Three major advocacy groups unveiled a comprehensive health care reform plan on January 7 at a news conference in the State Capitol. "Wisconsin’s Healthier Choices for Affordable Health Care" is a plan aimed at lowering health care costs and providing benefit flexibility to employers and employees.

"This plan ensures that more people in Wisconsin will have better care at a lower price without a government takeover of the health care system," said Steve Brenton, president of Wisconsin Hospital Association. ‘Healthier Choices’ will make sure more Wisconsin residents get the care they need at a price they can afford."

Brenton, along with representatives of Wisconsin Manufacturers & Commerce, and Wisconsin Association of Health Plans unveiled the six-point plan to curb double-digit health care inflation, while offering workers increased health care flexibility and promoting better health care choices for Wisconsin. The groups predict bi-partisan support for the plan, which will require changes in state law. Other parts of the plan require voluntary industry initiatives.

"Benefit flexibility is a key to controlling costs," said James S. Haney, president of Wisconsin Manufacturers & Commerce. "Current law requires numerous mandated health care benefits that mostly small employers must offer employees, even if they don’t need the coverage. Self-funded health care plans, offered by mostly large companies, are exempt from mandates."

"Clearly, if we give small employers the freedom to innovate with health care packages, more Wisconsin employers could offer health care at lower costs," Haney said. "State-mandated benefits force employers into an ‘all-or-nothing’ position, forcing them to offer employees benefit packages they may not need. That drives up costs."

Nancy Wenzel, executive director of the Wisconsin Association of Health Plans, said insurers, employers and health care providers are optimistic that the "Healthier Choices" plan will draw strong bi-partisan support.

"This is a comprehensive plan developed by health care providers, purchasers and payers from around the state," Wenzel said. "Wisconsin needs to help employers get health care costs under control, and this plan provides the road map."

In a public statement, the Wisconsin Medical Society (WMS) applauded the groups for working toward a solution to the ongoing health care crisis.

"It’s exciting that many health policy leaders agree it’s time for health reform," said Paul Wertsch, MD, WMS president. The Society said its own health system reform plan includes many similar goals.

The major themes of the health reform plan include:

• ENABLE AFFORDABLE COVERAGE – Increase the number of Wisconsin employers able to afford health care coverage by giving insurers flexibility in designing health insurance benefits that better meet employers’ needs.
• PROMOTE QUALITY – Encourage the continued development of a consumer-driven health care environment in Wisconsin. Promising collaborative efforts to collect and report information related to quality, safety and cost should continue among providers and health plans. The state should provide assistance to promote information sharing, to help employers and consumers understand publicly reported data and to encourage innovative quality and safety improvement efforts in the marketplace.
• REPEAL THE HIDDEN TAX – Cut the "hidden tax" on purchasers of private health insurance by adequately funding government health care programs, such as Medicaid and BadgerCare, and reforming the Health Insurance Risk Sharing Plan (HIRSP).
• GROW HEALTH CARE WORKFORCE – Increase the supply of health care professionals in Wisconsin by restoring funding for Graduate Medical Education and making it easier for the UWS and the WTCS to streamline the process of graduating qualified health care professionals. Direct the Department of Workforce Development (DWD) to issue an annual health care workforce report and make recommendations for improvement.
• CUT RED TAPE, CONTROL COSTS – Eliminate unnecessary and duplicative government regulation to reduce costs and give purchasers, providers and payers greater flexibility in creating solutions to the problems identified in health care today.
• PROMOTE HEALTHIER CHOICES – Strengthen the role of consumers in the health care system today by providing information on health care quality and cost, promoting the use of advance directives, and encouraging better lifestyle choices that improve health status.

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"We expected a large number of hospitals to participate in CheckPoint^sm, but these results have exceeded our expectations," WHA President Steve Brenton commented. "This shows that Wisconsin hospitals are committed to providing consumers information on the quality and safety of health care provided in their communities."

Governor Jim Doyle will publicly congratulate the leaders of nine state organizations, including four health care systems, recognized by the Wisconsin Forward Award program for organizational excellence. Mercy Health System, Inc., of Janesville will receive the top honor with the Governor’s Forward Award of Excellence at a ceremony January 15 at the Monona Terrace Community and Convention Center.

All Saints Healthcare, Racine and Physicians Plus Insurance, Madison (owned in part by Meriter Hospital) both received Mastery recognition, while Agnesian HealthCare, Inc., Fond du Lac, and Wisconsin’s quality improvement organization, MetaStar, Madison received recognition at the Proficiency level.

"This again confirms that Wisconsin’s community hospitals and health systems are leaders in advancing the competitive position and world-class status of Wisconsin organizations….the primary goals of Wisconsin Forward Award Program," said WHA President Steve Brenton.

"It is an honor to receive the prestigious Wisconsin Forward Governor’s Award of Excellence," said Mercy Health System President and CEO Javon R. Bea. "This award celebrates our strength as a system and recognizes our unwavering commitment to organizational excellence."

Three statewide associations representing providers, purchasers and payers of health care services this week unveiled a health reform agenda designed to tackle the problem of rising health insurance costs. This cooperative effort, led by WHA, the Wisconsin Association of Health Plans and Wisconsin Manufacturers & Commerce proposes a variety of initiatives designed to improve the ability of Wisconsin employers to afford health care coverage for employees and their families.

The plan, dubbed Healthier Choices, recognizes that the problem of rising health insurance costs is not limited to one issue…and hence, cannot be solved in a single act. Unlike "sound bite" solutions offered by others, Healthier Choices recognizes the complexity of the health care cost dilemma. The plan also recognizes that opportunities for improvement must engage health care providers, insurers, employers, consumers and state government.

Healthier Choices has organized solutions into six key areas, which are explained in some detail in the report, which is available on WHA’s web site at www.wha.org/2004healthierchoices.pdf. Thematically, the proposals call for:

A good number of the Healthier Choices initiatives will become part of a legislative agenda pursued by WHA, WMC, WAHP and others in 2004. But, much of the agenda also facilitates private sector initiatives that need government to "get out of the way" and allow those most directly affected by the payment and delivery of health care to get the job done free from government interference.

The city’s major health care systems and the Wisconsin Hospital Association should be commended for their collaborative "primary care initiative," an effort to increase access to primary medical care in Milwaukee’s underserved neighborhoods.

These competing health providers – Aurora Health Care, Children’s Hospital of Wisconsin, Columbia St. Mary’s, Covenant Healthcare System, Froedtert Hospital and the Medical College of Wisconsin – have agreed to put competition aside for the sake of working with the city’s community health centers to tackle the growing problem of uninsured or under-insured patients using hospital emergency rooms for primary medical needs. This costly practice is one of the reasons behind employers’ rising health care costs. As hospitals’ unpaid debts increase, hospitals have no choice but to shift the burden of uncompensated care onto everyone else.

In early February, representatives of the primary care initiative will travel to Washington, D.C., to meet with Tommy Thompson, head of the U.S. Department of Health & Human Services, to seek a federal grant to create a pilot project that would improve the availability of primary care in Milwaukee. The grant would be a welcome opportunity for these large health systems to team up as the "non-profit" organizations they claim to be in order to assist lower-income citizens with their health care needs.

Regardless of the outcome of the hospitals’ discussions with Thompson, at least one other community health center – Sixteenth Street – will have to expand. The clinic, one of four federally qualified health centers in Milwaukee, has asked at least two major health providers, Aurora and Covenant, to help fund the clinic’s plan to build another location or renovate an existing structure to accommodate another 40,000 to 50,000 patient visits per year. Sixteenth Street CEO John Bartkowski says the health center is so full it is sending patients to other providers, including hospital emergency rooms, which exacerbates that problem.

Depending on how much money Bartkowski is requesting, it would appear that financial support for Sixteenth Street’s expansion would be a wise investment for the health systems.

The latest editions of the Hospital Performance Report and the Wisconsin Health Care Service Inventory are now available on the WHA web site at www.wha.org/financeAndData/data.aspx.

The Hospital Performance Report is a source book of utilization and finance benchmarks. Included are 19 measures that will allow you to compare your facility’s performance with any of several comparison groups.

The Wisconsin Health Care Service Inventory presents information on the many services, both inpatient and outpatient, that are provided by individual general medical-surgical (GMS) hospitals in the state of Wisconsin.

The Assembly Health Committee held a hearing on a number of health care related bills this week including AB 290, AB 509, AB 554, and AB 689 (to read the full text of these bills, visit www.legis.state.wi.us and type in the bill number).

AB 290 authored by Rep. Eugene Hahn (R-Cambria) increases the individual tax deduction for health insurance from 50% to 100% in cases where the person’s employer does not pay any of the medical insurance costs. WHA supports AB 290 because it will allow more people to afford health insurance. However, the non-partisan Fiscal Bureau estimates that this bill would reduce tax revenues by $1.2 million, and while there is no real opposition to the proposal, because of the fiscal impact the bill may face an uphill road.

With AB 509, Rep. Peggy Krusick (D-Milwaukee) would like to see pharmacies given the same discounts on drugs that hospitals and other health care facilities receive. Krusick believes that not extending the discounted price to others (pharmacists) who sell directly to the consumer is discriminatory. While she believes current law already prohibits this, the Department of Agriculture, Trade and Consumer Protection (DATCP) believes the law is unenforceable. Krusick’s bill is intended to give DATCP even more explicit authority to police pharmaceutical companies for predatory pricing. Interestingly, DATCP testified neither for nor against the bill. WHA will continue to monitor this legislation.

Spearheaded by the Alzheimer’s Association of Wisconsin and authored by Rep. Judy Krawczyk (R-Green Bay), AB 554 would clarify Wisconsin law so that power of attorney declarations drafted in other states that are consistent with Wisconsin law are enforceable in Wisconsin. According to the Elder Law Section of the Wisconsin State Bar, there have been a number of instances around the state where health care providers question whether the out-of-state declarations are valid in Wisconsin. AB 554 should make it clear that a declaration issued in another state should be followed just as if it were drafted in Wisconsin, assuming it is consistent with Wisconsin law. WHA supports AB 554.

AB 689 authored by Rep. Steve Wieckert (R-Appleton) requires those who write prescriptions to ask the patient if they would like the symptom or purpose of the drug to be written on the drug label (this is in addition to the other information already required to be listed). The bill contains no penalties for nurse practitioners or doctors who fail to ask the patient this question. According to Rep. Wieckert, this bill will help curb misuse of medication and provide another measure of safety for prescription drug users. WHA will monitor this legislation.

Attorney General Peg Lautenschlager sent a letter to many hospitals and other health care providers regarding the appropriate release of protected health information by providers to law enforcement personnel under HIPAA. The Attorney General’s letter, however, did not discuss that in certain circumstances Wisconsin law is more restrictive than HIPAA concerning the release of health information and that health care providers must comply with the most restrictive law.

The UW Medical School has announced it will hold training sessions for parties interested in accessing the Blue Cross funds, The Wisconsin Partnership for a Healthy Future. These funds were made available to the University of Wisconsin Medical School and the Medical College of Wisconsin as a result of the conversion of Blue Cross to a stock corporation, Cobalt Corporation. In accordance with the Insurance Commissioner’s order, 35% of the proceeds to each medical school must be allocated to public health and public health community based initiatives.

Both medical colleges have prepared five year plans for the intended use of the dollars. The plans are currently under review by the Wisconsin United for Health Foundation, Inc., the oversight body created to supervise the transfer of the proceeds from the stock sale to the medical colleges. The programs will not be launched until after the Foundation approves the plans.

These UW-sponsored sessions are designed to provide organizations an opportunity to prepare for the application process, and to provide information, assess needs for technical assistance, clarifications and guidance for potential applicants. Individuals are asked to register for the sessions. These sessions only apply to the UW Medical School program. The Medical College of Wisconsin has not scheduled training sessions at this time.

Individuals are asked to register for the sessions via email to bcbs@bluecross.med.wisc.edu, indicating the session attending and the name and organization of the attendee(s). The schedule of sessions is listed below:

    Thursday, January 15, 2004 2-5pm
    Westwood Conference Center, 1800 W. Bridge Street, Wausau
    For directions visit www.sodexhoconferencing.com/properties.htm

    Tuesday, January 27, 2004 2-5pm
    Alliant Energy Center, 1919 Alliant Energy Way, Madison
    For directions visit www.alliantenergycenter.com

    Tuesday, February 10, 2004 9am-noon
    UW La Crosse Cleary Center, 615 East Avenue North, La Crosse
    For directions visit www.uwlax.edu

    Wednesday, February 11, 2004 10am-1pm
    Northwest Sports Complex, 301 Walnut Street, Spooner
    For directions visit www.nwsportscomplex.com/index.html

    Wednesday, February 25, 2004 2-5pm
    UW Green Bay, 2420 Nicolet Drive, John M. Rose Hall Room 250, Green Bay
    For directions visit www.uwgb.edu

    Thursday, February 26, 2004 2-5pm
    Clarion Hotel and Conference Center, 5311 S. Howell Avenue, Milwaukee
    For directions visit www.ClarionMilwaukee.com

The educational seminar "Chargemaster Maintenance for 2004" is scheduled for February 18 for chargemaster/APC coordinators, coding staff, office managers, CFOs, and others who are responsible for charge generation processes. Hospitals have to work smarter to ensure all charges and claim forms are accurate, and this program focuses on the issues impacting the chargemaster relative to the 2004 updates.

The seminar will be held on February 18, 2004, from 9 am to 4 pm at Holiday Inn-East in Madison. 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 this seminar for five (5) continuing education hours.

For more information on the program content, contact Jennifer Frank at 608-274-1820 or jfrank@wha.org. For registration questions, contact Jenny Boudreau at 608-274-1820 or jboudreau@wha.org.

The educational seminar "New Year, New Challenges, New APCs, and New Headaches" is scheduled for February 19. Chargemaster/APC coordinators, coding staff, CFOs and others who are involved in billing, coding and operational issues should plan to attend.

Hospitals have been operating under Ambulatory Payment Classification groups (APCs) for almost four years and are still experiencing operational issues, billing problems and coding concerns. This seminar goes beyond the basics in reviewing the latest CMS program memorandums, providing financial analysis, and providing recommendations, to ensure hospitals are able to adapt and remain current in the ever-changing outpatient health care arena.

The seminar will be held on February 19, 2004, from 9 to 4 at Holiday Inn-East in Madison. 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).

Kunkel, Bounds & Associates, Inc., in conjunction with WHA Financial Solutions, Inc., will be conducting a first of its kind Comprehensive Wisconsin Hospital Group Health Benefits Survey beginning this February. The survey will seek to analyze data specific to Wisconsin hospitals for the purpose of providing many benefits:

• As a tool for comparison of plan design—useful in analysis of employee recruitment and retention
• As a measurement of health plan performance in many areas, including prescription drug benefit management, claim administration capabilities, reporting, case management results and more
• As a way of identifying unique or creative "best practices" in group health benefit management, which can be shared with the rest of the hospitals in Wisconsin
• As a baseline for future measurement of trends, such as consumer-driven health care and HRA models, cost increases or insurance carrier policy changes

"I commend the Wisconsin Association of Health Plans, the Wisconsin Hospital Association, and Wisconsin Manufacturers & Commerce for the thorough analysis they’ve used to address one of the most difficult challenges our state faces: providing affordable, quality health care.

I agree that finding a solution won’t come easily or quickly. That is why it is imperative that, as this model proposes, there must be a partnership between the private and public sector along with greater consumer awareness to develop a means of driving down costs without sacrificing quality care."
- Senate Majority Leader Mary Panzer (R-West Bend)

"I personally welcome this proposal and its inclusion in the discussion as we advance into the spring legislative session. As Co-Chair of the Joint Committee on Finance, I expect we will look carefully at these initiatives and make sure they receive the level of consideration they deserve."
- Sen. Alberta Darling (R-River Hills), Co-Chair, Joint Committee on Finance

"Increased health care costs present a comprehensive problem that needs to be addressed on many fronts. As chairperson of the Senate Health Committee, I am eager to pursue many of the initiatives set forth in the ‘Healthier Choices’ plan.

Certainly an area of concern is that of over-regulation. It is time to closely review the regulatory framework of Wisconsin’s Health Care System and eliminate unnecessary duplication. While it is critical to hold the industry to a high standard, it is not only wasteful but also costly to impose duplicative requirements upon the industry. These added costs get passed along to the consumer."
- Sen. Carol Roessler (R-Oshkosh), Chair, Senate Health Committee

"Rising health care costs undermine the ability of the state of Wisconsin to retain and create family sustaining jobs. Today Wisconsin employers, providers and insurers have laid out a full menu of proposals that deserve serious consideration by the legislature."
- Rep. Gregg Underheim (R-Oshkosh), Chair, Assembly Health Committee

Here’s your opportunity to talk directly with Governor Doyle. The Governor is holding listening sessions around the state before his annual State of the State speech on January 21. Let’s make sure he hears from Wisconsin’s hospitals on important issues, such as appropriate funding for Medicaid and WHA’s new "Healthier Choices" health reform initiative.

The next listening session is scheduled for Monday, January 12 from 5-6 p.m. in Chippewa Falls at the City Hall Council Chambers located at 30 W. Central Street. Future issues of Valued Voice and WHA’s website will contain information for meeting locations slated for Green Bay, La Crosse, Milwaukee, Monona and Superior as soon as the details are announced.

For more information, please contact Jodi Bloch at 608-274-1820, or jbloch@wha.org.

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