In delivering his State of the State address this week, Governor Doyle said the realities of Wisconsin’s fiscal picture are bleak. But the Governor also said that while nothing of what’s ahead for the state will be easy, by working together, any challenge can be met.

In his speech, Doyle said estimates put Wisconsin’s budget gap at $5.4 billion and when the latest data is released, that number would likely grow. As predicted, updated economic news late this week from the Legislative Fiscal Bureau confirmed the continuing downward slide.

The latest revenue numbers released by the Fiscal Bureau show declining economic indicators pointing to general fund tax collections decreasing by an additional $342 million from those estimated by the Department of Revenue in November, putting the overall budget shortfall closer to $5.7 billion.

Perhaps the biggest question in Madison now revolves around the level of federal aid Wisconsin might receive. Expectations are that the state’s share of money from a federal stimulus package will be significant, with some estimates putting the potential amount at $3 billion.

Doyle indicated that while much of these funds could be used for state infrastructure improvements such as roads, bridges, school repairs and improvements to the state’s power grid, he said "The stimulus package is not the answer to all our challenges."

"This is not a time for big new programs," Doyle said, previewing his upcoming budget. "Staying even will be the new increase."

Governor Doyle is set to introduce his biennial budget plan in early February, outlining his spending priorities for the next two years. In addition to the growing future budget deficit, Wisconsin faces a $594 million shortfall for the current fiscal year ending June 30.

Expected to be introduced soon, the revamped hospital assessment proposal will also play a significant role in the state’s upcoming fiscal deliberations. Because it captures hundreds of millions in additional federal Medicaid dollars, the proposal not only brings much needed and long-overdue Medicaid reimbursement relief to hospitals, it also allows the state to make valuable reinvestments in the Medicaid program.

The Wisconsin Hospital Association and the Rural Wisconsin Health Cooperative are working with members of the Wisconsin Congressional Delegation to urge that Critical Access Hospitals (CAH) receive the same incentive payments as their Prospective Payment System hospital counterparts when implementing health information technology. Billions of incentive dollars will be made available under the economic recovery package pending in Congress; however, due to a three-word phrase contained in the House version of the bill, CAHs are specifically excluded from receiving these funds. WHA’s communications have stressed strong support for the HIT provisions and their focus on providing needed funding for health information technology (HIT) implementation.

"The HIT funding commitment is a bold plan that will speed the implementation of digital health records nationwide. But the rationale put forward for excluding CAHs in the House bill is based on a faulty assumption that because they receive cost-based reimbursement they already receive reimbursement for HIT costs," said WHA President Steve Brenton. "Cost-based reimbursement does not provide for the initial capital required for the purchase of electronic medical record software and related hardware, an issue that requires further address."

"As we struggle with the many issues due to our current national economic crisis, please know that we face the same ‘downstream’ consequences of larger hospitals," said Burnett Medical Center CAH CEO Gordy Lewis in contacting his members of Congress.

"That is why I am shocked to learn that Critical Access Hospitals are specifically excluded from the HIT incentive payment provisions of the proposed Economic Recovery and Reinvestment Act…Clearly, without this HIT incentive we will fall behind in the critical initiatives needed to continue to ensure the delivery of quality and safe care in an effective, efficient and contemporary fashion," Lewis said.

The economic recovery package is advancing quickly, and passed the U.S. House of Representatives this week without funding parity for CAHs. On the Senate side, language was included during Senate Finance Committee work that does provide incentive payments to CAHs, although the payments will be capped at a lower amount than PPS hospitals. Ultimately the issue is likely to be resolved in a conference committee, probably later next week.

WHA also expressed concern about several privacy provisions contained in the same legislation which have the potential of hampering the efficient use of HIT for hospitals and physicians.

"I would like to ensure that the bill’s privacy provisions do not jeopardize public-private partnerships, such as those in Wisconsin and throughout the country, which use de-identified data to help improve health care quality and efficiency," said Cong. Tammy Baldwin before the House Energy & Commerce Committee vote on this legislation.

WHA has been working with AHA staff to address the privacy issues but it appears increasingly likely that those issues will end up being worked out in the regulatory arena over the coming months.

Mark your calendar and plan to join 600 of your peers from across the state in Madison at Advocacy Day 2009 on April 1. A complete program and registration form are available online at www.wha.org. New this year, you can also register for this free event on-line at www.wha.org.

AHA Executive Vice President Rick Pollack will keynote the event. Pollack has firsthand knowledge about how the new administration will tackle the major health care issues, from health care reform to electronic medical records, facing the country.

At the state level, attendees will hear important insights on state issues from legislators themselves, during the always-popular state legislative panel discussion, and from luncheon keynote speaker Governor Jim Doyle (invited).

Changes at the Department of Regulation and Licensing (DRL) have led to improvements in the licensing process, but at a January 23 meeting with DRL staff, WHA President Steve Brenton asked for assurances that the Department would continue to make progress.

At the January meeting, which was a follow-up to one held with DRL last year with WHA and Wisconsin Medical Society staff, DRL reported that they have added staff in the licensing area and new policies were enacted at the Medical Examining Board level. In addition, DRL staff said they are tracking how long it takes to process licensing applications.

The changes have resulted in an impressive improvement in licensure time. The Department reported that the time of first review (when an application packet is initially reviewed by credentialing staff) has gone from more than four weeks to three to five days.

WHA expressed appreciation to DRL staff for the considerable progress and asked DRL what assurances they could offer that the licensing process improvements would be maintained. The Department responded that it is cross-training employees so staff absences can be covered to ensure timelines would continue to be met.

WHA also raised concerns about license delays for pharmacists and physical therapists and asked the Department how performance levels would be met during peak periods, such as the RN graduation period in May and June. The Department said they have made arrangements to staff up for peak time periods.

Delays in the licensing process are of great concern to Wisconsin hospitals. The time it takes to license a physician or other health care professional can influence where they chose to practice. In the past, Wisconsin hospitals often called WHA to voice their dissatisfaction with the excessively long delays in the DRL licensing process. That prompted WHA to initiate a meeting with DRL last year. At the meeting, WHA and the Medical Society expressed their concern with and described the impact that prolonged licensure times have on hospitals and patient care. DRL promised action.

"The Department of Regulation and Licensing has made significant improvements in their processes and are diligently working to address the delays hospitals encountered in the past," Brenton said. "We applaud their efforts in ensuring license applications will be handled promptly and efficiently, particularly as Wisconsin faces a shortage of physicians in many areas of the state."

WHA continues to watch this issue closely. Members are encouraged to contact Judy Warmuth at 608-274-1820 or jwarmuth@wha.org with their observations and experiences related to licensing.

President Obama and many members of Congress want to make the rapid implementation of digital health records an immediate national priority. This bold goal, which will be leveraged by significant Medicare incentive payments and future payment penalties for laggards, is to fully computerize the nation’s medical records in about five years. The vehicle for getting all of this done is the fast-moving Economic Stimulus Bill.

The rationale behind what some are calling an "audacious" plan is that electronic medical records (EMRs) improve quality and safety while reducing costs by improving clinical efficiencies throughout the delivery system. While that claim has few naysayers, the actual predicted national "savings" in some cases are so huge as to defy credibility. Dr. David Brailer, former national coordinator for health information technology in the Bush Administration, is on record claiming that $300 billion a year can be saved by a fully-computerized health record system. That prediction is certainly an overreach and not backed by early health information technology (HIT) adaptors that have implemented costly systems throughout Wisconsin.

Nevertheless, Wisconsin hospitals and clinics welcome the spotlight on EMRs. Our state’s private sector is a national leader in EMR implementation and the home of two major vendors of EMR software systems. The millions of dollars in additional Medicare payments will accelerate the diffusion of HIT throughout Wisconsin communities.

There is still much to do to accomplish a five-year implementation goal, including the identification of financial and technical support and infrastructure necessary to get the job done. And the privacy "safeguards" included in the Economic Stimulus Bill, unless effectively addressed via regulation, may prove to be needlessly costly and a barrier to the sharing of data for quality improvement efforts. Finally, the question of incentive payment parity for Critical Access Hospitals (CAHs) remains an unsettled issue in Washington D.C. and was an unfortunate omission in the House version of the bill.

In addition to making available necessary resources for all hospitals, getting more realistic about future delivery system "savings," and "fine tuning" the privacy restrictions, the national EMR discussion also needs to focus on the absence of national standards that should enable the seamless sharing of digitalized records between delivery organizations. There’s been almost nonexistent progress on that not-so-small issue, and federal regulatory intervention is necessary.

Steve Brenton,
President

For decades WHA has produced a newsletter on Fridays and printed and mailed hundreds of copies. After reviewing our communications vehicles, the decision was made to reduce the Association’s dependence on paper and send more communications to members electronically.

Each WHA member hospital and system CEO will continue to receive the Friday Packet that will include a hard copy of the newsletter, "The Valued Voice." All other recipients of the newsletter will receive it and other WHA communications by email only starting February 6.

If you are currently receiving a hard copy only of The Valued Voice by mail and wish to receive it by email, contact Tammy Hribar at thribar@wha.org or 608-274-1820. The Friday Packet is also available 24/7 from the WHA Web site at www.wha.org, with the current issue on the home page and past issues in Publications & Archives.

The Division of Quality Assurance (DQA) released a memo this week notifying hospitals, nursing homes, and other regulated entities that DQA is requiring new Plan Approval Application forms for the facilities they regulate, including hospitals. Beginning February 1, 2009, hospitals must use the new forms to submit construction and remodeling plans to DQA for their mandated reviews under Chapter 50. If the new forms are not used, DQA will return the application to the submitter.

DQA modified the new forms to streamline the information required, reduce errors, enhance the identification of the scope of the project DQA is reviewing, and reflect a slight fee increase for hospital and nursing home submissions.

The Wisconsin Healthcare Public Relations and Marketing Society (WHPRMS) will offer a special Professional Development Day for its members and others interested in attending following the WHA’s Advocacy Day luncheon, April 1, 2009, from 1 to 4 p.m.

The WHPRMS presents two branding powerhouses, Anne Curley of Curley Communication and Lori Bruss of The Roberts Group, to speak about brand management challenges health care communication professionals face both internally and externally. Learn how to become the "keeper of your brand." Discover how to build internal support and convert naysayers into brand champions. Find out how to take a brand audit and then plan a communication platform that starts with awareness and leads to referrals and recommendations. This high-level presentation will include case studies, work groups and practical tactics that can be taken back and implemented immediately.

For more information or to register, visit www.WHPRMS.org or contact Jim Tome at 847-717-5400 (ext. 42) or jtome@dcinteractivegroup.com. You need not be a WHPRMS member to attend this session. A separate registration and fee are required to attend.

Frances Finley has been chosen to lead the new Aurora Medical Center in the Town of Summit. Finley started her new position on Monday, January 26.

Finley joined Aurora Health Care in February 2003 as the first leader of Aurora’s new hospital in Oshkosh. She was instrumental in opening Aurora Medical Center in Oshkosh in October 2003.

Prior to joining Aurora, Finley held a number of leadership positions in the Charleston Area Medical Center Health System in West Virginia. Her last position there was administrator of Charleston Area Medical Center General Hospital.

Finley earned a doctor of health administration degree from Central Michigan University in 2005. She also holds a master’s degree in health care administration from Washington University in St. Louis, Missouri, and a bachelor’s degree in administrative management from Southwest Missouri State University.

The HIPAA Collaborative of Wisconsin (COW) Spring Conference, "The HIPAA Traveler’s Guide to Success," is scheduled Friday, April 3, 2009 at the Tundra Lodge Resort and Waterpark in Green Bay. This event will feature keynote speaker Tom Walsh, three EDI and three privacy/security/eHealth breakout sessions.

There is no role in life more important than parenting, but it comes with challenges. Mitch Connell is a psychotherapist who specializes in families and children. He is one member of Aurora’s Behavioral Health Services team in Fond du Lac, an outreach program for Aurora Medical Center Oshkosh. Each year, Mitch provides a wealth of helpful support to parents—free of charge—through workshops and presentations.

Extreme Parenting is a four-week workshop that helps parents and children achieve more mutually satisfying outcomes. The class helps parents learn techniques for play using a behavior-management model that allows the child to lead and the parent to learn. Mitch also teaches parents how to manage their own stress.

Throughout the year, Mitch’s individual presentations cover topics timed to the school calendar. For example, the June presentation discusses managing kids in the summer, maintaining academic interests and occupying kids on automobile trips. As the new school year approaches, calming anxious children is a topic. That is followed by a presentation on Attention Deficit Hyperactivity Disorder—how to recognize it and how to help a child succeed in spite of it. The ADHD workshop coincides with parent-teacher conferences.

Further complementing the TeenScreen® initiative conducted by pediatricians and primary care physicians at Aurora Health Center in Fond du Lac, the November topic helps parents learn how to support a depressed teen.

One of the challenges hospitals face in north central Wisconsin involves nursing students who choose to leave the area to pursue a four-year degree. Few nursing graduates return home to seek employment after earning their bachelor’s degree.

To address the nursing shortage, community leaders, including representatives from the two major hospitals in the area—Saint Clare’s Hospital and Aspirus—as well as the Wausau Chamber of Commerce, came together to discuss the issue. They found that students who wanted a bachelor’s degree were leaving town for cities like Oshkosh, Madison, and Eau Claire in order to get their nursing degree.

"Once they left, few were coming back," said Mary Krueger, president of Saint Clare’s Hospital.

In response, Saint Clare’s Hospital in Weston is supporting a "Step Ahead" program, a collaboration between UW-Marathon County (UW-MC) and Northcentral Technical College (NTC), which allows registered nurses to earn their bachelor’s degree without leaving the Wausau area. Saint Clare’s Hospital is contributing $50,000 annually to the collaborative over a four-year span (2006 – 2009).

"We knew we had to create an opportunity for graduates of the high schools in the region to be able to get a bachelor’s degree right here in Wausau, and keep them local," added Krueger.

As part of the collaborative, NTC and UW-MC worked out an agreement so a student can take a year of general education courses through the UW-MC campus, and the credits will transfer to NTC, allowing the student to earn a bachelor of nursing degree (BSN). The student can then they pick up one more year through the university system and graduate with a BSN. The collaboration also includes the University of Wisconsin-Oshkosh.

"The collaborative keeps students who are interested in entering a four-year program right here in Wausau," said Krueger. "It’s a win for the community, because we’re producing more baccalaureate-level nurses, and it has opened a lot of doors for collaboration to produce this vital commodity to keep it functioning at a high level," said Krueger.

Fall Prevention is an important aspect of continued good health for all seniors. Beloit Memorial Hospital’s physical medicine department held a Fall Prevention Fair at a local senior center to provide free education to decrease frequency of in-home falls.

The team completed fall risk assessments with residents and offered home safety screens. A home safety screen consists of going into an individual’s home and assessing the environment for overall safety concerns such as bathroom equipment needs, tripping hazards and general accessibility throughout one’s home. They also gave away night lights for added safety.

Lifeline, the hospital’s emergency home alert program, was also involved to let seniors know about this excellent option. Lifeline keeps their costs very low by using hospital volunteers as installers, test callers, and office assistants. To ensure that those who need Lifeline can afford it, the program works with seniors to find sources of funding if available and waives the $25 installation fee.

"Now hold that stretch . . . a little longer . . . and slowly drop your arms to your side." Typical instruction for an exercise class? Maybe. Typical exercise class? Definitely not!

Twice a week, adults ages 65-94 meet for the Brookfield Senior Exercise Class. The free class is held in the Senior Center at Brookfield City Hall and attracts 60 to 70 participants every Tuesday and Thursday. The class is taught on a rotating basis by three Occupational Therapists from Wheaton Franciscan Healthcare-Franciscan Woods, a transitional rehabilitation facility in Brookfield, and Wheaton Franciscan Healthcare-Elmbrook Memorial. The therapists are "donated" by Wheaton Franciscan Healthcare, and the expertise they bring to this exercise class is greatly appreciated by those in attendance.

Because the class is taught by licensed rehabilitation professionals, it’s not just an exercise class—it’s a flexibility/balance/strength training/coordination/stretching/breathing class. The instructors use chair exercises, standing techniques, music, resistance bands, and laughter to touch upon all the different fitness concepts necessary to keep seniors active and independent.

While exercises concentrate on fitness techniques, they have an impact on quality of life issues, too. Mobility, stamina, continence, flexibility—the class helps participants with all these things.

One gentleman confided to Sandie Gerosa, OT/instructor and operations manager of rehabilitation at Franciscan Woods, that since he has started attending the class, he no longer has to get up and go to the bathroom at night. Another woman is very pleased because after going to the classes on a regular basis, she is no longer confined to the main floor of her home since she now has the stamina to climb stairs.

In their roles as rehabilitation therapists at a transitional rehab facility, Sandie and her fellow instructors help seniors stay safely at home for as long as they can. By sharing their expertise with the community, they can help many more individuals be functional and independent—by attending the Brookfield Senior Exercise Class!

The Initial Medical and Pediatric Assessment, Consultation and Training (IMPACT) Program provides child developmental screenings to the Milwaukee community. IMPACT works in partnership with sponsoring churches, child care centers and community organizations to screen children to identify delays, suggest interventions that will help improve development and refer children to treatment programs as necessary. The IMPACT screening is particularly valuable because pediatric specialists in occupational, speech and physical therapy conduct it. Additionally, the therapists instruct teachers and care providers in daily activities to help in child development.

At first glance, it may seem that Kelly had several behavior problems. She struggled with direction, had a hard time interacting with classmates and seemed to be ignoring her teachers. When IMPACT came to her daycare center to perform a developmental screening, the pediatric therapists found her to be severely delayed in her visual, fine motor, gross motor and communication skills. They referred her to the Milwaukee Public School System to receive a full development evaluation and further therapy, free of charge.

When the IMPACT coordinator called Cynthia, Kelly’s mom, to talk to her about Kelly’s results, she realized this was just the tip of the iceberg. Cynthia knew Kelly’s visual problems were affecting her behavior in the classroom; however, neither Cynthia nor Kelly had health insurance. Cynthia was part of the growing number of the uninsured working class. Cynthia explained how Kelly had a visual test the following week, but she had no way of paying for it or any follow-up treatment. When Kelly had health issues, she explained how she often wouldn’t eat in order to pay for Kelly’s medications, doctor visits, etc. Her daughter’s health and well-being was her number one priority. After talking with Cynthia, the social worker was able to put her in touch with a local agency to sign Kelly up for BadgerCare. Thankfully, Kelly was enrolled in BadgerCare.

Within 24 hours, Kelly was screened by Project IMPACT, referred to the Milwaukee Public School System for further services, and applying for BadgerCare.

Today Kelly is still receiving services from all of these agencies. Her behavior has dramatically improved at school and at home. Cynthia is able to breathe a little easier knowing she doesn’t have to choose between paying for Kelly’s health care and buying her next meal.

Submit hospital community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

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