November 27, 2013
Volume 57, Issue 48


CMS Gives Consumers Extra Week to Sign Up on Federal Exchange in 2013
WI Legislative Special Session Dec. 2 focuses on Medicaid, HIRSP

The Centers for Medicare and Medicaid Services (CMS) announced November 22 that consumers now have until December 23 instead of December 15 to enroll in the health insurance exchange for coverage effective January 1, 2014. The sign-up period for the exchange still runs through March 31, 2014.

CMS also rolled back the start of the 2015 open enrollment period from October 15 to November 15, 2014. Insurers were given an additional month—from April 2014 to May 2014—to submit applications to have a health plan offered on the exchange. The Obama Administration has indicated the delay is intended to give insurers more time to analyze claims from 2014 before setting 2015 premiums. However, the move has been criticized as a maneuver to postpone public review of premiums to just after mid-term elections.

As reported in The Valued Voice November 15, Governor Scott Walker called for a delay in disenrolling current recipients from the Medicaid program and transitioning them into the exchange from January 1 to April 1 in response to the problems that have dogged the launch of the exchange website. Walker also announced a three-month continuation of the state’s Health Insurance Risk-Sharing Program (HIRSP). Without the extension, the HIRSP program would sunset December 31, 2013.

WHA President Steve Brenton called the delay "a good decision in the face of the exchange’s ongoing problems." The Governor’s press release made clear that he is not backing away from the Medicaid program changes he has supported—expanding Medicaid for childless adults with income below the poverty line while moving adults with income above the poverty line off the Medicaid rolls. However, a delay is needed to better help "smooth the transition" to exchange coverage for 77,000 people who would otherwise lose Medicaid coverage January 1.

The Legislature is expected to meet in Special Session in December to enact needed statutory changes to implement the delays. There are also other moving parts to the Governor’s proposal that may need federal approval. WHA will continue to monitor the details of the legislation and the state and federal processes.

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WHA to Host Wisconsin Medicaid RAC Webinar December 9

The much-anticipated Medicaid Recovery Audit Contractor (RAC) is now live in Wisconsin. To help hospitals understand the Medicaid RAC process as it rolls out, WHA is holding a members-only webinar—The Medicaid RAC: What Your Hospital Needs to Know As HMS Goes Live in Wisconsin. The webinar will feature Wisconsin’s Medicaid RAC, HMS, and is scheduled December 9 from 3-4 p.m.

This one-hour webinar will include representatives from HMS who will discuss their work with the Wisconsin Office of Inspector General to analyze and review Medicaid claims. As Wisconsin’s Medicaid RAC, HMS will provide information about its audit and what hospitals can expect during the process.

The webinar is free, but registration is required and is limited to WHA members and corporate members. WHA members may register for this webinar at http://events.SignUp4.com/13MedicaidRAC1209.

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Wisconsin Hospitals Conduit & State PAC Campaign Closes in on Goal

With just a little more than one month left until the close of the year, totals to the 2013 Wisconsin Hospitals Conduit and State Political Action Funds campaign continue to rise. The campaign has just under $28,000 to go to meet the $260,000 year end goal.

While still behind last year’s pace, the gap is closing and while the 2013 campaign was down nearly $30,000 from 2012 totals just four weeks ago, the campaign is currently behind just $7,000 from the 2012 pace.

So far 335 individuals have joined the campaign contributing $232,000. Individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. Thank you to the 2013 contributors to date who are listed below. They are listed alphabetically by contribution amount category. The next publication of the contributor list will be in the December 13 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Contributors ranging from $1 to $499
Allen, Patricia Columbia St. Mary's, Inc.
Ambs, Kathleen St. Mary's Janesville Hospital
Anderson, Phil Sacred Heart Hospital
Andritsch, Stacie Wheaton Franciscan Healthcare
Appleby, Jane Aurora Health Care
Bagnall, Andrew St. Nicholas Hospital
Bair, Barbara St. Clare Hospital & Health Services
Ballentine, Anne Wheaton Franciscan Healthcare
Baltzer, David Memorial Medical Center - Neillsville
Bayer, Tom St. Vincent Hospital
Bergmann, Ann Spooner Health System
Block, Jeffrey Monroe Clinic
Bloom, Deborah Sacred Heart Hospital
Boson, Ann Ministry Saint Joseph's Hospital
Bowman, Andrew Sacred Heart Hospital
Breeser, Bryan Aurora Medical Center Summit
Brenholt, Craig St. Joseph's Hospital
Brennan, Karen St. Mary's Hospital
Brenny, Terrence Stoughton Hospital Association
Brenton, Andrew Wisconsin Hospital Association
Burgener, Jean Aspirus Wausau Hospital
Buss, Diane St. Mary's Hospital
Campau, Patricia Columbia St. Mary's, Inc.
Capelli, A.J. Aurora Health Care
Cardinal, Lori Agnesian HealthCare
Casey, Candy Columbia Center
Censky, Bill Holy Family Memorial
Clark, Renee Fort HealthCare
Collins, Sherry Wisconsin Hospital Association
Coniff, Barbara St. Mary's Hospital Medical Center
Connors, Lawrence St. Mary's Hospital Medical Center
Cormier, Laura Bellin Hospital
Culotta, Jennifer St. Clare Hospital & Health Services
Dahl, James Fort HealthCare
Dalebroux, Steve St. Mary's Hospital
Danner, Forrest Aspirus Wausau Hospital
Dearth, Charles Monroe Clinic
DeMars, Nancy Sacred Heart Hospital
Dietrich, Dean Aspirus Wausau Hospital
Drengler, Kathryn Aspirus Wausau Hospital
Dux, Larry Froedtert & MCW Community Memorial Hospital campus
Dwyer, Amy Sacred Heart Hospital
Dwyer, Maxine St. Mary's Hospital
Ericson, Allen Froedtert & MCW St. Joseph's Hospital campus
Feldhausen, Mary St. Vincent Hospital
Ferrigno, Sandra St. Mary's Hospital
Fielding, Laura Holy Family Memorial
Folstad, John Sacred Heart Hospital
Fox, Stephen Aspirus Wausau Hospital
Fry, William Columbia St. Mary's, Inc.
Furlong, Marian Hudson Hospital & Clinics
Gagnon, Annette HSHS-Eastern Wisconsin Division
Gajeski, Lynn St. Vincent Hospital
Gansemer, Sheila Wheaton Franciscan Healthcare
Garvey, Gale St. Mary's Hospital
Gille, Larry St. Vincent Hospital
Goldberg, David Froedtert & MCW Community Memorial Hospital campus
Granger, Lorna Aurora Health Care
Gresham, James Wheaton Franciscan Healthcare
Gruber, Richard Mercy Hospital and Trauma Center
Grundstrom, David Flambeau Hospital
Guffey, Kerra Meriter Hospital
Gulan, Maria Aspirus Wausau Hospital
Gullicksrud, Lynn Sacred Heart Hospital
Hafeman, Paula St. Vincent Hospital
Halida, Cheryl St. Joseph's Hospital
Hamilton, Mark
Hansen, Karen Memorial Medical Center - Ashland
Hardy, Shawntera Hudson Hospital & Clinics
Hattem, Marita Aspirus Wausau Hospital
Helgeson, Jason HSHS-Eastern Wisconsin Division
Henricks, William Rogers Memorial Hospital
Hieb, Laura Bellin Hospital
Hockers, Sara Holy Family Memorial
Hockin, Jennifer Aspirus, Inc.
Hofer, John Bay Area Medical Center
Hueller, Julie Wheaton Franciscan Healthcare
Hupf, Angela Memorial Health Center
Huys, Geoffrey Ministry Health Care
Jelle, Laura St. Clare Hospital & Health Services
Jensema, Christine HSHS-Eastern Wisconsin Division
Jensen, Russell St. Mary's Hospital
Johnson, Charles St. Mary's Hospital
Johnson, Kimberly Sacred Heart Hospital
Josue, Sherry St. Mary's Hospital
Karuschak, Michael Amery Regional Medical Center
Keene, Kaaron Memorial Health Center
Kelsey Foley, Kathy Aspirus Wausau Hospital
Kempen, Jacob Aspirus Wausau Hospital
King, Peggy Memorial Health Center
King, Steve St. Mary's Hospital
Klay, Chris St. Joseph's Hospital
Klay, Lois St. Joseph's Hospital
Klein, Tim Holy Family Memorial
Knutzen, Barbara Agnesian HealthCare
Kocourek, Cathie Aurora Medical Center in Two Rivers
Krueger, Kari St. Mary's Janesville Hospital
Lambrecht, Randy Aurora Health Care
Lange, George Westgate Medical Group, CSMCP
Larson, William St. Joseph's Hospital
Lentz, Darrell Aspirus, Inc.
Leonard, Mary Kay St. Mary's Hospital
Lepien, Troy St. Mary's Hospital
Lucas, Roger Aspirus Wausau Hospital
LuCore, Patricia Sacred Heart Hospital
Luehring, Sally St. Vincent Hospital
Lynch, Sue Mayo Health System - Franciscan Healthcare
Marcouiller, Don Memorial Medical Center - Ashland
Maroney, Lisa
Martin, Nancy Ministry Saint Michael's Hospital
Maurer, Mary Holy Family Memorial
McCarthy, Steven Southwest Health Center
McManmon, Kristin St. Mary's Hospital
McMeans, Scott Holy Family Memorial
Meicher, John St. Mary's Hospital
Needham, Jean Westfields Hospital
Neikirk, Jon Froedtert & The Medical College of Wisconsin
Nevers, Rick Aspirus, Inc.
Nguyen, Juliet Sacred Heart Hospital
Nicklaus, Todd Aspirus, Inc.
O'Brien, Laura
O'Hara, Tiffanie Wisconsin Hospital Association
O'Keefe, Robert
Oland, Charisse Rusk County Memorial Hospital and Nursing Home
Olson, Bonnie Sacred Heart Hospital
Ose, Peggy Riverview Hospital Association
Ostrander, Gail HSHS-Eastern Wisconsin Division
Ott, Virginia St. Joseph's Hospital
Palecek, Steve St. Joseph's Hospital
Pavelec-Marti, Cheryl Ministry Saint Michael's Hospital
Peck, Lori Memorial Health Center
Peiffer, Susan Sacred Heart Hospital
Pempek, Kalynn Aspirus Wausau Hospital
Penczykowski, James St. Mary's Hospital
Pinske, Heather St. Mary's Hospital
Reinke, Mary Meriter Hospital
Reising, Chris Aspirus, Inc.
Rocheleau, John Bellin Hospital
Roundy, Ann Columbus Community Hospital
Sanicola, Suzanne Columbia St. Mary's Columbia Hospital
Schaetzl, Ron St. Clare Hospital & Health Services
Schmitz, Bonnie Agnesian HealthCare
Schneider, David Langlade Hospital - An Aspirus Partner
Schubring, Randy Mayo Health System - Eau Claire
Scieszinski, Robert Ministry Door County Medical Center
Scinto, Jeanne Aspirus Wausau Hospital
Sheehan, Heather Hayward Area Memorial Hospital and Nursing Home
Sio, Tim Wheaton Franciscan Healthcare - All Saints
Slomczewski, Constance Wheaton Franciscan Healthcare - All Saints
Smith, Brian Aspirus, Inc.
Statz, Darrell Rural Wisconsin Health Cooperative
Stelzer, Jason St. Clare Hospital & Health Services
Strasser, Kathy Aspirus, Inc.
Swanson, Becky Sacred Heart Hospital
Swiderski, Julie Wheaton Franciscan Healthcare
Tandberg, Ann St. Joseph's Hospital
Taylor, Steve Beloit Health System
Teigen, Seth St. Mary's Hospital
Theiler, Brian Gundersen Tri-County Hospital and Clinics
Thornton, Eric St. Mary's Janesville Hospital
Topinka, Ralph Mercy Hospital and Trauma Center
Tuttle, Kathryn Memorial Medical Center - Ashland
Vergos, Katherine Ripon Medical Center
Voelker, Thomas Aspirus Wausau Hospital
Waldoch, Timothy Columbia St. Mary's, Inc.
Walker, Troy St. Clare Hospital & Health Services
Westrick, Paul Columbia St. Mary's Columbia Hospital
Wheeler, Susan St. Nicholas Hospital
White-Jacobs, Mary Beth Black River Memorial Hospital
Whitinger, Margaret Agnesian HealthCare
Wilke, Julie Monroe Clinic
Wipperfurth, Kay Fort HealthCare
Woleske, Chris Bellin Psychiatric Center
Wymelenberg, Tracy Aurora Health Care
Wysocki, Scott St. Clare Hospital & Health Services
Yaron, Rachel Ministry Saint Clare's Hospital
Contributors ranging from $500 to $999
Anderson, Rhonda Columbia St. Mary's Milwaukee Hospital
Ashenhurst, Karla Ministry Health Care
Bablitch, Steve Aurora Health Care
Behl, Kevin Columbia St. Mary's Milwaukee Hospital
Boecker, Ron Wheaton Franciscan Healthcare
Bukowski, Cathy Ministry Health Care
Bultema, Janice
Busch, Rebecca Spooner Health System
Carlson, Dan Bay Area Medical Center
Chumbley, Clyde ProHealth Care, Inc.
Deich, Faye Sacred Heart Hospital
Dewitt, Jocelyn
Dicus-Johnson, Coreen Wheaton Franciscan Healthcare
Dietsche, James Bellin Hospital
Dolohanty, Naomi Aurora Health Care
Dube, Troy Chippewa Valley Hospital
Eckels, Timothy Hospital Sisters Health System
Frangesch, Wayne Wheaton Franciscan Healthcare
Freimund, Rooney Bay Area Medical Center
Griffin, Gregory ElderSpan Management
Hartberg, David Gundersen Boscobel Area Hospital and Clinics
Hinner, William Ministry Saint Clare's Hospital
Houlahan, Beth
Hyland, Carol Agnesian HealthCare
Jacobson, Terry St. Mary's Hospital of Superior
Johnson, Kenneth St. Mary's Hospital Medical Center
Joyner, Ken Bay Area Medical Center
Kellar, Richard Aurora West Allis Medical Center
Korom, Nancy Children's Hospital of Wisconsin
Krueger, Mary Ministry Saint Clare's Hospital
Larson, Margaret Mercy Medical Center
Lewis, Gordon Burnett Medical Center
Logemann, Cari Aspirus, Inc.
Mantei, Mary Jo Bay Area Medical Center
May, Carol Sauk Prairie Memorial Hospital
McCarthy, Bruce Columbia St. Mary's, Inc.
McNally, Maureen Froedtert & The Medical College of Wisconsin
Mueller, Joan Mayo Health System - Franciscan Healthcare
Mugan, James Agnesian HealthCare
Mulder, Doris Beloit Health System
Natzke, Kristin
Nelson, James Fort HealthCare
Ouimet, Mary Wheaton Franciscan Healthcare - All Saints
Pollard, Dennis Froedtert & The Medical College
Quinn, George Wisconsin Hospital Association
Richards, Theresa Ministry Saint Joseph's Hospital
Richardson, Todd Aspirus, Inc.
Rickelman, Debbie WHA Information Center
Rocole, Theresa Wheaton Franciscan Healthcare
Rohrbach, Dan Southwest Health Center
Rouzer, Cindy Spooner Health System
Sczygelski, Sidney Aspirus Wausau Hospital
Selberg, Heidi HSHS-Eastern Wisconsin Division
Shabino, Charles Wisconsin Hospital Association
Simaras, James Wheaton Franciscan Healthcare
Smith, Gregory Wheaton Franciscan Healthcare
Sommers, Craig St. Mary's Hospital
Stuart, Philip Tomah Memorial Hospital
Swanson, Kerry St. Mary's Janesville Hospital
Thurmer, DeAnn Waupun Memorial Hospital
Van Meeteren, Bob Reedsburg Area Medical Center
VanCourt, Bernie Bay Area Medical Center
White, Pamela Mayo Health System - Eau Claire
Zenk, Ann Ministry Saint Mary's Hospital
Zorbini, John Aurora Health Care
Contributors ranging from $1,000 to $1,499
Bedwell, Elizabeth Children's Hospital of Wisconsin
Borgerding, Dana
Britton, Gregory Beloit Health System
Buck, Catherine Froedtert & The Medical College of Wisconsin
Dexter, Donn Mayo Health System - Eau Claire
Gullingsrud, Tim Hayward Area Memorial Hospital and Nursing Home
Gutzeit, Michael Children's Hospital of Wisconsin
Hart, Shelly Aurora Health Care
Heifetz, Michael SSM Health Care-Wisconsin
Herzog, Sarah Wheaton Franciscan Healthcare
Huettl, Patricia Holy Family Memorial
Hymans, Daniel Memorial Medical Center - Ashland
Kosanovich, John Watertown Regional Medical Center
Lappin, Michael Aurora Health Care
Lewis, Jonathan St. Mary's Hospital
Martin, Jeff Ministry Saint Michael's Hospital
McKevett, Timothy Beloit Health System
Mohorek, Ronald Ministry Health Care
Natzke, Ryan Marshfield Clinic
Nauman, Michael Children's Hospital of Wisconsin
Nelson, Dave HSHS-Western Wisconsin Division
Rakowski, Mark Children's Hospital of Wisconsin
Reynolds, Sheila Children's Hospital of Wisconsin
Robertstad, John ProHealth Care - Oconomowoc Memorial Hospital
Roller, Rachel Aurora Health Care
Russell, John Columbus Community Hospital
Sanders, Robert Children's Hospital of Wisconsin
Schafer, Michael Spooner Health System
Sohn, Jonathan Wheaton Franciscan Healthcare
Spooner, Allan Columbia St. Mary's Milwaukee Hospital
Standridge, Debra Wheaton Franciscan Healthcare
Wolf, Edward Lakeview Medical Center
Worrick, Gerald Ministry Door County Medical Center
Contributors ranging from $1,500 to $1,999
Alig, Joanne Wisconsin Hospital Association
Anderson, Sandy St. Clare Hospital & Health Services
Bloch, Jodi Wisconsin Hospital Association
Boese, Jennifer Wisconsin Hospital Association
Byrne, Frank St. Mary's Hospital
Canter, Richard Wheaton Franciscan Healthcare
Clapp, Nicole Grant Regional Health Center
Coffman, Joan St. Joseph's Hospital
Court, Kelly Wisconsin Hospital Association
Eichman, Cynthia Ministry Our Lady of Victory Hospital
Francis, Jeff Ministry Health Care
Frank, Jennifer Wisconsin Hospital Association
Geboy, Scott Hall, Render, Killian, Heath & Lyman
Grasmick, Mary Kay Wisconsin Hospital Association
Harding, Edward Bay Area Medical Center
Heywood, Matthew Aspirus, Inc.
Hilt, Monica Ministry Saint Mary's Hospital
Khare, Smriti Children's Hospital of Wisconsin
Lepore, Michael Wheaton Franciscan Healthcare
Levin, Jeremy Rural Wisconsin Health Cooperative
Mattes, Dan Wheaton Franciscan Healthcare
Meyer, Daniel Aurora BayCare Medical Center in Green Bay
Millermaier, Edward Bellin Hospital
Olson, David Froedtert & The Medical College
Potter, Brian Wisconsin Hospital Association
Sanders, Michael Monroe Clinic
Sexton, William Prairie du Chien Memorial Hospital
Stanford, Matthew Wisconsin Hospital Association
Wallace, Michael Fort HealthCare
Warmuth, Judith Wisconsin Hospital Association
Contributors ranging from $2,000 to $2,999
Brenton, Mary E.
Desien, Nicholas Ministry Health Care
Duncan, Robert Children's Hospital of Wisconsin
Gage, Weldon Children's Hospital of Wisconsin
Herzog, Mark Holy Family Memorial
Jacobson, Catherine Froedtert & The Medical College
Kachelski, Joe Wisconsin Statewide Health Information Network
Kief, Brian Ministry Saint Joseph's Hospital
Leitch, Laura Wisconsin Hospital Association
Little, Steven Agnesian HealthCare
Manas, Julie Sacred Heart Hospital
Mettner, Michelle Children's Hospital of Wisconsin
Neufelder, Daniel Ministry Health Care
Normington, Jeremy Moundview Memorial Hospital & Clinics
O'Brien, Kyle Wisconsin Hospital Association
Oliverio, John Wheaton Franciscan Healthcare
Pandl, Therese HSHS-Eastern Wisconsin Division
Potts, Dennis Aurora St. Luke's Medical Center
Starmann-Harrison, Mary Hospital Sisters Health System
Taylor, Mark Columbia St. Mary's, Inc.
Troy, Peggy Children's Hospital of Wisconsin
Woodward, James Meriter Hospital
Contributors ranging from $3,000 to $4,999
Borgerding, Eric Wisconsin Hospital Association
Kammer, Peter The Kammer Group
Katen-Bahensky, Donna
Turkal, Nick Aurora Health Care
Contributors $5,000 and above
Brenton, Stephen Wisconsin Hospital Association
Kerwin, George Bellin Hospital
Size, Tim Rural Wisconsin Health Cooperative
Tyre, Scott Capitol Navigators, Inc

 

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Patient Focus Earns Prairie du Chien Memorial Hospital National Recognition
Discharge process improvement starts at the bedside with frontline nurses

A successful discharge planning process ensures a smooth transition to a different level of care, whether the destination is to home or to a long-term care facility. The entire care team must work together to help the patient and family members understand what care is going to be required and their collective responsibilities in the process. If discharge instructions are not understood, it can lead to a readmission, a trip to the emergency room or a medication error.

The staff at Prairie du Chien Memorial Hospital knows how important a successful discharge process can be to the health of their patients. And as a result of their focused efforts to ensure that when patients leave the hospital they have a smooth transition to their next setting, the hospital was recently ranked as one of the five best in its peer group for its discharge process. The ranking was based on a national study that looked at how patients scored their hospital stay across several domains, including the discharge process.

Their outstanding score caught the attention of researchers at Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. Johns Hopkins invited Julia Nelson, chief quality officer and Bethany Schiefelbein, medical surgical pediatric nurse, to present at a national conference along with some of the top-performing health care organizations in the country.

"We’re always looking for evidence-based best practices to help us improve patient care processes," said Schiefelbein. "We feel strongly that achieving the best outcome for our patients requires the highest level of involvement possible from the patient, their family and their health care team," she added.

Prairie du Chien Memorial frontline staff used a multi-faceted approach to improve the discharge process and positively impact their performance scores. According to Schiefelbein, one of the most important and effective aspects of the hospital’s improvement in patient satisfaction was sparked by their participation in the Wisconsin Hospital Association (WHA) Transforming Care at the Bedside (TCAB) initiative.

"TCAB engaged staff nurses in quality improvement starting at the bedside," said Ellen Zwirlein, RN, chief nursing officer. "It really energized and empowered our nurses. No one knows the patient better than their nurses, and when you start by looking at how changes are perceived through the eyes of the patient, the process improvement becomes logical and practical for not only the patient, but to their family and all their caregivers as well."

TCAB has taken hold in Wisconsin with 45 hospitals participating in the program to date. WHA is committed to continue supporting TCAB through 2014.

"TCAB is a major commitment for a hospital; it is an 18-month project involving the chief nursing officer, unit managers and frontline staff," according to Judy Warmuth, RN, WHA vice president, workforce development.

Participation in TCAB is rigorous; it requires monthly data reporting, team culture surveys and sharing of best practices with other hospitals. TCAB directs staff nurses to evaluate their care processes from the patient’s perspectives and encourages innovative solutions.

Prairie du Chien Memorial’s commitment to engaging patients in their care resonates across their entire campus. When the hospital announced its plans to build a new hospital, patients and community members’ input was solicited to ensure patient needs and values were met. The new hospital, which is expected to open in 2015, is in all respects, truly a community asset.

"We know that high quality health care is an essential asset to our community’s ability to compete for economic development," according to CEO Bill Sexton. "Engaging the public ‘from the ground up’ in our building project was simply an extension of our commitment to serve our patients in the best way possible."

TCAB is a project of Aligning Forces for Quality, an initiative of the Robert Wood Johnson Foundation to improve the quality of health and health care in targeted communities around the country, through a grant to the Wisconsin Collaborative for Healthcare Quality (WCHQ). In Wisconsin, the Aligning Forces for Quality effort is a joint project of WCHQ, WHA, and other organizations. WHA represents more than 130 community hospitals.

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President’s Column: Moody’s Downgrade, Paying for the SGR and Something to be Thankful for

The Moody’s report mentions the possibility of new Medicare DSH reductions, which would be on top of ACA reductions already in place. The notion that hospitals no longer need those payments due to expected reductions in uncompensated care is preposterous, especially in light of the bungled start of the insurance exchange. Nationally, experts are already slashing their estimates for new net coverage—even assuming the "glitches" get fixed.

Unfortunately, legislation required to accomplish the above is roundly opposed by Republican leaders in Congress who have not shown similar passion for objecting to new hospital cuts.

About the only alternative to hospital cuts or drug rebates is raising the Medicare eligibility age or further means testing Medicare benefits. Democrats, for the most part, reject that approach, so we are left with a potential food fight over who’s to pay. That could pit PHARMA vs. the hospital field with much at stake. But drug companies have done well under recent coverage expansions, including Medicare Part D. Time to reciprocate.

Steve Brenton
President

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