WHA Senior Vice President George Quinn, who spearheaded the effort, is impressed with the results.

"The financial results provide perspective on the resources that hospitals devote to raising the health status in their communities, but it is the stories about the people whose lives were saved, changed, or simply touched by a hospital’s generosity that are truly impressive, and differentiate hospitals from every other industry in the community," according to Quinn. Members should watch their email over the next few days for more communications from WHA related to the launch.

Wisconsin will soon be able to boast that 100 percent of the hospitals are publicly reporting community benefits. This year, WHA introduced a new online survey tool, but many hospitals said while the tool was easy to use, they did not have a effective system in place within the hospital to collect the data. On December 7, WHA is hosting its second community benefit workshop that will include an overview of best practices among Wisconsin hospitals on how to accurately and efficiently collect the data within a hospital, along with case studies that show how to develop programs that meet an identified health need in the community.

Understanding the role of governance, mission and vision is crucial to the success of hospital community health programs, and building alliances with other agencies is equally important. Both of these important concepts will be covered at the workshop, along with the importance of communicating with the community, hospital employees and the hospital board.

The workshop will be held at the Kalahari Resort in Wisconsin Dells on December 7 from 9 am – 3 pm. The registration fee is $95 for member hospitals with a $75 per person team rate if two of more register from the same organization. The non-hospital rate for this event is $150 per person. Registration materials are in this week’s packet, or go to www.wha.org/education/pdf/2006commbenefits12-7.pdf

For more information on content, contact Mary Kay Grasmick, mgrasmick@wha.org; direct questions related to registration to Sherry Rabuck, srabuck@wha.org, or call 274-1820.

The National Labor Relations Board ("NLRB") recently issued its much-anticipated decision in Oakwood Healthcare, Inc., which clarified the supervisory status of certain charge nurses. Under the National Labor Relations Act, supervisors do not have a legally protected right to self organize or to form, join, or assist labor organization or to engage in other concerted activities. Because they are not covered employees, supervisors cannot vote in union elections. Ultimately, the NLRB in this new case decided that Oakwood’s permanent charge nurses were true supervisors and could not vote in the union election. The NLRB, however, held that Oakwood’s rotating charge nurses were not supervisors and could cast ballots in the election.

The determination of who is and who isn’t a supervisor under the NLRA can make the difference between winning and losing a union election. The new guidelines provided by the NLRB in this case, while helpful, provide only general guidance to health care providers and other employers. Each case will turn on its own particular facts. A detailed analysis of this case from Hall Render Killian Heath and Lyman is available on the WHA Web site under legal and regulatory.

The Wisconsin Supreme Court held oral arguments on October 11 for Lornson v. Siddiqui. The question before the court is whether an estate, through its personal representatives, has standing to pursue a wrongful death claim when neither an estate nor its representatives are included among the list of potential medical negligence claimants in the statutes.

WHA and the Wisconsin Medical Society, as amici curiae, have urged the Wisconsin Supreme Court to affirm the trial court’s decision. In their brief submitted to the Court in August, WHA and WMS argued that in determining the claimants entitled to bring medical malpractice claims, the Legislature made specific policy choices. The brief continued that, "When faced with the need to draw the line on who can collect for loss of society and companionship, this court and others have recognized that claims ‘should be limited to those who suffer most severely from the loss of an intimate relationship.’"

At oral arguments, Attorney Lynn Laufenberg representing the appellants, argued that in a medical malpractice case §895.01(1)(o) of the Wisconsin Statutes provides that a wrongful death claim survives the death of the wrongdoer as well as the death of a person claiming loss of society and companionship resulting from another’s wrongful death. §895.01(1)(o) states "[A]ll of the following also survive: (o) Causes of action for wrongful death, which shall survive the death of the wrongdoer whether or not the death of the wrongdoer occurred before or after the death of the injured person."

Justice Jon Wilcox questioned Attorney Laufenberg where such an interpretation of the statute might lead. "What if any cut off could there be? Could you have a fifth cousin living in England [recover the deceased’s loss of society and companionship]; is that where we’re going here?" Attorney Laufenberg responded, "We could have that situation," which prompted Justice Wilcox to observe "I don’t know of any good reason once we start extending this [to determine] where does this end up?"

Attorney Michael Russart, arguing on behalf of the appellees contended that the survivorship statute, §895.01, on its face provides that wrongful death claims only survive the death of the wrongdoer. Justice Patience Roggensack asked, "Why would the legislature have chosen to limit the survival of wrongful death claims to the death of the wrongdoer?" Attorney Russart responded, "[For] the same policy reasons that the legislature has decided to limit wrongful death claims to living relatives…the same reason the Legislature decided to limit wrongful death claims generally to pecuniary damages; it provided a special exception to certain relationships, spouses, parents, children, minor siblings and allowed them to claim for loss of society and companionship damages."

At the conclusion of the arguments, Chief Justice Shirley Abrahamson thanked both attorneys for their arguments "in yet another medmal wrongful death case." A decision from the Court on this case can be expected in several months.

On October 10, 2006, the Wisconsin District I Court of Appeals issued its decision in Hegarty v. Beauchaine. Among several other fact-specific issues addressed in the opinion, the Court of Appeals addressed the applicability of §893.55(7) of the Wisconsin Statutes relating to evidence of amounts paid in determining a plaintiff’s medical expenses, as well as the applicability of the statute when one of the negligent parties was not a chapter 655 health care provider.

The Court of Appeals first noted the recent decision by the Wisconsin Supreme Court in Lagerstrom v. Myrtle Werth, that §893.55(7) permits a fact-finder to "use collateral source evidence ‘to determine the reasonable value of medical expenses,’" though "collateral source payments do not automatically reduce the amount of medical expenses." The Court of Appeals then concluded that the trial court did not err when it determined that the reasonable value of the plaintiff’s medical expenses was the amount paid by the plaintiff’s insurer rather than the amount charged.

However, the plaintiffs argued that §893.55(7) does not apply in this case because 75 percent of the causal negligence was attributed to an unlicensed first-year resident physician who was not a chapter 655 health care provider at the time. The other 25 percent of the causal negligence was attributed to a physician who was indisputably a chapter 655 health care provider. The defendant’s argued that regardless of whether the unlicensed physician was a chapter 655 health care provider, §893.55(7) still applies to the physician, and furthermore, the court should look at the "big picture," that the plaintiff’s brought a medical malpractice case against multiple health care providers, all of whom but one were undisputedly chapter 655 health care providers to whom §893.55(7) applies. The Court of Appeals agreed with the defendant’s arguments that it should look at the "big picture," and determined that although one of the physicians may or may not have been a chapter 655 health care provider, the fact that the other negligent physician was indisputably a chapter 655 health care provider necessitates the application of 893.55(7) to the plaintiff’s medical expenses.

One of the three justices, Justice Fine, dissented from the majority’s opinion on the application of §893.55(7), arguing that the measure of recovery of medical expenses should have been the amount billed. Justice Fine also argued that §893.55(7) should not be applied because one of the physicians was not a chapter 655 health care provider.

The case was remanded back to the trial court.

Next week the WHA Board will discuss and likely approve several recommendations developed by the Association’s Task Force on Access and Coverage. The primary recommendation is the identification and endorsement of specific principles that will guide WHA’s activities during the coming health care reform debate and provide the foundation from which WHA will evaluate and engage specific reform initiatives.

WHA’s current strategic plan identifies three broad guidelines that shape our advocacy priorities. Those guidelines suggest that WHA will work diligently to: 1) foster consumerism and improve health care literacy; 2) improve coverage, access and the health of our communities; and 3) promote member accountability to the communities we serve.

Guided by this strategic plan, WHA’s new task force has met over the past several months and examined the state’s health care delivery and financing system, evaluated pending reform proposals and laid the course for WHA’s future advocacy agenda.

First and foremost, task force members strongly concurred that "Wisconsin’s health care system must provide affordable coverage for everyone’s basic health care needs." But just as important, the task force recommendations embrace the notion of "shared responsibility." Specifically, task force principles identify specific roles for government, individuals, hospitals and physicians, employers, and payers. Collaboration among health care stakeholders must be the catalyst for improving access and coverage while reducing unsustainable health care cost increases.

Over the next few weeks, look for additional information in the Valued Voice relating to the current and future work of WHA’s Task Force on Access and Coverage. Special thanks to Task Force Chair Leo Brideau for his extra efforts in guiding this initiative.

Steve Brenton,
President

Dale Schultz is a member of the Republican Party. He resides in Richland Center. He was elected to the State Assembly in 1982 and later elected to the State Senate in a September 1991 special election. In 2005, Dale was elected by his peers as the Senate Majority Leader. In 2003 Dale received WHA’s Health Care Leadership Award.

John Simonson is a member of the Democratic Party. He resides in Walwick Township in Iowa County with wife. John is a retired professor from UW-Platteville where he taught for 38 years. Earlier in his career, he served three years in the U.S. Army.

Candidate Survey Results: Candidates’ answers to selected abbreviated questions from WHA’s 2006 candidate survey appear below. John Simonson did not respond to the survey. To view the entire survey for this or any other race, contact Eric Borgerding or Jodi Bloch 608/274-1820.

Wisconsin’s Medicaid and BadgerCare programs pay hospitals about 49 cents for every dollar it costs hospitals to care for these patients. In 2005, this resulted in $550 million of unpaid costs that were shifted to the private sector. Known as the "Hidden Health Care Tax," this level of cost-shifting due to under-funded government programs contributes to rising health insurance premiums. The situation is much the same for Wisconsin’s nursing homes, many of which are owned/subsidized by hospitals. Would you support the state budgeting additional funds to pay hospitals and nursing homes more adequately and to reduce the "Hidden Health Care Tax" on Wisconsin employers?

Schultz: YES. "I supported additional funding for nursing homes and hospitals."

In the past, legislation was introduced that would have required hospitals to obtain government approval for new construction, renovation or expansion projects and major new equipment purchases. This legislation failed. Should state government approve hospital decisions about the purchase of state-of-the-art equipment and construction of new facilities?

Schultz: NO.

Schultz: NO.

This past session, WHA supported increasing the tobacco tax by as much as $1.00 and dedicating a large portion of those funds to the Medicaid program and reducing the "Hidden Health Care Tax." Tobacco related diseases cost Wisconsin’s Medicaid program $442 million annually. Forty-three other states, including Illinois, Michigan and Minnesota, have increased their tax since 2002 and Wisconsin now ranks 29^th in what we tax tobacco. A 2005 poll of Wisconsin voters showed overwhelming support (75%) for increasing the tobacco tax if the money is earmarked for state health care programs.

Schultz: YES.

Suder is a Republican who was first elected to the State Assembly in 1998 and has been re-elected ever since. He is a graduate of UW-Eau Claire, is an independent small businessman and a former legislative aide, and a member of the WI Air National Guard and a veteran of Operation Iraqi Freedom.

Swiggum, a Democrat, is the Mayor of the City of Owen. A small businessman, he operates several restaurants. He attended the University of Missouri-Columbia and served three years in the military.

Candidate Survey Results: Candidates’ answers to selected abbreviated questions from WHA’s 2006 candidate survey appear below. To view the entire survey for this or any other race, contact Eric Borgerding or Jodi Bloch 608/274-1820.

Wisconsin’s Medicaid and BadgerCare programs pay hospitals about 49 cents for every dollar it costs hospitals to care for these patients. In 2005, this resulted in $550 million of unpaid costs that were shifted to the private sector. Known as the "Hidden Health Care Tax," this level of cost-shifting due to under-funded government programs contributes to rising health insurance premiums. The situation is much the same for Wisconsin’s nursing homes, many of which are owned/subsidized by hospitals. Would you support the state budgeting additional funds to pay hospitals and nursing homes more adequately and to reduce the "Hidden Health Care Tax" on Wisconsin employers?

Suder: YES. Swiggum: UNDECIDED. "I believe that hospitals should be reimbursed for the full costs of health care. I think that the Legislature needs to focus on the idea of universal single payer health insurance that would help with preventive medicine for lower income and uninsured."

In the past, legislation was introduced that would have required hospitals to obtain government approval for new construction, renovation or expansion projects and major new equipment purchases. This legislation failed. Should state government approve hospital decisions about the purchase of state-of-the-art equipment and construction of new facilities?

Suder: NO. Swiggum: UNDECIDED. "With the looming and continuing health care crisis, it would seem untimely to spend millions of dollars on new facilities even though some may be needed. Reducing costs is key right now."

Suder: NO. Swiggum: NO. "Hospitals know best what services cost but when costs are artificially inflated then an explanation is due. I don’t believe the government should set prices but could monitor them."

This past session, WHA supported increasing the tobacco tax by as much as $1.00 and dedicating a large portion of those funds to the Medicaid program and reducing the "Hidden Health Care Tax." Tobacco related diseases cost Wisconsin’s Medicaid program $442 million annually. Forty-three other states, including Illinois, Michigan and Minnesota, have increased their tax since 2002 and Wisconsin now ranks 29^th in what we tax tobacco. A 2005 poll of Wisconsin voters showed overwhelming support (75%) for increasing the tobacco tax if the money is earmarked for state health care programs.

Suder: NO. "I oppose all new taxes, however I would support additional GPR for such programs if fund are available." Swiggum: YES. "The overall picture of the health care system would need to be addressed with these funds. The funding of wellness programs is essential in reducing overall costs."

Cong. Ron Kind (D-La Crosse) was the featured speaker at the WHA West Central Region’s Annual Trustee Forum held on October 11 in Eau Claire. Cong. Kind provided the roughly 50 attendees a national snapshot on health care issues, including information about what the next legislative session may hold.

As a steering committee member of the Rural Health Care Coalition, Kind continues to be an advocate for rural hospitals, and he indicated he would again concentrate on rural health legislation next session.

In discussing other health care issues, he cited the importance of preventing Medicare physician payment cuts. He also spoke of the need for more investment in preventive activities, specifically noting childhood obesity as an example, and in end of life care, citing the example for Medicare where more than 25 percent of the costs of that program are spent on patients in the last year of their lives.

Columbia St. Mary’s (Milwaukee) Hosts State Sen. Jeff Plale

September found State Sen. Jeff Plale (D-South Milwaukee) visiting the hospital he represents, Columbia St. Mary’s in Milwaukee. Sen. Plale represents two of the system’s three Milwaukee campuses.

Columbia St. Mary’s (CSM) CEO Leo Brideau used this relationship-building meeting to familiarize Sen. Plale with the hospital and its mission, and to also provide insight into the hospital’s activities and initiatives.

During the visit, CSM staff gave information on efforts to improve quality and safety, reduce costs and increase access to health care. When talking about transparency, CSM highlighted the work of hospitals through initiatives such as WHA’s CheckPoint and PricePoint. As Chair of the WHA Task Force on Access and Coverage, Brideau was able also to give Sen. Plale an up-to-the-minute look at the work of this high-level task force.

The visit concluded with an update on CSM’s construction project and a tour.

Synergy Health Hosts Rep. Pat Strachota

Rep. Pat Strachota (R-West Bend) visited with leaders from SynergyHealth System and its West Bend facility, St. Joseph’s Community Hospital.

During the meeting, Synergy CEO Greg Banaszynski stressed to Rep. Strachota that it would be helpful for legislators to all start from the same vantage point when evaluating health care proposals. He said one of the most important things for legislators to know before crafting a proposal are the true cost drivers. This way legislators will not be crafting proposals that fail to address those cost drivers.

Synergy also reported on its partnership with UW Waukesha County to do an economic development impact study to quantify what Synergy provides to the local community and economy.

Sauk Prairie Memorial Hospital Hosts Schultz, Freese

Sen. Dale Schultz (R-Richland Center) and Rep. Steve Freese (R-Dodgeville) recently visited with Sauk Prairie Memorial Hospital & Clinics (SPMHC) management and physicians. During the visit, Schultz and Freese stressed the importance of consumer access to health care data.

SPMHC leaders used the time to encourage both legislators to continue their work on maintaining Wisconsin’s positive medical liability environment, citing problems in other states with losing physicians when malpractice costs become unaffordable.

Froedtert Hospital will offer an Advance Trauma Care for Nurses course (ATCN) on December 7 and 8, 2006, at the Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee. Sponsored by the Society of Trauma Nurses, Froedtert Hospital, the Medical College of Wisconsin, the American College of Surgeons, and the Wisconsin Trauma Coordinator’s Group, the benefits of the ATCN course include an educational, team building, collaborative, and synchronized approach to trauma care as trauma nurses share didactic lectures with the physician attendees of the Advance Trauma Life Support course.

Doctors and nurses will have the opportunity to share a common language and approach to trauma care as they break out in specific skill stations. For more information, contact Robin Evans at Froedtert Hospital, 414-805-8621.

The Department of Health and Family Services (DHFS) has launched a Web site that patient advocates and those who work directly with patients on issues related to billing questions will find helpful. The Web site allows online access to the Family Medicaid1 (including Healthy Start and BadgerCare), in addition to several other programs. The ACCESS Web site (www.access.wi.gov) includes three easy-to-use features: (1) a short self-assessment tool to find out if someone appears eligible for health and nutrition programs; (2) an online application tool; and (3) a benefit management tool so Medicaid and BadgerCare recipients (and some other recipients) can check the status of their benefits and report required changes to maintain coverage.

ACCESS may be of interest to hospital administrators, hospital social workers and patient advocates because now patients - and hospital staff who assist them – can quickly apply for Family Medicaid and BadgerCare from any computer with internet access. The benefits to hospitals from assisting uninsured patients to enroll in Medicaid and BadgerCare are considerable – timelier payment for medical care, less uncompensated care, backdated coverage, and better quality care. Uninsured low-income patients also benefit from receiving needed health care without incurring medical bills they may have difficulty paying.

ACCESS is easy to navigate, utilizes simple language, friendly icons, progress indicators, HELP screens, and relies on check boxes to minimize typing. The site has received many positive comments from users.

There are many ways hospitals can use ACCESS;

• Tell patients about the service;
• Display or give ACCESS brochures and cards to patients; (You can order free materials online at www.dhfs.wisconsin.gov/em/access/advocates.htm)
• Add a link to ACCESS from your webpage;
• Provide private internet-ready workstations where patients can use ACCESS;
• Directly assist patients to complete the online screener or application.

Want More Details?

"Am I Eligible" This tool helps people find out if they appear eligible for Family Medicaid (including BadgerCare), EBD Medicaid, Institutions MA, Community Waivers, Medicare Premium Assistance, family planning waiver, SeniorCare & Medicare Part D. AIE also checks eligibility for FoodShare, child nutrition programs and tax credits. It takes customers 15-20 minutes to enter information on their household, income and bills. They instantly get a printable summary of which programs specific people in the household appear eligible for and instructions on applying. Over 100,000 people have used this screening tool to date. Ninety percent of those completing the questionnaire appear eligible for one or more programs – 50 percent for Family Medicaid2.

"Apply For Benefits" This tool enables people to submit an application for Family Medicaid, BadgerCare, family planning services, and FoodShare. It takes about 45 minutes, but applicants can save their work and return later. Medicaid applicants can request backdated coverage up to three months prior to the current month to pay for recent treatment. Applications are "signed" by checking a box. Submitted applications arrive within seconds at the local Human Services office. Caseworkers then mail applicants a list of documents to provide (and can be mailed, faxed, or dropped off). Interviews are not required for Family Medicaid and BadgerCare. About 2,000 applications are received via ACCESS each month – 70 percent for Medicaid and BadgerCare.

"Check My Benefits" This tool allows people who already receive Medicaid (including BadgerCare) and SeniorCare to manage their benefits online. (FoodShare & Caretaker Supplement recipients also can use CMB). Clients can find out basic information about their benefits such as who is covered, dates of coverage, premium amounts and due dates, and when case reviews must be conducted. Recipients can also report some required household changes to the local agency to maintain their benefits.

1 Elderly, blind and disabled persons may use ACCESS to apply for EBD Medicaid but a caseworker will need to contact the applicant to get information on their assets and medical bills. DHFS plans to enhance ACCESS in the future to collect this information online.

2 The "Am I Eligible?" screener may incorrectly tell some households they appear "ineligible" for Family Medicaid. This is because the screener doesn’t apply special rules (FFU logic) that extend eligibility for some people in certain circumstances. AIE also does not test eligibility for the MA deductible program. Applicants that may be affected include households that have (1) medical bills, (2) step-children, (3) unmarried parents with a child(ren) in common, (4) pregnant women, or (5) child(ren) with income. AIE warns about this on the Results page. If any of these households appear ineligible for Family Medicaid, applicants and providers should know that the only way to determine the household’s actual eligibility is for them to submit a full application.

When Reedsburg Area Medical Center (RAMC) moved into its new Reedsburg Area Senior Life Center in the fall of 2005, it left the existing nursing home (Edward Snyder Nursing Home) vacant. The old nursing home would remain vacant and virtually untouched until it was to be razed in the summer of 2006, to make way for the Medical Center’s newest construction project.

Aware of a countywide homeless organization, Homeless Haven, that had recently lost its shelter, RAMC president George Johnson opened this vacant building to become a temporary home for the homeless of our county.

Says Johnson, "Offering our assistance gave Homeless Haven some time to seek alternative housing and it at least covered them throughout the winter months. The location was also good because people could walk to jobs in the area, use the city cab service and be near medical care."

"A common misconception about homeless people is that it is their fault or that the problem does not exist," commented Betty Krueger, director of Homeless Haven. "We’re trying to get rid of the myth that there are no homeless here."

Medical Center staff was thrilled to pitch in, offering their support in donations of food, toys, supplies and more. Homeless Haven would compile a wish list, submit it to staff and their spirit of giving came out flying.

Reedsburg Area Medical Center was pleased to help in these ways – it was the right thing to do and another example of how RAMC is dedicated to going beyond the expected.

Submit hospital community benefit stories to Mary Kay Grasmick, editor, mgrasmick@wha.org or call 608-274-1820.

WHA is currently soliciting appointment requests from WHA members to WHA councils and subcommittees. Appointments are being sought for five councils and one committee. A council preference form is in this week’s packet. Please review and return it by November 17. Direct questions to Sherry Rabuck or Steve Btrenton at 608-274-1820.

WHA Financial Solutions is pleased to announce that Sheri Rasmussen has joined the company as director of employee benefits. Having made a career of the insurance industry for more than 25 years, Sheri has extensive experience with medical and dental programs with various funding arrangements, as well as group life, disability, and vision programs. She holds an active life and health insurance license in the state of Wisconsin.