• Health care coverage would be made available to every child in Wisconsin by implementing "BadgerCare Plus," an expansion of BadgerCare to include families with higher incomes than current BadgerCare eligibles.
• A greater number of childless adults would also be covered, by extending eligibility to individuals having incomes of up to 200 percent of the poverty level.
• Small businesses would have more affordable health insurance by having access to a purchasing pool.
• Hospitals and physicians would be better able to reduce medical errors by accessing a $30 million fund for technology.

"Governor Doyle’s goals align well with WHA’s principles regarding access and coverage," said Steve Brenton, WHA president. "That being said, we have lots of questions about funding and federal approvals. Indeed, the ‘devil is in the details’ in all of these initiatives."

For example, WHA has questions about where the funding will come from and whether a rumored hospital tax, which has proven controversial in other states, will be on the table to pay for these or other proposals included in the budget. Also uncertain is whether the Federal government will approve the waivers that are necessary to implement the new programs. Finally, WHA had hoped to see some proposals that would enhance free-market, consumer-based solutions to health care costs.

"We look forward to working with the Governor and the Legislature on meaningful initiatives to reach common goals," Brenton said.

With three years of public reporting experience, hospitals are in a good position to counsel and assist physicians with publicly reporting performance measures, according to WHA Vice President Dana Richardson. Speaking at the February 1 meeting of the WHA Medical and Professional Affairs Council, Brad Manning, MD, who chairs the Council, said public reporting may some day be linked to physician payment by CMS as it is for hospitals.

In January 2006, CMS introduced the Physician Voluntary Reporting Program (PVRP). In December 2006, a payment incentive for physician quality reporting became law. While the new reporting requirement is still voluntary, the 2007 PVRP was expanded to include 66 measures and it includes a payment incentive for physician quality reporting.

Richardson said since hospitals have been publicly reporting quality data for three years, they are in a good position to assist physicians in this transition. "Physicians need information from the hospital to provide the data that is required for them to participate in the public reporting program. Physician reporting will also further engage practitioners in process improvement within the hospital and clinic setting," Richardson noted.

Richardson reported that the new hospital heart attack, congestive heart failure, pneumonia, and surgical infection prevention indexes are now being reported on www.wicheckpoint.org, and that the feedback on the aggregate measures has been positive.

Debbie Rickelman, RHIT, manager of the WHA Information Center, described the changes that will take effect in the facility billing form (UB-04), which were approved by the National Uniform Billing Committee in 2004. The paper form will be implemented May 23, 2007; the electronic version cannot be fully implemented until DHHS approves the form for electronic HIPAA transactions. The most significant change is the addition of a new clinical data element, referred to as the "present on admission" indicator. Physician documentation will be the key factor that will enable coders to accurately apply the indicator code.

The impact to hospitals, according to Rickelman, will be that it improves hospitals’ ability to report quality and patient safety information and it will improve accuracy in pay for performance. However, Rickelman said Medicare may use this information in reducing hospital payments for specific DRGs if they determine the care was the result of an error or hospital acquired infection.

WHA Senior Vice President George Quinn presented the 2007 Draft WHA Goals. The Council members said they want to continue to assist members in developing physician leaders through education programming; identifying solutions for medical staff issues; and creating opportunities for WHA members to explore strategies for building business relationships with physicians.

Twenty hospitals have signed up to participate in the WHA Rural Hospital Surgical Infection Prevention (SIP) Project. The SIP Project is sponsored by a grant from the Wisconsin Office of Rural Health and will focus on improving the quality of care through the proper standardization of certain surgical processes at participating rural hospitals over a period of six months.

The number of hospitals that signed up exceeded WHA Vice President Dana Richardson’s expectation. "This is the first collaborative project offered in Wisconsin that is specific to rural hospitals," according to Richardson. "I had hoped to have 10 hospitals participate. The advantage to having more is that there is a greater opportunity to learn from each other’s experiences. Since all participants are rural, we will have the opportunity to identify strengths and challenges unique to rural hospitals."

The strategies used by the Project will include the appropriate use of antibiotics, as well as appropriate hair removal and postoperative normothermia for patients having colon, hip replacement, hysterectomy, and knee replacement surgeries. The Rural SIP Project will include education regarding scientific evidence and successful strategies for preventing surgical infections in rural/critical access hospitals.

The following hospitals will be participating in the Rural Hospital SIP Project:

Amery Regional Medical Center, Amery
Baldwin Area Medical Center, Baldwin
Boscobel Area Health Care, Boscobel
Columbus Community Hospital, Columbus
Good Samaritan Health Center, Merrill
Grant Regional Health Center, Lancaster
Hayward Area Memorial Hospital, Hayward
Hudson Hospital, Hudson
Langlade Memorial Hospital, Antigo
Memorial Hospital of Lafayette Co., Darlington
Memorial Medical Center, Ashland
Memorial Medical Center, Neillsville
Reedsburg Area Medical Center, Reedsburg
Ripon Medical Center, Ripon
Sacred Heart-St. Mary’s Hospital, Rhinelander
Sauk Prairie Memorial Hospital, Prairie du Sac
Southwest Health Center, Platteville
Spooner Health System, Spooner
Tomah Memorial Hospital, Tomah
Westfields Hospital, New Richmond

For more information about this SIP project, contact Dana Richardson at drichardson@wha.org or 608-274-1820.

AHA members should or will shortly receive materials for AHA’s Annual Meeting to be held May 6-9 in Washington, DC. WHA will coordinate a number of special member events during this meeting, including a luncheon briefing and a special dinner on Monday, May 7. Meetings with Wisconsin’s Members of Congress will be scheduled for Tuesday, May 8 and, if need be, Wednesday, May 9.

With a new Congress and new legislative priorities, this year’s Annual Meeting provides Wisconsin hospital leaders a key opportunity to meet personally with their Members of Congress on important issues. The Annual Meeting also provides an opportunity for you to network with your peers from across the country and hear from national policymakers. WHA encourages you to consider attending this important event. To facilitate Hill visits, WHA staff will make appointments with members of the Wisconsin delegation on your behalf.

Please contact Jenny Boese, vice president of external relations & member advocacy, at jboese@wha.org or 608-268-1816 if you are planning to attend the Annual Meeting.

Don’t allow last week’s "love fest" for Governor Doyle’s tobacco initiatives fool you. Advancing the strong anti-tobacco agenda will be difficult. There are savvy and influential forces that will work hard to dismantle the proposals, and there’s plenty of time to accomplish that task.

One of the leading voices of opposition to increasing the tobacco tax appears to be the Tavern League of Wisconsin. The organization opposes the tobacco tax increase and the call for a statewide smoking ban in public places, including their venues.

Hospital participation in a coalition supporting Governor Doyle’s proposed tobacco tax increase has caught the attention and the ire of the League. The group’s recent newsletter opined "How about a tax on the "profits" Wisconsin’s not-for-profit hospitals realize from Wisconsin residents every year?" The League’s lobbyist suggested that "at a time when health care costs are spiraling out of control, Wisconsin hospitals want to increase the cigarette tax from 77¢ a pack to $1.77 (Governor Doyle is actually proposing $2.02 per pack) so they can pile more money into their plush new facilities while seeing their record profits continue to grow."

Of course, that rhetoric ignores the fact that Wisconsin’s hospitals provide literally hundreds of millions in quantifiable community, not to mention economic, benefits every year. All the so-called "profits" from Wisconsin’s not-for-profit hospitals are plowed back into patient care services, technology, nursing homes, and various other "money-losing" services that are often taken for granted, except when they are gone.

Just as intended with a cigarette tax, a hospital tax will be passed on to those who use the "product." So, the question being posed appears to be: "Shall we tax that which makes us sick, or just tax the sick?" To me, that’s a pretty easy question to answer.

• Kudos to Senate Republicans for offering up a "Smart Medicine" health reform proposal intended to address cost, quality and access challenges. The initiative, developed by Senator Alberta Darling (R-River Hills) and Senator Carol Roessler (R-Oshkosh) focuses on aggressive disease management for Medicaid enrollees as a cost containment strategy and suggests a "serious legislative commitment toward more equitable (provider) reimbursement rates" to begin addressing the cost shifting "hidden tax." The "Smart Medicine" initiative also embraces evidence-based medicine and treatment protocols, tax deductibility for health savings accounts, tax-exempt financing for health care technology purchases and escalation of current private sector public reporting initiatives. All of these recommendations align nicely with WHA’s Health Reform Principles.
  
• Labor unions have apparently enlisted the backing of congressional Democrats to support legislation that circumvents secret ballots for collective bargaining elections. This issue has flown below the radar screen, but look for a huge organized labor push about one month from now for "card check" campaign legislation. As written, the bill would force employers to recognize a union if the union presents the employer with "card checks" representing a majority of employees. The American Hospital Association is on the Steering Committee of the Coalition for a Democratic workplace, an organization formed to serve as a coalition that will oppose this highly un-democratic proposal. Look for more on this issue soon.

Steve Brenton
President

Hospital pricing information is now available to health care consumers in the state of Washington with the recent launch of a pricing transparency Web. The site, www.wahospitalpricing.org, was developed by WHA Information Center under a contract with the Washington State Hospital Association.

Data from all 97 hospitals in Washington is available on the Web site.

"Reliable information allows patients and purchasers to make informed decisions about where they choose to seek care. It also helps policy makers and the public measure the cost and quality of hospital care," said Leo Greenawalt, president of the Washington State Hospital Association.

Greenawalt added, "Many patients want to know what they will owe out of their own pocket for their hospital care. Answering these questions requires a combined effort among hospitals, health plans, and even the patient’s employer. Washington hospitals are committed to doing their part."

The Web site was created in response to requests from legislators and the public for more hospital-specific data. During the 2006 session of the Washington State Legislature, numerous bills were proposed to establish new reporting requirements for hospitals.

Leading legislators, including the chair of the Senate Health and Long-Term Care Committee, offered praise for the Web site.

Washington joins hospital associations in Iowa, New Hampshire, New Mexico, Oregon, Utah and Virginia in providing a PricePoint-based Web site.

The Centers for Medicare & Medicaid Services (CMS) has proposed changes to Medicare’s direct graduate medical education (GME) and indirect medical education (IME) payment policies for residents being trained at a non-hospital site.

Currently, hospitals can count such residents in calculating their medical education payments if the teaching hospital pays "all or substantially all of the costs for the training program in the non-hospital setting." Under a proposed rule governing reimbursement to long-term care hospitals released this week, CMS would reduce the level of non-hospital site training costs that hospitals would need to incur in order to receive GME and IME payments, and would allow hospitals to use specified proxies to determine those costs to ease the administrative burden of documenting them. The changes, if finalized, would become effective July 1.

Two days after Governor Doyle delivered his State of the State address, Lt. Governor Barbara Lawton traveled to St. Mary’s Hospital/Ministry Health Care in Rhinelander where she met with several dozen hospital and physician leaders for a health care chat.

Lawton spent an hour explaining the details of the Governor’s proposals and engaging employees in conversation. Those proposals include the expansion of BadgerCare to cover 71,000 single, childless adults, creation of grants for health IT, expansion of FamilyCare, government agency streamlining, simplifying the program enrollment process, a cigarette tax increase, a reinsurance/catastrophic coverage pool for businesses.

Ministry Health Care Northern Region CEO Brian Kief, a member of the WHA Access and Coverage Task Force, thanked the Lt. Governor for coming to Rhinelander to meet with them. "It’s exciting to listen to this ‘live’ and to think about being in a state that’s on the cutting edge of change in health care," he began. "Could you share with us how these programs will be funded?"

Lawton responded that funding details will be released in the Governor’s budget address on February 13, but that the funding will come from a "variety" of sources, including an increased cigarette tax, federal government matching, and savings from state government streamlining. Kief indicated that as providers, they would not support a hospital tax as a means of funding the initiatives, as is rumored by some in Madison. The Governor is slated to release budget details on February 13.

Columbia St. Mary’s Host Recently Elected State Rep. Jim Ott

Hospitals across the state continue to invite their elected legislators to visit, and this week Columbia St. Mary’s (CSM) hosted newly elected State Rep. Jim Ott (R-Mequon). Rep. Ott met with CSM CEO Leo Brideau, Executive VP & COO Therese Pandl and VP Paul Westrick at the CSM-Ozaukee Campus.

CEO Leo Brideau provided Rep. Ott an overview of principles to keep in mind when evaluating health care reform. The principles are the result of the WHA Task Force Brideau chaired.

Rep. Ott indicated he would depend on the expertise of those in health care in evaluating these proposals saying, "there are a lot of health care reform proposals out there, so it’s good to have contacts with those who have that experience."

The meeting also provided the opportunity to focus on the possibility of a hospital tax, as has been rumored by some in Madison. Rep. Ott quickly responded in the negative, adding he couldn’t understand how this wouldn’t increase the cost of health care. CSM and WHA agree; a tax only serves to increase the cost of health care, as it will ultimately be shifted onto private payers.

HHS Secretary Mike Leavitt announced January 25 that Wisconsin was among 27 states to receive federal Medicaid Technology Transformation grant awards to improve efficiency, economy and quality of care. These grants will be distributed over fiscal years 2007 and 2008.

Wisconsin received $3,043,272 to be used to develop and implement health information exchange initiatives. A portion of those dollars ($945,000) will be used to implement the Milwaukee Emergency Department Care Coordination’s IT Linkage Project. This project has been in development over the past two years and involved participants from each of the five Milwaukee County health care systems, WHA staff, and the Wisconsin Primary Health Care Association, representing the county’s federally qualified health centers (FQHCs).

The grant will enable an electronic, 24/7, real time web-based system to be implemented that would connect all hospital emergency departments, the four FQHCs and their primary care physicians and case managers, with the EDS information database (including pharmacy), the General Assistance Medical Program (GAMP) information database, as well as with medical information database on uninsured patients as they come into the system. This medical information will enable emergency department clinicians to better assist patients in diagnosing their medical needs at the time of presentation. In addition, this system will aid in med-reconciliation issues, helping patients to find primary care homes, thereby enabling patients to be a part of a care management system, and reduce potential medical errors.

The 2007 Health Care Administrative Professionals Conference will focus on understanding the communication styles of others to assist in improving your own communications, reading between the lines of an e-mail message to respond more effectively, and learning to tame the "e-mail lion" that traps most of us each day.

This program is designed for executive assistants, administrative assistants, business office managers, secretaries, and other support staff in hospitals and other health care settings. A brochure and registration form are included in this week’s packet. Please pass it on to the valued support service professionals in your organization.

The conference will be held March 9 at the Kalahari Resort in Wisconsin Dells. It opens with an optional networking reception and dinner on the evening of March 8, and continues with a full day of education on March 9.

The scene of the accident looks horrific. A smashed car. Beer bottles. Bodies covered with blood. An ambulance. The coroner. A hearse.

Fortunately, this "accident" is only a simulation — a visual lesson about drinking and driving for the high school students who surround the scene. The "victims" of the crash are their peers. The ambulance staff, rescue team and the funeral home personnel are real — volunteering their time to hopefully prevent a scene like this from actually occurring.

The Trauma Center at Luther Midelfort has been coordinating simulations such as this one since 1997 at high schools throughout the Chippewa Valley. The goal of the event is to help prevent injuries and death in young people by showing them what can happen when they drink and drive, said Karen Geissler, R.N., an injury prevention coordinator at Luther Midelfort.

"Research says there is a two-week glow after an event like this when behavior does change," said Geissler. "So we try to time our simulations close to high-risk periods, like prom and graduation."

In addition to Luther Midelfort, several area agencies and businesses participate in the simulations including the Eau Claire Police Department, Eau Claire Fire Department, Gold Cross Ambulance, Mayo One Eau Claire and Evergreen Funeral Home.

If seeing the scene isn’t enough, students also learn about the legal charges for the intoxicated driver from a police officer, the intensive care and long-term health impacts from a health care provider, how the family of the dead person is notified from a police chaplain, and the decisions a family must make in planning a funeral from a funeral director.

An average of four presentations are held each spring at schools throughout the Chippewa Valley. Since it started in 1997, more than 11 schools have participated, and other schools conduct similar presentations on their own with Geissler’s help.

Does it really make an impact on the students? Judging by the hushed and somber crowd made up of hundreds of students, we think it does.

Submit hospital community benefit stories to Mary Kay Grasmick, editor, mgrasmick@wha.org or call 608-274-1820.

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