This week the independent Medicare Payment Advisory Commission, or MedPAC, released its much-anticipated report on geographic variation in health care costs. Their conclusion? Even when adjusting for the effects of wages, patient health status and other factors, unexplained geographic variations exist in both Medicare spending and Medicare service use. This is the same conclusion advocated for years by the Dartmouth Atlas and the recently formed Healthcare Quality Coalition, of which the Wisconsin Hospital Association and many other Wisconsin providers are members.

"The report put out by MedPac validates that regional variation is a substantial issue affecting Medicare service and spending," said Wisconsin Rep. Ron Kind of La Crosse. "The Institute of Medicine studies, which I led the way to include in the House of Representatives health care reform bill and which will be implemented by the Administration, will examine this problem and realign priorities to incentivize quality care, eliminate overutilization, save money, and provide higher quality care to patients across the country."

The Healthcare Quality Coalition strongly supports the movement toward incentivizing and rewarding value in health care, as promoted by Rep. Kind, Senators Kohl and Feingold and others and currently included in both versions of health care reform legislation pending in Congress.

"While there has been push back on the Dartmouth Atlas research and others, this independent MedPAC report supports the underlying conclusions yet again that unexplained regional variation exists," said WHA President Steve Brenton. "This is why WHA and many high-quality, cost-efficient providers are advocating that true health care ‘reform’ move in the direction of rewarding and recognizing value."

According to the MedPAC report, Measuring Regional Variation in Service Use, in order to characterize regional differences, Medicare spending figures were adjusted to remove the impact of factors such as differences in wages, health status of beneficiaries, and special Medicare payments. The adjusted figures—which MedPAC calls "service use"—better reflect the differences in volume of services provided to beneficiaries across the country.

The report found substantial variation between high and low per beneficiary spending—a 50 percent difference between the highest 10 percent and the lowest 10 percent of areas—as well as substantial differences in Medicare service use, a 30 percent difference, between those highest and lowest areas.

Governor Jim Doyle signed an executive order on December 1 that takes an initial step toward planning and creating a statewide health information exchange (HIE) that would facilitate the electronic movement of health care information among organizations. The executive order creates the Wisconsin Relay for Electronic Data (WIRED) for Health Board, whose charge is to develop a plan for statewide health information exchange by June 1, 2010.

"WHA and other key stakeholders have been engaging in the development of DHS’s initial plans to create a health information exchange in Wisconsin for the past several months," said WHA President Steve Brenton. "Ensuring that a statewide health information exchange creates net value has been a key message."

As stated in a December 1 letter to Department of Health Services (DHS) Secretary Karen Timberlake jointly signed by WHA, the Wisconsin Medical Society, the Wisconsin Health Information Organization and the Wisconsin Collaborative for Healthcare Quality:

"A great deal of work needs to occur in order to create a viable state-level health information exchange capability for Wisconsin, and we recognize that we are just in the first steps of the process. However, it is critical that we get these first steps right in order to create a viable, value-focused HIE capability throughout Wisconsin."

Initial funding for the planning of the exchange is to be provided, in part, by a $9.4 million grant from the federal government. However, DHS has indicated that the final cost of a statewide electronic exchange could cost significantly more. Where ongoing funding will come from is uncertain at this time. All 50 states are expected to receive similar grant funding through ARRA stimulus funds to develop exchange capabilities throughout the nation.

Governor Doyle will be appointing 14 individuals to the WIRED for Health Board shortly. Two of the individuals on the WIRED for Health Board are to represent hospitals, with one of the seats to represent rural hospitals. WHA President Steve Brenton and Rural Wisconsin Health Cooperative Executive Director Tim Size have indicated to Secretary Timberlake their intent to apply for the two hospital seats.

The remaining 12 seats on the WIRED Board will have representation that includes a commercial payer, a patient or consumer organization, physicians, the business community, pharmacies, laboratories, higher education, quality/health organizations, public health, Medicaid and the state chief information officer.

In addition to the WIRED for Health Board seats, DHS is soliciting nominations for membership on several WIRED for Health committees, including a Finance and Audit Committee, a Standards and Architecture Committee, a Legal and Policy Committee, and a Communications, Marketing, and Education Committee.

DHS has indicated that it plans to introduce legislation in early 2010 that would move the WIRED for Health Board from DHS to a new non-profit entity whose charge would be to continue planning and ultimately implement an exchange. DHS has also suggested that the legislation may address statutory issues that have been previously identified as barriers to private-sector development of electronic health information exchanges.

Additional information on the Governor’s Executive Order and the WIRED for Health Project can be found at http://dhs.wisconsin.gov/ehealth/WIREDforHealth/index.htm.

The Wisconsin Hospitals State PAC and Conduit Fundraising Campaign has raised $182,037 or just over 85 percent of its $213,000 goal. The 2009 Campaign ends on December 31, 2009.

To date, 521 individuals have contributed an average of $349. Last year, 601 individuals contributed to the Campaign so getting the support again of those past participants in the last three weeks of this year will be key in getting closer to the goal.

Thank you to those who have already contributed to the 2009 campaign. Individual contributors are listed below by name and affiliated organization. Contributors are listed alphabetically by contribution amount category. The final 2009 contributor list will be published the first week in January in The Valued Voice.

For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Contributions Ranging from $1 - $249

Adams, Daniel         Memorial Medical Center - Ashland

Albers, Kirstin         Meriter Hospital

Albert, Matthew         St. Mary's Hospital

Ambs, Kathleen         St. Mary's Hospital

Anderson, Mark         Sacred Heart Hospital

Annala, Shannon         Aspirus Wausau Hospital

Appleton, Karl         St. Mary's Hospital Medical Center

Arendt, Kathleen         Aspirus Wausau Hospital

Axelsen, Kathern         Sacred Heart Hospital

Baalrud, Laura         St. Joseph's Hospital

Baker, Dave         Ministry Health Care - Saint Joseph's Hospital

Banaszynski, Gregory         Aurora Health Care

Barkovich, Catherine         Sacred Heart Hospital

Bartingale, Robert         St. Vincent Hospital

Bauer, David         Sacred Heart Hospital

Beckler, Rick         Sacred Heart Hospital

Beckman, Candace         Columbus Community Hospital

Beglinger, Joan         St. Mary's Hospital

Bellin, Carolyn         Froedtert Memorial Lutheran Hospital

Bergmann, Ann         Spooner Health System

Bernklau, Robert         Memorial Health Center

Bertsch, Cynthia         St. Nicholas Hospital

Bessen, Paulette         Ministry Health Care - Saint Michael's Hospital

Bjork, Ted         Westfields Hospital

Bliven, David         Aspirus Wausau Hospital

Block, Jennifer         Sacred Heart Hospital

Bloom, Deborah         Sacred Heart Hospital

Bosio, David         Aspirus Wausau Hospital

Boson, Ann         Ministry Health Care - Saint Joseph's Hospital

Bowe, Cynthia         Sacred Heart Hospital

Bowman, Andrew         Sacred Heart Hospital

Bradley, Connie         Columbia St. Mary's Columbia Hospital

Braun, James         Flambeau Hospital

Brenholt, Craig         St. Mary's Hospital

Brenholt, Mary         St. Mary's Hospital

Brennan, Karen         St. Mary's Hospital

Brenny, Terrence         Stoughton Hospital Association

Brisch, Joe         Holy Family Memorial Medical Center

Brown, John         St. Mary's Hospital

Brueggeman, Mary         St. Joseph's Community Health Services

Bryans, Richard         Sacred Heart Hospital

Burgener, Jean         Aspirus Wausau Hospital

Burtch, Sue         Aspirus Wausau Hospital

Busch, Rebecca         Spooner Health System

Buss, Diane         St. Mary's Hospital

Caldwell, James         Fort HealthCare

Campau, Patricia         Columbia St. Mary's, Inc.

Campbell-Kelz, Nancy         Aspirus Wausau Hospital

Carlson, Carol         Sacred Heart Hospital

Casey, Karen         Columbia Center

Caven, Michael         Memorial Medical Center - Ashland

Censky, Bill         Holy Family Memorial Medical Center

Chartier, Jacklyn         Aspirus Wausau Hospital

Christensen, Leslie         St. Mary's Hospital

Chumbley, Clyde         ProHealth Care

Coblentz, Kathy Jo         St. Joseph's Community Health Services

Cohen, Joan         Aspirus Wausau Hospital

Colby, Daniel         Mercy Health System

Collins, Sherry         Wisconsin Hospital Association

Cook, Craig         Ministry Health Care - Saint Joseph's Hospital

Cook, John         Mercy Health System Corporation

Cox, Tamarah         Aspirus Wausau Hospital

Craft, Carolyn         St. Joseph's Hospital

Culotta, Jennifer         St. Clare Hospital and Health Services

Dalebroux, Steve         St. Mary's Hospital

Danner, Dean         Aspirus Wausau Hospital

Danzinger, Marcia         Sacred Heart Hospital

Davis, Kathleen         Children's Hospital of Wisconsin

Decker, Dawn         Aspirus Wausau Hospital

DeMars, Nancy         Sacred Heart Hospital

Derks, Darla         Sacred Heart Hospital

Dettman, Amy         Bellin Memorial Hospital

DeWitt, Pamela         St. Joseph's Community Health Services

Diemer, Peggy         Aspirus Wausau Hospital

Dietsch, Teresa         St. Clare Hospital and Health Services

Dittrich, Peggy         Memorial Health Center

Dorpat, Denice         Aspirus Wausau Hospital

Draxler, Deborah         Aspirus Wausau Hospital

Dryden, Shawn         Sacred Heart Hospital

Duda, Carrie         Wheaton Franciscan Healthcare - All Saints

Dufek, Nancy         Memorial Medical Center - Ashland

Dux, Larry         Community Memorial Hospital

Dwyer, Amy         Sacred Heart Hospital

Dwyer, Maxine         St. Mary's Hospital

Elliott, Roger         St. Joseph's Hospital

Ellis, Nancy         Aspirus Wausau Hospital

Entenmann, Kim         St. Joseph's Hospital

Erickson, Susan         Meriter Hospital

Eskridge, Melissa         Sacred Heart Hospital

Evenson, Rock         Froedtert Memorial Lutheran Hospital

Facey, Alice         St. Clare Hospital and Health Services

Fedorov, Emilie         St. Mary's Hospital

Feldhausen, Mary         St. Vincent Hospital

Folstad, John         Sacred Heart Hospital

Freiberg, Kerry         Community Memorial Hospital

Fuchs, Thomas         St. Joseph's Hospital

Gahagan, Marsha         St. Mary's Hospital

Galfano, Victor         Sacred Heart Hospital

Gantner, Sue         Aspirus Wausau Hospital

Garavet, Scott         Aspirus Wausau Hospital

Garcia, Dawn         Sacred Heart Hospital

Garvey, Gale         St. Mary's Hospital

Gengler, Tim         Aspirus Wausau Hospital

Giedd, Janice         St. Joseph's Hospital

Gigot, Kelly         St. Vincent Hospital

Giles, Barbara         St. Joseph's Hospital

Gjolberg, Skip         St. Joseph's Hospital

Goelzer, Mark         Mercy Health System Corporation

Goffinet, Jo         St. Mary's Hospital

Gormican, John J.         Agnesian HealthCare

Graf, John         UW Health Partners Watertown Regional Medical Ctr

Grohskopf, Kevin         St. Clare Hospital and Health Services

Groskreutz, Kevin         St. Joseph's Hospital

Gulan, Maria         Aspirus Wausau Hospital

Gullicksrud, Lynn         Sacred Heart Hospital

Hafeman, Paula         St. Vincent Hospital

Haggerty, Peggy         Columbus Community Hospital

Halberg, Carole         St. Mary's Hospital

Halberslaben, Holly         St. Mary's Hospital

Harrop, Pauline         Meriter Hospital

Harter, Ellen         Aspirus Wausau Hospital

Hassemer, Robert         Sacred Heart Hospital

Hedrington, Brian         Sacred Heart Hospital

Herbert, William         Meriter Hospital

Hieb, Laura         Bellin Memorial Hospital

Hinton, George         Aurora Sinai Medical Center

Hinz, Russ         Aurora Health Care

Hoege, Beverly         Reedsburg Area Medical Center

Holmes, Kristine         Meriter Hospital

Holmes, Sheri         Aspirus Wausau Hospital

Hueller, Julie         Wheaton Franciscan - Milwaukee

Huemmer, Paul         St. Mary's Hospital

Jablonske, William         St. Joseph's Hospital

Jay, John         Community Memorial Hospital

Jelle, Laura         St. Clare Hospital and Health Services

Johnson, Kimberly         Sacred Heart Hospital

Johnson, Patricia         Hayward Area Memorial Hospital

Jones, Mary         Meriter Hospital

Jones, Tom         St. Joseph's Community Health Services

Juckem, Elizabeth         Columbia St. Mary's, Inc. - Columbia Campus

Kaiser, Ann         Sacred Heart Hospital

Karow, Deborah         Aspirus Wausau Hospital

Kempen, Jacob         Aspirus Wausau Hospital

Klauck, James         Froedtert Memorial Lutheran Hospital

Klay, Lois         St. Joseph's Hospital

Krueger, Pamela         Aspirus Wausau Hospital

Kuehni-Flanagan, Tracy         Sacred Heart Hospital

Kurtz, David         Mercy Health System Corporation

Lachecki, Therese         Memorial Medical Center - Ashland

Lang, Susan         Aspirus Wausau Hospital

Lange, George         Westgate Medical Group, CSMCP

Larson, Piper         Sacred Heart Hospital

Leonard, Mary Kay         St. Mary's Hospital

Lerch, Shawn         Columbus Community Hospital

Lien, Kristine         Sacred Heart Hospital

Logemann, Tim         Aspirus Wausau Hospital

Lopas, Mary         Door County Memorial Hospital

Lorenz, Bruce         Aspirus Wausau Hospital

Lucas, Roger         Aspirus Wausau Hospital

LuCore, Patricia         Sacred Heart Hospital

Lunde, Pam         Columbus Community Hospital

Mackey, Theresa         Sacred Heart Hospital

Maloney, Evelyn         St. Joseph's Hospital

Marcouiller, Don         Memorial Medical Center - Ashland

Margan, Rob         Wisconsin Hospital Association

Markgraf, Janelle K.         Langlade Hospital - An Aspirus Partner

Marquardt, Amy         Columbia St. Mary's Columbia Hospital

Marsch, Jean         St. Vincent Hospital

Mason, Paul         Wheaton Franciscan Healthcare - All Saints

Mathews, Larry         St. Vincent Hospital

McKay, Jean         Sacred Heart Hospital

McKenzie, Paula         St. Mary's Hospital

Meicher, John         St. Mary's Hospital

Merwald, Alfred         Aspirus Wausau Hospital

Meyer, Markie         Community Memorial Hospital

Mickelson, Ronald         St. Clare Hospital and Health Services

Miloszewicz, Angela         Wisconsin Hospital Association

Mohr, Carol         Sacred Heart Hospital

Moss, Kenneth         Meriter Hospital

Mourey, Gerald         Aspirus Wausau Hospital

Mueller, Bonita         St. Mary's Hospital

Mulder, Doris         Beloit Memorial Hospital

Nelson, Mark         Sacred Heart Hospital

Nemeth, Joseph         Mercy Health System Corporation

Ness, Nita         Sacred Heart Hospital

Nohelty, Peter         Sacred Heart Hospital

Ohrmundt, Joel         Aspirus Wausau Hospital

Oland, Charisee         Rehabilitation Hospital of Wisconsin

Olson, Bonnie         Sacred Heart Hospital

Olson, Keri         St. Clare Hospital and Health Services

Onsager, Sandra         St. Mary's Hospital

Ose, Peggy         Riverview Hospital Association

Osen, John         Aspirus Wausau Hospital

Ott, Virginia         St. Joseph's Hospital

Padilla, Gilbert         Sacred Heart Hospital

Palecek, Steve         Sacred Heart Hospital

Peck, Lori         Memorial Health Center

Peickert, Barbara         Hayward Area Memorial Hospital and Nursing Home

Peiffer, Susan         Sacred Heart Hospital

Pengra, Mary         Sacred Heart Hospital

Peters, Kenneth         Bellin Memorial Hospital

Peterson, Brenda         Sacred Heart Hospital

Peterson, Lawrence         St. Mary's Hospital

Pielhop, Judy         Sacred Heart Hospital

Pinske, Heather         St. Mary's Hospital

Piper, Barbara         Sacred Heart Hospital

Pittenger, Jeannie         Sacred Heart Hospital

Plaisance, Christopher         Aspirus Wausau Hospital

Polenz, Scott         Memorial Medical Center - Neillsville

Powell, Stacey         Sacred Heart Hospital

Preston, Mark         Sacred Heart Hospital

Probst, Paula         Sacred Heart Hospital

Proehl, Sheila         Hudson Hospital

Prunty, Brian         Aspirus Wausau Hospital

Pupanek, William         Meriter Hospital

Quade, Steve         Door County Memorial Hospital

Rasmussen, Sheri         WHA Financial Solutions, Inc.

Reding, Rick         Aspirus Wausau Hospital

Reinke, Kathy         Shawano Medical Center

Richbourg, Mary         Sacred Heart Hospital

Ripsch, Sue         Mercy Health System Corporation

Rocole, Theresa         Wheaton Franciscan Healthcare - All Saints

Rooney, Suzanne         St. Joseph's Hospital

Rosenberger, Herb         ProHealth Care

Rounds, Thomas         St. Mary's Hospital

Roundy, Ann         Columbus Community Hospital

Rubenzer, Deanne         St. Joseph's Hospital

Rubenzer-Pike, Janet         St. Joseph's Hospital

Rudolph, Wade         Sacred Heart Hospital

Sale, Nora         Froedtert Memorial Lutheran Hospital

Sauk, Michael

Schade, Randy         Aspirus Wausau Hospital

Schaefer, Joyce         Amery Regional Medical Center

Schneck, Judy         Sacred Heart Hospital

Schraufnagel, Patricia         Memorial Medical Center - Ashland

Schuster, Lynn         Wheaton Franciscan Healthcare

Schweitzer, Susan         Columbus Community Hospital

Scinto, Jeanne         Aspirus Wausau Hospital

Segerstrom, Amy         Sacred Heart Hospital

Sergey, Mark         Sacred Heart Hospital

Sheehan, Heather         Hayward Area Memorial Hospital and Nursing Home

Skifton, Russell         Ministry Health Care - Saint Michael's Hospital

Skulan-Balmer, Anna         Sacred Heart Hospital

Smith, Julie         Sacred Heart Hospital

Sorenson, Heather         Sacred Heart Hospital

Sorenson, Jim         Sacred Heart Hospital

Soward, Cindy         Sacred Heart Hospital

Spanos, Chris         Meriter Hospital

Sparks, Steven         St. Mary's Hospital

Spindler, Greg         Sacred Heart Hospital

Sprengeler, John         Sacred Heart Hospital

Stelzer, Jason         St. Clare Hospital and Health Services

Stone, Stacy         Sacred Heart Hospital

Storing, Sandy         Sacred Heart Hospital

Stranberg, Kevin         Memorial Medical Center - Ashland

Sullivan, Anne         Memorial Medical Center - Ashland

Swanson, Becky         Sacred Heart Hospital

Swanson, Kerry         SSM Health Care-Wisconsin

Tandberg, Christine         Sacred Heart Hospital

Thurmer, DeAnn         Waupun Memorial Hospital

Tincher, Pat         Langlade Hospital - An Aspirus Partner

Todd, Jeffrey         Aspirus Wausau Hospital

Tryba, Jennifer         Aspirus Wausau Hospital

Turtenwald, Robyn         Community Memorial Hospital

Tuttle, Kathryn         Memorial Medical Center - Ashland

VanDeVoort, John         Sacred Heart Hospital

Verploegh, Alan         Aspirus Wausau Hospital

Voelker, Thomas         Aspirus Wausau Hospital

Vogler, Linda         Sacred Heart Hospital

Voigt, Yolanda         Aspirus Wausau Hospital

Wade, Matthew         ProHealth Care

Waldoch, Timothy         Froedtert Memorial Lutheran Hospital

Walker, Troy         St. Clare Hospital and Health Services

Walton, Michelle         WHA Financial Solutions, Inc.

Wanserski, James         Aspirus Wausau Hospital

Watts, Susan         St. Vincent Hospital

White, Bridget         St. Mary's Hospital

Whiteaker, Les         Memorial Medical Center - Ashland

Wilson, Deanna         Upland Hills Health

Winckler, Carol         Sacred Heart Hospital

Wojciechowski, Gary         Aspirus Wausau Hospital

Worthing, Kelli         Sacred Heart Hospital

Wrobel, Roberta         Sacred Heart Hospital

Wynimko, Susan         St. Joseph's Hospital

Yarbrough, Ruth         Mercy Health System Corporation

Zeller, Brad         Hayward Area Memorial Hospital and Nursing Home

Zemaitis, Tom         Sacred Heart Hospital

Zorbini, John         Froedtert Memorial Lutheran Hospital

Contributions Ranging from $250 - $499  

Abitz, John         WHA Financial Solutions, Inc.

Abrams, K. Scott         Beaver Dam Community Hospitals

Achenbach, Connie         Prairie du Chien Memorial Hospital

Allison Stonebraker, Pat         Children's Hospital of Wisconsin

Ayers, Mandy         Wisconsin Hospital Association

Baker, Chris         St. Mary's Hospital

Bauer, Carl         Memorial Medical Center - Ashland

Biros, Marilyn         SSM Health Care-Wisconsin

Blanchard, Michael         Ministry Health Care - Saint Joseph's Hospital

Boudreau, Jenny         Wisconsin Hospital Association

Calhoun, William         Affinity Health System

Carlson, Dan         Bay Area Medical Center

Clapp, Nicole         Grant Regional Health Center

Clough, Sheila         Ministry Health Care - Howard Young Medical Center

Coffman, Joan         St. Joseph's Hospital

Conwell, Lisa         WHA Financial Solutions, Inc.

Curran, Joan         Gundersen Lutheran Medical Center

Danner, Forrest         Aspirus Wausau Hospital

Deich, Faye         Sacred Heart Hospital

Dietrich, Dean         Aspirus Wausau Hospital

Drengler, Kathryn         Aspirus Wausau Hospital

Erickson, Robert         Aspirus Wausau Hospital

Erickson, William         Sacred Heart-St. Mary's Hospitals

Furlong, Marian         Hudson Hospital

Geiss, Peter         ProHealth Care

Gruber, Richard         Mercy Health System

Grundstrom, David         Flambeau Hospital

Guffey, Kerra         Meriter Hospital

Gutsch, Mike         Southwest Health Center

Hamilton, Mark

Hattem, Marita         Aspirus Wausau Hospital

Hessert, Peter         Aspirus Wausau Hospital

Hofer, John         Bay Area Medical Center

Hoff, Linda         Meriter Hospital

Holmes, Sandra         Wheaton Franciscan Healthcare

Huettl, Patty         Sacred Heart Hospital

Huggins, Melissa         Meriter Hospital

Hyland, Carol         Agnesian HealthCare

Jensen, Russell         St. Mary's Hospital

Johnson, Charles         SSM Health Care-Wisconsin

Keene, Kaaron         Memorial Health Center

Kehrberg, MD, Mark         Affinity Health System

Kostroski, Sharon         Ministry Health Care - Saint Joseph's Hospital

Koutouzos, Connie         Bay Area Medical Center

Krause, Carolyn         Meriter Hospital

Lambrecht, Randy         Aurora Health Care

Mantei, Mary Jo         Bay Area Medical Center

Marciano, Karol         Columbia St. Mary's Milwaukee Hospital

Maroney, Lisa

May, Carol         Sauk Prairie Memorial Hospital

McCoic, Kristie         St. Joseph's Community Health Services

McKevett, Timothy         Beloit Memorial Hospital

McNally, Maureen         Froedtert Memorial Lutheran Hospital

Meysembourg, Len         Spooner Health System

Miller, Kimberly         Beaver Dam Community Hospitals

Mugan, James         Agnesian HealthCare

Neikirk, Jon         Froedtert Memorial Lutheran Hospital

Nelson, James         Fort HealthCare

Nelson, Nanine         ProHealth Care

Nevers, Rick         Aspirus Wausau Hospital

Nick, Mary         Meriter Hospital

Nockerts, Steven         Richland Hospital

Oberholtzer, Curt         Bay Area Medical Center

O'Connell, Blaine         Froedtert Memorial Lutheran Hospital

Olkowski, Leland         Aspirus Wausau Hospital

Olson, Gregory         Memorial Health Center

Penczykowski, James         St. Mary's Hospital

Peterson, Douglas         Chippewa Valley Hospital and Oakview Care Center

Pinekenstein, Barbara         ProHealth Care - Oconomowoc Memorial Hospital

Roberts, Phillip         Columbus Community Hospital

Ross, Forrest         WHA Financial Solutions, Inc.

Rowe, Jeanne         Aspirus Wausau Hospital

Rozenfeld, Jonathan         St. Mary's Hospital

Russell, John         Boscobel Area Health Care

Sanders, Paul         Community Memorial Hospital

Sanicola, Suzanne         Columbia St. Mary's Columbia Hospital

Schneider, David         Langlade Hospital - An Aspirus Partner

Schroeder, Larry         Sauk Prairie Memorial Hospital

Schulz, Janet         ProHealth Care

Sczygelski, Sidney         Aspirus Wausau Hospital

Selberg, Heidi         St. Mary's Hospital Medical Center

Shapiro, David         Columbia St. Mary's Columbia Hospital

Shaw, Mary         St. Mary's Hospital of Superior

Smith, Gregory         Wheaton Franciscan Healthcare

Spieckerman, Jill         Sacred Heart-St. Mary's Hospitals

Staffileno, Gerri         Columbia St. Mary's Ozaukee Hospital

Statz, Darrell         Rural Wisconsin Health Cooperative

Stein, Dr. Rick         Bay Area Medical Center

Stout, Johni         WHA Financial Solutions, Inc.

Stuart, Philip         Tomah Memorial Hospital

Svetlik, Joe         Reedsburg Area Medical Center

Swiderski, Julie         Wheaton Franciscan - Milwaukee

Taplin Statz, Linda         SSM Health Care-Wisconsin

Tapper, Joy         Milwaukee Health Care Partnership

Tarantino, Jennifer         Aurora Health Care

Van Meeteren, Bob         Reedsburg Area Medical Center

VanCourt, Bernie         Bay Area Medical Center

Vogel, Martin         Children's Hospital of Wisconsin

Voss, Mark         Aspirus Wausau Hospital

Yunk, Dennis         Agnesian HealthCare

Contributions Ranging from $500 - $999  

Andersen, Travis         St. Elizabeth Hospital

Anderson, Rhonda         Columbia St. Mary's, Inc.

Anderson, Sandy         St. Clare Hospital and Health Services

Andritsch, Stacie         Wheaton Franciscan Healthcare

Bablitch, Steve         Aurora Health Care

Bagemihl, Katherine         Froedtert Memorial Lutheran Hospital

Bailet, Jeff         Aurora Health Care

Bayer, Tom         St. Vincent Hospital

Bea, Javon         Mercy Health System Corporation

Borgerding, Dana

Braddock, Michelle         WHA Financial Solutions, Inc.

Brophy, Michael         Aurora Health Care

Buerstatte, Gary         ProHealth Care

Bukowski, Cathy         Ministry Health Care - Howard Young Medical Center

Bultema, Janice

Butler, John         St. Mary's Hospital

Callies, Julie         WHA Information Center

Canter, Richard         Wheaton Franciscan Healthcare

Decker, Michael         Divine Savior Healthcare

Dietsche, James         Bellin Memorial Hospital

Eager, David         Aurora Health Care

Eddy, Lee Anne         Children's Hospital of Wisconsin

Ela, Susan         Aurora Health Care

Frank, Jennifer         Wisconsin Hospital Association

Geboy, Scott         Hall, Render, Killian, Heath & Lyman

Gutzeit, Michael         Children's Hospital of Wisconsin

Harding, Edward         Columbus Community Hospital

Heifetz, Michael         SSM Health Care-Wisconsin

Hilt, Monica         Sacred Heart-St. Mary's Hospitals

Huber, Mark         Aurora Health Care

Hymans, Daniel         Memorial Medical Center - Ashland

Kellar, Richard         Aurora West Allis Medical Center

Kerfoot, Karlene         Aurora Health Care

Kersten, Juliet         Children's Hospital of Wisconsin

Kerwin, George         Bellin Memorial Hospital

Klawiter, Anne         Southwest Health Center

Klimisch, Ronald         Aspirus Wausau Hospital

Korom, Nancy         Children's Hospital of Wisconsin

Levin, Jeremy         Rural Wisconsin Health Cooperative

Little, Steven         Agnesian HealthCare

Lockhart, MD, Jack         Gundersen Lutheran Medical Center

Martin, Jeff         Ministry Health Care - Saint Michael's Hospital

Merline, Karen

Miller, Jim         Children's Hospital and Health System

Mlynarek, Robert         Waukesha Memorial Hospital

Neufelder, Daniel         Affinity Health System

Norton, Andrew         Froedtert Memorial Lutheran Hospital

Page, Alison         Baldwin Area Medical Center

Petonic, Mary Frances         Meriter Hospital

Pollard, Dennis         Community Memorial Hospital

Postler-Slattery, Diane         Aspirus Wausau Hospital

Potter, Brian         Wisconsin Hospital Association

Richards, Theresa         Ministry Health Care - Saint Joseph's Hospital

Ronstrom, Stephen         Sacred Heart Hospital

Runge, Charles         Froedtert Memorial Lutheran Hospital

Sachdeva, Ramesh         Children's Hospital of Wisconsin

Schafer, Michael         Spooner Health System

Shabino, Charles         Wisconsin Hospital Association

Ship, Mark         Children's Hospital of Wisconsin

Siebecker, William         Aspirus Wausau Hospital

Sohn, Jonathan         Wheaton Franciscan Healthcare

Stine, Stephen         Aspirus Wausau Hospital

Wallace, Michael         Fort HealthCare

Wolf, Edward         Lakeview Medical Center

Woodward, Jim         Meriter Hospital

Worrick, Gerald         Door County Memorial Hospital

Contributions Ranging from $1,000 - $1,999  

Bazan, Bill         Wisconsin Hospital Association

Birkenstock, Timothy         Children's Hospital of Wisconsin

Bloch, Jodi         Wisconsin Hospital Association

Boese, Jennifer         Wisconsin Hospital Association

Braddock, Jonathan         WHA Financial Solutions, Inc.

Brideau, Leo         Columbia St. Mary's Columbia Hospital

Britton, Gregory         Beloit Memorial Hospital

Byrne, Frank         St. Mary's Hospital

Chapin, Rocklon         St. Mary's/Duluth Clinic Health System

Christensen, Cinthia         Children's Hospital of Wisconsin

Duncan, Larry         Children's Hospital of Wisconsin

Dunigan, Thomas         Children's Hospital of Wisconsin

Eichman, Cynthia         Ministry Health Care - Our Lady of Victory Hospital

Fale, Robert         Agnesian HealthCare

Fish, David         St. Joseph's Hospital

Gazzana, Thomas         Children's Hospital of Wisconsin

Getto, Carl

Grasmick, Mary Kay         Wisconsin Hospital Association

Herzog, Mark         Holy Family Memorial, Inc.

Kachelski, Joe         WHA Information Center

Kammer, Peter         Essie Kammer Consulting Group

Karuschak, Michael         Amery Regional Medical Center

Kief, Brian         Ministry Health Care - Saint Joseph's Hospital

Kosanovich, John         UW Health Partners Watertown Regional Medical Ctr

Kryda, Michael         Ministry Health Care - Saint Joseph's Hospital

Leitch, Laura         Wisconsin Hospital Association

Loftus, Philip         Aurora Health Care

Mattes, Dan         Wheaton Franciscan Healthcare - St. Francis

Merline, Paul         Wisconsin Hospital Association

Mettner, Michelle         Children's Hospital of Wisconsin

Meyer, Loren         Wheaton Franciscan Healthcare

Mohorek, Ronald         Ministry Health Care

Morgan, Dwight         Aurora Health Care

Munson, Kenneth         Children's Hospital of Wisconsin

Niemer, Margaret         Children's Hospital of Wisconsin

O'Brien, Mary         Aurora St. Luke's Medical Center

Oldham, Keith         Children's Hospital of Wisconsin

Olson, David         Bay Area Medical Center

Olson, Edward         ProHealthCare - Waukesha Memorial Hospital

Pandl, Therese         St. Mary's Hospital Medical Center

Petasnick, William         Froedtert Memorial Lutheran Hospital

Radoszewski, Pat         Children's Hospital of Wisconsin

Reynolds, Sheila         Children's Hospital of Wisconsin

Richardson, Dana         Wisconsin Hospital Association

Robertstad, John         ProHealth Care - Oconomowoc Memorial Hospital

Roller, Rachel         Aurora Health Care

Sanders, Michael         Monroe Clinic

Sanders, Robert         Children's Hospital of Wisconsin

Size, Pat

Stanford, Matthew         Wisconsin Hospital Association

Titus, Rexford         ProHealth Care

Troy, Peggy         Children's Hospital and Health System

Turkal, Nick         Aurora Health Care

Warmuth, Judith         Wisconsin Hospital Association

Westrick, Paul         Columbia St. Mary's Milwaukee Hospital

Contributions Ranging from $2,000 - $2,999  

Brenton, Mary E.

Buser, Kenneth         Wheaton Franciscan Healthcare - All Saints

Desien, Nicholas         Ministry Health Care

Erwin, Duane         Aspirus Wausau Hospital

Katen-Bahensky, Donna

Oliverio, John         Wheaton Franciscan Healthcare

Quinn, George         Wisconsin Hospital Association

Starmann-Harrison,         Mary SSM Health Care-Wisconsin

Tyre, Scott         Capitol Navigators, Inc

Contributions $3,000 and up  

Borgerding, Eric         Wisconsin Hospital Association

Brenton, Stephen         Wisconsin Hospital Association

Size, Tim Rural         Wisconsin Health Cooperative

On November 19, Reedsburg Area Medical Center President Bob Van Meeteren hosted a meeting with Sen. Dale Schultz to discuss the state’s impending 10 percent cut in Medicaid payments to critical access hospitals. Van Meeteren was joined by colleagues from the 17th Senate District, including Nicole Clapp, president/CEO, Grant Regional Health Center, Lancaster; Phyllis Fritsch, administrator, Upland Hills Health, Dodgeville; and John Russell, administrator, Boscobel Area Health Care.

As part of its effort to slash more than $600 million from the Medicaid program, the Wisconsin Department of Health Services is poised to beginning cutting Medicaid payments to rural hospitals on January 1, 2010. Without quick action to restore the cuts, the impact for some rural areas could be devastating.

"Rural hospitals are vital to their communities and often provide services well beyond the four walls of the hospital—these cuts could be devastating to those efforts," said Reedsburg’s Bob Van Meeteren. "Sen. Schultz has always been a strong supporter of rural health care, and we were pleased to have him in the hospital to hear our concerns."

Debate over health care in Washington is sure to intensify in the coming weeks as the Senate prepares to take up its version of reform legislation. Almost daily, key elements are being tweaked, turned and twisted in an effort to find the 60 votes necessary to pass something out of the Senate and get to a conference committee. The horse-trading is intense, as evidenced by the state-specific Medicaid funding "deals" being cut to court fence-sitters. As that vote gets closer the stakes are rising for everyone, but especially for innovative states like Wisconsin that have already made significant investments of time, effort and money to cover their uninsured populations.

Improving access to coverage for the uninsured is the most fundamental and widely shared goal of health care reform. Both the House and Senate bills rely on expanding Medicaid eligibility as a primary means to achieve this end. The proposals differ in some respects (and the Senate’s bill is still pending), but both would expand coverage by increasing Medicaid eligibility to persons earning in the range of less than 130-150 percent of the federal poverty level (FPL).

Medicaid is financed jointly by state and federal governments, and as part of the expansion deal the feds would pick up a greater share of the funding for what appears to be "newly eligible" Medicaid enrollees. Sounds simple enough and quite attractive to states like Wisconsin where skyrocketing Medicaid enrollments are busting budgets.

But here’s the catch—it’s unlikely there will be many, if any, "newly eligibles" in Wisconsin. Why? BadgerCare, BadgerCare Plus, BadgerCare Core (and now possibly BadgerCare Basic) are Wisconsin-specific variations of Medicaid that already expand coverage to the uninsured via income thresholds higher than those included in either bill. Over a decade ago, Wisconsin began expanding Medicaid to targeted, uninsured residents. These forethoughtful efforts are partly responsible for Wisconsin having the second lowest rate of uninsured in the country and 98 percent of our residents having access to some form of health insurance. But most states have been far less proactive.

In Wisconsin, a person is eligible for one of the BadgerCares if their income is less than 200 percent of the FPL (300 percent FPL under certain circumstances and all children are eligible). That’s already substantially higher than what is being proposed in Washington, and well above most other states. But it appears there will be little, if any, benefit for Wisconsin and the handful of states that didn’t wait for Congress to address their uninsured problem.

Not being rewarded for these efforts is one thing; being essentially penalized for them is another. The dollars used to pay for these expansions will come in part from deep (and getting deeper) reductions in Medicare payments to hospitals. For Wisconsin, those cuts could be in excess of $3 billion over ten years, undoubtedly higher if the actual cost of health care reform goes over budget. Bottom line—the table is being set for billions of dollars to be taken out of Wisconsin to fund coverage expansions in other parts of the country. It’s a realization that has many health care leaders and policymakers in the BadgerCare State feeling a bit "out on a limb."

Wisconsin has long been a "donor state"—we send more tax dollars to Washington than we get back—and it’s looking like certain aspects of health care reform might exacerbate that problem. I hope I am wrong. There is still a long way to go and many of the details could change, but this is just one example of how proactive states like Wisconsin are being squeezed into a one-size-fits-all approach to national health care reform.

This week, the Assembly Public Health Committee held a hearing on Assembly Bill (AB) 207 relating to patient notification of hospital clinic charges. Committee Chair Representative Chuck Benedict (D-Beloit) is the bill’s author.

AB 207 is similar to a proposal Benedict introduced in the previous legislative session, but the original language in this year’s version imposed far more prescriptive, and costly, notification requirements on hospitals. While a few outstanding issues remain, discussions between hospitals and Benedict and his staff have resulted in significant changes to the bill.

In testimony, Benedict said the bill will ultimately "…create greater transparency within the mystical world of medical billing." His interest in the issue dates back to 2005 and relates to a constituent who was surprised by a hospital clinic bill.

If passed in its current form, AB 207 would require hospitals to orally notify patients at the time an appointment is scheduled that there may be a separate bill for clinic services and, upon the patient’s request, provide a good faith estimate of what that charge may be. Separately, the bill also requires insurers to disclose whether a policy or plan covers a hospital’s charge for clinic services and how that coverage may relate to any deductible amount under the policy or plan.

Testifying at the hearing, Paul Merline, WHA’s vice president, government affairs, thanked Rep. Benedict and his staff for their good faith efforts in working on the details of the proposal and their willingness to incorporate some hospital suggested modifications.

Merline noted that individually, hospitals strive to be as clear and open as possible with patients about services and charges. He said in the area of transparency, Wisconsin hospitals are already leading by example. By publically posting pricing information on the PricePoint Web site (www.wipricepoint.org) and quality measures on the CheckPoint Web site (www.wicheckpoint.org), Wisconsin hospitals continue to prove they are dedicated to providing consumers useful information for making sound decisions about their health care.

In describing hospital charges for clinic services, Merline pointed out that they are simply a fee for services provided by the hospital. This outpatient charge generally covers a broad range of important hospital services, such as nursing and other professional services, pharmacy, electronic medical records and a wide variety of hospital functioning systems. He also said it was important to note that most insurers, public and private, pay for hospital outpatient services.

UW Hospital in Madison and Children’s Hospital in Milwaukee also testified for information and described their current notification practices, which include notifying patients about hospital charges for clinic services. Both also pointed out that with annual patient appointments that reach well into the hundreds of thousands, any new requirements have the potential for significant additional cost impact. Froedtert Memorial Lutheran and Wheaton Franciscan hospitals also submitted written testimony.

Still outstanding is how language in the bill will address multiple required notifications for patients who have already been informed of the hospital charges and who are back for repeat or follow up appointments. Hospitals also believe there is value in the option of direct written or electronic patient correspondence that includes hospital charge information as a tool for patients to check on their coverage.

Discussions on AB 207 continue and the bill will likely be voted on early next year.

The Wisconsin Hospital Association Task Force on Behavioral Health finalized on December 2 the core components of a report of its conclusions, analysis, and recommendations regarding significant mental health policy issues facing hospitals.

Led by task force chair George Kerwin, president, Bellin Hospital in Green Bay, the Task Force discussed four major topics for the report: Access, varying interpretations of mental health laws, emergency detentions, and the role of counties in mental health treatment.

"All of the topics led to a common theme—Wisconsin does not have a consistent and cohesive mental health treatment system and thus care can greatly vary depending upon where one lives in Wisconsin," said George Quinn, WHA senior vice president.

The task force considered 11 recommendations to improve mental health care in Wisconsin. Those recommendations included adding psychiatry to the Wisconsin Council on Medical Education and Workforce priorities, developing education programs on mental health law, encouraging collaboration and best practices between hospitals, counties, law enforcement and others involved in the mental health system, and exploring options to regionalize Wisconsin’s current county-based mental health safety net system.

A report of the task force’s activities will be made to the WHA Board of Directors on December 10, and a final report will be made public in late December or early January.

Two bills (SB 308 and AB 464) that would permit employees who are volunteer emergency responders to be late or absent from work if that lateness or absence is due to responding to an emergency, have been amended and passed out of their respective committees.

Testifying at each bill’s hearing, Judy Warmuth, WHA vice president of workforce development, endorsed the value and importance of volunteers in Wisconsin communities, but explained the possible unintended consequences of these proposals on hospitals. Warmuth testified that "An emergency responder, who is a direct care provider and is late or completely absent from work leaves an unpredicted and unexpected staffing vacancy. That vacancy could have serious implications for patient care. Hospitals employ a significant number of EMT-prepared staff, and the bill would leave them particularly vulnerable to staff shortages."

At the request of WHA, both bills were amended in committee to not apply to employees that provide direct patient care in emergency rooms and intensive care units. The amendments, offered by Sen. Kathleen Vinehout (D-Alma) in the Senate and Rep. Andy Jorgensen (D-Fort Atkinson) in the Assembly ensure that staff scheduled to be on duty will be there to provide emergency and intensive care services to patients.

The bills now move to their respective houses of the Legislature where they are available to be scheduled for a vote.

Travel and education restrictions are common in Wisconsin hospitals these days, especially for out-of-state and national conferences. However, there is still an important need to provide professional leadership training to your physician leaders. For 2010, consider WHA’s proven, in-state option for physician leadership development training, offering high quality education at about one-half the cost of the national programs, with less travel expense and less time out of the hospital and away from practice.

The fifth annual WHA "Physician Leadership Development Conference" is scheduled Friday, March 12 and Saturday, March 13, and registration is now open. This year’s event will again be held at The American Club in Kohler. The full conference brochure, with final agenda, registration and resort information, is included in this week’s packet.

This popular conference offers nationally-recognized faculty to assist in developing physician leadership skills and facilitating the transition of your physicians from clinicians to physician leaders. Physician leaders must represent both clinical and managerial interests, and each year at this event, presenting faculty from the American College of Physician Executives (ACPE) focus on important leadership skills that help physician leaders to move beyond their clinical training and take a new approach to managerial decision-making and problem solving.

Each year, attendees express to WHA 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 2010 conference.

A discounted "early bird" registration fee is available to those registering by January 22, as well as a group discount to those registering early. Additionally, a "host" registration option 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 provide 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.

Dave Dobosenski will assume the CEO position at St. Croix Regional Medical Center (SCRMC), replacing Lenny Libis who is retiring in mid-December. Dobosenski began his new role November 2.

Dobosenski has worked as the chief operating officer for Fairview Lakes Health Services based out of Wyoming, Minnesota since 2000. His previous positions include regional assistant administrator for Fairview Northland Health Services in Princeton, Minnesota, quality improvement consultant and senior management engineer for Fairview Hospitals and Health Care Services in Minneapolis.

Dave has a Baccalaureate of Science in Industrial Engineering from St. Cloud State University and a Masters of Business Administration from St. Thomas University.

After nearly nine years as CEO of St. Croix Regional Medical Center (SCRMC), Lenny Libis will retire December 18.

Libis holds an MBA degree and served as the River Valley Medical Clinic Administrator from 1988-92. He subsequently worked for Allina Health Systems for nine years prior to becoming interim CEO of the newly merged St. Croix Regional Medical Center in November 2001. He served as interim until April 2002 when he became the CEO. Libis is also past president of WHA’s West Central region.

Libis has a passion for providing excellent patient/customer service. Under Libis’ guidance, SCRMC has expanded the medical specialties available in its hospital and clinics. Since 2001, the medical center’s entire physical infrastructure has been under renovation along with the construction of a new clinic, surgery center, and helipad. In addition, Libis has always emphasized that SCRMC is part of the community it serves and that it has responsibilities to that community. "We try to use local businesses whenever possible," said Libis.

"Since I’m retiring at the end of the year," Libis concluded, "I would like to say that I have very much enjoyed working for this Medical Center. It’s been a privilege and an honor. . . and a great way to end my health care career. I’ve been very fortunate to work with so many wonderful and competent people, and to see that we have been successful in achieving what we set out to accomplish."

"Thank you so much. This is a big help for me and is deeply appreciated."

Those are the words scrawled at the bottom of a letter that the Richland Hospital received in response to a patient application that was approved for a 100 percent adjustment on the balance of their account.

Shirley Smith (name changed to protect confidentiality) is a 79-year-old senior citizen who broke her hip in 2008. With only Medicare to pay for her surgery and stay, Shirley didn’t know how she would be able to make ends meet.

On a fixed income without any assets, options were few. "I didn’t know how I would be able to pay for it all," she said.

"The surgeon did a great job and I have made a good recovery," Shirley said. "I am back home today and feel really good."

Charity Care at the Richland Hospital is designed for individuals who do not have health insurance or worry that they may not be able to pay for part or all of their care. The Richland Hospital, Inc. may be able to provide charity care to patients based on their income, assets and financial needs. In addition, we may be able to help you apply for insurance coverage through the State Medical Assistance Program or to work with you to arrange a manageable payment plan.

If Dawson had been born just six months earlier, he might not be the smiling one-year-old he is today.

You’d never know by looking at the happy toddler that Dawson has a rare disease that is fatal if not caught early. He has a severe cellular immunodeficiency, officially, leukocyte adhesion deficiency III. His white blood cells do not work effectively—meaning a simple cold or flu bug could be devastating.

That’s why investigators at Children’s Hospital of Wisconsin identified the need to add a test to Wisconsin’s newborn screening panel for severe combined immunodeficiencies (SCID), commonly known as the "boy in the bubble" disease. SCID received widespread attention in the movie, "The Boy in the Plastic Bubble," when John Travolta portrayed a boy with the disease. The symptoms appear as colds or infections and caregivers and physicians may not diagnose SCID unless they see the larger trend of infection problems. Investigators soon discovered that the test not only detected SCID, but other primary immunodeficiencies.

However, adding the test not only entailed years of testing complemented by the brain power of the physicians at Children’s Hospital and the Wisconsin State Laboratory of Hygiene, where the test is performed, it also required funding. With the help of the Jeffrey Modell Foundation, an organization dedicated to raising awareness about SCID, Children’s Hospital provided the funding to get the project going.

"As physicians, we saw the need for this test. If SCID and other serious immunodeficiencies are caught early, they can be cured in 95 percent of cases. If it’s not, they usually are fatal – which leaves parents devastated, not understanding what happened to their child," said Jack Routes, MD, medical director of Allergy and Clinical Immunology at Children’s Hospital. "When we proposed our idea, hospital administrators didn’t question it. Their attitude was that if there was a need for our kids that we could fill, we’d find the money to cover it. There was no question."

In 2008, Children’s Hospital invested more than $13 million in research to help improve the lives of children and their families through translational research projects such as the newborn test. From new discoveries in hemophilia to early identification of juvenile diabetes, the goal of investigators at Children’s Hospital is to find life-saving cures and treatments for children.

Fortunately, Dawson was born at a time when this type of disease could be identified, saving his life. "We didn’t even know what he was being tested for," said Melissa, Dawson’s mother. "We knew about the newborn screening test, but we didn’t know about the additional test. I can’t think about what could have happened to him if the test hadn’t been there when he was born."