As the Wisconsin Legislature prepares for a 2007-08 session that is expected to focus on health care reform, a new study by the Wisconsin Policy Research Institute, Inc., concludes that the Wisconsin Health Plan (WHP) is seriously flawed as a reform proposal.

The study, An Evaluation of The Wisconsin Health Plan, (www.wpri.org/Reports/Volume%2020/Vol20no1.pdf) written by Lakeland College labor economist M. Scott Niederjohn and UW-Milwaukee Professor Mark Schug, bluntly calls the WHP "a one-size-fits-all health insurance plan without brakes and state government at the steering wheel."

The WHP was developed in large part by former state budget director David Riemer and a version of the proposal was introduced last year as Assembly Bill 1140.

The study finds that the proposed 13 percent employer/employee payroll tax would under-fund the program’s first year of operations by $4 billion. The authors say that the total payroll tax would have to be at least 17 percent to fully fund the program, and they conclude that the WHP would almost certainly be under-funded in subsequent years as growth in Wisconsin payrolls lags behind increases in health care costs.

Niederjohn and Schug used four criteria to guide their analysis of the WHP:

1. Does the proposed health care policy improve accessibility and reduce the number of people without access to health care?
2. Does the proposed health care policy increase the role of individual consumers in making health care decisions?
3. Does the proposed health care policy increase price competition?
4. Does the proposed health care policy limit the role of government?

Although they gave the WHP a "passing grade" for improving access to health care and recognizing the value of health care consumerism, questions about funding, equity, sustainability and government control led the authors to ultimately conclude that lawmakers should "reject the broad policy approach represented by the WHP."

In a prepared statement, Wisconsin Hospital Association President Steve Brenton said, "The study confirms the reservations we’ve had about the proposal and aligns with a previous analysis by the non-partisan Legislative Fiscal Bureau, which provided an early warning about the Plan’s potentially serious negative consequences."

The study recommends that a third-party consultant should conduct an analysis of the WHP’s costs. It also recommends that WHP legislation should explicitly recognize the high likelihood of cost overruns and includes a large contingency reserve in its cost projections.

"We wholeheartedly agree that the proposal needs much more scrutiny," said Brenton. "A third-party consultant is currently working on an analysis of the WHP, and we are open to further discussions based on the conclusions of that analysis. But this study reminds us that health care reform is an extremely complex issue," Brenton added.

On Thursday, January 11, the Center for Medicaid and Medicare Services (CMS) held a national teleconference to provide informal guidance on Section 6032 of the Deficit Reduction Act ("Section 6032"). Section 6032 mandates that state Medicaid programs amend their State Plans to require any entity that receives annual payments of at least $5 million under a state Medicaid program to establish written policies for its employees, contractors, and agents. The policy must include detailed information about:

• Federal False Claims Act
• Program Fraud Civil Remedies Act
• State laws pertaining to civil or criminal penalties for false claims and statements
• Whistleblower protections provided under such federal and state laws
• The entity’s policies and procedures for detecting and preventing fraud, waste and abuse and the entity’s whistleblower protections.

Section 6032 also requires that if the entity has an employee handbook, the handbook must include similar information.

Notably, Section 6032 provides that the required policies are a condition of payment.

CMS has issued limited guidance on this provision. In addition to the January 11 teleconference, CMS has issued a State Medicaid Director letter and a State Plan amendment pre-print, both of which are available on the WHA Web site. During the teleconference, CMS confirmed that the effective date of Section 6032 is January 1, 2007. States are expected to amend their Medicaid State Plans and to promulgate guidelines or regulations implementing this provision. However, because of current policies, the states can amend their State Plans until March 31 and still have an effective date of January 1.

Although there is a reasonable argument that the effective date applies to the states and not the entities, during the call CMS stated its position that the January 1, 2007 effective date also applies to the entities. For this reason and because the requirements are a condition of payment, many providers are implementing policies now to limit (or eliminate) their risk of nonpayment by the Medicaid program.

CMS also confirmed during the call that many of the implementation and enforcement decisions for Section 6032 are being left to the states. WHA and the Wisconsin Health Care Association met with Alan White, director of the Wisconsin Medicaid Program’s Bureau of Health Care Program Integrity, and Neil Gebhart, DHFS Office of Legal Counsel, to discuss implementation and enforcement issues. WHA and WHCA will be working with the Medicaid Program as it clarifies which providers are subject to the new requirements and other important details concerning the implementation and enforcement of the law.

As previously provided in The Valued Voice (see November 17, 2006 edition), in an effort to help providers, WHA, with the assistance of Catherine Eastham, Rich Donkle, Bob Reed, Ralph Topinka, and Lori Wink, prepared a draft model policy that hospitals might consider using in order to make a good faith effort to comply with Section 6032. Similar information can be included in any employee handbook.

The draft policy includes summaries of the federal and state laws. A hospital must add the information related to its policies and procedures for detecting and preventing fraud, waste and abuse and its whistleblower protections.

WHA will continue to monitor information from both CMS and the Wisconsin Medicaid Program, and will provide more information when guidance is available.

Here are four themes that will almost certainly be included in Governor Doyle’s health reform package when that legislation is unveiled in February.

1. "Cover all kids" – This was a strong theme in the Governor’s Inaugural Address last week. A lot of kids currently lacking coverage are actually eligible for public programs. Look for an aggressive outreach program here to find these children and enroll them in a redesigned BadgerCare program.
2. Childless adults below 200 percent of the poverty guidelines – This coverage initiative will be a BadgerCare expansion designed to provide coverage for as many as 61,000 low-income childless adults who were previously ineligible for public programs. The key here will be to not drive this targeted population out of private coverage.
3. Premium subsidies for vulnerable populations – This Healthy Wisconsin Council initiative will provide $100 million in subsidies for participants in private co-op insurance programs and vulnerable small groups.
4. Full state income tax deductibility – This initiative will provide individuals who purchase their own health insurance with a state income tax deduction for their insurance premiums.

Our support for these initiatives will depend on a lot of details that are currently unknown, but all four of these proposals align with WHA’s current access and coverage principles. If done right, these proposals should deserve our active support…including support for higher tobacco taxes that will be necessary to help fund these coverage expansions.

Here are two more health care affordability initiatives that also deserve support. Both of these offerings will significantly strengthen the larger health reform agenda and create a more comprehensive and bipartisan approach for 2007.

1. Medicaid provider payment increases – As recommended by the Healthy Wisconsin Council, provider payment increases are urgently needed to begin chipping away at the "hidden tax" while assuring that an adequate supply of providers are available to take care of public program beneficiaries.
2. Tax deductibility for HSA contributions – HSAs are an important tool for addressing the affordability issue, and Wisconsin is just about the only state in the nation that currently fails to provide state income tax deductibility for HSA contributions. This needs to be "fixed" in 2007.

Successfully knitting together all six of these "themes" can propel Wisconsin into the forefront of states working to meaningfully address access, coverage and cost issues as part of a 2007 health reform agenda.

Steve Brenton
President

Sue Lynch, a volunteer at Franciscan Skemp of La Crosse, has been appointed by the American Hospital Association (AHA) Board of Trustees to serve a three-year term on the AHA Committee on Volunteers. Sue Lynch is the Public Policy Education (PPE) chair for Partners of WHA, and has led the Franciscan Skemp auxiliary for eight years.

"Sue is the epitome of what Partners of WHA represents," said Jenny Boese, WHA’s vice president of external relations and member advocacy. "Her appointment to AHA’s Committee on Volunteers is a testament to her dedication and commitment. I can’t think of an individual more suited for this committee and its work."

In her role as PPE chair, Lynch works cooperatively with WHA on educating and mobilizing hospital volunteers on important issues. For example, the Partners of WHA made the lack of access to dental health care an educational focus in 2006. Later that year, WHA was able to successfully partner with Lynch on grassroots efforts with the Partners organization on a proposal to increase access to dental care.

During her tenure on the AHA Committee on Volunteers, Lynch will help provide insight and direction for volunteers and auxiliaries nationwide. The Committee plays a significant role in supporting AHA’s mission and public policy agenda, including:

• Identifying issues and policies
• Identifying institutional practices requiring AHA’s consideration and action
• Advising AHA on programs and services directed to volunteers and auxilians
• Providing AHA with a community perspective on hospital issues

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Effective January 26, 2007, the following sections of the Medicare Conditions of Participation will be amended: anesthesia services, medical staff, nursing services, medical record services, and pharmaceutical services.

Seven regional luncheon meetings are planned for high-level hospital and health system leadership to focus on and become engaged in their hospital’s emergency preparedness planning.

Bill Bazan of WHA will review the role of senior management in hospital preparedness and discuss the next steps the federal and state government will be taking to assist hospitals. Dennis Tomczyk of the Wisconsin Division of Public Health will review what has been accomplished over the last five years to assist hospitals in their emergency preparedness efforts.

High-level hospital leadership should plan to attend one of the seven scheduled luncheon meetings. This includes CEOs/administrators, physician leaders, nurse leaders, vice presidents, and other members of the hospital’s administrative team. Each meeting will convene at 12 p.m. and adjourn by 1:30 p.m. There is no cost to attend, and lunch will be provided. Hospital leaders can choose to attend one of the seven scheduled meetings that best fits his/her schedule.

WHA is offering a two-hour webinar and audioconference entitled "Race & Ethnicity Data Collection" on February 28, initiated by the Wisconsin Cancer Council as part of Wisconsin’s statewide Comprehensive Cancer Control Plan, and co-sponsored by the Wisconsin Cancer Reporting System, Wisconsin Department of Health and Family Services, and the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center. This seminar will assist hospitals in meeting the mandated rate reporting requirements by providing training for systematic collection of race and ethnicity data, discussing why it’s important to collect race and ethnicity data; how to collect the data (including patient/registration staff practice scripts); and how to best use the data collected.

At the conclusion of the session, participants will understand the importance of collecting race and ethnicity data, be able to assess current data collection practices, have the knowledge to accurately collect race and ethnicity data in a systematic way, and know how to use these data to improve quality of care and accurately assess resource needs to meet community needs.

The webinar is scheduled for Wednesday, February 28, from 10 a.m.-12 p.m. CST. The webinar is free, but advance registration is required to ensure delivery of instructional materials and call-in instructions, which will be distributed after the registration cut-off date of February 16.

NEW Community Clinic provides health care for those in need at a number of sites throughout the Green Bay area, including a pediatric clinic in Green Bay’s Nicolet School where Aurora pediatrician Yolo Diaz, M.D. provides health services.

Bonnie Kuhr, NEW Community Clinic director, Green Bay, says the program has been invaluable to the community.

"It’s been a great collaborative between the Green Bay School District, which provides the space; our clinic, which provides the medical assistant; and Aurora, which provides Dr. Diaz. The clinic is a lifeline for children whose families don’t have the resources to pay for health services. Without it, parents may be forced to delay care until the child faces significant health issues that could have been prevented from a simple clinic visit.

"Children are coming to see me, they’re listening to me and it’s definitely making a difference," says Dr. Diaz, who works with students to fight obesity by developing nutritional guidelines that are easy for families to follow.

Dr. Diaz champions daily exercise and encourages families to seek exercise programs available to them through the schools and YMCA. She has also been instrumental in receiving grant funding to allow her to provide fluoride treatments – an intervention that "re-mineralizes" teeth that have already started to decay – for students who have gone too long without proper dental care.

As a mother of two young boys, she addresses the challenges and health care needs of Hispanic parents who come to see her at the NEW Community Clinic. This includes efforts to guide Hispanic women toward screening tools to detect breast cancer. Speaking both English and Spanish fluently, Dr. Diaz is able to effectively communicate with the Hispanic population and stress the importance of learning English and the American culture while maintaining their own heritage.

Submit hospital community benefit stories to Mary Kay Grasmick, editor, mgrasmick@wha.org or call 608-274-1820.

Herb Bostrom, deputy administrator of the Wisconsin Division of Public Health, retired on January 1, 2007. In his administrative roles at DPH, Herb has been a long-time friend and supporter of hospitals and has helped to create a strong partnership between the public and private sectors. WHA and its hospitals owe a special debt of gratitude to Herb for his role in the accomplishments of the Hospital Disaster Preparedness Program. From its very inception in January 2002, Herb involved both WHA and hospitals in writing the first grant and has kept the Program consistently focused on hospital needs and goals. For example, overhead costs for this Program have been kept a minimum, less than 5 percent, which is very low compared to neighboring states. Over 80 percent of all funds have gone directly to hospitals for various emergency preparedness projects. WHA offers its congratulations and best wishes to Herb on his retirement.

WHA Financial Solutions is pleased to announce that Lisa Conwell has joined the company as an account manager for retirement services. Lisa brings with her over eight years of experience in the financial services industry, specializing in financial consulting, long-term planning, asset management, and investment advisory.

Lisa comes to us from one of the world’s largest wealth management and investment advisor firms, where she worked as an investment advisor on a team with a $300 million book of business. Her responsibilities included conducting equity and fund research and managing portfolio models on a discretionary platform. In addition, Lisa provided financial guidance to individual clients. By assessing an individual’s total financial picture and risk tolerance, Lisa was able to implement an asset allocation and investment strategy to achieve the individual’s financial goals.

In her role at WHA Financial Solutions, Lisa is responsible for managing retirement plans for a number of clients. This includes working with plan sponsors to increase plan participation, managing vendor relationships, and service resolution. Lisa also conducts educational group and individual meetings, helping people learn the value of asset allocation, basics of investing, individual risk tolerance assessment, and portfolio rebalancing.

Lisa earned her B.A. from Gustavus Adolphus College in St. Peter, Minnesota with a double major in political science and criminal justice. She holds an active life and health license in Wisconsin, Minnesota, and Iowa; as well as NASD Series 6, 7, 63, and 65 licenses.

The ITW Foundation – Miller Electric is providing $300,000 and the Robert Wood Johnson Foundation is providing $90,000 to support a new model of hospital care ThedaCare™ is developing, aimed at producing better patient care at a lower cost.

Under development for nearly a year, this hospital of the future care model is based on every patient receiving care from a core team made up of physician(s), nurses, pharmacists, therapists and other clinicians. Grant proceeds will be used to make process and facility changes necessary to implement this new model of care on the pilot unit.

"Traditional hospital nursing units are not designed to support the frequency and intensity of ongoing collaboration among caregivers that will occur in this new model," said John Toussaint, MD, ThedaCare’s president and CEO. "We need to break down some walls, both physical and behavioral, to bring this care model to our patients. The generosity of the ITW Foundation - Miller Electric, and the Robert Wood Johnson Foundation, is critical to our success."

Baldwin Area Medical Center is pleased to announce the appointment of Gregory Burns as chief executive officer effective January 9, 2007. Burns has over 27 years experience in health care administration, including seven years as the administrator for St. Joseph’s Community Hospital of West Bend, West Bend, Wisconsin and five years at Ministry Health Care.

Burns received his undergraduate degree from the University of Wisconsin – Stevens Point and a Master of Arts in Business – Health Services Administration from the University of Wisconsin - Madison.

Aurora Health Care announced the appointment of Bruce Van Cleave, M.D., as chief medical officer and senior vice president for strategic management. Van Cleave will be responsible for clinical leadership, care management, quality improvement, patient safety, clinical integration, health care transformation, research and clinical innovation. He also will lead strategic planning for Aurora and oversee the Aurora UW Medical Group and Aurora’s participation in the Center for Urban Population Health.

Van Cleave is a family physician and a member of the American College of Physician Executives. He earned his Master of Science degree from the University of Wisconsin-Madison in 1973 and his medical degree from the Medical College of Wisconsin in 1977.

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