With just weeks left before year end, the 2007 Wisconsin Hospitals Political Action Fundraising Campaign has surpassed its goal to raise $195,000, to date raising almost $197,000—more than $10,000 over last year’s record total.

"This is the most that the fundraising campaign has ever raised in a single year and represents an increase of more than $135,000 in just six years," said WHA Advocacy Committee Chair Mary Starmann-Harrison from SSM Health Care-Wisconsin. "I want to personally thank all of the individuals around the state who participated in our campaign and my fellow Advocacy Committee members who really stepped up to the plate in recruiting new contributors."

Starmann-Harrison also noted that WHA staff contributed almost $25,000 to the effort.

While the campaign was busy raising money in a non-election year, it was equally busy disbursing dollars to candidate campaigns all across the state. To date in 2007, the campaign has disbursed over $110,000 to candidates who understand the valuable role that individuals affiliated with hospitals play in their communities!

Some other interesting facts about this year’s record breaking 2007 Campaign.

• 627 individuals participated in this year’s Campaign—a new record!
• The average contribution was $315 in 2007—almost a 6 percent increase from 2006.
• Individuals from 102 hospital/hospital systems have contributed—a 19 percent increase from 2006.

A final listing of contributors to the 2007 fundraising campaign will be published in the December 14 edition of The Valued Voice. For more information about the Campaign, contact WHA’s Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

A bill requiring health care providers and insurers to provide patients with cost information upon request was recently introduced by Senator Jim Sullivan (D-Wauwatosa).

Senate Bill (SB) 337 requires a health care provider to, within a reasonable period of time after the request, provide a consumer with the usual and customary charges, assuming no complications, for the health care service performed by the provider that the consumer specifies.

In addition, upon request, the health care provider must provide the consumer with the usual and customary charge, assuming no medical complications, for each of the 50 health care services most frequently performed by the provider. Further, insurers must provide a good faith estimate of the insured’s total out-of-pocket cost for the specified service. Any cost estimates are not to be construed as legally binding.

WHA staff met with Senator Sullivan’s office and made suggestions on improving the bill.

Companion legislation to SB 337 is also being introduced in the Assembly by Representatives Steve Wieckert (R-Appleton) and Terry Moulton (R-Chippewa Falls). WHA continues to discuss the advances in pricing transparency hospitals have made, and meetings regarding transparency legislation continue with the Legislature.

The Governor’s eHealth Care Quality and Patient Safety Board on December 4 recommended amending Wisconsin’s medical record laws in Chapter 146 (general health care records) and §51.30 (mental health records). The amendments would remove barriers to electronic health care records and the electronic exchange of health care information among health care providers.

"We need to modernize statutes that were based on a paper environment," eHealth Board Chair and Health and Family Services Secretary Kevin Hayden told the eHealth Board. "Health care in Wisconsin…is clearly moving towards an electronic medical record format. We have to have the statutes move with the environment."

The eHealth Board adopted four recommendations developed by workgroups convened by DHFS in which WHA actively participated. The recommended statutory amendments would ease restrictions on redisclosure of health care records, reduce unnecessary documentation requirements, reduce barriers to sharing information with family members involved in the care of a patient, and permit a limited exchange of mental health information among providers for treatment purposes. Additional detail on the recommendations can be found at www.wha.org/legalAndRegulatory/Statutes146and51.30.pdf.

"The eHealth Board’s recommendations are a positive step toward the goal of achieving widespread use of interoperable electronic medical records," said Catherine Hansen, director, health information services, St. Croix Regional Medical Center, and a member of the eHealth Board. "A lot of work and a lot of perspectives went into developing these recommendations."

Secretary Hayden called the recommendations forwarded by the workgroups a "compromise consensus," and told the eHealth Board that DHFS will continue to work with stakeholders as the recommendations are drafted. Some privacy advocates have suggested that additional restrictions should be placed on the exchange of mental health information, while health care providers felt that the changes did not go far enough to facilitate electronic mental health records and the exchange of such records among providers for coordination of care.

The eHealth Board was told that the Governor will be introducing legislation in early 2008.

Secretary Hayden also stated that DHFS would continue to work with WHA on additional changes to §146.81 -.84 that could be incorporated with the four recommendations adopted by the eHealth Board. These additional changes to §146.82 stem from draft language to modernize §146.81 - .84 created by a WHA-convened workgroup of attorneys, privacy officers, and health information managers just prior to the initiation of the Governor’s eHealth initiative.

"I am very pleased that the Secretary is committed to working with WHA on these important additional changes to 146.82," said Hansen.

The eHealth Board also received information on other eHealth related issues, including short presentations on funding sources for provider IT adoption, preliminary exploration of a statewide Health Information Exchange infrastructure, Sen. Sullivan’s disclosure bill (see article "Health Care Pricing Transparency Proposal Introduced" above), and DHFS plans for educating consumers about eHealth.

The Board also received a report on electronic medical record adoption in Wisconsin. See "Physician Use of Electronic Medical Records Higher in Wisconsin Than U.S." below for additional information on the report.

In March, the curtain will essentially close on the 2007-08 legislative session. While the first 12 months of the session have been marked by delays, partisan fighting and a grossly overdue state budget, the remaining months will be hectic and fast paced. Legislators and lobbyists will work overtime to achieve their priorities before the Legislature calls it quits and moves on to the November elections—and WHA will be no exception.

Several important issues remain to be addressed in these final months of the session. Below is a summary of just a few.

Medicaid Reimbursement: The recently concluded state budget is the seventh straight with no increase in Medicaid payments for hospitals. If nothing changes, the end of 2008 will mark the fourteenth year in which hospital medical assistance (MA) payments have either essentially remained stagnant or been cut. But will nothing change?

There is talk of reviving the failed hospital assessment as separate legislation. Nothing concrete has emerged, but there is clearly interest on the part of Democrats and some Republicans in bringing the assessment back this session. Any proposal will face an uphill battle in the Republican controlled Assembly this session, but looking ahead, the next state budget is already on the horizon (agency staff will begin preliminary work around August), and it is very likely to include a hospital assessment.

Whether a new bill is introduced or not, Medicaid will remain WHA’s top legislative priority in 2008 and beyond. With an eye towards 2009, WHA will use the coming months to educate the public and candidates for office about Medicaid and its impact on health care cost and access.

Health Care Reform: Health care costs, and efforts to bring them down, remain a centerpiece issue in the minds of the public and politicians. Recent measures of pubic opinion about health care reform point in a direction of incremental targeted change. While overhauling the health care financing and delivery system does not appear to sit well with most, clearly, neither does the current system. With an election approaching, watch for a flurry of reform proposals to hit the Legislature in the coming months, each claiming to address what the public "wants."

Senate Democrats will bring back their more government-focused Healthy Wisconsin plan next year, with tweaks to address some of the concerns raised during the first round. Republicans will counter with HSAs, transparency and other reforms intended to empower individuals and, ultimately, inject more accountability from patients, payers (insurers) and providers into the system.

There IS an appropriate role for government in health care (Governor Doyle’s incremental and targeted approach with BadgerCare is a good example) AND a need for more consumer involvement in a better functioning marketplace. WHA believes a compromise can and should be reached that melds each of these philosophies without jeopardizing the strengths of, and access to, one of the highest quality health care delivery systems in the country—Wisconsin’s.

However, the notion of consumer empowerment and the purer competition it promises will not work as long as one of the largest players in the system (Medicaid) is paying 54 percent LESS than what it costs hospitals to provide the service. Medicaid underpayment has a disproportionate impact on some health care providers burdened with high MA utilization and the cost shifting that results will continue to skew prices in the market. Reforming health care and Medicaid must go hand in hand.

Will that middle ground be reached in a politically charged election year? Hard to say. But whether health care reform happens in 2008 or waits until the next Legislature is sworn in come 2009, WHA is committed to being an active participant in this important ongoing debate. To this end, our standing Task Force on Access and Coverage will reconvene in January to take stock of the current situation and plan for next steps.

Price "Transparency": Health care cost "transparency" has again become the marquis reform concept for the more "market minded" members of the Legislature. WHA has long embraced the notion of providing consumers with better information about price and quality so they can indeed become wiser "consumers" of health care. Wisconsin hospitals are nationally recognized for their proactive efforts in this area, and many states are looking here for a model. But more is expected and should be accommodated.

At least one piece of legislation has been introduced on this issue (see article, "Health Care Pricing Transparency Proposal Introduced" above), and more are anticipated. Given our proactive approach (the WHA Information Center, PricePoint and CheckPoint), Wisconsin’s hospitals are well positioned to participate in this debate—and we are.

Continuing to Improve Hospital Quality: Health care quality also remains a top issue for WHA. And though Wisconsin is one of the leaders in collecting and publicly disseminating information about hospital quality and safety, here again, more can be done. Fostering cooperation, collaboration and an environment where health care professionals learn from and work to prevent mistakes is the goal of WHA’s Quality Improvement Act (QIA). This bill overwhelmingly passed the Legislature during the 2005-06 session, but unfortunately was vetoed by Governor Doyle. WHA is working with a coalition of health care providers to redraft the QIA in a form that will remove disincentives to quality improvement and hopefully, be signed into law.

While there are just a few months left in the legislative session, there is still much to be accomplished. WHA will remain focused on these and other priorities in 2008 while also looking toward, and preparing for, the challenges on the 2009 horizon.

After passing the full Assembly last month, Assembly Bill (AB) 224, which adds to current immunity protections for good faith reporting of possible law or standard of care violations, received a hearing this week by the Senate Committee on Judiciary, Corrections and Housing.

Sen. Lena Taylor (D-Milwaukee), the Committee Chair, agreed to hold a hearing on the bill after it was received from the Assembly. Testifying in support at the hearing were the bill’s author, Rep. Don Pridemore (R-Hartford), and Michael Berndt, attorney supervisor from the Department of Regulation and Licensing. WHA also submitted testimony in support of the bill.

The Department of Regulation and Licensing supports the proposal because the provisions of AB 224 would allow them to more quickly and efficiently follow up on complaints with fewer patient records being disclosed, and require less impact on providers and facilities that must respond to their record requests.

As previously reported, AB 224 includes an amendment proposed by WHA that added immunity protections for reporting information to any prospective employer of an employee or former employee of a health care provider or facility information related to allegations of violations.

Unfortunately, there have been instances where patients have been put at risk by individuals who have repeatedly violated clinical or ethical standards. By allowing the sharing of that information with prospective employers, without the fear of liability, patients will be protected and quality of care will be improved.

WHA supports the bill as a way to improve and enhance Wisconsin’s already nationally recognized high levels of patient safety and quality of care by encouraging the reporting of violations.

AB 224 would need approval by the Senate Committee on Judiciary, Corrections and Housing before it can be taken up by the entire Senate and forwarded to Governor Doyle for his consideration. A Committee vote is expected soon.

A report prepared for the Governor’s eHealth Care Quality and Patient Safety Board found that Wisconsin is ahead of the nation in physician use of electronic medical records (EMRs). The report also concludes that the greatest barrier to additional EMR use is lack of capital. The report, Wisconsin Ambulatory Health Information Technology (HIT) Survey 2006-2007, was presented to the eHealth Board on December 4.

"The rate of adoption of electronic health records [by ambulatory practice sites] in Wisconsin in 2006-2007 is substantially higher than that reported by a nationwide sample of physicians in 2005," states the report.

The report’s survey found that 36 percent of Wisconsin physicians practice at sites with fully electronic medical records, and over 83 percent practice at sites with at least partially electronic records. This compares to an earlier nationwide study that reported only 11 percent of physicians use fully electronic health records and only 25 percent used at least a partially electronic record. The survey did not address hospital inpatient electronic medical records.

"The high rate of EMR implementation in sites belonging to large multi-site health care systems, combined with the higher than average proportion of clinicians practicing in such large systems, probably partially accounts for Wisconsin’s advanced rate of EMR implementation," states the report.

Among respondents that did not have an EMR, lack of capital was cited as the greatest barrier to EMR implementation. The study noted "impact on productivity during implementation, doubt about the return on investment, the lack of EMR certification, clinician acceptance, and the time needed to implement the EMR," as other substantial barriers to EMR implementation cited by respondents.

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WHA Education: Prepare Your Staff for 2008 OPPS Final Rule Via December 20 Audioconference

Learn the details of the CMS changes for APCs in 2008, including all the key elements and their impact on hospital outpatient billing, without leaving your hospital. On December 20, WHA is offering the audioconference "2008 Outpatient Prospective Payment System (OPPS) Final Rule: What You Need to Know to Prepare Your Hospital" from 9-10:30 a.m. Upon completion, attendees will be able to discuss the implications of billing changes and key areas of impact under OPPS for 2008, evaluation reimbursement changes, and work with clinical departments to evaluate approaches to the 2008 billing requirements.

Register for the 2008 OPPS Final Rule audioconference to educate your entire staff in a short period of time without incurring multiple registration fees or travel expenses. The registration fee includes one toll-free telephone connection to the presentation, so you can gather numerous staff members in one room to "attend" for one economical price. Prior to the event, you will receive dial-in information and supporting materials, which you can distribute to all participants.

For more information about the content or to register, visit the education section of WHA’s Web site at www.wha.org. The fee to participate is $169 per site. Advance registration is required to ensure delivery of instructional materials and call-in instructions, which will be distributed after the registration cut-off date of December 14. For registration questions, contact Lisa Geishirt at 608-274-1820 or email lgeishirt@wha.org.

Experience in a rural medical setting is often required for students pursuing a health care career. For others, the rural experience might not be necessary, but access to a training facility located close to home is important. For both of these reasons, Memorial Medical Center in Neillsville serves as a training facility for students in universities, technical colleges and high schools.

Jason Tischer, a student at St. Mary’s University – Minneapolis Campus, is studying to become a Certified Registered Nurse Anesthetist. To graduate, students must complete clinical, hands-on training in administering pain control measures such as nerve blocks and spinal injections.

"Clinicals are the only way we truly ‘become’ medical professionals, be it nurses or whomever. The real-world education that hospitals provide is what polishes our skills and independence, so it’s key that you open your doors to us," comments Tischer.

Andy Arndt completed his internship in May. Staff in health information service, coding, accounts receivable, and transcription all worked with him, providing job shadowing and hands-on experience. Now graduated from Chippewa Valley Technical College with a degree in Health Information Technology (HIT), Arndt credits his training at Memorial Medical Center with helping him secure employment.

"Initially, the internship showed me how much more was under the umbrella of HIT. It was really important for me to have time in each department to feel capable. All said and done, I’m confident in my skill level, and I know that showed in my interview. That’s the advantage Memorial gave me, so thanks," tells Arndt.

Our high school job shadow program underscores the value of academics in reaching career goals and helps students investigate different career paths. Jenny Schmidt, now a freshman in college, entered our program last year, with a special interest in physical therapy.

"I didn’t do any hands-on patient treatment, but I was right there watching the therapies. I’m lucky to start college with this higher level of know-how, and I’ll take every advantage I can get," explains Schmidt.

Although Memorial Medical Center receives no monetary reimbursement for time spent educating youth, our return on investment is solid. We play a role in developing a knowledgeable, skilled, and compassionate health care workforce – from which an untold number will benefit.

Donna Katen-Bahensky, CEO at University of Iowa Hospitals and Clinics and senior associate vice president for medical affairs at University of Iowa Health Care since 2002, has been named president and CEO of University of Wisconsin Hospital and Clinics. She will join the hospital effective February 4, 2008.

"Katen-Bahensky brings a genuine zeal for compassionate, patient-centered care, solid leadership, and a commitment to community service," said Patrick G. Boyle, chair of the UW Hospitals and Clinics Authority Board and UW regent emeriti. "She also understands that quality patient care is enriched and advanced through partnerships within the medical sciences center, and in her new role will continue her strong commitment to this collaboration."

University of Iowa Health Care consists of the clinical enterprise functions of the Carver College of Medicine, the 650-member University of Iowa Physicians, and the University of Iowa Hospitals and Clinics (UIHC). Prior to joining UIHC, Katen-Bahensky served as executive vice president and chief operating officer at the Virginia Commonwealth University Health System and Medical College of Virginia Hospitals and Clinics, where she oversaw operations for a 750-bed hospital and more than 80 outpatient practice sites.

Katen-Bahensky began her career at the University of Nebraska Medical Center, where she rose to hospital chief operating officer after having started as the director of strategic planning and marketing and completing an administrative residency at the University of Michigan Hospitals. She received her B.A. in anthropology and a master’s of science degree in public health administration, with an emphasis in health services management, from the University of Missouri in Columbia.

Aurora Health Care has received national recognition from the Institute for Safe Medication Practices (ISMP) for a unique initiative focusing on medication safety in the medical clinic. The Institute selected Aurora’s Walworth County Patient Safety Council for a Cheers Award, which honors individuals, organizations and companies that have set a standard of excellence for others to follow in the prevention of medication errors and adverse drug events.

The Walworth County Patient Safety Council represents a new approach to the issue of medication safety. Patients and a safety expert from Midwest Airlines joined with Aurora physicians and pharmacists to implement an effort that improved medication safety for local senior citizens. Also working with Aurora on this effort was Consumers Advancing Patient Safety. This project was supported with a grant from the U.S. Agency for Healthcare Research and Quality.

"A key element of our commitment to enhance safety is the involvement of the community, which has helped us to approach our initiatives from the patient’s perspective," said Kathryn Leonhardt, M.D., Aurora’s patient safety officer and medical director of care management.

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