The Senate Agriculture and Insurance Committee, chaired by Sen. Dan Kapanke (R-La Crosse), voted on a party line 4-3 vote to advance AB 766 out of Committee. AB 766, scheduled for a vote on the Senate floor on Tuesday, November 8, caps non-economic damage awards at $450,000 for adults and $550,000 for children and establishes a regular review process for determining adequate damage awards going forward.

Three amendments to the bill were defeated in the Committee. Two amendments offered by Sen. Mark Miller (D-Monona) would have increased the amount of damages awarded, but offered two different approaches. Both failing on party line votes, the first amendment would have set the cap at $1 million for adults and $1.5 million for children, and the second amendment capped non-economic damages at $2 million and ratcheted down the damage award by one percent for every year that the individual is over 18 in addition to reducing the amount of PCF coverage that a doctor must have from $1 million to $750,000.

While Sen. Miller’s amendments ultimately failed, Sen. Ron Brown (R-Eau Claire) continued to try and find compromise, offering an amendment to Sen. Miller’s first amendment, which would have increased the caps to $650,000 for adults and $750,000 for children. That amendment failed 5-2 with only Sens. Brown and Luther Olsen (R-Berlin) voting in favor.

The Committee also advanced AB 764 on a 4-3 vote, which requires juries to take into account collateral source payments in determining damage awards. With much less controversy, they also advanced AB 765, which clarifies that first year residents are covered by the Injured Families and Patients Compensation Fund (PCF). All of these bills and AB 769, which requires an actuarial audit of the PCF every two years, will be up for a vote before the full Senate November 8.

For more information about these bills or any other legislation, contact WHA’s Jodi Bloch at 608-274-1820.

The phone calls, letters and emails are already going out from HEAT members to their state Senators in advance of Tuesday’s vote on medical liability legislation, Assembly Bill 766.

Have YOU made your call or sent your email yet? If not, it’s not too late. Log onto www.wha.org/speakUp/statesenate.aspx and contact your Senators today.

Contact Jenny Boese at jboese@wha.org with questions or with your grassroots stories so we can highlight your efforts on behalf of your hospitals and communities.

This Wednesday, November 2, joint committees in the Senate and Assembly co-chaired by Sen. Dave Zien (R-Eau Claire) and Rep. Scott Suder (R-Abbotsford) heard more than ten hours of testimony on AB 763 and SB 403, the concealed carry bills. The bills allow the lawful carrying of concealed weapons in Wisconsin with few exceptions. The bills do allow businesses to decide if they want to allow concealed carry on their premises, but they must post a notice at entrances stating this and approach violators warning them before contacting authorities. Proponents argue that people should have the right to carry a concealed weapon for personal protection with little exception.

WHA submitted written remarks in opposition to these bills without an exemption for health care facilities. WHA believes that when patients come to the hospital, they expect the hospital to be a safe environment. AB 763 and SB 403 jeopardizes the ability of Wisconsin hospitals to provide that safe patient care environment if people can bring weapons into a hospital. WHA also explained that health care facilities should be one of the exemptions because unlike taverns, restaurants and stadiums, which are current exemptions in the bill, hospitals contain many highly combustible materials that could have devastating consequences for people all over the facility if ignited.

Similar legislation introduced last session did include an exemption for hospitals and other health care facilities that was backed by WHA.

The committees are expected to vote on the bills next week. WHA urges you to contact your representatives and urge them to support an exemption for health care facilities. For more information about this legislation, contact WHA’s Jodi Bloch at 608-268-1836.

Since the end of May 2005, the American Hospital Association (AHA) and state hospital associations have been working with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to alleviate concerns raised when JCAHO announced that it was selling analyses of accredited hospitals data to 14 Blue Cross Blue Shield (BCBS) health plans. As a result of these meetings, JCAHO agreed to accept amended 2006 Accreditation Contracts through October 1, 2005.

For hospitals, there are still three serious issues that have triggered ongoing discussions between AHA and JCAHO. They are:

• Health Insurance Portability and Accountability Act (HIPAA) compliance issues raised by JCAHO’s plans to seek patient-level data from accredited hospitals and its use unrelated to accreditation;
• Necessity of JCAHO separately to collect patient-level performance data that duplicates the hospital quality Alliance’s effort; and,
• Apparent conflicts created when JCAHO, as an accrediting body, sells data analyses to insurance companies and other third parties.

As of October 31, 2005, JCAHO has not responded completely to these concerns. Therefore, AHA has requested guidance for hospitals from the Department of Health and Human Services (HHS) Office of Civil Rights (OCR), which has enforcement responsibility of HIPAA. AHA will seek appropriate amendments to the 2006 JCAHO Accreditation Contract if necessitated by this guidance. In addition, AHA has requested that JCAHO limit its collection of patient level performance data to that essential for hospitals’ accreditation survey and end its sale of analyses of accredited hospitals’ data to third parties.

The Wisconsin Hospital Association (WHA) is not aware that Wisconsin hospitals’ data has been sold to BCBS or any other third party, but we will continue to monitor this situation.

Questions about this issue can be directed to Dana Richardson, WHA vice president of quality, at drichardson@wha.org or 608-274-1820.

I am a physician practicing family medicine in Black Earth. I am one of many physicians who moved to Wisconsin from Illinois. This state attracted physicians because of the quality of life and because of the medical liability environment. It was a dark day for doctors and patients when the Wisconsin Supreme Court struck down the cap on awards for pain and suffering for injuries associated with negligence.

I deeply believe it is justified and right that patients are compensated for preventable injuries that occur while under a physician’s care. Patients now, as in the past, always receive all damages awarded to them related to economic losses they incur as a result of these injuries. This includes lost wages and all medical bills associated with the care they need because of the injury.

I did not take the decision to leave my practice in Illinois lightly. After six years, I had a rapport with my patients. I did not want to feel like I was leaving them without medical care. At the same time, I wrestled with the fact that in order to justify the extremely high insurance premiums I was paying, I would need to expand the number of patients that I accepted beyond my comfort level. I made several changes to my practice in Illinois to reduce my insurance premiums before moving to Wisconsin. The first was to stop delivering babies, considered a high-risk procedure by insurance carriers. For my patients, this decision meant that they would need to drive 30 miles to the next community for their delivery.

Illinois physicians who never had a claim saw their liability insurance skyrocket. Imagine having your car insurance increase 15 – 50 percent without ever filing a claim. Making a bad situation worse, when medical liability rates soar, insurance companies leave the state, too. For physicians, this means fewer or no choices among carriers.

Add to the reality of rising premiums the reality of decreasing payments for Medicaid and Medicare, and you have a formula for disaster. While the situation was bad all over in Illinois, the southern, more rural areas of the state were hit hardest. Specialists relocated to other states leaving trauma centers without neurosurgeons; birthing centers without obstetricians. Hospitals were largely unsuccessful in recruiting new physicians to a state in the midst of this medical access meltdown.

My practice was saturated, and I was forced to see even more patients to pay the increasing premiums. I reached my breaking point and made the difficult decision to leave.

When I heard that the Wisconsin Supreme Court struck down the near half-million dollar cap on pain and suffering awards, my heart sank. I couldn’t help but wonder how this could happen here when just south of us, the impact of not having a cap could be seen everywhere. It is frustrating to think that Wisconsin communities, patients and doctors will go through the dire straits that Illinois endured before a cap was restored there last August. Illinois learned the hard way that a cap on the non-economic damages keeps physicians, but more importantly, averts a medical access crisis.

Illinois is now rebuilding after the wreckage of years of seeing more physicians leave the state than enter it. My fear is that if the Wisconsin Legislature and the Governor do not take these lessons to heart now, we are bound to repeat those mistakes.

Janelle Hupp is a family medicine physician practicing in Black Earth and at Sauk Prairie Memorial Hospital in Prairie du Sac.

Janelle Hupp, MD, now practicing in Black Earth, is just one of the many excellent physicians who considered Wisconsin a good place to practice medicine because of the favorable medical liability environment. She shared her opinion with the Wisconsin State Journal in an editorial that ran Sunday, October 30, which is reprinted this week in The Valued Voice (see page 3). Hupp agreed to allow WHA to use her compelling story, and her picture, on a poster that encourages physicians to call Gov. Doyle and ask him to sign AB 766.

The WHA Foundation’s 2005 Annual Fundraising Campaign is underway, having raised $26,000 within the first three weeks of the campaign. The WHA Foundation’s Board of Directors has set a goal to raise $500,000 by the end of 2008.

In the past four years, the WHA Foundation has supported initiatives such as the development and launch of the CheckPoint Web site, the development of the Wisconsin Nursing Redesign Consortium, and has awarded 58 scholarships to students in their final semester of a health care-related degree at one of Wisconsin’s 16 technical colleges – more than 85 percent of whom are now employed by Wisconsin hospitals.

"For the first time since 2001, the Foundation is seeking the support of WHA hospital and corporate members, to help continue the strategic direction of the Foundation and WHA. Now is the time to work on rebuilding the base of support for the wonderful programs the Foundation has funded, and allow us to find new initiatives that continue to meet our mission of focusing on projects that have statewide impact for Wisconsin hospitals," said Jennifer Frank, director of the WHA Foundation.

"A special thank you goes out to those organizations and individuals who have stepped up early in this campaign and shown support for the Foundation. Additionally, the Foundation would like to recognize both UW Hospital & Clinics and WHA Financial Solutions, Inc., for their support as Champion Donors."

To make a contribution, or for more information on the WHA Foundation’s annual fundraising campaign, contact Jennifer Frank at 608-274-1820 or jfrank@wha.org.

Champion Donors – gifts of $5,000 or more
UW Hospital & Clinics, Madison
WHA Financial Solutions, Inc., Madison

Contributions from Organizations
Black River Hospital, Black River Falls
Flambeau Hospital, Park Falls
SSM Health Care of Wisconsin, Madison
St. Vincent Hospital, Green Bay

Contributions from Individuals
Steve Brenton, Wisconsin Hospital Association
Jennifer Frank, Wisconsin Hospital Association
Dan Hymans, Memorial Medical Center
John Landdeck, Beaver Dam Community Hospital
John Marnell, Hudson Hospital
Tom Plantenberg, Friends of Froedtert

Gov. Jim Doyle announced the creation of the eHealth Care Quality & Patient Safety Board charged with developing a plan to automate all health care information systems in Wisconsin.

"The field of medicine has yet to harness the power of information technology at the most important point in the health care system – patient treatment," said Governor Doyle. "This board will develop a road map for the private and public sectors to move forward in a coordinated way, develop this capacity for Wisconsin in a way that improves care for the Wisconsin population, and reduce overall health care costs for both the public and private sectors."

Department of Health and Family Services Secretary Helene Nelson will chair the board with additional appointees to be announced in the future. "Investment in information systems is an important and necessary strategy to improve patient safety and quality, while reducing costs in the longer term," said WHA President Steve Brenton. "We look forward to working collaboratively with the private and public sector stakeholders who will be involved in this important endeavor."

The statewide e-health information infrastructure would be designed to improve the quality and reduce the cost of health care by:

• Ensuring health information is available at the point of care for all patients.
• Reducing medical errors and avoiding duplicative medical procedures.
• Improving coordination of care between hospitals, physicians and other health professionals.
• Furthering health care research.
• Providing consumers with their health information to encourage greater participation in their health care decisions.

Doyle’s Executive Order also directs the new board to:

• Comprehensively review issues surrounding the creation of an electronic health information infrastructure in Wisconsin and develop guidance - to be known as the "Wisconsin Action Plan for Health Care Quality and Safety" - for the users of such infrastructure.
• Consider the extent to which an integrated or interoperable system or underlying technology may be cost effective, which includes assessing benefits of the system for supporting rapid deployment of medical care practitioners, promoting accurate and appropriate shared information about individual patients among health care providers, and standardizing performance indicators among health care provider organizations to improve organization performance and public reporting of quality, safety and efficiency data for consumers and health care purchaser decision making.
• Provide that the Board annually assess the use of automated information and decision support systems by health care providers.
• Annually assess options and progress on the action plan to achieve automation of all health care systems by 2010.
• Identify existing electronic health resources, including funding sources, to support the development of a statewide electronic health information infrastructure.
• Identify technology options, and their advantages and disadvantages, for a state electronic health information infrastructure.
• Identify options for serving consumer health information needs.
• Insure health information privacy and security in electronic health information exchange.
• Facilitate statewide adoption of electronic health record standards to enable health information exchanges across the state and nationally.
• Create organization and governance structures for a statewide electronic health information infrastructure.

Access Executive Order 129 at www.wisgov.state.wi.us/journal_media_detail.asp?locid=19&prid=1499

The Wisconsin Division of Public Health strongly discourages health care providers from prescribing oseltamivir (Tamiflu®), zanamivir (Relenza®) or any other influenza antiviral medication for private stockpiling purposes. This trend has been identified because of concerns regarding the potential of an influenza pandemic and the current avian influenza situation in Southeast Asia, China, Europe and elsewhere.

The following facts can be used to support this DPH recommendation:

• No sustained or ongoing transmission of the H5N1 avian influenza strains among humans has occurred in anywhere in the world.
• There has been no H5N1 avian influenza in poultry or humans in the United States.
• There are limited supplies of Tamiflu® and Relenza® in the United States. Hoarding of these drugs now because of concerns about a future pandemic may result in these antiviral medications becoming unavailable for those who need it most during the current regular influenza season.
• The indiscriminate and inappropriate use of Tamiflu® or Relenza® may promote the development and spread of resistance to these important drugs among influenza viruses.
• To be maximally effective as prophylaxis, antiviral medication must be taken each day for the duration of influenza activity in the community, making use of these drugs for prophylaxis questionable and very costly.

Appropriate use of neuraminidase inhibitors

The highest current priority for use of Tamiflu® or Relenza® is for treatment of people during the upcoming regular influenza season who are at greatest risk of serious complications from influenza virus infection (e.g. persons >65 years, young children, and persons with certain chronic diseases). If administered within two days of illness onset, neuraminidase inhibitors can reduce the duration of uncomplicated influenza infection by approximately one day.

The next highest priority is for use of Tamiflu® as prophylaxis in persons at high risk of serious complications from influenza infection who are exposed to influenza (e.g. household in which someone has been diagnosed with influenza or hospital or nursing home with an outbreak of influenza) during the regular influenza season. It should be noted that Relenza® has not been approved for prophylaxis.

Important measures to prevent influenza

Additional steps people can take to help keep other people healthy this influenza season include: getting their influenza vaccination, covering their mouths with tissues when coughing, staying home from work or school when sick with cough illness and washing hands immediately after coughing or touching respiratory secretions.

The educational seminar "Mastering Chargemaster-2006 is Almost Here!" is scheduled for November 16, from 9 am to 4 pm at the Plaza Hotel & Suites, Wausau. This program will concentrate on keeping you "in the know" for CPT and HCPCS coding revisions and new codes impacting the charge document processes.

November 17 Education Offered on New APCs

The education seminar "New Year, New Challenges, New APCs, and New Headaches" is scheduled for November 17, from 9 am to 4 pm at the Plaza Hotel & Suites, Wausau. This is a seminar that goes beyond the basics. The OPPS Final Rule for 2006 will be reviewed in-depth, along with review of the latest CMS program memorandums.

Chargemaster/APC coordinators, coding staff, office managers, CFOs, and others who are responsible for charge generation processes are encouraged to attend these events.

Brochures with registration forms are included in this week’s packet and on the web site at www.wha.org. On-line registration is available. The American Health Information Management Association (AHIMA) has approved each seminar for five (5) continuing education hours.

Special Discount

If you register for both seminars: "Mastering Chargemaster-2006 is Almost Here!" on Wednesday, November 16 and "New Year, New Challenges, New APCs, and New Headaches" on Thursday, November 17 you can receive a $75 discount on your total registration fee. If interested in attending both seminars, contact Sherry Rabuck for more information at 608-274-1820 or srabuck@wha.org.

It’s on the front burner: Transparency. But what does it mean in health care? That subject will be explored at a seminar sponsored by the Wisconsin Forum for Healthcare Strategy (WFHS) on November 16 from 9 am to 2 pm at the Country Springs Inn in Waukesha.

Humana’s CFO Gary Hovila will describe how their subscribers are making use of online tools that equip them with important health care plan analysis and decision-making information. Hovila will also share how Humana’s providers are responding to the need to put more information in the hands of consumers.

Greg Herrle, principal at Milliman, provides the media and health care providers with analyses of health care data that sometimes make the front page and often land on the CEO’s desk. He’ll give participants an idea of how he sees providers navigating the changing marketplace.

Ford Titus, CEO at ProHealth Care, Inc., knows that consumerism and transparency are more than buzzwords. In the health care system he leads, it is a way of life. Ford preaches the "value proposition" in health care, and will explain what he thinks the changing market will bring to consumers and providers.

The Centers for Medicare & Medicaid Services (CMS) has released a list (www.cms.hhs.gov/providers/hipps/sec422_cap_increases.pdf) of hospitals that applied for additional residency slots under Section 422 of the Medicare Modernization Act, and the number of direct and indirect graduate medical education slots awarded to the hospital effective July 1, 2005. Section 422 allowed teaching hospitals to request up to an additional 25 full-time equivalent residents from the estimated pool of unused slots for purposes of direct and indirect GME payments under Medicare. By law, CMS must distribute the unused slots first to rural hospitals, second to urban hospitals not located in large urban areas, and third to hospitals training residents in a program that is the only program in the state. CMS mailed letters to each hospital on October 27 notifying them of their final award determinations.

The Joint Commission on Accreditation of Healthcare Organizations named Memorial Health Center, Medford, Wisconsin, a 2005 winner of the ninth annual Ernest Amory Codman Award to recognize excellence in the use of outcomes measurement by health care organizations to achieve improvements in the quality and safety of health care.

Memorial Health Center is one of two recipients of the award in the hospital category and is being recognized for improving the care and outcomes for diabetes patients. As a result of Memorial Health Center’s initiative, the majority of their 500-plus patients with diabetes are successfully controlling their blood-sugar levels within nationally recommended goal ranges.

"Achieving this award and this level of acknowledgment for our diabetes care is momentous for our organization," says Greg Roraff, CEO, Memorial Health Center. "Great things can come from a small place where you have the dedication and the desire to really make a difference in the lives of patients. I’m pleased and proud to work with professionals who have the drive to provide the best patient care possible and who are willing to go the extra mile to achieve their goal to do so. Receiving this award will provide the impetus to take our quality initiatives to another level. I also offer my own gratitude for the project team’s efforts and congratulate all our staff for their success in working together to improve the diabetes care processes for our patients."

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