More than 300 health care professionals packed the Plaza Hotel in Eau Claire October 18-19, 2004 for what was the largest ever Wisconsin Quality and Safety Forum. Displaying 90 projects from 57 hospitals, quality and safety experts from across the state also shared their knowledge by presenting their work at 17 breakout sessions.

WHA Chair Chuck Shabino, MD, noted that four years ago, 90 people attended the first Patient Safety Forum and they displayed 18 poster projects. He said Wisconsin leads the nation in both the number of projects and the amount of resources that are devoted to constantly improving the quality and safety of hospital care.

"Wisconsin aspires to become the safest place in the country to receive health care," Shabino told the audience.

Shabino recognized the leadership of the Wisconsin Patient Safety Institute’s (WPSI) recent director, A.B. Orlik. He said Orlik’s efforts helped expand the patient safety agenda in Wisconsin and he acknowledged her assistance in bringing together more than 30 diverse organizations to participate in and support the work of WPSI. Since funding has been an ongoing issue, Shabino announced that WPSI will no longer be able to retain a full time staff and will now move to MetaStar, who will provide administrative support to WPSI.

"We will continue to move forward in Wisconsin by emphasizing the four C’s in our statewide quality agenda: connect, convene, collaborate and catalyze," Shabino said.

Nick Turkal, MD, chair of the WHA Medical and Professional Affairs Council, opened the conference by presenting a brief overview on the type of work that the council addresses and how this work supports the needs of the hospitals in Wisconsin as well as related external organizations.

WHA President Steve Brenton commended the quality experts for pushing the quality and safety of patient care in Wisconsin to new heights.

"I happen to think your time has come. You have propelled Wisconsin into national prominence by defining, measuring and reporting on the quality of care provided in your hospitals," Brenton said. "It is all about aligning the Institute of Medicine’s Six Aims, which will serve as a blueprint for reforming the health care system."

The WHA Board of Directors met for the first time in what will soon be WHA’s new headquarters at 5510 Research Park Drive in Fitchburg. WHA President Steve Brenton said the Association would permanently relocate in early December.

In his President’s Report, Brenton reviewed two draft white papers that were developed following the July Board planning session, where discussion focused on defining "transparency" in health care, and the crisis in Medicaid payment.

Brenton said health care reform is becoming defined around the issue of transparency. During the planning session, the Board agreed that a common definition of transparency as it relates to health care is: reliable health care information that can be used for decision making related to quality, safety, service and price. He noted that Competitive Wisconsin, a broad-based, private sector organization chaired by Frederic Wesbrook, MD, from the Marshfield Clinic, has endorsed a paper on transparency similar to the one Brenton shared with the Board.

While CheckPoint is the vehicle for communicating information about hospital safety and quality data, it is WHA’s intention to provide pricing information to the public through the WHA Information Center’s Web site. The WHAIC will seek member input on the Web site’s content and function before it is finalized.

WHA Senior Vice President Eric Borgerding said three main messages will be communicated when pricing information is publicly available: 1) Hospitals are being accountable to their communities, as promised; 2) This demonstrates that the private sector can take the lead in "transparency" without legislation or regulatory interference; and 3) This is important to consumers as they are being asked to take more responsibility for their own health care decisions.

Brenton said the second white paper on Medicaid was fully embraced by the WHA Task Force on Medicaid. WHA Senior Vice President George Quinn presented the Task Force’s findings and recommendations. The chief priorities for Medicaid set by the Task Force are:

1. Improve and enhance Disproportionate Share Hospital payments to the level allowed by Federal law.

2. Restore Graduate Medical Education payments to previous levels.

3. Increase payments for outpatient services to 70 percent of costs.

The Task Force recommended that the Association embark on a public education program to inform the legislature and the public on the importance of ensuring adequate Medicaid payment.

Quinn presented WHA’s 2005 budget, which was approved by the Board. He made the following key points: expenses would increase eight percent while dues increases will be held to between a one to three percent increase. The major change in operations is the move to the new building later this year.

The Board approved three WHA appointments to the newly created Wisconsin Council on Medical Education. Named to the Council were WHA Chair Chuck Shabino, MD; Carl Getto, MD, University of Wisconsin Hospital & Clinics; and Tim Size, Rural Wisconsin Health Cooperative.

Dana Richardson, WHA vice president of quality, provided the Board with the latest information on the CheckPoint^SM program. Richardson said WHA is evaluating the feasibility of adding to CheckPoint measures on surgical infection prevention, a new error prevention goal, and a display of all or some of the data from the national H-CAHPS survey. She also announced that WHA would obtain stakeholder input on the CheckPoint program from purchasers, legislators, and providers to ensure that the information collected and displayed is beneficial to all users.

The Wisconsin Hospital Association’s CheckPoint^SM Web site received an Award of Merit from the Wisconsin Healthcare Public Relations and Marketing Society at their annual Communications Review banquet on October 7 in Green Lake, Wisconsin.

Mary Kay Grasmick, WHA vice president for communications, said the excitement that CheckPoint won an award is shared with the 122 hospitals that participate in the program.

"We had a team of dedicated hospital PR professionals, along with CEO Terri Potter from Meriter Hospital, who worked closely with us to ensure that the Web site was easy to use, attractive and contained information that was valuable to consumers and hospitals," Grasmick said. "The award is really a confirmation that we are on track."

One of the Communications Review judges, who was not from Wisconsin, commented that the idea of "putting this information together at the state level is excellent," and urged WHA to continue to market the site to consumers because the information was easy to understand and follow.

The judge’s comment proved timely, as the Wisconsin Quality Steering Committe recently approved a CheckPoint Outreach Team that will work to create a higher awareness of the program among targeted stakeholders who influence consumers, and to assure that the program receives timely input from purchasers and practitioners.

A panel of seven federal judges ruled against the consolidation of the federal lawsuits that have been brought against 70 not-for-profit hospitals and health systems across the country. The AHA is a named defendant in many of the cases and, with the defendant hospitals, argued that the cases should not be consolidated. AHA argued that many of the issues in the various cases are local in nature and the consolidation would convenience only trial attorneys at the expense of hundreds of local hospitals.

The court said that consolidation, "would neither serve the convenience of the parties and witnesses nor further the just and efficient conduct of this litigation." The court concluded that the trial attorneys had, "failed to persuade us that these actions share sufficient common questions of fact to warrant" consolidation.

The court’s decision could lead to a speedier conclusion of the pending cases, permitting the hospitals to continue to focus their resources on providing care in their communities rather than on legal maneuvers that serve only to divert these resources.

This was a "breakout" year for the Wisconsin Quality and Safety Forum, which was held this week in Eau Claire.

Consider the following:

• Attendance at the event totaled close to 280 versus the 2003 attendance of 125.
  
• This year’s Forum showcased 89 quality and safety improvement projects submitted by 56 hospitals, health care systems and other related health care organizations. This represents a 100%+ participation bump over 2003.
  
• The focus of the 2004 Quality and Safety Forum was the Institute of Medicine’s (IOM) Six Aims for improving and reforming the health care system. Program speakers and breakout sessions aligned with the IOM focus on the provision of safe, equitable, timely, patient-centered, efficient and effective health care.
  
• This year’s Quality and Safety Forum, jointly sponsored by WHA and the Wisconsin Patient Safety Institute (WPSI), represents a major new alignment and broadening of stakeholder interest and ownership of the quality and safety themes.

The Wisconsin Quality and Safety Forum has now emerged as a major Association educational programming event, right up there with the WHA Annual Convention, the Rural Health Conference (also sponsored by the Office of Rural Health, the Rural Wisconsin Health Cooperative and the Wisconsin Primary Health Care Association), the WHA Advocacy Day program, and the "We Care" Employee Pride Program as major education and recognition activities that advance WHA’s strategic plan.

Importantly, and perhaps not surprisingly, the Quality and Safety Forum has achieved this "breakout" status in a year in which hospital and physician-led efforts to measure, report and improve patient care are at an historic high. And it’s about time that our quality improvement professionals who are leading statewide patient care improvement activities get the kind of recognition they so rightly deserve.

WHA staff has compiled a booklet that summarizes the projects that were showcased at the 2004 Forum, which will be widely circulated. In addition, next week’s WHA Friday packet will include a special supplement that will feature both photo and speech highlights taken during the Forum.

Steve Brenton
President

Following the terrorist attacks of September 11, 2001 and the subsequent Anthrax attacks, the U.S. Department of Health and Human Services directed the Health Resources and Services Administration (HRSA) to develop a state-based Emergency System for the Advance Registration of Volunteer Health Professionals (ESAR-VHP). Each state’s ESAR-VHP system will enable volunteer health professionals to provide, and hospitals responding to a disaster to find and receive, verifiable information regarding a volunteer health professional’s identity and licensing, credentialing, accreditation, and privileging information.

Upon final implementation, each state will be required to create and implement their own ESAR-VHP system, but each system will be required to have some commonality with all other ESAR-VHP systems. Recent action to implement the ESAR-VHP has occurred at both the national and state level.

Wisconsin Action…

The Wisconsin Department of Health and Family Services (DHFS) was one of ten entities across the country to receive a grant from HRSA to develop a pilot ESAR-VHP system. Pursuant to that grant, DHFS has led a task force involving members of the Wisconsin Association of Medical Staff Services and others to develop a volunteer registry called the Wisconsin Emergency Assistance Volunteer Registry (WEAVR) and a credentialing database called the Wisconsin Disaster Credentialing database (WDC). WHA will be meeting with DHFS next week to discuss these newly released proposals.

DHFS will also hold two teleconferences targeted at those responsible for medical staff credentialing verification to present a model of how WEAVR and WDC will allow a hospital to promptly verify a volunteer healthcare worker’s credentials during a disaster. The first teleconference is scheduled Wednesday, October 27, 2004 from 12:00 Noon until 1:30 PM (telephone number: 888-545-068; confirmation number: 10174625), and Monday, November 8, 2004 from 11:30 AM until 1:00 PM (telephone number: 888-545-068; confirmation number: 10174628). Further information regarding these teleconferences can be found at www.wha.org/disasterPreparedness/disaster_credentialing.aspx.

National Action…

In addition to the ten pilot states that have received grants to develop state-based registries, the AHA received a grant from HRSA to identify hospital implementation issues and solutions regarding the ESAR-VHP and to help draft guidelines to be used by all state ESAR-VHP systems. Pursuant to its charge, AHA convened a HRSA funded meeting last week in Washington, D.C., attended by Matthew Stanford, WHA associate counsel, and representatives from 36 other state hospital associations in order to discuss issues surrounding the national implementation of ESAR-VHP systems. The discussions primarily focused on design and content, credentialing, privileging and identification, security and privacy, recruitment, commonality, and legal issues associated with ESAR-VHP systems. Those discussions will be used to help develop proposed technical and policy guidelines to be released in January 2005 that will apply to all state ESAR-VHP systems.

Following the release of the proposed guidelines, Wisconsin’s WEAVR and WDC and the other nine pilot ESAR-VHP systems across the country will enter a testing phase to evaluate the pilot systems and the proposed technical and policy guidelines. The initial testing phase will be completed by June 2005. Final testing and evaluation involving 22 additional pilot states will conclude in December 2006.

Charlie Wolden is a member of the Democratic Party. He resides in Frederic where he currently serves as the village president. Like his opponent, he is also a veteran of the Vietnam War where he served as a Major in the Air Force. He currently operates a mental health facility.

Candidate Survey Results: Candidates’ answers to selected abbreviated questions from WHA’s 2004 candidate survey appear below. Challenger Charlie Wolden did not return the survey. To view the entire survey for this or any other race, contact Eric Borgerding or Jodi Bloch at 608-274-1820.

Hospitals are experiencing a growing shortage of health care workers from nurses to pharmacy technicians and this shortage is projected to worsen as the demands for health care increase even more as the baby boom generation approaches their senior years. Would you support efforts to target new or existing dollars within the technical college system and UW System to alleviate waiting lists and get more people into health care professions? Pettis: YES

WHA has identified a serious and growing shortage of physicians in Wisconsin including specialists and primary care physicians. The last budget slashed $45 million in funding for graduate medical education. Would you support restoring this funding? Pettis: YES

Do you think the property tax exemption for non-profit hospitals should continue? Pettis: YES

Wisconsin hospitals operate under multiple sets of rules and regulations, including the State of Wisconsin, Medicare, Medicaid and a national accreditation agency, among others. Would you support eliminating state hospital regulations if they are shown to be duplicative or similar to other regulations? Pettis: YES

Should state government approve hospital decisions about the purchase of new equipment and construction of new facilities? Pettis: NO

Brad Pfaff is a member of the Democratic Party. He resides in Onalaska where he is involved in the dairy operations of the family farms. Previously Brad worked for former Assembly Representative Virgil Roberts, U.S. Senator Herb Kohl and Congressman Ron Kind as his senior policy advisor.

Candidate Survey Results: Candidates’ answers to selected abbreviated questions from WHA’s 2004 candidate survey appear below. Brad Pfaff did not return the survey. To view the entire survey for this or any other race, contact Eric Borgerding or Jodi Bloch 608-274-1820.

WHA has identified a serious and growing shortage of physicians in Wisconsin including specialists and primary care physicians. The last budget slashed $45 million in funding for graduate medical education. Would you support restoring this funding? Kapanke: YES

Hospitals are experiencing a growing shortage of health care workers from nurses to pharmacy technicians and this shortage is projected to worsen as the demands for health care increase even more as the baby boom generation approaches their senior years. Would you support efforts to target new or existing dollars within the technical college system and UW System to alleviate waiting lists and get more people into health care professions? Kapanke: YES

Do you think the property tax exemption for non-profit hospitals should continue? Kapanke: YES

Wisconsin’s Medicaid and BadgerCare programs pay only 59 cents for every $1 it costs hospitals to care for these patients. The remaining unpaid costs must be recouped through cost shifting to the private sector also known as the "Medicaid Hidden Tax". Would you support proposals aimed at having the state pay more of actual hospital costs for the Medicaid and BadgerCare programs? Kapanke: YES

Should state government approve hospital decisions about the purchase of new equipment and construction of new facilities? Kapanke: NO

 Paying current RNs higher salaries
 Hiring internationally
 Giving big sign-on bonuses
 Recruiting more aggressively
 Working the staff harder
 None of the above!

With a common understanding that none of the above is the correct answer, leaders of health care delivery systems, deans of nursing schools and legislators met in Louisville, Kentucky on October 11-13 to discuss interventions that can help secure an adequate supply of nurses for America’s future. Judy Warmuth, WHA’s vice president of workforce, joined educators, recruiters and managers.

With fewer faculty being prepared and current faculty nearing or at retirement age, the nursing faculty attendees said there is an urgent need to increase the number of faculty in the pipeline. The schools said that unless the pay structure for faculty is altered, they cannot successfully compete in the marketplace for graduate-prepared nurses. Without additional faculty, nursing schools will be unable to increase enrollments.

New educational models were shared that include simulation labs; human patient simulators and volunteers trained as ‘standardized’ patients. These examples are costly, but may reduce the need for faculty numbers while assuring that students graduate with core experiences. Flexibility by regulatory agencies is critical to implementing new educational approaches.

Finally, the group examined the health care workplace itself. They identified reducing workplace stress, ensuring an adequate number of staff, and making work rewarding as necessary elements to recruiting RNs. The same interventions will keep experienced nurses at work. Magnet Hospital criteria were seen as one way to evaluate and strengthen nursing care environments.

Julie Slowiak, a certified medical assistant in Luther Midelfort’s Orthopedics Department, was one of 15 health care workers in the country to receive a 2004 Cherokee Inspired Comfort Award. Slowiak was the top national prizewinner in the "Non-Physician Healthcare Professionals" category. She and the other 14 award winners were chosen from 1,633 nominations.

Slowiak, who has worked at Luther Midelfort since June 2000, was chosen for her efforts to enhance her training for the benefit of patients, according to Cherokee Uniforms.

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