Governor Jim Doyle announced today that his administration has reached an agreement in principle on the next important component of his BadgerCare Plus plan to expand health care coverage in Wisconsin. Under the proposal, those who are uninsured and who do not have children under their care may now have access to primary and preventive care. The five-year federal waiver proposal builds upon Wisconsin’s existing BadgerCare Plus program.

WHA President Steve Brenton commented, "This is terrific news! The approval of this waiver paves the way for important coverage improvements that are consistent with WHA health reform principles."

Brenton noted that the Association has been a strong supporter of the original BadgerCare Plus program, with many of its member hospitals sponsoring enrollment fairs throughout the summer to help eligible residents in their communities apply for the program.

Brenton said the coverage expansion to childless adults aligns with the Association’s health care reform principles, which advocate for strengthening Wisconsin’s safety-net programs for our most vulnerable populations while working to reduce costs and make employer-sponsored health insurance more affordable.

"The mission of all Wisconsin hospitals is to improve the overall health status of the communities they serve. Giving these adults access to services in the BadgerCare Plus program is a step in the right direction," Brenton said.

Brenton noted that the Wisconsin Hospital Association worked closely with the Doyle Administration and Wisconsin’s congressional delegation to secure approval of the waiver. Governor Doyle also expressed his thanks to U.S. Rep. Paul Ryan, U.S. Rep. Tammy Baldwin, U.S. Sen. Russ Feingold, and U.S. Sen. Herb Kohl, along with the rest of the Wisconsin delegation, for their bipartisan work to encourage the federal government to support this new health care plan that will benefit some of the state’s hardest working residents.

In announcing the waiver, Gov. Doyle said, "Today we cleared one of the final hurdles on the way toward my goal of providing access to health insurance for 98 percent of Wisconsin residents. However, the significant downturn in the national economy, and its effect on the state’s fiscal situation, will challenge our ability to quickly extend this program."

The state and federal government are currently working to finalize the waiver. Once the plan is finalized, the state will use federal funding that previously supported uncompensated care to provide health insurance coverage to low-income adults. Income-eligible adults, from age 19 through 64 who do not have children or do not have dependent children under age 19 living with them, may be able to enroll in the BadgerCare Plus Core Plan. This health insurance plan is for adults who were previously not eligible to enroll in state and federal health programs. In addition, individuals who have had health insurance or had access to employer subsidized health insurance during the previous 12 months are not eligible for the Core Plan.

The BadgerCare Plus Core Plan for Childless Adults is not a standard Medicaid benefit nor an entitlement program, and will be a limited benefit due to strict state and federal budgetary limits. The program will cover basic health care services, including primary and preventive care as well as generic drugs. Every adult who applies to the program will have to complete an online health needs assessment before the application can be submitted for approval, and all members must receive a comprehensive physical exam within the first year of being enrolled in the program.

After final federal approval, the state will develop an enrollment plan based upon available state resources. Adults who may be able to enroll can make no more than 200 percent of the Federal Poverty Level ($20,800 each year for a single person and $28,000 for a married couple) each year. These amounts are based on federal guidelines which increase by a small amount each year. For current federal poverty level guidelines, go to www.badgercareplus.org/fpl.htm.

Wisconsin hospitals continue to lead the way in public reporting as the CheckPoint program adds information related to patients’ experience of care to the Web site, www.wiCheckPoint.org. While the information is available on a national Hospital Compare Web site, www.HospitalCompare.hhs.gov, the Wisconsin Hospital Association’s CheckPoint program has become the first stop for many health care consumers and employers in Wisconsin.

Wisconsin hospitals have been reporting to CheckPoint since the program was launched in 2004. By providing information about patient experience of care, hospitals are continuing their efforts to be even more transparent about the many aspects of care they provide.

"Our goal with the CheckPoint program is to make information available to consumers that will help them choose the hospital care that is right for them. It only made sense to include the patient experience survey information, as improving care is an ongoing process and what a patient experiences is an important part of the process. We want to include all the information that hospitals publicly report under the same "roof," so it is as simple as possible for consumers to get a complete picture of each hospital they review on CheckPoint," according to Dana Richardson, WHA vice president, quality initiatives.

The Patient Experience of Care Survey results include responses to ten questions that are important to patients; such as how well their pain was controlled or if their medications were explained. In addition to the report on the percent of top ratings, CheckPoint users can view how any individual hospital scored on all survey questions. Finally, CheckPoint provides a trend graph that shows a hospital’s score for any one question over time.

Richardson emphasized that publicly reporting this survey data demonstrates Wisconsin hospitals’ continued commitment to transparency and quality improvement.

Concordia University Wisconsin, established in 1881 as one of the state’s earliest institutions of higher learning and currently one of the three largest private universities in Wisconsin, will open a School of Pharmacy in the 2010-11 academic year.

The decision will enhance the university’s academic offerings in the allied health professions and directly address the current and future shortage of trained pharmacists in the health care delivery system of Wisconsin and the country. Wisconsin has the highest demand for pharmacists of any state in the country according to the Pharmacy Manpower Project, a non-profit corporation that develops data on the size and demography of the pharmacy workforce.

Concordia University Wisconsin, owned and operated by the Lutheran Church Missouri Synod, will be developing the only Lutheran church-sponsored school of pharmacy in North America. The pharmacy program will concentrate on producing highly-skilled pharmacy practitioners for the growing, unmet needs of rural and urban Wisconsin locations. The curriculum will be taught using a learning-based approach with a focus on the patient in medication therapy management. It will use an integrated methodology to develop in the student the skills needed for the new, evolving, clinical roles in health care delivery in the retail, hospital, clinical and ambulatory setting. Because of the evolving nature of health care, one of the goals of the curriculum will be to develop lifelong learning skills that the students can use throughout their career. The curriculum will also emphasize the pharmacist’s involvement in the community.

The Concordia University Wisconsin (CUW) School of Pharmacy has chosen the 2-4 educational model, allowing students who complete their pre-pharmacy requirements at any college or university to apply for admission into the four-year professional pharmacy program at Concordia. The terminal degree will be a Doctor of Pharmacy, but CUW is also exploring the possibility of offering a bachelor’s degree in pharmaceutical sciences after the successful completion of the pre-pharmacy and first two years of pharmacy school.

A campaign to raise $20 million to build an 80,000 sq.ft. pharmacy school building is under way. A lead gift of $1 million has already been secured from the ShopKo Foundation of Green Bay. The new facility will include lecture halls, classrooms, labs, and offices equipped with the latest technology. Construction is scheduled to begin in early summer 2009.

Former state representative Curt Gielow, an experienced pharmacist and hospital executive, has been recruited as the executive dean with responsibilities to raise the monies, build the building and establish the professional and community relationships necessary for a successful start. Dean Arneson, PharmD, Ph.D. has been recruited as the academic dean with responsibilities for faculty recruitment and curriculum development as well as ACPE accreditation. Arneson comes to Concordia from the University of Oklahoma College of Pharmacy-Tulsa where he served as associate dean for academic affairs.

• There are several ominous signs that deep provider Medicare cuts may be on the Congressional chopping block next year. The first sign is the breathtaking magnitude of the federal budget deficit and the urgency to address it. If the Wisconsin revenue slowdown will generate a river of red ink, the federal deficit is an ocean of red ink. The second sign is the fact that expensive promises have been made this election season that will require new money, and Medicare is where the money is—the proverbial "deep pocket." Third, 2009 is not an election year and lawmakers tend to be more willing to make unpopular votes in non-election years, counting on voters to have short memories.

But there’s a strong case to be made that cutting hospital, physician, home health and skilled nursing care payments is the wrong choice, especially in the middle of what very well may be a severe national recession in which health care jobs and spending can be a stabilizing factor, as has been the case historically during other economic downturns.

• Anecdotal evidence combined with some actual initial data suggests that Wisconsin hospital financial performance over the past six to twelve months has declined. And the recent credit market collapse and sharp downturn of the equities market may result in the poorest statewide hospital financial performance this decade. Reports from the field include a decline in patient activity and a big uptick in bad debt, charity care and contractual allowances. Even hospitals claiming stable patient volumes indicate declining financial performance due to payer mix. Should these early indicators prove to be a quantifiable trend, the impact on capital spending, employment and the sustainability of current community benefit programs may be affected at the very time Wisconsin’s economy desperately needs health care to be a stable force for jobs and investment in local infrastructure.

• There’s a lot of "noise" that Congress will return to Washington D.C. in a few months to fashion a second economic stimulus bill designed to prime the faltering economy. If that happens, one likely provision of a stimulus package may be increased Medicaid funding for states, likely delivered by increasing the federal matching allocation. That could amount to tens of millions of dollars for Wisconsin’s beleaguered state budget. Some may recall that Congress did just that in 2003, an action that broke a log jam in the Wisconsin Legislature leading to a budget deal after weeks of partisan impasse.

Steve Brenton
President

Speaking at the Governor’s Economic and Workforce Development Conference October 28 in Wisconsin Dells, WHA Vice President of Workforce Development Judy Warmuth shared a sobering truth on the health care workforce.

Drawing from the recently-released "WHA 2008 Health Care Workforce Report," Warmuth provided data that shows that the demand for health care services by Wisconsin residents will soon outstrip the supply of workers available to fill health occupations. (The report is available at www.wha.org/workforce/Workforce_Report.aspx.)

"Hospitals are already competing with every other employer in Wisconsin for a smaller pool of candidates. That competition will grow as the size of the workforce fails to grow as quickly at population and demand. This demographic shift is causing us to look at everything from benefits to work environments to ensure that we can accommodate the older workers, while creating a work setting that attracts younger employees," Warmuth said.

Department of Workforce Development (DWD) Secretary Roberta Gassman shared a similar message. Using DWD statistics from their most recent report (see graph), Gassman showed that the rate of Wisconsin’s population growth is outpacing its ability to produce a workforce, which will trigger a serious shortage of workers across the board. Nowhere, however, will the shortage be felt more than in health care where it could directly affect access to care.

"We need to be assured that we are developing a well-trained, prepared workforce for current and future jobs, while at the same time, we are doing everything possible to retain our skilled workforce and attract new workers to Wisconsin," Gassman said.

Gassman said DWD has created a job Web site designed to attract workers back to Wisconsin—www.JobCenterofWisconsin.com. The site currently has more than 21,000 job postings. It is interesting to note that the new physician recruitment Web site created by WHA for the Wisconsin Council on Medical Education and Workforce has been extremely successful in attracting job postings as well, with now more than 600 positions posted for physician openings in Wisconsin. The Web site, Wisconsin Physician Careers, is at www.WisconsinPhysicianCareers.org.

Warmuth has prepared a presentation that outlines the workforce issues in Wisconsin. This presentation is now posted on the WHA Web site: www.wha.org/workforce/2008healthcare.ppt. It was designed for a general audience.

For more information contact Judy Warmuth at jwarmuth@wha.org or 608-274-1820.

WHA, with the help of RC Healthcare, kicked off the 2009-10 wage index improvement project with a meeting/conference call on Tuesday, October 28. WHA has been partnering with RC Healthcare for the past several years and has achieved excellent results on improving Wisconsin wage indices, which has a major impact on Medicare reimbursement for PPS hospitals.

RC Healthcare will be working directly with all Wisconsin PPS hospitals to help them review their Medicare cost report S-3 worksheet submissions for inconsistencies and to navigate through the CMS wage index process. As part of this process, they will also help hospitals as they review their occupational mix survey data. That survey covered payroll periods from July 1, 2007 through June 30, 2008. The occupational mix adjustment is another factor related to the wage index that impacts Medicare DRG payments.

The Centers for Medicare & Medicaid Services (CMS) last week issued revised interpretive guidelines clarifying that standing orders and written protocols for drugs or biologicals may be used in hospitals. WHA members had expressed concern about CMS requirements for signing of standing orders, with a specific concern that such orders are often in place to ensure a rapid and appropriate response to patient needs.

In a letter to CMS, the American Hospital Association warned that the original language was counter to accepted standards of care and would impede hospitals’ progress on quality improvement initiatives and could lead to patient harm. Among CMS’ clarifications, the agency said that standing orders should be written in the patient’s chart and signed by the practitioner responsible for the care of the patient, but that the timing of such documentation should not be a barrier to effective emergency response, timely and necessary care, or other patient safety advances.

The clarification, dated September 24, 2008 can be found at: www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter09-10.pdf.

The Wisconsin Department of Natural Resources (DNR) this week released four new publications to help health care facilities evaluate their compliance with hazardous waste regulations. The new publications include Self-Audit Checklists for Healthcare Facilities and a Table of Common Wastes in Health Care.

The new publications are an addition to DNR’s health care-focused Web site launched last month. The Web site provides technical assistance and guidance to bolster health care providers’ efforts to properly manage and dispose of hazardous waste.

The Web site is one part of a joint initiative announced on September 19 by the DNR and U.S. Environmental Protection Agency (EPA), Region 5, to make compliance with hazardous waste regulations in health care settings a priority for the next two years. As a part of that initiative, the EPA and DNR want to make sure that health care facilities are a part of the universe of business and facilities that are inspected in 2009 for compliance with hazardous waste regulations. The EPA has a goal of inspecting three Wisconsin health care facilities in fiscal year 2009.

Speaking at the WHA convention in September, Major General David Rubenstein, deputy surgeon general for the U.S. Army, encouraged Wisconsin hospitals to do whatever they could to help ease the transition between military and civilian life. America’s health care organizations, along with many others, must work together, according to Rubenstein, to do whatever they can to help returning military personnel.

A national effort is now underway to do just that. The Wisconsin Hospital Association has joined the American Hospital Association, HealthPartners and more than a dozen national organizations in a nationwide effort to educate millions of Americans about the problems faced by returning veterans and their families. Through the Joining Forces education campaign and curricula, medical professionals across the nation can now receive training online on how to address the health issues facing our nation’s troops as they return home from service. Additionally, outreach efforts are designed to inform the varied individuals and organizations that service men and women and their families might turn to for help about these available resources.

"My son served in Iraq and returned recently from the service so I know firsthand the challenges that he and many of his friends faced when they returned. I am pleased to have WHA serve as a sponsoring organization of this great effort to help health care providers and others in the community identify and help address the unique issues these returning troops and their families face as they transition back to civilian life," said WHA President Steve Brenton. "The Web site offers a wealth of information. I hope hospitals will help us spread the word in their communities about this new educational resource," he added.

The Web site, www.joiningforcesonline.org, will house the four-part series which addresses the most common issues returning soldiers face including challenges of reintegration, a general overview of health care issues faced by returning military, mild traumatic brain injury and post-traumatic stress disorder, as well as links to a variety of other resources.

The program was first developed in 2007 by Minnesota-based HealthPartners Institute for Medical Education in partnership with Twin Cities Public Television, the Minnesota Army National Guard and Minneapolis Veterans Affairs. Since that time, the American Hospital Association has recruited a variety of organizations including the American Medical Women’s Association, the American Association of Medical Colleges, the American Association of Nurse Executives and many others to help promote the program.

"What began as an effort to educate health caregivers in one community in Minnesota about the special needs of returning veterans and their families has grown into a collaboration among national organizations involving hospitals, doctors, nurses, social workers, clergy and many others all across our nation", said Rich Umbdenstock, president and chief executive officer, American Hospital Association. "Joining Forces tells an important story about the debt we owe our troops and the enormous level of support they enjoy back home."

"We have been extremely pleased with the response of veteran, health and social service organizations across the country," said Dr. Carl Patow, executive director of HealthPartners Institute for Medical Education. "With their support, we’re able to generate greater awareness among health care professionals, which in turn helps ensure improved care for our veterans and their families."

For more information about the program, go to www.joiningforcesonline.org. The Joining Forces curricula are available to anyone and can be used to meet continuing education credits for physicians across the nation.

Wisconsin Manufacturers and Commerce (WMC) initiated interviews with a number of companies that have taken bold steps to control their health care costs while improving the overall health status of their employees. These interviews have been documented in a series of papers now posted to WMC’s Web site, www.wmc.org (scroll down to "Do Business Better"). From the series of best practices papers that have been written to date, WMC notes that common elements or lessons learned have emerged among the employers interviewed, which include (but is not limited to) the following elements:

• Employees must be engaged in programs to improve employee health;
• Incentives are essential to employee engagement;
• Flexibility increases employee participation in wellness programs; and,
• Management of chronic/high risk diseases provides the best opportunity for cost savings. The 80/20 rule applies: 80 percent of health care costs are spent on 20 percent of the health care encounters.

Mike Shoys, WMC vice president administration said controlling health care costs has consistently ranked as one of the top two or three issues in WMC membership polls over the past five years. Consequently, he said, "The WMC legislative agenda focuses strongly on health care initiatives, including engaging employees in health care decisions. In talking to our members we learned that some companies were developing innovative programs to engage employees and control costs. As we listened to those companies, we found that they were very willing to share their stories, even with direct competitors."

Shoys invites any WHA member hospital to contact him, even if they are not a member of WMC, to share their best practices in employee health benefit and wellness efforts. He can be contacted at mshoys@wmc.org or 608-258-3400.

Peggy Troy, RN, MSN, currently chief operating officer of Methodist Le Bonheur Healthcare in Memphis, Tennessee, has been named president and CEO of Children’s Hospital and Health System. Troy will join the health system Jan. 11, 2009. She replaces Jon E. Vice who announced March 4 that he would leave the system after a new CEO was named.

Prior to serving as COO for Methodist Le Bonheur Healthcare, Troy was CEO of Le Bonheur Children’s Medical Center for three years. She also had nearly 20 years of leadership experience at Cook Children’s Medical Center, Fort Worth, Texas.

Troy earned her bachelor of science in nursing from Marquette University, Milwaukee, in 1974. While attending Marquette University, she served as a nurse intern at Children’s Hospital of Wisconsin. Troy also earned a master of science in nursing from DePaul University, Chicago.

Prior to the start of the planning process for the construction of a new medical center, Amery Regional Medical Center hosted a series of community forums to explain the need for a new facility and to answer questions the community might have regarding the project. One of the issues raised during these forums was what would happen to the old facility that was being vacated? The Medical Center had some plans for this space; however, one of the suggestions received at a forum was to consider using part of the existing building for a new public library.

The Medical Center started discussions with the City focused on selling a portion of the facility, or approximately 20,000 square feet, for a new library. During these discussions, the Amery Police Department chief asked the Medical Center to consider the possibility of their Department being relocated from City Hall into another part of the Medical Center’s old building.

In late 2007 the City of Amery and Amery Regional Medical Center reached an agreement for the City to purchase 28,000 square feet of space at the old facility at a deeply discounted price. As a result of a nearly $300,000 contribution to the community, both the Police Department and the Amery Area Public Library have new homes.

Good Samaritan Health Center in Merrill has a close relationship with a neighbor located only a short walking distance from its campus.

Bell Tower Residence, sponsored by the Holy Cross Sisters, is a not-for-profit Christian community committed to providing compassionate care in a comfortable home for older adults. Its skilled and dedicated staff promotes the independence and dignity of the residents, as well as their physical, intellectual and spiritual health. The Holy Cross Sisters also founded Good Samaritan over 80 years ago.

Good Samaritan has made a significant pledge to assist its neighbor with continuing its mission. The hospital has made a $100,000 pledge, paid over 10 years at $10,000 per year, to the Bell Tower Residence, which will assist the facility by providing a broad range of options that help seniors enjoy a full life. By combining elements of home with services that aid in daily activities, they offer a place where seniors live well, with dignity and purpose. The facility includes a special combination of residential housing, personalized supportive services, and health care designed for the individual needs of those requiring help with activities of daily living.

"In Merrill, the need for care for and housing of the elderly became the Holy Sisters’ mission and focus," said Mike Hammer, president of Good Samaritan. "We’re located in an aging community. Merrill is also a destination for retirees, and many people who had originally left to pursue their careers are returning to retire as residents of Bell Tower. It’s a focal point in our community."

Hammer said that the hospital’s pledge is a project that fit the dynamics of the community, it supported the Sisters who have been present locally for many years, and the Bell Tower residents are good neighbors. Good Samaritan also serves many patients that arrive from Bell Tower.

In early June, the city of Reedsburg and its surrounding towns of Rock Springs and La Valle experienced record-breaking downpours leading to roads being washed out and closed, and people fleeing their homes damaged by rising waters. Reedsburg Area Medical Center responded by going into disaster mode. Roads were impassable and phone lines were down which necessitated call teams staying in-house to assist with emergencies if/where necessary.

RAMC donated three cases of N-95 respirator masks to the RAFT (Reedsburg Area Flood Team) organization that was active in the community assessing and responding to emergencies. Hospital staff members trained the volunteers to use the masks that provided protections from mold and other respiratory ailments. The hospital donated time and materials and also immunized the volunteers and families against tetanus and TB.

Hospitals are always prepared for disasters. In the case of the floods in Reedsburg, the Medical Center put theirs into action to for the city, their patients and neighbors.

Through continued investment in Child and Adolescent day treatment programs in Milwaukee and patient continuing care funding, Rogers Memorial Hospital is committed to providing care to those who might otherwise be forced to walk away from vital behavioral health treatments simply due to an inability to pay.

In 2007, Rogers Memorial Hospital provided 1,500 unpaid days of care and over $175,000 in continuation funding through the hospital’s charitable Foundation. The Rogers Memorial Hospital Foundation administers the funds that are given to patients that demonstrate progress in their treatment plans but cannot afford additional treatment because their insurance and financial resources have been exhausted.