The Wisconsin Department of Justice has filed criminal charges against a nurse who mistakenly administered an epidural intravenously. In response to the charge, WHA released the following statement:

The Wisconsin hospital community continues to grieve for the family of Jasmine Gant and for the loss of her precious life. This tragic event has caused hospitals throughout Wisconsin, and in fact, across the nation, to further examine their policies to prevent this mistake from ever happening again.

The Department of Justice’s (DOJ) decision to pursue unprecedented criminal charges against a nurse who did not deliberately harm a patient accomplishes nothing other than to compound the anguish of this situation. The risk of a mistake can be minimized, but mistakes will occur. It is hard to say that and harder yet to accept that, but it is a reality, because the very nature of health care is that it is delivered from one person to another person. That said, it makes no sense to add to this tragedy by alleging that this mistake, as upsetting as it was, was more than a human error. And it is cruel to allege that this mistake constituted criminal conduct.

The State has a duty to investigate and take appropriate action to protect the public when a mistake occurs in a hospital that causes harm to a patient. The State Department of Health and Family Services, the Federal Center for Medicare and Medicaid Services, and the Wisconsin Department of Regulation and Licensing are, or have, conducted investigations to ensure that corrections are made that will improve the safety and quality of care. Actions by these agencies will have a profound impact on the hospital, the hospital staff, and, in particular, the nurse involved in the case.

We are concerned, however, that unlike the other agencies involved in this case, actions by the DOJ will actually have a negative impact statewide on the accessibility to and quality of care provided in Wisconsin. By setting a precedent that the DOJ will pursue criminal charges against health care professionals who make unintentional human errors, the DOJ sends a chilling message to health care professionals now in the state, and to those who are considering practicing here.

People enter the health care field to care for others. Knowing that the consequence of making an unintentional error could be criminal charges, students will take pause when considering a health occupation. Health professionals enter health care knowing that a mistake could cost them their license, livelihood, and financial stability. They understand that risk. What is incomprehensible is entering a career where a single error could lead to imprisonment.

With just days left to go before the 2006 fall elections, the Wisconsin Hospitals PAC and Conduit 2006 fundraising campaign has surpassed its goal to raise $185,000, to date raising $185,994, more than $10,000 over last year’s record year total.

"This is the most that the fundraising campaign has ever raised in a single year and when you look at the fact that in 2001, the campaign raised $60,000, this is a huge 310 percent increase in just five years," said WHA Advocacy Chair Ned Wolf from Lakeview Medical Center in Rice Lake.

"I want to personally thank all of the individuals around the state who made a contribution as well as WHA staff who again raised more than $20,000," added Wolf.

While the campaign was busy raising money, it was equally as busy disbursing those dollars to candidate campaigns all across the state this election year. To date in 2006, the campaign has disbursed over $207,000 to candidates who understand the valuable role that individuals affiliated with hospitals play in their communities – another record!

Some other interesting facts about the 2006 Campaign

• 625 individuals participated in this year’s campaign v. 525 individuals last year, a 19 percent increase.
• The average contribution was $298 in 2006.
• Individuals from 86 hospitals have contributed – that is 65 percent of Wisconsin hospitals.

A final listing of contributors to the 2006 fundraising campaign will be published in the November 17 edition of The Valued Voice. For more information about the campaign, contact WHA’s Jodi Bloch or Jenny Boese at 608-274-1820.

The Centers for Medicare & Medicaid Services (CMS) released its 2007 outpatient prospective payment system (PPS) final rule on November 2, which sets payment rates for calendar year 2007. The final rule delays until 2009 CMS’ proposed link between the outpatient payment update and the reporting of quality data. The rule also incorporates a payment reduction for 280 ambulatory surgical center (ASC) services previously paid more than the outpatient hospital setting and expands inpatient hospital quality reporting requirements for fiscal year (FY) 2008 and other important changes.

Highlights of the final rule:

• The rule includes a 3.4 percent market basket update; however, when combined with other factors, outpatient payments will increase by only 3.0 percent.
• CMS will tie the outpatient payment update to the reporting of outpatient quality measures beginning in 2009. CMS will work to develop measures of quality in the outpatient hospital setting for use in the new link to outpatient payment and quality. Hospitals that fail to report the quality measures would receive the outpatient PPS update minus 2.0 percentage points beginning in 2009.
• CMS reduces "hold-harmless" payments for small rural hospitals from 95 percent to 90 percent, as required by the Deficit Reduction Act of 2005 (DRA).
• CMS maintains the payment for most separately payable drugs at average sales price (ASP) plus 6 percent, rather than implement its proposal to decrease drug payment to ASP plus 5 percent.
• CMS increases the outlier fixed-dollar threshold from the current $1,250 to $1,825 in 2007 and is changing the methodology for calculating the hospital-wide cost-to-charge ratio. The agency proposes to maintain its current target for outlier payments at 1.0 percent of total outpatient spending.
• CMS made significant changes to the evaluation and management codes and payment levels for hospital clinic and emergency department (ED) visits. The rule will increase from three to five the number of ambulatory payment classifications (APCs) for clinic visits and ED visits. The rule also creates new codes for use by freestanding EDs. CMS set payment for these services equal to the payment for clinic visits.

Other important changes:

• CMS expands the quality measures for inpatient hospital reporting of quality data for the FY 2008 inpatient PPS annual update. The expanded measures were endorsed by the Hospital Quality Alliance (HQA) in July. The proposed measures include:
• HCAHPS® Patients’ Perspective of Care Measures;
• Three additional Surgical Care Improvement Project measures; and
• 30-day mortality measures for patients with acute myocardial infarction, heart failure and pneumonia.
• In 2007, CMS will cap payment for 280 ASC services at the hospital outpatient payment rate, as required in the DRA, and add 19 services to the list of covered ASC services.
• CMS revises the critical access hospital (CAH) conditions of participation to allow CAHs to use a registered nurse to perform the emergency medical screening examination mandated by the Emergency Medical Treatment and Labor Act.

The 2007 final outpatient rule is posted on the CMS website at: www.cms.hhs.gov/HospitalOutpatientPPS/HORD/list.asp#TopOfPage.

The agency also released the 2007 final rule for the physician fee schedule that included a 5.2% cut in payments to physicians. The final physician fee schedule is posted on the CMS website at: www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/list.asp#TopOfPage.

WHA is evaluating both of these rules and will release more detailed information soon.

• As discussed elsewhere in this week’s Valued Voice, the 2006 Wisconsin Hospitals Political Action funds contribution campaign surpassed its ambitious goal late last week. Our theme over the past few years has been "Politics is not a spectator sport!" WHA members’ voluntary embrace of our campaigns has been unparalleled…with record- shattering years since 2002.

Special thanks to WHA past chair, Ned Wolf, and members of the Advocacy Committee for their strong voluntary leadership efforts that have proven to be the catalyst for recent campaign success. Staff efforts led by Jodi Bloch, Jenny Boese, and Angela Miloszewicz have been nothing short of spectacular. What a terrific team!

• Conventional wisdom suggests that despite public criticism (bordering on outrage) over negative, mud-slinging campaign ads… they actually work! This reasoning claims that you can win elections by convincing voters that your opponent is a bigger scoundrel than you are! Campaign consultants call this "defining" your opponent.
  
  So in the race for the open 8^th congressional district seat you have "Dr. Millionaire Know It All" facing off against "Partisan Career Politician." For those residing outside the 8^th district, this is actually a contest between Steve Kagen, MD, a Fox Valley allergist, and current Assembly Speaker John Gard.
  
  One of the more interesting health care-related aspects of this campaign, which will likely end up being the most expensive congressional race in Wisconsin’s history, is the recent revelation that Dr. Kagen is not a Medicare provider. Since over 95 percent of Wisconsin physicians contract with Medicare as a direct payer, that’s a rather unusual distinction. The fact that Dr. Kagen has campaigned for a national health care solution labeled "No Patient Left Behind" that’s built around the notion of unitary pricing (fixed payments), more than a few barbs have been directed his way during the final hours of this particularly nasty campaign. The Gard campaign is asking the not-so-hypothetical question of just why voters should believe that a physician who refuses to accept payment from government programs has credibility for suggesting additional government-sponsored health care.
  
• Much is obviously at stake this coming Tuesday. Newly minted lawmakers will likely have a big impact on a variety of health care issues in the next two years, both in Washington and in Madison. As mentioned earlier, "Politics is not a spectator sport!"

Steve Brenton,
President

One of the WHA’s major strategic initiatives is to focus on the need for an increasingly closer alignment of physician and hospital agendas. One way WHA plans to contribute to this alignment is to provide forums for hospital senior leadership to explore state-of-the-art strategies for creating and managing business relationships with physicians, both as partners and as competitors.

As a first step, WHA is offering a one-day seminar, entitled "Hospital/Physician Business Relationships," on December 6. The day’s agenda will begin with a high-level examination of the current state of hospital/physician business relationships nationally, followed by a ground level presentation on state-of-the-art hospital/physician business partnership models.

Following lunch, attendees will focus on hospital-employed physicians and the future drivers of their compensation, including pay for performance, decreased reimbursement, physician workforce shortages, geographic and specialty mal-distribution, and changing physician lifestyle expectations. The day will wrap up with a peer panel discussion, giving insight into the various, and very different, business relationship models currently employed in Wisconsin.

The "Hospital/Physician Business Relationships" seminar will be held December 6, 2006, from 9 a.m. to 4:15 p.m. at the Kalahari Resort in Wisconsin Dells. A brochure with registration form is included in this week’s packet and on the Web site at www.wha.org. Online registration is available.

Attendance at this event is limited only to WHA hospital executives and their chosen leadership team members, in an attempt to keep the setting intimate and the discussion open. We encourage all hospital executives to consider which of your leadership team members, including physicians, would also benefit from participation in this one-day seminar. A discounted team registration rate is available.

In addition to providing Portage with an expert team of physicians and staff with state-of-the-art medical services, Divine Savior Healthcare understands the need and will of our community to promote wellness, improve its health and reach out to persons who are vulnerable or under-served.

Divine Savior Healthcare has been serving the Portage area community since 1917, and our mission is simple, yet far reaching: "We are deeply committed to a process of continuously improving the quality of care and services provided as an integral part of the Church’s healing ministry to all persons."

We carry out this mission every day at Divine Savior Healthcare, often through programs and activities that may seem ordinary in our every day work. From community education, health screenings and support groups, to fulfilling our community’s need and desire for a long-term care facility, Divine Savior Healthcare’s commitment to the community is deep and real.

Education

Each year, Divine Savior offers a variety of programs and classes to help educate Portage area residents about health-related issues. In 2005, over 1,500 community members participated in programs such as breast-feeding education, babysitting classes, cancer education programs, community health fairs, CPR/first-aid classes, diabetes education, heart disease education, nutrition and weight management, and exercise classes.

Health Screenings

Each week, Divine Savior offers free blood pressure screenings to the public, and we provide six reduced-cost cholesterol screenings annually. We were able to serve over 2,100 Portage-area residents with these screenings in 2005.

Support Groups

Divine Savior Healthcare coordinates or hosts several support groups for the Portage area community, including Grief Support Group, Enduring Loss Together (see below), Multiple Sclerosis Support Group, Breastfeeding Support Group, Diabetes Support Group, Caregivers Support Group, Alzheimer’s and Dementia Support Group: For Family and Friends of People Living with These Diseases, and Living with Cancer Support Group.

Enduring Loss Together

The arrival of a new baby is one of the happiest times in a parent’s life. Unfortunately, not all pregnancies go as planned, and the result can be one of the most difficult times in a parent’s life.

Divine Savior Healthcare offers Enduring Loss Together, a bereavement support group for mothers and fathers who have lost a baby. The group began meeting about five years ago after Divine Savior Obstetrics staff recognized the community’s need for a place where grieving parents could meet and share their emotions.

"We saw a need for more than pamphlets and our follow-up phone calls," said Daycia Johnston, RN, Bereavement Coordinator in Obstetrics at Divine Savior Healthcare. "Once parents leave the hospital after a miscarriage, we find they have lots of support from family, friends and co-workers for the first week. But after that, it can feel burdensome, and they try to handle the grief on their own."

Parents who attend Enduring Loss Together understand what fellow members are experiencing, and they share and talk about their feelings. The group holds a memorial service in December and May each year. Some attend only one support group session, while others continue over time. One woman has been attending since the group formed, Johnston said.

"That’s why we called the group Enduring Loss Together," Johnston says. "Grief doesn’t follow a schedule, and the loss of a baby is life-changing. These parents are truly enduring together."

Divine Savior Healthcare is also home to memorial gardens maintained by community volunteers and members of the Enduring Loss Together support group. Group members raised funds to help establish the gardens and assist with Divine Savior Healthcare’s purchase of a tear-shaped monument. During their memorial service each May, support group members plant flowers and shrubs in the gardens, which offer a peaceful place for reflection. "They are very proud of the gardens," Johnston said. "Not every parent is ready to come to the support group right away, so this still provides them a place to come when they need it."

Enduring Loss Together stretches beyond Divine Savior’s walls and grounds. Some members now meet socially outside of the support group, an amazing step that proves truly rewarding for Johnston and other OB staff at Divine Savior Healthcare.

Extended Care: Providing long-term care in Portage

One of our delegated responsibilities at Divine Savior Healthcare is "collaboration." We strive to collaborate not only with our colleagues to provide the best patient experience possible, but also with our community to be the best community partner possible.

In 1922, Divine Savior was able to strengthen it collaborative efforts when the Zienerts of Portage passed away, leaving their mansion to the Sisters of the Divine Savior to be used for long-term care. Divine Savior Healthcare has been providing a "home away from home" for its community’s aging ever since. Divine Savior’s current long-term care facility, Extended Care, is celebrating its 40th anniversary this fall.

Extended Care is a 111-bed facility for long-term and short-term care residents who may be undergoing rehabilitative therapy on-site or staying with us for continuous skilled nursing. Staff coordinates a variety of innovative activities open to all residents to meet their emotional, spiritual and social needs. At Extended Care, physicians and staff care for the whole person, not just his or her ailments.

However, due to financial constraints of family members and state and federal programs, Extended Care faces a loss of $22 per patient day at approximately 32,500 patient days per year.

"We are deeply committed to providing the highest quality of care to our community, and we hope to continue to provide our services at Extended Care as long as we can with these financial shortfalls," said Michael Decker, President & CEO of Divine Savior Healthcare.

"Keeping Portage area residents close to their family and friends despite illness or injury enhances their quality of life – we cannot place a dollar sign on that benefit, which is so deeply rooted in our mission."

Submit hospital community benefit stories to Mary Kay Grasmick, editor, mgrasmick@wha.org or call 608-274-1820.

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