Defending the constitutionality of an important provision of Wisconsin’s medical malpractice statute, WHA filed a brief of amicus curiae last week in the case of Lagerstrom v. Myrtle Werth Hospital - Mayo Health System, currently before the state Court of Appeals. In this case, the plaintiff and fellow amicus, the Wisconsin Trial Lawyers Association, challenge the constitutionality of the statute provision that abrogates the collateral source rule for medical malpractice cases in Wisconsin.

In general, the collateral source rule prohibits a defendant in a tort case from presenting to the jury evidence that the plaintiff has received compensation for his or her injuries from another source, such as the payment of medical bills by a health insurer. In Wisconsin medical malpractice cases, however, defendants may present evidence of compensation from other sources to the jury (abrogating the collateral source rule). In other words, without the current statute, a plaintiff’s attorney would be able to present a health care provider’s charges as the plaintiff’s losses even if the plaintiff incurred no costs. The Lagerstrom case involves discounted payments. The plaintiff’s attorney argues that the statute provision permitting the jury to hear evidence that the plaintiff did not pay the full price for health care services (paid a discounted rate of approximately 60% of charges) is unconstitutional.

In its brief, WHA argues that Wisconsin’s medical malpractice statute allows plaintiffs to be fully compensated for any losses they actually suffer, but does not permit plaintiffs to recover for costs not incurred. WHA further argues that, unrestrained, the cost of insuring against medical malpractice suits becomes a significant factor in the increasing cost of health care. When the payers of health care – often employers – can no longer afford to cover these costs, access to health care is jeopardized or, ultimately, lost. "The legislature recognized these problems and, after study and input, concluded abrogating the collateral source rule was, along with the caps, the best way to keep medical malpractice costs from rising and thus keep health care affordable. [T]he statute is constitutional as it meets the rational basis standard of review."

WHA is the only association representing health care providers defending the constitutionality of this important provision of Wisconsin’s medical malpractice statute. This marks the second time in two months that WHA has weighed-in on a key legal issue being considered by the courts that could impact hospitals’ ability to provide cost effective care. For information concerning Meriter Hospital, Inc. v Dane County, see the January 2, 2004 edition of the Valued Voice. For further information, contact WHA General Counsel Laura Leitch.

The Wisconsin hospital quality and safety initiative, CheckPointSM is nearly ready for its public debut. This week, Mary Kay Grasmick, VP, communications, presented the statewide communications plan that will be used to guide the public launch of the program, while Dana Richardson, VP, quality initiatives, demonstrated how the reports will be accessed and displayed through the CheckPoint Web site.

Bill Bruce, CEO, St. Joseph’s Community Health Services in Hillsboro, voiced his continuing support for the CheckPoint program at the WHA region meeting in La Crosse on January 28. Bruce, a member of the WHA Board of Directors, said the concept of public reporting was first discussed at the 2002 Board planning session.

"In the past, Wisconsin hospitals have been very clear that they oppose public reports that use proprietary processes to create the data. During the 2002 Board planning session, we developed an agenda based on the what we stand for," said Bruce. "Developing a consumer-focused report provides Wisconsin hospitals the opportunity to ensure integrity of the data that is being reported."

Nearly 50 people attended the Green Bay meeting, where attendees discussed key audiences that will use this report. It is anticipated that the report will be accessed by hospitals, policy makers, employers, insurers and other payers. In addition, the report is likely to be used by consumers interested in learning about evidence based medicine. The long term goal will be to use CheckPoint information to bring all consumers into the health care decision making process.

If you have not registered to attend one of the remaining CheckPoint regional meetings, contact Mary Kay Grasmick, mgrasmick@wha.org, 608-274-1820. The schedule follows:

February 4: North Central—Wausau Hospital, Boardroom, 9 a.m.
February 11: West Central—Myrtle Werth Hospital, Menomonie, 10 a.m.
February 13: Southern—Divine Savior Hospital, Portage, 11:30 a.m.
February 25: Southeast/Milwaukee—University Club, Milwaukee, 10 a.m
March 5: Vikingland—Hayward Area Memorial Hospital, 10 a.m.

The CheckPointSM program will be publicly announced at news conferences around the state on March 30.

St. Luke’s Medical Center hosted Governor Jim Doyle, Rep. Steve Wieckert (R-Appleton), transplant physicians and others, as the Governor signed Assembly Bill 477 into law. The bill, introduced by Rep. Wieckert and co-sponsored by Sen. Carol Roessler (R-Oshkosh), creates an income tax deduction of up to $10,000 for the expenses of a person who donates one or more of his or her organs as a "living donor."

With this bill, Wisconsin becomes the first state in the nation to have a law that assists individuals or families who are bearing the cost of a transplant.

"Wisconsin has been a national leader in organ procurement and transplantation," said Steve Brenton, WHA president. "This legislation removes an additional barrier to organ donation for potential donors and will positively impact the waiting list for donors."

Glen Grady, CEO, Memorial Medical Center, welcomed Congressman Ron Kind to the Neillsville hospital, where Kind spent considerable time touring the hospital and meeting with hospital employees.

Grady said he had an opportunity to explain to Kind some of the issues that are pressing in rural areas.

"We talked about three things. First, we asked him to look into the problem created with the fact that Medicare + Choice contracts don’t require insurance companies to pay critical access hospitals at cost, which makes it impossible for us to contract with them," Grady said.

"Secondly, the lack of people entering family practice programs, and the tendency for international medical graduates to not land in rural areas, is seriously affecting our ability to recruit physicians," Grady continued. "Lastly, we apprised him of our concern with the $400 million deficit in the Wisconsin Medicaid program and its impact on our hospital and nursing home patients."

While at the hospital, Kind also toured the new medical clinic and visited the nursing home.

On December 11, 2003, Assembly Bill 71 was signed into law as part of Wisconsin Act 104. This new law creates the same criminal penalties for hoaxes involving chemical, biological or radioactive substances that already exist for bomb threats. The penalty elevates this crime from a misdemeanor to a Class E felony punishable by up to five years in prison and/or a $10,000 fine. On January 7, 2004, the Homeland Security, Veterans and Military, and Government Reform Committee of the U.S. Senate passed Senate Bill 120 which relates to: creating a public health council, reimbursement for quarantine costs, intrastate mutual aid, and providing for penalties as outlined in Wisconsin’s Assembly Bill 71. SB 120 is now referred to the Joint Finance Committee of Congress.

On another note, 2-1-1 is the nation’s newest tool for community information and referral and can be important in preparing people for and responding to a disaster. Recognizing the value of a statewide 2-1-1 system, the Wisconsin Division of Public Health agreed to support the establishment of 2-1-1 statewide in Wisconsin by committing a one-time grant of $160,000 in bioterrorism grant funds to United Way of Dane County to support the initial start up costs. Currently, 2-1-1 is operating in four Wisconsin counties: Dane, Milwaukee, Racine and Waukesha. The WHA Foundation contributed $30,000 to help with start up costs in these counties.

Most Republicans support them…but Democrats loathe them.

President Bush briefly (and positively) mentioned them in his State of the Union address.

Large health insurance companies led by the Blue Cross and Blue Shield Association have made the goal of defeating them legislatively their number one 2004 priority, while small businesses claim that enabling federal legislation is crucial to improving their access to affordable health insurance.

What are they?

They are Association Health Plans (AHPs), mechanisms that would allow small businesses to band together into large state and even national pools to negotiate health insurance rates closer to those available to big employers, and avoid state regulation of their policies. In many ways, AHPs would level the playing field between the heavily regulated small employer market and the large group market.

Federal legislation that would create AHPs has significant support and, in fact, has already passed the House of Representatives. But opposition from Blue Cross and Blue Shield whose plans dominate much of the small group markets nationally, and opposition from many Democrats who believe that the initiative is too "incremental" and changes the subject from government-based "universal" initiatives makes Senate passage highly problematic. Unfortunately, it takes 60 votes to pass legislation in the Senate and those votes don’t exist right now for AHPs. And that’s unfortunate because while AHPs won’t "solve" the access problem for all small and medium sized employers, they certainly are an opportunity to provide a meaningful option for those employers…an option that does not exist today.

Health insurance coverage today is virtually universal for large employer groups in both the private and public sector. But access is a significant issue in the small group marketplace. And that’s truly a problem searching for solutions. Association Health Plans provide a real opportunity, and those who disagree should at least consider the notion of accepting a five-year "sunset" to determine whether their fears become reality.

Steve Brenton
President

Earlier this month, WHA, along with Wisconsin Manufacturers & Commerce (WMC) and the Wisconsin Association of Health Plans, announced a plan for controlling health care costs that differs sharply with some of the heavy-handed, one-size-fits-all government solutions proposed by others. The plan, dubbed "Wisconsin’s Healthier Choices for Affordable Health Care," identifies the key cost drivers of the U.S. health care system today and workable solutions. The solutions are organized into six key areas, which are explained in detail in the report enclosed in this week’s packet.

Additional copies of the booklet and summary are available from WHA at no charge to members. Contact Dawn DeSart at ddesart@wha.org to place your order.

Make plans now to attend WHA’s Advocacy Day on April 7 in Madison. An interesting line-up of speakers will kick off with a presentation by Fred Grandy, former Congressman in the U.S. House of Representatives and former president/chief executive officer of Goodwill Industries. Grandy will discuss the importance of grassroots advocacy and how to take action, from his perspective as a former legislator and non-profit leader.

Grandy’s eight-year career as a congressman established him as one of the most respected and well-liked members of Congress on both sides of the political aisle. Frustrated by partisan backbiting, gridlock, and the skyrocketing cost of getting re-elected, Grandy exited Congress in January of 1995, and two weeks later took over one of the nation’s largest charitable organizations, Goodwill Industries. There he spent the next five years rebuilding its reputation into America’s most successful workforce development network. During his last three years with Goodwill, Grandy was named one of the country’s most influential non-profit leaders by The Non Profit Times. In addition to his successful political and leadership career, Grandy also starred on the popular TV series The Love Boat.

Gene Ulm, an experienced pollster, will discuss how candidates use polls, when to believe polling results, and what current polls are showing about the November elections. Ulm is a partner for Public Opinion Strategies, one of the largest political and public affairs survey research firms in the nation.

Additionally, Gov. Jim Doyle has been invited to speak during the luncheon, and a panel of legislative leaders will share their perspectives on health care issues and how they may affect the fall elections.

Advocacy Day is a key event for Wisconsin hospitals. It is an opportunity to improve our grassroots effectiveness, while learning about the issues that will shape the future of health care delivery in Wisconsin. Again this year, WHA will present an Advocacy Award to the group that has demonstrated a keen understanding of and dedication to grassroots advocacy.

Eric Berkowitz, Ph.D., a well-known expert in the field of health care marketing, will be the featured speaker at a seminar sponsored by the Wisconsin Healthcare Public Relations and Marketing Society. The education session with Berkowitz will be held at Monona Terrace in Madison at 1 pm on April 7, which coincides with the WHA Advocacy Day program.

Berkowitz will use his experience consulting with health care organizations across the country to present "Responding to the Changing Cohorts," a discussion on how to market to customers based on similar value sets versus traditional generational grouping.

A separate registration is required to attend the WHPRMS program. The registration fee of $40 for WHPRMS members/$55 for non-members does not include lunch, but registrants for the Berkowitz seminar are welcome and encouraged to attend the WHA Advocacy Day program in the morning, and attend the complimentary luncheon, where Gov. Jim Doyle is scheduled to speak.

WHA corporate members continue to contribute significant financial support to WHA in 2004, following a record year in 2003. Corporate member support currently amounts to $147,000.

Fitzgerald, Clayton, James & Kasten, The MHA Group, and WHA Financial Solutions have again committed to be Corporate Champions in 2004, each contributing $10,000. Three additional companies, Dairyland Healthcare Solutions, Flad & Associates and Oscar J. Boldt Construction, have once again committed to be Corporate Partners, each contributing $5,000.

A listing of all current 2004 WHA corporate members is included in this week’s packet. Full company descriptions will be included in the upcoming 2004 WHA Directory and on the WHA web site 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 2004. 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 Rural Health Conference, the Annual Convention and the Quality & Safety Forum. Additionally, encourage companies that work with your hospital to consider supporting WHA through corporate membership

On January 20, WHA, with the help of RC Healthcare Management, held an education session to assist hospitals in understanding how to complete a new survey required by the Centers for Medicare and Medicaid Service (CMS). Over 50 hospitals were represented at the session, either in person or via teleconference.

Under current law, CMS is now responsible for collecting data every three years on the occupational mix of employees for each short-term, acute care hospital participating in the Medicare program, in order to construct an occupational mix adjustment to the wage index. The law also requires the application of the occupational mix adjustment to the wage index beginning October 1, 2004.

The new CMS survey provides for the collection of occupational mix data prospectively for a four-week period beginning on or after December 28, 2003 and ending February 7, 2004, or retrospectively for a 12-month period, that is, calendar year 2003. Hospitals may elect either of the two options that most accurately capture their true occupational mix. Hospitals must complete the survey if they are subject to the inpatient prospective payment system (IPPS), or subject to IPPS if not granted a waiver. It is important for hospitals to ensure that the data reported on the survey is accurate and verifiable through supporting documentation.

With over 400 CMS Program Memorandums issued by CMS in 2003 alone, it’s no wonder that hospitals struggle to keep on top of charging, billing and coding regulations. The half-day seminar "Resources Through the Informational Maze of Billing, Coding and Reimbursement" will enable attendees to explore live web sites and identify other key manuals and reference materials to get a handle on the ever-changing world of health care reimbursement.

Health care providers also continue to struggle with the correct billing of outpatient observation services, and the differentiation of an inpatient admission from an outpatient observation. The half-day seminar "Observation – Is It Worth It?" digs deeper into the operational issues involving physicians and hospitals in compliant and accurate reporting for these observation services.

Plan now to attend one or both of these half-day seminars offered by WHA. Both seminars will be held on March 23, 2004, from 9 am to 4 pm at Great Wolf Lodge 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. On-line registration is available. The American Health Information Management Association (AHIMA) has approved the full-day seminar for five (5) continuing education hours.

Two WHA-sponsored educational seminars focused on improving billing, coding and payment reimbursement are scheduled for February. The educational seminar "Chargemaster Maintenance for 2004" is scheduled February 18 and "New Year, New Challenges, New APCs, and New Headaches" is scheduled February 19. Chargemaster and APC coordinators, coding staff, office managers, CFOs, and others who are responsible for charge generation processes should plan to attend.

Register now to attend one or both seminars at the Holiday Inn-East in Madison. A brochure and a registration form can be found on the web site at www.wha.org, and easy, on-line registration is available. The American Health Information Management Association (AHIMA) has approved each seminar for five (5) continuing education hours.

The process of transitioning data collection responsibilities from the state Bureau of Health Information (BHI) to WHA Information Center, LLC, passed a major milestone this month.

After installing a new Web-based data collection system and training facilities in December, WHA Information Center began collecting live data from the fourth quarter of 2003 on January 2. The response has been overwhelmingly positive. Forty-five facilities have already submitted their data, and the following hospitals have completed their error corrections:

Bellin Psychiatric Center 
Bloomer Medical Center- Mayo Health Systems 
Boscobel Area Health Care 
Burnett Medical Center, Inc. 
Calumet Medical Center 
Howard Young Medical Center, Inc. 
Kindred Hospital - Milwaukee 
Lakeview NeuroRehab Center Midwest
Memorial Community Hospital, Edgerton
Memorial Health Center, Inc., Medford
Memorial Medical Center, Ashland
North Central Health Care Facilities
Reedsburg Area Medial Center
Waupun Memorial Hospital
Winnebago Mental Health Institute

Facilities that have not yet submitted data must do so by February 16, or must submit a 30-day extension request by February 4.