Wisconsin hospitals report it is increasingly difficult to recruit the number and type of employees that they need to fill specific vacant positions. A situation they fear will get worse if a remedy is not applied soon.

A new report released this week by the Wisconsin Hospital Association (WHA) says in 2004 there were 287,000 people working in health care in Wisconsin. By 2014 it is predicted that more than 350,000 individuals will be needed to meet the demand for health care by an aging population. Meeting that demand for workers is proving to be a challenge now to hospitals, educational facilities, and state government policymakers. To complicate the situation further, the rate of chronic disease is rising as people live longer, fueling demand for medical services at the same time large numbers of hospital employees reach retirement age.

WHA Vice President of Workforce Judy Warmuth, author of the report, said competition among industries will escalate for the "twenty-somethings," which has caused hospitals to take steps to attract middle and high school students and keep older workers they already employ.

"Hospitals are changing the physical environment of care to accommodate their older workers, designing more flexible employee benefit programs to keep and attract employees, and redesigning the role of workers within the health care delivery system all in an effort to meet the demand for care that they are now experiencing," according to Warmuth. She cautioned that despite these efforts, serious workforce shortages are on the horizon.

Wisconsin hospitals employ nearly 30,000 nurses. The sheer number of nurse vacancies open at any one time suggests they are the most difficult to fill. However, the number of nurses available to fill entry-level positions is considered adequate at this time. In fact, hospitals report that pharmacist and physical therapist positions are topping the list as being hardest to fill. The supply of these professionals could be affected by the fact that both of these occupations now require a clinical doctorate degree for entry into the profession, which requires more than five years of academic work. The commitment of time and the additional cost of these degrees could affect the number of students that are interested in entering these occupations. While there are many nurses in hospitals, there are far fewer pharmacists and physical therapists. Even one unfilled position for a pharmacist in a hospital can reduce access to care and delay response times.

Currently there is only one School of Pharmacy in Wisconsin at the University of Wisconsin-Madison. However, Concordia University recently announced that it plans to open a pharmacy program with a goal to begin enrolling students in the fall of 2008. UW-Milwaukee has announced it will expand the physical therapy program with a goal of graduating an additional 25 physical therapists per year. However, Warmuth said if the demand for health care continues to grow at projected rates, there are no assurances that these efforts alone will supply the workforce necessary to meet the demand for health care.

While the fact that hospitals are hiring more and more workers is good news for job seekers and the state’s economy, there is a downside. Hospitals report that costs related to keeping and training a workforce are now nearly 50 percent of their total expenses. Shortages are driving up salaries in key occupations. The Wisconsin Department of Workforce Development identified four occupations as having above-average wages for their educational group, which included: experienced pharmacists, $51 per hour; experienced physical therapists and registered nurses, $30 per hour; and, experienced radiologic technologists at $25 per hour.

WHA President Steve Brenton said controlling the increases in health care costs is directly tied to how hospitals manage the complexity of their workforce issues.

"Unlike other industries where advances in technology can often replace people, in health care nearly the opposite is true. The specialized technology and equipment that are necessary to deliver the best possible care require highly-skilled specialists," Brenton said. "We are treating and curing diseases that just a few years ago were claiming lives, but these life-saving technologies that often did not exist just a few years ago require people to deliver them, and that comes at a cost," he added.

Hospitals now have a significant percentage of workers who are older than 55. Predicting when health care workers will retire has become a necessity. One effort to predict the timing of health care retirements has been initiated by the Fox Valley Healthcare Workforce Alliance. Supported by the Fox Valley Workforce Investment Board, the Alliance surveyed 8,000 health care employees to determine their retirement intentions. With that information, they are able to more accurately predict the number, type and timing of positions that will be available due to retirements. Plans are in place for similar surveys in La Crosse, Madison, Milwaukee and Central Wisconsin. This is the type of data that will allow educational facilities to anticipate the demand for faculty and space in occupational programs.

Older workers bring vast experience to the workforce, but as they age, they also experience limitations, including their ability to lift, shift and move patients. Obesity in the patient population has made this even more difficult. Hospitals have started to more widely use equipment specifically designed to move patients, which has led to fewer work-related employee injuries and improved patient safety.

Workforce shortages are difficult to eliminate, but planning and acting now could avert some of the more serious shortages now reported in other states. WHA recommends several specific actions that must be taken, which include:

• Address specific shortages. Capacity in programs that train pharmacists and physical therapists must be increased now to catch up with the current demand.

• Closely monitor the supply of registered nurses. While hospitals are "holding their own" on nurses now, according to Warmuth, shortages loom. While Wisconsin’s nursing programs have done an admirable job of increasing capacity, those gains will be quickly lost if the shortage of nurse faculty and clinical sites that are essential to the training programs are not addressed.

• Educational facilities need data to plan for and prepare an increasing number of workers. While groups in some parts of the state are gathering workforce data related to when workers will retire, more and better data will be needed to wisely allocate resources.

• Hospitals must take steps to recruit and retain their older workers. Adaptations in the physical work environment, including patient lift-assist equipment, physical layouts that require less walking and standing, and better lighting must be incorporated into hospital design. Changes in employee benefits that encourage older workers to stay at work and serve as mentors to new employees must be considered. Flexible schedules and part-time work opportunities are attractive to older workers and can also serve as a recruitment tool for new employees.

The report is included in this week's packet and is available on WHA's Web site.  The link to the report, along with a summary of specific actions being taken in your local area illustrating how hospitals are attracting, recruiting and retaining employees is www.wha.org/Workforce/2007WorkforceReport.aspx. 

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The WHA Board this week agreed to establish a step-by-step approach to implementing a unified statewide response to the issue of non-billing for serious adverse events. During a teleconference February 14, the Board reviewed a concept paper that commits the Association to "work diligently to eliminate the occurrence of adverse events" and "work with members to implement policies that ensure patients are not billed for care related to a serious adverse event."

WHA President Steve Brenton said that national interest in the subject compels the Association to identify potential future actions in Wisconsin. "We need a Wisconsin approach that is responsive to the growing national consensus that this is a key patient safety issue hospitals must tackle in a uniform manner," Brenton said.

The WHA Board also approved the 2008 Association Goals at the meeting. WHA President Steve Brenton said he received a lot of positive feedback and good input on the goals from Board members.

In his report, Brenton briefly described a couple of important legal actions regarding the Injured Patients and Family Compensation Fund (Fund). He said the Wisconsin Medical Association’s lawsuit involving the raid on the Fund is still in the early stages and is expected to be on a lengthy timeline. He also recapped the Board’s legal activities related to the recently-resolved Schultz case.

WHA Executive Vice President Eric Borgerding said the state’s budget situation took a turn for the worse this week with the release of a Legislative Fiscal Bureau analysis February 13 that pegged the state budget shortfall at $650 million. He said that is a huge change from just a few months ago when the Legislature passed the State Budget. The massive downturn in the state’s revenue stream has spurred talk of program delays, budget cuts and rekindled interest in a hospital assessment, according to Borgerding.

"Fourth quarter tax revenue collections are way down. This is a serious situation, and it has everyone’s attention as we head into the elections in November," according to Borgerding. He said it will require the Governor to introduce a Budget Adjustment Bill and call the Legislature into special session. Borgerding said it is pretty clear that the budget debate is not over. He said if there is a special session, it will likely be after the regular session ends March 13.

WHA’s position on the hospital assessment is that the plan Governor Doyle put on the table in the late stages of the last budget is the one that is still viable going forward, according to Borgerding. "That proposal begins to address our Medicaid payment issues through the capture of $450 million in new federal revenue, and it stakes out our position as we head into the next debate on the assessment," he said. The Governor’s last proposal included statutory changes in the way the money was distributed, but Borgerding emphasized it does not preclude the Association from pursuing improvements in any plan to level an assessment on hospitals that may help it gain bipartisan support.

Borgerding told Board members that WHA staff has been busy in the capitol providing feedback and information on two proposals regarding price transparency. Rep. Leah Vukmir (R-Wauwatosa) is working on a proposal that requires, among other things, health care providers and insurers to give a good faith estimate on what a procedure will cost. Another transparency bill co-authored by Rep. Steve Weickert (R-Appleton) and Sen. Jim Sullivan (D-Sturtevant) would also require hospitals and all other health care providers to provide an estimate and more specific information. Under that proposal, providers would be required to make available the price of their 25 highest volume procedures immediately upon request.

"Our response to these proposals has been aided tremendously by the amount of proactive work both the Association and our member hospitals have done in the area of transparency the past few years," Borgerding commented. "Wisconsin hospitals lead the nation in transparency. CheckPoint and PricePoint are viewed as models that are continually evolving. These efforts are generally recognized by state legislators and have positioned us well in the transparency debate," he added.

Leo Brideau, chair of the WHA Task Force on Access and Coverage, reported at their January 24 meeting the Task Force reviewed and updated the WHA Access and Coverage Principles. He said the Task Force had a "thoughtful discussion on the issue of individual health insurance mandates," but did not reach closure on that difficult issue. Brideau said on the issue of transparency, hospitals can do a better job explaining costs to consumers. He said hospitals must be more proactive in providing pricing information, and work is being done at the Association to assist members in more readily providing that information. Brideau also mentioned that further work on WHA’s reform principles will focus on refinements that will make them easier to understand and more "consumer friendly."

Board members were briefed on Bush Administration proposed Medicare cuts that if enacted will cost Wisconsin hospitals over $1.3 billion over the next five years. Staff described Association plans to work with the Congressional delegation to "blunt the budget ax."

WHA expressed its support to the Assembly Committee on Public Health on February 13 for Assembly Bill 793. The bill aims to improve the safety, quality and efficiency of Wisconsin hospitals by facilitating the development of better, more comprehensive electronic medical records that improve patient care communication between providers.

A recent survey conducted by the WHA Information Center shows that 67 percent of Wisconsin hospitals have either fully or partially implemented key components of an integrated electronic system. Many of these systems have gone online in just the last few years. However, high implementation costs and antiquated laws stand in the way of broader adoption and improvement of these systems.

"This bill removes statutory barriers to communication that impede patient care," said Matthew Stanford, associate counsel, WHA. "These same statutory barriers are now impeding the implementation of improved electronic medical records systems that advance patient care by facilitating the sharing of patient care information between hospitals."

The bill, which was introduced on Monday, February 11, contains proposals recommended by the Governor’s eHealth Care Quality and Patient Safety Board that ease restrictions on redisclosure of health care records, reduce unnecessary documentation requirements, reduce barriers to sharing information with family members involved in the care of a patient, and permit a limited exchange of mental health information among providers for treatment purposes. The proposals were developed by workgroups of providers, IT experts, and patients convened by DHFS in which WHA actively participated.

"[Electronic Medical Records] systems cannot work unless we allow them to work," Rep. Terry Moulton (R–Chippewa Falls) told the Assembly committee. "With AB 793 we are taking another step toward achieving that goal. If we want to reduce costs and improve patient safety, we need to give patients and their doctors the ability to effectively exchange vital health information while still ensuring privacy. I am confident that this bill does just that."

Representatives Moulton, Chuck Benedict (D–Beloit), Brett Davis (R–Oregon), and Kim Hixson (D–Whitewater) introduced the bill.

"State statutes have not kept up with today’s advances in electronic record keeping, data sharing and information security," Rep. Benedict testified to the committee. "Under the changes proposed in AB 793, doctors will be able to make health record sharing decisions with patients’ health – not bureaucratic logistics – as their sole determining factor."

"While there are additional statutory barriers to communication and electronic medical records not addressed in this bill, WHA supports this bill as a good first step," added Stanford. "By improving the flow of information between providers, we can further advance Wisconsin’s already nationally-recognized high levels of quality and safe care."

The Bush Administration’s recently released federal budget proposal is breathtaking in its shoddy treatment of Medicare service providers, especially hospitals. The initiative targets an unprecedented $182 billion in provider payment reductions over the next five years, of which $135 billion would come from the nation’s hospitals.

A recent American Hospital Association analysis claims that, if enacted, the plan would cost Wisconsin hospitals $1.38 billion via: a three year freeze in the market basket (expense inflation) update for inpatient, outpatient, rehabilitation and SNF services; a five year freeze in home health payments; and severe reductions in medical education and DSH payments.

The conclusion, one might suspect, is that hospitals can somehow "hold the line on expenses" the next three to five years and convince our employees, suppliers and vendors to forgo wage, benefit and price increases.

A number of observers, including several members of the Wisconsin Congressional Delegation, point out that the Administration’s budget is DEAD ON ARRIVAL in Congress. But cuts of the magnitude suggested in the Bush budget unfortunately set providers up for lesser cuts that will have lawmakers claiming, "it could have been worse." In other words….we begin the budget season in a position of weakness.

Three thoughts as we settle into several months of effort that will be needed to blunt this latest federal budget ax:

1. There is NO WAY hospitals could successfully cost shift Medicare payment cuts of this magnitude. Our private payers can’t, won’t, and shouldn’t absorb this kind of "piling on." Twenty-five percent of the bill paid by commercial payers today is the result of already inadequate government payment. The sustainability of employer-based insurance is increasingly at risk due to this not so "hidden tax."
   
2. Much like Medicaid, the bipartisan nature of budget-driven provider payment cuts is a reality check that must be factored into any discussion of health reform. Lawmakers would rather add new benefits to existing programs than fairly pay the hospitals and physicians who care for the patients served by those public programs. That’s true in Wisconsin and it’s true in Washington.
   
3. Is it realistic to believe that somehow this sorry pattern would actually improve under any form of universal healthcare—especially if universality is framed by a sum-certain global budget and the de facto elimination of multiple payment streams through so-called managed competition? Available evidence suggests that providers would continue to be the first in line to "balance" annual budget shortfalls. And that would occur in a payment environment in which there would be no one to absorb the cost shift.

Steve Brenton, 
President

The Medical & Professional Affairs (MPA) Council brings together physicians and hospital leaders to promote high quality care and efficient hospital functioning through its efforts to monitor and influence professional practice. This is accomplished by promoting positive patient outcomes, continuing efforts to improve the value of care provided and by enhancing the quality and appropriate utilization of health care providers.

The MPA Council’s agenda includes educational presentations, as well as the opportunity to provide significant input into the initiatives of WHA and other health care industry organizations. In addition, participating members share and learn from each other how to approach specific performance challenges.

Over the past few years, the MPA Council has worked to improve clinical and administrative practices affecting patient care by centering attention on multiple initiatives. For example, the council identified a need for affordable physician leadership education in Wisconsin that resulted in the annual Physician Leadership Conference. The council also provides planning oversight to the annual Quality and Safety Forum. Other topics include, but are not limited to:

• CheckPoint
• Physician-level quality measurement
• Adverse event reporting systems
• Governor Doyle’s e-Health Plan
• Institute for Health Care Improvement 100K and 5 Million Lives Campaigns
• Participation in the development of the CMS Hospital Leadership Quality Assessment Tool
• Review of national reports like the Dartmouth End of Life Utilization Report
• DHFS Cardiovascular Health Alliance and Diabetes Advisory Committee Statewide Improvement Plans
• Wis. Stroke Committee’s survey results and stroke network of care initiative
• Role of the Wis. Medical Examining Board

In 2008, the MPA Council will continue its charge to improve patient and hospital outcomes and engaging our physician partners through continued attention to several of the above topics. Additional key initiatives will include:

• Wis. Wristband Standardization Project
• CMS Hospital Leadership Quality Assessment Tool
• Multi-state Peer Review Survey results review and education
• Wis. Quality Improvement Act

For additional information about the MPA Council, contact Dana Richardson at drichardson@wha.org or 608-274-1820 or Dr. Charles Shabino at cshabino@charter.net or 715-218-4854.

The first Family Safety Fair was declared a success by participants and attendees alike. More than 200 people visited Upland Hills Health’s new ambulance garage to gather information on ways to keep their loved ones safe.

Activities ranged from the assembly and give away of Family First Aid Kits to face painting.

Curious children swarmed the Dodgeville fire truck and ambulance for a first-hand look at the equipment. EMS personnel and fireman were on hand to answer questions and sound the sirens.

The highlight of the event occurred around 2 p.m. when the Med-Flight crew landed and allowed people to get up close and personal with the helicopter while asking questions about the Med-Flight Service.

All in all it was a great opportunity for various county resources to come together for a great cause—the safety of families. From poison ivy identifier cards and the D.A.R.E program to gun safety and free gun locks to make-your-own emergency survival kits—you could find info on just about any safety issue.

Patricia Lawson, Upland Hills Health Director of Marketing & Community Relations explained, "The event was the brainchild of Upland Hills Health’s Emergency Services staff—and they did a super job of putting it all together. We definitely will consider holding another such event in the future."

Jayme Waters started work as a lab technician at Consultants Laboratory in June 2005, just one month after graduating from Moraine Park Technical College (MPTC). Thanks to a learning partnership between the college and lab, the local student was more than prepared for her new job.

MPTC and Consultants Laboratory collaborated to create a two-year Clinical Laboratory Technician program. Waters was a member of the first class, and she states that the course’s combination of classroom education with laboratory clinicals provided valuable real world experience.

Eleven Wisconsin hospitals have been named to the Verispan Integrated Health Network (IHN) list, an annual assessment of the most highly integrated health care networks in the nation.

Wisconsin hospitals that made the list include:

Mercy Health System, Janesville
Affinity Health System, Menasha
Gundersen Lutheran Health Network, La Crosse
University of Wisconsin Hospitals & Clinics, Madison
Aurora Health Care, Inc., Milwaukee
The Monroe Clinic, Monroe
Columbia St. Mary’s, Milwaukee
Wheaton Franciscan Healthcare, Glendale

2008 Verispan IHN Best of the Rest

ProHealth Care, Waukesha
Ministry Health Care, Milwaukee
Fort HealthCare, Fort Atkinson

The Integrated Health Network Rating System rates local and regional, non-specialty integrated health care networks on their performance level and degree of integration. The rating system is a means for identifying the IHN 100 based on these critical success factors:

Former WHA Chair and retired hospital CEO Tom Miller III recently received the 2007 Citizen of the Year award at the Greater Menomonie Chamber of Commerce’s annual banquet.

Miller was described as being an exceptional role model, spending many hours contributing his time, skills and energy in the community. From 1974 until he retired in 2004, Miller, 56, was the administrator of Red Cedar Medical Center (formerly Myrtle Werth Hospital). He has served on innumerable boards over the years, including the Chamber, Greater Menomonie Area Community Foundation, Dunn County Cancer Society, United Way, Dunn County Visioning, Indianhead Enterprises, Workforce, and Oaklawn Harmony Centre.

An increasing number of employers, trying to curb the runaway costs of health coverage, are conducting dependent eligibility audits. Dependent eligibility audits, in which the employer collects proof that spouses and children qualify for benefits, are a device that can uncover substantial savings in the costs of health care, keep premiums down for legitimate beneficiaries, and catch outright fraudsters. The goal of the audit is to cull the benefits rolls in ineligibles, which could include ex-spouses, stepchildren who live elsewhere, or 29-year-old college grads still being claimed as dependents.

Typically, 5 to 15 percent of a plan’s covered dependents are found to be ineligible. By removing these dependents, a significant reduction in ongoing and future claims costs will be created. Employers are often surprised by the savings. An employer’s savings quickly dwarfs the cost of conducting an audit, as each dependent costs an average of $3,000 per year.