Department of Health and Human Services (HHS) Secretary Michael Leavitt recognized the Wisconsin Hospital Association as a Community Leader for Value-Driven Health Care this week. The Secretary said WHA was recognized for its commitment to the transformation of the U.S. health care system. WHA Vice President of Quality Dana Richardson said to be recognized, WHA had to demonstrate that it is promoting the "four cornerstones" for health care improvement, which include:

1. Interoperable Health Information Technology (Health IT Standards): Interoperable health information technology has the potential to create greater efficiency in health care delivery. Additional standards must be developed, and all health care systems and products should meet these standards as they are acquired or upgraded.

In a recent survey conducted by the Wisconsin Hospital Association, 67 percent of the hospitals reported that they had either fully or partially implemented key components of an integrated electronic health records system. These base systems are the foundation needed to put patient information into an electronic format that will enable quick, accurate and secure exchange of health information.

2. Measure and Publish Quality Information (Quality Standards): To make confident decisions about their health care providers and treatment options, consumers need quality of care information. Similarly, this information is important to providers who are interested in improving the quality of care they deliver. Quality measurement should be based on measures that are developed through consensus-based processes involving all stakeholders, such as the processes used by the AQA (multi-stakeholder group focused on physician quality measurement) and the Hospital Quality Alliance.

Wisconsin hospitals were the first in the nation to voluntarily publicly report information related to the quality and safety of care that they provide. The CheckPoint program (www.wicheckpoint.org) was launched in 2004 and initially reported 10 quality and five safety-related measures. Today, CheckPoint has more than 50 measurements and 100 percent of the hospitals reporting information. Three states—South Carolina, New Mexico and Utah—now also use WHA’s CheckPoint system to report hospital quality in their states.

3. Measure and Publish Price Information (Price Standards): To make confident decisions about their health care providers and treatment options, consumers also need price information. Efforts are underway to develop uniform approaches to measuring and reporting price information for the benefit of consumers.

Wisconsin consumers can easily access charge information about any type of hospitalization at any Wisconsin hospital on the WHA Information Center’s PricePoint Web site (www.wipricepoint.org). The Web site also lists charges for selected outpatient medical services performed in hospitals and free-standing ambulatory care centers. The PricePoint program has proven so popular, by the end of the year it will be in use in 17 states.

4. Promote Quality and Efficiency of Care (Incentives): All parties - providers, patients, insurance plans, and payers - should participate in arrangements that reward both those who offer and those who purchase high-quality, competitively-priced health care. Such arrangements may include implementation of pay-for-performance methods of reimbursement for providers or the offering of consumer-directed health plan products, such as account-based plans for enrollees in employer-sponsored health benefit plans.

The Wisconsin Hospital Association’s recently released "Principles for Access, Coverage and Cost" states that payers should provide meaningful incentives for providers to coordinate the delivery of health care services, especially to patients with chronic diseases, and design plans that provide incentives for prevention services and promote healthy lifestyles.

Leavitt acknowledged that significant action has been taken by Wisconsin hospitals to promote the four cornerstones, which contribute to building a value-driven health care system that delivers continued progress in medical care and good health for all Americans.

At a news conference Friday, February 1, Department of Health and Human Services (HHS) Secretary Michael Leavitt recognized the formation of the Wisconsin Healthcare Value Exchange. The newly organized Wisconsin Healthcare Value Exchange (WHVE) is comprised of seven members, including:

• Wisconsin Hospital Association
• Wisconsin Health Information Organization
• MetaStar
• Wisconsin Medical Society
• The Alliance
• The Business Health Care Group
• Wisconsin Collaborative for Healthcare Quality

Dana Richardson, who is representing WHA on the WHVE, said, "The WHVE leverages existing partnerships among organizations engaged in Wisconsin health care to accelerate market-based health care improvement."

The relationships formed provide the foundation for employers, health insurance plans, providers, and consumers to work together to improve health care. The group will participate in a national learning network and have access to summary Medicare provider performance results to more rapidly advance the goals of improving quality and containing costs.

During the news conference, Leavitt referred to Wisconsin as one of the "pillars of health care" in the country. Leavitt said in order to succeed, health care reform must focus on quality and value. "It won’t happen overnight, but it will happen when we see changes across the country like the ones that we have seen in Wisconsin," he added.

When asked by a reporter why he chose to be in Wisconsin, he replied, "Wisconsin is at the center of the electronic health information movement."

"There is already information available in Wisconsin to compare the price and quality of individual hospitals," Leavitt said in reference to WHA’s CheckPoint and PricePoint programs. Leavitt added that it is now time to broaden the agenda beyond hospitals and apply technology that would make information available across the entire health care system. Government’s role is to "use the power of government to enable what is happening and help perpetuate it independent of the political process," according to Leavitt.

WHA Executive Vice President Eric Borgerding, who participated in a meeting of Wisconsin stakeholders and the Secretary before the news conference, said WHA is very happy that Secretary Leavitt chose Wisconsin as one of the venues to announce the new national Chartered Value Exchange initiative.

"We are pleased with and support the Secretary’s approach to true health care reform, which is one of collaboration and incentives—not the mandates and penalties that have been the hallmark of past efforts where one-size-fits-all regressive mandates stagnated progress and innovation," Borgerding said.

According to the analysis, if all hospitals nationally were to achieve the three-year cost and mortality improvements found for pneumonia, heart bypass, heart failure, heart attack and hip and knee replacement patient populations, they could save an estimated 70,000 lives per year and reduce hospital costs by more than $4.5 billion annually.

"Our work with hundreds of hospitals across the nation provides evidence of how the U.S. health care system is showing improvements and patients are getting higher quality health care," said Richard Norling, president and chief executive officer of Premier. "The findings from this analysis clearly suggest that, through the reliable delivery of basic care processes, improving clinical quality and safely reducing costs is attainable for all hospitals across the country."

On average, the median hospital cost per patient for participants in the CMS/Premier project declined by over $1,000 across the first three years of the project, whereas the median mortality rate decreased by 1.87 percent.

"Our experiences with this pay-for-performance demonstration have provided us with invaluable guidance as we continue to pursue and develop value-based purchasing incentives," said Kerry Weems, acting administrator for CMS.

Nick Turkal, MD, president and CEO of Aurora Health Care, was one of three CEOs invited to present findings at the news conference held in Washington DC. He credited the demonstration project with accelerating Aurora’s quality culture from one where they were making "incremental progress," to a culture committed to the "pursuit of perfection."

"The change in culture has been dramatic. To get people to change the way they work when they are trained one way and asked to practice another way is not easy," Turkal said. Turkal said Aurora "hard-wired some processes to make sure we all do a good job. All our hospitals deliver the same care for a heart attack, for example, to ensure quality. The result for us as a system is mortality is down, cost is down significantly and quality is up. We made a difference for our patients because of this project. And we are not done. As the quality standards expand, we will look for perfection in those as well," he added.

"Wisconsin hospitals are well-positioned to engage in pay-for-performance due to our leadership position in quality measurement and improvement," said George Quinn, senior vice president for the Wisconsin Hospital Association. "And we support payment initiatives that include incentives for improving quality."

More information about the CMS/Premier can be found at: www.qualitydemo.com. You can access the PowerPoint presentation used in the press conference at www.wha.org/financeAndData/premier2-08.ppt.

It’s a pretty safe bet that no domestic policy issue will get more play this election year than health care. As discussed at the WHA Task Force on Access and Coverage meeting last week, the issue resonates with voters. In fact, for women and for seniors, a candidate’s health care agenda may well be the driving determinant of how those demographic groups vote in November. But if you actually "drill down" on recent polling data and focus group opinion, ambiguity reigns! Here are a few specifics:

• The public is eager for lawmakers to address "health reform" but universal in their distrust of "government run" health care.

• Despite a strong political focus on expanding access and coverage, the public (as identified in focus group discussion) is of one mind when it comes to an unwillingness to pay for health care for "illegal immigrants and deadbeats."

• Personal health care affordability is the resonating issue with voters—but restricting choice of physicians, paying additional "out of pocket," and limiting access to specialists and technology (sans Canada) are "fighting words" with the public.

• The public claims to desire "more information that will help us shop for health care" but numerous studies suggest that currently available information is used by only a small (but growing) subset of patients and families.

• Individuals, at least in Wisconsin, are uniformly pleased with their own health care "quality," but seem anxious about the "impersonal" health care business model that delivers that care.

• The public clearly understands that bad lifestyle choices are a huge health care cost driver but are reluctant to support punitive measures that may be necessary to actually influence behavioral change.

What all of this means is that eventually the "fine print" will matter when it comes to health reform legislation. Just because political sound bites score with voters in 2008 doesn’t mean that those same voters will support a specific plan once they begin to understand the potential impact of that plan—especially the impact on them personally. That’s why the political "handlers" are making sure that their candidates’ health care platforms are broadly thematic as opposed to specific. But the "fine print" will matter at some point. And the public’s ambiguity as it relates to health care may end up being the most significant impediment to advancing the more overreaching reform initiatives. And that’s probably a good thing.

Steve Brenton
President

This is a reminder to hospitals that RN licenses are currently being renewed. Information was mailed to RNs the first week in January, with responses required by February 13 for licenses to be in-hand by March 1, 2008. While the mailing promises a 10-working-day response by the Department of Regulation and Licensing, current renewals are NOT being received within that time frame.

At a press event held at Children’s Hospital of Wisconsin, Governor Jim Doyle met with doctors, nurses and community members to discuss BadgerCare Plus, which will allow every Wisconsin family, regardless of income, to buy affordable, comprehensive health care coverage for their kids. Families can begin signing up for BadgerCare Plus on February 1, 2008 by visiting www.BadgerCarePlus.org.

"BadgerCare Plus makes quality, affordable health care achievable. It seizes the opportunity before us, and fulfills the moral responsibility we have to the children and families of this state," Governor Doyle said. "Health care in Wisconsin should be a birthright, not a ticket to bankruptcy. BadgerCare Plus is simple and will provide health care coverage that our children deserve, at a price families can afford. This is a historic moment in Wisconsin history."

BadgerCare Plus offers health coverage to every child in Wisconsin by streamlining Medicaid, BadgerCare and Healthy Start into one comprehensive program. Low-income families will be able to enroll their children into BadgerCare Plus at no charge. Higher earning families will be able to buy into the program for as little as $10 a month for each qualifying family member. For example, a family income of $63,000 would pay a premium of $76 per child per month. There are also "crowd out" provisions in BadgerCare Plus that discourage families from dropping their employer-based insurance. If a person had access in the past 12 months or dropped coverage of employer-covered insurance in the past three months, they would not be eligible unless there is a good cause exception.

For more information on BadgerCare Plus, go to www.badgercareplus.org or call 1-800-362-3002.

Wisconsin’s rural hospitals play a unique role in ensuring that our rural residents have access to care in their local communities. To assist our rural hospital members in carrying out their missions, WHA’s Council on Rural Health focuses on the problems of rural hospitals and formulates the development of Association positions for solutions to these problems. It also coordinates educational programming relating to the needs of these hospitals. In 2008, the Council on Rural Health will carry out the following activities:

WHA Goal – Rural Health Conference. The Council has historically played a major role in the design of each year’s Rural Health Conference. This year, the Conference will be held at the Osthoff Resort in Elkhart Lake. The Council will advise staff on themes, topics, and speakers.

WHA Goal – Protecting Critical Access Hospitals’ ability to modernize their facilities, respond to community needs within their service areas, and join in collaborative quality improvement activities. Recent CMS administrative actions are threatening the ability of CAHs to carry out those most basic activities. WHA strategies will include monitoring CMS and Wisconsin Division of Quality Assurance actions, suggesting changes in administrative rules, and mobilizing support for potential legislative changes.

On a related front, the Council will continue to review issues surrounding hospital surveys and plan reviews, which tend to have a disproportionate impact on rural hospitals.

WHA Goal – Quality and Safety Initiatives. As part of its quality initiatives, WHA designs projects that are unique to the rural setting. This year’s project is a rural hospital stroke improvement project funded by a Wisconsin Office of Rural Health grant. The Council will be given periodic updates on the progress on this project.

Assembly Bill (AB) 731, which expands Wisconsin’s pharmacy practice act to allow remote dispensing of medications, received a hearing in the Assembly Public Health Committee this week. WHA testified in support of the proposal.

Currently, pharmacists in Wisconsin may only dispense medications from a licensed pharmacy. This restriction has prevented the Pharmacy Examining Board (PEB) from reviewing and approving programs and projects designed to dispense prescriptions from clinics and small sites that have a medication supply but do not meet the regulatory description of a pharmacy. Most often this means that they do not have a pharmacist on site. The PEB has been working to change the law to allow more freedom for pharmacists to remotely dispense medications.

WHA’s testimony, which was also offered on behalf of the Rural Wisconsin Health Cooperative, focused on the current and future shortage of pharmacists, especially noting the difficulty rural locations have attracting and recruiting pharmacists.

In testimony, Judy Warmuth, Vice President of Workforce for WHA stated, "WHA and RWHC share the desire for patients to have prescriptions filled safely, and at a time and place that is convenient. We also want patients to have access to accurate information and education—no matter where in Wisconsin they live or seek health care." Warmuth noted that in some locations in Wisconsin it is taking more than a year to fill vacant pharmacist positions.

Also testifying in support of AB 731 were the PEB, the Pharmacy Society of Wisconsin, and the Marshfield Clinic. Testimony from each of them indicated that physicians currently may dispense remotely, but pharmacists may not.

A well-timed illustration of how this proposal could benefit patients pointed to the dangerously cold weather from this past week as an example of a situation that might prevent patients from traveling distances to obtain their medications. Also cited was the fact that many prescriptions are never filled by patients, perhaps in part because of time or distance restraints on reaching a pharmacist.

Committee members raised several questions and expressed concerns about the potential proliferation of medication dispensing machines. They also spoke of the possible loss of ‘personal’ touch in health care.

AB 731 awaits final approval by the committee before it can be acted on by the full Assembly and subsequently forwarded to the Senate for consideration.

The Centers for Medicare and Medicaid Services (CMS) has officially postponed until April 1 the requirement that National Drug Codes (NDCs) be included on outpatient hospital claims submitted for Medicaid reimbursement in Wisconsin.

CMS is requiring NDC reporting from state Medicaid programs to facilitate documentation of drug utilization for rebate purposes, beginning in 2008.

Wisconsin’s Department of Health and Family Services (DHFS) had asked CMS to approve a delay until the new Wisconsin Medicaid Management Information System (MMIS) is implemented. The target date for implementing the new MMIS is now October 1.

DHFS officials are continuing to pursue temporary alternative methods of compliance—involving back-end aggregate reporting of claims activity—that will meet CMS’ requirements in the interim. DHFS’ goal remains to postpone the actual claims-submission requirement the implementation of the new MMIS.

DHFS has not yet issued a formal communication to providers about the delay. WHA continues to seek answers to several technical implementation and compliance questions. We expect to provide further details, when they become available, in a future edition of The Valued Voice.

On January 28, 2008, President Bush signed into law the Support for Injured Servicemembers Act, which grants additional leave under the Family and Medical Leave Act (FMLA) to employees who have family members in the military. Under the law, relatives of military service personnel would be permitted to take their FMLA entitlement "because of any qualifying exigency" arising out of the spouse’s, parent’s or child’s active duty (or notice of an impending call or order to active duty). Relatives of injured service personnel would be eligible for up to six months of leave to provide care for the injured servicemember. Regulations will be enacted to explain and define these additional components of FMLA; however, employers are expected to make good faith efforts to comply with the FMLA amendments as soon as possible.

Given the increasing complexity and challenges facing health care delivery, the role of physician leadership has never been more demanding, yet critical, to the success of caring for our patients and communities. In response to this need and at the request of physicians across the state, the WHA "Physician Leadership Development Conference" was developed to offer opportunities for current and future physician leaders to acquire and polish leadership skills not taught in medical school or residency training.

Each year the conference topics are selected based on "needed practical skills" identified by physicians across the state. Nationally recognized faculty who are both content experts and skillful physician educators are selected in collaboration with the American College of Physician Executives (ACPE). The presentations are designed to provide learning opportunities for both veteran physician leaders as well physicians just beginning leadership roles.

The 2008 conference will focus on the topics of health care finance and the principles of negotiation. Physicians, including past conference attendees, have identified financial data interpretation, analysis and use in the strategic planning process as critical skills needing enhancement for use in their own practices, as well as a means of increasing their effectiveness as they work with their hospitals and health systems. Negotiating has become a skill essential to the success of physician leadership whether the issue is managing colleague relationships, contracting or conflict resolution. Physician leadership requires the skill to move the process from a contact sport to a win-win engagement. Understanding of basic negotiating principles, tactics, process and impact of personality styles were all identified by physicians as areas essential to their success and needing additional education.

Feedback from past conferences has been very positive, both in regard to content learned, as well as networking with both their local physician/hospital colleagues attending and other physicians across the state with similar leadership interests. Any physicians new to their leadership roles or who have leadership/management interest or potential should plan to attend this conference. Also, chiefs of staff, medical directors, chief medical officers, new medical presidents, new clinical department chairs, and new committee chairs are encouraged to attend or designate a physician with leadership potential to attend, as part of your organization’s succession planning. In addition, a "host" registration option is available to those who would like to accompany their physicians to the conference but do not need the CME credit.

For Ron Komas, The Kathy Hospice began as a dream and a promise in memory of the love of his life. For over 200 families, The Kathy Hospice has become a place of peace and comfort for their loved ones facing the end of life.

The Kathy Hospice opened in February 2006 on the 143-acre campus of SynergyHealth

St. Joseph’s Hospital south of West Bend. The hospice is owned by the SynergyHealth Foundation and operated by the hospital. Prior to construction of the hospice, Washington County had no freestanding residential hospice facility. Now, The Kathy Hospice offers the option of a homelike hospice close to home, with eight private rooms, round-the-clock nursing and pain control for patients, and compassionate support for families.

Ron’s wife Kathy was a mother, teacher, artist, and Ron’s best friend since their youth. When Kathy’s cancer returned in 2001 after a five-year respite, and her symptoms became severe, Ron was unable to give her the care she needed at home. He searched for but couldn’t find a residential hospice near their home in Washington County.

After Kathy died in 2002 at the age of 56, Ron wanted to do something positive to help other families. He took his vision for a residential hospice to St. Joseph’s which was planning to build a new hospital.

The story of Kathy’s struggle and Ron’s vision struck a chord with hospital leaders and physicians, and spread to the entire community. The campaign to raise over $1.5 million for the hospice captured the hearts of many who saw their own experiences mirrored in Ron’s story.

"So many people said they had gone through a similar tragedy and didn’t know what to do," said Ron, who devotes his time as a volunteer at the hospice, board member, and champion for fundraising efforts.

By July 2007, The Kathy Hospice served more than 200 terminally ill patients. Income does not meet expenses for the non-profit hospice, yet it has remained true to its mission of never having to turn anyone away because of inability to pay.

Families and community groups continue to support the hospice through the SynergyHealth Foundation with memorials, donations, and fundraisers. Dozens of volunteers have helped maintain the grounds, and local nurseries provided plants and trees.

Anne Wickland, a beloved and unforgettable teacher who taught Spanish at West Bend West High School for 21 years, battled cancer for eight years before her death on March 29, 2007.

Al found at The Kathy Hospice a comforting non-clinical atmosphere and dedicated staff.

"They have not only the nursing skills, but training for hospice care," Al said. "They can tell how a person is doing by just looking at them and touching them. They know the correct action to take, whether to periodically change the position of the patient. They also have training to help families, and know how to answer their questions properly."

He has seen first-hand what the hospice means to people. He remembers the way a nurse who had lost her spouse comforted him and helped him understand what he was going through. He appreciated the large patient rooms that allowed family members to visit Anne and share a meal. He saw how much it meant for a woman in her 70s to be able to drive to the hospice to visit a loved one.

Al was so touched by the caring work of the hospice, like Ron Komas he is now a trained hospice volunteer, coming to The Kathy Hospice Mondays after work to help with serving meals or engage in conversation with patients and families.

"If I didn’t believe in the hospice, I wouldn’t be volunteering there," he said.

When Jose Antonio Escandell and his wife, Luceth Rincon, led their three daughters up the steps of San Damiano House in Green Bay, it was the start of a new life for the family that had just emigrated to the U.S. from Cali, Colombia, to Green Bay.

Just up the street, St. Vincent Hospital towered above them, a bastion of hope and possibility. That was last year.

This year, the Escandells have moved out of San Damiano House, the cozy home that St. Vincent has offered rent free to immigrant families for the past 3 ½ years while they resettle in Green Bay. Their respite helped the Escandell adults find jobs and their children, Luceth, 11, Sthephany, 7, and Katherine, 3, get settled into school and daycare in their new community.

Today, after that early help from St. Vincent, the family is making a new home for themselves quite literally at 326 S. Jackson St. in Green Bay. It’s a recently completed Habitat for Humanity home that has been constructed with the help of community and business volunteers, including volunteers from St. Vincent. The Escandell family has also worked on the house themselves and Jose Antonio and Luceth are committed to donating 500 hours of work on Habitat homes before they can take over ownership.

Back at San Damiano House, a new family has already filled the suddenly silent space on Porlier Street. San Damiano House was named after the place near Assisi, Italy, that became central to the life of St. Francis of Assisi, the patron saint of the Hospital Sisters who sponsor St. Vincent Hospital.

A couple from Ethiopia and their three children, looking for a new life just like the Escandells before them, are settling into the house on Porlier and making do with donated furnishings.

That new family, like the Escandells, has language skills to learn, money matters to overcome and education to overcome in a place that is totally foreign to them.

The Escandells, who enjoyed their newfound freedom in Green Bay, called the city "paradise." "It’s a big city but people live like it’s a little city," Jose Antonio said in an interview last year. "All the people smile. All people have problems, but they don’t reflect their problems. All the time they smile."

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