The Legislature’s Joint Audit Committee this week approved a request for a formal audit of the Physician Office Visit Data (POVD) program. Authorization for the in-depth review was granted by a unanimous vote of the Committee and will be conducted by the Legislative Audit Bureau.

The audit comes as the result of a formal request submitted July 14 by Rep. Sheldon Wasserman (D-Milwaukee). Wasserman, who is a physician, is one of many in the medical community who have been critical of the program and its implementation. POVD, which collects claims data from approximately half of the state’s physicians, is funded through a $75/year assessment on all Wisconsin physicians.

The audit will include a staffing and expenditure analysis, an evaluation of whether the program is being effective, a comparison of POVD and programs run by private sectors, an assessment of the privacy issues for patients and providers, and a review of compliance with statutory requirements.

"It is clear that even (BHI) board members are not getting sufficient information on POVD program finances, whether POV data is valid and if it can measure quality," Wasserman said in testimony before the Joint Audit Committee.

In its roughly six-year existence, the POVD program has released very little useable data, a situation also noted by Wasserman. "The Wisconsin Hospital Association’s similar data collection effort (WHA Information Center) was operational in less than a year, with fewer employees. The WHA and Wisconsin Collaborative for Health Care Quality are demonstrating how private sector models are making government mandates obsolete."

In an October 22 letter to the Joint Audit Committee, WHA indicated its support for the audit request. "To our knowledge, there has never been a formal or significant performance review of the POVD program or of any health care data programs administered by BHI," WHA’s letter stated. "Before the legislature entertains any new state-run or mandated data programs (including a massive new data public authority), it is absolutely critical, and simply reasonable, to understand and learn from the experience and past performance. An audit of BHI will help do just that."

Both WHA and WHAIC anticipate being involved in the audit process. "Given the charge of the audit and our history with health care data collection, we look forward to discussing our experiences with BHI and sharing our insights," said WHA Senior Vice President Eric Borgerding. "This is about moving forward, but to do that you have to learn from the past, as we are doing with WHAIC."

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Five years after the release of the Institute of Medicine’s report on medical errors, a new national survey shows that people are more aware of the issue of health care quality and safety, but most are still not aware of the quality improvement efforts that are taking place on their behalf in the nation’s health care system. Respondents indicated that they are beginning to use information they find on the Internet on the quality and safety of hospital and physician services.

"This is what we expect will happen over time. As information becomes more available, consumers will begin to use it to make decisions," according to Dana Richardson, WHA vice president for quality initiatives. "With CheckPoint, Wisconsin hospitals anticipated the need for this information. Our challenge is to stay one step ahead of consumer demand."

Those who saw health quality information on hospitals or health plans and chose not to use it were most likely to say they did not use it because they did not need to make a decision about their care at the time or the information they saw was not specific to their health concerns.

Of particular interest to Richardson was the fact that only 10 percent of the respondents indicated that the information they saw about quality was confusing or difficult to understand, while 53 percent said if they didn’t find value in the information, it was because it was not specific enough about their condition or concern.

"We have to make sure that as we provide information to consumers, we don’t over simplify it to the point where we drop specifics that they are looking for," Richardson said. "When someone has a concern, diagnosis, or a chronic condition, their learning curve may be short and steep. This study indicates that they don’t place as much value on information that is generalized or simplified."

• Wisconsin Republicans might want to request a "timeout" to look at recent election results in Colorado, the birthplace of the Taxpayer Bill of Rights (TABOR) that some would like to enact here in Wisconsin. In Colorado, Democrats seized control of both chambers of the state legislature for the first time in 44 years! And local pundits say that widespread voter discontent over the impact that Colorado’s TABOR has had on education and health programs was a major reason for Democratic success.
  
• Who says that tobacco taxes are politically unpopular? Not voters in three states who overwhelmingly supported increasing tobacco taxes on initiative and referendum ballots on November 2. Voters in Colorado, Oklahoma and Montana (red states!) by wide margins approved statewide measures increasing tobacco taxes and directing at least part of the new revenue to health care programs.

In Montana, the cigarette tax will increase by $1.00…to $1.70 per pack… and taxes on other tobacco products will increase by 50 percent. Almost two-thirds of Montana voters supported the increases.

In Oklahoma, the cigarette tax will jump 80 cents, a huge increase supported by 53 percent of that state’s voters.

In Colorado (TABOR country), 61 percent of voters supported a state constitutional amendment that increases the cigarette tax by 64 cents and taxes on other tobacco products by 40 percent. Most of that money will go to finance health-related programs.

Wisconsin’s current tobacco tax of 77 cents is significantly less than the national average and Medicaid payment rates are among the lowest in the nation. WHA will be strongly supporting a tax (we’ll call it a "fee") increase in 2005 with new revenues targeted to improve woefully low Medicaid provider payments.

• The State of Illinois is a national leader in high medical liability insurance rates. But that hasn’t stopped huge increases from being implemented this year. According to Medical Liability Monitor, Illinois obstetricians/gynecologists now pay $230,000 in annual premiums, a 50-plus percent increase over 2003. General surgeons are paying $183,500, an 84 percent jump over last year, and internists pay close to $60,000, a 40-plus percent increase.

Last year’s WHA/WMS Task Force on Wisconsin’s Future Physician Workforce noted that the Badger State’s relatively favorable malpractice environment is a real plus when it comes to attracting and retaining physicians. A look south confirms that finding.

Steve Brenton
President

On November 23, WHA, together with the Wisconsin Medical Society (WMS) and the American Medical Association (AMA), will be filing a request to file an amicus brief with the Supreme Court in Phelps v. PIC Wisconsin. This case will require the Court to consider whether a first-year medical resident is afforded protection under Wisconsin’s cap on noneconomic damages in medical malpractice cases and whether communications regarding such a resident’s work are protected by Wisconsin’s peer review privilege. The case also presents issues regarding the standard of care applicable to a first-year resident, a defendant’s right to a jury trial, and the applicability of Wisconsin’s noneconomic damage caps to a sibling’s loss of consortium claim.

WHA, WMS, and the AMA filed the request because of their concern that the Court’s ruling in this appeal with respect to first-year medical residents will have serious consequences on the health care delivery system in Wisconsin as a whole. According to Laura Leitch, WHA Vice President and General Counsel, "Wisconsin is beginning to experience a physician shortage. Supporting graduate medical education in Wisconsin is an important priority for WHA because there is a correlation between physicians who complete their residency in Wisconsin and physicians who ultimately practice in Wisconsin."

The Department of Health and Family Services (DHFS), the State Trauma Advisory Council (STAC) and trauma professionals from nearly 30 hospitals, along with the Wisconsin Hospital Association, have been working towards the implementation of a statewide trauma care system. The major goals of the trauma care system are to decrease mortality and morbidity of severely injured patients and to match resources with the needs of the trauma patient. The new Administrative Rules to govern the system will go into effect January 1, 2005 and will include requirements for classification as required by State Statute 146. Included in the rules is a requirement that all hospitals self-determine their respective trauma designation. The rules also encourage hospitals to apply for state designation as a trauma center. Participation in the statewide trauma care system is strictly voluntary.

The educational seminar "New Year, New Challenges, New APCs, and New Headaches" is scheduled for January 20, 2005. Chargemaster/APC coordinators, coding staff, CFOs and others who are involved in billing, coding and operational issues should plan to attend.

Hospitals have been operating under Ambulatory Payment Classification groups (APCs) for almost five years and are still experiencing operational issues, billing problems and coding concerns. This seminar goes beyond the basics in reviewing the latest CMS program memorandums and providing financial analysis and recommendations to ensure hospitals are able to adapt and remain current in the ever-changing outpatient health care arena.

The seminar will be held on January 20, 2005, from 9 AM to 4 PM at Madison Marriott West, Middleton. A brochure and a registration form are included in this week’s packet and on the web site at www.wha.org. On-line registration is available. This seminar is approved for five (5) continuing education hours by the American Health Information Management Association (AHIMA).

A booklet entitled, "Public Health Emergencies: Your preparedness guide," was recently published by the Wisconsin Division of Public Health to help Wisconsin families prepare for and protect against various types of emergencies. It contains information about weather-related disasters as well as communicable diseases and possible terrorist incidents. It also has a reference page that readers can complete for ready access to personal telephone numbers in a crisis situation.