This week WHA released the results of a member economic impact survey that indicated hospitals are feeling the strain of the nation’s weak economy. Often misperceived as "recession proof," hospitals report that they are being hit hard by a nasty one-two punch brought on by the rapid recession. Falling revenues, precipitated by increasing amounts of charity care and abysmal reimbursement from government programs are resulting in an unprecedented strain on hospitals.

A survey of the state’s non-profit hospitals recently conducted by the Wisconsin Hospital Association (WHA) illustrates the deteriorating financial picture for the first three quarters of 2008.

Compared to the same time period in 2007:

• Total margins declined 73.5 percent
• Charity care increased 19.1 percent
• Bad debt increased 19.6 percent
• Days cash on hand declined in 80 percent of hospitals
• Nearly one-third of hospitals had trouble accessing capital in 2008

To cope with the current economic situation:

• Nearly two-thirds of hospitals say they are planning to cancel, delay or scale back capital projects
• Nearly one in six are planning to cut existing programs or services
• One-third are considering reducing or freezing staffing levels

Brian Potter, WHA vice president, finance, and the WHA Council on Finance, developed the survey.

"The survey covered the time period of January 1 – September 30, and the results show that hospitals are seeing significant increases in charity care and bad debt and a large decrease in their total margin," according to Potter. "It is important to note that this survey does not include October and November results that we know were even worse for the economy as a whole and undoubtedly for hospitals as well."

WHA President Steve Brenton said, "We are very concerned with the survey results because healthy hospitals are essential to maintaining healthy communities in so many ways. Wisconsin’s non-profit hospitals are the front-lines of the health care safety net, often the only place people can turn when they have lost their health insurance or simply can’t find access to basic care."

In 2007, nearly 700 patients per day received their hospital care free of charge. In 2008, that number is likely to increase. Also in 2007, Wisconsin non-profit hospitals donated or spent hundreds of millions on community health projects, clinics, medical professional education, research, and numerous other community health needs unaddressed by federal, state and local government.

Wisconsin hospitals are also critical to local economies. Hospitals directly employ more than 113,000 people (second only to local schools) and pay over $4.5 billion in wages that generate hundreds of millions of dollars in state tax revenue. Hospitals provide family sustaining jobs for a wide range of skill levels with many opportunities for advancement and growth. Hospitals invest millions in workforce development that helps create new jobs – exactly what is needed in difficult economic times.

"Despite these tough times, hospitals will stay committed to their communities and their missions, but to do so they must also remain strong and viable," Brenton said.

Compounding the situation are the falling payments hospitals receive from the Wisconsin Medicaid program. Hospitals are currently paid less than 50 cents for every dollar they spend treating Medicaid patients. The resulting $635 million shortfall must be shifted to other patients, meaning higher health insurance costs for businesses and families – exactly what is not needed in tough economic times.

Medicaid is funded by both the State of Wisconsin and the federal government. For every dollar the state spends on Medicaid, it receives a match of $1.50 from Washington. Despite this beneficial partnership, Wisconsin ranks near the bottom nationally in capturing federal revenues for health care and leaves hundreds of millions of its own federal tax dollars on the table for other states to claim.

"If we accomplish only one thing to help address health care costs during these challenging times, it has to be aggressively going after our fair share of health care dollars from Washington," Brenton said. "We have to start making a substantial effort to reduce Medicaid cost shifting and the inflationary effect it has on the price of health insurance."

The 2009 annual "Physician Leadership Development Conference," for new, potential and seasoned physician leaders, will be offered by WHA on Friday, March 13 and Saturday, March 14. This year’s conference will be held at the Midwest’s only AAA Five Diamond Resort Hotel, The American Club in Kohler, Wisconsin. The full conference brochure, with agenda, registration and resort information is included in this week’s packet.

This popular conference offers nationally-recognized, CME-qualifying education necessary to develop physicians’ leadership skills and make the transition from clinician to physician leader at both a reasonable price and with more limited travel time and expense than the national conferences.

Each year, the conference agenda is based on feedback from past attendees, as well as from chief medical officers, medical directors and CEOs from around the state. The 2009 conference agenda will focus on the topics of strategic planning/marketing and peer review/dealing with disruptive physician behavior, presented by faculty from the American College of Physician Executives (ACPE). These are new and different topics than at past events, but were chosen based on member and attendee feedback. Those who attended in the past are encouraged to continue their education as a physician leader, and those who may be attending for the first time will find it invaluable as well.

Any physicians new to their leadership roles or who have leadership/management interest or potential should plan to attend this conference. Also, chiefs of staff, medical directors, chief medical officers, new medical presidents, new clinical department chairs, and new committee chairs are encouraged to attend or designate a physician with leadership potential to attend, as part of your organization’s succession planning. Finally, seasoned physician leaders who are looking for new ideas or perspectives are also encouraged to attend.

One of the most interesting observations from past conferences, both formally via the attendee evaluations and anecdotes from those in attendance, was the value of attending the conference as a team—physician leader and management leader—allowing for invaluable informal, one-on-one conversation and team building during the event. This opportunity will once again be available at the 2009 conference.

A discounted "early bird" registration fee is available to those registering by January 23, as well as a group discount to those registering early. Additionally, a "host" registration option, which includes all meals, is available to those hospital representatives/management leaders who would like to accompany their attending physicians to the conference but do not need the CME credit.

ACPE is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. ACPE designates this educational activity for a maximum of 12 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. Additionally, these programs are part of the ACPE and CCMM requirements toward a graduate degree or certification in medical management.

Just one month ago, this space featured a column that asked the above question. Based on hospital survey results described elsewhere in this week’s Valued Voice, the answer is a resounding YES!! And that’s not good news for our most vulnerable patients who rely on community hospitals as their primary care safety net.

The fact that statewide hospital charity care and bad debt increased 20 percent in just one year (9-07 to 9-08) is a startling and disturbing number and a likely harbinger for 2009 and beyond. Here’s a short list of must dos for the new Wisconsin Legislature:

• Pass the hospital assessment bill as free-standing legislation in early 2009. The legislation, of course, must remain true to the principles established by the WHA Board one year ago.
• Find funding to implement the new Medicaid Childless Adults initiative in the next biennial budget cycle in order that tens of thousands of our most chronically uninsured can find meaningful coverage and hopefully more appropriate access than the hospital EDs many currently use.

The 2009-10 Wisconsin budget will be a difficult one for lawmakers, taxpayers and affected stakeholders—that’s just about all of us. But the above "to do" list is modest, necessary and actionable.

Steve Brenton
President

The WHA Information Center Board of Directors held its annual meeting on December 11 in Madison. WHAIC Board Chair Ford Titus, president/CEO, ProHealth, presented the WHAIC Annual Report to the WHA Board and described 2008 as a "very good year" for the Information Center.

"The Information Center is a real success story. In five short years, it has developed a well-deserved reputation around the country for innovation and service while saving Wisconsin hospitals millions of dollars as a result of privatization," Titus reported. He called attention to the continued revenue growth for WHAIC’s hospital pricing Web site, PricePoint, and WHAIC’s new agreement with Nevada Hospital Association (NHA) to collect hospital outpatient data.

In 2008, the WHA Information Center reported:

• Revenues exceeded budgeted amounts by about five percent. This increase is due to larger sales volumes, because data fees were not increased this year.
• Expenses will come in slightly under budget.

In 2009, revenue from PricePoint is expected to increase substantially as new clients that came on board during 2008 contribute a full year of hosting fees. Standard data fees will increase approximately 3.5 percent next year. Other major expense items include new hardware and software to implement the NHA data collection, and an APC grouper to allow WHA to model Medicaid data in the way that the state intends to reimburse outpatient services beginning in July 2010.

WHAIC Vice President Joe Kachelski commended the Information Center staff…."We had an outstanding year because we have an outstanding staff. We have come a long way in our five years, and we look forward to even better performance in the future."

Newly-elected Assembly Representative Mark Radcliffe (D-Assembly District 92) met with Tomah area health care representatives, including Tomah Memorial Hospital Chief Financial Officer Joe Zeps and Marketing/PR Coordinator Eric Prise during a panel discussion hosted by the Tomah Chamber of Commerce.

During the discussion, Rep.-Elect Radcliffe heard input on a number of health care issues, including the shortfalls in Medicaid reimbursements and nursing workforce issues like potential legislation to ban the use of mandatory nurse overtime.

Zeps said the event was an excellent opportunity to meet our new representative and have a productive discussion regarding many of the challenges facing rural health care in Wisconsin. "Hopefully our input into some of these issues will accompany Representative Radcliffe to Madison and eventually effect some positive changes in our state," Zeps said.

Radcliffe said he was looking to area health care representatives to come up with solutions to solve a number of health care issues affecting residents of the 92nd district. He predicted small steps will be necessary to resolve the problems. Health care providers and representatives from the Tomah Veterans Affairs Medical Center, Gundersen Lutheran and Franciscan Skemp also attended the approximately 90-minute session.

Radcliffe, a Black River Falls attorney, replaces Terry Musser, a Republican who didn’t seek re-election after 11 terms, and will head to Madison next month as a member of the Democratic Assembly majority.

Edgerton Hospital & Health Services Hosts Rep. Kim Hixson

Rep. Kim Hixson (D-Whitewater) visited with Edgerton Hospital CEO Jim Pernau, members of the hospital’s senior leadership team and Hospital Board Member Jim Schultz this week.

The visit allowed Rep. Hixson to learn more about the hospital and its commitment to the community. Attendees were able to inform Rep. Hixson about their efforts at improving community members’ overall health and wellness and various strategies for implementing green and sustainable community development. Also discussed were various legislative issues of importance to hospitals.

University of Wisconsin and state health officials announced this week that a record-breaking 39,000 calls were made to the state’s Tobacco Quit Line in 2008 and celebrated the Quit Line fielding 122,000 calls in its seven-year history.

Wisconsin Department of Health Services Secretary Karen Timberlake said for the first time in Wisconsin history, the adult smoking rate is below 20 percent. The annual cost in Wisconsin to treat smoking-related illnesses is $2.2 billion, and lost productivity accounts for another $1.6 billion each year.

WHA’s Dana Richardson, who spearheaded the Association’s effort that saw 100 percent of Wisconsin hospitals become tobacco-free campus-wide, applauded the work of the UW Center for Tobacco Research and Intervention (UW-CTRI).

"The staff at UW-CTRI assisted Wisconsin hospitals with resources and tools that enabled them to become models in their communities by making their entire campus tobacco-free," according to Richardson. "In many communities, hospitals have led the effort to reduce tobacco use by helping their employees, patients and in fact, the entire community by offering tobacco cessation classes and other resources to smokers. These efforts continue to be valuable resources to those attempting to give up tobacco use."

The interest in 2008’s Quit Line was attributed to a number of factors: an increase in the cigarette tax, heightened interest in smoke-free places, and expanded Quit Line services including stop-smoking medications. In addition to the coaching that callers typically receive, residents who called the Quit Line after January 1, 2008, were able to obtain a free two-week starter kit of quit-smoking medications—nicotine patches, gum or lozenges—that were mailed directly to their homes to complement the coaching.

UW-CTRI administers the Quit Line on behalf of DHS. Dr. Mike Fiore, UW-CTRI director said, "There is nothing better a smoker can do for his or her health than to quit. It requires hard work, but smokers across Wisconsin are succeeding. In fact, for the first time ever, the Centers for Disease Control reported that Wisconsin’s smoking rate has dropped below 20 percent this year. The Quit Line’s 122,000 callers contributed to that positive development. I hope many more smokers will call in 2009 to take advantage of this free treatment."

In the spirit of the upcoming holidays, the WHA Foundation would like to thank those organizations and individuals who have already contributed more than $10,000 to this year’s fundraising campaign. Those supporters are listed below.

The new year will bring another round of workshops for staff nurses to explore their leadership potential, the 2009 Health Literacy Summit, and more than 30 scholarships for technical college students pursuing health careers, all supported by funding from the WHA Foundation. As we continue on through the season of giving, if you have not yet contributed, please consider making a contribution to the WHA Foundation’s annual fundraising campaign, and help move these and other worthy programs forward in 2009.

Agnesian HealthCare, Fond du Lac
Flambeau Hospital, Park Falls
Memorial Medical Center, Ashland
Partners of WHA, Inc., Madison
SSM Health Care of Wisconsin, Madison

Contributions from Individuals:

Bill Bestor, Community Memorial Hospital, Menomonee Falls
Jenny Boese, Wisconsin Hospital Association
Steve Brenton, Wisconsin Hospital Association
Leo Brideau, Columbia St. Mary’s, Inc., Milwaukee
Ken Buser, Wheaton Franciscan Healthcare – All Saints
James Casanova, MD
Bob Fale, Agnesian HealthCare, Fond du Lac
Jennifer Frank, Wisconsin Hospital Association
Dan Hymans, Memorial Medical Center, Ashland
Mike Karuschak, Amery Regional Medical Center, Amery
John Kosanovich, UW Health Partners Watertown Regional Medical Center
Roger Lucas, Aspirus, Wausau
Dan Neufelder, Affinity Health Care, Appleton
Ronald Packzkowski, Franciscan Skemp, La Crosse
Doug Peterson, Chippewa Valley Hospital, Durand
Sharyn Richardson, St. Joseph’s Community Health Services, Hillsboro
Janet Rubenzer-Pike, St. Joseph’s Hospital, Chippewa Falls
Mike Schafer, Spooner Health System, Spooner
Tim Size, Rural Wisconsin Health Cooperative
DeAnn Thurmer, Waupun Memorial Hospital, Waupun

Ingrid Olson, a registered nurse with Southwest Health Center’s Hospice Program, recently gave a presentation at First Congregational United Church of Christ. That presentation inspired Platteville resident Joyce Miller to begin work on another special project – to create a passage quilt for the hospital’s newly introduced Hospice program.

Kathryn Carlson, First Congregational’s pastor, has been a partner in Joyce’s mission of creating special quilts to mark meaningful passages in people’s lives. The passage quilt that was created for the Hospice program is an extension of that as it will be used to cover the deceased person’s body as he/she is transported to the funeral home. According to Kathryn, Joyce has made quilts for many of their community members who have celebrated transitions in their lives. From new babies to newlyweds to newly-retired, parishioners have been touched by the heartfelt and personal expression of warmth and love. Kathryn blesses each and every quilt before it is presented.

"I was touched by this generous gesture from Joyce. The passage quilt is just beautiful. It will help us to make a more meaningful and dignified transition as the loved one is escorted from their home following his or her death," according to Ingrid. "Use of the quilt helps allow a time and presence of a more at-home atmosphere for the family and loved ones to reflect on the person’s life and death."

The Community Healthcare Foundation of Community Memorial Hospital (CMH), located in Oconto Falls, hosted the 16th Annual Love Lights Tree Lighting Ceremony.

For the past 16 years, the Community Healthcare Foundation has been proud to start the holiday season with this very special and touching event in which community members are invited to remember and honor loved ones through the purchase of commemorative red and green lights that will adorn Christmas trees on display outside of the CMH Oconto Falls Primary Care Clinic through the holiday season. In addition, the names of honored loved ones are printed in a commemorative program pamphlet that is distributed to all event participants.

The Christmas trees were lit following a welcome address by CMH Administrator Jim Van Dornick and a dedication ceremony led by a member of the Oconto Falls area clergy. Event attendees also enjoyed joyous holiday music provided by the Oconto Falls High School choirs. The rising nationwide demand for food pantry supplies and resulting pressure on local pantries to meet this need has also impacted food pantries located throughout Oconto County. Therefore, for the past two years, the Community Healthcare Foundation Board of Directors has honored the true spirit of the holiday season by donating all Love Lights proceeds to various area food pantries.

Kingdom Come, NEWCAP Services, Feed My Sheep, and New Beginnings food pantries of Oconto County were selected by the Foundation board to divide event proceeds. Generous Love Lights donors, the Community Healthcare Foundation, and Community Memorial Hospital in Oconto Falls recognized the recipients of this year’s event proceeds during the tree lighting ceremony. Bill Kamke, Foundation Board President, presented a representative from each food pantry with a check for $600 to assist with the delivery of services benefiting needy community members throughout the Oconto County area. In addition, to the donations that were received from the community, the hospital augmented the donations in order to make the contribution more significant to each charity.

Following the tree lighting, participants were invited to the hospital’s Community Room for fellowship and refreshments to end this special and meaningful evening. Once again, this was a wonderful event for all who took time out of their busy holiday schedules to remember and honor loved ones and to assist their neighbors in need through their generosity.

For the fifth year, Luther Midelfort employees have worked together to make the holidays brighter for families and groups in the area.

Departments at Luther Midelfort have purchased gifts and other items for about 50 families. The gifts corresponded with wish lists for children and adults who will receive everything from clothes and toys to household items and food.

Mitten trees were placed at each clinic site to collect hats, mittens and scarves for people of all ages. Items were collected in Eau Claire, Barron, Bloomer, Cameron, Chetek, Chippewa Falls, Colfax, Mondovi, Osseo, Prairie Farm and Rice Lake. Last year, more than 1,000 items were collected. The winter gear is distributed to groups and schools throughout the area.

Ornament trees also were placed at Eau Claire’s two clinic sites. Employees purchased gifts for four families and four nonprofit organizations based on wish lists written on the paper ornaments.

The employee response has been overwhelming. "We are thrilled to get this opportunity to help people in our communities," said Lynn Salter, chairperson of Luther Midelfort’s Employee Volunteer Committee. "By working together, we reach even more people in need."

When the 332D National Guard Unit of Berlin was called to active duty in June of 2007, thoughts focused on the soldiers and their dedication to their calling overseas to Iraq.

Throughout the 11-month timeframe of the 332D Unit being in Iraq, Community Health Network (CHN) offered support in many different ways. CHN received The Patriotic Employer Award for "showing great support to the Guard and their families by being very flexible with work schedules. They allowed family members to alter schedules to accommodate meetings and other needs of the family."

A second award, The Freedom Salute Campaign, designed to publicly acknowledge Soldiers and those who supported them during the Presidents call to duty for Operations Noble Eagle, Enduring Freedom and Iraqi Freedom. This award was presented to Meg Roggow and Pat Rodensal from CHN Juliette Manor activities department.

They spearheaded making Christmas cards with the residents to be sent to the 332D soldiers. When employees of CHN heard of the Christmas cards, they took it upon themselves to do a drive for non-perishable items, which resulted in nearly 600 pounds of items to be included with the handcrafted cards.

When members of the community heard about the efforts of CHN personnel, they joined up with cash donations and additional items, and what started out as a small idea had now snowballed into a huge operation. Everything was packed and sent and arrived for a Christmas Party in Iraq. It was declared by Commander Lt. Col. Julie Gerety, "Soldiers were able to go shopping through the packages for everything they needed, it was great. It was truly amazing how much we received from CHN and how the efforts of two resulted in a great holiday celebration for many."

The entire project grew beyond what either Meg or Pat anticipated, but the overwhelming spontaneous support from fellow associates and community members truly made for a glorious holiday celebration for the members of National Guard Unit 332D, and also for those who played a part.

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