December 1, 2006
Volume 50, Issue 44
A sharp increase in the utilization of prescription drugs and more pharmacists retiring than joining the field are fueling a shortage of pharmacists. In Wisconsin, hospitals are reporting that finding a pharmacist is their most challenging recruitment issue, a problem that will not be solved without increasing the number of pharmacists graduated in Wisconsin. Admissions to Wisconsin’s only pharmacy school have remained flat since 2001, a situation that is forcing Wisconsin hospitals to spend up to a year recruiting nationwide for out-of-state graduates to meet the growing demand for pharmacists. According to a new health care workforce report released by the Wisconsin Hospital Association (WHA) today, hospitals report that the top five most difficult positions to fill are pharmacists, physical therapists, radiologic technologists, physicians and registered nurses. Pharmacists top the list due in part to the exploding demand for pharmacists in retail outlets and the fact that utilization of prescription drugs increased 71 percent from 1994-2005.
"Many hospitals employ a relatively small number of pharmacists, so even a single vacancy can create a crisis in coverage. As key members of the patient care team in hospitals, a vacancy can mean limiting hours of access or delays in obtaining medications," according to Judy Warmuth, WHA’s vice president of workforce and author of the report.
Shortages Loom as Nurses Approach Retirement
Five years ago, hospitals were deeply concerned about higher than expected nurse vacancy rates. With fewer students choosing nursing, graduation rates were not keeping pace with hospitals’ need for nurses. WHA and its member hospitals worked closely with the technical college and university nursing degree programs to promote nursing as a career. As applications to nursing schools rose and waiting lists burgeoned, schools expanded class size to accommodate the students. While nursing school enrollments have risen dramatically, the number of graduates has grown more slowly for two reasons. First, it is taking students longer to graduate, and secondly, some students who enter a program fail to complete it. In spite of this, nursing programs have made significant progress in addressing what is believed will be severe and persistent nursing shortages in the future.
"The average nurse working in a Wisconsin hospital is 47 years old. We need to prepare for the fact that soon we could see a large number of nurses retire at about the same time. The nursing schools have done an extraordinary job expanding their programs and promoting nursing as a career that should help avert a nursing shortage crisis similar to those that are already hitting other parts of the country," said Warmuth. "For now, we can say our nursing vacancy rates are low in Wisconsin, but we certainly can’t say we won’t see shortages in the near future."
More Physical Therapists Needed
Another occupation that is being closely monitored by WHA is physical therapy. Physical therapists are currently difficult to recruit, but the number of physical therapists is expected to increase given a recent resurgence of interest in this career and a corresponding growth in enrollments. However, with the addition of a Doctorate degree in physical therapy, a one-time drop off in the number of graduates in the job market is being anticipated as students stay in school to complete a longer program. Warmuth said there is concern that interest in the career could fall off as expenses to achieve a degree in physical therapy mount.
Hospitals Report Shortages of Specialized Radiologic Technologists
While hospitals are not reporting the widespread shortages experienced just three years ago, an unmet need still exists for radiologic technologists in specialty areas. Warmuth credits the Wisconsin Technical Colleges for abating the shortages by expanding their programs and educating more radiologic technologists, many who are now working in Wisconsin hospitals. This occupation needs careful monitoring to prevent a relapse to a shortage situation.
The Never-Ending Effort to Recruit Physicians
Lastly, physician recruitment is an ongoing challenge, especially for rural and inner city hospitals. While shortages exist, Warmuth said Wisconsin suffers more from an unequal distribution of physicians than from true shortages. Recently, UW-Madison developed the Wisconsin Academy for Rural Medicine (WARM), an initiative to create a group of medical school graduates more likely to practice in rural Wisconsin. WARM is modeled after programs in other states that recruit and admit into medical school students from small towns and rural locations with a strong commitment to practice in these areas upon graduation. The WARM has a goal of increasing the medical school enrollment by 25 students.
"This program is in an excellent position to connect students with an interest in rural medicine with communities that need doctors. Although a great start, this single intervention alone will not provide the physicians needed for Wisconsin’s future," Warmuth said. She added that it takes more than 10 years to prepare a physician for independent practice, so the success of the program will not be apparent for many years.
The WHA report can be found at: www.wha.org/workForce/pdf/2006workforce_october.pdf
A copy of the report is included in this week’s packet.
WHA Responds to Sen. Decker Release on Hospital "Profits"
Wisconsin Hospital Association (WHA) President Steve Brenton released the following statement in response to a press release issued November 27 by Senator Russ Decker (D-Schofield):
"As we do every year about this time, WHA is responding to a press release that grossly overstates Wisconsin hospital ‘profits.’ Senator Russ Decker, in his November 27 press release ‘Hospital Profits Top One Billion,’ again uses incomplete data to paint a misleading picture of health care costs in Wisconsin.
Below are just a few facts that provide a more complete and accurate assessment of hospital finances and the role hospitals play in propping-up essential, yet often ignored, components of our health care system.
Senator Decker refers to $1 billion in hospital "profits," but fails to mention that nearly HALF of that total is from investment income or receipts from such activities as philanthropic gifts, hospital gift shop or parking revenues - things that have absolutely no impact on the cost of health insurance premiums.
In reality, the statewide margin from patient care amounts to 5.5 percent, representing only TWO AND A HALF CENTS of each dollar spent on health insurance premiums – hardly a major factor behind health insurance premium increases or a leading cause of unaffordable health care.
Last year 30 WISCONSIN HOSPITALS LOST MONEY TAKING CARE OF PATIENTS, a total that would have been higher were it not for the federal Critical Access Hospital Program, which helps preserve access to small, rural hospitals through higher Medicare and Medicaid payments.
This year a hospital in central city Milwaukee closed, largely due to unsustainable losses incurred while caring for enrollees in Wisconsin’s (not Washington’s) Medicaid and BadgerCare programs. Medicaid payments to hospitals have not been increased in nearly a dozen years.
Ninety-eight percent of Wisconsin’s hospitals are not-for-profit, so what are these so-called ‘profits’ used for?
"Profits" are reinvested in the local community, providing life-saving technologies that our patients deserve, and update facilities and information systems that make hospitals safer, more convenient and as efficient as possible.
"Profits" sustain other, typically money losing, health care services. Hospital-subsidized physician clinics, primary care sites, nursing homes and home health services would either be severely reduced or cease to exist if not for the "profits" generated by some hospitals. Misleading statements about gross hospital ‘profits’ ignore this very important fact.
In 2005, hospitals provided over $900 million in community benefits, including free clinics, health screenings, and medical education to the citizens who have the least amount of access to health care. These services clearly are not "profitable" and are often provided to people and in places that are not being adequately served by government health care programs.
Left unsaid in Senator Decker’s press release is the important role hospitals play in Wisconsin’s economy, while providing high quality, cost-effective care. Over 104,000 people are employed by Wisconsin’s hospitals, with a payroll of over $5.1 billion. In many parts of Wisconsin, hospitals are the economic backbone of their communities. Millions of people are touched in a positive way by our community hospitals.
"We look forward to working with members of both parties and in both houses of the Legislature to address rising health care costs," said WHA President Steve Brenton. "But if Wisconsin is to make progress, it will require an accurate presentation and understanding of the basic facts and interrelated components of an increasingly complex health care delivery and financing system. Using selected data to portray a fraction of the total picture will only sidetrack this debate and result in poor public policy decisions."
Sen. Robson Shares Legislative Perspectives with WHA Workforce Council
At the November 15 meeting of the WHA Workforce Council, Senator Judy Robson (D-Beloit) provided her perspectives on health care workforce issues and previewed the coming legislative session. Though invited several weeks earlier, Sen. Robson’s appearance at the meeting came only days after the election and the announcement that she will lead the new Democrat Majority in the State Senate.
Sen. Robson noted that all candidates heard that health care cost and access are the priority issues, as articulated by voters throughout the campaign season. As a result, health care reform will likely be an early focus in the next legislative session. She feels that there are existing proposals that deserve serious review and consideration.
The Senator expressed concern regarding the criminal negligence charges filed against an RN in Wisconsin and the affect these charges would have on medical practice and practitioners in Wisconsin. She noted that such prosecutions could have the unintended affect of making health care providers reluctant to report errors and work in an open way to prevent them. She was also concerned about the affect that a criminal case would have on interest and recruitment of new health care workers.
Council members asked the Senator about educational capacity at state-supported schools that prepare health care workers. She responded that the Legislature might need to allocate funds to assure educational programs can meet workforce needs.
Kathy Harris, vice president of human resources at Mercy Health in Janesville described Mercy’s award-winning program designed to attract and retain older workers. She explained that the older worker is a part of Mercy’s larger strategy to partner with employees to become a best place to work for all employers. Mercy Health is first on the "2006 List of AARP’s Best Places to Work." For older workers, Mercy’s plan includes:
Judy Warmuth, WHA vice president of workforce provided the WHA update, which included:
2006 WHA Program Priorities – IMPRESSIVE OUTCOMES!
By Mary Starmann-Harrison, WHA Board Chair
[Editor’s Note: In January, WHA Chair, Mary Starmann-Harrison, penned a guest column outlining her 2006 WHA program priorities. Here’s Mary’s overview of outcomes associated with each priority.]
Although we are still four weeks away from the New Year, I’m pleased to report that we batted 1,000…. a perfect 5 for 5…. when it came to achieving our 2006 program priorities.
In January, I said that:
1. We need to restore Wisconsin’s previous status as a state that welcomes physicians with a favorable medical malpractice environment that includes limits on non-economic damage awards. To accomplish this goal we must take advantage of bipartisan support for a legislative "fix" early in the New Year.
Outcome – Accomplished, with strong votes in the House and Senate for a new $750,000 non-economic damage cap that was signed by Governor Doyle.
2. We must support the recommendations of WHA’s Task Force on Community Benefits and implement a statewide public reporting system by mid year. Such an initiative will allow us to tell our stories of service to our communities and can provide convincing evidence of how.... as nonprofit organizations...we are living our missions daily.
Outcome – Accomplished, with 100% member participation and a statewide report released in October.
3. Wisconsin must remain a national leader when it comes to private sector initiatives that measure, report and improve patient safety and quality care. We’ve earned that distinction…but we now need to further evolve our public reporting programs in ways that empower our caregivers and benefit our patients.
Outcome – Accomplished. The WHA Board in October approved a series of new measures that will be added to CheckPoint over the next two years and PricePoint was recently updated to include outpatient prices. WHA is also actively partnering with the Wisconsin Collaborative for Healthcare Quality and the new Wisconsin Health Information Organization to align our public reporting efforts.
4. Health care costs continue to be a major issue of concern to the business community, lawmakers and the public. We need to "dust off" our public policy initiative (Healthier Choices), update it, and in partnership with others lead discussion that identifies meaningful solutions for what is a complicated but highly charged issue.
Outcome – This is a work in progress with WHA teaming up with the Wisconsin Medical Society, Wisconsin Manufacturers and Commerce and the Wisconsin Association of Health Plans to develop and advocate a common-sense agenda next year.
5. While the fall elections will likely preclude serious legislative discussion of increasing the TOBACCO TAX, we must position WHA to be a leading voice supporting such an initiative in 2007.
Outcome – Accomplished. We are on track for advancing the tobacco tax as a coalition strategy in 2007. And I’m proud of our recent decision to endorse a voluntary statewide effort to promote tobacco free campuses by the end of 2007.
Special thanks to WHA staff and members for your significant contributions to these impressive outcomes.
New Measures Approved for CheckPoint
The WHA Board of Directors recently approved new measures that will be added to CheckPoint over the next 18 months. These hospital quality and safety measures will significantly increase the breadth and depth of clinical conditions and procedures reported to the public on CheckPoint. For the first time, consumers will have an "index" that provides a patient-focused summary of heart attack, congestive heart failure, pneumonia and surgical infection prevention care. Additional process measures will also be provided for these conditions and surgical procedures.
Mortality rates for common diagnoses and procedures will be available in the summer of 2007. The data are from Wisconsin hospitals inpatient claims data and results will be calculated and risk-adjusted using the Agency for Healthcare Research and Quality Inpatient Quality Indicator methodology. These measures will focus on mortality during a hospital stay, in contrast to the 30-day mortality rates that the Center for Medicare and Medicaid Services will make available to the public on Hospital Compare in 2007.
Hospitals are also working to collect information about their patients experience with their care that will be available in the fall of 2007.
For a complete list of current and future CheckPoint measures, refer to the insert included with this week’s packet or on the web site at www.wha.org/cpmeasures10-06.pdf
Utah has joined the growing list of states where Wisconsin’s groundbreaking PricePoint and CheckPoint Web sites have found an adoptive home.
"We are pleased to provide consumers with a significant step in improving transparency in health care quality and costs," said Joseph M. Krella, president of the Utah Hospitals and Health Systems Association (UHA).
Krella expressed thanks for WHA’s assistance in developing and launching the two Web sites. "We’re pleased that we were able to get these sites up and running very quickly. The folks at WHA deserve a lot of credit for their innovation and their willingness to help their sister organizations," Krella said.
The sites are jointly sponsored by UHA, the Utah Department of Health, which collects the state’s discharge data, and HealthInsight, the state’s Medicare-designated Quality Improvement Organization (QIO). The Web sites can be accessed at www.utpricepoint.org and www.utcheckpoint.org .
The UHA joins its counterparts in Oregon, New Hampshire, New Mexico and Virginia as sponsors of a PricePoint-based pricing transparency Web site. A total of ten other states will have a PricePoint system by January 2007. Utah and New Mexico also sponsor CheckPoint sites.
20 Laboratories Honored for Emergency Preparedness Training
Reinforcing their commitment to their communities, 20 hospital and clinical laboratories around the state have qualified for the Certificate of Achievement for Laboratory Training in Emergency Preparedness from the Wisconsin Laboratory Response Network (WLRN).
The WLRN is a network of more than 130 clinical laboratories in Wisconsin, with the Wisconsin State Laboratory of Hygiene as the coordinating laboratory. The WLRN is a subset of the National Laboratory Response Network (LRN), a collaborative, voluntary system of laboratories that are equipped to respond quickly to acts of chemical or biological terrorism, emerging infectious diseases, and other public health threats and emergencies.
Laboratories in the WLRN have three primary roles in emergency response: 1) recognition of unusual organisms in patient specimens; 2) ruling out unusual organisms according to the laboratory’s testing capabilities and protocols; and 3) referral of unusual organisms to the Wisconsin State Laboratory of Hygiene in those cases where a bioterrorism agent or other unusual organism cannot be ruled out.
The WLRN developed a series of four laboratory examination modules (Biosafety, Emergency Laboratory Response, Packaging and Shipping Samples, and Laboratory Diagnostics for Bioterrorism) to document laboratory training achievements in emergency preparedness. To qualify for the award, at least two members of laboratory staff must successfully complete each module. There is no deadline for participation in the voluntary training program, so more laboratories are expected to qualify for the award in the future.
Laboratories that have qualified for the award so far are (alphabetical by city — * denotes that laboratory has received their certificate in an award ceremony):
More than just emergency preparedness
Although the WLRN was created to facilitate the response to acts of terrorism, according to WLRN Coordinator Carol Kirk, its impact extends beyond emergency preparedness.
"During the recent multi-state E. coli O157:H7 in spinach outbreak, Wisconsin was the first state in the country to identify the ‘DNA fingerprint’ of the organism that sickened nearly 200 and killed three people, and we also reported the most cases," Kirk explains. "We believe that this was at least partly due to our network of actively engaged hospital and clinic laboratories that swiftly forwarded to the WSLH E. coli 0157:H7 isolates from ill patients. This enabled the WSLH to rapidly identify the matching ‘DNA fingerprints’ from multiple patients and spur the national response to the outbreak."
The Wisconsin State Laboratory of Hygiene commends the staff and leadership of the laboratories that have qualified for the award, both for their commitment to emergency preparedness and their contributions to public health in Wisconsin. The
CMS Removes 24-Hour Discharge Notice From Final Rule
Final Rule significantly revised
On November 27, the Centers for Medicare & Medicaid Services (CMS) released a final rule outlining its Medicare discharge notice policy. The rule is significantly different from what was originally proposed in April of this year.
Under the original proposal, hospitals would have been required to issue a notice of discharge 24 hours before a patient’s release. During CMS’s comment period on the rule, upwards of 500 comments were submitted in response to this proposal, including comments from the Wisconsin Hospital Association and many of its member hospitals. Expressed in those comments were concerns with the duplicative nature of the notice, as an "Important Message from Medicare" (IM) is already required to be provided to patients, as well as the unpredictable and complex nature of hospital care, making it difficult to provide notice 24 hours in advance. With the latter, the concern was that it could force hospitals to extend patient stays by 24 hours simply to comply with the notice requirement.
CMS agreed with many of these comments and significantly amended the discharge rule to require hospitals to only issue a revised version of the IM that fully explains patients’ discharge rights. Rather than issuing a second and different notice 24 hours before discharge as was proposed, hospitals will issue the IM within two days of admission, answer any questions, and get the signature of the patient or his or her representative on the notice. Hospitals will be required to provide a copy of the signed notice before the patient leaves the hospital, but not more than two days before the departure. For short stays, this means that the copy of the notice need be provided only once.
CMS will be developing the revised notice text, but before submitting it to the Office of Management and Budget for public comment and paperwork clearance, the agency intends to test it with beneficiary focus groups. The rule becomes effective July 1, 2007.
Access text of the final rule in the Federal Register online at: http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/E6-20131.pdf
CMS and OQA publish new hospital requirements
On November 27, 2006, the Centers for Medicare and Medicaid Services finalized its proposed rule to relax four conditions of participation that hospitals must meet to participate in the Medicare and Medicaid programs. The final rule, which has an effective date of January 26, 2007, modifies the following requirements:
History and Physical Examination: The rule gives hospitals up to 30 days before a patient’s admission or 24 hours after admission to complete a medical history and physical examination and allows more health care professionals to perform the exam. The record of the exam must be entered into the patient’s medical record within 24 hours after admission.
Authentication of Verbal Orders: The rule provides that all verbal orders given by a medical professional must be recorded within 48 hours in the patient’s medical record by the medical professional or another practitioner responsible for the patient’s care. (See the state requirements concerning the authentication of verbal orders at http://dhfs.wisconsin.gov/rl_DSL/Hospital/hosp06006.htm)
Securing medications: The rule requires hospital to secure all drugs and biologicals.
Post-anesthesia Evaluations: The final rule permits any individual who is qualified to administer anesthesia, rather than the person who administered it, to conduct the post-anesthesia evaluation.
In addition, on November 27, 2006, the state Office of Quality Assurance released two new provider bulletins. One bulletin provides guidance to providers of psychiatric inpatient (residential) services about patients’ rights to privacy in relation to audio and video monitoring. The other bulletin reviews the current reporting requirements and explains new reporting requirements concerning abuse, neglect, and exploitation of adults-at-risk.
A copy of the final rule from CMS is available on the WHA Web site under legal and regulatory. The OQA memos can be viewed at http://dhfs.wisconsin.gov/rl_dsl/Publications/BQAnodMems.htm
Stories From Our Hospitals
St. Joseph’s Community Health Services, Hillsboro
St. Joseph’s physicians and physical therapists contribute to community benefits in the hill country community
Each year St. Joseph’s Community Health Services commits to offering WIAA Sports Physicals to any high school student in our market area who will be playing sports during the next school year. The physical includes an examination by one of our physicians as well as mobility testing with one of our physical therapists. The Sports Physical helps to determine the individual student’s ability to participate in the rigorous activity involved in school sports.
This year over 70 students participated in this community benefit offered by St. Joseph’s. The students came from eight different cities in the area, including Hillsboro, Elroy, Wonewoc, La Valle, Ontario, Mauston, Cazenovia, Wilton, Richland Center, Lone Rock, and Sextonville.
The Sports Physicals are available at no charge, but most parents appreciate the value and convenience of the physical and are happy to make a $10 donation to the St. Joseph’s Memorial Foundation. This makes it a win-win situation for all involved.
The estimated total cost of offering the community benefit of free sports physicals to the Hill Country Community for this school year is approximately $2,700. The team involved in the physicals, which includes staff from St. Joseph’s Family Clinics, St. Joseph’s Physicians and our Rehab Services staff, enjoy the opportunity to work with the student athletes and make sure each student is able to safely participate in sport programs.
St. Joseph’s Community Health Services is proud to offer this community benefit to all high school students in our area.
Stories From Our Hospitals
Shawano Medical Center, Shawano
On the day that Nancy Amundson learned that she was being nominated for a customer service award at Shawano Medical Center, she spent her morning updating a resume. But not her resume…it was for a patient whose medical problems included epilepsy and whose personal problems included a recent release from jail.
"He wanted to pay his bill," Nancy said. "But to do that he needed a job. So we spent some time looking for the positive experiences in his life for his resume."
This was not a typical day for Nancy, but is typical of the way she works with patients. Nancy, who has been with Shawano Medical Center since 1997, is the Patient Financial Counselor.
When Nancy organized her office, she included a table and chairs. She felt that it was too intimidating to sit across a desk, and more collaborative to have everyone around a table. "People come in anxious and nervous. I want my office to be a calm space where they can feel at ease," she said.
As a patient’s advocate, Nancy makes extra efforts to call Medicare, Medicaid, or insurance companies, and helps the patient communicate with these insurers.
Sometimes that takes more than a phone call. A couple asked for advice on whether to continue on with Medicare or look at a Medicare Replacement Program. Nancy, not wanting to commit to an opinion, went with the patients to an appointment with an insurance agent to review the program. Nancy was able to ask questions of the agent that the patients would never have asked.
Nancy mentions often that her main purpose at Shawano Medical Center is helping her patients when at all possible. If there is a way to help a patient through financial counseling, Nancy will find it.
Free Childbirth Classes
Childbirth classes are free to teens who can’t afford them. Our educator has also taught childbirth to individual teens who are uncomfortable in a regular class. "They are uncomfortable in a class with all couples, especially ‘older’ couples," she said.
Teens can have more than one coach in childbirth. "Sometimes a boyfriend is interested, but really can’t be the only coach. The teen wants mom there, for instance," she explained.
We also do programs to schools or groups on the childbirth experience, share a "sympathy belly" and show model babies with fetal alcohol syndrome or cocaine effects.
The hospital, through its Healthier Communities Initiative grant program, is a sponsor of the "Baby Think it Over" program at the local high school. The program uses model babies with recorders and lets teens experience what life is like with a newborn. Last year, we bought a baby!
Submit hospital community benefit stories to Mary Kay Grasmick, editor, mgrasmick@wha.org or call 608-274-1820
Position Available: Chief Executive Officer, Dawson, MN
Johnson Memorial Health Services (JMHS) located in Dawson, Minnesota is seeking a chief executive officer. JMHS is a well-established, well-run, financially sound, independent, 20-bed acute care hospital with a 56-bed nursing home and on-site clinic with four medical practitioners
The ideal candidate will have a Master’s Dgree in Healthcare Administration or related area; minimum of three years of successful high-level management experience in an acute care setting; Nursing Home Administrator license and appropriate experience; Clinic management experience; Excellent interpersonal communication, leadership, and problem-solving skills; Strong financial analysis abilities and proven fiscal management skills; A track record of working collaboratively with stakeholders – employees, physicians, the community, governmental board, similar facilities in neighboring communities; Demonstrated understanding of compliance and funding issues affecting rural hospitals; Experience with Critical Access status desirable; Computer literate, including experience using Dairyland, Word, Excel, and Outlook preferred. Please note that the CEO is required to live in the hospital district.
Please send a letter of introduction and your resume with salary requirements (a must) by December 8, 2006 preferably via e-mail to mnresume@wipfli.com or to: Pat Connelly, Wipfli LLP, 7601 France Avenue South, Suite 400, Minneapolis, MN 55435; Fax: 952-548-3403.