WHA Web site Speeds Legislative Contacts -- "It's a one-stop shop for health care advocates"
February 21, 2003
Volume 47, Issue 8
Budget Wrap Up
WHA's initial review of Governor Doyle's massive 1,100 page budget revealed the following provisions. Watch the newsletter for developing budget information as the continuing review exposes more items that are important to Wisconsin hospitals. As proposed by Governor Doyle:
President's Message
Overall, Wisconsin's Medicaid program fared well in Governor Doyle's just-released budget. Especially in the context of the need to fill a $3.2 billion biennial deficit, health care programs escaped the kind of drastic cuts being witnessed in much of the nation. The Doyle budget appears to have maintained current eligibility for Medicaid and BadgerCare, fully funds growing caseloads and avoids across-the-board provider payment cuts.
There are, however, several "buts" that require our attention. And more may be discovered as we examine the budget document's fine print:
The funding foundation of the Medicaid budget is based on a new intergovernmental transfer (IGT) that will maximize federal spending and the taking of $200 million in Patient Compensation Fund (PCF) reserves that will be matched with federal funds. These two revenue sources provide over $1 billion of Medicaid funding over the next two years. Both proposals will prove to be controversial (the IGT has strong enemies in Washington, D.C. and the patient compensation transfer will have critics in Madison).
The decision to eliminate Wisconsin's historic Medicaid commitment to fund the education and training of Wisconsin's future physician workforce is hugely disappointing. The elimination of almost $30 million annually (60% of which is federal funding) will severely affect the ability of teaching hospitals to train physicians at a time when experts are predicting a shortage of physicians in the very near future. The short-term and the long-term implications of this proposal are profound and unacceptable. WHA will obviously make a major effort to restore this vital funding during upcoming budget deliberations.
Another disappointing initiative eliminates a special Medicaid Rural Adjustment that provides targeted payments to a handful of especially Medicaid/Medicare dependent rural hospitals. This program also deserves significant attention and full restoration.
Returning to the issue of the new intergovernmental transfer, WHA will work hard to convince state and federal lawmakers to advance this initiative as a vitally important ingredient in backfilling necessary Medicaid funding. Failure to access these new funds will create a budget chasm requiring devastating new cuts in payments and services.
WHA Web site Speeds Legislative Contacts --
"It's a one-stop shop for health care advocates"
Contacting legislators is now fast and easy, thanks to the redesigned WHA Web site that features a "Speak Up" section. Participation in grassroots efforts has grown at a fast pace, with more hospital employees contacting legislators than ever before--a rate, according to Ann Lucas, WHA vice president of external relations and member advocacy, that will help keep health care issues on the front burner in the legislature.
Since Governor Doyle rolled his budget out, WHA has worked at a furious pace to put into place a strategy for employing the WHA's grassroots network that was so successful in beating back the hospital construction ban and other harmful initiatives in the last legislative session. Health care advocates will be encouraged over the next few weeks to make both state and federal legislative contacts.
"In the last legislative session we were successful in turning back several efforts that would have been damaging to the delivery of health care in Wisconsin. Now, we will need to unleash those forces once again as we begin the budget battle in Madison," commented Eric Borgerding, WHA senior vice president.
The Speak Up section provides a fast way to make legislative contacts for both seasoned pros and those new to the process. It provides all the tools needed to find out who your legislator is and then enables you to send an email through WHA's Web site.
WONE Annual Convention in Madison, April 23-25
Wisconsin Organization of Nurse Executives (WONE) will host its annual convention for nurse leaders on April 23-25 in Madison. Vicki George, senior vice president & chief nursing officer for Catholic Health Initiatives, will open the event by speaking on the benefits of achieving magnet status for your health care organization.The convention will be held at the Monona Terrace and The Concourse Hotel in Madison. Anyone who has responsibilities in leading and managing RNs will benefit from the educational agenda and is welcome. 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 Web site at www.wha.org. CEUs will be applied for and granted through Aurora Health Care, Nursing Education Department, Milwaukee.
For more information on the program content, contact Jennifer Frank at 608-274-1820 or email at jfrank@wha.org. For registration questions, contact Bridget Gifford at 608-274-1820 or email at bgifford@wha.org.
WHA Counters Decker's Profit Claims
On February 13, Sen. Russ Decker issued a press release that focused on hospital profits. In response, WHA's George Quinn, senior vice president, wrote the following letter to the editor, which was placed in select daily newspapers in Northern Wisconsin.
February 18, 2002
Dear Editor;
Senator Russ Decker, in his February 13 press release "Hospital Profits at All Time High," manages to mix together so many unrelated topics that it's difficult to set the record straight in a simple and understandable way. But the issue of health care costs is too important a topic to be left to sound bites and misinterpretations of data.
Let's first look at the statements regarding hospital costs and profits. Senator Decker criticized what he described as $614 million in hospital profits but failed to mention that nearly HALF of that total comes from interest earned on reserves, gifts and bequests, and receipts from such activities as the hospital gift shop or parking revenues. In reality, the statewide hospital margin from patient services amounts to 4.8%, about the national average and only ONE AND A HALF CENTS of each dollar spent on health insurance premiums -- hardly a major factor behind health insurance premium increases.
It's also important to note that what Senator Decker calls "profits" in many cases sustain other -- typically unprofitable -- community health care services such as physician clinics, bio-terrorism preparedness activity, nursing homes and home health services. In fact, a recent WHA study of southeastern Wisconsin hospital system "profits" showed that about one half of these funds are actually reinvested in unprofitable but necessary community health programs. Focusing solely on hospital "profits" ignores the fact that these funds are often used to support the total continuity of care our communities need.
Senator Decker also talks about "government health care programs struggling to keep their heads above water." The fact is that the government program here in Wisconsin, the Medicaid program, pays hospitals only 70% of their costs. In fact, Medicaid and its federal counterpart, Medicare, shortchanged Wisconsin hospitals by more than $750 million in 2001. These unreimbursed costs must be passed on to commercial insurers, and unfortunately become a major source of insurance premium increases.
Finally, Senator Decker's press release brought renewed attention to his failed efforts of last year to bring Madison-based hospital regulation to what currently are decisions made in local communities like Wausau, Park Falls, Marshfield and Eau Claire. Lawmakers last year overwhelmingly concluded that decisions about nursing salaries, the acquisition of state of art medical technology and hospital and clinic capacity are best made in local communities. We agree with that viewpoint and remain eager to work with Senator Decker on finding real and sustainable solutions to health care cost issues.
George Quinn
Senior Vice President
Wisconsin Hospital Association
Join your colleagues and be a voice for health care in Madison and Washington DC.
WHA Advocacy Day
Registration materials are available at www.wha.org and www.hospitalconnect.com.
WHA Board Approves Task Force; Creates Quality Steering Committee
The Wisconsin Hospital Association Board of Directors received a thorough briefing on Governor Doyle’s recently released state budget at their meeting in Madison February 20. WHA Senior Vice President Eric Borgerding told the Board that WHA is preparing strategies to restore funding to the rural hospital supplement and the graduate medical education program, both of which were eliminated in the Doyle budget. In addition, WHA seeks to restore the Medicaid share of the Medicare crossover, also eliminated in the Governor’s budget.
"Like other MA providers, we are taking are taking some big cuts, but this is just the beginning of the process and we will be working vigorously to shape its final outcome in the months ahead," Borgerding warned. (See related budget story on page one.)
Chuck Shabino, co-chair of the WHA Initiative on Quality and Accountability, reported significant progress on the Quality reporting program. To date, WHA has made more than 22 presentations across the state. Dana Richardson, vice president, quality initiatives, said WHA’s goal is to present the program to members of hospital boards and medical staffs to ensure that WHA reaches its goal of 100 percent member participation. The key, according to Richardson, is gaining the cooperation of physicians and earning credibility for the quality program from stakeholders.
Shabino explained that the natural succession to the WHA Task Force on Quality and Accountability is the formation of a Steering Committee. The steering committee would essentially develop the framework to move forward to monitor and develop future measures. The Board approved the concept of including a mix of committee members that includes 40 percent from clinical, 40 percent purchasers, and 20 percent from hospital leadership, for a total of 20 members, who would report directly to the WHA Board.
Shabino explained that forming partnerships with purchasers and including them on the steering committee will help establish credibility and will bring people who are prominent in the health care and business community to assist WHA in its effort to deliver a quality report that purchasers, consumers, and hospitals will find valuable.
Richardson said a task force will also be formed that will provide guidance on marketing the quality report and will present ideas to the steering committee on handling the public relations and educational components of introducing the new quality report.
In other actions, the Board approved the formation of a Physician Recruitment Task Force that will be charged with identifying a specific course of action that will help avert a serious shortage of family practice physicians and specialists. WHA President Steve Brenton pointed out that he hoped this effort would create an awareness and urgency around this problem, as the workforce campaign was successful in doing in late 2001. Bobbe Teigen, chair of WHA’s Council on Rural Health, said the recruitment of physicians and specialists was a major discussion item at the last council meeting.
In his report to the Board, Brenton presented the following:
Council on Finance and Payment Chair Ned Wolf said members are reporting problems with Medicaid HMOs not paying at emergency room rates, asserting that some visits are non-emergent. WHA General Counsel Laura Leitch is drafting a letter to the Department of Health and Family Services to alert them to this widespread problem to determine the DHFS position on this issue. Wolf said 16 of the council members have indicated that they will purchase the Medicare revenue forecasting financial modeling software. Their experience with this product will be used to market this product to all WHA members.
AHRQ Announces New Web-Based Medical Journal with Patient Safety Lessons Drawn from Actual Cases
In hospitals across the country, clinicians routinely hold Morbidity and Mortality (M&M) conferences to discuss specific cases that raise issues regarding medical errors and quality improvement. Until now, there has been no comparable national or international forum to discuss and learn from medical errors. AHRQ saw the opportunity to use the Web to host an ongoing national M&M conference aimed at improving patient safety by sharing information from anonymous cases.
"The AHRQ WebM&M site offers the medical community a unique opportunity to learn about patient safety from the experiences of their colleagues across the country and around the world," said AHRQ Director Carolyn M. Clancy, M.D. "The anonymity safeguards will enable physicians to share their experiences without fear of reprisal. Their involvement will contribute to the education of other providers about how to prevent medical errors and improve patient safety."
Every month, five interesting cases of medical errors and patient safety problems--one each in medicine, surgery/anesthesiology, obstetrics-gynecology, pediatrics, and other fields, including psychiatry, emergency medicine and radiology--will be posted along with commentaries from distinguished experts and a forum for readers' comments. Each month, one of these five cases will be expanded into an interactive learning module ("Spotlight Case") featuring readers' polls, quizzes, and other multimedia elements and offering continuing medical education credits. Cases are limited to near misses or those that involve no permanent harm.
The Web site was developed for AHRQ under a contract to an editorial team at the University of California, San Francisco. The editorial team is led by Robert M. Wachter, M.D., Associate Chairman of UCSF's Department of Medicine and Chief of the Medical Service at UCSF Medical Center. The editorial board and advisory panels include many of the nation's experts in patient safety.
Dr. Lucian Leape, a leading patient safety researcher and a member of the AHRQ WebM&M Advisory Panel, praised the new journal. "To make real progress in patient safety, we have to engage physicians and break down the shame and silence surrounding errors," he said. "By presenting real-life cases of medical errors along with dynamic, systems-oriented expert commentaries, AHRQ WebM&M is an ideal way for physicians to learn more about, and ultimately improve, patient safety."
In its inaugural issue, the Web-based journal features cases on a mix-up involving two patients with the same last name in the same hospital room; a mistaken drug administration causing a patient to stop breathing unexpectedly; a procedural mishap requiring emergency vascular surgery; an infusion pump flying into an MRI, narrowly missing a child; and a misdiagnosis of delusions in a man later found to have metastatic brain and spine cancer. For more information, contact AHRQ Public Affairs, 301-594-1364; Ron Rabbu, 301-594-0378 (RRabbu@ahrq.gov); Farah Englert, 301-594-6372 (FEnglert@ahrq.gov). The AHRQ information can be accessed through the WHA Web site in the Quality and Patient Safety Link Library.
Member News
Stoughton Hospital and SSMHC of Wisconsin Form Affiliation
Stoughton Hospital and SSM Health Care of Wisconsin (SSMHC/WI) have signed an affiliation agreement that provides SSMHC/WI with a minority interest in Stoughton Hospital. Stoughton Hospital will remain under local control.
Program Provides Tools to Write Grants That Produce Results
Remember to register now for the "Grant Writing 101 and Beyond" seminar on March 19 at Hotel Mead in Wisconsin Rapids. A brochure and on-line registration are now available on the Web site at www.wha.org.
Whether you're a novice or experienced grant writer, attending this seminar will sharpen your skills and improve your understanding of the grant making process. Learn from those who know - the workshop presenters regularly write, review and award grants. Additionally, learn about grant opportunities at both the federal and state level to help bring health funding to Wisconsin communities. Ultimately, attendees will leave this workshop able to prepare more competitive grant proposals.
This program is co-sponsored by the Wisconsin Hospital Association, the Wisconsin Office of Rural Health, Wisconsin Primary Health Care Association, and the Rural Wisconsin Health Cooperative. For more information on the program content, contact Jennifer Frank at 608-274-1820 or email at jfrank@wha.org. For registration questions, contact Bridget Gifford at 608-274-1820 or email at bgifford@wha.org.
UW-Madison Expands Nursing Program to Gunderson Lutheran Campus
The University of Wisconsin-Madison School of Nursing has received permission from the University Academic Planning Council and the State of Wisconsin Board of Nursing to offer a baccalaureate nursing program and degree to students at Gundersen Lutheran Medical Center in La Crosse. The first class of 12-14 nursing students will begin their program in the fall of 2003. Eventually, there may be as many as 48 students enrolled, representing a net increase of almost 50 percent in the UW-Madison Nursing School's undergraduate enrollment.
Gundersen Lutheran includes a La Crosse-based 325-bed hospital and clinic, along with numerous medical and eye clinics, several nursing homes, and behavioral and home health services throughout the tri-state region. When the organization completed a strategic plan a few years ago, developing a first-rate department of nursing education and research was among the top priorities. UW Medical School already has a "western clinical campus" at Gundersen Lutheran, and nursing leaders used that arrangement in part as a model for the new venture.
The nursing shortage in Wisconsin and throughout the nation is acute. One of the difficulties in training new nurses has been a lack of sufficient qualified instructors. The bachelor of science in nursing program expansion will add to UW enrollment without requiring more instructors, because Gundersen Lutheran nursing specialists will teach courses in collaboration with Madison faculty.
Gundersen Lutheran Medical Foundation is contributing a significant portion of the operating costs of this program expansion, with the goal of increasing the potential pool of university-educated nurses in La Crosse and the Coulee region.
"This is an exciting option for western Wisconsin students who want to become nurses," said Katharyn May, dean of UW-Madison's School of Nursing. We've been working on developing this program for more than a year, and it's one big step toward creating more educational opportunities for the nurses our state desperately needs."
May is especially delighted with one early, unexpected result: UW-La Crosse, already well known for its allied health programs, is going to be a partner as well. The school will provide instruction in the required pathology and pharmacology courses, in addition to the student services available to all UW-La Crosse students (such as access to the Health center, counseling and testing, recreational facilities, etc.). Students in the expanded bachelor of science program will be admitted, assessed and graduated as if they were attending at Madison; the degree will be a UW-Madison degree.
Students will work with patients at Gundersen Lutheran's various hospital and clinic settings and at other community agencies. Students who want more information about the new program should call the School of Nursing in Madison at 608-263-5167.