The year is almost over, and by all accounts, 2007 was a major success for the Wisconsin Hospital Association. Perhaps the biggest news of 2007 was the Agency for Healthcare Research and Quality’s announcement that the quality of health care in Wisconsin is the best in the nation. That achievement confirms that Wisconsin hospitals are committed statewide to providing the highest quality, safest care in the country. From the first day that CheckPoint was launched, hospitals devoted much time and effort to not only improving the quality of care in their own communities, but also to the idea of "raising all boats" across the state.

The revised WHA Billing and Collection Guidelines caught the attention of Attorney General J.B. Van Hollen. At the 2007 Advocacy Day, he applauded the efforts as providing "a thoughtful approach to bill and to collect payments from those that are uninsured." Nearly every Wisconsin hospital returned a "Confirmation of Commitment" confirming that their billing and collection policies met or exceeded those in the WHA guidelines.

The Association pursued Medicaid payment improvements in what became a challenging, and very long, state budget process. WHA worked tirelessly to obtain long overdue increases in Medicaid reimbursement, only to see hope fade by fall due to an impossibly difficult climate in the state Legislature. Medicaid reimbursement improvements will continue to be the top issue in 2008 and beyond.

Cuts in worker’s compensation reimbursement to hospitals were narrowly avoided in 2007. The Workers Compensation Advisory Council proposed a fee schedule in June that contained huge cuts in hospital and physician payments related to worker’s compensation cases. Several months and a lot of meetings later, WHA staff, with the help of several partners, emerged from the process with no cuts to provider reimbursement.

The HEAT program got a lot hotter in 2007! Wisconsin hospitals are participating in state government in record numbers, thanks to the Hospitals Education & Advocacy Team (HEAT). This year, hospitals had more than 375 meetings with legislators, including 250 legislative visits in conjunction with Advocacy Day—the highest number ever.

Speaking of records, the Wisconsin Hospital PAC shattered previous fundraising records by raising more than $200,000, and exceeding the 2007 goal. It’s the most that the fundraising campaign has ever raised in a single year, and it represents an increase of more than $135,000 in just six years.

The WHA Information Center achieved a positive bottom line in its third full year of operations since taking over data collection responsibilities from the State. Notably, WHAIC’s cost of operations in 2007 was about 60 percent of the State’s Bureau of Health Information’s budget in 2003.

WHA President Steve Brenton attributed the Association’s success in 2007 to both WHA staff and members. Member support of the Association goals indicates their continued commitment to improve the health of patients and communities alike.

The WHA 2007 Results publication is in this week’s packet. WHA encourages members to share the Results with members of their administrative team and with their hospital board members. Additional copies of 2007 Results are available by contacting Shannon Nelson at snelson@wha.org or 608-274-1820, or copies can be downloaded from www.wha.org/pubArchive/special_reports/2007Results.pdf.

What would happen if physicians age 50 or older suddenly decided to turn in their stethoscopes?

Given the sheer number of physicians in this age cohort, the results would be disturbing, to say the least. According to the AMA,

47 percent of all doctors in the U.S.—some 387,160 physicians—are 50 or above. In Wisconsin, 42 percent of the licensed physicians are over 50. There are currently 23,589 physicians licensed in Wisconsin; 13,000 are providing patient care. Clearly, any exodus of older physicians from medicine would incapacitate our current health care delivery system, both nationally and in the Badger State.

While no such immediate exodus is anticipated, the aging of the physician population is cause for concern. Merritt, Hawkins & Associates tracks the concerns and career plans of older physicians through our Survey of Physicians 50 to 65 Years Old. The 2007 Survey was recently released and reveals some interesting findings.

Fourteen percent of the 1,175 physicians we surveyed plan to retire in the next one to three years. Another seven percent plan to find a medical job in a non-clinical setting, while three percent plan to find a job in a non-medical setting. In all, about one-quarter of doctors surveyed said they plan to opt out of patient care sometime in the next one to three years. In addition, 12 percent said they plan to work part-time (20 hours a week or less), eight percent plan to significantly reduce their workload and four percent plan to work locum tenens.

People do not always do what they say they will in surveys. Nevertheless, these numbers are sobering. Should only ten percent of older physicians retire or opt out of patient care in the next one to three years, tens of thousands of doctors would be removed from the national physician workforce, and Wisconsin could stand to lose close to 1,000 physicians. Should an additional ten percent choose to work part-time or slow down significantly in the next one to three years, many additional FTEs would be lost. At that point, the number of exits from medicine would exceed the number of entrants.

Given that the U.S. is already experiencing a physician shortage in many areas, a significant reduction in the number of older physicians in the near future would be particularly inopportune. Consider that virtually all of the major presidential candidates support health policies that would extend health care access to millions of people who lack such access now. The enhanced demand for medical services would tax the current physician workforce, and very likely would overburden a workforce diminished by retirement and other forms of attrition.

Though this fact often seems to fly under the radar, health policies must be implemented by people, and any policy that expands access without also expanding the supply of physicians, nurses and other health professionals will most likely fall short of expectations. By extension, any plan that causes a significant number of older doctors to walk away from patient care also will be unlikely to succeed.

A copy of Merritt, Hawkins & Associates’ 2007 Survey of Physicians 50 to 65 Years Old is available at www.merritthawkins.com or you may call Mr. Mosley at (800) 876-0500.

Kurt Mosley is vice president of business development for Merritt, Hawkins & Associates, the nation’s leading physician search firm and a division of AMN Healthcare, the largest health care staffing company in the United States. He can be reached at kmosley@mhagroup.com.

The Wisconsin Hospital Association is fortunate to have many individuals who are willing to serve on Association councils and committees. This participation ensures that member constituencies are well represented in top-level discussions on issues facing the health care industry in Wisconsin. Every action taken by the Association is a result of member involvement and input.

There are many opportunities to be involved in the Wisconsin Hospital Association. Member participation in the Association will reach an all-time high in 2008, with nearly 200 individuals serving on one or more of WHA’s seven councils or committees. In addition, members also participate on state and local health-related boards, councils and commissions, providing valuable leadership on key health care issues.

Volunteer leaders are the backbone of a strong Association, according to WHA President Steve Brenton. "The Association provides a forum for discussing and developing responses and solutions to some of the most pressing issues facing Wisconsin hospitals," Brenton said. "This year Medicaid reimbursement will be a top-priority, along with consideration of proposals for health care reform," he added.

"We appreciate and place a high value on input and direction provided by our volunteer leaders," said Brenton.

For a list of council/committee members, visit www.wha.org and click on the "About" tab.

The WHA councils and committees are:

Council on Finance & Payment
Chair: Tom Bayer, COO, St. Vincent Hospital, Green Bay
Primary WHA Staff: George Quinn
The Council on Finance & Payment will identify and examine financial problems and issues affecting the health care delivery system in Wisconsin.

Council on Public Policy
Chair: David Olson, President/CEO, Bay Area Medical Center, Marinette
Primary WHA Staff: Eric Borgerding
The Council on Public Policy will oversee and coordinate the development of public policy initiatives for review and final action by the WHA Board of Directors. The Council will be responsible for coordinating the Association’s overall advocacy efforts that affect WHA members and staff, the media, government officials and other advocacy groups.

Council on Medical & Professional Affairs
Chair: Brad Manning, MD, Board Member, Wisconsin Medical Society
Primary WHA Staff: Dana Richardson
The Council on Medical & Professional Affairs will promote efficient hospital functioning and quality care through its efforts to monitor and influence professional practice. This is to be accomplished by assuring the quality and appropriate utilization of health care providers, promoting positive patient outcomes and efforts to continuously improve the value of care provided. This includes improvement in clinical and administrative practices affecting patient care, promotion of a working environment conducive to attracting and retaining qualified health professionals, improvement in patient outcomes, reduction in health care costs and medication errors, and the potential for individual and corporate health care consumers to understand information needed to assess health care quality.

Council on Rural Health
Chair: Bill Bruce, CEO, St. Joseph’s Community Health Services, Hillsboro
Primary WHA Staff: George Quinn
The Council on Rural Health will address the problems of hospitals located in Wisconsin’s rural communities and formulate the development of Association positions for solutions to these problems. It will also coordinate educational programming relating to the needs of these hospitals.

Council on Workforce Development
Chair: Phil Stuart, CEO, Tomah Memorial Hospital, Tomah
Primary WHA Staff: Judy Warmuth
The Council on Workforce Development will monitor the supply and distribution of the current health care workforce. It will work to ensure that an adequate supply of workers is available to staff Wisconsin hospitals. The Council will provide input into WHA’s advocacy program related to workforce issues and will also initiate and support projects related to the workforce.

Advocacy Committee
Chair: Bob Fale, President/CEO, Agnesian Healthcare, Fond du Lac
Primary WHA Staff: Jodi Bloch
The Advocacy Committee will provide oversight to the fundraising activities of the Wisconsin Hospitals PAC and Conduit.

Audit Committee
Chair: Greg Britton, President/CEO, Beloit Memorial Hospital
Primary WHA Staff: George Quinn
The Audit and Investment Committee will oversee the annual audit, review Association investment policies and performance annually, and present results to the Board of Directors.

Two long-serving rural hospital CEOs conclude their distinguished careers this week. Glen Grady, Administrator at Memorial Medical Center in Neillsville and George Johnson, President at Reedsburg Area Medical Center are both leaving their organizations following several decades of terrific leadership. They are also leaving behind two community hospitals that are markedly better off because of their commitment and service.

I had the opportunity to first meet George and Glen when I was with WHA the "first time," early in my career. George and Glen have always personified the adjectives leadership and stewardship. The greater Neillsville and Reedsburg communities’ fine health care infrastructure is a legacy of their proactive involvement and vision. Wisconsin’s national reputation as a rural health care leader is directly due to executives like George and Glen—and others like Harold Brown and Tim Size—who have leant their many talents to organizations that believe that quality health care knows no geographic boundary.

WHA has also been blessed by the active leadership commitment provided by both of these gentlemen, over many years. George is a past WHA chair and AHA delegate. Glen was a longtime WHA Board member and WHA-FS chair. Their contributions were many, and came without expectation of personal reward or recognition. As I’ve stated more than once, it is the demonstrated and consistent commitment of WHA’s voluntary leaders that separates WHA from other trade and/or personal membership associations, especially when it comes to the art of governance. George and Glen make my case.

Thanks Glen and George…and enjoy your well-deserved retirement!

Steve Brenton,
President

Many thanks to the entire WHA Team for your assistance this year! What an effective team they are; they sure made my role easier than it could have been and it was a pleasure to work with them.

Thanks also to the members who placed their confidence in me; it was an honor and a chance to learn from some very bright people on your Board of Directors.

This past summer while fishing with my six year old grandson, he asked me if other people "talk to themselves without opening their mouth." When I told him that everyone does, he asked me why. After telling him that he had me stumped, he said, "Maybe it’s because sometimes when you say it out loud it sounds really silly!" More about that later.

My plan for this year was to accomplish four things.

1. Enhance statewide community benefit reporting: Our second annual Community Benefit report gave more evidence of how local hospitals are benefiting their communities, especially to the poor and vulnerable.

2. Improve upon the billing and collection guidelines which were endorsed by the Board four years ago: during the 2007 WHA Advocacy Day, Attorney General Van Hollen stood before the large group of attendees and endorsed the Association’s voluntary Hospital Billing and Collection initiative. A white paper, developed by the Billing and Collections Subcommittee on Communications, outlining best practices in the areas of communicating charity care policies, discounting and billing information became the basis for statewide news releases.

3. Make sure that WHA was actively engaged in shaping the health care reform debate: WHA assumed a leadership role in the analysis and debate of the ill-conceived Healthy Wisconsin proposal, which was defeated. Further, WHA applied board-adopted reform principles to effectively endorse the Administration’s incremental approach to reform that targets the poor and vulnerable.

4. Encourage more active participation of the membership: By nearly any measure, participation was up. Registrations for educational programs were 21 percent ahead of the previous year, and the special conference calls that were scheduled on several occasions were very well attended.

Member unity throughout the year was consistently solid despite the various budget proposals that were floated. Perhaps when the members were evaluating some of the proposals, we all agreed with my grandson.

Childhood obesity and lack of physical activity is an issue facing many other communities. Reedsburg Area Medical Center is helping address this issue locally, in a very creative way – with the sponsorship of the Feelin’ Good Mileage Club.

Feelin’ Good Mileage Club is a fitness program that successfully motivates young people (grades K – 5) to get fit and stay in shape through exercise. The program is simple. Several times each week at recess, elementary students walk and run on a designated track on the school playground. A volunteer, playground supervisor or older child marks children’s Mile Marker cards each time they complete a lap on the course and rewards are given at various mileage goals.

After initiating the program in elementary schools within Reedsburg and surrounding areas, Reedsburg Area Medical Center pays for and provides all of the materials, incentives and awards to help make this program successful and keep it motivating to students. Shoelaces, shoelace tokens (brightly colored plastic tokens worn on shoelaces), certificates and posters to celebrate the children’s accomplishments within the school and at home and other rewards all help kids keep moving and are provided by the Medical Center, to the schools. Besides fitness children also learn responsibility, mathematics (counting fractions of miles in laps), goal setting, record keeping skills and self- esteem building. Best of all, this happens while the child builds muscles, burns calories, burns off excess energy, reduces stress and learns good lifetime habits. But beyond all of this the kids simply enjoy the exercise and think it is pure fun!

To date, Feelin’ Good Mileage Club is up and running in five of the Reedsburg and surrounding elementary schools and continues to grow and expand. In fact, the enthusiasm generated from this program has expanded for requests for an adult program for school staff.

Indeed, this concept is an important one for Reedsburg Area Medical Center. When people’s fitness levels increase, self-esteem and self-image go up as well. A good place to start building a healthy and well-rounded community is by teaching children that exercise and fitness are fun. Reedsburg Area Medical Center is proud to play a part in that!

In the mid 1990s, with their three teenagers still at home, Gina and Bill Peterson were blindsided with a calamity of health problems that forced each of them to leave work because of disabilities. They were still in their 40s.

Further health concerns arose and the couple struggled to stay afloat in a sea of welling medical bills. Thankfully, a glimmer of hope emerged recently in the form of Sauk Prairie Memorial Hospital & Clinics’ (SPMHC) Community Care program. Bill and Gina learned the program would pay their medical bills—now and into the future. So far, Community Care has paid more than $5,000 in medical expenses on behalf of the Petersons.

SPMHC’s Community Care program assists patients by paying a portion or all of their medical bills, awarding more than $1 million in medical bill relief to hundreds of patients in 2006.

Financial relief came after years of health problems suffered by both of the Petersons. Their nightmare began in 1994 when Bill suffered a fractured skull in an industrial accident, and three years later, brain damage and a broken back and neck as a result of a motorcycle collision. Gina, who worked as a nursing assistant at the time, struggled to care for her disabled husband, mother her three children, and manage finances and household duties.

"A couple of years after his last accident, I just got so that I couldn’t work anymore and keep up with everything," she said. "I was so worn out physically and mentally that I had a breakdown."

Still, the Petersons hadn’t yet hit rock bottom. Their onslaught of health problems continued to mount, and this year, culminated in six surgical procedures to treat a myriad of serious problems. Along with each surgery came more bills.

In 2007, surgeons repaired herniated disks in Gina’s back and operated on her arthritic shoulder. Between each procedure, Gina cared for Bill, who underwent four heart procedures in four months.

"He’s had four surgeries since February to put stents into clogged arteries in his heart and arms," she said. And, while Medicare covered the lion’s share of these medical expenses, it didn’t cover everything. "We pay around $200 a month just for prescriptions," she said. "One bill from surgery was $58,000. Medicare covered all but $900 of it. I kept paying $50 per month on the medical bills, but they just kept adding up."

As a low-income couple, the Petersons maintain they couldn’t afford supplemental insurance to pick up costs not covered by Medicare. They admit, they could barely handle monthly medication costs. Fortunately, the Petersons discovered they qualified for Community Care.

"Community Care represents the hospital’s commitment to improving the health of our community," said Linda Ward, patient financial specialist at SPMHC. "One of the most tangible ways we can do this is to recognize people who may be struggling to pay medical bills. We can help determine if our patients can get financial help from local, state and federal health care programs and we can help them apply for our Community Care or other discount programs."

Ward worked closely with Gina to help her apply for Community Care — an easy process, according to Gina. "I just completed a sheet outlining our budget and detailed our income and monthly bills. I am terribly relieved we qualified because we are low-income and it was very hard to keep up with our medical expense payments," she said.

How are the Petersons feeling today? Much better, attests Gina. Not only are they relieved to be free of their debts, they are gaining strength physically day by day.

"The MRI of my shoulder showed that it was full of arthritis and bone spurs," she said. "I had so much pain I couldn’t bend my arm." Thanks to surgery and therapy, Gina reports her arm is healing well, but the process is slow. Moreover, surgeons successfully alleviated 80 percent of her back pain as a result of her back surgery earlier this year.