September 24, 2010
Volume 54, Issue 37
Health Care Reform Study Committee Focuses on Exchanges
Experts from Utah, Massachusetts share experiences and challenges
This week the Legislative Council Study Committee on Health Care Reform Implementation heard from a variety of invited speakers as they began a closer examination of the challenges and opportunities surrounding the creation of a health insurance exchange in Wisconsin. Two hospital CEOs are among the 21 Committee members. They are William Petasnick, president/CEO, Froedtert Health, and Ed Harding, president/CEO, Columbus Community Hospitals.
Among the provisions in the Patient Protection and Affordable Care Act (PPACA), exchanges are required to be established as new mechanisms for expanding access to health insurance. States have the opportunity to establish an exchange. The U.S. Department of Health and Human Services (HHS) is responsible for establishing and operating an exchange for those states that choose not to establish one or for states that will not have their exchange operable by January 1, 2014.
The idea behind an exchange is to create an organized and competitive market for health insurance, governed by common rules, and designed to help consumers (individuals and businesses) better understand their health insurance options. While federal planning grants are available to assist states in their efforts, opinions differ on whether states should be among the first to establish their exchanges or should wait and more thoroughly evaluate how exchanges evolve in other states.
The list of invited speakers for this week’s meeting included: Bill Oemichen – president & CEO of the Cooperative Network; Dave Stella – secretary, Department of Employee Trust Funds (DETF) and staff; Jon Kingsdale, Kingsdale & Associates, former executive director of the Massachusetts Health Connector; Dave Jackson – director, Utah Health Exchange; and Jason Helgerson – Medicaid director, Department of Health Services (DHS). Helgerson was unable to attend; Rachel Currans-Sheehan, executive assistant, DHS, provided testimony to the committee in his absence.
In his presentation, Kingsdale gave a brief description of health reform, its progress in Massachusetts and some of the design issues and lessons learned from the development and implementation of their exchanges – Commonwealth Care, which connects eligible, uninsured, low-income residents to subsidized health plans; and Commonwealth Choice, which connects residents and businesses to commercial health insurance products. According to Kingsdale, a key difference between their exchanges is that Commonwealth Care aggressively negotiates with insurers, whereas Commonwealth Choice acts more as a marketplace, marketing the health plans.
Kingsdale said among the key questions for states are determining the exchange’s goals and addressing design issues, such as determining the governance structure and addressing adverse selection. He listed outreach and marketing to members, integrated eligibility determination, transparency of cost, access and quality, and simplification of choice and enrollment as some of the administrative challenges. Among the lessons learned, Kingsdale mentioned both the challenges and opportunities related to automation (technology) and opportunities for outsourcing, partnering and collaborating where he said a high amount of private commercial capacity exists.
In moving toward the establishment of their exchange, Jackson said Utah identified the same issues that are evident in other states including: escalating premium costs, consumers increasingly detached from the market, employers dropping insurance, too many uninsured, and misaligned incentives. Based on their identification of the issues, he said Utah made a commitment to a systemic change with six areas of emphasis: health insurance reform, personal responsibility, transparency and value, maximization of tax advantages, optimization of public programs, and a modernization of governance.
Jackson listed several similarities between the Utah and Massachusetts exchanges. Both are state-based and state-specific solutions and both are consumer-centered approaches that achieved broad, bi-partisan consensus supporting their basic reform elements.
But Jackson said there are also several differences between how the two states approached their exchanges: Massachusetts has individual and employer participation mandates, Utah does not; Massachusetts acts more as a contracting agent, the State of Utah’s role is that of a market facilitator; Massachusetts established their exchange with broad regulatory responsibilities, the Utah exchange’s regulatory authority is limited to the establishment of electronic data standards; and Massachusetts acted first on public sector reforms and is now rolling out private insurance market reforms, Utah began by implementing private reforms first, with public sector reforms to follow.
In her discussion, Currans-Sheehan indicated that work continues at the state’s Office of Health Care Reform (OHCR) on a detailed exchange plan that is guided by five key ideas: keep the exchange simple; make the exchange transformative; make sure it builds off of Wisconsin’s strengths; make sure there’s a focus on customer service; and coordinate wherever possible with existing initiatives.
Currans-Sheehan said the OHCR has submitted an application requesting nearly $1 million in federal planning grant funding to complete the research and analysis related to implementing an exchange in Wisconsin. According to Currans-Sheehan, a significant portion of the dollars will go toward a comprehensive survey to better understand the insurance marketplace in Wisconsin and to develop a predictive model for what insurance premiums through an exchange might look like.
She also indicated that the OHCR will be submitting comments on health insurance exchanges in response to a request for public comment from DHHS. WHA is also developing and will be submitting comments prior to an October 4 deadline.
According to Committee Co-Chairs Rep. Richards and Sen. Erpenbach, among the decisions the Committee will begin making at their next meeting is whether the Committee should recommend that Wisconsin establish an exchange or allow the responsibility for our state’s exchange to fall to HHS. And if Wisconsin does develop an exchange, should it be our own or done as part of a regional or multi-state exchange.
Also presented at the meeting was a proposal from David Reimer, director – Community Advocates Public Policy Institute; Joe Leean, former secretary of DHS; and Robert Kraig, executive director – Citizen Action of Wisconsin describing what Wisconsin exchange’s governing body and functions might look like.
During discussion after the presentations, Petasnick made the point and Committee Co-Chairs Richards and Erpenbach agreed that before the Committee makes any significant determinations on exchange details, Committee members need to focus on a set of guiding principles for their deliberations. To that end, the co-chairs instructed the Committee members to submit their ideas on guiding principles to Legislative Council staff along with comments and alternatives related to an exchange governing body for development of an options paper for discussion.
All materials related to this study committee, can be found at: www.legis.state.wi.us/lc/committees/study/2010/REFORM/index.html. The next meeting is scheduled for October 21.
WHA asks Supreme Court to Review Property Tax Exemption CaseThe Wisconsin Hospital Association this week asked the Wisconsin Supreme Court to accept Covenant Healthcare’s Petition for Review of the Court of Appeal’s decision that denied the hospital property tax exemption for St. Joseph Hospital’s Outpatient Center. In its brief, WHA acknowledged that Supreme Court review is the exception rather than the rule, but emphasized, "This is an exceptional case."
David Edquist of von Briesen & Roper, writing on behalf of WHA, argued that the Supreme Court is presented with an opportunity to step back and consider the nonprofit hospital exemption "in light of the history of property tax exemptions generally, and the purposes and functions of modern hospitals in particular." Quoting Justice William O. Douglas ("Common sense often makes good law"), Edquist noted, "[W]hen a lower court adopts an interpretation of the law that is totally contrary to common sense, a second look is in order."
WHA’s brief points to the realities of health care today: "The increased provision of hospital services on an outpatient basis has brought improved access to advanced life-saving and life-enhancing services to Wisconsin communities. […] These innovations have reduced the cost of surgical and treatment procedures while providing the best in patient safety and care." According to the brief, hospitals should not be required to risk their property tax exemption when transitioning services from an inpatient to an outpatient setting.
In WHA’s brief, Edquist also emphasized that the Court’s review is important to restore consistency and predictability for future interpretations of the nonprofit hospital exemption. Finally, when describing the significant statewide impact of the Court of Appeals decision, WHA’s brief explained that the vast majority of Wisconsin hospitals, throughout the state, are nonprofit. Most services provided by these nonprofit hospitals are outpatient services; this is particularly true for small rural hospitals that are relatively more dependent on outpatient services to provide care in their communities.
After filing WHA’s brief in support of Wheaton’s Petition for Review, Edquist said, "We understand that the Court generally accepts less than one out of 10 civil cases for review. But given the impact the Court of Appeals decision could have on the access to and cost of health care in Wisconsin, particularly those areas of the state already struggling to maintain services, we are hopeful that the Court will accept this case. We are asking the Court to review this entire body of law in order to restore consistency, clarity, and common sense."
A copy of the WHA brief in support of the Petition for Review is available on the WHA Web site at
www.wha.org/legalAndRegulatory/PropertyTaxVV9-24-10.pdf.Top
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Political Action Spotlight: 2010 Fundraising Campaign Surpasses $200K Mark
Heading into the last two months before the November election, the 2010 Wisconsin Hospitals State PAC and Conduit fundraising campaign has raised more than $200,000. The $200,571 total raised to date accounts for 93 percent of the $215,000 goal.
To date the Campaign has raised this total from 423 individuals affiliated with 85 hospitals/hospital systems. This is an increase of 35 individuals in the last two weeks.
Contributions to candidate campaigns have also exceeded $200,000 the past two weeks totaling more than $226,000 in disbursements. This is an increase of more than $65,000 ahead of 2008 at this same time, the last election year and no surprise given that there are a record number of open seat state legislative races, an open seat gubernatorial race and competitive Congressional races around the state. Remember to contact WHA’s Jodi Bloch or Jenny Boudreau to check your Wisconsin Hospital Conduit account balance when a candidate campaign requests your financial support.
Individual contributors’ names are published below by amount categories in alphabetical order. They will be published again in two weeks. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.
Contributions Ranging from $1 - $499
Adams, Daniel Memorial Medical Center - Ashland
Anderson, Mark Sacred Heart Hospital
Appleton, Karl HSHS-Eastern Wisconsin Division
Arendt, Kathleen Aspirus Wausau Hospital
Arriola, Josephine St. Joseph’s Hospital
Ashenhurst, Karla Ministry Health Care
Axelsen, Kathern Sacred Heart Hospital
Ayers, Mandy Wisconsin Hospital Association
Bair, Barbara St. Clare Hospital and Health Services
Baker, Christine St. Mary’s Hospital
Ballentine, Anne Wheaton Franciscan Healthcare
Bares, Diane Aurora Health Care
Barkovich, Catherine Sacred Heart Hospital
Beckler, Rick Sacred Heart Hospital
Beglinger, Joan St. Mary’s Hospital
Bell, Kristine Aspirus Wausau Hospital
Benz, Staci Children’s Hospital and Health System
Bergmann, Ann Spooner Health System
Bernklau, Robert Aspirus Wausau Hospital
Biros, Marilyn SSM Health Care-Wisconsin
Bliven, David Aspirus Wausau Hospital
Block, Jennifer Sacred Heart Hospital
Bloom, Deborah St. Joseph’s Hospital
Bosio, David Aspirus Wausau Hospital
Bosman-Clark, Jane Children’s Hospital and Health System
Boson, Ann Ministry Saint Joseph’s Children’s Hospital
Boudreau, Jenny Wisconsin Hospital Association
Bowman, Andrew Sacred Heart Hospital
Braddock, Jonathan WHA Financial Solutions
Braunschweig, Jennifer Gundersen Lutheran Medical Center
Brenholt, Craig St. Mary’s Hospital
Brenny, Terrence Stoughton Hospital Association
Brown, John St. Mary’s Hospital
Bryans, Richard Sacred Heart Hospital
Buettner, Susan Aurora Health Care
Buhl, Mike
Burgener, Jean Aspirus Wausau Hospital
Burtch, Sue Aspirus Wausau Hospital
Busch, Rebecca Spooner Health System
Buss, Diane St. Mary’s Hospital
Calhoun, William Mercy Medical Center
Campau, Patricia Columbia St. Mary’s, Inc.
Campbell, Mark Aspirus Wausau Hospital
Campbell-Kelz, Nancy Aspirus Wausau Hospital
Carlson, Carol Sacred Heart Hospital
Casey, Candy Columbia Center
Caven, Michael Memorial Medical Center - Ashland
Cieslak Duchek, Mary Aurora Health Care
Clark, Mary Ann Cumberland Memorial Hospital
Connor, Michael Aurora Health Care
Conwell, Lisa WHA Financial Solutions
Coon, Lawrence Hall, Render, Killian, Heath & Lyman
Cox, Tamarah Aspirus Wausau Hospital
Craft, Carolyn St. Joseph’s Hospital
Cryns, Janice Children’s Hospital and Health System
Dalebroux, Steve St. Mary’s Hospital
Danner, Dean Aspirus Wausau Hospital
Danzinger, Marcia Sacred Heart Hospital
Davis, Kathleen Children’s Hospital and Health System
DeMars, Nancy Sacred Heart Hospital
Derks, Darla Sacred Heart Hospital
Dettman, Amy Bellin Hospital
Dietrich, Dean Aspirus Wausau Hospital
Dietsche, James Bellin Hospital
Dillon, Michael Sacred Heart Hospital
Dixon, Janet Children’s Hospital and Health System
Dodd, Petra Aspirus Wausau Hospital
Donlon, Marcia Holy Family Memorial, Inc.
Dorpat, Denice Aspirus Wausau Hospital
Drengler, Kathryn Aspirus Wausau Hospital
Dryden, Shawn Sacred Heart Hospital
Dwyer, Amy Sacred Heart Hospital
Eady, Diane Sacred Heart Hospital
Eddy, Lee Anne Children’s Hospital and Health System
Elliott, Roger St. Joseph’s Hospital
Entenmann, Kim St. Joseph’s Hospital
Erickson, William Ministry Saint Mary’s Hospital
Ertl, Denise Aspirus Wausau Hospital
Evans, Kim Bellin Hospital
Facey, Alice St. Clare Hospital and Health Services
Feeney, John Aurora Medical Center in Oshkosh
Feldhausen, Mary St. Vincent Hospital
Fielding, Laura Holy Family Memorial, Inc.
Fields, Mary Aurora Health Care
Fochs, Mary Aspirus Wausau Hospital
Francaviglia, Stephen Aurora Health Care
Fuchs, Thomas St. Joseph’s Hospital
Furlong, Marian Hudson Hospital
Gantner, Sue Aspirus Wausau Hospital
Garavet, Scott Aspirus Wausau Hospital
Gengler, Tim Aspirus Wausau Hospital
Giedd, Janice St. Joseph’s Hospital
Gerike, Nancy St. Clare Hospital and Health Services
Gigot, Kelly St. Vincent Hospital
Gjolberg, Skip St. Joseph’s Hospital
Goelzer, Mark Mercy Health System Corporation
Goffinet, Jo St. Mary’s Hospital
Gormican, John J. Agnesian HealthCare/St. Agnes Hospital
Govier, Mary Holy Family Memorial, Inc.
Grohskopf, Kevin St. Clare Hospital and Health Services
Gruber, Richard Mercy Health System Corporation
Gullicksrud, Lynn Sacred Heart Hospital
Gutekunst, Penny Children’s Hospital and Health System
Habel, Heidi Hayward Area Memorial Hospital
Hafeman, Paula St. Vincent Hospital
Haggerty, Peggy Columbus Community Hospital
Halida, Cheryl St. Joseph’s Hospital
Hamilton, Mark
Hammel, Jennifer Children’s Hospital and Health System
Hansen, Carrie Ministry Health Care
Hassemer, Robert Sacred Heart Hospital
Hattem, Marita Aspirus Wausau Hospital
Hedrington, Brian Sacred Heart Hospital
Hennessy, Candace Aurora Health Care
Hessert, Peter Aspirus Wausau Hospital
Hink, Dawn Sacred Heart Hospital
Hiremath, Satchi Aurora Health Care
Hoege, Beverly Reedsburg Area Medical Center
Hofer, John Bay Area Medical Center
Holmes, Sheri Aspirus Wausau Hospital
Huettl, Patricia Holy Family Memorial, Inc.
Hundt, Pamela Sacred Heart Hospital
Jelle, Laura St. Clare Hospital and Health Services
Jensema, Christine HSHS-Eastern Wisconsin Division
Jensen, Christopher Children’s Hospital and Health System
Jensen, Russell St. Mary’s Hospital
Jentsch, Lisa Children’s Hospital and Health System
Johnson, Charles SSM Health Care-Wisconsin
Johnson, Kimberly Sacred Heart Hospital
Johnson, Patricia Hayward Area Memorial Hospital
Johnson, Roy Children’s Hospital and Health System
Jones, Linda Children’s Hospital and Health System
Karow, Deborah Aspirus Wausau Hospital
Kelsey Foley, Kathy Aspirus Wausau Hospital
Kempen, Jacob Aspirus Wausau Hospital
Kepchar, Dennis Ministry Health Care
Kerecman, Laura Children’s Hospital and Health System
Kerfoot, Karlene Aurora Health Care
King, Steve St. Mary’s Hospital
Klay, Lois St. Joseph’s Hospital
Kleaveland Kupczak, Sarah Wheaton Franciscan Healthcare
Kluesner, Kevin Aurora Health Care-South Region
Klunk, Timothy Children’s Hospital and Health System
Kowske, Steve Aurora Health Care
Krueger, Pamela Aspirus Wausau Hospital
Lange, George Westgate Medical Group, CSMCP
Larson, William St. Joseph’s Hospital
Lathrop, Randall Sacred Heart Hospital
Leonard, Joanne
Leonard, Mary Kay St. Mary’s Hospital
Lerch, Shawn Columbus Community Hospital
Lien, Kristine Sacred Heart Hospital
Logemann, Tim Aspirus Wausau Hospital
Lorenz, Bruce Aspirus Wausau Hospital
Lortscher, Loren Sacred Heart Hospital
Lucas, Roger Aspirus Wausau Hospital
LuCore, Patricia Sacred Heart Hospital
Mackey, Theresa Sacred Heart Hospital
Marcouiller, Don Memorial Medical Center - Ashland
Margan, Rob Wisconsin Hospital Association
Marsch, Jean St. Vincent Hospital
Mathews, Larry St. Vincent Hospital
Maurer, Mary Holy Family Memorial, Inc.
McKevett, Timothy Beloit Memorial Hospital
McNally, Maureen Froedtert Memorial Lutheran Hospital
Meicher, John St. Mary’s Hospital
Mello, Sadie Sacred Heart Hospital
Miller, Clint Spooner Health System
Mohr, Carol Sacred Heart Hospital
Moon-Mogush, Cindy Aurora Health Care
Moraski, Kevin Ministry Health Care
Mourey, Gerald Aspirus Wausau Hospital
Mulder, Doris Beloit Memorial Hospital
Nelson, James Fort HealthCare
Nelson, Mark Sacred Heart Hospital
Nevers, Rick Aspirus Wausau Hospital
Nockerts, Steve The Richland Hospital, Inc.
Norton, Marcella Aspirus Wausau Hospital
O’Keefe, Robert Aurora Health Care
Olive, Willie Children’s Hospital and Health System
Olkowski, Leland Aspirus Wausau Hospital
Ordinans, Karen Children’s Hospital and Health System
Ose, Peggy Riverview Hospital Association
Osen, John Aspirus Wausau Hospital
Padilla, Gilbert Sacred Heart Hospital
Page, Alison Baldwin Area Medical Center
Palecek, Steve St. Joseph’s Hospital
Pascente, Maria Aurora Health Care
Paul, Mary Columbia St. Mary’s, Inc. - Milwaukee
Peck, Lori Memorial Health Center
Pedretti, Julie Children’s Hospital and Health System
Peickert, Barbara Hayward Area Memorial Hospital
Peiffer, Susan Sacred Heart Hospital
Pempek, Kalynn Aspirus Wausau Hospital
Pennebecker, Allen Ministry Health Care
Perlock, Sandra Aspirus Wausau Hospital
Peterson, Doulas Chippewa Valley Hospital
Pichotta, Naomi Aurora Health Care
Piehl, Steven Children’s Hospital and Health System
Pielhop, Judy Sacred Heart Hospital
Piper, Barbara Sacred Heart Hospital
Pirsig-Anderson, Jane Aurora Health Care
Podhora, Ida Children’s Hospital and Health System
Polenz, Scott Memorial Medical Center - Neillsville
Potts, Dennis Aurora Health Care
Powell, Stacey Sacred Heart Hospital
Preston, Mark Sacred Heart Hospital
Priest, Geoffrey Meriter Hospital
Proehl, Sheila Hudson Hospital
Prunty, Brian Aspirus Wausau Hospital
Reinke, Mary Aurora Health Care
Richbourg, Mary Sacred Heart Hospital
Roberts, Paula Children’s Hospital and Health System
Roberts, Phillip Columbus Community Hospital
Rocheleau, John Bellin Hospital
Roethle, Linda Bellin Psychiatric Center
Ross, Forrest WHA Financial Solutions
Rouzer, Cindy Spooner Health System
Rowe, Jeanne Aspirus Wausau Hospital
Rozenfeld, Jonathan St. Mary’s Hospital
Rubenzer, Deanne St. Joseph’s Hospital
Rubenzer-Pike, Janet St. Joseph’s Hospital
Rudolph, Wade Sacred Heart Hospital
Rueber, Joel Aspirus Wausau Hospital
Sachse, Kelly Children’s Hospital and Health System
Schade, Randy Aspirus Wausau Hospital
Schaetzl, Ron St. Clare Hospital and Health Services
Schoof, Susie Essie Kammer Consulting Group
Schraufnagel, Patricia Memorial Medical Center - Ashland
Schroeder, Larry Sauk Prairie Memorial Hospital
Schweitzer, Susan Columbus Community Hospital
Scinto, Jeanne Aspirus Wausau Hospital
Sczygelski, Sidney Aspirus Wausau Hospital
Sheehan, Heather Hayward Area Memorial Hospital
Skulan-Balmer, Anna Sacred Heart Hospital
Spieckerman, Jill Ministry Saint Mary’s Hospital
Stanford, Cynthia Wisconsin Hospital Association
Stelzer, Jason St. Clare Hospital and Health Services
Stenson, Jill Agnesian HealthCare/St. Agnes Hospital
Stine, Stephen Aspirus Wausau Hospital
Stone, Stacy Sacred Heart Hospital
Storing, Sandy Sacred Heart Hospital
Stout, Johni WHA Financial Solutions
Strobel, Donald Aspirus Wausau Hospital
Swanson, Becky Sacred Heart Hospital
Swessel, Catherine Children’s Hospital and Health System
Tandberg, Christine Sacred Heart Hospital
Tapper, Joy Milwaukee Health Care Partnership
Tarantino, Jennifer Aurora Health Care
Thiel, Mike Children’s Hospital and Health System
Todd, Jeffrey Aspirus Wausau Hospital
Turner, Sally Aurora Health Care
Tuttle, Kathryn Memorial Medical Center - Ashland
Twinem, Thomas Children’s Hospital and Health System
Vakoc, Patricia Aspirus Wausau Hospital
Verploegh, Alan Aspirus Wausau Hospital
Voelker, Thomas Aspirus Wausau Hospital
Vogler, Linda Sacred Heart Hospital
Vogt, Paula Aspirus Wausau Hospital
Walker, Troy St. Clare Hospital and Health Services
Warren, Scott Memorial Medical Center - Ashland
Washburn, Juliane Bay Area Medical Center
Watts, Susan St. Vincent Hospital
Weden, Mary Children’s Hospital and Health System
Werlein, George Sacred Heart Hospital
Whiteaker, Les Memorial Medical Center - Ashland
Winter, Jean Aspirus Wausau Hospital
Wise, Richard Sacred Heart Hospital
Witt, Heather Aspirus Wausau Hospital
Wymelenberg, Tracy Aurora Health Care
Wynimko, Susan St. Joseph’s Hospital
Zeller, Brad Hayward Area Memorial Hospital
Contributions Ranging from $500 - $999
Andersen, Travis St. Elizabeth Hospital
Anderson, Rhonda Columbia St. Mary’s, Inc.
Anderson, Sandy St. Clare Hospital and Health Services
Bayer, Tom St. Vincent Hospital
Bonin, Christopher Aurora Health Care
Borgerding, Dana
Brenton, Mary E.
Bukowski, Cathy Ministry Health Care’s Howard Young Medical Center
Butler, John St. Mary’s Hospital
Callies, Julie WHA Information Center
Carlson, Dan Bay Area Medical Center
Chess, Eva Aurora Health Care
Clapp, Nicole Grant Regional Health Center
Clough, Sheila Ministry Health Care’s Howard Young Medical Center
Coffman, Joan St. Joseph’s Hospital
Deich, Faye Sacred Heart Hospital
Farkas, David Aurora Health Care
Frank, Jennifer Wisconsin Hospital Association
Geboy, Scott Hall, Render, Killian, Heath & Lyman
Grundstrom, David Flambeau Hospital
Harding, Edward Columbus Community Hospital
Heifetz, Michael SSM Health Care-Wisconsin
Hinton, George Aurora Sinai Medical Center
Hyland, Carol Agnesian HealthCare/St. Agnes Hospital
Hymans, Daniel Memorial Medical Center - Ashland
Jenks, David Aurora Health Care
Just, Lisa Aurora Medical Center in Hartford
Kammer, Peter Essie Kammer Consulting Group
Kellar, Richard Aurora West Allis Medical Center
Kerwin, George Bellin Hospital
Klein, Rick Aurora Health Care
Klimisch, Ronald Aspirus Wausau Hospital
Korom, Nancy Children’s Hospital and Health System
Krueger, Mary Ministry St. Clare’s Hospital
Lambrecht, Randy Aurora Health Care
Mahoney, Lorelle Aurora Health Care
Mantei, Mary Jo Bay Area Medical Center
Marquardt, Amy Columbia St. Mary’s, Inc. - Columbia
McDonald, Brian Aurora Health Care
McDonald, Mary Beth Aurora Health Care
McKennie, Randall Aurora St. Luke’s Medical Center
Merline, Karen
Miller, Jim Children’s Hospital and Health System
Mlynarek, Robert ProHealth Care - Waukesha Memorial Hospital
Moulthrop, David Rogers Memorial Hospital
Mugan, James Agnesian HealthCare/St. Agnes Hospital
Murphy, Mike Bay Area Medical Center
Normington, Jeremy Moundview Memorial Hospital and Clinics
Oberholtzer, Curt Bay Area Medical Center
Postler-Slattery, Diane Aspirus Wausau Hospital
Potter, Brian Wisconsin Hospital Association
Richards, Theresa Ministry Saint Joseph’s Children’s Hospital
Russell, John Boscobel Area Health Care
Selberg, Heidi HSHS-Eastern Wisconsin Division
Shabino, Charles Wisconsin Hospital Association
Ship, Mark Children’s Hospital and Health System
Size, Pat Rural Wisconsin Health Cooperative
Smith, Linda Aurora Health Care
Staffileno, Gerri Columbia St. Mary’s, Inc. - Ozaukee
Strasser, Kathy Aspirus Wausau Hospital
Stuart, Phil Tomah Memorial Hospital
Swanson, Kerry St. Mary’s Janesville Hospital
Taplin Statz, Linda SSM Health Care-Wisconsin
Topinka, Ralph Mercy Health System Corporation
Van Meeteren, Bob Reedsburg Area Medical Center
VanCourt, Bernie Bay Area Medical Center
Wallace, Michael Fort HealthCare
Contributions Ranging from $1,000 - $1,499
Bazan, Bill Wisconsin Hospital Association
Birkenstock, Timothy Children’s Hospital and Health System
Britton, Gregory Beloit Memorial Hospital
Brophy, Michael Aurora Health Care
Buser, Kenneth Wheaton Franciscan Healthcare - All Saints
Byrne, Frank St. Mary’s Hospital
Chapin, Rocklon St. Mary’s/Duluth Clinic Health System
Christensen, Cinthia Children’s Hospital and Health System
Devermann, Robert Aurora Medical Center in Oshkosh
Duncan, Robert Children’s Hospital and Health System
Dunigan, Thomas Children’s Hospital and Health System
Eichman, Cynthia Ministry Our Lady of Victory Hospital
Fale, Robert Agnesian HealthCare/St. Agnes Hospital
Falvey, Patrick Aurora Health Care
Friberg, Deb Columbia St. Mary’s, Inc. - Milwaukee
Garcia, Dawn Sacred Heart Hospital
Greenberg, Beverly Aurora Health Care
Hahn, Brad Aurora Health Care
Hilt, Monica Ministry Saint Mary’s Hospital
Kief, Brian Ministry Saint Joseph’s Children’sHospital
Kryda, Michael Ministry Saint Joseph’s Children’s Hospital
Lappin, Michael Aurora Health Care
Loftus, Philip Aurora Health Care
Maciver, Carolyn Aurora Health Care
Marciano, Karol Columbia St. Mary’s, Inc. - Milwaukee
Martin, Jeff Ministry Saint Michael’s Hospital
Nauman, Michael Children’s Hospital and Health System
Nelson, Dave SSM Health Care-Wisconsin
Niemer, Margaret Children’s Hospital and Health System
Park, Dr. Joon Aurora Health Care
Petasnick, William Froedtert Memorial Lutheran Hospital
Radoszewski, Pat Children’s Hospital and Health System
Reynolds, Sheila Children’s Hospital and Health System
Robertstad, John ProHealth Care - Oconomowoc Memorial Hospital
Roller, Rachel Aurora Health Care
Ronstrom, Stephen HSHS-Western Wisconsin Division
Sanders, Robert Children’s Hospital and Health System
Schafer, Michael Spooner Health System
Sexton, Bill Prairie du Chien Memorial Hospital
Stanford, Matthew Wisconsin Hospital Association
Titus, Rexford ProHealth Care
Troy, Peggy Children’s Hospital and Health System
Warmuth, Judith Wisconsin Hospital Association
Westrick, Paul Columbia St. Mary’s, Inc. - Milwaukee
Wolf, Edward Lakeview Medical Center
Woodward, James Meriter Hospital
Worrick, Gerald Ministry Door County Medical Center
Contributions Ranging from $1,500 - $1,999
Bailet, Jeffrey Aurora Health Care
Banaszynski, Gregory Aurora Health Care
Bloch, Jodi Wisconsin Hospital Association
Boese, Jennifer Wisconsin Hospital Association
Brooks, Alenia Aurora Health Care
Capelli, A.J. Aurora Health Care
Fish, David St. Joseph’s Hospital
Grasmick, Mary Kay Wisconsin Hospital Association
Herzog, Mark Holy Family Memorial, Inc.
Johnson, Peter Aurora West Allis Medical Center
Kachelski, Joe WHA Information Center
Kosanovich, John UW Health Partners Watertown Regional Medical Center
Leitch, Laura Wisconsin Hospital Association
Levin, Jeremy Rural Wisconsin Health Cooperative
Mettner, Michelle Children’s Hospital and Health System
Morgan, Dwight Aurora Health Care
O’Brien, Mary Aurora St. Luke’s Medical Center
Olson, David Columbia St. Mary’s, Inc.-Ozaukee Campus
Contributions Ranging from $2,000 - $2,499
Bablitch, Steve Aurora Health Care
Ela, Susan Aurora Health Care
Katen-Bahensky, Donna
Merline, Paul Wisconsin Hospital Association
Neufelder, Daniel Affinity Health System
Oliverio, John Wheaton Franciscan Healthcare
Pandl, Therese HSHS-Eastern Wisconsin Division
Quinn, George Wisconsin Hospital Association
Sanders, Michael Monroe Clinic
Starmann-Harrison, Mary SSM Health Care-Wisconsin
Contributions Ranging from $2,500 - $2,999
Brideau, Leo Columbia St. Mary’s, Inc.-Columbia Campus
Erwin, Duane Aspirus Wausau Hospital
Contributions Ranging from $3,000 - $3,999
Borgerding, Eric Wisconsin Hospital Association
Desien, Nicholas Ministry Health Care
Turkal, Nick Aurora Health Care
Tyre, Scott Capitol Navigators, Inc
Contributions Ranging from $4,000 - $5,000
Contributions $5,000 +
Brenton, Stephen Wisconsin Hospital Association
Size, Tim Rural Wisconsin Health Cooperative
Breaking News...As we go to press, the WIRED for Health Board voted unanimously today (September 24) to recommend that the Wisconsin State Health Information Network (WISHIN) should serve as the state-designated entity (SDE) to implement a system of statewide health information exchange. WISHIN is an organization being formed by a consortium of WHA, the Wisconsin Medical Society, the Wisconsin Collaborative for Healthcare Quality, and the Wisconsin Health Information Organization.
The recommendation next goes to DHS Secretary Karen Timberlake for her approval, which is expected by the end of September. Watch for more information in next week’s Valued Voice.
WMC Files Lawsuit Challenging New Prohibition on Certain Employer MeetingsWisconsin Manufacturers and Commerce (WMC) and the Metropolitan Milwaukee Association of Commerce (MMAC) have filed a lawsuit challenging, among other things, the constitutionality of last session’s amendments to the Wisconsin Fair Employment Act (WFEA). With the passage of 2009 Wis. Act 290, Wisconsin became the second state in the country to pass legislation that, with limited exceptions, prohibits employers from requiring employees to attend meetings to discuss whether employees should join or support a union. WHA joined WMC and other groups opposing what was Senate Bill 585. Senate Bill 585 passed the Senate on a voice vote prior to passing the Assembly 52-45 largely along party lines (all Democrats except Rep. Robert Ziegelbauer supported and all Republicans except Rep. Richard Spanbauer opposed the bill).
WMC and MMAC filed their lawsuit against the State of Wisconsin on September 8, 2010, arguing that the legislation not only is unconstitutional but also is preempted by the National Labor Relations Act (NLRA). As described in the WMC and MMAC complaint, the NLRA expressly protects the right of employees to hold mandatory meetings and other mandatory communications with employees for purposes of communicating their views about whether employees should join or support a labor organization. The National Labor Relations Board (NLRB) has upheld this fundamental right for more than half a century and the NLRB and federal courts have recognized the important contribution such meetings make to informed decision-making. The complaint argues that the new Wisconsin law interferes with these rights and, thus, is preempted by the NLRA.
The WFEA amendment is broader than prohibiting employer-mandated meetings about labor organization; 2009 Wis. Act 290 prohibits discrimination against an employee who declines to attend an employer-sponsored meeting or participate in any communication with an employer, the primary purpose of which is to communicate opinions about religious or political matters. The Department of Workforce Development (DWD) requires employers to post in their workplaces a notice advising employees of their rights under the new law. In addition, employers who violate the WFEA by discriminating or retaliating against employees who refuse to attend such meetings may be held liable for compensatory and punitive damages.
The WMC/MMAC lawsuit is in the U.S. District Court, Eastern District of Wisconsin. The WHA Board of Directors will be briefed on this issue and is considering WHA’s options to support the lawsuit. Watch The Valued Voice for updates as this case proceeds.
President’s Column: By the Numbers...It’s Been an Eventful Week
6 — That’s the six months that have passed since the Health Reform legislation was passed by Congress and signed by President Obama.
61 — That’s the percent of Americans who favor repeal of the legislation as revealed in a Rasmussen Reports survey just this week. The number is at an all time high.
0 — That’s the likelihood that the law will be repealed prior to 2013 when the President will either leave office or be sworn in for a second term.
100 — That’s the 100 percent guarantee that the law will continue to be a "lightening rod" in 2011 and beyond.
3.1 — As in $3.1 billion dollars—the latest estimate on the structural budget deficit facing the next Wisconsin Governor and Legislature for the 2012-13 Biennium.
1.2 — That also in dollars—$1.2 billion, maybe more, for the likely Medicaid budget shortfall for the next biennium, assuming that Congress will not enact another stimulus bill that will continue higher FMAP.
0 — As in ZERO, which is just about the chance that Congress will enact another stimulus bill next year that will include new Medicaid relief for the states.
The numbers describe what amounts to two interesting story lines for 2011.
Steve Brenton
President
The Health Insurance Risk-Sharing Plan (HIRSP) Board has finalized its budget and the associated provider reimbursement rates for 2011.
For inpatient services, the required discount from base DRG rates will increase from 23.2 percent to 24.4 percent. But base rates will increase 3.6 percent, producing a net 2.0 percent reimbursement increase from 2010 levels.
For outpatient hospital services, the discount off billed charges will increase from 51.2 percent to 54.4 percent. Combined with assumed increases in billed charges, the new payment rate is expected to produce a 4.9 percent increase in reimbursement for outpatient services.
The outpatient rates will apply for the first quarter of 2011. The HIRSP Board is considering possible changes to the outpatient hospital reimbursement methodology that will create a fee schedule for some outpatient services effective April 1, 2011.
Joe Kachelski is WHA’s representative on the HIRSP Authority Board of Directors. Questions about HIRSP can be directed to him at jkachelski@wha.org or 608-274-1820.
WHA Toolkit Resources Available on Medicare/Medicaid EHR Incentive ProgramsInformation on the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, including the EHR meaningful use final rule, is available in WHA’s online Toolkit. The Toolkit includes two separate presentations designed to help hospitals strategically plan for the Medicare and Medicaid EHR Incentive Programs by providing high-level insights into the EHR meaningful use and certification final rules. The EHR Incentive Program/Meaningful Use portion of the Toolkit can be found at www.wha.org/toolKit/EHR.pdf.
The information contained in the Medicare EHR Incentive Program portion of the Toolkit includes key concerns facing hospitals as they begin short and long-term planning for meeting meaningful use, payment methodologies under the Medicare EHR Incentive Program, and the differences among the proposed meaningful use rules and the final meaningful use rules. The portion of the Toolkit highlighting the Medicaid EHR Incentive Program focuses on eligibility for the program, calculating the 10 percent Title XIX Medicaid volume threshold, Wisconsin’s plans for implementing its Medicaid EHR Incentive Program and the payment differences between the Medicaid and Medicare EHR Incentive Programs.
Additional information on the Medicare and Medicaid EHR Incentive Programs can be found on CMS’s Web site at www.cms.gov/EHRIncentivePrograms and on HHS’s Web site at http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204. For more information, contact WHA’s Matthew Stanford at mstanford@wha.org or 608-274-1820.
Hospital CEOs, WHA Meet With Ron KindRecently all of the hospitals paid under Medicare’s prospective payment system (PPS) in the 3rd Congressional District met with Rep. Ron Kind in La Crosse to highlight their concerns and displeasure with the decision of the Centers for Medicare & Medicaid Services (CMS) to move forward with a 2.9 percent coding offset under the FY 2011 Inpatient Prospective Payment (IPPS) System rule. The Wisconsin Hospital Association is strongly opposed to the coding offset and has been spearheading various grassroots efforts, like the Kind meeting, to push back against the cuts.
For FY 2011, the estimated loss to Wisconsin’s prospective payment system hospitals is $49 million. CMS indicates it will recoup a similar amount through the FY 2012 IPPS rule, costing Wisconsin hospitals another $49 million in FY 2012 and a cumulative $1 billion over the next decade. (See below for estimated impacts by Congressional district)
Congressional District (CD) 2011 Reduction from 2.9% offset
CD 1 - Cong. Paul Ryan -$4.399 million
CD 2 - Cong. Tammy Baldwin -$9.342 million
CD 3 - Cong. Ron Kind -$3.894 million
CD 4 - Cong. Gwen Moore -$9.481 million
CD 5 - Cong. Jim Sensenbrenner -$9.065 million
CD 6 - Cong. Tom Petri -$3.419 million
CD 7 - Cong. David Obey -$4.668 million
CD 8 - Cong. Steve Kagen -$4.794 million
Statewide Impact -$49 million
Despite an outcry from hospitals, associations and a full majority of the U.S. House and Senate, CMS chose to move forward, saying the 2.9 percent cut is necessary to eliminate the effect of coding or classification changes it believes do not reflect real changes in case-mix when moving to Medicare Severity diagnosis-related groups (MS-DRGs). The agency believes hospitals are "upcoding" under MS-DRGs, which has led an increase in aggregate hospital payments without corresponding increases in actual patient severity of illness.
According to analysis done by the American Hospital Association (AHA), Wisconsin Hospital Association (WHA) and others, the coding and classification reduction is not justified and fails to take into account the historic effect of actual case-mix changes in hospitals, including changes in treatment patterns and patient populations.
WHA and hospitals are particularly concerned with the IPPS cuts in light of the estimated $2.6 billion in Medicare market basket/productivity cuts Wisconsin hospitals will see over the next 10 years due to the health reform law.
WHA will continue to work with hospitals on similar grassroots meetings as well as with the AHA on legislation to fight these cuts.
Find out more by reading WHA’s "Frequently Asked Questions" piece on the IPPS coding offset at www.wha.org/FAQ2011IPPSCodingOffset.pdf.
Quality and Finance Collaboration Workshop Planned for October 19On October 19, WHA is hosting national health care payment reform expert Harold Miller to kick off a day-long workshop to help attendees explore the potential impact of non-payment for adverse events, quality and value-driven reimbursement models, increasing attention on measurable improvement, and the impact on the bottom line.
Registration is now open for "At the Crossroads: The Collaboration of Quality and Finance," scheduled Tuesday, October 19 at the Ramada Hotel in Stevens Point. This event will provide education and practical takeaways on topics specifically related to payment reform—and how finance and quality improvement leaders can work together to meet the challenges of payment reform.
Presenters from the South Carolina Hospital Association and Bellin Health in Green Bay will share practical experience and tools to determine cost savings as a result of improved quality or patient safety and to find common ground between finance and clinical improvement functions. Also, facilitated discussion work groups will allow attendees to interact as a team and identify ways to improve collaboration and information sharing going forward.
Teams made up of hospital/health system CFO, quality lead, nurse executive and others involved in finance or quality improvement are encouraged to attend together, and a team discount is available.
A full agenda and online registration are now available at
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WHA Leads Statewide Initiative to Eliminate CLABSI - Join Today!
Nearly two million patients develop health care-associated infections, which contribute to 99,000 deaths each year and $28 to $33 billion in health care costs. Each year, 250,000 cases of CLABSI occur in U.S. hospitals with 18 percent of those cases resulting in death. In addition to the hardship this causes the patient, physicians and hospital staff, CLABSIs account for $3 billion in excess health care costs per year. The good news is that CLABSI are often preventable, and the science and methods are available to prevent them.
The Wisconsin Hospital Association (WHA) is leading a statewide initiative to eliminate central line-associated blood stream infections (CLABSI). This National quality improvement collaborative involves numerous state hospital associations, their patient safety partners and member hospitals focusing on the elimination of CLABSI’s in hospitals. "On the CUSP: Stop Bloodstream Infections" is the collective term to describe two similar efforts to successfully reduce infections and save lives in America’s hospitals. The project is based on a system developed by Peter J. Pronovost, M.D., Ph.D, of the Johns Hopkins University Quality and Safety Research Group, and later implemented statewide in Michigan by the Johns Hopkins Quality and Safety Research Group and the Michigan Health & Hospital Association (MHA) Keystone Center for Patient Safety and Quality.
The collaboration leverages the experience of the Johns Hopkins Quality and Safety Research Group (JHU QSRG), Michigan Health and Hospital Association Keystone Center, Health Research and Educational Trust (HRET) and hospitals nationwide over three years. The specific program components include implementation of the comprehensive unit-based safety program (CUSP), and activities to measure and eliminate central line-associated blood stream infections (CLABSI).
Currently 38 Wisconsin hospitals are participating in On the CUSP: Stop BSI. Thanks to additional funding made available by the Wisconsin Division of Public Heath, WHA is proud to announce the expansion of the On the CUSP: Stop BSI initiative, and invites you to join. The next wave of hospitals joining the project begins September 30, 2010 and the final wave will begin January 2011.
Information on this program is included in this week’s packet, or to request an enrollment packet, contact Jill Hanson at 608-268-1842 or
jhanson@wha.org.Aligning Forces for Quality is supported by the Robert Wood Johnson Foundation, through a grant to the Wisconsin Collaborative for Healthcare Quality. In Wisconsin, Aligning forces for Quality is a joint project by the Wisconsin Collaborative for Healthcare Quality, Wisconsin Hospital Association, and other organizations.
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EPA Seeking Comments on Draft Guidance on Unused Pharmaceuticals
The Federal Environmental Protection Agency (EPA) has been studying unused pharmaceutical disposal practices at health care facilities and has drafted a guidance document for health care facilities which describes:
The EPA is currently seeking comments on the draft through November 8, 2010. The EPA expects a final version of the document will be published in late 2010.
The draft guidance document as well as instructions for submitting comments on the document to the EPA can be found at
http://water.epa.gov/scitech/wastetech/guide/unusedpharms_index.cfm.Top
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Introducing the Wisconsin-1 Disaster Medical Assistance Team
The National Disaster Medical System and the State of Wisconsin are pleased to announce the creation of the Wisconsin-1 Disaster Medical Assistance Team (WI-1 DMAT).
The WI-1 DMAT is a team that can be rapidly deployed at disasters and large-scale events where local medical resources are overwhelmed or destroyed. DMAT’s consist of medical personnel, logistical and administrative personnel, and all of the equipment required to provide medical care in austere environments.
WI-1 DMAT is part of the National Disaster Medical System (NDMS). NDMS is a federally-coordinated system that provides medical capabilities in the event of a large-scale emergency that overtaxes local capabilities. NDMS is administered through the Office of the Assistant Secretary for Preparedness and Response (ASPR) in the United States Department of Health and Human Services.
DMAT elements are organized by state, though they are considered federal assets. While under official orders, all DMAT personnel are considered federal employees, allowing their licensure and credentials to be recognized throughout the country. In addition, DMAT personnel receive federal wages and professional liability protection while activated. DMAT personnel are also protected by the Uniformed Services Employment and Reemployment Rights Act, which prevents discrimination in civilian careers due to government service.
The WI-1 DMAT is endorsed by NDMS, the state of Wisconsin, and an academic medical partnership of the Medical College of Wisconsin, the University of Wisconsin School of Medicine and Public Health, Children’s Hospital of Wisconsin, Froedtert Hospital, and the UW Health System.
The creation of a DMAT in Wisconsin adds another capability for disaster medical response in the state. WI-1 is proud to join with the Wisconsin Emergency Assistance Volunteer Registry (WEAVR) and Wisconsin units of the Medical Reserve Corps (MRC) to form a comprehensive, flexible system contributing to local, state, and national readiness.
WI-1 DMAT is also interested in partnering with local agencies, community organizations, and health care institutions within Wisconsin to build a coordinated effort in emergency preparedness.
WI-1 DMAT is currently recruiting professionals interested in assisting in medical care during disasters or mass casualty incidents. The team is seeking people with the following skills:
Candidates for application need to be able to tolerate the stresses of field work in austere environments with limited privacy, and be flexible enough to work in roles that may be different from their regular jobs. Team members are also expected to dedicate their own time for education and training.
For more information on the WI-1 DMAT, visit the team Web site at
www.wi1dmat.org.