The Wisconsin Hospitals Issue Advocacy Council (WHIAC) on October 13 released its second radio ad in a month as a part of an ongoing "Fair Share for Health Care" campaign. The effort is targeted at educating the public and state lawmakers about the lack of Medicaid funding the state of Wisconsin captures from the federal government and the impact it is having on health care costs.

According to the Wisconsin Hospital Association (WHA), hospital prices in Wisconsin were $635 million higher in 2007 because the state Medicaid program reimburses less than half of what it costs to deliver care to Medicaid patients. The $635 million is the amount of the shortfall that is passed on to everyone else.

"We are sending hundreds of millions of our tax dollars to Washington every year, but not doing enough to bring our fair share back home," said WHA Executive Vice President Eric Borgerding. "Because we’re not doing enough to capture those dollars, millions are going to other states, like Illinois, to help control their health care costs."

Medicaid is the safety net health care program for low-income, uninsured patients. It is a state/federal partnership in which the federal government provides $1.46 for every $1 contributed by the state. Wisconsin ranks among the worst in the country in terms of drawing down federal dollars for hospital Medicaid payments and subsequently ranks among the worst in the country in overall dollars received from Washington.

Wisconsin ranked 44th in the per capita state and federal Medicaid dollars used for hospital payments—well behind most of its Midwestern neighbors. As a percentage of its total state budget, Wisconsin is the 11th worst when it comes to investing in the Medicaid program. The result—$635 million in unpaid Medicaid costs were shifted to small employers and families in 2007.

The new WHIAC ad, titled "$635 Million," will run for two weeks statewide and urges listeners to contact their state legislators and capture Wisconsin’s "Fair Share" of federal Medicaid dollars. The ad script appears below.

The Wisconsin Hospital Association is a membership organization that advocates for the ability of its members to provide high quality health care services to Wisconsin communities. The Wisconsin Hospitals Issue Advocacy Council, Inc. includes a coalition of Wisconsin health care providers committed to promoting, developing, and distributing information about Wisconsin’s health care climate and the importance of enabling high quality health care to the general public of Wisconsin. For more information, visit www.wha.org.

Ad Script: We Can Do Better

Announcer: $635 million. That’s the amount of unpaid hospital costs from one government health care program last year. $635 million. That’s how much more we pay for health care because government isn’t paying its fair share. Millions of our federal tax dollars are going to other states…dollars that could be used to lower our health care costs in Wisconsin. State legislators can change this. Call them at 800-362-9472 and tell them to bring our share of health care dollars home. Paid for by the Wisconsin Hospital Issue Advocacy Council.

Speaking at the WHA Board of Directors meeting October 16 in Madison, Department of Health Services Secretary Karen Timberlake commended the Association for its commitment to CheckPoint (www.wiCheckPoint.org) and its transparency initiatives that continue to drive higher quality.

"This Association has been a leader in public reporting, and you have a great story to tell that doesn’t get told enough," she said. Timberlake said the Wisconsin Health Information Organization (WHIO)—both Timberlake and WHA President Steve Brenton serve on the WHIO Board—will be another resource in the future where the data collected could be helpful in improving the efficiency and quality of health care while also serving as a medium to share best practices.

In his introduction of Timberlake, Brenton said the Association works closely with both her and the Department. Brenton said he is particularly pleased to see the Secretary personally involved in the Milwaukee Partnership Program, which is actively shaping solutions that will lead to expanded capacity for and access to health care for vulnerable populations.

State Budget Faces Huge Deficit

Sec. Timberlake said the state budget is "heading into choppy water," facing a potential $3 billion deficit leading into the next Biennium. Sales and income tax collections are falling off. The good news is, according to Timberlake, "We’ve been here before…the bad news is we have had six years to move forward and now we’ve been pushed back due to the turmoil at the national level."

Timberlake said there are a lot of questions about what is on the table, but at this point, said she has no information. Governor Doyle has continued to say he will protect key priorities, leaving new spending most at risk. Timberlake said DHS continues to wait for the federal waiver necessary to fund the Childless Adults expansion. The fact that other states are seeking approval for similar waivers should be a good sign, and Timberlake is cautiously optimistic.

Timberlake said the priorities for the Department have not changed and continue to reflect the Governor’s agenda. They remain focused on providing affordable, high quality health care in Wisconsin, expanding BadgerCare Plus, and working in other areas through Family Care, and managed long-term care initiatives. She said they are working to clear the 11,000-person waiting list of those who qualify for publicly–funded long term care. Timberlake said the Department will sharpen its focus on prevention and continue to have a keen interest in the correctional system. She said the correction system has become a defacto behavioral health system, as they see the admission rates in the State’s two mental health facilities soar. She said that problem could be a symptom of a much larger issue, which is the decline in private inpatient beds.

Timberlake noted that the formation of an Association Task Force on Behavioral Health was of great interest to the Department as well as the WHA’s work on issues surrounding the health care workforce. She commented that she "can’t get through a week without both of those issues being raised," and looks forward to continued collaboration with WHA on those and other issues.

BadgerCare Plus Update

Since February, more than 85,000 new participants have been enrolled in BadgerCare Plus, which includes 55,000 children. The additional dollars required to cover these people, "can be managed" according to Timberlake. Of the 85,000, more than 80 percent were already eligible under previous requirements and should have been enrolled earlier.

Affordable insurance for employees who work in small businesses continues to be a priority of the Doyle Administration. According to Timberlake, 20-30 percent of Wisconsin employees are in businesses that employ between two and 50 employees. Only 44 percent of those businesses can afford health insurance. Timberlake said the goal is to pool the collective buying power of those businesses to create a virtual marketplace where insurance companies can bid a more flexible benefit package, forcing more reasonable rates.

Hospital Assessment

The Department has a group working on how to finance Medicaid. Timberlake said the hospital assessment is the only way to significantly raise Medicaid rates. The assessment will be proposed again in 2009; the timing depending on the political and economic environment. Timberlake thanked Brenton and the Association for working with the Department to sort through the complex components of an assessment and improve the potential for a workable solution that will provide significant relief to hospitals now so poorly reimbursed by Medicaid.

2010 State Health Plan

Timberlake said the next State Health Plan will refocus the dollars that Wisconsin spends on public health toward shaping a set of goals and outcomes that will improve overall health status. Frank Byrne, MD, president, St. Mary’s Hospital, Madison, is WHA’s representative on the Healthiest Wisconsin 2020 Planning Team. Timberlake said she doesn’t expect a lot of changes to the health priorities, but does expect the focus to be on implementation and measurement.

According to Timberlake, 2010 fell short because, "The plans sat on the shelf and were not utilized outside the traditional public health sectors. More attention should be paid to identifying partners and identifying their roles for the 2020 plan."

The Planning Team hopes to spend the majority of their time working on implementation and redefining the vision of the public health infrastructure—and hospitals are a key part of that infrastructure.

eHealth Initiatives

The Department has an eye toward continuing to push hospitals to adopt electronic health records, recognizing it is very costly. The Department wants to continue to understand the barriers to adopting EMR. Timberlake recognized the success of the ED Linking Project in Milwaukee, calling out the fact that it is just the beginning of demonstrating the power of effectively sharing medical records. She sees the role of government as that of a "convener" to ensure standardization and inoperability.

President’s Report

Just prior to the President’s Report, WHA Board Chair Ken Buser recognized the new physician recruitment Web site, www.WisconsinPhysicianCareers.org, developed by WHA for the Wisconsin Council on Medical Education and Workforce. He said the effort aligns nicely with hospitals efforts to recruit physicians.

Brenton said the WHA staff has completed many projects over the past couple of months, and the Association is well on the way to achieving its 2008 goals. In particular, the WHA 2008 Health Care Workforce Report and the physician career Web site were completed in October; mortality measures were added to the CheckPoint Web site late in September and WHA issued a Health Information Technology Report that was well received by members and the media this fall.

The Board Planning Session in June focused on health reform and discussion on how to achieve the principles set forth by the WHA Task Force on Access and Coverage.

"Planning session discussion earlier this summer has well prepared WHA to actively promote a meaningful reform agenda that focuses on improving coverage and access with an eye to containment," Brenton said.

Advocacy Developments

WHA Executive Vice President Eric Borgerding briefed the Board on the current political environment and its potential impact on health care policy. "A rapid confluence of unanticipated and challenging developments in the economy and stock market all set against the backdrop of the election season makes preparation now for next year critical," Borgerding said.

According to Borgerding, the Association is now laying the groundwork for working with a new Legislature following the elections. Since the September primary, he and Paul Merline, WHA vice president of government relations, have completed 54 visits with incumbents and candidates to ensure that they are educated on and know the issues hospitals are facing before they arrive in Madison. Preparation is essential as the state budget will once again dominate the political landscape in 2009.

"We are facing an ugly revenue situation going into the next legislative session. Revenue collections are way down and there are serious shortfalls. Looking ahead, there are a lot of things looming that will make the situation even worse next year. The $200 million shortfall, if the WCPCF suit is successful, is in play as well. The Medicaid Budget request is at $600 million cost to continue, which is general purpose revenue, and does not include the federal match. Put that against the deficit, and this is a bad situation going forward," Borgerding said.

Borgerding said WHA’s pre-election strategy has hinged on three key priorities:

• Candidate visits (see above) that emphasize
• Medicaid and its various related issues
• Hospital effort to improve health care access and reduce cost
• The leadership role Wisconsin hospitals are playing in the area of quality and transparency
• Wisconsin hospitals’ massive financial and service commitments to their communities
• Race and issue polling. Health care continues to be a key issue for voters. According to Borgerding, the public needs more education about how state legislators’ actions on Medicaid impact their health care costs. With that in mind, the Association is focusing on the impact of cost shifting and the hundreds of millions in federal Medicaid dollars the state is leaving for other states to claim. "Wisconsin is not aggressively pursuing its fair share of Medicaid dollars, and health care costs are rising as a result," he said.
• Issue advocacy radio ads. Consistent with these Medicaid messages, Borgerding played the first two of three ads airing on 75 radio stations in the state. The ads can be found at www.wha.org/governmentRelations/medicaidFairShare.aspx.
• Post election. Borgerding said the Association will ramp up all elements of its strategy in preparation for the 2009-10 legislative session.

WHA Senior Vice President George Quinn briefed Board members on ongoing staff efforts with DHS Medicaid staff to ‘fine tune’ aspects of the hospital assessment and payment related issues, noting that WHA Board-approved principles frame the work.

WHA Council Reports

The Board heard reports from WHA’s Councils. Highlights included:

WHA Council on Medical and Professional Affairs
Dana Richardson

• The 2008 Quality and Safety Forum is next week in Wisconsin Dells.

• AHRQ inpatient HCAHPS data will be displayed on CheckPoint by the end of the month.

• Pressure ulcer improvement project: A wide variety of stakeholders have been meeting for the past six months. The collaborative is modeled after the successful New Jersey project. Richardson urged hospitals to sign up for this collaborative.

WHA Council on Finance and Payment
George Quinn

• The Council discussed a couple of initiatives related to the WHA Guidelines on Billing and Collections confirmation of commitment on charity care. Hospitals will be urged to post their charity care guidelines on their Web site. Information will be sent to CFOs and PR managers within the next two weeks on this initiative.

WHA Council on Workforce Development
Judy Warmuth

• At the last meeting the Council discussed union strategy and the potential for public policy impacts, ratios legislation, and mandatory overtime. Dean Sally Lundeen from UW-Milwaukee College of Nursing spoke at the meeting and continues to be concerned about a faculty shortage.
• The next meeting will focus on increasing the number of pharmacy clinical hours required for accreditation, fatigue and what steps are being taken locally to address these issues.

WHA Council on Public Policy
David Olson, Chair, Public Policy Council

• State Budget Director David Schmiedcke attended the last Public Policy Council meeting and previewed the difficult budget challenges that lay ahead.
• WHA Associate General Counsel Matthew Stanford provided an overview of the amicus brief WHA provided in the Injured Patients and Families Compensation Fund case.

Top of page

Following a successful year of supporting a variety of initiatives with positive statewide impact, the WHA Foundation has officially kicked off its 2008 annual fundraising efforts, announced Foundation Chair Dan Hymans.

"The Foundation Board continues to focus its funding priorities on initiatives that have statewide impact on health care in Wisconsin, and we ask our hospital members to continue to support the work of the Foundation by making a contribution this fall," Hymans said.

According to Foundation Director Jennifer Frank, the funds raised last year were used for a variety of initiatives. The WHA Foundation scholarship program awarded 35 scholarships worth more than $37,000 to technical college students finishing their final semester of a health care-related degree program. Also, recognition and financial support were provided to a free dental clinic in Stevens Point and an Eau Claire-area mental health resource initiative for teens and children through the WHA Foundation Global Vision Community Partnership Award. Funds raised in the 2008 campaign will be used to continue these initiatives, offer another round of nurse leadership programming, and give the Foundation Board the opportunity to consider new funding initiatives.

Since the national launch of the new physician career Web site, www.WisconsinPhysicianCareers.org, more than 53 different health care organizations in Wisconsin have posted over 600 positions. Of the 600 posted, 145 were in family medicine, 20 for pediatricians, and 68 positions were listed for internists. The response from hospitals and clinics that have posted positions have been extremely positive, but they are not the only ones who find the site beneficial.

Rob Fishman, MD, a second year resident in the Wausau-based UW Family Medicine Residency Program is still undecided where he will locate his medical practice when he completes his training in 2009. The California-native is, however, very impressed with the physician career Web site.

"It is very detailed and a well-organized site with a high degree of transparency and honesty. From the list of the sponsoring organizations on the front page, to the way the hospitals and clinics describe the positions, it is very genuine and accessible," according to Fishman. "I like the fact that you can search for openings statewide, on your own time, send an email to find out more about a position directly to the hospital or clinic that has an opening, and have much more control over who contacts you and when," he added.

Fishman said he receives a steady stream of emails and direct mail pitches from recruitment agencies across the country—he knows the competition for hiring physicians is fierce. But he said what they often forget to include is information about the quality of life.

"After four years of medical school, and three years in a residency, the most important consideration for me as I get closer to completing my residency is finding a practice in a community where I can enjoy a high quality of life. The recruiters push salary, and with student loans that is one consideration, but it is not the most important to me," Fishman said. "This Web site is clearly focused on quality of life and provides a lot of detail about what it’s like to live and work in the community where you’d be practicing medicine."

WHA Senior Vice President George Quinn said the Association spent a lot of time researching what type of vehicle would best meet the needs of Wisconsin providers seeking physicians and in turn, also be of value to physicians seeking a practice location. What WHA learned in focus groups is physicians want to have as much control over their job search as possible and wanted direct contact with potential employers.

"Based on the feedback we’ve received from our members and from physicians who have started using the site, the time we spent up front seeking input on the site is really paying off," according to Quinn. "One of the main advantages is that it is a Wisconsin-only site. It focuses entirely on positions that are open in Wisconsin health care provider settings. By doing that, we instantly gave our physician vacancies greater visibility."

Quinn said WHA is working with the site sponsor, the Wisconsin Council on Medical Education and Workforce, to release a nationwide marketing campaign for the Web site aimed at drawing back to Wisconsin physicians who have an educational or family tie.

Since 2004, many steps have been taken to address the various challenges framing the physician workforce issue including the creation of a multi-stakeholder Wisconsin Council on Medical Education and Workforce (WCMEW) chaired by Carl Getto, MD, senior vice president for medical affairs, UW Hospitals and Clinics, and staffed by WHA Senior Vice President George Quinn and Senior Medical Advisor Chuck Shabino, MD. WCMEW has been proactive in charting the course for several initiatives that are addressing physician workforce supply concerns. The group will soon (November) release its second report, including a new analysis of physician supply forecasts and specific recommendations aimed at showcasing opportunities that will address current and looming access challenges.

The new Web site, www.WisconsinPhysicianCareers.org is a WHA staff-produced WCMEW initiative that is being embraced by hospitals, clinics and the intended physician audience. With over 600 physician vacancy postings, the Web site was unveiled this week to much deserved acclaim. Importantly, the Web site design aligns with the strongly-stated desire by prospective candidates (identified via direct candidate feedback) to have a "one stop, 24/7 accessible" online center for Wisconsin opportunities.

Going forward, the success of WisconsinPhysicianCareers.org will be determined, in part, by the field’s commitment to maintain an up-to-date listing of physician vacancies and the effectiveness of WCMEW stakeholders in marketing the site to interested candidates. We will certainly do our part at WHA to advance both of those operational priorities over the coming weeks and months.

Steve Brenton
President

More than 600 Wisconsin individuals registered to vote for the November elections as a result of Aurora Health Care’s voter registration drives held in October. Registration drives were held at each of the health care system’s 13 hospitals across eastern Wisconsin. A total of 658 people signed up to vote.

Aurora employees and volunteers, who were trained by the Wisconsin Government Accountability Board to serve as special registration deputies, were on hand to register voters in advance of the November 4 election.

"We are delighted that so many people took the opportunity to register to vote," said Kimberly A. Welch, senior vice president of corporate affairs. "We know that crowds and long lines are expected at polling places across the state on Election Day, and we were happy to do our part to help lessen the pressure at the polls.

"We are pleased that everybody who registered can now participate in our democratic process," said Welch.

WHA and the BloodCenter of Wisconsin have teamed up to offer a half-day session designed for nurses and those involved in blood transfusion therapy, including ICU, oncology and other nurses, as well as nurse educators. A choice of the morning or afternoon session is available on November 5 in Stevens Point.

Each session will include a review of "what’s in the bag," patient safety issues, who’s getting blood and why, transfusion reactions, and the nurse’s responsibility. Pass this information on to nurses in your organization who would benefit from this session.

Both the morning and afternoon session are approved for 3.0 contact hours by the Wisconsin Nurses Association Continuing Education Approval Program Committee, an accredited approver by the American Nurses Accreditation Center’s Commission on Accreditation.

Jack Schwem, 68, died Saturday, October 11, 2008, in his home of complications related to cancer. Schwem moved to La Crosse in 1971 and served as CEO of Lutheran Hospital and Lutheran Health System until his retirement in 1995. Through his leadership, and supported by a trusted team, he guided the hospital from the one major hospital to a multi-hospital, multi-nursing home, multi-corporation health system.

An active volunteer, he gave his time over the years, advocating for community partnerships including Dubna/La Crosse Hospital Exchange and the potential consolidation of La Crosse medical institutions. He was a founding member of Rotary East, worked with the Coulee Council on Addictions, offered advice to small businesses through SCORE and provided tax help to seniors through AARP.

Chad Collier, a parenting instructor at Aurora BayCare Medical Center, leads a class for a unique group of expectant parents: men. The class, exclusively for expectant and new fathers, helps them understand how their new role may affect their lives. The all-male environment enables first-time fathers to discuss concerns and ask questions without fear of embarrassment.

Taught by dads for dads in a relaxed setting, the class covers the emotional and social adjustments men experience in their transition to parenthood, as well as practical matters such as changing diapers, how to hold, feed, burp and bathe their babies, as well as bonding and comforting techniques, partner support and lifestyle changes.

Asthma School
At Aurora BayCare Medical Center, a national certified asthma instructor facilitates a program called Asthma School, and it’s not just for kids. Parents and support persons of children with asthma are encouraged to attend, and classes are structured so that parents, caregivers and children can learn simultaneously. Participants learn about individual asthma triggers and how to manage their episodes.

The Winning Weighs team from Gundersen Lutheran Nutrition Therapy partnered with the University of Wisconsin-La Crosse (UW-L) and the School District of La Crosse to launch "Winning Weighs for Kids with Learning Disabilities Program." Thanks to support from the Children’s Miracle Network, a service of Gundersen Lutheran Medical Foundation, the program was offered free to participants.

This program helps kids with disabilities and their families learn skills they need to develop and maintain healthy eating and activity habits. The program, which includes children with a variety of disabilities such as autism, Down syndrome, behavioral disorders and physical impairments, centers on the concept of maintaining a "happy heart."

Gundersen Lutheran registered dietitians use puppets, games and visual aids to teach kids a new healthy-lifestyle topic each week. By the end of the eight weeks, the kids are able to identify the foods and activities in their lives that produce a happy heart, and understand that a happy heart will keep them healthy and strong.

Parents attend the classes along with their children and learn about the benefits of introducing new, healthy foods to their children, as well as the importance of being a healthy role model. Parents also share valuable tips and strategies with each other on overcoming difficult situations, like introducing vegetables to picky eaters.

Christopher and Marie started their life together as in a fairy tale. He proposed a year to the day after they met and they vowed to work hard to make a life together. They did keep those vows, working hard, doing the right things. Marie advanced in her jobs in health care, getting promotions and working to ensure mental health services were provided to people in need. Christopher advanced in his career in law enforcement, getting a degree, receiving promotions and planning on a law degree. An advanced cancer diagnosis, however, was a barrier difficult to overcome.

Still in his 20s and with no family history of the disease, Christopher was diagnosed with Stage 4 colon cancer. He and Marie continued their pattern of working hard and doing the right thing. Second opinions, treatment at nationally-recognized cancer centers, surgeries and complications followed over the next four years. The advanced disease and its treatment demands put a hold on Christopher’s law enforcement career. Eventually, he accepted Social Security Disability and Medicare coverage. Marie’s job was eliminated at her workplace, but she had plenty of work at home in her role of comforter, medical system navigator and recipient of medical bills. And there were many medical bills to receive.

Again, they did all the right things. Christopher and Marie put together any money they had to purchase supplemental Medicare coverage. Eventually they sold the car they had finally paid off in order to pay bills and continue the supplemental insurance. But the bills for uncovered services and expensive medications kept coming.

Marie said, "I was convinced that no one would ever step forward to help us." She recalls that a financial counselor from Columbia St. Mary’s (CSM) had talked to her and listened to her about the seemingly insurmountable problems. A Community Care application had been sent to her to reduce their CSM medical bills. But she still was convinced that Community Care wouldn’t work for her and Christopher. After all, they had been paying a mortgage for several years and Marie didn’t think "homeowners" were eligible.

The application sat for several months. Eventually, Julie Manthei, CSM financial team leader, called to ask about the application and to assure Marie that she could help. Marie said, "Looking back I was in a comfortable state of hell, I was hopeless and believed that nothing could be done. Strangely, it was difficult to leave that feeling. But I remember being told that sometimes you have to leave your comfort zone, become uncomfortable and hope to find an uncomfortable heaven."