The relationship between hospitals and physicians is evolving because of a number of factors that were described by presenters on December 6 at the Hospital and Physician Business Relationships Seminar in Wisconsin Dells. The way hospitals and physicians are reimbursed, along with changes in how patients are accessing health care services, are forcing changes in the traditional business models.

The landscape is rapidly changing around physicians, according to Michael Sachs, chairman of Sg2. For instance, primary care services are now available in big box retail outlets that post the prices for specific procedures. Along with that, Sachs said, "The $100 deductible is dead; patients are paying considerably more, which is creating empowered consumers."

"Consumers will take control, moving around to different sites and demanding more new technology and making decisions about their health plan, where they will receive a service, and treatment options," he added. "The increases we are seeing in hospital bad debt can be attributed to patients being required to meet higher deductibles," he noted.

Sachs observed that health care delivery is unique to the area where the practice is located. "If you’ve seen one practice, you’ve seen one practice," Sachs said. "There are huge differences in physician practice patterns based on location. Some areas have a lot of multi-specialty clinics, others are single specialty practices," he observed.

Charles Shabino, MD, WHA senior medical advisor, said, "Strong sustainable relationships between physician and hospitals are at the core of successful organizations. These relationships are moving from solely focusing on the organized medical staff hospital venue to include that of business relationships with individual physicians."

Following Sachs, Scott Geboy and Gregg Wallander, both from the law firm of Hall Render Killian Heath & Lyman, provided a high level examination of state-of-the-art physician business models. David Gans from the Medical Group Management Association shared national data on physician compensation models.

Closer to home, a panel of WHA members moderated by Ken Buser, Wheaton Franciscan Healthcare, described how they manage and develop physician relationships. Panelists included: Sandra Anderson, St. Clare Hospital & Health Services, Baraboo; Christine Woleske, Bellin Hospital, Green Bay; Michael Kryda, MD, CEO, Saint Joseph’s Hospital, Marshfield; Loren Meyer, MD, Wheaton Franciscan Medical Group, Racine; and Tom Tiggelaar, Franciscan Skemp Healthcare, La Crosse.

One of the WHA’s major strategic initiatives is to focus on the need for an increasingly closer alignment of physician and hospital agendas. One way WHA plans to contribute to this alignment is to provide forums for hospital senior leadership to explore state-of-the-art strategies for creating and managing business relationships with physicians, as both partners and as competitors. On March 16-17, 2007, WHA will sponsor a Physician Leadership Development Conference at the American Club in Kohler. Information and registration materials will be available soon. (See related story on page 8.)

"Every hospital was founded on community need. Community residents decide there needs to be a hospital and with bake sales and booster buttons, they build it from the ground up," according to Rick Palagi, president/CEO at Sauk Prairie Memorial Hospital. Speaking at the WHA Community Benefit Forum held December 7 at the Kalahari Resort in Wisconsin Dells, Palagi described how providing benefit to the community is supported in his own organization.

"Benefit to the community is about upholding our responsibility and seeing it as the privilege that it is. It is not about meeting public reporting requirements or complying with external rules," Palagi said. "If we do our job right, that is a natural outcome of our work. It is our unique role in society," he added.

Mark Huber, director of community relations at Aurora Health Care, presented several community assessment models that can be used, including:

• Existing data
  • Hospital discharge data
  • Agency data
• Key informant interviews/community forums
• Community health surveys
• Patient surveys
• Healthiest Wisconsin 2010 priorities

Huber said a community needs assessment can assist hospitals in prioritizing and aligning community benefit services with needs expressed by the community. It also documents need for fund development and advocacy and creates opportunities for media coverage and partnership recruitment.

Marathon County Health Director Julie Willems Van Dijk is glad Wisconsin hospitals are increasing the visibility of services and programs that improve the community health status.

Why work together? "The smoking rate in Marathon country went from 33 percent to 19 percent over a 15 year period. Those are the kinds of results that you get when you stick with it," Willems Van Dijk said.

James Shulkin, director of planning and market development at Fort Healthcare described the Rock River Free Clinic that serves Jefferson County. A partnership among the Jefferson County Health Department, Fort HealthCare, and Watertown Area Health Services brought the free clinic to life. When it opened in 2003, it served 665 patients. In 2005, more than 1,300 patients sought care at the clinic. Shulkin, who recently visited the clinic, talked to several patients and one declared, "They saved my life!" Shulkin said dental services would be available at the clinic soon, as well

Lacking a PR or marketing department, Schafer named a project champion and identified her as the contact person for the collection of community benefits in the hospital. "If she had questions about what counted or how to report it, we found that WHA was always there to answer questions. For a small hospital, that was extremely helpful," said Schafer.

Carol Ryczek, Shawano Medical Center, and John Hofer, Bay Area Medical Center in Marinette, echoed Schafer’s sentiment about the need for top down support for gathering the data. Ryczek shared the excel spreadsheet that she uses to catalog activities that are later transferred to the WHA online survey, emphasizing that simple tools can be used to organize data. Keep employees involved in the process was Hofer’s advice, and encourage them to share their stories

Annette Grunseth from St. Mary’s Medical Center in Green Bay is the "resident storyteller" at St. Mary’s. This is a role she is happy to fill, because it brings her closer to the employees who are at the frontlines of patient care, as well as to the patients that the hospital serves. She shared a story gathering "map" that included tips on how to cultivate stories within the hospital.

Anne Ballentine, Wheaton Franciscan Healthcare, brought it all together by telling the audience how WFH shares their community benefit report in the community. She said they distribute their community report to human service and local health agencies, elected officials, and other key stakeholders in their service area. Ballentine joked with group, saying, "I know I haven’t done my job if we have reports left over at the end of the year!"

WHA Senior Vice President George Quinn outlined the Association’s 2007 goals related to community benefit reporting, which are:

• Maintain 100 percent participation in ServePoint

• Enhance member capability in the areas of communication, data gathering and program development

• Increase statewide visiability of hospital community benefits activities

In early 2007, additional training on the online survey tool will be offered by WHA. WHA will continue to collect and publish hospital community benefit stories for publication in the weekly newsletter and will post them on www.wiservepoint.

return to top

An article featured in the November edition of Health Affairs exposed the challenging conundrum facing public policymakers on the difficult issue of taming sky-rocketing health care costs.

The featured article, "Exploring the Public’s Views on The Health Care System: a National Survey on the Issues and Options" came to the not so startling conclusion that Americans favor health insurance benefit and coverage expansion, but are appalled at the notion of paying more for their health care. Consumers overwhelmingly want to retain choice of health plans, choice of physicians and hospitals, and have full coverage for all routine expenses without sharing the financial burden associated with higher deductibles and co-pays. The notion of being asked to "shop" for health care services is not a popular concept.

While hardly startling, these findings expose the potential political fire-storm that will be fanned by any attempt to close down the "open bar at the wedding" health care delivery and financing system that most consumers… especially consumers who vote… currently enjoy.

There is little debate that the number one cost driver for heath insurance premiums is the exploding utilization of health care services, especially diagnostic testing, ambulatory procedures, and prescription drugs. Driven in part by the early onset of chronic disease, new medical technologies and pharmaceuticals are increasingly making it possible to treat just about anything and/or effectively manage the chronic disease process. It is this health care utilization cost driver — not greedy hospitals, doctors and insurance companies, not drug company oligopolies, and not the absence of a health insurance mandate on small employers that is driving the health insurance affordability issue.

Most health reform initiatives currently in play nationally and in Wisconsin contain some element of shared responsibility on the part of health care consumers. That basically means that consumers should be involved in responsibly managing their own health care and paying a portion of their health care bill. The Health Affairs study confirms that a significant majority of the public increasingly view health care as an entitlement that they have little interest in personally paying for. That public sentiment, ripe to be energized by political rhetoric, will make meaningful health reform a difficult public policy debate.

Steve Brenton, President

return to top

The WHA Task Force on Pricing and Billing, chaired by Tom Bayer, assistant administrator, St. Vincent Hospital, Green Bay, met on December 5. The charge of the Task Force is to evaluate current Wisconsin hospital billing and collection practices and price transparency and recommend a set of guidelines to the WHA Board.

Relative to billing and collection, the Task Force will update the Association’s 2004 Uncompensated Care Guidelines, with particular emphasis on five areas:

On transparency, the Task Force will:

The Task Force will meet again in January to finalize a set of recommendations to the Board.

return to top

The Wisconsin eHealth Care Quality and Patient Safety Board has submitted its Wisconsin eHealth Action Plan to Governor Jim Doyle.

The Board, which was created by Governor Doyle in November 2005, was challenged to help achieve statewide adoption of electronic health records and information exchange to enable better, safer and more efficient patient care. One of the responsibilities of the eHealth Board was to develop a five-year Action Plan to implement the needed statewide health information infrastructure.

Although the recommendations in the Action Plan could improve quality of care and patient safety if fully implemented, they will require a philosophical shift in such important matters as how providers are paid, who and what drives technology, who owns a patient’s medical record, and who has access to patient-identifiable data. Implementation of the Action Plan will present issues related to legislation and policy, the upcoming state budget, hospital budgets, and other hospital operations. The Action Plan acknowledges that there are substantial financial barriers that may frustrate the widespread adoption of e-health technologies.

Wisconsin hospitals are well represented on the eHealth Quality and Patient Safety Board by Gary Bezucha, FACHE, administrator, Boscobel Area Health Care; Catherine Hansen, RHIA, director, health information services, St. Croix Regional Medical Center; and Debra Rislow, CIO and director of information systems, Gundersen Lutheran. WHA staff participating in the workgroups were Steve Brenton, Governance Workgroup; Dana Richardson, Patient Care Workgroup; Laura Leitch, Solutions Workgroup; and Debbie Rickelman, Information Exchange Workgroup.

A full copy of the Action Plan is available at http://ehealthboard.dhfs.wisconsin.gov/.

return to top

Citizen Action of Wisconsin, a non-profit organization with a history of false accusations against hospitals and health care providers, has admitted that it falsely represented the operations of Ridgewood Care Center in Racine in a political ad sent to voters.

In a letter sent to Ridgewood Care Center, a county-owned nursing home, Linda Honold, deputy director of Citizen Action of Wisconsin, "apologize[d] for the error committed by Citizen Action of Wisconsin in a mailing that we sent out that referenced the Ridgewood Care Center." In the letter, Honold blamed the error on Citizen Action’s use of "research data that was incomplete."

The mailing, which was sent during the state Senate race between Racine County Executive Bill McReynolds and Senator-elect John Lehman, accused McReynolds of cutting staff at the Ridgewood Care Center and using inmates from the county jail to take care of the elderly.

According to Citizen Action’s letter, it now understands that "the positions in question were three jobs in the laundry of the facility." The positions are filled as part of a work-release program which employs nonviolent female inmates in the facility’s laundry.

"Citizen Action’s lies not only damaged Ridgewood’s reputation, but they also caused unnecessary apprehension for Ridgewood residents, their families, and the random recipients of (the group’s) mailing," said Ridgewood Administrator Fran Petrick in a press release obtained by the Racine Journal Times.

Citizen Action’s apology letter dated November 21, came almost a month after the Racine Journal Time’s October 25 article, "Anti-McReynolds flier makes for nice reading but there’s a problem — it’s not true," which called Citizen Action’s mailing "a fabrication." In that article, Darcy Haber, program and communications director for Citizen Action, defended the flier saying that their purpose is to "convince any public official out there that this is not a good decision to make."

This is not the first time Citizen Action has printed unsubstantiated claims against health care providers in Wisconsin. In its August 2005 press release regarding medical malpractice caps, Haber called a poll conducted by Public Opinion Strategies "utterly bogus" when it showed overwhelming support for caps. Again without providing any support for its statement, Citizen Action went on to state that "there is absolutely no experience or evidence that would show that there is any correlation between malpractice rates and whether or not Wisconsin has a cap in place."

return to top

The Wisconsin Hospital Association is pleased that the Wisconsin Department of Health and Family Services, at the urging of WHA, worked with Promissor to provide more convenient fingerprinting services for health care job applicants in Shawano County.

Beginning in March 2006, the Wisconsin Department of Health and Family Services began to implement a federal pilot program that, per DHFS’s proposed program, requires long term care entities, including hospitals with swing beds, in four counties to conduct fingerprint-based federal background checks. The four pilot counties are Dane, Kenosha, La Crosse, and Shawano.

DHFS entered into an agreement with the Department of Administration and Promissor, a private vendor, to provide fingerprint-scanning services in the pilot counties. The fingerprint scanning services were available in Dane, Kenosha, and La Crosse Counties. The services, however, were not available in Shawano County, meaning that job applicants in Shawano had to drive over 30 miles to either Green Bay or Wausau. In May 2006, DHFS stated that, "Since many of Wisconsin’s more rural counties would not be located near a fingerprint capturing facility if this were a federal requirement, it is extremely important to measure the impact of such a policy on a rural county such as Shawano. . . . [R]est assured that we are noting this significant challenge."

The WHA continued to work with DHFS to resolve this significant burden for job applicants in Shawano, pointing out that increasing the burden for applicants adds to the challenges of an already difficult recruitment process. WHA recently received word that Promissor will be providing fingerprint-scanning services in Shawano County through a mobile unit. WHA is pleased that this issue has been resolved.

return to top

This week, U.S. Senate Finance Committee Chair Chuck Grassley (R-Iowa) and Ranking Democrat Senator Max Baucus (D-Mont.) unveiled a bipartisan compromise to address a number of tax, trade and health issues, including physician payments under Medicare. The Senate proposal appears to be the framework for a Senate and House health care package that was announced December 7.

The compromise proposal provides a one-year, zero percent update for physician payments for 2007. This action would stave off a five percent cut in physician payments for 2007. WHA President Steve Brenton found this week’s compromise encouraging.

"WHA’s position has always been to oppose the physician payment cuts," said Brenton. "We are encouraged by this compromise if the physician payment freeze is appropriately funded."

The compromise package also includes the following:

In the spirit of the recent Thanksgiving holiday, the WHA Foundation would like to thank those organizations and individuals who have already contributed over $35,000 to this year’s fundraising campaign. Additionally, the Foundation would like to recognize UW Hospital & Clinics and WHA Financial Solutions*, the most recent Champion Donors.

In that same vein, as we enter the season of giving, the Foundation asks those who have not yet contributed to consider making a contribution to its annual fundraising campaign.

Currently, nearly 40 Wisconsin hospitals are employing one or more WHA Foundation Scholars Program scholarship recipient; 77 different hospitals took advantage of the Foundation-sponsored Nurse Leadership Succession project in 2006; and 24 hospitals have received recognition and financial support through the Foundation’s annual Global Vision Community Partnership Award. If your hospital has been directly affected by one or more of the Foundation’s initiatives, we ask they you consider giving back. Make a donation to help cover a scholarship, give a nurse the opportunity to learn more about becoming a nurse leader, or assist one of the many important initiatives to be funded by the Foundation in 2007.

• Columbia St. Mary’s, Milwaukee

• UW Hospital & Clinics, Madison

• WHA Financial Solutions, Madison *

• Agnesian HealthCare, Fond du Lac

• Amery Regional Medical Center, Amery

• Divine Savior Healthcare, Portage

• Flambeau Hospital, Park Falls

• Hayward Area Memorial Hospital, Hayward

• SSM Health Care of Wisconsin, Madison

• St. Vincent Hospital, Green Bay

• Wisconsin Hospital Association

• St. Nicholas Hospital, Sheboygan\

• Loren Anderson, Aurora Health Care – Southern Region

• Jenny Boese, Wisconsin Hospital Association

• Steve Brenton, Wisconsin Hospital Association

• Jennifer Frank, Wisconsin Hospital Association

• Mary Kay Grasmick, Wisconsin Hospital Association

• Brian Potter, Wisconsin Hospital Association

• Judy Warmuth, Wisconsin Hospital Association

• Eric Borgerding, Wisconsin Hospital Association

• Dan Hymans, Memorial Medical Center, Ashland

• Tom Plantenberg, Friends of Froedtert, Milwaukee

• Terri Richards, Saint Joseph’s Hospital, Marshfield

• Kevin Stranberg, Memorial Medical Center, Ashland

return to top

In 2006, WHA offered its first "Physician Leadership Development Conference" with sold out attendance, a waiting list of 20, and positive feedback from attendees. Due to both the success of the 2006 event, as well as the continued member requests for tools to assist with identifying, educating and nurturing physician leadership, WHA will once again offer this conference in 2007.

The second annual "Physician Leadership Development Conference," for both new and potential physician leaders, is scheduled Friday, March 16 and Saturday, March, 17, 2007, at The American Club in Kohler, Wisconsin. The full conference brochure, with the final agenda, registration and resort information, will be available by the end of December, both via WHA’s newsletter and on the Web site. Hospital executives and medical staff leaders are encouraged to think about a new or potential physician leader in your organization who would benefit from attending this conference, as well as discussing the 2007 conference with your physician leader who attended the 2006 event.

The intent of this conference is to offer reputable, CME-qualifying education necessary to develop physicians’ leadership skills and make the transition from clinician to physician leader at both a reasonable price and with more limited travel time and expense than the national conferences. Feedback from 2006 attendees was extremely positive and showed overwhelming support to continue the conference as an annual event, for both new and repeat attendees.

The most interesting observation, both formally via the attendee evaluations and anecdotes from those in attendance, was the value of attending the conference as a team – physician leader and management leader – allowing for invaluable informal, one-on-one conversation during the one-and-a-half day event. This opportunity will once again be available at the 2007 conference as well.

The 2007 conference agenda will focus on the topics of quality and patient safety, and aspects of health law, which are different topics than at the 2006 event but they were chosen based on the feedback from the new physician leaders in attendance in 2006. Those who attended in 2006 are once again encouraged to continue their education as a physician leader, and those who may be attending for the first time will find it invaluable as well. Once again, WHA expects the 2007 event to be a great setting for physician leaders and hospital administrators to attend the event together and take advantage of the opportunity for some informal, one-on-one discussions.

For more information on this conference, contact Jennifer Frank at 608-274-1820 or via email at jfrank@wha.org.

return to top

They’re not wearing the uniform but they can be found close to the field at the home football games in Platteville. Their three-point shot isn’t too sharp but they rarely miss a home basketball game at Cuba City High School. They are not coaches but the team looks to them for expert advice on how to maximize their playing potential – particularly when someone has a health concern or injury. They are Certified Athletic Trainers and for the past two years, these Southwest Health Center professionals have been providing a vital service to the sports teams at both the Platteville and Cuba City High Schools.

Abby Thibadeau and Julie Grabandt have been key partners of the school’s teams and are familiar faces to their fans. The assigned athletic trainer attends practice sessions and home games for football, basketball, soccer, volleyball, wrestling, track & field in addition to baseball and softball for both Cuba City & Platteville. In their role as Certified Athletic Trainers, they evaluate, advise and treat these athletes to assist them in recovering from and preventing injuries.

According to Scott Statz, Platteville High School’s Football Coach, the service that these athletic trainers provide is invaluable. "Abby’s real honest with the kids. There’s a difference between a kid having a minor injury and one who has an injury serious enough to keep him or her out of the game. The student athlete and I don’t necessarily know the difference but she does. . .and we trust her judgment 100 percent."

Prior to January, 2005, these athletic training services were provided by an area medical clinic but a reorganization led to their discontinuation of that service. Both Cuba City and Platteville High Schools appealed to Southwest Health Center to fill the gap. Southwest Health Center provides these training services at no charge and the schools pick up the related cost of supplies and equipment.

Recognized by the American Medical Association as allied health professionals, athletic trainers specialize in the prevention, assessment, treatment, and rehabilitation of musculoskeletal injuries. They also may be involved in the rehabilitation and reconditioning of injuries. They help prevent injuries by advising athletes on the proper use of equipment and applying protective or injury-preventive devices such as tape, bandages, and braces. Injury prevention often includes educating people on what they should do to minimize their risk for injuries.

Southwest Health Center’s athletic trainers work under the supervision of Dr. Kevin Carr, a local Dean Care physician, and in cooperation with other local health care providers. For athletes, athletic trainers also provide a vital communication link between the injured athlete, the physician, the coach, and sometimes the athlete’s family, to determine when it’s right to return to practice and play.

Providing these athletic training services is a true example of a community partnership. It is just one of the many ways in which Southwest Health Center supports the health of our communities. The program has had a positive influence on hundreds of student-athletes in our communities. "Our involvement and support of the athletic training at our local schools is a vital step toward promoting good health to our young community members. We see this program as a wise investment in the future health and wellness of our young people," said Anne Klawiter, president and CEO.

return to top

Navigating the complexities and almost constant changes in health care and insurance reimbursement is a great challenge for anyone. But for senior citizens, the task can be especially frustrating. St. Clare Hospital in Baraboo created GoldenCare, a free membership program for adults age 60 and older, as a resource for seniors. Golden Care advisor Lois Luethy has been a tremendous asset in providing critical assistance in a warm, compassionate and positive manner. The following is a typical letter from a GoldenCare member praising her skills:

Here is another story as observed by a co-worker: "One day not long ago I watched amazed when a GoldenCare member came to see Lois for what I assumed was insurance, Medicare or billing advice. Instead the elderly man broke into tears when she greeted him. He had come to Lois because he had nowhere else to go. He had no family and lived alone. He had been ill for several days and didn’t think he could afford to see a doctor, and now he was turning to the only person he knew that could help him. And Lois immediately went into action to get this dear man the care he needed."

Stories and letters like these not only highlight the importance of her work, but also her persistence and dedication to serving as a health care advocate for the 3,622 GoldenCare members in her charge.

On October 18, 2006, the Internal Revenue Service announced cost of living adjustments applicable to dollar limitations for pension plans and other items for Tax Year 2007.

Section 415 of the Internal Revenue Code provides for dollar limitations on benefits and contributions under qualified retirement plans. It also requires that the Commissioner annually adjust these limits for cost-of-living increases. Many of the pension plan limitations will change for 2007. For most of the limitations, the increase in the cost-of-living index met the statutory thresholds that trigger their adjustment.

See this month’s Solutions Spotlight,included in this week’s packet, for a summary of the 2007 limits, or contact a member of WHA Financial Solutions’ retirement team at 800-362-7121 for more information.

return to top