Milwaukee County Executive Scott Walker announced at a joint press conference on September 27 that his 2005 county budget proposal recommends full funding for the General Assistance Medical Program (GAMP). Also participating in the press conference were Lee Holloway, chair of the Milwaukee County Board of Supervisors, and Bill Bazan, WHA vice president, Metro Milwaukee. GAMP, established in 1996 after the closure of Milwaukee County’s public hospital, is a "safety net" program for nearly 26,000 Milwaukee County low income and uninsured residents that brings in $38M (a combination of county, state and federal dollars) for a variety of health care services, including hospital emergency department and inpatient care, primary care delivered in 18 community-based clinics, pharmacy expenses, specialty physician reimbursement, home health, and emergency medical services costs.

During a time of challenging county budget deficits, Milwaukee County health care systems (Aurora, Covenant, Columbia St. Mary’s and Froedtert Community Memorial) stepped forward and entered into an agreement with the county executive and county board chair to partner with the county and contribute funding in the following areas:

• $244,000 as salary and benefits for four GAMP eligibility workers stationed in four of the larger community clinics;
• $500,000 grant to the County which chose to use those grant dollars to establish two community-based eight-bed mental health crisis centers which will help alleviate the overcrowding at the County’s mental health hospital and allow law enforcement to more easily triage mental health patients in their custody;
• Nearly $400,000 in home health expenses will be absorbed by the hospitals when discharging GAMP patients who need this service.

In a related separate agreement with the county executive, Aurora HealthCare will pay for the existing GAMP nurse help line which they operate ($65,000) and county employee occupational health services ($60,000).

"The true beneficiaries of this good news announcement by County Executive Walker are the GAMP patients themselves….a very vulnerable population in the County," said Bill Bazan.

Steve Brenton, president of WHA, applauded the effort. "Great credit goes to the leadership of the four Milwaukee County health systems and their respective staffs who worked diligently to make the announcement happen," he said.

Rep. Mike Huebsch (R-West Salem) made it clear to the members of the WHA Public Policy Council at their meeting on September 28 – Medicaid is the number one budget issue facing the legislature when it returns to work in January.

"The Medical Assistance budget will be the first area that will need money, and it will get it. There is a significant cost-shifting problem that is driving up health care costs," Huebsch said. "This is a snowball we need to stop."

Huebsch pointed out that Wisconsin "leads the nation" in taking care of those who are less fortunate.

"Wisconsin is generous in taking care of those who cannot take care of themselves. One thing that you will see with SeniorCare and BadgerCare is that we lead the nation in providing coverage for everybody," Huebsch said. "We are very proud of that."

While WHA has opposed the Tax Payer Bill of Rights (TABOR), Huebsch said he doesn’t believe that TABOR will decrease medical assistance payments to hospitals. TABOR, he believes, forces government to set priorities, and he feels that the Medical Assistance budget is a very high priority.

"We are past the point where government needs to live within its means. Now government needs to live within our means," according to Huebsch. "You (hospitals) are in a good position to advocate for your programs."

Graduate Medical Education fell under the axe in the last budget session, a fate that Huebsch thinks can be avoided by educating the legislature.

"The belief is that GME is a Milwaukee issue, when in fact, it is a statewide issue," he said. "We need to educate the new legislators when they come in and show them the impact GME has statewide."

The recently unveiled Republican jobs agenda contained several items that are directly related to health care.

"You can’t talk about the economy and jobs without talking about health care. Beyond regulation and reform, it is the cost of health care for their employees and families that is a concern for business in Wisconsin," Huebsch said. "We need to give people more control over their health."

He said the proposal that would eliminate the tax on health insurance premiums will be analyzed for its impact on the state budget, but he said it is important to view it in light of the positive impact it would have on increasing the ability of an individual to buy into a group health plan.

The "100 Day Jobs Agenda" can be viewed at www.wha.org along with a news release WHA issued on the Job Agenda.

One hospital administrator in Wisconsin put his experience in both health care and the military to work in Afghanistan. Nathan Geraths, director at the Madison VA Hospital, describes his 83 days of duty in Afghanistan as "life changing." His call to service came in the form of an appeal on a weekly Veterans Health Administration Director’s conference call for volunteers to help provide leadership to the Rabia Balkhi Women’s Hospital in Kabul, Afghanistan.

HHS Secretary Tommy Thompson contacted Secretary Principi about VA assistance in a multi-agency effort to support a facility in desperate need of help. The statistics were shocking: The maternal death rate in Afghanistan is the second highest in the world, nearly 300 times higher than the U.S.; 40 percent of deaths among women of childbearing age are caused by preventable complications related to childbirth; prenatal care is virtually nonexistent; and one in five Afghan babies die before reaching their fifth birthday. The Defense Department was re-building infrastructure; Health and Human Services physicians were training hospital staff and treating patients; but there was a crucial need for leadership.

Geraths was the third VA career executive to lead the efforts to improve the facility. The challenges are nearly unbelievable. It’s hard to imagine a hospital expected to care for an illiterate and high-risk population with no budget, substandard equipment, a high infection rate, an inadequate water supply, unpredictable electricity, sporadic plumbing, an abundance of sewage problems including on the operating room floor, 80–100 admissions and 40 births daily, no medical records system, no triage system, no emergency room and no system to register patients. These challenges were complicated by the fact that the entire area surrounding the hospital was very crowded and male visitors were not allowed inside.

Geraths drew on his extensive military background to engage two groups of Army military that had access to millions of dollars in emergency relief and nation-building funds. The first group, his host at the military compound in Kabul, was willing to fund projects but had insufficient manpower and expertise to correct the numerous facility failures facing the Rabia Balkhi Women’s Hospital. Geraths sought the assistance of the Army Corps of Engineers who proved to be a talented, competent, and willing partner in proposing major construction modifications that would correct the electrical, water, plumbing and sewage inadequacies that plagued the hospital. They enthusiastically threw themselves into the rehabilitation process of the hospital and devised their own creative solutions to problems that were particularly unique to Moslem patients. For instance, they devised foot-bathing facilities in the women’s bathrooms so the women could wash their feet before their five daily prayer sessions.

He began English classes for the children and for a group of envious doctors who asked him to give up his lunchtime so they could learn how to speak English. Every one of the days he spent at the hospital or at the Ministry of Health brought small but humanistic rewards to this hospital consultant volunteer. But one of the most rewarding aspects of the assignment was to have the burkaed women, who by religious practice were separated from men, accept Geraths into their hospital and allow him freedom to move freely about the hospital because they believed he was truly there to help them and improve the welfare of their infant children.

Armed military personnel provided the daily transportation and protection for Geraths in his commutes from the housing compound to and back from the hospital. He was required to wear a bulletproof vest during that transportation. The housing was provided in a U. S. military compound of older Afghan homes leased by the military, surrounded by walls and fortification. Each room was used for multiple purposes but basically housed up to 12 people by putting bunk beds in all available space.

One sobering adjustment for Geraths, who had served 30 years in the Reserve and active duty, was the ever-present danger of living in a war zone. This threat was constantly reinforced by the requirement that two armed Army shooters accompany him wherever he traveled and, of course, the ever-present ceramic bulletproof vest—all 30 pounds of it!

Geraths found, however, that the people of Afghanistan, outside of the marauding Taliban, were very appreciative of the efforts being made to rebuild their nation. They are a proud people with many martyrs and with a great deal of psychological and physical hardship, but intensely Afghan and desirous of a return to peace and prosperity.

Upon returning from his duty in Afghanistan, Geraths provided a presentation for the hospital staff. After seeing photographs of the stark conditions being faced by the patients of the hospital in Kabul, a group of Madison employees initiated a hospital-wide collection of comfort items to support that facility. Toiletries, paper products and a wide variety of other items were shipped to Kabul in support of the efforts.

The Wisconsin Supreme Court heard oral arguments on September 23 on the troubling prisoner dumping case, Meriter Hospital, Inc. v. Dane County. As previously reported, this case involves a County prisoner who was at Meriter for a total of 34 days; his medical bills totaled more than $187,000. Meriter Hospital and WHA, as a friend of the Court, each filed briefs with the Court stressing that the County was responsible for payment of the prisoner’s medical bills. The County claimed that because the prisoner had been released from custody after the third day of hospitalization, the County was not responsible for the prisoner’s medical bills beyond the first three days. The evidence indicates that the prisoner was released so the County could avoid paying overtime for a required guard at the hospital. The prisoner was in a coma and determined not to be a flight risk. Once the prisoner was released from the hospital, the prisoner was taken back into custody.

Guy DuBeau, an attorney with Axley Brynelson, LLP, presented Meriter’s arguments at the oral arguments and stressed to the Court that Wisconsin statutory law prohibits counties from avoiding their responsibility to provide appropriate care to prisoners by acting in the manner in which Dane County proceeded.

The Court questioned both Meriter’s and Dane County’s positions by questioning the legal implications of extending Meriter’s interpretation of the law to all prisoner care situations, and also questioning the County’s motivation in releasing the prisoner. Additionally, Chief Justice Shirley Abrahamson noted that if Dane County prevailed, the Court’s decision would have an effect on overall health care costs caused by the effective shift of the costs for the prisoner’s care from County taxpayers to private payers.

A decision from the Court on this case can be expected in two to six months.

Certain health care providers who are organized as Limited Liability Companies (LLCs) will receive a notice from the Patients Compensation Fund (PCF) that their coverage under the Fund will be terminated December 31, 2005, unless there is a change to the statute prior to that date.

In addition to other eligibility provisions, the authorizing statute for the Patients Compensation Fund provides eligibility for coverage under the Fund to a corporation organized and operated in Wisconsin for the primary purpose of providing the medical services of physicians or nurse anesthetists. According to counsel hired by the Fund, an LLC is not a corporation and, thus, the Fund argues that LLCs are not eligible for Fund coverage. In order to provide LLCs that currently have Fund coverage with an opportunity to obtain coverage from other sources and to provide the Legislature with an opportunity to amend the statute, the Fund plans to permit coverage for LLCs currently in the Fund through December 31, 2005. The Fund will not accept new applications for coverage from LLCs.

It is important to note that hospitals and ambulatory surgery centers will not receive the notice, as they are eligible for Fund coverage through different statute provisions. In addition, this issue does not affect the personal eligibility for physicians, but only an entity’s coverage if the entity is organized as an LLC and is not otherwise eligible.

A copy of the legal opinion from the law firm of Cullen Weston Pines and Bach, LLP, concerning this issue and a copy of the notice from the PCF is available on the WHA Web site under Legal and Regulatory.

It’s time the news media ask this question: Just who is bankrolling Consejo de Latinos Unidos?

The organization, reportedly funded nationally by the plaintiff’s bar and an insurance company mogul who markets individual health savings accounts, is engaged in an advertising campaign that is trolling for litigants who have hospital billing and collection anecdotes.

Because of this effort, hospitals are facing legal and political challenges that question the integrity of how they treat indigent patients. But the truth is that hundreds of medically indigent patients are cared for every day in Wisconsin hospitals. And just who will pay for that care and how much will be paid is never a consideration.

At a time when well-funded forces with legal and political agendas designed to erode the reputations of hospitals are working hard to do just that…Wisconsin hospitals are providing uncompensated care at historically high levels. In 2002 (the most recent available data), Wisconsin hospitals provided charity care to an average of 518 patients at a cost of more than $485,000 every day. In that same year, nearly 200,000 individuals from all across the state received over $177 million in charity care. When bad debt is added to that number, the price tag soars dramatically.

New billing and collection guidelines adopted by the WHA Board earlier this year provide further assurances for Wisconsin residents that community hospitals take their commitment to provide care—regardless of ability to pay—seriously. Those guidelines suggest minimum income eligibility for financial assistance, the need to ensure that discounted bills to low-income or uninsured patients are not inconsistent with amounts charged to a typical insured patient, and provide guidance on specific collection practices that should be avoided.

It’s important to note that former Wisconsin governor and current Health and Human Services Secretary Tommy Thompson has praised WHA’s leadership, noting that the guidelines are a "thoughtful, well reasoned approach—that will serve the patients who are served in Wisconsin’s hospitals well."

Attempts to demonize and destroy the reputation of mission-driven community hospitals are outrageous. And we will not be timid about rebutting this nonsense with the facts.

Steve Brenton,
President

Stoughton Hospital celebrated 100 years of service to the community on September 26 with an open house and ceremony that marked the occasion. U.S. Representative Tammy Baldwin presented the hospital with a flag that was flown over the nation’s capitol. She also presented a check to the hospital for over $29,000, which will be used to purchase new defibrillators. Stoughton Hospital President Terry Brenny congratulated the hospital staff on their efforts and thanked the community for their support.

The Wisconsin Quality Steering Committee reviewed the preliminary recommendations for new measures that would be added to CheckPoint^SM, the WHA public reporting program, at their meeting on September 29 at WHA headquarters in Madison.

The Measures Team, which reports to the Steering Committee, presented a plan that included the measures that would be added to CheckPoint over the next two years. When the preliminary recommendation is approved by the Steering Committee, WHA will obtain input from key stakeholders, including hospitals, purchasers/insurers, and legislators to ensure that the resources required in collecting and reporting the data are justified by the value that the information has to the end users.

"Development of the CheckPoint program is right on target, meeting all of its commitments, including the addition of four new measures in September. We will continue to update the information currently being reported," WHA Chair Chuck Shabino said, who also chairs the Wisconsin Quality Steering Committee. "Now is the time to identify the type of information that can be added to the system to create even greater value in the future," he added.

Committee members heard a presentation by Chris Queram, president, Employer Health Care Alliance Cooperative, on the current national reporting initiatives that have the potential to affect state, regional and local reporting of quality information. Queram indicated that there were several value-based purchasing initiatives for inpatient and outpatient services that are being piloted around the country. Although these initiatives are still working through data issues and other challenges, they are gaining traction. Many of these initiatives are sponsored by General Electric. Queram also reported that the Institute of Medicine recently formed the "Benefits, Payment, Process Improvement" Committee as required by the Medicare Modernization Act. This Committee will release three or four reports over the next three years on the effectiveness of the Quality Improvement Organization’s (QIO) ability to provide quality oversight to Medicare recipients, performance-based reimbursement and evidence-based benefit design.

Finally, the steering committee approved the charter of a new sub-team, the Outreach Team. This team will be formed to ensure two-way communication with key stakeholders, including purchasers, physicians and other practitioners. The Team will work to create a higher awareness and use of the information in CheckPoint over time. Expected outcomes from this team could include a toolkit for large employers and insurers that will help them identify ways to share the information with their employees; and, identification of community-based demonstration models where hospitals, employers and others community members are working together to understand and utilize health care quality data for improvement and decision making.

A new brochure is available on the WHA Web site for members to use in recruitment programs. The brochure is titled "A Career in Health Care: Where the Jobs Are." Designed to address all health care jobs, the brochure focuses on jobs, scheduling, community and the rewards of working in health care. It directs questions to the local hospital and includes space on the back panel to add hospital specific information. Two versions have been created—a PDF version that can be printed directly from the Web site ready to be used, and a Word document version that allows the insertion of quotes, pictures and ideas promoting specific institutions.

This project was reviewed by the WHA Workforce Council as one of their 2004 tasks to assist members with recruitment efforts.

There is still time to register for the 2004 Wisconsin Quality & Safety Forum, which is co-sponsored this year by WHA and the Wisconsin Patient Safety Institute. The Forum, scheduled October 18-19 at The Plaza Hotel in Eau Claire, will combine education sessions with a showcase of 90 projects focused on current quality improvement and/or patient safety initiatives submitted by a diverse group, including health care clinicians, researchers, coalitions, advocacy groups and others from across the state.

Health care quality directors, risk managers, CEOs/administrators, clinician managers, physicians, nurses, pharmacists, patient advocates, health care purchasers, researchers, educators, students, legislators, regulators, and other policy makers are encouraged to attend.

This activity has been planned and implemented in accordance with the Essential Areas, Elements and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Wisconsin Medical Society and the Wisconsin Hospital Association. The Wisconsin Medical Society is accredited by the ACCME to provide continuing medical education for physicians.

The Wisconsin Medical Society designates this educational activity for a maximum of eight (8) category 1 credits toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The Forum has also been submitted to award eight (8) continuing education hours from the National Association of Boards of Examiners of Long Term Care Administrators (NAB)/National Continuing Education Review Services (NCERS). WHA has also been authorized to award eight (8) hours of pre-approved category II (non-ACHE) continuing education credits by the American College of Healthcare Executives.

The full conference brochure with registration information is available on the Web site at www.wha.org/education/quality.aspx. Don’t forget to ask for the WHA room block (group #3390) at The Plaza when making your reservation. Call 800-482-7829 to make your hotel reservation. The special room rate will be available only until October 3.

The educational seminar "Mastering Chargemaster-2005 is Almost Here!" is scheduled November 30 for chargemaster/APC coordinators, coding staff, office managers, CFOs, and others who are responsible for charge generation processes. With the elimination of the grace period, hospitals will need to update their chargemasters before the start of 2005. This program focuses on the issues impacting the chargemaster relative to the 2005 updates.

The seminar will be held on November 30, 2004, from 9 am to 4 pm at the Holiday Inn in Stevens Point. A brochure and a registration form are included in this week’s packet and on the Web site at www.wha.org/education. On-line registration is available. The American Health Information Management Association (AHIMA) has approved this seminar for five (5) continuing education hours.

Presentations that offered exciting examples of great recruitment and retention practices were featured at a seminar sponsored by the Wisconsin Hospital Association and the Wisconsin Society of Healthcare Human Resources Administration (WSHHRA). The seminar "Healthcare Recruitment and Retention Practices" provided an opportunity to share what has worked for six WHA member hospitals in attracting and retaining employees.

Norma Tirado, president of WSHHRA and vice president, employee services at Agnesian HealthCare, served as moderator throughout the conference. Leo Brideau, president/CEO at Columbia St. Mary’s, Inc. in Milwaukee, and a member of the AHA’s Commission on Workforce for Hospitals and Health Systems, discussed the "In Our Hands" project. The "In Our Hands" project outlined a workforce agenda for the nation that provided ideas and support to hospitals are they wrestle with workforce shortages.

"Recruitment and retention of staff is the most important issue facing health care," Brideau said.

Publishing recruitment and retention strategies has been a part of that AHA Project, and nearly 50 hospitals from Wisconsin have been featured in those reports since the project’s inception three years ago. Five presentations showcased Wisconsin’s health care workforce efforts:

• Harold Brown, president/CEO, from Prairie du Chien, discussed innovative workforce approaches for rural hospitals.

"We want students to know about the opportunities in rural health care. Our goal for participating in the training programs is to get students to come back to stay," according to Brown. "We’re not always successful, but we know they were given a good exposure to rural health care."

• Randy Schade, Jennifer Tryba, and Tina Seidl of Aspirus presented workforce strategies that work in a competitive environment.

"It’s important to have a full cross-section of employees participate in your recruitment task force. Strong senior leadership commitment is essential, so have some VPs on your task force," Seidl said.

• Gail Sherry, Western Wisconsin Technical Institute, shared information about the Health Care Recruitment Camps done cooperatively with both Franciscan Skemp and Gundersen Lutheran Hospitals in La Crosse.

"Just having students (campers) hear a lecture doesn’t work. They need to do a hands-on activity, similar to what a practitioner would do," Sherry offered.

• John Zorbini of Community Memorial in Menomonee Falls described his hospital’s "School Partnership" Program.

"It is important for hospitals to make health careers visible since high school counselors sometimes do not have the time," said Zorbini.

• Nicole Einbeck and Blase Strobl of the Monroe Clinic Hospital talked about their no-lift program implementation and success to date.

"There was some resistance from staff at first. But, in a very short period of time, they couldn’t imagine their day without this program," according to Einbeck.

The Joint Commission on Accreditation of Healthcare Organizations and the Centers for Medicare and Medicaid Services (CMS) announced that they have signed an agreement to work together in completely aligning current and future common Hospital Quality Measures in their condition-specific performance measure sets. The current Hospital Quality Measures are included in the Joint Commission’s ORYX® Core Measures and CMS’ 7th Scope of Work Quality of Care Measures on heart attack, heart failure, pneumonia and surgical infection prevention.

CMS and the Joint Commission released and made available on their Web sites a common measures specification manual, which includes a data dictionary, measure information forms, algorithms and other technical support information. The specification manual can be found on the Joint Commission Web site at www.jcaho.org/pms/core+measures/aligned_manual.htm. The intent is to achieve full alignment of common measures by the time that data for January patient discharges begins.

The intended measure alignment will make it easier and less costly for hospitals to comply with existing CMS and Joint Commission requirements for data collection and reporting. The measures in the four Joint Commission and CMS hospital measure sets presently in use calculate the same way, but there are differences in the format of the specifications for data elements, types of cases excluded, calculation algorithms, and other measure dimensions.

Core measures are an integral component of efforts by CMS and the Joint Commission to improve the quality of care provided to hospital patients and bring value to stakeholders by focusing on the actual results of care. All of the hospital measure sets currently being used by the Joint Commission and CMS have been reviewed and endorsed by the National Quality Forum. The public availability of core measure data also permits user comparisons of hospital performance at the state and national levels.