On December 5, 2005, the U.S. Court of Appeals for the 7^th Circuit struck down a Milwaukee County ordinance, commonly referred to as the Labor Peace Ordinance, which was enacted in 2000 by the then-County Executive Tom Ament and the County Board of Supervisors. Among other things, this ordinance mandated that all county human service organizations having a contract with the county for $250,000 or more must allow labor unions to attempt to organize the human service employers’ workers without the employer interfering. Names, home addresses and home phone numbers would have to be provided to union organizers as well as a room in the employer’s place of business for union officials to meet with workers.

The three-judge panel of the 7^th Circuit Court of Appeals reversed an earlier decision by U.S. District Judge Lynn Adelman. Judge Adelman had ruled in favor of Milwaukee County by dismissing the legal challenge brought forth by the plaintiff, the Metro Milwaukee Association of Commerce and the coalition of the human services’ members of that organization. WHA’s Bill Bazan represented the Milwaukee County health care systems at meetings of the coalition. Milwaukee health system leaders committed significant financial resources to the legal efforts led by attorney Jonathan Levine of Michael Best and Friedrich.

"Had this ruling been upheld by the 7^th Circuit," says Bill Bazan, "the Milwaukee County Board was poised to introduce an amendment to the Labor Peace Ordinance that would extend the ordinance beyond human service organizations to health care organizations. The General Assistance Medical Program (GAMP) of the County, a $38 million safety net program, would have been at risk. All county hospitals participate in GAMP."

Three of Milwaukee County’s health care systems, Aurora, Covenant and Children’s, have significant human service divisions with their respective organizations. Unless labor organizers decide to take this ruling to the U.S. Supreme Court, contracts can now be signed with the County without fear of heavy-handed union organizers coming into their places of business.

"This ordinance was a hugely flawed attempt to prevent employers from educating their employees about collective bargaining issues," said WHA President Steve Brenton. "The Court of Appeals ruling is welcome news."

The Labor Peace Ordinance became a national test case for organized labor. Milwaukee County was chosen by national labor organizations because of its strong union orientation. In addition to the national office of the AFL-CIO, the U.S. Chamber of Commerce and the American Hospital Association had great interest in the outcome of the Court of Appeals ruling.

At its recent meeting, the Wisconsin Council on Medical Education and Workforce (WCMEW) supported two major initiatives that will provide greater insight into Wisconsin’s physician workforce by providing data on physicians now practicing.

Linda Syth from the Wisconsin Medical Society provided an overview of their plan to develop a physician database. Currently, physician information (e.g. name, residency, board certifications) is held in three state databases along with similar information at the Wisconsin Medical Society. The majority of the information is duplicative and financially supported by physicians. Syth said merging the databases would:

• Eliminate data entry duplication;
• Decrease the cost of maintaining separate databases;
• Allow for each group to focus their IT resources on their unique needs;
• Decrease new license application time; and,
• Make physician information easily available to the public in one spot.

The Medical Society released the RFP’s to potential vendors. The plan is to conduct beta testing in the summer of 2006, and activate a new system in 2007. WCMEW Chair Carl Getto, MD, and council members voiced their support to the Society’s plan as they move forward.

Tara Breslin, a physician with the UW Medical School is in the process of soliciting grants to support a survey of surgeons practicing in Wisconsin. The survey would provide information related to the surgical workforce in terms of geographic distribution, specialty, practice characteristics, and future practice plans.

Breslin said she would perform a comprehensive survey of Wisconsin surgeons in both urban and rural areas with the following aims:

• Characterize demographics, distribution, and education, practice types
• Evaluate utilization of midlevel providers
• Identify barriers to technology transfer and skills enhancement
• Understand comfort level with medical backup provided by primary care physicians

A survey of all licensed physicians, including residents and fellows in training, has been conducted by the Wisconsin Bureau of Health Care Information in the past and currently by the Department of Health Information and Policy, but Breslin said she is having difficulties accessing this data. Several other members of the Council that tried to access this information ran into similar obstacles.

WCMEW will provide Breslin a letter of support. The information gathered in the surgeon survey will assist in characterizing the current workforce, and provide essential data for forecasting future supply.

Byron Crouse, MD, asked the Council for a letter of support for a project backed by the Wisconsin Academy for Rural Medicine (WARM). WARM is dedicated to improving both the supply of physicians in rural Wisconsin and the health of rural communities. Students in the project will participate in a longitudinal education curriculum designed to prepare them for rural practice by providing extensive clinical training in rural settings. The Council agreed to provide a letter of endorsement that will be sent to the new chancellor when named.

Carl Sirio, MD, University of Pittsburg, Department of Critical Care Medicine, presented at the meeting and said the AMA is currently working on a transformation of medical education initiative to review the current education system and assess the medical professional training model. A group of 40 participants from all different aspects of business, education, purchasing, and others within and without the medical industry will be asked a selection of questions in hopes to generate different topics and views of the current medical system. From that, a report will be created that will suggest changes to the current training and education system. The report will be available in 2006 with expected implementation in 5-10 years.

The mission of WHA Financial Solutions, Inc., is to support our parent, the Wisconsin Hospital Association, by providing their membership with a trusted resource for employee benefits, retirement services and corporate insurance planning.

WHA Financial Solutions has helped several health care organizations offer competitive employee benefit packages. Most recently, we’ve seen several organizations, including the Wisconsin Hospital Association, introduce health savings accounts. While still a small percentage of the group medical market, 40 percent of Wisconsin hospitals are likely to offer a high deductible health plan in the future with 50 percent of those implementing a health savings account and 35 percent implementing a health reimbursement account. This is according to our 2005 Wisconsin Hospital Group Benefits Survey. WHA employees - who now have a year of experience with an HSA - often make comments such as, "I know more about buying health care than I ever did before," while the employee and WHA both saved money. We are seeing real evidence of consumerism and making informed decisions about our personal health care choices.

Wisconsin is seeing the first symptoms of a widespread medical liability crisis. With the Actuarial Committee of the Injured Patients and Family Compensation Fund recommending a 25 percent increase in premium rates to the fund, it is only logical that the private insurers will follow suit. Some carriers are already citing a minimum of a 10 percent increase for early 2006 renewals. While WHA Financial Solutions has been instrumental in the past in bringing more insurers to the state, the situation could quickly, over a matter of months, worsen. Our biggest nightmare is to relive the medical liability insurance crisis we experienced in the late 1970s. At WHA Financial Solutions, we are doing everything we can to hold down premium rates for medical liability, and are assisting WHA lobbyists by contributing our knowledge and expertise as they work with the Legislature to restore a meaningful non-economic damage cap in Wisconsin.

The Centers for Medicare and Medicaid Services (CMS) has issued guidelines regarding those instances when existing CAHs relocate. The guidelines appear to adhere to the same "75% rules" that were described in the final regulations published earlier this year. WHA and the Rural Wisconsin Health Cooperative (RWHC) were instrumental in turning back CMS regulations that would preclude any CAH not currently in the midst of a construction project from relocating outside of its existing campus. The final regulations allowed relocation as long as the CAH in its new location—

"(i) Serves at least 75 percent of the same service area that it served prior to its relocation;
(ii) Provides at least 75 percent of the same services that it provided prior to the relocation; and
(iii) Is staffed by 75 percent of the same staff (including medical staff, contracted staff, and employees) that were on staff at the original location."

These requirements appear reasonable, but they are very general. As we all know, the application and interpretation is where the potential problems occur. The Bureau of Quality Assurance (BQA) will be responsible for the interpretation in Wisconsin. WHA will continue to be vigilant on the relocation issue, and together with RWHC, will work with BQA to ensure that the intent of the regulations are satisfied and that Wisconsin’s Critical Access Hospitals are able to continue to meet the needs of their communities.

In 2006, the WHA Foundation will:

• Cover tuition and books to help 32 students through their final semester and graduate with a health care-related degree.
• Give 100 Wisconsin nurses the opportunity and tools to consider a career path toward nursing leadership.
• Provide recognition and financial support to several WHA member-sponsored community initiatives, through the Global Vision Community Partnership Award.

Please consider making a contribution to the WHA Foundation annual fundraising campaign and supporting these important initiatives.

• There are four irrefutable reasons to be optimistic that our current disappointment with Governor Doyle’s veto of medical liability reform legislation may be short-lived:

• Despite the veto, there is overwhelming bi-partisan legislative support for meaningful limits on non-economic damage awards. Every Senate Democrat supported an amendment that would have set $1 million as the award ceiling and six Assembly Democrats actually supported the vetoed legislation, with others calling for "compromise."

• As we enter an election year, public support for medical liability reform is overwhelming. More than 75 percent of recently surveyed Wisconsin voters expressed support for reinstating award limits. That support is so strong, in fact, that 68 percent of respondents said they are more likely to vote for legislative candidates who support damage limits.

• With the predictable exception of the Madison Capital Times, statewide editorial support for medical liability reform has been universal.

• The urgency of addressing liability reform is palpable and was validated by the recent recommendation of the Injured Patients and Families Compensation Fund Actuarial Committee to increase hospital and physician premiums by 25 percent—solely because of the Supreme Court’s July decision.

Medical liability reform remains WHA’s top short-term legislative priority. And Governor Doyle’s veto message suggests willingness to "compromise." That compromise, however, must lead to a meaningful solution that will restore Wisconsin’s medical liability reputation.

• The recent Hospitals & Health Networks feature article on Wisconsin reporting initiatives has confirmed WHA’s contention that Wisconsin is a national leader. The article, "Ahead of the Pack," quotes noted health care guru Paul Ginsberg, president of the Center for Studying Health System Change, Washington, DC, opining that Wisconsin’s health care and business leaders "are out in front on a lot of quality and transparency issues." Ginsberg stated that Wisconsin leaders aren’t "bucking the trends, they are running with the trends."

          As we look to establish 2006 WHA issue priorities, the need and desire to maintain momentum as a national leader must be high on our priority list.

• Five years ago, the Milwaukee County Board passed an ordinance, commonly referred to as the Labor Peace Ordinance, which mandated that human service organizations that contract with the County must allow labor unions to organize workers without employer interference. This past week, the U.S. Court of Appeals for the 7^th Circuit struck down the ordinance, concluding a sorry chapter in Wisconsin labor relations history.

WHA and Milwaukee-based health system leaders provided financial support for legal efforts that were led by the Metro Milwaukee Association of Commerce. The so-called Labor Peace Ordinance, if upheld, would have served as a gag order preventing employers from educating employees about collective bargaining issues. But sanity prevailed, thankfully.

Steve Brenton
President

During 2005, WHA’s Council on Medical & Professional Affairs discussed the need for an in-state option for physician leadership development training. High registration fees and travel costs, as well as time out of the hospital and away from practice, associated with many reputable national training programs deter many hospitals from offering the opportunity of outside, professional leadership training to their newest physician leaders and those with the potential to be future leaders.

As a result of the Council’s discussion and recommendation, WHA will offer its first "Physician Leadership Development Conference" in March 2006. This new education offering for both new and potential physician leaders will be held at The American Club in Kohler, Wisconsin. The one-and-a-half day conference is scheduled for Friday, March 24 through noon on Saturday, March 25, 2006.

The March 24 program is entitled "Enhancing Physician Performance" and will be presented by William "Marty" Martin, PsyD, MPH, an American College of Physician Executives (ACPE) faculty member. His program will provoke the thinking about managing the performance of physicians, as well as improve practical skills and knowledge of attendees. The program will focus on moving from process to results; establishing standards of behavior and performance; managing conflict and giving feedback; managing a disruptive physician; how to reward, punish, sanction and discipline effectively; and how to prevent claims of discrimination and harassment.

The March 25 morning program is entitled "Effective Meetings, Leadership and Communication" and will be presented by Barbara Linney, MA, who is also an ACPE faculty member. She will discuss how to run a meeting well in order to be thought of as a good leader, including controlling those who talk too much and getting information from those who talk too little. The program will also focus on understanding your own leadership and communication style; learning the style of others in order to influence them; deciding what kinds of meetings to have and when; using a technique to identify problems and solutions; how to remain calm and professional in emotionally charged situations; and how to plan for powerful presentations.

Physicians who are fairly new to their leadership/management roles and physicians with leadership/management potential should mark their calendars and plan to attend this conference. Also, chiefs of staff, medical directors, medical presidents, chief medical officers, clinical department chairs, and committee chairs are encouraged to attend or designate a physician with leadership potential to attend, as part of your organization’s succession planning.

ACPE is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The American College of Medical Education designates this educational activity for a maximum of 11 category 1 credits toward the American Medical Association’s Physician Recognition Award. Each physician should declare only those credits that he/she actually spent in the activity. Additionally, these programs are part of the ACPE and CCMM requirements toward a graduate degree or certification in medical management.

Speaker John Gard (R-Peshtigo) met with Affinity Health System CEO Kevin Nolan, Northern Region COO Robert Turner, and Government Affairs Director Jim Hemes at St. Elizabeth Hospital in Appleton on Monday, December 5.

One of the priority issues discussed was the need for Wisconsin to restore its once-envied liability environment by returning a cap on non-economic damages. Noting the Governor’s veto of Assembly Bill 766 last week, Speaker Gard reiterated his strong commitment to restoring a cap. Nolan thanked Gard for this unyielding support.

Concealed carry legislation, currently making its way through the legislative process, was also discussed. The companion bills – Senate Bill 403 and Assembly Bill 763 – as originally introduced, included few exceptions. The Wisconsin Hospital Association worked with legislative leaders like Speaker Gard and members of the Joint Finance Committee to include an exemption for health care facilities. The Joint Finance Committee incorporated that health care facility exemption into the legislation on November 30 on a 14-0 vote.

Jeri Gabrielson, regional coordinator for U.S. Senator Russ Feingold’s Milwaukee office, met with the executive team of All Saints Healthcare System in Racine on Monday, December 5.

President and CEO Ken Buser provided an overview of the Wheaton System, of which All Saints is a part, and its Wisconsin presence. John Skeans, CFO, provided a financial overview for Gabrielson, including capital projects underway; commitment to IT improvements and development of an electronic health record; charity care and uncompensated care; and All Saints’ payer mix. Concern was expressed to Gabrielson over the lack of adequate reimbursement for facilities that take government payers and the growing number of uninsured. This poses problems for hospitals, as they provide care for all patients regardless of ability to pay. The cost-shifting that results must ultimately be borne by private payers. Gabrielson indicated that Sen. Feingold is committed to working on improvements in these programs. She also added that when Sen. Feingold travels the state for his listening sessions, health care issues are a priority concern for constituents.

The group went on to discuss community benefits and the various ways All Saints contributes to the greater Racine community. Susan Boland, COO, described for Gabrielson All Saint’s collaborative relationship with Racine’s Health Care Network – a comprehensive program that provides free or low-cost medical services to low income or medically uninsured residents; and with the Racine Family Practice Residency Program, a partnership with the Medical College of Wisconsin. Jim Beck, sr. vice president, shared information on initiatives underway to partner with local employers and organizations in reducing health care costs and improving the overall health of the community.

All Saints indicated to Gabrielson its commitment and support for transparency initiatives. And in closing, Boland urged Senator Feingold to continue to support educational institutions and programs aimed at addressing workforce development issues and meeting the ever-growing challenge of health care staffing shortages.

The meeting with Sen. Feingold’s office is part of All Saints’ commitment to ensuring strong, working relationships with local, state and federal legislators.

Sen. Joe Leibham (R-Sheboygan) recently spent time at Holy Family Memorial (HFM) to discuss important state legislative issues. During the visit, Leibham and Holy Family leadership discussed Medicaid funding and medical liability caps.

Due to the Wisconsin Supreme Court’s recent decision declaring a cap on non-economic damages unconstitutional, Wisconsin’s 10-year cap on pain and suffering damages in medical liability lawsuits has been nullified. HFM focused on this issue during Sen. Leibham’s visit in order to reiterate the importance of a cap for Wisconsin hospitals. HFM cited the great concern they have in an uncapped liability environment because of its negative impact on the desire of physicians, particularly in some specialties, to practice in states without a cap on non-economic damages.

Holy Family Memorial considers this and similar legislative visits part of their commitment to providing for the health care needs of the residents of Manitowoc County.

An article was recently published in the November/December, 2005 issue of the journal Health Affairs, titled "Perspective: Why Employers Need to Rethink How They Buy Health Care." The timing couldn’t be better, as right now many hospital administration teams are (hopefully!) wrapping up the details on their January 1 health insurance renewals, catching their breath, and looking back and reviewing how the process went. If the process was less than satisfactory, you are not alone. According to the article, for most employers, "a major gap exists between ideal and actual purchasing practices."

What is the solution to this problem? Simply put: Information.

Many hospitals have difficulty getting access to information on their group health plans. To find out why, read Solutions Spotlight, included in this week’s packet.

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