In a letter sent this week to Wisconsin’s Congressional Delegation, WHA President Steve Brenton outlined the harmful impacts of President Bush’s recently proposed budget on Wisconsin hospitals.

"Over the next five years, the proposed budget will cut the nation’s hospitals by $135 billion and Wisconsin hospitals by $1.4 billion," Brenton said in the letter. "The one year loss to Wisconsin hospitals alone is a staggering $122 million."

Senators Kohl/Feingold             $122 million statewide     $1.4 billion statewide
Cong. Baldwin                          $23 million                      $274 million
Cong. Kagen                            $10 million                      $120 million
Cong. Kind                               $11 million                      $123 million
Cong. Moore                            $39 million                       $442 million
Cong. Obey                             $10 million                       $121 million
Cong. Petri                              $6.7 million                      $81 million
Cong. Ryan                             $9.5 million                     $111 million
Cong. Sensenbrenner               $11.8 million                   $140 million

The most troubling cuts come from the elimination of both inpatient and outpatient market basket updates for FFYs 2009-2011 and then a reduction of both market basket updates by 0.65 percent in FFYs 2012-2013. All total, these cuts to Wisconsin hospitals equal roughly $868 million.

The budget reduces the Indirect Medical Education (IME) adjustment and eliminates hospital IME payments for Medicare Advantage beneficiaries—another $243 million cut over five years. Hospital Disproportionate Share payments are also reduced, translating into an $118 million loss over five years. Additional cuts come from provisions affecting capital payments and bad debt among others.

"With Medicare already paying just 75 cents on the dollar of costs, these provisions will do nothing but increase the hidden health care tax for Wisconsinites," Brenton closed. "Hospitals could never successfully cost shift Medicare payment cuts of this magnitude, nor should private payers be expected to somehow absorb that kind of cost increase."

WHA will aggressively advocate against these cuts in the coming months, including during the annual trip to Washington, DC in April.

For additional information, contact Jenny Boese at 608-268-1816 or jboese@wha.org.

The Congressional Budget Office (CBO) concluded in a new report that about half of all growth in U.S. health care spending over the past several decades was associated with technological advances in medicine. "On the basis of review of the economic literature, CBO concludes that roughly half of the increase in health care spending during the past several decades was associated with the expanded capabilities of medicine brought about by technological advances," it said. The report defines technological advances as changes in clinical practice that enhance the ability of providers to diagnose, treat or prevent health problems.

Despite its potential to improve care and outcomes, new technology can drive increases in a number of ways. The report includes examples such as diagnostic imaging. Diagnostic scans may be less expensive than more dangerous and costly exploratory surgeries, "but by their nature they invite much greater use and therefore tend to increase total spending compared with previous methods."

Similarly, the treatment of coronary disease went through dramatic changes over the past several decades. Treatment of patients with heart disease was formerly fairly inexpensive because there was little physicians could do – bed rest and morphine were the protocols of choice for those suffering a heart attack. Since then, angiography was developed, allowing for greatly improved diagnosis of heart disease, and angioplasty replaced more costly bypass surgery. As a result, patients are diagnosed earlier, are provided less invasive treatments, and live longer, but this all comes at the price of greater utilization and higher overall cost for the U.S. as a whole.

The report asserts that future increases in spending "could be moderated if costly new medical services were adopted more selectively…and if diffusion of existing costly services was slowed." It recognizes, however, that current financial incentives for both providers and patients encourage the use and overuse of new technologies. Furthermore, it states that there is currently little cost/benefit analysis of new technologies.

The CBO suggests several solutions to this problem, including having Medicare and private payers change their payment policies on high-tech procedures to reduce the incentives currently in place for providers and patients, and by placing more emphasis on "comparative effectiveness analysis." A greater emphasis on evidence-based delivery of health care might lower future spending levels, but "such actions are likely to be difficult to implement and might prove controversial among both providers and patients," the report concludes.

The Assembly Committee on Public Health voted 7-1 on February 20 to recommend passage of Assembly Bill 793, which would remove various statutory barriers to electronic medical records. The bill is backed by WHA and contains proposals recommended by the Governor’s eHealth Care Quality and Patient Safety Board.

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.

Also on February 20, the Senate Committee on Health, Human Services, Insurance, and Job Creation held a hearing on the Senate version of the bill, Senate Bill 487. That committee is expected to vote on the bill shortly.

"This bill saves time, saves duplication, and saves money," said Committee Chair Senator Jon Erpenbach, one of the lead sponsors of the Senate bill.

"WHA and many other organizations and individuals support this bill as a good first step toward removing antiquated statutory barriers to electronic medical records and the communication of patient care information between providers," said Matthew Stanford, associate counsel, WHA. "It will help keep Wisconsin hospitals at the national forefront of providing the safest and highest quality care."

South Carolina became the fourth state hospital association to begin using WHA’s CheckPoint program (www.mySChospital.org) on February 21. The Wisconsin Hospital Association launched CheckPoint (www.wicheckpoint.org) in 2004. Since that time, the Utah, New Mexico, and now South Carolina hospital associations have leased the CheckPoint Web site to meet their hospitals’ public reporting needs.

"Wisconsin was the first state in the nation to publicly report hospital quality, safety and price. We have quite a lot of experience with public reporting because our hospitals embraced public reporting early and took the steps necessary to collect and report the data," according to Dana Richardson, WHA vice president, quality initiatives. "Other hospital associations are now interested in putting our program to work in their states," she added.

"Wisconsin’s early lead in public reporting has contributed to our state being ranked number one in quality in the nation by the federal Agency for Healthcare Research and Quality," Richardson said. "Our commitment to public reporting has paid off for Wisconsin hospitals and the patients they serve."

Four months ago the WHA Board agreed to drop its opposition to the hospital tax because the initiative had been overhauled to address longstanding concerns regarding potential CMS approval and safeguards necessary to assure that hospitals would actually receive higher payments promised by the plan. The Board’s action acknowledged the need to secure meaningful Medicaid payment improvements in the face of a difficult state budget environment and over a decade of legislative inaction.

In December, the Board revisited the tax, recognizing that the issue would be back, probably in early 2009 when the next biennial budget would be debated. The Board’s action stated that the reworked hospital assessment initiative "remains a viable approach" going forward. The Board statement recognized that millions of dollars in new federal funding could shore up the state’s "safety net" hospitals and begin reducing the "hidden tax" on health insurance premiums that are the legacy of years of Medicaid payment inadequacy.

Well, it’s not 2009 yet, but the assessment is back. Recent news of a $650 million revenue shortfall for the current biennium means that lawmakers will soon be scrambling to reach consensus on a budget "repair" bill. Action is required under state law due to the magnitude of the "red ink." And it is likely that the final package will include a mix of program cuts and/or delays as well as new revenue "enhancers."

The hospital assessment is back in play. No other initiative has the potential to: 1) leverage hundreds of millions of dollars in federal funding that has been left on the table for far too long; 2) provide relief for hospitals serving a growing and disproportionate share of Medicaid and uninsured patients; 3) reduce the "hidden tax" on health insurance premiums that is threatening the sustainability of employer-based coverage; and 4) possibly protect several new health reform initiatives that might otherwise face the budget ax (recent Medicaid expansions and increased assistance for Wisconsin’s fine network of community clinics, for example).

The hospital assessment, in the form that emerged in October, can represent a win-win-win-win (see previous paragraph) in the context of addressing critical health care issues facing Wisconsin lawmakers and those of us directly involved in the delivery of health care services. And the state’s very real economic challenges now serve as a catalyst to speed consideration of the assessment on a fast track not imagined even a few weeks ago.

Steve Brenton                                  Ken Buser
President                                         2008 Chair
Wisconsin Hospital Association        WHA Board of Directors

In a recent survey, physicians from Columbia St. Mary’s and Froedtert and Community Health indicated that behavioral symptoms, especially depression, anxiety and poor health habits, frequently contribute to the medical conditions they treat. The physicians said while they can treat mild symptoms, they needed more information on when and where to refer patients who required specialized care.

"Physicians are deeply concerned about both the mental and physical health of their patients. Bringing the two disciplines together, though, is often difficult from both the perspective of the practitioner and the patient," said Dr. Ken Johnson, department chair for psychiatry at Columbia St. Mary’s. "We decided the best way to begin to address the issue was to go directly to physicians and have them help us develop a more integrated approach."

The information gathered from the survey was used to develop an educational program. Last November, Rogers Memorial Hospital and Mental Health America sponsored a program aimed at helping physicians and hospitals address mental health and substance abuse needs of patients. The goal was to improve general access to behavioral health services, improve patient outcomes and reduce health care costs.

Speaking at the program, Dr. David Katzelnick from the University of Wisconsin School of Medicine and Public Health outlined the importance for and key components of integrated health care. Following his presentation, participants were divided into primary care, specialty care and emergency care subgroups to discuss barriers to behavioral services as well as recommendations for improving care integration. These discussions revealed a high level of physician interest and generated the following recommendations:

1. Increase physician access and communication with existing behavioral health resources.
1. Distribute a comprehensive behavioral health provider directory for physician use.
2. Offer training and face-to-face discussions between mental health professionals and general medical staff in physician-identified interest areas.
3. Increase the flow of patient care information from specialized mental health providers to medical practitioners while protecting patient confidentiality.
4. Establish a centralized "call center" or triage line for behavioral services that can link patients with treatment and health care professionals with behavioral health consultants.
2. Expand implementation of behavioral health services embedded into primary care clinics.
3. Explore the possibility of developing a care management model for patients with chronic behavioral conditions as an alternative to existing current behavioral health insurance carve out programs.

According to Dr. Tom Heinrich, assistant professor at the Medical College of Wisconsin and chief of psychiatric consultation services at Froedtert Hospital, "The event confirmed that behavioral disorders are increasingly frequent and challenging for hospital physicians and administrators. For too long, it appears, mind and body have been treated separately and untreated behavioral disorders have unnecessarily exacerbated medical conditions," Heinrich said. "We see great opportunity to improve patient care and reduce overall health care costs through more integrated treatment," he added.

On January 16, Safe Care Wisconsin launched a statewide medical education project aimed at encouraging people to write down their medications and carry the list in their wallets. The project—List it. Don’t Risk it. Write it down.— is now starting up in some areas of the state by hospitals with support from their Partners of Wisconsin Hospital Association chapter.

St. Joseph’s Hospital, Chippewa Falls, launched a medicine list project using many of the Safe Care Wisconsin materials. In an article that ran in the Chippewa Herald, St. Joseph’s Hospital noted that medication cards, along with a plastic pouch to keep them in, were available for pick up in the hospital gift shop, or they could be mailed directly to the requester.

Ministry Health Care is also actively promoting the use of medication lists and, like St. Joseph’s, is using the Safe Care materials. In fact, Ministry provides a link on the front page of their Web site to www.safecarewisconsin.org. Their push is being supported by public service announcements, releases to local media and an insert in the newspaper.

Local campaigns bolster the work of Safe Care Wisconsin, a statewide group comprised of WHA along with other health care organizations focused on helping people become better health care consumers. Partners of the Wisconsin Hospital Association, a statewide hospital volunteer group, set their own goal of having all 12,000 of their members fill out a medicine list—and then complete one for a friend or family member, for a total of 24,000.

Bonnie Olson, member of Partners of St. Joseph’s Hospital, Chippewa Falls, and local spokesperson on their project, is enthusiastic about this issue coming to the public’s attention.

"We want everyone to know how critical it is to write down and carry a list of medicines," Olson said. "It’s convenient to have a complete list when you are filling out a medical history form in a doctor’s office . . . but in the event of an accident and you are unable to communicate to hospital medical personnel, it becomes critical for them to know the medications, both prescription and non-prescription, you are taking."

For more information about Safe Care Wisconsin or the medication list project, List it. Don’t Risk it. Write it Down., contact Dana Richardson, drichardson@wha.org, or Mary Kay Grasmick, mgrasmick@wha.org, or call 608-274-1820.

For the past eight years, several organizations in New Richmond, Wisconsin have worked together to host a Kids Asset Carnival. The mission of the event is to promote the 40 developmental assets that have been identified by the Search Institute as necessary to grow healthy and resilient children.

Westfields Hospital participated by presenting a hands-on activity designed to teach children how to make good choices when selecting snack foods and what the consequences of poor choices might mean. Linda Stefonek, registered dietitian, brought samples of healthy snack foods for kids to taste and let kids wear a 25-pound "fat" vest to see what it feels like to carry the extra weight. Grocery shopping lists were available for parents to encourage them to keep healthy snacks readily available.

Parents and children surprised themselves to find they liked the taste of some "healthy" choices they had never tried before. "I try to encourage parents to have a prepared list of healthy snack items handy when they go grocery shopping. Replace one or two items each trip to the store," says Stefonek. "Generally if you keep fruits, nuts, veggies and dips prepared, handy and ready to go, kids will eat them," she adds.

The event, which is geared at the Pre-K to sixth grade level, served 193 families and 400 individuals.

Luther Midelfort Chippewa Valley, formerly known as Bloomer Medical Center, recently participated in a hazardous materials regional drill. This drill was sent up to educate city staff, county officials, and health care employees on how to coordinate and activate a decontamination plan and to successfully decontaminate individuals within the community. To prepare for the drill before it took place, those involved such as the Bloomer First Responders, Fire Department, Police Department, Ambulance Crew, Chippewa County Health Officials and the Luther Midelfort regional facilities, met to discuss the scenario and review duties during a hazardous material contamination. Once the scenario was set up and a date was chosen, all parties took the information back to their staff for rollout.

On the day of the event, the first responders were the first on the Bloomer High School scene where students were mixing chemicals in a photography lab and they spilled the chemicals and ingested the fumes. The police officer identified everyone present and noted that other students had left the premise after being contaminated. The students still at the school were decontaminated and taken to Luther Midelfort Chippewa Valley for follow-up treatment. The HazMat Team and all staff present at the medical facility had been assigned roles at the Labor Pool and were ready to triage and treat those individuals arriving at the facility.

At other medical facilities in the area, students that had left the school before the first responders arrived were being decontaminated and treated as having been exposed to some sort of hazardous chemical. Luther Midelfort Chippewa Valley held the wrap-up session after all victims were treated and stable. Each department shared any concerns or comments about how the process went. The team identified areas for improvement for future drills or if a real hazardous spill occurred. It was a great learning tool if this type of event were to occur, not only the parties involved, but also for all the surrounding communities in which people live and work.

Colorectal cancer - cancer of the colon and rectum - is quickly becoming the second leading cause of cancer-related deaths in the United States. At least half of these deaths could be prevented if men and women, age 50 and better, were more proactive about routine screenings.

In an effort to motivate this target demographic, Wheaton Franciscan Cancer Care once again sponsored "Break the Silence: Win the Race Against Colorectal Cancer," an annual seminar to promote awareness of the disease and to encourage adults to have colonoscopies. Two free, public seminars were held in March at Wheaton Franciscan Healthcare in Wauwatosa and the Franklin Public Library – attracting more than 125 individuals at each location.

The seminars featured well-known gastroenterologists, Aaron Baltz, MD, and Ali Diba, MD, who discussed early detection and the importance of early screening. The physicians were joined by registered dietitians, Mary Schulteis and Elena Ferrise, who gave tips on nutritional habits to help protect against the disease.

Wheaton Franciscan Cancer Care increased attendance this year through a straightforward, "no frills" advertising campaign. The campaign included a print ad placed in the main news section of the Milwaukee Journal Sentinel and on-air spots by WMIL-FM radio’s Karen Dalessandro and Scott Dolphin, hosts of the seminars. Radio commercials and an interview with a registered nurse also sparked listener’s interest in the seminars.

In addition to these media tactics, attendees were offered refreshments and a chance to win door prizes including: gift baskets containing scented oils, bath soaps and gourmet fruit; gift certificates for free yoga, massages and aromatherapy; and a four pack of tickets to any Milwaukee Brewer’s game.

John Toussaint, MD, will resign as president and chief executive officer of ThedaCare to lead the ThedaCare Center for Creating Value in Healthcare, a new ThedaCare-sponsored effort to promote value-based purchasing.

Toussaint, 52, a board-certified internal medicine specialist, was appointed president and CEO in April 2000. His tenure as president and CEO of ThedaCare was marked by impressive growth as well as growing worldwide notoriety for ThedaCare’s success in applying lean manufacturing principles and the Toyota Production System to the delivery of patient care.

George Seidenstricker, a longtime Wisconsin hospital administrator, passed away February 14 at the age of 81. George served in the Navy during WWII and the Korean War. He was a graduate of Marquette University and had a long career in hospital administration and regional health care planning. He volunteered many hours for both the community and his church. He was an avid golfer, deer hunter, reader and enjoyed singing with barbershop quartets.

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