Republicans in the State Senate and Assembly picked up one seat each in the record-setting election Tuesday, November 2. The Senate GOP increased its margin to 19-14, while Assembly Republicans now hold 60 of the 99 seats in the Assembly.

In the Senate, all incumbents retained their seats, but Senate Republicans picked up the open 32nd district seat in the La Crosse area. In a hotly contested race, Republican Dan Kapanke (52.5%) defeated Democrat Brad Pfaff (47.5%). Kapanke, a business owner from La Crosse is noted for supporting an increase in Wisconsin’s cigarette tax. His opponent opposed an increase.

WHA supports increasing the cigarette tax and believes revenues should be dedicated to ending cost shifting/the Medicaid hidden tax on health insurance premiums – similar to how gasoline tax revenue is dedicated to road building.

"Raising Wisconsin’s cigarette tax, which is five cents below the national average, is an emerging issue for 2005," said WHA’s Eric Borgerding. "The result in the 32nd Senate district is important in that it shows raising the cigarette tax, especially if earmarked for health care, is something politicians can embrace, not run from. That is clearly what is happening in other states."

In the Assembly, the parties swapped incumbents. In the 5th district, Democrat Tom Nelson defeated incumbent Republican Becky Weber. In the 29th, incumbent Joe Plouff was defeated by Republican challenger Andy Lamb.

Two open seat results in the Assembly are of special interest to WHA. In the 68th, Republican Terry Moulton handily defeated challenger Joe Bee Xiong. Aside from being a world-renowned musky fisherman, Moulton is a highly regarded former employee of St. Joseph’s Hospital in Chippewa Falls where he worked in the finance department.

In the heavily Republican 41st district, Joan Ballweg trounced Constitution party candidate James Tostenson by winning 84% of the vote. Ballweg currently serves as the Chairperson of the Waupun Memorial Hospital Board of Directors and has participated as a panelist in WHA education programs.

There are now at least three members of the legislature with direct hospital management knowledge and experience – Moulton, Ballweg and Representative Curt Gielow.

Democrat Gary Sherman (74th) easily survived a challenge from Republican Barbara Linton (a former Democrat member of the Assembly). The NRA targeted Sherman for defeat after his deciding vote to uphold Governor Doyle’s veto of concealed carry legislation. With Sherman’s seven-point margin of victory, the NRA may need to re-sight their guns.

There were a number of other hotly contested open seats, most of which were carried by the incumbent party.

If you have any questions about how the candidates fared in your area, contact Jodi Bloch at 608-274-1820.

The election marked a record for Healthy Wisconsin, WHA’s PAC and conduit. In 2004, WHA members and friends contributed a record $152,000 to Healthy Wisconsin, an increase of 176 percent in just three years. More importantly, $203,000 (including some carry-over from 2003) was distributed to candidates or used to buy independent, positive newspaper ads in 2004, an incredible 350 percent increase from 2001. These efforts included ten Healthy Wisconsin sponsored fundraisers and 30 positive independent newspaper advertisements in 2004.

"We are extremely pleased with the program this year, including our members’ commitment to this critical component of our advocacy program – that’s the real story here," said WHA President Steve Brenton. "We look forward to building on these accomplishments in 2005 and 2006, including bringing more hospitals into Healthy Wisconsin, sponsoring more fundraisers and further honing our distribution strategies, including independent expenditures."

On October 29, the Supreme Court denied a motion to reconsider its recent decision in Maurin v. Hall, thereby maintaining one of the key victories of WHA’s Courtroom Advocacy efforts.

In Maurin, the Court upheld the constitutionality of the noneconomic damage caps in medical malpractice wrongful death actions and held that the medical malpractice and the wrongful death caps cannot be stacked. The plaintiffs in Maurin and the Litigation Section of the State Bar had asked the Court to reconsider its decision; the Court, by a 4-2 vote, denied that request.

WHA, with the Wisconsin Medical Society and the American Medical Association, filed an amicus brief in Maurin supporting the non-economic damage caps in wrongful death cases as a vitally important part of Wisconsin’s comprehensive medical malpractice system. In Maurin, the Court found the caps to be constitutional, acknowledging the legislature’s interest in controlling the costs of health care, including the costs related to medical malpractice.

Justices Prosser, Wilcox, Bradley, and Roggensack voted to deny the motion to reconsider while Justices Abrahamson and Crooks supported the motion. Justice Butler did not participate in the decision. A copy of Chief Justice Abrahamson’s dissenting opinion is available on the WHA Web site under Legal and Regulatory.

WHA, with the Wisconsin Medical Society, submitted a supplemental brief in Pierce, as amicus, arguing that when there is a single occurrence of medical malpractice that leads to death, the recent decision in Maurin v. Hall requires that all noneconomic damages for that act of medical malpractice are subject to a single cap, the wrongful death cap, under Wisconsin’s medical malpractice statute.

At oral arguments, Attorney George Burnett representing the Wisconsin Patients Compensation Fund contended: "This is a case about statutes. What the legislature wrote and what it meant when it wrote them." Burnett argued that under the medical malpractice and wrongful death statutes, this case "has nothing to do about what happened to [the plaintiff], and everything to do about what happened to her child. We are compensating [the plaintiff] today because she is a parent, not because she is a patient."

Conversely, Attorney Avram Berk, representing the plaintiff mother, argued that although there is only one plaintiff, she has two claims resulting from the same stillbirth that are subject to two separate damage caps. "Under section 655.007, we have the parent who may bring a wrongful death claim for the child’s death and we have the patient who may bring a claim for physical and emotional injury," maintained Berk. "[The plaintiff] wears both hats."

A decision from the Court on this case can be expected in two to six months.

That program is being threatened by actions of some Medicare auditors in recouping payments from several hospitals. Essentially, Medicare’s portion of Graduate Medical Education (GME) is being eliminated in those instances where residents rotate through nonhospital settings because the auditors have concluded that the proper paperwork - "written agreements" - had not been completed.

This insanity happened despite the fact that teaching occurred, payments were made by the hospital, and patients were treated. In other words, the objectives of the program were met, but a bureaucratic interpretation may result in at least two hospitals being penalized. Unless this action is overturned, these hospitals will lose over $500,000, and this is for just one year. They also face the potential of future recoupments, and the other ten hospitals involved with UW Family Medicine are potentially exposed as well.

One might ask: "How can this be? It was Congress’ intent that Medicare pay its share of teaching physicians. It’s important to validate that the intent was carried out, but has this requirement been useful in determining whether hospitals have actually paid for the residents?"

Well, the answer to those questions has been answered by The Centers for Medicare and Medicaid Services (CMS) itself. In August, it stated that: "In retrospect, we believe the regulatory requirements concerning the written agreements may not have been the most efficient aid to fiscal intermediaries in determining whether hospitals would actually incur all or substantially all of the costs of the training programs in nonhospital settings. The fiscal intermediaries have been required to ensure that hospitals are complying with the regulations regarding written agreements, in addition to determining whether a hospital actually incurred the appropriate costs. We believe it would be more appropriate and less burdensome for both fiscal intermediaries and hospitals if we instead focus the fiscal intermediaries’ reviews on the statutory requirement that hospitals must incur all or substantially all of the costs of the program in the nonhospital setting."

CMS goes on to say that they will no longer require the written agreements. But they are going ahead and denying Medicare reimbursement for these two hospitals for a prior year because they failed to comply with the now obsolete requirement.

Is this bureaucratic myopia…..or doesn’t the right hand know what the left hand is doing? In either case, the situation for the two hospitals remains – and could ultimately affect all 12 hospitals currently partnering with UW Family Medicine. WHA is aggressively pursuing remedies to this unacceptable finding. The threat to this important statewide program will be met with all the resources that we can muster.

Less than one week before the deadline for previewing quality data submitted as part of the Hospital Quality Alliance, roughly one in four hospitals still has not previewed its data for accuracy, according to the Centers for Medicare & Medicaid Services (CMS).

Hospitals have until Nov. 6 to review their first-quarter 2004 quality data at www.qnetexchange.org and notify their Quality Improvement Organization (QIO) of any substantive errors. The AHA and CMS are urging hospitals that have not yet done so to review their data and notify their QIO (www.medqic.org/content/qio/qio.jsp?pageID=4) of any technical difficulties they experience or errors they identify in their data. Hospitals receiving a full market basket update in fiscal year 2005 for participating in the Alliance will not have the option of withholding their data from public display, but CMS has pledged to make every effort to correct significant errors.

State Senator Cathy Stepp (R), 21st Senate District, recently met with Aurora Health Care’s team in Racine County. The wide ranging discussion focused on a number of issues including reimbursement disparities, charity care, the taxpayer bill of rights legislation known as TABOR, quality initiatives that Aurora is involved in, and health care costs.

Loren Anderson, executive vice president of Aurora’s South Region, and Wisconsin Hospital Association board member, said, "Establishing strong working relationships with our area legislators is an important priority for us. As a business owner and health care purchaser, Sen. Stepp is very informed about health care related issues and it was an excellent opportunity to share our perspectives. We look forward to continuing our dialogue with her as we move forward."

Stepp added, "Learning more about Aurora’s plans to address the future health care needs of my district was extremely valuable. Health care affects everyone and the demands for quality health care services will continue to grow as our population ages.’’

As the demand for charity care continues to rise and government reimbursement levels decline, both Anderson and Stepp agreed that steps need to be taken to address this trend.

"Obviously, we want to work together to find a long term solution that’s beneficial for everyone," said Anderson. "Last year, Aurora Health Care provided $70.5 million in charity care. We have an obligation to meet the health care needs of the communities that we serve, but at the same time, we need to be diligent about our resources."

Stepp said that Aurora’s commitment to the uninsured and underinsured is clear, but indicated that the solution involves many players.

"The situation is going to take a multi-faceted approach that will involve not only health care providers and legislators, but insurers, employers and health care consumers and the pharmaceutical industry," she said.

The December 15 seminar "2005 Denials Management and Managed Care Contract Update" will focus on the process of properly submitting claims, collecting payment and meeting coding and documentation compliance. It will show you how to develop, implement and maintain an integrated compliance and denials management system that will improve your cash flow process.

Additionally, this seminar will focus on improving your managed care reimbursement contracts. Specific topics include contracting with silent PPOs and ERISA payers, as well as what you need to know about "pay for performance" agreements and consumer driven health care plans.

This program is a follow-up to WHA’s popular November 2003 program "Improving Your Reimbursement Contracts," featuring Maria Todd, PhD, but it will be new and valuable information for those who both did and did not attend last year’s program.

The seminar is scheduled for Wednesday, December 15, at the Great Wolf Lodge in Wisconsin Dells. The registration fee is $225 per person. A brochure with registration form is included in this week’s packet and on the Web site at www.wha.org. On-line registration is available for this seminar.

Gov. Jim Doyle has appointed Sandra Anderson, president, St. Clare Hospital & Health Services to the newly created Public Health Council.

The Pubic Health Council was established by Act 186 to advise the Secretary of the Department of Health and Family Services on public health emergency preparedness and provide oversight for the implementation of Healthy Wisconsin 2010.

The members and leaders of the nursing staff at St. Joseph’s Hospital, West Bend, were featured in an October 11 Advance for Nurses article that describes how patient safety is being designed into new hospitals from design through construction. The nursing staff was involved from the beginning in patient room design of the new hospital in West Bend, which will open next summer.

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