WHA has asked members of the Wisconsin Congressional Delegation to support and co-sponsor legislation designed to assist physician recruitment in medically underserved areas.

WHA is supporting bi-partisan legislation that will reauthorize and improve an ongoing federal initiative called the Conrad State 30 Program. The program was created one decade ago to help medically underserved areas recruit physicians, primarily by using J-1 visa waivers that allow foreign physicians to receive non-immigrant status.

"This pending legislation not only reauthorizes the Conrad State 30 Program but improves that program by providing very necessary state flexibility that will enable the State of Wisconsin, working with hospitals and primary care clinics, to place physicians in communities where the need is the greatest," noted WHA President Steve Brenton and Rural Wisconsin Health Cooperative Executive Director Tim Size in a communication sent to the legislators.

The letter also notes the recent release of the WHA Task Force on Wisconsin’s Future Physician Workforce report that documents a current physician shortage "that will only worsen in coming years absent the implementation of a multi-faceted action plan."

Affinity Health System, Menasha
Agnesian Health Care, Fond du Lac
Amery Regional Medical Center
Aurora Medical Center – Hartford
Aurora Sinai Medical Center, Milwaukee
Baldwin Area Medical Center
Beaver Dam Community Hospital
Beloit Memorial Hospital
Black River Memorial Hospital
Boscobel Area Health Care
Burnett Medical Center, Grantsburg
Children’s Hospital of Wisconsin - Kenosha
Children’s Hospital of Wisconsin - Neenah
Columbia St. Mary’s, Glendale
Community Health Care/Wausau Hospital
Community Memorial Hospital, Oconto Falls
Eagle River Memorial Hospital
Elmbrook Memorial Hospital, Brookfield
Flambeau Hospital, Park Falls
Fort Memorial Hospital, Fort Atkinson
Franciscan Skemp Healthcare - Arcadia
Franciscan Skemp Healthcare - La Crosse
Franciscan Skemp Healthcare - Sparta
Grant Regional Health Center, Lancaster
Gundersen Lutheran, La Crosse
Howard Young Medical Center, Woodruff
Hudson Hospital
Kindred Hospital Milwaukee
Langlade Memorial Hospital, Antigo
Memorial Health Center, Medford
Memorial Hospital of Lafayette County
Memorial Medical Center, Ashland
Memorial Medical Center, Neillsville
Mercy Health System, Janesville
Meriter Health Services
Moundview Memorial Hospital, Friendship
Oconomowoc Memorial Hospital
Orthopaedic Hospital of Wisconsin, Glendale
Our Lady Of Victory Hospital, Stanley
Sacred Heart Hospital, Eau Claire
Saint Joseph’s Hospital, Marshfield
Saint Michael’s Hospital, Stevens Point
Sauk Prairie Memorial Hospital
Shawano Medical Center
Southwest Health Center, Platteville
Spooner Health System
St. Clare Hospital & Health Services, Baraboo
St. Francis Hospital, Milwaukee
St. Joseph Regional Medical Center, Milwaukee
St. Joseph’s Community Health Services, Hillsboro
St. Joseph’s Hospital, Chippewa Falls
St. Luke’s Medical Center, Milwaukee
St. Luke’s South Shore, Cudahy
St. Michael Hospital, Milwaukee
St. Nicholas Hospital, Sheboygan
St. Vincent Hospital, Green Bay
The Monroe Clinic
The Richland Hospital, Richland Center
The Wisconsin Heart Hospital, Wauwatosa
Tomah VA Hospital
Vernon Memorial Healthcare, Viroqua
Watertown Memorial Hospital
Waukesha Memorial Hospital

I started in politics as a congressional aide from Iowa, and later was elected as the representative from that same district. (Grandy was a regular on the 1980s TV hit, "The Love Boat.") After "Love Boat," I saw there was a condition in the Midwest that was very troubling. There was an economic downturn and a collapse in agriculture, and I decided to run for congress.

For 15 months, I visited every bean feed and town meeting where more than 2 people were gathered. I wanted to pick up on the pulse of the people. I look back on that time as the most rewarding part of my career. At first I was kind of suspect—the celebrity hanging around in the grain elevator, a kind of information-gathering process. But people could say, he was here, we talked about commodity prices, foreign policy, and through that, I created a rapport of accessibility.

The New York Times recently ran a story that stated grassroots action would play a big role in the presidential election. Do you agree?

Grassroots has been an important force in American politics since George Washington. One of the reasons why large media establishments are re-learning about it is because of the splintered focus of the people. Newspapers are not as important as they used to be. Internet, radio, cable channels are all important tools now.

Howard Dean understood this merging of technology and he used tried and true grassroots techniques to get support. If Dean gives up some of those lists he created via the Internet, someone is going to have a list of real people who can organize meetings, drive people to the polls, and get people to focus on the election.

People sometimes feel intimidated by the political process. What do you say to these people to encourage them to make contacts?

Know what you are talking about and reduce it to three or four bullet points. Legislators learn to speak by constantly reading executive summaries and key points. Long verbose statements are not read by anyone but staffers. The attention span of a legislator is roughly that of a mayfly so you have to make your point quickly. Peter Drucker has been very instructive in this. He talks about the difference between value to a customer and value to a supplier. Most people go to their legislators thinking that they are customers and the legislator is the supplier. That’s backwards. You are the supplier – you have the information he needs. He depends on you to get elected. You need to get that point across. If you are afraid of your legislator, they will cultivate that fear. Make sure you let them know the leash is short.

There are so many ways to amicably harass legislators with email and visits. The most effective way to communicate is still face-to-face. And remember, legislative staff people are not statues, they are moving upwards and backwards in the process. You need to cultivate staff relations. You may get to know a staffer and find that they have now moved up the food chain. It is like Glenn Ford said, "Be nice to people as you are coming up, you may see them on the way down."

We see actors running for, and winning, public offices. What do you think they learn after they win?

Running for public office is hard work. Actors can’t always see themselves standing in the cold light of a grain elevator at 5 am. The ability to humble themselves is a bridge too far for a lot of actors. California Governor Arnold Schwartzenegger got around all that because the campaign was very quick. However, take Jesse Ventura. He is a local guy, well liked. He learned this is hard work, no fun, and no one likes you.

In my case, I ran for office out of genuine concern for my home state. It is a common ailment among those who live in the public world, sports or entertainment. They translate that idolization into real support. Most people are smarter than that. They figured out Howard Dean and he soon lost one race after the other. There is a kind of selection process that goes on under the media radar. Dean was the odds-on favorite to be where Sen. John Kerry is now. But something happened, there was a prudent discernment by the public, and they decided they needed something more than Dean could offer.

Representative Ron Kind (D-3CD) met with St. Joseph’s Community Hospital employees, trustees and volunteers on Wednesday April 13. Rep. Kind toured the hospital and nursing home, stopping to visit with residents and staff members. Joe Havlik, RT(R), demonstrated the capabilities of the CT scanner, which arrived in June 2003. This technology upgrade makes CT scanning available to the patients in the area, a capability that was previously only available by a trip out of the community.

After the tour, Rep. Kind met with employees for 45 minutes and had a wide ranging discussion about the changes to the Medicare program, the importance of the critical access hospital program for rural facilities, drug reimportation from Canada and the 2003 Farm Bill and its impact on rural family farms.

"Representative Kind has been a good friend to St. Joseph’s Hospital, supporting rural health issues," said Bill Bruce, CEO. "As a matter of fact, Ron helped us secure the necessary federal sign offs which allowed us to refinance the long term debt for our facility. We are pleased to have Ron as our voice in Washington, D.C."

Earlier this week, Governor Doyle vetoed SB 508, which would have adopted the federal wage exemption for overtime pay for companionship services. While our neighboring states and others have passed similar legislation without much controversy, Governor Doyle chose to veto this legislation because he believes the bill would only make the shortage of health care professionals worse. WHA believes that by not extending the same exemption to agency workers, more seniors will be forced out of their homes and long-term care costs will increase.

WHA registered in support of SB 508, which was initiated by the home health care agencies after a Department of Workforce Development ruling on the issue conflicted with federal law. Because the Governor vetoed this bill, seniors who hire companion caregivers directly will continue to be exempt from the overtime pay laws, but those companion caregivers who are employed by an agency will have to be paid overtime wages rates if they work more than 40 hours per week. Increased funding from the state and federal governments, private insurers and seniors will be needed to continue to provide this service through an agency where there are already additional costs that include worker’s compensation and liability insurance in addition to background screenings.

The Centers for Medicare and Medicaid Services (CMS) has published several program transmittals to implement changes to Medicare reimbursement based on the Medicare Prescription Drug, Improvement and Modernization Act of 2003. Changes apply to the Inpatient Prospective Payment System (PPS), Outpatient PPS, Home Health PPS, Graduate Medical Education (GME) payments, and Disproportionate Share Hospital (DSH) payments.

Sheboygan County officials are pondering the sale of the County’s two nursing homes to private owners. The facilities are generating less than $27 million annually with expenses exceeding $32 million. That 20% negative margin begs the question…what if there are no buyers? Sheboygan County’s dilemma is but one example of many faced by public and private sector long-term care providers across the state. The Medicaid program’s dismal failure to pay anything approaching the actual costs of care is creating a crisis of sustainability for providing health care services to elderly and oftentimes disabled residents. And this in a state that spends just about half the national average (as a percentage of total state spending) on Medicaid.

Now, some Wisconsin lawmakers are floating the notion of amending the Wisconsin Constitution to cap state and local spending and require voter approval of tax increases in statewide or local referendums. Several legislators want to move quickly and vote on the amendment as early as May. It doesn’t take much effort to imagine the fate that awaits the already poorly funded and politically unpopular Medicaid program should this constitutional amendment pass.

There are compelling reasons for the Wisconsin Legislature to slow down and have a real debate about the Taxpayer Bill of Rights (TABOR) instead of rushing to judgment and passing a resolution this spring. Here are just three of them:

• Just because it’s popular doesn’t mean it’s the right thing to do. While the notion of limiting spending (isn’t that the Legislature’s and Governor’s job?) and allowing taxpayers to "approve" by referendum new tax increases is popular…incredibly popular…so are many other ideas that lawmakers would find distasteful. As Waukesha County Board Chairman Jim Dwyer noted just last week, "What if I put on the ballot a question that asked, ‘Would you like to have a unicameral legislature with 35 members that would cut your budget by ‘X’ amount of dollars and met twice a year?’…and 85% of the voters said yes? Would anybody in Madison vote themselves out of a job? Absolutely not."

Representative democracy sometimes brings with it difficult challenges for elected officials. Theoretically, that’s why they’ve been elected!

• The law of unintended consequences. The Sheboygan County conundrum presents a terrific illustration of what might happen to local units of government all across Wisconsin if efforts to provide necessary services to frail citizens are further hampered by TABOR. Inadequate Medicaid payment, which will likely worsen under TABOR, will hardly entice private sector purchasers of financially failing public facilities. When local taxpayers likely reject efforts to further subsidize their safety net facilities through higher property taxes, there will be no options for elected officials other than facility closure.

Another "unintended consequence" will find a legislature already reluctant to adequately fund Medicaid further weighed down by this constitutional amendment. The impact on already high health insurance premiums subject to an ever increasing cost shift or "Medicaid hidden tax" will be significant.

• The Colorado example. Wisconsin TABOR supporters claim that they will "Wisconsinize" TABOR and avoid Colorado’s fiscal problems that even they agree exist due to that state’s TABOR. But there is good reason to be dubious. Reports from Colorado indicate that Medicaid is faring poorly as a budget priority compared to the politically popular K-12 education budget line item. In fact, the Colorado Health and Hospital Association (CHA) is currently fighting a $10 million Medicaid provider payment cut and an 8-10% reduction in program eligibility. CHA reports that over the past decade, provider payments have been reduced by tens of millions of dollars. And they site TABOR as the culprit.

For Wisconsin’s hospitals, TABOR is not a partisan debate of taxing and spending philosophy. It is a simple question of government paying for the programs government has already created. Because right now, and perhaps even more so in a TABOR future, it is employers, through cost shifting (dubbed the Medicaid "Hidden Tax" by WMC), who are absorbing the true unpaid costs of Medicaid, BadgerCare, SeniorCare, HIRSP and other programs.

It’s time to take a deep breath and have a sound public discourse on the pros and cons of TABOR so all the issues can be aired, discussed and debated. The Wisconsin Hospital Association will continue to communicate our concerns with Medicaid, and now TABOR, over the coming days and weeks.

Steve Brenton,
President

On March 26, 2004, the Centers for Medicare and Medicaid Services (CMS) published Phase II of its regulations under the "Stark" physician self-referral law. Following the close of a comment period, the final rule becomes effective on July 26, 2004. With the Stark II, Phase II rules complete, for now, the CMS rules interpreting the Stark self-referral ban and government enforcement in this area is expected to begin when these new final rules become effective in July 2004.

This seminar, "Countdown to Enforcement: The Final Stark II Phase II Regulations," will describe the significant provisions of the final Stark II, Phase II rulemaking and identify focus areas for internal compliance, where changes to existing arrangements may be needed. Compliance officers, in-house counsel, CEOs/administrators, vice presidents, CFOs and physician recruiters should consider attending this important event.

Two half-day seminar options are being offered. The first is on May 11, 2004, from 1-4 pm at the WHA Headquarters in Madison. Enrollment in this seminar is limited to 35 people.

The second seminar is being offered on May 12, 2004, from 9 am to 12 pm at the Holiday Inn in Stevens Point. A brochure and a registration form for either seminar are included in this week’s packet and on the web site at www.wha.org. Easy, on-line registration is available as well.

Appleton-based ThedaCare was prominently featured in a recent Wall Street Journal article titled: "To Fix Health Care, Hospitals Take Tips from Factory Floor."

Dated April 9, 2004, the article described how some U.S. hospitals are studying and applying the production methods of Toyota Motor Corporation. The Deming-inspired, Toyota-perfected techniques have been used by the automaker to streamline operations, improve quality and cut costs.

As employers face increases in health care costs, they are saying, "Hey guys, this is broken. You really have to fix it," ThedaCare President/CEO John Toussaint, MD, said in the article.

ThedaCare recently hired consultants steeped in the Toyota system after seeing the results at the Ariens Corporation, a large snowblower manufacturer in nearby Brillion. After a three-hour visit to the Brillion plant, ThedaCare’s leaders were convinced. "It was the only time in memory we all agreed on something," Toussaint said in the article.

ThedaCare is applying quality and process improvement principles ("mistake proofing," "value stream mapping") to prevent errors, reduce wait times and move patients through their system more efficiently. ThedaCare joins about a dozen other hospitals and hospital systems across the country employing similar methods.

Frank Byrne, MD, was named president of St. Marys Hospital Medical Center in Madison effective July 12.

"We are very excited about Dr. Byrne joining us at St. Marys," said SSM Health Care President and CEO Mary Starmann-Harrison. "Gerald Lefert, the hospital’s current president, is retiring after 32 years of outstanding service with St. Marys and will work closely with Dr. Byrne in the transition of leadership."

Byrne most recently served as president of Parkview Hospital in Fort Wayne, Indiana. In his 20-plus years at Parkview Hospital, Dr. Byrne also served in the leadership roles of executive vice president of the Parkview Health Foundations and president of the medical staff. He holds a BS degree from the University of Notre Dame. He earned his medical degree from the State University of New York-Health Science Center of Brooklyn and received his post-graduate medical training at Indiana University Medical Center in Indianapolis, specializing in Pulmonary and Critical Care Medicine.

In an effort to respond to the growing need for nurses, a recent $50,000 donation awarded to the Fox Valley Technical College (FVTC) from Affinity Health System will be used to increase enrollment in the college’s nursing programs.

This donation is an addition to the $100,000 Affinity gave the college last year in support of its five-year enrollment expansion plan. With the money, FVTC will be able to increase its Associate’s Degree Nursing program enrollment by 50% – from 72 to 108 new students.

The donations from Affinity will ensure that the college, in the second year of its five-year plan, will be able to keep the 108 new student enrollments for the next three years.

Red Cedar Medical Center – Mayo Health System, located in Menomonie, Wisconsin, is seeking an Associate Administrative Officer for our integrated medical center. The position reports directly to the Chief Administrative Officer (CAO). The AAO will provide supervision of assigned departments and be an active participate in the leadership team. A Master’s degree in health care administration or related health care field from an accredited university is preferred. MBA with health care administration experience acceptable. A minimum of two years of professional administrative experience in the health care field is required. RCMC-MHS offers a competitive wage and benefit package including health, dental, life, disability, 401K, and vacation /sick time. For benefit or community area information, please contact Human Resources at 715-233-7211 or inquire on-line through our web site at www.rcmc-mhs.org. Resumes and salary requirements must be sent to: Human Resources, Red Cedar Medical Center – MHS, 2321 Stout Road, Menomonie, WI 54751 by April 23, 2004.

Waupun Memorial Hospital (WMH) is seeking a President/Chief Executive Officer to lead this progressive hospital toward continued growth and financial prosperity. As a member of Agnesian HealthCare, WMH plays a vital role in the growth of the system, which serves a population of approximately 250,000.

This position reports to the President of Agnesian HealthCare. Major responsibilities include; development and implementation of strategic initiatives, working closely with the local board of directors and the medical staff to improve outcomes and inspiring employee commitment to the hospital mission. Recently recognized by the Wisconsin Forward Award Program, the system places a heavy emphasis on quality and is the benchmark for quality in a number of areas.

For more information, contact Norma Tirado-Kellenberger, VP Employee Services and Organizational Development, or Robert Fale, President/CEO, Agnesian HealthCare, phone 920-926-5703, tirado@agnesian.com or fale@agnesian.com, or write Agnesian HealthCare at PO Box 385, Fond du Lac WI, 54936-0385.

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