"This initiative is a proactive response to growing public interest in measuring patient quality and safety," according to WHA President Steve Brenton. "This level of participation clearly demonstrates that Wisconsin hospitals place a high priority on providing information that will help people become more informed consumers of health care."

Brenton said new measures will be added on a regular basis. He explained that the first 10 measures were chosen because they include data on the three main causes of hospitalization: pneumonia, heart attack, and congestive heart failure.

"By giving consumers information about these three conditions, we can help improve their overall health status," according to Brenton. "This is an evolving science; CheckPoint^SM is not meant to be a final product, rather it is a first step to share measurements that are scientifically proven to produce quality outcomes."

Charles Shabino, MD, chief medical officer at Community Health Care, Inc., Wausau, is a member of the Wisconsin Quality Steering Committee that guides the WHA quality initiatives. He said the task force he co-chaired with Ken Buser, president and CEO, All Saints Healthcare System, Racine, considered what the best data are for measuring the quality of care in hospitals.

Shabino pointed out that one of the important aspects of the program, in addition to providing information to the public, is that data will be shared among over 100 hospitals in Wisconsin that can be used for their own internal quality improvement programs.

"It there is a practice that is proven to improve quality in one setting, through CheckPoint^SM, it will be shared with other hospitals and ultimately, increase the quality of care statewide," Shabino added.

CheckPoint^SM information will be displayed on a public Web site that is now under development and scheduled to be operational early in 2004.

(see map of participants at www.wha.org/qualityAndPatientSafety/accountability.aspx)

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The quality of health care services in Wisconsin is literally second to none. I am terribly proud of the professionals and the facilities that I am aware of in Wisconsin. It is a bragging point for me as a representative from Northeastern Wisconsin. By any measure, we are doing a good job in health care in this state. I think efforts at self-improvement are fantastic. That is the wave of the future. Health care professionals provide good care, not because of mandates, but because of who they are. The fact that the Wisconsin Hospital Association and health care professionals are coming together to set the bar and then raise it should not be a surprise to anyone. I would love to see in the future such issues as reimbursement rates tied to performance measures. That is the answer. Your reimbursement should not be driven by geography but by the quality of care you are providing. This is a positive development and it is very exciting.

Medicare reimbursement is the single most important issue facing our state. It threatens access to care in Wisconsin if something is not done soon. I worry about the ability of institutions in rural areas, particularly in northern Wisconsin that I represent, to stay open and continue to provide care. The Medicare Reform Bill that is in conference now presents what may be a once in a generation opportunity to address the reimbursement gap. And from my perspective, that may be the most exciting thing about the Medicare Reform Bill. We are monitoring it very closely and are working with the rural health care coalition and other organizations to ensure that some of the positive provisions of the bill remain in the final product.

Prescription drug coverage and Medicare reform must go hand in hand. In political terms, piecing together the coalition to save Medicare both nationally and in Wisconsin is held together with prescription drugs. A prescription drug benefit is something we must do. And so we think by holding prescription drug coverage for seniors together with Medicare reform will do something extraordinarily good. Whether or not the final bill will be something that will fulfill the promise is delicate at this point. The conference committee has not begun casting the tough votes. We are all hopeful and impatient.

The house version of prescription drugs and Medicare reform has a number of provisions in it that will dramatically increase federal reimbursement under Medicare to Wisconsin hospitals. Now, remember, Wisconsin is a state with all different kinds of communities and facilities, so not everyone benefits to precisely the same degree, but when one looks at the state as a whole, it is clear the situation will improve dramatically under the House version of the bill.

3. What health care issues or concerns are being expressed by your constituents?

We have heard a lot about the rising cost of health care. It is replacing taxes as the #1 issue for small businesses, because they are taking a look at their rising costs, and they see rising costs increasingly are becoming major drivers in the cost of production. It has reached the point where health care issues are no longer just health care, they are economic issues. I have already had a number of meetings on competitiveness and manufacturing in Wisconsin and loss of jobs. Health care is part of that. Our rising costs of health care make some of our businesses less competitive than their counterparts in other countries.

The shortage of health care workers is going to get worse before it gets better. In terms of funding, we haven’t passed the Health and Human Services bill yet, and it will have funding for workforce in it. There have been a variety of efforts to address the shortage, especially nursing. All of them are good, but all of them may not be enough. There is no silver bullet. We need to increase nursing education and find ways to make the nursing profession more attractive. I think we need to reach out to all sectors of the community to talk about the great fulfillment that health care careers provide. Literally, we will need to do all of the above, and more, to solve this crisis. We have talked to a lot of people about it, we support them, but the sobering news still doesn’t get us past the immediate shortage. People in health careers take on the role of healers, and we have not done enough as a society to reach out to schools and let people know what is involved. We have a stereotype of who we think should be a nurse and what they should do. Nursing today is such a broad range of opportunities and services. And people who have not thought about nursing before—should! There should be more outreach to get men into the field of nursing, break down the stereotypes and let them know the service that they can provide to society while finding a deep sense of personal satisfaction. We must also recognize the benefit of working with our institutions of higher education. Graduate Medical Education programs must be adequately funded. We have asked the conferees to increase funding for the Wisconsin Technical College training program to benefit health care programs, to help address the health care provider shortage.

One other area we are all working on is litigation reform as a tool to manage health care costs. Wisconsin is one of literally a handful of states that does not have a medical malpractice liability crisis. I am proud to say it is because of what we did 10 years ago. I authored litigation reform when I was a legislator in Wisconsin. We should be talking about how important that has been and important it will continue to be. We are engaging in a debate on the national level on medical malpractice costs. The reason why we have to debate it on the federal level is that now so much of insurance premiums are driven by consolidation in the insurance sector, large managed care and insurance corporations setting rates. What goes on in other state affects us, and we need to be talking about litigation reform right along with the rest of the states.

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Last year, changes were made in the way that the Wisconsin Nurse Aide Registry operates, and the mechanism for testing graduates of Nurse Aide Preparation Courses was also changed. The Registry, operated by the Department of Health and Family Services (DHFS) and state authorized testing programs, was replaced by an outside vendor, Promissor. Several problems arose with this change which included an inadequate number and location of testing sites, the timed nature of the new test, a new $100 fee for testing, questionable test pass rates, and inaccuracies in the Registry.

The Wisconsin Technical College System (WTCS) had been allowed under the previous system to test their own graduates. In the new system, that testing was done by Promissor. WTCS refused to allow their facilities to be used for testing.

In May, a hearing was held by the Assembly Long Term Care and Aging Committee. Many technical school students and staff testified about the above issues. At the hearing, Rand Key, executive vice president of WTCS, put forth an offer that WTCS would assume responsibility for all Nurse Aide testing in Wisconsin and would do so without fees to the user.

On Monday, October 13, 2003, stakeholders were assembled to hear the results of more than four months of planning by WTCS, DHFS and Promissor. The results announced at that meeting were a surprise to most of the audience. WTCS representative Rand Key acknowledged that the task for which he had volunteered the technical college system was too large and too complicated for it to accomplish. In addition, DHFS announced that the U.S. General Accounting Office had initiated an investigation of Nurse Aide Training and Registry regulatory compliance with Wisconsin practice as a focus.

The result of these announcements is that Promissor will continue to be the vendor for both testing and registry services in Wisconsin. Additionally it was reported that:

• The WTCS is encouraging its colleges to offer facilities as testing sites.
• The WTCS is encouraging it faculty and staff to become Promissor testers.
• Errors on the Registry have been corrected and most changes to the Registry are on-line and available within one working day.
• The timing requirement for the nursing skills test has been removed.
• Some sources of funding for the $100 fee exist, with Workforce Investment Boards being an example.

What can you do?

• Encourage your local technical college to become a testing site.
• Report ongoing and/or new issues with nurse aide training, testing, or the registry to Sue Larsen, Interim Chief, Caregiver Regulation, Bureau of Quality Assurance, at 608-243-2084.

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Earlier this year, it was suggested that Wisconsin can become a national leader in initiating private sector programs that are designed to improve patient quality and safety. With recent developments, it’s now becoming clear that, in fact, Wisconsin is a national leader in private sector-driven quality and safety initiatives. Consider this:

• This week, WHA announced that more than 100 Wisconsin hospitals have volunteered to participate in the CheckPoint^SM initiative. That participation rate means that Wisconsin hospitals serving 95% of the state’s inpatient population have agreed to publicly report 10 key clinical measures and progress toward achieving five safety goals that will provide consumers and purchasers with reliable and meaningful data. And the evolution of this program promises an even more robust set of measures over the next few years.
• Next week, the Wisconsin Collaborative for Healthcare Quality…a provider-led organization with significant business/labor partners…will unveil an impressive array of measures relating to physician and hospital performance. A key tenet of the group’s mission is "publicly reporting performance of health care delivery organizations against the established measures."
• And in Madison, the Madison Patient Safety Collaborative has been operating since 2000 as a joint activity between St. Marys Hospital Medical Center, Meriter Hospital, the University of Wisconsin Hospital and Clinics, and the William S. Middleton Memorial VA Hospital (and the community’s major physician organizations) in order to advance a strong patient safety agenda.
• Also in Madison, the Wisconsin Patient Safety Institute (WPSI) represents a voluntary, statewide commitment by dozens of organizations to meaningfully improve patient safety through a variety of special initiatives.
• Each of these activities and other ongoing projects in communities statewide demonstrate a commitment to accountability that may be unmatched in the nation. The willingness of providers to publicly report performance is especially profound! That commitment is receiving widespread and well deserved favorable commentary.

In addition to the public reporting of quality and safety measures, it’s important that as these initiatives evolve, efforts be deployed to support necessary educational programming in which outcomes and identified best practices can be shared among providers and purchasers (including the real consumers) of health care. Frankly, provider organizations today are a bit ahead of our public stakeholders who are generally delighted about the willingness to share information but a bit uncertain as to what all of this means. Long-term success means engaging consumers and improving their health care literacy if patient-centered health care is to become reality.

Steve Brenton
President

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The WHA Board of Directors met October 16 in Madison. Chair Jerry Worrick introduced the new WHA Information Center Vice President Joe Kachelski.

WHA President Steve Brenton presented the WHA 2003 Board Planning Session Outcomes. He reviewed 15 expected outcomes organized under three themes: accountability, workforce, and advocacy.

Brenton also presented the 2003-2007 Strategic Plan, which was shaped by the Board Planning Sessions of 2002 and 2003. Following review by the Board, the Strategic Plan was approved.

The Board also approved the 2004 WHA budget, which provides resources for implementation of new workforce and quality initiatives, and includes an average dues increase of 2.5%.

Joe Kachelski, vice president, WHA Information Center, and George Quinn, WHA senior vice president, presented a progress report on the collection of hospital claims data being transferred to the Association. Kachelski reported several new employees will be assuming their positions in early November and the transition is progressing. Quinn said a governing board as well as a users group will be created for the new Information Center.

Other reports included:

• Mary Starmann-Harrison, chair, WHA Public Policy Council, said the council meeting convened in Washington DC was worthwhile and effective.
• Ford Titus, chair of the Advocacy Committee announced the 2003 goal of $125,000 for Healthy Wisconsin has been met, and 217 new individual givers were added this year. The committee will meet soon to set goals for 2004.
• Task Force on Wisconsin Future Physician Workforce Chair Leo Brideau reported that the group has made progress and will work on three issues at the next meeting: physician preparation; primary care physician supply; and the preparation process for specialists.
• Finance Council Chair Ned Wolf reported on a workgroup that is looking at payment issues related to Medicaid and HMO handling of ER visit payments; worker compensation issues; business coalition issues; non-standard coding; and benefit design changes that result in discriminatory business practices.
• George Quinn reported that the Council on Rural Health discussed member issues regarding BQA surveys and ways that WHA could address the problem.

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Make plans now to attend one, or several, of the educational seminars being offered by WHA this fall.

• EMTALA Final Rules: The Basics, The Changes, and The Implications
  October 29 at Crowne Plaza in Madison

• Improving Your Reimbursement Contracts
  November 5 at Kalahari Resort in WI Dells

• The Revenue Cycle: Successful Strategies for Positive Reimbursement
  November 6 at Great Wolf Lodge in WI Dells

• Conference for Executive and Administrative Assistants
  November 6 & 7 at Great Wolf Lodge in WI Dells

• 2004 JCAHO Environment of Care: A Practical Approach to the Survey Process
  November 13 at Crowne Plaza in Madison

• The Health and Safety Challenges for the Infection Control Practitioner and Safety Professional
  November 14 at Crowne Plaza in Madison

Virginia Regional Medical Center, located 60 miles from Duluth, Minnesota, is seeking a chief executive officer. This 83-bed acute care and 116-bed long-term care health care facility, located in Northern Minnesota provides a full spectrum of inpatient and outpatient services serving the needs of Virginia and surrounding communities.

Qualified candidates must have bachelor’s degree in health care administration, business administration or related field with a master’s degree preferred. At least ten (10) years progressive experience in healthcare management with three (3) years CEO experience is required. For confidential consideration, please send your resume and cover letter to: John Skube, Virginia Hospital Commission, Virginia Regional Medical Center, Administration, 901 9th Street North, Virginia, MN 55792. For information or questions, contact Steve Roskoski, human resources director, at 218-749-9423 or e-mail stever@vrmc.org .