A bill from Representative Don Pridemore (R-Hartford) that adds to current immunity protections from civil and criminal liability for good faith reporting of possible law violations or standard of care violations is set to pass the Assembly.

Assembly Bill 224 (AB 224) passed the Assembly Judiciary Committee by a unanimous vote earlier this year. A final vote by the full Assembly is expected next week where the proposal is also likely to receive bi-partisan support.

WHA supports this measure as a way to improve and enhance Wisconsin’s already nationally recognized high levels of patient safety and quality of care by encouraging the reporting of violations.

In addition to providing liability immunity, current law prohibits a health care facility or health care provider from taking or threatening to take disciplinary action against an employee of the facility or provider who, in good faith, reports a possible law or standard of care violation to specified individuals or entities.

AB 224 expands these protections to any health care provider, health care facility, or employee of a health care provider or facility that in good faith does any of the following:

• Reports any information relating to an allegation that another health care provider, health care facility, or employee has violated any standards established by law, or any clinical or ethical standards in patient care to any accrediting or standard setting body, or to any officer, director, or supervisor of the health care facility or health care provider
• Initiates, participates in or testifies in any action or proceeding relating to the above information
• Provides to any legislator or legislative committee information relating to the above information

An amendment proposed by WHA and offered by Rep. Joel Kleefisch (R-Oconomowoc) was approved during Assembly floor debate. This amendment added immunity protections for reporting information to any prospective employer of an employee or former employee of a health care provider or facility, information relating to allegations of violations of clinical or ethical standards.

Unfortunately, there have been instances where patients have been put at risk by individuals who have repeatedly violated clinical or ethical standards. By allowing the sharing of that information with prospective employers without the fear of liability, patients will be protected and quality of care will be improved.

If approved by the full Assembly, AB 224 will then move to the Senate for consideration.

Year to date, 581 individuals have contributed to the 2007 Campaign. This includes CEOs, employees, volunteers, and trustees affiliated with 102 hospitals from around the state who together have contributed nearly $186,000 to date. This accounts for 95 percent of the $195,000 fundraising campaign’s monetary goal.

This year’s goal, if met, would surpass last year’s record setting total of $187,000. In the last six years, contributions to the campaign have grown over 300 percent!

The next list of contributors will be published in the November 9 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

As indicated in last week’s Valued Voice, the Wisconsin Medical Society filed a lawsuit against the State on October 29, 2007, concerning the State Budget provision that takes $200 million from the Injured Patients and Families Compensation Fund ("Fund") for other state purposes. The lawsuit alleges, among other things, that the taking of the money from the Fund for purposes other than those for which the Fund was created is an unconstitutional taking without just compensation, an unconstitutional impairment of contract, a breach of contract, and an invalid tax. A copy of the Society’s complaint can be viewed on the WHA Web site under Legal and Regulatory.

WHA is currently soliciting appointment requests from WHA members to participate on a WHA council or committee. This is your opportunity to be on a council/committee that identifies key membership policy issues and makes recommendations on positions to the WHA Board.

We are seeking member participation for five councils and one committee:

• Advocacy Committee
• Council on Finance and Payment
• Council on Medical and Professional Affairs
• Council on Public Policy
• Council on Rural Health
• Council on Workforce Development

A council/committee request form is included in this week’s packet. Additional information including council responsibilities and current member information is located on WHA’s Web site at www.wha.org/pubArchive/general_memos/gm3-07.pdf. You may direct questions to Sherry Collins at scollins@wha.org or 608-274-1820.

A growing number of consumers are familiar with health care quality and safety reports, but the question is whether they are in a position to take action on what they learn. That was just one of the questions that was discussed with an audience of physician researchers at the Wisconsin Research and Education Network’s (WREN) Research Forum held November 1 and 2 in Wisconsin Dells.

Dana Richardson and Chuck Shabino, MD, from the Wisconsin Hospital Association, who were invited to present at the forum, described WHA’s transparency initiatives. Shabino said public reporting has led to quality improvement in hospitals, but the question remains, who is using the data, and how are they using it?

He said consumers are accessing the data more often, but most have a limited ability to act on what they learn. On the other hand, purchasers are using the data to create incentives related to reporting and performance. Shabino referenced the fact that all Wisconsin hospitals recently received their full-market basket update from the Centers for Medicare and Medicaid Services for publicly reporting data on 21 measures.

Richardson pointed out that nearly all quality and safety measures are developed based on the use of evidence-based practices. She said in the past, clinics and hospitals were responsible for developing their own clinical practice guidelines. "Now that work is done for us," she added.

"While research has defined our best practices, it still takes 17 years to move what we learn in research to common practice in the clinical setting," according to Richardson.

WREN is a practice-based research network (PBRN) that involves 130 primary care clinicians and academic researchers in Wisconsin. Community-based clinicians and their staff engage in activities designed to understand and improve primary care. PBRN’s efforts link relevant clinical questions with rigorous research methods in community settings to produce scientific information that is externally valid, and in theory, assimilated more easily into everyday practice.

Under the demonstration program operating in California, Florida and New York, RACs can review the last four years of provider claims for the following types of services: hospital inpatient and outpatient, skilled nursing facility, physician, ambulance and laboratory, as well as durable medical equipment. The RACs use automated software programs to identify potential payment errors in such areas as duplicate payments, fiscal intermediaries’ mistakes, medical necessity and coding. During fiscal year 2006, the RACs collected $69 million in overpayments and found $3 million in underpayments. An additional $232 million was identified for collections, but the final outcome has yet to be determined.

The Tax Relief and Health Care Act of 2006 made the RAC program permanent and authorized CMS to expand the program to all 50 states by 2010. CMS plans to expand RAC review to all states by March 2008.

WHA Activities

After learning from other states that have gone through the transition to RAC audits, it is clear this initiative will be burdensome and potentially costly for hospitals.

Representatives from the California, New York and Florida hospital associations have shared their RAC implementation experiences, and it is clear there is an important member education role for hospital associations to play.

There is also a public policy role for WHA as we work with AHA to make sure that the RAC follows the approved scope of work and has rules and protocols for their reviews. California, in particular, has had significant issues with their RAC denying claims that hospitals ultimately recover during the appeals process. Here are some activities that WHA will undertake to help Wisconsin hospitals work with this new initiative:

• Establish an ongoing relationship with the selected RAC
• Help facilitate and promote training and education opportunities in cooperation with the RAC and CMS
• Identify other educational opportunities in this area
• Establish and maintain a database of RAC liaisons at each Wisconsin hospital
• Create a RAC Task Force to help guide WHA activities. This will be multidisciplinary, reflecting need to draw in financial, legal and clinical expertise.
• Develop a list serve tool so hospitals can share their experiences as they move through these claims reviews.

Stay tuned for next steps.

WHA, with the help of RC Healthcare, launched the 2008-09 Wage Index Improvement Project with a meeting/conference call on Tuesday, October 23. 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 navigate through the CMS wage index process. As part of this process, they will also help hospitals as they prepare for the next occupational mix survey filing. That survey covers 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.

This half-day seminar provides attendees with the "basics" to the chargemaster and tools needed to keep this vital document current. Hospital clinical staff, billers and HIM coders newly involved in the facility’s chargemaster or those with little or no background in billing, coding, or reimbursement should attend. The workshop is scheduled 8 a.m. - 12 p.m. November 14 in Wisconsin Dells.

"2008 APC Updates" Offered November 14

This half-day session reviews the OPPS Final Rule for 2008 in-depth, along with the latest CMS program memorandums. Financial analysis by ancillary departments will be explored with operational recommendations to ensure hospital departments are able to adapt and remain viable in the ever-changing outpatient health care arena. This half-day seminar is scheduled from 1-5 p.m. November 14 in Wisconsin Dells.

"2008 Chargemaster Updates" Offered November 15

This full-day program will focus on updating your chargemaster for the 2008 reporting requirements and new chargemaster opportunities to keep you "in the know" for CPT and HCPCS coding revisions, concentrating on those new codes impacting the chargemaster.

Chargemaster/APC coordinators, coding staff, office managers, CFOs, and others responsible for charge generation processes are encouraged to attend these events. The three workshops will be held November 14-15 at the Kalahari Resort in Wisconsin Dells. A brochure with registration information is included in this week’s packet, and is available online at www.wha.org, as well as easy, online registration.

Discounts are available for those who register for more than one of the three sessions. For registration information, contact Lisa Geishirt at lgeishirt@wha.org or at 608-274-1820.

The community benefit stories submitted by three Wisconsin hospitals (see page 6) were featured at a federal hearing as examples of how hospitals nationwide are providing financial assistance to patients in need. The American Hospital Association featured three Wisconsin hospitals in a handout developed for a U.S. Senate Finance Committee roundtable discussion on tax-exempt status held in Washington, DC

October 30. The publication, "Care in Action" highlighted stories from patients who experienced charity care or other means of financial assistance at hospitals across the country.

AHA board member and CEO of Billings (MT) Clinic Nicholas Wolter, MD, warned the Committee about proposed changes to the hospital community benefit standard.

"Charity care is one very important component of what hospitals do for their communities. Recognizing and supporting the other myriad of benefits that hospitals supply is critical as well," according to Wolter.

The Committee’s exploration of legislative reforms comes as the Internal Revenue Service expects to finalize a revised Form 990 for tax-exempt organizations, along with the new Schedule H, which tax-exempt hospitals must use to demonstrate compliance with the community benefit standard.

The Wisconsin Hospital Association has collected more than 160 stories that demonstrate Wisconsin hospitals are spending millions of dollars for the sole purpose of improving the health status of their communities. They do not receive, and do not expect, reimbursement for the many programs and services they offer that improve, save, and touch the lives of the communities they serve.

The "2007 WHA Community Benefits Annual Report" contains more than 100 stories from Wisconsin hospitals, along with a community benefit financial summary. It is a useful handout for local political leaders, hospital boards and at meetings with outside partners.

WHA’s 2007 Community Benefits Annual Report is posted on the ServePoint Web site at www.wiServePoint.org. All WHA member hospitals should have received 10 copies of the Community Benefits 2007 Annual Report. To order additional copies, access the order form at www.wha.org/communitybenefits/CBOrderForm.pdf or contact Elizabeth Schumann at eschumann@wha.org or 608-274-1820.

The WHA book, "Hospitals Connecting with Our Communities" is a showcase of "stories" and program descriptions of hospital sponsored and supported programs that help improve the health status of the community. It is organized alphabetically by hospital name. It contains all 172 stories submitted by hospitals for the WHA community benefit project.

All member hospitals received one storybook free of charge. If you would like additional copies of the storybook, please call WHA at 608-274-1820. This book is also available on our Web site at www.wiServePoint.org. Additional storybooks are $5 each, and a maximum of five books per member are available.

Like many farmers, Ronald was accustomed to working with aches and pains. But one pain in particular brought him to Memorial Medical Center’s emergency department. From there, Ronald was admitted to the hospital for several days. After consulting with physicians and running tests, he was finally discharged. Ronald and his wife lived primarily on his Social Security. When Ronald received his bill in the mail, he made an appointment to speak with Amanda in Financial Services. "I just told her the truth—that I was going to need help paying the bill. And Amanda couldn’t have been nicer. Two days later, Amanda called to say it was taken care of," Ronald said. "We can’t thank them enough."

A 64-year-old Wisconsin woman with aggressive uterine cancer quickly accumulated thousands of dollars in hospital bills. She couldn’t afford health insurance, was denied disability because of her limited income, and was just shy of qualifying for Medicare. With limited financial resources and no health insurance, she found hope in her birthday horoscope – "You’re in line for a miracle, so you can take on the impossible." That day she got a call from Sauk Prairie Memorial Hospital & Clinics’ Community Care program saying that her medical bills would be covered. This program helps 300-500 patients every year.

Larry and his wife Agnes weren’t prepared when Larry felt like he was having a heart attack. When they arrived at the Luther Midelfort Emergency Department, they were worried about Larry’s health, but Agnes had another concern — they did not have insurance or the means to pay a large hospital bill. "I told staff right away that we didn’t have insurance, but they said ‘don’t worry about that right now. We’ll talk about that when Larry is stable.’ There was never any pressure," she says. Today, Larry has recovered from quadruple cardiac bypass surgery and is finishing up the cardiac rehabilitation program. And, their entire hospital bill was covered by the financial assistance program. "We are so thankful," Agnes says.

WHA held its annual United Way Campaign drive during the second week of October. The event kicked off with a staff breakfast on Monday and concluded with an ice cream social on Friday afternoon. In between, the WHA staff donated $11,278.82 to the United Way through their pledge forms and other fundraising activities held during the week.

Forty WHA and subsidiaries staff participated in the 2007 campaign that beat last year’s mark of $10,488.

"WHA has had a long and rewarding relationship with the United Way of Dane County and the many agencies it supports," said Brian Potter, who chaired WHA’s 2007 campaign. "It is great to see the continued generosity of WHA staff to support such a worthwhile organization."

Top of page