Following Senator Barack Obama’s victory in the race for the White House, and Democratic gains in both the U.S. Congress and Senate, Democrats now also control all legislative branches of government in Wisconsin for the first time since 1986.

Change came to the Wisconsin Assembly, where Democrats took majority control for the first time since 1995 by defeating three incumbents and winning in two open seat races where Republicans did not seek re-election.

At the end of the last legislative session, Republicans held a 52-47 advantage. But prior to the elections, the margin was narrowed to 51-47-1 when former Republican Representative Jeff Wood (I-Bloomer) declared himself an Independent.

In a surprise, long-time incumbent Representative Frank Lasee (R-Green Bay) was defeated by Democrat Ted Zigmunt. Also losing were Representative J.A. "Doc" Hines (R-Oxford) to Democrat Fred Clark and Representative Terry Moulton (R-Chippewa Falls) who fell to Democrat challenger Kristen Dexter. With Dexter’s margin of victory at 275 votes, a recount is possible in this race.

Two open seats formerly held by Republicans—who earlier this year announced their retirement—were also captured by Democrats. In the open 57th Assembly District, previously held by Steve Wieckert (R-Appleton), Democrat Penny Bernard-Schaber defeated Republican Jo Eglehoff. In the open 92nd Assembly District, formerly held by Terry Musser (R-Black River Falls), Democrat Mark Radcliffe beat Republican Dan Hellman.

The close margins in a few other races also raise the possibility of recounts to verify the winners. In the open 47th Assembly District, vacated by retiring Representative Eugene Hahn (R-Cambria), Republican Keith Ripp narrowly defeated Democrat Trish O’Neil by just 28 votes out of over 31,000 votes cast. Incumbent Republicans Dan Meyer (R-Eagle River) and Mary Williams (R-Medford) also won their elections by just 160 and 227 votes respectively, and the margin in Independent Jeff Wood’s victory over Republican challenger Don Moga was just 105 votes.

With Wood winning his race, the margin in the Assembly, pending any potential recount changes, will become 52 Democrats, 46 Republicans, and 1 Independent.

In the state Senate, Democrats entered Election Day with an 18-15 majority (with two open seats). Initial results show no change to that margin as incumbents won their races and the open seats were filled by candidates of the same party.

In a close race in the open 12th Senate District, vacated by the appointment of Senator Roger Breske (D-Eland) as Railroad Commissioner, former Democrat legislator Jim Holperin narrowly defeated Republican Tom Tiffany by a 51-49 percent margin.

In another very close race in the open 18th Senate District, vacated by the appointment of Senator Carol Roessler (R-Oshkosh) as Administrator of State and Local Finance for the Wisconsin Department of Revenue, Republican Randy Hopper defeated Democrat Jessica King by less than 200 votes out of over 83,000 votes cast, making a recount likely.

As incumbents and newly-elected legislators prepare to take office, it is clear the looming budget deficit will present the biggest challenge of the next legislative session. Throughout the process, WHA will work with both parties to achieve the best public policy possible and ensure that the hospital voice is heard in Madison.

The returns are in, and one of the things implicit in Barack Obama’s victory is that Congress will soon be considering the thorny topic of health care reform.

During the election, both major candidates promised that, if elected, they would find a way to extend affordable health care to all Americans. Obama proposed enlarging existing government programs such as Medicaid and creating new government subsidized programs that would cover virtually everyone in the country. McCain proposed a more market-driven approach based on consumer choice and increased competition among health insurance companies.

What both candidates seemed to have missed is the simple fact that health care is provided by people—mainly by physicians and nurses. If the goal is to make health care accessible to more people, a corresponding goal should be to increase the supply of doctors and nurses who actually deliver care.

Unfortunately, neither candidate made the connection between health care access and physician and nurse supply. Nowhere on their Web sites or in printed documents outlining their health care reform plans did Obama or McCain call for significant increases in physician and nurse training. This is particularly unfortunate because the supply of physicians and nurses already is inadequate to meet our current needs, let alone the increased demand for health care that expanded access would create.

Hospitals already are experiencing an 8.5 percent nurse vacancy rate, according to the U.S. Department of Health and Human Services (HHS.) HHS projects that by 2020 there will be 800,000 too few nurses—a deficit of 24 percent. Richard Cooper, M.D., co-chair of the Council on Physician and Nurse Supply, has projected a deficit of 200,000 doctors by 2020. These projections do not take into account the additional stress put on physician and nurse supply that would result from expanded or universal access.

According to a study by the Lewin consulting firm, universal access would create the need for 35,000 additional physicians and 45,000 additional nurses. A key test case is Massachusetts, which greatly increased access to health care in the state through its reform plan. However, it has been widely reported that many of the newly insured are not able to access physicians in a timely manner. The lesson is that comprehensive health reform does not necessarily mean comprehensive access to care.

It is to be hoped that Obama’s health care team will examine this problem and conclude that both nurse training and physician training needs to be enhanced. Prominent researcher Linda Aiken (also co-chair of the Council on Physician and Nurse Supply) projects that about 110,000 new nurses per year will be needed between 2002 and 2012 to meet demand. Dr. Cooper of the Council recommends that the number of physician residency slots be increased by 30 percent.

The physician shortage is particularly acute in primary care. Due to comparatively low reimbursement and other factors, fewer medical students are interested in becoming primary care doctors. This could further undermine any attempt to broaden access to care and would also undermine the attempt to create a system more oriented to preventive care. Preventive care depends on primary care physicians spending more time with patients educating them and monitoring their progress. One thing over-worked primary care doctors don’t have today is time.

There has been a lot of discussion of late regarding the patient-centered medical home. Under this model, primary care doctors would be paid more based on a three-tiered compensation system that includes a patient management component, a fee-for-service component, and a quality outcomes component. Enhancing the stature and pay of primary care doctors through the medical home model may be one way to attract more medical students to primary care. First, however, the Obama team may wish to consider removing the cap on Medicare-based funding of physician graduate medical education. It also should consider ways to increase faculty at nurse training programs. A general lack of faculty is the main reason why tens of thousands of qualified applicants to nursing schools are turned away each year.

Here’s wishing the new president the best of luck in creating a health care system that makes quality care more accessible to all Americans.

Kurt Mosley is senior vice president of business development for Merritt, Hawkins & Associates, a national physician staffing firm and a division of AMN Healthcare. He can be reached at kmosley@mhagroup.com.

WHA is currently soliciting appointment requests from WHA members to participate in WHA councils and subcommittees. Now is your opportunity to participate on the councils that are at the forefront of identifying key policy issues for the membership and making recommendations on positions to the WHA Board.

There are five councils and one committee for which we are looking for member participation:

• 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/gm1-08.pdf. You may direct questions to Sherry Collins at scollins@wha.org or 608-274-1820.

The Centers for Medicare & Medicaid Services (CMS) this week announced it is postponing all activity involving the four permanent Medicare recovery audit contractors due to a "RAC protest and stay of performance." Furthermore, all outreach sessions in the first round of RAC states originally scheduled to begin this month have been delayed until further notice. CMS said that, in the meantime, it continues to prepare for the permanent nationwide RAC program and indicated that it will post further details about the reasons behind the postponement on its Web site at www.cms.hhs.gov/RAC.

Monday, November 10, the Wisconsin Council on Medical Education and Workforce (WCMEW) will hold three news conferences in three locations to release the 2008 Wisconsin Physician Workforce Report. Member hospitals will find an advance copy of the report, written by the Wisconsin Hospital Association on behalf of WCMEW, in this week’s packet.

The news conferences will be held in Wausau, Madison and Milwaukee. WHA is providing information to hospital public relations professionals to prepare them for the statewide news release that will be sent to all media on November 10.

Watch for complete coverage of the news conferences in the November 14 issue of The Valued Voice. For more information on the report, contact George Quinn at gquinn@wha.org or 608-274-1820.

The Barack Obama tidal wave that hit this week certainly did not miss Wisconsin. Indeed, the surge that swept Senator Obama into the White House brought with it enough momentum to give Wisconsin Democrats some big wins, especially in the State Assembly. For the first time in 14 years Democrats will have a majority in the so-called "lower house" and for the first time in 22 years, Democrats will control the Assembly, Senate and Governor’s chair.

Pending a recount in the 18th district, Democrats in the Senate retained their 18-15 majority. By taking five GOP seats, Assembly Democrats now have a 52-46-1 margin (also pending a handful of recounts in very close races). It’s a majority identical in size to that held by Assembly Republicans for most of the 2007-08 session, which proved very difficult to manage.

As soon as next Friday, we may know who will lead the new Assembly majority and minority into the next legislative session. Awaiting them are a host of serious issues and challenges, not the least of which will be addressing a potential $3 billion (or higher) budget shortfall and a number of other priorities, some of which were heavily debated in the elections.

So what will this mean for hospitals and health care? How will we "ride the wave?" Here are just three issues to consider.

Health Care Reform: Health care reform in Wisconsin will now be focused on two different roads to achieving the same end—universal coverage. One road, Healthy Wisconsin, took a beating in the campaign with many successful candidates seen as distancing themselves from the proposal. Does that mean the Healthy Wisconsin approach to reform is dead? Hard to say, but doing nothing or debating to a status quo is even less likely given the Democrats’ reform themes during the campaign and the majorities they now hold.

Governor Doyle’s targeted approach to reform through BadgerCare Plus got a big boost last week when the feds approved the waivers necessary to move ahead with the expansion to low-income childless adults. Doyle’s next phase of targeted reforms will likely focus on affordability for small businesses, which may be revealed in his upcoming biennial budget. But the state’s dire fiscal situation could put a damper on both these approaches.

Finally, when President-Elect Obama takes office in January, backed with expanded Democrat majorities in the House and Senate, many expect/demand fundamental health care reform to be one of his first major tasks. Will this give pause to stand-alone efforts here in Wisconsin? Or another question—Which approach to reform in Wisconsin would be most compatible with a future federal plan? In the past, Wisconsin has been unintentionally penalized for getting out ahead of the feds. SeniorCare is a perfect example. But does anyone have the patience to continue "waiting on Washington"?

Medicaid/Hospital Assessment: The multi-billion budget problem has pretty much eliminated the likelihood of securing additional state budget dollars for much needed hospital Medicaid payments. But this is not a new situation, nor did it take a budget crisis to get here. It has been over a decade since hospitals received a meaningful increase from Medicaid. Thus, we fully expect the hospital assessment to be back on the table, and soon.

Like they did with Healthy Wisconsin, independent issue groups also targeted some candidates, though to a lesser degree, for supporting the hospital assessment. But assessment supporters stuck to their guns, talking in debates and interviews about embracing it as a way to capture our fair share of federal health care dollars, increase hospital Medicaid payments, decrease the amount of cost-shifting to business, and bring much needed dollars to the state’s Medicaid program. These candidates all prevailed. Without a doubt, the hospital assessment will be back in 2009, and assuming it is the improved proposal that was debated last session, it will have WHA’s support.

Mandatory Overtime and Staffing Ratios: Banning the use of mandatory/unavoidable overtime in health care facilities and mandating specific staff-to-patient ratios have long been priorities for the state nursing unions. Hospitals, nursing homes and others have vehemently opposed these proposals because of the detrimental impact both will have on patient care. Just look at California (the only state that has passed mandatory ratios) for examples of the havoc staffing ratios wreak on a 24/7/365 industry that faces chronic staffing shortages already.

With Democrat majorities in both houses, the chances of these bills moving forward have increased, but their fundamental problems remain. The real question for the next Legislature should be "Do we want to comprehensively address the fatigue from overtime (especially voluntary) in health care settings, or will we simply pass legislation that avoids this broader problem?" That’s the question we will be asking, and those truly concerned about patient safety should also.

There will be both opportunities and challenges in the coming months. Stay tuned!

Every ten years, Wisconsin is, by law, required to develop a public health plan. The Wisconsin Department of Health Services (DHS) is currently working on the state public health plan for the next decade, i.e., for the years 2010 to 2020. The new public health plan is called "Healthiest Wisconsin 2020." According to DHS, "Healthiest Wisconsin 2020 will become the policy roadmap to protect health and safety, eliminate inequalities in health, and transform our public health system to achieve our shared vision of Healthy People in Healthy and Safe Wisconsin Communities."

Frank Byrne, MD, president, St. Mary’s Hospital, Madison, represents WHA on the Healthiest Wisconsin 2020 Leadership Planning Team.

DHS has scheduled a series of "community engagement forums" to solicit public feedback as DHS develops state public health policy for the next decade. The next forum is:

• Southern Wisconsin: Madison, November 13, 2008 (2 - 6 p.m.)
  Howard Johnson Inn, 3841 E. Washington Avenue, Madison, WI 53704

If you wish to participate, complete a registration form (available at http://dhs.wisconsin.gov/statehealthplan/hw2020/forums.htm) and return it to DHS. If you have any questions about the forums, feel free to contact Jennifer Potts of DHS at 414-227-4922 or email jennifer1.potts@dhs.wisconsin.gov.

For more information on Wisconsin State Health Plan: Healthiest Wisconsin 2020, visit http://dhs.wisconsin.gov/statehealthplan/hw2020/index.htm.

Watch The Valued Voice for further information on the development of Healthiest Wisconsin 2020 as it becomes available.

Fifteen Wisconsin hospitals were among the 412 honored recently by the Department of Health and Human Services (HHS) for sustaining an organ donation rate of 75 percent or more of eligible donors. To receive the Medal of Honor for Organ Donation, hospitals must have eight or more potential organ donors in a 26-month period and sustain a 75 percent donation rate for at least a year. The Organ Donation Breakthrough Collaborative, launched by HHS’ Health Resources and Services Administration in 2003, helps hospitals identify and share effective organ donation practices. The 15 Wisconsin hospitals honored are:

Luther Midelfort Eau Claire, Eau Claire

Aurora Bay Care Medical Center, Green Bay

St. Vincent Hospital, Green Bay

Gundersen Lutheran, La Crosse

St. Mary’s Hospital, Madison

University of Wisconsin Hospitals and Clinics, Madison

Saint Joseph’s Hospital, Marshfield

Aurora St. Luke’s Medical Center, Milwaukee

Children’s Hospital of Wisconsin, Milwaukee

Froedtert Memorial Lutheran Hospital, Milwaukee

Wheaton Franciscan Healthcare-St. Joseph, Milwaukee

Theda Clark Medical Center, Neenah

Wheaton Franciscan Healthcare-All Saints, Racine

Waukesha Memorial Hospital, Waukesha

Aspirus Wausau Hospital, Wausau

According to the Wisconsin Department of Motor Vehicles, about 52 percent of Wisconsin’s drivers and ID card holders have said "yes" when asked by DMV staff if they wish to be recorded as potential donors. That compares to 46 percent at the end of 2004. People who wish to become an organ donor should add an orange donor dot and sign their driver’s license. It is important to tell your family that you support donation. People can also complete a living will and/or a Power of Attorney (POA) that states their wishes to be a donor.

A credit class through CESA 11 and WITC taken over the summer by B-W High School Guidance Counselor Kit Smestad at Baldwin Area Medical Center has given her insight into medically related fields which will help her advise kids about them.

Smestad spent time over the summer in 16 separate areas at BAMC to gain knowledge about each of the areas and the qualifications needed for each.

"Now I have a better idea how to advise kids and can make them aware of different opportunities in the medical field," said Smestad. "It’s not to tell them what to do but to give them information so they can decide what to do."

Smestad worked with BAMC Human Resources Director Trudy Achterhof to set up the course. Over the summer Smestad was able to spend time in departments or areas including: surgery, risk management, infection control, diabetes control, respiratory therapy, clinic, social services, lab, radiology, ER, OB and scheduling and registration.

Achterhof said that because BAMC is a smaller facility Smestad was better able to see the whole of the operation, rather than at a large medical facility which has thousands of employees spread across hundreds of areas. She added that the 16 areas visited by Smestad were probably three-quarters of the areas at BAMC. "It made it more manageable for Kit," said Achterhof.

Smestad said the course, practically speaking, involved spending time in each of the departments, speaking to the people in them "and finding out what they do." She also discussed schools that educate students in their areas. The connections she made with employees also provides Smestad with a contact person for a student if they have questions in that area.

"The great thing about health care is there are many options and the training varies from on-the-job to being a doctor," said Smestad.

"That’s the message we try to send when we go to schools," added Achterhof, "there are many options." She said BAMC puts lots of energy into recruiting and working on partnerships with schools because of the shortage of health care workers. "We try to make ourselves available to their school programs and to be speakers and participate in their school programs and in interview days as a way of saying we care about students who want to advance themselves and help them achieve their goals in health care."

Achterhof said BAMC has between 20 and 25 students yearly from WITC and CVTC who do clinical rotations. She said that provides a pool of resources from which the hospital may recruit in the future. "Many people prefer to be in a small [hospital] environment," said Achterhof. BAMC also offers multiple rotations, she added, with nursing a great example. A nurse can be trained in four or five areas at BAMC, while at a large facility a nurse would work in only one area. "People who come here want the diversity and variety they get."

BAMC also offers a program called "Me and my shadow" for high school students to shadow a health care practitioner in an area of their interest, said Achterhof. "In surgery, for example, a student may get a chance to be in surgery."

As part of a community initiative, nearly 1,000 youth athletes and active teens participated in free screenings to identify those who might have a deadly heart condition called Hypertrophic Cardiomyopathy (HCM).

Hypertrophic Cardiomyopathy is the most common cause of sudden death among young athletes in the U.S. In fact, every two weeks in the U.S. a young person dies from this condition. Generally, those who die from the condition are young athletes who have just participated in some form of strenuous exercise.

While HCM usually has no symptoms, there is a test that can, in many cases, detect the problem. But, because the cost of a complete echocardiogram costs about $1,000, it is seldom used as part of routine student physicals.

As an effective alternative, the Green Bay Packers, Bellin Health and Cardiology Associates of Green Bay teamed up, along with a number of other businesses and organizations, to offer free, abbreviated screenings to area student athletes. The abbreviated screenings will, in most cases, indicate whether further medical testing is needed. The 90-second test is non-invasive and provides immediate results.

As a result of the screenings, nearly 30 individuals were recommended for additional, more comprehensive testing, two had clear indications of HCM, and two other major heart defects were detected. Those individuals and their parents received immediate consultations with the medical experts on hand.

"It’s important to note that if a young person has this condition, it is something they can live with, but it will mean the student should not participate in any strenuous or vigorous physical activity," said Dr. James Rider, who initiated this effort.

Held over three Saturdays in July, the effort is believed to be the first time in this country where the medical community has partnered with a major professional sports organization to do this type of screening.

Bellin Health is looking at this program as a pilot. "We hope that this program will expand every year to include more students and additional locations," said Dr. Rider. "In fact, we hope it will spur on other communities to do the same."