December 30, 2010
Volume 54, Issue 51
Gov.-Elect Walker Announces Key Cabinet Picks
As Valued Voice goes to press, Governor-Elect Scott Walker is holding a press conference in Madison to announce several key cabinet appointments. Dennis Smith, former Bush administration director of the federal Center for Medicaid and State Operations at the Centers for Medicare and Medicaid Services, was named Secretary of the Department of Health Services (DHS) and the Department of Administration (DOA) Secretary will be former Assembly speaker and La Crosse-area state Rep. Mike Huebsch.
WHA offered the Association’s congratulations to both Smith and Huebsch on their new appointments.
"WHA stands ready to assist Secretary-Designates Smith and Huebsch and the other experienced and talented appointees announced today by Governor-Elect Walker," Brenton said.
"DHS is one of the state’s most important agencies, advancing significant population health initiatives and administering a wide array of health care programs, including Medicaid," Brenton added. "The Medicaid program purchases safety net health care services for over 1 million citizens. But as we enter 2011, the program’s funding is under severe pressure and enrollment is outpacing most other states in the country. Working together, we must find ways to maintain Medicaid safety-net health coverage for those with no other options, align spending and available revenues, and minimize the hundreds of millions in unpaid Medicaid costs that are shifted to Wisconsin employers, workers and their families every year."
As head of the agency that oversees the state budget, DOA Secretary-Designate Huebsch will be responsible for advising the Governor on how best to utilize the state’s financial resources as the state struggles to balance a budget. Addressing issues that range from K-12 education and workforce development to natural resources and Medicaid, Huebsch and his team will work to prepare the Administration’s proposed budget that is expected to be presented to the Legislature in February.
"There’s a difficult road ahead to navigate our way out of the huge structural budget deficit facing Wisconsin," said WHA Executive Vice President Eric Borgerding, "but Mike Huebsch certainly has the knowledge and experience that will be required to get the job done, and we look forward to working with him and with his new team."
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2010 "Results" Illustrates WHA’s Progress on Key Priorities
In the last few days of 2010, it’s appropriate to hit "rewind" and take stock of the past year. And what a year it was. From the passage of one of the most historic pieces of federal health care legislation in decades to an election that flipped Washington and Madison on their heads, it was a year to remember.
Amidst the turmoil, hospitals remained mission-focused and patient-centered as they continued to deliver the highest quality care in the nation. As the recession maintained its assault on the nation’s economy, hospitals implemented cost-saving measures and took action to ensure that their finances remained sound, which secured the health care safety net in communities across Wisconsin.
One of WHA’s top priorities—Medicaid program funding—became the focus of the Association’s most successful grassroots campaign in its history. Threatened by a 10 percent cut in Medicaid funding, Critical Access Hospitals (CAHs) led the effort to avert the cuts by proposing and supporting a hospital assessment similar to the program created in 2009 for PPS hospitals. WHA lobby efforts in Madison were bolstered by literally dozens of in-district meetings between local hospital leaders and legislators that contributed to the successful passage of legislation that will help preserve access to care in rural Wisconsin.
Hospitals looked to WHA to help them navigate the new environment created by federal health reform. The Association took the lead and advocated for Wisconsin hospitals in Washington DC and in the State Capitol on health-reform related issues that ranged from accountable care organizations, state insurance exchanges, reimbursement and public reporting. WHA emphasized that reform should recognize—and reward—the commitment that Wisconsin health care organizations have to creating value by providing high quality, affordable care.
Wisconsin hospitals have led the country in public reporting for nearly a decade. This year, CheckPoint (WiCheckPoint.org) added information related to birthing services and birth-related quality measures. PricePoint (WiPricePoint.org), WHA’s hospital price reporting Web site also expanded in 2010 and added a new report that provides the hospital’s median charge for the top 75 most common reasons for hospitalization. Using this newly-created module on PricePoint, hospitals are able to comply with price transparency legislation that takes effect January 1 that requires them to provide this report to patients upon request.
For a complete review of the significant and commendable progress that WHA and its member hospitals made in 2010 on the Association’s key priorities, WHA staff has prepared a report entitled, "Results." The WHA 2010 Results publication is in this week’s packet. WHA encourages members to share the "Results" with members of their administrative team and with their hospital board members. Additional copies of WHA’s 2010 "Results" are available by contacting Shannon Nelson at email@example.com or 608-274-1820, or copies can be downloaded from www.wha.org.
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"Privilege to Serve..."
By David Olson, 2010 WHA Board Chair
This was an outstanding year, and a busy one for WHA. I hope you will take time to review your Association’s annual report included with this week’s newsletter and share it with your executive staff and hospital board members. Simply, but appropriately titled—"Results"—it provides a summary of WHA’s accomplishments in 2010.
The considerable achievements over the past year were only possible because of the hard work of members and WHA staff alike. Most importantly, this level of success is only attained when the membership is actively engaged in the activities of our Association
If you look at the WHA membership surveys, you can see that our members are delighted with the work that WHA does and believe that staff is focused and the priorities are correct. You recognize when you are on the WHA Board what a privilege and an honor it is to serve. It is exciting to see the success that we have had in this state, and the recognition that WHA has received, as we have gained a national reputation for being leaders and innovators in the health care field.
WHA is recognized as being a strong organization, and when you say you are member, you realize just how much weight it carries. It has been a remarkable experience to watch this organization begin making the transition so quickly to working with a new Administration and new Legislature. There are few advocacy organizations that enjoy great relationships with political leaders, regardless of party. Our ability to work across party lines so effectively is a key reason for our "results" which are considerable. That agility and foresight is a credit to Steve Brenton and his staff, and we are very proud to be a part of this great organization.
I would like to offer my congratulations to Dr. Nick Turkal as he takes office in January, and I thank you for giving me the opportunity to serve.
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Department of Revenue Revises Revenue Projections
Governor-elect Walker estimates deficit for current budget at $133 million
In a report earlier this week to the Wisconsin Department of Administration (DOA), the Department of Revenue (DOR) revised revenue projections up for fiscal year 2011 and for the 2012-13 biennium.
According to DOR data, state revenue will increase over the next three years by $292.8 million more than previously estimated. DOR is now projecting state revenue for Fiscal Year 2011 will be up $57.4 million and $235 million for the 2012-13 biennium.
The numbers are significant as incoming Governor-elect Walker and state legislators begin work to solve Wisconsin’s daunting budget deficit, estimated to be over $3 billion for the next biennium. The Medicaid shortfall alone is $188 million GPR for the remainder of the current 2011 biennium and an estimated $1.6 billion for 2012-13.
In a statement, outgoing DOA Secretary Dan Schoof credited recently extended federal tax cuts and personal income growth in Wisconsin.
In a statement the following day, Governor-elect Walker’s Transition Director John Hiller also detailed current 2011 Fiscal Year deficits at the Department of Corrections ($30 million) and the Office of the State Public Defender ($5 million) in addition to the Medicaid shortfall.
When combined with the revenue re-estimates, previously updated revenue balances and this week’s announced $23.1 million performance bonus Wisconsin received for increased monthly enrollment in Children’s Health Insurance Programs (CHIP) from the federal government related to the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Hiller estimated the current budget shortfall at $133 million.
The estimate does not reflect potential Fiscal Year 2011 repayment of $200 million related to the Injured Patients’ and Families Compensation Fund transfer.
"While yesterday’s revenue re-estimate is a step in the right direction, we are disappointed that it didn’t address the impact on the budget for the current fiscal year. In fact, the appropriation shortfalls in the current budget actually got worse, not better," Hiller said.
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Four Wisconsin Health Plans Aim to Improve Prenatal Care, Birth Outcomes
Four BadgerCare Plus contracted health plans are working together on an initiative aimed at improving care for high-risk pregnant women in southeast Wisconsin by connecting them with a medical home. The health plans have recruited several health care centers to serve as medical home pilot sites. A majority of the participating sites are affiliated with WHA member health systems, all of which have a long history of serving the medically-disadvantaged in their communities.
The health plans will use the medical home model and a range of incentives designed to help ensure that women remain enrolled in the medical home throughout their pregnancy and through the postpartum period. Center Pregnancy, an evidence-based program providing group-based care of women with similar due dates, is a key component of patient engagement strategies. Each plan emphasizes an obstetric care provider will be the primary point of contact for the women and will be responsible for coordinating all needed care among multi-disciplinary teams.
According to DHS, "Care coordinators will work with each clinic to ensure that each BadgerCare Plus member enrolled in the medical home receives the services and supports she need to have a healthy baby."
The health care organizations involved with the project all have demonstrated success with their prenatal and postpartum programs. Many have established some of the capabilities required for a medical home and have demonstrated an interest and readiness toward becoming a fully-developed medical home, according to the plan submitted by Community Connect Health Plan.
The health plans will work closely with the Milwaukee providers to identify patient members while they are still waiting in the emergency department and to connect them with their OB care team, which will allow the ER to focus on more critical cases. The Wisconsin Health Information Exchange may be useful in identifying ways to improve care coordination.
The four participating health plans are: Abri Health Plan, Children’s Community Health Plan, Community Connect Health Plan and United Healthcare, which serve BadgerCare Plus members enrolled in the Standard and Benchmark plans in Milwaukee County and the five surrounding counties.
According to a report filed by DHS with the Joint Finance Committee, the medical home pilot programs begin operation January 1 and will continue for two years.
For more information on the project, see the DHS report to Joint Finance: www.wha.org/JFC_DHSreport.pdf
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Looking Ahead to 2011 — Observations and Predictions
Governor Walker’s 2012-13 Budget will be void of new general tax increases, ‘raids’ on segregated funds, and accounting gimmicks. Unlike his predecessors, both Dem and GOP, it will be an honest and painful plan that will eliminate the state’s chronic structural deficit. It is exactly what Wisconsin needs to avoid this:
There are laudable reasons to alter the Accountable Care Act but "death panels" aren’t one of them. Medicare should pay physicians for discussing end-of-life issues and decisions with patients who then voluntarily determine their own preferences. Look at La Crosse County’s admirable experience with end-of-life physician/patient engagement (even without payment) to understand why this is such an unfortunate issue.
Will Hospital Acquired Infections (HAI) become "the next asbestos" for trial lawyers constantly seeking new deep pockets to sue?
Regardless of the answer to the above question…the demand for hospital specific transparency for reporting HAI will escalate and the issue deserves a proactive response from the field.
You know the world has changed when the newly-elected Democratic Governor of New York…the bluest of blue states…goes on the record opposing new taxes to tackle an inherited budget deficit that surpasses $9 billion.
And then there’s Illinois (see above link) where the recently elected Governor is proposing the borrowing of $15 billion to pay down IOUs held by state vendors, including hospitals and doctors.
Remember Provider Sponsored Organizations (provider owned HMOs) from the 1990s? Commercial health plans were scared to death back then about new competition. It’s déjà vu (all over again) as commercial plans work to hamper the emergence of Accountable Care Organizations. The soon to be released ACO rules will be telling on that
Speaking of ACOs, they may prove to be meaningless in Wisconsin unless historic Medicare spending is factored in as a benchmark for future shared savings. Providers who’ve already done a good job managing costs should be given at least partial credit for that effort.
When WHA releases the results of the 2011 member survey (we plan to conduct early next year) the Physician Workforce issue/concern will continue to rank #1 despite a likely uptick in worries about Medicaid. Despite two fine medical schools, a positive payment and tort environment and attractive workplace options… Wisconsin loses too many new physicians to other venues and our lack of residency venues and disinterest from our current programs for growing the size of our classes is troublesome. And primary care capacity is 90 percent of our challenge.
How can you have delivery and payment reform without adequate primary care capacity?
CMS will fall in love with the ability to extract beaucoup dollars from payment penalties for hospital readmissions, HAIs and other described "mistakes." This is a landmine that will be difficult for hospitals and physicians to navigate.
Finally, expect local units of government to crank up the property tax/user fee issue as it relates to non-profits. With state-based aids and revenue sharing frozen or cut….the beast must be fed.
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Grassroots Spotlight: Hospitals Continue Hosting Legislators
Rep.-Elect Loudenbeck at Beloit; Sen. Hansen Shadows Bellin CEO
With the new Legislature preparing to be sworn in on January 3, 2011, hospitals across the state continue to invite elected officials in for visits and shadow days.
Recently, Beloit Health System CEO Greg Britton and members of his senior leadership team hosted newly-elected State Rep. Amy Loudenbeck, Republican, on a tour of the hospital. Loudenbeck will represent the 45th Assembly District, formerly held by Chuck Benedict who retired this year.
"We have a responsibility to make sure our elected officials are casting informed votes and view us as a reliable resource to help make those decisions," said Beloit Health System CEO Greg Britton. "Educating policymakers is a continuous process, a commitment to grassroots advocacy that we buy into here."
"This was a great opportunity to bring in a brand new legislator and begin what is a continuous process of education about our issues," said Beloit Health System Senior Vice President Tim McKevitt. "We spent some quality time with Amy, discussing real issues that need to be addressed in Madison, including the flawed system of emergency detention, and we made sure to involve our care giving staff who deal with these challenges daily."
In the Northeastern part of the state, Bellin Hospital (Green Bay) CEO George Kerwin hosted Sen. Dave Hansen during a shadow day.
During their shadow day, Hansen was able to see a snapshot of what it takes to run a hospital and all that Kerwin deals with day-in and day-out. Hansen participated in meetings and was able to discuss issues facing both the hospital and the greater Green Bay area.
"I was glad to be able to host Sen. Hansen," said Kerwin. "And show him the issues that affect our hospital, but really, his whole district and the state.
Later Sen. Hansen joined Kerwin in seeing the hospital’s health information technology system as well as observing a robotic surgery.
"We had a great time," closed Kerwin. "I would definitely do this again."
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NLRB Proposes Rule Requiring Employers to Post Notice of Union Organizing
By: Attorneys Jon Pettibone and David Kern, Quarles and Brady
On December 22, 2010, the National Labor Relations Board (the "Board") published a notice of proposed rulemaking that would have sweeping impact on almost all employers. If the proposed rule becomes final, employers subject to the jurisdiction of the NLRB (which includes the vast majority of private-sector employers in the United States) will be required to post a Notice advising employees of their rights under the National Labor Relations Act ("NLRA" or the "Act").
The Board states that the underlying purpose of its action is to remedy what they have described as a "knowledge gap" regarding employee rights under the NLRA. In the Board’s view, the relatively small number of unionized workers (approximately 7.2 percent of private sector employees in the United States) is directly attributable to this knowledge gap, and employees will be more likely to exercise their right to unionize if they are notified of their right to do so.
The rule itself would require employers to post a Notice that, among other things, details employee rights under the NLRA. The Notice must also be electronically distributed, if that is the method by which the employer customarily communicates with its employees. Among other things, the Notice advises employees of their protected right to:
Discuss terms and conditions of employment or union organizing with co-workers or a union.
Take action with one or more co-workers to improve working conditions by, among other means,
Organize a union to negotiate with their employer concerning wages, hours, and other terms and conditions of employment.
The Notice goes on to advise employees that it is illegal for an employer to take a variety of actions against them, including:
Prohibiting employees from soliciting for a union during non-work time.
Questioning employees about their union support or activities.
Prohibiting employees from wearing union hats, buttons, t-shirts and the like.
Significantly, the Board’s proposed rule also contains stiff sanctions for non-compliance. If an employer fails to post the Notice as required, the employer may be deemed to have committed an unfair labor practice in violation of Section 8(a)(1) of the NLRA, which prohibits employer actions which interfere with, restrain or coerce employees in the exercise of their rights under the Act. More importantly, the failure to post the Notice may serve to toll or extend the six-month statute of limitations for filing an unfair labor practice charge under the NLRA. In addition, if an employer is found to have knowingly ignored the posting requirement, the Board may presume that the employer possesses an unlawful anti-union motive, if other charges are filed against the employer and unlawful motive is an element of those charges.
The language of the proposed Notice tracks the language of a Notice now being required of certain government contractors and subcontractors, pursuant to a rule adopted by the Department of Labor earlier in 2010. Under that rule, contractors and subcontractors are required to post the identical Notice if they have entered into covered federal contracts or subcontracts containing the posting requirement. We described that rule and its posting requirements in a May 2010 alert.
Board Member Brian Hayes dissented from the NLRB’s decision to grant the rulemaking petition. In his view, the Board does not have the authority to require such a posting under the terms of the National Labor Relations Act. In contrast to the Fair Labor Standards Act, Title VII of the Civil Rights Act of 1964, the Age Discrimination in Employment Act, the Occupational Safety and Health Act, and other Federal legislation, the National Labor Relations Act contains no provision requiring employers to post notices informing employees of their statutory rights. One can, therefore, expect litigation over the Board’s right to have issued and to enforce the rule.
Interested parties have 60 days, or until February 22, 2011, to comment on the proposed rule.
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Wisconsin Office of Rural Health Accepting Applications for Loan Assistance
The Office of Rural Health is currently accepting applications and making awards for the Health Professions Loan Assistance Program. This Program makes awards to health care providers working in rural and urban underserved areas in Wisconsin to help pay off education loan debt. Applications for these awards are accepted throughout the year. The following awards are available:
Primary care physicians (MD and DO, including psychiatrists) and dentists working in a rural
or urban federally-designated shortage area can receive up to $50,000. Primary care
physicians working in a rural shortage area can receive an additional $50,000, for a total
award of $100,000.
Primary care physicians working in a rural, non-shortage area can receive up to $50,000.
Primary care Nurse Practitioners and Physician Assistants, Certified Nurse Midwives and Dental Hygienists working in a rural or urban federally-designated shortage area can receive up to $25,000.
Providers must agree to work full time in an eligible site for three years; eligible sites include community health centers and tribal health centers. All awards are federal and state tax free. The program is open to newly-hired and currently-employed providers. Providers who are not currently working in an eligible location must have an employment contract when they apply. You can determine whether a site is in a shortage area at this federal Web site: http://hpsafind.hrsa.gov where you can search by county, or http://datawarehouse.hrsa.gov/GeoAdvisor/ShortageDesignationAdvisor.aspx where you can search by address
More information including the online application is available on the Office of Rural Health Web site at http://worh.org . For more information contact Kevin Jacobson at the Office of Rural Health at 608-261-1888.
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