At a news conference held February 24 at the State Capitol, WHA announced that a majority of Wisconsin’s voters—77 percent—favor a $1 per pack hike in the cigarette tax and devoting the revenue to health care programs. When asked if they would reelect a politician who had promised to not raise taxes—but then voted for an increase in the cigarette tax once elected—79 percent of respondents said it would either make no difference at all, or would actually make them more likely to vote for that politician. That sentiment is derived from a bi-partisan sampling of 500 Wisconsin voters, including current smokers.

While Wisconsin’s political environment is extremely anti-tax, that is largely focused on property taxes. An overwhelming majority of voters surveyed in a poll sponsored by the Wisconsin Hospital Association (WHA) and the American Cancer Society (ACS) said that an increase in the tobacco tax on cigarettes is a political winner, and a preferred way to fund state health care programs. The poll was conducted on January 24 and 25 by Public Opinion Strategies.

Voters rejected cutting spending on health care for programs like Medicaid (82 percent), and they embraced the idea of using new tobacco tax revenue to pay for health care programs, including Medicaid. It is estimated the Medicaid program spends more than $375 million each year in the treatment of smoking-related illnesses.

Support for the $1 a pack increase in the cigarette tax crosses party and regional lines. Support is highest in Madison, where 85 percent of those surveyed say they approved of a $1 increase, followed closely by 82 percent in Wausau/Rhinelander, 76 percent in Green Bay/Appleton, 74 percent in La Crosse/Eau Claire, and 74 percent in Milwaukee. Support was lowest in the northern region of the state, but even there, a strong majority (69 percent) indicated that they supported an increase in the tax.

According to the poll, increasing the cigarette tax enjoys massive support across party lines, with 72 percent of Republicans, 76 percent of Independents and 83 percent of Democrats supporting a $1 increase.

"We’ve all known for a long time that raising the cigarette tax is good health care policy, that evidence is overwhelming and undeniable," said WHA Senior Vice President Eric Borgerding.  Unfortunately the cigarette tax has become mired in political paranoia associated with other taxes. But the reality, as shown in the poll, is that this is a political slam-dunk. There is no reason for a politician in any part of the state to fear a cigarette tax increase; in fact, it should be embraced."

American Cancer Society Wisconsin Legislative Liaison Alison Prange said raising the tax by $1 on a pack of cigarettes will cause 44,000 adult smokers to quit, while "the number of kids who would not even try their first cigarette (72,000) would almost fill Camp Randall Stadium."

"In the Medicaid program," Prange continued, "14 percent of all funds are used for treating smoking-related illnesses." She noted that the actual cost of a pack of cigarettes, factoring in the health costs associated with smoking, is $7.14. Prange added, "Raising the tax will prevent almost 10,000 deaths associated with smoking in Wisconsin over a five-year period. The health benefits are undeniable."

William Scheckler, MD, chair of the Wisconsin Medical Society’s Council on the Health of the Public, agrees.

"Raising the cigarette tax by a dollar per pack is an absolutely fool proof way to save lives and reduce health costs," said Dr. Scheckler, an internal medicine specialist in Madison. "It has worked every single time, in every single state and Wisconsin will enjoy the same health benefits," he added.

The Wisconsin Hospital Association Board of Directors on February 17 approved new measures that will be added to CheckPoint^SM, WHA’s quality and safety public reporting program. The new measures, which will be added over the next 12-18 months, are:

1. Surgical Infection Prevention (SIP) measures for each of the following procedures: knee replacement, hip replacement, colon surgeries and hysterectomies.
2. One new error prevention measure related to the JCAHO goal of medication reconciliation.
3. The H-CAHPS (patient experience of care) survey results when this survey is available through the National Quality Initiative.

"The science of quality measurement and the availability of tested measures to allow ‘apples-to-apples comparisons across sites is moving faster than ever, allowing us to move forward in sharing these valuable added metrics. At the same time, the measurement science is ‘not there’ for some clinical metrics that we will be eager to use in the future. And we need to assure that the data management burden to hospitals across the state is realistic," according to Patricia Schroeder from Covenant Health Care, chair of the Measures Team.

The new measures are the result of a 15-step process involving at least 200 individuals that the CheckPoint Measures Team followed as they developed a list of recommendations for the Wisconsin Quality Steering Committee and the WHA Board. The Measures Team:

1. Identified 122 topics of interest (April 2004)
2. Collected information on each topic including availability of existing measures
3. Scored each topic based on the CheckPoint Measures Selection Attributes
4. Selected 18 topics/measure sets for further review (June 2004)
5. Obtained feedback from the WI Quality Steering Committee (June 2004)
6. Scored each topic/measure set based on the CheckPoint Principles and Market Evaluation Standards
7. Selected six topics/measure sets for further review (August 2004)
8. Obtained feedback from the WI Quality Steering Committee (September 2004)
9. Obtained feedback from the WHA Board of Directors (October 2004)
10. Obtained feedback from hospitals at WHA region meetings (November 2004)
11. Conducted Listening Sessions to obtain feedback from key stakeholders including hospitals, purchasers and legislators (November-December 2004)
12. Selected three measure sets (December 2004)
13. Obtained feedback from the WHA Board of Directors (December 2004)
14. Asked for approval of three measure sets by the WI Quality Steering Committee (January 2005)
15. Asked for approval of the three measure sets by the WHA Board of Directors (February 2005)

"We spent considerable time listening to members and other stakeholders as we identified potential new measures," said Wisconsin Quality Steering Committee Chair Chuck Shabino, MD. "The end result is new measures that will help evolve CheckPoint in a meaningful way for clinicians and consumers."

On February 21, WHA, together with the American Hospital Association (AHA) filed an amicus brief with the Supreme Court in Ferdon v. Wisconsin Patient Compensation Fund. The brief supports the constitutionality of Wisconsin’s non-economic damage caps in medical malpractice cases. The plaintiffs, with the support of the Wisconsin Academy of Trial Attorneys and the Association of Trial Lawyers of America who each filed an amicus brief in this case, are challenging the constitutionality of the non-economic damage caps.

"Acting within its unique and constitutional role, the Wisconsin legislature chose to remedy what it determined was a health care crisis by enacting [caps on non-economic damages in medical liability cases]," stress WHA and AHA in their support of the constitutionality of the caps. "The overwhelming evidence, both nationally and on the State level, demonstrates the choice was reasonable.

"Medical malpractice insurance premiums in states with meaningful medical malpractice liability systems such as Wisconsin, are lower than in other states. Lower medical malpractice premiums help hospitals retain qualified physicians and, in turn provide a broad range of health care services to patients. Upsetting the legislature’s policy choice by finding [the caps] unconstitutional could have a devastating impact on hospitals’ ability to provide patient care."

Cindy Buchko, attorney, Whyte Hirschboeck Dudek S.C. and author of WHA’s and AHA’s amicus brief notes, "Maintaining Wisconsin’s favorable medical malpractice environment is key to addressing Wisconsin’s growing physician shortage that is particularly problematic in rural areas and Milwaukee." That shortage is documented in a March 2004 study released by WHA and the Wisconsin Medical Society entitled "Who Will Care for Our Patients?"

The plaintiffs in their briefs to the court argue, despite overwhelming evidence to the contrary, that the caps do nothing to lower the cost of health care and do not affect access to health care for Wisconsin citizens. They further argue that the caps impermissibly violate the plaintiff’s state constitutional right to a jury trial, a certain remedy for wrongs committed on him, and equal protection and due process of law.

As a part of Wisconsin’s comprehensive medical liability system, non-economic damages, including damages for pain and suffering, in medical malpractice lawsuits are capped at $410,322 (adjusted yearly for inflation). Wisconsin law further caps non-economic damages in all wrongful death lawsuits at $350,000 in the case of a deceased adult and $500,000 in the case of a deceased child.

Wisconsin has no cap on economic damages in medical malpractice cases. Economic damages include, for example, damages for loss of earnings, and loss of earning capacity, and damages related to future medical treatment, care, or custody. Furthermore, Wisconsin has established the Patient’s Compensation Fund (now the Injured Patient and Families Compensation Fund) which covers the full amount of damages awarded to injured patients that are in excess of their health care providers’ statutorily required liability insurance – thus ensuring a solvent source for a patients’ recovery of damages.

A decision and oral arguments in Ferdon can be expected later this year.

The results of the tobacco tax survey, released this week at the State Capitol, absolutely destroy so-called conventional wisdom that the public strongly opposes all forms of new and higher taxes and that politicians supporting such taxes will face electoral retribution. In fact, poll results clearly indicate that elected officials who oppose higher tobacco taxes do so at their own peril.

The most significant finding of the WHA-sponsored Public Opinion Strategies survey is that a majority (79%) of voters say that voting for a $1 hike in the cigarette tax would make them more likely to vote for a candidate or make no difference in their vote for a candidate. And that sentiment is derived from a broad, bi-partisan cross section of Wisconsin’s electorate, including current smokers.

Without question, Wisconsin’s political environment is extremely anti-tax. But, that sentiment is largely focused on property taxes. An overwhelming majority of voters surveyed said that an increase in the tobacco tax on cigarettes is an acceptable way to balance Wisconsin’s budget. And that support held firm when the notion of a $1 hike was raised.

Importantly, voters strongly reject cutting spending on health care for programs like Medicaid (82%). And the idea of using new tobacco tax revenue to pay for health care programs, including Medicaid, is universally embraced. After all, smoking-related illnesses account for over $375 million in Medicaid expenditures annually. Higher tobacco taxes should be looked at as a user fee to help pay for this chronically underfunded program.

WHA has suggested that Governor Doyle’s 2005-07 budget is flawed in that the Medicaid program is "balanced" with new funding from one-time funding sources (Patients Compensation Fund and bonding). That fact will lead to a structural Medicaid deficit beyond the upcoming biennium. What that means is that in 2007, another round of Medicaid cuts, new/higher provider taxes and an exploding Medicaid "hidden tax" for businesses is almost certain. We can’t let that happen. Wisconsin’s Medicaid program requires new, dedicated and sustainable resources to fund the core program, improve hospital payment levels and reduce the $450 million "hidden tax." An increase in the tobacco tax is such a funding source and its acceptance—actually, its embrace—by the electorate is overwhelming and universal.

Steve Brenton
President

The Wisconsin Hospital Association in cooperation with the Hospital Bioterrorism Preparedness Program, Wisconsin Division of Public Health, is sponsoring free of charge a four-part series on emergency preparedness topics that are targeted for senior management at Wisconsin hospitals.

Wisconsin hospitals have been diligently working on building surge capacity for a mass casualty incident and have so far been the recipients of more than $20 million to help with this effort. This series focuses on the role that senior managers will play in a mass casualty incident. The target audience for this series is:

• Hospital CEO, President, Administrator
• Vice Presidents
• Chief Medical Officers
• Members of the Boards of Directors
• Other senior managers

The seminars included in the series are:

Wednesday, March 23, 2005, 1–2 pm: "Executive Leadership Challenges in a Mass Casualty Incident"

• "I know my hospital can deal with the disaster today. I am not sure how we will be able to handle it on the second day." Anonymous CEO
• Managing a workforce that is anxious, afraid and emotionally affected by the disaster
• Managing operations with reduced resources
• The implications for our patients and staff when the "Standard of Care" is the "greatest good for the greatest number"

Wednesday, April 20, 2005, 1–2 pm: "Executive Leadership’s Role in the National Response Plan"

• "There is no way that we will be able to manage this by ourselves." Anonymous CEO
• The federal, state and local assets that will be available to assist your hospital
• Your hospital Incident Command Center and your Incident Commander are in charge

Tuesday, May 17, 2005, 1–2 pm: "How the Hospital Emergency Preparedness Plan Will Unfold in a CBRNE Incident"

• An overview of how the Wisconsin Hospital Emergency Preparedness Plan (WHEPP) will unfold in a biological, mass trauma or chemical incident
• How "your hospital’s level of readiness" is being measured
• The resources that are available to help your hospital increase its level of readiness

Tuesday, June 21, 2005, 1–2 pm: "Assuring That There Is Not a Legal and Financial Disaster at My Hospital After the Disaster"

• Recovery is a major component of any disaster plan
• There are legal and financial questions for which there are answers
• There are legal and financial questions for which there are not yet answers
• What resources are available to help hospitals with these legal and financial dilemmas

The toll free call in number for each of the four teleconferences is: 888-296-1938; the identification code number is 972184. The format will include 30 minutes of presentation, followed by 30 minutes for questions and discussion. Hospitals will receive a Power Point presentation and handouts one week prior to the teleconference.

Option One: The hospital can have all participants in one room to participate in the presentation and discussion.

Option Two: The hospital can further distribute the presentation and handouts so that participants can dial in from a non-hospital site such as their home or office and load the Power Point on their own personal computer.

Start making plans to attend WHA’s 2005 Advocacy Day, May 11 at the Monona Terrace Convention Center in Madison. The day will begin at 9 am with the inside scoop from Washington correspondent Mark Shields (invited). Called the "wittiest political journalist in America" by The Wall Street Journal, Shields has a unique ability to make audiences laugh and think.

A syndicated columnist, author and political analyst, Shields is the principal political analyst on The News Hours with Jim Lehrer and moderator of The Capital Gang, CNN’s award-winning public affairs roundtable.

Also included on the day’s agenda is an issue briefing by WHA’s government relations team in the morning, an address by Governor Jim Doyle (invited for lunch), and an interactive session in the afternoon called, "Making the Most of Your Legislative Visit." The day will adjourn at 2:15 pm to allow time for legislative visits.

The Magnet Recognition Program was developed by the ANCC to recognize health care organizations that provide the very best in nursing care and uphold the tradition within nursing of professional nursing practice. The Magnet Recognition Program is based on quality indicators and standards of nursing practice as defined in the American Nurses Association’s Scope and Standards for Nurse Administrators (2003). The Magnet designation process includes the appraisal of both qualitative and quantitative factors in nursing.

"The process has taken more than three years to complete," said Tim Gengler, vice president of nursing at Aspirus Wausau Hospital. "It has been a lot of hard work, but worthwhile. Not only did we achieve our goal and become a Magnet organization, we learned a lot about continuous improvement and about teamwork. We see this as a beginning and will keep on getting better."

Regardless of an organization’s size or location, the Magnet designation serves two primary purposes: to attract and retain quality employees and to help consumers identify it as a hospital with a proven level of excellence in care. It’s a seal of approval for quality care.