The American Hospital Association is joining WHA in the fight to protect Wisconsin’s comprehensive medical liability system. The Supreme Court of Wisconsin has accepted for review Ferdon v. Wisconsin Patient Compensation Fund, a case in which the plaintiff is challenging the constitutionality of Wisconsin’s statutory cap on noneconomic damages in medical malpractice actions. (See the December 23, 2004, edition of The Valued Voice.) WHA and AHA will request permission from the court to file an amicus brief in the case supporting the constitutionality of the caps.

Wisconsin’s health care delivery system has been called "the envy of the nation." Together, the Wisconsin legislature and the entire health care community achieved this status by continually focusing their efforts on a common goal: the creation and continuation of a system that provides high quality, readily accessible, and affordable health care to Wisconsin’s health care consumers. One of the major factors reinforcing this beneficial health care environment is Wisconsin’s comprehensive medical liability system. The Wisconsin legislature created this system in 1975, and refined it over the next 30 years, based on policy decisions that balance the costs and effects of medical malpractice awards on the system at large with patients’ ability to recover compensation beyond full reimbursement for economic damages. It is important to note that Wisconsin is one of only six states not currently experiencing a medical malpractice "crisis." In "crisis" states, the high cost of malpractice insurance has made health care more expensive and less accessible.

"Almost half of the hospitals in crisis states report a loss of physicians or a loss of coverage in emergency departments," noted WHA President Steve Brenton. "Addressing this medical liability crisis at the national level is a major priority for AHA. WHA is pleased to have AHA’s support in this crucial case needed to maintain the Wisconsin system that has been so beneficial to health care consumers, providers, and purchasers."

Continue to watch The Valued Voice for more information as this important case develops.

Plaintiffs challenging hospital billing practices received important setbacks in federal courts around the country in the last few weeks. The effect of these significant victories for not-for-profit hospitals may be that many of the uninsured billing lawsuits brought in federal courts may begin to move to state courts.

In late December, a Colorado federal district court judge dismissed with prejudice plaintiffs’ federal and state claims against two Colorado hospital systems based on their federal tax-exempt status. The American Hospital Association was also a defendant in these cases. In a strongly worded opinion, the judge criticized plaintiffs’ attorneys for "seeking to use this court as a forum to reform the health care system," and further called claims that federal tax-exempt status creates an enforceable contract "patently untenable." The judge also suggested that the plaintiffs’ claims based on EMTALA would have an uphill battle.

Following the Colorado dismissal, a Florida lawsuit challenging the billing of uninsured patients by two Florida hospital systems is now on the verge of being dismissed from federal court following the plaintiffs’ motion last week to voluntarily withdraw the case from federal court. The motion to withdraw came after the federal district court judge in that case questioned the legitimacy of the plaintiffs’ claims and suggested that the plaintiffs would potentially face sanctions for filing a frivolous or insufficiently supported lawsuit.

Following the activity in the Florida and Colorado courts, cases in Louisiana, Texas, Georgia, and Illinois have all been voluntarily withdrawn from federal courts which may signal that following these and other losses in the federal courts, plaintiffs are attempting to move to state courts in search of a more favorable forum. 

The Valued Voice will continue to follow this rapidly changing story.

Edward H. (Ned) Wolf, president/CEO at Lakeview Medical Center in Rice Lake, has his priorities set as he assumes his new position as the 2005 WHA Board Chair, and funding the Medicaid program is high on his list.

"The Medicaid program has been under funded for many years, creating an additional cost and burden—the ‘hidden tax’—that business and individuals who pay for insurance are now bearing, and that has to stop," Wolf told Valued Voice Editor Mary Kay Grasmick.

"We also believe it is our responsibility to be a voice for Medicaid recipients," added Wolf. "Cutting Medicaid funding and services might prevent patients from seeking the care they need when they need it."

Medicaid isn’t the only issue that WHA will work on in 2005. Wolf will also continue to support initiatives that increase the amount of information that is useful to the public in making good decisions about their own health care.

Wisconsin hospitals are committed to providing even more information that will help consumers, according to Wolf. In 2004, the CheckPoint Web site was launched, where people can find data related to hospital quality and safety.

In 2005, WHA will add information to CheckPoint related to how satisfied patients are with the care they receive while in the hospital, and WHA will launch a new Web site that will make hospital price information readily available.

Wolf is anxious to get started in his new position, and looks forward to the challenge of representing a diversity of hospitals in Wisconsin—ranging from the very largest to the smallest.

"It is an honor for me to be able to work on and represent such important health care issues for our Association," said Wolf.

The WHA has set an aggressive agenda in 2005, one that WHA President Steve Brenton is confident that Wolf will lead with passion and wisdom.

"Ned’s leadership position recognizes his strong commitment to advancing a proactive and successful health care environment in Rice Lake as hospital CEO, and statewide through his active involvement in WHA," Brenton said. "Ned is representative of the type of health care leader that works hard every day to improve Wisconsin’s outstanding collection of community hospitals. He will be an outstanding WHA Chair."

Wolf has served in many leadership positions at WHA. He has been a member of the Board of Directors since 2000, chaired the Council on Finance and Payment since 2001, served on the Council on Governance from 1996-1997, is a past chair of the West Central Hospital Council, joined the Executive Committee in 2003, and served on the Nominating and Awards Committee in 1999 and 2000.

Wolf joined Lakeview Medical Center, a 75-bed hospital in northern Wisconsin, in 1994. During his tenure, he successfully revised the strategic planning process, attained new goals in the areas of quality and patient safety, and established several new health programs in the Rice Lake community.

A diplomat of the American College of Healthcare Executives, Wolf received his bachelor’s degree in biology and master’s degree in public health from the University of Missouri-Columbia. He served as vice chair of the Wisconsin State Trauma Council in 1999 and is on both the board and executive search committee for the VHA-Upper Midwest.

Ann Lucas, WHA’s vice president for external relations and member advocacy, has been tapped to head-up the Bridge Community Clinic in Wausau. Lucas, who came to WHA in January of 2002, will become the clinic’s new executive director later this month. Ann was one of the clinic’s original founders in 1995, and also served as Board president.

"Ann has been a key member of our advocacy team, contributing on many different levels," said WHA’s Eric Borgerding. "She helped supercharge the Healthy Wisconsin PAC and conduit and breathe new life into our grassroots efforts. She has been instrumental in revitalizing WHA’s advocacy programs, and will be sorely missed."

During Lucas’s tenure, contributions to Healthy Wisconsin PAC and conduit increased by 176 percent, topping $150,000 in 2004. WHA’s grassroots organization also improved significantly, including creation of the 400+ member Hospital Advocates group.

"It has been a great honor to represent Wisconsin’s hospitals, and work with so many talented and dedicated hospital staff," Lucas said. "WHA members’ willingness to tackle difficult issues and their commitment to putting the needs of their patients and communities first is second to none. Thank you."

Ann’s last day with WHA will be January 14. WHA has started a search to fill this key position.

WHA President Steve Brenton emphasized how important hospitals are in rural communities during a presentation at the Wisconsin Electric Cooperative Managers Association meeting in Madison. Brenton provided a briefing that focused on the major issues that face hospitals in the coming year. Keeping health insurance affordable and factors that contribute to high premiums was one of the topics covered for the managers’ group.

Rick Kolb, general manager of the Scenic Rivers Cooperative in Lancaster and chair of the Board of Trustees at Grant Regional Medical Center, said the electric cooperatives are particularly interested in ensuring that residents in rural areas continue to have access to high quality health care in their communities.

"The people who belong to our cooperatives live, work and raise their families in rural areas, and they want to receive health care as close to home as possible," Kolb said. "In addition, we do a lot to promote economic development in the communities we serve, and having a financially stable, thriving hospital is an important consideration to businesses when they are looking to locate in rural Wisconsin."

Wisconsin’s 24 electric cooperatives serve about 215,000 farmers, residences, and businesses in the state. Nearly one out of every ten electric consumers in Wisconsin is an electric cooperative member.

In April 2004, the WHA Board approved a series of principles and recommended policies for hospitals to follow in addressing billing and collection practices for uninsured patients.

We received a reality check about this topic last week with an unfortunate Milwaukee Journal Sentinel story, followed by an editorial highly critical of a local hospital billing and collection incident.

The media loves this stuff! And there is nothing more convoluted than a hospital bill. Trying to explain "charges" to a layperson is akin to arguing with a toddler. The fact that no one (especially the uninsured!) pays anything close to billed charges is lost on critics eager to demonize.

But there’s at least one important bottom line that also should be viewed as a reality check: A quick peek at the graph below indicates that charity care and bad debt (together these amounts equal uncompensated care) are approaching a half billion dollars annually and are climbing at a rate faster than hospital revenue growth. This is hardly a symptom of hospitals gouging uninsured patients!

It’s important to point out that Health and Human Services Secretary Tommy Thompson, after reviewing the WHA guidelines, said that "The Wisconsin Hospital Association has developed a thoughtful, well-reasoned approach to this problem, and I commend them for their efforts and thank them for the hard work that they’ve done. This new proposal (guidelines) will serve the patients who are served in Wisconsin’s hospitals and the hospitals in Wisconsin well."

This issue is not going away. But Wisconsin hospitals have nothing to hide when it comes to full disclosure of our proactive uncompensated care programs. Let’s make sure that we are the ones telling our story.

Steve Brenton
President

The Centers for Medicare and Medicaid Services (CMS) audit of medical residency programs was one of the issues discussed when Congressman Mark Green (R- 8CD) met recently with Kevin Nolan, president and CEO of Affinity Health System, and Jim Hemes, Affinity’s director of community and government relations at St. Elizabeth Hospital, Appleton.

They discussed the recent CMS audit of the UW/Department of Family Medicine/ Fox Valley Residency Program that partners with Appleton Medical Center and St. Elizabeth Hospital. The audit resulted in a reduction of Medicare reimbursement to the two hospitals because CMS determined that the hospitals did not have the required written agreements to allow the hospitals to allocate costs for training of physicians in out-of-hospital settings. This was in spite of the fact that the hospitals incurred the costs, and training did take place.

Although CMS has recently issued a new rule that acknowledges that the written agreements were not generally useful for auditing purposes, they nevertheless determined that the hospitals were not in compliance and made the adjustments to reimbursements.

Nolan emphasized the importance of the residency program for St. Elizabeth and the contribution the residency program has made in addressing the looming physician shortage for Wisconsin. St. Elizabeth plans to appeal the initial finding.

WHA staff is working with a coalition of Wisconsin hospitals who sponsor UW Family Practice residency programs, UW Department of Family Medicine, HHS, CMS and United Government Services (UGS, the Medicare Fiscal Intermediary), to come to a suitable reconciliation of the issue.

With the influenza vaccine shortage behind them, state public health officials are now offering the vaccination to anyone who wants it. An estimated 135,000 doses are still available in Wisconsin.

Governor Jim Doyle praised the efforts of public and private health providers for their cooperation in averting what could have been a "nightmarish" situation.

"I am proud of the way our public health professionals, private health care providers, and Wisconsin’s citizens responded to the flu vaccine shortage," Governor Doyle said.

In October, when the national influenza vaccine shortage became evident, Governor Doyle directed the Department of Health and Family Services to issue a public health order to limit the vaccine to the most vulnerable citizens, ensuring that Wisconsin would not run out of vaccine. The emergency order was used to alleviate the long lines of people seeking vaccine, and to ensure that those most at risk for complications due to influenza were able to get their shot.

Health care providers from around the state report that the demand for vaccine by people in the priority groups has been satisfied, according to the Governor’s office.

Many hospital clinical staff, billers and health information coders are now intimately involved in the facility’s chargemaster. Staff with little or no background in billing, coding or reimbursement are being asked to assume the role of "chargemaster coordinator." Trying to "learn it all at once" is often overwhelming and can be costly to the facility.

The educational seminar "Chargemaster 101-Starting at the Beginning" is scheduled for February 22. Chargemaster/APC coordinators, especially those new to their position, coding staff, case mangers, reimbursement specialists, business office managers and others interested in learning the basics to conduct a chargemaster review with continual updates and maintenance should plan to attend.

Whether a seasoned chargemaster coordinator or an entry-level director, this seminar provides attendees with the "basics" to the chargemaster and tools needed to keep this vital document up-to-date. This is a hands-on program where attendees will actually create and check the chargemaster.

The seminar will be held on February 22, 2005, from 9 am to 4 pm at the Holiday Inn, Madison East. 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. This seminar is approved for five (5) continuing education hours by the American Health Information Management Association (AHIMA).

In a comprehensive survey, Child magazine has rated Children’s Hospital of Wisconsin as the third best children’s hospital in the nation. In subspecialties, Children’s Hospital’s Emergency Department earned the elite ranking of number one in the nation in pediatric emergency medical care, the Herma Heart Center was rated fifth in pediatric cardiac care, orthopedic care rated sixth, and neonatology ranked seventh in the nation. The articles about the top ten children’s hospitals and five "super-specialties" appear in the February 2005 issue of Child magazine.

"This is only the third time that Child magazine has published this biennial report, and was by far the closest contest to date," said Karen Cicero, senior editor of Child magazine. "Children’s Hospital of Wisconsin clearly emerged as a leader not only in the top ten, but as the prestigious third in the nation. The quality of pediatric care the hospital provides on so many levels is most impressive."

The announcement of these new rankings of children’s hospitals was made on the Today show on NBC on January 4. Children’s Hospital’s third overall ranking proved to be the greatest "upset" to this year’s list, as the hospital has not been included on the list in previous survey years.

"We are absolutely thrilled to have been ranked so high on this prestigious list," said Jon E. Vice, president and CEO of Children’s Hospital and Health System. "We always have known that our hospital is a leader when it comes to caring for children. This ranking proves that we are highly competitive with the best in the nation, and now are part of this elite group."

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