On January 28, the Health Coverage Coalition for the Uninsured (HCCU), a diverse group of national organizations that includes the AHA, announced a consensus proposal to cover a significant portion of the nation’s nearly 47 million uninsured.

The organizations set aside political and ideological differences to structure a specific two-phased proposal that includes both public and private initiatives to expand coverage for uninsured children and adults, starting immediately with expanded coverage for children in 2007. With Congress scheduled to consider reauthorization of the State Children’s Health Insurance Program (SCHIP), the proposal could have an immediate impact. Its first phase is a "Kids First Initiative" that would allow parents to more easily enroll their children in public programs like SCHIP and Medicaid.

The agreement is the result of discussions over two years among the coalition’s members: the AHA, America’s Health Insurance Plans, Families USA, American Academy of Family Physicians, American Medical Association, American Public Health Association, BlueCross BlueShield Association, Federation of American Hospitals, AARP, Johnson & Johnson, Catholic Health Association, Healthcare Leadership Council, Kaiser Permanente, Pfizer, United Health Foundation and the U.S. Chamber of Commerce.

Speaking at the announcement event in Washington, AHA Board Chairman Kevin Lofton said, "In this 21st Century, here in America, no one should have to go without health insurance, least of all a child. I hope that the agreement announced today marks a significant step toward expanding coverage to those who currently have none. Let’s get to work and expand coverage for the uninsured, beginning immediately with kids."

The proposal also calls for a new tax credit to help families cover some of the cost of providing private health insurance for their children. The second phase of the coalition’s proposal focuses on uninsured adults. It would give states the flexibility and funds to expand Medicaid eligibility to cover all adults with incomes below the poverty level. For those with incomes between 100-300 percent of the federal poverty level, a refundable, advanceable tax credit would be established to help individuals cover the costs of private insurance.

There is still time to register at the "early bird" rate for the WHA Physician Leadership Development Conference, March 16-17 at The American Club in Kohler.

Presented by American College of Physician Executives (ACPE) faculty, this new conference is designed to assist physicians who have recently assumed a leadership or management role, and those who have the interest and/or potential to be future leaders, to transition from their traditional clinical training to a new managerial approach in decision-making.

Any physicians new to their leadership roles or who have leadership/management interest or potential should plan to attend this conference. Also, chiefs of staff, medical directors, chief medical officers, new medical presidents, new clinical department chairs, and new committee chairs are encouraged to attend or designate a physician with leadership potential to attend, as part of your organization’s succession planning. CEOs/administrators or other management leaders should consider attending this event as a "host" attendee, taking the opportunity to accompany their physician leaders and have some informal, one-on-one discussion time with each of them.

The discounted "early bird" registration fee is available to those registering by February 1, as well as a group discount to those registering early. Additionally, the "host" registration option, which includes all meals, is available to those who would like to accompany their physicians to the conference but do not need the CME credit.

ACPE is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The American College of Medical Education designates this educational activity for a maximum of 10 category 1 credits toward the American Medical Association’s Physician Recognition Award. Each physician should declare only those credits that he/she actually spent in the activity. Additionally, these programs are part of the ACPE and CCMM requirements toward a graduate degree or certification in medical management.

People are concerned about health care issues related to cost and access. I represent an economically diverse district concerned about health care costs and out-of-pocket costs. In my own experience of starting a small business, I found the cost of insurance even for a young, healthy couple to be about $1,400 per month. We have these huge burdens on consumers, small businesses, and municipalities. When I was an alderman in Wauwatosa, we saw our health care costs escalate 22 percent. I sat on an advisory committee for Sen. Feingold, and I heard from business leaders how they could not expand their businesses because they could not keep up with the cost of health care. It is a burden for everyone. Hospitals are burdened with providing a huge amount of uncompensated care. From my perspective, I see a system now that burdens hospitals, hurts working people, and generates a huge amount of uncompensated care. It has been my hope that we can find a plan that provides broader coverage and at the same time, is a workable plan for hospitals and other medical providers.

Given the composition of the Wisconsin Legislature, we have an opportunity to craft a workable, bi-partisan compromise. I have been actively looking to bridge the gaps between some of the voices who are looking for a particular plan and the people who work in health care who just want to be able to provide high quality care.

It is top of mind for me that I represent a district with multiple hospitals and regional medical centers and that is an important issue to me. While I don’t consider myself an expert on health care, my legal background does include representing physicians and hospitals. I have an open mind on these issues. Coming up with solutions in the public sector that work for medical providers is a top priority for me.

2. Would you support a $1 increase in the cigarette tax if the money generated from the increase was devoted to state health programs, including increases in Medicaid provider rates?

Decreasing smoking is a good idea. Tobacco use generates health care costs, so it is only fitting that users should shoulder some of that burden. I agree that the money generated from the proposed tax should be used for health programs, including Medicaid, since we have very serious problems with the Medicaid reimbursement rate. I think the Medicaid rates should be increased. The key is to make sure that the dollars go to Medicaid and health care related programs.

3. As a member of the Senate Health & Human Services Committee, which will analyze various health care reform proposals this year, what do you see as the key principles that should be included in a reform proposal?

As a member of the Committee, I will hopefully be working with a number of different constituencies in my Senate district in a bipartisan manner on health care reform and work to broaden the risk pool to make sure that we can provide coverage to a broader group of people. Key elements that I will be watching for in proposals include:

• Cover every child.
• A proposal that can pass both houses of the Legislature.
• A health savings account is not enough on its own, but it can be one tool that could be available to pay for care.
• Work towards universal coverage. The easiest way to do that could be to work within an employer-based system and create a more market-based system. The role of government should not be to control it, but to manage the boundaries. We cannot continue to allow insurance companies to laser out people for pre-existing conditions. The feature I like about a universal risk pool is that it allows us to spread out the risk and bring down costs.

We have an opportunity, working with hospitals, to come up with something that works for both providers and the public. My priority is to talk to people from the hospital sector. I want to come up with something that will work for them. My theory is that if we can develop a plan that is supported by caregivers, they will not be saddled with the issues associated with uncompensated care, and they will be able to concentrate their efforts on caring for patients. I don’t want to hold out for the "ideal" plan. I want to find one that works and works now.

4. A Madison nurse was criminally charged after making an unintentional error. Would you support legislation to protect our health care workforce from criminal charges for unintentional errors?

If it is unintentional, yes. I think if there is negligence, it should be dealt with in a malpractice context. I was surprised that the nurse was charged since it was unintentional. I am concerned that the threat of criminal charges will have a chilling affect on health care professionals.

5. Access to dental health is a growing problem. What do you think government can do to help with this access crisis?

Again, this takes us back to inadequate Medicaid reimbursement rates. We have provided coverage for dental in the Medicaid program, but dentists won’t see these patients because of the low reimbursement. There are dentists who make a point of adding a certain percentage of public assistance to their practice. I would like to see dentists step up and take some of those patients, as doctors do. Any of us in a profession should try to not just serve clients, but also serve the community. Certainly hospitals and a lot of physicians are treating Medicaid patients and those who are not able to pay, but we are not seeing that level of commitment across all professions.

In 2006, WHA strongly supported a rule change to allow dental hygienists to bill Medicaid directly for preventive dental services. Last June, a legislative committee approved a portion of that rule change while objecting to other portions of it. This week that same legislative committee debated the remaining portions of the rule and whether to introduce legislation to sustain those original objections. Because the committee deadlocked (5-5) on the issue, the entire rule goes into effect immediately.

During its public hearing this week, the Joint Committee for Review of Administrative Rules (JCRAR) took testimony from the Department of Health & Family Services (DHFS) among others. DHFS testified that in only a few months time, 26 dental hygienists had been certified and 374 individuals treated. DHFS argued in support of placing the rule into effect so that care could be provided to the thousands of children and adults currently awaiting dental care.

The rule in effect now allows a dental hygienist certified as a Medicaid provider to bill Medicaid for:

• Oral screenings/preliminary exams
• Prophylaxis
• Topical application of fluoride
• Pit and fissure sealant
• Scaling and root planning
• Full mouth debridement
• Periodontal maintenance

Due to the impact that the lack of access to dental care by Medicaid patients has on hospital emergency departments, WHA has been a leading supporter of allowing hygienists to bill Medicaid for certain preventive services. In late 2005 through mid-2006, hospital ERs had over 22,000 dental-related visits. Close to 20,000 of those visits were "preventable" (i.e., not accident or trauma related).

License renewal for Licensed Practical Nurses will begin soon. This year, the Department of Regulation and Licensing is making an effort to have LPNs renew their licenses online by not mailing printed application/renewal forms. For the first time, current license holders will receive only a reminder that it is time to renew their license, not a renewal form.

There are several risks with this strategy that hospitals should keep in mind:

• All LPN staff may not have access to the Internet for license renewal.
• All LPN staff may not have a mechanism for online payment of renewal fees.
• A post card may not be a sufficient reminder to license holders.

Judy Warmuth, WHA vice president, workforce, encourages hospitals to make computers accessible in the workplace for LPNs without Internet access. "The key will be communication about the changes and access to computers. Making a computer available in the hospital or nursing home specifically for this purpose will be very much appreciated by LPNs who do not have access to the Internet at home," Warmuth said. Warmuth recommends that employers alert LPNs to the changes, advise them of the availability of computers in the workplace, and remind them that they will need their LPN license number (not social security or driver’s license number) to complete the renewal process.

Frequently Asked Questions

How can an LPN pay for his/her license online? The Web site will accept VISA, MasterCard, Discover and American Express.

Where on the Internet does an LPN go to renew his/her license? The Department of Regulation and Licensing Web site at: http://drl.wi.gov/index.htm. Click on: License Renewal Online.

What if an LPN doesn’t have access to the Internet? Or what if he or she doesn’t have a credit card? A license may be renewed in the traditional way, but it will require specific action by the license holder. To renew a license on paper, an LPN will need to call the Department of Regulation and Licensing. The department will print off a bar-coded application and mail it to the LPN. The phone call/mail process will prolong/delay the renewal.

Will LPNs get a reminder? There will be no reminder sent by the Department.

By what date are license renewals required? A renewed license is required for practice by April 30, but the Department cannot assure LPNs that they will have their license in hand if renewal applications are received after April 15.

The Department of Regulation and Licensing is rolling out online renewal for all regulated groups. Smaller groups have already used the system and it has gone well. This is a much larger group of license holders. Eventually, most, if not all, licenses will be renewed this way.

Contact WHA’s Judy Warmuth, vice president, workforce, at jwarmuth@wha.org if you or your nursing staff encounter barriers or problems with this renewal process.

Last week, WHA’s Task Force on Pricing and Billing met to decide on recommendations that it will forward to the Board on hospital pricing and billing practices. Principal among these recommendations will be important updates to the 2004 "Billing and Collection Guidelines for Wisconsin Hospitals."

Since the introduction of the Guidelines, scrutiny of hospital billing practices has intensified, and members have also requested more specific recommendations from WHA. In its two meetings, the Task Force examined key issues in the current environment and considered factors such as public perceptions, current practices, and administrative feasibility before arriving at the following five updates to the Guidelines:

1. Standard Discounts for the Uninsured

Issue: Assertions from the public and policymakers that the uninsured are billed more than insured patients.

Recommendation: Hospitals should have a standard discount for all uninsured patients. Hospitals can consider a flat discount or a discount similar to those given to commercial insurers.

2. Uninsured Patients with Incomes Between 100 Percent and 300 Percent of the Federal Poverty Level (income only)

Issue: While there is general agreement that uninsured patients with incomes below 100 percent of the Federal poverty level should receive charity care, and those above 300 percent should in general receive only the standard uninsured discount, members have expressed a need to have specific guidelines for those uninsured patients between those two levels.

Recommendation: Hospitals should consider the following alternative approaches -- a flat discount amount greater than the standard discount, or adjustable discounts that change with the income level of the uninsured patient.

3. Financial Assistance for Catastrophic Health Care Bills

Issue: Financial assistance is generally made available to patients with incomes below 300 percent of the Federal poverty level. However, uninsured patients who have incomes above 300 percent of the poverty level may still face catastrophic health care bills that they are unable to pay in a timely manner.

Recommendation: Hospitals should have a policy that would provide financial assistance (discounts and/or extended payment terms) in those cases where the hospital bill is large in comparison to the uninsured patient’s assets or income (means).

4. Collection Agency Relationships

Issue: While most hospitals have policies in place for their staff to ensure fair and sensitive treatment of the uninsured in their collection practices, these same controls may not always exist for those situations where the function is contracted to an outside collection agency.

Recommendation: Hospitals should obtain written assurances that, at a minimum, the selected organization complies with the Fair Debt Collection Practices Act and the ACA International’s Code of Ethics and Professional Responsibility. Hospitals should review and assess collection agency practices on a regular basis.

5. Collection and Billing Information More Available to Public

Issue: There is a need to make the public more aware of hospital billing and collection guidelines for two reasons -- to demonstrate that hospitals are being transparent in their practices, and to reduce the number of cases where patients "fall between the cracks" and are not provided financial assistance because they were not made aware of these policies.

Recommendation: Hospitals should display and/or make available their billing and collection policies. Hospitals should provide information on the policies within the patient registration packet.

The Task Force feels strongly that these five recommendations will go a long way toward meeting the needs of WHA members and in addressing public criticism surrounding hospital billing practices.

WHA Chair Bob Fale said before he accepted the position as 2007 WHA Board chair, he called some of his colleagues and asked them for their advice. Their overwhelming response, according to Fale, was that "I should do it because the staff functions as an excellent team." That teamwork, and a dedication to serving the membership, earned WHA exceptionally high marks on a recent membership survey. "Even Brett Favre knows he can’t go to the Super Bowl if he doesn’t have a good team behind him," Fale said to staff gathered at an employee recognition luncheon January 17 in Madison.

WHA President Steve Brenton said the high marks from members reflect the coordinated efforts and shared values throughout the entire organization, including WHA Financial Solutions and the WHA Information Center. "All of us, no matter what organization we ‘belong to,’ contribute to the goal of advocating on behalf of Wisconsin hospitals so they can continue to provide accessible, high quality health care to the people in their communities," Brenton said.

Each employee received a crystal recognition plaque.

Joe Neidenbach, longtime administrator at St. Vincent Hospital, Green Bay, will retire effective March 31.

Neidenbach, who joined HSHS, a 13-hospital system based in Springfield, IL, in 1974, served first as assistant administrator and later administrator at St. Nicholas Hospital in Sheboygan. He made the move to St. Vincent in 1982 when he was named the hospital’s administrator and executive vice president.

"Joe Neidenbach is an inspirational leader, colleague, and friend of the Hospital Sisters, Hospital Sisters Health System and the Green Bay community, particularly St. Vincent Hospital," said Stephanie McCutcheon, HSHS president and CEO. "His vision, dedication and commitment are unmatched."

In a message to hospital staff, Neidenbach wrote, "I am proud of my 25-year involvement with such an excellent, caring organization, and I am pleased to know its future is in the hands of leaders who will carry on the healing mission to which I have devoted much of my life."

Neidenbach provided many years of service to the Wisconsin Hospital Association, including Board Chair in 1986, and chair of numerous WHA committees and councils throughout his career. In 1995, he received WHA’s Excellence in Management Award.

"Joe’s exemplary track record as a health care executive for more than three decades is a testament to his visionary leadership and strong personal values," said WHA President Steve Brenton.

Neidenbach is a Sioux Falls, SD, native and a Vietnam veteran who earned a Bronze Star during his military career. He and his wife, Jeanne, have four children and one grandchild.

HSHS will begin the search for a new administrator immediately.

Ten new and six re-elected members joined the 52-member Wisconsin Manufacturers & Commerce (WMC) Board of Directors during the annual WMC membership meeting on January 17 in Waukesha. Among the new members are: Diane S. Postler-Slattery, president & COO, Aspirus Wausau Hospital, Wausau; and Jeff Thompson, M.D., CEO, Gundersen Lutheran, La Crosse.

The WMC Board of Directors sets the business and industry legislative agenda for WMC, the state chamber of commerce. As the state’s largest business association, WMC represents 4,000 members including manufacturers and service companies, chambers of commerce, and trade associations. Like WMC’s diverse membership, the board of directors includes large and small manufacturers, service companies and chambers of commerce throughout Wisconsin.

Baby Tara was slowly starving to death.

What chance did she have when her well-intentioned, 14-year-old mother answered her cries of hunger with watered-down formula? Baby Tara seemed doomed to become one more Milwaukee infant mortality statistic—that is, until Julia Means, R.N., came to her rescue in Columbia St. Mary’s Blanket of Love program.

Funded through a March of Dimes grant secured by Columbia St. Mary’s Foundation, Blanket of Love surrounds young central city, African American mothers-to-be with childbirth education, parenting skills, problem-solving skills, mentoring and education about family communication. After the birth of her child, the young woman is welcomed back to the group along with her infant to learn more about infant care and parenting skills. Since family members are welcome to attend Blanket of Love meetings, the baby’s father and the young woman’s mother or sisters frequently attend.

Julia has found that misunderstanding about aspects of infant care is not uncommon among Blanket of Love participants. Tara’s mother is a typical example. She was purchasing premixed formula for her baby because it seemed cheaper to her. Then she decided to "water it down" to have enough for feedings between her visits to the Women, Infants and Children (WIC) food support program. Because Tara’s mother had seen other mothers add water to powdered formula, she believed she also needed to add water to the liquid formula.

The mother could not understand an explanation of why the watered-down formula was inadequate for her baby nor why powdered milk was more cost effective than premixed formula. She was convinced that one can of powdered milk was more expensive than, for example, three bottles of premixed milk. Julia had to demonstrate the "how to" and the benefits of powdered formula to the young mother by actually mixing several bottles of formula while the girl watched.

Not surprisingly, Baby Tara is thriving now that mom understands how to prepare her formula.

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