea meets with all new employees during orientation to cover various health topics including importance of vaccinations. During the months of September through February, a flu vaccination is offered to each new employee at orientation and she has had great results with this.

When the flu vaccine arrives, Andrea makes use of a cart, which she has dubbed the "flu light special."

"I visit every department and let the managers know in advance when I will be there. I want to make it upbeat and fun," Andrea said. "I encourage managers to be vaccinated first to demonstrate their support for and the importance of employee flu vacations."

Andrea said when the H1N1 was circulating through the state last year and the initial shipment of vaccine was in short supply, she provided the H1N1 vaccine to direct patient caregivers first, followed by those employees that had already received the seasonal flu shot. That served as a "carrot" of sorts to encourage employees to get their seasonal flu vaccination.

Andrea said she was anticipating the employee flu vaccination rate to drop this year, but she thinks "the ice was broken" for some employees last year that, in the past, were reluctant to receive the flu shot, but got it last year for the first time.

With "great support from administration" and encouragement to be creative in her approach to immunizing employees, it’s no wonder that the staff at SHS are very accepting of the vaccination program.

This year for the first time, Spooner Health System and Indianhead Medical Center in Shell Lake combined their efforts to organize and staff public flu clinics. The clinics ran smoothly and the community participation was outstanding, according to Andrea.

Andrea offers this advice: "Be as proactive as you can, anticipate what may occur before it happens and provide the best education opportunities possible for your employees."

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UPDATE: 2nd Medicaid EHR Incentive Program Webinar Scheduled January 21

On January 13 at 9 a.m., WHA and the Wisconsin Department of Health Services will jointly present a webinar on the 2011 launch of Wisconsin’s Medicaid EHR Incentive Program. Due to demand, the webinar will be repeated Friday, January 21 at 1 p.m.

These webinars are intended to provide hospitals information they will need to know to participate in Wisconsin’s Medicaid EHR Incentive Program.

Key hospital leaders and staff charged with directing the hospital’s participation in the "meaningful use" EHR incentive programs are strongly encouraged to participate in either of these no-cost webinars. Key topics addressed will include:

To register for the January 13 or January 21 webinar go to www.wha.org/education/ehr1-13-11.aspx.

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Wisconsin Hospitals Community Benefits: Uncompensated Care

Fear of a bill should never prevent a patient from seeking care at a Wisconsin hospital. Wisconsin hospital charity care programs provided $226 million to more than 700 patients a day in 2009. 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.

Young breast cancer patient gets the care she needs

At 33, breast cancer was the last thing on Laura’s mind. So when the lump she found turned out to be cancerous, she was stunned. Because breast cancers in young women tend to be aggressive, the breast cancer specialists at Froedtert Hospital recommended a mastectomy as well as chemotherapy and radiation to reduce the chances of a recurrence.

Laura tolerated chemotherapy well and continued to work during treatment. She had just begun her course of chemotherapy when the next blow struck—she was laid off from her job. She couldn’t afford to continue her health insurance through COBRA, so she found herself without insurance coverage in the middle of treatment for a serious form of breast cancer.

Laura applied for charity care through Froedtert Hospital and qualified for 100 percent assistance. Through June 2009, the hospital provided approximately $66,000 in free care to Laura. She has completed chemotherapy but still needs radiation therapy and hopes to have reconstructive surgery in the future.

"I’m so grateful to Froedtert for this program," Laura said. "I don’t know what I would have done without it."

Froedtert Memorial Lutheran Hospital, Milwaukee

Financial assistance program gives patients peace of mind

The Community Memorial Hospital financial assistance program provides some patients with a reduction in bills based on their income and assets. This program was the saving grace for Erika Neu, who struggled to pay bills after she was diagnosed with colon cancer.

Erika, who was living on Social Security, was shocked to find out she had stage 3 colon cancer. She had to have surgery and chemotherapy, and her self-paid insurance plan was expensive and didn’t cover many of the treatments and medications she needed.

"It came at a very inopportune time for me," she said. "I had always been healthy and never had any other problems. I didn’t know much about cancer."

Erika was relieved to find out that low-income patients can get help paying their medical bills if they fill out a request for assistance. For instance, with the help of hospital staff she found out medication programs for patients who need assistance can be found on the needymeds.org Web site. Erika benefitted from a medication program called Genentech BioOncology Access Solutions. Community Memorial’s Outpatient Pharmacy is also involved in helping patients access medications.

"That was a lifesaver for me," Neu said. "There’s no way I could have ever paid that back being on Social Security. I was really grateful to the hospital for giving me good care. They were there for me when I needed answers and to know what was happening to me."

Erika, now 65, eventually applied for supplemented Medicare and Title 19.

"Now I don’t feel so bad and I know my bills will get paid," she said.

With the worries of paying for her medical bills behind her, Erika likes to spend time with her grandchildren, play sheepshead with her friends and may even get back to doing some needlework.

"I’m more at peace with my life and I enjoy it a lot more," she said.

Community Memorial Hospital, Menomonee Falls

Will he make it?

One patient, a 53-year-old male patient presented four times in 2008 for inpatient treatment for alcoholism. It was made clear that his continued Community Care assistance was contingent on his compliance with a treatment program. He started in a treatment program in late 2008 and is hopefully continuing to do well. All who cared for him desired a better life for him. He is self employed and unable to find or be accepted by any affordable health insurance. $98,000 for the hospital alone was given in Community Care assistance for this patient.

Holy Family Memorial Medical Center, Manitowoc

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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