Dan Schoof, deputy secretary of the Department of Administration, is in the unenviable position of grappling with what he described to the WHA Board as the "biggest fiscal crisis the state has faced in the past 30 years."

"We are so dependent on personal income tax withholding and sales tax revenue…it was fine until the entire nation fell off the financial cliff," according to Schoof. "We saw it start to fall off in September and October. Things that are under consideration (for the next budget) are potentially dramatic. There are some difficult choices to be made," he said.

Schoof said Governor Doyle and several other governors met December 10 with President-elect Barack Obama and with Wisconsin Congressman Dave Obey, who chairs the House Appropriations Committee.

"Decisions that will be made in Washington will determine whether we have to make deep cuts and how permanent these will be," Schoof said. He said cuts should, however, not be made to safety net programs.

The debate on how the federal government will assist the states will last into January. Schoof said states have been submitting projects for consideration for federal assistance. President-elect Obama has made it clear that he wants turn-key projects. Schoof said the Administration included an electronic medical records funding request among their submissions.

In a follow up question on electronic health records (EHR), WHA President Steve Brenton noted that Wisconsin is a national leader in the implementation of EHR, but it comes with a huge financial burden for hospitals. Brenton said the amount of money requested by the state for EHR "scratches the surface" of what will be required to implement it in all hospitals. Brenton suggested that the state’s e-Health Initiative could provide guidance if federal dollars did become available to help hospitals and clinics with the heavy investment that is required.

Schoof concluded by thanking the Board and voiced his appreciation for WHA staff involvement in working with the DOA on the hospital assessment and other issues.

"We have been working through the issues, and it has been a positive and collaborative relationship," Schoof noted.

The Elections, The Budget, Medicaid….What’s Next??

WHA Executive Vice President Eric Borgerding, referring to his last presentation to the Board, noted that the elections have shifted the balance of power in the Capitol. He said WHA staff met with more than 60 candidates prior to the election and as a result, he said staff feels well prepared as new legislators take their seats. Mike Sheridan, the new Assembly Speaker, spoke recently to the Public Policy Council and Borgerding said staff has worked hard to keep legislators informed of issues and positions before the new session begins January.

According to Borgerding, it is likely Wisconsin will look to Washington and the new Obama Administration for large scale health care reform, but that will not mean states like Wisconsin will sit idle while waiting. He believes that the Governor’s targeted approach to reform will be the path followed in Wisconsin with other ideas for achievable reforms being developed by health care leaders in the Legislature.

Borgerding warned that the cap on non-economic damages is a likely target for the trial attorneys, and he believes it will be an issue that could reappear at the Capitol in 2009.

The hospital assessment is expected to be one of the issues taken up early by the new Legislature. Borgerding said there has been no specific proposal introduced at this point, but that the assessment contained in the budget adjustment bill last spring would serve as WHA’s preferred framework going forward.

WHA Senior Vice President George Quinn delivered a detailed analysis of the hospital assessment, including likely improvements from the version debated last spring. He said that WHA’s role is to help shape a hospital assessment that aligns with the WHA Board-approved principles for support.

WHA Chair Report: Ken Buser

In his final report to the Board as Chair, Ken Buser took the opportunity to praise the "hardworking team" at WHA and WHA Board members for their support and confidence in the Association.

Buser said WHA had excellent results and achieved the 2008 goals. He commended members for remaining unified on the Association’s position on the hospital assessment. He also congratulated WHA staff and Advocacy Chair Bob Fale for exceeding the 2008 PAC and conduit goals.

Buser said WHA has been proactive in providing education opportunities so members can be prepared for a changing labor environment. He said all transparency performance goals were implemented in 2008, which continues to keep Wisconsin at the forefront of measurable performance improvement.

"Our communications remain strong and consistent both internally and externally," he said and added that he recommends Board members read the Results 2008 publication that was distributed at the Board meeting and review the 2008 outcomes. ("Results 2008" will be distributed to members in the December 31 weekly mailing.)

WHA President’s Report: Physician Workforce Tops Member Priority List

Referring to the WHA outcomes in 2008, Brenton said Association staff is specifically accountable for each goal and that outcomes are remarkable. He said the Board will receive the proposed 2009 WHA goals at the February Board meeting.

Brenton noted that while much time in 2008 has been spent in discussions about Medicaid, for most members, physician workforce issues are their number one issue. He pointed out that WHA was instrumental in creating the Wisconsin Council on Medical Education and Workforce, a multi-stakeholder group that works to address the complex issues associated with maintaining an adequate supply of physicians in Wisconsin. The most visible WHA activity associated with this issue was the launch of www.WisconsinPhysicianCareers.org, which now has nearly 700 physician career opportunities posted. Brenton noted that WHA’s George Quinn authored the Physician Workforce Report, which was released in three news conferences coordinated by WHA.

"In recent days, the shortage of primary care physicians has been pushed to the forefront of national news. It serves to remind us that if there is not access, there is not health reform. The Workforce Report outlines a game plan on how we can address this very serious issue over time," according to Brenton.

Brenton pointed out that Wisconsin was among a handful of states to receive funding from the Robert Wood Johnson Foundation in partnership with the Wisconsin Collaborative for Healthcare Quality. Over the long term, Brenton added, the grant will enable Wisconsin to make even greater strides in improving the quality of patient care.

WHA Council Reports

Public Policy Council: Eric Borgerding presented the report. He said a highlight of the meeting was the Council’s special guest, Assembly Speaker-elect Mike Sheridan (D-Janesville). Sheridan, who was just elected Assembly Speaker the previous week, discussed his background as president of the local United Auto Workers Union and how he hopes to use that experience to work in a bipartisan fashion to address the challenges facing the state.

Borgerding said the policy forecast for the 2009-11 Legislative Session is shaped almost entirely by the revenue shortfalls confronting the state. These realities make general purpose revenue (GPR) for hospital Medicaid increases impossible, Borgerding said, and make a deliberately crafted hospital assessment a viable solution for both the state and Wisconsin hospitals. But he warned that tinkering with the assessment could have the direct opposite effect of driving health care costs up. Staff also briefed Council members on key developments in the area of behavioral health, including WHA’s creation of a new Behavioral Health Task Force. The Council heard reports on health care reform and coverage expansion; labor and workforce issue; health care quality, safety and transparency; medical malpractice, regulation and hospitals’ tax-exempt status.

Borgerding thanked David Olson, WHA’s Board Chair-elect, for his three years of service as chairman of the Council and welcomed new Chairperson Diane Postler-Slattery.

Investment and Audit Committee: Chair Greg Britton said while investment news is generally not good right now, WHA has pretty good results from its investments given the current market. The Committee heard from First Business Trust and Investments about the difficult market. First Business then presented the 2008 investment performance through October for WHA and its other companies against industry benchmarks. They have taken a conservative posture in these tough times to help improve the returns. Some of those things include carrying a larger cash balance, positioning the equity percent of the holdings at the low end of our range, and using other risk diversifying strategies. The Committee made no changes to the current investment strategy.

Wipfli reviewed the 2008 audit engagement letter and discussed the risk-based standards that are now in place for organization audits. Wipfli and the committee discussed their responsibilities as it relates to the audit and their understanding of WHA and its potential risk areas. The committee discussed the engagement letter and had no changes. The 2008 WHA audit will take place the second week in February.

Wipfli also discussed the new IRS form 990 form and some of the new areas of focus. WHA will be using the audit committee to review their 990 prior to submission to comply with one of the new questions on the 990.

Workforce Development: Chair Phil Stuart said considerable time was spent at the last meeting discussing the issue of fatigue. He presented a recommendation from the Workforce Development Council relative to fatigue that would be useful to member hospitals to start an internal dialogue on the issue. The Board approved the recommendation.

Judy Warmuth, WHA vice president of workforce, told the Board that any discussion of fatigue must include employees. At the last Council meeting, the Wisconsin Safety Partnership, a coalition of groups including OSHA, DWD, unions and employers showed a PowerPoint presentation on long work hours and fatigue. The group’s focus is on worker safety. The presentation summarizes the research available on fatigue and crosses all industry sectors. The presentation is available for use with groups. The Partnership will be presenting on the topic at local, regional and state conferences attended by risk managers and human resource professionals.

The Wisconsin Health Insurance Risk-Sharing Plan (HIRSP), the state’s "insurer of last resort" for those whose medical conditions prevent them from purchasing individual health insurance, continues to reprocess 2008 inpatient hospital claims to correct for unanticipated underpayments.

About $2 million in additional payments ultimately will be issued. At this point approximately half of the inpatient claims have been reprocessed. The change is the result of an inaccurate estimate of hospital inpatient costs related to the transition from a DRG-based reimbursement system in 2007 to MS-DRGs in 2008. The resulting payment rates to hospitals were lower in aggregate than intended.

Meanwhile, hospital reimbursement rates will increase another 19 percent for both inpatient and outpatient services in 2009 because of unexpectedly low claims costs for HIRSP.

By law, policyholders pay 60 percent of program costs and insurers (through assessments) and providers (through discounts) fund 20 percent each. Because overall HIRSP costs have been lower than expected, the discounts applied to provider reimbursement have caused providers to over-contribute to the program. Much of the increase in 2009 is meant to spend down the surplus in the provider "account" within HIRSP. The discount off the HIRSP fee schedule or DRG rates in 2009 will be 19.3 percent, down from 29 percent in 2008.

The Wisconsin Hospital Association and the Wisconsin Hospital Emergency Preparedness Program (WHEPP) this week announced they are developing a series of briefing papers on various aspects of hospital emergency preparedness. The briefing papers will be released periodically and distributed through the WHA weekly mailing and posted to the WHA Web site. The first paper is in this week’s packet.

According to WHA’s Bill Bazan, the briefing papers will address some of the ethical considerations that hospitals need to consider as they prepare for major emergent events.

"There is a lot of information on hospital emergency preparedness. However, it can absorb a lot of time to find critical pieces of information," says Bazan, who serves as WHA’s liaison to WHEPP. "Hospitals will find the briefing papers helpful as they work on their emergency preparedness plans with employees, vendors and their communities."

Wisconsin scores high in health emergency preparedness

This week, the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) released the sixth annual Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism report, which gave Wisconsin a perfect score based on 10 key indicators that assess health emergency preparedness capabilities. Louisiana, New Hampshire, North Carolina, Virginia, and Wisconsin scored the highest with 10 out of 10. More than half of the states and D.C. achieved a score of seven or less out of 10 key indicators.

The report cautioned that progress made to better protect the country from disease outbreaks, natural disasters, and bioterrorism is now at risk due to budget cuts and the economic crisis. The report concludes that major gaps remain in many critical areas of preparedness, including surge capacity, rapid disease detection and food safety.

The Wisconsin Hospital Association is again teaming up with the American Stroke Association and the Wisconsin Office of Rural Health to offer rural Wisconsin hospitals the opportunity to participate in a stroke improvement collaborative in 2008-2009. The Rural Hospital Stroke Improvement Project II will focus on reducing stroke morbidity and mortality through the implementation of the Brain Attack Coalition stands of care. In addition to improving care within the hospital, this year’s project will focus on engaging your community to improve stroke outcomes.

The project will include education regarding the scientific evidence for stroke care, as well as sharing of best practices and lessons learned. Each participating hospital will receive one year of free access to the Get With the Guidelines online patient management tool that includes the new consensus measures endorsed by the American Stroke Association, The Joint Commission and the Centers for Disease Control.

In 2007-2008, 19 rural Wisconsin hospitals participated in the Rural Hospital Stroke Improvement project. These hospitals made significant improvement in several key processes known to improve stroke outcomes including:

• 100 percent of eligible ischemic stroke patients received t-PA within two hours of the onset of stroke symptoms;
• 90 percent of stroke patients were screened for dysphagia; and
• 60 percent of stroke patients received complete stroke education prior to discharge.

Stroke is the third leading cause of death in the United States when considered independently from other cardiovascular disease. Approximately 700,000 Americans have a new or recurrent stroke each year. Stroke also remains a leading cause of serious, long-term disability in the United States.

Rural Wisconsin hospitals are encouraged to participant in the Rural Hospital Stroke Improvement Project II. The registration deadline is January 5, 2009. A brochure with registration information is included in this week’s packet and it is available online at www.wha.org.

To learn more about this project, contact Dana Richardson at dirchardson@wha.org or at 608-274-1820. For registration information, contact Lisa Geishirt at lgeishirt@wha.org or at 608-274-1820.

WHA is one of the top Associations in Wisconsin, a distinction that would not be possible without the dedicated service of voluntary leaders, according to WHA President Steve Brenton. At the December 11 WHA Board meeting, WHA President Steve Brenton recognized the following Board members for their service to the Association:

• Stan Gaynor, CEO, Black River Memorial Hospital, representing the WHA Western Region
• Leo Brideau, President/CEO, Columbia St. Mary’s, who will continue to Chair the WHA Health Reform Task Force
• Ford Titus, WHA 2002 Chair, President/CEO, ProHealth, and he will Chair the WHA Information Center Board of Directors in 2009
• Bob Fale, WHA 2007 Board Chair, President, Agnesian HealthCare, will serve as AHA Board Alternate in 2009
• Doug Peterson, President/CEO, Chippewa Valley Hospital, representing the WHA West Central Region
• Terri Richards, WHA 2001 Chair, Executive VP, Saint Joseph’s Hospital, serving as an AHA Delegate

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SPECIAL REMINDER: The WHA membership satisfaction survey was distributed directly to hospital and health system leaders on December 8. Please take a moment to complete either the online or written version of the survey by December 19.

At the most recent quarterly Hospital Forum meeting, George Quinn and Laura Leitch, WHA, and Tim Size, RWHC, met with Cremear Mims and Division of Quality Assurance staff to discuss various compliance issues important to Wisconsin hospitals.

Mims related significant and appreciated improvements to the hospital building plan approval process. Hospitals now can check the review status of building plans that hospitals have submitted to DQA. In addition, DQA has made permanent the second plan check-in site, with one site located in Madison and one in Milwaukee. DQA also provided the results of the hospital construction questionnaires provided to hospitals after on-site surveys by DQA engineers. Thirty out of 31 responses received were positive or very positive.

DQA staff also provided fourth quarter hospital federal and state citation data. Infection control continues to be a focus for the surveyors. DQA also asked that hospitals remember to verify any nurse aides in their facilities are on the Wisconsin nurse aide registry. The citation data and brief descriptions of the bases for the citations are available on the WHA Web site.

Finally, DQA provided copies of CMS memos to the State Survey Agency Directors, including a November 21, 2008 memo related to the CAH co-location and provider-based location requirements. Copies of the memos are available on the WHA Web site.

Recently, State Senator Glenn Grothman and State Representative Don Pridemore visited Aurora Medical Center in Washington County. Grothman and Pridemore both represent the hospital, and the time was an opportunity for them to meet with key hospital leaders and to learn about the hospital, its community benefits and more.

Sen. Grothman and Rep. Pridemore spent time with Lisa Just, vice president and chief administrative officer of the hospital, and Jennifer Tarantino, manager of Kettle Moraine community relations. Grothman and Pridemore were provided information on the various hospital services, partnerships and commitments to the Washington County community. Both legislators were especially interested in Aurora’s wellness efforts focused on the community and area businesses. They also received a tour of the hospital.

The Department of Health Services (DHS) told eHealth leaders on December 10 that advancing a comprehensive rewrite of Wisconsin’s general health care information statutes first developed by a WHA work group would be an eHealth policy priority for 2009. The announcement was made during a meeting of the Governor’s eHealth Care Quality and Patient Safety Board on December 10.

The proposed rewrite is substantially based on the work of a work group convened by WHA of 19 attorneys, privacy officers, and health information managers whose goal was to simplify Wisconsin’s general health care information statutes, Wis. Stats §§146.81-146.84. The WHA work group created draft statutory language that would make Wisconsin law more similar to the Federal HIPAA privacy laws but without making changes that would make Wisconsin’s existing privacy protections significantly less stringent.

DHS has been working with WHA to include the WHA work group’s draft language as part of a second round of eHealth legislation.

"These proposals build on the changes made in the 2008 eHealth Act that removed regulatory barriers to electronic medical records and information exchange," said WHA Associate Counsel Matthew Stanford. "They go far in removing administrative burden, cost and confusion caused by having similar but different state and federal medical records laws."

DHS also proposed developing additional regulatory and statutory changes relating to mental health records in 2009. These changes would be developed by yet-to-be-created DHS workgroups charged with reviewing and addressing security, oversight, and privacy issues related to electronic records and exchange. These work groups would report to the Governor’s eHealth Board.

For more information contact Matthew Stanford at mstanford@wha.org or 608-274-1820.

Heliport liability insurance has recently surfaced as a highly desired and necessary coverage. The most common exposure for health care facilities that do not own or operate a helicopter is helipad liability. Some facilities may believe their commercial general liability (CGL) policy covers this exposure but there may be an exclusion "in connection with aviation activities" within the CGL policy or umbrella policy that should be addressed.

Most CGL policies may treat a helipad as an extension of the hospital or as another location and coverage may include care and maintenance of the helipad. However, any type of "aviation-related activity" exclusion may create gaps in coverage.

In next month’s Solutions Spotlight, we will examine the exposures needed to be evaluated relative to your facility to consider the need for separate heliport liability coverage.

For additional information, contact Matt Wahoske, FinCor Solutions, at mwahoske@fincorsolutions.com or 608-469-8590.

Edgerton Hospital and Health Services (EHHS) and SSM Health Care of Wisconsin (SSMHC/WI) have signed a limited affiliation agreement. The agreement expands the current relationship and provides the legal framework to allow the two organizations to work together to enhance health care in south-central Wisconsin.

Edgerton Hospital and Health Services will remain under local control. Jim Pernau, CEO of Edgerton Hospital, will continue to report to a board composed of nine service-area members. "With SSMHC/WI’s management and planning expertise, our patients will benefit from having a relationship with one of the top health care systems in the country," said Pernau. SSMHC/WI will provide EHHS with access to group purchasing and other requested services.

"We feel fortunate to be working with the Edgerton team," says Mary Starmann-Harrison, Regional President/CEO of SSMHC/WI. "They share our commitment to building strong local health care services and offering excellence in patient care."

Five Wisconsin hospitals have made the list of the nation’s 100 top cardiovascular hospitals as measured by Thomson Reuters Healthcare® (formerly Solucient). The annual Thomson Reuters award for cardiovascular services objectively measures performance on key criteria at 1,000 of the nation’s top performing acute-care hospitals.

Thomson scored facilities in eight key performance areas: risk-adjusted medical mortality, risk-adjusted surgical mortality, risk-adjusted complications, core measures score, percentage of bypass patients with internal mammary artery use, procedure volume, severity-adjusted average length of stay, and wage- and severity-adjusted average cost.

All hospitals analyzed had to provide care for patients with heart failure and for those with acute myocardial function (AMI), and must offer both coronary angioplasty and coronary bypass surgery.

The benchmarks are based on publicly available data from 2006 and 2007. The key findings in this year’s benchmarks focus not just on quality patient care, but also on efficiency and cost of care. If all hospitals provided the same level of cardiovascular care as those on the list, more than 6,000 patients per year would survive.

To keep comparisons meaningful, hospitals are measured against their peer institutions. The hospitals that made the list are below.

Teaching Hospitals with Cardiovascular Residencies:

University of Wisconsin Hospitals and Clinics, Madison
Aurora St. Luke’s Medical Center, Milwaukee

Teaching Hospitals without Cardiovascular Residencies:

Aspirus Wausau Hospital, Wausau
Saint Joseph’s Hospital, Marshfield
Gundersen Lutheran Health System, La Crosse

Mother Nature has shown her power to many communities across Wisconsin this year. Flood waters have destroyed many personal belongings, businesses, homes, gardens, etc. Many people have been displaced from their homes. It is during this time that we turn to our neighbors.

St. Joseph’s Community Health Services reached out to our neighbors in Elroy, Wonewoc, Hillsboro, La Valle and La Farge by offering free tetanus vaccinations to volunteers whom were fighting Mother Nature and helping community members save their homes, businesses and with the clean-up process.

The community and volunteers of La Valle were very appreciative of St. Joseph’s offer and two nurses were sent to a local church to give the vaccinations. It is in this time of need that we share the benefit of being involved in a wonderful community where we all turn towards each other for support.

St. Joseph’s Community Health Services strives to offer our community many types of benefits and free tetanus vaccinations was one way this year that St. Joseph’s was able to reach out and put forth our mission statement – "neighbors caring for neighbors. . . body, mind, and spirit."

A new program providing physical and educational necessities for expectant teens will help the youthful mothers deliver healthy babies and earn their wings as parents.

Madison’s first Stork’s Nest, a nationwide initiative of Zeta Phi Beta Sorority and the March of Dimes, opened Nov. 17 in partnership with St. Mary’s Hospital. Dean Health System will act as the referral source. Stork’s Nest will be open the first and third Saturdays from 10 a.m. to noon.

"My entire career has been in human services. I’ve watched too many young women have babies with no knowledge of prenatal care, nutrition and general health for themselves and their babies," says Theola Carter, a member of Zeta Phi Beta who served 10 years as chapter president. "Bringing a Stork’s Nest to Madison has been one of my dreams."

Madison’s Stork’s Nest, housed in St. Mary’s EMS Training Center at 999 S. Park St., is a distribution site where expectant mothers age 25 or younger can get necessary items such as maternity clothes, layettes and furniture.

"By keeping prenatal clinic appointments, attending classes ranging from nutrition and alcohol to infant care and parenting, and practicing healthy behaviors, participants will earn Stork Dollars that have a cash equivalent to be used to purchase items at the Stork’s Nest," Carter explains. Participants are eligible for up to two months after their babies are born, and Stork’s Dollars may be earned for well-baby visits, immunizations, breastfeeding and enrollment in the Women, Infants, Children (WIC) program.

"A lot of the patients we’ll refer come from families without good role models, or who are not supportive," says Mary Kay Macke, prenatal care coordinator for Dean Health System. "This is a wonderful opportunity for these young women – who are still in development themselves – to learn skills, improve the health of their babies and gain confidence for themselves."

Zeta Phi Beta, a predominately African-American women’s service organization, has a mentoring component to the Stork’s Nest program, too, encouraging young mothers to attend college.

The outreach effort is expected to make a tangible difference in the community, according to St. Mary’s President Frank Byrne, MD. "We are striving to achieve good health and self-sufficiency for young families," he says. "Help now will reduce the likelihood that they will need help down the road."

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