Will Wisconsin have enough physicians in the future? That is the challenge that the newly created Wisconsin Council on Medical Education and Workforce, which held its first meeting in Madison on January 13, hopes to address. Their goal is to act now in an effort to avert a major shortage of physicians that is looming on the horizon.

George Quinn, senior vice president at the Wisconsin Hospital Association and author of a physician workforce report issued in March 2004 that recommended a statewide council be created to work on the issue, said one of the areas that the Council will focus on will be in finding out why physicians come to Wisconsin, why they stay, and, more importantly, why they leave.

"We must start by collecting data on the current workforce—where they are working, where they went to school, why they are practicing in Wisconsin—before we can determine the efforts we need to take now to attract and retain an adequate physician workforce," Quinn said. "We also need to track where our medical students go for their residencies because we know that where physicians do their residencies is a strong indicator of where they will practice."

Historically, only 38 percent of Wisconsin’s medical school students stay in Wisconsin to practice medicine. The Council wants to find out what can be done to improve retention.

Carl Getto, MD, senior vice president of medical affairs, UW Hospital & Clinics, Madison, was elected chair of the group at the January meeting. He emphasized the loss of substantial funding previously provided for graduate medical education in the most recently passed State of Wisconsin budget.

"Over 30 million dollars in Medicaid payments to Wisconsin teaching hospitals disappeared during the last budget cycle," said Getto. "Those funds were used to teach and train Wisconsin’s future physician workforce and must be restored as one of our top legislative priorities."

The Council will lead a statewide effort to collect data and encourage research that will assist in monitoring and predicting the number of physicians that will be needed in Wisconsin by type of practice and location. In addition, the Council will recommend policies and practices that encourage physicians to enter and remain in practice in Wisconsin. One of the key components of this policy will be to help protect Wisconsin’s favorable medical malpractice environment.

"Wisconsin must preserve its current favorable medical malpractice environment as a strategy to address the physician supply issue," said Susan Turney, MD, executive vice president/CEO, Wisconsin Medical Society and a Council member. "That environment has allowed us to attract physicians to Wisconsin from states that have experienced a medical malpractice insurance meltdown during the last couple of years."

Members of the Wisconsin Council on Medical Education and Workforce (WCMEW) include:

Wisconsin Academy of Physician Assistants
Jeffrey Nicholson, M.Ed., PA-C, President; Director of Physician Assistant Program, Department of Family Medicine, University of Wisconsin-Madison

Medical College of Wisconsin and Froedtert Hospital
Kenneth B. Simons, MD, Senior Associate Dean for Academic Affairs, The Eye Institute

Wisconsin Hospital Association
Charles Shabino, MD, Chief Medical Officer, Aspirus Wausau Hospital
Tim Size, Executive Director, Rural Wisconsin Health Cooperative
Carl Getto, MD, Senior Vice President, Medical Affairs, UW Hospital & Clinics

Wisconsin Medical Society
Susan Turney, MD, Executive Vice President/CEO
Paul Wertsch, MD, Board Member; Wildwood Family Clinic, Madison
John Beasley, MD, Board Member; UW Health, Verona

Wisconsin Academy of Family Physicians
Thomas Grau, MD, Program Director, La Crosse-Mayo Family Practice Residency

University of Wisconsin Medical School
Byron Crouse, MD, Associate Dean for Rural & Community Health

A national survey conducted by the Kaiser Family Foundation and the Harvard School of Public Health released on January 11, shows that nearly seven in 10 Americans agree that a law to cap pain and suffering awards would help reduce overall health care costs in the U.S. The survey further found that 63 percent of Americans support legislation that would limit the amount of money that can be awarded as damages for pain and suffering to someone suing a physician for malpractice.

Currently, 22 states, including Wisconsin, have caps on damages for pain and suffering in medical malpractice lawsuits. According to a 2002 report by the U.S. Department of Health and Human Services, physicians and hospitals in states with caps on average pay a significantly lower premium for medical malpractice liability insurance coverage.

As a part of Wisconsin’s comprehensive medical liability system, non-economic damages, including damages for pain and suffering, in medical malpractice lawsuits are capped at $410,322 (adjusted yearly for inflation). Wisconsin law further caps non-economic damages in all wrongful death lawsuits at $350,000 in the case of a deceased adult and $500,000 in the case of a deceased child.

Wisconsin has no cap on economic damages in medical malpractice cases. Economic damages include, for example, damages for loss of earnings, and loss of earning capacity, and damages related to future medical treatment, care, or custody. Furthermore, Wisconsin has established the Patient’s Compensation Fund which covers the full amount of all injured patients’ economic damage claims that are in excess of their health care providers’ statutorily required liability insurance – thus ensuring a solvent source for a patients’ recovery of economic damages.

The constitutionality of Wisconsin’s non-economic damage cap in medical malpractice lawsuits is being challenged in the Ferdon v. Wisconsin Patients Compensation Fund case currently before the Wisconsin Supreme Court. (See January 7, 2005 and December 23, 2004 issues of The Valued Voice.) This case puts at risk Wisconsin’s comprehensive medical liability system; WHA and the AHA are requesting permission to file an amicus brief in that case supporting the constitutionality of the caps.

WHA’s effectiveness depends on health care leaders committed to working with the Association, analyzing issues and forming overall policy. WHA Chair Ned Wolf has announced a slate of committed individuals who have volunteered their time and leadership in helping to advance WHA’s mission in 2005.

The Wisconsin Quality Steering Committee approved the addition of three measure sets at their January 13 meeting in Madison, which will be phased in over the next 18 months. The new measures, subject to approval by the WHA Board of Directors, include: surgical infection prevention, error prevention - medication reconciliation and patient experience of care (HCAHPS).

Steering Committee Chair Charles Shabino, MD, informed the group that progress has been made to identify areas of synergy between the Wisconsin Collaborative for Healthcare Quality and WHA that lend themselves to future collaboration. Leaders of both organizations agree on the need to embrace a complementary and coordinated working relationship. This will, in turn, facilitate the collection and dissemination of information in a way that is meaningful for consumers and purchasers of health care, and useful for providers generating data. The first step will be to minimize possible confusion from multiple quality reporting sites through the creation of a single Web portal that will be marketed to consumers.

Dana Richardson, WHA vice president of quality, reviewed the results of the listening sessions that were held in late 2004 to obtain input on the value of CheckPoint and the proposed new measures. Four separate sessions were held composed of hospital quality staff, health care purchasers and legislators. Key themes included recognizing the value of both process and outcome measures, and the request for cost information being connected to quality/safety/service measures.

Mark Xistris from The Alliance gave a presentation on the pilot program for "Pay for Performance" with the hospitals in their market located in Southcentral Wisconsin. Measures include the rates for C-sections, readmissions, mortality and implementation progress towards computerized physician order entry and the use of intensivists. Xistris discussed principles used to build an incentive structure around the measures. They continue to evaluate the process as they pilot the program with six hospitals.

Iowa Governor Tom Vilsack, in his Condition of the State address to the Iowa Legislature this week, did something that Wisconsin Governor Jim Doyle did not do in his State of the State address. Vilsack called on the Iowa Legislature to raise the cigarette tax to help close the Hawkeye State’s $100 million Medicaid deficit and increase spending on health-related needs.

Governor Vilsack is a "lame duck" who, unlike Governor Doyle, will never again face re-election. Other than that, circumstances in the two states are very similar. Medicaid woes facing Wisconsin are virtually identical to Medicaid’s sorry status in Iowa. Current and future deficits, "below cost" provider payments and rising Medicaid utilization are shared symptoms. But in Wisconsin, a rhetorical commitment to "no new taxes" has placed Governor Doyle and GOP leaders in the awkward position of closing the door on a practical funding source for a program that provides health care to seniors, the disabled and children. The good news is that it’s only the top of the first inning in what may be an extra inning ball game.

Wisconsin lawmakers have made the wrong call if they believe a higher tobacco tax is political baggage. Just two months ago, two-thirds of Montana voters supported a one-dollar increase in that state’s cigarette tax. In Oklahoma, voters approved an eighty-cent per pack tax increase and in Colorado, 61 percent of voters supported a state constitutional amendment (!) that will increase the cigarette tax by 64 cents per pack. In each of these cases, most of the new revenue will finance health-related programs. In each of these cases, voters embraced higher tobacco taxes.

Wisconsin’s current tobacco tax—77 cents per pack—is less than the national average, and Medicaid payment rates to hospitals and physicians are among the lowest in the nation. The upcoming debate on how to "fix" Wisconsin’s Medicaid deficit, as well as the expected focus on the "hidden tax" associated with Medicaid underpayment, will create a strong case for "new" dollars regardless of other proposed solutions.

WHA is an active member of SmokeFree Wisconsin—a coalition whose advocacy focus is on increasing the cigarette tax as a way to stop kids from smoking and generating revenues to finance priority health care programs. This coalition provides an important platform to build support among policymakers and the media for raising the tobacco tax.

Here’s a prediction that despite the current absence of discussion and support for a tobacco tax increase in the Governor’s office and in much of the Legislature, the prospects for an increase will improve over the next few months as the Legislature grapples with difficult budget realities. Our job is to help create an environment that is conducive to bi-partisan support for increasing the tobacco tax with new monies fully targeted to health care.

Steve Brenton
President

WHA members can choose from a wide variety of WHA educational offerings again in 2005, ranging from billing and coding education to workforce-related topics. The full 2005 Education Calendar is included in this week’s packet. Also included in the calendar are dates for WHA’s important annual events.

As member needs change, so will the WHA educational offerings. The calendar includes all planned events as of January 7, 2005, but continue to watch for information on additional educational programming throughout 2005.

Specific seminar/event brochures and registration information will be distributed approximately eight weeks prior to the event dates via direct mailing and WHA’s weekly newsletter and packet. The same information will also be available on the web site at www.wha.org. Remember that you can register on-line for most 2005 programs.

The 2005 Employee Pride Program reception and recognition dinner is set Thursday, April 28 at the Kalahari Resort in Wisconsin Dells. Watch for more information later this month on how your hospital can participate in this important event.

Wisconsin Forward Award announced the recipients of the 2004 Wisconsin Forward Award, the state’s highest award for organizational excellence.

All Saints Healthcare, Racine, along with the Madison-based organizations of St. Marys Care Center, Meriter Hospital, and Physicians Plus Insurance Corporation, are the 2004 Mastery Award recipients.

Agnesian HealthCare, Inc., Fond du Lac; Bay Area Medical Center, Marinette; Children’s Hospital of Wisconsin–Fox Valley; Hudson Hospital; Luther Midelfort, Mayo Health System, Eau Claire; St. Clare Meadows Care Center, Baraboo; received recognition at the Proficiency Level.

"Wisconsin hospitals provide top quality care to the patients in the community. It is no surprise that they are at the top of the class in organizational performance results," according to Wisconsin Hospital Association President Steve Brenton.

The primary objective of Wisconsin Forward Award, Inc. is to help organizations improve their performance results. The program also serves to recognize performance excellence throughout the state. The Wisconsin Forward Award is given at four levels—Excellence (the top Award), Mastery, Proficiency, and Commitment—and is the culmination of a rigorous assessment process that uses the Criteria for Performance Excellence of the Malcolm Baldrige National Quality program. 2004 Award recipients were evaluated by an independent Board of Examiners in the areas of leadership; strategic planning; human resources; customer and market focus; information, knowledge, and process management; and results.

Each participating organization receives a feedback report outlining strengths and improvement opportunities. This feedback is used for organizational learning, planning, and improvement, helping organizations position themselves for changes in a dynamic and competitive marketplace.

The Wisconsin Primary Health Care Association is sponsoring a one-day conference on Thursday, February 17, 2005 entitled "Wisconsin’s Health Care Safety Net: What is Your Role?" The conference, which is directed toward legislators, safety net providers, and payers, aims to demonstrate each party’s integral role in maintaining and strengthening the health care safety net in Wisconsin.

Local, regional, and national speakers will present on various issues related to the health care safety net, including the following:

• Steve Wilhide, executive director of the National Rural Health Association, will present on collaborations between community health centers and rural hospitals.
• Roger Schwartz, legislative counsel and director of state affairs for the National Association of Community Health Centers, will provide an update on Medicaid from a state and national perspective.
• Terry Ludeman, chief labor economist at the Wisconsin Department of Workforce Development, will explain Wisconsin’s health care workforce trends.
• Anne Klawiter, CEO of Southwest Health Center in Platteville, will address the "Challenges of Serving the Uninsured."
• Additional topics include Health Literacy, TeleHealth, Hmong Health, Obstetric Care in an Urban Health Center, and Chronic Disease Management Among the Uninsured and Underserved Populations.

Four Wisconsin health care systems have been named "Best Places to Work" in Southeastern Wisconsin by Milwaukee Magazine and MRA-The Management Association’s fourth annual study of workplace practices.

This year, 10 large companies (501 or more employees) located in Southeastern Wisconsin were on the list. To be named to the list, firms were required to fill out an extensive survey that asked some 500 detailed questions in nine different categories. WHA members who made the list included: ProHealth Care (#3); Children’s Hospital of Wisconsin (#5); All Saints Healthcare System, Inc. (#6); and Froedtert Hospital (#10).

Although a disabling illness or injury can have severe consequences, many employees do not have adequate protection. One-third of employees indicate they could only live for three months or less on their savings or other income if the primary wage earner lost his or her income due to a disability. For many employees, the ability to earn an income is their most significant resource for financial security.

American Health Insurance Plans conducted a survey in mid-2004 of full-time employees to gauge how informed employees are about the issues surrounding disability insurance. What did they find? Read this month’s issue of Solutions Spotlight, included in this week’s packet.

The newest report from the American Hospital Association’s Commission on Workforce continues the process of sharing workforce ideas submitted by member hospitals. All of the past reports have included ideas submitted from Wisconsin hospitals and this report is no different. Featured are ideas submitted by: Baldwin Area Medical Center, Bellin Memorial Hospital (2); Columbia St Mary’s; Covenant Healthcare; Saint Joseph’s Hospital of Marshfield, (2); and University of Wisconsin Hospital and Clinics.

These reports include contact persons for each idea, which make them a good source of information on workforce strategies that have been successful in other settings.

For more information on workforce issues, contact Judy Warmuth, WHA’s vice president of workforce, at jwarmuth@wha.org or 608-274-1820.

This individual serves in the capacity as the Chief Physician Executive of Community Memorial Hospital. Responsibilities include setting strategic direction for community health programs, ensuring physicians are engaged about issues critical to their and the hospital’s success (e.g., quality, patient care outcomes, patient service), strengthening relationships between the Medical Staff and the hospital, leading the identification and development of new programs, and acting as a liaison between administration, the hospital staff and the Medical Staff. Oversees and supports the Medical Staff structure, assuring high quality patient care and compliance with regulatory and accreditation requirements. The Vice President of Medical Affairs is a member of the senior executive team. Contact: John Zorbini, vice president of human resources, at 262-257-3045 or email jzorbini@communitymemorial.com.