The long overdue state budget came to a relatively quick end this week when the Assembly and Senate agreed to a compromise version. A deal was announced last Friday and both houses quickly passed the compromise bill on Tuesday, October 23. Governor Doyle signed the budget into law today (Oct. 26).

The final version of the bill does not include the hospital assessment, but does take $200 million from the Injured Patients and Families Compensation Fund (IPFCF) to help balance the budget. The compromise also includes laudable health care initiatives, such as a one dollar increase in the cigarette tax, BadgerCare Plus, and full deductibility of health insurance premiums.

Both sides claimed victory with the compromise, but many aren’t pleased. In the Assembly, 29 out of 52 majority Republicans voted against the bill. Over in the Senate, majority Democrats all voted for the compromise, but less than 24 hours after the vote, Senate Majority Leader Judy Robson (D-Beloit) had been replaced by Senator Russ Decker (D-Schofield). And on Thursday, October 25, just a day before Governor Doyle signed the budget into law, the Wisconsin Medical Society announced it will file a lawsuit to block the $200 million IPFCF transfer.

Upon hearing news of the budget deal last Friday, WHA issued a statement concerning the various aspects of the compromise (please see this week’s President’s Column).

The fate of the hospital assessment during this session is unclear. While a handful of legislators have stated they plan to reintroduce the proposal as separate legislation, it appears unlikely to gain approval in the Assembly without significant changes. Stay tuned.

The Wisconsin Medical Society announced on October 25 that it will file a lawsuit against the State to protect the Injured Patients and Families Compensation Fund (IPFCF) from a "raid" that is part of the State’s Budget Bill that received final approval earlier today (Oct. 26). The Budget takes nearly a quarter of the Fund’s assets—$200 million over two years—to support other state programs.

When asked about the taking, Tom Pyper, an attorney with Whyte Hirschboeck Dudek who is representing the Society, observed, "It’s a tax on injured patients and families. It’s a tax on health care providers, and it’s ultimately a tax on health care in the state of Wisconsin." The Medical Society expects to file the lawsuit soon after the Governor signs the Budget Bill into law.

"The Wisconsin Hospital Association has long recognized the importance of the Fund as part of Wisconsin’s comprehensive and exclusive medical liability system," said WHA Senior Vice President and Fund Board Member George Quinn. "Its strength protects injured patients and their families and, ultimately, improves the quality of and access to health care in Wisconsin by creating an environment that enables hospitals to attract and retain quality health care professionals. We are concerned by any action that weakens the Fund."

Watch The Valued Voice for more information as the lawsuit progresses.

The federal Medicare Modernization Act established a three-year demonstration project, Recovery Audit Contractors (RAC), to recover overpayments and identify underpayments in Medicare. The 2006 Tax Relief and Healthcare Act of 2006 made this demonstration project permanent in all 50 states.

The RAC program originally included a phased-in implementation across the nation, but late last week the Centers for Medicare & Medicaid Services (CMS) issued an RPF indicating RACs will begin review of inpatient and outpatient hospital claims for coding errors in all 50 states by March 2008. The rollout timeframe for RAC review of more complex claims reviews, such as review of medical necessity, has not yet been determined. CMS will select RACs by January 2008.

RACs can review the last four years of provider claims for: inpatient, outpatient, skilled nursing facilities, physician, ambulance, lab services and durable medical equipment. The original demonstration project has been in place in three states—New York, California and Florida. Those states have varying experiences with their RACs, but generally the following concerns have been raised:

• RACs ability to review for "medical necessity." Is this appropriate? Are RACs sufficiently trained/educated to review for this?
• Look back period of four years (reduced to three years under the RFP) is too long
• No limit on the number of claims RACs can review or the dollars involved
• No electronic tracking system so hospitals know where a claim is in the process
• Insufficient oversight of RACs by CMS
• Overly focused on overpayments with little review of underpayments

The American Hospital Association is taking a leading role in educating and providing insight to hospitals on how to proceed, including a free audioconference by AHA Solutions (www.aha-solutions.org) November 7 from 1-3 p.m. Central Time. Register online at www.surveymonkey.com/s.aspx?sm=gryyIV7y8TFT5GoNBAsXow_3d_3d

The Wisconsin Hospital Association is developing a plan of action to ensure members are informed and educated on the RAC program and its impact in Wisconsin. Watch for details in future Valued Voice newsletters. Contact Brian Potter or Jenny Boese at 608-274-1820 with questions.

Following a successful year of supporting a variety of initiatives that had a positive statewide impact, the WHA Foundation has officially kicked off its 2007 annual fundraising efforts, announced Foundation Chair Dan Hymans.

"We are asking our members to be generous this year in supporting the workforce development and quality and safety projects of the Foundation," Hymans said.

"The Foundation Board continues to focus its funding priorities on initiatives that have statewide impact on health care in Wisconsin," said Foundation Director Jennifer Frank.

"The funds raised last year were used to continue the scholarship program, which awarded 32 scholarships worth $35,000 in 2007; to provide recognition and financial support to two community outreach initiatives through the Global Vision Community Partnership Award; to continue the successful nurse leadership development program; and to support the state’s first conference focused on health literacy. Funds raised in this year’s campaign will be used to continue these initiatives, as well as give our Board the opportunity to consider new funding initiatives."

The Wisconsin Hospital Association (WHA) is disappointed that the budget compromise announced Friday evening fails to include Medicaid payment improvements for hospitals. The compromise excludes the reworked hospital assessment and in doing so leaves $400 million in new federal revenue unclaimed—dollars that could have been used for much needed Medicaid payment improvements for Wisconsin’s safety net hospitals.

Hospital Medicaid payments have not increased in over a decade. Hospitals are now paid 48 cents for every dollar they spend providing care to Medicaid patients. As a result, last year some $550 million in unpaid hospital costs were shifted onto the health care bills of employers and employees across the state, resulting in higher health insurance premiums. Under the budget compromise, this "hidden health care tax" remains unaddressed, and will grow over the next two years.

While rejecting the hospital assessment, the compromise takes $200 million from the Injured Patients and Families Compensation Fund (IPFCF). We are puzzled by this choice. The IPFCF is funded through premiums paid by hospitals and doctors to help individuals injured by medical errors. This transfer will not generate new federal dollars, will not improve Medicaid payments, will not reduce the "hidden health care tax," and is certain to be challenged in court. In the meantime, the transfer amounts to a one time tax on health care providers, as every dollar "transferred will undoubtedly need to be replaced in the form of higher premiums.

The budget compromise does have laudable, WHA-backed items, including expansion of health insurance coverage for children through BadgerCare Plus and income tax deductibility for health insurance premiums. These are significant initiatives that advance Wisconsin’s leading role in providing coverage for vulnerable populations.

With the announcement of a compromise, the budget stalemate appears to be at an end. But we agree with the comments made by Governor Doyle last night—during the remaining months of the 2007-2008 legislative session, hospital Medicaid payments must be revisited. It is essential that renewed efforts be taken to address the growing crisis faced by Wisconsin’s safety net hospitals and the "hidden health care tax" through separate legislation.

There are five new students in the UW medical school class this fall that are perhaps being followed a little more closely than others. The reason is they are the first students to be accepted into the Wisconsin Academy of Rural Medicine (WARM). All five have expressed a strong desire to practice medicine in rural Wisconsin.

While more than 33 percent of Wisconsin’s citizens live in rural areas, only 11 percent of physicians have rural practices. In addition, 83 percent of Wisconsin’s counties are designated totally or partially as medically underserved, and 77 percent of these underserved counties are rural.

One group, the Wisconsin Council on Medical Education and Workforce (WCMEW), chaired by Carl Getto, MD, who is currently interim president of the UW Hospitals and Clinics, has been active for nearly four years. Their goal is to help Wisconsin avert a physician shortage. Rural areas and the inner city are already reporting physician shortages. When WCMEW member Byron Crouse, MD, introduced the idea of a rural medicine academy to the group, it received strong support from WCMEW. Crouse was instrumental in ushering the concept through the necessary approvals, all the way to Robert Golden, MD, dean of the medical school, who embraced the WARM almost immediately.

"It’s a better idea to produce doctors where they are needed, and that’s primary care such as family medicine, internal medicine and pediatrics in rural areas," according to Golden.

Chuck Shabino, MD, WHA’s senior medical advisor, described WARM as "a great first step toward WCMEW’s goal to recruit, enroll and train individuals in Wisconsin’s medical schools who are likely to practice in Wisconsin with particular attention to underserved parts of our state."

The WARM is dedicated to improving the supply of physicians in rural Wisconsin and improving the health of rural Wisconsin communities. The plan is to increase the size of the medical school class beginning with five students in the fall of 2007 and increasing until the goal of 25 new students per year is reached over the next several years. The program utilizes a targeted admissions process designed to select those students most likely to develop rural medical practices.

This initial class of five medical students will take part in educational programs in their third and fourth year of medical school at Marshfield Clinic locations that include Marshfield, Wausau, Eau Claire, Minocqua and Rice Lake.

The next class of medical students in the WARM program will work at Gundersen Lutheran clinics in communities such as Viroqua, Prairie du Chien, Whitehall, Sparta and Tomah. In the following years, the WARM students will have educational opportunities in towns near Green Bay.

For more information on the WARM program, visit www.med.wisc.edu/education/md/warm/index.php.

Inaugural WARM Class "Bright…Enthusiastic"

The five students listed below were accepted into the Wisconsin Academy of Rural Medicine (WARM) this fall. Chuck Shabino, MD, WHA’s senior medical advisor, had an opportunity to meet the students.

"After meeting these students it was evident that the program has attracted bright Wisconsin students who are committed to practicing in rural Wisconsin communities, similar to where they grew up," according to Shabino. "They are bright and academically well prepared to meet the rigors of Wisconsin’s medical schools," he added.

Name: Diane Anderson
Hometown: Waupun, Wis. (most recently resided in Bayfield, Wis.)
Undergraduate study: UW-Green Bay (Business Administration) and UW-Superior (Postbaccalaureate—Pre-Medical Studies)
Health care experiences and exposure: First exposed to the medical profession while working part time in a rural health clinic during high school; held executive-level positions for medical equipment companies; hospice volunteer; initiated walking/exercise program for seniors in Bayfield and instructed fitness classes; served on local school board’s nutrition and policy committees; board member of church’s parish nurse program.
Interest in WARM: Genuine interest in rural medicine and rural communities; hope in part to address the health disparities (distance to medical care, lack of insurance, etc.) facing people in rural Wis.

Name: Carla Carlson
Hometown: Boyceville, Wis.
Undergraduate study: University of Wisconsin-Madison (Kinesiology)
Health care experience and exposure: Hospital volunteer; anatomy department peer helper; physical therapy unit volunteer; lab research
Interest in WARM: Grew up in a small, rural community and wants to return to hometown and set up a clinic—Eager to be a part of a new program

Name: Nathan Vakharia
Hometown: McFarland, Wis.
Undergraduate study: University of Wisconsin-Madison (Zoology)
Health care experience and exposure: Pathology department research specialist; neurology research; volunteer Emergency Medical Technician (EMT)
Interest in WARM: The option of exploring different specialties; desire to practice rural medicine and raise my son in a rural area

Name: Henry "Clay" Dean
Hometown: Blue River, Wis.
Undergraduate study: University of Wisconsin-Platteville (Biology)
Health care experiences and exposure: Employed as a community living assistant to persons with disabilities; hospital volunteer; teaching assistant for human gross anatomy college course; physician job shadowing; father is a vet and mother and sister are both nurses
Interest in WARM: Enjoys the rural lifestyle; values the importance of being active in and giving back to the community

Name: Shanna Berger
Hometown: Baldwin, Wis.
Undergraduate study: University of Wisconsin-Eau Claire (Chemistry with a business emphasis)
Health care experiences and exposure: Medical missions trip to the Dominican Republic; clinical experience program at Marshfield Clinic; physician job shadowing; employment as a pharmacy technician; caregiver for a terminally ill cancer patient; hospital volunteer; father is a physician assistant
Interest in WARM: Commitment to a rural lifestyle and to improving access to care in rural Wis.

Our hospital experienced many calls from parents who had heard reports of children becoming seriously ill or dying from influenza. They were frightened, especially when it began to travel through the schools. Area schools do a great job of trying to prevent infectious diseases from spreading, but the fact is, diseases spread because children act like children. They forget to wash their hands, don’t always cough into their sleeves, and willingly share their eating utensils, snacks and drinks with their friends.

Information from the Hayward Community School’s nurse showed the school does post information and teaches prevention methods. In addition, they used antibacterial wipes to clean classroom surfaces and sanitizing agents are placed in high traffic areas such as the gym. Even doing a good job of cleaning, the nurse saw instances where the symptoms matched influenza and other cases were confirmed through medical testing.

Since it has been documented that frequent hand washing is one of the strongest methods used in the prevention of influenza, the Education and Infection Control staff saw a way to help the schools prevent children from acquiring or spreading influenza and thereby reducing the threat to the entire community.

To do this, the staff knew the teachers needed a quick and easy way to have students cleanse their hands at the moment a cough, sneeze or other bacteria spreading incident occurred. They felt hand sanitizing gels that can kill bacteria even better than antibacterial soap were the answer. They ordered large containers of hand sanitizing gel and delivered 300 of them to Hayward Community School District classrooms and the LCO School classrooms on the reservation.

The Hayward school nurse told the hospital staff the bottles of gel were well received by the teachers. Many of them asked if the donation could be repeated in the fall.

The hospital also incorporates hand washing in their Kid’s Day program. Kid’s Day is an event that brings all first grade classes in Sawyer County to the hospital to experience an activity developed many years ago to introduce children to the hospital setting. A mock hospital room is set up in the Education Department and the health care professionals who teach the sessions show the children what they might experience if they were to become ill or injured and have to be admitted to the hospital. Education on hand washing, the spread of infectious disease and other health safety issues are covered.

Four Wisconsin hospitals, Aurora Sheboygan Memorial Medical Center, Sheboygan; Holy Family Memorial, Manitowoc; Mercy Medical Center, Oshkosh; and St. Elizabeth Hospital, Appleton, have been honored with the 2007 Premier | CareScience Select practice National Quality Award. These hospitals are four of 49 nationally with superior patient outcomes measured to be in the top 1 percent in both quality and efficiency. The award recognizes this elite group of hospitals from across the United States that were identified using the Premier | CareScience Select Practice National Quality Awards methodology, which evaluates quality and efficiency using patient-level risk analysis based on 16 clinical factors. Hospitals do not apply for this recognition, but instead are identified as the exceptional performers in quality and efficiency among all acute care facilities in the MEDPAR 2005 data, regardless of bed size or teaching status.

The American Heart Association recently bestowed Gold-Level recognition to Fort HealthCare, Fort Atkinson, and St. Mary’s Hospital, Madison, for their dedicated efforts toward building a healthy workforce. Awarded twice per year, gold-level recognition is for companies that fulfill criteria such as offering employees physical activity support, increasing healthy eating options at work, promoting a wellness culture, as well as implementing at least six of the physical activities, two of the nutrition activities and one of the culture activities listed in the Start! application form.