At their meeting on November 13, the WHA Public Policy Council reviewed the just completed state budget process, received updates on several important issues affecting hospitals, and discussed how those issues could develop through the remainder of the legislative session.

WHA President Steve Brenton provided a recap of how two issues in particular – the hospital assessment and Medicaid reimbursements – developed during nine months of state budget discussions.

Brenton spoke in detail about the evolution of the WHA Board’s position and how significant statutory language changes to the original proposal and the observed deliberations of the Legislature led to their modified position. The statutory language changes included: requiring federal approval for the assessment, ensuring proposed payments to hospitals actually flowed to hospitals, protecting assessment revenue to the greatest extent possible, including a sunset provision, and several other key provisions.

Brenton noted these changes, combined with the fact that hospitals have not seen a Medicaid payment increase in over a decade, and the unlikelihood that any stand-alone increases could be delivered by the Legislature, left the WHA Board with little choice but to remove their opposition to the assessment.

"While the overall vote to remove opposition was strong, this was a very difficult action for the Board to take," Brenton told the Public Policy Council. "But in the end, the Board determined that the reworked hospital assessment was the only way to advance their number one legislative priority – significant Medicaid payment improvements."

Also attending the meeting was special guest Senator Russ Decker (D-Weston), the new Senate Democrat Majority Leader, who discussed the post-budget outlook for the hospital assessment and health care reform.

Senator Decker indicated that both the hospital assessment and Healthy Wisconsin, the Senate Democrat’s health care reform plan, will come back as separate legislation, most likely after the first of the year.

Regarding the hospital assessment, Senator Decker indicated that one of the biggest questions is, "…how we strategize to bring the assessment back and pull in those additional federal dollars. If there ever was a time for you to be at the table, this is it." Referring to Healthy Wisconsin, the Senator said, "It will be changed somewhat to soften the blow for small employers, but the plan is coming back."

Senator Decker also discussed a dental initiative he is working on with Marshfield Clinic designed to increase the number of dentists that graduate in Wisconsin each year. Council members were pleased to learn of the proposal, as WHA has long been an advocate for improving access to dental care.

"Access to dental care is an important issue for hospitals," added WHA Executive Vice President Eric Borgerding. "Unfortunately, we see the result of inadequate dental care in our hospital ERs, which is clearly not the appropriate place to be receiving this care."

WHA staff updated Council members on a number of important issues affecting hospitals, including:

• A health care pricing transparency proposal from Senator Jim Sullivan (D-Wauwatosa) that would require providers and insurers to provide patients with cost information upon request.
• Assembly Bill (AB) 224 from Representative Don Pridemore (R-Hartford) that adds to current immunity protections for good-faith reporting of possible law or standard of care violations.
• Health Care Provider Criminal Negligence and the Quality Improvement Act
• A possible amicus brief filing opposing recent action by the Injured Patients and Families Compensation Fund (IPFCF) action against a provider.
• E-health initiatives designed to improve the sharing of patient information.

WHA staff also provided updates on a number of important federal issues affecting hospitals, including: SCHIP, Medicare, Critical Access Hospital (CAH) relocation and Medicare Recovery Audit Contractors (RAC).

RACs are the implementation component of a federal program established in 2003 as a demonstration project to identify improper Medicare overpayments and underpayments. The timeframe for RACs to move to Wisconsin has been pushed back to 2009. WHA is in the process of forming a task force to help hospitals prepare for upcoming RAC reviews. Additional information will be available soon.

Jenny Boese, WHA vice president, external relations and member advocacy, updated members on progress towards the 2007 Wisconsin Hospitals PAC/Conduit fundraising goal of $195,000. To date, 611 individuals have contributed $190,000, which places the campaign at 97 percent of its 2007 goal. Over the past seven years contributions have increased 300 percent.

Boese also highlighted outcomes from the recent Grassroots Leadership Training Workshops. Seventy-eight individuals attended the four workshops and gave the program a 4.8/5.0 overall rating. Seventy-six percent said the program motivated them to become more involved in legislative/grassroots initiatives, including joining the HEAT grassroots program and talking with co-workers about issues. In addition to offering the training again in 2008, another outgrowth of the workshops will be to develop one-hour webinars on timely legislative issues.

What started as perhaps a stretch goal set a year ago—all hospitals in Wisconsin becoming tobacco-free campus wide by November 15, 2007—is almost a reality. Now, 96 percent—123 in all—of Wisconsin’s hospitals are tobacco-free campus wide. More will join those ranks in the near future. In late 2006, the Wisconsin Hospital Association Board of Directors recommended that 100 percent of hospitals become tobacco-free by the American Cancer Society’s Great American Smokeout, November 15, 2007.

WHA President Steve Brenton said the recommendation met with strong statewide support from hospitals and from community leaders.

"Many employers struggle with the decision on whether to enact a tobacco-free work environment, even though the risks of tobacco use are well documented," said Brenton. "In some communities, hospitals were the first to become tobacco-free. That put them in a good position to be a resource for other businesses looking to implement tobacco use policies in their own workplaces," he added.

Mile Bluff Medical Center, Mauston, was the first hospital in the state to go tobacco-free campus wide in 1988.

Hospitals that have gone through the process are quick to share what they learned along the way. Michael Schmidt, president of Saint Joseph’s Hospital in Marshfield, said his organization directed communication strategies at patients, family and staff—with a special emphasis on supporting employee efforts to stop smoking. Schmidt also credited their success to having support from other health care providers.

"It is now more accepted for entire hospital campuses to be smoke-free, thanks to the early efforts of Wisconsin hospitals," Schmidt commented. He advised hospitals that are in the early stages of implementing tobacco-free policies to allow for extended planning timelines, foster respectful communications on the topic, and encourage employee ownership of the importance of becoming tobacco-free.

Mary Starmann-Harrison, immediate past chair of the WHA Board and regional president/CEO of SSM Health Care-Wisconsin, was instrumental in ushering the tobacco-free campus wide recommendation through the WHA Board. "Eliminating tobacco on your campus is not without its challenges," she said, based on SSM’s experience. "It takes a tremendous amount of planning and follow-through from writing the policy to providing employees, patients and visitors with alternatives to tobacco."

Starmann-Harrison said the early roadblocks to becoming tobacco-free are slowly being removed. "The first hospitals to adopt the policy met the most resistance, and Mike Schmidt is right—they helped knock down the roadblocks. ‘It can’t be done here’ was replaced with ‘why not?’ in many communities," Starmann- Harrison added. Starmann-Harrison predicts that sometime in the very near future, the public will just expect hospitals to not allow tobacco anywhere on their campuses.

According to the Center for Tobacco Research and Intervention (CTRI) at the UW School of Medicine and Public Health, more Wisconsin residents die every year from disease directly caused by cigarette smoking than from AIDS, illegal drugs, alcohol, suicide and homicide combined. Smoking costs the Wisconsin economy $3 billion per year, including $1.6 billion in direct health care costs and $1.4 billion in lost worker productivity. Health insurance premiums are higher because of these expenses. There are 800,000 smokers in Wisconsin, representing 22 percent of all state residents. CTRI reports that more than 70 percent of Wisconsin smokers want to quit and 50 percent try each year.

"We treat patients every day who are suffering from an illness that was either caused by or made worse by the use of tobacco," said Starmann-Harrison. "The dangers of both tobacco use and second hand smoke are well-documented. Hospitals must lead by example. By not permitting the use of tobacco on our campuses, we demonstrate our firm commitment to the health and safety of our employees and patients."

A list of Wisconsin hospitals that are tobacco-free campus wide is below.

Agnesian HealthCare/St. Agnes Hospital, Fond du Lac

Amery Regional Medical Center, Amery

Appleton Medical Center, Appleton

Aspirus Wausau Hospital, Wausau

Aurora BayCare Medical Center, Green Bay

Aurora Lakeland Medical Center, Elkhorn

Aurora Memorial Hospital of Burlington

Aurora Medical Center, Hartford

Aurora Medical Center, Kenosha

Aurora Medical Center, Oshkosh

Aurora Medical Center, Two Rivers

Aurora Psychiatric Hospital, Wauwatosa

Aurora Sheboygan Memorial Medical Center, Sheboygan

Aurora Sinai Medical Center, Milwaukee

Aurora St. Luke’s Medical Center, Milwaukee

Baldwin Area Medical Center, Baldwin

Beaver Dam Community Hospitals, Inc., Beaver Dam

Bellin Hospital, Green Bay

Beloit Memorial Hospital, Beloit

Berlin Memorial Hospital, Berlin

Black River Memorial Hospital, Black River Falls

Bond Health Center, Oconto

Boscobel Area Health Care, Boscobel

Burnett Medical Center, Grantsburg

Calumet Medical Center, Chilton

Children’s Hospital of Wisconsin, Milwaukee

Children’s Hospital of Wisconsin-Fox Valley, Neenah

Children’s Hospital of Wisconsin-Kenosha, Kenosha

Chippewa Valley Hospital, Durand

Columbia Center, Milwaukee

Columbia St. Mary’s, Inc. - Columbia Campus, Milwaukee

Columbia St. Mary’s, Inc. - Milwaukee Campus, Milwaukee

Columbia St. Mary’s, Inc. - Ozaukee Campus, Mequon

Columbia St. Mary’s, Inc. - Sacred Heart Rehabilitation Institute, Milwaukee

Columbus Community Hospital, Columbus

Community Memorial Hospital, Oconto Falls

Community Memorial Hospital, Menomonee Falls

Cumberland Memorial Hospital, Inc., Cumberland

Divine Savior Healthcare, Portage

Door County Memorial Hospital, Sturgeon Bay

Eagle River Memorial Hospital, Eagle River

Edgerton Hospital and Health Services, Edgerton

Flambeau Hospital, Park Falls

Fort HealthCare, Fort Atkinson

Franciscan Skemp Healthcare-Mayo Health System, Arcadia

Franciscan Skemp Healthcare-Mayo Health Sys., La Crosse

Franciscan Skemp Healthcare-Mayo Health System, Sparta

Froedtert Memorial Lutheran Hospital, Milwaukee

Good Samaritan Health Center, Merrill

Grant Regional Health Center, Lancaster

Gundersen Lutheran Health System, La Crosse

Hayward Area Memorial Hospital, Hayward

Holy Family Memorial, Inc., Manitowoc

Howard Young Medical Center, Woodruff

Hudson Hospital, Hudson

Kindred Hospital Milwaukee, Greenfield

Ladd Memorial Hospital, Osceola

Lakeview Medical Center, Rice Lake

Langlade Memorial Hospital, Antigo

Luther Midelfort, Eau Claire

Luther Midelfort Chippewa Valley, Bloomer

Luther Midelfort Northland, Barron

Luther Midelfort Oakridge, Osseo

Memorial Health Center, Medford

Memorial Medical Center, Neillsville

Memorial Medical Center, Ashland

Mercy Health System Corporation, Janesville

Mercy Medical Center, Oshkosh

Mercy Walworth Hospital and Medical Center, Lake Geneva

Mile Bluff Medical Center, Mauston

Moundview Memorial Hospital & Clinics, Inc., Friendship

New London Family Medical Center, New London

Oconomowoc Memorial Hospital, Oconomowoc

Orthopaedic Hospital of Wisconsin, Glendale

Our Lady of Victory Hospital, Stanley

Prairie du Chien Memorial Hospital, Prairie du Chien

Red Cedar Medical Center - Mayo Health System, Menomonie

Reedsburg Area Medical Center, Reedsburg

Richland Hospital, Richland Center

Ripon Medical Center, Inc., Ripon

River Falls Area Hospital, River Falls

Riverside Medical Center, Waupaca

Riverview Hospital Association, Wisconsin Rapids

Sacred Heart Hospital, Eau Claire

Sacred Heart-St. Mary’s Hospital, Rhinelander

Sacred Heart-St. Mary’s Hospital, Tomahawk

Saint Clare’s Hospital, Weston

Saint Joseph’s Hospital, Marshfield

Saint Michael’s Hospital, Stevens Point

Sauk Prairie Memorial Hospital, Prairie du Sac

Shawano Medical Center, Shawano

Southwest Health Center, Platteville

Spooner Health System, Spooner

St. Clare Hospital & Health Services, Baraboo

St. Croix Regional Medical Center, St. Croix Falls

St. Elizabeth Hospital, Appleton

St. Joseph’s Community Health Services, Hillsboro

St. Joseph’s Hospital, Chippewa Falls

St. Luke’s South Shore, Cudahy

St. Mary’s Hospital, Madison

St. Mary’s Hospital Medical Center, Green Bay

St. Mary’s Hospital of Superior, Superior

St. Nicholas Hospital, Sheboygan

St. Vincent Hospital, Green Bay

Stoughton Hospital Association, Stoughton

SynergyHealth St. Joseph’s Hospital, West Bend

The Monroe Clinic, Monroe

Theda Clark Medical Center, Neenah

Tomah Memorial Hospital, Tomah

Tri-County Memorial Hospital, Whitehall

Upland Hills Health, Inc., Dodgeville

Vernon Memorial Healthcare, Viroqua

Watertown Memorial Hospital, Watertown

Waukesha Memorial Hospital, Waukesha

Waupun Memorial Hospital, Waupun

West Allis Memorial Hospital, West Allis

Westfields Hospital, New Richmond

Wheaton Franciscan Healthcare-All Saints, Racine

Wheaton Franciscan Healthcare-Elmbrook Memorial, Brookfield

Wheaton Franciscan Healthcare-St. Francis Hosp., Milwaukee

Wheaton Franciscan Healthcare-St. Joseph, Milwaukee

Wild Rose Community Memorial Hospital, Wild Rose

Wisconsin Heart Hospital-Wheaton Franciscan, Wauwatosa

State officials left $400 million in federal money on the table when they passed the new budget bill - money that would help pay for health care for the poor while easing a significant burden on Wisconsin businesses. It's now time for the Legislature to seize this opportunity.

Medicaid is a federal-state partnership that provides health care for low-income individuals and families. In Wisconsin, the program is grossly underfunded, reimbursing hospitals less than half of what it costs to provide care. The result is cost-shifting to patients who have commercial health insurance, and this constitutes a huge hidden tax on employers and consumers.

Medicaid reimbursements in Wisconsin have not increased in 12 years as policy makers in Madison ignored the growing problem, and Wisconsin now ranks near the bottom among the states in reimbursement levels. This situation is simply unsustainable.

The hospital assessment proposed by the governor and revised during state budget deliberations would have allowed Wisconsin to capture $400 million in additional federal money for Medicaid. Regrettably, this worthy effort to pay for care for the disadvantaged became a bargaining chip in last month's budget mayhem and was sacrificed. Politics, in the end, affects people.

The $400 million that was left on the table included $165 million that would have flowed to southeastern Wisconsin - money to help support the "safety net" hospitals in the Milwaukee area that care for many people enrolled in Medicaid. Without meaningful Medicaid payment increases, these hospitals are at great risk.

The Wisconsin Hospital Association calculates that the Medicaid shortfall for Wisconsin hospitals totaled $2.98 billion over the past 12 years. In 2006 alone, the shortfall for Milwaukee area hospitals totaled $205 million. Most of that cost presumably was shifted to employers and consumers through higher insurance premiums—the so-called hidden tax. That is just not right.

This enormous hidden tax continues to threaten the competitiveness of Wisconsin businesses and burdens hard-working people who are struggling to pay for the rising cost of health insurance.

Opponents of the hospital assessment have wrongly labeled it a tax on the sick. It is no such thing. It is a reasonable way to leverage additional federal support for our most vulnerable patients and at the same time reduce the cost-shifting that has long been a chronic problem for Wisconsin's health care system. This idea received the support of health care providers, the Greater Milwaukee Committee and the Metropolitan Milwaukee Association of Commerce.

A hospital assessment is one way to address this problem. There certainly are others. Whatever approach is taken, state officials must act quickly. The situation is critical, and we simply cannot let another biennium pass without a solution.

Providing adequate support for Medicaid is a fundamental responsibility of state government, like the funding of education, transportation and other vital needs.

Medicaid shortfalls are a major driver of health care costs in Wisconsin. Wisconsin citizens and businesses expect their state officials to address this problem, and to do so now.

You may have heard about it…a new federal program where recovery audit contractors, known as RACs, look for overpayments and underpayments in Medicare. The program has been operational in three states as a demonstration and will roll out nationwide over the next year. The RAC program will likely come to Wisconsin in January 2009. To begin preparing hospitals for this program, WHA’s online Toolkit now includes a RAC background paper.

"The experiences of the three demonstration states reveal the importance of the hospital association in educating members on this issue," said WHA President Steve Brenton. "This Toolkit paper is one of the many means WHA will use to make certain our members are well informed as this program comes to Wisconsin," he added.

WHA will work with other state associations and the American Hospital Association to address implementation, policy or other problems that arise with RACs in Wisconsin. Watch for future Valued Voice articles or log onto www.wha.org/governmentRelations/rac.aspx for details in the coming months.

The Wisconsin Insurance Commissioner’s Group Health Insurance Index has recently shown some favorable signs on insurance premiums that suggest group health insurance premium increases are stabilizing.

The Group Health Insurance Index is a tool that the Office of the Commissioner of Insurance (OCI) has been using since 1997 as an indication of group insurance rates in Wisconsin. OCI surveys the largest health insurers and asks them to provide a quote on a hypothetical "small" (25 employees) and a "large" (75 employee) group, each with sets of health conditions. The groups are situated in Milwaukee and Wisconsin Rapids. The averages of all of the quotes can be seen as rough measures of what may be happening in the Wisconsin health insurance market as a whole.

It is not surprising that the hypothetical premiums in the Index have shown increases over the past ten years similar to what actually has been experienced. But while the ten-year trend shows significant increases, a look at the latest data suggests a slow down. The chart below, using a three-year moving average to remove year-to-year peaks and valleys, shows that the last several years have seen a significant moderation in premium increases.

The first part of this decade saw dramatic increases in premiums, and the Group Health Insurance Index reflected that environment. But recent data, including surveys conducted by Kaiser, Hewitt, and Mercer, suggests a dampening. The Wisconsin Index supports those findings.

We can all speculate as to the reasons behind this trend. The first and most obvious is the movement toward higher deductible plans. Higher deductibles have two affects: first, more health care costs are being shared by employees; and second, because of that cost sharing, employees are more likely to consider costs in seeking care, which should ultimately reduce consumption.

On the provider side of the equation, we have seen a greater emphasis on quality improvement and efficiency. Hospitals and health systems have embraced quality improvement initiatives, such as WHA’s CheckPoint and the 100,000 Lives Campaign. Better quality inevitably leads to lower costs. Hospitals are also actively involved in improving their efficiency in delivering health care. Six Sigma and LEAN management principles are being implemented in many health systems. Care management—coordination between provider settings and chronic disease management—is being integrated into every health care provider’s delivery system.

At the same time, however, several cost drivers have not diminished in their importance. Medicare and Medicaid payment shortfalls continue as a "hidden tax" on commercial insurance premiums. Advances in technology, while improving the diagnosis and treatment of illnesses, come at an ever-increasing cost.

Ultimately, premiums reveal the combined effects of all of the factors outlined above, and those premiums show a slow down in rate increases. Only time will tell if this becomes a long-term trend, but the signs are encouraging.

The Continuous Service Readiness (CSR®) program is now available to all Wisconsin hospitals, through a partnership between WHA and Joint Commission Resources (JCR). This program offers hospitals a package of expert guidance and education on maintaining continuous compliance with The Joint Commission Standards, National Patient Safety Goals and Disease-Specific Care Certification Requirements, at a reduced group rate.

Receive a Joint Commission 2008 update on the new Emergency Management Standards, 2008 National Patient Safety Goals and strategies for being "survey ready" at any time, and learn more about the CSR® program by participating in one of two free Introduction to CSR® teleconferences, scheduled:

• Monday, December 10, 9 - 10 am CST
• Monday, December 17, 11:30 am to 12:30 pm CST

During the teleconference, current CSR® clients will discuss how the program has helped their organizations achieve continuous compliance and improve patient safety. All teleconference participants are also eligible for a free, private 15-minute phone consultation with a CSR® consultant. The phone consultation offers the opportunity to ask individual questions and gain insight from an experienced consultant.

To register for the teleconference, please complete the registration form available at www.wha.org/qualityAndPatientSafety/WiCSR11-14-07.doc by Friday, December 7, 2007, and return it to Frankie Poe at JCR. Details on scheduling the free phone consultation will be shared at the conclusion of the teleconference.

Until recently, health care workforce planning was hit or miss. Now, thanks to hospitals and several regional health care workforce consortiums working together, data is being compiled that will help health care organizations meet their workforce needs in the future.

Joanne Sandvick, project specialist at the La Crosse Medical Health Science Consortium, told the WHA Workforce Council November 15 that La Crosse is conducting the workforce survey created and reported by the Fox Valley Healthcare Alliance. Starting this fall, health care employers will be surveyed about new and replacement positions. Next spring, the La Crosse Consortium will conduct the employee portion of that survey, which focuses on plans to change positions or retire. Hospitals and health facilities within the south central and southwest workforce investment areas are also conducting surveys and intend to begin that process yet this year.

Sandvick said the La Crosse group is also piloting an online list of all clinical placements for nursing students in that region and working to expand the number of clinical faculty to create preceptors and improve population health—all while improving cooperation and creating efficiencies among health care providers in the region.

Also reporting to the group were Eric Grasso and Victoria Udalova from the Office of Economic Advisors (OEA) within the Department of Workforce Development. Grasso described the process the Department uses to make workforce projections. He said the projections are done every two years by OEA. He and Udalova outlined the process, reminded the group of the benefits and limitations of these projections and invited hospitals (who contribute the data OEA uses) to dialog and offer feedback on their work.

Warmuth provided an update on other workforce issues including current legislative initiatives, the declining pass rate on the RN licensing exam and Concordia University’s plan to open a school of pharmacy. She thanked Chair Mike Schafer for his service to the Council and congratulated him on his election as 2008 chair-elect of the WHA Board.

Launched in late October, the WHA Foundation’s 2007 Annual Fundraising Campaign continues, raising approximately $9,000 within the first month of the campaign. Contributions are used to fund a variety of workforce development and health care quality and safety initiatives throughout the year. In 2007, the Foundation funded its WHA Foundation Scholarship Program at the state’s 16 technical colleges, the Nurse Leadership Succession Project, the Global Vision Community Partnership Awards, and other statewide initiatives that support hospitals throughout Wisconsin.

"There is little evidence that policy approaches, such as mandating ratios, improve patient outcomes," according to Sean Clarke, MD, University of Pennsylvania faculty member. When California implemented mandatory ratios, it was done with little data and thin evidence to support their move. Since that time, nurse researchers have started to examine the issue, looking for evidence on which to base practice and policy.

Clark reported on the current state of nurse staffing research at the annual Wisconsin Center for Nursing Conference held in early November. He acknowledged that this is a new area of research interest and much of what is currently known has been abstracted from publicly available information on nurse employment and patient discharge information. That means these studies report hospital-wide averages and outcomes, not patient or nurse unit outcomes. He said some hospitals have better outcomes than others, and presented a framework for investigating why this might be true. His model includes hospital leadership, nurse practice environments, nurse staffing, nurse job outcomes, the process of delivering care and patient outcomes in a complex matrix.

Judy Warmuth tracks workforce issues for the Wisconsin Hospital Association. "Wisconsin hospitals know that staffing practices need to be evidence-based. Just implementing ratios because it seems like a good idea is not the right way to approach this challenging issue," Warmuth said. "Dr. Clarke provided a great overview of what the evidence does and does not tell us about the relationship between the number of nurses and patient outcomes," Warmuth added.

The large audience of nurse leaders and nurse faculty members that were at the conference also heard about best practices from panels on Magnet Hospitals and on long-term care and community settings. Participants were also asked to help the Wisconsin Center for Nursing develop strategies to strengthen the nursing workforce.

The Rural Hospital Stroke Improvement Project will focus on reducing stroke morbidity and mortality through the implementation of the Brain Attack Coalition standards of care. The project will include education regarding the scientific evidence and best practices. Each participating hospital will receive one year of free access to the Get With the Guidelines online patient management tool that includes new consensus measures endorsed by the American Stroke Association, The Joint Commission and the Centers for Disease Control. In addition, the project will explore the role of the rural hospital in the movement toward a statewide Stroke System of Care.

Stroke is the third leading cause of death in the United States when considered independently from other cardiovascular disease. Approximately 700,000 Americans have a new or recurrent stroke each year. Stroke also remains a leading cause of serious, long-term disability in the United States.

Major advances have been made during the past decade in stroke prevention, treatment and rehabilitation. Despite these improvements, significant obstacles remain in consistently translating these evidence-based standards of care into practice.

Rural Wisconsin hospitals are encouraged to participant in the Rural Hospital Stroke Improvement Project. The registration deadline is December 11, 2007. A brochure with registration information is included in this week’s packet and it is available online at www.wha.org. To learn more about this project, contact Dana Richardson at dirchardson@wha.org or at 608-274-1820. For registration information, contact Lisa Geishirt at lgeishirt@wha.org or at 608-274-1820.

Health care managers who don’t have a financial background can gain a working knowledge of performance reporting and financial performance planning/budgeting at a December 5 workshop entitled, "Health Care Budgeting & Financial Management for Non-Financial Managers."

Participants will learn how to read financial performance reports, develop a budget, identify performance improvement targets, and analyze work processes to enhance productivity and improve customer satisfaction.

Learn the details of the CMS changes for APCs in 2008, including all the key elements and their impact on hospital outpatient billing, without leaving your hospital. On December 20, WHA is offering the audioconference "2008 Outpatient Prospective Payment System (OPPS) Final Rule: What You Need to Know to Prepare Your Hospital" from 9-10:30 a.m. Upon completion, attendees will be able to discuss the implications of billing changes and key areas of impact under OPPS for 2008, evaluation reimbursement changes, and work with clinical departments to evaluate approaches to the 2008 billing requirements.

Register for the 2008 OPPS Final Rule audioconference to educate your entire staff in a short period of time without incurring multiple registration fees or travel expenses. The registration fee includes one toll-free telephone connection to the presentation, so you can gather numerous staff members in one room to "attend" for one economical price. Prior to the event, you will receive dial-in information and supporting materials, which you can distribute to all participants.

Nothing compares to learning from those who are doing. That is the goal of the Human Resource Best Practices Conference, which is held annually and co-sponsored by the Wisconsin Hospital Association and the Wisconsin Society of Healthcare Human Resources Administration.

This year’s conference, held November 8 in Stevens Point, showcased five projects. Jan Bultema, vice president of human resources at University of Wisconsin Hospitals and Clinics, described a program they have in place that teams HR with other hospital departments to achieve quick improvements in the workforce planning process. Bultema said the partnership has led to better data collection and analysis.

Columbia St. Mary’s health system, Milwaukee, presented "Socially Just Medical Plan" that focuses on providing an affordable health plan to employees experiencing financial challenges. Also from Columbia St. Mary’s was a report on the steps they have used to create process improvements in the problem-prone Family Medical Leave of Absence process.

Mercy Health System, Janesville, once again was recognized by AARP as being a best place to work. Mercy uses a variety of strategies to recruit and retain mature workers. Some of the strategies required benefits, scheduling and work process changes.

The Rural Wisconsin Health Cooperative (RWHC) and Sauk Prairie Hospital presented "Club Scrub," a project to create interest in health careers among middle school students. The program is currently in place in several RWHC member hospitals. Creative ideas for working with this age group included a suturing session, a simulated ER trauma case, t-shirts and picture books.

When a homeless person becomes really desperate, newspapers serve as bandages. Ellen Krueger, RN learned this fact as she provided outreach service for St. Ben’s Clinic at an outreach site in St. James Meal Program in downtown Milwaukee. She was approached there by Harold, a man who had lived on the streets for some time. He was one of the many street people who have a difficult time trusting others, even when in pain. On this day, however, the pain was too much to bear and he asked Ellen for her help with his feet.

As Harold took off his shoes, Ellen saw one reason for his foot pain, no socks. His poor-fitting shoes were rubbing directly on his swollen feet. He had large open sores that he tried to relieve by packing newspapers into the shoes. Needless to say, the newspapers were making his feet dirtier and only making things worse. Ellen’s first action was to cover his wounds with gauze and then to talk to him seriously about coming to St. Ben’s Clinic to have the wounds really cared for.

Harold had developed enough trust in Ellen that he did come to the Clinic. There his feet were soaked, antibiotic ointment was supplied and new socks were given to him. A voucher for shoes was provided by the social worker, and Harold was on his way to healing. It did take him several more appointments to have his feet healed completely, but that afforded the time for him to really develop trust in the Clinic and to begin to address his Chronic Lung Disease. Now that he is a part of a health care system, he will no longer need newspapers for bandages.

Lakeview Medical Center (LMC) wrapped up its third annual Hang on Thru the Holidays promotion with stunning results once again.

This seven-week program was designed to motivate participants to avoid the extra weight commonly gained during the holidays—and even lose some pounds. The cost was $5 per person, with all the money collected returned in cash prizes. The individual who lost the most weight won $100. Also, for every pound a participant loses, their name is entered into a drawing for $100 – the more they lost, the more chances to win. Participants were required to weigh in weekly with LMC Cardiac Rehab or Health & Wellness Center staff.

During the 2006 program, 242 participants lost a combined 517 pounds. Eleven participants won $100.