On January 27, WHA and other health care provider and advocacy groups partnered with SmokeFree Wisconsin to back their effort to launch a campaign to garner legislative support to increase the tobacco tax in Wisconsin by $1.

Mary Starmann-Harrison, Regional President and CEO, SSM Wisconsin, spoke briefly about the personal effects tobacco use has had on her family and the impact smoking has on society. WHA Senior Vice President Eric Borgerding told the group that smoking has a profound impact on the Medicaid budget and he spoke to the need for earmarking increased tobacco tax revenues for Wisconsin’s health care programs. Other hospital participants in addition to Mary Starmann-Harrison included Tim Size, Wisconsin Rural Health Cooperative and Michael Heifetz from Dean/St. Marys Hospital/SSM Healthcare.

WHA is partnering with the SmokeFree Wisconsin coalition as part of a larger advocacy agenda to work with like-minded groups to find solutions to Wisconsin’s health care problems, which includes ending the hidden tax by adequately funding Medicaid, while also keeping 72,000 youth from smoking.

State Representative J.A. "Doc" Hines (R-Oxford) announced he will introduce legislation to increase the tobacco tax by $1, which would raise the tax on cigarettes to $1.77 per pack if enacted. A $1 increase in the tax would raise $251 million annually, but when coupled with federal matching funds if earmarked for Wisconsin’s health care programs, it would bring in a total of $625 million in new revenue.

Currently, smoking-related illness costs Wisconsin’s Medicaid program $375 million a year – approximately l5% of the budget. As Borgerding explained, "That’s why it is critical to tie the tobacco tax to Medicaid funding and tobacco prevention programs, just like how the state treats the gas tax, indexes it annually for inflation and earmarks it for transportation funding."

Former state representative and Tobacco Control Board member Mary Ann Lippert pointed out to participants that this is the only tax that can generate revenue, while at the same time also contain program costs because every person who quits, or every kid who doesn’t start, lessens the burden smoking will be on the state’s health care programs and private health insurance.

WHA encourages members to discuss the benefits of increasing the tobacco tax with their elected officials. For more information, contact WHA’s Jodi Bloch at 608-274-1820.

Did you know the money Wisconsin collects now from the cigarette tax ($.77 per pack) doesn’t come close to covering the health costs of treating sick smokers? In fact, every pack of cigarettes sold results in $7.14 in health costs, according to the U.S. Centers for Disease Control and Prevention.

We need to close this gap and fast by encouraging people to quit smoking, for their good health and the financial health of the state. Raising the cigarette tax is the answer. It is the single most effective way to reduce teen smoking and bring in money at the same time.

Add a dollar per pack onto the cigarette tax and we can save thousands of Wisconsin citizens from an early death and provide a steady, annual stream of new revenue for our cash-strapped state.

The $250 million stream of new money each year from this proposal can help fund Medicaid health care programs for the poor and elderly that are now in deficit. Those who are less educated and earn less money are more likely to smoke than wealthier, more educated citizens, in part, because tobacco company marketing targets the young and low-income groups. Still, a higher tax for smokers is appropriate because taxpayers shoulder the immense burden of covering smoking-caused illnesses for Medicaid recipients. There isn’t universal support for raising this "user fee" because some say poor people would get stuck paying most of the freight. But the reality is that smokers—rich and poor alike—are the ones who are most likely to benefit from a higher tax.

What’s happened in states that have raised their cigarette tax by a significant amount is something we can all cheer: children are much less likely to start smoking, many smokers simply quit and those who continue to smoke tend to smoke less. Raising this tax provides an economic incentive to give up what is truly a lethal addiction. In fact, raising the cigarette tax is the single most powerful way to reduce teen smoking.

Secondly, all smokers, low-income ones included, can choose to quit and not pay a cigarette tax at all. That’s good for the former smoker and better for the taxpayer, who will be relieved of astronomically high health bills in the future.

Smoking is not only the most preventable cause of early death but Wisconsin simply can no longer afford to suffer its economic consequences. Smokers can continue to smoke if they choose, but they must begin to pick up a greater share of the consequences of their decision.

Our fantasy scenario is zero tobacco revenue comes to the state following a significantly higher cigarette tax because all smokers in Wisconsin simply quit in protest. The hundreds of millions of dollars saved in health costs would more than offset the lost tobacco revenue. Unfortunately, we all know that won’t happen over night, if ever. Still, a substantial number of smokers would quit and 72,000 of today’s children may never become smokers in the first place if Wisconsin experiences what other states have from increasing their tax.

The beauty of this proposal is that once enacted, there is no way it can fail. All the evidence clearly demonstrates that raising the cigarette tax leads to fewer smokers and more tax revenue. What more could we possibly ask when health costs are rising rapidly and greater demands are being made on government? Under the circumstances, there is no worthier option.

But logic will not result in action until more of us tell our elected officials we need a higher cigarette tax—not because anyone is hell-bent on blaming nicotine addicts, but because everyone deserves a chance to avoid a smoking-caused death or illness. Likewise, taxpayers deserve a break from the overwhelming costs of treating sick smokers.

Susan Turney, MD is CEO/EVP of the Wisconsin Medical Society. Steve Brenton is president of the Wisconsin Hospital Association.

On January 21, the Supreme Court granted the request by WHA and the American Hospital Association (AHA) to jointly file an amicus brief with the Supreme Court in Ferdon v. Wisconsin Patient Compensation Fund. As detailed in prior issues of The Valued Voice, this important case challenges the constitutionality of Wisconsin’s non-economic damage cap in medical malpractice lawsuits and puts at risk Wisconsin’s comprehensive medical liability system.

The Court has also granted the individual requests of the Wisconsin Academy of Trial Lawyers and the Association of Trial Lawyers of America, as well as the joint request of the Wisconsin Medical Society and the American Medical Association, the joint request of Wisconsin Manufacturers and Commerce and the Wisconsin Coalition for Civil Justice, and the joint request of Wisconsin Insurance Alliance, Physicians Insurance Company of Wisconsin and the Property Casualty Insurers Association of America, to file amicus briefs in the case. All amicus briefs are due to the Court on February 14, except for WHA’s and AHA’s brief which is due on February 21.

As one of only six states not currently experiencing a medical malpractice "crisis" according to the American Medical Association, maintaining the non-economic damage caps is particularly important in maintaining and improving access to health care that is timely and not burdensome for Wisconsin patients.

"Recently, the Task Force on Wisconsin’s Future Physician Workforce released a report that showed a growing unmet need for both primary and specialty physicians in Wisconsin, particularly in rural areas and in the inner city of Milwaukee," stated George Quinn, senior vice president, WHA. "One way to fill that need would be to attract physicians from other states, and the stability of Wisconsin’s medical liability environment has been a very positive influence on our ability to do so. Adding instability to the medical liability environment can only negatively impact our efforts."

On February 23, WHA will join with Wisconsin Manufacturers & Commerce (WMC) and several other business groups and the Chamber of Commerce to co-sponsor Business Day in Madison. This event is a very important gathering for business leaders across the state, including hospital leaders.

This is a great opportunity to partner with business leaders, which is part of WHA’s overall advocacy strategy in working together to find solutions to Wisconsin’s many policy challenges, including finding ways to reduce Wisconsin’s hidden tax on health care by appropriately funding Wisconsin’s Medical Assistance programs.

In addition, WHA government affairs staff will hold a members-only briefing on key issues facing hospitals in the 2005 legislative session. There will also be opportunities for our members to speak with their legislators, network with other community leaders and hear from a high-powered lineup of speakers including Tony Snow, Rich Galen and Governor Jim Doyle.

Please note, this program will not duplicate, nor take the place of, WHA’s own Advocacy Day in Madison, scheduled for May 11, 2005. Again this is an opportunity for hospital leaders to meet with their business counterparts and hear first hand about the key issues facing Wisconsin and the nation.

If you are interested in learning more about Business Day in Wisconsin, contact Angela Miloszewicz at 608-274-1820 or go to WHA’s website at www.wha.org to download a registration form.

WHA’s number one advocacy priority in 2005 is Medicaid payment. And despite a difficult state budget environment, we will not be satisfied with an outcome that succeeds only in blocking Medicaid payment cuts. Our Medicaid advocacy agenda calls for reducing the "hidden tax" on health insurance premiums by advancing a "down payment" of payment improvements that include: restoration of Graduate Medical Education funding, an enhanced Disproportionate Share Hospital (DSH) program, and higher outpatient hospital payments. Payment hikes…not the status quo…will be the measure of our success.

Where will the money to improve payments come from?

WHA has joined with other organizations calling for an increase in Wisconsin’s cigarette tax with new dollars targeted for health care programs, including Medicaid. In 2004, over a dozen states increased their cigarette taxes and at least that number (including Iowa) are likely to increase tobacco taxes in 2005. A higher tobacco tax will generate funds that can be used to draw down federal Medicaid money and improve provider payments. And we are optimistic that bi-partisan legislative support will exist later this year for this new revenue stream.

Over the past few months, a couple of you have asked whether a hospital tax should be considered as a source of Medicaid funding. In fact late last year, WHA’s Medicaid Task Force looked at that option and tabled it. The truth is that a tax on hospitals is a hugely problematic way to finance the state out of its Medicaid funding dilemma. Here’s five specific reasons why that’s the case:

1) A tax on hospitals will create hospital "winners" and "losers" (mostly losers we suspect). And a divided WHA membership is certain to distract us from advancing our larger Medicaid agenda.

2) While several states have recently enacted hospital taxes (Illinois, for example), the Centers for Medicare and Medicaid Services (CMS) has been leery about approving new Medicaid plan amendments that spend new Medicaid funds raised via taxes. Attempts to "hold harmless" hospital "losers" in order to develop political support to pass a tax will doom its approval in Washington, DC.

3) Once hospitals "agree" to tax themselves to pay for Medicaid, it is unlikely that elected officials will ever again look seriously at using "real" dollars to finance the Medicaid program. Doubters of this assertion should ask Wisconsin’s nursing homes about their "taxing" experience.

4) There’s no guarantee that hospital taxes will be used to generate new Medicaid dollars that will go to…hospitals. State governments across the country, including our neighboring state of Minnesota, have redirected hospital taxes to pay for legislative priorities unrelated to health care. The Kentucky Hospital Association, in fact, is about to sue state officials for reneging on a tax deal that was supposed to generate millions of dollars in higher hospital payments. Instead, funds will be used to balance the Kentucky budget.

5) Finally, how can we rationalize taxing hospitals that receive 58 cents on the dollar for treating indigent patients? We already have a "hidden tax"…we don’t need a new "unhidden" tax.

Steve Brenton
President

During a visit with Meriter Health Services employees on January 21, it was evident that health care policy is still very much a priority for Congresswoman Tammy Baldwin. During her opening remarks, Baldwin shared her pleasure with her recent appointment to the House Committee on Energy and Commerce. (She received an appointment to the Health Subcommittee this week.)

Baldwin said this was great news because she’ll be able to fight for some good Wisconsin ideas and "dive into issues with greater influence." She also shared the challenges that face any bill introduced in this session due to the make-up of the House and Senate.

Meriter President and CEO Terri Potter and a small group of administrative staff met with her earlier in the morning to share highlights on everything from community solutions for the uninsured and underinsured to progress on electronic medical records systems to the hospital’s involvement in economic development. Potter asked her to keep three things in mind as Medicare policies are being considered:

1. What is a fair payment for services? The underpayment for the cost of Medicare services creates a cost shift to employers, which has a significant negative impact on the health and vitality of our economy. The "hidden tax" needs to be addressed.

2. How is the money going to be used? The onerous number of Medicare rules, regulations and interpretation requires more money to be dedicated to the paper shuffle than in keeping nurses and other care givers at the bedside. Providers need to be able to use a greater percent of each dollar paid to them on clinical services.

3. What should Medicare pay for? Legislators can’t continue to add benefit on top of benefit, regardless of cost. We need to re-examine the overall Medicare benefit design and set contemporary priorities.

The Wisconsin Hospital Association, along with the Wisconsin Society of Healthcare Human Resources Administration, the Wisconsin Organization of Nurse Executives, and the Wisconsin Healthcare Public Relations and Marketing Society, are proud to sponsor the Wisconsin Hospital Employee Pride Program 2005. This program is designed to celebrate the pride that hospital employees have in their work and recognize the contributions that they make to their patients, their community and to their profession. Last year, over 60 hospital employees were honored, and this year we hope to increase the number of hospitals that participate in this program. A reception and dinner will be held April 28 in Wisconsin Dells at the Kalahari Resort to honor one employee from each WHA member hospital.

A designated leader from administration, human resources, public relations or patient care from each hospital is asked to coordinate the program. Employees will be encouraged to submit to their hospital a one-page essay, poem, or story that explains why they chose to work in health care. From those essays, a committee at the hospital will pick one employee to represent their hospital. That employee will be honored at the reception and dinner April 28 in Wisconsin Dells.

Pride Program materials are being mailed to the human resources contact at each hospital. In addition, these materials are available on WHA’s web site at www.wha.org.

Work in health care often holds deep and personal meaning, with sometimes personal and compelling reasons why people have chosen the field of health care. Last year, the essays and poems reflected the selflessness and dedication of those who work in health care.

Don’t miss this opportunity to participate in the 2005 Pride Program. For more information contact Mary Kay Grasmick at mgrasmick@wha.org,  or Shannon Nelson at snelson@wha.org or call 608-274-1820.

On January 27, the Office of Inspector General (OIG) of the Department of Health and Human Services issued the updated voluntary compliance program guidance for hospitals that was first issued in 1998 to promote compliance with the rules and regulations for participation in Medicare and other Federal health care programs.

The document, entitled "OIG Supplemental Compliance Program Guidance for Hospitals," is available on the OIG home page at http://oig.hhs.gov/fraud/docs/complianceguidance/012705HospSupplementalGuidance.pdf.

It takes into account recent changes to hospital payment systems and evolving industry practices.

While the original guidance focused on how hospitals could design effective voluntary compliance programs, the supplemental guidance focuses on measuring and improving the effectiveness of existing compliance efforts and identifies additional fraud and abuse risk areas for hospitals.

Risk areas discussed in the supplement include: billing under the outpatient prospective payment system, the physician self-referral law, the federal anti-kickback statute, relationships between hospitals and physicians, relationships between hospitals and other providers, joint ventures, practitioner recruitment, and the furnishing of substandard care. The guidance also identifies practical measures hospitals can use to gauge the effectiveness of their compliance programs.

WHA corporate members continue to contribute significant financial support to WHA in 2005. Corporate member support currently amounts to $169,500.

The MHA Group, MHA Insurance and WHA Financial Solutions have committed to be Corporate Champions in 2005, each contributing $10,000. Additionally in 2005, WHA has a record eight Corporate Partners, each contributing $5,000. The 2005 Corporate Partners include: Dairyland Healthcare Solutions, Databay Resources, Hoffman LLC – Healthcare Facilities Division, Intellimed International Corp, Lincoln Financial Group, Oscar J. Boldt Construction, Plunkett Raysich Architects, and Principal Financial Group.

A listing of all current 2005 WHA corporate members is included in this week’s packet. Full company descriptions are included in the 2005 Member Directory and on the WHA website at www.wha.org. Later in the first quarter, WHA will again distribute "Business Connection," a directory of services provided by corporate members distributed directly to a variety of decision-makers.

You will continue to see and hear about these WHA supporters in a variety of ways throughout 2005. Please remember to consider these corporate member organizations when you have a need in your hospital, and pass their information on to other decision-makers in your facility. Additionally, please thank them for their support of WHA and health care in Wisconsin when you see them at events such as the Wisconsin Rural Health Conference, the Annual Convention and the Wisconsin Quality & Safety Forum. Also, encourage companies that work with your hospital to consider supporting WHA through corporate membership.

In 2001, DHFS was directed by the Legislature to develop guidelines for an online, electronic filing system for Wisconsin vital records. The Vital Records Online Study Committee reported on their investigation and DHFS and the Office of Vital Records is now moving forward to implement the first stages of electronic vital record submission. By studying programs and software implemented by other states, the office has learned much about electronic data submission. From that experience, it has been decided that birth records will be the first module implemented. The office is ready to put out a request for proposals (RFP) for birth records software. The RFP requirements demand a web-based model, secure to meet HIPPA requirements, and easy for submitting agencies to learn and use. The department believes that several good software packages already exist to meet Wisconsin’s needs and that a program can be put in place relatively quickly.

Money has been set aside from operating revenue within the department. Once the decision on software has been made and software purchased, it will be provided free of charge to Wisconsin hospitals and they will be expected to move toward using the DHFS system or a system that can batch download or interface with it.

John Kiesow, State Registrar, has committed to working with Wisconsin hospitals to make this transition a smooth and easy one. WHA is monitoring the process and will keep in contact with Kiesow and the office to assure that the needs, concerns and questions of Wisconsin Hospitals are addressed. Contact Judy Warmuth at 608-274-1820 or jwarmuth@wha.org with questions.

Keeping Wisconsin healthy requires a workforce that is healthy. Back safety and health are issues for health care workers who are at risk for sprains and strains related to lifting, turning and positioning patients. Concern about potential injury may result in earlier retirements and perhaps even deter some interested in a health care career.

WHA and the Wisconsin Department of Workforce Development are partnering to offer the Wisconsin Safe Patient Handling Conference on March 16, 2005, as a special project of the state’s Select Committee on Health Care Workforce Development. This conference will provide attendees with lessons learned and best practices from hospitals and nursing homes throughout Wisconsin who have taken steps toward implementing processes for a safe patient lifting and moving environment, and to look at, test and evaluate patient handling equipment.

WHA members presenting at the conference include St. Joseph Hospital, West Bend; Rusk County Memorial Hospital, Ladysmith; and St. Luke’s Hospital, Milwaukee.

The conference is reasonably priced at $75 per person to attract a large and diverse audience. The Chula Vista Resort in Wisconsin Dells was chosen to minimize travel and lodging expenses for attendees as well. Risk managers, quality managers, nurse executives and managers, physical therapists, nursing home administrators and home health agency directors should consider attending this important event.

The conference will be held on March 16, 2005, from 9:00 am to 4:30 pm at the Chula Vista Resort in Wisconsin Dells. A brochure and a registration form are included in this week’s packet and on the web site at www.wha.org. Easy, on-line registration is available as well. Please share the conference information with other professionals and organizations who would benefit from attending.

Each January, newspapers run a tragic headline: Newborn found dead. According to Safe Place for Newborns, this month has the highest number of newborn abandonments. Yet through the efforts of this life-saving organization and Wisconsin’s law, that is changing.

In Wisconsin, a parent may confidentially hand over her unwanted, unharmed newborn, up to three days old, to any hospital employee, EMT, or police professional in the state without fear of prosecution. This law, commonly known as the "safe haven law" or Wisconsin Act 2, went into effect in April 2001.

In the past it was tragically familiar to annually lose five or more babies at their mothers’ hands. In 2004, Safe Place for Newborns reduced that number to one. Twenty-four babies are alive in Wisconsin because of Safe Place for Newborns’ efforts to promote the "safe haven law."

Another measure of success is the number of calls to the national 24-hour hotline (877-440-2229). Operated by Newborn Lifeline Network, it receives 300 calls per year from women in crisis in 43 states – the majority (nearly 25% of all calls) came from Wisconsin (January – August 2004).

Terry Walsh, executive director of Wisconsin’s Safe Place for Newborns, praised Wisconsin hospitals for their support of the program.

"Hospitals have been instrumental in spreading the word in their communities about Safe Place for Newborns," according to Walsh. "In addition to being a place to drop off a newborn, hospitals provide essential community education that may reach someone who is contemplating inappropriately abandoning a newborn."

Community involvement is key. "People don’t realize that they can help save a newborn’s life and help a frightened woman very simply. Safe Place for Newborns has informative posters, brochures, even discrete pocket cards that can be posted in schools, malls, taverns," Walsh added.

Walsh can be contacted at 608-225-5544.

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