Figures released by the Wisconsin Ethics Board once again show WHA’s lobbying effort near the top of Wisconsin’s 755 registered lobbying organizations. During the two-year 2005-2006 legislative session, WHA staff logged 9,364 lobbying hours - 30 percent more than the 2003-2004 session. Almost half of WHA’s lobbying hours were devoted to Medicaid funding and medical malpractice reform, including restoring the non-economic damage cap. During the session, WHA led all lobbying organizations in lobbying hours on medical malpractice reform bills; WHA logged 60 percent more hours lobbying to restore a cap on non-economic damages than the leading opponent of medical malpractice reform. 

“Health care access and funding will always be top issues in the State Capitol, and WHA will continue to aggressively and effectively advocate for our members,” said WHA’s Steve Brenton. “WHA is committed to being a strong presence at the State Capitol.”

Over the two-year 2005-2006 legislative session, WHA ranked third among lobbying organizations in the amount of dollars ($1,532,927) devoted to lobbying, behind only lobbying giants WMC ($1,591,931), and WEAC ($1,533,186). Others in the top five were the Wisconsin Independent Businesses ($1,103,748) and the Wisconsin Merchants Federation ($1,088,633).

“The 2005-2006 session was a busy but successful session for Wisconsin hospitals,” said WHA’s Eric Borgerding. “A great team at WHA and our committed membership led to many victories for Wisconsin hospitals, ranging from the signing of a new non-economic damage cap, to a unanimous vote by the Joint Finance Council to increase MA reimbursement for hospitals for the first time in 10 years, to expanding the nursing loan forgiveness program.” 

“Just as we did in the last session, WHA will continue to aggressively represent our members in what is clearly going to be a very busy 2007-2008 session,” said Borgerding. “A new hospital tax, Medicaid expansions, health care reform, criminalization of unintentional medical errors, and a host of anticipated new regulatory proposals will assure WHA staff again log lots of time and effort in the halls of the State Capitol.”

The pace has been furious at the WHA since Governor Doyle’s announcement of a hospital tax in his state budget. WHA staff continues to identify flaws in the methodology that the tax is based upon. They expect to release the WHA detailed analysis later next week.

WHA Senior Vice President Eric Borgerding said legislators continue to have questions about the impact that the hospital tax would have on hospitals in their community. “Everyone is concerned about the impact the tax will have on the cost of health care locally, and we are getting lots of calls about the data that has been used by the Governor to develop the proposal,” Borgerding said. “A great many legislators have come out solidly opposed to this new tax, and we appreciate their support. Others have been trying to figure it out, wondering if the numbers add up. We’ve had lots of contact from Democrats and Republicans, questioning the numbers and methodologies used to put the proposal together. It’s clear there is a lot of skepticism from the Legislature and the public, and from what we are learning about the proposal, those doubts are warranted.” 

Member hospitals can find resources on the hospital tax, including the latest newspaper and video clips, on the front page at www.wha.org. Just added this week was a video clip from WHA Public Television’s program, “Here and Now.” Fredericka Freiberg, the program host, interviews WHA President Steve Brenton on the reasons WHA opposes the tax. View the clip at 
www.wha.org/HereandNow2-07.wmv.

On February 15, the WHA Board unanimously voted to oppose the hospital tax and issued a statement to that effect, which has been shared with the media. The Association has fielded dozens of media calls since the tax was announced, and two newspaper editorials questioned the logic of “taxing hospitals to pay hospitals.” A copy of the Milwaukee Journal Sentinel editorial is in this week’s packet. 

“The WHA Board position acknowledges strong Association support for coverage expansion initiatives and much needed payment increases,” said WHA President Steve Brenton. “The Board also found a hospital tax to be an awful precedent and is confident that revenues from other sources, including higher tobacco taxes, are available to draw down federal matching funds to finance these important priorities.”

UW School of Medicine and Public Health Dean Robert Golden, MD, has not been on the job very long, but he already is concerned about an issue that keeps hospital CEOs awake at night: the uneven distribution of physicians in Wisconsin.

"We need to look at all providers across the board. Rural areas are in need of physicians, dentists and other health care professionals," according to Golden. "I applaud your efforts to create the Wisconsin Academy for Rural Medicine (WARM). We need to look at other areas of the state, too," he said, suggesting that Milwaukee’s inner city is an area that might require a different solution to attract and retain physicians than what is being tried with the WARM program for rural Wisconsin.

Golden described for members of the Wisconsin Council on Medical Education and Workforce (WCMEW) at their February 12 meeting a plan that was used in North Carolina where a health care provider "team" consisting of a new physician, pharmacist, and others relatively new to private health care practice, were assigned to a rural area for a summer and given the charge to work together to address a community health care need. The idea, according to Golden, was to address the problem where new physicians or pharmacists are just "dropped" into a rural area and feel very isolated from other professionals. "If they work in groups, they are more connected and much more likely to stay in the community," he said. The community, in turn, created incentives to keep these health professionals.

Advanced Practice Providers

Laura Nelson, MD, MBA, the medical director for the north division of the Marshfield Clinic, described Marshfield Clinic’s utilization of advanced practice professionals (APP) for the Council members. She said the first step to successfully integrating advanced practice professionals into a physician practice is to create a definition for APP and delineate the scope of practice. Nelson said the advantages of using APPs in a practice include:

• Increase access to care in the community
• Physicians are able to spend more time on complex or new cases
• Increases communication with and education for patients
• Assistance with nursing home rounds and communication with staff and patients in the nursing home

Nelson said the clinics that make the most efficient use of advanced practice professionals are those that use a team approach to patient care and allow the entire department to access the APP’s skills. "Like so many health care professionals, APPs are hard to recruit, especially in rural areas," according to Nelson.

Wisconsin Physician Information Repository

Susan Wiegmann from the Wisconsin Medical Society reviewed the current plan for the Wisconsin Physician Information Repository. The goal, according to Wiegmann, is to make it easy for physicians to access and update their own information in the repository, as well as making it a good resource for consumers. Now there are four groups collecting information on physicians. The repository would end the redundancy and create a data source.

The first step of creating a survey tool to collect data has been completed, and it will be piloted at Marshfield Clinic. After receiving feedback from the Marshfield physicians about the survey, it will be sent to physicians statewide.

WCMEW Chair Carl Getto called the Repository and survey a "good step forward." The data collected from the physicians will be useful in assessing the current physician workforce and determining future need.

Earlier this week, WHA staff hosted two conference calls designed to brief members about Governor Doyle’s “hospital tax.” Staff shared the WHA Board’s rationale for unanimously opposing the initiative, explained the fact that the tax is “not needed” to fund Medicaid coverage expansions and provider rate increases due to other available revenues that can draw federal matching funds, and described our current understanding as to how the hospital tax and payment plan would work.

Specific details gleaned from the Doyle Administration’s plan are cause for serious concern. The bottom line: This initiative was not ready for “prime time.” Data used to create the tax is four to five years old and fails the “apples to apples” comparability test (e.g., for many hospitals, employed physician data skewers the gross hospital revenue numbers upon which the tax is based). The plan is based on dubious and “just plain wrong” assumptions. The likelihood that HMOs will pass along higher payments to hospitals (as assumed in the Governor’s plan) is…unlikely. And at least 15 Critical Access Hospitals (CAHs) promised millions of dollars in higher DSH payments would never receive the funds due to a federal law that tax plan creators failed to factor into their payment scheme. There is NO doubt that we will find additional glitches.

But here’s something else we discovered during our review of the 1,757-page budget document and related materials. Every cent from the “hospital tax” will be dumped into a new “trust” fund…The HEALTH CARE QUALITY FUND. Along with the millions from the proposed annual raid on the Injured Patients and Families Fund ($175 million – one time money grab), all of the tobacco tax increase and tobacco settlement bonds endowment monies (about $50 million annually), the hospital tax 
($205 million in year one and $213 million in year two) is slated to pay for a variety of health care programs…including the Medicaid deficit and higher hospital payments. 

Take a look at the Funding Table below. Note how the new “trust” fund essentially runs out of money at the end of the biennium...and how the new revenue sources other than the hospital tax actually decline or disappear...and how the expenditures increase! What will happen in FY10? My bet would be either a reduction in hospital rate increases – or – a higher tax. Probably both! 

I’ll elaborate more next week.

Steve Brenton,
President


TABLE 13: HEALTH CARE QUALITY FUND CONDITION STATEMENT

                                                                FY08                        FY09

REVENUES

Balance from prior year                                                             $97,300,000

Injured Patients & Family Fund Transfer     $175,000,000                             0

Tobacco Tax Increase                                 275,700,000             270,500,000

Tobacco Permanent Endowment Transfer     50,000,000                 50,000,000

Hospital Assessment                                 205,532,800              212,726,500

TOTAL                                                     $706,232,800             $630,526,500


EXPENDITURES

Healthy Wisconsin Authority Admin                 $500,000                   $500,000

Childless Adult Expansion                                          0                  6,153,700

Hospital Assessment MA Funding                 59,409,700                63,250,200

Hospital Rate Increase                                 146,123,100             149,476,300

Tobacco Control Activities                              30,000,000               30,000,000

E-Health                                                       10,000,000               10,000,000

MA Funding Stabilization                              362,900,000             370,902,800

TOTAL                                                       $608,932,800           $630,283,000

On March 6 Wisconsin hospital representatives will join with hospitals from across the country at the American Hospital Association’s budget advocacy day in Washington, DC. Hospitals representatives are scheduled to meet with members of Congress to discuss the negative impact the proposed budget will have on hospitals.

Under the President’s proposed budget, Wisconsin hospitals would see roughly $360 million in Medicare payment reductions for FY 08-12. The reductions would be the result of changes to the market basket update, the phase-out of bed debt and IME.

Wisconsin hospital representatives are scheduled to meet with the offices of Wisconsin’s Congressional Delegation. During those visits, district-specific information will be provided to legislators regarding the reductions their hospitals will see under the proposed budget.

Legislation undermining a bedrock principle of free and fair elections was approved by a Congressional committee last week. The bill, H.R. 800, overturns a long-standing policy, established more than 70 years ago in the National Labor Relations Act, to guarantee employees the right to determine whether they wish to be represented by a union through a secret ballot election. H.R. 800, dubbed the "Employee Free Choice Act," was approved by the House Education and Labor Committee on a party-line vote of 26-19. Wisconsin Cong. Petri, a member of this committee, did not vote.

H.R. 800 allows for a so-called "card check" system where, if a simple majority of individuals sign authorizations, the union must be recognized. Supporters of H.R. 800 claim this legislation is needed because the current secret ballot process is too slow and employees are being intimidated or fired. However, statistics show that the average election takes 39 days and a full 94 percent of all elections are completed within 56 days. Further, only 1 in 100 individuals, or 1 percent, are illegally fired. When this unfortunate situation does occur, the National Labor Relations Board has the right to force the employer to recognize and bargain with the union, regardless of the election result. In reality, the only thing H.R. 800 does is circumvent a federally supervised and democratic secret ballot process.

The House is expected to vote on the legislation in the near future. President Bush has indicated he will veto H.R. 800 if it reaches his desk.

Registration information for this free event will be available in early March at www.wha.org.

For more information, contact Lisa Geishirt at 608-274-1820 or lgeishirt@wha.org.

To schedule an appointment to meet with your legislator on the afternoon of May 1, contact Angela Miloszewicz directly at 608-268-1801.

What is it like to work in health care? The occasional headline indicating unhappy workers and unrewarding work are proven untrue by the powerful essays hospital employees write as Pride Program entries. This program, designed to celebrate the pride that health care employees have in their work, and the contributions that they make to their patients, their community, and their profession, provides powerful stories of the rewards of working in health care.

Many member hospitals have already begun the process of announcing the guidelines and deadlines for this year’s Wisconsin Health Care Employee Pride Program. If you have not yet begun, there is still time. If you have questions, the most frequently asked ones are listed below.

Is there a statewide Pride winner? No, the purpose of WHA’s program is to recognize all nominees submitted by member hospitals. Each hospital’s nominee will be individually recognized at the Pride Program dinner on April 26, 2007, at the Kalahari Resort.

What benefit comes from the essays? WHA will publish all essays and distribute to both recognized employees and participating hospitals. In addition, press releases will be provided to each hospital so that essays and their authors can be highlighted in local press/media. The essays are also posted on WHA’s Web site. You can view last year’s essays at www.wha.org/workForce/pdf/2006pridebook.pdf. WHA will share these essays with a wide variety of audiences to demonstrate the rewarding nature of health care work. Members are invited to do the same.

How should we recognize our hospital’s winning essay? Member hospitals have chosen a variety of ways to recognize their winners. Some examples are: flowers, a stay at the Kalahari and paying for dinner tickets for spouse, parents or children.

Who from the hospital should attend the banquet with our winner? This is a very big event for the winners. They often come with proud family and friends. The organizational representative who attends with your employee can be anyone in the organization. Some CEOs attend; sometimes the employee is accompanied by an immediate supervisor.

Staff members at WHA look forward to receiving these great entries in March and are available to help you with your hospital’s contest and questions. Please plan to join us at the Kalahari on April 26. Pride Program 2007 information is available at www.wha.org/workforce/pride_2007.aspx, or contact Judy Warmuth at jwarmuth@wha.org or 608-274-1820 with questions.

...and thanks to our employees who are proud to work in health care.

Mark your calendar for March 22, when WHA will be co-sponsoring a seminar entitled "The Just Culture Community" with MetaStar, the Wisconsin Organization of Nurse Executives, and the Wisconsin Society of Healthcare Human Resources Administration.

The event will be held at the Kalahari Resort in Wisconsin Dells. Risk managers, nursing leaders, human resources professionals, quality managers, CEOs/administrators, COOs, CMOs and public relations professionals are encouraged to attend.

Caring for an elderly spouse or parent can seem like an insurmountable problem. In Walworth County, Aurora senior resource coordinators link families to respite care, transportation and other vital services that help a person to stay in their home and remain as independent as possible. The coordinators often collaborate with the Walworth County Department of Health and Human Services.

"With an increasing older adult population and tight budgets, it’s vital to find a way for different agencies and organizations to work together," said Lori Muzatko, Aging Division Manager, Walworth County Department of Health and Human Services. "If Aurora coordinators find a person in need of Meals on Wheels, they connect them to us. If we have a client who can’t find a necessary service, we link them to a coordinator.

Aurora’s collaborative approach helps us to eliminate or reduce stressful situations for families. Each week we see the results of this partnership – through the smile of an older person who doesn’t have to worry about leaving their home or the gratitude of a daughter who doesn’t have to fret about her mom because we’ve connected them with the right services and resources," Muzatko said.