The WHA Board approved a plan to promote community benefits reporting at their December 15 meeting in Madison. Community Benefits Task Force Chair Bob Fale asked the Board to approve the implementation of a community benefit survey and reporting process for 2006. Fale said the Task Force also recommended that hospitals develop a community benefit plan, with input from the community.

Key points included in the community benefits reporting plan are as follows:

• The hospital field should be proactive, rather than reactive, in its approach to community benefit reporting;
• Promote quality and compassion of care;
• Include all internal and external audiences; and,
• The key message is hospitals are providing meaningful community benefits, using hard data and real life stories to illustrate that point.

Fale said his own hospital board at Agnesian HealthCare just approved a new community benefit plan, which met with a lot of positive feedback, especially from the community board members. WHA Chair Ned Wolf echoed Fale’s experience, saying he included community benefit information at recent employee meetings. Fale emphasized that CEOs will play a pivotal role in the success of community benefit reporting because they formulate the messages that are then carried forward by all hospital employees as they interact in the community.

WHA Senior Vice President George Quinn provided a report on the most recent meeting of the Wisconsin Council on Medical Education and Workforce (see December 9 Valued Voice article for details). Ken Buser, chair of the Medicaid Task Force, reported that at the first Medicaid Task Force meeting on November 30, the group reviewed WHA’s current Medicaid priorities related to advancing the down payment agenda. Buser thanked Rep. Curt Gielow for speaking at the Task Force meeting, who set the tone by making three suggestions related to Medicaid:

1. Help increase the use of generic drugs among the Medicaid population, as only 62 percent of the prescriptions are now generic.
2. Increase the prior authorizations for brand name drugs.
3. Require the purchase of long term care insurance, as LTC now accounts for 60 percent of the cost in the Medicaid program.

Buser said there are many challenges ahead, but preliminary ideas from the Task Force are to incorporate system redesign into the scope of their work, look at both long and short term issues, and factor in political realities, including the fact that the legislature will grapple with a $65 million Medicaid shortfall in FY 2006-2007.

WHA Senior Vice President Eric Borgerding reported that Governor Doyle vetoed WHA-backed legislation reinstating a cap on non-economic damages in medical malpractice cases. WHA was very disappointed with the veto, but not entirely surprised. According to Borgerding, another bill will soon be drafted and he is optimistic that it will again make it to Governor Doyle’s desk. Borgerding said WHA will be working with Republicans and Democrats to craft sound cap legislation that will address specific objections raised by the Supreme Court. But before a bill can be considered by the Court, it must first get there, and that means the ultimate decision will again be in the hands of Governor Doyle. Borgerding said restoring a cap will be WHA’s top priority in 2006,which is also an important election year for the Governor and Legislature.

Borgerding said the Governor is expected to once again veto concealed carry; however, the Legislature appears set for an override. Knowing that, Borgerding said WHA’s Jodi Bloch worked tirelessly to gain an exemption for health care facilities in a bill that stands a very good chance of surviving a veto override. He commended Bloch for her efforts. Borgerding also called out for the Board the major progress made in grassroots activity in Wisconsin hospitals, thanks in large part to the efforts of Jenny Boese, WHA’s vice president, external relations and member advocacy. The number of legislative contacts hit 3,000, while hospitals are hosting legislative visits at a record pace. Almost any way it is measured, according to Borgerding, it was a record-shattering year for WHA’s grassroots program, known as the Hospital Education Advocacy Team (HEAT). Borgerding said in 2006, the emphasis would be on getting more CEOs involved in grassroots advocacy.

WHA Advocacy Committee Chair Chuck Shabino reported that WHA members set new records in both the amount they gave and the number of hospitals that participated in the Wisconsin Hospitals Political Action Committee and Conduit. Next year’s goal will be $180,000. Shabino noted that WHA staff contributed $20,000 to the PAC in 2005.

In other action, the Board approved:

• The WHA Information Center and WHA Financial Solution’s budgets.
• The rosters of the WHA councils and committees.
• The budget and fund raising goals set for the WHA Foundation.

WHA President Steve Brenton acknowledged the service of WHA Chair Ned Wolf, who in turn thanked Brenton, the Board and WHA staff for their assistance over the past year. Brenton also recognized the following members of the board whose terms were ending: Jean Needham, president, Holy Family Hospital, New Richmond; Nick Desien president/CEO, Ministry Health Care, Milwaukee; Bobbe Teigen, Administrator, Aurora Medical Center of Manitowoc County, Two Rivers; Chuck Shabino, MD, Chief Medical Officer, Aspirus Wausau Hospital; Dave Fish, executive vice president, St. Joseph’s Hospital, Chippewa Falls; and George Johnson, president, Reedsburg Area Medical Center.

The following news release was issued to the statewide press on December 16.

MADISON (December 16, 2005) — After several years of watching their health care delivery system erode, Texas voters approved a cap on excessive pain and suffering awards associated with medical liability. Now, two years after the limit was approved, patients in Texas are seeing improved access to health care as physicians return to that state and to a much less hostile legal environment.

As is true in Texas, Wisconsin patients have unlimited recovery of damages associated with lost wages, medical care and other out-of-pocket expenses associated with their care following a successful medical malpractice suit ("economic damages"). The cap only applies to non-economic damages, most commonly awarded for pain and suffering or other intangible losses.

During the late 1990s and early 2000s, Texas endured a medical access crisis fueled by unpredictable and excessive pain and suffering awards. In response to the growing crisis, Texas voters approved Proposition 12, a constitutional amendment in 2003 that limited awards of pain and suffering and other non-economic damages to $250,000 against physicians and health care providers.

The stories of improved access in Texas are numerous.

The Texas Medical Association reported that one year after a cap on excessive pain and suffering awards was passed, Corpus Christi added 47 new physicians. This is in contrast to the 40 physicians that left Corpus Christi in the five years prior to the passage of medical liability reforms. One of those 47 new physicians included Mathew Alexander, MD, who was recruited from a Wisconsin residency program. As reported in the Corpus Christi Caller-Times, Alexander said if the reforms hadn’t passed he would not have gone to Texas. "I’m here to take care of patients, not worry about the legal ramifications of my practice," said Alexander. "Practicing defensive medicine is expensive and doesn’t provide good care."

The historically underserved Rio Grande Valley has added 128 physicians since the enactment of a cap two years ago. This includes 11 pediatricians, 10 family physicians, eight gastroenterologists and seven internists in Hidalgo County alone.

In the 18 months prior to the passage of lawsuit reform, the Beaumont medical community saw a net loss of 12 doctors. Since the passage of a cap on excessive pain and suffering awards, the community has gained 26 physicians including seven anesthesiologists and 18 emergency medicine physicians.

Statewide, physicians say fewer among them are avoiding high-risk patients following the passage of the cap.

A 2003 survey by the Texas Medical Association conducted before the passage of a cap found that more than half the surveyed doctors had stopped providing certain services to patients. However, a 2004 study found that since the enactment of a cap on excessive pain and suffering awards, only 13 percent of Texas physicians had stopped providing certain services.

"For patients in Texas who had been suffering through a medical access crisis induced by mega-awards for pain and suffering, Texas’ cap has clearly been effective medicine," said Wisconsin Hospital Association Senior Vice President Eric Borgerding.

In July, the Wisconsin Supreme Court struck down the cap on non-economic damages. Since then, hospitals have reported that it is more difficult to recruit physicians to the state. This, Borgerding said, is the first sign of a medical access crisis brewing in Wisconsin.

"We should be learning from states like Texas, before things get out of control," said Borgerding. "The bottom line is that we must restore a cap in Wisconsin this legislative session, and we are calling on the Legislature and Governor to do just that."

WHA, through the recommendation of the Council on Finance and Payment, has formed a subcommittee, called GAIN (Group Appeals and Initiatives), which will work with the law offices of Hall Render to undertake Medicare group appeals and other payment initiatives from a collective standpoint.

Joining forces to pursue Medicare and Medicaid initiatives and appeals can yield positive results for hospitals. Not only does a group effort increase the likelihood of success on the issues themselves, the efficiencies and cost-savings that result from the collective pursuit of common issues cannot be understated. Instead of a number of hospitals each hiring attorneys and/or consultants to present virtually identical arguments to regulators in separate documents, the argument is developed and presented on behalf of all interested hospitals with a stake in the issue. That’s the rationale behind GAIN, and why the Council on Finance and Payment formed the subcommittee.

The process begins by informing hospitals of the potential for pursuit of group initiatives and appeals. Potential issues are then identified and submitted to the WHA group appeals subcommittee. GAIN is comprised of eight members (CFOs and reimbursement directors) representing a cross-section of hospitals, balanced in size and geography. WHA and Hall Render attorneys serve as staff to the subcommittee. The subcommittee will meet quarterly to discuss potential appeals, discuss new issues, and hear the status of pending appeals.

As GAIN identifies issues, the membership will be informed about group appeal possibilities. Members of GAIN include:

Randy Hillman – All Saints Healthcare & Covenant Healthcare System
Mike Everson – Froedtert and Community Health
Scott Abrams – Beaver Dam Community Hospital
Paul Bammel – Luther Midelfort Mayo
Rich Donkle – Rural Wisconsin Health Cooperative
Steve Kowske – Aurora Health Care
Kris Smith – Affinity Health System
Neil Kadlec – Ministry Health Care

WHA General Counsel Laura Leitch has joined the law firm of Hall, Render, Killian, Heath & Lyman, which will be providing general counsel services to WHA and its affiliated organizations. Leitch’s office remains at WHA’s headquarters and members should continue to call her with questions.

"I’m pleased to be associated with the Hall Render attorneys and will rely on their expertise to provide the best information possible to our members," said Leitch.

"We have a great team at WHA, and I’m pleased that it will not only remain intact, but we’ll be adding depth to our already strong bench," observed Eric Borgerding, WHA senior vice president.

As in the past, WHA will continue to partner with other law firms for special projects and expertise.

"Wisconsin is fortunate to have a number of law firms with strong health law practices. They are an increasingly important part of WHA, and we appreciate their support. We will continue to work to strengthen the relationship between the firms and WHA members," added WHA President Steve Brenton.

This week in the Capitol, a hearing was held to receive comments on a set of proposed new regulations (INS 9) for preferred provider plans (PPPs). According to the Office of the Commissioner of Insurance (OCI), the state agency responsible for policing insurance companies, the rule was developed by OCI and "Wisconsin’s major insurers." One provision in the rule makes that perfectly clear:

(PPPs must) include in all contracts with participating providers … a provision requiring the participating provider that schedules an elective procedure or other scheduled non-emergency care to fully disclose to the enrollee at the time of scheduling the name of each provider that will or may participate in the delivery of the care and whether each provider is a participating or nonparticipating provider.

In testimony before a heated session of the Joint Committee for Review of Administrative Rules (JCRAR), WHA opposed this regulatory tongue-twister for several reasons, but primarily due to the fact that …. HOSPITALS ARE NOT INSURANCE COMPANIES!

On the surface, some find this mandate on providers to be quite reasonable. Of course patients should have as much information as possible about the health care providers delivering their care.

In the real world, this provision demonstrates a severe misunderstanding of the realities in which 24/7/365 accessible hospitals operate.

Hospitals cannot always know all of the providers who may participate in the delivery of care to a particular patient. Surgical patients, for example, might require different procedures and providers depending on the course of the surgery.

Ministry Health Care echoed this concern in written comments submitted to JCRAR:

The rule as proposed would force our health care providers to make assumptions that frequently may not be correct and/or subject to change. Changes may occur as the course of treatment is determined based on lab tests or other diagnostic results or if complications arise. The need for immediate specialty consults such as cardiology, neurology, psychology etc. also arise unexpectedly and other medical incidents occur. Any of these events may result in the involvement of additional or different providers beyond those originally identified.

But more troubling is the notion that providers are in a better position than insurers to advise their members of the details of their insurance policy. Isn’t that what we pay insurance companies to do? Hospitals cannot possibly know all of the contracts entered into between insurers and physicians, or the numerous other health care providers covered by INS 9.

And it is flat out ridiculous to expect hospital staff, including busy nurses scheduling surgeries, to know all of the contracts a patient’s insurer might have with various providers.

The bottom line is this: preferred provider plans and all other health insurers must be accountable to their enrollees – that’s why we pay insurance premiums. It is incumbent upon insurers/PPPs to make sure they have the providers in their networks to deliver the level of coverage they promise. And if an insurance company can’t tell you which health care providers are in their network, how in the heck is a hospital supposed to do it?

The primary role of a hospital, and the health care professionals who perform within its walls, is to provide care and comfort to patients, not sort through the myriad or insurance rules and regulations, decipher between health maintenance organizations, defined network plans or preferred provider plans, and certainly not to assume the role of insurance plan administrator.

Having said that, we know there is an ongoing need to improve the information available to consumers. Wisconsin’s health care delivery and financing systems are in transition, becoming more consumer-driven, with individuals being asked to take on more responsibility for if, when and how they access the system. The goal is, of course, to incentivize more prudent use of health care, and ultimately more cost-efficient and more effective/higher quality health care.

For this approach to work, individual consumers must have information. Reliable data about price and quality that when considered together, will aid employers and consumers in choosing not only the lowest cost/highest quality health care providers, but also which insurance companies can best facilitate access to that care.

For our part, Wisconsin hospitals are at the forefront of this effort, emerging as the recognized national leaders developing consumer-friendly information about price and quality of hospital care. Indeed, WHA’s PricePoint and CheckPoint programs have gained national attention.

A recent article in Hospital and Health Networks Magazine, titled "WISCONSIN Ahead of the Pack," proclaimed: "Wisconsin is emerging as a national model for private-sector initiatives to meet demands for information on health care costs and quality." The full article is available at:   www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/PubsNewsArticle/data/0511HHN_FEA_Quality_WISC&domain=HHNMAG

In this same article, Paul Ginsberg, president of the Center for Studying Health System Change in Washington, D.C., stated that Wisconsin’s health care leaders are out in front on quality and transparency issues. According to Ginsberg, we aren’t "bucking the trends, (Wisconsin is) running with the trends."

These nationally recognized, proactive efforts are the product of thoughtful deliberation and, most importantly, intense collaboration among health care providers and purchasers. That’s how WHA does things.

To be sure, there is a need to continuously improve and expand the information that flows between insurers and their enrollees — insurers and our patients — and WHA is in the process of engaging in a collaborative effort to look at realistic ways of doing just that. In fact, this week we will convene a member work group charged with examining a host of emerging "contractual issues" ranging from INS 9, to "assignment of benefits" and "silent PPPs." The group will include insurer representatives as warranted by each issue.

Wisconsin hospitals seek out opportunities for greater accountability, we don’t look for ways to dodge or point the finger elsewhere.

The WHA Foundation has raised more than $45,000 to date toward its goal of raising $500,000 by the end of 2008. The Foundation Board extends its appreciation to each organization and individual who has made a contribution to this effort.

"The WHA Foundation Board is very excited about the opportunity to increase the base of support for the wonderful programs that we fund. The gifts we receive will make a difference and improve health care in our state," said John Marnell, 2005 WHA Foundation Chair.

The funds raised through the Foundation’s annual fundraising campaign, its first fundraising effort since 2001, will be used to fund the WHA Foundation Scholarship Program at the state’s 16 technical colleges, the Nurse Leadership Succession Project, the Global Vision Community Partnership Award, and other statewide initiatives that support hospitals throughout Wisconsin.

All Saints Healthcare System, Racine
Aspirus – Wausau Hospital, Wausau
UW Hospital & Clinics, Madison
WHA Financial Solutions, Inc., Madison

Contributions from Organizations

Amery Regional Medical Center, Amery
Bay Area Medical Center, Marinette
Bellin Health, Green Bay
Black River Hospital, Black River Falls
Flambeau Hospital, Park Falls
Holy Family Hospital, New Richmond
Lakeview Medical Center, Rice Lake
Memorial Health Center, Medford
Memorial Medical Center, Ashland
Mercy Health System, Janesville
Sacred Heart-Saint Mary’s Hospitals, Rhinelander/Tomahawk
Saint Joseph’s Hospital, Marshfield
SSM Health Care of Wisconsin, Madison
St. Vincent Hospital, Green Bay

Contributions from Individuals

Steve Brenton, Wisconsin Hospital Association
Daniel Fischer, in honor of Mrs. Lillian Fischer’s 85^th Birthday
Jennifer Frank, Wisconsin Hospital Association
Dan Hymans, Memorial Medical Center
Mike Karuschak, Amery Regional Medical Center
John Landdeck, Beaver Dam Community Hospital
John Marnell, Hudson Hospital
Tom Plantenberg, Friends of Froedtert

The Office of the Inspector General (OIG) has released its Work Plan for Fiscal Year 2006. The Plan identifies perceived vulnerabilities of the U.S. Department of Health and Human Services’ programs and promotes program improvement, efficiency, and effectiveness. The Plan impacts Medicare hospitals, nursing homes, physicians, and other health care providers, outlining work to be performed by the OIG’s offices of Audit Services, Evaluations and Inspections, Investigations, and Counsel to the Inspector General.

This week’s Packet includes a General Memo that provides a comprehensive summary of the Work Plan, a copy of which is available on the WHA Web site.

A patient nearly died recently in a Pennsylvania hospital due to confusion caused by color-coded wristbands, prompting the Patient Safety Authority to issue a Supplementary Advisory on the risks associated with using a specific color to convey clinical information.

A recent "near-miss" report submitted to the Authority through the Pennsylvania Patient Safety Reporting System (PA-PSRS) describes an event in which clinicians nearly failed to rescue a patient having a cardiac arrest because health care workers mistakenly believed the patient’s wristband color meant "Do Not Resuscitate," when it was actually meant to convey a different message.

"The problem was caused partly by a health care provider’s confusion about the meaning of a yellow wristband," said Alan B.K. Rabinowitz, Authority administrator. "In this particular facility, a yellow wristband means ‘Do Not Resuscitate,’ but in a nearby facility a yellow wristband is used to mean that a patient should not have blood work or an IV placed in that particular arm."

Because the provider worked in both facilities, she inadvertently used the yellow wristband in the wrong facility. When other health care workers later saw the yellow wristband, they incorrectly thought the patient was designated as "Do Not Resuscitate."

According to Dr. John Clarke, PA-PSRS clinical director, there are a number of steps facilities can take to make the use of color-coded patient wristbands safer. "Although standardizing the meaning of different colors can only be done by coordination among health care facilities," Clarke noted, "individual facilities can limit the number and colors of patient wristbands and use printed text to reinforce the meaning of specific colors. They can also reconfirm clinical instructions with both patients and hospital staff."

To assess the potential scope of the problem, the Patient Safety Authority surveyed patient safety officers in all Pennsylvania hospitals and ambulatory surgical facilities (ASFs). The 139 survey respondents represented one-third of these health care facilities. The results of the survey and improvements that can be made to minimize patient risk when using color-coded armbands are included in a Supplementary Advisory published this week by the PA-PSRS program.

Highlights of the Supplementary Advisory include:

• In a recent survey, about four out of five Pennsylvania facilities responding use color-coded patient wristbands to communicate important medical information.
• There are no standard meanings among health care facilities for different colors.
• Limiting the number of wristbands and the colors used may help to avoid confusion for health care providers working in multiple facilities.
• Printed instructions on wristbands can help to reinforce the message conveyed by a particular color.

Rabinowitz cites the usefulness of gathering reports in "real time" through the PA-PSRS system as a major contributor in helping improve patient safety by disseminating information about potential risks to facilities throughout the state.

"The wristband issue is not one that will be resolved overnight," Rabinowitz said. "However, by sending out an advisory to all health care facilities making them aware of the potential problem associated with color-coded wristbands in one hospital, we are giving all health care facilities the opportunity to implement steps to prevent a similar event from happening in their own facility."