February 11, 2005
Volume 49, Issue 6
Governor Jim Doyle unveiled his 2005-07 budget during an appearance before a joint session of the Wisconsin Legislature Tuesday evening (February 8). The Governor’s $52 billion budget includes a spending increase of 4.1 percent in the first year of the biennium, and 3.1percent in year two. New spending initiatives include over $700 million in new school aid funding and a substantial increase in Medicaid.
The Doyle budget addresses the well-publicized $600 million Medicaid deficit by transferring $180 million from the Injured Patients and Families Compensation Fund and by tapping a number of other segregated accounts. Some of this new one-time funding is slated to pay for Medicaid medical education payments and targeted rural and urban hospital adjustments. The proposal also allocates $10 million to a new Healthcare Quality and Patient Safety Board that will disburse the funds via grants and loans to hospitals and clinics for the acquisition of information technology systems.
The Doyle budget proposes a new 6 percent assessment on Medicaid HMOs and a $50 per bed per month increase in the current nursing home bed tax (currently $75). The budget also includes a significant cut in Medicaid pharmacy payments and a targeted cut for hospital outpatient therapy services.
In a statement released to the press Wednesday morning, WHA noted "Governor Doyle’s 2005-07 budget bill appears to be an improvement in some areas (from the 2003-05 state budget), and a disappointment in others." WHA expressed support for Governor Doyle’s commitment to partially restore Graduate Medical Education (GME) funding and strong support for the medical information technology grants. WHA also protested new hospital outpatient therapy payment cuts and expressed concern about funding higher and ongoing Medicaid costs with one-time funding sources (see President’s Message, page 3).
"The Doyle budget provides ample evidence of the need to support a new, dedicated and sustainable revenue stream for the core Medicaid program and for necessary hospital payment improvements," said WHA President Steve Brenton. "That’s why we will continue to advance a significant increase in the tobacco tax as a top priority throughout budget discussion and debate." Watch for a more detailed analysis of Governor Doyle’s budget and its impact on Wisconsin’s hospitals.
On-line Access to Hospital Charge Information Now Available
Web site shows charges from all Wisconsin hospitals
www.wipricepoint.org
WHA issued the following as a news release to selected press on February 11, 2005.
A new Web site unveiled today (February 11) provides free access to an unprecedented level of detail about charges and services at Wisconsin hospitals. The Web site, known as "PricePoint" (www.wipricepoint.org), allows users to easily access charge information about any type of hospitalization at any Wisconsin hospital. The Web site is being sponsored by WHA Information Center, which recently replaced a state agency as the entity responsible for collecting and reporting Wisconsin hospital data.
"PricePoint is just one of the many ways that Wisconsin hospitals are demonstrating their commitment to providing information that can help consumers, employers and insurers with health care decisions," said Joe Kachelski, WHA Information Center vice president.
Kachelski said PricePoint is unique among similar Web sites across the country in that it provides aggregate "discount" information for each hospital for the three major kinds of health care coverage – private insurance, Medicare and Medicaid. This information allows users to understand how hospitals’ charges compare to the amount of revenue they actually collect for services provided to the three patient categories.
In most cases out-of-pocket hospital costs for privately insured patients are determined by their health insurance policies, which have negotiated specific discounts with a hospital or health system and do not reflect actual charges. However, a growing number of Wisconsin residents are being covered by so-called consumer-directed health plans, under which the billed charge may factor into the amount that a patient would pay for a specific procedure at the hospital.
"We expect that as the health insurance market evolves, hospital charges may be increasingly relevant to consumers in the future," Kachelski said. "PricePoint will be a valuable tool as health care consumerism increases."
Kachelski said PricePoint provides more complete and current information than a Web site formerly operated by the state of Wisconsin. PricePoint displays the four most recently reported quarters of data from hospitals, and will include information about all hospitalizations. The former state Web site included hospital-specific information only about selected obstetric and knee-replacement hospitalizations.
""The PricePoint Web site is exactly the kind of innovation that we envisioned would result from our partnership with the WHA Information Center."
- Marc Marotta, Secretary, Department of Administration
"I have consistently advocated for innovative applications of information technology in health care. The PricePoint Web site is light years ahead of the old system and makes hospital charge information easy to obtain and understand."
- State Sen. Ted Kanavas (R-Brookfield)
Author of the legislation that privatized the hospital data collection
"As consumer driven health care becomes increasingly more popular and necessary, health care cost transparency has become a critical component in empowering consumers to make educated decisions. Through their new 'PricePoint' website, the Wisconsin Hospital Association has successfully compiled and organized hospital charge data in a way that is easy to understand and is readily available to anyone interested in comparing hospital charges across the state. This represents a significant step in allowing Wisconsin health care consumers to 'comparative shop' for health care."
- State Sen. Carol Roessler (R-Oshkosh); Chair, Senate Health, Children, Families, Aging & Long Term Care Committee
"We hear a lot of talk about the concept of health care transparency. It is great to see that concept put into practice in this new Web site."
- State Rep. Sheldon Wasserman, M.D. (D-Milwaukee); Ranking Democrat on the Assembly Health Committee
"When it comes to health care information, more is generally better, as long as it's understandable and credible. The PricePoint Web site significantly expands the amount of credible information about hospital charges in Wisconsin, and it is extremely user-friendly."
- James Mueller, President, Frank F. Haack & Associates, Wauwatosa
The most disappointing aspect of Governor Doyle’s 2005-07 budget is the fact that virtually every dollar in new General Purpose Revenue (GPR) is spent on K-12 education. That may delight some, but it’s bad news for Medicaid because most of the new funding for higher and ongoing Medicaid costs would now come from either a one-time funding source (Patient Compensation Fund and bonding) or from new taxes on nursing homes and health plans. The fact is that this will lead to a structural Medicaid deficit beyond the next biennium. In 2007, that means yet another round of Medicaid cuts, new/higher provider taxes, and an exploding Medicaid "hidden tax" for businesses. And we can’t let that happen.
Wisconsin’s Medicaid program needs new, dedicated and sustainable resources to fund the core program, improve hospital payment levels and reduce the $450 million "hidden tax" in three areas, including:
Enhancing the current Disproportionate Share Hospital (DSH) program that provides special payments for high Medicaid volume hospitals;
Full restoration of the Medical Education funding cut in 2003; and
Increasing woefully inadequate outpatient payment rates that amount to $94 for a tonsillectomy.
It’s important we recognize Governor Doyle’s budget commitment to partially restore some of the massive cuts made in Graduate Medical Education funding two years ago. These new funds are needed if we are to avert a looming physician shortage crisis in Wisconsin. Governor Doyle kept the commitment he made in his veto message18 months ago to revisit this issue.
WHA applauds Governor Doyle for his proposal to make available $10 million in grants and loans for the acquisition of costly electronic information technologies. The Governor understands the complexity and cost of adopting new and innovative information technology by hospitals and clinics. While others have proposed massive, one-size-fits-all technology mandates, the Governor has chosen to partner with hospitals and clinics in this new endeavor.
Our positive outlook on Medical Education funding and new information technology funding is dampened, however, by proposed payment cuts for therapy services provided to children and disabled adults in the outpatient hospital setting. We are still trying to understand the impact of this proposal but are puzzled why a budget that could find $6 million in "new" Medicaid funding to pay cab fares for seniors chose to cut spending on services needed by kids and disabled adults.
Ultimately, we recognize that difficult times require difficult choices. And many budget decisions were framed within that context. While the Governor put at risk future Medicaid budgets by relying on one-time funding sources and shifting GPR from Medicaid to K-12, he also chose to avoid the massive Medicaid cuts being proposed in other states.
But now it shouldn’t be a difficult choice to offer up the notion that higher tobacco taxes are essential to produce the dedicated funding stream Wisconsin’s Medicaid program requires for its long-term fiscal health. It should be a bipartisan slam dunk.
Steve Brenton, President
Eric Borgerding, Senior Vice President
The Wisconsin Hospital Association (WHA), in collaboration with the National Committee for Quality Health Care and the University of Iowa College of Public Health Care Science recently distributed a survey to determine the impact of governance and leadership on the effectiveness of quality improvement activities in hospitals.
It is important that the survey be completed by February 17, 2005.The questions should be completed by the CEO, or the individual in the hospital who has the greatest knowledge of quality improvement activities.
The 20-question survey aims to identify organizational characteristics that are most likely to influence and strengthen hospital quality improvement activities. Forty-eight Wisconsin hospitals have already completed the survey. If you have not completed the survey, it can be accessed through http://websurveyor.net/wsb.dll/21151/leadershipandqualityofcare.htm
The data collected during the study will be aggregated in a manner that will not identify any institution. Participating hospitals will receive the final report of the project, which will provide summary information and include recommendations for hospital quality improvement programs. WHA will receive state level data that will be used to guide future development of educational programs in Wisconsin.
If you have any questions, contact Nancy Hoffman WHA director of quality by calling 608-274-1820 or email nhoffman@wha.org .
Plaintiffs challenging not-for-profit hospital billing practices received setbacks in federal courts around the country in the last few weeks. However, following these and other setbacks in federal courts, Richard Scruggs, the Mississippi trial attorney who has led the way in these lawsuits, announced a "second legal offensive" -- he would begin to file new claims against not-for-profit hospitals in state courts.
Since early January, U.S. district courts in Tennessee, Arkansas, and Minnesota have all dismissed with prejudice federal claims against not for-profit-hospitals, and declined to exercise jurisdiction over state law claims thereby allowing those claims to be filed in state court. The court in Minnesota did however permit the plaintiffs to re-file their EMTALA claim if they could assert sufficient facts to establish an EMTALA violation. Plaintiffs in Ohio and Georgia have also voluntarily withdrawn their federal lawsuits since early January. These actions follow dismissals or withdrawals in federal district courts in California, Colorado, Florida, Georgia, Illinois, Louisiana, Michigan, Pennsylvania, and Texas.
Meanwhile, Scruggs in a February 8 news conference to announce his new offensive in state courts said, "In state courts, the defendants will find themselves directly before their own communities in front of juries made of the very people whom they are supposed to be servicing."
In March 2004, WHA released "Billings and Collections Guidelines for Wisconsin Hospitals," to help provide guidance to Wisconsin hospitals in balancing their responsibilities to their patients. Wisconsin hospitals have a long tradition of providing needed health care to their communities, 24 hours a day, seven days a week. That care is provided regardless of ability to pay. In fact, the Guidelines note that in 2002, Wisconsin hospitals provided uncompensated care to almost 2,300 patients EACH DAY at a cost of more than $1.2 million, and that in all, over 836,000 individuals received over $428 million in uncompensated care from Wisconsin hospitals that year. The Guidelines can be found at www.wha.org/newsCenter/pdf/2004uncompcare.pdf.
WONE Annual Convention in La Crosse, March 30-April 1
Wisconsin Organization of Nurse Executives (WONE) will host its annual convention for nurse leaders and managers from March 30-April 1 in La Crosse. Pamela Thompson, president of the American Organization of Nurse Executives, will open the event by focusing on the future of health care and the role of nurse leaders in that future.
The convention will be held at the Radisson Hotel in downtown La Crosse. Anyone who has responsibilities in leading and managing RNs will benefit from the educational agenda. Attendance is not limited to current WONE members or to registered nurses.
A brochure and registration form are included in this week’s packet and on the WONE Web site at www.w-one.org. This program has been approved by 8.4 contact hours. Aurora Health Care, Milwaukee, Wisconsin, is an approved provider of continuing nursing education by the Wisconsin Nurses Association Continuing Education Approval Program Committee, and accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
For more information on the program content, contact Jennifer Frank at 608-274-1820 or email at jfrank@wha.org . For registration questions, contact Sherry Rabuck at 608-274-1820 or email at srabuck@wha.org .
Improving Medical Record Documentation Focus of April 14 Seminar
The Joint Commission on Accreditation of Healthcare Organizations has identified miscommunication, or lack of communication, as one of the top five reasons that wrong things happen to patients. In the medical, legal and regulatory driven environment in which health care professionals work, it is essential that written communication, specifically medical record documentation, is done properly.
The April 14 seminar "Improving Medical Record Review and Documentation" will take an intensive look at medical record review/documentation and address how hospitals can build an organizational framework to support this process. Medical records directors, nurse executives and managers, compliance officers, quality managers and medical staff directors should consider attending this important event.
The seminar will be held on April 14, 2005, from 9 am to 4 pm at Chula Vista Resort in Wisconsin Dells. A brochure and a registration form are included in this week’s packet and on the web site at www.wha.org. Easy, on-line registration is available as well.
For more information on the program content, contact Jennifer Frank at 608-274-1820 or email at jfrank@wha.org . For registration questions, contact Sherry Rabuck at 608-274-1820 or email at srabuck@wha.org .
Canadian Drugs Cannot be Reimbursed Through an
FSA, HRA, or HSA
Prescription drugs qualify as medical expenses under Code Section 213(d) only if they are "legally procured." IRS Publication 502 states, "In general, you cannot include in your medical expenses the cost of a prescribed drug brought in (or ordered shipped) from another country, because you can only include the cost of a drug that was imported legally." There are, however, two exceptions:
•You can include the cost of a prescribed drug the FDA announces can be legally imported by individuals.
• You can include the cost of a prescribed drug you purchase and consume in another country if the drug is legal in both the other country and the United States.
The FDA’s position is that virtually all drugs imported to the U.S. from Canada by or for individual U.S. consumers violates U.S. law.
The bottom line: prescription drugs imported from Canada or other foreign sources cannot be reimbursed from an FSA, HRA or HSA unless the FDA declares importation of that particular drug as legal.
Read this article in its entirety in Solutions Spotlight, included in this week’s packet.