December 12, 2003
Volume 47, Issue 49
Physician Training Fund Cuts Threaten Supply, Access to Docs
Training Physicians in State Saves Money
The Wisconsin Hospital Association this week emphasized the need for the state to fund the Graduate Medical Education program at adequate levels. In a news release issued December 11, WHA stressed the point that the one program that actually increases the number of physicians in the state and can alleviate physician shortages in the future, suffered major cuts in the recently passed state budget. Without state support, the number of physicians trained in Wisconsin could fall considerably short at a time when more, not fewer, physicians are needed to care for an aging population.
The Graduate Medical Education program (GME), which is used to fund medical residency programs in 17 Wisconsin communities, was all but eliminated in the state budget.
In his budget veto message, Governor Jim Doyle indicated his desire to revisit funding levels for physician training. "Our teaching hospitals play an important role in preparing and training Wisconsin’s future physicians, and I am committed to maintaining this support now and in the future," Doyle said. But with a predicted shortage of physicians looming, Wisconsin may find it did too little too late.
Wisconsin Hospital Association President Steve Brenton said cuts to GME must be restored soon to prevent a major crisis in the accessibility of patient care in the future.
"We are certainly encouraged by the Governor’s willingness to restore some physician training funds and growing legislative interest targeting this as a priority. We just hope that funding arrives in time to prevent the dismantling of the current infrastructure," Brenton said.
Richard A. Cooper, MD, a sought after expert on physician workforce issues at the Medical College of Wisconsin, shares Brenton’s concerns. "At the state level, funding cuts in GME will result in losses in the medical residency program," according to Cooper. "There are a large percentage of medical residents who finish their residency and stay where they are to start their practices. If you don’t train physicians in your state, they are not going to come to your state."
Cooper authored a study that appeared in the December 8, 2003 issue of the Journal of the American Medical Association. The study said that a large majority of medical school deans and state medical society executives reported shortages of physicians in various specialties.
Kevin O’Connell, MD, director of the UW-Family Residency Practice Program in Wausau agrees with Coopers findings. According to O’Connell, of 120 graduates of the Wausau residency program, 65% are practicing in Wisconsin, and of those, 65% are in rural areas. "We import more physicians than we export; 70% of our graduates come from outside of Wisconsin and two-thirds stay in the state. We would have a difficult time attracting these physicians to Northern Wisconsin if they had not completed a residency here," O’Connell said.
According to Kurt Mosley from Merritt Hawkins, one of the largest physician recruiting groups in the country, 90% of physicians practice in the state where they were either born, trained, or initially licensed.
"If a doctor has never been to a place, they won’t go there. If you don’t have a physician training program, you lose all of your recruitment advantages," Mosley said.
Carl Getto, MD, senior vice president, medical affairs at the University of Wisconsin Hospital and Clinics, warns that a lack of physicians trained in the state will force health care providers to spend a lot of money, upwards from $30,000 each, to recruit physicians from outside of Wisconsin. Those recruitment efforts, he says, will increase health care costs.
"The residency program short circuits a long and costly recruitment process," according to Getto. "We are saving health care dollars when we are able to keep a physician who is already in the community versus recruiting one from the outside."
Getto said investments in physician training programs have a tremendous return for Wisconsin residents.
"It is an investment that has incredible return in quality of care, quality of life, and in the overall perception of Wisconsin as a place to live and do business," Getto said. "Anything that the state of Wisconsin can do to promote better health care will be returned in terms of our ability to attract and retain business, even in our ability to attract tourists."
Cooper said without state support of GME, there will be significant reductions in the number of medical residents. Already, he said, Wisconsin lacks a sufficient number of physicians that, coupled with fewer medical residents to share the workload, exacerbates an already stressful work environment. Combined with low reimbursement rates, it becomes nearly unbearable for physicians, according to Cooper.
"The loss of GME funding is a major cut for hospitals. It is inevitable that if you are running a hospital, and there is not funding support for a program, it will be cut," Cooper said. "Wisconsin has to recognize that there is a problem and it must be fixed. Restoring the Medicaid funding for GME is one of the fixes."
The Centers for Medicare & Medicaid Services (CMS) published in the November 7 Federal Register the final rule for the Medicare hospital outpatient prospective payment system (OPPS) for calendar year (CY) 2004. In addition to statutory changes for 2004, the rule contains considerable policy changes, such as revisions to the Ambulatory Payment Classifications (APC) weights and rates; payments for drugs, devices and biologicals; and payments for outliers. The rule takes effect January 1, 2004.
Key Provisions of the Final Rule:
You can view the final rule and a more detailed analysis at http://www.wha.org/financeAndData/pps_outpatient.aspx.
Worker’s Compensation Market Narrows
The Wisconsin Worker’s Compensation Act requires employers to purchase this coverage to pay the medical expense and/or lost wages of their employees due to accidents or diseases incurred because of employment.
Recently, Royal Sun announced plans to exit the work comp business, narrowing the Wisconsin marketplace. In the past, carriers would compete against each other—offering strong incentives, such as affluent retro plans or high-level dividends. However, with fewer markets, it is important to remain with a carrier rated A or better by A.M. Best -- or one with strong financials.
Read the entire article in Solutions Spotlight, included in this week’s packet or contact WHA Financial Solutions at 800-362-7121 or Fitzgerald, Clayton, James & Kasten at 877-700-3255 if you are affected by Royal Sun leaving the market, looking for a new work comp carrier, or need help mitigating losses.
This column has previously noted that Wisconsin is a national leader in private sector initiatives aimed at reporting patient safety and quality. This high level recognition by a CMS leader who heads the organization’s Center for Medicare Management underscores the growing national recognition of Wisconsin’s unique position.
Government-run health care consistently features a shortage of physician specialists and waiting lists for diagnostic testing and "elective" procedures …procedures that for most Americans would hardly be deemed to be "elective."
But, one might also suspect that "differences in the systems of care" also relate to the absence of innovation found in single-payer health care. It’s hard to imagine that a public sector that governs by fiat and by rationing can compete with a private sector energized by encumbered access to technology and innovation.
Steve Brenton
President
Bloch Joins WHA Staff as Vice President, Government Relations
The Wisconsin Hospital Association (WHA) is pleased to announce that Jodi Bloch will join their staff as vice president, government relations, effective January 5, 2004.
"Jodi is a veteran Capitol lobbyist whose experience and insight will be a key addition to our team," said WHA Senior Vice President Eric Borgerding. "Advocacy is WHA’s top priority, and Jodi understands what it takes to be effective in the Capitol. We are very pleased to have her on board."
Bloch comes to WHA from the Wisconsin Bankers Association (WBA), where she has been involved in all aspects of government affairs since 1996. This year Bloch was named director of government relations for WBA, previously serving as assistant director, government relations, and as political action manager. Bloch also served as an office manager for U.S. Senator Russ Feingold from 1994 to 1996. Bloch has been a registered lobbyist since 1999 and has extensive experience with political fundraising and grassroots organization.
"I look forward to working for WHA, an organization that understands the important role Wisconsin hospitals play in providing high quality health care services to Wisconsin communities. WHA has a great story to tell and I am looking forward to helping get that message out to the public and our elected officials," Bloch said.
A 1993 graduate of UW-Madison, Bloch holds a bachelor’s degree in political science. She lives in Madison with her husband Peter.
Jodi Jensen, who formerly held the position of vice president, government relations at WHA, has joined the staff of state Rep. Mike Huebsch, who represents the La Crosse area. Jodi was a valuable member of the WHA team, and we wish her well in her new position.
Public Health Advisory Council, WISCA Briefed on Data Collection Transition
As WHA Information Center, LLC, continues preparations to accept fourth-quarter 2003 data submissions from hospitals and ambulatory surgery centers, the Information Center’s staff is reaching out to key audiences to explain the transition and its implications.
On December 5, WHA Information Center Vice President Joe Kachelski briefed the Public Health Advisory Council (PHAC) on issues related to the Information Center’s assumption of data collection responsibilities from the Bureau of Health Information (BHI).
Kachelski assured PHAC members that they would continue to have access to hospital and ambulatory surgery center data because WHA Information Center will provide complete quarterly data sets to BHI free of charge.
He told PHAC members that WHA Information Center "wants an ongoing dialogue with consumers of hospital and ambulatory surgery data," but reminded them that WHA cannot unilaterally mandate collection of new types of data. He invited interested PHAC members to participate in a Data User Group that WHA Information Center will soon establish to receive input from data consumers.
Kachelski spoke at the Wisconsin Surgery Center Association (WISCA) board meeting on December 9. WISCA members indicated that the Information Center’s Web-based submission tool will be a welcome improvement to the current BHI submission and edit-correction process.
Save The Date
January 14, 2004
Business Day in Madison
Monona Terrace and Convention Center
Keynote Speaker, Oliver North
Invitations are in the mail…
Safe Place for Newborns offers Spanish Language Posters
Hospitals are required by law to be ready to confidentially receive an unwanted newborn from a parent under Wisconsin’s "safe haven" law. Safe Place for Newborns of Wisconsin has been providing sample policies & procedures, along with posters, brochures and cards to educate the public since the law passed in April 2001.
Safe Place for Newborns now has a poster available in Spanish that states Wisconsin’s "safe haven" law:
A parent can anonymously relinquish her unharmed newborn, up to three days old, to any hospital employee in the state. She can even call 911. No questions asked. No prosecution. The baby will be given any needed medical care, then placed in foster care for adoption.
Callers to the toll-free hotline will have the option to speak with a Spanish translator 24/7.
Hospitals can call the Safe Place for Newborns office at 608-225-5544 to request the poster in English or Spanish, as well as English brochures or cards. The statewide non-profit also offers a 30-second television Public Service Announcement (PSA) in English or Spanish and a 30-second radio PSA in English available, with the option of hospital sponsorship for local paid airing.
If a newborn has been turned in to your hospital, please call Safe Place for Newborns at 608-225-5544. While reporting is not required, Safe Place for Newborns fields questions from hospitals around the state. Your input would be invaluable to provide the best, soundest care and ensure the rights and responsibilities of all are upheld.